Pan african Medical Journal - Volume 28 Pan african Medical Journal. Volume 28 2017-09-23T04:55:21+01:00 pamj logo text/html 2017-09-23T11:55:21+01:00 Gezahen Negusse Ayane, Mikel Walsh, Jemal Shifa, Kadimo Khutsafalo [Case report] - Right congenital diaphragmatic hernia associated with abnormality of the liver in adult - 22 September 2017. <b>A Bochdalek hernia (BH) occurs when abdominal contents herniate through the postero-lateral segment of the diaphragm. The right side is affected considerably less commonly than the left. Most BHs present are diagnosed early in life, with some element of cardio-respiratory distress. Rarely, hernias that remain clinically silent until adulthood when they present as life-threatening surgical emergencies. We report a case 35 year old female who emergency exploratory laparotomy for a complete mechanical bowel obstruction. At surgery the redundant transverse colon was twisted and incarcerated within the right hemithorax, creating a closed loop obstruction. The right colon, appendix, terminal ilium, and three accessories right liver lobes were also dragged into the right thoracic cavity. After reducing the hernia, the diaphragmatic defect was primarily repaired with non-absorbable suture. The redundant transvers colon which had been compromised was resected and primary end-to- end anastomosis was carried out. Incidental appendectomy was done. The patient was sent into ICU for post-operative monitoring. She made an uneventful recovery and remains asymptomatic at nine month follow-up. I discuss what i believe to be the first case report of complicated right diaphragmatic hernia in Botswana, associated with another congenital mal-formation (accessories hepatic lobes, partial mal-rotation, and redundant transvers colon) in adult.</b><br/> text/html 2017-09-23T11:55:21+01:00 Lamia Kabbage, Meryem Elkouhen, Ahmed Taghy, Kaoutar Znati, Nawal Kabbaj [Case report] - A rare presentation of hepatocellular carcinoma in non-cirrhotic liver - 22 September 2017. <b>Hepatocellular carcinoma is the most frequent type of liver malignancy. Most cases of hepatocellular carcinoma are secondary to either viral hepatitis (hepatitis B, C) or alcoholic cirrhosis. Liver cirrhosis due to any other causes is considered as a risk factor for development of hepatocellular carcinoma; however, hepatocellular carcinoma in non cirrhotic livers remains a rare condition. The present case report describes a 59-year-old woman patient admitted to explore right hypochondriac and epigastric pain, with no evidence of pre-existing liver disease and with a good general condition. The computed tomography was very suggestive of a gastro-intestinal stromal tumor. But, at laparotomy, a huge hepatic tumor was discovered. Histopathological study confirmed the presence of primary hepatocellular carcinoma. Hepatocellular carcinoma occurs more frequently on a cirrhotic liver. However, it can occur on a non cirrhotic liver and remains and extremely rare case.</b><br/> text/html 2017-09-23T11:55:21+01:00 Modupe Comfort Ayoola, Victor Oluwatoyin Akinseye, Eniola Cadmus, Emmanuel Awosanya, Olufemi Akinyele Popoola, Oluwaseun Oladapo Akinyemi, Lorraine Perrett, Andrew Taylor, Judy Stack, Ignacio Moriyon, Simeon Idowu Cadmus [Research] - Prevalence of bovine brucellosis in slaughtered cattle and barriers to better protection of abattoir workers in Ibadan, South-Western Nigeria - 22 September 2017. <b>INTRODUCTION: Brucellosis is a neglected zoonosis of public health importance. This study was conducted to determine the prevalence and risk factors of brucellosis among slaughtered cattle as well as challenges to the protection of abattoir workers in Nigeria. METHODS: a slaughterhouse study was conducted in a major abattoir in Ibadan from March to August, 2013. To diagnose brucellosis, serum samples from 1,241 slaughtered cattle were tested using Rose-Bengal test (RBT) and competitive enzyme-linked immunosorbent assay (cELISA); again, 57 milk samples were tested with milk ring test (MRT) and indirect ELISA (iELISA). Furthermore, a survey on the usage of personal protective equipment (PPE) and challenges to its use by abattoir workers was done. Data were analysed using Stata 12. RESULTS: seroprevalence by RBT was 7.8%; 77.3% (75/97) of these were corroborated by cELISA. Prevalence in milk samples by MRT and indirect ELISA were 33.3% and 3.5%, respectively. Sex (OR: 2.5; 95%CI:1.3-4.5) was the factor significantly associated with Brucella seropositivity. None of the abattoir workers used standard protective overalls; while, 99.6% of the meat handlers and 84.1% of the butchers worked barefoot. Most of the workers (75.7%) wore no protective gloves. The respondents agreed that provision of free PPE and sanctions against non-users would encourage its use. CONCLUSION: our findings indicate moderate prevalence (7.8%) of bovine brucellosis with sex of cattle being a risk factor. A notable barrier to better protection of abattoir workers against brucellosis is perceived inconvenience arising from use of gloves. Therefore, preventive and control measures against brucellosis must include education and use of PPE among abattoir workers.</b><br/> text/html 2017-09-23T11:55:21+01:00 Kunche Nyavor, Margaret Kweku, Isaac Agbemafle, Wisdom Takramah, Ishmael Norman, Elvis Tarkang, Fred Binka [Research] - Assessing the ownership, usage and knowledge of Insecticide Treated Nets (ITNs) in Malaria Prevention in the Hohoe Municipality, Ghana - 22 September 2017. <b>INTRODUCTION: Malaria remains one of the top five killer diseases in sub-Saharan Africa (SSA) and its burden is skewed towards pregnant women and children under five. Insecticide Treated Bed-Net (ITN) usage is considered one of the most cost-effective preventive against malaria. This study sought to assess ownership, usage, effectiveness, knowledge, access and availability of ITNs among mothers with children under five in the Hohoe municipality. METHODS: in August 2010 a cross-sectional survey was carried out in 30 communities, selected using the WHO 30 cluster sampling technique. In the selected communities, mothers/caregivers with children under five years were selected using the snowball method. Data was collected using questionnaire and direct observation of nets. Descriptive statistics was used to analyse the data collected. RESULTS: a total of 450 mothers/caregivers were interviewed and their mean age was 30 ± 7 years. ITN ownership was 81.3%, and usage was 66.4%. Majority (97.8%) of the mothers/caregivers said ITNs were effective for malaria prevention. Awareness about ITNs was high (98.7%) and majority (52.9%) heard about ITNs from Reproductive and Child Health (RCH) Clinic and antenatal clinic (33.6%). Over 60% of the ITNs were acquired through free distribution at RCH clinics, antenatal care (ANC) clinics and home distribution during mass immunization sessions. Majority of the mothers/caregivers (78.6%) knew the signs and symptoms of malaria, what causes malaria (82.2%) and who is most at risk (90%). CONCLUSION: behaviour change communication strategies on ITN use may need to be further targeted to ensure full use of available ITNs.</b><br/> text/html 2017-09-23T11:55:21+01:00 Jemal Zeberga Shifa, Alemayehu Mekonnen Gezmu [Research] - Presenting signs of retinoblastoma at a tertiary level teaching hospital in Ethiopia - 22 September 2017. <b>INTRODUCTION: Retinoblastoma is a primary malignant intraocular neoplasm that arise from immature retinoblasts with in developing retina. The commonest presenting sign in developing country is proptosis which is the late presenting sign. We report presenting signs of retinoblastoma in Ethiopian children seen at a tertiary level teaching hospitals in Ethiopia. METHODS: prospective case series study wasdone on children who presented with retinoblastoma between May 1, 2005 and September 1, 2006. This study was done as part of requirement for partial fulfilment of certificate of speciality study in ophthalmology during the year 2005 to 2006. SPSS 11 statistical package was used to analyse the data. RESULTS: among 41 patients seen during the study period, 24 (58.5%) were males and 17(41%) were females. Unilateral retinoblastoma wasfound in 32 (78%) patients and bilateral cases were found in 9(22%). Mean age of onset for right eye was 27.5 months and left eye 33.7 months.The mean ages of presentation at time of diagnosis for right and left eye were 34.4 and 40.2 months, respectively .In bilateral retinoblastoma mean age of presentation was 33.3 months.The commonest presenting sign was proptosis 22(53.7%) followed by leucocorea nine (22%),ocular inflammation four (9.0 %), strabismus three (7.3%), glaucoma one (2.4%), loss of vision one (2.4%)and hyphemaone (2.4%). CONCLUSION: the commonest presenting signs of retinoblastoma in our set up were Proptosis followed by leucocorea. This is due to late presentation of patient and late referral by medical professionals. Health education to the public and health professionals will help early detection of retinoblastoma.</b><br/> text/html 2017-09-23T11:55:21+01:00 Ilhame Naciri, Baderddine Hassam [Images in medicine] - Une tumeur historique de l’&eacute;paule - 22 September 2017. <b>Le chondrosarcome est une tumeur osseuse maligne d'origine m&eacute;senchymateuse, qui survient habituellement apr&egrave;s l'&acirc;ge de 40 ans, et qui si&egrave;ge pr&eacute;f&eacute;rentiellement au niveau du pelvis et de l'&eacute;paule. Nous rapportons le cas d'une patiente &acirc;g&eacute;e de 65 ans, sans ant&eacute;c&eacute;dents pathologiques notables, hospitalis&eacute;e pour exploration d'une tumeur volumineuse de l'&eacute;paule droite, &eacute;voluant depuis 3 ans, avec notion d'alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral. L'examen clinique retrouvait une tumeur g&eacute;ante en dos de chameau, faisant 44 × 32 cm de grand axe, dure, adh&eacute;rente, avec des signes inflammatoires en regard et des signes de compression vasculo-nerveuse. La mobilit&eacute; de l'&eacute;paule &eacute;tait limit&eacute;e et douloureuse. Le bilan radiologique objectivait un processus tumoral expansif &eacute;piphyso-m&eacute;taphyso-diaphysaire h&eacute;t&eacute;rog&egrave;ne, multilobul&eacute;, mal limit&eacute;, et calcifi&eacute;, avec une destruction compl&egrave;te de l'articulation gl&eacute;no-hum&eacute;rale et un important envahissement des parties molles et extension locor&eacute;gionale. L'examen histologique d'une biopsie profonde &eacute;tait en faveur d'un chondrosarcome peu diff&eacute;renti&eacute;. Le bilan d'extension r&eacute;v&eacute;lait des ad&eacute;nopathies axillaire bilat&eacute;rales et de multiples nodules sous pleuraux et h&eacute;patique d'allure m&eacute;tastatiques. L'&eacute;volution &eacute;tait fatale au bout de 2 mois. Notre observation souligne l'importance de la sensibilisation de la population pour un diagnostic et une prise en charge pr&eacute;coce.</b><br/> text/html 2017-09-23T11:55:21+01:00 Olufemi Gbenga Omitola, Olujide Oladele Soyele, Opeyemi Sigbeku, Dickson Okoh, Abdulwarith Olaitan Akinshipo, Azeez Butali, Henry Ademola Adeola [Research] - A multi-centre evaluation of oral cancer in Southern and Western Nigeria: an African oral pathology research consortium initiative - 22 September 2017. <b>INTRODUCTION: Oral cancer is a leading cause of cancer deaths among African populations. Lack of standard cancer registries and under-reporting has inaccurately depicted its magnitude in Nigeria. Development of multi-centre collaborative oral pathology networks such as the African Oral Pathology Research Consortium (AOPRC) facilitates skill and expertise exchange and fosters a robust and systematic investigation of oral diseases across Africa. METHODS: in this descriptive cross-sectional study, we have leveraged the auspices of the AOPRC to examine the burden of oral cancer in Nigeria, using a multi-centre approach. Data from 4 major tertiary health institutions in Western and Southern Nigeria was generated using a standardized data extraction format and analysed using the SPSS data analysis software (version 20.0; SPSS Inc. Chicago, IL). RESULTS: of the 162 cases examined across the 4 centres, we observed that oral squamous cell carcinomas (OSCC) occurred mostly in the 6th and 7th decades of life and maxillary were more frequent than mandibular OSCC lesions. Regional variations were observed both for location, age group and gender distribution. Significant regional differences was found between poorly, moderately and well differentiated OSCC (p value = 0.0071). CONCLUSION: a multi-centre collaborative oral pathology research approach is an effective way to achieve better insight into the patterns and distribution of various oral diseases in men of African descent. The wider outlook for AOPRC is to employ similar approaches to drive intensive oral pathology research targeted at addressing the current morbidity and mortality of various oral diseases across Africa.