Pan african Medical Journal - Volume 31 Pan african Medical Journal. Volume 31 2018-09-26T05:13:26+01:00 pamj logo text/html 2018-09-26T12:13:26+01:00 M&eacute;dard Nyandekwe, Jean Baptiste Kakoma, Manass&eacute; Nzayirambaho [Research] - The health-related Millennium Development Goals (MDGs) 2015: Rwanda performance and contributing factors - 26 September 2018. <b>INTRODUCTION: The Millennium Development Goals (MDGs) 2015 are the eight international development goals adopted by the Millennium Summit of the United Nations in 2000 to which Rwanda is signatory. In 1990, Rwanda was at least one of the Sub-Saharan Africa countries with poor performance on health-related MDGs indicators. To date, despite the setbacks caused by the 1994 genocide, impressive performance is registered. The objective of the study is to document Rwanda gradual progress to achieving the health-related MDGs 2015 targets from 1990 to 2014/2015. METHODS: The study is retrospective and comparative documenting the period of 1990 to 2014/15. RESULTS: The performance of Rwanda on health-related MDGs 2015 targets is impressive despite the negative effects of the 1990-1994 civil wars and the 1994 genocide against Tutsi on 1990’s levels. In effect, out of 17 health-related MDGs indicators, eleven (11) registered “remarkable” performances, i.e. reached global levels or fastened Vision 2020 targets attainment, two (2) registered “good performances”, i.e. reached basic or revised own targets exhibiting overall impressive performance, while four (4) “weaknesses” are observed, i.e. accused gaps until now. . The good governance, Vision 2020 effective implementation, consistent resources invested in health sector and the Rwanda Universal Health Coverage implementation contributed greatly to achieving the above health-related MDGs 2015 performance. CONCLUSION: Rwanda Performance of health-related MDGS 2015 targets is impressive. However, some relative gaps still persist, and hence should be prioritized while implementing the emerging Sustainable Development Goals.</b><br/> text/html 2018-09-26T12:13:26+01:00 Aim&eacute;e Mudekereza Musimwa, Hermann Tamubango Kitoko, Gray Kanteng Wakamb, Stanis Wembonyama Okitotsho, Oscar Luboya Numbi [Research] - Concentration s&eacute;rique en fer au cours de la malnutrition de l’enfant: cas d’une zone urbaine et rurale en R&eacute;publique D&eacute;mocratique Congo - 25 September 2018. <b>INTRODUCTION: La malnutrition (prot&eacute;ine &eacute;nerg&eacute;tique et vitaminique) contribue &agrave; la survenue d’une an&eacute;mie. Parall&egrave;lement, l'an&eacute;mie ferriprive est l'un des troubles nutritionnels les plus r&eacute;pandus au monde et particuli&egrave;rement dans le pays en voie d&eacute;veloppement. Ainsi l’objectif de cette &eacute;tude est de d&eacute;terminer le taux de fer chez l’enfant malnutri de 6 &agrave; 59 mois et les facteurs li&eacute;s &agrave; sa variation. METHODES: Il s’agit d’une &eacute;tude transversale men&eacute;e sur la p&eacute;riode allant du 01 juillet 2013 au 31 juillet 2014. Nous avons collig&eacute; 180 enfants malnutris d&egrave;s leur admission dans centre de prise en charge nutritionnelle. Un autre groupe a &eacute;t&eacute; recrut&eacute; en p&eacute;riph&eacute;rie de la ville, dans le village Kawama. Une ponction veineuse a &eacute;t&eacute; effectu&eacute;e et le sang pr&eacute;lev&eacute; a subi une centrifugation puis une lecture au spectrom&egrave;tre. RESULTATS: Il ressort que 93,4 % de l’&eacute;chantillon soit 170 enfants ont pr&eacute;sent&eacute; une concentration s&eacute;rique inf&eacute;rieure &agrave; la valeur normale. Par contre 6,59% soit 12 enfants ont pr&eacute;sent&eacute; un taux de fer entre 610-1300 µg/L de fer s&eacute;rique avec la m&eacute;diane qui &eacute;tait &agrave; 159,5 µg/L. Parmi les 170 enfants qui avaient un taux de fer s&eacute;rique de <610 µg/L, 79 enfants soit 42,18% &eacute;taient &acirc;g&eacute;s de moins de 24 mois dont 3 (1,78%) &acirc;g&eacute;s de moins de 6 mois. A Kawama, 62 enfants soit 36,47% de l’&eacute;chantillon total avaient un taux de fer < 610. Aucun lien statistiquement significatif entre le fer et les facteurs de risque n’a &eacute;t&eacute; trouv&eacute; sauf pour la variable provenance o&ugrave; le p &eacute;tait significatif (p< 0,05).</b><br/> text/html 2018-09-26T12:13:26+01:00 Hakan Sarbay, Y&#305;lmaz Ay [Research] - Evaluation of children with macrocytosis: clinical study - 25 September 2018. <b>INTRODUCTION: In this study, it is aimed to emphasize the causes and importance of macrocytosis in paediatric practice. METHODS: in the paediatric hematology and oncology clinic, 1752 patients evaluated in 2017, patients with macrocytosis were examined retrospectively with clinical and laboratory findings. Patients with macrocytosis were compared with the frequency of severe hematologic diseases such as acute leukemia and bone marrow failure in patients with normocytic and microcytic mean corpusculer volume. RESULTS: Macrocytosis was detected in 72 out of 1752 patients (4.1%) in the study. Acute lymphoblastic leukemia in 11(15.2%), acute myeloid leukemia in 3(4.1%), Fanconi aplastic anemia in 7(9.7%), Diamond-Blackfan anemia in 2(2.7%), aplastic anemia in 1(1.3%), congenital diseritropoetic anemia in 1(1.3%), deficiency of vitamin B12 in 14(19.4%) were diagnosed. Down syndrome was presented in 33 cases (45.8%). The number of patients with acute leukemia diagnosis was 14(0.8%) in the group in which the mean corpusculer volume was either microcytic or normocytic. The incidence of acute leukemia and bone marrow failure was significantly higher in the group with macrocytosis compared between the two groups. CONCLUSION: Although vitamin B12 deficiency is considered firstly in patients who have undergone cytopenia and macrocytosis in our country, haematological malignancies, bone marrow failures, myelodysplasia and myeloproliferative diseases should be remembered especially in the individuals with Down syndrome at the same time.</b><br/> text/html 2018-09-26T12:13:26+01:00 Ploutarchos Karydakis, Dimitrios Giakoumettis, Ioannis Nikas, Dimitrios Panagopoulos, George Sfakianos, Marios Themistocleous [Case report] - Post-traumatic tremor in child after mild head trauma - 25 September 2018. <b>Despite the fact that movement disorders can be noted after severe traumatic brain injury (TBI), there are very few cases in the literature regarding children with a mild head injury. In addition, their pathophysiological mechanism, radiological features, and treatment options have not been well described yet. Hereby, we report a case of a 3-year-old girl who suffered a head injury after a two-meter fall, resulting in generalized body tremor and dystonia.</b><br/> text/html 2018-09-26T12:13:26+01:00 Mohamed Essarghini, Ahmed Bounaim [Images in medicine] - M&eacute;tastases au niveau des sites d’introduction des trocarts secondaires &agrave; un ad&eacute;nocarcinome de la v&eacute;sicule biliaire - 24 September 2018. <b>La d&eacute;couverte fortuite de l’ad&eacute;nocarcinome de la v&eacute;sicule biliaire apr&egrave;s chol&eacute;cystectomie cœlioscopique pour chol&eacute;cystite aigue &agrave; travers l’examen histologique syst&eacute;matique est rare. Cette situation impose une reprise chirurgicale par voie sous costale pour r&eacute;section du lit v&eacute;siculaire ainsi que des trajets d’introduction des trocarts. Nous pr&eacute;sentons un cas d’une patient de 73 ans qui a &eacute;t&eacute; op&eacute;r&eacute;e il y a trois ans pour chol&eacute;cystite aigue par voie laparoscopique et dont l’examen anatomopathologique a r&eacute;v&eacute;l&eacute; un ad&eacute;nocarcinome tubulo-papillaire de la v&eacute;sicule mais la patiente a refus&eacute; la r&eacute;intervention. Actuellement, elle consulte pour deux masses de la paroi abdominale ant&eacute;rieure dont une ulc&eacute;r&eacute;e. Une tomodensitom&eacute;trie abdominale a objectiv&eacute; deux masses tissulaires p&eacute;riton&eacute;o-parietales et le dosage du CA19-9 est largement positif &agrave; 946 U/ml (soit 30 fois la valeur normale). Une biopsie sous anesth&eacute;sie locale a confirm&eacute; la r&eacute;cidive tumorale et la patiente a &eacute;t&eacute; adress&eacute;e en oncologie pour chimioth&eacute;rapie type GEMOX avant r&eacute;&eacute;valuation pour &eacute;ventuelle chirurgie.</b><br/> text/html 2018-09-26T12:13:26+01:00 Abdelhakim El Yajouri, Chafiq Mahraoui [Case report] - Patient with CHARGE syndrome - 24 September 2018. <b>A two-years-old boy presenting multiple anomaly syndrome (congenital heart disease, Tetralogy of Fallot, bilateral ear anomalies, and micropenis) was consulted in the Pneumo-allergology unit of Rabat children hospital in Morocco. It was ruled out the possibility of multiple deformities caused by genomic imbalances. The patient was then clinically considered to have CHARGE syndrome, an autosomal dominant multi-system disorder involving defects in multiple organs.</b><br/> text/html 2018-09-26T12:13:26+01:00 B&eacute;kaye Traor&eacute;, Lamissa Ciss&eacute; [Images in medicine] - N&aelig;vus verruqueux g&eacute;ant chez une adolescente de 15 ans: &agrave; propos d’un cas - 24 September 2018. <b>Le n&aelig;vus verruqueux est une tumeur b&eacute;nigne &agrave; disposition lin&eacute;aire suivant les lignes de Blaschko. Cette affection est due &agrave; des mutations en mosa&iuml;que du g&egrave;ne du r&eacute;cepteur FGFR3. Elle repr&eacute;sente surtout un pr&eacute;judice esth&eacute;tique, mais aussi fonctionnel en raison des manifestations prurigineuses, les l&eacute;sions peuvent &ecirc;tre localis&eacute;es ou &eacute;tendues (g&eacute;antes). Dans notre contexte, la raret&eacute; des centres sp&eacute;cialis&eacute;s en dermatologie constitue un facteur de retard diagnostique incitant le patient &agrave; entreprendre des th&eacute;rapeutiques peu appropri&eacute;es, responsables de complications infectieuses ou d&eacute;g&eacute;n&eacute;ratives. Nous rapportons le cas d’une adolescente de 15 ans qui pr&eacute;sente depuis l’enfance des l&eacute;sions papuleuses keratosiques dispos&eacute;es en bande de fa&ccedil;on lin&eacute;aire le long du cou, du membre sup&eacute;rieur droit, du flanc. L’examen histologique confirme le diagnostic de n&aelig;vus verruqueux.