Pan african Medical Journal - Volume 33 Pan african Medical Journal. Volume 33 http://www.panafrican-med-journal.com/ 2019-08-23T13:12:38+01:00 pamj logo http://www.panafrican-med-journal.com http://www.panafrican-med-journal.com/img/logo.png text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Valerian Mwenda, Jane Githuku, Gladwell Gathecha, Benjamin Maranga Wambugu, Zeinab Gura Roka, Willis Owino Ong'or [Research] - Prevalence and factors associated with chronic kidney disease among medical inpatients at the Kenyatta National Hospital, Kenya, 2018: a cross-sectional study - 23 August 2019. http://www.panafrican-med-journal.com/content/article/33/321/abstract/ <b>INTRODUCTION: The burden of chronic kidney disease (CKD) is increasing worldwide. Few studies in low and low-middle income countries have estimated the prevalence of CKD. We aimed to estimate prevalence and factors associated with CKD among medical inpatients at the largest referral hospital in Kenya. METHODS: we conducted a cross-sectional study among medical inpatients at the Kenyatta National Hospital. We used systematic random sampling and collected demographic information, behavioural risk factors, medical history, underlying conditions, laboratory and imaging workup using a structured questionnaire. We estimated glomerular filtration rate (GFR) in ml/min/1.73m2 classified into 5 stages; G1 (? 90), G2 (60-89), G3a (45-59), G3b (30-44), G4 (15-29) and G5 (<15, or treated by dialysis/renal transplant). Ethical approval was obtained from Kenyatta National Hospital/University of Nairobi ethics committee (P510/09/2017). We estimated prevalence of CKD and used logistic regression to determine factors independently associated with CKD diagnosis. RESULTS: we interviewed 306 inpatients; median age 40.0 years (IQR 24.0), 162 (52.9%) were male, 155(50.7%) rural residents. CKD prevalence was 118 patients (38.6%, 95% CI 33.3-44.1); median age 42.5 years (IQR 28.0), 74 (62.7%) were male, 64 (54.2%) rural residents. Respondents with CKD were older than those without (difference 4.4 years, 95% CI 3.7-8.4 years, P = 0.032). Fifty two (44.1%) of the patients had stage G2, 17 (14.4%) had end-stage renal disease; 64(54.2%) had haemoglobin ? 8g/dl while 33 (28.0%) had hyponatremia. Male sex (aOR 2.63, 95% CI 1.49-4.63), history of anaemia (aOR 1.80, 95% CI 1.02-3.19), proteinuria (aOR 5.16, 95% CI 2.09-12.74), hematuria (aOR 7.68, 95% CI 2.37-24.86), hypertension (aOR 2.71, 95% CI 1.53-4.80) and herbal medications use (aOR 1.97, 95% CI 1.07-3.64) were independently associated with CKD. CONCLUSION: burden of CKD was high among this inpatient population. Haematuria and proteinuria can aid CKD diagnosis. Public awareness on health hazards of herbal medication use is necessary.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Basil Benduri Kaburi, Fred Yaw Bio, Chrysantus Kubio, Donne Kofi Ameme, Ernest Kenu, Samuel Oko Sackey, Edwin Andrew Afari [Research] - Psychological working conditions and predictors of occupational stress among nurses, Salaga Government Hospital, Ghana, 2016 - 23 August 2019. http://www.panafrican-med-journal.com/content/article/33/320/abstract/ <b>INTRODUCTION: Occupational stress is a recognized health problem among nurses. Globally, its prevalence varies between 9.2% and 68.0%. It detracts from nurses' quality of life and efficiency of job performance. In Ghana, we do not know the important contributory factors to this problem. Our study sought to identify the important predictors of occupational stress among nurses. METHODS: in January 2016, we conducted an institutional-based survey among nurses of Salaga Government Hospital. They completed a five-point Likert type questionnaire adopted from the British Psychological Working Conditions Survey, and the Nurse Stress Index. Across 30 predictor variables, a mean score of 4.00 to 5.00 represented high to extreme occupational stress. We performed bivariate and multivariate analyses to identify important predictors of occupational stress at 95% confidence level. RESULTS: of 167 nurses, 58.1% (97) were females. Respondents who experienced high to extreme stress levels had a 2.3 times odds of reporting sickness absence (CI: 1.03-5.14). Sources of occupational stress included: manual lifting of patients and pieces of equipment (OR: 16.23; CI: 6.28 - 41.92), the risks of acquiring infections (OR: 14.67; CI 5.90 - 36.46), receiving feedback only upon unsatisfactory performance (OR: 28.00; CI: 9.72 - 80.64), and inadequate opportunities for continuous professional development (OR: 63.50; CI: 19.99 - 201.75). CONCLUSION: the working conditions of nurses were stressful. The most significant predictors of occupational stress were poor supportive supervision by superiors, lack of adequate skills to perform routine tasks, uncertainty about their job role, and the lack of adequate opportunities for career advancements.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fatima-zahra Agharbi [Images in medicine] - Tumeur noire de l’ombilic - 22 August 2019. http://www.panafrican-med-journal.com/content/article/33/319/abstract/ <b>Les nævus pigmentaires, encore appelés nævus mélanocytaires ou plus improprement « nævus nævocellulaires » sont des tumeurs mélanocytaires bénignes caractérisées par une prolifération de mélanocytes à proximité de la jonction dermoépidermique, avec un regroupement en amas ou thèques qui les différencient des mélanocytes normaux. Les nævus congénitaux sont présents dès la naissance et surviennent chez environ 1% des nouveau-nés sans prédominance de sexe. Leur survenue est très majoritairement sporadique, bien qu'existent aussi de rares formes familiales. Ils peuvent être séparés de manière arbitraire en fonction de leur plus grand diamètre le jour de la naissance: petits nævus congénitaux si <1,5cm, moyens de 1,5 à 20cm et grands si > à 20cm. L'ombilic est une localisation rare de naevus. Nous rapportons un cas de nævus congénital dont la localisation atypique et rare nous a paru intéressante à rapporter. Il s'agit d'une jeune fillette qui consultait pour un nodule pigmenté de l'ombilic remontant à la naissance devenu gênant récemment. Devant cet aspect clinique nous avons évoqué: un nævus, un mélanome ou une endométriose. Une exérèse a été réalisée confirmant le diagnostic de naevus.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Chigozie Jesse Uneke, Henry Chukwuemeka Uro-Chukwu, Onyedikachi Echefu Chukwu [Review] - Validation of verbal autopsy methods for assessment of child mortality in sub-Saharan Africa and the policy implication: a rapid review - 22 August 2019. http://www.panafrican-med-journal.com/content/article/33/318/abstract/ <b>Reliable data on the cause of child death is the cornerstones for evidence informed health policy making towards improving child health outcomes. Unfortunately, accurate data on cause of death is essentially lacking in most countries of sub-Saharan Africa due to the widespread absence of functional Civil Registration and Vital Statistics (CRVS) systems. To address this problem, verbal autopsy (VA) has gained prominence as a strategy for obtaining Cause of Death (COD) information in populations where CRVS are absent. This study reviewed publications that investigated the validation of VA methods for assessment of COD. A Medline PubMed search was undertaken in June 2018 for studies published in English that investigated the validation of VA methods in sub-Saharan Africa from 1990-2018. Of the 17 studies identified, 9 fulfilled the study inclusion criteria from which additional five relevant studies were found by reviewing their references. The result showed that physician certified verbal autopsy (PCVA) was the most widely used VA method. Validation studies comparing PCVA to hospital records, expert algorithm and Inter VA demonstrated mixed and highly varied outcomes. The accuracy and reliability of the VA methods depended on level of healthcare the respondents have access to and the knowledge of the physicians on the local disease aetiology and epidemiology. As the countries in sub-Saharan Africa continues to battle with dysfunctional CRVS system, VA will remain the only viable option for the supply of child mortality data necessary for policy making.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Benilde Bepouka Izizag, Aaron Ngandu, Daddy Liombo Mbiso [Case report] - Syndrome de la selle turcique vide: à propos d’un cas - 21 August 2019. http://www.panafrican-med-journal.com/content/article/33/317/abstract/ <b>Le syndrome de la selle vide est une affection dans laquelle la selle turcique est partiellement ou complètement remplie de LCR, entraînant un déplacement de l'hypophyse. Nous rapportons le cas d'un patient obèse de 49 ans qui a présenté de façon progressive les céphalées, une asthénie physique et une hypothyroïdie et chez qui le scanner cérébral a été en faveur d'un syndrome de la selle turcique vide.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Amadou Doumbia, Youssouf Koné, Abdoulaye Koné, Oumou Maïga, Adama Dembélé [Case report] - Syndrome de Kartagener de découverte fortuite au cours d'un bilan d'infécondité du couple à propos d'un cas - 21 August 2019. http://www.panafrican-med-journal.com/content/article/33/316/abstract/ <b>Le syndrome de Kartagener est une entité particulière parmi les dyskinésies ciliaires primitives (DCP) caractérisée par une triade clinique: sinusite, bronchectasie et situs inversus complet ou incomplet. C'est une maladie congénitale rare à transmission autosomique récessive. Nous rapportons un cas de syndrome de Kartagener dans un contexte d'infertilité avec une akinospermie au spermogramme.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Nkengafac Boris Anu, Claude Ngwayu Nkfusai, Marvelle Nanyongo Mbua Evelle, Liza Enanga Efande, Fala Bede, Joyce Shirinde, Samuel Nambile Cumber [Research] - Prevalence of stillbirth at the Buea Regional Hospital, Fako Division south-west region, Cameroon - 21 August 2019. http://www.panafrican-med-journal.com/content/article/33/315/abstract/ <b>INTRODUCTION: The study investigated the prevalence of stillbirth at the Buea Regional Hospital, by taking cases of pregnant women who attended antenatal clinic(s) and those who did not attend but had thier deiveries at the Buea regional hospital. The study specifically estimated the prevalence of stillbirths; identified possible risk factors associated with stillbirths, and determined whether the number of antenatal clinic visits is related to the occurrence of stillbirths-because during antenatal clinic visits, pregnant women are educated on risk factors of stillbirths such as: preterm deliveries; sex of the stillbirth; history of stillbirth; history of abortion(s); what age group of mothers are more likely to have a stillbirth. METHODS: the study was a hospital based retrospective study at the maternity in which there were 3577 deliveries registered at the Buea Regional Hospital dated May 1st, 2014 to April 30th, 2017. With the aid of a checklist data was collected, analysed and presented with the use of tables, pie-charts and bar charts. RESULTS: the prevalence of stillbirths was 26‰; possible risk factors associated with stillbirths included: preterm deliveries; women aged 20-29 years; history of abortion(s); a history of stillbirth; sex of stilbirths were more of females than males; and insufficient antenatal clinic attendance (&#8804;1 antenatal clinic attendence) had more stillbirths. CONCLUSION: the study estabished that stillbirths can occur in any woman of child-bearing age. possible risk factors associated with stillbirths included: preterm deliveries; women aged 20-29 years; history of abortion(s); a history of stillbirth; gender of stilbirths were more of females than males; and insufficient antenatal clinic attendance (&#8804;1 antenatal clinic attendence) had more stillbirths.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Annabel Ako Mangwi, Peter Vanes Ebasone, Desmond Aroke, Larry Tangie Ngek, Ako Simon Nji [Case report] - Non-obstetric vulva haematomas in a low resource setting: two case reports - 20 August 2019. http://www.panafrican-med-journal.com/content/article/33/314/abstract/ <b>Vulva haematomas are uncommon outside the obstetric population, with an incidence of 3.7% and represent only 0.8% of all gynaecological emergencies. The first case is a 24-year-old G2P1011 referred after the failure of conservative management of a progressively increasing right labia majora swelling. Vulva incision, exploration and relieve of hematoma were done under local anaesthesia. The second case is a 17-year-old G1P1001, a student who presented with spontaneous pain and swelling of the left labia majora. The swelling was rapidly increasing, tense and tender. It spontaneously ruptured, clots were drained and the wound was packed. Vulva hematomas are not very common hence necessitating careful assessment, right diagnosis and management. Management could be conservative (analgesics, local compression) as well as surgical in cases of hemodynamic instability, rapidly increasing size of hematoma and pain intensity. Prompt surgical management reduces the risk of infection and longer hospital stays, which is important in low resource settings like ours.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Dwayne Koot, Alicia McMaster, Monique Nel, Alet van Tonder, Alan Barret, Poobalan Naidoo [Perspectives] - Medical Science Liaisons (MSL) in Africa: a perspective - 20 August 2019. http://www.panafrican-med-journal.com/content/article/33/313/abstract/ <b>The role of a Medical Science Liaison (MSL) is of growing importance to pharmaceutical, biotechnology, diagnostic and medical device companies. Through scientific engagement MSLs add value to clinical practice, ultimately benefiting patients. The MSL role is dynamic and encompasses in-depth product and disease knowledge together with the ability to communicate relevant, unbiased scientific information concisely and timely. Tasks are focussed on contributing towards the advancement of medical knowledge, scientific data generation and dissemination. Professional relationships are developed, fostering collaboration between external experts and typically the medical affairs departments of pharmaceutical companies through a credible liaison. Through such relationships, critical insights are shared that shape the development pipeline, promote successful clinical translation and guide the market deployment strategy of therapeutic interventions through-out their life cycle. Despite the rising number of MSLs in the field and the implicit medical value of the role, there remains a lack of understanding for what the roles of an MSL entails. In Africa, where exponential growth of the pharmaceutical industry is expected, the number of MSLs will increase rapidly. Given the complexities of the African continent, the MSLs in this burgeoning environment will face various challenges including remote locations, time-constraints, regulatory and bureaucratic hurdles and importantly physician misperception of the MSL role that collectively may thwart the goal of meaningful scientific engagement; but these challenges can be surmounted through astute proactive planning and utilization of opportunities including digital communication strategies.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Badr Slioui, Achraf Zaimi, Latifa Chat [Case series] - Syndrome de Kartagener de découverte fortuite au cours d'un bilan d'infécondité du couple à propos d'un cas - 20 August 2019. http://www.panafrican-med-journal.com/content/article/33/312/abstract/ <b>Le syndrome de Kartagener est une entité particulière parmi les dyskinésies ciliaires primitives (DCP) caractérisée par une triade clinique: sinusite, bronchectasie et situs inversus complet ou incomplet. C'est une maladie congénitale rare à transmission autosomique récessive. Nous rapportons un cas de syndrome de Kartagener dans un contexte d'infertilité avec une akinospermie au spermogramme.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Helen Chioma Okoye, Ijeoma Angela Meka, Angela Ogechukwu Ugwu, Isah Adagiri Yahaya, Ochuko Otokunefor, Olugbenga Olalekan Ojo, Emmanuel Onyebuchi Ugwu [Research] - Perception of problem based learning versus conventional teaching methods by clinical medical students in Nigeria - 20 August 2019. http://www.panafrican-med-journal.com/content/article/33/311/abstract/ <b>INTRODUCTION: Problem-based learning (PBL) method which was introduced about 50 years ago in Canada is beginning to gain acceptance over conventional teaching method (CTM) worldwide in medical education but still remains unpopular in Nigeria. This study aims to determine the perception of clinical medical students to the use of both learning methods in pathology courses. METHODS: a cross-sectional quantitative survey was conducted in four Nigerian Universities drawn from four regions of the country. Data were collected using pretested semi-structured self-administered questionnaires. RESULTS: the study included 310 respondents, 182(58.7%) males and 128(41.3%) females. Of all the participants, 257(82.9%) had heard of PBL prior to the study and 260(83.9%) thought it suitable for teaching and learning Pathology. Majority of participants, 221(71.3%) preferred a combination of both PBL and CTM while 238(76.8%) thought PBL suitable for all medical students. Some identified factors capable of enhancing adaptation of PBL into medical curriculum include conducive quiet spaces for learning and availability of computers with internet facilities for students' use. CONCLUSION: participants demonstrated high level of awareness of PBL and thought it suitable for all medical students. Availability of computers and up-to-date libraries with internet and audio-visual facilities could enhance adaptation of PBL into medical curriculum in Nigeria.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Brenda Mbouamba Yankam, Cho Sebastine Anye, Ngwayu Claude Nkfusai, Joyce Shirinde, Samuel Nambile Cumber [Research] - Knowledge and practice of pregnant women and health care workers on hepatitis B prevention in the Limbe and Muyuka health districts of the south west region of Cameroon - 20 August 2019. http://www.panafrican-med-journal.com/content/article/33/310/abstract/ <b>INTRODUCTION: Hepatitis B virus (HBV) infection is a major health problem worldwide owing to its high prevalence and significant morbidity and mortality. There are about 2 billion people living with HBV worldwide and over 360 million chronic carriers. The purpose of this study was to assess the knowledge and practices of pregnant women and health care workers in the ANC and maternity units on HBV infection and its transmission.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Teklewoini Mariye, Alem Girmay, Tsyion Birhanu, Hagos Tasew, Girmay Teklay, Zeray Baraki, Hadgu Gerensea, Tewolde Teklu, Gebrewahed Bezabeh [Research] - Adherence to insulin therapy and associated factors among patients with diabetes mellitus in public hospitals of Central Zone of Tigray, Ethiopia, 2018: a cross-sectional study - 20 August 2019. http://www.panafrican-med-journal.com/content/article/33/309/abstract/ <b>INTRODUCTION: Adherence to insulin therapy is a critical factor for adequate control of diabetes mellitus. Despite the multiple well-known benefits of adherence to insulin therapy, poor adherence remains to be a common cause of diabetes mellitus-related complications. A better management of diabetes mellitus requires determining the level of patient adherence and identifying why non-adherence to insulin therapy occurs. Therefore, this study was designed to assess the level of adherence to insulin therapy and associated factors among diabetes mellitus patients. METHODS: the study was conducted from May 1 to July 1, 2018, using a cross-sectional study design. Interviewer-administered questionnaire was employed for data collection and systematic random sampling technique was used to select study participants. The collected data were entered using Epi data version 3.1.1 and exported to SPSS version 22 for analysis. Logistic analysis was carried out to check the level of association between adherence to insulin therapy and the independent variables with significance level of 0.05 at 95% confidence interval. RESULTS: 273 respondents were selected with a 100% response rate. Near to one-fourth (24.2%) of the respondents were adherent to their insulin therapy. The study revealed that good knowledge of diabetes mellitus [AOR=6.51; 95% CI [1.58, 26.71], age [>30 years] [AOR=2.63; 95% CI [1.27, 5.42], knowledge regarding insulin self-injection [AOR=4.21; 95%CI [1.06,16.65], favorable attitude towards insulin injection [AOR=2.14; 95% CI [1.04,4.41], free-of-cost insulin therapy [AOR= 4.62, 95% CI [1.06,16.65], having of glucometer at home [AOR= 2.82, 95% CI [1.12,7.09], and being a member of Ethiopian diabetic association [AOR= 5.41, 95% CI [2.31,12.64] were found to significantly affect adherence to insulin therapy. CONCLUSION: nearly one-fourth of the study participants were adherent to their insulin therapy. Good knowledge and favorable attitude towards insulin injection, good knowledge regarding diabetes mellitus, being a member of the Ethiopian Diabetes Association, age greater than thirty years old, free-of-cost insulin therapy and having glucometer at home were found to be significant predictors of adherence to insulin therapy.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Kawtar Belkhadir, Ouafae Cherkaoui [Images in medicine] - A closer look at the eyelashes! - 20 August 2019. http://www.panafrican-med-journal.com/content/article/33/308/abstract/ <b>A 7-year-old child presented with bilateral anterior blepharitis. He had no medical history. The careful examination of the eyelashes found several lice attached to them with their ovoid nits. The parasitological examination revealed a phtirius pubis. Screening of other family members did not find similar effects. The treatment consisted in the removal of all the lesions and their nits. Because mercury-based ointments were unavailable in our country, we have advocated rigorous hygiene of the eyelids, and the use of antibiotic ointment to smother the lice and their nits. The mode of transmission in this case is unknown. There was no evidence of ill-treatment or poor hygiene in the family. The evolution after treatment has been favorable.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Jacques Tuyishimire, Funmbi Okoya, Adebisi Yusuff Adebayo, Fabrice Humura, Don Eliseo Lucero-Prisno [Research] - Assessment of self-medication practices with antibiotics among undergraduate university students in Rwanda - 19 August 2019. http://www.panafrican-med-journal.com/content/article/33/307/abstract/ <b>INTRODUCTION: Antimicrobial Resistance (AR) is on a rise as one of the major global public health threats. It is therefore important to assess contributory factors to the rise in the cases of resistance reported. The main objective of this study was to assess the nself-medication practices with antibiotics among the University of Rwanda students in Huye Campus. METHODS: a sample of 570 students from all levels and colleges of the University of Rwanda in Huye Campus were selected using a simple random sampling to participate in this study. A questionnaire was administered to be answered individually by the consented respondents where the self-medication practices with antibiotics in the past 6 months were assessed. The results were statistically analyzed using SPSS v.16. RESULTS: the study showed that 12.1% (n=69) practiced self-medication with antibiotics. The major reason for self medication with antibiotics was illness not serious to have a consultation (50.72%). The main diseases being treated were common cold/fever/cough (47.83%). The antibiotic that was mostly used was Amoxicillin capsules (59.42%), while the main source of antibiotics was community pharmacy (72.42%). CONCLUSION: the prevalence of self medication is considerably high among university students. Regarding the main reasons of self-medication with antibiotics, diseases being treated, and the antibiotics used, it was found that all these may be related to the students' lack of knowledge about the need for rational use of antibiotics and a study was needed to confirm it.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mariem Ghardallou, Manel Limam, Abdejelil Khelifi, Ons Khairi,Hédi Khairi, Ali Mtiraoui, Thouraya NabliAjmi [Research] - Obstetric referrals to a tertiary care maternity: a descriptive study - 19 August 2019. http://www.panafrican-med-journal.com/content/article/33/306/abstract/ <b>INTRODUCTION: An effective referral system is considered as a key to saving mothers' and children's lives. The aims of this study were to determine the frequency and the indications of obstetric referrals in a Tunisian tertiary care maternity and to assess the conformity of referral mechanisms with the National Perinatality Programme (NPP) guidelines.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Nkemngu Blake Afutendem, Aubin Nino Baleba, Azefack Léon Tapondjou, Claude Ngwayu Nkfusai, Vecheusi Zennobia Viyoff, Frankline Sanyuy Nsai, Joyce Shirinde, Samuel Nambile Cumber [Research] - Assessing implementation modalities of mhealth intervention on pregnant women in Dschang health district, west region of Cameroon - 19 August 2019. http://www.panafrican-med-journal.com/content/article/33/305/abstract/ <b>INTRODUCTION: Every 90 seconds, a woman dies of complications related to pregnancy and childbirth, resulting in more than 340,000 maternal deaths a year. Antenatal care (ANC) and postnatal care (PNC) are significant determinants of maternal health and, particularly, safe motherhood. Antenatal care is an important predictor of safe delivery and provides health information and services that can improve the health of women and infants. mHealth broadly encompasses the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems. This study aimed at assessing the acceptable implementation modalities of mHealth intervention on pregnant Women in Dschang Health district, West Region of Cameroon.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mohamed Amine Oukhouya, Saad Andaloussi, Mohammed Tazi, Abdelhalim Mahmoudi, Khalid Khattala, Youssef Bouabdallah [Case series] - L’évolution à long terme du reflux vésico-rénal chez l’enfant - 19 August 2019. http://www.panafrican-med-journal.com/content/article/33/304/abstract/ <b>Le reflux vésico-rénal (RVR) est une pathologie fréquente chez l'enfant nécessitant un suivi long pour réduire l'évolution vers l'insuffisance rénale chronique. L'objectif de notre étude est d'analyser les aspects épidémiologiques, le diagnostic, la prise en charge du reflux vésico-rénal et l'évolution à long de terme de cette pathologie. Pour cela on a mené une étude rétrospective portant sur une série de 42 patients hospitalisés au service de chirurgie pédiatrique viscérale du CHU Hassan II de Fès suspectés porteurs d'un reflux vésico-rénal (RVR) sur une période de 6 ans allant de Janvier 2010 à Décembre 2015. On a trouvé que l'âge médian au moment du diagnostic était de 3 ans et 2 mois. Le sex ratio était de 1,8. Le RVR était retrouvé isolé chez 81%, et secondaire ou associé chez 19%. Le principal mode de révélation était l'infection urinaire (90,4%). La fonction rénale était altérée chez (54,8 %) des enfants. Le traitement a consisté une antibiothérapie des IU documentées (90,4%) et une antibio-prophylaxie si récidive, une réimplantation de type COHEN dans (97,62%). Les indications ont concerné d'emblée tous les grades IV et V (73,9%), ainsi que les reins altérés, et 26,1% après traitement médical. L'évolution postopératoire précoce et tardive était en général satisfaisante: on a noté (92,68 %) de disparition du RVR. L'UHN a régressé sauf chez (9,52 %) patients, (95,23%) malades ont normalisé leur fonction rénale. La récurrence des IU a diminué (19,04 % après la chirurgie). La majorité des parents ont jugé positivement l'évolution de l'état général de leurs enfants (54,76 %) après la chirurgie.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Soumaya Mrabet, Mohamed Salah Jarrar, Amine Gouader, Imen Akkari, Elhem Ben Jazia [Case report] - Duodenal duplication: a rare cause of abdominal pain in adults - 19 August 2019. http://www.panafrican-med-journal.com/content/article/33/303/abstract/ <b>Duodenal duplication is an extremely rare congenital abnormality that occurs mostly in children. It represents only 2% to 12% of all gastrointestinal tract duplication. Its clinical presentation is highly variable and non-specific making the positive diagnosis very difficult. Imaging modalities can help to detect the lesions making the diagnosis more accurate before surgery. Here, we report a case of duodenal duplication revealed by chronic abdominal pain and treated by surgical resection in a 26-year-old man. Even in adults, it is necessary to evoke the diagnosis of duodenal duplication in patients with unexplained abdominal pain. Surgical resection remains the treatment of choice and endoscopic treatment is reserved for selected patients in whom surgery is difficult.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Supa Pengpid, Karl Peltzer [Research] - HIV status, knowledge, attitudes and behaviour of persons with and without disability in South Africa: evidence from a national population-based survey - 19 August 2019. http://www.panafrican-med-journal.com/content/article/33/302/abstract/ <b>INTRODUCTION: People with disabilities have been identified as a key risk population for HIV. The aim of this study was to investigate HIV status, knowledge, attitudes, behaviours and its correlates in persons with and without disabilities in South Africa. METHODS: cross-sectional data of 26404 participants 15 years and older from the "2012 South African national HIV prevalence, incidence and behaviour survey" were analysed. RESULTS: 1348(5.3%) had a disability. Persons with a disability were older (median age 52 years, IQR=24; versus 36 years, IQR=29), more often men, had a lower education and lower income and more likely living in a rural area than persons without disability. The prevalence of HIV infection was 16.7% in persons with disability, 23.0% in persons with visual/hearing or speech disability, 31.6% in persons with hearing disability and 16.2% in persons without disability. Antiretroviral (ARV) exposure in the HIV positive population was 41.3% among persons with disability and 30% in persons without disability. In multivariable logistic regression analysis, persons with disability had a lower odds to know an HIV testing site (Odds Ratio=OR: 0.46, Confidence Interval=CI: 0.22, 0.98) and a higher odds to have had two or more sexual partners in the past 12 months (OR 2.74, CI: 1.44, 5.21), had casual or transactional sex (OR: 6.25, CI: 2.57, 15.21) and psychological distress (OR: 2.10, CI: 1.50, 2.95) than persons without disability. In multivariable logistic regression analysis in both groups (with and without disability), psychological distress (OR: 2.90, CI: 1.53, 5.47, and OR: 1.90, CI: 1.20, 3.01, respectively) and high HIV stigma (OR: 0.31, CI: 0.25, 0.67, and OR: 0.57, CI: 0.34, 0.96, respectively) were associated with increased prevalence of HIV infection. CONCLUSION: the study found a high prevalence of HIV infection in persons with disabilities, in particular in those with hearing impairment. In some areas, persons with disability showed lower knowledge and higher risk behaviours than persons without disabilities. There is a need to strengthen HIV information and communication strategies geared towards targeting people with all types of disabilities.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Taoufik Africha, Omar Boulahroud [Images in medicine] - Kyste épidermoïde extradural géant - 19 August 2019. http://www.panafrican-med-journal.com/content/article/33/301/abstract/ <b>Une patiente de 68 ans qui consulte pour des céphalées et des troubles de la marche depuis 6 mois, avec un syndrome cérébelleux et des troubles de l'équilibre. Une tomodensitométrie cérébrale a montré une volumineuse lésion extra-durale médiane de la Fosse Cérébrale Postérieure (FCP) avec des calcifications, une érosion de l'os occipital et une prise de contraste périphérique. Une IRM de caractérisation a montré un processus lésionnel extradural médian de la FCP en hypo signal T1 (A), hyper signal T2 (B), hétérogène en Flair (C), avec rehaussement périphérique modéré (D), et hyper signal diffusion. Un traitement chirurgical a permis l'exérèse complète de la tumeur et l'examen histologique a confirmé le diagnostic de kyste épidermoïde. Les kystes épidermoïdes de la FCP sont rares, c'est des tumeurs congénitales à croissance lente mais peuvent se révéler à tout âge, sans prédominance de sexe. Les localisations intra-durales, au niveau de l'angle ponto-cérébelleux et para-sellaire, sont les plus habituelles. La tomodensitométrie montre un processus tumoral bien limité sans prise de contraste, c'est l'IRM qui permet une meilleure caractérisation de la lésion comme dans notre cas. Le diagnostic différentiel se fait avec les kystes arachnoïdiens et les kystes dermoïdes. Le traitement des kystes épidermoïdes est chirurgical avec ablation complète de la tumeur et de la capsule.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Seydou Sogoba, Mamadou Ibrahima Kampo, Bourama Coulibaly, Tioukani Augustin Théra, Djibril Kassogué [Case report] - Polype fibro-épithélial géant de l'anus sur grossesse: à propos d'un cas - 16 August 2019. http://www.panafrican-med-journal.com/content/article/33/300/abstract/ <b>Le polypefibro-épithélial anal est une tumeur bénigne rarement rapportée au cours de la grossesse. Nous rapportons un cas de polype fibroépithélial géant de l'anus chez une multipare de 31 ans. L´apparition a été progressive depuis plus de 3 ans. L'examen découvrait une formation bourgeonnante, de consistance ferme, à base sessile, appendue à la marge anale sur une grossesse normalement évolutive de 31 semaines d'aménorrhée. L'examen endo-anal était sans particularité. Une exérèse chirurgicale a été réalisée sous rachianesthésie. La pièce opératoire est une formation unique de 21x12x7cm recouverte par la peau. L'examen histologique a objectivé un polype fibro-épithélial anal sans signe de malignité. Les suites opératoires ont été simples.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mercy Obasi, Stephen Manortey, Kofi Adesi Kyei, Michael Kwabeng Addo, Sharon Talboys, Lynette Gay, Frank Baiden [Research] - Sexual and reproductive health of adolescents in schools for people with disabilities - 14 August 2019. http://www.panafrican-med-journal.com/content/article/33/299/abstract/ <b>INTRODUCTION: Persons with disabilities have the same sexual and reproductive health (SRH) needs as the abled people but they often face barriers to SRH information and services which are necessary for healthy and safe relationships, protection from HIV and other sexually transmitted infections (STIs). This study sought to access the SRH services among adolescents with disabilities in four Special Needs Schools in Ghana.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Anke Rohwer, Elizabeth Wager, Taryn Young [Workshop report] - Advancing research integrity: a programme to embed good practice in Africa - 13 August 2019. http://www.panafrican-med-journal.com/content/article/33/298/abstract/ <b>In Africa, training programmes as well as institutional policies on research integrity are lacking. Institutions have a responsibility to oversee research integrity through various efforts, including policies and training. We developed, implemented and evaluated an institutional approach to promote research integrity at African institutions, comprising a workshop for researchers ("bottom-up") and discussions with senior faculty on institutional policies ("top-down"). During the first day, we facilitated a workshop to introduce research integrity and promote best practices with regards to authorship, plagiarism, redundant publication and conflicts of interest. We used a variety of interactive teaching approaches to facilitate learning, including individual and group activities, small group discussions and case-based learning. We met with senior faculty on the following day to provide feedback and insights from the workshop, review current institutional policies and provide examples of what other research groups are doing. We evaluated the process. Participants actively engaged in discussions, recognised the importance of the topic and acknowledged that poor practices occurred at their institution. Discussions with senior researchers resulted in the establishment of a working group tasked with developing a publication policy for the institution.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Malumani Malan, Wu Xuejingzi, Song Ji Quan [Review] - The efficacy of Mohs micrographic surgery over the traditional wide local excision surgery in the cure of dermatofibrosarcoma protuberans - 13 August 2019. http://www.panafrican-med-journal.com/content/article/33/297/abstract/ <b>Usually most patients with dermatofibrosarcoma protuberans (DFSP) may present rather late when the tumor is in protuberant phase due to its rarity and indolent onset. It has a high propensity for local recurrence and destructive nature. Management of DFSP requires a biopsychosocial and Multidisplinary approach regardless of the clinical or immunohistochemical variant. Surgery is the Gold standard management of localized disease. DFSP rarely exhibits any lymphatic or hematogenous dissemination. It is because of its high recurrence rate associated with Wide Local Excision (WLE), the introduction of Mohs Micrographic Surgery (MMS) has really helped in reducing the rates of recurrence of DFSP. Thus, the aim of this meta-analysis and systemic review is to advocate for MMS over WLE for DFSP and other cutaneous malignancies using DFSP as a prototype. The objective of this study were to conduct a meta-analysis on comparative surgical methods used in the cure of DFSP with regards to WLE verses MMS, to evaluate the cure rates with relation to recurrence rates, offer a recommendation on the various treatment modalities based on the location of lesion, and use of adjuvant therapy in different clinical-medical setups. A comprehensive retrospective analysis search in EMBASE, Google Scholar and Medline (PubMed) for studies published from 2008 to 2018 containing the surgical management of DFSP with WLE verses MMS were reviewed. Five studies of moderate-quality evidence (level B) with a pooled patient load of 684 was analyzed and found for recurrence of DFSP after WLE and MMS to be 9.10% and 2.72% respectively after an average follow-up time for both groups of 5.32 years with a female predominance of 1.58. The trunk is the commonest site for the DFSP lesion which was at 52.80%then the upper and lower extremities zones and the head and neck zones at 31.75% and 15.45% respectively. The pooled adjusted odds ratio (OR) analysis indicated that there was a direct relationship with regards the reduced recurrence rate of DFSP in the MMS group compared to the WLE group (OR:0.31;95% CI :0.17-0.56). Furthermore, there was significant association between the reduced recurrence rate with the MMS in DFSP patients with a statistical P-value of 0.0001 at 95% CI. The expected increased recurrence rate by zones was in WLE head and neck zone at 38.19% then trunk and extremities zone at 13.34%. In the MMS group it was at of 23.4% as compared to 16.0% in the head and neck zone. Mohs Micrographic Surgery (MMS) is more efficacious in the cure rate and recurrence reduction of DFSP and should be advocated for as first line therapy especially in high recurrence prone zones.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Alix Dehayem-Kamadjeu, Justus Okonda [Research] - X-ray fluorescence analysis of selected micronutrients in ten African indigenous leafy vegetables cultivated in Nairobi, Kenya - 13 August 2019. http://www.panafrican-med-journal.com/content/article/33/296/abstract/ <b>INTRODUCTION: There is a growing interest on vital roles of micronutrients in the maintenance of good health and enhancement of the immune system for prevention of diseases. METHODS: Energy dispersive X-Ray spectrometer (EDXRF) was used for qualitative and quantitative analysis of selected micronutrients Zinc (Zn), Iron (Fe), Magnesium (Mg), Calcium (Ca) and Potassium (K) in ten African indigenous leafy vegetables (AILVs) (Corchorus olitorius, Cucurbita moschata, Amaranthus blitum, Brassica carinata, Cleome gynandra, Solanum scabrum, Crotalaria ochroleuca, Urticadioica, Manihot esculenta, Vigna unguiculata) which are cultivated, marketed and consumed in Kenya and across East and West Africa. RESULTS: In this study, the highest levels of Calcium, Zinc and Iron were found in Urticadioica leaves (75.0 mg/g), Manihot esculenta leaves (0.1 mg/g) and Cucurbita moschata leaves (1.0 mg/g). Amaranthus blitum leaves exhibited the highest content of Magnesium (9.5 mg/g) and Potassium (36.5 mg/g) respectively. This study demonstrated that based on weight and bioavailabilty, 10g of Cucurbita moschata (dried weight) provides between 57% to 136% daily value of iron for children age between 7 and 10 years old and can provide up to 41%, 81% and 27% daily value of iron for female aged 18+, lactating females aged 18+ and males aged 18+ respectively. A 10 g portion of Urticadioica leaves (dried weight) will provide 75% or 58% of the daily value of calcium based on the North American or western European recommendation respectively while the same amount of Amaranthus leaves provides between 37% to 50 % of daily value of magnesium for adults nineteen years and older based on their weight. The daily value of zinc despite its dependency with age, weight and Zinc bioavailability can be supplied by 10 g of Manihot esculenta leaves (dried weight) at a percentage ranged from 8% to 39%. Based on the 3510 mg daily recommendation, 10 g of Amaranthus, Brassica carinata, Cleome gynandra and Cucurbita moschata (dried weight) will provide 10.4%, 10.0%, 9.8% and 9.3% daily value for potassium respectively. CONCLUSION: The research findings are scientific evidences of the nutritional contribution of African indigenous leafy vegetables.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Boniface Muamba Kamanga, Jean Marie Ntumba Kayembe, Constant Ekisawa Nkiama, Patrick Kalambayi Kayembe, Louise Kalabo Kikontwe, Marie Jeanne Lenga Nkoy [Research] - Valeurs spirométries de référence dans la population bantoue de Kinshasa de 20 à 70 ans - 13 August 2019. http://www.panafrican-med-journal.com/content/article/33/295/abstract/ <b>INTRODUCTION: Les valeurs spirométriques de référence ne sont pas extrapolables entre populations, étant tributaires de nombreuses variables humaines et environnementales, d'où l'intérêt des études locales dans ce domaine. L'objectif est de déterminer des valeurs de référence chez des adultes sains de Kinshasa. METHODES: une étude transversale incluant 7443 sujets (3208 femmes, 43%). Le VEMS, la CVF et le DEP ont été corrélés aux données anthropométriques. Cinq groupes d'âge ont été constitués et les comparaisons effectuées en fonction du sexe, de l'âge, de l'IMC et de la pratique d'une activité sportive. RESULTATS: les différences sont évidentes entre sexes, pour le VEMS (3,00 vs 2,21 L), la CVF (3,19 vs 2,38 L), et le DEP (6,8 vs 5,70 L/s); de même que pour les tranches d'âge extrêmes. Elles sont comprises entre: 2,33 et 4,54 vs 1,93-3,3 L dans le groupe de 20-29 ans et 1,76-3,39 vs 1,60 vs 2,53 L chez les 60-70 ans; pour La CVF entre 2,44-4,89 vs 1,96-3,56 L et 1,79-3,78 vs 1,66-2,74 L; pour le DEP entre 4,34-12,2 vs 3,62-8,58 L/s et 2,99-6,76 vs 2,99-7,34L/s chez les 60-70 ans. CONCLUSION: les différences liées au genre, à l'âge, aux données anthropométriques ainsi qu'à la pratique d'une activité sportive sont évidentes. Ces résultats justifient des enquêtes plus étendues et montrent la pertinence des valeurs basées sur les percentiles dans la déterminantion d'un référentiel spirométrique dans une population donnée.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Folusho Mubowale Balogun [Essay] - The state of adolescent immunization in Nigeria: a wake up call for all stakeholders - 13 August 2019. http://www.panafrican-med-journal.com/content/article/33/294/abstract/ <b>The number of children who survive to adolescence is increasing in Nigeria, significantly due to the success of child survival programs, with immunization as a major theme. However, the national immunization schedule in Nigeria is presently restricted to early childhood with no attention paid to immunization in adolescence. Presently, the vaccines that are readily available for adolescents include tetanus toxoid which is normally administered to pregnant women, so necessarily includes adolescent mothers; and a few research programs which offers hepatitis B vaccines. Also, there are few Nigerian adolescents who access immunization as a requirement for travelling outside the country or as a result of parental effort. Knowledge and awareness about adolescent immunization is generally poor. Nigerian adolescents have been shown to be poorly protected from tetanus, rubella and hepatitis B which are vaccine preventable. Neonatal, childhood and adult tetanus, congenital rubella syndrome, cervical cancer and hepatocellular carcinoma are just few of the diseases whose incidence can be reduced with an effective adolescent immunization program. This will also ensure that the gains of childhood immunization is concretized and socioeconomic losses as a result of vaccine preventable diseases are eliminated to create a healthy and vibrant workforce. There is an urgent need to build a viable adolescent immunization program in Nigeria as adolescents represent a window of opportunity to prevent diseases which affect both the younger and older age group. This can be extended to other developing countries as well.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Bilel Ben Amor, Hanene Sayadi, Manel Jemel, Houcem Mrabet, Rym Hadhri, Tensim Slim, Rym Klii, Ines Khochtali [Case report] - Erdheim-chester disease revealed by diabetes insipidus - 13 August 2019. http://www.panafrican-med-journal.com/content/article/33/293/abstract/ <b>Erdheim-Chester disease (ECD) is a very rare and aggressive form of non-Langerhans histiocytosis with unclear pathogenesis. Because of the heterogeneity of clinical presentation, diagnosis is often challenging and delayed. Currently, Interferon alpha is the first line treatment that is associated with a better survival. The prognosis is relatively poor, especially in case of neurological and cardiovascular involvement. Herein, we report the case of a 64-year-old Tunisian female patient presenting an aggressive form of ECD revealed by diabetes insipidus and cerebellar ataxia with a diagnosis delay of 4 years. The assessment of disease extent had also shown associated asymptomatic cardiac and bone involvement. Pegylated Interferon alpha was started at high dose allowing disease stabilization. This case illustrates that physicians should be aware of the heterogeneous manifestations of ECD in order to insure an early diagnosis and treatment. Long-term and regular follow-up is crucial because of the risk of disease progression.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Nzozone Henry Fomukong, Ngouagna Edwin, Mandeng Ma Linwa Edgar, Ngwayu Claude Nkfusai, Yunga Patience Ijang, Fala Bede, Joyce Shirinde, Samuel Nambile Cumber [Case report] - Management of face presentation, face and lip edema in a primary healthcare facility case report, Mbengwi, Cameroon - 08 August 2019. http://www.panafrican-med-journal.com/content/article/33/292/abstract/ <b>Face presentation is a rare obstetric event and most practitioners will go through their carriers without ever meeting one. Face presentation can be delivered vaginally only if the foetus is in the mentum anterior position. More than half of the cases of face presentation are delivered by caesarean section. Newborn infants with face presentation usually have severe facial oedema, facial bruising or ecchymosis. These syndromic fascial features usually resolved within 24-48 hours.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ahmed Nugud, Shomous Nugud [Images in medicine] - Synovial-cell sarcoma - 08 August 2019. http://www.panafrican-med-journal.com/content/article/33/291/abstract/ <b>Thirty-nine years old patient presented to the emergency department with left-sided chest pain for four months and 4kg weight loss through the same period. Physical examination showed bulging of the left scapula which is tender to touch and decreased breath sounds on the left side. Chest X-ray (A) done in ED showed opaque left hemithorax with rib resections. A CT (A) was done showing a heterogeneous mass shadow with a solid and cystic component associated with linear calcifications causing a near total collapse of the left lung with shifting of the mediastinum to the right side. Similar findings were seen on an MRI (B). A PET-CT scan showed hypermetabolic complex mass occupying most of the left hemithorax infiltrating the back muscles bulging to the subcutaneous fat with Irregular thick active gastric mucosa as well and intense large colon activity (B). A biopsy of the lesion and immunohistochemical studies were done and showed malignant diffuse spindle cell neoplasm positive for CD56, CD99, Bcl2 CKAE1/AE3, H. Caldesmon and EMA. The patient was started on IFOS/DOX chemotherapy regimen and completed three cycles uneventfully.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Misai Hukuimwe, Asaph Ziruma, Muchabayiwa Francis Gidiri, Marshall Manase [Case report] - Large B cell lymphoma presenting as an adnexal mass in an HIV positive patient: a case report - 07 August 2019. http://www.panafrican-med-journal.com/content/article/33/290/abstract/ <b>We present a 34-year-old HIV positive woman who presented with a 2-month history of abdominal pain, abdominal distension, night sweats and fever. She had a firm, immobile and irregular abdominopelvic mass of about 30 weeks uterine size. Investigations showed a haemoglobin of 6.5g/dl, (NR 12-14) cancer antigen 125 of 44U/ml (NR 0-35), serum beta HCG of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7ng/ml (NR <10). Her CD4 count was 63cells/mm<sup>3</sup>. At laparotomy there was a left ovarian mass and the rest of the abdomen and omentum looked grossly normal, leading to the conclusion that the primary was in the ovaries. A total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. Sigmoidectomy and Hartmann’s procedure were also performed. Histology of the specimens showed a large B cell lymphoma. She has since been commenced on chemotherapy and antiretroviral therapy and has been doing well.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Saida Zelfani, Hela Manai, Yosra Riahi, Mounir Daghfous [Research] - Out of hospital cardiac arrest: when to resuscitate - 07 August 2019. http://www.panafrican-med-journal.com/content/article/33/289/abstract/ <b>INTRODUCTION: This study explores why resuscitation is withheld when mobile emergency medical team arrive at the scene of a cardiac arrest.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Khaled Elmezughi, Chukwuma Ekpebegh [Case report] - Hereditary spherocytosis with successful splenectomy in a pregnant black South African lady: a case report - 07 August 2019. http://www.panafrican-med-journal.com/content/article/33/288/abstract/ <b>Hereditary spherocytosis is a rare cause of chronic haemolytic anaemia. It is rarer in the black population with extremely few cases reported. Initial assessment of a patient with suspected disease should include documenting clinical features of chronic haemolysis and a family history. Its management in pregnancy is challenging and needs a multidisciplinary team. We report on a black South African woman with hereditary spherocytosis and massive splenomegaly presenting with severe haemolytic anaemia at 23<sup>rd</sup> week of pregnancy. She had a successful splenectomy.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Isaac Okyere, Paul Sedem Komla Glover, Paa Kobina Forson, Perditer Okyere, Delali Blood-Dzraku [Case report] - Catamenial pneumothorax in Ghana: case report and literature review - 06 August 2019. http://www.panafrican-med-journal.com/content/article/33/287/abstract/ <b>Catamenial pneumothorax is a rare condition that is often misdiagnosed. It is defined as spontaneous pneumothorax occurring within 72 hours before or after onset of menstruation. Etiology is unknown but could be linked to endometriosis. Pleural ablation via thoracoscopy and hormonal therapy are mainstay treatment options to avoid recurrence. We present a case of a young adult female who experienced gradual painless abdominal distention that resolved spontaneously after each menses twelve years post menarche. She was first seen at a peripheral facility where laparotomy undertaken was negative for suspected ectopic pregnancy. However, a bleeding omental mass was noticed and a biopsy taken. Histopathology reported it as an endometriotic tissue. The patient subsequently had recurrent cyclical chest pains and breathlessness leading to the diagnosis of catamenial pneumothorax. She had chemical pleurodesis done with sterile talc after chest tube drainage and has been well over two years now.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Moulay El Mehdi El Hassani, Benali Saad, Moukit Mounir, Jaouad Kouach, Driss Moussaoui Rahali [Case report] - Catamenial cyclic vomiting syndrome responding to Oestrogen therapy: an adolescent case report - 06 August 2019. http://www.panafrican-med-journal.com/content/article/33/286/abstract/ <b>Cyclic vomiting syndrome (CVS) is defined by episodes of vomiting lasting from a few hours to several days, alternating with periods of no symptoms. Various symptoms can be associated with vomiting such as nausea, migraine or abdominal pain. Common triggers of CVS include infection, psychological stress and menstruation. CVS's diagnosis requires exclusion of alternative diseases particularly neurological and gastrointestinal. CVS shares many common features with catamenial migraine including treatment. We herein report a case of CVS in a 16 years old girl characterized by stereotypical vomiting attacks occurring in every menstrual period. Recurrent vomiting episodes began 2 years before admission. Given the negativity of paraclinical exams and the absence of response to different therapeutic approaches as well as the similarity with catamenial migraine, we treated our patient with permenstrual percutaneous oestrogen for six months. The evolution was marked by the disappearance of symptoms within the first month and the absence of their recurrence after treatment cessation during a follow-up of 6 years.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Amirhossein Zahirnia, Mitra Boroomand, Hassan Nasirian, Sara Soleimani-Asl, Aref Salehzadeh, Dara Dastan [Research] - The cytotoxicity of malathion and essential oil of Nepeta crispa (lamiales: lamiaceae) against vertebrate and invertebrate cell lines - 06 August 2019. http://www.panafrican-med-journal.com/content/article/33/285/abstract/ <b>INTRODUCTION: Pesticides are used as essential tool to control of vector-borne diseases and agricultural pests and maintain quality and quantity crop production. Scientists attempt to use derived plant natural products due to environmental safety and low mammalian toxicity. Therefore, the cytotoxicity of malathion and Nepeta crispa essential oil against vertebrate L929 and invertebrate Sf9 cell lines were investigated. METHODS: About 2×103 cells were placed into the wells of a 96-well plate experiments. Then appropriate concentrations of malathion and N. crispa essential oil added to the wells. The cells were allowed to grow for 3-5 days and estimated the cell numbers. Control cell wells contained only cells with DMSO. All treatments and controls repeated at least four replicates. RESULTS: About 2×103 cells were placed into the wells of a 96-well plate experiments. Then appropriate concentrations of malathion and N. crispa essential oil added to the wells. The cells were allowed to grow for 3-5 days and estimated the cell numbers. Control cell wells contained only cells with DMSO. All treatments and controls repeated at least four replicates. CONCLUSION: Plant essential oil not only had no negative effects but also had boosting effects on the L929 cell viability. Nepeta crispa essential oil had negative effects on the Sf9 cell viability with the differences that derived plant natural products containing environmentally friendly and readily biodegradable derivatives, hydrolyzing rapidly in nature and nearly having no destructive effects on mammals and environment.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Abba Kabir, Mwajim Bukar, Haruna Asura Nggada, Harun Bakari Rann, Abubakar Gidado, Alhaji Bukar Musa [Research] - Prevalence of human papillomavirus genotypes in cervical cancer in Maiduguri, Nigeria - 05 August 2019. http://www.panafrican-med-journal.com/content/article/33/284/abstract/ <b>INRODUCTION: Cervical cancer is the commonest gynaecological malignancy and the second most common cancer among women worldwide. Several epidemiological, clinical and molecular studies have strongly implicated oncogenic high-risk human papillomavirus infection in the aetiopathogenesis of cervical cancer. The objectives of this study were to determine the cervical HPV prevalence and genotype distribution in cervical cancer in Maiduguri, Nigeria.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mohamed Said Belhamidi, Youssef Zorkani, Hicham Krimou, Abdessamad Kaoukabi, Mohamed Menfaa, Fouad Sakit, Karim Choho [Case report] - Pseudomyxome péritonéal secondaire à une tumeur mucineuse de l’ovaire: à propos d’un cas - 02 August 2019. http://www.panafrican-med-journal.com/content/article/33/283/abstract/ <b>Le pseudomyxome péritonéal (PMP) ou l'ascite gélatineuse est une entité rare, décrite pour la première fois par R. Wyerth en 1884. Il correspond à une atteinte péritonéale diffuse, composée d'une ascite mucineuse et d'implants épithéliaux mucineux multifocaux. Cette maladie touche essentiellement les femmes. Son incidence est estimée à 2 cas par un million d'habitants. Le pseudomyxome péritonéal peut rester asymptomatique, découvert lors d'une laparotomie. Le symptôme le plus fréquent est représenté par une distension abdominale associée à des douleurs abdominales diffuses. Le scanner abdominal constitue le moyen diagnostique le plus spécifique. Il met en évidence des signes pathognomoniques de l'ascite gélatineuse. Les tumeurs mucineuses de l'appendice sont la cause la plus fréquente du pseudomyxome péritonéal avec 90% des cas. L'origine ovarienne en constitue une cause très rare. Il existe essentiellement deux types de traitement du PMP: premièrement le « debulking » chirurgical multiple et deuxièmement la chirurgie de cytoréduction avec chimiothérapie intra-péritonéale péri-opératoire consistant en une chimiothérapie hyperthermique intrapéritonéale avec ou sans chimiothérapie intrapéritonéale post opératoire immédiate. Nous rapportons un cas de pseudomyxome péritonéal secondaire à une tumeur mucineuse de l'ovaire gauche.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Karima Mouden, Soukaina Wakrim, Afaf Semmar [Case report] - Paratesticular liposarcoma: a case report - 02 August 2019. http://www.panafrican-med-journal.com/content/article/33/282/abstract/ <b>Paratesticular liposarcomas (PLS) are a very uncommon pathology type of paratesticular sarcomas, with less 200 similar cases reported to date in the English literature. There are a few cases regarding giant paratesticular liposarcoma measuring over 10cm. We present an unusual case with a giant Well differentiated PLS of the left testis extended to the pelvic cavity. We report the case of a 55-year-old man who presented with large left groin mass. The patient underwent left orchiectomy following a cure of a scrotal hernia. Histological and immunohistochemical findings were suggestive of a well-differentiated liposarcoma of spermatic cord. The surgical margins were positive. Metastatic work-up, which included CT of the thorax, abdomen and pelvis, did not reveal any distant metastasis in thorax but there is a left pathological external iliac lymph nodes and a left lateroplevic lipomatous mass extended to the iliac fossa and left parietocolic gutter up to the umbilicus measuring 15x7x17 cm. Our patient refused treatment. A review of the literature revealed that there is a fiewer cases of giant well differentiated paratesticular liposarcoma extended to the pelvic cavity were reported. This study focuses on the clinical characteristics and treatment of this rare type of tumours.