</b><br/> text/html 2017-09-23T11:55:21+01:00 Nidain Maneh, Kossivi Apetse, B&eacute;n&eacute;dicte Mar&egrave;be Diatewa, Sidik Abdou-Bakr Domingo, Aid&eacute; Isabelle Agba, Koffi Didier Ayena, Koffi Agnon Balogou, Komi Patrice Balo [Case report] - Myasth&eacute;nie juv&eacute;nile oculaire en Afrique Subsaharienne: cas de deux sœurs germaines issues d’un mariage consanguin au Togo - 21 September 2017. <b>La myasth&eacute;nie est une pathologie auto-immune acquise rare &agrave; l'origine de la d&eacute;ficience de la transmission neuro-musculaire dont la forme juv&eacute;nile se manifeste souvent par une atteinte oculaire exclusive. Nous rapportons deux cas de myasth&eacute;nie juv&eacute;nile oculaire (MJO) au sein d'une m&ecirc;me fratrie. il s'agit de deux fillettes XA et XB respectivement &acirc;g&eacute;es de 11 et 9 ans d'origine malienne r&eacute;sidant au Togo, issues d'un mariage consanguin de 1er degr&eacute;, amen&eacute;es en consultation d'ophtalmologie, pour une baisse progressive de l'acuit&eacute; visuelle (AV). XA avait aux deux yeux, une AV &agrave; 8/10 et XB, une AV de 3/10 am&eacute;lior&eacute;e au trou st&eacute;nop&eacute;&iuml;que &agrave; 7/10 en faveur d'une am&eacute;tropie. XA pr&eacute;sentait un ptosis bilat&eacute;ral qui remontait &agrave; l'&acirc;ge de 2 ans avec une action du releveur de la paupi&egrave;re sup&eacute;rieure (RPS) &agrave; 7 mm et XB, un ptosis bilat&eacute;ral remontant &agrave; l'&acirc;ge de 3 ans avec une action du RPS nulle. Pour les deux, le test au gla&ccedil;on &eacute;tait franchement positif, le signe de Cogan pr&eacute;sent avec une par&eacute;sie oculo motrice sans diplopie. Le dosage des auto- anticorps anti r&eacute;cepteurs de l'ac&eacute;thylcholine &eacute;tait normal. Le diagnostic de MJO associ&eacute;e &agrave; une am&eacute;tropie a &eacute;t&eacute; &eacute;voqu&eacute;. Une correction optique de l'am&eacute;tropie par des lunettes et un traitement sp&eacute;cifique par la pyridostigmine avait &eacute;t&eacute; instaur&eacute;e mais les patientes ont &eacute;t&eacute; perdues de vue. la myasth&eacute;nie auto-immune avec des manifestations ophtalmologiques inaugurales est rare mais possible chez l'enfant en Afrique subsaharienne o&ugrave; des &eacute;tudes sont n&eacute;cessaires pour y d&eacute;terminer les &eacute;ventuelles particularit&eacute;s de la maladie.</b><br/> text/html 2017-09-23T11:55:21+01:00 Ogochukwu Chinedum Okoye, Henry Enyinmisan Slater, Nilum Rajora [Research] - Prevalence and risk factors of intra-dialytic hypotension: a 5 year retrospective report from a single Nigerian Centre - 21 September 2017. <b>INTRODUCTION: Intra-dialytic hypotension (IDH) is a common complication of haemodialysis that impacts negatively on the patient's quality of life and can induce serious cardiovascular events. METHODS: ecords of all adults who had haemodialysis treatments from Jan 2012-Jan 2016 were reviewed. Socio-demographic data, health status of patient, aetiology of renal disease, clinical and biochemical parameters such as systolic and diastolic blood pressures (SBP and DBP), packed cell volume, were collated using Microsoft Excel. RESULTS: the overall prevalence of intra-dialytic hypotension was 8.6%. Of all haemodialysis patients, 45.7% experienced a drop in SBP > 20mmHg, 28.5% required nurses' intervention and 8.6% had symptoms. Diagnosis of obstructive nephropathy (OR: 3.1, CI:1.43-6.60, p = < 0.004) and sepsis (OR: 3.57, CI: 1.31- 9.75, P = 0.013) increased the odds of experiencing IDH. Only 5% of patients with predialysis SBP < 100mmHg developed IDH (OR: 0.12, CI: 0.02-0.93, P = 0.04).</b><br/> text/html 2017-09-23T11:55:21+01:00 Mohammed Alae Touzani, Othmane Yddoussalah [Images in medicine] - Sarcome de kaposi penien chez un patient seronegatif - 21 September 2017. <b>Les sarcomes p&eacute;niens repr&eacute;sentent moins de 5% des tumeurs p&eacute;niennes. Elles sont domin&eacute;es par le sarcome de Kaposi que l'on retrouve le plus souvent chez les sujets HIV positifs. Cependant, de r&eacute;centes &eacute;tudes ont montr&eacute;es une association entre le sarcome de Kaposi et l'infection par le HHV-8 (Human Herpes Virus 8), ce qui justifie l'occurrence de ce sarcome chez les patients non immunod&eacute;prim&eacute;s, non s&eacute;ropositifs. Nous rapportons ici le cas d'un patient de 72 ans, sans ant&eacute;c&eacute;dents, qui rapporte depuis 3 ans l'apparition progressive d'un bourgeon charnu d'allure tumorale au niveau du gland, sans autre localisation. Devant le tableau clinique, nous avons suspect&eacute; un carcinome &eacute;pidermo&iuml;de ou un carcinome sarcomatoide de la verge. Une premi&egrave;re biopsie faite est revenue n&eacute;gative, la seconde est revenue en faveur d'un sarcome de Kaposi, confirm&eacute; par l'immunohistochimie. Le patient a b&eacute;n&eacute;fici&eacute; d'une chimioth&eacute;rapie.</b><br/> text/html 2017-09-23T11:55:21+01:00 Mohammed Alae Touzani, Othmane Yddoussalah [Images in medicine] - M&eacute;tastase caverneuse d’une tumeur de vessie - 21 September 2017. <b>L'incidence d'apparition de m&eacute;tastases caverneuses apr&egrave;s traitement radical d'une tumeur de vessie est exceptionnelle et est de l'ordre de 1%. Le d&eacute;lai d'apparition est en moyenne de 8 mois apr&egrave;s la chirurgie, avec certains cas ou il arrive &agrave; 10 ans. Le diagnostic est confirm&eacute; par la biopsie qui met en &eacute;vidence l'origine uroth&eacute;liale. Nous rapportons ici le cas d'un patient de 56 ans, tabagique, ayant b&eacute;n&eacute;fici&eacute; en Janvier 2017 d'une cystoprostatectomie totale, qui consulte 2 mois plus tard pour une induration de la verge, sans autre signe associ&eacute;. Le priapisme et la gangr&egrave;ne de la verge d'origine infectieuse ont &eacute;t&eacute; &eacute;voqu&eacute;s mais vu le contexte clinique, le diagnostic de m&eacute;tastase caverneuse &eacute;tait le plus probable. Le patient a refus&eacute; &agrave; deux reprises une biopsie, sur deux consultations &agrave; 15 jours d'intervalle (A, B). Une biopsie a &eacute;t&eacute; accept&eacute;e par le patient &agrave; la 3&egrave;me consultation (C, D), elle a confirm&eacute; le diagnostic de m&eacute;tastase caverneuse.</b><br/> text/html 2017-09-23T11:55:21+01:00 Uvie Ufuoma Onakpoya, Adebisi David Adenle, Anthony Taiwo Adenekan [Research] - Early experience with open heart surgery in a pioneer private hospital in West Africa: the Biket medical centre experience - 21 September 2017. <b>INTRODUCTION: More than forty years after the first open heart surgery in Nigeria, all open heart surgeries were carried out in government-owned hospitals before the introduction of such surgeries in 2013 at Biket Medical Centre, a privately owned hospital in Osogbo, South-western Nigeria. The aim of this paper is to review our initial experience with open heart surgery this private hospital. METHODS: All patients who underwent open heart surgery between August 2013 and January 2014 were included in this prospective study. The medical records of the patients were examined and data on age, sex, diagnosis, type of surgery, cardiopulmonary bypass details, complications and length of hospital stay were extracted and the data was analysed using SPSS version 16. RESULTS: Eighteen patients comprising of 12 males and 6 females with ages ranging between 8 months and 52 years (mean = of 15.7+/-15 years) were studied. Pericardial patch closure of isolated ventricular septal defect was done in 7 patients (38.9%) while total correction of isolated tetralogy of Fallot was carried out in 5 patients (27.8%). Two patients had mitral valve repair for rheumatic mitral regurgitation. Sixty day mortality was 0%. CONCLUSION: Safe conduct of open heart surgery in the private hospital setting is feasible in Nigeria. It may be our only guarantee of hitch free and sustainable cardiac surgery.</b><br/> text/html 2017-09-23T11:55:21+01:00 Malick Bodian, Awa Thiaw, Simon Antoine Sarr, Kana Babaka, Fatou Aw, Aliou Alassane Ngaïde, Mouhamadou Bamba Ndiaye, Adama Kane, Modou Jobe, Alassane Mbaye, Maboury Diao, Moustapha Sarr, Serigne Abdou Ba [Research] - Syndrome cardio-r&eacute;nal: aspects &eacute;pid&eacute;miologiques, &agrave; propos de 36 cas dans un service de cardiologie de Dakar - 21 September 2017. <b>INTRODUCTION: Le syndrome cardio-r&eacute;nal (SCR) est un trouble physiopathologique du cœur et des reins dans lequel une dysfonction chronique ou aigu&euml; de l’un peut induire une dysfonction chronique ou aigu&euml; de l’autre. En Afrique et au S&eacute;n&eacute;gal en particulier l’incidence du syndrome cardio-r&eacute;nal est mal connue. L’objectif de cette &eacute;tude &eacute;tait d’appr&eacute;cier la pr&eacute;valence du SCR en milieu cardiologique. METHODES: Nous avons men&eacute; une &eacute;tude r&eacute;trospective incluant tous les insuffisants cardiaques ayant une alt&eacute;ration de leur fonction r&eacute;nale et hospitalis&eacute;s entre avril 2010 et avril 2011 au service de cardiologie. Les donn&eacute;es &eacute;taient analys&eacute;es avec le logiciel statistique Epi-info 3.5.3. RESULTATS: Nous avons inclus 36 patients. La pr&eacute;valence &eacute;tait de 3,7% avec une pr&eacute;dominance masculine (sex-ratio &agrave; 1,77) et un &acirc;ge moyen &agrave; 56,9 ans [30-92]. Les ant&eacute;c&eacute;dents &eacute;taient domin&eacute;s par l’hypertension art&eacute;rielle (52,77%) et le diab&egrave;te (19,4%). Les principales &eacute;tiologies &eacute;taient la cardiomyopathie hypertensive (39%) et l’insuffisance coronarienne (19,44%). La symptomatologie &eacute;tait domin&eacute;e par la dyspn&eacute;e (69,4%) et les œd&egrave;mes (50%). On notait une an&eacute;mie (17 patients). La clairance moyenne (MDRD) &agrave; 46 ml/min. L’&eacute;chocardiographie Doppler retrouvait majoritairement des troubles de la cin&eacute;tique (89,3%), une dysfonction systolique VG (71%). Les 3 &eacute;chographies r&eacute;nales &eacute;taient normales. Six d&eacute;c&egrave;s (16,7 %) &eacute;taient not&eacute;s. CONCLUSION: Le syndrome cardio-r&eacute;nal est une r&eacute;alit&eacute; et marque un tournant dans l’&eacute;volution de toute cardiopathie et n&eacute;phropathie. Sa pr&eacute;valence en milieu cardiologique s&eacute;n&eacute;galais est faible. Des &eacute;tudes prospectives et multicentriques sont n&eacute;cessaires pour une meilleure &eacute;valuation au S&eacute;n&eacute;gal.</b><br/> text/html 2017-09-23T11:55:21+01:00 Hendrick Mbutshu Lukuke, Eric Kasamba, Abdulu Mahuridi, Roger Ngatu Nlandu, Suganuma Narufumi, Abel Ntambue Mukengeshayi, Vicky Malou, Michel Makoutode, Fran&ccedil;oise Malonga Kaj [Research] - L’incidence des infections nosocomiales urinaires et des sites op&eacute;ratoires dans la maternit&eacute; de l’H&ocirc;pital G&eacute;n&eacute;ral de R&eacute;f&eacute;rence de Katuba &agrave; Lubumbashi en R&eacute;publique D&eacute;mocratique du Congo - 21 September 2017. <b>INTRODUCTION: Les patients hospitalis&eacute;s en Afrique intertropicale sont expos&eacute;s &agrave; un risque des infections nosocomiales. La raret&eacute; des donn&eacute;es publi&eacute;es sur le sujet limite l’analyse descriptive de la situation. L’objectif de ce travail &eacute;tait de d&eacute;terminer l’incidence, les germes en cause et les facteurs de risque des infections nosocomiales urinaires et des sites op&eacute;ratoires &agrave; la maternit&eacute; de l’HGR Katuba de Lubumbashi en R&eacute;publique D&eacute;mocratique du Congo(DRC). METHODES: nous avons r&eacute;alis&eacute; une &eacute;tude descriptive longitudinale de la p&eacute;riode allant du 1<sup>er</sup> octobre 2014 au 1er Janvier 2015. Notre population d’&eacute;tude &eacute;tait constitu&eacute;e de 207 femmes ayant s&eacute;journ&eacute; dans cette maternit&eacute;. La collecte de donn&eacute;es &eacute;tait r&eacute;alis&eacute;e d’une mani&egrave;re exhaustive.</b><br/> text/html 2017-09-23T11:55:21+01:00 Mustafa Nkaoui, El Mehdi El Alouani [Images in medicine] - Osgood-schlatter disease: risk of a disease deemed banal - 21 September 2017. <b>Osgood-schlatter disease, non-articular osteochondrosis, is characterized by pain of anterior tibial tuberosity (TTA), which mainly affects the growing adolescent sportsman. It corresponds to "chronic lesions, due to microtrauma of repeated tractions on the area of insertion of the patellar tendon at the level of the anterior tibial tuberosity". This condition remains benign if the young patient rests well, the only treatment proven effective to avoid complications such as the removal of the anterior tibial tuberosity. The case reported in this article illustrates this complication. He is a 15-year-old boy, followed for Osgood-Schlatter disease, who did not respect the advice given by his attending physician; and who was the victim of an accident during a soccer match: brutal contraction of the quadriceps during an upset extension of the left knee, causing pain and total functional impotence. The examination showed a large oedematous knee with pain on palpation of TTA, with a deficit of active extension of the knee (A). Standard radiographs of the left knee showed avulsion of the anterior tibial tuberosity (B). The treatment was surgical with reduction of the fragment and osteosynthesis by two cortical screws through the median approach (C). With a follow-up of 6 months, the knee mobility was normal and the fracture consolidated. Osgood-Schlatter disease, a pathology of growth, is generally of good prognosis, resolving spontaneously with skeletal maturity. However, if the young athlete does not change his practice, he may seriously aggravate it (removal of the TTA requiring orthopedic or even surgical treatment) and therefore with much more serious consequences for its sporting recovery.</b><br/> text/html 2017-09-23T11:55:21+01:00 Meriem El Bahloul, Fouad Chra&iuml;bi, Marrakchi Mohammed, Meriem Abdellaoui, Idriss Benatiya [Case report] - Colobome maculaire unilat&eacute;rale: &agrave; propos d’un cas - 21 September 2017. <b>Le colobome maculaire est une affection cong&eacute;nitale en rapport avec une anomalie de fermeture de la fissure fœtale, pouvant &ecirc;tre int&eacute;gr&eacute; dans un cadre h&eacute;r&eacute;ditaire. Il se caract&eacute;rise cliniquement par une acuit&eacute; visuelle basse avec une l&eacute;sion excav&eacute;e maculaire o&ugrave; le tissu r&eacute;tinien normal est absent ou rudimentaire et la scl&egrave;re est ectasique. La tomographie en coh&eacute;rence optique maculaire est fortement &eacute;vocatrice du diagnostic et le bilan &eacute;lectrophysiologique s'il est demand&eacute; est alt&eacute;r&eacute;. Le diagnostic diff&eacute;rentiel se pose avec les pathologies entrainant une l&eacute;sion atrophique et excav&eacute;e de la macula, particuli&egrave;rement la toxoplasmose cong&eacute;nitale.