</b><br/> text/html 2018-09-26T12:13:26+01:00 Ibrahima Diallo, Bineta Ndiaye, Cheikh Abdoukhadre Fall, Mouminatou Mbaye, Imane Korch, Papa Silman Diawara, Ababacar Mbengue, Sara Boury Gning, Papa Saliou Mbaye, Fatou Fall [Case series] - Inactive hepatitis B carriers: outcomes of patients followed at h&ocirc;pital principal de Dakar, Senegal - 21 September 2018. <b>The evolutive profile of inactive HBV carriers is variable. Patients can remain inactive, or may evolve into chronic active hepatitis or hepatocellular carcinoma. Aim: to describe the long-term outcome of chronic hepatitis B inactive carriers followed at H&ocirc;pital Principal de Dakar. This is a retrospective study including all inactive HBV carriers, followed since 2001, and with regular monitoring of at least 5 years. Transaminases, viral load and screening for hepatocellular carcinoma were performed every 6 to 12 months. We included 52 patients. The mean follow-up was 76.2 months (60-162), the mean age 36 years (13-62 years) and the sex ratio 0.93 (25 men, 27 women). Four patients (7.7%) had have an ALT above the normal. Eleven patients (21.1%) had persistently elevated viral load greater than 2000 IU/ml, while in three cases (5.8%), this increase was transient. Twenty-six patients (50%) had a detectable viral load, but still below 2000 IU/ml. Twelve patients (23.1%) had an undetectable viral load for the duration of monitoring. Eleven patients (21.2%) underwent liver biopsy. The activity or fibrosis were minimal in all cases (A or F = 1) or absent (A or F = 0). Only four patients (7.7%), had HBs seroconversion after a follow-up of six, seven and ten years. There was no focal lesion or cirrhosis detected during the follow-up. After a follow-up of at least 5 years, inactive HBV carriers remain inactive in 92,3% of cases. Their evolutive profile is characterized by an absence of elevated liver enzymes but with fluctuations of the viral load. HBs seroconversion rate is low and the risk of progression to hepatocellular carcinoma almost nil.</b><br/> text/html 2018-09-26T12:13:26+01:00 Assane Ndiaye, Souleymane Diatta, Pape Salmane Ba, Magaye Gaye, Modibo Doumbia, Pape Adama Dieng, Amadou Gabriel Ciss, Mouhamadou Ndiaye, Banga Nkomo David Douglas [Case series] - Indications et r&eacute;sultats de la chirurgie de r&eacute;section des bulles d’emphys&egrave;me pulmonaire - 20 September 2018. <b>La chirurgie d'ex&eacute;r&egrave;se des bulles ou bullectomie, principal moyen th&eacute;rapeutique dans la prise en charge des bulles d'emphys&egrave;me pulmonaire, est g&eacute;n&eacute;ralement r&eacute;serv&eacute;e aux patients dont les bulles sont compliqu&eacute;es ou, sont &agrave; l'origine d'une dyspn&eacute;e invalidante. Le but de notre &eacute;tude &eacute;tait de d&eacute;terminer les indications de la bullectomie et d'&eacute;valuer les r&eacute;sultats de cette chirurgie dans notre service. Nous avons men&eacute; une &eacute;tude r&eacute;trospective descriptive de 24 patients (23 hommes et 1 femme), dont la moyenne d'&acirc;ge &eacute;tait de 49 ans, et qui ont b&eacute;n&eacute;fici&eacute; d'une bullectomie entre 2004 et 2013. Les donn&eacute;es recueillies &eacute;taient les facteurs favorisant la survenue d'un emphys&egrave;me bulleux, les circonstances de d&eacute;couverte de la bulle, les donn&eacute;es des examens radiologiques, les donn&eacute;es de l'&eacute;valuation fonctionnelle respiratoire et cardiovasculaire, les donn&eacute;es de la technique de la bullectomie, les donn&eacute;es de l'&eacute;valuation clinique et fonctionnelle post op&eacute;ratoire. Le taux de morbidit&eacute; &eacute;tait de 37,5%. La principale complication &eacute;tait la fuite a&eacute;rienne prolong&eacute;e (7 cas). Un patient est d&eacute;c&eacute;d&eacute; au 2e jour post op&eacute;ratoire suite &agrave; une insuffisance respiratoire aig&uuml;e. La dur&eacute;e moyenne de suivi &eacute;tait de 26 mois. Durant ce suivi, nous avons observ&eacute; une am&eacute;lioration de la dyspn&eacute;e chez tous les patients et nous n'avons not&eacute; aucune complication. La bullectomie est une technique chirurgicale efficace, fiable et s&ucirc;re qui peut permettre aux patients d'avoir une meilleure qualit&eacute; de vie pendant quelques ann&eacute;es.</b><br/> text/html 2018-09-26T12:13:26+01:00 Mamadou Oury Safiatou Diallo, Ibrahima Bah, Fode Bangaly Sako, Karamba Sylla, Fode Amara Traor&eacute;, Aminata Oumou Sylla, Mamadou Saliou Sow, Moussa Sidib&eacute;, Ali Abdessand Hach&eacute;mi, Fran&ccedil;ois Boiquigny, Mohamed Cisse [Case report] - Tuberculose multifocale associ&eacute;e &agrave; une toxoplasmose c&eacute;r&eacute;brale sur terrain immunod&eacute;prim&eacute; &agrave; VIH chez un patient immigr&eacute; africain au Centre Hospitalier de Soissons, France - 20 September 2018. <b>Dans les pays industrialis&eacute;s et notamment en France, vu les moyens de pr&eacute;vention, d&eacute;pistage pr&eacute;coce et prise en charge imm&eacute;diate de l'infection &agrave; VIH, la survenue d'infections opportunistes ne se voit presque chez les immigr&eacute;s et certaines couches socio-professionnelles d&eacute;favoris&eacute;es. Nous rapportons donc le cas d'un homme de 42 ans, immigr&eacute; africain, hospitalis&eacute; pour syndrome infectieux dans un contexte d'alt&eacute;ration de l'&eacute;tat g&eacute;n&eacute;ral, VIH1 positif sous antir&eacute;troviraux depuis deux ans, arr&ecirc;t&eacute;s depuis quatre mois, une tuberculose pulmonaire trait&eacute;e et d&eacute;clar&eacute;e gu&eacute;rie en novembre 2017 avec, &agrave; l'examen une lenteur a l'id&eacute;ation, une fi&egrave;vre &agrave; 39,6°C et un amaigrissement. Le nadir CD4 &agrave; 12/mm3, une charge virale VIH1 &agrave; 5,80log. Le scanner thoraco-abdominale et l'IRM c&eacute;r&eacute;brale ont permis de visualiser des l&eacute;sions intra-abdomino-thoraciques et c&eacute;r&eacute;brales avant la confirmation diagnostique de la tuberculose et de la toxoplasmose. Le patient fut mis sous trith&eacute;rapie antir&eacute;trovirale &agrave; quinze jours du traitement antituberculeux, puis au traitement antitoxoplasmique avec une &eacute;volution favorable.</b><br/> text/html 2018-09-26T12:13:26+01:00 Yohannes Ghebremedhin Tseghereda, Nyanga Murega Joseph, Nyerere Kimang'a Andrew, Mehari Hagos Tadesse, Gebrekidan Hadgu Yishak [Research] - Glucose-6-pphosphate dehydrogenase deficiency allelic variants and their prevalence in malaria patients in Eritrea - 20 September 2018. <b>INTRODUCTION: Glucose 6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymopathy with a relatively high frequency in malaria-endemic regions. In Eritrea, there is scant knowledge of G6PD deficiency. The aim of the study was to characterize and determine the prevalence of four common G6PD allelic variants.</b><br/> text/html 2018-09-26T12:13:26+01:00 Kays Chaker, Abdelrazek Bouzouita, Marwa Gharbi, Ahlem Blel, Marouene Chakroun, Haroun Ayed, Mohamed Cherif, Mohamed Riadh Ben Slama, Soumaya Rammeh, Amine Derouiche, Mohamed Chebil [Case series] - Diagnostic et prise en charge des cystites &agrave; &eacute;osinophiles - 20 September 2018. <b>La cystite &agrave; &eacute;osinophiles est une pathologie inflammatoire de la paroi v&eacute;sicale. Elle est rare, il n'existe pas des recommandations &eacute;tablies concernant sa prise en charge. Il s'agit d'une &eacute;tude r&eacute;trospective ayant concern&eacute;e dix observations de cystite &agrave; &eacute;osinophiles diagnostiqu&eacute;es et prises en charge dans notre service entre 2006 et 2017. L'&acirc;ge moyen des patients &eacute;tait de 46 ans. On a not&eacute; une pr&eacute;dominance masculine. Un terrain atopique &eacute;tait not&eacute; dans 3 cas. Le mode de pr&eacute;sentation le plus fr&eacute;quent &eacute;tait des signes urinaires irritatifs dans 9 cas, une h&eacute;maturie macroscopique dans 8 cas et des algies pelviennes dans 6 cas. Une hyper-&eacute;osinophilie sanguine &eacute;tait pr&eacute;sente dans 4 cas. La cystoscopie avait montr&eacute; des p&eacute;t&eacute;chies dans 5 cas, un aspect pseudo-tumoral dans 4 cas et &eacute;tait normal dans un cas. Pour les formes pseudo-tumorales une r&eacute;section endoscopique a &eacute;t&eacute; pratiqu&eacute;e. Quatre patients ont &eacute;t&eacute; trait&eacute;s par les anti-inflammatoires non st&eacute;ro&iuml;dien, avec am&eacute;lioration des sympt&ocirc;mes. Six malades ont &eacute;t&eacute; surveill&eacute;s. Apr&egrave;s un recul moyen de 50 mois, aucune r&eacute;cidive n'a &eacute;t&eacute; rapport&eacute;e. La cystite &agrave; &eacute;osinophiles est une pathologie rare. La pr&eacute;sentation clinique est non sp&eacute;cifique. La prise en charge repose sur des moyens m&eacute;dicaux non invasifs dans les formes peu symptomatiques.</b><br/> text/html 2018-09-26T12:13:26+01:00 Saad Alaoui Mhamedi, Hicham Meghraoui, Mohammed Benabdelhak, Yassamine Bentata, Intissar Haddiya [Case series] - La ponction biopsie r&eacute;nale: indications, complications et r&eacute;sultats - 20 September 2018. <b>La ponction biopsie r&eacute;nale (PBR) est une technique indispensable au diagnostic des maladies r&eacute;nales. Ce geste demeure invasif avec diverses complications, essentiellement h&eacute;morragiques. L'objectif de notre travail &eacute;tait d'&eacute;tudier notre pratique de la PBR, mettre le point sur la technique de la biopsie r&eacute;nale transcutan&eacute;e, &eacute;valuer ses complications, et d&eacute;terminer les n&eacute;phropathies diagnostiqu&eacute;es dans notre r&eacute;gion. Il s'agit d'une &eacute;tude r&eacute;trospective, men&eacute;e entre Janvier 2015 et Juin 2017. Nous avons inclus 69 patients du service de N&eacute;phrologie du CHU Mohamed VI, Oujda, Maroc ayant b&eacute;n&eacute;fici&eacute; d'une biopsie de reins natifs. L'&acirc;ge moyen des patients au moment de la PBR &eacute;tait de 38,16 ±13 ans (12-77 ans), le sexe ratio (H/F) &eacute;tait de 0,86. Le syndrome n&eacute;phrotique &eacute;tait l'indication la plus fr&eacute;quente tout &acirc;ge confondu. Les n&eacute;phropathies glom&eacute;rulaires repr&eacute;sentaient 81% des maladies r&eacute;nales, r&eacute;parties comme suit: la glom&eacute;rulon&eacute;phrite extra-membraneuse retrouv&eacute;e chez 19% des patients, la hyalinose segmentaire et focale chez 18%, la glom&eacute;rulon&eacute;phrite lupique chez 11%, les glom&eacute;rulon&eacute;phrites chroniques diagnostiqu&eacute;es dans 11% des cas, la glom&eacute;rulon&eacute;phrite membrano-prolif&eacute;rative chez 7%, la glom&eacute;rulon&eacute;phrite extra-capillaire chez 5% &agrave; part &eacute;gale avec l'amylose r&eacute;nale. Quatre pour cent (4%) des PBR &eacute;taient en faveur d'une n&eacute;phropathie diab&eacute;tique. Avec un taux estim&eacute; &agrave; 2% chacune, l'&eacute;tude histopathologique avait retrouv&eacute; la glom&eacute;rulon&eacute;phrite aigue post-infectieuse, la l&eacute;sion glom&eacute;rulaire minime, la n&eacute;phropathie &agrave; IgA, les vascularites, les n&eacute;phropathies tubulo-interstitielles ainsi que la microangiopathie thrombotique. Cinq pour cent (5%) des PBR &eacute;taient aglom&eacute;rulaires. L'h&eacute;maturie macroscopique &eacute;tait la principale complication observ&eacute;e dans notre s&eacute;rie avec une fr&eacute;quence de 2,8%. La PBR reste le gold standard du diagnostic de la maladie r&eacute;nale, cependant le diagnostic syndromique permet au clinicien d'identifier la maladie r&eacute;nale la plus probable et de guider les th&eacute;rapeutiques urgentes.