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Othmane Zouiten, Zineb Benbrahim, Lamiae Amaadour, Nawfel Mellas [Case report] - La dégénérescence cérébelleuse paranéoplasique révélant une récidive métastatique du cancer d’ovaire - 02 August 2019. http://www.panafrican-med-journal.com/content/article/33/281/abstract/ <b>Le syndrome neurologique paranéoplasique (SNP) est caractérisé par l'apparition aigue et subaigue d'un syndrome neurologique associé à un cancer actif ou infraclinique. C'est manifestation rare dont le diagnostic précoce modifie le pronostic neurologique et carcinologique. Parmi les SNP on distingue la dégénérescence cérébelleuse subaiguë souvent associé à un cancer gynécologique ou mammaire. Nous rapportons le cas d'une patiente de 50 ans suivi pour un adénocarcinome d'ovaire opéré et dont la récidive s'est révélée par une dégénérescence cérébelleuse subaiguë avec des AC anti Yo positifs.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Imen Akkari, Elhem Ben Jazia, Soumaya Mrabet, Imen Jemni [Case report] - Candida albicans: a cause or a consequence of esophageal intramural pseudo-diverticulosis - 02 August 2019. http://www.panafrican-med-journal.com/content/article/33/280/abstract/ <b>Esophageal intramural pseudo-diverticulosis is a rare disease of unknown etiology. It is characterized by multiple pseudodiverticula with segmental or diffuse involvement of the esophagus. We report, the case of a 78-year-old male who suffered from severe dysphagia. Diagnosis of Esophageal intramural pseudo-diverticulosis was based on endoscopic and radiologic explorations. Histological analysis of esophageal mucosal biopsies has shown the presence of candida albicans. Antifungal treatment leads to spectacular improvement of dysphasia. Subsequently, the patient presented a cardio-respiratory failure and died despite adequate treatment.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Hekmat Chaara, Hind Adadi, Imane Attar, Sofia Jayi, Fatima-Zahra Fdili Alaoui, Moulay Abdelilah Melhouf [Case series] - Diagnostic anténatal de la dysplasie rénale multikystique: à propos de 18 cas - 31 July 2019. http://www.panafrican-med-journal.com/content/article/33/279/abstract/ <b>La dysplasie rénale multikystique (DRMK) correspond à l'expression clinique la plus fréquente des Congenital Abnormalities of Kidney and Urinary Tract (CAKUT). Son étiopathogénie reste discutée et l'hypothèse obstructive est généralement admise. L'échographie obstétricale représente le moyen de référence pour son diagnostic anténatal et qui nécessitera la recherche d'autres malformations associées. Une prise en charge anténatale repose principalement sur la surveillance échographique de l'évolution de la grossesse et de la pathologie, de l'apparition d'autres anomalies et de la quantité du liquide amniotique. L'objectif est de rapporter l'expérience du Service de Gynécologie-Obstétrique 2 du CHU Hassan II de Fès afin de: préciser l'épidémiologie de la DRMK; rapporter la pertinence de l'échographie obstétricale dans le diagnostic positif et étiologique; décrire les aspects échographiques; établir un suivi des grossesses et évaluer l'évolution de la pathologie; écrire les modalités de surveillance et de prise en charge anténatales; rapporter l'évolution en postnatal et établir un pronostic.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Tabe Armstrong Tambe, Xavier Tchetnya, Claude Ngwayu Nkfusai, Joyce Shirinde, Samuel Nambile Cumber [Letter to the editors] - Reasons for non-compliance to immunization among Fulani Children aged between 0-11 months in the Vekovi community in Cameroon - 31 July 2019. http://www.panafrican-med-journal.com/content/article/33/278/abstract/ <b>Effective immunization coverage has been one of the greatest challenges to the government of Cameroon especially in the rural areas. The lack of effective immunization in communities lead to the constant outbreak of preventable diseases such as measles, polio, yellow fever and hepatitis that could have been avoided with an effective Expanded Program on Immunization coverage. We aimed at finding the reasons for non–compliance to immunization in the Fulani children aged 0-11 months at the Vekovi community using a cross sectional study design. The researchers identified various constraints such as the people have low level of education, not knowing the importance of the vaccination and its calendar and poor customer service from the health personnel as the reasons for the high non-compliance to vaccination in the community.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Adekunle Olatayo Adeoti, Mobolaji Dada, Tobiloba Elebiyo, Joseph Fadare, Opeyemi Ojo [Research] - Survey of antiretroviral therapy adherence and predictors of poor adherence among HIV patients in a tertiary institution in Nigeria - 31 July 2019. http://www.panafrican-med-journal.com/content/article/33/277/abstract/ <b>INTRODUCTION: Adherence is vital to effective antiretroviral therapy (ART) for reducing viral load and HIV/AIDS-related morbidity and mortality. This study was aimed at evaluating the adherence of HIV seropositive patients to ART in a tertiary institution in Nigeria. METHODS: a cross sectional observational study was conducted among 400 HIV seropositive patients. The study was carried out between December 2016 and February 2017 at the HIV clinic of the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. RESULTS: the mean age of the HIV patients was 42.2±9.5 years with a predominant female gender (Male: Female= 1: 2.8). The median CD4 counts increased from 302.1±15.0cells/mm<sup>3</sup> at diagnosis to 430.8±13.3cells/mm<sup>3</sup> at the time of the study. Majority of participants were unaware of their spouses' HIV status (59.3%) while 32.5% of participants had a serodiscordant spouse. Poverty was a major challenge as 73.3% earned less than 140 dollars per month. Depressive symptoms, anxiety disorder and insomnia were also reported in 40.7%, 33.2% and 47.2% respectively. Poor adherence to ART was observed in almost 20% of the patients. Logistic regression indicated that predictors of poor adherence were depression, anxiety and low CD4 counts. CONCLUSION: adherence to anti-retroviral therapy was good amongst the majority of HIV seropositive patients. Depression, anxiety disorder and low CD4 count were however associated with poor adherence. This emphasizes the role of the psychology units as integral part of the HIV clinic to assist patients' adherence to anti-retroviral regimens.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ahmed Azahouani, Najlae Zaari, Fatine El Aissaoui, Mohamed Hida, Mohamed Fitri, Larbi Benradi, Houssain Benhaddou [Case report] - Kyste du cholédoque rompu: revue de la littérature - 30 July 2019. http://www.panafrican-med-journal.com/content/article/33/276/abstract/ <b>Les malformations kystiques des voies biliaires sont des affections congénitales rares évaluées à environ 1/2 000 000 naissances. C'est une affection qui peut se révéler gravement par une complication notamment l'angiocholite, la pancréatite chronique, cirrhose biliaire progressive, l'hypertension portale ou les lithiases biliaires.Sa perforation spontanée est l'une des rares complications, décrite pour la première fois en 1934 par Weber. Nous rapportant le cas d'un garçon de 18 mois admis pour syndrome sub-occlusif avec une péritonite biliaire. Une échographie a été réalisée montrant un épanchement abdominal avec formation kystique communicantes des voies biliaires associée à un épanchement sous capsulaire du foie confirmé par scanner. L'intervention a consisté en une toilette péritonéale avec mise en place d'un drain de redon au niveau de la perforation et un drain sous hépatique sans excision du kyste. Le patient a été réadmis 6 mois après cet incident pour sa cure définitive.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Saida Zelfani, Hela Manai, Saoussen Laabidi, Abir Wahabi, Sara Akeri, Mounir Daghfous [Case report] - Pulmonary embolism mimicking acute myocardial infarction: a case report and review of literature - 30 July 2019. http://www.panafrican-med-journal.com/content/article/33/275/abstract/ <b>The diagnosis of pulmonary thromboembolism (PTE) with changes shown by electrocardiography (ECG) is a challenge in the clinical practice due to rare pathognomonic findings. We report the case of a 37-year old woman managed in out of hospital sitting for a chest pain. Electrocardiogram was suggestive of antero-septal acute myocardial infarction (AMI). Catheterization revealed non occlusive coronary disease. Transthoracic echocardiography showed an elevated pulmonary and right heart pressures. Computed tomography pulmonary angiography confirmed the diagnosis of bilateral pulmonary embolism. PTE with ECG changes should be considered in the differential diagnosis of AMI, particularly in young patients with chest pain and ST segment elevation suggestive of acute coronary syndrome.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fatima-Zahra Agharbi [Images in medicine] - Kératose pilaire - 30 July 2019. http://www.panafrican-med-journal.com/content/article/33/274/abstract/ <b>La kératose pilaire est caractérisée par des petites élevures centrées sur les follicules pileux. La kératose pilaire simple est formée d'éléments gris et kératosiques sur les bras, les cuisses, les fesses principalement. Elle est plus fréquente chez les femmes. La kératose pilaire rouge a souvent une évolution atrophiante. Plusieurs tableaux sont réalisés: ulérythème ophryogène, atrophodermie vermiculée, alopécie de Siemens. Les kératoses pilaires sont essentiellement d'origine génétique et peuvent s'intégrer dans différentes maladies héréditaires, en particulier le syndrome de Noonan ou encore des troubles vitaminiques. Le traitement fait surtout appel aux émollients et aux kératolytiques, il n'est que suspensif. Nous rapportons l'observation d'une femme de 30 ans ayant comme antécédents une atopie personnelle et familiale qui consulte pour des papules kératosiques diffuses du tronc. Le reste de l'examen clinique ne trouvait pas de signes en faveur d'une anomalie génétique et la patiente a été mise sous kératolytiques et emollients avec légère amélioration.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fatima-Zahra Agharbi [Images in medicine] - Aphte géant - 30 July 2019. http://www.panafrican-med-journal.com/content/article/33/273/abstract/ <b>L'aphte est une ulcération douloureuse, de petite taille, précédée d'une sensation de cuisson, unique ou multiple, à fond jaune cerné d'un liseré rouge, non indurée, guérissant habituellement en 8 à 10 jours. Il est fréquent sur la muqueuse buccale, mais parfois bipolaire (orogénital) avec la possibilité de variantes: aphtes profonds >1cm; aphtes herpétiformes: 1 à 3mm; géants; miliaires. L'aphtose idiopathique bénigne est fréquente, réactivée par certains contacts alimentaires (agrumes, tomate, noix, gruyère). Des médicaments sont inducteurs d'ulcérations aphtoïdes: AINS, nicorandil, alendronate monosodique, bêtabloqueurs, analgésiques opiacés, savarine, sirolimus, anti-EGFR. L'aphtose complexe (au moins 3 aphtes récurrents) est parfois inaugurale d'une entérocolopathie ou d'une maladie cœliaque, parfois révélatrice d'une carence martiale ou d'un déficit vitaminique (folates, vitamine B12). Dans l'aphtose bipolaire, il faut rechercher les éléments évocateurs d'une maladie de Behçet. Nous rapportons l'observation d'un homme de 40 ans qui consultait pour une augmentation du volume de la cuisse gauche. L'étude échographique objectivait un anévrysme de l'artère fémorale. L'examen clinique trouvait un aphte géant de la langue. L'interrogatoire trouvait la notion d'aphtose génitale et buccale récidivante et l'examen ophtalmologique objectivait une uveite postérieure. Le diagnostic de maladie de behcet a été retenu et un bolus de corticothérapie avec immunosuppresseurs (Cyclophosphamide) a été démarré en urgence.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Kofoworola Olaide Savage, Olabisi Hajarat Oderinu, Adeleke Oke Oginni, Omolara Gbonjugbola Uti, Ilemobade Cyril Adegbulugbe, Oluwole Oyekunle Dosumu [Research] - Dentine hypersensitivity and associated factors: a Nigerian cross-sectional study - 30 July 2019. http://www.panafrican-med-journal.com/content/article/33/272/abstract/ <b>INTRODUCTION: Prevalence of dentine hypersensitivity (DH) may be on the increase as a result of changing lifestyles. This study aimed to assess the prevalence of DH and relative importance of associated factors in 18-35 year old Nigerians and compare to findings from a similar European study. METHODS: Following ethical approval, 1349 subjects from the six geopolitical zones in Nigeria participated in this cross sectional study. DH was clinically evaluated by cold air tooth stimulation, patient pain rating (yes/no) and investigator rated pain using the Schiff ordinal scale (0-3). Erosive tooth wear using the BEWE index was assessed. A questionnaire regarding the nature of the DH, erosive dietary intakes, tooth brushing habits and other factors was completed by patients. Bivariate analysis was conducted. RESULTS: The 32.8% of patients reported pain on tooth stimulation and 32.9% scored &#8805;1 on Schiff scale for at least one tooth. Questionnaire reported sensitivity was 41.2%. There were statistically significant associations between Schiff score and clinically elicited DH (p < 0.001); and BEWE erosive tooth wear score and clinically elicited DH (p < 0.001). There were significant associations between DH and some oral hygiene practices such as brushing frequency, brush movement and brushing after breakfast. Fresh fruit and fruit/vegetable juice intake also showed significant association. CONCLUSION: The most important risk factors of DH for this population in Nigeria appear to be the frequency and characteristics of tooth brushing. This should be considered in its prevention and management.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Guido Freckmann, Stefan Pleus, Annette Baumstark [Commentary] - Comment on “accuracy and precision of four main glucometers used in a sub-Saharan African country: a cross-sectional study” by Choukem et al - 30 July 2019. http://www.panafrican-med-journal.com/content/article/33/271/abstract/ <b>In their article, Choukem <i>et al</i>. report of assessments of the analytical quality of blood glucose monitoring systems. Although there are some commendable aspects regarding the methodology, some major shortcomings could preclude the conclusions drawn by Choukem <i>et al</i>. Nevertheless, independent assessments of the performance of blood glucose monitoring systems are an important issue.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Youness Jabbour, Youness Boukhlifi [Images in medicine] - Migration of a double j stent presenting as a painless total urinary incontinence - 30 July 2019. http://www.panafrican-med-journal.com/content/article/33/270/abstract/ <b>Double j (DJ) stent is a thin hollow tube placed inside the ureter to ensure drainage of urine from the kidney into the bladder. It holds its denomination of the presence of J shaped curls at both ends to keep the tube in place and prevent migration. Urinary Incontinence is a frequent complaint of patients holding DJ stents mostly presenting as urge or stress incontinence. Stent-related total incontinence is the result of stent migration across the urethral sphincter making it ineffectif. It's about a 35-year-old man who undergone a flexible laser ureteroscopy for management of an obstructive calculi of the lumbar ureter with DJ stent placement. It was planned to remove the DJ stent after one month, but It appears that the patient tolerated his DJ stent so well that he didn't show up until three months later with total urinary incontinence. He reported no incidents after stent placement but an onset of a sudden total and painful urinary incontinence without accompanying signs evolving for two days. Since the patient was known to be a DJ stent holder and given the sudden onset of the urinary incontinence, we thought about the migration of the DJ stent through the uretral sphincter. Urethro-cystoscopy showed the presence of the lower loop of the double j stent at the anterior ureter and allowed the extraction of the double j stent. The patient regained his continence immediately after removal of the double-j stent and left the hospital the same day.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Joshua Gikonyo, Betty Mbatia, Patrick Okanya, George Obiero, Carlene Sang, James Nyangao [Case study] - Rotavirus prevalence and seasonal distribution post vaccine introduction in Nairobi county Kenya - 29 July 2019. http://www.panafrican-med-journal.com/content/article/33/269/abstract/ <b>Rotaviruses are one of the leading etiological agents of gastroenteritis in young children, for which a monovalent G1P(8) vaccine has been provided for free in Kenyan since July 2014. The main objective was to estimate the post vaccine prevalence and seasonal distribution of rotavirus diarrhea in children less than 5 years in Nairobi County, Kenya. Rotavirus positive samples were collected from children below 5 years of age in two hospitals within Nairobi County where vaccination status was card-confirmed. The children were examined and the demographic and clinical profiles of the children were recorded. Fecal specimens were analyzed for rotavirus antigen using an ELISA kit, followed by characterization by PAGE. Out of the total 323 samples, 49 had detectable rotavirus infection, representing 15.2% prevalence. Age distribution of rotavirus prevalence was as follows: &#8804; 6 months-8.5%, 7-12 months-27.4%, 13-24 months - 41.4%, 25-36 months-16.4% while 36-65 months had 6.3%. Rotavirus diarrhea was more common in wet and cold months of the year, the highest prevalence being observed in August (24.5%), 12.3% in both July and March, while April scored a prevalence of 10.2%. Out of the 49 rotavirus positive children, 48 had vomiting and abdominal cramps while all had fever and watery stool. The prevalence of Rotaviral diarrhea in children less than 5 years in Nairobi County Kenya has greatly reduced following the vaccine introduction and is more common during the wet and cold seasons of the year.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Amine Raggabi, Issam Lalya, Ahmed Bourazza [Case report] - Le syndrome du condyle occipital: la partie visible de l&acute;iceberg - 29 July 2019. http://www.panafrican-med-journal.com/content/article/33/268/abstract/ <b>Le syndrome du condyle occipital est un entité clinique rare, définie cliniquement par l'association de céphalées occipitales intenses et d'une paralysie de la douzième paire crânienne. Son étiologie est dominée par la pathologie tumorale métastatique. L'imagerie est la pierre angulaire du diagnostic permettant à la fois de mettre en évidence la lésion du condyle occipitale et de rechercher la tumeur primitive. Le traitement repose d'une part sur le soulagement de la symptomatologie douloureuse moyennant les antalgiques, les corticoïdes et très souvent la radiothérapie externe. Et d'autre part sur le traitement de la tumeur métastatique par chimiothérapie cytotoxique, thérapies ciblées ou immunothérapie en fonction du profil moléculaire de la tumeur primitive.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fatima-Zahra Agharbi [Images in medicine] - œdeme aigu hemorragique du nourisson - 29 July 2019. http://www.panafrican-med-journal.com/content/article/33/267/abstract/ <b>L'œdème aigu hémorragique du nourrisson (OAHN) est caractérisé par la survenue rapide de lésions purpuriques en cocardes, associées à des œdèmes initialement localisés aux extrémités chez l'enfant de moins de 2 ans. Cette affection reste le plus souvent bénigne, sans atteinte viscérale et le diagnostic est clinique, il n'existe pas de signes biologiques spécifiques et l'analyse histologique des lésions (qui est inutile dans la majorité des cas) est le plus souvent sans spécificité (il existe parfois une vascularite leucocytoclasique non spécifique). Sa place nosologique reste incertaine, faisant discuter, pour certains, une forme clinique du purpura rhumatoïde. On retrouve parfois un épisode rhino-pharyngé dans jours précédents faisant discuter une étiologie virale. Il existe une discordance nette entre le bon état général et l'aspect profus et spectaculaires des lésions. La surveillance de ces enfants dans les premiers jours doit être rigoureuse mais les complications sont exceptionnelles (invagination intestinale aigue?). L'évolution se fait spontanément vers la régression en une dizaine de jours. La prise en charge thérapeutique consiste en une surveillance attentive de l'état général de l'enfant. Une fièvre, l'extension des lésions purpuriques et surtout des signes d'altération de l'état général peuvent faire discuter le diagnostic de purpura fulminans. Un autre diagnostic différentiel est l'urticaire aigue hémorragique ou ecchymotique. Nous rapportons l'observation d'un nourrisson de 3 mois qui présente des lésions pseudo-cocardes diffuses dans un contexte d'apyrexie et de conservation de l'état général. L'évolution était favorable sans aucun traitement ce qui a permis de confirmer le diagnostic d'OAHN.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fatima-Zahra Agharbi [Images in medicine] - Le syndrome des cheveux étrangleurs: à propos d'un cas - 29 July 2019. http://www.panafrican-med-journal.com/content/article/33/266/abstract/ <b>Le syndrome du tourniquet ou du «cheveu étrangleur» est la conséquence de la strangulation d'un appendice ou d'une extrémité corporelle par un lien constricteur. Orteils et doigts sont les extrémités les plus atteintes mais aussi les organes génitaux qu'il s'agisse du pénis, des petites ou grandes lèvres ou du clitoris. La plupart des liens sont des cheveux, plus rarement des fibres textiles (coton, laine). La rapidité de diagnostic est importante afin de procéder à l'ablation du lien dans les plus brefs délais et éviter de voir leprocessus évoluer vers la nécrose ou l'amputation spontanée ou chirurgicale de l'extrémité ischémiée. La difficulté réside dans le fait que l' œdème inflammatoire consécutif à la constriction progressive est un processus lent qui peut durer des semaines. L'œdème participe à l'enfouissement du lien le rendant accessible à la vue, retardant son ablation en augmentant le risque d'atteinte osseuse, de nécrose et d'amputation partielle ou totale. Au début du processus, des pleurs incessants peuvent résumer la symptomatologie présente par le nourrisson. Différentes méthodes ont été décrites pour retirer le lien: ablation mécanique ou chirurgicale. Nous rapportons l'observation d'un nourrisson qui présentait un œdème et érythème douloureux d'installation brutale du troisième orteil gauche en dehors d'un contexte traumatique. La radiographie n'objectivait pas de fracture ni autre anomalie et l'exploration trouvait une constriction par des poils de la mère. L'évolution était favorable après ablation des poils et application des crèmes cicatrisantes.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Hicham El Malki, Hanae Bouhdadi, Aziz Belkhadir, Jaafar Rhissassi [Case report] - Traumatic tricuspid insufficiency with a ventricular septal defect in a child: a case report - 29 July 2019. http://www.panafrican-med-journal.com/content/article/33/265/abstract/ <b>Traumatic tricuspid insufficiency is very rare. In this report we describe an interesting case of a 13-year-old boy who suffered chest trauma from a horse kick. Echocardiography demonstrated a remarkable tricuspid regurgitation with ventricular septal defect. Once assessing the diagnosis, an emergency open heart surgery was necessary to repair the injuries with good results.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Kouamé N’goran, Kouadio Kouamé Eric, Doukouré Brahima, Sétchéou Alihonou, Konan Anhum Nicaise, Ettien Kouamé Jean-Jacques, N’Goan-Domoua Anne-Marie, Konan Alexis Victorien [Research] - Profil épidemio-clinique et échographique des moles hydatiformes à Abidjan - 29 July 2019. http://www.panafrican-med-journal.com/content/article/33/264/abstract/ <b>INTRODUCTION: Décrire les aspects épidémio-cliniques et échographiques des môles hydatiformes (MH) à Abidjan. METHODES: Etude transversale de 6 ans (janvier 2011 à décembre 2016) réalisée au CHU de Yopougon au service de radiologie. Elle a consisté en la description du profil épidémio-clinique et échographique des patientes porteuses de MH. Les examens échographiques ont été réalisés par voie mixte (endovaginale et sus pubienne) en modes B et Doppler Couleur par des radiologues seniors. Une étude anatomo-pathologique du contenu utérin a été effectuée. RESULTATS: Vingt-cinq cas de MH ont été diagnostiquées sur 12190 échographies obstétricales réalisées soit 0,2% d’incidence radiologique. L’Âge moyen des patientes était de 33, 4 ans avec des extrêmes de 22 et 50 ans. Il n’y avait pas de classe d’âge dominante. La notion de masse abdominale 36% et de métrorragies 28% étaient les signes cliniques prédominants qui accompagnaient l’aménorrhée (100%). Sur le plan échographique, l’utérus était hypertrophique dans 100% des cas, homogène dans 96% et myomateux dans 4% des cas. La MH avait une épaisseur moyenne de 42,7 mm. Son aspect était décrit comme vésiculaire dans 68%, en nid d’abeille dans 16%, multikystique dans 12% et en tempête de neige dans 4%. Les MH étaient classées partielles dans 4% des cas, complètes dans 92% des cas et invasives dans 4% des cas. Les ovaires étaient hypertrophiques dans 44% des cas avec une notion de macrofollicules dans 32% et des kystes dans 8% des cas. Le diagnostic échographique de MH a été confirmée à l’anatomopathologie dans 100% des cas. CONCLUSION: Les MH demeurent rares à Abidjan et sont dominées par la forme complète. La notion de survenue à des âges extrêmes n’a pas été retrouvée.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Kiady Ravahatra, Michel Tiaray Harison, Oninala Fenitra Rakotondrasoa, Emeline Lucie Ramirana, Iantsotiana Davidson Rakotondrabe, Marie Odette Rasoafaranirina, Anjara Mihaja Nandimbiniaina, Jocelyn Robert Rakotomizao, Joelson Lovaniaina Rakotoson, Rondro Nirina Raharimanana [Case series] - Le délai diagnostique des cancers broncho-pulmonaires vus à l'USFR de Pneumologie Befelatanana, Antananarivo, Madagascar - 29 July 2019. http://www.panafrican-med-journal.com/content/article/33/263/abstract/ <b>Le délai entre l'apparition des premiers signes cliniques et le diagnostic du cancer bronchique doit être le plus court possible afin que l'on puisse le prendre en charge de façon précoce et efficace. A Madagascar ce délai diagnostique reste inconnu d'où cette étude qui a pour objectif d'évalué le délai diagnostique des cancers broncho-pulmonaires vu à l'USFR de Pneumologie Befelatanana, Antananarivo, Madagascar. Il s'agit d'une étude rétrospective, descriptive portant sur les cancers broncho-pulmonaires diagnostiqués au sein de l'USFR de Pneumologie Befelatanana pendant la période du 1er janvier 2011 au 31 décembre 2015 (5 ans). Nous avons inclus dans l'étude tous les patients hospitalisés pendant la période d'étude et ayant un diagnostic de cancer broncho-pulmonaire avec preuve anatomopathologique. Durant la période de notre étude, nous avons colligé 43 patients présentant un cancer broncho-pulmonaire confirmé histologiquement, soit 0,64% des patients hospitalisés. Le délai pré-hospitalier, le délai hospitalier et le délai total étaient respectivement de 171,74 jours, 13,97 jours et 185,71 jours. Le délai entre l'apparition des premiers symptômes et la consultation chez un médecin était moins de trois mois dans 30 cas (69,76%), entre 3 et 6 mois dans 8 cas (18,60%). Notre délai pré-hospitalier chez nos patients était très long par rapport à la recommandation internationale sur le délai diagnostique des cancers broncho-pulmonaire. Un effort doit être fait à ce niveau pour améliorer le délai diagnostique.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ali Ulas Tugcu, Deniz Anuk Ince, Ozden Turan, Burcu Belen, Lale Olcay, Ayse Ecevit [Case series] - Hemolytic anemia caused by non-D minor blood incompatibilities in a newborn - 29 July 2019. http://www.panafrican-med-journal.com/content/article/33/262/abstract/ <b>Hyperbilirubinemia is one of the most widely seen cause of neonatal morbidity. Besides ABO and Rh isoimmunization, minor blood incompatibilities have been also been identified as the other causes of severe newborn jaundice. We report a newborn with indirect hyperbilirubinemia caused by minor blood group incompatibilities (P1, M, N, s and Duffy) whose hemolysis was successfully managed with intravenous immunoglobulin therapy. A thirty-two gestational weeks of preterm male baby became severely icteric on postnatal day 11, with a total bilirubin level of 14.66 mg/dl. Antibody screening tests revealed incompatibility on different minor groups (P1, M, N, s and Duffy (Fya ve Fyb)). On postnatal day thirteen, the level of bilirubin increased to 20.66 mg/dl although baby was under intensive phototherapy. After the administration of intravenous immunoglobulin and red blood cell transfusion, hemoglobin and total bilirubin levels became stabilised. Minor blood incompatibilities should be kept in mind during differential diagnosis of hemolytic anemia of the newborn. They share the same treatment algorithm with the other types hemolytic anemia. New studies revealed that intravenous immunoglobulin treatment in hemolytic anemia have some attractive and glamorous results. It should be seriously taken into consideration for treatment of minor blood incompatibilities.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Doumbia Amadou, Koné Youssouf [Images in medicine] - La cyclopie, maformation rare du visage dans un centre de santé de référence de Bamako à propos d'un cas - 29 July 2019. http://www.panafrican-med-journal.com/content/article/33/261/abstract/ <b>La cyclopie également appelée «cyclope» est une malformation génétique rare. Elle est la forme la plus sévère de l'holoprosencéphalie alobaire. Il s'agit d'une forme rare de l'hypotélorisme se caractérisant par la fusion des deux orbites et la présence d'un seul œil au milieu du front d'où son nom. Cette malformation est associée à d'autres malformations du visage. La cyclopie est liée à l'absence de développement du bourgeon frontal rentrant dans le cadre de l'ectroprosopie. Nous rapportons un cas de cyclopie chez un nouveau né de sexe féminin issu d'une grossesse estimée à terme. L'accouchement était dystocique et la mère n'a suivie aucune consultation prénatale. L'interrogatoire ne retrouve pas de lien de consanguinité des parents du nouveau né. Absence de malformation dans la fratrie qui est composée de 4 enfants. A la naissance, le nouveau né pesait 4600 grammes avec une taille de 58 cm. L'examen du nouveau né mettait en évidence une malformation du visage avec un gros œil unique au milieu du front et une absence totale du nez et des orbites évoquant le diagnostic d'une cyclopie. Le nouveau né est décédé une dizaine de minutes après sa naissance. Aucune exploration complémentaire à visée étiologique n'a pu être réalisée à cause du refus des parents.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mohammed Akibu Mohammed, Nigussie Tadesse Sharew [Research] - Adherence to dietary recommendation and associated factors among diabetic patients in Ethiopian teaching hospitals - 26 July 2019. http://www.panafrican-med-journal.com/content/article/33/260/abstract/ <b>INTRODUCTION: Dietary management is considered to be one of the cornerstones of diabetes care. Improvement of dietary practice alone can reduce glycosylated hemoglobin (HbA1c) by an absolute 1 to 2% with the greatest impact at the initial stages of diabetes. METHODS: data from Hospital based cross sectional study were used to assess the level of dietary adherence and its determinants among diabetic patients. The morisky 8 item medication adherence scale was used to develop 10 item tool for evaluation of dietary adherence. Multiple logistic regression was conducted to identify factors which affect dietary adherence and variables with P vale < 0.05 were considered statistically significant. RESULTS: more than half of 303 participants (55.7%) were found to be non-adherent to the recommended dietary approach. Gathering with family and friends and eating out were the major reasons for not being compliant with the recommended regimen. Attending diabetic nutrition education (AOR= 2.8 95% C 1.97, 5.61) and having the disease for more than 10 years (AOR 2.9 95% CI 1.32, 5.84) were statistically significant with adherence to dietary recommendation. CONCLUSION: non-adherence to recommended dietary practice was observed in more than fifty percent of patients; it is therefore a major public health problem. Attending diabetic nutrition education and length of diabetes greater than 10 years were the factors associated with adherence to dietary recommendation. This findings indicate that it is important to design strategies to help patients understand their dietary regimens and improve their adherence.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Isaac Okyere, Christiana Adu-Takyi, John Appiah Adabie, Perditer Okyere, Nana Addo Boateng [Case report] - Accidental guidewire migration following emergency femoral central venous catheterization - 26 July 2019. http://www.panafrican-med-journal.com/content/article/33/259/abstract/ <b>Central venous catheter placement especially the femoral venous catheter is a common practice in critically ill patients. Awareness of potential complications of the guidewire such as guidewire migration is of utmost importance. Though potentially retrievable by a vascular surgeon or interventional radiologist if it occurs, close supervision by a senior person during passage by a junior or inexperienced person, the use of ultrasound before and after placement of catheter, and use of a checklist may help to identify and prevent its occurrence. We present a very rare complication of central venous cannulation of a guidewire migration in our institution. A 12-year-old girl presented to the paediatric emergency unit (PEU) with status epilepticus and aspiration pneumonia and subsequently transferred to the Paediatric Intensive Care Unit (PICU) for ventilatory support. She had accidental guidewire migration to the left internal jugular vein following a right transfemoral central venous catheterization. She underwent successful guidewire retrieval via a right groin incision.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Olfa Fekih, Mariem Touati, Hsouna Mehdi Zgolli, Sonya Mabrouk, Omar Haj Said, Imene Zeghal, Leila Nacef [Case series] - Corps étranger intraoculaire et endopthalmie: facteurs de risque et prise en charge - 26 July 2019. http://www.panafrican-med-journal.com/content/article/33/258/abstract/ <b>Le but est d'identifier les facteurs de risque de survenue d'endophtalmie post traumatique (EPT) avec corps étrangers intra oculaire (CEIO) dans les traumatismes pénétrants du globe et d'évaluer les résultats de la prise en charge thérapeutique. Il s'agit d'une étude descriptive rétrospective portant sur 60 patients hospitalisés pour plaie pénétrante avec corps étranger intraoculaire à l'institut Hédi Raies d'ophtalmologie de Tunis, sur une période de 10 ans. Nous avons inclus dans notre travail les patients présentant un traumatisme oculaire pénétrant avec CEIOprésentant une EPT. Nous avons également identifié les facteurs de risque cliniques de survenue d'endophtalmie chez ces patients. Nous avons colligé 60 patients présentant un traumatisme pénétrant avec corps étranger intraoculaire. Dix de ces patients soit 16,66% ont présenté des manifestations cliniques d'endophtalmie. Tous les CEIO étaient localisés dans le segment postérieur. L'acuité visuelle (AV) moyenne initiale était de 2,26 en Log MAR. L'AV moyenne finale était de 2,18 en Log MAR. Nous avons trouvé un lien statiquement significatif entre la survenue d'une endophtalmie et les facteurs suivants: l'origine rurale p=0,021, le délai d'extraction du CEIO p=0,01, la localisation postérieure du CEIO p=0.012, la rupture capsulaire p=0,022, le décollement de rétineassocié p<0,0001. L'identification des facteurs de risque de survenue d'EPT vont permettre de mieux adapter la prise en charge thérapeutique et préventive de cette complication à fin d'améliorer le pronostic et la qualité de vie des patients.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Abdoul-Karim Paré, Adama Ouattara, Gnimdou Botcho, Brahima Kirakoya, Fasnewendé Aristide Kaboré, Amidou Bako, Delphine Yé, Dramane Bayané, Mireille Konaté, Timothée Kambou [Case series] - La fracture de verge: à propos de six observations au CHU Sanou Souro de Bobo-Dioulasso, Burkina Faso - 26 July 2019. http://www.panafrican-med-journal.com/content/article/33/257/abstract/ <b>La fracture du pénis est une urgence urologique rare, définie comme une rupture traumatique de la tunique albuginée du corps caverneux. Elle touche essentiellement le sujet jeune au cours de l'activité sexuelle. Le but de ce travail était de rapporter les résultats de la prise en charge de 06 cas de fracture de verge observés dans le service d'Urologie-Andrologie du Centre Hospitalier Universitaire Sanon Souro (CHUSS) de Bobo-Dioulasso. Il s'agissait de six patients d'âge moyen de 38,3 ans, reçu pour tuméfaction douloureuse de la verge pour 04 cas et d'urétrorragie persistante pour 02 cas au décours de faux pas du coït ou de manipulation forcée de la verge. La tuméfaction douloureuse de la verge avec la verge en "aspect d'aubergine" a été le principal signe retrouvé. Le traitement a consisté en une évacuation de l'hématome intra-caverneux suivi d'une albuginorraphie pour 05 cas et pour un cas d'un traitement conservateur. Les suites opératoires ont été simples pour l'ensemble des patients.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Isaac Okyere, Perditer Okyere, Paul Sedem Komla Glover [Case report] - Traumatic right diaphragmatic rupture with hepatothorax in Ghana: two rare cases - 26 July 2019. http://www.panafrican-med-journal.com/content/article/33/256/abstract/ <b>A rare case series of traumatic right diaphragmatic rupture with hepatothorax in Ghana is reported. The first case involved a middle-aged man who sustained a penetrating chest injury following an unprovoked attack by a wild bull. The second case was a young woman who sustained a blunt chest injury after being knocked down by a moving vehicle whiles crossing the road. Both presented with ruptured right diaphgramatic rupture and had to undergo repair through thoracotomy after stabilization and the two had been well one year after surgery without any complications or sequelae.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Maryama El Kaddoumi, Ouafa Cherkaoui [Images in medicine] - Les accessoires infantiles en métal: quand un bijoux devient un réel risque de perte oculaire !! - 26 July 2019. http://www.panafrican-med-journal.com/content/article/33/255/abstract/ <b>Il s'agit d'une petite fille de 10 ans, admise aux Urgences Ophtalmologiques suite à un traumatisme domestique par son bijou en metal, accroché à la conjonctive et à paupiere. L'examen clinique ophtalmologique etait strictement normal à l'exception du corps etranger remarquablement visible à l'oeil nu, l'ablation du corps etranger à laisser place à une hemorragie sous conjonctivale localisée sans lésions palpebrales ou du muscle droit latéral ni de lacération conjonctivale ou sclérale. La patiente a beneficié d 'un traitement par larmes artificielles et antibiotiques avec bonne évolution. La vaccination antitétanique était à jour. Attention aux accessoires en metal chez les enfants mais aussi chez toute la population.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ahmedou Moulaye Idriss, Yahya Tfeil, Jiddou Sidi Baba, Sid'Ahmed Md Boukhary, Mohamed Abdallahi Deddah [Research] - Applicabilité de la classification Clavien-Dindo dans l'évaluation des complications postopératoires dans la clinique chirurgicale du centre hospitalier national de Nouakchott: analyse observationnelle de 834 cas - 26 July 2019. http://www.panafrican-med-journal.com/content/article/33/254/abstract/ <b>INTRODUCTION: Les complications postopératoires ne sont pas rares; certaines sont transitoires, d'autres peuvent être graves, mais elles sont toutes importantes pour les patients. L'une des plus importantes lacunes dans la recherche chirurgicale est le manque de consensus sur le résultat préféré, comment la mesurer ou l'évaluer. METHODES: Nous rapportons une étude rétrospective des complications post opératoires survenues au service de chirurgie générale du centre hospitalier national de Nouakchott. Huit cents trente-quatre patients opérés pendant sept mois (1er janvier 2017 au 31 juillet 2017). Les paramètres démographiques et cliniques ont été étudiés, analysés statistiquement sur le logiciel SPSS 20. RESULTATS: Il s'agit de 834 patients dont 426(51,1%) hommes. L'âge moyen: 34,81 ans (1-90ans). Quatre cents trente-deux (51,2%) patients opérés en urgence. Le sexe ratio (H/F): 1.04. L'ethnie arabo berbère représentait (77,8%). La pathologie appendiculaire (41,12%), pathologie hépatobiliaire (17,76%), pathologie de la paroi abdominale (16,1%). La pathologie thyroïdienne (5,6%). Cent quatre-vingt-trois (21,94%) patients ont développé des complications postopératoires dont 4(2,1%) décès. Le grade II clavien-Dindo est le plus représenté avec 82,5% des compliquées et représente 17,91% de tous les opérés. L'infection du site opératoire a été de 62.8% de toutes les complications. CONCLUSION: Cette étude a montré que la classification de Clavien-Dindo peut être appliquée pour les patients ayant subi une chirurgie élective et une chirurgie d'urgence. Nous pensons que le manque de suivi et le manque de moyen de lutte contre l`infection et le non-respect rigoureux des mesures d'asepsie et d'antisepsie jouerait un rôle important.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Manix Ilunga Banza, Jules Panda Mulefu, Lire Ipani Lire, Yannick Tietie Ben N’dwala, Israel Badypwyla Tshiamala, Vincent de Paul Kaoma Cabala [Research] - Pathologies digestives associées à la drépanocytose à Lubumbashi: aspects épidémiologiques et cliniques - 26 July 2019. http://www.panafrican-med-journal.com/content/article/33/253/abstract/ <b>INTRODUCTION: La drépanocytose est une maladie génétique de transmission autosomique liée à une anomalie de structure de l’hémoglobine qui aboutit à la formation de l’hémoglobine S. Le but de notre étude est de colliger les cas de pathologies digestives rencontrées chez les drépanocytaires de Lubumbashi et d’en ressortir les caractéristiques épidémiologiques et cliniques. METHODES: Il s’agit d’une étude rétrospective, descriptive transversale réalisée au Centre de Recherche de la drépanocytose de Lubumbashi. Elle a concerné les dossiers des patients suivi pour drépanocytose ayant présenté une pathologie digestive au cours de notre période de 3 ans (de janvier 2015 à décembre 2017). Le recueil des données s’est fait grâce à une fiche d’enquête comportant différents paramètres d’étude comprenant: l’âge, le sexe, le motif de consultation, le diagnostic, le type de crise vaso-occlusive, les examens paracliniques réalisés, le traitement à l’hydroxyurée. RESULTATS: Nous avons colligé 206 dossiers (N=206) des patients drépanocytaires ayant fait une pathologie digestive sur un total de 403 dossiers examinés, ce qui représente une fréquence de 51,11% des pathologies digestives chez les drépanocytaires. Les 2 sexes sont représentés avec une légère prédominance féminine (51,94%) et un sexe ratio H/F: 0,92. La tranche d’âge la plus représentée est celle comprise entre 1 et 6 ans (32,52%), la moyenne d’âge: 11,8ans; écart-type: 21,9; âges extrêmes: 13 mois et 38 ans. Le motif de consultation est dominé par la fièvre (60,67%), la douleur abdominale (44,66%) et les troubles digestifs (30,09%). Les crises vaso-occlusives abdominales sont retrouvées chez 65 patients (31,55%) parmi lesquels 36 patients ont présenté 1 seule crise, 24 en ont présenté 2 et 5 patients en ont présenté 3. Les pathologies intestinales étaient présentes chez 121 patients (69,41%) dominées par la parasitose intestinale(retrouvée chez 58 patients dont l’examen des selles a mis en évidence 4 parasites: le Yersinia enterocolitis, l’entamoeba histolytica, le Giardia intestinalis et le clostridium difficile); les pathologies gastriques retrouvées chez 105 patients (50,97%) reparties en ulcère gastro-duodénal (45 patients) et gastrite (60 patients); la pathologie vésiculo-biliaire présente chez 40patients (19,41%) comprenant la lithiase vésiculaire sans cholécystite 32 patients,la cholécystite lithiasique 5 patients et 3 cas de lithiase de la voie biliaire principale; 1 seul cas de pancréatite aigue diagnostiquée. Lespathologies associées les plus retrouvée dans notre étude sont respiratoires avec 169 cas (82,03%), oto-rhino-laryngologiques avec 157 cas (76,21%), les crises vaso-occlusives osseuses (146 cas soit 70,87%), pathologies uro-génitales avec 64 cas(31,06%) et le paludisme chez 51 patients(24,75%). Les atteintes spléniques et hépatiques ont constitué chacun 47 cas (22,81%) et 18 cas (8,73%). L’échographie a était demandé chez 79 patients mais seulement 31 d’entre-eux l’ont réalisée, faute de moyen financier car il coute sur place 20 dollars américains. En cas de splénomégalie cliniquement évidente, le corps de Jolly a été demandé chez 23 patients mais seulement 2 patients l’ont réalisé vu qu’il coute 10 dollars américains. L’hémogramme de routine fait de l’hémoglobine, hématocrite, bilan inflammatoire et la goutte épaisse a été réalisée chez tous nos patients mais le bilan hépatique, les examens des selles, des urines sont préconisés en fonction de la plainte. Sur nos 206 patients, 60 seulement d’entre eux étaient sous traitement à l’hydroxyurée (29,16%). CONCLUSION: Les pathologies digestives sont fréquentes chez les drépanocytaires et représentent quasiment la moitié de l’effectif drépanocytaire. Malheureusement, la meilleure prise en charge reste butée à la pauvreté manifeste de la population limitants les examens paracliniques très utiles dans la pathologie digestive rencontrée chez le drépanocytaire.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mohamed Bourouache, Rachida Mimouni, Mohamed Nejmeddine, Smail Chadli, Fatima Benlmeliani, Jamila Sardi, Mourad Malmoussi, Zineb Ouagar, Maryam El Basbassi, Mohamed Aghrouch [Research] - The prevalence of syphilis in HIV-seropositive patients: a retrospective study at the regional hospital in Agadir, Morocco - 25 July 2019. http://www.panafrican-med-journal.com/content/article/33/252/abstract/ <b>INTRODUCTION: HIV and syphilis are major public health problems in Morocco. The region of Souss-Massa, south-west of the country, hold more than 24% of HIV seropositive cases registered in Morocco during 2009. The aim of this study is to evaluate the seroprevalence of syphilis among HIV seropositive patients in the region of Souss-Massa, south-west of Morocco. METHODS: to evaluate the seroprevalence of syphilis and neurosiphylis among HIV seropositive patients, we retrospectively investigated the medical records of HIV-infected patients attending the regional hospital located in the city of Agadir, during the period comprised between 2011 and 2016. RESULTS: the population studied involved 1381 males (49.18%) and 1427 females (50.82%) HIV seropositive patients. Among them, 481 patients were seropositive for syphilis and three cases were diagnosed with neurosyphilis. The sex ratio distribution was 243 male (52.71%) and 218 female (47.29%). The prevalence of syphilis among the studied population was estimated to 16.42% with a slight dominance in male (17.63%) compared to female (15.28%). By contrast, neurosyphilis was only detected in male patients, with a prevalence estimated to 0.11%. CONCLUSION: even if the prevalence of HIV and syphilis is stable in the region of Souss-Massa, the prevalence of syphilis among HIV seropositive patients remained high and correlated positively with that of HIV infection. We did not find a significant difference between the genders, in relation to the prevalence of HIV and syphilis. We concluded that it was essential to continue monitoring the population, in order to improve the prevention and the access to the medical care in the south-west of Morocco.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Sarra Jouini, Héla Manai, Olfa Slimani, Hana Hedhli, Fatma Hebaieb, Mohamed Mezghanni, Asma Aloui, Rym Ben Kaddour [Research] - Profil épidémiologique et pronostic de l’insuffisance cardiaque aiguë: expérience du service d’accueil des urgences de l’hôpital Charles Nicole de Tunis de 2013 à 2014 - 24 July 2019. http://www.panafrican-med-journal.com/content/article/33/251/abstract/ <b>INTRODUCTION: L'insuffisance cardiaque aiguë (ICA) correspond à une entité syndromique spécifique, regroupant plusieurs tableaux cliniques hétérogènes; fréquemment rencontrées aux urgences. L'objectif de cette étude a été décrire les caractéristiques épidémiologiques, cliniques, thérapeutiques et pronostiques des patients admis aux urgences pour ICA. METHODES: Nous avons mené une étude prospective descriptive dans un service d'accueil des urgences qui a inclu tous les patients admis pour ICA. Nous avons étudié les caractéristiques épidémiologiques, cliniques, thérapeutiques et pronostiques chez ces patients. RESULTATS: Nous avons inclu 180 patients pour ICA ayant entrainé une hospitalisation dans le service d'urgence. Le sexe ratio a été de 1,27. L'âge moyen a été de 66+/-12 ans. Quatre vingt deux pour cent des patients étaient hypertendus et 69% étaient diabétiques connus. Les étiologies de décompensation étaient essentiellement une poussée hypertensive chez 61,7% des patients, un syndrome coronaire aigu chez 24%. Le support respiratoire a été assuré essentiellement par la CPAP dans 73,3% des cas. Le traitement pharmacologique a été à base de dérivés nitrés dans 70% et de diurétique dans 40,5% des cas. Le taux de récidive de l'insuffisance cardiaque aiguë à un mois a été de 21,7% (n=39 patients), et celui de la mortalité à 3 mois a été de 13,3%. CONCLUSION: L'ICA vues aux niveaux des urgences est essentiellement sous forme hypertensive. Le traitement est basé essentiellement sur la CPAP, les vasodilatateurs et les diurétiques. Le taux de récidive était important, et la mortalité était aussi élevée.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Afnan Rajeh, Andreas Albers, Annett Pudszuhn, Veit Maria Hofmann [Case report] - Rare involvement of paranasal sinuses in sarcoidosis: case report and literature review - 24 July 2019. http://www.panafrican-med-journal.com/content/article/33/250/abstract/ <b>Sarcoidosis is a non-caseating inflammatory chronic systemic disease of unknown etiology, which may affect one or more organs. Paranasal sinuses involvement occurs sporadic in sarcoidosis. We report a patient with a medical history of sarcoidosis involving her lungs, liver, and lymphatic system for four years who now presented with nasal and sinuses symptoms. The primary treatment with local cortisone showed no improvement. Computed tomography (CT) scan of the paranasal sinuses (PNS) revealed signs of chronic pansinusitis. She was successfully treated with endoscopic sinonasal surgery. Subsequent histological analysis confirmed the involvement of the PNS with sarcoidosis. Her follow-up during the last 6 months was without recurrence.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fatima-Zahra Bandadi, Chaimae Raiss, Aziza Moustachi, Mohamed Lyagoubi, Sara Aoufi [Case series] - Quarante cas de cryptococcose neuroméningée diagnostiqués en 21 ans au laboratoire de parasitologie de l’hôpital Ibn Sina de Rabat - 23 July 2019. http://www.panafrican-med-journal.com/content/article/33/249/abstract/ <b>La cryptococcose neuroméningée (CNM) est une mycose opportuniste fréquente et sévère causée par une levure encapsulée Cryptococcus neoformans. Elle est fréquente chez l'immunodéprimé en particulier le sujet atteint du virus de l'immunodéficience humaine (VIH) à un stade avancé de la maladie,et elle est rare chez l'immunocompétent. Nous rapportons 40 cas de cryptococcose neuroméningée (CNM) diagnostiqués au laboratoire de parasitologie de l'hôpital Ibn Sina de Rabat sur une période de 21 ans (1993 à 2014). Le diagnostic de la cryptococcose neuroméningée a reposé sur la mise en évidence de Cryptococcus neoformans dans le liquide céphalorachidien (LCR) après l'examen direct à l'encre de Chine et la culture sur milieux de sabouraud sans actidione, ainsi que la recherche d'antigènes solubles cryptococciques. Trente cinq patients étaient infectés par le VIH, deux patients étaient apparemment immunocompétents et 3 patients immunodéprimés non VIH (30 hommes et 10 femmes). L'âge moyen des patients était de 38 ans. La cryptococcose neuroméningée était révélatrice de l'infection par le VIH dans 13 cas. Dans 22 cas elle a représenté une complication du SIDA. Vingt sept patients de notre série ont été traités par une monothérapie à base de fluconazole. L'amphotéricine B a été utilisée chez 13 patients. L'évolution a été favorable pour 13 patients(32.5%) et trois cas ont connu une complication (7.5%). Alors que 18 patients sont décédés(45%) et 6 ont été perdus de vue(15%). Pour un diagnostic rapide, la recherche de Cryptococcus neoformons doit être appliquée systématiquement devant le moindre signe neurologique.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Younes Barbach, Fatima Zahra Mernissi [Images in medicine] - Érysipèle sur carcinome épidermoïde récidivant de la grande lèvre après radio-chimiothérapie - 23 July 2019. http://www.panafrican-med-journal.com/content/article/33/248/abstract/ <b>L'érysipèle est une infection bactérienne due le plus souvent dans 85% des cas, à un streptocoque ²-hémolytique du groupe A (SGA), donnant un tableau de dermo-hypodermite non nécrosante. De nombreux facteurs peuvent favoriser sa survenue tel que les facteurs généraux: le diabète, l'immunodépression, la chimiothérapie et la radiothérapie, ainsi que les portes d'entrée locorégionales telle qu'un ulcère de jambe, une piqûre d'insecte, un intertrigo. La survenue d'un érysipèle sur un carcinome épidémoide récidivant après radiochimiothérapie est exceptionnelle, cette atteinte nécessite d'abord un traitement urgent de la dermo-hypodermite, puis une prise en charge appropriée et multidisciplinaire du carcinome. Le mécanisme d'apparition de l'érysipèle après radiothérapie rejoint la physiopathologie. En effet, ce volet thérapeutique très utilisé dans le traitement des carcinomes épidermoides altère le retour les vaisseaux lymphatiques et entraine très progressivement une fibrose de la lymphe diminuant ainsi le mécanisme de défense. L'association d'une altération de l'immunité cellulaire, favorisée aussi bien par la radiothérapie que la chimiothérapie faciliterait l'apparition de l'érysipèle sur ce terrain. Nous rapportons le cas d'une patiente âgée de 50 ans, suivie depuis 1 an pour carcinome épidermoide de la grande lèvre droite, traitée par radio-chimiothérapie, avec rémission. Huit mois plus tard, la patiente présentait une récidive de son carcinome, l'évolution était marquée par l'apparition d'un placard érythémateux chaud douloureux de la cuisse droite évoquant un érysipèle, confirmé par le bilan biologique infectieux, elle a été mise sous antibiothérapie avec bonne amélioration puis adressée en oncologie pour la prise en charge de sa récidive.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Nathalie Dinganga Kapessa, Prince Muteba Katambwa, Florent Tshibwid Zeng, Tresor Kibangula Kasanga, Yannick Tietie Ben Nduala, Willy Arung Kalau [Case report] - Récidive d'une hernie primaire de Jean-Louis Petit: à propos d'un cas - 23 July 2019. http://www.panafrican-med-journal.com/content/article/33/247/abstract/ <b>La hernie de Jean-Louis Petit constitue avec la hernie du quadrilatère de Grynfelt le groupe des hernies lombaires. Son diagnostic clinique est confirmé par la tomodensitométrie, et éventuellement l'échographie ou la radiographie. L'indication opératoire est formelle du fait de la tuméfaction ou de la gêne fonctionnelle, mais plus encore de l'étranglement toujours à craindre. Nous rapportons un cas rare de récidive de hernie primaire de Jean Louis Petit, chez un homme de 65 ans.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Almamy Diabaté, Koffi Kouamé Pacôme Gbandama, Amon Anderson Stephen Kouabenan, Irenée Gué, Bamba Vagamon, Boussou Romain Aka [Case report] - A case of squamous cell carcinoma occurring on a scar of Buruli ulcer in Bouake, Ivory Coast - 23 July 2019. http://www.panafrican-med-journal.com/content/article/33/246/abstract/ <b>Buruli ulcer is infectious necrotizing panniculitis due to Mycobacterium ulcerans. Buruli ulcer is healed by leaving dystrophic, fibrous and retractile scars. On these scars can occur long-term squamous cell carcinoma. We report the first case of squamous cell carcinoma occurring on healing of Buruli ulcer. A 32-year-old woman with Buruli ulcer who has been cured for about 10 years is seen for ulcero-bulging knee swelling. The examination had revealed a large swelling of about ten centimeters in diameter, ulcero-budding, with an easily bleeding cauliflower appearance. The diagnosis of squamous cell carcinoma being retained without metastasis, resection of the tumor with scarring after one month without chemotherapy. There was no recurrence after six months of decline. The epidemiology of Buruli ulcer, responsible for scarring, explains the young age of our patient and the localization of carcinoma on the limb. The carcinomatous degeneration of scars, especially the scars of old burns, is constantly reported. The characteristics of Buruli ulcer scars, which bring them closer to burn scars, may explain why they are particularly affected by carcinomatous degeneration. One could also mention the chronicity of the wound in this infection, or wonder if the mycobacteria itself could play a role in carcinogenesis. This observation is, in our opinion, an alarm signal. We must fear an outbreak of cases in the years to come. To this end, preventive measures should already be taken by sensitizing the patients for an early consultation before any modification of their scars. After recovery, Buruli ulcer seems to present a risk of long-term evolution to a cancer. The scars of this condition, which could be considered precancerous lesions.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Salim Gallouj, Niema Aqil, Taoufiq Harmouch, Fatima Zahra Mernissi [Case series] - L'intérêt de la chirurgie micrographique dans la prise en charge du carcinome basocellulaire: expérience du service de dermatologie CHU Hassan II de Fès, Maroc - 23 July 2019. http://www.panafrican-med-journal.com/content/article/33/245/abstract/ <b>La chirurgie micrographique de Mohs (CMM) est une technique permettant le contrôle histologique per-opératoire de la totalité de la marge d'exérèse chirurgicale des tumeurs malignes. Le but de ce travail est de valider l'intérêt de la CMM dans la guérison maximale des carcinomes basocellulaires (CBC) chez nos malades. Sur une période de 5 ans, nous avons retenu 29 patients présentant un CBC de la face. La médiane d'âge était de 45,8 ans (12-80). Le sex-ratio H/F était de 1,23. Une seule étape était nécessaire pour une exérèse complète dans 51% des cas. Le recours à 3 étapes était nécessaire dans 14% des cas. La durée moyenne de l'intervention a été d'une heure pour les cas ne nécessitant qu'une seule étape. Aucune complication n'a été rapportée en post opératoire et les suites étaient simples. Le résultat esthétique et fonctionnel était satisfaisant. Aucune récidive n'a été notée. Le CBC représente environ 80% de tous les cancers de la peau. La décision de traiter le CBC par CMM est basée sur trois variables: le siège et la taille de la tumeur, l'aspect histologique avec la définition de la marge d'exérèse et le caractère récidivant. La CMM est actuellement la méthode la plus efficace pour le traitement du CBC et permet la préservation du maximum de tissu sain. C'est une méthode chirurgicale sûre et reproductible, fondée sur un travail d'équipe et adaptée au traitement des CBC à haut risque de récidive. Les résultats esthétiques et fonctionnels sont satisfaisants. Le taux de récidive à 5 ans est 10 fois inférieur aux autres méthodes.