</b><br/> text/html 2017-09-23T11:55:21+01:00 Marie-Rosette Nahimana, Candide Tran Ngoc, Olushayo Olu, Jose Nyamusore, Ayodeji Isiaka, Vedaste Ndahindwa, Lakruwan Dassanayake, Andr&eacute; Rusanganwa [Research] - Knowledge, attitude and practice of hygiene and sanitation in a Burundian refugee camp: implications for control of a Salmonella typhi outbreak in 2016 - 21 September 2017. <b>INTRODUCTION: A <i>Salmonella typhi</i> outbreak was reported in a Burundian refugee camp in Rwanda in October 2015. Transmission persisted despite increased hygiene promotion activities and hand-washing facilities instituted to prevent and control the outbreak. A knowledge, attitude and practice (KAP) study was carried out to assess the effectiveness of ongoing typhoid fever preventive interventions. METHODS: a cross-sectional survey was conducted in Mahama Refugee Camp of Kirehe District, Rwanda from January to February 2016. Data were obtained through administration of a structured KAP questionnaire. RESULTS: a total of 671 respondents comprising 264 (39.3%) males and 407 (60.7%) females were enrolled in the study. A comparison of before and after institution of prevention and control measures showed a 37% increase in the proportion of respondents who washed their hands before eating and after using the toilet (p < 0.001). About 52.8% of participants reported having heard about typhoid fever and only 25.9% had received health education. Only 34.6% and 38.6%, respectively of the respondents knew how typhoid fever spreads and is prevented. Most respondents (98.2%) used pit latrines for disposal of feces. Long duration of stay in the camp, age over 35 years and being unemployed were statistically associated with poor hand washing practices. CONCLUSION: the findings of this study underline the need for bolstering up health education and hygiene promotion activities in Mahama and other refugee camp settings.</b><br/> text/html 2017-09-23T11:55:21+01:00 Mousa Victor Al-Madani, Nancy Khalaf Al-Raggad, Naser Abdallah Al-Fgarra, Amal Mousa Al-Thawaby, Ahmed Abdelra’of Jaafar [Research] - The risk of ischemic optic neuropathy post phacoemulsification cataract surgery - 21 September 2017. <b>INTRODUCTION: The aim was to study the risk of non arteritic ischemic optic neuropathy after phacoemulsification cataract surgery. METHODS: this study was conducted at King Hussein Medical Center during the period between January 2015 and July 2016. Patients attending ophthalmology clinic complaining of decreased vision due to lens opacity were evaluated. Patients were divided into two groups. First group included patients with no medical illness and second group included patients with diabetes mellitus, hypertension or hyperlipidemia. The two groups were further divided into two subgroups. First subgroup included patients who had phacoemulsification surgery and second subgroup did not have surgery. All patients were followed up for 6 months. They were assessed by neuro-ophthalmologist looking for ischemic optic neuropathy. RESULTS: a total number of 568 patients were enrolled. Group 1A included patients with no medical illness who underwent surgery and group 1B did not undergo surgery. The number of patients in these two subgroups was 119 and 103 respectively. Number of patients in group 2A (medical illness and surgery) was 188 and number of patients in group 2B (medical illness and no surgery) was 130. The incidence of ischemic optic neuropathy was 4.3 % in group 2A, 4.2 % in group 1A, 0.8% in group 2B, and 0% in group 1B. CONCLUSION: phacoemulsification is a risk factor for non arteritic ischemic optic neuropathy independent of the presence of medical risk factors. Suggested mechanisms would be local anaesthesia, intraocular pressure fluctuation and local intraocular inflammation.</b><br/> text/html 2017-09-23T11:55:21+01:00 Amina Kissou, Badr Eddine Hassam [Images in medicine] - Cyst of the back of the hand - 20 September 2017. <b>A 70 year-old man, farmer by profession consulted for a firm and painless nodule of the back of his right hand that was evolving since 09 years. The clinical examination revealed a subcutaneous nodular lesion; firm; immobile and painless. The diameter was about 0.8cm. The skin above was normal. Surgical excision was indicated. Intraoperatively the lesion was cystic and surrounded by a whitish membrane. Histological examination confirmed an epidermoid cyst who was abducted in totality. The occurrence of epidermoid cyst in hands can be explained by repeated trauma. It is seen most often in men "a manual worker." Clinically, it is about a firm nodule often sitting at the distal phalanx in size from 0.5 to 2cm. The Pulp location is the common location against in back of the hand which is possible but unusual, as in our patient. The overlying skin is normal or punctuated and the lesion is painless in half of the cases. Treatment is the complete surgical excision of the capsule and the overlying skin to avoid the risk of recurrence.</b><br/> text/html 2017-09-23T11:55:21+01:00 Salah Bellasri, Soufiane Belabbas [Images in medicine] - Lhermitte-Duclos disease: an extremely rare cerebellar tumor - 20 September 2017. <b>A 42-year-old female presented with complaints of mild occipital headaches of severe months duration. There were no cutaneous lesions or significant family history suggesting any genetic disease. On examination, she did not have any papilloedema, dymetria, dysdiadokokinasia or ataxia. Her cranial nerve examination was normal. On non-enhanced computed tomogram (CT) showed a mildly hyperdense well circumscribed lesion, in the left upper cerebellar hemisphere with no bone involvement (not schown). MRI showed an intra-axial lesion measuring 3.7cm × 3.5cm × 2.5cm in relation to the tentorium cerebelli and lateral sinus which was hypointense on T1-weighted image (T1WI) (A), with the characteristic striated appearance or "tiger-striped" appearance on T2-weighted image (T2WI) (B), there was no apparent contrast enhancement (C). This lesion was hyperintense in diffusion (D) and in fluid attenuation inversion recovery (FLAIR) (E). There was no extension into the internal auditory canal. There was no compression of the brainstem and ventricular system. Proton (¹H) MR spectroscopy study (MRS) revealed normal N-acetyl-aspartate (NAA)/Creatine (Cr) ratio (1.48), moderately decreased choline (cho)/Cr (0.76) (F). An abdominal ultrasound was performed in order to evaluate the intraabdominal organs and found to be normal. She has been under routine follow-up for 3 years. On the last control, the brain MRI showed lesion stability. Given the well-tolerated nature of her headaches and the stability of the lesion, the staff of the neurosurgeons indicated a routine control without surgery.</b><br/> text/html 2017-09-23T11:55:21+01:00 Hamza Dergamoun, Zayd El Boukili El Makhoukhi [Images in medicine] - G&eacute;antes lithiases de stase sur vessie il&eacute;o-caecale - 20 September 2017. <b>L'exstrophie v&eacute;sicale est une malformation caract&eacute;ris&eacute;e par la d&eacute;hiscence de la paroi abdominale ant&eacute;rieure sous ombilicale et la paroi ant&eacute;rieure de la vessie. Rencontr&eacute;e environ dans 30000 &agrave; 40000 naissance par an, elle semble plus toucher les gar&ccedil;ons que les filles, la d&eacute;rivation externe continente semble donner de bons r&eacute;sultats &agrave; long terme elle n'est cependant pas d&eacute;nu&eacute;e de complications. Nous rapportons le cas d'une patiente &acirc;g&eacute;e de 30 ans, op&eacute;r&eacute;e il y a 13 ans pour extrophie, ayant b&eacute;n&eacute;ficie d'une cystectomie avec remplacement par vessie il&eacute;o caecal, suivie pendant 5 ans puis perdue de vue. Elle se pr&eacute;sente en mars 2017 dans un tableau de douleurs abdominales &agrave; type de pesanteur ainsi qu'une constipation &eacute;voluant dans un contexte d'apyrexie et de conservation de l'&eacute;tat g&eacute;n&eacute;ral. L'examen retrouve une patiente en bon &eacute;tat g&eacute;n&eacute;ral avec une cicatrice de laparotomie m&eacute;diane, la valve de la poche est continente non invagin&eacute;e avec des touchers pelviens sans particularit&eacute;s. La palpation hypogastrique retrouve une masse dure pierreuse non douloureuse. L'arbre urinaire sans pr&eacute;paration objective une opacit&eacute; de tonalit&eacute; calcique 130*110 mm ainsi qu'une disjonction symphysaire. L'&eacute;chographie r&eacute;nale et pelvienne objective plusieurs images hyper&eacute;chog&egrave;nes avec c&ocirc;ne d'ombre post&eacute;rieur occupant tous le pelvis, deux reins de tailles normales bien diff&eacute;renci&eacute;es sans ur&eacute;t&egrave;ro-hydron&eacute;phrose. L'uroscanner retrouve une n&eacute;o vessie si&egrave;ge de 5 volumineux calculs de densit&eacute; calcique autour de 730 UH dont la plus volumineuses mesures 112*101mm. La fonction r&eacute;nale &eacute;tait normale et l'examen cytobact&eacute;riologique des urines a mis en &eacute;vidence une infection urinaire &agrave; E COLI BLSE sensible aux carbapen&egrave;mes. Le traitement a consist&eacute; en une antibioth&eacute;rapie adapt&eacute;e associ&eacute;e &agrave; une enterocystolithotomie avec extraction laborieuse de 5 gros calculs. A l'&eacute;tude spectrophotom&eacute;trique les calculs sont de nature phospho-ammoniaco-magnesienne. Les suites op&eacute;ratoires &eacute;taient simples, l'arbre urinaire sans pr&eacute;paration post op&eacute;ratoire &eacute;tait stone free.</b><br/> text/html 2017-09-23T11:55:21+01:00 Christine Ngaruiya, Alison Hayward, Lori Post, Hani Mowafi [Essay] - Obesity as a form of malnutrition: over-nutrition on the Uganda “malnutrition” agenda - 20 September 2017. <b>The objectives were to highlight the burden of overweight and obesity as an additional area of importance for the malnutrition agenda in Uganda and to provide evidence-based considerations for stakeholders involved. Introduction: Mirroring other Low- and Middle-Income Countries (LMICs), Uganda is experiencing a "double burden" of over-nutrition related issues - both obesity and overweight, and related non-communicable diseases (NCDs) alongside the under-nutrition that has long plagued the country. Despite the commonplace assumption that under-nutrition is the predominant form of malnutrition in Uganda, we explore recent literature that in fact, challenges this notion. While food insecurity has contributed to the under-nutrition problem, a lack of dietary diversity also has a demonstrated role in increasing over-nutrition. We cannot afford to ignore over-nutrition concomitant with stunting and wasting in the country. Increase in the burden of this less acknowledged form of malnutrition in Uganda is critical to investigate, and yet poorly understood. A move towards increased regionally targeted over-nutrition research, funding, government prioritization and advocacy is needed.</b><br/> text/html 2017-09-23T11:55:21+01:00 Fatima Ezzaitouni, Youssef Thiyfa, Mohamed Tahiri, Fouad Haddad, Wafaa Hliwa, Ahmed Bellabah, Wafaa Badre [Case report] - Le d&eacute;ficit immunitaire commun variable &agrave; r&eacute;v&eacute;lation tardive par des manifestations digestives: &agrave; propos d’un cas - 20 September 2017. <b>Le d&eacute;ficit immunitaire commun variable (DICV) est une pathologie rare, il s’agit d’un d&eacute;ficit constitutionnel de l'immunit&eacute; humorale caract&eacute;ris&eacute; par des infections bact&eacute;riennes &agrave; r&eacute;p&eacute;tition, et par une fr&eacute;quence accrue de tumeurs, de maladies auto-immunes ou granulomateuses. Les manifestations gastro-intestinales sont tr&egrave;s variables et parfois r&eacute;v&eacute;latrices d’un d&eacute;ficit immunitaire commun variable. Nous rapportons le cas d’un patient &acirc;g&eacute; de 31 ans, ayant comme ant&eacute;c&eacute;dent des infections respiratoires &agrave; r&eacute;p&eacute;tition depuis le bas &acirc;ge, compliqu&eacute;es d’une dilatation des bronches, qui pr&eacute;sente depuis 3 ans une diarrh&eacute;e glaireuse r&eacute;currente, chez qui l’ensemble du bilan &eacute;tiologique est en faveur d’un DICV avec une manifestation auto-immune (vitiligo). Le traitement a consist&eacute; en une perfusion mensuelle d’immunoglobulines (Ig) avec une bonne &eacute;volution. Le recul actuel est de deux ans.</b><br/> text/html 2017-09-23T11:55:21+01:00 Hicham Attifi, Mehdi Lagtoubi [Images in medicine] - Lipome du lobe profond de la glande parotide - 20 September 2017. <b>Les lipomes de la parotide sont des tumeurs b&eacute;nignes se d&eacute;veloppant &agrave; partir du tissu graisseux de la glande. Ils sont rares repr&eacute;sentant 0,6 &agrave; 4,4 % de toutes les tumeurs b&eacute;nignes et ceux situ&eacute;s dans le lobe profond de la glande restent exceptionnels. Leur diagnostic clinique est tr&egrave;s difficile &agrave; &eacute;tablir. La tomodensitom&eacute;trie et surtout l'imagerie par r&eacute;sonance magn&eacute;tique peuvent &eacute;tayer le diagnostic. Le traitement est chirurgical mais ses modalit&eacute;s sont tr&egrave;s controvers&eacute;es. Patiente &acirc;g&eacute;e de 52 ans sans ant&eacute;c&eacute;dents pathologiques particuliers a consult&eacute; pour une masse pr&eacute;auriculaire gauche asymptomatique &eacute;voluant depuis un an et augmentant progressivement de volume. L'examen clinique a retrouv&eacute; une tum&eacute;faction &eacute;lastique, indolore, de 2 × 1,5 × 1 cm, s'&eacute;tendant du lobule de l'oreille &agrave; l'angle mandibulaire gauches. Le canal de St&eacute;non &eacute;tait libre et la salive &eacute;tait claire. La patiente ne pr&eacute;sentait aucun signe de paralysie faciale. La tomodensitom&eacute;trie mettait en &eacute;vidence une masse unilobulaire hypodense, homog&egrave;ne, parfaitement cloisonn&eacute;e, situ&eacute;e dans le lobe profond de la glande parotide. Aucune ad&eacute;nopathie cervicale suspecte n'&eacute;tait retrouv&eacute;e. L'imagerie par r&eacute;sonance magn&eacute;tique a confirm&eacute; la pr&eacute;sence d'un processus tissulaire intraparotidien, homog&egrave;ne et de nature lipomateuse. Apr&egrave;s la parotidectomie superficielle et r&eacute;clinaison des branches du nerf facial, une masse jaun&acirc;tre apparaissait sous les rameaux buccal et mandibulaire du nerf facial. Son ex&eacute;r&egrave;se en bloc a &eacute;t&eacute; r&eacute;alis&eacute;e jusqu'&agrave; l'espace parapharyng&eacute; gauche. Les suites op&eacute;ratoires ont &eacute;t&eacute; simples. L'examen anatomopathologique a confirm&eacute; le diagnostic du lipome du lobe profond de la glande parotide.