</b><br/> text/html 2018-09-26T12:13:26+01:00 Youssef Darouassi, Mohamed Amine Hanine, Abdelfettah Aljalil, Amine Ennouali, Brahim Bouaity, Mohamed Mliha Touati, Haddou Ammar [Case series] - Chirurgie des hyperthyro&iuml;dies: &agrave; propos de 60 cas - 20 September 2018. <b>L'hyperthyro&iuml;die englobe plusieurs maladies caract&eacute;ris&eacute;es par un niveau &eacute;lev&eacute; d'hormones thyro&iuml;diennes circulantes. La thyro&iuml;dectomie en est un des principaux traitements. L'objectif de notre &eacute;tude est d'&eacute;valuer, &agrave; travers une &eacute;tude r&eacute;trospective, les particularit&eacute;s &eacute;pid&eacute;miologiques, cliniques, th&eacute;rapeutiques, et &eacute;volutives des patients ayant b&eacute;n&eacute;fici&eacute; d'une prise en charge chirurgicale d'une hyperthyro&iuml;die dans le service d'ORL &agrave; l'h&ocirc;pital militaire Avicenne de Marrakech. Soixante patients ont &eacute;t&eacute; collig&eacute;s avec une pr&eacute;dominance f&eacute;minine et une moyenne d'&acirc;ge de 52 ans. La clinique a &eacute;t&eacute; domin&eacute;e par les signes de thyrotoxicoses qui ont &eacute;t&eacute; retrouv&eacute;s chez tous les patients. L'exploration a permis d'identifier 47 cas de goitre multih&eacute;t&eacute;ronodulaire toxique ou pr&eacute;toxique (soit 78.33% des cas), 5 cas de maladies de Basedow (soit 8.33%) et 8 cas d'ad&eacute;nome toxique (soit 13.33%). Une pr&eacute;paration m&eacute;dicale a &eacute;t&eacute; de mise chez tous nos patients. Une thyro&iuml;dectomie totale a &eacute;t&eacute; r&eacute;alis&eacute;e chez 50 patients (soit 83.33%) et une loboisthmectomie chez 10 patients (soit 16.33%). En post-op&eacute;ratoire, des complications sont &eacute;t&eacute; collig&eacute;s: un cas de paralysie laryng&eacute;e transitoire (1,6% des cas), neuf cas d'hypoparathyro&iuml;die transitoire (15% des cas), un cas d'hypoparathyro&iuml;die d&eacute;finitive (1,6% de cas), et un seul cas d'h&eacute;matome compressif (1,6% de cas). La chirurgie des goitres toxiques r&eacute;put&eacute;s h&eacute;morragiques et adh&eacute;rents, doit &ecirc;tre r&eacute;alis&eacute;e par un chirurgien exp&eacute;riment&eacute; qui doit doubler de vigilance pour minimiser la morbidit&eacute; repr&eacute;sent&eacute;e essentiellement par la paralysie laryng&eacute;e et l'hypoparathyro&iuml;die.</b><br/> text/html 2018-09-26T12:13:26+01:00 Ary&eacute; Weinberg, Andreas Eberhard Albers [Images in medicine] - Klippel-Feil syndrom: a duplicated thumb - 20 September 2018. <b>A 71-year-old woman was admitted to our hospital because of a vertigo. At clinical examination a duplicated right thumb was noticed. The Patient revealed that she was suffering from Klippel-Feil Syndrom (KFS). KFS is a rare skeletal disease where a mutation of the GDF6 and GDF3 genes can be found. It is characterized by congenital fusion of any of the 7 cervical vertebrae. There can be associations with other malformations such as congenital elevation of the scapula (Sprengel’s deformity), spina bifida, scoliosis, cleft palate, malformations of the heart, head, face, arms, legs and fingers. Because of these heterogeneous medical associated conditions treatment for KFS is symptomatic and can include surgery.</b><br/> text/html 2018-09-26T12:13:26+01:00 William Ngatchou, Isabelle Drezen, Felicit&eacute; Kamdem, Gis&egrave;le Imandy, Cecile Okalla, Albert Nkana, Jean Pierre Hacquebard, Pierre Origer, Joseph Sango, Daniel Lemogoum, Sidiki Mouliom, Anastase Dzudie, Henri Ngote, Romuald Hentchoya, Junette Metogo, Olivier Germay, Eug&egrave;ne Belley Priso, Jean Luc Jansens, Henry Luma, Tome Nadjovski [Case report] - Pr&eacute;l&egrave;vement de plaquettes pour la chirurgie cardiaque: premi&egrave;re exp&eacute;rience d'aph&eacute;r&egrave;se &agrave; l'H&ocirc;pital G&eacute;n&eacute;ral de Douala - 20 September 2018. <b>La chirurgie cardiaque sous circulation extracorporelle (CEC) est r&eacute;guli&egrave;rement associ&eacute;e &agrave; la perte d'une quantit&eacute; importante de sang. Une bonne anticipation de ces pertes sanguines et une bonne h&eacute;mostase perop&eacute;ratoire sont reconnues comme moyens permettant de limiter ces saignements post op&eacute;ratoires. Jusqu'&agrave; ce jour, la compensation des besoins en plaquettes des patients op&eacute;r&eacute;s sous CEC dans notre service se faisait par transfusion de sang total ou de concentr&eacute;s plaquettaires pr&eacute;lev&eacute;s &agrave; partir de plusieurs donneurs. Nous rapportons la premi&egrave;re exp&eacute;rience de pr&eacute;l&egrave;vement de concentr&eacute;s plaquettaires par la technique d'aph&eacute;r&egrave;se &agrave; l'h&ocirc;pital G&eacute;n&eacute;ral de Douala.</b><br/> text/html 2018-09-26T12:13:26+01:00 Awatif El Hakkouni, Nabil Mansouri [Case report] - L’aspergillose pulmonaire invasive chez un patient immunod&eacute;prim&eacute; s&eacute;ropositif pour le VIH - 20 September 2018. <b>L'aspergillose pulmonaire invasive est une infection opportuniste parmi les plus rares au cours de l'infection par le VIH. Son pronostic est sombre. Aspergillus fumigatus est l'esp&egrave;ce la plus fr&eacute;quemment incrimin&eacute;e. Le diagnostic doit &ecirc;tre pr&eacute;coce, &eacute;voqu&eacute; sur un faisceau d'arguments cliniques, radiologiques (le scanner thoracique) et mycologiques. L'examen direct du liquide de lavage bronchiolo-alv&eacute;olaire, coupl&eacute; &agrave; la culture permet l'identification de l'Aspergillus sp. L'examen anatomopathologique de biopsies scanno-guid&eacute;es est n&eacute;cessaire en cas de n&eacute;gativit&eacute; du LBA. Le dosage de l'antig&egrave;ne galactomannane est tr&egrave;s utile au diagnostic. Le Voriconazole est la mol&eacute;cule &agrave; prescrire en premi&egrave;re intention avec la n&eacute;cessit&eacute; de v&eacute;rifier l'absence d'interactions m&eacute;dicamenteuses avec les antir&eacute;troviraux hautement actifs.</b><br/> text/html 2018-09-26T12:13:26+01:00 Amine Tahir, Amine Sdoudi, Mohamed Chahed, Aniss Elbaitil, Lkoutbi Fakherdine, Yasser Sbihi, Driss Bennouna, Mustafa Fadili [Case report] - Syndrome du canal carpien secondaire &agrave; une vari&eacute;t&eacute; anatomique rare du nerf m&eacute;dian - 20 September 2018. <b>Le syndrome du canal carpien repr&eacute;sente l'un des motifs de consultation les plus fr&eacute;quents en chirurgie de la main, son incidence annuelle est de 300 par 100.000 habitants et 80.000 interventions chirurgicales pour le syndrome du canal carpien sont faites chaque ann&eacute;e en France. Dans la plupart des cas, le syndrome du canal carpien est idiopathique survenant sans qu'aucune cause puisse &ecirc;tre identifi&eacute;e, cependant en dehors de ces formes l'intrication de plusieurs m&eacute;canismes peuvent expliquer la relation cause &agrave; effet de cette pathologie. A travers cette observation on va essayer de mettre la lumi&egrave;re sur une association exceptionnelle d'un syndrome du canal carpien secondaire &agrave; une vari&eacute;t&eacute; anatomique rare du nerf m&eacute;dian.</b><br/> text/html 2018-09-26T12:13:26+01:00 Katerina Krompa, Ines Barka, St&eacute;phanie Malard, Sopio Tatulashvili, Camille Baudry, H&eacute;l&egrave;ne Bihan, Marinos Fysekidis [Case report] - Ketosis prone diabetes presenting as fulminant type 1 diabetes - 20 September 2018. <b>Patients with ketosis prone diabetes have been reported primarily in Africans and African Americans. At presentation, both insulin secretion and insulin action are impaired in ketosis prone diabetes patients. Fulminant diabetes is a subtype of type 1 diabetes reported mainly in the Asian populations characterized by diabetic ketosis or ketoacidosis occurring soon after the onset of hyperglycemic symptoms with inappropriately low HbA1c (< 8.5%). We report here the first case of a ketosis prone diabetes presenting as fulminant diabetes.</b><br/> text/html 2018-09-26T12:13:26+01:00 Mohamed Moez Kammoun, Rim Karray, Kais Regaieg, Mabrouk Bahloul, Mounir Bouaziz [Case report] - Une cause exceptionnelle des p&eacute;ritonites: une perforation il&eacute;ale par un corps &eacute;tranger lors de la r&eacute;duction d’une hernie inguinale - 18 September 2018. <b>La p&eacute;ritonite secondaire est fr&eacute;quemment rapport&eacute;e dans la litt&eacute;rature. Les causes sont multiples. Nous rapportons un cas d'une perforation il&eacute;ale par une cause exceptionnelle. Il s'agit d'une perforation il&eacute;ale par un corps &eacute;tranger lors de la r&eacute;duction d'une hernie inguinale, responsable d'une p&eacute;ritonite grave avec tableau de d&eacute;faillance multivisc&eacute;rale.</b><br/> text/html 2018-09-26T12:13:26+01:00 Mehdi Hasnaoui, Mohamed Masmoudi, Jamel Chefai, Nouha Ben Hmida, Khalifa Mighri, Nabil Driss [Case series] - Le kyste de la vall&eacute;cule symptomatique chez l’adulte: &agrave; propos de 4 cas - 18 September 2018. <b>Le kyste de la vall&eacute;cule est une l&eacute;sion b&eacute;nigne rare. Ces kystes sont souvent asymptomatiques chez l'adulte. Les auteurs rapportent 4 cas de kystes de la vall&eacute;cule symptomatique de l'adulte. Trois patients ont consult&eacute; pour une dysphagie haute mixte associ&eacute;e &agrave; une dysphonie. Le quatri&egrave;me patient se plaignait d'une sensation de corps &eacute;tranger dans la gorge. La laryngoscopie a montr&eacute; une formation kystique dans la r&eacute;gion vall&eacute;culaire gauche dans tous les cas. La tomodensitom&eacute;trie a confirm&eacute; la pr&eacute;sence d'une formation kystique de la vall&eacute;cule. Le traitement a consist&eacute; en une marsupialisation du kyste dans deux cas et une r&eacute;section endoscopique dans deux cas. &Agrave; partir de ces 4 cas cliniques, nous nous proposons de pr&eacute;ciser les particularit&eacute;s diagnostiques et th&eacute;rapeutiques de cette affection.</b><br/> text/html 2018-09-26T12:13:26+01:00 Molla Temere Mekonen, Hana Abebe Dagnew, Tesfay Ambaye Yimam, Hayat Nuradis Yimam, Melese Abate Reta [Research] - Adolescent-parent communication on sexual and reproductive health issues and associated factors among high school students in Woldia town, Northeastern Ethiopia - 18 September 2018. <b>INTRODUCTION: Sexual and reproductive health (SRH) communication is most likely to promote healthy sexual practices and to reduce risky sexual behavior among adolescents. Communication is the principal means for parents to transmit sexual values and knowledge to their children. This study aimed to assess adolescent-parent communication on SRH issues among high school students in Woldia town. METHODS: A cross-sectional study was conducted from December 15-31, 2016. Systematic random sampling technique was used to select 693 students from Grades 9 and 10. Data were entered into Epi-info version 3.5.1 and analyzed by usingSPSS version 20. Logistic regression with OddsRatios(OR) and 95% Confidence intervals (CI) was used to identify the independent predictors of adolescent-parent communication. RESULTS: 674 students accepted to participate in this study giving a response rate of 97.3%.Only 205(30.4%) had discussed on two or more SRH topics with their parents. In logistic regression analyses, mothers who could read and write [AOR=2.0; 95% CI=1.3-3.1] and had diploma certificate [AOR=2.0; 95% CI=1.4-2.9] were more likely to discuss on SRH issues with their children. Adolescents who agreed on the importance of discussion on SRH issues [AOR=2.5; 95% CI=1.3-4.5], whoever gotSRH information [AOR=2.0; 95% CI=1.4-2.9] and those whoever had sexual intercourse [AOR=1.7; 95% CI=1.1-2.6] were more likely to discuss on different SRH issues with their parents. CONCLUSION: This study revealed that parent-adolescent communication on SRH issues was inadequate.Therefore, there is a need to equip and educate parents on different adolescents' SRH issues.