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Dorine Djuissi Tekam, Noel Vogue, Claude Ngwayu Nkfusai, Maurice Ebode Ela, Samuel Nambile Cumber [Research] - Accès à l'eau potable et à l'assainissement: cas de la commune d'arrondissement de Douala 5ème(Cameroun) - 23 July 2019. http://www.panafrican-med-journal.com/content/article/33/244/abstract/ <b>INTRODUCTION: L'accès à l'eau potable et à l'assainissement est depuis longtemps l'enjeu d'un combat mené par de nombreux États. Cependant, il représente un combat quotidien pour des centaines de milliers de citadins qui vivent principalement dans les pays en développement. Le gouvernement camerounais avec l'aide des bailleurs de fond ont élaboré des stratégies devant faire de l'assainissement et l'accès à l'eau potable une réalité. Nous avons donc décidé d'évaluer l'assainissement et l'accès à l'eau potable de la sous-division de Douala 5. METHODES: il s'est agi d'une étude transversale descriptive. L'étude s'est effectuée sur une période allant de mai en juin 2018. Un échantillonnage aléatoire à deux dégrées était utilisé. Les données ont été collectées à l'aide d'un questionnaire. L'analyse a été faite par épi info version 7.1.3.3. RESULTATS: il ressort de notre étude que 22,47% déversaient ses eaux dans la nature après usage. Puis 65,55% (493/752) de ménages consommaient l'eau de forage. 53,69% de ménage parcouraient entre 1 à 5 km et 49,25% marchaient plus de 15minutes pour avoir de l'eau. 85,50% de ménages n'utilisaient pas une méthode de traitement de l'eau. Seulement 14,49% pratiquaient une méthode de traitement. Aucun ménage n'utilisait la méthode de potabilisation par rayonnement solaire (SODIS). 2/752 ménages (0,26%) n'avaient pas de latrine. La majeure partie des ménages 54,52% (410/752) déversaient les ordures dans la rue. CONCLUSION: la mise en place des unités décentralisées: les forages, les bacs à ordures et l'éducation de la population sur les méthodes de traitement de l'eau pour les besoins élémentaires est une urgence.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Bensassi Achraf, Redouane Elghadraoui, Anass Zahraoui, Mohammed Elidrissi, Abdelhalim Elibrahimi, Abdelmajid Elmrini [Case series] - La couverture des pertes de substances cutanées du tiers inférieur de la jambe: à propos de 09 cas - 23 July 2019. http://www.panafrican-med-journal.com/content/article/33/243/abstract/ <b>La couverture des pertes de substances cutanées du tiers inférieur de la jambe est compliquée, et ce dû à la pauvreté des tissus mous adjacents, la précarité de la vascularisation locale et l'exposition osseuse. Nous avons mené une étude rétrospective d'une série de 9 cas de couvertures cutanées du tiers distal de la jambe traitée au CHU Hassan 2 de Fès de l'année 2016 à 2018. L'objectif de notre étude est de relever la particularité des pertes de substances cutanées du tiers inférieur de la jambe, tout en soulignant la difficulté de couverture.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Omar El Aoufir, Moulay Rachid EL Hassani, Mohamed Jidane, Meriem Fikri [Case report] - Tumeur du nerf sciatique: neurinome ou neurofibrome? L'IRM peut-elle faire la différence? - 23 July 2019. http://www.panafrican-med-journal.com/content/article/33/242/abstract/ <b>Le nerf sciatique est la branche terminale du plexus sacré. La sciatalgie traduit une souffrance des racines nerveuses. La sciatique relève le plus souvent de l'origine dégénérative discale, la pathologie tumorale reste exceptionnelle. Il s'agit d'une tumeur nerveuse, révélée par un syndrome sciatique rebelle au traitement, diagnostiquée à l'IRM, chez un patient de 33 ans. La pathologie tumorale du nerf sciatique est rare, de diagnostic difficile. Les informations fournies par l'IRM sont cruciales car elles conditionnent l'approche chirurgicale.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Saad Benali, Jaouad Kouach [Images in medicine] - Une cause rare d’hémorragie du post-partum: le thrombus génital - 19 July 2019. http://www.panafrican-med-journal.com/content/article/33/241/abstract/ <b>Patiente âgée de 30 ans, primipare, ayant accouché par césarienne pour souffrance fœtale aigüe, d'un garçon de 3500g. A deux heures du post-partum, la patiente a installé une tuméfaction ecchymotique vulvaire bilatérale doloureuse en faveur d'un thrombus vulvaire du post-partum. Devant la stabilité de la taille de cet hématome à la surveillance, l'absence de douleur insupportable et l'état hémodynamique stable, on a opté pour un traitement médical conservateur (vessie de glace + AINS). L'évolution était favorable avec une diminution progressive de la taille de l'hématome jusqu'à disparition à 8 semaines du post-partum. Le thrombus ou hématome génital est une complication hémorragique rare du post-partum, mais potentiellement gravissime. On distingue quatre grandes sortes d'hématomes génitaux: l'hématome vulvaire, l'hématome vulvo-vaginal, l'hématome vaginal proprement dit et l'hématome pelvi-abdominal. Les facteurs favorisants sont la primiparité, les extractions instrumentales, la toxémie gravidique, les grossesses gémellaires et les varices vulvovaginales. Il faut savoir l'évoquer devant toute symptomatologie douloureuse et/ou d'hémorragie interne du post-partum et réaliser au moindre doute une inspection vulvovaginale. Le traitement doit être appliqué rapidement et associe à la réanimation hémodynamique, la chirurgie en première intention et l'embolisation artérielle radiologique percutanée en cas d'échec de celle-ci.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Houda Chattri, Meryem Kouara, Khadija Chetouani [Case report] - Torsion ovarienne en post-partum: à propos d’un cas - 19 July 2019. http://www.panafrican-med-journal.com/content/article/33/240/abstract/ <b>La torsion d'ovaire est une étiologie rare de douleurs pelviennes en postpartum. L'absence de signes cliniques et radiologiques peu spécifiques rendent la suspicion et le diagnostic préopératoire difficile. Le retard de prise en charge peut mettre en jeu la viabilité de l'ovaire. Nous présentons le cas d'une patiente de 24 ans à J5 du postpartum qui s'est présentée aux urgences pour des douleurs pelviennes aigues, chez qui le diagnostic de torsion ovarienne sur masse kystique a été fait sur la base des signes échographiques, permettant à la patiente de bénéficier d'une kystectomie et d'un traitement conservateur.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ibrahim Dan Dano, Sani Ousmane, Kamaye Moumouni, Adamou Lagare, Idi Issa, Jean Testa [Research] - Risk factors associated with Streptococcus pneumonia carriage in children under five years old with acute respiratory infection in Niger - 19 July 2019. http://www.panafrican-med-journal.com/content/article/33/239/abstract/ <b>INTRODUCTION: <i>streptococcus pneumonia</i> is a leading cause of bacterial pneumonia, meningitis and sepsis in children, and pneumococcal carriage is an important source of horizontal spread of these pathogens within the community.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Gladys Anguezomo, Ghizlane El Mghari, Nawal El Ansari [Case report] - Néoplasie endocrinienne multiple type 1: à propos d'un cas - 19 July 2019. http://www.panafrican-med-journal.com/content/article/33/238/abstract/ <b>La néoplasie endocrinienne multiple type1 (NEM1) est une maladie rare, définie par l'atteinte tumorale, chez le même sujet, d'au moins deux glandes endocrines affectant l'antéhypophyse, les parathyroïdes et le tissu endocrine duodéno-pancréatique. Cette pathologie héréditaire autosomique dominante est liée la mutation du gène NEM1 codant pour la ménine et situé sur le chromosome 11q13. Il existe, toutefois, des formes sporadiques dans 8 à 14% des cas. La lésion endocrinienne initiale peut être unique dans environ 75%. Cependant, chacune des principales atteintes peut être inaugurale. Le cas rapporté ici est révélé par un adénome hypophysaire somatoprolactinique ayant un caractère agressif, ne répondant pas au traitement conventionnel. La découverte d'une hyperparathyroïdie primaire ainsi qu'une tumeur neuroendocrine du pancréas (pNET) sept ans plus tard en font toute la particularité. L'attitude thérapeutique est discutée au sein d'une équipe pluridisciplinaire spécialisée dans le domaine de la pathologie endocrine.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mohamed Amine Triki, Nader Naouar, Sofien Benzarti, Hamdi Kaziz, Thabet Mouelhi, Mohamed Laaziz Ben Ayeche [Case series] - Septic arthritis of the wrist: about six cases - 19 July 2019. http://www.panafrican-med-journal.com/content/article/33/237/abstract/ <b>The wrist is a rare location of septic arthritis. It often involves patients with preexisting joint disease which symptoms could be confused with infection making the diagnosis more difficult and usually delayed. It is often responsible for residual functional impairment and for a high mortality rate among vulnerable patients. We report 6 cases of septic arthritis of the wrist in 3 males and 3 females. The mean age was 32 years in the male patients and 66 in the female patients. All the women were followed for rheumatoid arthritis. Biological results showed elevated rates of white blood cells and c-reactive protein in all the patients. Joint fluid analyses showed elevated white blood cell count. The treatment was medico-surgical consisting in synovectomy, joint debridement and immobilization of the wrist. At the average follow-up of 1 year and 4 months, 3 patients recovered a perfect mobility of the wrist without any limitation of the range of motion nor the strength. Three patients developed stiffness of the wrist.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Perditer Okyere, Isaac Okyere, Thomas Akuetteh Ndanu, Charlotte Osafo, Bright Amankwaa [Research] - Factors associated with acute kidney injury recovery in a tertiary hospital in Ghana: a prospective study - 19 July 2019. http://www.panafrican-med-journal.com/content/article/33/236/abstract/ <b>INTRODUCTION: Acute kidney injury (AKI) is a challenging problem in developing countries due to late presentation of its victims to health care facilities. Data on the pattern of AKI, its outcome and factors associated with its recovery is scanty in developing countries therefore impeding AKI management. Aim: to study AKI recovery rate and its associated factors. METHODS: An observational study conducted from September 2013 to June 2014 at Korle-Bu Teaching Hospital (KBTH). Participants were adults, admitted with AKI at KBTH. Kidney Disease: Improving Global Outcomes (KDIGO) criteria was used to diagnose and stage AKI. RESULTS: Mean age (SD) of the participants was 41.9 (± 19.2) years. About a third of the patients (34.6%) were less than 29 years with 30-39 years and 40-60 years constituting 23.0% and 23.6% respectively. Females were in the majority (56.0%). AKI stages I, II and III accounted for 11.0%, 6.8% and 70.7% respectively. Majority, 82.2% of the patients recovered their kidney function. Stage III AKI was significantly associated with decreasing odds of recovery [OR = 0.4, 95%CI = 0.4 – 2.6, p = 0.002]. In addition, normal blood sodium was associated with recovery from AKI [OR, 95%CI = 2.3, (1.1 – 5.3), p = 0.043]. Almost half (45.5%) presented with fever whereas 32.5% and 22.5% presented with peripheral oedema and pulmonary oedema respectively. CONCLUSION: The study demonstrated high kidney function recovery following AKI. Dominant clinical features were fever, peripheral and pulmonary oedema. Advanced stage was associated with poor recovery whereas normal serum sodium level improves kidney function recovery.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mohamed Mahmoud El Hacen, Sid’ahmed Limam, Abdoulay Aw, Kemal Ahmed, Noura Biha, Cheikh Ne [Case report] - Lambeau de Mac Gregor, solution de sauvetage: à propos d'un cas, clinique et résultat - 19 July 2019. http://www.panafrican-med-journal.com/content/article/33/235/abstract/ <b>Le lambeau inguinal est un lambeau « axial » pédiculé à distance. Il s'agit d'un lambeau très fiable pour les couvertures des grandes pertes de substance du membre supérieur, même si son inconvénient majeur est de nécessiter deux temps opératoires. Il reste un lambeau de choix dans l'arsenal thérapeutique de la chirurgie de la main gauche, en urgence ou en chirurgie réglée. Cela s'explique par son épaisseur graisseuse et son pédicule court, de petit calibre, aux variations anatomiques fréquentes. Le but de cette étude est de montrer son intérêt en mettant en balance ses avantages et ses inconvénients. Nous rapportons le cas d'une patiente âgée de 33 ans qui a présenté suite à un traumatisme ouvert complexe de la main une déformation grave avec fermeture de la première commissure et ankylose de la première articulation métacarpo-phalangienne. Il a été opéré en deux temps avec ouverture la première commissure et arthrodèse M1-trappez stabilisé par embrochage suivi d'une couverture cutané immédiate par un lambeau inguinal de McGregor et en deuxième temps après 21 jours pour sevrage et suture du site donneur. Le résultat anatomique et fonctionnel a été jugé bon. Les patients étaient satisfaits par la cicatrice du site donneur aisément dissimulable dans les sous-vêtements, par la fonctionnalité et l'esthétique de la main. Le lambeau de Mac Gregor est une solution de couverture intéressante avec des avantages non négligeables tant du point de vue fonctionnel qu'esthétique. Sa place devrait être remise en valeur dans l'arsenal thérapeutique des lambeaux de recouvrement des membres.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com David Odoyoh Odatuwa-Omagbemi [Research] - Open fractures: epidemiological pattern, initial management and challenges in a sub-urban teaching hospital in Nigeria - 19 July 2019. http://www.panafrican-med-journal.com/content/article/33/234/abstract/ <b>INTRODUCTION: Management of open fractures poses a constant challenge to orthopaedic surgeons in Nigeria. Our aim is to determine the epidemiological pattern of open fractures in our centre and share our experiences on the initial management and problems encountered.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Khairreddine Raddaoui, Wafa Khedhri, Karima Zoghlami, Mohamed Radhouani, Emna Trigui, Olfa Kaabachi [Research] - Perioperative morbidity in total knee arthroplasty - 19 July 2019. http://www.panafrican-med-journal.com/content/article/33/233/abstract/ <b> INTRODUCTION: as the life expectancy and weight of patients are increasing, more old and obese patients are undergoing total knee arthroplasty (TKA). TKA may lead to several perioperative complications. These include anesthesia-related risks, exacerbation of comorbid medical issues and complications of surgical procedure. We have no studies reporting medical complications following TKA among our population. This study aimed to evaluate perioperative complications of TKA and to identify the related risk factors. METHODS: it was a monocentric retrospective including 410 observations in the local TKA registry. Data of patients operated for primary unilateral TKA during the period from January 2014 to December 2017 were reviewed. All patients had standardized protocols of anesthesia and post operative care for three days following surgery. Multivariate logistic regression was used to identify the predicting factors for complications. RESULTS: incidence of perioperative complications was 37.1%. The most frequent were per operative hypotension (14.1%) and postoperative desaturation (21.7%, including pulmonary embolism in 2.4%). Multivariate logistic regression analysis identified: age ≥ 65 years (OR=1.9; p=0.006), respiratory diseases (OR=1.8; p=0.042) and general anesthesia (OR=2.8; p=0.009) as significant risk factors for any complications. Loss of autonomy (OR=4.8; p <0.001) and general anesthesia (OR=2.6; p=0.03) were significant risk factors for hypotension. Age ≥ 65 years (OR=2.6;p<0.001), female gender (OR=4.3;p=0.006) and respiratory diseases(OR=1.9;p=0.02) were associated with postoperative desaturation. CONCLUSION: this study highlighted hemodynamic and respiratory complications as the most common early complications in TKA. Age ≥ 65years, general anesthesia and respiratory diseases were significant risk factors. </b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Jamel EL Ghoul, Soued Ferjani [Images in medicine] - Hemothorax caused by vertebral exostoses - 18 July 2019. http://www.panafrican-med-journal.com/content/article/33/232/abstract/ <b>Spontaneous hemothorax is a rare condition and sometimes occurs during anticoagulant therapy for venous thromboembolism. Other causes of the condition are bleeding disorders, complication of spontaneous pneumothorax and pleural malignancy. Vertebral exostosis represents an exceptional etiology of hemothorax, as a result of direct traumatic injury of the pleura or diaphragm by the intrathoracic tumour. Exostosis often occurs in hereditary multiple exostoses, but can also be isolated. We present a case of spontaneous hemothorax in a patient with vertebral exostoses and propose a new etiology of hemothorax. A 22-year-old man with no specific history elements and no previous trauma presented has been experiencing a right-sided pleuritic chest pain and respiratory discomfort for 6 days. Physical examination revealed dullness to percussion and decreased breath sounds on the right side of the chest. Chest x-ray showed right pleural effusion and diagnostic thoracocentesis revealed gross blood. Pleural effusion's hematocrit was 52%, while that of the peripheral blood was 39%. Hemothorax was diagnosed. Thoracic Computed tomography scan (CT-scan) (A and B, arrows) followed by magnetic resonance imaging (MRI) showed the presence of two vertebral exostoses arising from the right transverse processes of the 10<sup>th</sup> and 11<sup>th</sup> thoracic vertebrae (C and D, arrows). These, encroached on the 11<sup>th</sup> intercostal space. The hemothorax was managed successfully with chest-tube insertion. However, surgical resection of exostoses was indicated in our patient given the risk of loco-regional complications, and the recurrence of the hemothorax. The postoperative course was uneventful and the patient was followed without recurrent hemothorax for two years.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fatima-zahra Agharbi [Images in medicine] - Ulcérations périnéales révélant une maladie de Crohn - 18 July 2019. http://www.panafrican-med-journal.com/content/article/33/231/abstract/ <b>On appelle lésions anopérinéales de la maladie de Crohn, l'ensemble des lésions attribuées à la maladie de Crohn qui touchent le canal anal, la peau du périnée, le bas-rectum et la cloison recto-vaginale. Les principales lésions élémentaires sont représentées par les ulcérations, les suppurations et les sténoses. La nature crohnienne des lésions anopérinéales est souvent évoquée devant un processus très inflammatoire, un épaississement de la peau péri-anale, des marisques œdémateuses, des lésions multiples, des lésions qui s'étendent au-dessus de la ligne pectinée. Les fistules prennent classiquement naissance au sein d'une ulcération ou dans une cicatrice plutôt qu'au niveau des cryptes du canal anal. Les lésions élémentaires de la maladie de Crohn sont rarement isolées et elles sont le plus souvent observées en association. La présence d'une sténose du canal anal ou du rectum est très souvent associée à un processus inflammatoire et suppuratif . Les ulcérations anales sont compliquées d'une suppuration dans la moitié des cas. Nous rapportons l'observation d'une femme de 45 ans suivie pour thyroidite auto-immune et vitiligo qui consultait pour des ulcérations périnéales douloureuses linéaires avec aspect coupées en couteau [ image 1]. L'interrogatoire trouvait des épisodes de diarrhées . L'etude histologique des lésions cutanées montrait un granulome epithélio-giganto-cellualure sans nécrose casseuse et l'exploration digestive montrait un aspect évoquant une maladie de crohn qui a été confirmé à l'histologie.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Zied Jlalia, Dhia Kaffel [Images in medicine] - Langerhans cell histiocytosis of the hip in children - 18 July 2019. http://www.panafrican-med-journal.com/content/article/33/230/abstract/ <b>Eight year old girl was referred to our consultation for a lameness with a flessum of the left hip with fever (38.5°C). Biology showed an inflammatory syndroma (CRP: 29 mg/l). Pelvic X-ray showed an osteolysis of the roof of the left acetabulum with regular contour (A). Magnetic resonance imaging (MRI) showed tissue thinning and damage to the roof of the left acetabulum (B). A scanno-guided biopsy was performed, anatomopathological study confirmed the diagnosis of Langerhans cell histiocytosis. A discharge, with traction was done. The child has improved and biology has normalized. The radiograph of the hip after 1 year showed a filling of the gap (C). Langerha's cell histiocytosis is a proliferation of mononuclear phagocytic cells. It is also called eosinophilic granuloma. It is often located at the skull and spine. The localization at the hip represents only 8% of the cases it is especially supra-acetabular it's spontaneous evolution is favorable.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Nomena Finiavana Rasaholiarison, Julien Razafimahefa, Jenny Larissa Rakotomanana, Alain Djacoba Tehindrazanarivelo [Research] - Fréquence et profil clinique de la maladie de Parkinson et des autres syndromes Parkinsoniens vus au service de neurologie de l'hôpital Befelatanana Antananarivo - 18 July 2019. http://www.panafrican-med-journal.com/content/article/33/229/abstract/ <b>INTRODUCTION: Actuellement nous n'avons pas de données précises sur les syndromes parkinsoniens à Madagascar. Nous voulions rassembler des données sur ces maladies. Alors l'objectif de notre étude étant de décrire la fréquence et le profil clinique des syndromes parkinsoniens dans notre Service de Neurologie. METHODES: il s'agit d'une étude rétrospective descriptive allant de janvier 2014 à juin 2018 dans le Service de Neurologie, Befelatanana. Les données démographiques et cliniques des patients diagnostiqués comme ayant un syndrome parkinsonien étaient collectées. Nous en avons évalué les fréquences et les caractéristiques puis comparé les patients avec Maladie Parkinson idiopathique et les autres syndromes parkinsoniens. Les données étaient traitées par le logiciel R. RESULTATS: nous avons retenus 104 patients sur 3528, vus dans notre service. Parmi les patients avec un syndrome parkinsonien, 67(64,42%) avaient une maladie de Parkinson idiopathique (MP) et 37 (35,47%) un syndrome parkinsonien autre. L'intervalle moyen entre le début de la maladie et la consultation ou l'hospitalisation dans le service était de 2,5 ans. Pour les MP, l'âge moyen de début était à 58,5 [23; 80] ans, l'âge du diagnostic à 62 [28; 83] ans et la sex-ratio était de 1,97. La médiane de score de Hoehn et Yahr était de 2.0. Les formes de MP étaient tremblantes dans 24(35,42%), mixte 28(41,71%) et akineto-rigide 15(22,38%) des cas. Pour les autres syndromes parkinsoniens, 27(72,97%) étaient des hommes, l'âge moyen de début était à 57,5 [26; 83] ans, l'âge du diagnostic à 59,3 [26; 83] ans, les étiologies étaient dominées par l'Atrophie Multi-Systématisée avec 17/37(46,64%). Les patients atteints d'autres syndromes parkinsoniens avaient plus de troubles cognitifs (p=0,0306) et les MP étaient plus sensible au DOPAMINE (p=0,006).</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Kawtar Kettani, Imane Chahid [Images in medicine] - Nodule de sœur Marie-Josèphe - 18 July 2019. http://www.panafrican-med-journal.com/content/article/33/228/abstract/ <b>Nous rapportons le cas d'une patiente âgée de 6 ans, sans antécédents pathologiques, qui s'est présentée pour des douleurs abdominales diffuses et une distension abdominale évoluant depuis 2 mois dans un contexte d'altération de l'état général. L'examen clinique a trouvé un abdomen distendu, une ascite de moyenne abondance, une circulation veineuse collatérale et de multiples masses abdominales mobiles, de consistances dures, de 3-4 cm de diamètres au niveau de la fosse iliaque et de l'hypochondre gauches avec la présence d'une masse ombilicale arrondie, bien circonscrite, dure, de 3cm de diamètre soulevant la peau avec des signes inflammatoires en regard (A). Le reste de l'examen clinique était normal. Le scanner thoraco-abdominal a mis en évidence un nodule ombilical sous cutané (B), à rehaussement homogène mesurant 36x29x19mm, associé à un magma d'adénopathies mésentériques, une masse pelvienne et un épaississement étendu du jéjunum. La cytoponction de la masse a objectivé la présence de plusieurs noyaux nus et quelques blastes et la biopsie était en faveur d'un lymphome de burkitt. Ainsi, le diagnostic de lymphome de Burkitt révélé par un nodule de Sœur Marie-Josèphe a été retenu et la patiente a été mise sous chimiothérapie selon le protocole LMB01. L'évolution a été favorable, marquée par la régression du nodule et des masses abdominales. Le nodule de Sœur Marie-Josèphe est une métastase ombilicale d'une tumeur le plus souvent abdomino-pelvienne essentiellement un adénocarcinome, exceptionnellement un lymphome. C'est un signe rare dont l'incidence est de 1-3% de toutes les néoplasies abdomino-pelviennes, avec un pronostic péjoratif. Ce nodule mérite d'être connu comme lésion secondaire d'une tumeur solide afin d'éviter un retard dans la prise en charge de la néoplasie sous-jacente.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Madiha Chellakhi, Ilham Khalfaoui, Nadia Benchakroun, Zineb Bouchbika, Hassan Jouhadi, Nezha Tawfiq, Souha Sahraoui, Abdellatif Benider, Nabila Chellakhi, Asmaa Quessar [Case report] - Radiation therapy in mycosis fungoid patient - 18 July 2019. http://www.panafrican-med-journal.com/content/article/33/227/abstract/ <b>Mycosis fungoid (MF) is a non-Hodgkin's T-cell lymphoma determined by primary cutaneous involvement. It is a slow-progressing chronic indolent disease characterized by atypical T cells with a cerebral nucleus. Management of this disease depends on the stage and is based essentially on the systemic treatment. Radiotherapy intervenes in case of localized or extended tumor, indeed, the radiosensibility of this tumor, like any other hematological affection, makes it possible to obtain a high rate of response. Clinical case: we report the observation of a 46-year-old patient followed since 2012 for mycosis fungoid revealed by a papullo-squamous lesion located at the level of the right lumbar fossa. The diagnosis was confirmed by cutaneous biopsy, showing the presence of T lymphocytes expressing CD2, CD3, CD4, CCR4, CD45RO markers. Initial assessment included a thoraco-abdominal pelvic CT, which was normal, an accelerated sedimentation rate at the 1st hour, a high C reactive protein (CRP), the electrolytic, renal, hepatic status and the hemogram were normal. Patient received 6 courses of chemotherapy according to the COPP protocol with a decrease in the size of the lesion estimated at 40%. A norm fractionated radiation therapy was delivered at the dose of 36Gy. The evolution was marked by a complete remission, maintained after 6 months of the treatment. Mycosis fungoid is a rare disease, whose management must be discussed in a multidisciplinary team. Radiotherapy remains an interesting option for all stages, but has to be validated in largest studies.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Khadidjatou Saké Alassan, Rachidi Sidi Imorou, Honorat Sonombiti, Kabibou Salifou, Edgar-Marius Ouendo [Case series] - Séroprévalence et facteurs associés à l'hépatite virale B chez les gestantes à Parakou en République du Bénin - 18 July 2019. http://www.panafrican-med-journal.com/content/article/33/226/abstract/ <b>L'objectif est de déterminer la séroprévalence et les facteurs associés à l'hépatite virale B chez les gestantes au centre hospitalier universitaire départemental du Borgou (CHUD-B). Il s'est agi d'une étude transversale à visée descriptive et analytique avec recueil prospectif des données. Elle a porté sur les gestantes suivies et/ou ayant accouchées au CHUD-B du 1er avril 2017 au 30 juin 2017. Etaient incluses, celles ayant données leur consentement à participer à l'étude. Les variables étudiées étaient les données sociodémographiques des gestantes et le résultat de l'AgHBs. La recherche de l'AgHBs sur les prélèvements sanguins des gestantes était faite par un test biologique de diagnostic rapide. Les résultats positifs étaient confirmés par la technique ELISA. Deux cent quatorze (214) gestantes étaient incluses dans l'étude. Leur âge moyen était de 26,73 ± 5,68 ans. L'âge médian de la grossesse en cours était de 31 semaines d'aménorrhée (SA) avec des extrêmes de 4 SA et 42 SA. Parmi elles, 30 femmes étaient dépistées positives à l'AgHBs soit une prévalence de 14,02%. Les facteurs associés à ce portage étaient la pratique des scarifications, l'antécédent personnel d'ictère et les antécédents familiaux d'hépatite virale B. La séroprévalence de l'hépatite virale B chez les gestantes au CHUD-B est élevée ce qui rend bien compte du problème majeur de santé publique que pose l'infection par le virus de l'hépatite B sous nos cieux.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mohamed Maniboliot Soumah, Mor Ndiaye, Yawo Apélété Agbobli, El Hadj Omar Ndoye, Abibatou Dia Sall, Mamadou Lamine Sow [Case series] - Certificats médicaux pour coups et blessures volontaires en pratique médico-judiciaire à Dakar - 18 July 2019. http://www.panafrican-med-journal.com/content/article/33/225/abstract/ <b>La rédaction du certificat médical est une étape cruciale dans la procédure judiciaire. Il est souhaitable que ce document à visée judiciaire soit rédigé dans une consultation médico-judiciaire. Les objectifs de notre étude étaient d'évaluer la qualité des certificats médicaux dans une consultation médico-judiciaire et d'étudier les critères de validité des certificats médicaux interprétatifs. Il s'agit d'une étude rétrospective portant sur les patients reçus à la consultation médico-judiciaire de l'Hôpital général de Grand-Yoff, victimes de coups et blessures volontaires du mois d'avril 2012 au mois de février 2015. L'ensemble des certificats médicaux a été inclus dans une fiche d'enquête analysée par Epi Info version 6.04. L'ensemble des 249 certificats étudiés était imprimé en « Arial police 12 », lisible et compréhensible. Tous les certificats médicaux étudiés comportaient une identification complète du médecin et de la victime. La date et l'heure de l'agression figuraient sur 248 certificats (99,6%). Le type de violence subie était précisé sur l'ensemble des 249 certificats avec 164 rixes (65,9%), 64 agressions unilatérales (25,7%). La description précise des lésions figurait sur les 246 certificats où la nature des lésions a été donnée. La localisation des lésions était établie par rapport à des repères anatomiques fixes, dans les différents plans de l'espace. La consultation médico-judiciaire, coordonnée par le médecin légiste, a permis d'améliorer sensiblement la qualité des documents délivrés. Il demeure que la vulgarisation de ces pratiques de rédaction et de délivrance est nécessaire notamment au niveau des hôpitaux régionaux dans le cadre de la formation continue ou post doctorale.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Akateh Derek, Deresse Assefa Seme, Cho Sabastine Anye, Claude Ngwayu Nkfusai, Samuel Nambile Cumber [Research] - Modern family planning use among people living with HIV/AIDS: a facility based study in Ethiopia - 18 July 2019. http://www.panafrican-med-journal.com/content/article/33/224/abstract/ <b>INTRODUCTION: Despite increasing efforts to address the reproductive health needs of persons living with Human Immuno-Deficiency Virus (HIV), a high unmet need for contraception exists among HIV+ women in sub-Saharan Africa. Currently, Ethiopia promotes integration of family planning (FP) services in to HIV chronic care. Yet the contraceptive prevalence rate among clients remains low. The objective of the study was to assess the role of socio-cultural factors on modern family planning use among HIV+ clients attending Anti-Retroviral Therapy clinics in Addis Ababa sub-cities. METHODS: the study involved a facility based cross sectional survey. The ten sub cities were initially categorized/stratified into 5 based on direction (East, West, South, North and Central) and from each category one sub city was randomly selected. The total sample size was proportionally allocated to the selected health facilities according to previous monthly average client load per health center. Participants were selected using simple random sampling technique during their routine visit at the health centers. Data were collected through a semi-structured interviewer administered questionnaire. Both descriptive and inferential statistics were generated and results considered significant at 95% confidence level using STATA version 14.0. RESULTS: six hundred and thirty-six clients participated in the study. Majority of them were age between 30-39 years. Though majority, 607 (95.4%) participants approved the use of modern FP method, current use rate stood at 39%. Condom was the most (14.5%) commonly used single method. The odds of FP use by participants who disclosed their HIV status were almost twice that of their counterparts (AOR= 1.84; 95% CI: 1.14, 2.95). Participants who held discussion with their spouse/partners concerning FP, irrespective of the frequency had an odd of more than four when using FP than their counterparts (AO= 4.35; 95% CI: 2.69, 7.04). CONCLUSION: this study revealed that 6 out of every 10 HIV+ clients are not currently using FP methods. Disclosure of HIV status as well as open discussion with spouse/partner were positively associated with family planning use. These study findings call for comprehensive and client focus FP education and counseling in line with disclosure of HIV status and dialogue with spouse/partner in order to increase uptake and utilization of FP among clients. Partners have a great influence on the use and choice of FP methods, so their views are paramount.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Tresor Kibangula Kasanga, Jeef Bukasa Misenga, Manix Ilunga Banza, Nathalie Dinganga Kapessa, Tshiband Mosh Bilond, Prince Muteba Katambwa, Dimitri Kanyanda Nafatalewa, Stephanne Ilunga Muka Ngala, Tshibwid Azf, Papy Mukimba Ngabunda, Didier Tshibangu Mujinga [Case report] - Malformation anorectale avec fistule recto-uretro-bulbaire prise en charge tardivement: à propos d'un cas - 18 July 2019. http://www.panafrican-med-journal.com/content/article/33/223/abstract/ <b>Les malformations ano-rectale (MAR) sont un ensemble hétérogène d'anomalies de la mise en place de la filière rectale. Son incidence reste faible en général et se trouve un peu plus élevée dans certains pays en développement. Les garçons sont plus atteints que les filles et la fistule recto-bulbaire associée à une atrésie du canal anal demeure la forme la plus fréquente chez eux. Nous présentons un nourrisson de sexe masculin âgé de 10 mois, dont la mère habite dans une région minière et s'est plainte de fecalurie depuis la naissance de son enfant. L'examen physique a révélé la présence d'une empreinte à 1 cm au-dessous du croisement du raphé médian et de la ligne bi-ischiatique. Les examens paracliniques n'ont montré aucune autre malformation associée. La prise en charge a consisté en une ano-rectoplastie par double abord, abdominal et périnéal, en réalisant la technique d'abaissement abdominopérinéal. En période post-opératoire, une antibiothérapie et une analgésie intraveineuses ont été instaurées, de même que les dilatations, lesquelles ont été poursuivies après la sortie du patient 2 semaines après l'intervention. Aucune complication n'a été observée et les suites ont été favorables.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Selly Ba, Ndeye Mery Dia Badiane, Steve Hawes, Louise Fortes Deguenonvo, Fatima Sall, Cheikh Tidiane Ndour, Khadim Faye, Fatou Traoré, Macoumba Touré, Marie Pierre Sy, Dana Raugi, Nancy Kiviat, Robert Smith, Moussa Seydi, Papa Salif Sow, Gottlieb Geoffrey [Research] - Infection à VIH-2 au Sénégal: échecs virologiques et résistances aux antirétroviraux (ARV) - 18 July 2019. http://www.panafrican-med-journal.com/content/article/33/222/abstract/ <b>INTRODUCTION: Le VIH-2, endémique en Afrique de l’Ouest , est naturellement résistant aux inhibiteurs non nucléosidiques de la rétro transcriptase, ce qui rend difficile la prise en charge dans les pays en développement. Objectifs: déterminer la prévalence de l’échec virologique au 12<sup>éme</sup> et 24<sup>éme</sup> mois (M12 et M24) de traitement antirétroviral de première ligne chez les patients infectés par le VIH-2 et d’en décrire les résistances génotypiques associées. METHODES: Il s’agit d’une étude descriptive longitudinale et prospective, durant la période de Novembre 2005 à Juin 2017. L’échec virologique a été défini comme toute charge virale supérieure à 50 copies/ml après 6 mois de traitement ARV à deux reprises. La recherche de mutations de résistance a été réalisée dans les régions codantes de la protéase et de la transcriptase inverse. RESULTATS: Au total 110 patients ont été colligés, d’âge médian de 46 ans (Extrêmes 18-67) avec un ratio F/H de 2,54. A l’inclusion, la charge virale était détectable dans 44% des cas avec une médiane de 935cp/ml (Extrêmes 17- 144038). Le schéma antirétroviral associait 2 INTI à 1IP dans 94% des cas. La durée médiane de suivi était estimée à 1200 jours (Extrêmes 1-3840). 94 puis 76 patients ont respectivement complété leur bilan à M12 et M24. Au suivi M24, 39 patients étaient en échec virologique soit une prévalence de 39% estimée à 33% à M12 et 11% à M24. 45% des patients avaient des résistances aux INTI, 41% des résistances aux IP et 30% des multi résistances aux INTI et IP. CONCLUSION: Il est impératif de rendre accessibles les nouvelles classes thérapeutiques pour le traitement de sauvetage des patients infectés par le VIH-2 dans les pays à ressources limitées.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Halima Marhari, Fatima Zahra Chahdi Ouazzani, Hanan El Ouahabi, Laila Bouguenouch [Case report] - Le syndrome de Kallmann-de Morsier: à propos de trois cas - 18 July 2019. http://www.panafrican-med-journal.com/content/article/33/221/abstract/ <b>Le syndrome de Kallmann-de Morsier (KS) est une maladie génétique du développement du système olfactif caractérisée par l'association d'un hypogonadisme hypogonadotrophique par déficit en gonadolibérine (GnRH) et d'une anosmie ou hyposmie. Le diagnostic se fait le plus souvent à l'adolescence devant une absence de puberté spontanée associée à un trouble de l'odorat, avec visualisation sur l'IRM hypothalamo-hypophysaire d'une hypoplasie voire une aplasie des bulbes et/ou des lobes olfactifs. Parfois, le diagnostic peut être évoqué dans la petite enfance devant l'association d'une cryptorchidie et d'un micropénis. Une mutation dans l'un de ses gènes connus n'est retrouvée que dans moins de 30% des cas et donc plusieurs autres gènes restent à découvrir. Grâce au traitement hormonal, la puberté se produit dans tous les cas, et la fertilité peut être obtenue dans la plupart des cas. Dans la présente étude, nous rapportons 3 cas de patients atteints de ce syndrome.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Aliou Zabeirou Oudou, Ismael Dandakoye Soumana, Tarek Souiki, Karim IBN Majdoub, Imane Toughrai, Said Ait Laalim, Khalid Mazaz [Case report] - Volvulus total du grele sur mesentere commun incomplet, une complication exceptionnelle chez l’adulte: à propos d’un cas - 17 July 2019. http://www.panafrican-med-journal.com/content/article/33/220/abstract/ <b>Le volvulus total du grêle complique le mésentère commun incomplet correspond à un arrêt de la rotation à 180° de l'anse intestinale primitive. La racine du mésentère est très courte et l'ensemble de l'intestin grêle se trouve pédiculé sur l'axe artériel mésentérique supérieur. Cette situation est à très haut risque de volvulus du grêle et d'infarctus entero-mésentérique. Le volvulus aigu impose une intervention chirurgicale en urgence; l'imagerie ne doit pas retarder la prise en charge chirurgicale. Le geste chirurgical consiste à la détorsion du volvulus (dans le sens antihoraire), la viabilité de l'intestin appréciée. L'intestin est rangé position de mésentère commun complet: cœcum dans la fosse iliaque gauche. Nous rapportons l'observation d'un patient de 60 ans admis pour volvulus total du grêle sur mésentère commun incomplet, opéré en urgence avec une évolution postopératoire favorable.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ayodele Timilehin Adesoji, Jude Prince Onuh, Aisha Omokhefue Musa, Peter Femi Akinrosoye [Research] - Bacteriological quality and antibiogram study of bacteria from "suya" and smoked fish (Clarias gariepinus) in Dutsin-Ma, Katsina State, Nigeria - 17 July 2019. http://www.panafrican-med-journal.com/content/article/33/219/abstract/ <b>INTRODUCTION: Suya and smoked fish are cherished food delicacy in Nigeria, but can be a source of dissemination of Multi-Drug Resistant (MDR) bacteria. Moreover, there are limited studies on these MDR bacteria from Dutsin-Ma. Therefore, this study examined the bacteriological quality and antibiogram profiles of bacteria in these foods from this area in Nigeria. METHODS: Twenty samples of each of suya and smoked fish were collected from the study area and microbiologically analyzed. Total viable count, coliform count, characterization and identification of bacteria was carried out by standard microbiological techniques. RESULTS: Findings revealed that Suya samples possessed the highest total viable bacteria count (3.4x105 to 7.7x105 cfu/g) and coliform count (2.1x105 to 6.2x105 cfu/g). A total of 85 and 78 bacteria were isolated from suya and smoked fish samples respectively. E. coli (24.7% and 24.4%) was the most frequently isolated from each sample respectively. Highest (66.7%) resistance to each of cefuroxime, gentamicin, amoxillin-clavulanate and ciprofloxacin were observed among E.coli from Suya. MDR phenotypes commonly isolated was resistance to ceftazidime, cefuroxime, ampicillin, ciprofloxacin, augmentin and nitrofurantoin. CONCLUSION: This studies showed the presence of MDR bacteria in samples, hence, raise the need for improved production hygiene and public health awareness.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Thomas Hambridge, Yvonne Nartey, Amoako Duah, Amelie Plymoth [Research] - Hepatitis B mother-to-child transmission in the Eastern Region of Ghana: a cross-sectional pilot study - 17 July 2019. http://www.panafrican-med-journal.com/content/article/33/218/abstract/ <b>INTRODUCTION: Hepatitis B is a major health concern in Ghana, where prevalence of the virus remains high and most chronic patients are infected during childhood or at birth. This study aimed to determine the prevalence and main factors associated with mother-to-child transmission of hepatitis B in the context of Ghana. METHODS: in this cross-sectional pilot study, we tested infants born to hepatitis B positive mothers at a hospital in the Eastern Region of Ghana to determine the prevalence of mother-to-child transmission. A questionnaire was completed by hepatitis B positive mothers to investigate the association between factors surrounding the birth of the child and whether transmission had occurred. These factors were analyzed independently using Fisher's exact test. To investigate the relationship between mother's age at the time of delivery and viral transmission, a univariate logistic regression analysis was performed. RESULTS: the prevalence of mother-to-child transmission was 5.9%, with 51 hepatitis B positive mothers included in the study and three infants testing positive. A majority of infants received the standard hepatitis B vaccination schedule (96.1%) while two-thirds received the birth dose. There was no significant association observed between the clinical interventions reported in the study and mother-to-child transmission. No significant association was observed between the age of the mother at the time of delivery and viral transmission (OR: 1.077, 95% CI: 0.828 - 1.403, p = 0.58). Viral marker testing during pregnancy was absent in the population and could not be reliably assessed. CONCLUSION: there was a low prevalence of HBV mother-to-child transmission observed despite a clear absence of viral marker and viral load testing. It is recommended that viral profile analysis is performed for hepatitis B positive pregnancies to identify high risk cases.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Wonpen Kaewpan, Karl Peltzer [Review] - Nurses’ intention to work after retirement, work ability and perceptions after retirement: a scoping review - 17 July 2019. http://www.panafrican-med-journal.com/content/article/33/217/abstract/ <b>Nurses have been identified as active workforce post-retirement. Little is known about nurses' intention to work post-retirement and their work ability and perceptions post-retirement. The aim of this scoping review is to identify studies that have investigated nurses’ intention and recruitment strategies to work post-retirement and their work ability and perceptions post-retirement. PubMed, CINAHL, Web of Science, Nursing and Health Database and in addition Google scholar were searched using different keywords (retired nurses, retired RNs, work intention, work ability, work perceptions, and older nurses) and an independent reviewer cross-validated all the identified articles. Of the thirty-seven studies identified from the search, 26 papers were excluded based on exclusion criteria, with a total of 11 studies finally included in the study sample. The review found in two studies low and high intentions to work as nurses after retirement. Factors influencing both intentions and recruitment strategies to work as a nurse post-retirement focused on lighter and flexible work conditions, supportive environment, financial incentives and formal rehiring policies. Nurses working post-retirement reported benefits (intrinsic factors such as self-worth, overcoming social isolation) and barriers (such as job demands and reduced physical work ability). The review found low and high intentions to work as nurses after retirement and identified factors influencing both intentions and recruitment strategies to work as a nurse post-retirement and benefits and barriers of working as nurses post-retirement that can inform strategies to retain nurses post-retirement.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Yousra Krimou, Sanae Erraghay, Ahmed Guennoun, Nisrine Mamouni, Chahrazad Bouchikhi, Abdelaziz Banani [Case report] - Myoma praevia and pregnancy - 17 July 2019. http://www.panafrican-med-journal.com/content/article/33/216/abstract/ <b>The association of myoma and pregnancy is becoming more frequent due to the increasing age of first pregnancy. It may affect the outcome of fertility, pregnancy, labor and peripartum course. A 37 years old patient was referred to our unit for discovering uterine leiomyoma at 37 weeks of pregnancy. Ultrasound screening showed a praevia isthmic leiomyoma measuring 16cm. A caesarean delivery was scheduled and a large interstitial isthmic uterine myoma measuring 25cm was found. Hysterectomy was corporeal. The post-operative and puerperium course was normal.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Abdul Rahman Shour, Benjamin Holmes, Emmanuel Adoyi Ameh, Oluwole Olayemi Olaomi, Ronald Anguzu, Laura Dawn Cassidy [Research] - Motor vehicle accident is a risk factor for traumatic head injury among children in Abuja: analysis of the first trauma registry in Nigeria - 16 July 2019. http://www.panafrican-med-journal.com/content/article/33/215/abstract/ <b>INTRODUCTION: Pediatric traumatic injury is a major public health concern that is poorly documented in lower and middle-income countries. This study analyzed data on pediatric injuries from a unique hospital trauma registry in Abuja, Nigeria. METHODS: Data were analyzed on 220 traumatically injured patients aged 21 years/less to describe injury characteristics and to determine the association between mechanism of injury and pediatric head injuries in Abuja, Nigeria, between 2014 and 2015. Bivariate analysis using Pearson's chi-square and adjusted logistic regression were conducted to characterize the population and identify risk factors for head injury. P-values <0.05 were considered statistically significant. All statistical analyses were performed using STATA v.15.1. RESULTS: The majority of patients were male (60.9%) with a mean age (SD) of 12.5±6.9 years. Head injuries were most common (49.6%), followed by chest (14.1%), abdomen (12.3%) and back (7.7%). The Mechanism of injury was statistically significantly associated with head injury (p=0.027) with 63% of children in a motor vehicle accident sustaining a head injury. After adjusting for covariates, the odds of head injury were 3.8 times higher for children injured in an MVA compared to those with falls (95%CI 1.40-10.40). CONCLUSION: This analysis reveals that motor vehicle accident is a risk factor for traumatic head injury among children in Nigeria. Therefore, efforts should be made to address motor vehicle accidents involving children. These data will help to inform age-related prevention and treatment strategies. The results of this study highlight the importance of collecting pediatric trauma data in developing countries.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Samuel Adegboyega Olatoke, Suleiman Olayide Agodirin, Adedire Timilehin Adenuga, Bashir Oladimeji Lawal, Kazeem Olatunde Ibrahim, Olaleke Oluwasegun Folaranmi [Case report] - Primary jejunal melanoma as a cause of adult intussusception: a case report and review of literature - 16 July 2019. http://www.panafrican-med-journal.com/content/article/33/214/abstract/ <b>Primary melanoma of the small bowel is a rare clinical entity with a paucity of published reports in literature. Most cases of gastrointestinal melanomas are metastatic lesions arising from skin or ocular origins. This is a case report of a 63 year old female with adult intussusception with jejunal melanoma as the lead point. The index patient had a long history of abdominal pain associated with significant weight loss and presented with features of intestinal obstruction. The possibility of a regressed or unidentified extra-intestinal site cannot be absolutely excluded as the patient did not have a PET scan. Due to the vague nature of clinical symptoms and signs, the diagnosis of small bowel melanoma is difficult, especially in patients with no obvious cutaneous pathology. A high index of suspicion for melanoma as a malignant lead point for adult intussusception should always be entertained.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Tom Marwa, Sarah Karanja, Justus Osero, Alloys Orago [Research] - The effects of HIV self-testing kits in increasing uptake of male partner testing among pregnant women attending antenatal clinics in Kenya: a randomized controlled trial - 16 July 2019. http://www.panafrican-med-journal.com/content/article/33/213/abstract/ <b>INTRODUCTION: HIV self-testing could add a new approach to scaling up HIV testing with potential of being high impact, low cost, confidential, and empowering for users. METHODS: pregnant women attending antenatal clinics (ANC) and their male partners were recruited in 14 clinics in the eastern and central regions of Kenya and randomly allocated to intervention or control arms at a ratio of 1:1:1. Arm 1 received the standard of care, which involved invitation of the male partner to the clinic through word of mouth, arm 2 received an improved invitation letter, and arm 3 received the same improved letter and, two self-testing kits. Analysis was done using adjusted odds ratios (aOR) at 95% confidence intervals (CI) to calculate and determine effects of HIV self-testing in increasing uptake of male partner testing. RESULTS: a total of 1410 women and 1033 men were recruited; 86% (1217) women and 79% (1107) couples were followed up. In arm 3, over 80% (327) of male partners took HIV test, compared to only 37% (133) in arm 2 and 28% (106) in arm one. There was a statistical significance between arm one and two (p-value=0.01) while arm three was statistically significant compared to arm two (p-value<0.001). Men in arm three were twelve times more likely to test compared to arm one (aOR 12.45 (95% CI 7.35, 21.08)). CONCLUSION: giving ANC mothers test kits and improved male invitation letter increased the likelihood of male partner testing by twelve times. These results demonstrate that HIV self-test kits could complement routine HIV testing methods in the general population.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mariem Ettarfaoui, Salma El Ghissassi, Amina Barkat [Case report] - Déficit congénital en facteur VII révélé par une hémorragie post circoncision - 16 July 2019. http://www.panafrican-med-journal.com/content/article/33/212/abstract/ <b>Le facteur VII ou proconvertine est un facteur de la coagulation vitamine K-dépendant qui intervient dans la voie exogène de la coagulation. Le déficit constitutionnel en facteur VII est une maladie héréditaire de transmission autosomique récessive, très rare. Nous rapportons le cas d'un nouveau-né issu de parents consanguins du premier degré, et admis à J10 de vie pour prise en charge d'un syndrome hémorragique post circoncision. Le bilan biologique a montré un taux de prothrombine bas et un TCA normal. Un bilan de la coagulation a montré un déficit isolé en facteur VII évalué à 18%. Le nouveau-né a été transfusé de culots globulaires et de plasma frais congelé permettant d'arrêter l'hémorragie avec une évolution favorable. A travers cette observation, nous rappelons les caractéristiques de ce déficit rare. Le pronostic de la maladie reste lié au risque de survenue d'hémorragies graves, notamment cérébrales survenant en période néonatale comme c'est le cas de notre patient. D'où la nécessité de faire un bilan de crase pré-circoncision.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Sanam Moradan, Sati Nik Darzi, Raheb Ghorbani [Research] - Diagnostic value of saline infusion sonohysterography for detecting endometrium focal lesion - 16 July 2019. http://www.panafrican-med-journal.com/content/article/33/211/abstract/ <b>INTRODUCTION: Different diagnostic tools are available to evaluate endometrial focal lesion such as hysteroscopy, sonohystrography and transvaginal ultrasound. The present study aimed to determine the diagnostic value of saline infusion sonohystrography (SIS) in diagnosis of intrauterine lesions in women with Abnormal Uterine Bleeding (AUB).</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Damaris Ogake Ondimu, Gideon Mutie Kikuvi, Walter None Otieno [Research] - Risk factors for hypertension among young adults (18-35) years attending in Tenwek Mission Hospital, Bomet County, Kenya in 2018 - 16 July 2019. http://www.panafrican-med-journal.com/content/article/33/210/abstract/ <b>INTRODUCTION: Hypertension ranks third in the world, after underweight and unsafe sex, in the list of six major risk factors contributing to the global disease. In Kenya, the prevalence stands at 24% in the general population, while among the young adults, the incidence of hypertension has been reported to be in the rise; a fact attributed to increased number of risks. We therefore sought to determine awareness and risk factors of hypertension among young adults attending Tenwek hospital. METHODS: A case-control study of young adults ages 18-35, involving 80 cases and 80 controls at Tenwek Mission Hospital, Bomet County. Cases included males and females newly diagnosed with hypertension (diagnosed at the time of data collection) and if they reported taking antihypertensive medication and reported as hypertensives in the hospital records at any clinic visit or at interview, while controls included persons with no history of hypertension. RESULTS: Those having a BMI &#8805; 25 were 3.05 times more likely to be hypertensive (OR: 3.05, 95% CI 1.26, 7.40; p=0.014). Having a relative suffering from hypertension increased almost thrice the odds of being hypertensive (OR: 2.78, 95% CI 1.20, 6. 46; p= 0.018). Not drinking alcohol reduced the chance of suffering from hypertension by 70%, (OR=0.30, 95% CI 0.11, 0.81; p= 0.017). CONCLUSION: The prevalence of hypertension in younger adults is not as low as generally perceived. Preventive measures should be formulated in a manner to address variety of major risk factors in young adults.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Tshegofatso Siphora Mekgoe, Kelebogile Lepedi, Patricia Tshepo Makhutle, Lufuno Makhado, Karabo Madiba, Nokuphila Senamile Nontokozo Langa [Research] - Experience of nursing students regarding clinical support in the management of TB and HIV patients in a primary healthcare setting: a phenomenological study - 16 July 2019. http://www.panafrican-med-journal.com/content/article/33/209/abstract/ <b>INTRODUCTION: management of tuberculosis (TB) and Human Immunodeficiency Virus (HIV) within primary health care (PHC) facilities involve nursing students as part of them integrating theory to practice. Clinical learning for nursing students requires adequate support from the Nursing Education Institution (NEI) and nursing professionals. Given the dearth of literature regarding clinical support for nursing students in the management of TB/HIV in PHC setting, this study is aimed at exploring and describing nursing students' experiences regarding clinical support. METHODS: a phenomenological design was used to explore and describe the experiences of nursing students using an individual, unstructured, in-depth interview. Audio-taped interviews were transcribed verbatim and analysed using Atlas TI software. RESULTS: themes derived from the study were factors inhibiting clinical support which incorporated shortage of professional nurses (PNs), lack of accompaniment, fear of managing TB/HIV patients and negative attitudes of PNs; outcomes of poor clinical support included inability to integrate TB/HIV theory to practice and lack of confidence among nursing students; nursing students' desired outcomes through clinical support included becoming a competent TB/HIV nurse and the ability to integrate TB/HIV theory to practice; and strategies to strengthen and promote clinical support in TB/HIV management through strengthened occupational health and safety learning, provision of knowledge regarding post-exposure prophylaxis and infection control, and appointed clinical PN for students in each facility. CONCLUSION: the development of policies for clinical support, increasing supervision, appointment of clinical preceptors and accompanists in facilities where nursing students are placed would promote clinical learning within the NEI and the production of competent and confident nurses.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Cynthia Semá Baltazar, Caroline Wheatley, Peter Nsubuga [Letter to the editors] - The challenges of getting the research published when English is not the first language: the example of Mozambique Field Epidemiology Training Program - 16 July 2019. http://www.panafrican-med-journal.com/content/article/33/208/abstract/ <b>NA</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Omobolaji Oladayo Ayandipo, Oludolapo Ola Afuwape, Oluwafunmilayo Yewande Soneye, Akintunde Taiwo Orunmuyi, Gbolahan Oladele Obajimi [Research] - A sub-Saharan African experience in the surgical management of soft tissue sarcomas in an oncology unit in: a retrospective cohort study - 15 July 2019. http://www.panafrican-med-journal.com/content/article/33/207/abstract/ <b>INTRODUCTION: Soft tissue sarcomas (STS) consist of over 70 histologic subtypes and constitute only 1% of adult malignancies. The fulcrum of management is surgical resection with neoadjuvant or adjuvant treatment-chemoradiation.