</b><br/> text/html 2017-09-23T11:55:21+01:00 The Pan African Medical Journal [Erratum] - Erratum: Paragangliome m&eacute;sent&eacute;rique - 19 September 2017. <b>This erratum corrects “Paragangliome m&eacute;sent&eacute;rique”. The Pan African Medical Journal. 2017;26:142. doi:10.11604/pamj.2017.26.142.11813.</b><br/> text/html 2017-09-23T11:55:21+01:00 Ilhame Naciri, Baderddine Hassam [Images in medicine] - Une tumeur exophytique du cuir chevelu - 18 September 2017. <b>La tumeur trichilemmale prolif&eacute;rante, encore appel&eacute;e kyste trichilemmal prolif&eacute;rant, est une tumeur annexielle maligne peu fr&eacute;quente, qui se d&eacute;veloppe &agrave; partir des cellules de la gaine folliculaire externe ou le plus souvent &agrave; partir d'un kyste trichilemmal, apr&egrave;s de multiples traumatismes et/ou d'inflammations it&eacute;ratives. Nous rapportons le cas d'une patiente &acirc;g&eacute;e de 64 ans, sans ant&eacute;c&eacute;dent, qui consultait pour une tumeur du cuir chevelu, &eacute;voluant progressivement depuis 18 mois. L'examen clinique montrait une masse tumorale ulc&eacute;ro-bourgeonnante indolore, ferme, adh&eacute;rente, de 12 cm de grand axe si&eacute;geant au niveau du vertex. Les aires ganglionnaires &eacute;taient libres. L'examen histologique montrait une prolif&eacute;ration cellulaire malpighienne agenc&eacute;e en massifs et en lobules coalescents centr&eacute;s par une k&eacute;ratinisation abrupte selon un mode trichilemmal, avec des atypies cyto-nucl&eacute;aires tr&egrave;s marqu&eacute;es et un stroma infiltr&eacute; fibreux, faisant &eacute;voquer une tumeur trichilemmale prolif&eacute;rante. Le bilan d'extension n'a pas objectiv&eacute; de m&eacute;tastase. La patiente a b&eacute;n&eacute;fici&eacute; d'une ex&eacute;r&egrave;se chirurgicale large suivie d'une recoupe en profondeur, sans r&eacute;cidive avec un recul de 3 ans.</b><br/> text/html 2017-09-23T11:55:21+01:00 Rachid Lefryekh, Ahmed Bensaad, Fatimazahra Bensardi,Khalid Elhattabi,Mounir Bouali, Bessam Daif, Abdelaziz Fadil, Zakaria Jouahari, Tazi Hicham, Aziz Hamdani, Maha Soussi Abdalaoui [Case report] - Hepatic fascioliasis presenting with bile duct obstruction: a case report - 18 September 2017. <b>Fascioliasis is a zoonotic infection caused by a liver trematode: fasciola hepatica; which commonly affects cattle and sheep, humans are accidental hosts. Several cases have been reported in the literature worldwide with a large geographical distribution. We present a case of bile duct obstruction due to a hepatic fascioliasis, successfully treated with both a combined surgical and medical approaches. A high index of suspicion should be kept in mind for all cases of obstructive jaundice, especially in areas in which human fascioliasis infection is repeatedly reported.</b><br/> text/html 2017-09-23T11:55:21+01:00 Viviane Marie Pierre Cisse Diallo, Louise Fortes Deguenonvo, Khardiata Diallo Mbaye, Daye Ka, Ndeye Aissatou Lakhe, Ibrahima Ndiaye, Daouda Thioub, Sylvie Audrey Diop Nyafouna, Aminata Massaly, Alassane Di&egrave;ye, Moustapha Diop, Cheikh Tidiane Ndour, Moussa Seydi [Case report] - Co-infection tuberculose/VIH et Maladie de kaposi sous traitement de substitution par la m&eacute;thadone: &agrave; propos d’un cas - 15 September 2017. <b>Le diagnostic tardif de l’infection &agrave; VIH peut &ecirc;tre fatal car favorisant l’apparition d’infections opportunistes dont la prise en charge n&eacute;cessite l’utilisation de plusieurs mol&eacute;cules pouvant provoquer des interactions m&eacute;dicamenteuses. Nous rapportons le cas d’une patiente de 45 ans, sous traitement de substitution &agrave; l’h&eacute;ro&iuml;ne par la m&eacute;thadone, VIH1 sous traitement antir&eacute;troviral. Cette patiente pr&eacute;sentait un tableau pulmonaire non sp&eacute;cifique associant une toux quinteuse s&egrave;che avec une dyspn&eacute;e d’apparition progressive &eacute;voluant dans un contexte f&eacute;brile. Par ailleurs l’examen notait un lymphœd&egrave;me du membre inferieur gauche surmont&eacute;e de nodules angiomateux indolores &eacute;voluant depuis trois ans associ&eacute; &agrave; des plaques, des nodules angiomateux d’apparition plus r&eacute;cente au niveau de la face ant&eacute;rieure du thorax. Le GeneXpert sur les crachats avait permis d’isoler Mycobacterium tuberculosis. Le diagnostic retenu &eacute;tait celui d’une tuberculose pulmonaire associ&eacute;e &agrave; une maladie de kaposi cutan&eacute; sur un terrain d’immunod&eacute;pression au VIH.</b><br/> text/html 2017-09-23T11:55:21+01:00 Pilakimw&eacute; Egbohou, Tabana Mouzou, Kadanga Beketi, Essossinam Kpelao, Abdel Kader Moumouni, Hamza Doles Sama, Sarakawabalo Ass&eacute;nouw&eacute;, Gnimdou Akala-Yoba, Kadjika Tomta [Case series] - Les m&eacute;ningiomes intracr&acirc;niens op&eacute;r&eacute;s au CHU Sylvanus Olympio de Lom&eacute;: aspects anesth&eacute;siologiques et complications: &agrave; propos de 21 cas - 15 September 2017. <b>L’objectif &eacute;tait de relever les aspects anesth&eacute;siologiques et les complications p&eacute;riop&eacute;ratoires des m&eacute;ningiomes intracr&acirc;niens op&eacute;r&eacute;s au CHU Sylvanus Olympio de Lom&eacute; (CHU SO).</b><br/> text/html 2017-09-23T11:55:21+01:00 Ngoie Muleka Serge, Cilundika Mulenga Philippe, Mukuku Kabiriko Olivier, Kakisingi Ngama Christian, Sangwa Milindi C&eacute;drick, Nawej Tshimwang Pascal, Mwamba Mulumba Claude, Ngoy Nkulu Dophra, Muteta Wa Pa Manda Faustin [Research] - Maladie r&eacute;nale chronique: facteurs associes, &eacute;tiologies, caract&eacute;ristiques clinique et biologique &agrave; Lubumbashi en R&eacute;publique D&eacute;mocratique du Congo - 15 September 2017. <b>INTRODUCTION: La maladie r&eacute;nale chronique constitue un v&eacute;ritable probl&egrave;me mondial de sant&eacute; publique du fait de l’augmentation de ses principaux facteurs de risque &agrave; savoir l’hypertension art&eacute;rielle et le diab&egrave;te sucr&eacute;. Dans nos milieux &agrave; faible revenu et sp&eacute;cialement dans notre pays, peu d’&eacute;tudes sont connues sur cette pathologie diagnostiqu&eacute;e &agrave; un stade tr&egrave;s avanc&eacute;e et posant un probl&egrave;me de prise en charge.</b><br/> text/html 2017-09-23T11:55:21+01:00 Olushayo Olu, Amos Petu, Martin Ovberedjo, Diane Muhongerwa [Case series] - South-South cooperation as a mechanism to strengthen public health services in Africa: experiences, challenges and a call for concerted action - 15 September 2017. <b>Calls for implementing new models of development cooperation have been on the increase including a call for increased use of horizontal development cooperation mechanisms such as South-South Cooperation (SSC) as a way to enhance aid effectiveness in the health sector of developing countries. In this policy and practice paper, we review recent experiences in application of SSC initiatives to two public health situations in Africa to demonstrate the veracity of this new paradigm. Our review highlight the immense benefits associated with the use of SSC for health and provide evidence for increasing use of horizontal development coordination mechanisms to strengthen public health services delivery and socioeconomic development among African countries. Opportunities for SSC among African countries include in the areas of disease prevention and control, production of medical products and essential medicines, harmonization of regulatory processes, and health workforce development among others. However, pitfalls such as poor coordination, inadequate political commitment, lack of conducive policy environments, language barrier and inadequate financing opportunities for SSC initiatives present major dilemma for the use of SSC mechanisms. We conclude that the need for a paradigm shift from vertical to horizontal development cooperation needs no further proof but a call to action. We call on the concerned stakeholders to support the establishment of a systematic approach for use of SSC mechanisms in the health sector of Africa, designation of an African Centre of Excellence for SSC in public health and development of a regional mechanism for monitoring and evaluation of SSC initiatives in Africa.</b><br/> text/html 2017-09-23T11:55:21+01:00 Ghizlane El Mghari, Bouchra Rafiq, Nawal El Ansari [Case report] - Kyste &eacute;pidermoide de la selle turcique: &agrave; propos d’un cas - 15 September 2017. <b>Le kyste &eacute;pidermo&iuml;de (KE) ou cholest&eacute;atome est une tumeur b&eacute;nigne d'origine souvent cong&eacute;nitale, survenant dans les espaces sous-arachno&iuml;diens, son traitement est principalement chirurgical. Nous rapportons le cas d'un patient, &acirc;g&eacute; de 38 ans, qui a pr&eacute;sent&eacute; d'une fa&ccedil;on progressive, un syndrome d'hypertension intracr&acirc;nienne, associ&eacute; &agrave; des signes d'insuffisance ant&eacute;hypophysaire des axe corticotrope, thyr&eacute;otrope et gonadotrope install&eacute;s depuis 1an et chez qui l'IRM c&eacute;r&eacute;brale a &eacute;t&eacute; en faveur d'un craniopharyngiome, avec r&eacute;v&eacute;lation de kyste &eacute;pidermoide sur pi&egrave;ce anatomo-pathologique.</b><br/> text/html 2017-09-23T11:55:21+01:00 Hanane Oummad, Maryama Elkaddoumi, Josiane Mar&eacute;, Mounir Lezrek, Ouafae Cherkaoui [Case report] - R&eacute;tinoschisis maculaire bilat&eacute;ral associ&eacute; &agrave; un r&eacute;tinoschisis p&eacute;riph&eacute;rique unilat&eacute;ral - 14 September 2017. <b>Le retinoschisis juv&eacute;nile li&eacute; au chromosome X est une affection h&eacute;r&eacute;ditaire qui affecte habituellement les gar&ccedil;ons avec de rare cas d’atteinte du sexe f&eacute;minin. Les premi&egrave;res manifestations cliniques apparaissent g&eacute;n&eacute;ralement au cours de la premi&egrave;re d&eacute;cennie. Il est responsable d’une baisse d’acuit&eacute; visuelle d’importance variable et lentement progressive. Cette &eacute;volution peut &ecirc;tre &eacute;maill&eacute;e d’h&eacute;morragies dans le vitr&eacute; et de d&eacute;collements de r&eacute;tine volontiers r&eacute;cidivants. Nous pr&eacute;sentons le cas d’un patient &acirc;g&eacute; de 17ans. Au fond d'œil on retrouve remaniement maculaire microkystique stellaire bilat&eacute;ral, centr&eacute; sur la fov&eacute;ola, associ&eacute; &agrave; des schisis p&eacute;riph&eacute;riques avec d&eacute;collement de r&eacute;tine et d&eacute;chirure des feuillets interne et externe unilat&eacute;ral.</b><br/> text/html 2017-09-23T11:55:21+01:00 Chigozie Jesse Uneke, Issiaka Sombie, Henry Chukwuemeka Uro-Chukwu, Ermel Johnson, Friday Okonofua [Workshop report] - Using equitable impact sensitive tool (EQUIST) and knowledge translation to promote evidence to policy link in maternal and child health: report of first EQUIST training workshop in Nigeria - 14 September 2017. <b>The Equitable Impact Sensitive Tool (EQUIST) designed by UNICEF and knowledge translation (KT) are important strategies that can help policymakers to improve equity and evidence-informed policy making in MNCH. The purpose of this study was to improve the knowledge and capacity of an MNCH implementation research team (IRT) and policy makers to use EQUIST and KT. A modified "before and after" intervention study design was used in which outcomes were measured on the target participants both before the intervention (workshop) is implemented and after. A 5-point likert scale according to the degree of adequacy was employed. A three -day intensive EQUIST and KT training workshop was organized in Edo State, Nigeria with 45 participants in attendance. Some of the topics covered included: (i) Knowledge translation models, measures & tools; (ii) Policy review, analysis and contextualization; (iii) Policy formulation and legislation process; (iv) EQUIST Overview & Theory of change; (v) EQUIST's situation analysis, scenario analysis and scenario comparison. The pre-workshop mean of understanding of use of KT ranged from 2.02-3.41, while the post-workshop mean ranged from 3.24-4.30. Pre-workshop mean of understanding of use of EQUIST ranged from 1.66-2.41, while the post-workshop mean ranged from 3.56-4.54 on the 5point scale. The percentage increase in mean of KT and EQUIST at the end of the workshop ranged from 8.0%-88.1% and 65.6%-158.4% respectively. Findings of this study suggest that policymakers' and researchers KT and EQUSIT use competence relevant to evidence-informed policymaking can be enhanced through training workshop.</b><br/> text/html 2017-09-23T11:55:21+01:00 The Pan African Medical Journal [Erratum] - Erratum: Food hygiene assessment in catering establishments in Hay Hassani district-Casablanca - 14 September 2017. <b>This erratum corrects "Food hygiene assessment in catering establishments in Hay Hassani district-Casablanca." The Pan African Medical Journal. 2016;24:335. doi:10.11604/pamj.2016.24.335.9171</b><br/> text/html 2017-09-23T11:55:21+01:00 Hasan Hamze, Asrat Mengiste, Jane Carter [Research] - The impact and cost-effectiveness of the Amref Health Africa-Smile Train Cleft Lip and Palate Surgical Repair Programme in Eastern and Central Africa - 14 September 2017. <b>INTRODUCTION: Cleft lip with or without cleft palate (CLP) is a congenital malformation that causes significant morbidity in low and middle income countries. Amref Health Africa has partnered with Smile Train to provide CLP surgeries since 2006. METHODS: we analyzed anonymised data of 37,274 CLP patients from the Smile Train database operated on in eastern and central Africa between 2006 and 2014. Cases were analyzed by age, gender, country and surgery type. The impact of cleft surgery was determined by measuring averted Disability-Adjusted Life Years (DALYs) and delayed averted DALYs. We used mean Smile Train costs to calculate cost-effectiveness. We calculated economic benefit using the human capital approach and Value of Statistical Life (VSL) methods. RESULTS: the median age at time of primary surgery was 5.4 years. A total of 207,879 DALYs were averted at a total estimated cost of US$13 million. Mean averted DALYs per patient were 5.6, and mean cost per averted DALY was $62.8. Total delayed burden of disease from late age at surgery was 36,352 DALYs. Surgical correction resulted in $292 million in economic gain using the human capital approach and $2.4 billion using VSL methods. CONCLUSION: cleft surgery is a cost-effective intervention to reduce disability and increase economic productivity in eastern and central Africa. Dedicated programs that provide essential CLP surgery can produce substantial clinical and economic benefits.