</b><br/> text/html 2018-09-26T12:13:26+01:00 Roger Tshimanga Mukadi, Maurice Sumaili Mwana Ntambwe, Hermann Tamubango Kitoko, Joseph Malashi Mwisi, Fiston Ilunga Mbayo [Research] - Sexualit&eacute; des jeunes en milieu scolaire dans la ville de Likasi en R&eacute;publique D&eacute;mocratique du Congo - 14 September 2018. <b>INTRODUCTION: Des nombreuses &eacute;tudes sur la sexualit&eacute; en Afrique subsaharienne, notent un accroissement de l'activit&eacute; sexuelle des jeunes c&eacute;libataires, cette sexualit&eacute; est pr&eacute;coce, instable, multipartenaire, d&eacute;pendant de l'environnement proche des jeunes et des membres de leurs m&eacute;nages. Cette &eacute;tude vise &agrave; d&eacute;terminer la pr&eacute;valence des jeunes sexuellement actifs et &eacute;valuer les facteurs influant sur le comportement sexuel. METHODES: Il s'agit d'une &eacute;tude d'observation descriptive transversale couvrant la p&eacute;riode allant de Mai &agrave; Juin 2017. L'&eacute;tude a port&eacute; sur 249 &eacute;l&egrave;ves de 5&eacute;me et 6&eacute;me secondaires de 4 &eacute;coles de Likasi (CS Kalunga, CS la Borne, College Tutazamie et Lyc&eacute;e Musofi). Les donn&eacute;es ont &eacute;t&eacute; saisies et encod&eacute;es avec le logiciel excel 2013. RESULTATS: Deux cent quarante neuf jeunes ont r&eacute;pondu &agrave; l'enqu&ecirc;te dont 153 filles et 96 gar&ccedil;ons, parmi lesquels 104 sont sexuellement actifs soit une pr&eacute;valence de 42%. L'&acirc;ge Moyen au premier rapport sexuel chez le gar&ccedil;on est de 16,7 ans et 17,2 ans chez la fille, 38% ont eu leurs premiers rapports sexuels entre 10 et 15 ans, 56% d&eacute;clarent avoir eu plus d'un partenaire sexuel. Le media, l'internet, le niveau et milieu de vie sont identifi&eacute;s comme facteurs qui influencent le comportement sexuel des jeunes. CONCLUSION: selon l'ONUSIDA, le SIDA s'est juvenilis&eacute;, l'&eacute;limination de cette &eacute;pid&eacute;mie passe par la promotion d'une sexualit&eacute; saine et responsable selon la strat&eacute;gie ABC.</b><br/> text/html 2018-09-26T12:13:26+01:00 Abdoulaye Ousmane, Harouna Amadou Mahaman Laouali, Oumarou Amadou, Adakal Ousseini, Harouna Magagi Lawanou, Laouali Boubou, Djimraou Oumarou, Moussa Abdoulaye, Mamadou Saidou [Case series] - Aspects &eacute;pid&eacute;miologiques et bact&eacute;riologiques des infections du site op&eacute;ratoire (ISO) dans les services de chirurgie &agrave; l’H&ocirc;pital National de Niamey (HNN) - 14 September 2018. <b>Ce travail &agrave; consister &agrave; &eacute;tudier les aspects &eacute;pid&eacute;miologiques et bact&eacute;riologiques des souches bact&eacute;riennes isol&eacute;es au cours des infections du site op&eacute;ratoire (ISO) &agrave; l'H&ocirc;pital National de Niamey. Nous avions men&eacute; une &eacute;tude r&eacute;trospective, et descriptive sur une p&eacute;riode de 24 mois. Toutes les souches isol&eacute;es &agrave; partir de pr&eacute;l&egrave;vements bact&eacute;riologiques effectu&eacute;s chez les patients pr&eacute;sentant une infection du site op&eacute;ratoire ont &eacute;t&eacute; identifi&eacute;es et test&eacute;s aux antibiotiques selon les m&eacute;thodes classiques conventionnelles. Les analyses bact&eacute;riologiques ont permis d'isoler 126 souches bact&eacute;riennes avec une pr&eacute;dominance de S.aureus (n=39, 31%) suivi d'Escherichia coli (n = 29, 23%) et de Pseudomonas aeruginosa (n=12, 9,5%). Les souches d'Escherichia coli &eacute;taient sensibles &agrave; 100% &agrave; l'imipen&egrave;me. Elles ont montr&eacute; des r&eacute;sistances marqu&eacute;es &agrave; l'ampicilline, l'amoxicilline, l'acide-clavulanique et la ticarcilline. Elles pr&eacute;sentaient des r&eacute;sistances variables aux aminosides (62% &agrave; la gentamycine, et 78% &agrave; l'amikacine), et aux fluoroquinolones (acide nalidixique 74%, pefloxacine 33%, l'ofloxacine 69%, ciprofloxacine 61%). L'ensemble des isolats d'ent&eacute;robact&eacute;ries &eacute;taient sensibles &agrave; l'imip&eacute;n&egrave;me. Les souches de S.aureus avaient montr&eacute; des r&eacute;sistances &agrave; la P&eacute;nicilline G (88,6%) et &agrave; l'oxacilline (83%). Elles avaient montr&eacute; aussi des r&eacute;sistances de 37% et 57% respectivement &agrave; la vancomycine et teicoplanine. Par contre, elles &eacute;taient sensibles &agrave; la lincomycine et aux aminosides test&eacute;s. Compte tenu de ces r&eacute;sultats, nous pensons qu'il faudra am&eacute;liorer les protocoles d'antibioprophylaxie et d'antibioth&eacute;rapie probabiliste dans les services chirurgicaux. Aussi, mener des &eacute;tudes p&eacute;riodiques de surveillances des ISO.</b><br/> text/html 2018-09-26T12:13:26+01:00 Bounoual Mohammed, Omana Jean paul, Ahsaini Mustapha, Tazi Karim, Mellas Soufiane, EL Ammari Jalaleddine, Tazi Mohammed Fadl, El Fassi Mohammed Jamal, Farih Moulay Hassan [Case report] - Incontinence urinaire r&eacute;v&eacute;lant une fistule v&eacute;sico-ut&eacute;rine: &agrave; propos d’un cas - 14 September 2018. <b>La fistule v&eacute;sico-ut&eacute;rine (FVU) est une l&eacute;sion rare et ne repr&eacute;sente que 4% de toutes les fistules uro-g&eacute;nitales. Elle est le plus souvent cons&eacute;cutive &agrave; une c&eacute;sarienne et r&eacute;alise une communication entre la vessie et l'ut&eacute;rus. Nous rapportons un cas d'une jeune patiente qui pr&eacute;sentait une FVU suite &agrave; une c&eacute;sarienne. Le but de ce travail &eacute;tait d'analyser les aspects cliniques et th&eacute;rapeutiques de cette affection.</b><br/> text/html 2018-09-26T12:13:26+01:00 Aruyaru Stanley Mwenda, Alex Muturi, Fredrick Ouma Oluga [Opinion] - Six stormy years and the audacity to confront a challenging future: taking stock of the Kenyan Doctors’ Union - 13 September 2018. <b>The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) was formed in August 2011. Within the last six years, this union has galvanized the Kenyan doctors together, agitated for healthcare policy reforms and successfully negotiated and registered a Collective Bargaining Agreement (CBA). Though political will and the national citizens' psyche on matters pertaining to public healthcare remains a challenge, this union has made its foot prints on the Kenyan conversation space. KMPDU looks forward to engaging local, regional and international health stake holders to improve the state of the country's health care, key among these being to have a national commission handling all the human resources for health.</b><br/> text/html 2018-09-26T12:13:26+01:00 Anass Ayyad, Maria Rkain, Abdeladim Babakhouya, Noufissa Benajiba [Case report] - La varicelle n’est pas toujours b&eacute;nigne - 13 September 2018. <b>La varicelle est une maladie &eacute;ruptive due au virus varicelle-zona qui touche essentiellement les enfants et dont l'&eacute;volution est habituellement b&eacute;nigne. Cependant des complications de gravit&eacute; variable peuvent &ecirc;tre observ&eacute;es tel que les complications infectieuses bact&eacute;riennes et les complications neurologiques. Nous rapportons deux observations de varicelle compliqu&eacute;e. Comme premi&egrave;re observation, un nourrisson de 5 mois sans ant&eacute;c&eacute;dents qui pr&eacute;sente depuis six jours une &eacute;ruption cutan&eacute;e fait de v&eacute;sicules et pustules, la symptomatologie s'est aggrav&eacute;e la veille de son admission au service par l'installation d'une d&eacute;tresse respiratoire. Comme deuxieme observation, une fillette de 7 ans, admise au service pour prise en charge d'une convulsion simple, et chez qui l'examen clinique a objectiv&eacute; des cicatrices de varicelle g&eacute;n&eacute;ralis&eacute;es et une ataxie c&eacute;r&eacute;belleuse. Bien que la varicelle soit connue comme une affection virale commune, le plus souvent b&eacute;nigne, plusieurs &eacute;tudes ont r&eacute;cemment fait &eacute;tat d'une recrudescence de ses complications, qui semblent responsables de 0,2 &agrave; 1,5% des motifs d'hospitalisation des enfants atteints de varicelle.</b><br/> text/html 2018-09-26T12:13:26+01:00 Ahmed Youssef Kada, Kheireddine Abdelouahed Bouyoucef [Case series] - La mort enc&eacute;phalique post traumatique: &eacute;pid&eacute;miologie et facteurs de risque - 13 September 2018. <b>Il est possible de pr&eacute;voir l'&eacute;volution d'un patient vers l'&eacute;tat de mort enc&eacute;phalique et plusieurs &eacute;quipes se sont int&eacute;ress&eacute;s &agrave; la recherche de facteurs pr&eacute;dictifs de la mort enc&eacute;phalique, cependant la difficult&eacute; de proposer un mod&egrave;le coh&eacute;rent r&eacute;side dans le choix des crit&egrave;res propos&eacute;s, qui, dans la plupart des &eacute;tudes est subjectif. Il conviendrait d'analyser une population uniforme et de d&eacute;finir des crit&egrave;res universels pour pouvoir pr&eacute;dire avec certitude le passage en mort enc&eacute;phalique, un score pr&eacute;dictif &eacute;tant alors parfaitement envisageable.</b><br/> text/html 2018-09-26T12:13:26+01:00 Amine Benmoussa, Khaoula Khalil, Fatimazzahra Boufarissi, Ilias Tazi [Case report] - Leuc&eacute;mie agressive &agrave; cellules NK (Natural Killer): &agrave; propos d'un cas dans la population africaine et revue de la litt&eacute;rature - 13 September 2018. <b>La leuc&eacute;mie agressive &agrave; cellules NK (ANKL) fait partie des syndromes lymphoprolif&eacute;ratifs &agrave; cellules NK. C'est une entit&eacute; rare touchant essentiellement les asiatiques, elle est tr&egrave;s rarement d&eacute;crite dans la population africaine (l'int&eacute;r&ecirc;t de notre cas). Nous rapportons le cas d'une patiente de 19 ans, d'origine marocaine, qui pr&eacute;sente un syndrome d'insuffisance m&eacute;dullaire d'installation brutale avec syndrome tumoral, le diagnostic de la Leuc&eacute;mie &agrave; NK a &eacute;t&eacute; retenu par l'&eacute;tude microscopique et immunoph&eacute;notyique de la moelle osseuse. L'&eacute;volution est fatale avec d&eacute;c&egrave;s de la patiente dans 2 mois apr&egrave;s le diagnostic par un choc septique. Le pronostic d'ANKL est tr&egrave;s mauvais et la survie m&eacute;diane apr&egrave;s le diagnostic est en moyenne de deux mois. En l'absence d'&eacute;tude prospective, aucune attitude th&eacute;rapeutique consensuelle n'est &agrave; ce jour &eacute;tablie.