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Soufiane Ennaciri, Halim Lababidi [Images in medicine] - Un kyste hydatique mimant une tumeur renale - 15 July 2019. http://www.panafrican-med-journal.com/content/article/33/206/abstract/ <b>Le kyste hydatique du rein constitue une atteinte rare des hydatidoses viscérales, estimée entre 2 et 4% de l'ensemble des localisations de la maladie. Il est dû à la forme larvaire d'un Tænia du chien, l'echinococcus granulosus, véritable problème de santé publique dans certains pays de la méditerranée. Le kyste hydatique pseudo tumoral, stade IV pose particulièrement un problème diagnostic en mimant une pathologie néoplasique. Nous rapportant le cas d'un patient de 54ans, sans antécédents particuliers, chez qui on a découvert fortuitement lors d'un angioscanner réalisé dans le cadre d'une artérite des membres inférieurs, une masse rénal droite d'allure tumoral. Le scanner thoraco-abdomino-pelvien décrit un processus expansif médio rénal et polaire supérieur de 50mm de diamètre, hétérogène avec des calcifications et prenant partiellement le contraste sans localisation secondaire par ailleurs. Le patient était complétement asymptomatique, il n'avait pas d'hydaturie ni d'autres signes urinaires. Après réunion de concertation pluridisciplinaire, une néphrectomie totale élargie droite a été réalisée et l'examen anatomopathologique a montré qu'il s'agissait d'un kyste hydatique du rein sans signes de malignité.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Senthil Kumar Aiyappan, Akilesh Suvindran [Images in medicine] - Lupus enteritis - 15 July 2019. http://www.panafrican-med-journal.com/content/article/33/205/abstract/ <b>Lupus enteritis is a rare and poorly understood cause of abdominal pain in patients with systemic lupus erythematosus (SLE). We report a patient with this rare condition who was referred to radiology department for CT abdomen examination. A 40-year-old female patient presented with abdominal pain, distension, fever and diarrhea for the past 1 week. Antinuclear antibody was strongly positive showing speckled pattern. The double stranded DNA was positive. Clinically she gave history of joint pain and on examination oral ulcers and malar rash were present. Hence a definitive diagnosis of systemic lupus erythematosus was considered. CT abdomen was done which showed presence of bowel wall thickening, dilatation of intestinal segments, engorgement of mesenteric vessels, increased attenuation of mesenteric fat, ascites, peritoneal enhancement, retroperitoneal lymphadenopathy and target sign which is due to submucosal edema. In view of the patient's medical history of systemic lupus erythematosis (SLE) and the appearance of the bowel, lupus enteritis from vasculitis was diagnosed. Patient was treated with steroids and the patient subsequently improved. Mesenteric vasculitis is uncommon (2.2-9.7%) and highly lethal among gastrointestinal complications of SLE, if it is not carefully diagnosed and promptly treated. CT scanning has become the gold standard for diagnosis of lupus enteritis. The most frequent findings described were the bowel, mesenteric changes, ascites and retroperitoneal lymphadenopathy which our patient had. Lupus enteritis is a rare manifestation of the disease, but is important to suggest as the vasculitis requires control of the disease by high doses of steroids.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ali Jad Abdelwahab Yousef [Images in medicine] - Abdominal distension in ICU patient - 15 July 2019. http://www.panafrican-med-journal.com/content/article/33/204/abstract/ <b>A 77 year old male, who is known to be diabetic and hypertensive, underwent left hip replacement three months ago. He developed major complications including infections and pulmonary embolism for which he is still hospitalized. Three days ago he became tachypnic, tachycardic, hyopotensive and collapsed suddenly after development of massive abdominal distension with opstipation. He was intubated and surgical consultation sought. His physical examination disclosed a huge distended tense abdomen with tympanic note, absent bowel sounds and empty dilated rectum. He was afebrile with mild leukocytosis .Presence of peritonitis could not be assessed because the patient was unconscious. Portable plain abdomen X-ray was obtained (A). The patient diagnosis was acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, which has the clinical and radiological pictures of colonic obstruction without mechanical cause. The patient was treated surgically for fear of imminent perforation. The whole colon was massively dilated but there was no perforation. Cecostomy was done and the bowel was decompressed and the patient improved significantly. He died after one month due to co morbidities. In mechanical obstruction such as volvulus, the course will be more dramatic with rapid progression towards perforation and peritonitis. In ischemic colitis the patient prominent complaint will be severe pain associated with bloody diarrhea. On the other hand, in toxic megacolon the patient will be one, who is acutely ill, febrile, with bloody diarrhea and leukocytosis.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Paul Macaire Ossou-Nguiet, Dieudonné Gnonlonfoun, Karen Lise Obondzo-Aloba, Komi Assogba, Edgard Matali, Dominique Nguiegna, Franck Ladys Banzouzi, Julien Arzur [Research] - Abus médicamenteux et céphalées chroniques à Brazzaville: profil et parcours thérapeutique des patients - 15 July 2019. http://www.panafrican-med-journal.com/content/article/33/203/abstract/ <b>INTRODUCTION: Les céphalées par abus médicamenteux (CAM) restent le type de céphalées le moins étudié en Afrique. METHODES: dans le but de rapporter l'expérience Brazzavilloise, nous avons mené une étude longitudinale durant 4 ans, de septembre 2010 à août 2014, en consultation de neurologie à Brazzaville. Nous avons inclus tous les patients présentant des céphalées primaires chroniques selon la classification International Classification of Headache Disorders-2 (ICHD-2). Tout patient présentant des céphalées secondaires ou n'ayant pas donné son consentement a été exclu. Les patients ont été divisés en deux groupes: ceux ayant évolué vers une CAM, et ceux qui ne présentent pas des critères d'abus médicamenteux (sans-CAM). Les variables d'études ont été sociodémographiques, les caractéristiques de la céphalée primaire initiale et la prise en charge de la CAM. RESULTATS: sur 212 patients inclus, 193 ont constitué notre population d'étude. L'âge moyen de 42±14 ans, dont 66,32% de femmes. La fréquence des CAM était de 35,75%. Les facteurs associés identifiés étaient: l'âge jeune (p=0,003), l'utilisation de l'association antiinflammatoire non stéroïdien (AINS) et paracétamol (p=0,0001) et l'automédication (p<0,0001). Par contre, le niveau d'instruction supérieur (p<0,0001) et l'utilisation de l'AINS seul (0,002) étaient protecteurs contre la survenue de la CAM. Le sevrage ambulatoire a été le plus pratiqué, l'amitriptyline reste le médicament le plus utilisé. CONCLUSION: les CAM sont fréquentes en consultation de neurologie en Afrique et méritent d'être identifiées pour une meilleure prise en charge.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Anas Bennis, Reda Hafiane, Jaafar Benouhoud, Amine El Khaoudi, Khadija Ibahioin, Abdelhakim Lakhdar, Ihsane Moussaid, Smaïl El Youssoufi, Said Salmi [Case report] - Epidural cavernous haemangioma during pregnancy: a case report and a literature review - 15 July 2019. http://www.panafrican-med-journal.com/content/article/33/202/abstract/ <b>Cavernous haemangiomas are benign vascular malformations that can locate in the central nervous system. The epidural spinal location remains unusual. Pregnancy is known to be a precipitating factor. The aim of this study is to review general aspects of these lesions and specific facts about their relationship to pregnancy. A 32-year-old full-term pregnant woman is managed during early labor for a progressive spinal cord compression syndrome. After delivery, exploration by a lumbar MRI found an epidural vascular dorsal mass. Surgical exploration and histopathological examination confirmed the diagnosis of epidural cavernous haemangioma. The patient achieved complete recovery after 1 month. Spinal cavernous haemangiomas are rare malformations. Specific mechanisms seems to be involved in their growth during pregnancy. Although clinical and radiological presentation are spectacular and misleading, the prognosis is generally good, and urgent surgical treatment during pregnancy is usually not indicated.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Felipe Tavares Rodrigues, José Augusto da Costa Nery [Images in medicine] - Multiple infected ulcerative plaques in an alcohol addicted patient - 15 July 2019. http://www.panafrican-med-journal.com/content/article/33/201/abstract/ <b>A 47-year-old male patient came to the Souza Araújo outpatient clinic of the Oswaldo Cruz Foundation, a reference center for treating leprosy, to confirm mycobacteriosis after living in close contact with a leprosy patient. The patient was emaciated, having lost 12 kg in 2 months, febrile and presented nystagmus. The patient had multiple erythematous-livedoid, hypoesthetic, ulcerated, and purulent wounds in light-exposed areas, which had appeared suddenly 2 months before admission and did not regress after amoxicillin therapy. The patient reported loss of sensitivity, paresthesia, and asthenia in the lower limbs. Adenomegaly and visceromegaly were not observed. The patient had an approximately 25-year history of alcoholism and smoking. The patient also reported having intermittent diarrhea. The patient was instructed to take 300 mg of niacinamide per day, ingest other B-complex vitamins, use amoxicillin-clavulanic acid to treat impetigo, reduce alcohol intake and improve nutrition. On the return visit one month later, the lesions and peripheral neuropathy had regressed significantly, although the patient had used B-complex formulations containing only 50 mg of niacinamide for financial reasons. Pellagra was described in eighteenth-century Europe by Gaspar Casal, related to poverty and low ingestion of animal products. It was a public health problem in the United States at the beginning of the last century, but pellagra is rare today and diagnosed particularly among individuals with alcohol abuse, taking some medications, with desorption syndromes and HIV. The classic triad of symptoms includes dermatitis, diarrhea and dementia. Scaly dermatitis is more common in areas exposed to sunlight.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Sylvie Ndongo Amougou, Simon Maginot Mintya'a Mbita, Dieudonne Danwe, Pierre-Marie Tebeu [Research] - Factor associated with progression to chronic arterial hypertension in women with preeclampsia in Yaoundé, Cameroon - 15 July 2019. http://www.panafrican-med-journal.com/content/article/33/200/abstract/ <b>INTRODUCTION: Hypertensive diseases in pregnancy are the leading medical problem during pregnancy. Some of the women affected remain hypertensive after pregnancy and the post-partum period. This study aimed to assess the factors associated to the persistence of hypertension after preeclampsia.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Meryem Himmiche, Youssef Joulali, Imane Staouni Benabdallah, Mohammed Benzagmout, Khalid Chakour, Mohammed Faiz Chaoui [Case series] - Shwannomes rachidiens: étude de séries - 15 July 2019. http://www.panafrican-med-journal.com/content/article/33/199/abstract/ <b>Les shwannomes rachidiens sont des tumeurs bénignes qui représentent 30% des tumeurs rachidiennes. Ils se développent à partir des cellules de shwann des racines rachidiennes. Nous rapportons dans cet article l'expérience du service de neurochirurgie du CHU Hassan II de Fès dans la prise en charge des shwannomes rachidiens, du diagnostic aux modalités thérapeutiques sur une période de 13ans. Les shwannomes rachidiens représentent 19,5% des cas de compression médullaire opéré durant la même période. L'âge moyen était de 45 ans avec une discrète prédominance féminine.la symptomatologie était insidieuse avec un délai de consultation en moyenne de 18 mois, elle est dominée par les douleurs rachidiennes et radiculaires. La moitié de nos patients avaient des déficits neurologiques. L'IRM médullaire a été réalisée chez tous nos patients. La localisation la plus fréquente était au niveau thoracique (40%). Soixante-eux pourcent des shwannomes étaient intra duraux, rarement extra duraux (8%), mixte dans 4%. L'exérèse chirurgicale était complète dans 96% avec recours à une ostéosynthèse dans deux cas et une arthrodèse dans un seul cas. l'étude histologique a confirmé le diagnostic de neurinome bénin dans 23 cas, un cas de shwannome malin et un cas de neurofibrome. L'évolution était favorable chez la majorité des cas, deux cas ont présenté des complications, une infection de la paroi et une aggravation neurologique. L'intérêt de ce travail est d'apprécier les caractéristiques ce cette lésion et de comparer les résultats de notre série avec les données de la littérature.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Valérie Bedia-Tanoh Akoua, Pulchérie Christiane Marie Kiki-Barro, Konaté Abibatou, Etien Angora Kpongbo, Fulgence Kassi Kondo, Henriette Bosson-Vanga, Jean Sebastien Miezan Asouhoun, Vincent Djohan, William Yavo, Ignace Hervé Menan Eby [Research] - Aspects cliniques et étiologiques des intertrigos d’origine fongique à Abidjan (Côte d'Ivoire) - 12 July 2019. http://www.panafrican-med-journal.com/content/article/33/198/abstract/ <b>INTRODUCTION: L’épidémiologie de ces affections surtout d’origine mycosique est peu connue en Côte d’Ivoire. Cette étude avait pour objectif de déterminer les différents aspects cliniques et fongiques des intertrigos. METHODES: D’avril à octobre 2012, une étude transversale a été conduite dans le service de dermatologie clinique du Centre Hospitalier et Universitaire de Yopougon (Abidjan-Côte d’Ivoire). Elle a concerné les patients vus en consultation et présentant des lésions des plis, évocatrices d’une atteinte mycosique. Les prélèvements de sérosités par écouvillonnage ou de squames par raclage à la lame de Bistouri ont été réalisés au niveau des lésions. Les agents fongiques responsables de ces lésions ont été identifiés après culture du produit biologique. RESULTATS: Au total, 200 patients ont présenté des lésions évocatrices d’intertrigo d’origine fongique. L’âge moyen des patients était de 29,8 ans (écart type = 11,1 ans). Les intertrigos mycosiques ont représenté 6,7 % des motifs de consultation. Une prédominance féminine a été observée (76,7%). Les lésions siégeaient majoritairement au niveau de l’aine (40,8%) et des plis inter-fessiers (36,9%). Les symptomatologies les plus observées étaient la macération (52,4%) suivie de la brûlure (18,4%). Les intertrigos étaient causés dans 89,3% des cas par les levures, parmi lesquelles Candida albicans (33%) et Candida parapsilosis (19,4%) étaient prédominants. CONCLUSION: Les intertrigos d’origine mycosique affectent principalement les adultes jeunes de sexe féminin. Les lésions siègent préférentiellement au niveau des plis inguinaux et inter-fessiers. Les principaux agents étiologiques sont représentés par des levures du genre Candida.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mohamed Kane, Mohamed Zakaria Benaboud, Samba Traore, Salma Lokman, Soumia Nasri, Narjisse Aichouni, Imane Skiker, Imane Kamaoui [Case report] - Gastrointestinal hemorrhage caused by small intestinal benign tumors: 2 cases report - 12 July 2019. http://www.panafrican-med-journal.com/content/article/33/197/abstract/ <b>Gastrointestinal bleedings caused by small intestinal tumors are rare and difficult to diagnose because they are not easy to access to the conventional endoscopy. We report two cases, one of them from proximal jejunum and the other one from ileal intestine complicated by intussusception. The two cases are admitted in the emergency department for hematochezia and melena, the diagnosis was established by enhanced helical computed tomography angiography.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Amel Achour Jenayah, Mohamed Waheb Abdallah [Images in medicine] - La grossesse ovarienne: un challenge échographique - 12 July 2019. http://www.panafrican-med-journal.com/content/article/33/196/abstract/ <b>La grossesse ovarienne (GO) est rare: 3,2% des grossesses extra-utérines. Notre patiente était âgée de 36 ans, 3ème geste, 2ème pare. Le seul facteur de risque de grossesse ectopique retrouvé chez elle était un antécédent de contraception par dispositif intra-utérin. La symptomatologie clinique était dominée par la survenue de douleurs pelviennes sur une aménorrhée de 5 semaines. Le dosage des BHCG fait aux urgences était de 2134 UI/L. Le diagnostic de grossesse ovarienne a été évoqué en préopératoire suite à la visualisation en échographie d'une image arrondie faisant 26mm avec double couronne hyperéchogéne au niveau de l'ovaire gauche sans épanchement libre associé au niveau du cul de sac de douglas. Le traitement de cette grossesse avait comporté une cœlioscopie avec exérèse des villosités choriales ectopiques de siège ovarien gauche. Un traitement médical par méthotrexate à raison de 1mg par kilogramme de poids de la patiente en injection intramusculaire a été administré en postopératoire immédiat vu le risque de persistance d'un infime matériel trophoblastique. Le diagnostic a été confirmé par l'étude histologique de la pièce opératoire. Les suites opératoires étaient simples.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ahmadu Baba Usman, Pembi Emmanuel, Dogo Belmont Manchan, Akoma chinyere, Ovansa Emmanuel Onimisi, Mava Yakubu, Kenji Hirayama [Case report] - Pellagra, a re-emerging disease: a case report of a girl from a community ravaged by insurgency - 12 July 2019. http://www.panafrican-med-journal.com/content/article/33/195/abstract/ <b>Pellagra is a nutritional disorder of niacin deficiency which is characterized by triad of dermatitis, diarrhea and dementia. It is often seen in a state of poor nutrition among alcoholics, homeless and patients suffering from malabsorption. Though seldom occurs in children, its re-emerging is seen as a result of worsening food security in vulnerable population during conflict or insurgency. We report the case of 12-year-old female pastoralist who presented darkening and thickening of the hands, feet, ankles, neck and her upper trunk. Conflicts and insurgency usually occur in resource constraint settings where health workers are few and overworked. Therefore, continuously educating health workers and the general public regarding nutrition and its disorders like pellagra is a priority. Public Health authorities and policy makers also ought to take pediatric nutrition serious in order to avoid its escalation in internally displaced persons or children orphaned by insurgency.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mohammed Guini, Mohammed Khoulali, Nabil Raouzi, Noureddine Ouali, Fayçal Moufid [Case report] - Une forme pseudo-tumorale du neuro-Behçet: a propos d'un cas et revue de la littérature - 12 July 2019. http://www.panafrican-med-journal.com/content/article/33/194/abstract/ <b>Pas toute masse intra cérébrale n'est nécessairement une tumeur. Nous décrivons un cas de patient suivi pour maladie de Behçet qui se présente avec un tableau de processus expansif intracrânien révélé par une hémiparésie droite avec des signes d'hypertension intracrânienne; l'imagerie par résonance magnétique (IRM) cérébrale a objectivé une lésion faisant penser à une tumeur gliale, mais les contextes cliniques, biologiques et radiologiques ont permis d'établir le diagnostic de forme pseudo tumorale de neuro-Behçet. Cette description est suivie d'une analyse clinique à la lumière de la littérature disponible sur la pathologie.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Zaineb El Houssaini, Nadia Harrar, Khalid Zerouali, Houria Belabbes, Naima Elmdaghri [Research] - Prévalence des staphylocoques à coagulase négative dans les hémocultures au Centre Hospitalier Universitaire Ibn Rochd de Casablanca - 12 July 2019. http://www.panafrican-med-journal.com/content/article/33/193/abstract/ <b>INTRODUCTION: la réalisation des hémocultures est le meilleur moyen de diagnostic des bactériémies, cependant les résultats faussement positifs peuvent entraîner une confusion concernant les schémas thérapeutiques antibiotiques, mettant ainsi en danger la sécurité des patients. L'objectif principal de ce travail est d'évaluer la prévalence des Staphylocoques à coagulase négative (SCN) ainsi que Corynebacterium spp et Bacillus spp dans les ballons d'hémoculture analysés au laboratoire de microbiologie du Centre Hospitalier Universitaire (CHU) Ibn Rochd de Casablanca. Cette prévalence a été aussi évaluée en fonction de différents services hospitaliers sur l'année 2016. METHODES: il s'agit d'une étude rétrospective descriptive basée sur une analyse de la base de données informatisée du laboratoire de bactériologie-virologie du CHU Ibn Rochd de Casablanca sur une période de 12 mois allant du 1er janvier au 31 décembre 2016, Ont été inclus dans notre étude les bactéries faisant partie de la flore commensale (staphylocoque à coagulase négative,corynébactéries spp et Bacillus spp) Les ballons d'hémoculture ont été incubés sur automate Bactec FX . L'identification des germes à partir d'une culture positive a été réalisée selon les techniques standards de bactériologie et l'antibiogramme selon EUCAST 2015. L'étude est basée sur une analyse de la base de données informatisée du système KALISIL (Netika) version (2.2.10.) du laboratoire de microbiologie du CHU Ibn Rochd-Casablanca Maroc. RESULTATS: sur 7959 demandes d'hémocultures adressées au laboratoire de bactériologie provenant de 5801 patients, 2491 étaient positifs dont 848, soit 34% des ballons positifs ou 10,6% de l'ensemble des ballons reçus durant l'année 2016, ont été représentées par staphylocoque à coagulase négative, 56 soit (2,2%) ballons des hémocultures par corrynébacteruim SP, suivi par 60 soit (2,4%) ballons par bacillus sp. La fréquence d'isolement du SCN par rapport aux autres bactéries en fonction des services cliniques a montré une fréquence plus élevée dans les services de pédiatrie avec 47,2% suivie des services de médecine avec 44,1%. CONCLUSION: cette étude montre que, Les staphylocoques à coagulase négative sont les organismes les plus fréquemment isolés des hémocultures, ils constituent une cause non négligeable d'infections nosocomiales mais, ils sont également les contaminants les plus courants des hémocultures.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mohammed Alae Touzani, Imad Ziouziou [Images in medicine] - Calcul géant compliquant un diverticule caliciel - 12 July 2019. http://www.panafrican-med-journal.com/content/article/33/192/abstract/ <b>Le diverticule caliciel correspond à une cavité kystique dans le parenchyme rénal, communiquant avec le système collecteur via un infundibulum. Il s'y associe dans plus de 40% des cas un calcul et prend le plus souvent un aspect de niveau hydrique de tonalité calcique, ou de multiples calculs de petite taille. Nous rapportons ici le cas d'un patient de 82 ans, sans antécédents personnels, souffrant de douleurs légères et intermittentes au flanc droit depuis 8 ans. L'examen clinique était normal. Le patient a d'abord bénéficié d'une radiographie de type arbre urinaire sans préparation montrant une image de tonalité calcique se projetant dans le pôle supérieur du rein droit (A). Le patient a ensuite bénéficié d'un uroscanner montrant un calcul géant de 28mm dans un diverticule caliciel du pole supérieur communiquant directement avec le pelvis rénal (B). Il n'y avait pas d'infection urinaire associée, ni d'hématurie. Étant donné que le patient était pauci-symptomatique, non infecté et compte tenu de son âge, nous avons décidé l'abstention thérapeutique et la surveillance. Conformément aux recommandations des experts, seuls les calculs intra-diverticulaires symptomatiques doivent être traités. En premier lieu, la LEC permet une amélioration de la symptomatologie chez 1 patient sur 2 et un résultat sans fragment chez 1 patient sur 4. En deuxième intention, une urétéro-rénoscopie souple a tout son intérêt. En cas de localisation inférieure de la pierre, ce qui est rare, une NLPC peut être proposée. Enfin, en cas d'échec, un traitement par laparoscopie ou chirurgie ouverte peut être proposé.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fatima-Zahra Agharbi [Images in medicine] - Œdeme aigu hémorragique du nourisson - 12 July 2019. http://www.panafrican-med-journal.com/content/article/33/191/abstract/ <b>L'œdème aigu hémorragique du nourrisson (OAHN) est caractérisé par la survenue rapide de lésions purpuriques en cocardes, associées à des œdèmes initialement localisés aux extrémités chez l'enfant de moins de 2 ans. Cette affection reste le plus souvent bénigne, sans atteinte viscérale et le diagnostic est clinique, il n'existe pas de signes biologiques spécifiques et l'analyse histologique des lésions (qui est inutile dans la majorité des cas) est le plus souvent sans spécificité (il existe parfois une vascularite leucocytoclasique non spécifique). Sa place nosologique reste incertaine, faisant discuter, pour certains, une forme clinique du purpura rhumatoïde. On retrouve parfois un épisode rhino-pharyngé dans jours précédents faisant discuter une étiologie virale. Il existe une discordance nette entre le bon état général et l'aspect profus et spectaculaires des lésions. La surveillance de ces enfants dans les premiers jours doit être rigoureuse mais les complications sont exceptionnelles (invagination intestinale aigue?). L'évolution se fait spontanément vers la régression en une dizaine de jours. La prise en charge thérapeutique consiste en une surveillance attentive de l'état général de l'enfant. Une fièvre, l'extension des lésions purpuriques et surtout des signes d'altération de l'état général peuvent faire discuter le diagnostic de purpura fulminans. Un autre diagnostic différentiel est l'urticaire aigue hémorragique ou ecchymotique. Nous rapportons l'observation d'un nourrisson de 3 mois qui présente des lésions pseudo-cocardes diffuses dans un contexte d'apyrexie et de conservation de l'état général. L'évolution était favorable sans aucun traitement ce qui a permis de confirmer le diagnostic d'OAHN.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fatima-Zahra Agharbi [Images in medicine] - Les lentigines - 12 July 2019. http://www.panafrican-med-journal.com/content/article/33/190/abstract/ <b>Lentigines sont des macules hyperpigmentées, de petite taille (1 à 3mm), qui se distinguent des éphélides: par leur teinte plus foncée (brune ou noire) et par leur absence de modification après exposition solaire. Généralement régionales, elles peuvent se répartir sur toute la surface du tégument et/ou sur les muqueuses. Elles peuvent apparaître dans l'enfance ou plus tardivement au cours de la vie. Ces lentigines apparaissent parfois très rapidement sur un mode éruptif. Les lentigines correspondent à une hypermélanocytose épidermique, avec présence occasionnelle de grains de mélanine géants, dénommés macromélanosomes. Les lentigines sont souvent isolées. Parfois, elles s'intègrent dans des syndromes complexes, à expression multiviscérale, et représentent de ce fait des marqueurs ectodermiques utiles, permettant d'évoquer le diagnostic de ces affections. Ces différentes affections sont la lentiginose centrofaciale neurodysraphique de Touraine, la lentiginose périorificielle de Peutz-Jeghers-Touraine, la lentiginose multiple (syndrome LEOPARD), le Complexe de Carney et le Xeroderma pigmentosum. Nous rapportons l'observation d'un jeune de 30 ans sans antécédents pathologiques notables qui présente des lentigines axillaires. L'examen clinique trouvait des neurofibromes sous cutanés et cutanés et de multiples tâches café au lait ce qui a permis de retenir le diagnostic de neurofibromatose.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Nzozone Henry Fomukong, Alain Chichom Mefire, Gerard Beyiha, Mbuagbaw Lawrence, Mandeng Ma Linwa Edgar, Ngwayu Claude Nkfusai, Samuel Nambile Cumber [Research] - Predictors of mortality of pediatric burn injury in the Douala General Hospital, Cameroon - 11 July 2019. http://www.panafrican-med-journal.com/content/article/33/189/abstract/ <b>INTRODUCTION: Burn injuries are a major cause of hospitalization and are associated with significant morbidity and mortality, particularly in children aged four years or below. In Cameroon, the mortality rate of pediatric severe burns was estimated at 41.2%. There is need to determine the predictors of such mortality in order to guide appropriate management.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Amine Raggabi, Ahmed Bourazza, Issam Lalya [Case series] - Prise en charge de la radionécrose cérébrale: expérience du Service de Neurologie de l'Hôpital Militaire d'Instruction Mohammed V - 11 July 2019. http://www.panafrican-med-journal.com/content/article/33/188/abstract/ <b>La radionécrose cérébrale est une complication rare mais redoutable de la radiothérapie externe pour les cancers ORL en particulier du nasopharynx et pour les tumeurs cérébrales. Peu de travaux se sont intéressés à cette complication aussi bien dans la population maghrébine qu'africaine. L'objectif de notre étude est donc de décrire les aspects démographiques, cliniques, paracliniques, thérapeutiques et évolutifs de la radionécrose cérébrale au sein du Service de Neurologie de l'Hôpital Militaire d'Instruction Mohammed V de Rabat (HMIMV) sur une durée de 18 ans (2000-2017). Il s'agissait de 04 femmes et 13 hommes âgés en moyenne de 50 ans. Le délai moyen entre la fin de la radiothérapie et le début des signes neurologiques était de 28 mois. La réalisation systématique d'une IRM cérébrale parfois complété d'une spectro-IRM avait permis de faire le diagnostic chez 100% des cas. Sur le plan étiologique, cette complication survenait après radiothérapie pour cancer du cavum et du larynx chez tous les cas. 15 patients ont été traités par l'association: corticothérapie en bolus, antiagrégants plaquettaires, associée à l'oxygénations hyperbare (OHB) avec une bonne évolution, et 2 patients, chez qui l'oxygénothérapie était contre-indiquée pour problème pulmonaire, et ORL, ont reçu l'association corticothérapie en bolus et antiagrégants plaquettaires avec une évolution stationnaire. A la lumière de ces résultats, nous insistons sur l'intérêt du diagnostic précoce en raison de la gravité potentielle de certains tableaux surtout neuropsychiatriques ainsi que sur le traitement par association bolus de corticoïdes + OHB car il est le meilleure garant d'une évolution favorable de ces atteintes, sans omettre le rôle crucial des mesures de prévention.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Jotamo Come, Edgar Cambaza, Rita Ferreira, José Manuel Correia da Costa, Carla Carrilho, Lúcio Lara Santos [Essay] - Esophageal cancer in Mozambique: should mycotoxins be a concern? - 11 July 2019. http://www.panafrican-med-journal.com/content/article/33/187/abstract/ <b>Fumonisin B1 (FB1) is a mycotoxin frequently found in agricultural commodities. The toxin poses a considerable risk for human and animal health. FB1 is among several mycotoxins produced by Fusarium spp. contaminating virtually any cereal and other Poaceae. Their intracellular action includes the promotion of oxidative stress through the generation of reactive oxygen species (ROS) that damage biomolecules such as DNA. These toxic effects were observed in vivo and in vitro. However, the association between esophageal lesions and oxidative stress induced by FB1. Studies in China, Iran and South Africa showed higher exposure to fumonisins in areas with higher risk of esophageal cancer (EC). Exposure to mycotoxins may be inevitable in Mozambique. How mycotoxins, particularly fumonisins from the contaminated food, can be associated with the emergence of EC in Mozambique? Herein, we revise the literature and present some pieces of evidence in order to highlight the burden of mycotoxins and to provide evidence-based considerations for the stakeholders involved in the management of the EC agenda in Mozambique. The information presented herein supports the need to implement novel and/or to revisit the existent detoxification methods to reduce the global burden of mycotoxins and its outcomes in health management.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Alhassan Abdul-Mumin, Sean Ervin, Elizabeth Eby Halvorson [Research] - Clinical characteristics associated with increased resource utilization of hospitalized children under 5 years with acute gastroenteritis at a tertiary hospital in the northern region of Ghana: a retrospective study - 11 July 2019. http://www.panafrican-med-journal.com/content/article/33/186/abstract/ <b>INTRODUCTION: Acute gastroenteritis (AGE) is a leading cause of mortality in children in developing countries. Management of AGE consumes medical resources, including antibiotics and intravenous fluids, but factors affecting resource utilization in the management of AGE are under-studied. We hope to identify clinical predictors of resource utilization in AGE.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fatima-Zahra Agharbi [Images in medicine] - Chancre mou - 11 July 2019. http://www.panafrican-med-journal.com/content/article/33/185/abstract/ <b>Le chancre mou (ou chancrelle ou chancre de Ducrey) est une maladie sexuellement transmissible (MST) due au bacille de Ducrey (ou Haemophilus ducreyi) caractérisée par un chancre d'inoculation ulcéré associée à des adénopathies. La maladie se manifeste, après une période d'incubation variant de 24 heures à 15 jours (en moyenne 5 jours), par une petite papule rosée au lieu de pénétration de la bactérie. La lésion évolue rapidement vers une ulcération plus ou moins étendue, rosée, douloureuse, profonde, aux bords très inflammatoires et nets, d'aspect déchiqueté. Les adénopathies, apparaissant 2 à 3 semaines après le contact. Elles sont souvent unilatérales, et peuvent évoluer vers l'ulcération avec écoulement de pus au niveau de la peau. Des compliations sont possibles: Gangrène de la verge, gangrène cutanée étendue, surinfection locale, association à d'autres IST. L'identification de la bactérie peut se faire par examen microscopique d'un frottis du chancre, plus rarement par ponction à l'aiguille fine d'une adénopathie. La coloration de Giemsa ou celle de Pappenheim permet d'identifier le germe. Le traitement fait appel à l'azithromycine (1 g. per os en dose unique) ou à la ceftriaxone (250 mg par voie intramusculaire en dose unique). Nous rapportons l'observation d'un homme de 30 ans qui présentait 1 semaine après un rapport sexuel non protégé une ulcération du scrotum bien limitée profonde à centre nécrotique. L'haemophilus ducrey a été mis en évidence à la culture et le patient a été mis sous approche Azithromycine avec bonne évolution.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Tresor Kibangula Kasanga, Daniel Ilunga Ntanga, Eric Mbuya Musapoudi, Nathalie Dinganga Kapessa, Dimitri Kanyanda Nafatalewa, Vincent De Paul Kaoma Cabala, Mbey Mukaz [Case report] - Carcinome urothélial invasif vésical récidivant traité par cystectomie avec enterocystoplastieiléale de substitution: à propos d'un cas - 11 July 2019. http://www.panafrican-med-journal.com/content/article/33/184/abstract/ <b>Notre travail vise à rapporter un cas de carcinome urothelial vésical qui est une tumeur rare chez les sujets de moins de 40 ans, et apporter notre experience thérapeutique, cela à travers l'observation d'un patient âgé de 37 ans, avec antécédent d'infection urinaire et un séjour dans une région riveraine (bilharziose) ayant consulté pour hypogastralgie et hématurie totale macroscopique. Le bilan clinique et paraclinique, mettaient en évidence une volumineuse masse tumorale vésicale d'allure infiltrante, sans envahissement ganglionnaire ou organique local ou à distance. Sa prise en charge chirurgicale a consisté en une exérèse biopsique tumorale vésicale suivie d'une cystectomie totale, avec enterocystoplastie iléale de substitution. Les suites opératoires ont été simples. Il avait beneficié egalement d'une chimiothérapie adjuvante et une vitaminothérapie B12. Les contrôles cliniques et paracliniques effectués 6 et 12 mois ne montraient aucune récidive.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Taimoor Khalid Janjua, Kunwer Naveed Mukhtar, Ahmed Kunwer Naveed, Erum Bashir Ahmed, Muhammad Rehan [Research] - Frequency of maintenance hemodialysis patients meeting K/DOQI criteria for serum calcium, phosphorus, calcium phosphorus product and PTH levels; a single institutional experience from Pakistan: a cross sectional study - 09 July 2019. http://www.panafrican-med-journal.com/content/article/33/183/abstract/ <b>INTRODUCTION: there is a great scarcity of literature in Pakistan investigating the proportion of End Stage Renal disease (ESRD) patients undergoing hemodialysis (HD) who meet the recommended Kidney Diseases Outcome Quality Initiative (K/DOQI) guidelines for serum Calcium (Ca), Phosphorus (P), Calcium Phosphorus product (Ca X P) and Parathyroid hormone (PTH) levels. Our study aimed to determine frequencies of patients who met the K/DOQI targets for these minerals at a tertiary care hospital’s dialysis unit.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ioannis Tsakiridis, Apostolos Mamopoulos [Images in medicine] - Elephantiasis in pregnancy - 09 July 2019. http://www.panafrican-med-journal.com/content/article/33/182/abstract/ <b>A 33-year-old primiparous woman was admitted for induction of labor at 39+2 gestational weeks due to gestational diabetes mellitus, treated with insulin. During physical examination, elephantiasis in both legs was revealed. Most common causes of this condition include infections and lymphadenectomy. In our case it first appeared at the age of seven following an ankle injury. Originally the edema affected only the right leg, but during pregnancy it also affected the left leg, with hypertrophy of the skin and subcutaneous tissues. There was excessive weight gain of 52kg during pregnancy (body mass index on admission: 49.6kg/m<sup>2</sup>), mainly due to the leg edema. Elephantiasis is neither an indication for intensive fetal monitoring during labor, nor for cesarean delivery. In our case, the woman delivered by emergency cesarean section, due to intrapartum fetal compromise, without any further complications. The edema remained almost unchanged at six weeks’ postpartum evaluation.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Olayemi Atinuke Alagbe, Adekunle Emmanuel Alagbe, Emmanuel Olugbenga Onifade, Temitope Olugbenga Bello [Case report] - Thrombocytopenia with absent radii (TAR) syndrome in a female neonate: a case report - 09 July 2019. http://www.panafrican-med-journal.com/content/article/33/181/abstract/ <b>Thrombocytopenia absent radius (TAR) syndrome is a rare congenital disorder that is consistently associated with skeletal abnormality and thrombocytopenic haemorrhage. This is a case of a neonate with bilateral absent radius and thrombocytopenia. The rarity of this case prompted this report.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Faten Limaiem, Saâdia Bouraoui [Images in medicine] - Nodule-forming pseudoangiomatous stromal hyperplasia of the breast: case report - 08 July 2019. http://www.panafrican-med-journal.com/content/article/33/180/abstract/ <b>Pseudoangiomatous stromal hyperplasia (PASH) is an uncommon benign proliferation of fibrous stroma, containing slitlike pseudovascular spaces lined by myofibroblasts. Less than 200 cases of PASH have been described in the English literature with the largest series including 40 cases. A 48-year-old woman with no particular past medical history, presented with a complaint of a slow, progressive, painless left breast mass. The patient underwent mammography which revealed a well delineated left breast nodule with microcalcifications classified BI-RADS 4. An excisional biopsy was performed on the mass to confirm the histological diagnosis. The specimen was a well-circumscribed whitish tumor measuring 3 x 3 cm with several microcysts (A). Histological examination revealed proliferation of fibrous stroma, with spindle cells and a network of slit-like empty clefts within acellular hyalinized stroma (B). The spindle cells were positive for CD34 and smooth muscle actin but were negative for Factor VIII. The final pathological diagnosis was nodular PASH. Postoperative course was uneventful and the patient is still being followed-up.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mahdi Graiouid, Youness Chakir, Issam Jandou, Messian Gallouo, Yassine Larrache [Case report] - Diverticule de l'urètre après urétro-méatoplastie: à propos d'un cas - 08 July 2019. http://www.panafrican-med-journal.com/content/article/33/179/abstract/ <b>Nous rapportons l'observation d'un diverticule de l'urètre pénien chez un garçon de 14 ans survenu après une urétro et méatoplastie suite à d'un accident de circoncision. À travers cette observation et une revue de la littérature, nous décrirons les aspects diagnostiques et thérapeutiques des diverticules de l'urètre.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Anass Elbouti, Mostafa Rafai, Said Jidane, Ahmed Belkouch, Hicham Bakkali, Lahcen Belyamani [Case report] - Ectopie rénale croisée de découverte fortuite chez l'adulte: à propos d'un cas - 08 July 2019. http://www.panafrican-med-journal.com/content/article/33/178/abstract/ <b>L'ectopie rénale croisée est une anomalie congénitale rare, dans laquelle, les deux reins se situent du même coté avec un des uretères, de longueur adaptée au siège du rein, qui croise la ligne médiane pour s'implanter dans la vessie du coté opposé. L'existence d'une fusion rénale entre les deux parenchymes est fréquente, et cette anomalie est le plus souvent asymptomatique et de découverte fortuite. Nous rapportons l'observation d'un patient de 36 ans sans antécédents (ATCD) pathologiques notables, présentant une ectopie rénale croisée découverte fortuitement suite à une cholécystite aigue compliquée d'abcès péri vésiculaire. Sur la base de cette observation et des données de la littérature, nous discuterons les aspects étiopathogéniques, cliniques, radiologiques et thérapeutiques de cette malformation.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mahamadou Mallé, Hamidou Tounkara [Images in medicine] - Dégénérescence maligne d'un tératome sacro coccygien avec volumineuse kyste du mésentère: à propos d'un cas à Bamako - 05 July 2019. http://www.panafrican-med-journal.com/content/article/33/177/abstract/ <b>Le tératome sacro coccygien malin est une tumeur embryonnaire congénitale rare à forte potentialité de dégénérescence maligne. Nous rapportons un cas chez un nourrisson de 20 mois, de sexe féminin. Quatrième enfant du couple dont la mère est âgée de 29ans avec quatre grossesses, quatre parités, quatre vivants et zéro avortement. Il s'agissait d'une grossesse mal suivie, à terme, accouchement par voie basse, une PEV correcte avec un BCG positif et une marche autonome à 13 mois, chez la patiente on retrouve une tuméfaction inguinale et de la grande lèvre gauche, douloureuse, fluctueuse (A), un abdomen distendu avec une plaie suintante de 4cm/3cm de la fesse droite (A). Au cliche ASP on retrouve un abdomen distendu flasque avec surcroit d'opacité de la région péri-ombilicale et de l'hypogastre (B), l'échographie montre une volumineuse masse tissulaire sous vésicale finement calcifié de 87*54mm (C). Une TDM thoraco abdominale réalisée objective une masse tissulaire sacro coccygienne de 83*59 mm, calcifiée avec une discrète lyse du pubis gauche et une formation kystique abdominale sans paroi propre (D,E), il existe également des images nodulaires de taille variable sur les poumons et le foie (F,G). Le nourrisson a été pris en charge par une équipe d'onco-pediatre.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Yawovi Mawufemo Tsevi, Eyram Yoan Makafui Amekoudi, Kodjo Abossisso Sakiye, Kwame Doh, Kossi Akomola Sabi, Komi Dzidzonu Nemi, Kodjo Agbeko Djagadou, Eugene Attisso, Clement Kan Ackounddou [Case report] - Rupture non traumatique de la rate révélée par une insuffisance rénale aiguë - 05 July 2019. http://www.panafrican-med-journal.com/content/article/33/176/abstract/ <b>Nous rapportons dans ce travail un cas d'hématome sous capsulaire spontané rompu de la rate, induite par un toxique traditionnel, et révélé par une insuffisance rénale aigue avec hémolyse intravasculaire.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Christopher Vunni Draiko, Khemika Yamarat, Alessio Panza, Judith Draleru [Research] - Knowledge, skills and competency retention among health workers one year after completing helping babies breathe training in South Sudan - 05 July 2019. http://www.panafrican-med-journal.com/content/article/33/175/abstract/ <b>INTRODUCTION: This study aimed to evaluate the long-term retention of knowledge, skills, and competency of health workers who completed a Helping Babies Breathe (HBB) training program and its effect on newborn mortality. METHODS: a quasi-experimental pre- and post-intervention study was conducted. Participants were health workers selected based on their previous training on HBB protocols. Participants were assessed for knowledge, skills, and competency in March 2017 (immediately before and after training), June 2017 (three months after training), and September 2018 (one year after training). Assessments were conducted using HBB questionnaires, checklists and practical skill drills. Mean scores were obtained and ANOVA, chi-squared test, and Pearson's test were used for pre intervention, post intervention, and one-year-after comparisons. The effect of training on the management of newborn asphyxia was assessed based on a review of the delivery registry at a maternity and children's ward. The scores were group into percentages and averages means and were computed using chi-squared tests. RESULTS: despite improvements in knowledge, skills, and competency three months after training, participants showed a marked decline one year after training. Knowledge increased from 42.5% pretest to 97% posttest but decreased to 84.5% three months' post training and further decreased to 69.4% one year post training. Skills increased from 26.1% pretest to 94.4% posttest, remained at 94.4% at three months, and decreased to 77.0% at one year. Simple resuscitation scores increased from 26.9% to 88.8% pre- and posttest, remained roughly at three months and decreased to 76.4% at one year. For complex resuscitation, scores decreased from 90.9% posttest to 76.9% at one year. The assessments at one year indicated a need for support and practice, especially with bag-mask ventilation. CONCLUSION: the immediate evaluation of health workers after HBB training showed significant increases in knowledge, skills and competency in neonatal resuscitation. However, this declined after one year. The training also resulted in decreased neonatal mortality.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Belghmaidi Sarah, Belhoucha Btissam, Hajji Ibtissam, Rochdi Youssef, Albab Nabil, Nouri Hassan, Aderdour Lahcen, Raji Abdelaziz, Moutaouakil Abdeljalil [Case series] - Dépistage de l'atteinte oculaire chez les enfants sourds - 05 July 2019. http://www.panafrican-med-journal.com/content/article/33/174/abstract/ <b>L'association de la surdité aux troubles visuels est fréquente. Ces troubles vont de simple anomalie de la réfraction jusqu'à la maladie grave qui peut constituer un handicap. D'où l'intérêt d'un dépistage précoce. L'objectif de cette étude est de montrer l'importance de la collaboration multidisciplinaire, et la nécessité de l'examen ophtalmologique chez chaque enfant présentant une surdité à travers cette étude prospective. Il s'agit d'une étude prospective monocentrique colligeant 200 enfants suivis pour hypoacousie de janvier 2014 à janvier 2015. Chaque enfant a bénéficié d'un examen ophtalmologique complet; examen ORL; et un examen général. Cent cinquante-cinq dossiers ont été colligés. Une atteinte oculaire était constatée chez 47 patients soit 30,4% des enfants. Elle est bilatérale chez 45patients. Les principales étiologies étaient syndromiques (syndrome d'usher (8cas), syndrome de Waardenbourg (5 cas), syndrome d'alport (3 cas), syndrome de Wolfram (2 cas), syndrome de Goldenar (3 cas), syndrome de Cogan (3 cas), syndrome de Fracheschetti (1 cas), syndrome de Charge (1 cas), syndrome otomandibulaire (1 cas), syndrome de stickler (1 cas), syndrome d'alstrom (1 cas), syndrome de Refsum (1 cas), syndrome de susac (1 cas) et KID syndrome (1 cas)). Le dépistage de l'atteinte oculaire a permis de raccourcir le délai d'attente pour implant cochléaire de 9 mois à 3 mois. Les atteintes oculo auditives sont très nombreuses du fait de la similitude embryologique et cellulaire de ces deux organes, notamment la rétine et l'oreille interne. Le diagnostic de ces atteintes est facilité par l'existence d'une dysmorphie faciale, en revanche, il reste difficile lorsqu'il existe que les atteintes neurosensorielles visuelles et auditives. La précocité du diagnostic des atteintes oculo auditives permet un meilleur développement psychomoteur et une insertion sociale optimale. Donc la prise en charge pluridisciplinaire précoce est nécessaire afin de permettre la meilleure rééducation psychomotrice, orthophonique et visuelle.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Amal Yassine, Abdelkader Jalil El Hangouche, Naoufel El Malhouf, Siham Maarouf, Jamal Taoufik [Corrigendum] - Corrigendum: Les caractéristiques de la population couverte par le régime de l’assurance maladie obligatoire au Maroc - 04 July 2019. http://www.panafrican-med-journal.com/content/article/33/173/abstract/ <b>Ce Corrigendum modifie l'article original «Les caractéristiques de la population couverte par le régime de l'assurance maladie obligatoire au Maroc». The Pan African Medical Journal. 2018;30:266. doi:10.11604/pamj.2018.30.266.13209.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Abdelkader Jalil El Hangouche, Ouiame Lamliki, Latifa Oukerraj, Taoufiq Dakka, Nawal Doghmi, Jamila Zarzur, Mohammed Cherti [Corrigendum] - Corrigendum: Kounis syndrome induced by oral intake of aspirin: case report and literature review - 04 July 2019. http://www.panafrican-med-journal.com/content/article/33/172/abstract/ <b>This corrigendum corrects article "Kounis syndrome induced by oral intake of aspirin: case report and literature review" and its publication references ie The Pan African Medical Journal. 2018;30:301. doi:10.11604/pamj.2018.30.301.14948.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Abdoulaye Bousso [Essay] - Health emergency operation centers implementation challenges in Africa - 04 July 2019. http://www.panafrican-med-journal.com/content/article/33/171/abstract/ <b>The African continent faced to many public health events. An effective organization is the key element for managing public health events. Health Emergency Operations Centers (HEOC) are strategic bodies that can help control such situations. We would like to share our experience about the HEOC implementation in Senegal, which is among the first in Africa while highlighting the challenges we have the HEOC concept is quite common in other continents, it is an innovation in Africa. And yet, Africa is the most affected by emergency situations and disasters and very few of its country possess HEOC. Consequently, emergency and disaster management interventions are done in a nonsystematic manner. The comprehension of the concept, the mission and organization need to be well understood for setting up a HEOC the added value of HEOC is great for African country to face public health events.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Yacoub Mohamed Sghair, Med Elmoktar Mballa, Sidi Mohamed Naji, Ahmed Kane [Case report] - Méga-urètre congénital compliqué de calculs: à propos d'un cas - 04 July 2019. http://www.panafrican-med-journal.com/content/article/33/170/abstract/ <b>Le méga-urètre congénital est une malformation rare à l'origine d'un désordre mictionnel avec parfois un retentissement sur le haut appareil urinaire. Malgré l'association fréquence avec d'autres malformations urinaires et extra urinaires, chez l'enfant, la complication par des calculs n'a été rapportée qu'une seul fois dans la littérature. Nous rapportons un cas de méga-urètre congénital compliqué de calculs de stase chez un enfant de 3 ans pris en charge avec succès au service de chirurgie pédiatrique du centre hospitalier mère et enfant de Nouakchott. A travers cette observation nous revenons sur les aspects épidémiologiques, cliniques et thérapeutiques de cette association entre méga-urètre congénital et calculs urinaires.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Servais Albert Fiacre Bagnaka Eloumou, Jean Pierre Nda Mefo’o, Winnie Tatiana Bekolo Nga, Gabin Ulrich Kenfack, Linus Yakana, Agnès Malongue, Cecile Okalla, Mathurin Kowo, Firmin Ankoune Andoulo, Christian Tzeuton, Marie Solange Doualla Bidja, Henry Luma Namme, Dieudonne Adiogo, Dominique Noah Noah [Research] - Cryoglobuline et facteurs associés chez le patient porteur de l'anticorps du virus de l'hépatite C dans un pays à ressources limitées - 04 July 2019. http://www.panafrican-med-journal.com/content/article/33/169/abstract/ <b>INTRODUCTION: Le virus de l'hépatite C (VHC) a plusieurs manifestations extra hépatiques parmi lesquelles la cryoglubulinémie. La cryoglobulinémie se définit par la présence anormale dans le sang d'une ou plusieurs protéines (cryoglobuline) pouvant précipiter au froid. METHODES: nous avons mené une étude transversale et analytique dans le service du laboratoire de biologie et l'unité d'hépatologie de l'Hôpital Général de Douala (HGD) pendant une durée de 6 mois. Etaient inclus dans le travail tous les patients acceptant de participer et porteurs d'un anticorps anti VHC avec ou sans traitement. Les cryoglobulines étaient recherchés par la méthode de Biuret et la classification était réalisée par une immunoélectrophorèse de Brouet. Une analyse multivariée a été réalisée, des facteurs de confusion tels que l'âge, le sexe et la durée après dépistage du VHC ont été ajustés. RESULTATS: nous avons inclus 116 patients. L'âge moyen était de 58,47 ± 9,95 ans. Le sexe masculin représentait 50,86% des cas. L'arthralgie était présente dans 69,80% des cas. La cryoglubiline était présente chez 63,80% des cas. Apres ajustement, le sexe féminin (ORa =2,18; IC à 95% [0,97-4, 90]; p= 0,059), l'asthénie seule (ORa =2,45; IC à 95% [1,04-5,80]; p= 0,041), l'asthénie couplée à l'arthralgie (ORa =2,84; IC à 95% [1,13-7, 10]; p= 0,026) et la présence de l'ARN du VHC (ORa =2,84; IC à 95% [1,13-7, 10]; p= 0,028) étaient des facteurs indépendamment associés à la présence de cryoglobuline. CONCLUSION: la prévalence de la cryoglobubine est élevée chez les patients porteurs de l'Ac anti VHC à l'HGD. Elle est recherchée par les méthodes biologiques simples. La recherche de cryoglobuline chez les patients porteurs du VHC est essentielle dans un pays à ressource limité.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Obioma Chukwudi Uchendu, Oluwapelumi Adeyera, Eme Theodora Owoaje [Research] - Awareness and utilization of female condoms among street youths in Ibadan, an urban setting in South-West Nigeria - 04 July 2019. http://www.panafrican-med-journal.com/content/article/33/168/abstract/ <b>INTRODCUTION: Female condom awareness and use have been poorly documented in Sub-Saharan region especially among street youths. This study assessed its awareness and use among street youths. METHODS: a cross-sectional study was conducted among 964 youths between ages 15 to 24 years old using questionnaires to elicit information. Univariate and multivariate analysis were conducted at 5% level of significance. RESULTS: more than half (69.9%) were males and between 20-25 years of age (61.2%). More than three-quarter (81.0%) had initiated sexual activity. Almost half (47.9%) of the respondents have heard about female condoms however only 16.8% have ever seen while 4.3% have actually ever used a female condom. Age, education, current sexual activity and experience of rape attempt were predictors of female condom awareness. CONCLUSION: awareness of female condom was a significant predictor of utilization of female condoms. There is therefore a need for proper awareness and education on the effectiveness of female condoms.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Kamal Chtira, Lamia Benantar, Houssaine Aitlhaj, Hasna Abdourafiq, Yassine Elallouchi, Khalid Aniba [Case report] - The surgery of intra-orbital hydatid cyst: a case report and literature review - 04 July 2019. http://www.panafrican-med-journal.com/content/article/33/167/abstract/ <b>Intra-orbital hydatid cyst is a very rare pathological entity that affects children and the young adults; it is secondary to the development in the orbit of the echinococcus granulosis tapeworm. Its frequency does not exceed 1% of all cases of hydatid disease. Clinical presentation of intra-orbital hydatid cyst is dominated by proptosis and a decrease in visual acuity, complete surgical excision is difficult, evolution is generally better when the treatment is early before the installation of irreversible optic atrophy. We report one case of a 3 years old girl operated for right intra-orbital hydatid cyst who presented with proptosis and blindness. Complete removal was difficult and puncture of the cyst was performed followed by excision of its membrane with good post-operative results. We also discuss the different epidemiological, clinical, radiological and therapeutic aspects of intra-orbital hydatid cyst and a review of literature of this rare pathology.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Refiloe Stephania Mabathoana, Chantel Van Wyk, Anthonio Oladele Adefuye [Short communication] - Factors influencing HIV risk-taking behaviours amongst textile factory workers living with HIV in Lesotho - 04 July 2019. http://www.panafrican-med-journal.com/content/article/33/166/abstract/ <b>With its number of employees ranging from 45,310 to 46,000, the textile and apparel industry is the main private sector employer of labour in Lesotho. It has been reported that a third (an estimated 34%) of these workers are living with HIV. There is perception that textile factory workers living with HIV (TFWLWH) in Lesotho indulge in HIV risk-taking behaviours. However, no study has yet investigated or documented factors that influence risk-taking behaviours amongst these workers. Transmitting the disease to others, treatment complications and death consequent to HIV reinfection are complications associated with HIV risk-taking behaviours by seropositive individuals. Using an in-depth, face-to-face, semi-structured interview, this study obtained the perspectives of ten factory workers from three randomly selected textile factories in Maseru, Lesotho on factors that influence HIV-risk taking behaviour amongst TFWLWH in Lesotho. Analysis of the comments given by workers revealed four core themes, namely, peer pressure, communication, cultural norms, and societal norms. Determining the predictors of HIV risk-taking behaviours amongst these workers will inform both present and future interventions aimed at supporting textile factory workers living with HIV in Lesotho. This supports the need for continued research to identify HIV risk-taking behaviours by people living with HIV countrywide, to decrease the incidence of new infections and complications arising from reinfection.