</b><br/> text/html 2017-09-23T11:55:21+01:00 Basma Karrakchou, Youssef Yaikoubi, Mohamed Said Chairi, Abdelouahed Jalil [Case report] - Elastofibroma dorsi: case report and review of the literature - 14 September 2017. <b>Elastofibroma dorsi (ED) is an uncommon benign soft tissue tumor with an uncertain pathogenesis. It mostly occurs in the infrascapular region of elderly people with a female predominance. Typically bilateral, ED can also be unilateral. While many patients remain asymptomatic, ED can be responsible of a periscapular arch source of ache. The diagnosis of ED is set on magnetic resonance imaging, and the pathological study ensures the diagnosis after surgical excision and establishes the differential diagnosis with malignant neoplasic process. The prognosis is excellent with extremely rare recurrence cases. Herein we report a case of a 54-years-old woman with a bilateral painful ED. The diagnosis was based on clinical and MRI findings that revealed bilateral tumors. Surgery was decided due to the symptomatic nature of the tumors. Pathological study confirmed the diagnosis. The post operative course was uncomplicated. We update through a review of the literature aspects of the diagnostic and therapeutic care of Elastofibroma dorsi.</b><br/> text/html 2017-09-23T11:55:21+01:00 Oyebimpe Jumoke Adenlewo, Peter Olalekan Adeosun, Olawunmi Adedoyin Fatusi [Research] - Medical and dental students’ attitude and practice of prevention strategies against hepatitis B virus infection in a Nigerian university - 14 September 2017. <b>Introduction: Medical and dental students are a high-risk group for hepatitis B virus (HBV) infection which is an occupational hazard for them and a leading cause of death globally. Prevention strategies include vaccination and observance of standard precaution. However, available reports claim utilization of the prevention strategies is low. This study evaluated the attitude of the students towards HBV vaccine and cross-infection practices.</b><br/> text/html 2017-09-23T11:55:21+01:00 Mohammed Alila, Abdelouahab Marouni, Imane Toughrai [Case report] - Hernie paraduod&eacute;nale gauche: une cause rare d'occlusion intestinale - 14 September 2017. <b>Nous rapportons l'observation de deux cas pr&eacute;sentant une occlusion intestinale aigu&euml;. L'intervention en urgence a trouv&eacute; une hernie para-duod&eacute;nale gauche obstructive &agrave; l'origine d'un volvulus, avec n&eacute;crose des anses gr&ecirc;les incarc&eacute;r&eacute;es pour un patient, trait&eacute; par r&eacute;section anastomose en un temps et un gr&ecirc;le souffrant mais viable pour le deuxi&egrave;me malade, trait&eacute; par la r&eacute;duction du gr&ecirc;le incarc&eacute;r&eacute; et l'obturation de l'orifice herniaire. Nous discutons &agrave; l'occasion de ces observations les particularit&eacute;s diagnostiques et th&eacute;rapeutiques de cette affection rare.</b><br/> text/html 2017-09-23T11:55:21+01:00 Mohamed Elyadari, Amina Berraho [Images in medicine] - Plaques scl&eacute;rales s&eacute;niles - 14 September 2017. <b>Nous rapportons le cas d'une femme &acirc;g&eacute;e de 75 ans, hypertendue sous traitement, pseudophake au niveau de l'œil droit, cataracte de l'œil gauche et chez qui l'examen ophtalmologique d&eacute;c&egrave;le de fa&ccedil;on bilat&eacute;rale et sym&eacute;trique des zones de d&eacute;pression scl&eacute;rale de couleur gris&acirc;tre situ&eacute;e en avant de l'insertion des deux muscles droits internes. La plaque scl&eacute;rale est le r&eacute;sultat d'une d&eacute;g&eacute;n&eacute;rescence de la scl&egrave;re li&eacute;e &agrave; l'&acirc;ge et est habituellement asymptomatique. La zone scl&eacute;rale touch&eacute;e devient mince et l&eacute;g&egrave;rement d&eacute;prim&eacute;e. Les l&eacute;sions sont d&eacute;crites comme &eacute;tant bilat&eacute;rales, sym&eacute;triques, bien d&eacute;finies et de forme ovo&iuml;de. Elles sont habituellement situ&eacute;es en avant de l'insertion des muscles droits internes.</b><br/> text/html 2017-09-23T11:55:21+01:00 Chong Yau Ong, Jin Lee Lim, Lourdes Ducusin Galang [Case report] - Extensive pyomyositis of vastus muscles - 14 September 2017. <b>We report a case study on a patient who presented with low back and thigh pain of one month duration. He was eventually diagnosed with left thigh pyomyositis. Tissue from thigh grew Staphylococcus aureus. With commencement of antibiotics and surgical drainage, patient made recovery despite prolonged hospital stay. The underlying mechanism of the extensive abscess accompanied by lack of systemic symptoms; is related to relative immunocompromised state of having underlying diabetes mellitus.</b><br/> text/html 2017-09-23T11:55:21+01:00 Mohammed Sbiti, khalid Lahmadi, Lhoussaine louzi [Case series] - Profil &eacute;pid&eacute;miologique des ent&eacute;robact&eacute;ries uropathog&egrave;nes productrices de b&ecirc;ta-lactamases &agrave; spectre &eacute;largi - 13 September 2017. <b>Les infections urinaires &agrave; ent&eacute;robact&eacute;ries productrices de b&ecirc;talactamases &agrave; spectre &eacute;largi (E-BLSE) constituent un risque infectieux, un enjeu th&eacute;rapeutique de taille et peuvent m&ecirc;me conduire dans certains cas &agrave; des impasses du fait de leur multi-r&eacute;sistance aux antibiotiques. Le but de ce travail est de pr&eacute;ciser le profil &eacute;pid&eacute;miologique des (E-BLSE) uropathog&egrave;nes et d&eacute;crire leur niveau actuel de r&eacute;sistance aux antibiotiques pour une meilleure prise en charge des patients selon les donn&eacute;es locales. Il s'agit d'une &eacute;tude r&eacute;trospective sur une p&eacute;riode de trois ans (du 1er janvier 2013 au 31 d&eacute;cembre 2015) concernant toutes les souches d' E-BLSE isol&eacute;es de tous les ECBU trait&eacute;s au laboratoire de microbiologie de &agrave; l'H&ocirc;pital Militaire Moulay Ismail de Mekn&egrave;s. La culture a &eacute;t&eacute; faite selon les techniques usuelles, et l'antibiogramme a &eacute;t&eacute; r&eacute;alis&eacute; par m&eacute;thode de disque diffusion sous g&eacute;lose Muller-Hinton selon les recommandations du Comit&eacute; de l'antibiogramme de la Soci&eacute;t&eacute; fran&ccedil;aise de microbiologie CA-SFM 2013/2014. Cette &eacute;tude a permis de noter une importante pr&eacute;valence globale d'isolement des E-BLSE (12.2 %), particuli&egrave;rement chez les patients hospitalis&eacute;s (54.8 %) dont la plus grande pr&eacute;valence (72 %) a &eacute;t&eacute; enregistr&eacute;e dans le service d'urologie. Parmi ces E-BLSE Escherichia coli constitue la majorit&eacute; (61 %) des isolats, cependant au sein de la m&ecirc;me esp&egrave;ce Klebsiella pneumoniae est le plus producteur de BLSE (25.8%). L'&eacute;tude de l'antibioresistance des E-BLSE durant ces trois ans a mis en &eacute;vidence des co-r&eacute;sistances &agrave; la ciprofloxacine (92.5 %), au sulfametoxazole-trimethoprime (88,4 %), &agrave; la gentamycine (67,2 %). Globalement nos r&eacute;sultats sont en accord avec les donn&eacute;es des autres pays m&eacute;diterran&eacute;ens exception faite pour l'amikacine dont la r&eacute;sistance est tr&egrave;s basse (6.1%) dans notre &eacute;tude. Cette &eacute;tude a montr&eacute; que la pr&eacute;valence des E-BLSE en milieu hospitalier est importante et que sa diffusion en milieu communautaire est un fait pr&eacute;occupant. Ces E-BLSE sont g&eacute;n&eacute;ralement r&eacute;sistantes aux antibiotiques, notamment des aux mol&eacute;cules utiles en urologie.</b><br/> text/html 2017-09-23T11:55:21+01:00 Adil Zegmout, Hicham Souhi [Images in medicine] - Tuberculosis of the scalp: the tubercle bacilli has not ceased to surprise us - 13 September 2017. <b>A 52-year-old men was referred with a 6-months history of a 3cm single skin lesion, erythematous, not pruriginous, with a verrucous surface, surmounted by scales, with circinated border. His history included weight loss of 8kg, but no other associated symptoms or contact with tuberculosis patients. Erythrocyte sedimentation rate (ESR) was slightly elevated at 82mm in the first hour. Mycological sampling was negative. Tuberculin skin test was positive (15mm) and anti-human immunodeficiency virus serology was negative. A skin biopsy was performed and sent for histopathology and culture. The skin biopsy showed inflammatory granuloma composed mostly of epithelioid cells and giant cells, consistent with tubercular granuloma. Mycobacteria were absent on Ziehl-Neelsen staining, tubercle bacilli were isolated and grown in culture from the lesion and confirmed a scalp localisation of tuberculosis. The scalp localization of tuberculosis very rare and not sufficiently described in the literature and demonstrates the multifaceted aspect of tuberculosis, which continues to yield surprises with its unusual clinical manifestations. Antitubercular chemotherapy consisting of isoniazid, rifampicin, ethambutol and pyrazinamide was started. Follow-up at the end of treatment at 6 months showed a clinical remission.</b><br/> text/html 2017-09-23T11:55:21+01:00 Rupali Awale, Ratnaprabha Maji, Parag Patil, Raghavendra Lingiah, Ashok Kumar Muhopadhyay, Subhadra Sharma [Short communication] - Toluidine blue: rapid and simple malaria parasite screening and species identification - 13 September 2017. <b>Malaria, a febrile illness mostly confined to the tropical countries is transmitted by bite of infected female Anopheles mosquito. In 2015 alone, 88% of the malaria burden and 90% deaths due to malaria were confined to the African and Asian countries. Although number of tests are available for rapid diagnosis and screening for malaria, peripheral blood smear examination remains the gold standard. Leishman stain is recommended by WHO however herein we evaluate one of the alternative methods of staining which is simple and rapid. Fifty patients attending the various outpatient departments of the tertiary care hospital with fever and suspected to have malaria were selected. Two air dried smears prepared from the peripheral venous blood from these subjects were stained by Leishman and Toluidine blue method. The findings of the slides by two independent qualified professionals were noted and the results were analyzed. A total of 14% (7/50) cases were diagnosed to have malaria. All the malaria cases which were positive in Leishman stain were also detected in Toluidine blue stain. Malarial parasites were clearly visible against the homogenously light green background in Toluidine blue. The detection of malarial parasite by Toluidine blue was quick, easy and confirmative. Toluidine blue stained peripheral blood smear allows for easy identification and speciation of malarial parasite at low magnification and in shorter period of time.</b><br/> text/html 2017-09-23T11:55:21+01:00 Amine Ghalem, Hanane Boussir, Kamal Ahsayan, Nabila Ismaili, Noha El Ouafi [Case report] - ST-segment elevation after blunt chest trauma: myocardial contusion with normal coronary arteries or myocardial infarction following coronary lesions - 13 September 2017. <b>Cardiac lesions secondary to blunt chest trauma vary from insignificant arrhythmias to fatal cardiac rupture. Of these, a distinction remains difficult; face to ST-segment elevation on ECG with positive cardiac biomarkers, is it a myocardial contusion or a genuine myocardial infarction (MI) secondary to coronary lesions? We report the case of a patient admitted for multiple trauma. Initial assessment showed an ST segment elevation on ECG, along with multiple fractures and abdominal injuries. We would like to discuss, through this case, the similarities and the differences between myocardial infarction due to coronary lesions and myocardial contusion in a traumatic context, but also emphasize the difficulty of striking the right balance between thrombotic and bleeding risks in this situation, and insist on the importance of a multidisciplinary and collegial reflexion so we can offer these patients the best care there is.</b><br/> text/html 2017-09-23T11:55:21+01:00 Aymen Saidi, Lassaad Hassini, Aymen Fekih, Monia Ben Othmen, Mohamed Allagui, Abderrazek Abid, Issam Aloui [Case report] - Intra-articular knee arborescent lipoma: a case treated with arthroscopic synoviectomy - 13 September 2017. <b>Arborescent lipoma is an unusual intra-articular lesion that typically develops in the knee and has to be evoked before chronic effusion. It corresponds to hyperplasia of mature fatty tissue and hypertrophy of synovial villi, developing within a joint. The reference treatment is synovectomy by arthrotomy. The rare forms localized to the anterior compartment of the knee can benefit from an arthroscopic synovectomy. The authors report a case of arborescent knee lipoma in a 47-year-old patient who received arthroscopic synoviectomy. To our knowledge, only a few cases of arborescent lipoma treated by arthroscopic synoviectomy have been reported in the literature.