</b><br/> text/html 2018-09-26T12:13:26+01:00 Elsa Ayo Bivigou, Mahutondji Christian Allognon, Francis Ndoume, Jean Bruno Mipinda, Emmanuel Ecke Nzengue [Research] - L&eacute;talit&eacute; de l’insuffisance cardiaque au Centre Hospitalier Universitaire de Libreville (CHUL) et facteurs associ&eacute;s - 13 September 2018. <b>INTRODUCTION: L'insuffisance cardiaque (IC) est une cause fr&eacute;quente de d&eacute;c&egrave;s en Afrique. La pr&eacute;sente &eacute;tude a pour but de d&eacute;terminer le taux de l&eacute;talit&eacute; de l'IC et de rechercher les facteurs associ&eacute;s. METHODES: il s'agissait d'une &eacute;tude r&eacute;trospective transversale r&eacute;alis&eacute;e dans le service de cardiologie du CHUL. Elle portait sur l'analyse de dossiers de patients hospitalis&eacute;s pour IC gauche ou globale collig&eacute;s de Janvier 2014 &agrave; D&eacute;cembre 2016. RESULTATS: la l&eacute;talit&eacute; &eacute;tait de 10,3%. L'&acirc;ge moyen des patients d&eacute;c&eacute;d&eacute;s (n=64) &eacute;tait de 57,4 ± 17 ans. Le d&eacute;lai moyen de prise en charge &eacute;tait de 15± 18 jours et la d&eacute;compensation faisait suite &agrave; un &eacute;cart de traitement chez 51,4% des patients d&eacute;c&eacute;d&eacute;s. L'association hypertension art&eacute;rielle et diab&egrave;te augmentait significativement le risque de d&eacute;c&egrave;s (OR= 2,2 (1,2-6,6)). Les facteurs associ&eacute;s &agrave; la l&eacute;talit&eacute; &eacute;taient essentiellement: l'hypotension art&eacute;rielle (OR=6,8(3,2-14,1)), l'insuffisance r&eacute;nale s&eacute;v&egrave;re (OR=3,5(1,7-7,2)), un index cardio-thoracique sup&eacute;rieur &agrave; 0,7 (OR= 54,4 (15,3-193,1)), une alt&eacute;ration s&eacute;v&egrave;re de la fraction d'&eacute;jection ventriculaire gauche (OR= 3,0(1,5-5,9)) et un taux &eacute;lev&eacute; de NT-proBNP (OR=3,5(1,2-10,5)). La mortalit&eacute; augmentait significativement avec le nombre de comorbidit&eacute;s. Les d&eacute;c&egrave;s &eacute;taient dus dans 28,4% des cas &agrave; une complication extracardiaque. CONCLUSION: la l&eacute;talit&eacute; de l'IC est li&eacute;e &agrave; la s&eacute;v&eacute;rit&eacute; et &agrave; la pr&eacute;cocit&eacute; des l&eacute;sions. Le retard de prise en charge et les comorbidit&eacute;s aggravent cette l&eacute;talit&eacute;. Le d&eacute;pistage des facteurs de risque et l'&eacute;ducation th&eacute;rapeutique pourraient diminuer cette mortalit&eacute; qui concerne des sujets relativement jeunes.</b><br/> text/html 2018-09-26T12:13:26+01:00 Ayesha Ahmed [Case report] - Chondroid and osseous metaplasia in an incidental type II papillary renal cell carcinoma with extensive solid areas: an unraveled molecular character - 13 September 2018. <b>Chondroid and osseous metaplasia in a Type II Papillary renal cell carcinoma (PRCC) with extensive solid areas is a complex histological combination that has not been reported before. A 21 years old male presented with a comminuted fracture of right femur. On hematological investigations he was found to have low RBC count and hemoglobin. Radiological examination revealed an incidental, exophytic complex solid and cystic, mass lesion measuring 7 x 6.5x 4.9 cm with thickened walls, septation and calcification. It was completely replacing upper pole of the left kidney with extension into perinephric fat. Enlarged para aortic and hilar nodes with necrosis were also noted. Radiological diagnosis was infectious processes such as tuberculosis versus malignancy. Surgical intervention comprising left partial nephrectomy was done. Histopathology and immunohistochemical analysis yielded the above diagnosis. Cytogenetic studies did not reveal gain of chromosome 7 and/or 17 or loss of chromosome Y,a characteristic genetic profile of PRCC.This case could be representative of a unique histological variant of PRCC in which the molecular profile yet needs to be unraveled.</b><br/> text/html 2018-09-26T12:13:26+01:00 Olajumoke Ajibola Effiom, Akanbi Clement Olurotimi Olojede, Olakanmi Ralph Akinde, Adetokunbo Babjide Olawuyi, Abiodun Taufeek Amoo, Godwin Toyin Arotiba [Research] - Dermatofibrosarcoma protuberans: clinicopathologic presentation in Nigerians - 12 September 2018. <b>INTRODUCTION: Dermatofibrosarcoma protuberance (DFSP) is in general a rare low grade malignant sarcoma and possesses a tendency for local recurrence. It has a site predilection for the trunk. Occurrence in the facial area is extremely rare. Ample knowledge of its clinical, histological and biologic characteristics is vital for accurate and prompt recognition. METHODS: Over 13 years, clinicohistologic information of cases was retrieved. Histological and immunohistochemical re-evaluation were performed to re-confirm diagnosis. Data collected and analyzed with SPSS Statistics version 20 were presented as frequency tables, charts and proportions as appropriate.</b><br/> text/html 2018-09-26T12:13:26+01:00 Habiba Suleiman Madjapa, Irene Kida Minja [Research] - Root canal morphology of native Tanzanian permanent mandibular molar teeth - 12 September 2018. <b>INTRODUCTION: Research has shown variations in morphology of root canals to differ amongst ethnic groups. We aimed to investigate the root morphology and canal configuration of permanent mandibular molars in a native Tanzanian population. METHODS: The 146 first and 85 second mandibular molars were collected from Tanzanian patients. After removal of the pulp tissues and staining using Methylene blue ink from the canal system, the teeth were decalcified and rendered clear using 98% methyl salicylate. The teeth were then examined under magnification of 10X for: number of roots, tooth length, number of canals, location of apical foramen, presence of an apical delta, and canal configuration using Vertucci’s classification. RESULTS: All mandibular molars had two separate roots. The mean tooth length for mandibular 1<sup>st</sup> and 2<sup>nd</sup> molars were 21.7 mm and 20.5mm, respectively, with no statistically significant difference in mean tooth length between males and females. All the mesial roots 1st and 2<sup>nd</sup> mandibular molars possessed two root canals, while 40.4% and 54.1% of the distal roots of 1st and 2<sup>nd</sup> molars, respectively, had two canals. The majority of the examined teeth had their apical foramen located centrally, with an apical delta present in the distal root of one-second molar. Root canal configuration types commonly reported were Type II in the mesial and Type I in the distal roots of the mandibular 1st molar; while the 2<sup>nd</sup> molar had, respectively, root types II / IV and type I. CONCLUSION: There were observed variations in the morphology of root canals in a Tanzanian population. Caution is advised to clinicians when performing root canal treatment.</b><br/> text/html 2018-09-26T12:13:26+01:00 Alila Mohammed, Hamdane Amine, Sara El Atiq, Bounoual Mohammed, Mouaqit Ouadii, Mazaz Khalid, Ait Taleb Khalid, Ousadden Abdelmalek [Case series] - Applicability and outcome of laparoscopic adrenalectomy for large tumours - 11 September 2018. <b>Laparoscopic adrenalectomy has been shown to be as safe and effective as conventional open surgery for small and benign adrenal lesions. With increasing experience with laparoscopic adrenalectomy, this approach has become the procedure of choice for the majority of patients requiring adrenalectomy. In our department, from 2011 to 2016, a total of 28 patients with 31 adrenal tumours underwent laparoscopic adrenalectomy regardless of tumour size. Our policy in the department is to exclude adrenal tumours that are potentially malignant or metastatic adrenal tumours for laparoscopic resection. In this a retrospective study, we divided patients into two groups according to tumour size: < 5 or &#8805; 5 cm, which was considered as the definition of large adrenal tumours. We compared demographic data and per- and postoperative outcomes. There was no statistical difference between the two groups for per-operative complications (16,6% vs 18,75%, P = 0.71), postoperative complications (16,6% vs 18,75% , P = 0.71), postoperative length of hospital stay (5 vs 8 days P = 0.40), mortality (0% vs 0%) or oncologic outcomes: recurrence and metastasis (8.3% vs 6.25% P = 0.70). The only statistical difference was the operating time, at a mean (SD) 194 (60) vs 237 (71) min (P = 0.039) and the conversion rate (0% vs 12.5% P < 0.01). Laparoscopic adrenalectomy can be done for all patients with adrenal tumours regardless of tumour size, even it needs more time for large tumour but appears to be safe and feasible when performed by experienced surgeons.</b><br/> text/html 2018-09-26T12:13:26+01:00 Olusesan Ayodeji Makinde, Clifford Obby Odimegwu [Research] - A qualitative inquiry on the status and adequacy of legal instruments establishing infectious disease surveillance in Nigeria - 11 September 2018. <b>INTRODUCTION: The threat of devastating disease outbreaks is on the rise with several outbreaks recorded across the world in the last five years. The intractable Ebola Virus Disease outbreak in West Africa which spread to Nigeria was a reawakening point. This study reviews the status and adequacy of the legal framework surveillance for disease in Nigeria. METHODS: a mixed methods approach comprising of document reviews and key informant interviews was used in data collection. RESULTS: fourteen key informants from the federal ministry of health (FMOH) and six States were interviewed. Five legal instruments were identified and reviewed. The Quarantine Act of 1926 remains the active National Law on disease surveillance in Nigeria. An Integrated Disease Surveillance and Response Policy (IDSR) was developed in 2005 as the means for achieving the International Health Regulations (IHR). CONCLUSION: the legal instruments establishing disease surveillance in Nigeria require strengthening and possibly enactment as a National Law in order to address emerging disease threats.</b><br/> text/html 2018-09-26T12:13:26+01:00 Aboyowa Arayuwa Edukugho, Jarlath Udoudo Umoh, Matthew Diem, Oyetunji Ajani, Belinda Uba, Lilian Okeke, Elizabeth Adedire, Adewole Adefisoye, Caroline Edukugho, Patrick Nguku [Research] - Knowledge, attitudes and practices towards rabies prevention among residents of Abuja Municipal Area Council, Federal Capital Territory, Nigeria - 10 September 2018. <b>INTRODUCTION: Rabies is a fatal neglected zoonosis killing 55,000 people worldwide annually. It is endemic in Nigeria with 10,000 people exposed annually through dog-bites. To inform adequate intervention due to the rise in reported dog-bite cases, we assessed knowledge, attitudes and practices (KAP). METHODS: we carried out a cross-sectional study among 224 residents of Abuja Municipal Area Council. We used structured questionnaires to collect data on sociodemographic characteristics, knowledge and attitudes on rabies prevention. Knowledge score of &#8805; 8 points based on ten-point domain questions were regarded as satisfactory. We analyzed data using Epi-Info and Excel for frequencies and proportions and associations were determined at 5% significance level. RESULTS: a total of 123 (55%) respondents owned dogs. One hundred and eighty-four (82%) respondents had satisfactory knowledge on rabies prevention. About 87% knew where to get dogs vaccinated and would seek medical treatment from the hospital when bitten by a dog. Majority (58%) did not know the frequency of anti-rabies administration for dogs and 63.3% did not know the appropriate first aid actions following dog-bites. Of 123 dog owners, 35% would allow their dogs roam without restriction and 94% reported vaccinating their dogs against rabies. Dog owners were more likely to have satisfactory knowledge of rabies compared to non-dog owners (OR 7.8, 95% CI 1.0-62.0, p = 0.02). CONCLUSION: knowledge on rabies is satisfactory but with knowledge gaps in the frequency of dog anti-rabies vaccination, appropriate first-aid following dog bites and non-restriction of dog movement. To prevent rabies, these knowledge gaps need to be addressed through public enlightenment and enforcement of dog movement restrictions laws.