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mustapha Ahsaini, Adil Mellouki, Soufiane Mellas, Jalaleddine El Ammari, Mohammed Fadl Tazi, Mohammed Jamal El Fassi, Moulay Hassan Farih [Case report] - Multiple lithiases de l’urètre prostatique associé à une anéjaculation révélant un dysraphisme spinale à type de syndrome de moelle bas attachée chez un jeune homme: à propos d’un cas exceptionnel - 03 July 2019. http://www.panafrican-med-journal.com/content/article/33/165/abstract/ <b>Le dysraphisme spinal (ou spina bifida) est une pathologie neurologique qui représente la première cause de handicap urologique congénital. Il peut avoir des expressions cliniques très variables, les troubles vésico-sphinctériens et sexuels sont fréquents et rarement isolés, noyés au sein des troubles moteurs, orthopédiques, sensitifs, digestifs voir cognitifs. Le syndrome de la moelle bas attachée est une complication du dysraphisme spinal. Affection est souvent découverte chez l&acute;enfant, peut être asymptomatique et rencontrée chez l&acute;adulte. Les troubles vésico-sphinctériens constituent la principale cause de morbi-mortalité par les complications uro-nephrologiques qu&acute;ils entrainent avec une altération significative de la qualité de vie de ces patients. Justifiant ainsi une prise en charge spécifique et multidisciplinaire et un suivi strict. Nous présentons un cas exceptionnel de dysraphisme spinale type syndrome de la moelle bas attachée de découverte fortuite à l&acute;âge adulte à l&acute;occasion du bilan étiologique de lithiases de l&acute;urètre prostatique associé à une anéjaculation.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Rachid Marouf, Ihsan Alloubi [Case report] - Schwannome bénin primitif de la plèvre - 03 July 2019. http://www.panafrican-med-journal.com/content/article/33/164/abstract/ <b>Le schwannome est une tumeur neurogène développée à partir des cellules de Schwann. Dans la région thoracique, le médiastin est le principal site d'apparition du schwannome. Le plus souvent, il s'agit d'une lésion solitaire et la localisation pleurale est extrêmement rare. Nous rapportons un cas de schwannome pleural bénin primitif chez une femme âgée de 44 ans chez qui la lésion a été découverte suite à la réalisation d'un bilan radiologique pour une douleur thoracique et une dyspnée. Le patient a eu résection chirurgicale complète de cette tumeur sous vidéo thoracoscopie. L'étude anatomopathologique a conclu à un schwannome bénin primitif de la plèvre.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Samira Boubker, Nassiba Zerrouki, Zaina Sidqi, Maria Moussi, Amine El Mekkaoui, Wafaa Khannoussi, Ghizlane Kharrasse, Zahi Ismaili [Case series] - Prevalence of hepatitis B and C in blood transfusion center, Oujda Morocco (2013-2015) - 03 July 2019. http://www.panafrican-med-journal.com/content/article/33/163/abstract/ <b>Viral hepatitis is a serious public health problem. Its epidemiology is not precisely known in Morocco. Our objective was to assess the prevalence of HBV and HCV in a particular population of "blood donors" at the Regional Blood Transfusion Centre in Oujda. A retrospective study was conducted from May 1, 2013 to May 31, 2015. Thirty-one thousand nine hundred and fifty-two blood donors were tested. Antigen detection was made according to ELISA technique (MonolisaTMHBs Ag ULTRA). HCV research was performed by ELISA using the kit « Monolisa HCV Ag-Ab ULTRA ». 177 blood donors included, they are divided into 155 male (87.6%) and 22 female (12.4%) subjects with a ratio of 7. The average age was 37.64 ± 12 years. Six cases were positive for HCV with an overall prevalence of 0.02%. The population study by sex shows a prevalence of 0.004% for 23177 male sera and 0.057% for 8775 female sera. Six donors were HCV positive, of which 05 were female (83.33%) and one was male (16.66%). The average age was 43 ± 14 years. Co-infection with HCV HBV-HCV and HCV-Syphilis and HCV-HIV are absent. Co-infection with HBV and HIV was found in one case. HBV-syphilis co-infection was found in 04 cases. Chronic viral hepatitis is a real global health problem. Its prevalence is currently estimated at 0.55% for HBV and 0.02% for HCV, reclassifying Morocco as a low endemic area. The prevention remains the most effective method to successfully control HBV and HCV infection.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Béfa Noto-Kadou-Kaza, Hissein Ali Mahamat, Naoufal Mtioui, Amina Izem, Lalla Meryam Abouamrane, Selma El-Khayat, Mohamed Zamd, Ghislaine Medkouri, Mohamed Gharbi Benghanem, Benyounes Ramdani [Research] - Autodialysis in Morocco: how much longer can we wait? - 03 July 2019. http://www.panafrican-med-journal.com/content/article/33/162/abstract/ <b>INTRODUCTION: Autodialysis is the dialysis performed by the patient himself at a local center instead of a hemodialysis center. In Morocco, the practice of hemodialysis dates back to 1970; however, an autodialysis center does not yet exist. The objective was to assess the potential medical fitness and adherence of the patients to an autodialysis program. METHODS: descriptive and analytical multicenter study conducted in March 2015 involving patients from of eight hemodialysis centers in Casablanca (Morocco). The study was conducted in two steps: 1) a transversal assessment of the medical potential to achieve autodialysis that included 556 patients; 2) a survey of the autodialysis membership that included 383 out of 556 patients who were deemed eligible for autodialysis. RESULTS: the average age was 54.63 ± 15.16 years; the average of hemodialysis duration was 85.9 ± 78.1 months. Diabetic nephropathy (22.7%) was the predominant cause of kidney disease. The assessment of medical potential to achieve autodialysis highlighted that almost all of the patients were in good condition (93%), independent (81%), and those without major comorbidities were less than 76 years old. Regarding the potential patients' adherence to autodialysis, among the 383 patients previously deemed suited for autodialysis, 293 (76.5%) responded favorably to the proposal of self-dialysis. CONCLUSION: the practice of hemodialysis should be implemented in a short time in Morocco because our patients' profile is perfectly suitable to this therapeutic method especially when they are young, in good general condition, autonomous, without major comorbidities, and willing to learn.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Jonathan Walubembe, Mike Engola Aremo, Conrad Tumwine, Florence Nabaale, Andrew Twinomasiko, Isaac Tukesiga, Phillip Ssenyomo, Apollo Mugaiga, Jerome Roy Semakula, Derrick Amone Olwedo, David Kitara Lagoro [Case report] - Carcinoma of the colon in a 40 year old female: a case report - 03 July 2019. http://www.panafrican-med-journal.com/content/article/33/161/abstract/ <b>We present a histologically proven mucinous adenocarcinoma of the colon in a 40 year old female from Gulu, Northern Uganda. Her elder sister died at 25 years with advanced adenocarcinoma of colon similarly with her mother who died of the same illness 10 years apart. Using the Amsterdam criteria for the diagnosis of the carcinoma of the colon, this is descriptive of Hereditary Non Polyposis Colorectal Carcinoma (HNPCC). Blood examinations revealed microcytic hypochromic anaemia. The Renal and Liver function parameters were essentially normal. The abdominal ultrasonography showed an ill-defined mass in the right hypochondrial region which was heterogeneous with central echogenicity approximately 7.2cm wide and with no intra-abdominal lymphadenopathy or ascitis. At laparotomy, the sonographic findings were confirmed with a demonstrable mass in the hepatic flexure of the colon with hyperemic areas on its serosa. Macroscopically, there was an annular fungating mass with a central necrosis in the hepatic flexure measuring over 7.0cm. Histology of the colonic tumour showed a mucinous adenocarcinoma of the colon (Duke's B). This finding highlights the occurrence of colonic adenocarcinoma in the young person in Northern Uganda, a finding which draws the attention of the medical community towards having a higher index of suspicion for carcinoma of the colon in patients with similar presentation.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Anas Loutfi, Sara Chibane, Abdenasser Drighil, Leila Azzouzi, Rachida Habbal [Case report] - Une complication rare et grave du traitement par l’acénocoumarol: l’hémorragie intra-alvéolaire - 03 July 2019. http://www.panafrican-med-journal.com/content/article/33/160/abstract/ <b>L'hémorragie intra-alvéolaire est une urgence médicale rare et grave ayant de nombreuses étiologies. Nous rapportons ainsi le cas clinique d’un patient qui pourrait contribuer à élargir la littérature sur ce sujet. Le patient est un homme âgé de 62 ans ayant un antécédent de fibrillation auriculaire sous anti-vitamines K et admis dans un tableau de dyspnée d’apparition brutale avec hémoptysie et notion d’automédication par anti-inflammatoires non stéroïdiens. La radiographie et le scanner thoracique ont montré des opacités alvéolaires bilatérales diffuses. Au bilan d’hémostase de l’admission, l’INR était incoagulable. Le diagnostic d’hémorragie intra-alvéolaire était suspecté cliniquement et radiologiquement puis confirmé par l’endoscopie bronchique avec lavage broncho-alvéolaire (LBA) retrouvant un liquide uniformément hémorragique. Les études précédentes présentant des cas similaires secondaires à la prise d’anti-vitamines K sont rares. En conclusion, Il parait très important de souligner l’intérêt d’une surveillance stricte et optimale clinico-biologique des patients traités en anti-vitamines K afin d’éviter un surdosage pouvant contribuer à un accident hémorragique grave engageant le pronostic vital.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Relebogile Mapuroma, Cheryl Cohen, Lazarus Kuonza, Alfred Musekiwa, Stefano Tempia, Akhona Tshangela, Claire von Mollendorf [Research] - Healthcare seeking behaviour for common infectious syndromes among people in three administrative regions of Johannesburg, South Africa, 2015: a cross-sectional study - 03 July 2019. http://www.panafrican-med-journal.com/content/article/33/159/abstract/ <b>INTRODUCTION: hospital-based surveillance programs only capture people presenting to facilities and may underestimate disease burden. We conducted a healthcare utilisation survey to characterise healthcare-seeking behaviour among people with common infectious syndromes in the catchment areas of two sentinel surveillance hospitals in Johannesburg, South Africa. METHODS: a cross-sectional survey was conducted within three regions of Johannesburg from August to November 2015. Premises were randomly selected from an enumerated list with data collected on household demographics and selected syndromes using a structured questionnaire. Fisher's exact or chi-square tests were used to determine association of characteristics among different regions. RESULTS: of 3650 selected coordinates, 3358 were eligible dwellings and 2930 (87%) households with 9850 individuals participated. Four percent of participants (431/9850) reported influenza-like illness (ILI) in the last 30 days; equal numbers of participants (0.2%, 20/9850) reported pneumonia or tuberculosis symptoms in the last year and <1% reported diarrhoea or meningitis symptoms. Sixty eight percent (295/431) of participants who reported ILI, 75% (6/8) of children with diarrhoea and all participants who reported pneumonia (20), tuberculosis (20) or meningitis (6) sought healthcare. For all syndrome most sought care at registered healthcare providers. Only 10% (24/237) attended sentinel hospitals, predominantly those that lived closer to the hospitals. In contrast, of patients with meningitis, 50% (3/6) sought care at sentinel hospitals. CONCLUSION: patterns of seeking healthcare differed by syndrome and distance from facilities. Surveillance programs are still relevant in collecting information on infectious syndromes and reflect a proportion of the hospital’s catchment area.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Chamunorwa Ndudzo, Jaya Prasad Tripathy, Fortune Tauro, Clemence Sibanda, Maikoro Chiramba, Amadeus Shamu, Kudzai Masinire, Tafadzwa Muchengwa, Ajay MV Kumar [Research] - HIV care among patients with presumptive tuberculosis in Masvingo district of Zimbabwe, 2017: how well are we doing? - 03 July 2019. http://www.panafrican-med-journal.com/content/article/33/158/abstract/ <b>INTRODUCTION: While HIV care among tuberculosis (TB) patients is successfully implemented and monitored, it is not routinely reported among "presumptive TB patients without TB". The present study describes the ascertainment of HIV status and receipt of antiretroviral therapy (ART) and the associated factors among presumptive TB patients (with and without TB) in 35 public health facilities of Masvingo district of Zimbabwe from January to June 2017. METHODS: this was an analysis of secondary programme data. We performed log binomial regression to calculate adjusted relative risks (aRR) and 95% confidence intervals (CI). RESULTS: of 1369 presumptive TB patients, 1181 (86%) were ascertained for HIV status (98% among those subsequently diagnosed with TB, 83% among non-TB). Of them, 748 (63%) were HIV positive, more among TB patients (69%) than those without TB (61%). Among HIV-positive patients, 475 (64%) received ART, significantly higher among TB patients (78%) compared to those without TB (57%). Patients without TB were significantly more likely to have non-ascertained for HIV status (aRR=2.4, 95% CI=1.4-5.0) and not receiving ART (aRR=1.8, 95% CI=1.6-2.0), compared to those with TB. CONCLUSION: we found high rates of HIV status ascertainment among presumptive TB patients. But, ART uptake was poor among "presumptive TB patients without TB" despite implementation of "test and treat" strategy in Zimbabwe. The programme should step up the monitoring of HIV status and ART receipt among presumptive TB patients, by introducing an indicator in the quarterly reports of the national TB programme.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Badreeddine Alami, Mustapha Maaroufi [Images in medicine] - Mounier-Kuhn syndrome - 02 July 2019. http://www.panafrican-med-journal.com/content/article/33/157/abstract/ <b>A 39-year-old man presented with a productive cough, a history of chronic dyspnea and recurrent lower respiratory tract infections. Physical examination and laboratory tests were unremarkable. A chest X-ray (A) showed an enlarged tracheal diameter (white arrows), with multiple cysts in the lower lobes (red arrows). A computed tomography scan of the chest (B) showed the dilatation of both the trachea and the two main bronchi (white arrows) with multiple diverticulae (blue arrows). It also revealed bilateral cystic bronchiectasis involving both lower lung zones (red arrows). A possibility of Mounier-Kuhn syndrome (MKS) was considered. MKS is a rare condition characterized by recurrent lower respiratory tract infections and tracheobronchial dilation that is due to atrophy of the muscular and elastic tissues in the trachea and main bronchial wall. The patient underwent bronchoscopy which demonstrated tracheal dilation with diverticulae and enlargement of both main bronchi confirming the diagnosis of MKS.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Sameh Sayhi, Nour Gueddich, Rym Dhahri, Najeh Bousetta, Bilel Arfaoui, Nadia Ben Abdelhafidh, Faida Ajili, Bassem Louzir [Case series] - Non-coronary cardiac manifestations of systemic lupus erythematosus in adults: a comparative study - 02 July 2019. http://www.panafrican-med-journal.com/content/article/33/156/abstract/ <b>Cardiac manifestations develop in the majority of patients with systemic lupus erythematosus (SLE) at some time during the course of their disease.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Constantine Davanas [Letter to the editors] - Off-label medicine use/prescribing controversies through patients’ eyes/“rights”: the example of povidone-iodine enemas/suppositories for “terminal” pouchitis - 01 July 2019. http://www.panafrican-med-journal.com/content/article/33/155/abstract/ <b>Off-label drug use/prescribing, although not uncommon by any means, is often stigmatized when no benefits and/or adverse effects occur, occasionally leading to legal vulnerability for doctors, especially when considered "experimental". Viewing the matter through a patient's insistence/willingness to assume all responsibility and risks in order to obtain doctors' prescriptions to use povidone iodine enemas/suppositories against severe pouchitis, the suggestion is put forth that drugs in the World Health Organization's "list of essential medicines" may be considered "quasi-experimentally appropriate" for first-time off-label prescriptions, waiving legal repercussions for doctors and at the same time, respecting the patient's "right" for a last resort treatment.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Moulay El Mehdi El Hassani, Saad Benali, Jaouad Kouach, Driss Moussaoui Rahali [Case report] - L'encéphalopathie postérieure réversible syndrome: à propos d'un cas - 01 July 2019. http://www.panafrican-med-journal.com/content/article/33/154/abstract/ <b>L'encéphalopathie postérieure réversible (EPR) est une entité radio-clinique associant une atteinte réversible du système nerveux central à une imagerie encéphalique typique. Il existe une grande variabilité dans la présentation clinique de ce syndrome et des aspects en imagerie parfois atypiques. L'EPR est une complication neurologique inhabituelle survenant au cours de la grossesse ou en post-partum, en dehors de toute pathologie préexistante de la grossesse dont l'œdème vasogénique par rupture de la barrière hémato encéphalique paraît être l'acteur principal. Nous rapportons l'observation d'une patiente primipare présentant des crises convulsives généralisées tonico-cloniques associées à un pic hypertensif, survenant au cours du troisième trimestre de grossesse. L'imagerie par résonance magnétique (IRM) cérébrale était en faveur d'une encéphalopathie postérieure réversible. L'EPR doit être évoqué devant tout signe d'appel neurologique, vu l'évolution favorable sans séquelles sous un traitement précoce et rapide.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Hamza Hasnaoui, Hicham El Bouhaddouti, Ouadii Mouaqit, El Bachir Benjelloun, Abdelmalek ousadden, Khalid Ait Taleb [Case report] - Invagination intestinale aiguë révélant un lymphome T digestif chez l'adulte: à propos d'un cas - 01 July 2019. http://www.panafrican-med-journal.com/content/article/33/153/abstract/ <b>L'invagination intestinale aiguë est une pathologie du nourrisson et du petit enfant. Sa survenue chez l'adulte est très inhabituelle. Elle est d'étiologie diverse. Dans l'immense majorité des cas, elle est secondaire à une tumeur qui peut être bénigne ou maligne. Un lymphome T digestif révélé par invagination intestinale est une entité très rare. Nous rapportons le cas d'un patient de 43 ans, admis aux urgences du centre hospitalier universitaire Hassan II de Fès, Maroc pour une occlusion intestinale. Le scanner abdominal a montré une invagination intestinale aiguë grêlo-grêlique sur un épaississement pariétal digestif de l'anse incarcérée. Le traitement était une résection chirurgicale carcinologique à ciel ouvert. L'étude anatomopathologique et immunohistochimique de la pièce opératoire a conclu à un lymphome anaplasique à grandes cellules de type T. Après la chirurgie, une chimiothérapie est indiquée dans le but d'améliorer le pronostic et d'éviter une éventuelle rechute. L'invagination intestinale est une affection rare chez l'adulte. Elle conduit le plus souvent à la découverte d'une cause organique pouvant être tumorale. A partir de ce nouveau cas et après analyse de la littérature, nous discutons les caractéristiques cliniques, diagnostiques et les possibilités thérapeutiques de cette pathologie rare.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Hedwig Eposi Nkwenti , Nkfusai Joseph Fonyuy , Ndeso Atanga Sylvester, Ngwayu Claude Nkfusai , Brenda Mbouamba Yankam , Samuel Nambile Cumber [Research] - The effect of subsidized malaria treatment among under-five children in the Buea Health District, Cameroon - 27 June 2019. http://www.panafrican-med-journal.com/content/article/33/152/abstract/ <b>INTRODUCTION: Access to free diagnoses and treatments has been shown to be a major determinant in malaria control. The Cameroon government launched in 2011 and 2014 the exemption of the under-fives' simple and severe malaria treatment policy to increase access to health care and reduce inequality, so as to reduce the mortality related to malaria among the under-fives. This study assessed the effect of providing free malaria treatment in the Buea Health district. METHODS: This retrospective and cross sectional study was carried out in the Buea health district. Aggregated monthly data from (2008-2010) before and (2012-2014) after the implementation of free malaria treatment was compared, to assess the attributable outcomes of free treatment. A semi-structure questionnaire was also used to assess barriers faced in providing free malaria treatment services by health care workers. Data was collected using a semi-structure questionnaire and a data review summary sheet. The Data was analysed using Epi-Info 7, Excel and SPSS (Statistical Package for the Social Sciences) version 20.0 for Windows. All statistical tests were performed at 95% confidence interval (significance level of 0.05). RESULTS: Increase utilisation of health care; as general and malaria related consultations (by 5.7% (p=0.001) witnessed an increase after the implementation of free malaria treatment services. Severe malaria hospitalisation also increased, indicating that most caregivers used the health facility when complications had already set in, which could have led to no significant reduction in mortality due to malaria among under-five children (4.4%, p=0.533). CONCLUSION: Utilisation of health care increased; as consultation and morbidity rate increased after the implementation of free malaria treatment services. Communication strategy should therefore be strengthened so as to better disseminate information, so as to enhance the effectiveness of the program. There is the need to make a large-scale study to assess the impact of subsidized malaria treatment.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Tu&#287;çenur Uzun, Ertunç Çinpolat [Case report] - Calcifying odontogenic cyst associated with the impacted third molar: a case report - 27 June 2019. http://www.panafrican-med-journal.com/content/article/33/151/abstract/ <b>Calcifying odontogenic cyst (COC) is a benign, locally aggressive, slow-growing lesion. Its occurrence constitutes about 2% of all odontogenic cysts. The most frequent sign is painless, slow growing swelling. Radiographically it appears as a well-defined unilocular radiolucency. The microscopical features of lesion showed well-delineated cystic proliferation of odontogenic epithelium with ghost cells and fibrous connective tissue wall. In the present study, 42 years old man who has COC associated with the impacted third molar treated with enucleation is reported after 6 months follow-up.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Youssef Darouassi, Abdelfettah Aljalil, Amine Hanine, Amine Enneouali, Brahim Bouaity, Mohamed Mliha Touati, Haddou Ammar [Case report] - Nasopharyngeal tuberculosis: report of four cases and review of the literature - 27 June 2019. http://www.panafrican-med-journal.com/content/article/33/150/abstract/ <b>Even if tuberculosis is a major cause of morbidity and mortality, nasopharyngeal location is unusual and extremely rare. We report four new cases observed with short time interval suggesting a trend towards increased frequency. The diagnosis was confirmed by histological analysis after a biopsy. The evolution was favorable after anti tuberculosis chemotherapy. In the light of those observations and a review of the literature, we will discuss different characteristics of this disease and we will highlight the need of a systematic biopsy in order to confirm diagnosis, and exclude undifferentiated carcinoma especially in endemic regions for both diseases.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Etienne Ngeh Ngeh [Letter to the editors] - Research among undergraduate biomedical students in Cameroon: contextual barriers, room for improvement - 27 June 2019. http://www.panafrican-med-journal.com/content/article/33/149/abstract/ <b>There is overwhelming evidence that the highest burden of disease worldwide is concentrated in low and middle-income countries (LMICs) and responsible for the high mortality in these countries. This high mortality rates have strongly been associated with poor health care systems and sub-optimal quality of health care delivery. The poor quality of health care delivery is powered by a lack of research evidence. Evidence can only be gotten by conducting high-quality research and generating local data based on peculiar health problems that can be used to inform guidance. Encouraging research among students early during training has been an effective strategy in stimulating interest in future research. This correspondence highlights some contextual barriers to clinical research practice among undergraduate biomedical students in Cameroon and suggests ways to improve the situation.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Yumi Yestiana, Tri Kurniati, Abdul Aziz Alimul Hidayat [Research] - Predictors of burnout in nurses working in inpatient rooms at a public hospital in Indonesia - 27 June 2019. http://www.panafrican-med-journal.com/content/article/33/148/abstract/ <b>INTRODUCTION: This study aimed to determine the factors that predict the incidence of burnout in nurses who work at the Public Hospital of Tangerang Regency in Banten, Indonesia. METHODS: a cross-sectional design was used in this study. Participants were selected from eight inpatient wards at the Public Hospital of Tangerang Regency (hereinafter termed the hospital) by using a proportionate stratified random sampling method. A total of 133 nurses working in the inpatient wards were recruited. Data were collected using a questionnaire on nursing work schedule setting policy, daily log questionnaire for workload, competency scale and the Maslach Burnout Inventory scale for nurse burnout. Stepwise multiple linear regression was used to analyze the data. RESULTS: for most respondents (54.1%), the nursing work scheduling policy was appropriate, whereas the average score of nurse workload was 80.42 with SD ± 0.49, and the competency of most nurses was appropriate (64.7%). The average score of nurse burnout was 17.48 with an SD ± 0.50. Work schedule policy and workload were significant burnout predictors, accounting for 87.2% of the variance (Adjusted R2=0.872) in burnout among nurses who worked in the hospital’s inpatient wards. CONCLUSION: nursing work schedule setting policy and workload were the main factors that led to burnout in nurses working in the inpatient wards. This issue can be overcome by regulating the workload in a balanced manner and applying appropriate policy in the nurse work schedule.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Aadithya Basavaraj Urs, Jeyaseelan Augustine, Deepika Negi, Rudra Deo Kumar, Sujoy Ghosh [Case report] - Pleomorphic adenoma: a rare presentation in buccal salivary gland with extensive squamous and mucous metaplasia - 26 June 2019. http://www.panafrican-med-journal.com/content/article/33/147/abstract/ <b>Pleomorphic Adenoma (PA) is the most common salivary gland tumor and accounts for about 60% of all salivary gland neoplasms. Intraorally, the hard palate is the most common presenting site (50-60%) followed by upper lip (15-20%) and rarely buccal mucosa (8-10%). Histopathologically, PA shows diverse morphology resulting from amalgamation of cellular and stromal components. The PA may show changes in the stromal and epithelial components, such as sebaceous, lipocytic and oncocytic metaplasia. A rare characteristic of PA is to show extensive squamous and mucous differentiation which poses diagnostic dilemma to the pathologist. Here, we present an unusual case of PA of buccal minor salivary gland with squamous and mucous metaplasia. The localization, gender and microscopic features of the presented case are unusual.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Victor Moses Musyoki, Moses Muia Masika, Winnie Mutai, Gitau Wilfred, Antony Kuria, Felista Muthini [Research] - Antimicrobial susceptibility pattern of Acinetobacter isolates from patients in Kenyatta National Hospital, Nairobi, Kenya - 26 June 2019. http://www.panafrican-med-journal.com/content/article/33/146/abstract/ <b>INTRODUCTION: Infection due to multidrug-resistant microorganisms is a growing threat in healthcare settings. Acinetobacter species specifically A. baumannii is increasingly becoming resistant to most antimicrobial agents recommended for treatment. This study aimed to determine the antimicrobial susceptibility pattern of Acinetobacter species isolated from patients in Kenyatta National Hospital. METHODS: We conducted a retrospective study based on VITEK 2 (BioMérieux) electronic records capturing identification and antimicrobial susceptibility of Acinetobacter isolates from patient samples analyzed between 2013 and 2015 at Kenyatta National Hospital microbiology laboratory. Generated data were analyzed using WHONET and SPSS. RESULTS: A total of 590 Acinetobacter isolates were analyzed. 85% of the isolates tested were multi-drug resistant (MDR). Among the 590 isolates, 273 (46%) were from tracheal aspirates and 285 (48%) from the critical care unit. A. baumannii was the most frequently isolated species with high susceptibility to amikacin (77%) and poor susceptibility to ciprofloxacin (69-76%), tobramycin (37%) and meropenem (27%). Both A. lwoffii and A. haemolyticus had high susceptibility to amikacin (80-100%) and meropenem (75-100%).</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fatoumata Ba, El Hadji Makhtar Ba, Modou Mbacké Guèye, Marième Soda Diop Sène, Massar Diagne [Case report] - Susac syndrome: about two cases - 26 June 2019. http://www.panafrican-med-journal.com/content/article/33/145/abstract/ <b>Susac syndrome is an autoimmune endothelopathy that affects precapillary arterioles of the brain, retina and inner ear. We report for the first time observations of two patients with Susac syndrome in Senegal.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Teshale Mulatu Dibisa, Tilayie Feto Gelano, Lemma Negesa, Tewelde Gebre Hawareya, Degu Abate [Research] - Breast cancer screening practice and its associated factors among women in Kersa District, Eastern Ethiopia - 26 June 2019. http://www.panafrican-med-journal.com/content/article/33/144/abstract/ <b>INTRODUCTION: Breast cancer is one of the most common cancers and cause of death among women globally. Mortality due to breast cancer was higher in lower (LMICs) and middle-income countries than high income countries (HICs) mostly due to lack of timely detection and treatment. There was limited evidence related to breast cancer screening practice among women in eastern Ethiopia. Therefore, the aim of this study was to assess breast cancer screening practice and its associated factors among women in this area. METHODS: a community based descriptive cross-sectional study design was conducted among 422 randomly selected women in Kersa district, eastern Ethiopia using systematic sampling. Data were collected using pretested interviewer administered questionnaire. Logistic regression was used to analyse the association between the dependent and independent variables. RESULTS: the overall breast cancer screening practice among women was 6.9%. Women with the age of 26 years and above were 2.3 times more likely to have breast cancer screening practice as compared to women with age of 25 years or less (AOR=2.3; 95% CI: 1.4, 3.7), and women who had good knowledge on breast cancer risk factors were 3.4 times more likely to had breast cancer screening as compared to their counterpart (AOR=3.4; 95% CI: 1.3, 9.4). The women who had ever heard about breast cancer screening were 2.8 times more likely to have breast cancer screening as compared to those who had never heard about breast cancer screening (AOR=2.8; 95% CI: 1.2, 6.5). CONCLUSION: the overall breast cancer screening practice was very low among women in the study area. Age and women's knowledge towards breast cancer risk factors and breast cancer screening information were identified as important factors for breast cancer screening practice.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Zein Ahmed, Ahmedou Moulaye Idriss, Ahmed Heiba, Isselmou Sidi [Case report] - Carcinome épidermoïde du sein: à propos d’un cas en Mauritanie - 25 June 2019. http://www.panafrican-med-journal.com/content/article/33/143/abstract/ <b>Le carcinome épidermoïde primitif (CEP) ou carcinome de cellules squameuses du sein est une tumeur maligne rare des cancers mammaires. D'origine métaplasique, son histogenèse et son pronostic sont controversés ainsi que sa présentation clinique et mammographique n'ont pas de particularité par rapport aux autres cancers. Le CEP du sein se caractérise par une évolution rapide et un traitement non codifiée. Le but de ce travail est de rapporter les aspects cliniques et évolutifs d'un nouveau cas de CEP avec une revue de littérature.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Metasebia Worku Abebe [Research] - Common causes and types of hand injuries and their pattern of occurrence in Yekatit 12 Hospital, Addis Ababa, Ethiopia - 25 June 2019. http://www.panafrican-med-journal.com/content/article/33/142/abstract/ <b>INTRODUCTION: Hand injuries constitute a major proportion of trauma emergencies in developing countries. The hand establishes the individual in society, allowing them to meet social and economic responsibilities. Previously hand traumas accounted for 12% of major limb traumas in Addis Ababa, Ethiopia; but data on the specific types of tissue injuries and pattern of occurrence of these injuries over the years is limited. METHODS: a retrospective study of sampled 178 patients with hand injury that presented to Yekatit 12 Hospital with hand injuries was done by reviewing the patient's medical records. RESULTS: hand trauma is the second commonest injury following burns that present to the Plastic and Reconstructive Surgery unit in Yekatit 12 hospital. It commonly occurs in males with ratio of 4:1. Average age of patients was 24.5 years. The right hand was more commonly injured than the left hand. Home and fall accidents were commonest cause of injury followed by machine injuries. Commonly occurring injuries were tendon injuries followed by fingertip injuries. The number of patients presenting to the hospital with hand injuries has doubled over the two year study period. CONCLUSION: the number of hand injury cases that presented to the hospital has doubled over the two years study period. Types of hand injuries presenting to the hospitals ranged from simple lacerations to deep tissue injuries requiring long duration of treatment and rehabilitation which has an impact on the productivity of the younger age group that was identified as the most at risk population.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Khadija Elboukhari, Hanane Baybay, Sara Elloudi, Zakia Douhi, Fatima Zahra Mernissi [Case report] - Idiopathic harlequin syndrome: a case report and literature review - 25 June 2019. http://www.panafrican-med-journal.com/content/article/33/141/abstract/ <b>Harlequin's syndrome is a rare dysautonomic syndrome of the face characterized by sweating with flush of one side and anhidrosis of the contralateral side. Mostly idiopathic although several secondary cases have been reported in the literature, the purpose of the treatment is mainly aesthetic and functional. We report the case of a patient having harlequin syndrome in its idiopathic form with a literature review.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Rachmat Attoumane Ben Ali, Zineb Hannoun, Khouloud Harraqui, Lotfi Zeghari, Youssef Aboussaleh, Samir Mohamed, Mohamed Anssoufouddine, Abdellatif Bour [Research] - Profile of diabetes and cardiovascular risk factors in adults Anjouan Island (Comoros) - 25 June 2019. http://www.panafrican-med-journal.com/content/article/33/140/abstract/ <b>INTRODUCTION: The aim of this study was to estimate the prevalence of Diabetes Mellitus (DM) and Impaired Fasting Glucose (IFG) in the peri-urban adult population living in the island of Anjouan, Comoros and to investigate the factors associated with diabetes mellitus. METHODS: the survey was a cross-sectional study, in which a sample of 902 individuals (540 women and 362 men) aged 25 to 64 was selected using empirical sampling "quotas" or "reasoned choice" survey method. Hypertension and obesity abdominal measurements of these subjects were collected during face-to-face interviews and following day fasting blood glucose was measured in capillary blood. RESULTS: participation rate was 83.5%. The mean age of subjects was 39.5 ± 11.63 years. The sex ratio was 0.67. Overall crude diabetes and IFG prevalence were 8.5% and 8.1%, respectively. The risk factors for diabetes type 2 onset were a family history of diabetes (P = 0.006), older age (P = 0.000), glycemic control (P = 0.010), excess waist circumference (P= 0.03) and hypertension (p = 0.000), were significantly positively associated with DM, contrary to sex (P = 0.142). CONCLUSION: these high figures confirm that diabetes and factors associated do not spare Anjouan population. Awareness, primary prevention, are to set up for a better control of non-communicable diseases.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fatma Saadallah, Imen Bouraoui, Lamia Naija, Saida Sakhri, Ines Zemni, Jamel Ben Hassouna, Tarak Ben Dhieb, Hatem Bouzaiene, Khaled Rahal [Case report] - Coexistence of invasive ductal breast carcinoma and fibroadenoma - 25 June 2019. http://www.panafrican-med-journal.com/content/article/33/139/abstract/ <b>Fibroadenomas are the most common breast disease that occurs usually in young. The coexistence of an invasive ductal carcinoma and a fibroadenoma in the ipsilateral breast is extremely rare. We present the case of a 52 years woman, presented to us for an upper-outer breast lump. Breast imaging concluded to tow contiguous lesions, one of them was suspicious. She had a conservative surgery. Histology concluded to a fibroadenoma and an invasive ductal carcinoma.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mounira El Euch, Olfa Hentati, Madiha Mahfoudhi, Wifak Bani, Fethi Ben Hamida, Fatima Jaziri, Khaoula Ben Abdelghani, Sami Turki, Taieb Ben Abdallah [Case report] - Extensive sphenoid chordoma mimicking a prolactinoma - 24 June 2019. http://www.panafrican-med-journal.com/content/article/33/138/abstract/ <b>The chordoma is a benign cartilaginous tumor whose sphenoidale localization is exceptional. This tumor has considerable difficulties of both diagnosis and treatment. We report the observation of a Tunisian adult who presented features of hypopituitarism set wrongly on account of a prolactinoma.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Claude Ngwayu Nkfusai, Samuel Nambile Cumber, Fala Bede, Tabe Armstrong Tambe, Joyce Mahlako Tsoka-Gwegweni [Research] - Assessment of the knowledge of the modes of transmission and prevention of malaria among pregnant women attending antenatal clinic at the Nkwen Health Center Bamenda, Cameroon - 24 June 2019. http://www.panafrican-med-journal.com/content/article/33/137/abstract/ <b>INTRODUCTION: Malaria is a life threatening disease caused by the Plasmodium parasite, transmitted through the bites of infected female anopheles’ mosquitoes. According to the latest WHO data published in 2017, malaria deaths in Cameroon reached 9.161 deaths accounting for 4.14% of total deaths. The age adjusted death rate is 29.11 per 100,000 and Cameroon is ranked the 30th in the world with a high prevalence of malaria. The aim of this study was therefore, to access the knowledge of the modes of transmission and prevention of malaria among pregnant women attending Antenatal Clinic (ANC) at the Nkwen Health Center, Bamenda. METHODS: This was a cross-sectional hospital based survey study. The researchers recruited 51 eligible women in the Nkwen Health Centre and used a validated and pre-tested questionnaires to collect data. Collected data were entered into Excel and analysed using descriptive statistics and the results presented in tables and figures. RESULTS: Sixty four percent of the women have basic knowledge about the mode of malaria transmission. Thirty six percent of the women had little knowledge about malaria transmission modes and the possible dangers of the disease. CONCLUSION: Slightly above 50% of pregnant women have basic knowledge on the modes of malaria transmission. Lack of knowledge regarding the modes of malaria transmission can be one of the reasons why there is still quite a high level of malaria prevalence among pregnant women attending ANC at the Nkwen Health Center, Bamenda. There is therefore, a need to educate women on malaria transmission modes.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Victor Olufolahan Lasebikan, Bolanle Adeyemi Ola, Tiwatayo Olufolahan Lasebikan [Research] - Shisha smoking in selected nightclubs in Nigeria - 24 June 2019. http://www.panafrican-med-journal.com/content/article/33/136/abstract/ <b>INTRODUCTION: Shisha consumption is a growing public health issue all over the globe and public health awareness about its deleterious health consequences is still not sufficiently raised.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Geremew Werkeshe Wana, Oyedunni Arulogun, Adebola Roberts, Abraham Sahilemichael Kebed [Research] - Predictors of risky sexual behaviour among pre-college students in Adama Town, Ethiopia - 24 June 2019. http://www.panafrican-med-journal.com/content/article/33/135/abstract/ <b>INTRODUCTION: The rate of sexually transmitted infection’s, including HIV has increased in recent years in Ethiopia. Many adolescents and young people still do not protect themselves against unintended pregnancies and STIs. Therefore, this study was conducted to assess the predictors of risky sexual behavior among pre-college students in Adama Town, Ethiopia. METHODS: school based cross-sectional study was employed. In this study 364 students were recruited from all pre-college schools in Adama town, Ethiopia. Bivariate and multivariate logistic regression analyses were used to examine the relationship between the outcome variables and independent variables. RESULTS: the mean age at sexual debut was 16.1 years (± 2.72SD). Social media usage for sexual activity and having multiple sexual partners were observed among students. About 7% of students used social media for watching pornography. The odds of risky sexual behaviour were higher among social media users compared to the nonusers AOR = 1.23(95% CI: 1.13,3.12). Risky sexual behaviour was almost 4 times more likely among night club goers AOR = 4.294 (95% CI: 2.033, 9.073). Peer pressure and substance abuse were also a significant predictor for risky sexual behavior AOR = 6.97 (95% CI: 4.24, 9.69). CCONCLUSION: social media use, peer pressure, substance abuse, and night club going were found to be significantly associated with risky sexual behaviour among precollege students. Thus, schools need to establish and strengthen reproductive health clubs to be able to equip students with required skills and knowledge about sexuality. Parents should be aware of the dynamic behavioral change of their children and, listen and attend to their needs.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mohamed Mouhoub, Achraf Miry, Anass Haloui, Nassira Karich, Imane Kamaoui, Saad Benkirane, Amal Bennani [Case report] - Primary angiosarcoma of the breast: a case report - 24 June 2019. http://www.panafrican-med-journal.com/content/article/33/134/abstract/ <b>Primary angiosarcoma of the breast is an extremely rare tumour with a difficult diagnosis and poor prognosis. We report a case of primary breast angiosarcoma diagnosed in the pathology department of the University Hospital of Oujda. An analysis of the epidemiological, diagnostic and therapeutic aspects of this type of tumour is made in this manuscript. Mastectomy is the standard treatment; the place of radiotherapy and chemotherapy is not well established. We report a case of a 18- year-old woman having an infectious symptomatology of the right breast for which she received an anti-infectious therapy inducing regression of inflammatory symptoms presented with a quick growing mass. Initial core needle biopsy showed a malignant vascular proliferation. The patient underwent a mastectomy. The tumor histology showed papillary formations and vascular structures lined by atypical cells with hyperchromatic nucleus and eosinophilic cytoplasm. The tumor cells expressed CD34 and CD31 but were negative for cytokeratin. The diagnosis of angiosarcoma grade I was made. The patient is now receiving chemotherapy. She is still alive.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Salifou Issiaka Traore, Ousmane Dembele, Soumaila Traore, Aly Diallo, Amadou Maiga, Malla Sylla, Adan Maiga, Moussa Kante [Case series] - Fistule urogénitale à Sikasso: à propos de 150 cas - 21 June 2019. http://www.panafrican-med-journal.com/content/article/33/133/abstract/ <b>L'objectif de cette étude était d'analyser les aspects épidémiocliniques, thérapeutiques et anatomopathologiques de la fistule urogénitale (FUG). L'étude rétrospective porte sur les cas de FUG admis dans le Service de Chirurgie Générale et Gynéco-obstétrique entre le 1er janvier 2014-30 décembre 2015 y compris les 5 premières campagnes du projet fistule-Mali. La FUG occupe 19,53% de nos activités urologiques. L' âge moyen au 1er mariage: 16,57 ans. La majorité (96,70%) de nos patientes était analphabètes et non salariées provenant à 85,36% des communes rurales. La stagnation du travail était l'étiologie dominante avec 91,50% de mort-né. Les patientes étaient primipares à 43,33% et, parmi elles 53,60% n'ont effectué aucune consultation prénatale. Le taux de divorce lié à la maladie était estimé à 7,30%. La plupart des patientes ont bénéficié d'une fistulorraphie simple dont 121 par voie basse, 26 par voies hautes et 3 par la voie mixte. Les résultats ont été satisfaisants chez 65,33% et mauvais chez 34,66% des patientes. Les fistules type I et type V ont montré les plus forts taux de succès comparés aux fistules types IV. La fistule urogénitale demeure un réel problème de santé publique. Le traitement est surtout chirurgical et son pronostic est compromis par l'étroitesse du champ, la complexité des lésions et l'état du tissu environnant. L'accent doit être mis sur la promotion socioéconomique des filles et l'accessibilité aux soins obstétricaux d'urgence. La recherche et les échanges doivent continuer afin de faciliter la mise au point d'une classification standard.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Jani Daniel Mothibi, Mpho Jama, Anthonio Oladele Adefuye [Research] - Assessing the knowledge of emergency medical care practitioners in the free state, South Africa, on aspects of pre-hospital management of psychiatric emergencies - 21 June 2019. http://www.panafrican-med-journal.com/content/article/33/132/abstract/ <b>INTRODUCTION: Studies have reported that emergency medical care practitioners (EMCPs) encounter challenges when attending to psychiatric emergencies. The EMC provider's ability to understand, assess and manage psychiatric emergencies has been reported to be poor due to limited knowledge and insufficient training. In South Africa (SA), little is known about the knowledge of EMCPs on pre-hospital management of psychiatric emergencies. The objective of this study was to assess the knowledge of EMCPs working in the Free State province on aspects of pre-hospital management of psychiatric emergencies. METHODS: this descriptive study used a questionnaire survey to obtain data on the knowledge of EMCPs on aspects of pre-hospital management of psychiatric emergencies. RESULTS: only 159 of the initial 192 questionnaires distributed were returned, giving a response rate of 82.8%. The majority (87.4%) of the participants reported inadequate knowledge of pre-hospital management of psychiatric emergencies. More than a third of the participants reported that they are not knowledgeable on how to assess a psychiatric patient (P < 0.01), 64.2% and 73.6% (P < 0.001 in both cases) could not perform mental status examination and lack the knowledge of crisis intervention skills for managing a psychiatric emergencies. The majority (76.7%; P < 0.001) of the participants are not conversant with the Mental Health Care Act 2002 (Act no. 17 of 2002). Finally, participants (94.3% and 86.8%, respectively; P < 0.001) agree that teaching and prior exposure to a psychiatric facility, as in work integrated learning, will empower EMC graduates with skills required to effectively manage psychiatric emergencies. CONCLUSION: EMC practitioners are often the first healthcare professionals arriving at any scene of medical emergencies including psychiatric emergencies. To avoid malpractices, which could be detrimental to patient's health, it is of utmost importance that EMCPs are well trained and equipped to manage any form of medical emergency including those involving psychiatric patients.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Foued Bellazreg, Maha Abid, Nadia Ben Lasfar, Zouhour Hattab, Wissem Hachfi, Amel Letaief [Case series] - Diagnostic value of dipstick test in adult symptomatic urinary tract infections: results of a cross-sectional Tunisian study - 21 June 2019. http://www.panafrican-med-journal.com/content/article/33/131/abstract/ <b>Urinary tract infections (UTIs) are common. The diagnosis is confirmed by urine culture which is costly and takes at least 24 hours before results are known. The aim of this study was to determine the diagnostic accuracy of dipstick test for the diagnosis of UTI in symptomatic adult patients. We conducted a cross-sectional study in the department of Infectious Diseases, Sousse-Tunisia during a two-year period. We included all patients with clinical signs of UTI. Urine samples were tested for the presence of leukocyte esterase (LE) and nitrites. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of LE and nitrites were calculated against urine culture as gold standard. Four hundred thirty one patients, 139 men (32%) and 292 women (68%) were included. One hundred sixty six patients (39%) had UTI. The most frequently isolated microorganism was Escherichia coli (75%). LE had a high sensitivity (87%) but a low specificity (64%), while nitrites had a high specificity (95%) but a low sensitivity (48%). Combined positive LE and nitrites had a high PPV (85%) and combined negative LE and nitrites had a high NPV (92%), while positive LE combined with negative nitrites had a low PPV (47%) and a low NPV (53%). In conclusion, in adult patients with UTI symptoms, an alternate diagnosis should be considered if the LE is negative, while an early empirical antibiotic therapy against Enterobacteriaceae should be started if the nitrites are positive.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Armand Duclaire Djimeli Kemo, Blaise Nkegoum, Charlette Nangue, Félicité Djuikwo, Landry Beyala Bita’a, Pierre Marie Tebeu [Research] - Histo-epidemiological aspects of gynecological and breast cancers at the University Teaching Hospital of Yaoundé - 21 June 2019. http://www.panafrican-med-journal.com/content/article/33/130/abstract/ <b>INTRODUCTION: The study was to describe the epidemiological and histopathological features of gynecological malignancies in the city of Yaoundé, Cameroon. METHODS: This was a descriptive cross-sectional study of histologically proven gynecological cancers over a 10-year period (2008-2017) in the Gynecology and Pathological Anatomy Departments of the University Teaching Hospital of Yaoundé. RESULTS: A total of 682 cancers were identified among which, 342 gynecological cancers, for an overall frequency of 50.1% and an annual frequency of 34.2 cases on average. The trend was to increase the number of cancers diagnosed from one year to another. The cervix was the most frequent location with 182 cases (53.2%); followed by breast 96 cases (28.1%); endometrial 33 cases (9.7%) and ovaries 15 cases (4.4%). These patients were on average 51.9±13.7 years old, housewives (56.8%), married (60.4%), multiparous (61.3%) and referred (62.6%). Histopathologically, cervical cancer was predominantly squamous cell carcinoma (86.8%), invasive (80.9%) and well differentiated (45.5%). For breast cancers, the majority were ductal carcinomas (78.1%), invasive (92%), and histological grade SBR II (50.6%). The most common histopathological types of endometrial and ovarian cancer were adenocarcinoma (72.2%) and serous cystadenocarcinoma (46.7%), respectively. CONCLUSION: Gynecological cancers are common. Cervical cancer screening is expected to increase to 30 years for cervical cancer and start at age 40 with mammography for breast cancer.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Faten Limaiem [Images in medicine] - Cystic neuroendocrine tumor of the pancreas a challenging clinical diagnosis! - 21 June 2019. http://www.panafrican-med-journal.com/content/article/33/129/abstract/ <b>Cystic pancreatic neuroendocrine tumor accounts for 13-17% of pancreatic neuroendocrine tumors and 9-10% of resected cystic tumors. This unusual variant can make clinical diagnosis particularly challenging. A 28-year-old female patient presented with abdominal pain and dyspepsia. General and physical examination was unremarkable. On computed tomography scan a 7.5×5.4×5.2cm thick-walled cystic lesion was noted in the tail region of the pancreas in the stomach bed (A). On the basis of the above findings, the radiologist reported it as suggestive of solid pseudopapillary neoplasm and advised pathological correlation. No abdominal lymphadenopathy was noted. The patient underwent laparoscopic removal of a pancreatic cyst. Intraoperatively, a large cyst was seen located posterior to the stomach in retroperitoneum and was intimately related to the tail of the pancreas. The cyst could be enucleated. On histopathological examination, the sections from the cyst wall showed collagen-rich fibrous tissue in which were embedded small clusters and nests of round cells (B). The cells were monotonous, small to medium in size with amphophilic cytoplasm with indistinct cell borders. The nucleus showed typical stippled nuclear chromatin and no mitoses were noted (C). There was no capsular invasion. Neuroendocrine nature of these round cells was confirmed by performing immunohistochemistry with synaptophysin and chromogranin A (C). Ki67 stained <3% of the cells. These findings corroborated the benign nature of the disease indicating a very good prognosis. Postoperative recovery of the patient was uneventful.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Gaurav Gheewala, Iqbal Ratnani [Images in medicine] - Rapid formation of new peripheral arteriovenous malformations post-interventions - 21 June 2019. http://www.panafrican-med-journal.com/content/article/33/128/abstract/ <b>A 17-year-old male with a history of recurrent peripheral arteriovenous malformations (pAVMs) of right chest, axilla, and right upper extremity (RUE), presented after having multiple procedures for pAVMs and complex right shoulder wound. Being managed conservatively at first, he later underwent diagnostic angiogram and biopsy which shows ectatic vessels, hence, Onyx embolization of right subclavian, axillary, and brachial arteries was performed (A). Within two years, due to his necrotic right shoulder wound with osteomyelitis of humeral head, he underwent RUE amputation and resection of newly developed right chest pAVMs with further Onyx embolization post angiogram (B). He also required series of reconstructive procedures including tissue expander placement and subsequent muscle flap to necrotic anterior right chest wound which was measured 14x3 cm. Patient was subsequently discharged from the hospital after six months and is being followed by vascular and plastic surgery team. Other than cerebral AVMs, pAVMs are rare and get diagnosed by history, angiography, imaging studies, or biopsy. Treatment options are embolization, and/or resection, however, these interventions lead to formation of new AVMs from increasing flow to the surrounding vasculature. Therefore, patients with AVMs remain at high risk for complications despite appropriate interventions.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Maurice Ebode Ela, Samuel Nambile Cumber, Rama Djouedjon Dakenyo, Dorine Djuissi Tekam, Patrick Charles Biyong Heumou, Giresse Lowe Marvin, Jérôme Ateudjieu, Eva Fomo Tsakoue [Research] - Association entre le paludisme et le faible poids de naissance à Yaoundé, Cameroun - 21 June 2019. http://www.panafrican-med-journal.com/content/article/33/127/abstract/ <b>INTRODUCTION: Le faible poids de naissance (FPN) est un important prédicteur de survie de l’enfant et de son développement ultérieur. De par sa physiopathologie, le paludisme est présumé en être un des facteurs de risques. La présente étude avait pour but de déterminer l’association entre l’accès palustre chez la femme enceinte (FE) et la survenue du FPN (poids < 2500 g). METHODES: il s’est agi d’une enquête analytique de type cas-témoins, basée sur l’administration d’un questionnaire et d’une grille d’observation. Nous avons calculé l’Odds ratio (OR) brut et l’OR ajusté pour déterminer l’association. La régression logistique a été appliquée pour reconnaître les variables qui sont effectivement les déterminants du problème étudié. RESULTATS: cent cinquante-six (156) femmes dont 78 cas et 78 témoins ont participé à la présente étude. La prévalence de FPN était de 12,32% (105/852); 41,02% (64/156) des femmes ont eu un accès palustre durant leurs grossesses et 42,14% de parturientes ont pris leurs trois doses de TPI (traitement préventif intermittent). Nous avons ressorti une association significative entre le paludisme et le FPN avec un OR brute = 3,75 [P = 0,0001 (p < 0,05)] et l’OR ajusté = 2,82 [P = 0,01 (p < 0,05)] a été obtenu en tenant compte des différents facteurs de confusions. CONCLUSION: la survenue du paludisme durant la grossesse est un facteur qui augmente le risque de FPN. Les efforts devraient être faits pour améliorer la couverture en TPI et en utilisation de moustiquaire imprégnée d’insecticide à longue durée d’action afin de prévenir le paludisme durant la grossesse.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mustapha Ahsaini, Youssef Kharbach, Hamid Azelmad, Soufiane Mellas, Jalaleddine Elammari, Mohammed Fadl Tazi, Mohammed Jamal Elfassi, Moulay Hassan Farih, Mohammed Sekal, Taoufik Harmouch [Case report] - Calculs vésicaux multiples compliquant une fistule vésico-vaginale d’origine tuberculeuse: à propos d’un cas exceptionnel - 19 June 2019. http://www.panafrican-med-journal.com/content/article/33/126/abstract/ <b>La fistule vésico-vaginale (FVV) continue d'être un problème majeur de la santé publique dans les pays en développement. Devant la situation particulière d'association FVV avec calcul; la question qui se pose d'abord est de définir si la fistule est primaire ou secondaire au calcul vésical, ensuite s'il faut traiter en un seul temps ou en deux temps. Mais la particularité de notre observation c'est l'origine tuberculeuse de cette présentation clinique rarissime. Il s'agit d'une patiente âgée de 62 ans qui a comme antécédent une spondylodisciite tuberculeuse traitée et déclarée guéri il y'a 4 ans, qui présentait depuis 2 ans des fuites urinaires permanente. L'examen clinique trouve une synéchie vaginale presque complète. Le complément scannographique et cystographique a mis en évidence la présence de 3 calculs sur le trajet de la FVV dont le plus grand mesure 6cm de grand axe avec passage du produit de contraste à la cavité utérovaginale à travers la fistule. La patiente fut admise au bloc opératoire où elle a bénéficié d'une cystolithotomie avec ablation des calculs qui se trouvaient sur le trajet fistuleux avec la biopsie du trajet fistuleux et la fermeture de la FVV en deux plans sans interposition de tissu autologue en un seul temps, les résultats anatomopathologiques ont confirmé la présence d'une tuberculose active sur le trajet fistuleux ayant nécessité une reprise de traitement anti-bacillaire pendant 9 mois. Le contrôle à 3 mois, 6 et à 9 mois a objectivé une bonne évolution clinique avec absence de fuites urinaire. L'origine tuberculeuse d'une FVV associée à des calculs urinaires est très peu retrouvée dans la littérature. Notre cas démontre la faisabilité d'un traitement médical anti-bacillaire associé à un traitement chirurgical en un seul temps avec des résultats très satisfaisants malgré les antécédents de notre patiente et l'ancienneté de sa pathologie.