</b><br/> text/html 2017-09-23T11:55:21+01:00 Evans Mokaya, Isaac Mugoya, Jane Raburu, Lora Shimp [Research] - Use of cellular phone contacts to increase return rates for immunization services in Kenya - 13 September 2017. <b>INTRODUCTION: In Kenya, failure to complete immunization schedules by children who previously accessed immunization services is an obstacle to ensuring that children are fully immunized. Home visit approaches used to track defaulting children have not been successful in reducing the drop-out rate. METHODS: This study tested the use of phone contacts as an approach for tracking immunization defaulters in twelve purposively-selected facilities in three districts of western Kenya. For nine months, children accessing immunization services in the facilities were tracked and caregivers were asked their reasons for defaulting. RESULTS: In all of the facilities, caregiver phone ownership was above 80%. In 11 of the 12 facilities, defaulter rates between pentavalent1 and pentavalent3 vaccination doses reduced significantly to within the acceptable level of < 10%. Caregivers provided reliable contact information and health workers positively perceived phone-based defaulter communications. Tracking a defaulter required on average 2 minutes by voice and Ksh 6 ($ 0.07). Competing tasks and concerns about vaccinating sick children and side-effects were the most cited reasons for caregivers defaulting. Notably, a significant number of children categorised as defaulters had been vaccinated in a different facility (and were therefore "false defaulters"). CONCLUSION: Use of phone contacts for follow-up is a feasible and cost-effective method for tracking defaulters. This approach should complement traditional home visits, especially for caregivers without phones. Given communication-related reasons for defaulting, it is important that immunization programs scale-up community education activities. A system for health facilities to share details of defaulting children should be established to reduce "false defaulters".</b><br/> text/html 2017-09-23T11:55:21+01:00 Eric Mbuya Musapudi, Aim&eacute; Lukoba Bwalya, Igor Mujinga wa Mujinga, Didier Tshibangu Mujinga, Julien Ilunga Nikulu, Guy Nday Ilunga [Case report] - Lymphangiome du sein: &agrave; propos d’un cas - 13 September 2017. <b>Le lymphangiome est une l&eacute;sion b&eacute;nigne de vaisseaux lymphatiques. C'est une affection p&eacute;diatrique rare et exceptionnelle chez l'adulte. Le site habituel est le cou, l'aisselle et l'abdomen. La localisation mammaire est exceptionnelle. Nous rapportons l'observation d'une patiente &acirc;g&eacute;e de 18 ans re&ccedil;ue en consultation pour une masse du sein gauche &eacute;voluant depuis 23 mois. La prise en charge &eacute;tait chirurgicale par une ex&eacute;r&egrave;se compl&egrave;te. L'examen anatomo-pathologique a conclu &agrave; un lymphangiome du sein. Son &eacute;volution a &eacute;t&eacute; bonne et sans r&eacute;cidive apr&egrave;s 10 mois de suivi.</b><br/> text/html 2017-09-23T11:55:21+01:00 Asma Ben Cheikh, Mahmoud Ben Maitigue, Karim Masmoudi, Thabet Mouelhi, Nader Naouar, Yamen Grissa, Karim Bouattour, Walid Osman, Mohamed Laziz Ben Ayeche [Case series] - L'ost&eacute;otomie f&eacute;morale de varisation par ouverture externe pour les gonarthroses f&eacute;moro-tibiales lat&eacute;rales sur genuvalgum idiopathique: &eacute;tude r&eacute;trospective de 10 cas - 13 September 2017. <b>L'ost&eacute;otomie f&eacute;morale de varisation est un traitement conservateur des gonarthroses uni-compartimentales externes qui reste de pratique peu courante et dont les r&eacute;sultats sont peu &eacute;tudi&eacute;s. L'objectif de ce travail &eacute;tait d'&eacute;valuer les r&eacute;sultats cliniques et radiologiques de l'ost&eacute;otomie f&eacute;morale de varisation chez les sujets pr&eacute;sentant une gonarthrose f&eacute;moro-tibiale externe sur genou valgum idiopathique r&eacute;pertori&eacute;s sur une p&eacute;riode de 21 ans(de 1992 &agrave; 2013) au service d'Orthop&eacute;die du CHU Sahloul &agrave; Sousse. L'&eacute;valuation clinique des patients a &eacute;t&eacute; faite &agrave; partir du score IKS (International Knee Society). L'&eacute;valuation radiologique a &eacute;t&eacute; bas&eacute;e sur un bilan pr&eacute; op&eacute;ratoire et un bilan au dernier recul. L'&eacute;tude portait sur une s&eacute;rie de 9 patients (et 10 genoux) dont l'&acirc;ge moyen &eacute;tait de 45,2 ans avec un sex ratio de 0,5. Le recul moyen &eacute;tait de 99 mois. Le score genou moyen est pass&eacute; de 48,4 points en pr&eacute;op&eacute;ratoire &agrave; 73,5 points au dernier recul avec une am&eacute;lioration statistiquement significative (p<10-3). Le score fonctionnel moyen s'est am&eacute;lior&eacute; d'une fa&ccedil;on significative avec une valeur pr&eacute;op&eacute;ratoire de 49,5 points et une valeur 72 pointsau dernier recul. La correction finale a permis de r&eacute;duire le valgus &agrave; une moyenne de 3,7° pour une valeur pr&eacute;-op&eacute;ratoire de 14°. Cette &eacute;tude, ainsi que l'analyse de la litt&eacute;rature, nous ont permis de d&eacute;duire que l'ost&eacute;otomie f&eacute;morale de varisation est l'indication de choix dans les genuvalgum invalidant d'origine f&eacute;morale, en l'absence d'arthrite rhumatismale, de surcharge pond&eacute;rale, d'arthrose f&eacute;moro-tibiale interne ou f&eacute;moro-patellaire s&eacute;v&egrave;re.</b><br/> text/html 2017-09-23T11:55:21+01:00 Japheth Mativo Nzioki, James Ouma, James Hebert Ombaka, Rosebella Ongutu Onyango [Research] - Community health worker interventions are key to optimal infant immunization coverage, evidence from a pretest-posttest experiment in Mwingi, Kenya - 13 September 2017. <b>INTRODUCTION: Immunization is a powerful and cost-effective health intervention which averts an estimated 2 to 3 million deaths every year. Kenya has a high infant and under five mortality and morbidity rates. Increasing routine child immunization coverage is one way of reducing child morbidity and mortality rates in Kenya. Community Health Workers (CHWs) have emerged as critical human resources for health in developing countries. The Community Strategy (CS) is one of the CHW led interventions promoting Maternal and Child Health (MCH) in Kenya. This study sought to establish the effect of CS on Infant Vaccination Coverage (IVC) in Mwingi west sub-county; Kenya. METHODS: this was a pretest -posttest experimental study design with 1 pretest and 2 post-test surveys conducted in intervention and control sites. Mwingi west and Mwingi north sub-counties where intervention and control sites respectively. Sample size in each survey was 422 households. Women with a child aged 9-12 months were main respondents. RESULTS: intervention site end-term evaluation indicated that; the CS increased IVC by 10.1% (Z =6.0241, P <0.0001), from a suboptimal level of 88.7% at baseline survey to optimal level of 98.8% at end term survey. Infants in intervention site were 2.5 times more likely to receive all recommended immunizations within their first year of life [(crude OR= 2.475, P<0.0001; 95%CI: 1.794-3.414) (adj. OR=2.516, P<0.0001; 95%CI: 1.796-3.5240)]. CONCLUSION: CS increased IVC in intervention site to optimal level (98.8%). To improve child health outcomes through immunization coverage, Kenya needs to fast-track nationwide implementation of the CS intervention.</b><br/> text/html 2017-09-23T11:55:21+01:00 Rajae Borki, Sihame Lkhoyaali, Karima Laadam, Sophia Nitassi, Fouad Zouaidia, Basma Elkhannoussi, Hassan Errihani, Anass Benbouzid, Leila Essakalli [Case report] - Lymphadenopathic kaposi sarcoma in an immunocompetent young patient: a case report - 12 September 2017. <b>Kaposi's sarcoma (KS) is a vascular lesion that usually originates from several sites in the mid-dermis extending into the dermis. Infection from human herpes virus type 8 (HHV-8) is the mostly associated cause. Several articles reported cases of KS, first in Africa, then worldwide because of its close association with HIV / AIDS. KS may also be due to iatrogenic immunosuppression of chronic steroid use, high level of expression of many cytokines and angiogenic growth factors. It can involve skin, mucous membranes, lymph nodes and viscera. We report a case of a 24-year-old immunocompetent, HIV negative male who presented with indolent lymphadenopathy, after adenectomy and histological and immunohistochemical examination revealed a KS. The patient did not have skin lesions. Refusing any other therapy, our patient still lives healthy.This very rare case shows that KS does not always equal immunodeficiency.</b><br/> text/html 2017-09-23T11:55:21+01:00 Sabrina Amiri, Samia Hammami, Kamel Amoura, Mazouz Dekhil, Ilhem Boutiba-Ben Boubaker [Research] - Characterization of carbapenem resistant acinetobacter baumannii isolated from intensive care units in two teaching hospitals from Algeria and Tunisia - 12 September 2017. <b>INTRODUCTION: This study was conducted to identify the enzymatic mechanism of carbapenem resistance in <i>A. baumannii</i> isolated from intensive care units of 2 teaching hospitals (Charles Nicolle hospital of Tunis and University hospital of Annaba). METHODS: Twenty seven non repetitive carbapenem-resistant <i>A. baumannii</i> were collected (7 strains in Algeria and 20 in Tunisia). Antibiotic susceptibility was performed by disk diffusion method. MICs were determined by agar dilution method. EDTA-disk synergy test was performed for metallo-B-lactamases (MBL) phenotypic detection. Detection of bla<sup>OXA-23-like</sup>, bla<sup>OXA-24-like</sup>, bla<sup>OXA-51-like</sup> and bla<sup>OXA-58-like</sup> families was performed by PCR followed by sequencing. Genetic relatedness between strains was investigated by pulsed-field gel electrophoresis (PFGE). RESULTS: Strains were recovered especially from respiratory tract specimens (n=12) and blood (n=11). All strains were co-resistant to all ?-lactams, gentamicin, amikacin and ciprofloxacin, but remainded susceptible to colistin. MBL production was negative for all isolates. bla<sup>OXA-51-like</sup> was detected in all strains and bla<sup>OXA-23-like</sup> in 23 strains. However, bla<sup>OXA-58-like</sup> and bla<sup>OXA-24-like</sup> were not found in any isolate. Six major PFGE patterns were found in the Tunisian isolates. However, the Algerian strains were clustered in one clone. CONCLUSION: This study shows a high distribution of blaOXA-23 in imipenem-resistant <i>A. baumannii</i> isolated in Tunisia and Algeria. It demonstrated the epidemic diffusion of this multidrug resistant pathogen. Thus, strengthening of prevention measures are required to control further spread of carbapenemases in the two countries.</b><br/> text/html 2017-09-23T11:55:21+01:00 Timothy Abiola Oluwasola, Rukiyat Adeola Abdus-Salam, Clement Abu Okolo, Akin-Tunde Ademola Odukogbe [Case report] - Bilateral ovarian serous cystadenocarcinoma in a teenager: a case report - 12 September 2017. <b>Epithelial ovarian cancers are uncommon among young girls and teenagers compared to germ cell tumors. We report a case of bilateral ovarian serous cystadenocarcinoma in a teenage girl with the attendant challenges of diagnosis, management and follow up. HT, 19 year old had presented at a secondary care level with features suggestive of benign ovarian tumor and had ovariectomy done. However, histology report revealed a malignant epithelial cancer, necessitating a repeat exploration. She was found to have surgical stage 3c disease and subsequently has total abdominal hysterectomy with bilateral salpingectomies, right oophorectomy and omentectomy. She was further managed with paclitaxel-carboplatin combination chemotherapy but defaulted after the 3rd cycle on account of financial constraints. She succumbed to the disease 11 months post diagnosis. Though uncommon, detailed evaluation of teenage patients for malignant ovarian cancer is expedient. The financial burden of cancer care in our environment is also highlighted.</b><br/> text/html 2017-09-23T11:55:21+01:00 Houcine Maghrebi, Zoubeir Bensafta [Images in medicine] - Expulsion trans abdominale spontan&eacute;e d’un corps &eacute;tranger - 11 September 2017. <b>L'ingestion d'un corps &eacute;tranger (CE) est une urgence m&eacute;dicale courante. Chez l'adulte, cet accident est beaucoup plus rare que chez l'enfant et survient le plus souvent sur des terrains pr&eacute;dispos&eacute;s. Nous rapportons le cas d’un patient &acirc;g&eacute; de 36 ans, suivi en psychiatrie, admis en urgence pour l’ingestion d’un fil de fer faisant 15 cm de long et qui a &eacute;t&eacute; spontan&eacute;ment expuls&eacute; &agrave; travers la paroi abdominale au niveau de l’&eacute;pigastre.L’examen clinique &eacute;tait sans anomalie notamment pas de signe p&eacute;riton&eacute;aux (A). La tomodensitom&eacute;trie abdominale (B) avait mis en &eacute;vidence un corps &eacute;tranger lin&eacute;aire ext&eacute;rioris&eacute; depuis l’antre gastrique &agrave; travers un trajet fistuleux gastro cutan&eacute;. Le fil de fer a &eacute;t&eacute; retir&eacute; sous anesth&eacute;sie g&eacute;n&eacute;rale par une traction douce ext&eacute;riorisant le bout restant dans l’antre laissant une fistule gastro cutan&eacute; qui n’a rien ramen&eacute;.Les suites op&eacute;ratoires &eacute;taient simples. L’ingestion de CE est un probl&egrave;me fr&eacute;quent en pratique courante. Pr&egrave;s de 80% des CE ing&eacute;r&eacute;s traversent spontan&eacute;ment la fili&egrave;re digestive sans aucune complication. Dix &agrave; 20% n&eacute;cessitent la r&eacute;alisation d’une extraction endoscopique et moins de 1% une intervention chirurgicale. L’expulsion spontan&eacute;e &agrave; traves la paroi abdominale reste un &eacute;v&eacute;nement exceptionnel.