</b><br/> text/html 2018-09-26T12:13:26+01:00 Michael Eteng Eyong, Happiness Uko Ntia, Joanah Moses Ikobah, Edu Michael Eyong, Helen Uket, Callistus Enyuma, Kelechi Uheagbu [Research] - Pattern of pubertal changes in Calabar, South South Nigeria - 07 September 2018. <b>INTRODUCTION: Puberty is an essential physiologic process that is characterized by the appearance of secondary sexual features. Secular changes in puberty occur from one generation to another and need to be documented. The assessment of pubertal stages in a child is only useful if recent and reliable reference data from the same population is available for comparison. The study aimed to profile clinical normative sexual maturity characteristics for children in Calabar, South-South Nigeria. METHODS: a cross-section of primary and secondary school pupils aged 6-18 years in the city of Calabar, Nigeria were randomly selected for the study. Sexual maturating rating was assessed using the pubertal staging for breast development and pubic hair as described by Marshall and Tanner (Tanner staging). Testicular volume in boys was measured using the Prader orchidometer. Menarche and "voice break" were established by recall of the event by the girls and boys respectively. RESULTS: a total of 2,830 children were seen, 1542 (54.5%) boys and 1288 (45.5%) girls. The mean age of onset of pubic hair was 11 years in both boys and girls. Pubertal testicular volume of 4 mls was seen in boys at a mean age of 11 years. Breast development in girls occurred at mean age of 11 years and menarche at 13 years. CONCLUSION: in this study, the onset of puberty is occurring at an earlier age than previously reported in Nigeria with a secular trend of a decreasing age at onset of puberty. These sexual characteristics are rather occurring at similar ages reported from western countries.</b><br/> text/html 2018-09-26T12:13:26+01:00 Kola Ademola Jinadu, Akindele Olupelumi Adebiyi, Olubunmi Olutoyin Sekoni, Eniola Adetola Bamgboye [Research] - Integrated disease surveillance and response strategy for epidemic prone diseases at the primary health care (PHC) level in Oyo State, Nigeria: what do health care workers know and feel? - 07 September 2018. <b>INTRODUCTION: Effective diseases surveillance remains an important operational tool in countries with recurrent epidemic prone diseases (EPDs). In Nigeria, insufficient knowledge among Health Care Workers (HCWs) on Integrated Disease Strategy and Response Strategy (IDSR) have been documented. This study assessed knowledge and attitude of HCWs towards IDSR strategy for EPDs at the Primary Health Care (PHC) level in Oyo State, Nigeria. METHODS: a cross-sectional facility based study using an interviewer-administered questionnaire was used to obtain information from 531 HCWs. In addition, 7 Key Informant Interviews was conducted. Discrete data were summarized as proportions while chi-square test was used to assess association between variables. A logistic regression model was used to assess predictors of knowledge of HCWs. All statistical significance was set at 5%. RESULTS: mean age of respondents was 42 ± 8.1 years with female preponderance (86.1%). Community Health Extension Workers (CHEWs) (36.9%) constituted the highest proportion of HCWs. About 70% and 90% of HCWs had good knowledge of EPDs and IDSR surveillance data flow respectively. Majority of HCWs 333(67.3%) knew how to use IDSR form 003 but less than 10% knew how to use other IDSR forms. The majority of HCWs {492(99.4%) and 345(69.7%)} agreed that reporting EPDs is necessary and IDSR tools are simple to use. Number of years post basic qualification was a predictor of HCWs' knowledge (AOR: 1.6; 95% CI: 1.0-2.3). CONCLUSION: this study showed poor knowledge on the use of IDSR forms although majority of HCWs had good knowledge and positive attitude towards IDSR strategy for EPDs. Thus, regular evaluation of health workers' knowledge and attitude towards IDSR strategy as a performance function of the surveillance system is recommended.</b><br/> text/html 2018-09-26T12:13:26+01:00 Luc Pascal Christian Loulouga Badinga, Nour Mekaoui, Lamiae Karboubi, Badr Sououd Benjelloun Dakhala [Case report] - Intoxication au M’khinza: &agrave; propos de deux observations - 06 September 2018. <b>Dysphania ambrosioides ou ans&eacute;rine, appel&eacute;e au Maroc M'Khinza est une plante appartenant &agrave; la famille des Chenopodiaceae. Utilis&eacute;e au Maroc pour ses propri&eacute;t&eacute;s th&eacute;rapeutiques notamment antipyr&eacute;tique, elle peut &ecirc;tre toxique si elle est mal dos&eacute;e. Nous rapportons deux cas d'intoxications collig&eacute;s au service des urgences m&eacute;dicales p&eacute;diatriques de Rabat: un nourrisson de 5 mois et une fille de 10 ans qui, suite &agrave; l'ingestion d'infusion de cette plante &agrave; des doses ind&eacute;termin&eacute;es dans un but antipyr&eacute;tique avaient pr&eacute;sent&eacute; respectivement une enc&eacute;phalopathie toxique et une d&eacute;shydratation s&eacute;v&egrave;re sur gastroent&eacute;rite aigu&euml; aboutissant aux d&eacute;c&egrave;s en moins de 12 heures. Ces nouveaux cas de neurotoxicit&eacute; et d'ent&eacute;rotoxicit&eacute; au M'Khinza doivent interpeler sur la n&eacute;cessit&eacute; de savoir &eacute;voquer le diagnostic, d'informer, de lutter contre la banalisation de sa consommation, d'inciter &agrave; la recherche sur la pharmacop&eacute;e traditionnelle permettant d'identifier leurs propri&eacute;t&eacute;s th&eacute;rapeutiques afin de formaliser, rationaliser et codifier leurs prescriptions.</b><br/> text/html 2018-09-26T12:13:26+01:00 Harriet Aber, Angela Nakanwagi Kisakye, Juliet Ndimwibo Babirye [Research] - Adherence to complementary feeding guidelines among caregivers of children aged 6-23 months in Lamwo district, rural Uganda - 06 September 2018. <b>INTRODUCTION: Malnutrition contributes to half of all deaths among children under-five years in developing countries such as Uganda. Optimal complementary feeding is one of the crucial interventions that could prevent these deaths. This study measured adherence to complementary feeding guidelines and its associated factors among caregivers of children aged 6-23 months in Lamwo district, rural Uganda. METHODS: a household cross-sectional study was used to collect data on adherence to complementary feeding among 349 caregivers. A composite variable with 9 indicators of complementary feeding was used to measure adherence. Univariable and multivariable logistic regression was used for statistical analysis using STATA software. RESULTS: a household cross-sectional study was used to collect data on adherence to complementary feeding among 349 caregivers. A composite variable with 9 indicators of complementary feeding was used to measure adherence. Univariable and multivariable logistic regression was used for statistical analysis using STATA software.nearly all (97.7%, 341/349) children had ever been breastfed. Complementary feeding was initiated at six months for 47.0% (164/349) of the children. The number of complementary meals ranged from 1-4 meals per day with a mean of 3 meals per day (SD = 0.8). About half (55.8%, 195/349) of the children were given less than the recommended amount of food. Overall only 40.1% (140/349) of all study respondents were adherent to complementary feeding guidelines. The odds of adherence to complementary feeding were higher among caregivers with children aged 6-8 months (AOR = 4.68, 95% CI: 1.91-11.48), children whose fathers had attained 8 or more years of formal education (AOR = 2.27, 95% CI: 1.22-4.19), caregivers with two children under five years (AOR = 5.46, 95% CI: 1.46-20.36), those living in the poorest households (AOR = 3.00, 95% CI: 1.37-6.57) and those who showed willingness to recommend initiation of complementary feeding at six months to another mother (AOR = 1.34 95% CI: 1.06-1.70). CONCLUSION: adherence to complementary feeding guidelines was very low in this rural African setting indicating an urgent need for interventions such as health education to improve adherence with consequent reduction in rates of under nutrition. These interventions should target caregivers with older children, fathers with less than 8 years of formal education and those living in the wealthiest households.</b><br/> text/html 2018-09-26T12:13:26+01:00 Michel Kengne, Marlise Beatrice Bidzogo Lebogo, Julius Mbekem Nwobegahay, Bienvenue Etogo Ondigui [Research] - Antibiotics susceptibility pattern of Streptococcus pneumoniae isolated from sputum cultures of human immunodeficiency virus infected patients in Yaound&eacute;, Cameroon - 05 September 2018. <b>INTRODUCTION: The susceptibility of Streptococcus pneumoniae to commonly used antibiotics is threatened by the emergence of resistance of S. pneumonia strains. So, to improve the management of lower respiratory tract infections (LRTIs) in human immunodeficiency virus infected patients, we assessed the antibiotic susceptibility of Streptococcus pneumoniae which is the most common bacterial cause of LRTIs in patients. METHODS: A cross sectional study was carried out from May to October 2014. HIV infected patients suspected of LRTIs attending the Center Medical laboratory and those followed up at the authorized treatment center of Yaounde Military Hospital in Cameroon were enrolled. Sputum was collected from each patient and cultured; identification of microorganisms was performed following standard methods. The disk diffusion method was used for antibacterial susceptibility testing according to the Antibiogram Committee of French Society for Microbiology guidelines. RESULTS: A total of 51 (25.5%) isolates of S. pneumoniae were recovered from sputum samples obtained from 200 HIV infected patients aged 19-66 years old (mean age: 36±10.087 years old); 144 (72%) of them were female (sex ratio M/F: 1/3). S. pneumoniae carriage was not age dependent (P = 0.384) and was significantly higher in male compared to female (P = 0.008). S. pneumoniae isolates were susceptible to amoxicillin-clavulinic acid (100%), pristinamycin (100%), erythromycin (100%) and cefixime (98.04 %). Highest resistance rates were recorded with fusidic acid (100%), fosfomycin (100%) and tetracyclin (100%). CONCLUSION: S. pneumoniae is still susceptible to some agents in our study area however; ongoing surveillance for antimicrobial susceptibility remains essential to identify emerging resistance and attempt to limit its spread.</b><br/> text/html 2018-09-26T12:13:26+01:00 Steven Tandean, Lutfi Hendriansyah, Stanislaus Djokomujianto, Nico Adi Saputra, Andry Juliansen, Silvia Valentina, Monica Ann Mulry, Julius July [Case report] - Neuroendoscopic aspiration and lavage of intraventricular empyema following shunt infection in infants - 05 September 2018. <b>Bacterial ventriculitis is one of the most common and serious complications of shunt placement. Shunt infection has varied management and is difficult to treat neurosurgically. We report a case of intraventricular empyema due to shunt infection. Standard management was failed for this case and reaccumulation of pus in the both ventricles. Neuroendoscopic surgery with intraventricular lavage and aspiration using cannula nasogastric tube (NGT) through a single burr hole, has successfully decreased the accumulation of intraventricular empyema. After lavage and aspiration, antibiotic can be distributed effectively to the affected area. Follow up imaging and cerebrospinal fluid (CSF) culture shown a good result and shorter length of stay in the hospital. Neuroendoscopy appears effective and safe for the management of bacterial ventriculitis due to shunt infection in infant. The strategy described in this report might be useful to treat intraventricular empyema.