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Yakub Martin Maimako, Adeola Fowotade, Anaedobe, Cinenye Gloria, Manga, Mohammed Mohammed, Bakare, Rasheed Ajani, Abimiku, Bawa Ahmed [Research] - Human papillomavirus correlates of high grade cervical dysplasia among HIV-Infected women at a major treatment centre in Nigeria: a cross-sectional study - 18 June 2019. http://www.panafrican-med-journal.com/content/article/33/125/abstract/ <b>INTRODUCTION: Persistent high-risk HPV (hrHPV) infection is higher among women living with HIV/AIDS thus increasing their risk for cervical cancer. We evaluated the virological and immunological correlates of cervical dysplasia in HIV-infected women. METHODS: a cohort of 220 consenting women attending the antiretroviral clinic of the Federal Medical Centre, Keffi, Nigeria was tested for cervical human papilloma virus (HPV) infection using PCR. The prevalent HPV genotypes were determined by DNA sequencing. CD4+T count and type specific HPV was correlated with cervical cytology. Descriptive and inferential statistical analysis of the data was done using the statistical package for social sciences (SPSS) version 20 (SPSS Inc, Illinois, USA) for analysis after validation. RESULTS: overall HPV prevalence was 54.1% while the hrHPV prevalence was 35.9%. Premalignant and malignant lesions were observed among participants with CD4+T counts between 200-300/mm3. A statistically significant association was observed between cervical premalignant lesions and CD4+ count (X2 = 24.747, P value = 0.001) as well as hrHPV infections (X2 = 46.800, P < 0.001). CONCLUSION: risk stratification with HPV screening among HIV-infected women will help in early case management of cervical precancerous lesions.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Esther Muitta, Tom Were, Anthony Kebira Nyamache, Ng'ethe Muhoho [Research] - Atypical cervical cytomorphologic predictors: a descriptive study of pre-cervical cancer patients of low education in Kenya - 18 June 2019. http://www.panafrican-med-journal.com/content/article/33/124/abstract/ <b>INTRODUCTION: High risk HPV is the perpetrator of cervical cancer disease, however screening and vaccination is not included in cervical cancer prevention program within public hospitals in Kenya. This descriptive study assessed the association of specific microbial STI and socio-demographic characteristics and practices with cervical cytomorphologic presentations in regards to pre cervical cancer grades amongst health seeking patients attending the reproductive health clinic of Nakuru County referral hospital, a public hospital under newly devolved health services governance. METHODS: A total of 142 patients (AGC/AIS, n=8; HSIL, n=59; LSIL, n=35; controls, n=40) whose median age ranged between 20-70 years were purposively sampled. A structured questionnaire with closed and open ended entries was administered and STI screening including Pap smear examination for cytomorphological profiling done according to revised 2014 Bethesda classification. Associations were established using chi-square and multivariate logistic regression model to determine prediction of cervical atypia manifestations. RESULTS: A majority of the study participants had only primary education or no education in AGC/AIS (63%) and HSIL (73%) relative to LSIL (49%) and controls (53%) (P=0.017). Koilocyte rates were higher in AGC/AIS (25%), HSIL (52%) and LSIL (77%) compared controls (12.5%) (P<0.0001). ASCUS predominated in HSIL (61%) and LSIL (86%), while almost all AGC/AIS had AGCUS (88%). HR HPV 16/18 infection rates were higher in AGC/AIS (100%), HSIL (80%) and LSIL (83%) relative to controls (10%) (P<0.0001), and was associated with higher risk of having AGC/AIS (OR, 2.0; 95% CI, 1.940-1.947; P<0.0001); HSIL, (OR, 36.3; 95% CI, 9.5-139.5; P<0.0001); and LSIL (OR, 50.1; 95% CI, 12.0-209.0; P<0.0001). CONCLUSION: Altogether, pre-cervical cancer in Kenyan women is characterized by koilocytosis and ASCUS probably from the high rates of HPV 16/18 infections. Promoting cancer education and screening for high risk HPV infections and pre-cancerous lesions will improve women's reproductive health.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Kwaku Asah-Opoku, Donne Kofi Ameme, Alfred Yawson, Chris Bambey Guure, David Ernest Mireku Aduama, Kareem Mumuni, Ali Samba, Ernest Tei Maya [Research] - Adherence to the recommended timing of focused antenatal care in the Accra Metropolitan Area, Ghana - 18 June 2019. http://www.panafrican-med-journal.com/content/article/33/123/abstract/ <b>INTRODUCTION: the proportion of antenatal attendants in Ghana who had at least four antenatal visits increased from 78% in 2008 to 87% in 2014. However, it is not known whether these visits followed the recommended timing of focused antenatal clinic attendance in Ghana. We sought to assess the adherence to the clinic schedule and its determinants in the Accra Metropolis. METHODS: a cross-sectional study was conducted. Face-to-face interviews were conducted with postpartum women. Multiple logistic regression was used in the analysis of determinants of adherence to the recommended timing of clinic attendance. A p-value of <0.05 was considered statistically significant. RESULTS: among 446 focused antenatal care clinic attendants, 378 (84.8%) had four or more visits. Among these, 101 (26.7%) adhered to the recommended clinic schedule. Women who adhered were more likely to have had education up to Junior High School [AOR=3.31, 95%CI (1.03-10.61)] or Senior High School [AOR=4.47, 95%CI (1.14-17.51)], or have history of abortion [(AOR=3.36, 95%CI (1.69-7.96)]. For every week increase in gestational age at booking at the antenatal clinic, respondents were 34% less likely to complete all four antenatal visits at the recommended times. [(AOR=0.66, 95% (0.60-0.73)]. CONCLUSION: majority of women receiving focused antenatal care in the Accra Metropolis have four or more visits but only about a quarter of them adhered to the recommended clinic schedule. Having high school education, history of abortion and early initiation of antenatal care were predictors of adherence to clinic schedule. Women should be educated on early initiation of antenatal care to enhance adherence.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Hajar Ouahbi, Meriem Benhami, Lamiae Nouikh, Nissrine Acharfi, Awatef Kelati, Karima Oualla, Zineb Benbrahim, Fatima Zahra Elmrabet, Samia Arifi, Fatimazohra Mernissi, Nawfel Mellas [Case report] - Dermatomyosite et cancer rectal: à propos d’un cas avec revue de la littérature - 18 June 2019. http://www.panafrican-med-journal.com/content/article/33/122/abstract/ <b>La dermatomyosite est une maladie systémique idiopathique, associant une double symptomatologie cutanée et musculaire. La maladie fait partie de dermatose paranéoplasique. L’association de la dermatomyosite à un cancer rectal est rarement décrite dans la littérature. Nous présentons un cas d’une patiente atteinte de dermatomyosite paranéoplasique associé à un adénocarcinome rectal métastatique, et qui a présenté une symptomatologie clinique typique d’une dermatomyosite paranéoplasique, confirmée par les autres examens complémentaire (taux de créatine phosphokinase (CPK) + EMG (électromyogramme) + biopsie cutanée). La patiente était mise sous chimiothérapie, mais après sa deuxième cure, la patiente a présenté une aggravation rapide de son état général, décédée en quelque jours dans un tableau de défaillance multi-viscérale. Notre objectif est d’illustrer le caractère agressif de la dermatomyosite paranéoplasique et de faire une mise au point des connaissances actuelles concernant la place de la chimiothérapie dans la dermatomyosite néoplasique.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Rim Batti, Amina Mokrani, Haifa Rachdi, Henda Raies, Omar Touhami, Mouna Ayadi, Khadija Meddeb ,Feryel Letaief, Yosra Yahiaoui, Nesrine Chraiet, Amel Mezlini [Case series] - Gestational trophoblastic neoplasia: experience at Salah Azaiez Institute - 17 June 2019. http://www.panafrican-med-journal.com/content/article/33/121/abstract/ <b>Gestational trophoblastic disease (GTD) develops from abnormal cellular proliferation of trophoblasts following fertilization. It includes benign trophoblastic disease (hydatidiform moles (HM)) and the malignant trophoblastic diseases or gestational trophoblastic neoplasia (GTN). The frequency of the GTD in Tunisia is one per 918 deliveries. The aim of this study is to analyze the clinical characteristics, treatment and outcomes of GTD at Salah Azaiez Institute (ISA). Medical records of women diagnosed with GTD at ISA from January 1<sup>st</sup>, 1981 to December 31<sup>st</sup>, 2012 were retrospectively reviewed. FIGO score was determined retrospectively for patients treated before 2002. One hundred and nine patients with GTN were included. Patients presented with metastases at 43% of cases. The most common metastatic sites was lung (30%) and vagina (13%). Fifty six (56 (51%) patients had low-risk and 21 (19%) cases had high-risk, the FIGO score was not assessed in 32 cases. After a median follow-up of 46 months, 21 patients were lost to follow-up, 12 patients died, 19 progressed and 8 relapsed. At 10 years, the OS rate was 85% and the PFS rate 79%. OS was significantly influenced by the presence of metastases at presentation (M0 100 % vs. Metastatic 62 %; p < 0.0001), FIGO stage (I-II 100% VS 61% and 65% for stage III and IV; p < 0.001), FIGO score (low-risk 99 % vs. high-risk 78 %; p < 0.001). GTN is a significant source of maternal morbidity with increased risk of mortality from complications if not detected early and treated promptly.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mahaman Laouali Harouna Amadou, Ousmane Abdoulaye, Oumarou Amadou, Ahamadou Biraïma, Sani Kadri, Abdoul Aziz Kabiru Amoussa, Ibrahim Maman Lawan, Laouali Tari, Maman Daou, Souleymane Brah, Eric Adehossi [Research] - Profil épidémiologique, clinique et évolutif des patients tuberculeux au Centre Hospitalier Régional (CHR) de Maradi, République du Niger - 17 June 2019. http://www.panafrican-med-journal.com/content/article/33/120/abstract/ <b>INTRODUCTION: Il s'agissait de décrire le profil épidémiologique, clinique et évolutif des patients suivis pour tuberculose au Centre Hospitalier régional de Maradi.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Lantonirina Ravaoarisoa, Arivony Hanitriniaina Pharlin, Niaina Zakaria Rodolphe Andriamifidison, Roger Andrianasolo, Jean de Dieu Marie Rakotomanga, Julio Rakotonirina [Research] - Nutritional status of female prisoners in Antanimora prison, Madagascar - 17 June 2019. http://www.panafrican-med-journal.com/content/article/33/119/abstract/ <b>INTRODUCTION: The prison population in low-income countries is a group vulnerable to undernutrition, particularly incarcerated women. The aim of the study is to assess the nutritional status of women in prison and to determine the social profile and prison conditions related to undernutrition. METHODS: a cross-sectional study was conducted among 125 women prisoners in Antanimora prison located in the city of Antananarivo, Madagascar. All women detained for 3 months or more at the time of the survey were included in the study. Data collection was conducted in May and June 2013. A survey of women and anthropometric measurements were carried out to collect the data. RESULTS: the proportion of undernourished female prisoners is 38.4%. Five percent of pregnant and lactating women and 44.3% of non-lactating and non-pregnant women are undernourished. The factors related to undernutrition of women prisoners are: taking two meals a day instead of three meals (p = 0.003), insufficient energy intake (p < 0.001), incarceration duration of more than 10 months (p < 0.001), absence of family visits (p = 0.013) and lack of financial assistance from family (p = 0.013). CONCLUSION: improving the prisoners' diets and assistance from family both help to fight against prisoner undernutrition in prisons.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mehdi Borni, Brahim Kammoun, Fatma Kolsi, Souhir Abdelmouleh, Mohamed Zaher Boudawara [Case report] - The Lhermitte-Duclos disease: a rare bilateral cerebellar location of a rare pathology - 14 June 2019. http://www.panafrican-med-journal.com/content/article/33/118/abstract/ <b>Dysplastic gangliocytoma or Lhermitte-Duclos disease is a rare disorder characterized by a slowly progressive unilateral tumour mass of the cerebellar cortex. It is probably hamartomatous, although the exact pathogenesis remains unknown. Lhermitte-Duclos disease was recently encountered to be part of a multiple hamartoma-neoplasia complex (Cowden's syndrome). It typically presents in young adults, although it has been encountered at all ages. We present the case of bilateral cerebellar location of this pathology in a 50 year - old man presented with a progressive onset and worsening of headaches accompanied by nuchal rigidity, photophobia and nausea awakening each morning. Upon physical examination, the patient was awake with a discrete right vestibular syndrome made of positive Romberg without nystagmus. MRI was performed and revealed salient "tiger stripe" appearance of the bilateral cerebellar cortex relevant to a Lhermitte-Duclos disease.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Samira Younes, Sabria Khouadja, Samia Younes, Lazhar Zarrouk [Case report] - Catatonia in patients with dementia: a case report - 14 June 2019. http://www.panafrican-med-journal.com/content/article/33/117/abstract/ <b>Catatonia occurring as part of a clinical picture of dementia has been reported with almost all types of dementia. It remains under-diagnosed in older adults and those with dementia. We review a case of a young patient admitted in our psychiatric department for catatonia and after efficient treatment with Lorazepam, assessment revealed a dementia. Catatonia is a severe neuropsychiatric syndrome with an excellent prognosis if recognized and treated without delay.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Amine Razzak, Anass Kassimi, Adil Mchachi, Leila Benhmidoune, Abderrahim Chakib, Rayad Rachid, Mohamed Elbelhadji, Abdelouahed Amraoui, Hassan Elkabli [Case series] - Œil et Maladie de Behçet: profil épidémiologique, clinique, thérapeutique et évolutif - 14 June 2019. http://www.panafrican-med-journal.com/content/article/33/116/abstract/ <b>Le but de ce travail est d'étudier le profil épidémiologique, clinique, thérapeutique et évolutif des manifestations oculaires au cours de la Maladie de Behçet. C'est une étude rétrospective descriptive étalée sur une période d'un an et demi entre janvier 2015 et juin 2016 analysant les dossiers de 121 patients suivis à la consultation spécialisée de la maladie de Behçet. La moyenne d'âge était de 35 ans, 63,6% des patients étaient de sexe masculin, l'atteinte oculaire était inaugurale dans 24% des cas. Les patients présentaient une uvéite antérieure (7,4%), une uvéite postérieure (15,7%), une vascularite (19%), des synéchies irido-cristalliniennes (17,5%), un œdème maculaire (7,4%), une atrophie optique (4,1%), un œdème papillaire (2,5%) et une ischémie rétinienne périphérique (1,7%). Dans notre série 41,3% des patients étaient sous colchicine, 23,1% sous corticoïdes par voie orale, 9% sous corticoïdes par voie intraveineuse, 4,9% sous corticoïdes topiques, 8,2% sous immunosuppresseurs et 5,8% sous anti-vitamine K. Sur un recul moyen d'une année, 40% des patients avaient une acuité visuelle stable sous traitement, 23% ont présenté une baisse significative de l'acuité visuelle dont 5% des cas de cécité absolue. Une prise en charge thérapeutique correcte permet de juguler rapidement la poussée inflammatoire et de réduire la fréquence et la gravité des récidives ce qui se traduit par une amélioration du pronostic visuel de nos patients par rapport à des séries antérieures.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Lamyaa Benchikhi, Hind Nafiaa, Abdelaaziz Zaroual, Abderrazzak Ouanass [Case report] - Prise en charge psychologique d'un cas du syndrome de Prader Willi: cas d'une jeune fille marocaine - 14 June 2019. http://www.panafrican-med-journal.com/content/article/33/115/abstract/ <b>Le syndrome de Prader Willi est une maladie génétique rare qui se manifeste par l'apparition d'une hyperphagie avec le risque d'obésité morbide, des difficultés d'apprentissage et des troubles du comportement, voire des troubles psychiatriques majeurs. L'objectif de cette analyse de cas est de faire une revue de littérature à propos du syndrome de Prader Willi, ainsi que de mettre en exergue ses conséquences sur la vie quotidienne, tant sur le plan physique que psychiatrique et ses moyens de prise en charge. On rapporte ici le cas d'une jeune fille marocaine, âgée de 11ans, qui présente le syndrome de Prader Willi, qu'on a accompagné durant sa vie quotidienne, bénéficiant d'une prise en charge biopsychosociale globale, lui permettant ainsi une meilleure qualité de vie. Nous soulignons ici le rôle primordial et central que joue le psychothérapeute dans la prise en charge du syndrome de Prader Willi, à travers l'accompagnement psychologique, les entretiens motivationnels et les techniques de la thérapie cognitive et comportementale. Le syndrome de Prader Willi est une maladie à manifestations psychiatriques importantes, qui doivent être prises en charge par une équipe multidisciplinaire dont fait partie le psychologue ou la psychiatre.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Oussama Ben Rejeb, Hela Ghali, Yosra Messaoudi, Anissa Gharbi, Imen Bouhlel, Samia Ernez, Abdallah Mahdhaoui, Gouider Jeridi [Research] - Etude de la repolarisation chez les sportifs de race noire - 14 June 2019. http://www.panafrican-med-journal.com/content/article/33/114/abstract/ <b>INTRODUCTION: Il est considéré que la mort subite qui survient lors d'une activité sportive touche un patient ayant une cardiopathie ignorée. L'ECG du sportif de race noire a été peu étudié et des particularités liées à l'ethnie ont été évoquées. Notre travail a pour objectif d'étudier le profil épidémiologique et les particularités de la repolarisation du sportif de race noire. METHODES: une étude descriptive a été menée durant 8 mois de mars à octobre 2014, incluant des sportifs de race noire sélectionnés parmi tous les sportifs qui étaient suivi dans le centre sectoriel de la Médecine et des Sciences de sports de Sousse. Le recueil de données a été réalisé grâce à un questionnaire médical. RESULTATS: trente-cinq (35) athlètes ont été colligés, avec une prédominance masculine (94,28%), ayant un âge moyen de 24,34 ans. Quatre athlètes avaient une hypertrophie ventriculaire gauche à l'échographie cardiaque. Il y'avait 8 athlètes avec un BAV de 1er degré et 8 athlètes avaient un HVG électrique. Les modifications du segment ST étaient plus marquées au niveau des dérivations précordiales. Cinq athlètes (14,2%) avaient des ondes T négatives en V2 et V3, et il s'agissait des mêmes athlètes qui avaient le sus décalage du segment ST dans ces mêmes dérivations. Un aspect de repolarisation précoce a été constaté chez 3 athlètes. Tous ces cas étaient type notch. CONCLUSION: les sportifs de race noire semblent avoir des modifications électriques assez spécifiques dont il importe de connaitre. Toutefois, notre échantillon n'est pas suffisamment important pour affirmer ces résultats. Une étude comparative avec des sportifs de race blanche serait très intéressante.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mohammed Tazi Charki, Mohammed-Amine Oukhouya, Zineb Benmassaoud, Abdelhalim Mahmoudi, Khalid Khattala, Youssef Bouabdallah [Case series] - Les complications du diverticule de Meckel chez l'enfant: à propos de 18 cas - 14 June 2019. http://www.panafrican-med-journal.com/content/article/33/113/abstract/ <b>Le diverticule de Meckel (DM) est une persistance du canal omphalo-mésentérique. Il est souvent asymptomatique, mais peut être responsable de complications diverses avec des tableaux cliniques variables notamment chez l'enfant. Nous avons réalisé une étude rétrospective au Service de Chirurgie Pédiatrique du CHU Hassan II de Fès (Maroc), sur les DM compliqués chez l'enfant dans le but de décrire les aspects cliniques, radiologiques et thérapeutiques. Sur une période de 10 ans (janvier 2009- décembre 2018), 18 enfants (15 garçons et 3 filles) âgés de 1 Jour à 15 ans (âge moyen de 5 ans) ont été opérés pour une complication du DM. L'invagination intestinale aigue et l'occlusion intestinale étaient les complications les plus fréquentes. Les autres complications décrites sont l'infection du DM (1 cas) et l'hémorragie digestive (2 cas). Deux formes néonatales rares ont été décrites (occlusion néonatale et fistule sur omphalocèle). L'imagerie basée sur la radiographie de l'abdomen sans préparation (ASP), l'échographie et la tomodensitométrie (TDM) abdominale n'ont objectivé le DM en aucun cas. La scintigraphie a été réalisée pour les 2 cas ayant une rectorragie et elle a permis de faire le diagnostic du DM dans un cas. Trois patients ont été opérés par laparoscopie avec résection du DM avec anastomose intestinale par out-laparoscopie. Les autres patients ont été opérés par laparotomie. L'iléostomie a été réalisée dans un cas suivi d'un rétablissement secondaire. L'évolution était bonne pour tous les patients hormis un cas de lâchage d'anastomose. Sur le plan anatomo-pathologique, deux cas d'hétérotopie ont été notés.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Robert Wangoda, Teddy Angida, Sam Kizito, Edith Nyangoma, Jane Nakibuuka [Research] - Animal bite injuries in the accident and emergency unit at Mulago Hospital in Kampala, Uganda - 13 June 2019. http://www.panafrican-med-journal.com/content/article/33/112/abstract/ <b>INTRODUCTION: Animal bite injuries are a common public health concern in Uganda. We sought to characterize animal bite injuries among patients presenting to Mulago National Referral Hospital in Kampala, Uganda. METHODS: this was a cross sectional study from 1st September to 30th November 2011. Participants were animal bite injury victims presenting to the accident and emergency (A&E) unit at Mulago hospital and were consecutively enrolled into the study. Socio-demographics, severity and patterns of injury, health seeking and dog handling behaviours were assessed using a standardized questionnaire. Descriptive statistics was used to summarize participant characteristics and the animal bite injuries. Poisson regression model's incident rate ratios (IRR) was used to explore the relationship of the number of days to accessing treatment at Mulago hospital with; a) received prior first aid, b) animal bite injury sustained during day time, c) unknown dog and d) victim resident in Kampala. Data were analyzed using STATA version 12.0 and statistical significance set at P < 0.05. RESULTS: of 25,420 patients that presented to the A&E unit during the study period, 207 (0.8%) had animal bite injuries, mean age 22.7 years (SD 14.3), 64.7% male, and 40.1% were <18 years. Majority 199 (96.1%) were bitten by a lone unrestrained and un-signaled dog that had bitten someone else in 22.2% of cases, and eight victims (0.4%) were attacked in canine gangs of 2-5 dogs. Rabies vaccination was confirmed in only 23 dogs (11.1%) as 109 (52.7%) were unknown to the victims or the communities. One hundred and eighteen victims (57.0%) sustained the dog bites within Kampala district whilst the rest occurred near or far from Kampala district, and the victims especially referred to access anti-rabies vaccine. Of 207, 189 victims (91.3%) presented within 2.6 days (SD ± 4.3). Two hundred victims (96.6%) sustained extremity injuries while the rest had injuries to other body parts. All injuries were minor and managed on out-patient basis with wound dressing, analgesics, prophylactic antibiotics and anti-rabies vaccination. Victims who received prior first aid had a rate of 1.7 times greater for seeking treatment at Mulago hospital (IRR 1.7, 95% CI 1.4-2.1) compared to those that had no prior first aid. Participants who sustained the animal bite injuries during day time had a rate of 1.6 times greater for seeking treatment at Mulago hospital (IRR 1.6, 95% CI 1.3-2.1) compared to those that sustained injuries at other times. Participants bitten by unknown dog and participants residing in Kampala had IRR 0.7, 95% CI 0.5-0.9 and IRR 0.6, 95% CI 0.5-0.8 respectively of accessing treatment at Mulago hospital compared to bitten by known dog and not residing in Kampala. CONCLUSION: dog bites injuries from unrestrained, un-signaled dogs are the commonest source of animal bite injuries especially among children (<18 years). Vaccination against rabies was only confirmed for a very small number of dogs, as majority were unknown and likely stray dogs. Government and public sensitization is urgently required to limit stray dogs, vaccinate dogs and restrain them to prevent a grave probability of a looming canine rabies epidemic.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Tara Catherine Bouton, Audrey Forson, Samuel Kudzawu, Francisca Zigah, Helen Jenkins, Tsigereda Danso Bamfo, Jane Carter, Karen Jacobson, Awewura Kwara [Research] - High mortality during tuberculosis retreatment at a Ghanaian tertiary center: a retrospective cohort study - 13 June 2019. http://www.panafrican-med-journal.com/content/article/33/111/abstract/ <b>INTRODUCTION: High mortality among individuals receiving retreatment for tuberculosis (RT-TB) persists, although reasons for these poor outcomes remain unclear. METHODS: We retrospectively reviewed 394 RT-TB patients diagnosed between January 2010 and June 2016 in Accra, Ghana. RESULTS: Of RT-TB patients, 161 (40.9%) were treated empirically (negative/absent smear, culture or Xpert), of whom 30.4% (49/161) had only extrapulmonary TB signs or symptoms. Mortality during treatment was 19.4%; 15-day mortality was 10.8%. In multivariable proportional hazards regression, living with HIV (aHR=2.69 (95 CI: 1.51, 4.80], p<0.01) and previous loss-to-follow up (aHR=8.27 (95 CI: 1.10, 62.25), p=0.04) were associated with mortality, while drug susceptibility testing (DST, aHR=0.36 (95 CI: 0.13, 1.01), p=0.052) was protective. Isoniazid resistance was observed in 40% (23/58 tested) and rifampin resistance in 19.1% (12/63 tested). CONCLUSION: High rates of extrapulmonary TB and smear/culture negative disease highlight the barriers to achieving DST-driven RT-TB regimens and the need for improved diagnostics. Our finding of poly-drug resistance in rifampin-susceptible cases supports access to comprehensive first line DST. Additionally, interventions to reduce mortality, especially in HIV co-infected RT-TB patients, are urgently needed.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Onani Zimba, Tsaone Tamuhla, Joyce Basotli, Gaoraelwe Letsibogo, Sherri Pals, Unami Mathebula, Anikie Mathoma, Christopher Serumola, Kitso Ramogale, Rosanna Boyd, Tran Tran, Alyssa Finlay, Andrew Auld, Anand Date, Heather Alexander, Violet Chihota, Tefera Agizew [Research] - The effect of sputum quality and volume on the yield of bacteriologically-confirmed TB by Xpert MTB/RIF and smear - 13 June 2019. http://www.panafrican-med-journal.com/content/article/33/110/abstract/ <b>INTRODUCTION: The World Health Organization endorsed (2010) the use of Xpert MTB/RIF and countries are shifting from smear microscopy (smear)-based to Xpert MTB/RIF-based tuberculosis (TB) diagnostic algorithms. As with smear, sputum quality may predict the likelihood of obtaining a bacteriologically-confirmed TB when using Xpert MTB/RIF. METHODS: From 08/12-11/2014, all people living with HIV were recruited at 22 clinics. For patients screened positive using the four TB symptoms their sputa were tested by Xpert MTB/RIF and smear. Laboratorians assessed and recorded sputum appearance and volume. The yield of bacteriologically-positive sputum evaluated using Xpert MTB/RIF and smear, likelihood-ratios were calculated. RESULTS: Among 6,041 patients enrolled 2,296 were presumptive TB, 1,305 (56.8%) had > 1 sputa collected and 644/1,305 (49.3%) had both Xpert MTB/RIF and smear results. Since >1 sputa collected from 644 patients 954 sputa were tested by Xpert MTB/RIF and smear. Bacteriologically-positive sputum was two-fold higher with Xpert MTB/RIF 11.4% versus smear 5.3%, p < 0.001. Sputum appearance and quantity were not predictive of bacteriologically-positive results, except volume of 2ml to < 3ml, tested by Xpert MTB/RIF LR+=1.26 (95% CI, 1.05–1.50). CONCLUSION: Xpert MTB/RIF test yield to bacteriologically-positive sputum was superior to smear. Sputum quality and quantity, however, were not consistently predictive of bacteriologically-positive results by Xpert MTB/RIF or smear.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Brice Nguedia Vofo, Vanelssa Gaelle Fotsing Ngankam, Beatrice Fonge, Shey Dickson Nsagha, Thomas Obinchemti Egbe, Jules Clement Nguedia Assob [Research] - High umbilical cord blood lead levels and "calabar chalk" consumption amongst pregnant women in two hospitals in Cameroon - 13 June 2019. http://www.panafrican-med-journal.com/content/article/33/109/abstract/ <b>INTRODUCTION: "Calabar chalk" is a lead-laden pica mostly consumed by pregnant women worldwide as a remedy for morning sickness. This clay material has been shown to have lead levels of up to 40mg per kilogram. Meanwhile blood lead levels, even at doses less than 10µg/dl will be toxic to humans and even worse-off to the fetus as it crosses the placenta. We, therefore, sort to determine the prevalence of "Calabar chalk" consumption amongst pregnant women and if it translates to higher umbilical cord blood lead levels. METHODS: we carried out a cross-sectional study by prospectively and consecutively enrolling 300 pregnant women from December 2014 through February 2015. A questionnaire was administered to ascertain "Calabar chalk" consumption. The levels of lead in the umbilical cord blood of 51 participants of each group of those who consumed and didn't consume "Calabar chalk" were measured by spectrometry and compared using the T-test (p<0.05). RESULTS: the prevalence of "Calabar chalk" consumption was 43.33%. This was mostly consumed during pregnancy only (46.34%), with higher rates observed amongst primigravidas. The mean umbilical blood lead levels amongst those who consumed and those who did not consume "Calabar chalk" was 39.19µg/dl and 25.33µg/dl respectively (P=0.111). CONCLUSION: the prevalence of "Calabar chalk" consumption was high in the pregnant women population. The overall umbilical cord blood lead levels were extremely high in both consumers and non-consumers. We recommend health education and chelation therapy to be considered.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ines Maaloul, Sana Kmiha, Sourour Yaich, Kamoun Thouraya, Jamel Damak, Hajer Aloulou, Mongia Hachicha [Case series] - Epidémiologie des accidents domestiques de l’enfant: expérience d’un Service de Pédiatrie Générale du sud tunisien - 12 June 2019. http://www.panafrican-med-journal.com/content/article/33/108/abstract/ <b>Les accidents domestiques représentent un problème sérieux de santé publique en pédiatrie. Ils sont responsables d’une lourde morbidité et mortalité parmi la population pédiatrique. Nous avons mené une étude rétrospective colligeant 231 cas d’accidents domestiques chez l’enfant au Service de Pédiatrie de l’Hôpital Hédi Chaker de Sfax durant une période de 5 ans (2008 - 2012). Durant la période d’étude, nous avons colligé 231 cas d’accidents domestiques. Il s’agissait de 124 garçons (53,7%) et 107 filles (46,3%). L’âge moyen était de 2 ans avec des extrêmes de 1 jour et 14 ans. Les enfants âgés de moins de 4 ans étaient les plus exposés (88,7%). Les intoxications accidentelles étaient les accidents les plus fréquents (105 cas). Les caustiques étaient les agents toxiques les plus fréquents (33 cas), suivis par les médicaments (28 cas) puis les hydrocarbures (16 cas). Les accidents par corps étrangers ont représenté le deuxième mécanisme accidentel (64 cas). Il s’agissait de 43 cas d’inhalation de corps étrangers et 21 cas d’ingestion de corps étranger. Nous avons enregistré 28 cas de traumatismes; il s’agissait d’une chute d’une certaine hauteur dans 25 cas. Nous avons recensé 26 cas d’envenimations scorpioniques, 5 noyades, 2 cas de brulure et un seul cas d’électrisation. Les intoxications accidentelles et les accidents par corps étrangers représentent les principaux accidents domestiques dans notre série et la tranche d’âge entre 1 et 4 ans est la plus exposée aux accidents domestiques.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ibn Hadj Amor Hassen, Kammoun Sofiane, Zoghlami Bilel, Zairi Ihsen, Kraiem Sondes [Case report] - Une cause rare de déplacement de la sonde de pacemaker: syndrome de Twiddler - 12 June 2019. http://www.panafrican-med-journal.com/content/article/33/107/abstract/ <b>Le syndrome de Twiddler, une complication rare mais potentiellement létale de l’implantation de stimulateur cardiaque. Il est généralement diagnostiqué dans la première année de l'implantation. Il est caractérisé par un dysfonctionnement de l'appareil en raison de délogement de la sonde de pacemaker suite à l’auto manipulation du patient. Le syndrome de Twiddler a été décrit en 1968 comme une complication de l'implantation du stimulateur. Il a également été rapporté avec les défibrillateurs implantables et les resynchroniseurs cardiaques. Il s'agit du cas d'une vieille dame admise pour syndrome de Twiddler, ce qui a entraîné un dysfonctionnement de stimulateur cardiaque secondaire au déplacement de la sonde du pacemaker. Elle a bénéficié d’un repositionnement de la sonde ainsi que des conseils appropriés.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Layu Donatus, Fanka Kifu Nina, Dohbit Julius Sama, Claude Ngwayu Nkfusai, Fala Bede, Joyce Shirinde, Samuel Nambile Cumber [Research] - Assessing the uptake of cervical cancer screening among women aged 25-65 years in Kumbo West Health District, Cameroon - 12 June 2019. http://www.panafrican-med-journal.com/content/article/33/106/abstract/ <b>INTRODUCTION: Cervical cancer remains one of the leading health hazards affecting a majority women across the globe. The situation is even more, preoccupying particularly in areas where screening programmes and services are absent. The World Health Organization (WHO) says “cervical cancer is the fourth most frequent cancer in women, with an estimated 570,000 new cases diagnosed in 2018 which represents 6.6% of all female cancers. Approximately 90% of deaths from cervical cancer occurred in low- and middle-income countries.” Despite the high mortality rate from cervical cancer globally, the trend could be reduced through a comprehensive approach that includes prevention, early diagnosis, effective screening and treatment programmes. In Cameroon, the prevalence of cervical cancer is 24% among women of reproductive age. An estimated 1,993 new cases are recorded annually in Cameroon with 1676 deaths. Despite this precarious situation, the uptake in cervical cancer screening service remains poor and stands at 19.6% in Cameroon. It is against this background that this paper evaluates the uptake of cervical cancer among women aged 25-65 years in the Kumbo West Health District (KWHD). Specifically, this study assesses the knowledge of women in this health district on cervical cancer and determines factors that affect the uptake of cervical cancer screening services. METHODS: This study is a cross-sectional study in the KWHD involving 253 consented women between the ages 25 to 65 years. The principal research instrument was a three-part questionnaire designed to collect information on socio-demographic profile, cervical cancer knowledge and associated factors for uptake in cervical cancer screening. Data was entered in MS Excel and analysed using Excel. Results were presented in tables and figures. RESULTS: Our study reveals that a majority of the participants (74.70%) had heard of cervical cancer and 43.48% had undergone cervical cancer screening. Again, 24.51% and 29.25% of the participants respectively could not identify any risk factor and symptom of cervical cancer. CONCLUSION: The study revealed that the uptake of cervical cancer screening in KWHD is higher than the national uptake. The level of awareness on the risk factors and symptoms of cervical cancer is low, posing a need to put more emphasis on educating and creating awareness of cervical cancer among communities on risk factors, prevention measures and signs and symptoms in all the health areas of the KWHD.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Tabe Armstrong Tambe, Ngwayu Claude Nkfusai, Frankline Sanyuy Nsai, Samuel Nambile Cumber [Letter to the editors] - Challenges faced by nurses in implementing aseptic techniques at the surgical wards of the Bamenda Regional Hospital, Cameroon - 12 June 2019. http://www.panafrican-med-journal.com/content/article/33/105/abstract/ <b>Surgical site infection is a significant clinical problem leading to morbidity and mortality as it can result to infections, pain, misery and unnecessary increase in health cost. Thus, this study sought to identify challenges and barriers that nurse face in the use of aseptic technique and its application in wound dressing at the surgical unit of the Bamenda Regional Hospital. This was a cross-sectional hospital based survey. Questionnaires were administered to 20 nurses randomly selected. Demographics and nurses’ knowledge and barriers faced in the implementation of the aseptic techniques and was analyzed. It was observed that 20% of the nurses follow aseptic techniques strictly, while a majority (80%) have never followed aseptic techniques seriously, with major reasons mentioned by the participants being restrained supply of equipment’s and financial constraints of patients. From this study, it can be deduced that despite the awareness, of nurses on the importance of aseptic techniques, its application still remains low among them due to the various challenges they face with limited resources of patients and also inadequate materials at their disposals for use in wound management.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Qariani Hajare, Aachak Meriem [Images in medicine] - Exophtalmie unilatérale révélant un géant anévrysme intra caverneux rompu de la carotide interne rompu - 11 June 2019. http://www.panafrican-med-journal.com/content/article/33/104/abstract/ <b>L'anévrysme géant de la carotide intra-crânienne est une pathologie relativement rare et qui peut présenter des complications redoutables. Les lésions du sinus caverneux sont habituellement révélées par une symptomatologie ophtalmologique, principalement, les paralysies oculomotrices. Nous rapportons le cas d'une patiente de 39 ans qui présente une exophtalmie unilatérale d'installation rapidement progressive (A, B), et une diplopie binoculaire associées à des céphalées en hémi-casque avec un seul épisode de vomissements évoluant dans un contexte d'apyrexie et de conservation d'état général. L'examen ophtalmologique retrouve une paralysie isolée du droit externe droit (déficit d'abduction) avec un examen stato-dynamique des paupières normal. L'acuité visuelle corrigée est à 5/10. L'examen à la lampe à fente montre une dilatation des vaisseaux conjonctivaux (C), cornée claire ne prenant pas la fluorescéine, reflexe photomoteur direct et consensuel conservé, une pression intra-oculaire à 15 mmhg, et des tortuosités veineuses au fond d'œil sans anomalies papillaires (D). Le bilan neuroradiologique à savoir l'angio- imagerie à résonnance magnétique (IRM) révèle un anévrysme de la portion intra-caverneuse de la carotide interne droite, compressif, avec une exophtalmie stade 3. L'angiographie cérébrale est en faveur d'un anévrysme sacculaire géant carotido-caverneux droit rompu dans le sinus caverneux (E) avec drainage veineux antérieure et postérieure associé à un anévrisme du syphon carotidien gauche (F).</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Aristomenis Kossioris, Nicholas Tentolouris,Chariclia V Loupa, Minos Tyllianakis [Research] - The role of amputative and non-amputative foot deformities severity in the risk for diabetic ulceration classification systems building: a cross-sectional and case-control pilot investigation - 11 June 2019. http://www.panafrican-med-journal.com/content/article/33/103/abstract/ <b>INTRODUCTION: Foot deformities and amputations, are parameters that have been studied as risk factors for diabetic foot ulceration (DFU). However, inclusion of "foot deformities" and "amputations" in a single, broad variable and with reference to the severity of these deformities, may better characterize subjects who are prone to develop DFU. METHODS: the objective of the study was the examination of amputative and non-amputative foot deformities severity as risk factor for DFU in relation with the other established risk factors. A cross-sectional and case-control study was conducted from October 2005 to November 2016. One hundred and thirty-four subjects with type 1 and 2 diabetes, with and without active foot ulcers, participated. A structured quantitative interview guide was used. Univariate logistic regression analysis for the literature’s established risk factors was performed, as well as for two versions of the “amputative and non-amputative foot deformities severity” variable. Subsequently, multivariate logistic regression analysis (MLRA) for three models and receiver operating characteristic (ROC) curve analysis were carried out. RESULTS: From the MLRA, only PAD was significant (OR 3.56, 95% CI 1.17-10.82, P=0.025 and OR 3.33, 95% CI 1.02-10.08, P=0.033). Concerning the ROC curve analysis of the models, the one with the three categories "amputative and non-amputative foot deformities severity" variable had the greatest area under the ROC curve (0.763, P<0.001). CONCLUSION: A united variable for lower extremity amputations and other foot deformities with reference to their severity, could be more helpful to the clinicians in identifying patients with diabetes at risk for foot ulceration.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Dondo Mara, Moussa Sylla, Seydou Ly, Ismaël Dandakoye Soumana, Badr Alami, Mustapha Maâroufi, Khalid Maazaz, Youssef Alaoui Lamrani [Case report] - Masses stromales gastro-intestinales multiples du grêle découvertes dans un contexte de péritonite - 11 June 2019. http://www.panafrican-med-journal.com/content/article/33/102/abstract/ <b>Nous rapportons une observation d'un cas de tumeur stromale gastro-intestinale à localisation multiple au niveau du grêle découverte dans un contexte de péritonite. La particularité de ce cas tient à la découverte en per-opératoire de masses tumorales multifocales grêliques, évoquant à la tomodensitométrie en post opératoire des tumeurs stromales gastro-intestinales. Ce tableau clinique de péritonite ne permettait en aucun cas d'évoquer une origine tumorale.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Adefisoye Oluwaseun Adewole, Olufunmilayo Fawole, IkeOluwapo Ajayi, Bidemi Yusuf, Abisola Oladimeji, Endie Waziri, Patrick Nguku, Olufemi Ajumobi [Research] - Determinants of intermittent preventive treatment of malaria among women attending antenatal clinics in primary health care centers in Ogbomoso, Oyo State, Nigeria - 11 June 2019. http://www.panafrican-med-journal.com/content/article/33/101/abstract/ <b>INTRODUCTION: Despite the effectiveness of intermittent preventive treatment in pregnancy using sulphadoxine-pyrimethamine (IPTp-SP), the uptake and coverage in southwest Nigeria are low. We assessed the factors influencing utilisation of IPTp-SP. METHODS: A multistage sampling technique was used to select 400 pregnant women from six primary healthcare centers in Oyo State. Data on socio-demographic characteristics, knowledge, attitude towards IPTp-SP and its utilisation were obtained using a semi-structured questionnaire. Data were analyzed using SPSS software. Focus group discussions (FGD) and key informant interviews (KII) were held for pregnant women and healthcare workers and analysed thematically. RESULTS: Mean age of respondents was 27.2 (SD ± 5.5) years. Mean gestational age was 29.5 weeks (SD ± 5.4). Overall, 320 (80.0%) took SP, of which 152 (47.5%) took 2 doses and 112 (35.0%) took under directly observed therapy (DOT). We found that early booking for ANC, more than two visits to ANC (adjusted odds ratio [aOR] = 5.6; 95% CI: 1.2 - 26.6), good knowledge on IPTp (aOR = 9.3; 95% CI: 5.4 - 16.0), positive attitude towards IPTp (aOR = 2.1; 95% CI: 1.5 - 2.9) and being employed (aOR = 1.4; 95% CI: 1.1 - 1.7) were factors associated with IPTp-SP utilisation. The FGD and KII revealed that IPTp-SP drugs were mostly taken at home due to stock out. CONCLUSION: Late ANC booking with stock out of IPTp-SP drugs was responsible for its low utilisation. There is need to encourage pregnant women to book early for ANC. Adherence to the practice of DOT scheme is recommended to improve IPTp-SP utilisation.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Teklewoini Mariye, Alem Girmay, Hagos Tasew, Girmay Teklay, Ebud Ayele, Hadgu Gerensea, Hussen Mokonnen [Research] - Determinants of hypertension among diabetic patients in Public Hospitals of the Central Zone, Tigray, Ethiopia 2018: unmatched case-control study - 11 June 2019. http://www.panafrican-med-journal.com/content/article/33/100/abstract/ <b>INTRODUCTION: Hypertension, among diabetic patients, is a worldwide public-health challenge and a leading modifiable risk factor for other cardiovascular diseases. The main purpose of this study was to identify determinants of hypertension among diabetic patients. METHODS: Data were collected from January to March 2018 using an interviewer-administered structured questionnaire. Data collectors and supervisors were trained before the period of data collection. The questionnaire was pretested on 5% of the sample at Suhul hospital. Bivariable logistic regression was employed to examine the crude associations between the outcome variable and determinant variables. This was followed by multivariable analysis to examine the determinants of hypertension among diabetic patients by selecting variables which had p value &#8804;0.2 in the bivariable analysis. RESULTS: The age range of the respondents was 18-80 years, with the median age of 51.56±14.92 years. Not attending diabetes mellitus education sessions (AOR=2.61, 95% CI (1.12,6.1), duration since diagnosis with diabetes (AOR=8.52; 95% CI (1.97, 36.84), poor glycemic control (AOR=22.99, 95CI (5.92,89.28), overweight (AOR=4.84, 95%CI (1.42,16.51), and non-adherence to diabetes medication (AOR=4.66, 95% CI (2.22,9.79), diet (AOR=9.70,95% CI (3.34,28.22), exercise (AOR= 5.47, 95% CI (2.35,12.75), and self-monitoring blood glucose (AOR=6.62, 95% CI (3.16, 13.86) were found to be the determinants of hypertension among diabetic patients. CONCLUSION: This research concludes that longer duration with diabetes, nonattendance of diabetes education sessions, poor glycemic control, and not-adherence to antidiabetic medications, diet, exercise and self-monitoring blood glucose were found to be the determinants of hypertension among diabetic patients.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Joyce Nguna, Michel Dione, Micheal Apamaku, Samuel Majalija, Denis Rwabita Mugizi, Terence Odoch, Charles Drago Kato, Gabriel Tumwine, John David Kabaasa, Kellie Curtis, Michael Graham, Francis Ejobi, Thomas Graham [Research] - Seroprevalence of brucellosis and risk factors associated with its seropositivity in cattle, goats and humans in Iganga District, Uganda - 11 June 2019. http://www.panafrican-med-journal.com/content/article/33/99/abstract/ <b>INTRODUCTION: The burden of brucellosis among smallholder farmers is poorly-documented in Uganda. The disease burden is likely to be high, given the high levels of endemicity, lots of exposures and due to lack of control measures. In order to designate appropriate control measures, the magnitude and risk factors for brucellosis need to be known. We established the burden of and risk factors for Brucella seropositivity in cattle, goats, and humans in Iganga district, eastern Uganda. METHODS: a cross-sectional study was conducted in in Kigulamo Parish, Iganga District. We enrolled 226 households and administered a structured questionnaire to heads of households to capture data on socio-demographic characteristics, human brucellosis-related risk factors, and livestock farming practices. Human, cattle, and goat blood samples were collected and tested serologically using commercial indirect-ELISA kits manufactured by USDA, USA. RESULTS: of 451 human blood samples, 20 (4.4%) were positive. Among 345 cattle blood samples, 4 (1.2%) were positive and among 351 goat blood samples, one (0.3%) was positive. Persons who reported consuming locally-made dairy products had 4 times higher odds of Brucella seropositivity (OR = 4.0, CI = 1.14-14.03, p = 0.031) than those who did not. None of the risk factors we asked about were significantly associated with seropositivity in cattle and goats. CONCLUSION: the seroprevalence of brucellosis in humans in smallholder households in Kigulamo was relatively low and associated with consumption of locally made dairy products. No risk factors were significantly associated with seropositivity in livestock, likely due to the small number of seropositive animals. We recommend a One Health approach to control brucellosis simultaneously in animals and humans needed to sustainably reduce the burden of brucellosis in Uganda and beyond.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mohammed Yassine Haouas, Mohamed Khoulali, Zinelabidine En-Nhaili, Hani El-Johani, Mounir Rghioui, Robin Srour [Case series] - Traitement chirurgical des kystes de Tarlov sacrés: à propos de 20 cas - 10 June 2019. http://www.panafrican-med-journal.com/content/article/33/98/abstract/ <b>Le kyste de Tarlov ou kyste périneural est une dilatation locale de l'espace sous-arachnoïdien se formant au contact d'une racine nerveuse et est rempli de liquide cérébro-spinal. Il n'y a pas de consensus sur le traitement optimal des kystes périnerveux sacrés symptomatiques. De nombreuses méthodes ont été appliquées pour traiter ces lésions symptomatiques, avec des résultats variables. Nous rapportons une série de 20 patients opérés pour un kyste de tarlov sacré. Nos résultats étaient satisfaisants avec 80% d'amélioration et sans aggravation neurologique en post-opératoire. Notre technique chirurgicale (laminectomie sacrée + ponction du kyste + mise en place d'un manchon dure-mèrien), décrite pour la première fois dans ce travail, semble efficace dans les 20 cas rapportés dans notre série.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Lahatriniavo Ritchy Ramiandrisoa, Haingo Freddie Richard Raveloson, Daniella Masinarivo Rakotoniaina, Nirina Rabearivony, Solofonirina Rakotoarimanana [Case report] - Endocardite de Libman-Sacks surinfectée: à propos d'un cas - 10 June 2019. http://www.panafrican-med-journal.com/content/article/33/97/abstract/ <b>L'endocardite de Libman-Sacks constitue une manifestation cardiaque peu fréquente de la maladie lupique au cours de laquelle il existe une végétation non infectieuse au niveau des valves cardiaques. Il y a un risque important d'endocardite infectieuse. Notre patiente était une femme de 38 ans, présentant une fièvre persistante et une polyarthralgie inflammatoire au niveau des poignets et des chevilles. Elle présentait un souffle systolique mitral 2 sur 6 et une tuméfaction douloureuse des poignets et des chevilles. Nous avions objectivé un syndrome inflammatoire biologique. Le dosage des anticorps anti-nucléaire était positif avec un aspect moucheté, ainsi que les anticorps anti-DNA natifs. La recherche de syndrome des anti-phospholipides (SAPL) était négative. L'échographie doppler cardiaque avait objectivé des végétations au niveau des valves mitrales et aortiques. Les améliorations clinique, biologique et morphologique n'avaient été obtenues qu'après association antibiothérapie et corticothérapie. Nous pouvons conclure que l'endocardite de Libman-Sacks est d'évolution favorable en l'absence d'un syndrome des anti-phospholipides associé. Il faut toujours craindre dans tous les cas une greffe bactérienne. Le traitement est basé sur l'association antibiothérapie-corticothérapie-antipaludéen de synthèse.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Gloria Akosua Ansa, Kenneth Nana Affoh Ofori, Ekua Essumanma Houphouet, Afua Asabea Amoabeng, Jerry Selase Sifa, Christian Kofi Amenuveve, Gifty Harriet Odame [Research] - Hepatitis B vaccine uptake among healthcare workers in a referral hospital, Accra - 10 June 2019. http://www.panafrican-med-journal.com/content/article/33/96/abstract/ <b>INTRODUCTION: Hepatitis B vaccination among healthcare workers (HCWs) in Ghana has not been actively pursued despite the endemicity of the infection. This study measures the hepatitis B vaccine uptake among HCWs at the University of Ghana Hospital, Legon (UGHL) and identifies the factors associated with vaccination. METHODS: an analytical cross-sectional study involving all staff who have direct contact with patients was conducted. Self-administered questionnaires were used to collect data on vaccination status, age, sex, type of staff, duration of work in the facility, exposure to blood or blood products, blood stained linens/waste, sharp instruments and performance of invasive procedures. Data was analysed using STATA 14. Continuous variables were described using median values and interquartile ranges (IQR) and categorical variables as proportions. Bivariate and multivariate analysis were conducted to identify the factors associated with hepatitis B vaccination status. RESULTS: of the 161 participants interviewed, 63.4% were females with median age 35 years (IQR: 27-45). Eighty-six (53.4%) of the respondents had taken the hepatitis B vaccine with 79.1% of them having completed the vaccination schedule. Factors associated with vaccination were working for more than 16 years (OR: 3.8, CI: 1.02-12.72), daily exposure to blood/blood products (OR: 4.1, CI: 1.43-11.81) and sharp instruments (OR: 4.45, CI: 1.39- 14.24), performing invasive procedures daily (OR: 3.0, CI: 1.07-8.45) and frequent exposure to blood stained linens/waste (OR: 6.1, CI: 1.41-26.51). CONCLUSION: the lack of hepatitis B vaccination among some HCWs at UGHL puts them at risk of contracting hepatitis B infection.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mouhamed Abdou Salam Mbengue, Serigne Omar Sarr, Aissatou Diop, Cheikh Tidiane Ndour, Bara Ndiaye, Souleymane Mboup [Research] - Prevalence and determinants of adherence to antiretroviral treatment among HIV patients on first-line regimen: a cross-sectional study in Dakar, Senegal - 10 June 2019. http://www.panafrican-med-journal.com/content/article/33/95/abstract/ <b>INTRODUCTION: Successful and long-term positive impact of antiretroviral treatment requires high rates of adherence (> 90%). In Senegal, there is a lack of data regarding adherence to antiretroviral treatment and only a few studies have looked at the determinants. The aim of this study is to assess the prevalence and determinants contributing to antiretroviral (ARV) adherence among Human Immunodeficiency Virus (HIV) infected outpatients receiving care at four public hospitals in Dakar, Senegal. METHODS: A cross-sectional based study was carried out among HIV-positive ART adults in Dakar, Senegal. Patients were systematically sampled during either their clinical visits or visit to collect ARV drugs from six public hospitals and data collected with a questionnaire. The study outcome was adherence to antiretroviral treatment assessed by a multiple approach method which combined three self-reported adherence tools: self-reporting, Visual Analog Scale (VAS), and the Simplified Medication Adherence Questionnaire (SMAQ). Data were entered with an Excel spreadsheet and transferred to STATA for descriptive, bivariate and multivariate analysis. All the statistical tests were done at the threshold level of 0.05. RESULTS: A total of 150 HIV-positive patients on first line ART regimen at six public health facilities were enrolled into the study. The mean age of patients was 43.1 years with a sex ratio of 0.3. Most of the patients were prescribed Tenofovir–based regimen. Of these patients, 26.67% were found to be highly adherent. After adjusting for health-related variables, demographic and socio-economic variables, better adherence was associated with participating actively within an association of persons living with HIV (AoR=2.89; 95% CI: 1.04 - 7.99; p value 0.041) while being widowed patient was associated with lower adherence (AoR=0.17; 95% CI: 0.03 - 0.94; p value 0.043). CONCLUSION: Our study findings imply that adherence should be routinely assessed during medical visits. Ongoing strategies to improve adherence such as out-of-clinic group-based models or psychological support should be directed toward outpatients' clinics to assist in improving adherence and long term virologic suppression in Senegal.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Shanti Merveille Mekam Nkengni, Aurelia Thérèse Condomat Zoumabo, Naomi Paloma Sangue Soppa, Adèle Besch Ngwem Sizono, Philippe Vignoles, Louis-Albert Tchuem Tchuenté, Félicité Flore Djuikwo Teukeng [Research] - Current decline in schistosome and soil-transmitted helminth infections among school children at Loum, Littoral region, Cameroon - 10 June 2019. http://www.panafrican-med-journal.com/content/article/33/94/abstract/ <b>INTRODUCTION: Soil-transmitted helminth infections (STHs) and schistosomiasis have serious consequences for the health, education and nutrition of children in developing countries. As Loum is known as a highly endemic commune for these infections, several deworming campaigns have been carried out in the past. The purpose of this study was to determine any changes that have occurred since then in the characteristics of these infections among schoolchildren in this site. METHODS: a cross-sectional study was conducted in October 2016 on 289 schoolchildren. Stool and urine samples were collected and examined to determine the prevalence and intensity of helminth infections. RESULTS: the highest prevalence was noted for Schistosoma haematobium (34.2%), followed by Ascaris lumbricoides (8.6%), S. mansoni (4.9%) and Trichuris trichiura (4.9%) in decreasing order. A prevalence of less than 2% was noted for each of the other two helminths. The highest mean intensity was found for S. haematobium (39.6 eggs/10 ml of urine), followed by A. lumbricoides (24.2 eggs per gram of faeces: epg), Strongyloides stercoralis (16.6 epg) and Schistosoma mansoni (12.3 epg). The prevalence of T. trichiura was significantly higher in boys and that of S. haematobium in children aged 10 years or older, while the differences between other values of prevalence or between egg burdens were not significant. CONCLUSION: compared with values reported in 2003, the prevalence and intensity of Schistosomiases and STH infections in Loum has sharply decreased in 2016. Confirmation of this decrease in the years to come allowed to space deworming campaigns among schoolchildren.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mouad Guenbdar, Jamal Louaste [Images in medicine] - Case study of verrucous carcinoma of the hand: rare location - 10 June 2019. http://www.panafrican-med-journal.com/content/article/33/93/abstract/ <b>Verrucous carcinoma is rare well-differentiated squamous cell carcinoma with very rare metastatic potentiel. Pappilomatosis carcinoides cutis (PPC) is the rarest form of verrucous carcinoma. The risk factors for PCC include chronic inflammation or irritation. It can have multiple locations such as the cheeks, nose, ears, hands, thighs etc. We present a patient with large, cauliflower-shaped mass of the fourth finger. A 60-year-old male presented with painful, cauliflower-shaped mass of 9cm*5cm of the fourth finger of the left hand. The tumor surface was exophytic, irregular, crossed by deep grooves. Disease history is 12 years, the mass was gradually growing. After the histopathological examination of skin biopsy, we have diagnosed pappilomatosis cutis carcinoides. There was no palpable lymphadenopathy. Routine blood investigations were with normal limits. Simple radiographs showed bony erosions. Hand magnetic resonance imaging was performed, an invasion into the bone and tendon was observed. Chest abdominal pelvic CT scan were normal. We performed a partial amputation of the fourth ray with safety margins (5mm) and a full-thickness skin graft. The histopathology of excisional mass border confirmed the tumor was removed entirely. He had no tumor recurrence or metastatic disease during follow-up for 4 years.