</b><br/> text/html 2017-09-23T11:55:21+01:00 Mohammed Amine Mahdi, Maryam Erraoui, Ange Ngeuleu, Latifa Tahiri, Hanan Rkain, Fadoua Allali [Research] - Falls, fear of falling and risk of falls in patients with rheumatoid arthritis: prevalence and associated factors - 11 September 2017. <b>INTRODUCTION: We aimed to analyze the prevalence of fall, fear of falling and risk of falls in the patients with rheumatoid arthritis and the associated factors. METHODS: one hundred and twenty-three participants with rheumatoid arthritis (RA) aged over 18 years were enrolled based on the 1987 ACR/EULAR classification criteria. Patients were asked to complete an interviewer-assisted questionnaire about the number of falls and fear of falling during the last 12 months. Comorbidities and complications related to the disease were also obtained. The disease activity was evaluated by the patient and evaluator global assessment (PGA, EGA), the tender and swollen joint counts (TJC28, SJC28), the disease activity Score 28 ESR (DAS28 ESR) and the clinical and simple disease activity indexes (CDAI, SDAI). The functional disability was measured by the health assessment questionnaire (HAQ). The risk of falls was estimated by five standardized performance tests: the Tinetti test (TIT), the timed get up and go test (TUG), the chair-rising test (CRT), the tandem and the tandem stand tests. The relation between disease parameters and the test of fall were analyzed by the r of Pearson, Spearman and Chi-square. The factors associated with falls and fear of falls were evaluated using multiple linear regression analysis and t independent test. RESULTS: twenty-three (18.7%) participants reported a fall and forty-five (36.6%) of them the fear of falls. Risk of falls was strongly correlated with age (CRT: r = 0.345, TIT: r = -0.314), TJC 28 (TIT: r = -0.482, TUG: r = 0.260), PGA (TIT: r = -0.481, TUG: r = 0.375) EGA (CRT: r = 0.27, TIT: r = -0.48), DAS28 ESR (CRT: r = 0.32, TUG: r= 0.25, TIT: r = -0.51), CDAI (TIT: r= -0.421, TUG: r= 0.292), HAQ (CRT: r= 0.411, TIT: r= -0.648, TUG: r= 0.537) and disease duration (CRT: r= 0.343, TIT: r= -0.400, TUG: r= 0.363). No relation was found between corticosteroid use and the risk of falls. Fear of falls was related in simple analysis to the presence of a comorbidity (p = 0.002 OR: 0.252 CI [0.104-0.611]), the walk with aid (p = 0.010 OR: 0.1225 CI[0.025-0.602]), the body mass index (BMI) (p < 0,001 OR:1.143 CI[1.064-1.228]), the disease duration (p < 0.001 OR:3.69 CI[1.97-6.92]), the VAS pain (p = 0.001 OR:1.03 CI[1.011.05]) and the HAQ (p < 0.001 OR: 3.69 CI[3.69-6.92]). In multiple regression analysis, fear of falls remained related to BMI, HAQ and disease duration. CONCLUSION: the falls in RA seems to be frequent. Several factors were associated to a high risk of falls and fear of falling: disease duration, HAQ, and especially the high disease activity, which is the case of many patients in African countries. These results suggest that the physician has to be aware of the high risk of falling in RA patients and the importance of identifying them with a simple interrogation and physical examination.</b><br/> text/html 2017-09-23T11:55:21+01:00 The Pan African Medical Journal [Erratum] - Erratum: Ownership and utilization of insecticide-treated nets (ITNs) for malaria control in Harari National Regional State, Eastern Ethiopia - 08 September 2017. <b>This erratum corrects "Ownership and utilization of insecticide-treated nets (ITNs) for malaria control in Harari National Regional State, Eastern Ethiopia." The Pan African Medical Journal. 2015; 21: 52. doi:10.11604/pamj.2015.21.52.5380.</b><br/> text/html 2017-09-23T11:55:21+01:00 Ghizlane El Mghari, Bouchra Rafiq, Nawal El Ansari, Nissrine Aboussair [Case report] - Retard de croissance staturo-pond&eacute;ral r&eacute;v&eacute;lant un syndrome de Silver Russell associ&eacute; &agrave; une composante in&eacute;dite - 08 September 2017. <b>Le syndrome de Silver-Russell (SSR) associe un retard de croissance intra-ut&eacute;rin, sans rattrapage, &agrave; une dysmorphie faciale et une asym&eacute;trie des membres. L'incidence est &eacute;valu&eacute;e &agrave; 1-30/100 000 cas et environ 500 cas sont rapport&eacute;s dans la litt&eacute;rature. Le d&eacute;ficit pond&eacute;ral est souvent plus marqu&eacute; que celui de la taille, avec un retard de maturation osseuse. Le volume normal du cr&acirc;ne contraste avec la petite taille et peut donner un aspect de pseudohydroc&eacute;phalie, dans de rares cas, une l&eacute;g&egrave;re d&eacute;ficience mentale est d&eacute;crite. La plupart des cas sont sporadiques. Une disomie uniparentale maternelle du chromosome 7 est retrouv&eacute;e chez 10% des patients. Environ 35 &agrave; 50% des cas ont une hypom&eacute;thylation du g&egrave;ne H19 dans la r&eacute;gion 11p15 soumise &agrave; empreinte parentale. Celle-ci r&eacute;sulte le plus souvent d'un m&eacute;canisme &eacute;pig&eacute;n&eacute;tique ou d'un micror&eacute;arrangement g&eacute;nomique, notamment une microduplication maternelle de la r&eacute;gion. Le diagnostic est avant tout clinique, mais il peut &ecirc;tre confirm&eacute; par la mise en &eacute;vidence de l'anomalie mol&eacute;culaire sous-jacente. Le conseil g&eacute;n&eacute;tique d&eacute;pend du m&eacute;canisme mol&eacute;culaire sous-jacent. Le risque de r&eacute;currence est extr&ecirc;mement faible en cas de disomie uniparentale du chromosome 7 ou d'anomalies &eacute;pig&eacute;n&eacute;tiques de la r&eacute;gion 11p15. Le diagnostic pr&eacute;natal n'est habituellement pas possible, puisque la majorit&eacute; des cas sont sporadiques. Le traitement est symptomatique. L'administration d'hormone de croissance acc&eacute;l&egrave;re la croissance et augmente la taille d&eacute;finitive, mais ne permet pas d'atteindre la taille cible. En dehors de la persistance d'une petite taille et d'une faible corpulence, le pronostic &agrave; long terme est bon. L'h&eacute;mihypotrophie ne semble pas &ecirc;tre associ&eacute;e &agrave; un risque tumoral accru.</b><br/> text/html 2017-09-23T11:55:21+01:00 Belarj Badia, Zegmout Adil, Biaz Asmae, El Machtani Samira, Bouhsain Sanae, Dami Abdallah, Aissam El Maataoui, Abid Ahmed, Ouzzif Zohra [Case report] - Un taux de procalcitonine s&eacute;rique d&eacute;routant! - 08 September 2017. <b>La procalcitonine (PCT) est un marqueur de gravit&eacute; du sepsis, dont la valeur absolue et la cin&eacute;tique sont corr&eacute;l&eacute;es &agrave; la s&eacute;v&eacute;rit&eacute; de l'infection. On rapporte le cas d'un patient qui pr&eacute;sente une PCT tr&egrave;s &eacute;lev&eacute;e sans relation avec un sepsis. Il s'agit d'un homme &acirc;g&eacute; de 55 ans, admis en rhumatologie pour des lombosciatalgies hyperalgiques f&eacute;briles. Le bilan biologique a montr&eacute; une hyperleucocytose &agrave; 15000 &eacute;l&eacute;ment/mm3 &agrave; pr&eacute;dominance neutrophile, associ&eacute;e &agrave; une CRP et une PCT s&eacute;riques, respectivement &agrave; 305 mg/l et 2,5ng/ml. Devant ce tableau &eacute;vocateur de sepsis, des h&eacute;mocultures &eacute;taient r&eacute;alis&eacute;es et un traitement antibiotique probabiliste &eacute;tait instaur&eacute;. L'absence d'&eacute;volution favorable du malade ainsi que la discordance entre les chiffres de la PCT demeurant tr&egrave;s &eacute;lev&eacute;s et les h&eacute;mocultures n&eacute;gatives, une IRM dorso-lombaire &eacute;tait r&eacute;alis&eacute;e. Elle a objectiv&eacute; une arthrite de la hanche droite, associ&eacute;e &agrave; des l&eacute;sions osseuses multiples secondaires du squelette axial &eacute;voquant une origine n&eacute;oplasique. Une TDM thoraco-abdomino-pelvienne a montr&eacute; la pr&eacute;sence d'une masse pulmonaire gauche. La biopsie pulmonaire a r&eacute;v&eacute;l&eacute; un ad&eacute;nocarcinome infiltrant.</b><br/> text/html 2017-09-23T11:55:21+01:00 Mohammed Abdi Hassan, Wanja Mwaura-Tenambergen, Muthoni Mwangi Eunice [Research] - Uptake of health insurance among Muslims in Nairobi county, Kenya - 08 September 2017. <b>INTRODUCTION: In Kenya and the world across, health insurance has been reckoned as an important health policy that serves to protect households from the direct financial consequences of health care and meet the Sustainable Development Goal of Universal Health Coverage and Poverty Eradication. However, health insurance uptake has remained to be a major challenge for universal health care coverage especially among Kenyan Muslims who have conflicting religious faith towards conventional health insurance. This study had two main objectives: (1) to determine level of uptake of health insurance among Muslims and (2) to examine the role of religion in health insurance uptake among Muslims.</b><br/> text/html 2017-09-23T11:55:21+01:00 Alpha Oumar Toure, Ibrahima Konate, Mamadou Seck, Abdelouahad Faouzi, Ousmane Thiam, Mohamadou Lamine Gueye, Mamadou Cisse, Ousmane Ka, Madieng Dieng, Cheikh Tidiane Tour&eacute; [Case series] - Les fistules anastomotiques (FA) post-colectomie au Service de Chirurgie G&eacute;n&eacute;rale de l’H&ocirc;pital Aristide Le Dantec - 07 September 2017. <b>La fistule anastomotique reste la complication la plus redout&eacute;e apr&egrave;s chirurgie colorectale et continue &agrave; poser un probl&egrave;me diagnostique et th&eacute;rapeutique. Le but de cette &eacute;tude est de d&eacute;terminer &agrave; la fois la pr&eacute;valence et les &eacute;l&eacute;ments de prises en charge diagnostiques et th&eacute;rapeutiques de la fistule colique apr&egrave;s colectomie. Nous avons men&eacute; une &eacute;tude r&eacute;trospective descriptive des cas de fistule colique apr&egrave;s colectomie sur une p&eacute;riode de 7 ans allant de janvier 2007 au d&eacute;cembre 2013. Il y avait 17 patients qui ont pr&eacute;sent&eacute; une fistule colique parmi les 170 patients ayant b&eacute;n&eacute;fici&eacute; de colectomie dans notre service soit un taux de 10%. L'&acirc;ge moyen au moment de l'intervention initiale &eacute;tait de 45,1 ans (extr&ecirc;mes de 20 et 78 ans). Il y avait une pr&eacute;dominance des patients de sexe masculin (n=13) avec un sex ratio de 3,3. Les pathologies tumorales colorectales (n=9) et le volvulus de colon pelvien (n=7) &eacute;tait les principales indications de colectomie L'intervention initiale a &eacute;t&eacute; r&eacute;alis&eacute;e en urgence chez 13 patients. Le d&eacute;lai moyen d'apparition de la fistule &eacute;tait de 10,8 jours. Il y avait 10 patients ayant pr&eacute;sent&eacute; une fistule colo-cutan&eacute;e et 7 cas de p&eacute;ritonites postop&eacute;ratoires stercorales. Onze de nos patients pr&eacute;sentaient une an&eacute;mie (taux moyen d'h&eacute;moglobine de 9,1 g/dl) et 8 patients, une hyperleucocytose (taux moyen de 15100 leucocytes/mm3). Une &eacute;chographie, r&eacute;alis&eacute;e chez 6 patients, &eacute;tait revenue normale chez 1 patient et avait mis en &eacute;vidence un &eacute;panchement intra p&eacute;riton&eacute;al chez 5 patients tandis que La tomodensitom&eacute;trie (TDM) sans opacification digestive, r&eacute;alis&eacute;e chez 2 patients, n'&eacute;tait contributive au diagnostic que chez 1 seul patient. Neuf patients avaient b&eacute;n&eacute;fici&eacute; de traitement m&eacute;dical seul. Ce dernier consistait en une couverture antibiotique, un r&eacute;gime hyperprot&eacute;ique, et un appareillage de la fistule par une poche de colostomie. La fistule s'est ferm&eacute;e spontan&eacute;ment, dans un d&eacute;lai moyen de 15 jours. La reprise chirurgicale a &eacute;t&eacute; r&eacute;alis&eacute;e chez 8 patients dans un d&eacute;lai moyen de 4,8 jours. Elle a &eacute;t&eacute; indiqu&eacute;e pour une p&eacute;ritonite par fistule anastomotique chez 7 patients et pour persistance de la fistule colo-cutan&eacute;e malgr&eacute; traitement m&eacute;dical chez 1 patient. Le geste chirurgical consistait en une stomie digestive dans 6 cas. Sept patients ont pr&eacute;sent&eacute; au moins une complication li&eacute;e &agrave; la fistule colique (2 r&eacute;cidives de la fistule, 3 suppurations et 2 &eacute;visc&eacute;rations). La dur&eacute;e moyenne d'hospitalisation &eacute;tait de 55,2 jours (extr&ecirc;mes de 15 et 168 jours). Deux d&eacute;c&egrave;s &eacute;taient enregistr&eacute;s cons&eacute;cutif &agrave; un choc septique. Une accessibilit&eacute; des moyens th&eacute;rapeutiques telles que la nutrition parent&eacute;rale et le drainage percutan&eacute; nous permettrait de r&eacute;duire une dur&eacute;e d'hospitalisation prolong&eacute;e et &eacute;galement des co&ucirc;ts de prise en charge &eacute;lev&eacute;s.</b><br/> text/html 2017-09-23T11:55:21+01:00 Djibril Boiro, Demba Di&eacute;dhiou, Babacar Niang, Djiby Sow, Mandiaye Mbodj, Anna Sarr, Aliou Abdoulaye Ndongo, Aliou Thiongane, Modou Gu&egrave;ye, Lamine Thiam, Ndiogou Seck, Yaay Joor Dieng, Abou Ba, Idrissa Demba Ba, Ibrahima Man&eacute; Diallo, Ousmane Ndiaye, Said Nourou Diop [Research] - L’hyperthyro&iuml;die de l’enfant au centre hospitalier universitaire de Dakar (S&eacute;n&eacute;gal) - 07 September 2017. <b>INTRODUCTION: l'hyperthyro&iuml;die de l'enfant semble rare et constitue un probl&egrave;me de par son retentissement psychosomatique. L'objectif &eacute;tait de faire le point sur ces aspects chez l'enfant &agrave; Dakar. METHODES: il s'agissait d'une &eacute;tude multicentrique, descriptive sur 15 ans. Etaient analys&eacute;s les aspects &eacute;pid&eacute;miologiques, cliniques et &eacute;tiologiques. RESULTATS: 239 patients s&eacute;lectionn&eacute;s avec une pr&eacute;valence de 2.4%, un sex ratio (H/F) de 0.36, un &acirc;ge moyen de 10.8 ans. &Agrave; l'inclusion, il s'agissait d'un ain&eacute; de famille (26.3%), d'une croissance avanc&eacute;e (36.9%), retard&eacute;e (12.5%), d'une corpulence insuffisante (40.1%). L'&eacute;tiologie &eacute;tait la maladie de Basedow dans 90.3% avec un facteur psychoaffectif dans 22.1%. Sur le plan clinique, pr&eacute;dominaient la tachycardie (92.4%), le goitre (91.1%), l'exophtalmie (81.8%), l'amaigrissement (69.8%) avec cependant une &eacute;nur&eacute;sie (30.2%) et des manifestations psychiques (3.1%). Les manifestations cardiovasculaires et cutan&eacute;es &eacute;taient positivement associ&eacute;es avec l'&acirc;ge (p < 0.05). Le goitre &eacute;tait associ&eacute; au sexe f&eacute;minin (p = 0.005), aux signes cardiovasculaires (p = 0.02), neuropsychiques (p = 0.03), cutan&eacute;es (p = 0.03) et &agrave; la diarrh&eacute;e (p = 0.03). La T4 libre &eacute;tait corr&eacute;l&eacute;e &agrave; l'&acirc;ge (p = 0.007), la diarrh&eacute;e (p = 0.021), l'anxi&eacute;t&eacute; (p = 0.024), la fr&eacute;quence cardiaque (p = 0.00) et la maladie de Basedow (p = 0.04). Plus le goitre &eacute;tait volumineux, plus &eacute;tait augment&eacute;e la T4 libre (p = 0.007). CONCLUSION: l'hyperthyro&iuml;die de l'enfant se diff&eacute;rencie de celle de l'adulte par les facteurs d'induction, les perturbations sur la croissance et l'&eacute;nur&eacute;sie. L'&acirc;ge et le sexe semble favoriser le tableau clinique de thyrotoxicose et les signes associ&eacute;s.