</b><br/> text/html 2018-09-26T12:13:26+01:00 Houyem Mansouri, Ines Ben Safta, Med Ali Ayadi, Selma Gadria, Tarek Ben Dhiab, Khaled Rahal [Case series] - Cancers primitifs de la verge: &agrave; propos de 11 cas et revue de la litt&eacute;rature - 04 September 2018. <b>Le cancer de la verge est une pathologie rare en Tunisie ou la circoncision est de pratique courante. Il s'agit dans 95% des cas d'un carcinome &eacute;pidermo&iuml;de. Le traitement repose essentiellement sur la chirurgie. Nous rapportons r&eacute;trospectivement les caract&egrave;res &eacute;pid&eacute;miologique, clinique, th&eacute;rapeutique et &eacute;volutif de 11 cas de cancers primitifs de la verge.</b><br/> text/html 2018-09-26T12:13:26+01:00 Fatogoma Issa Kon&eacute;, Kadidiatou Singar&eacute;, Siaka Soumaoro, Naouma Ciss&eacute;, N’Faly Konat&eacute;, Kassim Diarra, Yaya Demb&eacute;l&eacute;, Samba Karim Timbo, Mohamed Amadou Ke&iuml;ta [Case report] - Le traitement conservateur m&eacute;dical de la fistule œsotracheale - 04 September 2018. <b>Les fistules œsotrach&eacute;ales repr&eacute;sentent une entit&eacute; pathologique caract&eacute;ris&eacute;e par la pr&eacute;sence d'une communication anormale entre l'arbre trach&eacute;al et l'œsophage. A travers un cas clinique de fistule œsotrach&eacute;ale suite &agrave; l'ingestion d'un corps &eacute;tranger, nous abordions l'aspect &eacute;tiopathog&eacute;nique, &eacute;valuer notre principe th&eacute;rapeutique et faire une revue de la litt&eacute;rature. Il s'agit d'un patient de 15ans admis pour dysphagie &eacute;voluant depuis deux mois suite &agrave; l'ingestion d'un corps &eacute;tranger &agrave; type de morceau d'os. L'œsophagoscopie sous anesth&eacute;sie g&eacute;n&eacute;rale a permis l'extraction du corps &eacute;tranger. Le Transit Oeso-gastro-duod&eacute;nal (TOGD) en post-op&eacute;ratoire a objectiv&eacute; l'orifice fistulaire si&eacute;geant au niveau de C7. L'absence de l'orifice fistulaire a &eacute;t&eacute; not&eacute;e &agrave; J30 post-endoscopie au TOGD de contr&ocirc;le. Le traitement m&eacute;dical est une alternative th&eacute;rapeutique de la fistule œsotrach&eacute;ale et doit &ecirc;tre bas&eacute; sur des crit&egrave;res bien d&eacute;finis.</b><br/> text/html 2018-09-26T12:13:26+01:00 Mohamed El Amraoui, Badredine Hassam [Images in medicine] - Lichen with triple involvement: cutaneous, mucous and phanerian - 04 September 2018. <b>Lichen is a common chronic inflammatory dermatitis that can affect the skin, mucous membranes and phaneres. The simultaneous involvement of the three compartments is rare and testifies to the severity and activity of the disease. We present a case of this triple involvement. However, the complete muco-cutaneous and phanerienic forms are rare, testify to the severity of the disease and justify a systemic treatment and a regular and long-term monitoring view the risk of degeneration of the mucous lesions. We report the case of this 60-old-man, followed for papular dermatosis, hyperpigmentary, very itchy, generalized, with involvement of the genital mucosa, in the form of erosive balanitis and nails of the hands and feet. The cutaneous histology was in favor of lichen. The biological examinations did not show any dysthyroidism, liver or autoimmune diseases. The patient was placed on systemic and topical corticosteroids. A pigmentogenic evolution of the cutaneous lesions, a beginning of bleaching of the nail lesions and a resistance of the genital lesions were noted.</b><br/> text/html 2018-09-26T12:13:26+01:00 Mohamed El Amraoui, Abdelhafid Achbouk [Images in medicine] - A bleeding tumor of the foot - 04 September 2018. <b>Botriomycoma or pyogenic granuloma is a benign vascular tumor very common in daily practice, which often sits at the extremities and is favored by trauma. The evolution is often favorable enamelled by the frequency of recidivism; however some atypical or massively bleeding forms pose diagnostic and therapeutic difficulties. We present a case illustrating this problematic. Botriomycoma or pyogenic granuloma is a non-rare benign vascular tumor, favored by trauma, mainly at the extremities and characterized by post-traumatic bleeding recurrence. Spectacular and massively bleeding forms are rarely reported. We present a case. A 60-year-old woman, with a history of a recessive infra-centimeter nodule of the second left toe. Has consulted for an increase of this nodule up to three centimeters in diameter. She was lost to follow-up for four months, and then she reconsulted for the same tumefaction which became ulcerated and massively bleeding and having increased in volume to reach five centimeters of large diameter. Ultrasound showed a superficial and much vascularized tumor. In view of the very haemorrhagic character and the repercussions on the general condition of the patient, a total resection of the tumor was done urgently and the histology was in favor of a botriomycoma without signs of malignancy. The evolution was favorable. Most botriomyomas are small and at risk of recurrence, but rapidly progressive and massively bleeding tumor forms, as noted case, requires rapid management and collaboration between dermatologist and plastic surgeon.</b><br/> text/html 2018-09-26T12:13:26+01:00 Desmorys Raoul Moh, Anani Badj&eacute;, Nogbou Frederic Ello, Jean-Baptiste N’takp&eacute;, Jean-Baptiste Anzouan-Kacou, G&eacute;rard Menan Kouam&eacute;, Simplice Ackoundz&eacute;, Franck Boccara, Olivier Ba-Gomis, Serge-Paul Eholi&eacute;, Xavier Anglaret, Christine Danel [Case report] - Dissection aortique an&eacute;vrismale chez un adulte infect&eacute; par le VIH-1 dans le cadre d’un syndrome de reconstitution immune avec tuberculose - 04 September 2018. <b>Un homme de 35 ans, VIH-1, sans antécédents médicaux et chirurgicaux particuliers, a été hospitalisé à Abidjan, Côte d’Ivoire, dans un contexte fébrile, toux, dyspnée, douleurs thoraciques et à la radiographie pulmonaire, un déroulement de la crosse de l’aorte une semaine après avoir débuté les antirétroviraux (ARV). Les scanners angiothoraciques réalisés ont mis en évidence une ectasie aortique globale étendue avec thrombus mural. Une échocardiographie transoesophagienne conclut à une dissection aortique, type A de Stanford. Le diagnostic de tuberculose a été confirmé par l’isolation en culture de Mycobacterium Tuberculosis. Huit ans après, le patient est encore vivant, sans intervention chirurgicale et se plaint de douleurs thoraciques intermittentes. Sa pression artérielle est stable et a une insuffisance rénale modérée. Nous rapportons un cas rare de dissection aortique anévrismale chez un adulte infecté par le VIH-1 dans le cadre d’un syndrome de reconstitution immune avec tuberculose pulmonaire.</b><br/> text/html 2018-09-26T12:13:26+01:00 Amel Harzallah, Hayet Kaaroud, Narjess Laadhari, Rim Goucha, Ezzeddine Abderrahim, Sami Turki, Fethi Ben Hmida, Samia Barbouch, Taieb Ben Abdallah [Report] - Pronostic r&eacute;nal de la n&eacute;phropathie des vascularites &agrave; IgA de l’adulte: &eacute;tude monocentrique, &agrave; propos de 25 cas - 04 September 2018. <b>La n&eacute;phropathie de la vascularite &agrave; IgA conditionne le pronostic de cette affection chez l’adulte. Le but de notre &eacute;tude &eacute;tait d’&eacute;tudier les caract&eacute;ristiques cliniques de cette atteinte r&eacute;nale chez l’adulte et d’identifier les facteurs de pronostic r&eacute;nal. Il s’agit d’une &eacute;tude monocentrique r&eacute;trospective portant sur les patients ayant une vascularite &agrave; IgA (purpura rhumato&iuml;de) (crit&egrave;res de l’EULAR) avec une atteinte r&eacute;nale prouv&eacute;e histologiquement et class&eacute;e selon la classification de Pillebout. Nous avons analys&eacute; la survie r&eacute;nale et identifier les facteurs de pronostic r&eacute;nal. Vingt cinq patients ont &eacute;t&eacute; inclus (genre ratio M/F = 2,57) d’&acirc;ge moyen au diagnostic du purpura rhumato&iuml;de de 35,76 ans. Un purpura &eacute;tait pr&eacute;sent dans 100% des cas avec une atteinte articulaire dans 28%. Une insuffisance r&eacute;nale &eacute;tait pr&eacute;sente dans 44% des cas. La classification histologique la plus fr&eacute;quente &eacute;tait la classe II. Une r&eacute;mission clinique a &eacute;t&eacute; observ&eacute;e dans 44% des cas et une &eacute;volution vers le stade terminal de l’insuffisance r&eacute;nale chronique dans 36% des cas. La survie r&eacute;nale &agrave; 195 mois &eacute;tait de 57%. Les facteurs pronostiques identifi&eacute;s &eacute;taient l’atteinte digestive (p = 0,022), l’insuffisance r&eacute;nale initiale (p = 0,0004), la classification glom&eacute;rulaire (p = 0001) et la s&eacute;v&eacute;rit&eacute; des l&eacute;sions histologiques, le traitement par bloqueurs du syst&egrave;me r&eacute;nine angiotensine (p = 0,01) et les &eacute;changes plasmatiques (p = 0,03). Notre &eacute;tude montre que l’atteinte r&eacute;nale au cours des vascularites &agrave; IgA peut &ecirc;tre relativement s&eacute;v&egrave;re avec un mauvais pronostic r&eacute;nal. L’identification des facteurs pronostiques cliniques et histologiques pourrait guider l’&eacute;laboration d’&eacute;tudes th&eacute;rapeutiques prospectives.</b><br/> text/html 2018-09-26T12:13:26+01:00 Ghizlan EL Amri, Mohamed Zalagh, Fouad Benariba [Case report] - Un lymphome T/NK extra-ganglionnaire de type nasal se pr&eacute;sentant comme une cellulite orbitaire - 04 September 2018. <b>Le lymphome extra-ganglionnaire T/NK de type nasal est une forme rare des lymphomes malins non hodgkinien. Elle pose un probl&egrave;me diagnostique &agrave; cause des sympt&ocirc;mes peu sp&eacute;cifiques. Nous rapportons un cas de lymphome T/NK simulant une cellulite orbitaire. Il s'agit d'une patiente de 46 ans, suivie pour maladie de Beh&ccedil;et. Admise dans un tableau clinique de cellulite orbitaire. Le scanner du massif facial montrait une pansinusite avec infiltration orbitaire. En l'absence d'am&eacute;lioration sous traitement antibiotique. Un traitement chirurgical avec biopsie a &eacute;t&eacute; r&eacute;alis&eacute;. L'examen histologique a mis en &eacute;vidence des signes de vascularite inflammatoire et la patiente a &eacute;t&eacute; mise sous corticoth&eacute;rapie avec am&eacute;lioration clinique. Devant la r&eacute;cidive la patiente a b&eacute;n&eacute;fici&eacute; d'une reprise chirurgicale avec des biopsies de l'ethmo&iuml;de qui ont mis en &eacute;vidence un lymphome T/NK de type nasal. Le traitement a consist&eacute; en une radio-chimioth&eacute;rapie et la patiente est d&eacute;c&eacute;d&eacute;e dans les deux mois. Les lymphomes T/NK sont agressifs, ils touchent essentiellement les cavit&eacute;s naso-sinusiennes. Ils sont responsables d'une angio-destruction et de la n&eacute;crose qui rendent les sympt&ocirc;mes peu sp&eacute;cifiques et les biopsies souvent n&eacute;gatives, posant un probl&egrave;me de diagnostic diff&eacute;rentiel. Le traitement repose sur la radioth&eacute;rapie et la chimioth&eacute;rapie et le pronostic reste r&eacute;serv&eacute;.