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fahd Derkaoui Hassani, Mustapha Fadli, Najia El Abbadi [Case report] - Sarcoïdose hypophysaire mimant un adénome hypophysaire: à propos d'un cas et revue de la littérature - 07 June 2019. http://www.panafrican-med-journal.com/content/article/33/92/abstract/ <b>L'atteinte isolée de l'axe hypothalamo-hypophysaire dans la sarcoïdose est rare. Seulement quelques cas sont rapportés sur la littérature. Nous rapportons l'observation clinique d'une patiente âgée de 50 ans, opérée il y a 4 ans pour goitre avec thyroïdectomie totale sous traitement substitutif. Elle se plaint de céphalées chroniques depuis 6 mois devenues récemment rebelles concomitant avec la survenue d'une baisse de l'acuité visuelle. L'examen clinique retrouve un syndrome opto-chiasmatique avec altération importante du champ visuel. Elle présente aussi une paralysie du nerf occulo-moteur commun à droite avec ptôsis. L'IRM cérébrale a objectivé un processus sellaire de signal tissulaire avec prise de contraste hétérogène et qui s'étend à la tige pituitaire avec épaississement de celle-ci. Le bilan hormonal pré opératoire a retrouvé une légère insuffisance thyréotrope. La patiente a bénéficié d'une exérèse tumorale large par voie transnasale trans-sphénoidale endoscopique d'une tumeur de consistance fibreuse et peu hémorragique. L'évolution post opératoire était marquée par la survenue d'un diabète insipide et d'une fistule de LCR au 2ème jour post opératoire. L'évolution était bonne sous traitement médical avec drainage spinal. Le bilan général n'a pas retrouvé une autre localisation de la sarcoïdose notamment une tomodensitométrie thoraco abdominale et échographie cardiaque sans particularités. Le dosage de l'enzyme de conversion est revenu normal. La patiente a bénéficié d'une corticothérapie pour le traitement de la maladie systémique. La neuro sarcoïdose est un critère de mauvais pronostic chez un patient atteint d'une sarcoïdose. L'atteinte hypothalamo-hypophysaire est rare avec des complications plus fréquentes que les autres atteintes neurologiques et systémiques nécessitant une prise en charge multidisciplinaire à long terme.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Henry Ohem Okpa, Emmanuel Edet Effa, Sidney Kelechi Oparah, John Austin Chikezie, Elvis Mbu Bisong, Patrick Ntui Mbu, Daniel Emmanuel Otokpa [Research] - Intradialysis blood pressure changes among chronic kidney disease patients on maintenance haemodialysis in a tertiary hospital south - south Nigeria: a 2 year retrospective study - 06 June 2019. http://www.panafrican-med-journal.com/content/article/33/91/abstract/ <b>INTRODUCTION: Haemodialysis (HD) which is a form of renal replacement therapy is usually a treatment modality for patients with chronic kidney disease. However, it is not without deleterious haemodynamic responses which may occur either during or immediately after the termination of the procedure. These may include hypotension or hypertension. METHODS: This was a retrospective study on 64 chronic kidney disease (CKD) patients on maintenance haemodialysis at the renal unit of University of Calabar Teaching Hospital, Calabar, Nigeria and aims to determine the predictors of blood pressure changes during haemodialysis. Clinical and biochemical data were obtained from the records in the dialysis unit. RESULTS: There were more males (59.4%) than females (40.6%) in the study. The mean age was 51.71±15.43 years and 43.04±14.03years for males and females respectively. The prevalence of intradialysis hypertension (45.3%) is higher than that of intradialysis hypotension (31.3%) and the commonest cause of CKD requiring haemodialysis was diabetes mellitus nephropathy. CONCLUSION: The predictors of intradialysis hypotension were lower postdialysis systolic blood pressure (PDSBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and less number of antihypertensive medications; while the predictors of intradialysis hypertension were higher postdialysis SBP, MAP, greater number of antihypertensive medications and longer duration of haemodialysis.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Francois-Xavier Mbopi-Keou, Ginette Claude Mireille Kalla, Esther Voundi Voundi, Mohammad-Ali Jenabian, Ralph-Sydney Mboumba Bouassa, Frédéric Talla, Fru F Angwafo III, Laurent Belec [Research] - Differential influence of race and environment on indeterminate reactivities to non-treponemal and treponemal antigens by immuno-chromatographic dual syphilis rapid test - 06 June 2019. http://www.panafrican-med-journal.com/content/article/33/90/abstract/ <b>INTRODUCTION: Syphilis rapid test results may be influenced by numerous environmental and genetic factors. METHODS: the proportion of false positive syphilis non-treponemal (NT) and treponemal (T) test results using immuno-chromatographic dual syphilis rapid test on serum from Cameroonian blacks (n=103) versus French blacks (n=104) or French caucasians (n=51), all HIV-negative and free of clinical syphilis, was examined. RESULTS: black individuals in Cameroon had a significantly higher frequency of false positive NT or T tests than black individuals in France. black individuals in France had a higher frequency of indeterminate NT tests as compared to caucasians in France. CONCLUSION: both racial and environmental factors may affect immuno-chromatographic dual syphilis rapid testing.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Adino Tesfahun Tsegaye, Wagaye Alemu, Tadesse Awoke Ayele [Research] - Incidence and determinants of mortality among adult HIV infected patients on second-line antiretroviral treatment in Amhara region, Ethiopia: a retrospective follow up study - 06 June 2019. http://www.panafrican-med-journal.com/content/article/33/89/abstract/ <b>INTRODUCTION: Mortality of adult patients who are on antiretroviral therapy (ART) is higher in low-income than in high-income countries. After the failure of standard first-line treatment, patients switch to second-line regimens. However, there are limited data about the outcome of patients after switching to a second-line regimen in the study area. This study aimed to measure the rate of mortality and its determinants among HIV patients on second-line ART regimens. METHODS: multicenter institution based retrospective follow up study was conducted among 1192 adult patients who started second-line ART between 2008 and 2016 in eight selected hospitals of Amhara region. Patients who started second-line treatment after the failure of first-line treatment were included. Patient medical records, registration books, and computer database were used to collect the data. Time to death after a switch to second-line ART was the primary outcome of interest. Cox proportional hazard model was fitted to identify determinant factors of mortality. RESULTS: among 1192 patients who were on second-line ART, 136 (11.4 %) died with 3,157 person-years of follow up. Over the study period, the mortality rate was 4.33 per 100 person-years. Not taking isoniazid preventive therapy (IPT) (Adjusted Hazard Ratio (AHR): 6.6; 95 % CI: 2.9, 15.0), did not make modification on second-line regimen (AHR: 4.4; 95% CI: 2.8, 6.8), poor clinical adherence (AHR: 2.5; 95% CI: 1.4, 4.5), functional status of bedridden (AHR: 2.7; 95% CI: 1.5, 4.8), and having attained a tertiary level of education (AHR: 0.4; 95% CI: 0.2, 0.8) were independent determinants of mortality. CONCLUSION: the incidence rate of mortality was high and most of the deaths occurred within 12 months after switching to second-line ART. Higher mortality among adult HIV-infected patients was associated with poor adherence, no formal education, not taking IPT, being bedridden at the time of the switch, and not modifying second-line treatment. Improving treatment adherence of patients by providing consistent adherence counseling, providing INH prophylaxis and monitoring patient's regimen more closely during the first twelve months after switch could decrease mortality of HIV patients on a second-line regimen.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Adil Dehhaze, Yassine Benchamkha, Ouafa Dhaidah, Mouna Ejjiyar, Mariam Quaboul, Abdelkoddous Bhihi, Mehdi Sahibi, Moulay Driss Elamrani, Saloua Ettalbi [Case report] - Traitement chirurgical d’un lymphœdème scrotal - 06 June 2019. http://www.panafrican-med-journal.com/content/article/33/88/abstract/ <b>L’éléphantiasis scrotal se définit comme étant une augmentation du volume scrotal qui peut atteindre une taille très importante; Il s’agit du patient O.H âgé de 70 ans, marié et père de 4 enfants, originaire et résident à Agadir (sud du Maroc), agriculteur de profession. Le début de la symptomatologie remonte à 7 ans par l’installation de l’œdème scrotal puis des deux pieds et jambes augmentant progressivement de volume. L’examen local mettait en évidence un éléphantiasis scrotal de 80cm de circonférence et des deux jambes et pieds. Une Imagerie à résonnance magnétique (IRM) pelvienne a été demandée dans le cadre du bilan d’exploration locorégionale. Le patient a été programmé pour un geste d’exérèse scrotale en mono- bloc sous rachis anesthésie avec libération des deux testicules couvertes directement par la peau restante et de la verge qui a été couverte par greffe de peau mince. Le but du traitement est assurer la fonction et prendre en charge les préjudices esthétiques. Le traitement conservateur consistant à la dérivation lymphatique vers le réseau veineux ou à la dilatation des vaisseaux lymphatiques a été abandonné. On se base pour la prise en charge sur la chirurgie qui peut être abstenu en cas de contre indication absolue au geste chirurgical.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Pepanze Jill Pangmekeh, Mbunka Muhamed Awolu, Simo Gustave, Tayong Gladys, Samuel Nambile Cumber [Research] - Association between highly active antiretroviral therapy (HAART) and hypertension in persons living with HIV/AIDS at the Bamenda regional hospital, Cameroon - 06 June 2019. http://www.panafrican-med-journal.com/content/article/33/87/abstract/ <b>INTRODUCTION: The introduction of highly active antiretroviral therapy (HAART) in the treatment of HIV infection has provided different good results: like long-term viral suppression, the decrease of opportunistic infections, and repair of the immune system. METHODS: we carried out a hospital-based cross-sectional analytic study involving 315 participants 228 were on HAART (group 1) and 87 were HAART-naïve (group 2) at the HIV treatment centre of the Bamenda regional hospital with our study population being all people living with HIV (PLWHIV) in the North West region of Cameroon. The sampling was performed from the 15th of March to the 30th of June 2017. The questionnaire was administered face to face with participants and their vital signs taken. Blood pressure was measured using an automated electronic blood pressure monitor and hypertension (HTN) was considered as systolic blood pressure (BP) e" 140 mmHg and/or diastolic BP e" 90mmHg. RESULTS: the prevalence of hypertension in the HAART group was 36.44% (n=82, CI: 30.15%-43.10%) compared to that of the HAART-naïve group which was 13.33% (n=12, CI: 7.08%-22.13%, P=0.01). HAART was associated with HTN after controlling for gender, family history of hypertension, body mass index (BMI), smoking and alcohol consumption. The odds ratio of the HAART-treated versus the HAART-naïve was 3.86 (95% CI: 1.98-7.50). we also found an association between TDF/3TC/EFV (OR=2.83), AZT/3TC/NVP (OR=2.82), AZT/3TC+EFV (OR=3.48) and TDF/3TC+NVP (OR=2.36) and HTN whereas those on AZT+3TC+ATV/r (OR=0.84) and TDF+3TC+ATV/r (OR=0.45) were not associated to hypertension. CONCLUSION: our result suggests that blood pressure should be periodically measured and treated when necessary in PLWHIV on HAART.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Aziz Slaoui, Sarah Talib, Anass Nah, Kamal El Moussaoui, Intissar Benzina, Najia Zeraidi, Aziz Baydada, Aicha Kharbach [Case series] - Placenta accreta in the department of gynaecology and obstetrics in Rabat, Morocco: case series and review of the literature - 06 June 2019. http://www.panafrican-med-journal.com/content/article/33/86/abstract/ <b>Placenta accreta spectrum disorders is a rare pathology but the incidence has not stopped to increase in recent years. The purpose of our work was the analysis of the epidemiological profile of our patients, the circumstances of diagnosis, the interest of paraclinical explorations in antenatal diagnosis and the evaluation of the evolutionary profile. We hereby report a case series spread over a period of one year from 01/01/2015 to 01/01/2016 at the Gynaecology-Obstetrics department of the University Hospital Center IBN SINA of Rabat where we identified six cases of placenta accreta. We selected patients whose diagnosis was confirmed clinically and histologically. The major risk factors identified were a history of placenta previa, previous caesarean section, advanced maternal age, multiparity. 2D ultrasound and magnetic resonance imaging (MRI) allowed us to strongly suspect the presence of a placenta accreta in a pregnant woman with risk factor(s) but the diagnosis of certainty was always histological. Placenta Accreta Spectrum disorders were associated with a high risk of severe postpartum hemorrhage, serious comorbidities, and maternal death. Leaving the placenta in situ was an option for women who desire to preserve their fertility and agree to continuous long-term monitoring in centers with adequate expertise but a primary elective caesarean hysterectomy was the safest and most practical option. Placenta Accreta Spectrum disorders is an uncommon pathology that must be systematically sought in a parturient with risk factors, to avoid serious complications. In light of the latest International Federation of Gynecology and Obstetrics (FIGO) recommendations of 2018, a review of the literature and finally the experience of our center, we propose a course of action according to whether the diagnosis of the placenta is antenatal or perpartum.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Catherine Atuhaire, Ambrose Byamukama, Rosaline Yumumkah Cumber, Samuel Nambile Cumber [Research] - Knowledge and practice of testicular self-examination among secondary students at Ntare School in Mbarara District, South western Uganda - 06 June 2019. http://www.panafrican-med-journal.com/content/article/33/85/abstract/ <b>INTRODUCTION: Testicular self-examination (TSE) is a screening technique that involves inspection of the appearance and palpation of the testes to detect any changes from the normal. Globally, the incidence of cancer has increased among which is testicular cancer (TC). Data on this topic among male secondary school adolescents in Uganda is limited therefore this study sought to assess the knowledge and practice of testicular self-examination among secondary students at Ntare School, Mbarara District in south western Uganda. The objective of the study is to assess the knowledge and practice of testicular self-examination among secondary students at Ntare School in Mbarara district, south western Uganda. METHODS: we conducted a descriptive cross-sectional quantitative study among 165 students. Recruitment was made using simple random sampling technique. Respondents were selected among advanced level (A’ level) male students studying at Ntare School in Mbarara district, south western Uganda. Structured self-administered questionnaires was used for data collection.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Hannatu Janada Dimas, Nasir Mohammed Sambo, Muhammed Sani Ibrahim, Ike Oluwapo Oyeneye Ajayi, Patrick Mboya Nguku, Olufemi Olamide Ajumobi [Research] - Coverage of indoor residual spraying for malaria control and factors associated with its acceptability in Nasarawa State, North-Central Nigeria - 06 June 2019. http://www.panafrican-med-journal.com/content/article/33/84/abstract/ <b>INTRODUCTION: Indoor residual spraying (IRS) is among the major vector control strategies recommended for endemic populations by the World Health Organization (WHO). The success of IRS requires high coverage which is dependent on its acceptability. In Nigeria, IRS pilots have been ongoing and rejection has been a major setback to its coverage. We assessed coverage of IRS and determined factors associated with its acceptability in Nasarawa Eggon district, Nasarawa state, Nigeria. METHODS: a cross-sectional survey involving 409 households selected using multi-stage sampling was carried out. Trained data collectors administered pre-tested structured questionnaire to collect data on socio-demographic characteristics of household heads or their representatives, their perceptions on IRS and factors associated with IRS acceptability. Descriptive, bivariate and multivariate analyses were done at 5% level of significance. RESULTS: majority of respondents were male (79.7%) and married (82.6%), and their mean age was 36.4 ± 13.3 years. Coverage of IRS was 99.3%. However, only 82.6% of those who previously accepted IRS were willing to accept it in again. Factors independently associated with acceptability were perceived effectiveness of IRS (aOR = 21.8; 95%CI = 6.9-68.8) and lower household cost of malaria prevention after IRS (aOR = 5.0; 95%CI= 1.1-21.8). CONCLUSION: IRS coverage in the communities studied met WHO minimum standard of 85%. However, for similar results to be achieved in future, acceptability must be promoted by providing information on its effectiveness and its ability to reduce household cost of malaria prevention.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Serge Tonen-Wolyec, Francois-Xavier Mbopi-Kéou, Salomon Batina-Agasa, Ginette Claude Mireille Kalla, Michel Noubom, Ralph-Sydney Mboumba Bouassa, Jean De Dieu Longo, Jérémie Muwonga, Laurent Bélec [Research] - Acceptability of HIV self-testing in African students: a cross-sectional survey in the Democratic Republic of Congo - 04 June 2019. http://www.panafrican-med-journal.com/content/article/33/83/abstract/ <b>INTRODUCTION: The empowerment of young people aged 15-24 years is a key component of an effective AIDS response. HIV self-testing (HIVST) is progressively being implemented in the Democratic Republic of Congo (DRC). METHODS: Socio-demographic and behavioural factors associated with acceptability of HIVST were evaluated among university students in Bunia, DRC. A representative cross-sectional study was conducted using a self-administered semi-structured questionnaire. RESULTS: A total of 1,012 students were recruited. Acceptability of unsupervised HIVST was higher in the group of young students as compared with older students and was markedly associated with prior knowledge on HIVST. CONCLUSION: Adapted communication about HIVST appears likely essential to increase the supply and use of HIVST among students in DRC.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fanuel Damian Bellet, Sakina Mehboob Rashid, Mubashir Alavi Jusabani, Marieke Cornelia Johanna Dekker, Rogers Joackim Temu [Research] - The characteristics of cervical spinal cord trauma at a North Tanzanian Referral Hospital: a retrospective hospital based study - 04 June 2019. http://www.panafrican-med-journal.com/content/article/33/82/abstract/ <b>INTRODUCTION: Surviving a traumatic cervical Spinal Cord Injury (SCI) has an immense effect on an individual's physical function and independence. It also predisposes them to financial, social, psychological and several medical complications throughout their life. In high-income countries, improved multidisciplinary care has led to better long term outcomes, however in low-income countries, the burden of the condition and its associated mortality remain high. The aim of this study was to illustrate the sociodemographic and clinical characteristics of cervical level Traumatic Spinal Cord Injuries (TSCIs) at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. METHODS: This was a retrospective hospital-based study of 105 cervical TSCI cases admitted to KCMC from January 2012 to December 2016. RESULTS: We included 105 patients in the study cohort, with a male preponderance of 86.7%, giving a male-to-female ratio of 6.5:1. The mean age at injury was 44.1 years. Overall, 65.7% were farmers and 69 patients were from within the Kilimanjaro region. Road Traffic Crashes (RTCs) accounted for 47.6% of the injuries, 17.9% had associated injuries, 38.1% sustained complete TSCIs and 45.7% developed secondary complications during the ward stay. The mortality rate before discharge from hospital care was 35.2%. CONCLUSION: The majority of patients were males from a low socioeconomic background and the most common cause of injury was RTCs. The secondary complication rates and mortality rates before discharge from hospital care are high.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ernest Darko, John Tetteh, Martin Amogre Ayanore, Ishmael Damoah-Aferi [Research] - Socio-demographic determinants associated with ownership and use of long lasting insecticide treated nets among pregnant women in the Wa Municipality of Ghana - 04 June 2019. http://www.panafrican-med-journal.com/content/article/33/81/abstract/ <b>INTRODUCTION: an estimated 125 million pregnancies around the world are at risk of malaria infection every year. Insecticide Treated Bed Nets is a form of personal protection that has reportedly been shown to reduce severe disease and mortality due to malaria in endemic regions. This study investigated ownership and utilization of Long Lasting Insecticide Nets among pregnant women attending antenatal clinics in Wa Municipality of Ghana. METHODS: a cross-sectional study design was adopted to collect data among 394 pregnant women in six antenatal clinics. A two stage sampling technique was adopted and the data collection tool used was a semi-structured questionnaire. Descriptive and inferential statistics involving logistic regression were performed using Stata 14. RESULTS: more (33.3%) of the pregnant women were aged between 25-29 years with no formal education (29.9%) whiles most (69.6%) of the pregnant women were in Islam religion. About 95.9% have heard about Long Lasting Insecticide Nets and its benefits. Intuitively, ownership of Long Lasting Insecticide Nets was 82.2% with 69.3% utilization of Long Lasting Insecticide Nets. Pregnant women aged 30-34 and 35 years and above were significant predictors, however, less likely to own Long Lasting Insecticide Nets compared to 15-19 years [AOR(95%CI)=0.29(0.10-0.87) and 0.08(0.01-0.72) respectively] whiles pregnant women aged 35 years and above were significantly less likely to utilize Long Lasting Insecticide Nets compared to 15-19 years [OR(95%CI)=0.12(0.03-0.48)]. CONCLUSION: the study found utilization of Long Lasting Insecticide Nets among pregnant in the Wa Municipality low as compared to the National Malaria Control Program target in Ghana although Long Lasting Insecticide Nets ownership was high. The study recommends that Public Health Nurses and Disease Control Officers should intensify sensitization on the importance and misconception of the use of Long Lasting Insecticide Nets during outreach clinics.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Samira Younes, Sabria Khouadja, Samia Younes, Rim Ben Soussia, Walid Bouali, Ahmed Haj Mohamed, Lazhar Zarrouk [Case report] - Psychiatric disorders in the acoustic neuroma: about a case - 04 June 2019. http://www.panafrican-med-journal.com/content/article/33/80/abstract/ <b>Neurofibromatosis type 2 (NF2) is a rare autosomal dominant disorder characterized by formation of central nervous system tumors. They are associated to significant morbidity due to multiple problems such as hearing loss that can lead to many psychiatric disorders.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Edouard N’guessan, Franck Gbeli, Jean Marc Dia, Privat Guie [Research] - Pratiques contraceptives des femmes infectées par le VIH suivies en ambulatoire au Centre Hospitalier Universitaire de Treichville (Abidjan, Côte d'Ivoire) - 03 June 2019. http://www.panafrican-med-journal.com/content/article/33/79/abstract/ <b>INTRODUCTION: La planification familiale est une stratégie à hauts impacts pour la réduction de la mortalité maternelle et pour la prévention de la transmission mère-enfant du VIH. L'objectif de cette étude était de décrire les pratiques contraceptives des femmes infectées par le VIH suivies en ambulatoire au CHU de Treichville. METHODES: une enquête transversale descriptive a été réalisée dans les unités de soins ambulatoires aux personnes vivant avec le VIH du CHU de Treichville du 1er avril au 30 juin 2016. Durant cette période, toutes les patientes VIH positives en âge de procréer, fréquentant les services de gynécologie-obstétrique, pneumo-phtisiologie, dermatovénérologie et médecine interne ont été invitées à renseigner un questionnaire standardisé portant sur les caractéristiques sociodémographiques, médicaux et les pratiques contraceptives. RESULTATS: au total, 283 femmes ont accepté de participer à l'étude, l'âge médian était de 36 ans avec une parité moyenne de 1,7. Les patientes étaient nullipares dans seulement 22,3% des cas et vivaient en couple dans 54,8% des cas. Elles n'avaient pas d'enfant avec le conjoint actuel dans 68,2% des cas. Le conjoint était informé du statut VIH dans 51,6% des cas. Elles étaient sous traitement antirétroviral dans 92,9% des cas avec une médiane de CD4 de 382 éléments/ml. La majorité des patientes (62,9%) avaient déclaré utiliser une méthode contraceptive moderne. Elles utilisaient surtout les progestatifs injectables (45,5%) et l'implant (32,6%). La pratique de la double protection n'a été signalé par seulement 17,4% d'entre-elles. Le niveau scolaire secondaire et supérieur (OR=2,23 [1,35-3,69], p=0,01), la multiparité (OR=1,84 [1,11-3,06], p=,002) et la révélation du statut VIH au conjoint (OR=1,86 [1,14-3,03], p < 0,01) étaient les facteurs significativement associés à l'utilisation de la contraception. CONCLUSION: les pratiques contraceptives des femmes infectées par le VIH dans notre expérience restent globalement decevant. Il faut développer des stratégies visant à améliorer l'intégration de la planification familiale dans la prise en charge les femmes infectées par le VIH.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Lala Andriamasinavalona Rajaonarison, Ratsitohara Santatra Razafindrasata [Images in medicine ] - Lésions cérébrales hémorragiques multiples révélatrices d’un mélanome métastatique - 03 June 2019. http://www.panafrican-med-journal.com/content/article/33/78/abstract/ <b>Près de 75% des patients avec un mélanome métastatique développent des métastases cérébrales au cours de leurs pathologies. Nous rapportons le cas d'une femme de 83 ans hospitalisée pour des crises cloniques de la jambe gauche secondairement généralisée, en état de mal épileptique convulsif partiel motivant une prise en charge auprès du service de réanimation. Une exérèse d'un mélanome de la cheville gauche était pratiquée 6 mois avant son admission. L'examen neurologique montrait une mono parésie ataxique crurale gauche. L'électro-encéphalogramme montrait un foyer central et frontal droit avec diffusion à gauche. L'imagerie par résonance magnétique (IRM) encéphalique avec injection de gadolinium a montré des lésions encéphaliques multiples de taille et de forme différentes, en sus et sous tentoriel, en hyper signal T1 (A et A'), hémorragique en T2*(B et B'), prenant le gadolinium en T1 gado avec œdème péri lésionnel en Flair. La tomographie par émission de positon a montré de multiples métastases ganglionnaires et osseuses. La recherche de clone VE-1 était négative après biopsie ganglionnaire avec absence de mutation BRAFV600E à l'immunohistochimie. Une augmentation du nombre des lésions métastatiques a été notée lors d'un scanner cérébral de contrôle malgré une radiothérapie cérébrale sur 10 séances motivant la mise sous soins palliatif. Les crises épileptiques ont été contrôlées sous lévétiracétam. Devant des lésions cérébrales multiples, hémorragiques et spontanées, il est important de rechercher la notion de mélanome dans l'antécédent du patient et de faire un examen dermatologique minutieux. Ceci pour l'enquête étiologique et conditionnant la prise en charge thérapeutique du patient.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Souha Kallel, Malek Mnejja [Images in medicine] - Une cellulite cervicale révélant un carcinome extensif de la thyroïde - 03 June 2019. http://www.panafrican-med-journal.com/content/article/33/77/abstract/ <b>C'est une femme âgée de 45 ans qui présente depuis 15 jours une tuméfaction cervicale antérieure qui a augmenté très rapidement de taille avec apparition de signes inflammatoires locaux depuis 7 jours. L'examen a trouvé une énorme tuméfaction occupant toute la région cervicale antérieure, tendue et fixe. La peau en regard était inflammatoire avec présence d'un nodule de perméation (A). La patiente était fébrile à 38° avec un état général conservé. Une échographie cervicale a montré une volumineuse masse latéro-cervicale droite d'exploration difficile vu la taille. La TDM a montré une énorme masse thyroïdienne multi-kystique en superficie, comprimant la trachée et l'œsophage et refoulant l'axe vasculaire du cou (B, C). Le bilan biologique a noté une hyperleucocytose à 13.500 éléments/ml, une anémie à 8.3 g/dl, une CRP à 42mg/l et un bilan thyroïdien normal. La cytoponction a montré un matériel purulent et très inflammatoire sans signes cytologiques de malignité. D'où la décision était d'opérer la patiente. L'exploration opératoire a trouvé plusieurs logettes superficielles de contenu kystique et hémorragique avec en profondeur du tissu tumoral infiltrant la trachée. La tumeur arrivait latéralement à l'axe vasculaire droit et en haut jusqu'au niveau des muscles supra-hyoïdiens, la région submandibulaire droite et le nerf XII. Nous avons réalisé une thyroïdectomie totale élargie. L'examen histologique a conclu à un carcinome papillaire de la thyroïde de 11 cm de grand axe. Notre revue de la littérature n'a pas trouvé de carcinome papillaire kystique localement invasif de la thyroïde et se révélant par un tableau infectieux subaigu.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Kosisochi Chinwendu Amorha, Glory James, Chibueze Anosike, Mathew Jegbefume Okonta [Research] - Assessment of the steps taken towards avoidance of medication errors among hypertensive outpatients attending a tertiary health care facility in Nigeria: a cross-sectional study - 03 June 2019. http://www.panafrican-med-journal.com/content/article/33/76/abstract/ <b>INTRODUCTION: Active involvement of patients in the management of their health has been suggested as a major means of curtailing medication errors. This study aimed to assess the steps taken by hypertensive patients in avoiding medication errors before, during and after clinic visits. METHODS: a cross-sectional study was conducted in Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, Nigeria (June to August, 2016) using a standardized 35-item interviewer-administered questionnaire. The SPSS version 20.0 was utilized for statistical analysis with P < 0.05, considered statistically significant. RESULTS: a total of 200 questionnaires were completed and returned. Few (24.4%) of the respondents were taking non-prescribed medicines and most (61.5%) knew their names. Only 41.9% of the patients monitor their blood pressure very often. There was a statistical difference between the mean scores of steps to avoid medication errors after the clinic visit for the different occupations (F = 8.109; P < 0.001) and educational level (F = 6.182; P < 0.001). CONCLUSION: patients that took necessary steps in avoiding medication errors before their clinic visits were likely to avoid errors at the clinic. Also, patients that avoided medication errors at the clinic were likely to avoid medication errors after the doctor's visit.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fadoua Mouedder, Houssam Laachach, Abdelmalek Elyandouzi, Alaa Fliti, Chaymae Toutai, Nabila Ismaili, Noha Elouafi [Case report] - Une embolie pulmonaire simulant un syndrome coronarien aigu - 03 June 2019. http://www.panafrican-med-journal.com/content/article/33/75/abstract/ <b>L'embolie pulmonaire est affection médicale aigue et grave. Sa présentation clinique n'est pas pathognomonique et peut simuler d'autres urgences médico-chirurgicales. Nous rapportons le cas d'un patient admis dans un tableau de syndrome coronarien aigu avec modification électrique et ascension des enzymes cardiaques sans substrat significatif à la coronarographie, faisant diagnostiquer une embolie pulmonaire.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fatima-Zahra El Hattab, Fatima Zohra Radi, Loubna Hara, El Mehdi Hafidi, Jamila Zarzur, Mohamed Cherti [Case series] - Infarctus du myocarde inférieur: première série marocaine, à propos de 103 cas - 31 May 2019. http://www.panafrican-med-journal.com/content/article/33/74/abstract/ <b>L'infarctus du myocarde (IDM) représente une cause majeure de mortalité cardiovasculaire. L'IDM inférieur représente 30 à 50% de l'ensemble des infarctus avec un pronostic favorable par rapport à l'infarctus antérieur. Le but de notre travail est d'étudier les aspects épidémiologiques, cliniques, électriques, échocardiographiques et angiographiques de l'IDM inférieur, ainsi que ses complications et ses modalités thérapeutiques. Sur une période de 3 ans, nous avons admis 720 patients pour ST-Elevation Myocardial Infarction (STEMI) dont 103 de topographie inférieure soit une fréquence de 14,3%. On note une nette prédominance masculine avec une moyenne d'âge de 58 ans pour les hommes et 62 ans pour les femmes. Le tabagisme représente le principal facteur de risque cardiovasculaire retrouvé dans 57,28% des cas. L'infarctus ventricule droit (VD) est objectivé chez 11,65% des malades. La moitié de ces patients ont présenté une instabilité hémodynamique. Le Bicuspid aortic valve (BAV) 3ème degré a été diagnostiqué chez 12,6% des patients. Sur le plan thérapeutique, sept malades ont été thrombolysés et 42 ont bénéficié d'une coronarographie. La lésion coupable de l'IDM inférieur était la coronaire droite dans 53% des cas et l'artère circonflexe dans 47%. La coronaire droite est responsable de l'infarctus VD dans 100% des cas. L'angioplastie coronaire est réalisée chez 18 patients dans la suite de la coronarographie. Onze malades ont bénéficié d'une angioplastie transluminale (ATL) de la coronaire droite et celle de la circonflexe est réalisée chez 2 malades. La mortalité précoce à 30 jours est estimée à 1,94%. Dans le groupe de patients présentant un infarctus VD, la mortalité est aux alentours de 17%.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Winnie Tatiana Bekolo Nga, Servais Albert Fiacre Bagnaka Eloumou, Jean Paul Ndamba Engbang, Esther Mbassi Dina Bell, Anne Marthe Maison Mayeh, Etienne Atenguena, Martin Essomba Biwole, Georges Barthélémy Nko’o Ayissi, Gabin Kenfack, Dominique Noah Noah, Henry Namme Luma, Albert Mouelle Sone, Paul Ndom, Elie Claude Ndjitoyap Ndam [Research] - Facteurs pronostiques du cancer de l'œsophage au Cameroun: étude multicentrique - 31 May 2019. http://www.panafrican-med-journal.com/content/article/33/73/abstract/ <b>INTRODUCTION: Le cancer de l'œsophage est une affection rare. Le pronostic péjoratif est lié au diagnostic tardif. La survie à 5 ans est de moins de 20%. Le but de ce travail était de rechercher les facteurs associés à la survie des patients atteints d'un cancer de l'œsophage au Cameroun. METHODES: il s'agissait d'une étude pronostique, sur une période de 11 ans allant du 1er janvier 2005 au 31 décembre 2015 dans les hôpitaux généraux de Yaoundé et de Douala. Les paramètres étudiés étaient ceux associés à la survie. La survie était établie en fonction de la date du diagnostic et de la date du décès ou de la dernière consultation. Le logiciel SPSS (Statistical Package for Social Sciences) version 23 a permis l'analyse des données. La survie était présentée sous forme de courbe de Kaplan Meier. Le Test de Log Rank a permis la comparaison entre les différents groupes. La régression de Cox a permis de ressortir les différents facteurs associés. Le seuil de significativité était de 0,05. RESULTATS: nous avons colligé 49 dossiers. L'âge moyen était de 57,83 ans. Le sexe masculin était présent dans 71,4% (n = 35) des cas pour un sex ratio à 2,49. Le suivi moyen était de 3,2 mois. La médiane de survie était de 6,67 mois (IC95% [1,33-10,4]) et la moyenne de survie était de 7,99 mois (IC95% [4,42-11,17]). En analyse multivariée après ajustement il ressortait que le stade IV était un facteur prédictif de mortalité (HR = 2,79; IC95% [1,13-6,89], p = 0,025]). CONCLUSION: le cancer de l'œsophage reste une affection rare au pronostic péjoratif. Le facteur pronostique est le stade tumoral.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Yolaine Glèlè-Ahanhanzo, Alphonse Kpozehouen, Boniface Maronko, Colette Azandjèmè, Virginie Mongbo, Charles Sossa-Jérôme [Research] - "Avoir la peau claire ...…et pourquoi pas? ": dépigmentation volontaire chez les femmes dans une région du sud-ouest du Bénin - 31 May 2019. http://www.panafrican-med-journal.com/content/article/33/72/abstract/ <b>INTRODUCTION: cette étude avait pour objectif de déterminer la prévalence et les facteurs associés à l'usage des produits de dépigmentation volontaire chez les femmes de 15 à 49 ans dans la zone sanitaire de Comè au Bénin. METHODES: il s'agit d'une étude transversale réalisée en 2016 et qui a concerné 511 femmes âgées de 15 à 49 ans sélectionnées par sondage en grappes. Les données ont été collectées par questionnaire avec des informations sur les caractéristiques démographiques, socio-culturels et économiques des femmes. Les produits de dépigmentation ont été identifiés dans la liste de composition des laits corporels déclarés d'utilisation régulière. L'analyse s'est basée sur une régression logistique multiple. Le seuil statistique de signification a été fixé à 5%. RESULTATS: la prévalence de l'usage des produits de dépigmentation volontaire chez les femmes de 15 à 49 ans dans la zone sanitaire de Comè était de 79,22% IC95% = [75,72-82,78] et 84,23% des femmes connaissaient au moins un des effets néfastes sur la santé liés à l'usage des produits de dépigmentation cutanée. Les produits utilisés étaient à base d'hydroquinone à 98,24% et des dermocorticoïdes à 1,76%. Les facteurs associés à l'usage des produits de dépigmentation volontaire étaient l'état matrimonial (célibataire, veuve, séparée ou divorcée) de l'enquêtée (OR =3,1; IC95%= [1,29-7,44]), la recherche d'un mari ou de partenaire (OR= 4,92; IC 95%= [1,20-20,09]), l'existence des taches hyperpigmentées (OR= 10,32; IC95%= [2,87-37,01]). CONCLUSION: ces résultats ont montré que l'usage des produits de dépigmentation cutanée chez les femmes est un problème préoccupant de santé publique et de grande ampleur dans la zone sanitaire Comè; des interventions intégrées de communication pour un changement de comportement doivent être entreprises.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Younoussa Keita, Aliou Abdoulaye Ndongo, Cath&eacute;rine Bebey Engome, Ndeye Fatou Sow, Ndiogou Seck, Lamine Thiam, Papa Malick Diouf, Ahmed Tall Lemrabott, Idrissa Basse, Abdou Niang, Saoussen Krid, Claude Moreira, Remi Salomon, Boucar Diouf, Assane Sylla, Ousmane Ndiaye [Case report] - Continuous ambulatory peritoneal dialysis (CAPD) in children: a successful case for a bright future in a developing country - 30 May 2019. http://www.panafrican-med-journal.com/content/article/33/71/abstract/ <b>The authors report the first case of successful peritoneal dialysis (PD) in a developing country performed about a 13-year-old adolescent followed-up for stage V chronic kidney disease (CKD) with anuria. After 3 months of hemodialysis, the parents opted for continuous ambulatory peritoneal dialysis (CAPD) as they wished to return home located 121km from Dakar. After PD catheter insertion, the plan proposed to the patient consisted 3-4 hours stasis of isotonic dialysate during the day and a night stasis of 8 hours of icodextrin for an injection volume of 1L per session. The patient and his mother were trained and assessed on the PD technique. After dialysis adequacy was tested while hospitalised, they were able to return home and continued the sessions following the same plan prescribed and while keeping in touch, by telephone, with the medical team. The technique assessment at the day hospital every 2 weeks revealed dialysis adequacy and satisfactory tolerance of PD at home after 04 months of observation. It was the first case of successful CAPD in the pediatrics unit in this context. Scaling this technique is a challenge for the pediatric nephrologist in developing countries like Senegal.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fatima-Zahra Agharbi [Images in medicine] - Hidrocystome palp&eacute;bral - 30 May 2019. http://www.panafrican-med-journal.com/content/article/33/70/abstract/ <b>Les hidrocystomes palp&eacute;braux sont des tumeurs b&eacute;nignes. appel&eacute;s &eacute;galement: ad&eacute;nome kystique apocrine, kyste sudoripare, kyste r&eacute;tentionnel apocrine ou encore kyste de Moll. Ils se forment aux d&eacute;pens des glandes sudoripares eccrines ou apocrines. Souvent situ&eacute;s sur le visage et les paupi&egrave;res. D'autres localisations atypiques telles le thorax, les &eacute;paules et le pr&eacute;puce ont &eacute;t&eacute; rapport&eacute;es. L'hidrocystome r&eacute;alise un petit kyste translucide, brillant, unique ou multiple. Leur histogen&egrave;se demeure discut&eacute;e. En effet, l'hidrocystome apocrine pourrait d&eacute;river des r&eacute;sidus des glandes apocrines primitives ou de la glande de Moll et l'hidrocystome eccrine des glandes eccrines ou du segment excr&eacute;teur des glandes de Moll. Leur diff&eacute;renciation clinique &eacute;tant peu &eacute;vidente, le diagnostic est histologique. Deux formes cliniques peuvent &ecirc;tre caract&eacute;ris&eacute;es, les formes isol&eacute;es et les formes associ&eacute;es. La forme isol&eacute;e est la plus fr&eacute;quente: l'hidrocystome est unique ou multiple et non associ&eacute; &agrave; des signes extra-oculaires. Les hidrocystomes apocrines sont uniques dans 93% des cas alors que les hidrocystomes eccrines apparaissent le plus souvent multiples. Les formes associ&eacute;es sont plus rares et d&eacute;crites uniquement pour les hidrocystomes multiples. Si dans la majorit&eacute; des cas un traitement par laser Argon est suffisant, les hidrocystomes plus volumineux n&eacute;cessitent une ex&eacute;r&egrave;se chirurgicale. Nous rapportons l'observation d'une jeune patiente qui consultait pour un nodule translucide du canthus externe de l'œil gauche. Les diagnostics &eacute;voqu&eacute;s &eacute;taient: un hidrocystome, un mollusum pendullum et un syringome. Une ex&eacute;r&egrave;se chirurgicale a &eacute;t&eacute; r&eacute;alis&eacute;e avec &eacute;tude hiostologique confirmant le diagnostic d'hidrocystome.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Muwada Bashir Awad Bashir, Israa Mohammed Alfatih Hussein Albaawy, Samuel Nambile Cumber [Research] - Predictors and correlates of examination anxiety and depression among high school students taking the Sudanese national board examination in Khartoum state, Sudan: a cross-sectional study - 29 May 2019. http://www.panafrican-med-journal.com/content/article/33/69/abstract/ <b>INTRODUCTION: Test anxiety and depression are of the major challenges experienced in students' life, considering the inverse associations they have on their mental wellbeing and academic performance. Evidence from Sudan have reported high figures of adolescent's mental health problems of depression and anxiety. However, studies investigating its association with academic exam stress are lacking. We investigated the prevalence of exam anxiety and depression severity among student setting for Sudan national boarding examination, aiming at identifying possible predictors related to student's socio-demographic and academic status and measuring correlation between exam anxiety and depression severity status among students. METHODS: using cross-sectional design, data obtained using standardized west side anxiety scale for measuring test anxiety; and patient's health questionnaire (PHQ9) of nine items for measuring depression was presented in percentages. Association with sociodemographic and academic factors was measured using logistic regression models. Analysis was run at 0.05 level of significance. RESULTS: depression and exam anxiety were found to be highly correlated. The highest fractions of students are those with high levels of test anxiety and moderate to severe depression. Gender, maternal level of education, previous exam experience and academic performance are significant predictor for student's exam anxiety status. CONCLUSION: high figures of exam anxiety and depression are there among Sudanese students setting for their third years boarding exam. Males, low academic performance and maternal low education are risk factors. school mental health services and programs addressing such group of students are highly demanded in line with more elaborative research efforts in this arena.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Delia Akosua Bandoh, Ernest Kenu, Donne Kofi Ameme, Samuel Oko Sackey, Fredrick Wurapa, Edwin Andrew Afari [Research] - Sustainability of a field epidemiology and laboratory training programme: the Ghanaian story - 29 May 2019. http://www.panafrican-med-journal.com/content/article/33/68/abstract/ <b>INTRODUCTION: Field Epidemiology Training Programmes (FETPs) are functional ways of strengthening epidemiology, surveillance and outbreak response capacity in countries. However, sustainability of FETPs is a major challenge facing most countries especially in Africa. The Ghana Field Epidemiology and Laboratory Training Program (GFELTP) started in 2007 in the University of Ghana School of Public Health as a solution to gaps in the public health workforce. This paper assessed the sustainability strategies embedded in the Ghana Field Epidemiology and Laboratory Training Programme. METHODS: we assessed the sustainability of GFELTP by document reviews and interviews with programme staff and stakeholders to identify sustainability structures (programme, financial and institutional) that were in place. We grouped information into the following headings: programme structure, institutional, financial and political structures. RESULTS: a total of 350 public health experts have been trained in both frontline and advanced courses since the programme's inception. For funding structures, the programme is funded mainly by its partners and stakeholders who are local government organisations. They provide resources for running of programme activities. Under institutional and political structures, the programme was established as a Ministry of Health/Ghana Health Service programme based in the University of Ghana. The programme steering committee which is currently chaired by the Deputy Director Public Health of Ghana Health Service, jointly ensures its implementation. Other structures of sustainability observed were involvement of stakeholders and alumni in human resource of the programme; use of stakeholders as faculty for the programme. These stakeholders include staff from University of Ghana School of Public Health, Ghana Health Service and Veterinary Service Department, World Health Organization and Centers for Disease Control and Prevention. The programme showed evidence of stable sustainability strategies in all four structures evaluated. CONCLUSION: the assessment found the GFELTP to be sustainable. The main factors that contributed to rendering it sustainable were funding, programme, institutional and political structures embedded in the programme. One remarkable sustainability element observed was the strong collaboration that existed between stakeholders of the programme who worked hand in hand to ensure the programme runs smoothly. However, more sources of funding and other essential resources need to be considered to help the programme obtain a pool of resources for carrying out its activities.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Richard Magodi, Elia John Mmbaga, Julius Massaga, Dafrosa Lyimo, Alex Mphuru, Ahmed Abade [Research] - Factors associated with non-uptake of measles-rubella vaccine second dose among children under five years in Mtwara district council, Tanzania, 2017 - 29 May 2019. http://www.panafrican-med-journal.com/content/article/33/67/abstract/ <b>INTRODUCTION: In 2014, Tanzania introduced the combined measles-rubella vaccine in the routine immunization schedule. Two doses of measles-rubella vaccine (MR1 and MR2) are recommended at 9 and 18 months, respectively. In 2015, MR2 coverage among eligible 18-month-old children in Tanzania was only 57%, lower than the WHO-recommended coverage (95%). During the same period Mtwara District Council (MDC) reported a coverage of 52% which is lower than the nation average. We determined factors associated with non-uptake of MR2 among children in MDC Tanzania. METHODS: we conducted a community-based cross-sectional survey using cluster sampling during January - April 2017 in MDC. Caretakers of children born during January 2014 - January 2015 and residing in MDC for the past three years were recruited. We interviewed participants and reviewed vaccination cards. Logistic regression modeling was employed to identify independent factors associated with uptake of MR2. RESULTS: of 1,000 children assessed, 558 (55.8%) were unvaccinated with MR2. Factors independently associated with non-uptake of MR2 included the caretaker being unaware of the ages for MR1 and MR2 administration [aOR=3.50; 95%CI 1.98?6.21; p<0.001], having MR2 vaccination services offered at the local vaccination station fewer than three days per week [aOR=1.50; 95%CI 1.42-5.59; p<0.001], not having the vaccine available during vaccination days [aOR=3.38; 95%CI 1.08?10.61; p<0.01], unwillingness of health workers to open multi-dose vaccine vials for a single child [aOR=3.80; 95% CI 2.12-6.79; p<0.001], and long waiting times for vaccination services [aOR=1.80; 95% CI 1.08-3.00; p<0.01]. CONCLUSION: more than half the children under five years in MDC were not vaccinated with MR2. Lack of caretaker knowledge about appropriate vaccination age, unavailability of vaccine, having insufficient numbers of children waiting to warrant multidose vial use, and long clinic waiting times were associated with MR2 non-uptake. The community should receive education about MR vaccine; we recommend thorough screening of children?s vaccination status at each clinic visit and provision of vaccine whenever possible. Vaccine distribution should be improved in MDC.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Amani Maleya, Yves Kalume Kakudji, Roger Munan Mwazaz, Joseph Bulenda Nsambi, Hugues Ilunga Ngwej, Olivier Mukuku, Xavier Kinenkinda, Prosper Kakudji Luhete [Research] - Issues materno-fœtales des grossesses non suivies &agrave; Lubumbashi, R&eacute;publique D&eacute;mocratique du Congo - 29 May 2019. http://www.panafrican-med-journal.com/content/article/33/66/abstract/ <b>INTRODUCTION: Les grossesses non suivies se caract&eacute;risent par leur morbi-mortalit&eacute; et maternelle et fœtale importante. Cette s’est fix&eacute; comme objectifs de d&eacute;terminer la fr&eacute;quence des grossesses non suivies, d&eacute;crire le profil sociod&eacute;mographique et &eacute;valuer la morbi-mortalit&eacute; materno-fœtale lors de l’accouchement chez les femmes n’ayant pas suivi de consultations pr&eacute;natales (CPN) dans la ville de Lubumbashi. METHODES: C’&eacute;tait une &eacute;tude transversale analytique des accouch&eacute;es d’une grossesse monofoetale de D&eacute;cembre 2013 &agrave; Mai 2014 dans 10 maternit&eacute;s de r&eacute;f&eacute;rence &agrave; Lubumbashi. Les femmes n’ayant pas suivi les CPN ont &eacute;t&eacute; compar&eacute;es aux femmes qui les avaient bien suivies (CPN&#8805;4). Les param&egrave;tres sociod&eacute;mographiques maternels, la morbi-mortalit&eacute; maternelle et p&eacute;rinatale ont &eacute;t&eacute; analys&eacute;es. L’odds ratio et son intervalle de confiance ont &eacute;t&eacute; calcul&eacute;s. Le seuil de signification a &eacute;t&eacute; fix&eacute; &agrave; une valeur de p<0,05. RESULTATS: Nous avons trouv&eacute; que la fr&eacute;quence de l’absence de suivi de grossesses &eacute;tait de 21,23% et le nombre moyen de consultations pr&eacute;natales &eacute;tait de 2,6 ± 1,9. L’analyse de la relation entre les consultations pr&eacute;natales et les caract&eacute;ristiques sociod&eacute;mographiques des accouch&eacute;es montre que l’absence de suivi &eacute;tait 2,29 fois plus &eacute;lev&eacute;e chez les adolescentes que chez les femmes adultes (OR=2,29 [1,54-3,41]), 4 fois plus &eacute;lev&eacute;e chez les femmes vivant seules que chez celles vivant en union (OR=4,00 [2,05-7,79]) et 4,08 fois plus &eacute;lev&eacute;e chez les femmes de bas niveau de scolarit&eacute; (analphab&egrave;te ou primaire) que chez celles ayant un niveau de scolarit&eacute; &eacute;lev&eacute; (OR=4,08 [3,08-5,40]). Compar&eacute;es &agrave; celles les ayant bien suivis, nous avons que les femmes n’ayant pas suivi de consultations pr&eacute;natales pr&eacute;sentaient un risque &eacute;lev&eacute; d’&eacute;vacuation obst&eacute;tricale (OR=1,90 [1,26-2,95]), de rupture de membranes fœtales &agrave; l’admission (OR=1,31 [1,02-1,68]), de malpr&eacute;sentation fœtale (OR=1,89 [1,03-3,44]), d’accouchement par c&eacute;sarienne (OR=1,78 [1,21-2,63]), d’&eacute;clampsie (OR=3,00 [1,09-8,70]), de rupture ut&eacute;rine (OR=4,76 [1,00-47,19]) et d’an&eacute;mie (OR=2,33 [1,06-5,13]). Les taux de pr&eacute;maturit&eacute; (OR=1,93 [1,33-2,80]), de post-maturit&eacute; (OR=1,47 [1,00-2,30]), de faible poids de naissance (OR=2,33 [1,56-3,46]), de d&eacute;pression n&eacute;onatale (OR=3,89 [2,52-6,02]), de transfert en n&eacute;onatologie (OR=1,60 [1,11-2,32]) et de mortalit&eacute; p&eacute;rinatale (OR=2,70 [1,59-4,57]) &eacute;taient significativement plus &eacute;lev&eacute;s chez les nouveau-n&eacute;s issus des femmes n’ayant suivi de consultations pr&eacute;natales que chez ceux de celles les ayant bien suivis. CONCLUSION: Il ressort de notre &eacute;tude que l’absence de suivi des consultations pr&eacute;natales est associ&eacute;e &agrave; une forte morbidit&eacute; maternelle et une morbi-mortalit&eacute; p&eacute;rinatale &eacute;lev&eacute;e dans notre milieu.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Rachida Bouatay, Rim Ben Nasr, Adnène Moussa, Amel El Korbi, Khaled Harrathi, Jamel Koubaa [Case series] - Int&eacute;r&ecirc;t de la cytoponction &agrave; l'aiguille fine dans le diagnostic des tumeurs parotidiennes - 29 May 2019. http://www.panafrican-med-journal.com/content/article/33/65/abstract/ <b>L'objectif de ce travail &eacute;tait de d&eacute;terminer la valeur diagnostique de la cytoponction &agrave; l'aiguille fine (CPAF) et son apport dans la prise en charge des tumeurs parotidiennes, &agrave; travers une &eacute;tude r&eacute;trospective portant sur 47 patients op&eacute;r&eacute;s d'une tumeur parotidienne et ayant eu une cytoponction pr&eacute;op&eacute;ratoire. Quatre-vingt-un pourcent des malades pr&eacute;sentaient une tumeur b&eacute;nigne et 19% une tumeur maligne. La sensibilit&eacute; et la sp&eacute;cificit&eacute; de la CPAF &eacute;taient respectivement de 78% et de 92%. Les tumeurs parotidiennes ont &eacute;t&eacute; correctement class&eacute;es comme malignes ou b&eacute;nignes dans 89% des cas, le taux d'exactitude globale &eacute;tait de 64,4%. La CPAF est un examen fiable permettant une information pr&eacute;op&eacute;ratoire sur le planning th&eacute;rapeutique et les suites postop&eacute;ratoires.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Abdelouahed Lasri, Mohammed Alae Touzani, Mounir Lahyani, Tarik Karmouni, Khalid Elkhader, Abdellatif Koutani, Ahmed Ibn Attya Andaloussi [Case report] - Angiomyolipome r&eacute;nal &eacute;pith&eacute;lio&iuml;de malin (AREM): &agrave; propos d’un cas rare - 29 May 2019. http://www.panafrican-med-journal.com/content/article/33/64/abstract/ <b>L’angiomyolipome r&eacute;nal &eacute;pith&eacute;lio&iuml;de malin (AREM) est une entit&eacute; pathologique rare longtemps consid&eacute;r&eacute;e comme l&eacute;sion hamartomateuse et dont le diagnostic positif est purement immuno-histochimique, microscopiquement, il se caract&eacute;rise par des cellules mononucl&eacute;es &eacute;pith&eacute;lio&iuml;des a cytoplasme clair pr&eacute;sentant des atypies cytonucl&eacute;aires s&eacute;v&egrave;res, et exprimant les marqueurs musculaires lisses et m&eacute;lanocytaires (HMB 45). Nous rapportons un cas rare d’AREM diagnostiqu&eacute; apr&egrave;s analyse anatomopathologique d’une tumeur retrop&eacute;riton&eacute;ale dont l’origine ne pourrait &ecirc;tre pr&eacute;cis&eacute;e pr&eacute;alablement par la tomodensitom&eacute;trie.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Zied Jlalia, Dhia Kaffel [Images in medicine] - Giant lipoblastoma of the buttock - 28 May 2019. http://www.panafrican-med-journal.com/content/article/33/63/abstract/ <b>Ten years old girl was referred to our consultation for a tumefaction of the right buttock, it was soft consistency and mobile in relation to the deep planes (A). Magnetic resonance imaging reveals a large fatty lobulated mass well encapsulated with septa with low signal T1/T2 (B). Pathological examination of the resection piece confirmed the diagnosis of lipoblastoma (C). Lipoblastoma is a rare benign pediatric tumor derived from embryonic fat. It is often morphologically indistinguishable from primitive myxoid mesenchymal tumor of infancy. Translocations affecting the 8q11–13 region are commonly reported with lipoblastoma and proper diagnosis requires cytogenetic analysis to distinguish it from malignant myxoid liposarcoma. It is important to consider lipoblastoma in the diagnosis of a rapidly enlarging fatty mass in children. Complete resection is the only definitive treatment and should not be delayed when impingement on surrounding structures is imminent.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Sokona Tour&eacute;, Mahamadou Mall&eacute; [Images in medicine] - Chéloïde géante retro-auriculaire droite post-traumatique - 28 May 2019. http://www.panafrican-med-journal.com/content/article/33/62/abstract/ <b>Une ch&eacute;lo&iuml;de c'est une tumeur fibroblastique b&eacute;nigne le plus souvent secondaire &agrave; une cicatrice, mais peut &ecirc;tre spontan&eacute;e chez un sujet &agrave; peau noire. Nous rapportons le cas d'un patient &acirc;g&eacute; de 19 ans, &eacute;lectricien qui a consult&eacute; pour une masse g&eacute;ante retro auriculaire droite, &eacute;voluant depuis deux ans. Depuis quelques temps, le patient ressent une sensation de pesanteur sur le pavillon de l'oreille droite. La l&eacute;sion avait d&eacute;but&eacute; par une plaque dure, prurigineuse, non douloureuse qui a progressivement augment&eacute; de taille. Le patient avait re&ccedil;u &agrave; plusieurs reprises des traitements topiques et antiseptiques sans effet. Il y'avait une notion de blessure traumatique dans le sillon retro-auriculaire droit. Un mois apr&egrave;s, apparait une cicatrice hypertrophique prurigineuse. L'examen physique trouvait une tumeur retro-auriculaire de grande taille (10 × 6cm), couleur peau normale, dure, fixe, non douloureuse &agrave; la mobilisation. La base &eacute;tait sessile. Le reste de l'examen &eacute;tait normal. L'&eacute;chographie &agrave; montre une tumeur cutan&eacute;e peu vascularis&eacute; du sillon retro auriculaire droit de contours plus ou moyens nets, mesurant (9 x 5mm). Nous avions &eacute;voqu&eacute; deux hypoth&egrave;ses diagnostiques: une ch&eacute;lo&iuml;de post-traumatique le plus probable et le dermato-fibrosarcome de Darier Ferrand. Une biopsie a &eacute;t&eacute; r&eacute;alis&eacute;e et l'histologie a conclu &agrave; une ch&eacute;lo&iuml;de. La conduite a &eacute;t&eacute; l'ex&eacute;r&egrave;se chirurgicale intra-marginale. Les pi&egrave;ces op&eacute;ratoires pesaient 75 grammes. les suites op&eacute;ratoires &eacute;taient simples avec disparition de la pesanteur.