</b><br/> text/html 2017-09-23T11:55:21+01:00 Lamyae Amro, Siham Jridi, Hafsa Sajiai, Hind Serhane, Salma A&iuml;t batahar [Case report] - Endobronchial localization of Hodgkin’s disease - 07 September 2017. <b>The endobronchial localization of Hodgkin's disease is a rare entity which is often confused with endobronchial tuberculosis in our setting. We report the case of a 16 years old female who presented with 6 months history of dry cough, hemoptysis, dyspnea, dysphagia and dysphonia. The chest radiography showed a mediastinal and pulmonary opacity. The chest CT scan found enlarged mediastinal lymph nodes. The bronchial biopsy and peripheral lymph node biopsy confirmed Hodgkin's disease with endobronchial localization. The patient received chemotherapy (ABVD protocol) and radiotherapy with a favorable follow up.</b><br/> text/html 2017-09-23T11:55:21+01:00 Roch Fabien Niama, Nadia Claricelle Loukabou Bongolo, Edith Sophie Bayonne Kombo, Ruth Yengo, Pembe Issamou Mayengue, Etoka-Beka Mandingha Kosso, Igor Louzolo, Lucette Macosso, Ghislain Dzeret, Ang&eacute;lie Serge Patrick Dzabatou Babeaux, Marie-Francke Puruence, Henri Joseph Parra [Research] - Syphilis and HIV infections among pregnant women attending antenatal clinics in Republic of Congo - 07 September 2017. <b>INTRODUCTION: HIV and syphilis during pregnancy remain a public health concern especially in developing countries. Pregnant women attending antenatal clinics sites for the first time between September and December 2011 and who accepted to participate in the study were enrolled. The objective was to estimate the syphilis and HIV infection rate in this population. METHODS: a study was conducted in 44 selected ANCs from 12 departments (5 urban and 7 rural). Pregnant women who accepted to participate in the study, attending selected sentinel ANCs sites for the first time between September and December 2011 were enrolled. To detect HIV antibodies, two consecutive ELISA assays were used (Genscreen Ultra HIV Ag/Ac, (BioRad, France) and Enzygnostic Intergral II (Siemens, GMBH, Marbug-Germany). In case of discordant results, the Western blot test II, HIV1 and 2 (Bio-Rad, Marne la Coquette, France) was used as the reference method. The RPR (Bio-Scan, Karnataka, India) test was performed to detect syphilis infection. The RPR positive results were confirmed using the TPHA test (Biotech, Cambridge, UK). Data were analyzed using SPSS 17.0 software. RESULTS: a total of 2979 pregnant women attending ANCs were enrolled. The global HIV infection rate was estimated to be 3.6% (CI: 95%; 3.0-4.4). As expected, HIV prevalence was significantly higher in women aged above 25 years (4.4% [3.4-5.6], p = 0.026) and those attending urban ANCs (5.04%, p < 0.01). Also, women living in the urban area are more at risk to be infected (5.04 VS 2.38, p < 0.01). The RPR test was positive in 117 pregnant women (3.92%). The risk for syphilis occurrence was significantly higher among the single women compared to the married ones (4.4% VS 2.7%; p < 0.01). It was also estimated that the HIV and syphilis coinfection occurred in 22 cases (0.73%). CONCLUSION: the prevalence's of syphilis and HIV were relatively low. Marital status and sentinel site location were a risk factor associated with HIV and syphilis infections respectively. Therefore, substantial effort is needed to reinforce prevention strategies in this population to prevent mother-to-child and further horizontal transmissions of these infections.</b><br/> text/html 2017-09-23T11:55:21+01:00 Frank Ndaks Ndakala, Julius Otieno Oyugi, Margaret Ng’wono Oluka, Joshua Kimani, Georg Martin Norbert Behrens [Research] - The incidence of first-line antiretroviral treatment changes and related factors among HIV-infected sex workers in Nairobi, Kenya - 05 September 2017. <b>INTRODUCTION: In many settings, several factors including adverse drug reactions and clinical failure can limit treatment choices for combined antiretroviral therapy (cART). The aim of the study was to describe the incidence of first-line cART changes and associated factors in a cohort of Kenyan sex workers. METHODS: this was a retrospective review of medical records collected from 2009 to 2013. The review included records of HIV-infected patients aged e" 18 years, who received either stavudine or zidovudine or tenofovir disoproxil fumarate-based regimens. Using systematic random sampling, the study selected 1 500 records and censoring targeted the first incident of a drug change from the first-line cART. RESULTS: the overall incidence rate of cART changes was 11.1 per 100 person-years within a total follow-up period of 3 427.9 person-years. Out of 380 patients who changed cART, 370 (97%) had a drug substitution and 10 (3%) switched regimens. The most commonly cited reasons for changing cART were adverse drug reactions (76%). Tenofovir disoproxil fumarate had a lower drug change rate (1.9 per 100 person years) compared to stavudine (27 per 100 person years). Using zidovudine as the reference group, stavudine-based regimens were significantly associated with an increased hazard of drug changes (adjusted hazards ratio 10.2; 95% CI: 6.02-17.2). CONCLUSION: these findings suggest a moderate incidence of cART changes among sex workers in Nairobi, Kenya. Individuals using stavudine were at a higher risk of experiencing a change in their cART, mostly presenting within 20 months, and primarily due to adverse drug reactions.</b><br/> text/html 2017-09-23T11:55:21+01:00 Onyeanunam Ngozi Ekeke, Kelechi Emmanuel Okonta [Research] - Trauma: a major cause of death among surgical inpatients of a Nigerian tertiary hospital - 05 September 2017. <b>INTRODUCTION: Trauma presents a significant global health burden. Death resulting from trauma remains high in low income countries despite a steady decrease in developed countries. Analysis of the pattern of death will enable intervention to reduce these deaths from trauma in developing countries. This study aims to present the pattern of trauma-related deaths in the surgical wards of University of Port Harcourt Teaching Hospital (UPTH). METHODS: this was a retrospective study of all patients who died from trauma during admission into the surgical wards of UPTH from 2007 to 2012. Data on demography and traumatic events leading to death were collected from surgical wards, the emergency unit, and theatre records and analyzed using SPSS version 16.0. RESULTS: trauma accounted for 219 (42.4%) of the 527 mortalities recorded. Most of the deaths (62.6 %) occurred between 20 and 59 years. There were 148 males</b><br/> text/html 2017-09-23T11:55:21+01:00 Babatunde Oludare Fakuade, Joshua Biodun Adeoye [Case report] - Melanotic neuroectodermal tumor of infancy: a rare presentation of an extremely rare neoplasm and diagnostic implications in Gombe, Nigeria - 04 September 2017. <b>Melanotic neuro-ectodermal tumor of infancy is very rare. A unique neoplasm of the formative years, it typically involves the face or cranium; possesses rapid, expansile growth; presents as a firm swelling and displays a high rate of recurrence. Its rarity and unique features make diagnosis and management quite challenging. This challenge is increased in resource-limited settings like ours and with atypical presentation, such as was seen at our center, where patient presented with a bony hard swelling.</b><br/> text/html 2017-09-23T11:55:21+01:00 Kenny Moise, Joseph Junior Bernard, Jean Hugues Henrys [Short communication] - Evaluation of antibiotic self-medication among outpatients of the state university hospital of Port-Au-Prince, Haiti: a cross-sectional study - 04 September 2017. <b>In Haiti, where all drugs are available over the counter, self-medication with antibiotics appears as a common practice. Inappropriate use of beta-lactams and macrolides is likely to contribute to the development of antimicrobial resistance. This study aimed to (i) assess the extent of self-medication with antibiotics, (ii) explore the contributing factors (age, gender and educational background) and (iii) identify specific antibiotic drug classes used among patients attending the outpatient clinic of the State University Hospital of Port-au-Prince. A cross-sectional survey among 200 outpatients of the State University Hospital of Port-au-Prince was conducted in December 2014. Face-to-face interviews were conducted using a standardized questionnaire. Parents of pediatric patients were allowed to answer to questions on their behalf. Among the study sample, 45.5% practiced self-medication with antibiotics. It was less prevalent among patients with the highest education level (23.1%; OR: 0.89 (0.5-1.75), p = 0.001). Mild symptoms (28.6%) and vaginal itching (44.4%) were the main reasons for self-medication with antibiotics. Self-medication using amoxicillin was reported by 67.0%. Self-medication with antibiotics is a common practice among Haitian patients and is more common among the less educated. Amoxicillin for urinary tract infections is the most commonly used medication. It is crucial to raise awareness on the dangers of the practice in the population and inforce the current law regarding the use of over the counter antibiotics.</b><br/> text/html 2017-09-23T11:55:21+01:00 Daniella Rakotoniaina Masinarivo, Jenny Larissa Rakotomanana [Images in medicine] - Aspect clinico-&eacute;lectrocardiographique d'embolie pulmonaire masquant une dissection aortique r&eacute;v&eacute;l&eacute; par l'angioscanner thoracique - 04 September 2017. <b>Il s'agit d'une femme de 52 ans, hypertendue, tabagique et ob&egrave;se (IMC &agrave; 32,46 kg/m2), sans facteurs de risques thromboembolique &eacute;vident, hospitalis&eacute;e pour une douleur thoracique gauche &agrave; irradiation dorso-lombaire associ&eacute;e &agrave; une dyspn&eacute;e. L'examen clinique &agrave; l'entr&eacute; objectivait une pression art&eacute;rielle gauche &agrave; 100/60 mmHg, une tachycardie &agrave; 100/min, une d&eacute;saturation en oxyg&egrave;ne &agrave; 88% &agrave; l'air ambiant, avec auscultation cardio-pulmonaire sans particularit&eacute;, pouls p&eacute;riph&eacute;riques per&ccedil;us et absence de signes de phl&eacute;bite des membres inf&eacute;rieurs. L'ECG montrait un axe droit, un aspect S1Q3, une hypertrophie ventriculaire droite et un bloc de branche complet droit (A, B, C). L'angioscanner thoracique effectu&eacute; en urgence objectivait une dissection aortique allant de l'origine de l'aorte jusqu'&agrave; la bifurcation iliaque soit de type Stanford A. Notre patiente a &eacute;t&eacute; trait&eacute; m&eacute;dicalement par contr&ocirc;le de la pression art&eacute;rielle et de la fr&eacute;quence cardiaque ainsi que des antalgiques, avec une bonne &eacute;volution devant l'absence de moyen chirurgical.</b><br/> text/html 2017-09-23T11:55:21+01:00 Sylvie Ndongo Amougou, Dieudonn&eacute; Danwe, Hamadou Ba, Bonaventure Jemea, Liliane Kuate Mfeukeu, Christian Ngongang Ouankou, Jingi Musa Ahmadou, Samuel Kingue [Research] - Vascular hyperreactivity in black Cameroonian hypertensive and normotensive patients: a comparative study - 04 September 2017. <b>INTRODUCTION: Vascular hyperreactivity is a risk factor and a factor predicting hypertension (high blood pressure). Unlike other continents where several studies were carried out, it has rarely been studied in black Africa in general and in Cameroon in particular. METHODS: vascular reactivity was measured by the cold test. Vascular hyperreactivity was defined as an increase in blood pressure > 20 mmHg for systolic and/or > 15 mmHg for diastolic. Khi2, Man-Withney, Wilcoxon's signed ranks and logistic regression tests were used for statistical analysis. RESULTS: a total of 31 hypertensive and 31 normotensive patients matched by age and sex participated in this study. Vascular hyperreactivity was present in 77.4% hypertensive patients and 51.6% normotensive patients. There was a significant association between vascular hyperreactivity and hypertension [OR = 3.2 (1.07 - 9.63), p = 0.034]. The median arterial pressure was higher in responders compared to non-responders in the normotensive group. Age > 45 years, female sex, obesity and family history of hypertension appeared to be associated with vascular hyperreactivity, but only in normotensive patients. CONCLUSION: vascular hyperreactivity appears to be a risk factor for high blood pressure in black Cameroonians. It appeared to be associated with low blood pressure, age, sex, obesity and family history of hypertension but this was only in the normotensive.</b><br/> text/html 2017-09-23T11:55:21+01:00 David Kitara Lagoro, Denis Anywar Arony [Letter to the editors] - Nodding syndrome (NS) and Onchocerca Volvulus (OV) in Northern Uganda - 04 September 2017. <b>Nodding Syndrome (NS) is a childhood neurological disorder characterized by atonic seizures, cognitive decline, school dropout, muscle weakness, thermal dysfunction, wasting and stunted growth. There are recent published information suggesting associations between Nodding Syndrome (NS) with cerebrospinal fluid (CSF) VGKC antibodies and serum leiomidin-1 antibody cross reacting with Onchocerca Volvulus (OV). These findings suggest a neuro-inflammatory cause of NS and they are important findings in the search for the cause of Nodding Syndrome. These observations perhaps provide further, the unique explanation for the association between Nodding Syndrome and Onchocerca Volvulus. Many clinical and epidemiological studies had shown a significant correlation between NS and infestation with a nematode, Onchocerca volvulus which causes a disease, Onchocerciasis, some of which when left untreated can develop visual defect ("River Blindness"). While these studies conducted in Northern Uganda and Southern Sudan indicate a statistically significant association with (OV infection (using positive skin snips), we observe that (OV is generally endemic in many parts of Sub Saharan Africa and Latin America and that to date, no NS cases have been recorded in those regions. This letter to the Editor is to provide additional information on the current view about the relationship between Nodding Syndrome and Onchocerca Volvulus as seen in Northern Uganda.</b><br/>