</b><br/> text/html 2018-09-26T12:13:26+01:00 Asma Korbi, Amel khaskhoussy, Ons Cherif, Ahmed Hajji, Imen Gaddab, Amel Chaabene, Mouna Gara, Fathi Jbeli, Lotfi Grati, Med Salah Rhim, Raja Faleh [Case report] - Anaphylactic shock due to patent blue: case report and review of literature - 04 September 2018. <b>Intraoperative search for the sentinal node using patent blue is considered a non risk procedure. We emphasize the highly exceptional nature of this adverse effect previously observed in other disciplines using this coloring agent. We present a case of allergic reaction to patent blue in a patient who underwent left mastectomy with sentinel lymph node. About 25 min after the dye injection, the patient developed increased heart frequency and allergic skin reaction. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. The patient recovered uneventfully and was discharged from the PACU 3h after the end of surgery without skin changes and was discharged from hospital on the morning after surgery. Allergic reactions with the use of patent blue are far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye. Skin tests done later confirmed allergy to patent blue dye; the tests induced a small syndrome reaction. Surgical personnel who use patent blue dye should be made aware of the risk of allergic reactions, sometimes severe, to this dye.</b><br/> text/html 2018-09-26T12:13:26+01:00 Amine Kessab, Safaa Rokhssi, Meriem Rais, Mohamed Anass Benbouzid, Leila Esskalli, Nadia Cherradi [Case report] - Tumeur du sac endolymphatique au niveau du rocher: &agrave; propos d’un cas - 03 September 2018. <b>La tumeur du sac endolymphatique est une tumeur neuroectodermique rare d&eacute;riv&eacute;e de l’oreille interne qui poss&egrave;de un faible potentiel de malignit&eacute; mais avec un pouvoir d’agressivit&eacute; locale tr&egrave;s marqu&eacute; sans notion de m&eacute;tastase. Il s’agit d’un patient de 60 ans qui a pr&eacute;sent&eacute; des signes d’appel en faveur d’une atteinte de l’oreille interne accompagn&eacute; de sympt&ocirc;mes en faveur d’une atteinte de l’angle ponto c&eacute;r&eacute;belleux. L’examen radiologique par IRM a montr&eacute; un processus l&eacute;sionnel envahissant la masto&iuml;de et l’os temporal. L’examen anatomopathologique confirme la nature tumorale en pr&eacute;cisant le type histologique par une &eacute;tude immunohistochimique en retenant le diagnostic de tumeur sporadique du sac endolymphatique. Cette tumeur peut arriver &agrave; n’importe quel &acirc;ge avec une moyenne de 52 ans pour les cas sporadiques. Sur le plan histologique on distingue deux entit&eacute;s: papillaire et folliculaire. Il faut &eacute;liminer les autres diagnostiques diff&eacute;rentiels surtout les m&eacute;tastases du carcinome thyro&iuml;dien. La difficult&eacute; de la r&eacute;section chirurgicale de ces tumeurs est due &agrave; leur vascularisation et &agrave; leur infiltration dans les os et les m&eacute;ninges. L'excision compl&egrave;te est la meilleure garantie contre la r&eacute;cidive tumorale.</b><br/> text/html 2018-09-26T12:13:26+01:00 Aida Ida Tankoano, Judicael Marouane Milcisedek Some, Dominique Bicaba, Gis&egrave;le Marie Ursule Tapsoba, Adama Jean Honor&eacute; Konat&eacute;, D&eacute;nis Kontogom, Zakari Niki&egrave;ma [Case report] - Aspect tdm d’une anomalie de l’arc aortique: variante de Nehausser? - 03 September 2018. <b>Les malformations cong&eacute;nitales par anomalie de position et de d&eacute;veloppement des arcs brachiaux primitifs repr&eacute;sentent 1% des anomalies cong&eacute;nitales cardio-vasculaires. Nous rapportons le cas rare d'un nourrisson de 22 mois, n&eacute; par voie basse d'une grossesse men&eacute;e &agrave; terme qui a pr&eacute;sent&eacute; une dyspn&eacute;e intermittente depuis la naissance associ&eacute;e &agrave; une toux. L'angio-scanner cervico-thoracique a permis d'objectiver un arc aortique droit et une art&egrave;re sub-clavi&egrave;re gauche pr&eacute;-trach&eacute;o-oesophagienne prenant en pince l'œsophage et la trach&eacute;e &agrave; environ 15 mm au-dessus de la car&egrave;ne entrainant une st&eacute;nose d'environ 70% de la trach&eacute;e sur une hauteur de 16 mm. Cette malformation complexe repr&eacute;sente un type rare d'anomalie de l'arc aortique avec une variante inhabituelle du trajet de l'art&egrave;re sub-clavi&egrave;re gauche. Elle pose un probl&egrave;me diagnostique et de traitement dans notre contexte du fait des difficult&eacute;s d'accessibilit&eacute; au scanner et &agrave; la chirurgie.</b><br/> text/html 2018-09-26T12:13:26+01:00 Tariq Bouhout, Badr Serji, Ebo Usman Egyir, Benyounes El Amri, Imad Bouhout, Mehdi Soufi, Mohammed Bouziane, Tijani El Harroudi [Case report] - L’endom&eacute;triose de la paroi abdominale: &agrave; propos d’un cas - 03 September 2018. <b>L'endom&eacute;triose de la paroi abdominale, d&eacute;finie comme l’implantation ectopique du tissu endom&eacute;trial en dehors de la cavit&eacute; ut&eacute;rine, est une affection rare et souvent m&eacute;connue. Elle survient habituellement sur cicatrice d'intervention chirurgicale gyn&eacute;cologique ou obst&eacute;tricale. La pr&eacute;sentation clinique typique est celle d’une masse pari&eacute;tale associ&eacute;e &agrave; des douleurs rythm&eacute;es par les menstruations. Le diagnostic est confirm&eacute; par l’histologie. Le traitement est principalement chirurgical et repose sur l’ex&eacute;r&egrave;se compl&egrave;te de la l&eacute;sion.</b><br/> text/html 2018-09-26T12:13:26+01:00 Ernest Kateule, Ramya Kumar, Modest Mulenga, Victor Daka, Kelvin Banda, Raydel Anderson, Rebecca McNall, Marcia McGrew, Henry Baggett, Webster Kasongo [Research] - Mumps outbreak in an unimmunized population – Luanshya District, Copperbelt Province, Zambia, 2015 - 03 September 2018. <b>INTRODUCTION: Mumps is a vaccine-preventable viral disease that may cause deafness, orchitis, encephalitis or death. However, mumps vaccine is not included in Zambia’s Expanded Program for Immunization. In January 2015, Integrated Disease Surveillance and Response data revealed an increase in reported mumps cases in Luanshya District. We investigated to confirm the etiology and generate epidemiological data on mumps in Zambia. METHODS: We conducted active case finding, examined possible case-patients, and administered a standard questionnaire. A suspected mumps case was defined as acute onset of salivary gland swelling in a Luanshya resident during January - June 2015. Eight case-patients provided serum samples to test for mumps-specific immunoglobulin IgM, and buccal swabs to test for mumps viral RNA by RT-PCR, and genotyping of mumps virus at the Centers for Disease Control and Prevention, Atlanta, Georgia, USA. RESULTS: From January – June 2015, a total of 283 mumps cases were reported in Luanshya, peaking in April (71 cases) and clustering (81%) in two townships. Of 72 suspected case-patients interviewed, 81% were aged < 15 years (29%, 1 - 4 years) and 61% were female. Common clinical characteristics were buccal tenderness (29%) and fever > 37.5ºC (29%). Mumps virus genotype D was confirmed in five case-patients who tested positive by RT-PCR; six case-patients were sero-positive for anti-mumps IgM antibodies (total seven lab-confirmed cases). CONCLUSION: Our findings represent the first reported epidemiologic description of mumps in Zambia. While the epidemiology is consistent with prior descriptions of mumps in unimmunized populations and no serious complications arose, this report provides data to inform policy discussions regarding mumps vaccination in Zambia.</b><br/> text/html 2018-09-26T12:13:26+01:00 Abdelkader Jalil El Hangouche, Oumaima Alaika, Koffi Augustin Assié, Latifa Oukerraj, Nawal Doghmi, Taoufiq Dakka, Mohammed Cherti [Case report] - A complicated steroid resistant nephrotic syndrome: a large intracardiac thrombus with bilateral distal embolization - 03 September 2018. <b>Nephrotic syndrome (NS) is a consequence of the reduced ability of the glomerulus barrier to exclude proteins of intermediate size and other macromolecules from urine. Albumin and proteins that modulate the coagulation cascade are among the substances eliminated in urine. This is responsible of thromboembolic complication. The incidence of this extra renal complication is probably underestimated because of asymptomatic thromboembolic events. We report the case of a 23 years old man followed up for an idiopathic nephrotic syndrome since childhood who presented a large intracardiac thrombus complicated by distal embolisation of his two lower limbs, successfully treated by fogartisation-embolectomy and oral anticoagulation.</b><br/> text/html 2018-09-26T12:13:26+01:00 Frederick Oporia, Angela Nakanwagi Kisakye, Rebecca Nuwematsiko, Abdulgafoor Mahmood Bachani, John Bosco Isunju, Abdullah Ali Halage, Zziwa Swaibu, Lynn Muhimbuura Atuyambe, Olive Kobusingye [Research] - An analysis of trends and distribution of the burden of road traffic injuries in Uganda, 2011 to 2015: a retrospective study - 02 September 2018. <b>INTRODUCTION: gobally, 1.3 million people die from road traffic injuries every year. Over 90% of these deaths occur in low-and-middle-income countries. In Uganda, between 2012 and 2014, about 53,147 road traffic injuries were reported by the police, out of which 8,906 people died. Temporal and regional distribution of these injuries is not known, hence hindering targeted interventions. We described the trends and distribution of health facility reported road traffic injuries in Uganda from 2011 to 2015.METHODS: we obtained monthly data on road traffic injuries, from 112 districts from the Ministry of Health Uganda. We analyzed the data retrospectively to generate descriptive statistics. RESULTS: a total of 645,805 road traffic injuries were reported from January 2011 through December 2015 and 2,807 deaths reported from 2011 through 2014. Injuries increased from 37,219 in 2011 to 222,267 in 2014 and sharply dropped in December 2015 to 57,149. Kampala region had the highest number of injuries and deaths (18.3% (117,950/645,805) and 22.6% (634/2807)) respectively whereas Karamoja had the lowest injuries and deaths (1.7% (10,823/645,805) and 0.8% (21/2807)) respectively. Children aged 0-4 years accounted for 21.9% (615/2807) deaths; mostly females 81% (498/615) were affected. CONCLUSION: road traffic injuries increased during 2011-2014. Injuries and deaths were highest in Kampala and lowest in Karamoja region. It was noted that health facilities mostly received serious injuries. It is likely that the burden is higher but under reported. Concerted efforts are needed to increase road safety campaigns in Kampala and surrounding regions and to link pre-hospital deaths so as to understand the burden of road traffic crashes and recommend appropriate interventions.</b><br/>