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Rajaa Msaad, Rajaa Essadik, Karima Mohtadi, Hasnaa Meftah, Halima Lebrazi, Hassan Taki, Anass Kettani, Ghizlane Madkouri, Benyounes Ramdani, Rachid Sa&iuml;le [Research] - Predictors of mortality in hemodialysis patients - 28 May 2019. http://www.panafrican-med-journal.com/content/article/33/61/abstract/ <b>INTRODUCTION: Mortality in patients with chronic renal failure is high compared to the general population. The objective of our study is to evaluate the predictive factors related to mortality in hemodialysis. METHODS: this is a retrospective study involving 126 hemodialysis patients in the Nephrology Department of Ibn Rochd Hospital, Casablanca. Data were collected between January 2012 and January 2016. For each of our patients, we analyzed demographic, clinical, biological and anthropometric data. The Kaplan-Meier method and the log-rank test were used to evaluate and compare survival curves. To evaluate the effect of predictors of mortality, we used the proportional Cox hazard model. RESULTS: the analysis of the results showed that the surviving patients were younger than the deceased patients (43.07±13.52 years versus 53.09±13.56 years, p=0.001). Also, the latter has a significantly lower albumin and prealbumin levels (p=0.01 and p=0.04 respectively). Overall survival was 80.2%. Cox regression analysis at age (HR=1.26, p<0.0002), inflammation (HR=1.15, p<0.03), AIP> 0.24 (HR=2.1, p<0.002) and cardiovascular disease (RR=2.91, p<0.001) were associated with global and cardiovascular mortality. CONCLUSION: our study showed that the mortality rate is high in our cohort. In addition, cardiovascular diseases, under nutrition and inflammation are predictive factors for mortality. Treatment and early management of these factors are essential for reducing morbidity and mortality.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Benjamin Dean Holmes, Ruta Brazauskas, Emmanuel Adoyi Ameh, Oluwole Olayemi Olaomi, Laura Dawn Cassidy [Research] - When walking is bad for your back: a cohort study of risk factors for traumatic spinal injury in Abuja - 28 May 2019. http://www.panafrican-med-journal.com/content/article/33/60/abstract/ <b>INTRODUCTION: This study evaluates characteristics and risk factors of traumatic spinal injuries (TSIs) treated at a trauma center in Abuja, Nigeria. TSIs are a global concern. They are frequently disabling, leading to economic workforce, and quality of life strain. Little is known of the epidemiology of TSIs in Nigeria. METHODS: data were collected from National Hospital Abuja's trauma registry on 3025 patients treated at the hospital between 2014 and 2017. Patient characteristics were compared between spinal and nonspinal injury groups. Multiple logistic regression was used to identify risk factors of TSIs. RESULTS: 15% (452) of all injuries were spinal. Road traffic crashes were a significantly greater cause of spinal (77.4%) than nonspinal (59.4%) injuries (p<0.0001). Pedestrians were involved in 19% (356) of total crashes, occupying a significantly larger proportion of spinal (18.6%) than nonspinal (10.6%) injuries (p<0.0001). Three variables were modeled as risk factors of crash-related TSIs: mode of transportation, age, and gender. Only mode of transportation demonstrated statistical significance, with involvement as a pedestrian showing an adjusted odds ratio of 1.38 (95% confidence interval: 1.03-1.85, p=0.0329). CONCLUSION: determining characteristics and risk factors of TSIs is an essential step in addressing this health concern in Nigeria. Crashes are a significant cause of TSIs, and a quarter of TSI patients involved in a crash are pedestrians. Involvement in a crash as a pedestrian is associated with high risk of TSI. These results can help guide both the development of spinal injury prevention policies and the allocation of resources.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Anass Ayyad, Sahar Messaoudi, Rim Amrani [Case report] - Gangr&egrave;ne cong&eacute;nitale entit&eacute; rare en n&eacute;onatalogie: &agrave; propos d'une observation - 28 May 2019. http://www.panafrican-med-journal.com/content/article/33/59/abstract/ <b>La gangr&egrave;ne n&eacute;onatale est une entit&eacute; rare en n&eacute;onatalogie dont le pronostic est g&eacute;n&eacute;ralement mauvais. L'isch&eacute;mie aigu&euml; des membres est le plus souvent caus&eacute;e par des ph&eacute;nom&egrave;nes thromboemboliques. Bien qu'il existe plusieurs facteurs de pr&eacute;disposition, dans la majorit&eacute; des cas, aucun facteur &eacute;tiologique n'est retrouv&eacute;. L'&eacute;tendue de la gangr&egrave;ne est &eacute;galement variable, allant d'un ou plusieurs doigts ou orteils &agrave; l'ensemble du membre sup&eacute;rieur ou inf&eacute;rieur. Nous rapportons un cas de gangr&egrave;ne cong&eacute;nitale de la main collig&eacute; dans notre formation.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Bouchaib Hemmaoui, Mohamed Sahli, Noureddine Errami, Mohamed Moumni, Ilias Benchafai, Ali Jahidi, Mohamed Zalagh, Fouad Benariba [Case series] - Le nerf laryng&eacute; inf&eacute;rieur: consid&eacute;rations anatomiques et chirurgicales &agrave; propos de 60 thyro&iuml;dectomies - 27 May 2019. http://www.panafrican-med-journal.com/content/article/33/58/abstract/ <b>La chirurgie thyro&iuml;dienne n&eacute;cessite une parfaite connaissance de l'anatomie cervicale et les variations anatomiques, notamment celui du nerf laryng&eacute; inferieur afin d'&eacute;viter des l&eacute;sions iatrog&egrave;nes. L'objectif de notre &eacute;tude &eacute;tait d'analyser les rapports du nerf laryng&eacute; inf&eacute;rieur, l'existence de branches de division nerveuses et une appr&eacute;ciation subjective du calibre du nerf. Il s'agit d'une &eacute;tude prospective sur 1 an incluant 60 patients ayant b&eacute;n&eacute;fici&eacute; d'une thyro&iuml;dectomie. Soixante patients ont b&eacute;n&eacute;fici&eacute; d'une chirurgie sur la glande thyro&iuml;de entre f&eacute;vrier 2014 et janvier 2015 par le m&ecirc;me op&eacute;rateur principal (10 hommes et 50 femmes). L'&acirc;ge moyen de nos patients &eacute;tait de 51 ans. Pour les hommes ont &eacute;t&eacute; r&eacute;alis&eacute;es 6 thyro&iuml;dectomies totales, 2 lobo-isthmectomies gauches et 2 lobo-isthmectomies droites. Pour les femmes ont &eacute;t&eacute; r&eacute;alis&eacute;es 33 thyro&iuml;dectomies totales, 8 lobo-isthmectomies gauches et 9 lobo-isthmectomies droites. &Agrave; droite, le nerf &eacute;tait superficiel par rapport &agrave; l'art&egrave;re dans 71,6% des cas, il &eacute;tait divis&eacute; dans 33,3% des cas et il &eacute;tait anormalement fin dans 16,6% des cas. &Agrave; gauche, le nerf &eacute;tait profond par rapport &agrave; l'art&egrave;re dans 83,3% des cas, il &eacute;tait divis&eacute; dans 15% des cas et il &eacute;tait anormalement fin dans 11,6% des cas. La connaissance des variations anatomiques du nerf laryng&eacute; inferieur est indispensable dans la chirurgie thyro&iuml;dienne, le risque est particuli&egrave;rement important du c&ocirc;t&eacute; droit vu le calibre parfois tr&egrave;s petit et l'existence de branches division plus fr&eacute;quente que du c&ocirc;t&eacute; gauche.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Esma Leila Gouta, Hichem Jerraya, Wejih Dougaz, Mohamed Ali Chaouech, Ibtissem Bouasker, Ramzi Nouira, Chadly Dziri [Case series] - Endogenous hyperinsulinism: diagnostic and therapeutic difficulties - 27 May 2019. http://www.panafrican-med-journal.com/content/article/33/57/abstract/ <b>Endogenous hyperinsulinism is an abnormal clinical condition that involves excessive insulin secretion, related in 55% of cases to insulinoma. Other causes are possible such as islet cell hyperplasia, nesidioblastosis or antibodies to insulin or to the insulin receptor. Differentiation between these diseases may be difficult despite the use of several morphological examinations. We report six patients operated on for endogenous hyperinsulinism from 1st January 2000 to 31st December 2015. Endogenous hyperinsulinism was caused by insulinoma in three cases, endocrine cells hyperplasia in two cases and no pathological lesions were found in the last case. All patients typically presented with adrenergic and neuroglycopenic symptoms with a low blood glucose level concomitant with high insulin and C-peptide levels. Computed tomography showed insulinoma in one case out of two. MRI was carried out four times and succeeded to locate the lesion in the two cases of insulinoma. Endoscopic ultrasound showed one insulinoma and provided false positive findings three times out of four. Intra operative ultrasound succeeded to localize the insulinoma in two cases but was false positive in two cases. Procedures were one duodenopancreatectomy, two left splenopancreatectomy and two enucleations. For the sixth case, no lesion was radiologically objectified. Hence, a left blind pancreatectomy was practised but the pathological examination showed normal pancreatic tissue. Our work showed that even if morphological examinations are suggestive of insulinoma, other causes of endogenous hyperinsulinism must be considered and therefore invasive explorations should be carried out.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Abderrahmane Moulaye [Case series] - &Eacute;valuation des &eacute;tudiants, internes et r&eacute;sidents sur la pratique de la ponction lombaire au cours des stages hospitaliers - 24 May 2019. http://www.panafrican-med-journal.com/content/article/33/56/abstract/ <b>Bien que la ponction lombaire soit reconnue comme &eacute;tant d'un grand apport dans le diagnostic de certaines maladies neurologiques, les modalit&eacute;s d'apprentissage de ce geste technique restent encore mal d&eacute;finies dans la formation de nos &eacute;tudiants lors de leurs stages cliniques. L'appr&eacute;hension li&eacute;e au manque d'exp&eacute;rience et la peur de l'&eacute;chec font que ces derniers d&eacute;laissent la pratique de ce geste. Notre objectif &eacute;tait d'&eacute;valuer les comp&eacute;tences des &eacute;tudiants de la Facult&eacute; de M&eacute;decine de Nouakchott sur la pratique de la ponction lombaire et d'appr&eacute;cier leur ressenti subjectif vis-&agrave;-vis de ce geste. Nous avons men&eacute; au mois de mai 2017 une enqu&ecirc;te aupr&egrave;s des internes, des r&eacute;sidents, et des &eacute;tudiants inscrits en TCEM (Troisi&egrave;me cycle des &eacute;tudes m&eacute;dicales) et en DCEM 4 (Deuxi&egrave;me cycle d'&eacute;tudes de m&eacute;decine en 4 ans.) Pour cela, un questionnaire anonyme sur l'enseignement et la pratique de la ponction lombaire a &eacute;t&eacute; &eacute;labor&eacute; et rempli par 92 participants. L'analyse des donn&eacute;es de cette &eacute;tude a &eacute;t&eacute; effectu&eacute;e sur un logiciel SPSS, version 20. Sur un total de 105 fiches de questionnaire, nous n'avons pu en exploiter que 92, soit un taux de participation de 87,6%. Il y avait 67 gar&ccedil;ons pour 25 filles. Douze participants n'ont jamais pratiqu&eacute; la moindre ponction lombaire, le plus souvent par manque de confiance en eux-m&ecirc;mes. Pr&egrave;s de 10% des &eacute;tudiants n'ont jamais appris &agrave; faire ce geste et 22% l'ont appris sans &ecirc;tre supervis&eacute;s par un m&eacute;decin senior. Le taux d'&eacute;chec lors de la premi&egrave;re ponction &eacute;tait de 45% chez nos stagiaires. Peu d'entre eux reconnaissent (7,5%) qu'ils prescrivent une s&eacute;dation ou une anesth&eacute;sie locale au patient avant la r&eacute;alisation de la ponction lombaire (PL). La position assise &eacute;tait de loin plus utilis&eacute;e que le d&eacute;cubitus lat&eacute;ral, mais 30% des &eacute;tudiants d&eacute;clarent qu'ils ont utilis&eacute; les 2 positions. Le but de la PL (ponction lombaire) &eacute;tait diagnostiqu&eacute;e &agrave; 69%, mais dans 25% des cas elle a &eacute;t&eacute; r&eacute;alis&eacute;e dans un but &agrave; la fois diagnostique et th&eacute;rapeutique. Les indications diagnostiques &eacute;taient domin&eacute;es par les m&eacute;ningites et les m&eacute;ningo-enc&eacute;phalites tandis que l'hydroc&eacute;phalie &agrave; pression normale constituait le premier motif des PL th&eacute;rapeutiques. Au d&eacute;cours d'une PL, les complications rencontr&eacute;es par nos stagiaires &eacute;taient surtout une PL traumatique suivie par les c&eacute;phal&eacute;es. Le Service de P&eacute;diatrie &eacute;tait celui o&ugrave; les &eacute;tudiants ont pratiqu&eacute; le plus de PL (35%), suivi par la Neurologie (29%), les Urgences (19%) et la M&eacute;decine interne (9%). Les r&eacute;sultats de notre enqu&ecirc;te montrent que la ponction lombaire reste encore pour nombre d'&eacute;tudiants comme un geste difficile et risqu&eacute;, et qu'ils ne sont pas suffisamment pr&eacute;par&eacute;s pour l'affronter. Les modalit&eacute;s d'enseignement et d'apprentissage de ce geste technique devraient &ecirc;tre revues par les encadreurs qui pourraient int&eacute;grer de nouvelles techniques telles que la simulation sur mannequins comme c'est le cas actuellement dans la plupart des pays d&eacute;velopp&eacute;s.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com El Mahdi Graiouid, Youness Chakir, Messian Gallouo, Mohammed Dakir, Adil Debbagh, Rachid Aboutaieb [Case report] - Rhabdomyosarcome paratesticulaire: &agrave; propos d’un cas - 24 May 2019. http://www.panafrican-med-journal.com/content/article/33/55/abstract/ <b>Le rhabdomyosarcome (RMS) para-testiculaire est une tumeur rare. Le traitement doit &ecirc;tre multimodal et fait appel &agrave; la chirurgie, &agrave; la chimioth&eacute;rapie et &agrave; la radioth&eacute;rapie. &Agrave; la lumi&egrave;re de cette observation et d'une revue de la litt&eacute;rature, les auteurs discuteront les modalit&eacute;s diagnostiques et th&eacute;rapeutiques.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Sonia Hmad, Jihene Maatoug, Imed Harrabi, Rim Ghammem, Mylene Belkacem, Mounir Saadi, Souad Amimi, Khaoula Knani, Mustafa Al’Absi, Harry Lando, Najib Mrizak , Hassen Ghannem [Corrigendum] - Corrigendum: Clustering of chronic disease risk factors with tobacco smoking habits among adults in the work place in Sousse, Tunisia - 24 May 2019. http://www.panafrican-med-journal.com/content/article/33/54/abstract/ <b>This corrigendum corrects article "Clustering of chronic disease risk factors with tobacco smoking habits among adults in the work place in Sousse, Tunisia" and its publication references ie The Pan African Medical Journal. 2016 Jul 12;24:220. eCollection 2016. DOI: 10.11604/pamj.2016.24.220.7163.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Agust&#237;n Buero, Silvia Quadrelli, Leonardo German Pankl, Felix Vigovich [Case report] - Two-year disease remission of an unresectable basaloid thymic carcinoma with second line chemotherapy drugs: report of a case - 24 May 2019. http://www.panafrican-med-journal.com/content/article/33/53/abstract/ <b>Thymic carcinomas are extremely infrequent neoplasms (15% of all thymic epithelial tumors). Basaloid carcinoma is a peculiar tumor that represents no more than 2% of those infrequent thymic carcinomas. Surgical excision is the recommended treatment. As it's extremely rare, there is no evidence of the impact of different modalities of treatment. There are no reported cases that did not include surgery as part of their management. We herein present a case of an unresectable thymic basaloid carcinoma treated only with concurrent chemotherapy and radiotherapy that obtained a complete remission and free of disease after 2 years.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Judite Monteiro Braga, Lucas Nhantumbo, António Nhambomba, Esmeralda Cossa, Crescêncio Nhabomba, Tomas Dimas, Daniela Monteiro Nunes, Cristolde Salomão, José Paulo Langa, Cynthia Baltazar, Jonas Brant [Research] - Epidemiological profile of health consultations during the Mozambique 9th National Cultural Festival, August 2016 - 23 May 2019. http://www.panafrican-med-journal.com/content/article/33/52/abstract/ <b>INTRODUCTION: The use of mass gatherings as spaces to practice health surveillance has been growing in recent years. In Mozambique, the 9th National Festival of Culture in 2016 was selected for this practice. A specific public health surveillance system to facilitate rapid detection of outbreaks and other health-related events was implemented for this event with real time data collection and analysis. METHODS: a descriptive epidemiological evaluation of all the health consultations that occurred in fixed posts prepared for the event was conducted. The data were collected through electronic mobile system (tablets) in real time, with the aid of a form designed for this purpose and sent directly to the incident command system (ICS). RESULTS: during the event, a total of 355 patients were assisted, 52.3% were female, 87.0% were from Beira City, and the artists were the group that most frequently sought health care at 59.4%. The largest number of visits took place on the third day (36.4%). People over 45 years of age were the age group that most frequently sought health care (30.8%). The main provisional diagnoses of those who were attended to during the festival was arterial hypertension (20.3%), followed by febrile syndrome (19.0%), with falls being the most frequent causes of trauma during the festival (60.0%). CONCLUSION: the system of monitoring in real time using mobile technologies proved to be efficient for the monitoring of the main health events during the mass gatherings. This profile of health consultations encourages the health sector to plan strategies and actions geared to the reality of care for this type of event.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Michele Grieco, Giorgia Polti, Lara Lambiase, Diletta Cassini [Case report] - Jejunal multiple perforations for combined abdominal typhoid fever and miliary peritoneal tuberculosis - 23 May 2019. http://www.panafrican-med-journal.com/content/article/33/51/abstract/ <b>Typhoid fever and tuberculosis, considered rare diseases in western countries, is still considered a notable problem of health issue in developing countries. The gastrointestinal manifestations of typhoid fever are the most common and the typhoid intestinal perforation (TIP) is considered the most dangerous complication. Abdominal localization of tuberculosis is the 6th most frequent site for extra pulmonary involvement, it can involve any part of the digestive system, including peritoneum, causing miliary peritoneal tuberculosis (MPT). This is the case report of a 4 years old girl with multiple jejunal perforations in a setting of contemporary miliary peritoneal tuberculosis and typhoid fever occurred in "Hopital Saint Jean de Dieu" in Tanguiet&agrave;, north of Benin. The patient was admitted in the emergency department with an acute abdomen and suspect of intestinal perforation, in very bad clinical conditions, underwent emergency laparotomy. The finding was a multiple perforations of the jejunum in a setting of combined abdominal typhoid fever and miliary peritoneal tuberculosis. Typhoid intestinal perforations and peritoneal tuberculosis are a very rare cause of non-traumatic peritonitis in western country, but still common in developing country. Considering the modern migratory flux and the diffusion of volunteer missions all around the world, the western surgeon should know this pathological entities, and the best treatments available, well known by surgeons with experience of working in developing countries. The combination of both TIP and MPT in the same patient, is a very rare finding which can worsen the outcome of the patient itself.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Camillo Lamanna, Lauren Byrne [Research] - A pilot study of a novel, incentivised mHealth technology to monitor the vaccine supply chain in rural Zambia - 22 May 2019. http://www.panafrican-med-journal.com/content/article/33/50/abstract/ <b>INTRODUCTION: The World Health Organization estimates that up to half of vaccines are wasted, however only a minority of mHealth programs in Africa have been directed at vaccine supply chain optimisation. We piloted a novel mHealth solution dependent only on SMS technology that allowed workers in rural health centres in Zambia to report vaccine stock levels directly to an online platform. Small airtime incentives were offered to encourage users to engage with the system, as well as weekly reminder messages asking for stock updates. METHODS: the primary outcome measured was the percentage-of-doses-tracked, calculated over the study period. Each vaccine box was randomly allocated to offer either a standard or double airtime incentive and either weekly or daily reminders, in a 2 x 2 design; ANOVA was used to calculate if any of these factors affected time-to-reply. RESULTS: over the study period, the total percentage-of-doses-tracked was 39.9%. Within the subset of users who sent at least one message to the platform, the percentage-of-doses-tracked was 93.8%. There was no significant difference in average time-to-reply between the standard airtime incentive and double airtime incentive groups, nor was there a significant difference between the standard reminder and daily follow-up reminder groups. CONCLUSION: this pilot study found that in an active subgroup of health workers, an incentivised mHealth solution was able to collect tracking data for 93.8% of doses. More research is needed to identify methods to encourage healthcare workers to engage in timely stock reporting practices.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mehdi Hasnaoui, Mohamed Masmoudi, Nouha Ben Abdeljelil, Nouha Ben Hmida, Nabil Driss [Case report] - A rare case of primary inverted papilloma of the middle ear - 22 May 2019. http://www.panafrican-med-journal.com/content/article/33/49/abstract/ <b>Inverted papilloma (IP) of the middle ear as a primary lesion or as an extension of a sinonasal papilloma, is extremely rare. Only 23 cases of primary inverted papilloma of the middle ear have been reported in the literature. They are locally aggressive tumours, with a high rate of recurrence and associated malignancy. We present a rare case of a 59-year-old man presenting with unilateral otorrhoea, tinnitus, and hearing loss. Otoscopy revealed posterior perforation filled by irregular budding neoformation. The temporal CT scan showed tissue filling the tympanic cavity as well as the mastoid antrum without bone lysis. The patient underwent limited tympanoplasty. An intraoperative biopsy of polypoid tissue filling the tymapanic cavity was made and histopathology showed an IP. A recurrence occurred 4 months after surgery. We performed open tympanoplasty allowing complete resection of the lesions, with no recurrence after a follow-up of 30 months.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Rosa Belkaid, Malek Benakli, Naima Hammoudi-Bendib, Nadjia Ramdani-Bouguessa, Lamine Mahi [Research] - Perception de la carence martiale et de l'an&eacute;mie ferriprive par les m&eacute;decins de diff&eacute;rentes sp&eacute;cialit&eacute;s en Alg&eacute;rie en 2016: enqu&ecirc;te SUPFER DZ - 22 May 2019. http://www.panafrican-med-journal.com/content/article/33/48/abstract/ <b>INTRODUCTION: Les m&eacute;thodes de diagnostic et la prise en charge de la carence martiale et de l'an&eacute;mie ferriprive en pratique clinique en Alg&eacute;rie restent mal connues. METHODES: enqu&ecirc;te transversale r&eacute;alis&eacute;e en 2016 aupr&egrave;s de m&eacute;decins de diff&eacute;rentes sp&eacute;cialit&eacute;s concern&eacute;s par la prise en charge de l'an&eacute;mie ferriprive. RESULTATS: pour l'analyse des donn&eacute;es, 349 questionnaires ont &eacute;t&eacute; valid&eacute;s(anesth&eacute;sie/r&eacute;animation: 39; gyn&eacute;cologie/obst&eacute;trique: 111; oncologie/h&eacute;matologie: 71; h&eacute;pato-gastroent&eacute;rologie: c64; cardiologie: 36; m&eacute;decine interne: 28). Toutes sp&eacute;cialit&eacute;s confondues, 73%(254/349) des m&eacute;decins estimaient que l'an&eacute;mie ferriprive concernait au moins 30% de leur patient&egrave;le 65%(226/349) estimaient que la carence martiale concernait au moins 30% de leur patient&egrave;le. La carence martiale &eacute;tait explor&eacute;e syst&eacute;matiquement par 57%(63/111) des m&eacute;decins du groupe gyn&eacute;cologie/obst&eacute;trique, mais par 11%(26/238) seulement des autres m&eacute;decins; en effet, 82%(195/238) ne la recherchaient qu'en cas d'an&eacute;mie. Dans le cadre d'un bilan de carence martiale, l'h&eacute;moglobine (Hb) &eacute;tait presque toujours &eacute;valu&eacute;e (89%; 310/349) alors que les examens biologiques qui ciblent directement le m&eacute;tabolisme du fer l'&eacute;taient insuffisamment: par 70%(244/349) des m&eacute;decins pour la ferritine s&eacute;rique et par seulement 37%(128/349) pour le coefficient de saturation de la transferrine. En cas de carence martiale (avec ou sans an&eacute;mie), le fer oral &eacute;tait prescrit par 92%(322/349) des m&eacute;decins et 36%(127/349) prescrivaient du fer injectable en tenant compte essentiellement du taux d'Hb. CONCLUSION: cette enqu&ecirc;te montre que la carence martiale semble n'&ecirc;tre envisag&eacute;e que dans le cadre de l'an&eacute;mie. En particulier, les examens biologiques sp&eacute;cifiques de la carence martiale sont insuffisamment prescrits.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Martine Claude Etoa Etoga, Gilbert Akwa, Anne Ongmeb Boli, Ahmadou Musa Jingi, Jean-Claude Njabou Katte, Nelly Sandra Ndam Ngambou, Brigitte Wandji, Mesmin Dehayem, Jean Claude Mbanya, Simeon-Pierre Choukem, Eugene Sobngwi [Research] - The clinical and psychological profiles of patients with hypogonadism, followed in 3 reference hospitals of Cameroon: an observational study - 22 May 2019. http://www.panafrican-med-journal.com/content/article/33/47/abstract/ <b>INTRODUCTION: Hypogonadism refers to a syndrome that results from failure of gonads to function properly. The main concern is considerable rise in morbidity, as shown by increased cardiovascular risk, infertility, osteoporosis and above all, the psychological impact on the life of the patients with hypogonadism. Judicious steroid replacement and culturally-sensitive psychological support before and during steroid therapy remains the key tool in the management of this condition. The present study aimed at filling the knowledge gap on hypogonadism in Cameroon. METHODS: we conducted a cross-sectional study over a period of 12 months, in 3 reference hospitals of Cameroon. We included males and females diagnosed with hypogonadism, aged 16 to 50 years and 16 to 45 years respectively. After a complete clinical examination, patients were invited to fill the modified middlesex hospital questionnaire for psychoneurotic evaluation. RESULTS: we recruited 59 patients with a sex ratio of 1:1. The mean age of the females and males were 27.7 ± 9.1 years and 30.8 ± 11.7 years respectively. Normosmic Idiopathic Hypogonadotropic Hypogonadism (NIHH) was the most common presentation. Compulsive obsessive traits, phobic anxiety and hysterical trait, were most pronounced in these patients. Testosterone titers significantly correlated positively with testicular size and negatively with body mass index (BMI). A significant positive correlation was found between the testicular volumes measured with ultrasound (US) and with the orchidometer.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ines Zemni, Imène Sassi, Nedia Boujelbene, Sabrine Haddad, Raoudha Doghri, Riadh Chargui, Khaled Rahal [Case report] - Vulvar Darier-Ferrand dermatofibrosarcoma: unusual localization of a rare tumor - 22 May 2019. http://www.panafrican-med-journal.com/content/article/33/46/abstract/ <b>Dermatofibrosarcoma protuberans (DFSP) is a low-to-intermediate grade sarcoma of dermal origin that rarely presents in the vulva, typically occurring on the trunk of young to middle-aged adults. Even though it has a low potential for distant metastases, it often recurs locally. Therefore, surgical excision is the treatment of choice. We report a case of DFSP with fibrosarcoma transformation involving the vulva treated by large excision with tumor free margins followed by plastic reconstruction. Our aim is to highlight this rare disease and through literature evaluate the safety and efficacy of surgical treatment. Early recognition of this rare entity whose localization and the aggressive nature of the fibrosarcomatous component will be an issue in the surgical management.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Anthelme Kouessi Agbodande, Roger Leoubou Dodo, Aoulath Issa, Sonia Adjadohoun, Angèle Azon-Kouanou, Armand Finangnon Wanvoegbe, Mohamed Djivèdé Akanni, Roberto Prudencio, Djimon Marcel Zannou, Fabien Houngbe [Case report] - Une localisation rare de la tuberculose: la tuberculose endom&eacute;triale - 21 May 2019. http://www.panafrican-med-journal.com/content/article/33/45/abstract/ <b>La tuberculose demeure un probl&egrave;me de sant&eacute; publique, surtout dans les pays en voie de d&eacute;veloppement. Si la forme pulmonaire bacillaire est la plus fr&eacute;quente, la forme g&eacute;nitale est rare et sous-diagnostiqu&eacute;e. Nous rapportons un cas de tuberculose de l’endom&egrave;tre. Il s’agit d’une patiente de 72 ans ayant une h&eacute;moglobinopathie SC qui a consult&eacute; son gyn&eacute;cologue pour des leucorrh&eacute;es trainantes. L’examen cytobact&eacute;riologique des pr&eacute;l&egrave;vements vaginaux a mis en &eacute;vidence un Str&eacute;ptococcus agalactatiae. Malgr&eacute; une antibioth&eacute;rapie adapt&eacute;e, l’&eacute;volution a &eacute;t&eacute; marqu&eacute;e par une persistance des leucorrh&eacute;es. L’&eacute;chographie pelvienne a objectiv&eacute; un endom&egrave;tre &eacute;paissi avec une image hyper&eacute;chog&egrave;ne du fond de l’ut&eacute;rus, &eacute;vocatrice de tumeur de l’endom&egrave;tre. L’examen anatomopathologique des pi&egrave;ces de curetage biopsique de l’endom&egrave;tre a conclu &agrave; une endom&eacute;trite granulomateuse en faveur d’une tuberculose folliculaire. L’&eacute;volution a &eacute;t&eacute; favorable sous traitement antituberculeux. La tuberculose g&eacute;nitale n’est pas exceptionnelle et doit &ecirc;tre &eacute;voqu&eacute;e devant une leucorrh&eacute;e persistante malgr&eacute; un traitement adapt&eacute; en milieu d’end&eacute;mie tuberculeuse.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Aissam El Maataoui, Lamiae Ennefah, Aziza Mounach, Hamza Toufik, Sellama Nadifi, Abdellah El Maghraoui, Zahra Ouzzif [Research] - Relationships of plasma total homocysteine (HCY), folates and vitamin B12 levels to vertebral fracture and bone mineral density in Moroccan healthy postmenopausal women - 21 May 2019. http://www.panafrican-med-journal.com/content/article/33/44/abstract/ <b>INTRODUCTION: A potential role of Homocysteine (HCY) in bone metabolism has been considered from the observation of high prevalence of osteoporosis in subjects with Homocystinuria about 50 years ago. But the mechanism linking the increased level of HCY to increased fracture risk is not clear. The objective of this study was to investigate this possible relationship between vertebral fractures and HCY level in Moroccan postmenopausal women. METHODS: one hundred and twenty-two healthy postmenopausal women gave their informed consent to participate in this cross-sectional study. Women were recruited through advertisements and mouth to ear between January 2017 and May 2017. Bone mineral density was determined by a Lunar Prodigy Vision DXA system. Vertebral fracture assessment image was inspected visually by 2 clinicians. RESULTS: we found that a high level of HCYor low levels of vitamin B12 and folates are not associated to the bone mineral density and are not risk factors for vertebral fractures in healthy postmenopausal women. Whereas, the presence of vertebral fracture was associated to the number of years since menopause and to the OC level. Probably this is due to the young age of the patients involved in this study. We also showed that high level of HCY is associated with the number of years since menopause and not age for women. CONCLUSION: we found that a high level of HCY or low levels of vitamin vitamin B12 and folates are not associated to the bone mineral density and are not risk factors for vertebral fracture in healthy Moroccan postmenopausal women.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Oluwasola Julius Oke, kazeem Olarenwaju Amoo, Ifeoluwa Alex Akinwumi, Omomayowa Omotola Fawale, Adewuyi Temidayo Adeniyi, Emmanuel Oluwatosin Adeniji, Hammed Hassan Adetola, Busayo Gideon Ologun, Oluwatobi Faith Folarin, Dedmilade Kehinde Kuti [Case report] - Carpopedal spasm in a 4 year old boy with persisted vomiting and dyselectrolytemia in Wesley Guild Hospital Ilesa - 21 May 2019. http://www.panafrican-med-journal.com/content/article/33/43/abstract/ <b>Carpopedal spasm have various causes ranging from dsyselecrolytemia,syndromic, metabolic or endocrine causes. Any of these could cause a decrease in ionized calcium and tetany. Excessive vomiting leading to alkalosis, hypokaleamia and decreased ionised calcium should be kept in mind for early etiological diagnosis of carpopedal spasm. We report a case of 4-year-old boy presenting with a history of recurrent painful spasm and flexion of bilateral hands following excessive vomiting and electrolyte derangement.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Jackie Kleynhans, Florette Kathleen Treurnicht, Cheryl Cohen, Theesan Vedan, Mpho Seleka, Lwando Maki, Anne von Gottberg, Kerrigan McCarthy, Wayne Ramkrishna, Meredith McMorrow, Sibongile Walaza [Research] - Outbreak of influenza A in a boarding school in South Africa, 2016 - 21 May 2019. http://www.panafrican-med-journal.com/content/article/33/42/abstract/ <b>INTRODUCTION: We investigated an outbreak of influenza-like illness (ILI) at a boarding school in Eastern Cape Province, South Africa. We aimed to confirm the etiological agent, estimate attack rates and identify risk factors for illness. METHODS: we conducted a retrospective cohort study including senior school boarders (n=308). Students with ILI (cough and fever) were identified through school medical records. We also conducted a questionnaire-based cross-sectional study among senior students including boarders (n=107) and day students (n=45). We collected respiratory specimens for respiratory pathogen testing by real-time polymerase chain reaction from a subset of symptomatic students. We calculated attack rates of medically attended ILI (medILI) and identified factors associated with medILI using logistic regression. We calculated seasonal influenza vaccine effectiveness (VE) against medILI. RESULTS: influenza A (H3N2) virus was detected in 61% (23/38) of specimens. Attack rate for medILI was 13% among boarders (39/308) in the cohort study and 20% in both day students (9/45) and boarders (21/107) in the cross-sectional study. Playing squash was associated with medILI (aOR 5.35, 95% confidence interval [95% CI]: 1.68-17.07). Of the boarders, 19% (57/308) were vaccinated before the outbreak. The adjusted VE against medILI was 18% (aOR 0.82, 95% CI 0.38-1.78). The outbreak led to cancellation of several events and the need for academic remedial sessions. CONCLUSION: we confirmed an influenza A (H3N2) virus outbreak with a high attack rate. The outbreak affected academic and sports activities. Participation in sports and social gatherings while experiencing ILI should be discouraged to reduce viral transmission and impact on school activities.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Zied Jlalia, Dhia Kaffel [Images in medicine] - Primary synovial chondromatosis of the hip joint in children - 21 May 2019. http://www.panafrican-med-journal.com/content/article/33/41/abstract/ <b>A sixteen-year-old patient consulted for right hip pain, with limited mobility and no fever. Standard radiograph of the hip shows widening of the joint space with organized calcifications of the roof of the acetabulum (A). CT scan showed many intra-acetabular osteochondroma (B). The hip was approached anteriorly, without dislocation of the femoral head. Multiple free chondromes and some adherents to the acetabulum were found (C). The diagnosis was confirmed by anatomopathological study. The follow-up was good with recovery of mobility. Primary synovial chondromatosis is a benign synovial dystrophy, characterized by the formation of cartilaginous nodules (chondromas) that may ossify secondarily in a joint or synovial sheath. Its evolution is slow and asymptomatic at its beginning. It is a cause of lameness in children and often poses a problem of differential diagnosis with rheumatic arthritis.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fekih Aymen, Othman Youcef, Sa&iuml;di Aymen, Aloui Issam, Abid Abderrazek [Case report] - Triplane fracture of the proximal tibia: a case report and literature review - 21 May 2019. http://www.panafrican-med-journal.com/content/article/33/40/abstract/ <b>Triplane fractures of the proximal tibia are less well known than the distal extremity. The diagnosis is based on a good analysis of X-rays and possibly CT images to better plan the management. The authors reports a triplane fracture of the proximal tibial in a 12 years old boy treated by closed reduction and internal fixation. To our knowledge, only a dozen cases have been reported in the literature with generally a good evolution of the fracture.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Liaqat Ali Chaudhry, Wael Yasin Mohamed Elsadek, Ghazala Aslam Chaudhry, Feddha Eid Al-Atawi [Case report] - Factor XII (Hageman Factor) Deficiency: a rare harbinger of life threatening complications - 21 May 2019. http://www.panafrican-med-journal.com/content/article/33/39/abstract/ <b>Hageman factor (factor XII) has a key role in activation of intrinsic coagulation system gauged by activated partial thromboplastin time (aPPT)). Hageman factor deficiency is more often an autosomal recessive condition, but an autosomal dominant inheritance is also reported. This condition in its own is not known to cause bleeding complications rather is associated with paradoxical fatal thromboembolic complications. Exact prevalence of this condition is not known, as under normal conditions they are asymptomatic. In literature, a prevalence of 2.3% has been reported in one study on 300 patients presenting with complications. Homozygous patients has non-detectable levels of factor XII, while heterozygous individuals has variable levels ranging from 20-60%. Hageman factor is a pro-coagulation protein initiating intrinsic pathway. Intrinsic pathway is activated either by direct contact with a negative charged surface or by proteolytic activation on the endothelial cells via prekallikerin/kallikerin system. Factor XII as an integral part of this system leads to factor XI activation resulting in production of thrombin orchestrated by intrinsic system. In addition, there is concomitant activation of complement components C3 and C5 via C1-estrase activation. Patients with this condition are known to have spontaneous thromboembolic complications although less common but are prone to life threatening complications under provocating circumstances. The aim of this case report is to study the relation of factor XII deficiency and isolated raised activated partial thromboplastin time (aPPT) and how it can be prevented. We are presenting a Saudi female patient, 29 years of age who presented to accident and emergency room (A&E room) of our hospital with sudden severe breathlessness and chest pain.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ngwayu Claude Nkfusai, Samuel Nambile Cumber, Judith K Anchang-Kimbi, Kah Emmanuel Nji, Joyce Shirinde, Nota Damian Anong [Research] - Assessment of the current state of knowledge and risk factors of cervical cancer among women in the Buea Health District, Cameroon - 21 May 2019. http://www.panafrican-med-journal.com/content/article/33/38/abstract/ <b>INTRODUCTION: Cervical cancer is a malignant proliferation of the cells of the uterine cervix and can be treated if diagnosed earlier. It is the second most common gynecological malignancy worldwide and the leading cause of cancer associated mortality among women in Africa and Cameroon. This study sort to determine the current state of knowledge of cervical cancer and its risk factors in the Buea Health District of the South West Region of Cameroon. METHODS: this was a cross-sectional community based survey. We recruited 433 eligible women, in four (4) Health Areas (Molyko, Bolifamba, Muea and Buea Town) of the Buea Health District and used validated and pre-tested questionnaires to collect data. Collected data were keyed into Epi info version 7.2 statistical software and exported to SPSS Version 25 for analysis. Level of significance was set at P-value < 0.05. RESULTS: fifty eight percent (58%) of the participants had good knowledge of cervical cancer. 58.99% (95%CI = 54.30-63.52) had good knowledge on the risk factors of cervical cancer. 40% knew at least one of the following risk factors; cigarette smoking, many sexual partners, family history of cervical cancer, being HIV/AIDS positive and giving birth 5 or more times. There was a significant association, OR = 7.5; 95%CI = 2.14-26.33; P = 0.001; X2 = 11.4 between having heard of cervical cancer and having “good” knowledge of cervical cancer among women in Buea. CONCLUSION: most of the women had heard of cervical cancer but the knowledge of the risk factors of cervical cancer among women aged 18-68 years in the Buea Health District is low. We found no association between awareness and knowledge of risk factors among the women.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Panji Sananta, Andrew Jonatan, Shelby Amrus Ernanda, Ayu Novita Kartikaningtyas, Yanti Marito Parhusip, Yesi Amelia, Elli Maulidya, Muthi’ah Adira Juwono [Research] - Effects of nicotine on markers of bone turnover in ovariectomized rats - 17 May 2019. http://www.panafrican-med-journal.com/content/article/33/37/abstract/ <b>INTRODUCTION: Osteoporosis is characterized by low bone mass and density, as well as change in microarchitecture of bone tissue leading to decreased bone strength. In vitro research shows nicotine can increase osteoblast activity and proliferation, also suppress osteoclast activity. Therefore we explore nicotine anti-resorptive property by in vivo true experimental and randomized posttest only controlled group research that was conducted in 18-20 weeks old Rattus norvegicus. METHODS: twenty-five female rats were divided into five groups, with 5 rats per group. The first group represented normal rats (Sham), while the second to fifth group underwent bilateral ovariectomy. The second group serves as positive control group (ovariectomy-only/OVX). The third to fifth group serve as dose 1 (P1-0.25mg/kg), dose 2 (P2-0.5 mg/kg), and Dose 3 (P3-0.75 mg/kg) treatment group receiving daily per-oral nicotine for 28 days, started 3 weeks post- ovariectomy. After 28 days treatment, the serum was checked. RESULTS: nicotine has dose-dependent manner on serum osteocalcin and serum DPD level. Level of osteocalcin in P2 group was significantly lower (Mann-Whitney, p = 0.008) compared to OVX group (59.4% lower). Level of DPD in all group was not significantly different (ANOVA, p < 0.05) but shows lowest level in P2 group. For serum calcitonin level, there's no significant different between groups. CONCLUSION: nicotine at right low-dose might be able to inhibit osteoclast activity, thus open a possibility of anti-resorptive property of nicotine.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Asaph Ziruma, Misai Hukuimwe, Michael Nyakura, Rumbidzai Majangara, Mervyn Venge [Case report] - A rare case of Meigs syndrome in pregnancy - 16 May 2019. http://www.panafrican-med-journal.com/content/article/33/36/abstract/ <b>We present a case of Meigs syndrome in a 19 year old woman. We suspected metastatic ovarian cancer after she had presented in her first pregnancy at 12 weeks gestation. Ultrasound scan had confirmed a complex solid mass in the left adnexa, measuring 7cm x 8cm, a viable 12 weeks pregnancy and gross ascites. She had elevated Ca 125 and serum beta - HCG. She went on to have a spontaneous miscarriage while being worked up for exploratory laparotomy. At laparotomy, a left sided solid ovarian mass 8cm x 10cm with a smooth surface and intact capsule was found. This was later confirmed to be a fibrothecoma at histology. The patient went on to recover without any further reaccumulation of ascites.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Amoako Duah, Kofi Nyaako Nkrumah [Research] - Prevalence and predictors for spontaneous bacterial peritonitis in cirrhotic patients with ascites admitted at medical block in Korle-Bu Teaching Hospital, Ghana - 16 May 2019. http://www.panafrican-med-journal.com/content/article/33/35/abstract/ <b>INTRODUCTION: Spontaneous bacterial peritonitis (SBP) is one of the most common and life-threatening complications of patients with cirrhotic ascites. Recognition and prompt treatment of this condition is essential to prevent serious morbidity and mortality. This study aimed to determine the prevalence of SBP among in-patients with cirrhotic ascites attending our facility and to determine the clinical and laboratory parameters associated with SBP. METHODS: A cross-sectional study was conducted involving one hundred and three (103) patients admitted at medical block in the Korle-Bu Teaching Hospital (KBTH) with cirrhotic ascites from 25th March, 2016 to 25th November, 2016. Demographic and clinical data were collected using a standardized questionnaire. Ascitic fluid culture and cell count were conducted. Positive ascitic fluid culture and/or ascitic polymorphonuclear leukocyte &#8805;250cells/mm3 were diagnostic for SBP. RESULTS: Of the 103 patients with cirrhotic ascites, the mean age was 43.5 ± 12.2 years. There were fifty eight (58) male patients. The prevalence of SBP was 25.24% (26/103). Majority, 5 (55.6%) of the bacteria isolated from ascitic fluid with SBP was Escherichia coli. Severe ascites and high INR were found to be independent predictors of SBP. CONCLUSION: SBP is common among patients with cirrhotic ascites admitted at KBTH. Severe ascites and high INR were highly suggestive of SBP. Diagnostic paracentesis should be done immediately on admission to confirm the diagnosis irrespective of the clinical characteristics as part of baseline investigation.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Onyenonachi Charity Ihejirika, Obioma Chebechi Nwaorgu, Chikere Ifeanyi Ebirim, Callistus Muodebe Nwokeji [Research] - Effects of intestinal parasitic infections on nutritional status of primary children in Imo State Nigeria - 16 May 2019. http://www.panafrican-med-journal.com/content/article/33/34/abstract/ <b>INTRODUCTION: A cross-sectional study was conducted between the months of April to October 2015, to determine the effects of intestinal parasitic infections (IPIs) on nutritional status of school age children in Owerri and Orlu geographical zones, in Imo State, Nigeria. METHODS: Faecal samples were examined using Kato Katz method and formol-ether concentration techniques, while blood samples were examined using cyamethahaemoglobin method. Anthropometric indices were used as indicators of nutritional status, children whose Height-for-Age, Weight-for-Age and Weight-for-Height were <-2 standard deviation (SD) were classified as stunted, wasted, and underweight respectively. RESULTS: Total prevalence rate of 16.6% was recorded in the study areas with Ascaris lumbricoides (4.0%), Trichuris trichiura (0.6%), Hookworm (1.0%) Taenia sp (0.3%), Entaomeba histolytica (5.3%), Entamoeba coli (2.7%) and Giardia lambia (2.7 Majority (73.4%) of the children had light intensity. Anthropometric study results showed that 79(31.3%) of the children were malnourished. The prevalence of stunting, under-weight and wasting were higher in uninfected (86.1%, 90.0% and 10%) respectively than in infected children (13.9%, 10.0% and 0.0%) respectively, although not significant at p = 0.857, 0.587 and 0.368 respectively. Prevalence of anaemia was 17.4%, anaemia was insignificantly (p = 0.09) higher in infected (21.1%) than in uninfected (16.5%) children. Children that had co-infection recorded higher prevalence (2.2%) of severe anaemia. There was an association (p = 0.002) between anaemia and intensity of helminth infection. Malnutrition was insignificantly (p = 0.319) higher in children with heavy (100.0%) and moderate (75.0%) intensity of helminth infection than children that had light intensity (41.7%) of helminth infection. CONCLUSION: When compared with previous study, there were decline in the prevalence of intestinal parasitic infections and anaemia among school age children. Low intensity parasitemia with intestinal parasites had no significant effect on the malnutrition and haemoglobin profile of the children in the study areas. Therefore, improved sanitation and more deworming efforts should be intensified to ensure further decline in prevalence of intestinal parasitic infections.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Athanasios Syllaios, Spyridon Davakis [Images in medicine] - Herpes Simple Virus proctitis: a diagnostic dilemma between anal disorders - 16 May 2019. http://www.panafrican-med-journal.com/content/article/33/33/abstract/ <b>A 72-year-old man was referred to our surgical outpatient department because of severe anal pain, anal bleeding and itching for the last 5 days. Clinical examination revealed severe efflorescence with painful ulcers around the anus. Laboratory examinations revealed slightly elevated white blood cells count (WBC's= 13.000). There was taken liquid culture from the ulcer and sent for bacterial and virous analysis. The virus culture was positive for Herpes Simple Virus (HSV) type 2. The patient received valacyclovir 500mg per os for 10 days in order to reduce the risk for expansion of the disease as well as for minimizing the frequency and the duration of the relapses as there is no definite treatment. The patient was relieved from the symptoms and the rushing was diminished approximately ten days after the initiation of the appropriate medication. As a result, a high suspicion from physicians is required to diagnose HSV proctitis and surgeons should be aware of sexually transmitted anal diseases for the early detection and appropriate management of those patients, as patients may first appear to surgical outpatient departments seeking for help.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Enongene-Kome Constance, Hermann Ngouakam, Egbe Obinchemti Thomas, Dickson Shey Nsagha [Research] - Community participation in the retention of adults in HIV care in the Muyuka Health District, South-West Region, Cameroon - 16 May 2019. http://www.panafrican-med-journal.com/content/article/33/32/abstract/ <b>INTRODUCTION: Antiretroviral therapy (ART) is vital for people living with HIV (PLWHIV) and a substantial number of HIV/AIDS patients still face stigmatization from family and other members of the community. Stigma could lead to poor retention in HIV care and consequently result in decreased chances of survival and increased risk of HIV transmission. The aim of this study was to determine the retention of patients in HIV care and community participation in the retention of patients in HIV care at the Muyuka Health District, South-West Region, Cameroon. METHODS: this was an analytic cross-sectional retrospective study where 385 hospital records of people living with HIV (PLWHIV) enrolled in HIV care were reviewed, and we administered 348 questionnaires to community members. Data were collected and analysed using bivariate analysis and chi-square test. The Susan Rifkin's scoring method was used to measure community participation. Statistical significance was set at P-value < 0.05. RESULTS: a total number of 112(29.1%) of people living with HIV (PLWHIV) enrolled in HIV care were retained in HIV care against 273(70.9%), who were lost to follow-up over a two year and four months period. Patients on a Zidovudine containing ART regimen were about 7 times more likely to be lost to follow-up (OR 6.92; 95% CI 1.80-26.60, P-value = 0.005). The overall community participation in the retention of adults in HIV care in the Muyuka Health District was low; mean resource allocation score = 2.43, mean leadership score = 1.0; mean organization factor score = 1.30; but the mean needs assessment score was good (4.0). CONCLUSION: retention of patients enrolled in HIV care, and the community participation in the retention were low. Collaborations between health care structures and community initiatives should be resourced to foster continuum of care for people living with HIV (PLWHIV).</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Gaspard T&eacute;kpa, Valentin Fikouma, R&eacute;gis Martial Marada T&eacute;ngothi, Jean de Dieu Longo, Avilah Phrygie Amakad&eacute; Woyengba, Boniface Koffi [Case series] - Aspects &eacute;pid&eacute;miologiques et cliniques de la tuberculose en milieu hospitalier &agrave; Bangui - 15 May 2019. http://www.panafrican-med-journal.com/content/article/33/31/abstract/ <b>La tuberculose (TB) est end&eacute;mique en R&eacute;publique centrafricaine (RCA); son taux d’incidence est estim&eacute; &agrave; 391 pour 100.000 habitants en 2015. Notre objectif &eacute;tait d’&eacute;tudier les aspects &eacute;pid&eacute;miologiques et cliniques actuels de la tuberculose en milieu hospitalier centrafricain. Il s’agissait d’une &eacute;tude analytique r&eacute;trospective portant sur des patients hospitalis&eacute;s dans les Services de M&eacute;decine de l’H&ocirc;pital de l’Amiti&eacute; du 15 avril 2010 au 14 octobre 2011. Les donn&eacute;es ont &eacute;t&eacute; collect&eacute;es &agrave; l’aide d’un questionnaire puis analys&eacute;es avec le logiciel Epi Info 3.5.3. Pour comparer les proportions, le test de chi-carr&eacute; a &eacute;t&eacute; utilis&eacute; avec un seuil de significativit&eacute; de 5%. Sur 220 patients inclus il y avait 128 femmes (58,18%). La moyenne d’&acirc;ge &eacute;tait de 35,69 ± 10,65 ans. Dans 42,70% des cas, les patients &eacute;taient sans profession. La pr&eacute;valence hospitali&egrave;re de la TB &eacute;tait de 10,99%. En moyenne, 12 cas de TB &eacute;taient enregistr&eacute;s chaque mois. Les signes cliniques les plus fr&eacute;quents &eacute;taient: la toux chronique (71,81%), la fi&egrave;vre (96,82%), l’alt&eacute;ration de l’&eacute;tat g&eacute;n&eacute;ral (91,36%) et le syndrome de condensation pulmonaire (63,64%). Les pathologies les plus souvent associ&eacute;es &eacute;taient le VIH/sida (73,36%), le paludisme (48,63%) et l’an&eacute;mie (31,81%). Le d&eacute;lai moyen de diagnostic &eacute;tait de 37,65 jours. Nous avons enregistr&eacute; un taux de mortalit&eacute; de 18,63%. La co-infection TB/VIH et la localisation neuro-m&eacute;ning&eacute;e de la TB &eacute;taient associ&eacute;es &agrave; une forte mortalit&eacute; (p < 0,05). La tuberculose est une maladie fr&eacute;quente &agrave; Bangui et souvent associ&eacute;e &agrave; l’infection &agrave; VIH. Le pronostic est s&eacute;v&egrave;re en cas de localisation neuro-m&eacute;ning&eacute;e. La pr&eacute;vention et le contr&ocirc;le de l’infection &agrave; VIH pourraient contribuer &agrave; r&eacute;duire l’ampleur et de la gravit&eacute; de la TB.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Eric Kwasi Ofori, Seth Kwadjo Angmorterh [Research] - Relationship between physical activity, body mass index (BMI) and lipid profile of students in Ghana - 15 May 2019. http://www.panafrican-med-journal.com/content/article/33/30/abstract/ <b>INTRODUCTION: In Ghana, there is no data regarding physical activity habits and lipid profiles of students. Therefore, the aim of this study was to investigate the relationship between physical activities, Body Mass Index (BMI) and lipid profile of students in Ghana. METHODS: Cluster and systematic sampling techniques were employed to recruit 120 students, aged 18 years and above. This cross-sectional study was carried out among students from the University of Ghana. Biochemical analysis was conducted analysing total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL) and triglycerides (TG) in serum samples. Anthropometry measurements were also taken and BMI calculated. The physical activities, undertaken over a 7-day period, by the students were assessed using the International Physical Activity Questionnaire (IPAQ). RESULTS: 31.7% and 21.7% of the students were overweight and obese respectively. 61.5% of the obese students were engaged in high level physical activity as compared to 45.5% and 36.8% of the normal and overweight students, respectively. Normal weight students and overweight students showed significant differences in means of TC; [(4.56 ± 0.930 mmol/L) and (5.06 ± 0.93 mmol/L), respectively] and also between normal weight group (4.54 ± 0.93 mmol/L) and the obese students (5.24 ± 1.18 mmol/L). Significant correlations were also observed between TG, TC and BMI; and TC and TG, HDL and a strong correlation between LDL and TC (r=0.967). CONCLUSION: Strong correlations between BMI, physical activity and lipid profile indices among students in Ghana. Comprehensive efforts should be applied to reduce the incidence of CVDs among students.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Tchaa Abalo Bakai, Didier Koumavi Ekouevi, Essotoma Beweli, Jean Iwaz, Anne Thomas, Nagham Khanafer, Kariyiare Goilibe, Esseboe Sewu, Yao Kassankogno, Nicolas Voirin [Research] - Satisfaction des b&eacute;n&eacute;ficiaires du r&eacute;gime obligatoire d'assurance maladie des agents publics et assimil&eacute;s &agrave; Lom&eacute;, Togo - 15 May 2019. http://www.panafrican-med-journal.com/content/article/33/29/abstract/ <b>INTRODUCTION: En f&eacute;vrier 2011, le gouvernement togolais a instaur&eacute; un r&eacute;gime obligatoire d'assurance maladie au profit des agents publics et assimil&eacute;s. Quatre ans plus tard, cette &eacute;tude a enqu&ecirc;t&eacute; sur la satisfaction des b&eacute;n&eacute;ficiaires de ce r&eacute;gime dans la commune de Lom&eacute;. METHODES: l'enqu&ecirc;te a &eacute;t&eacute; r&eacute;alis&eacute;e aupr&egrave;s d'un &eacute;chantillon de b&eacute;n&eacute;ficiaires &agrave; l'aide d'un questionnaire anonyme administr&eacute; en face-&agrave;-face &agrave; la sortie de huit &eacute;tablissements de soins. Une analyse des r&eacute;ponses a permis de mesurer le degr&eacute; de satisfaction. Les donn&eacute;es quantitatives ont &eacute;t&eacute; d&eacute;crites &agrave; l'aide de m&eacute;dianes et d'&eacute;tendues interquartiles (EIQ) et les donn&eacute;es qualitatives transcrites verbatim. RESULTATS: parmi 288 sujet sollicit&eacute;s, 279 ont accept&eacute; de participer dont 58% &eacute;taient des femmes et 88% des agents encore en activit&eacute;. L'&acirc;ge m&eacute;dian &eacute;tait de 38 ans (EIQ: 30-47). Une tr&egrave;s grande majorit&eacute; de r&eacute;pondants (93,5%) a consid&eacute;r&eacute; cette assurance maladie « satisfaisante ». La note moyenne de satisfaction globale &eacute;tait de 6/10 (min: 5, max: 9). Les principaux &eacute;l&eacute;ments d'insatisfaction concernaient le refus de prise en charge des affections de longue dur&eacute;e (84% d'insatisfaits), la complexit&eacute; des formalit&eacute;s administratives (84% d'insatisfaits), et les longueurs des d&eacute;lais de prise en charge (67% d'insatisfaits). CONCLUSION: le niveau de satisfaction tr&egrave;s &eacute;lev&eacute; encourage le maintien et le d&eacute;veloppement de ce r&eacute;gime d'assurance maladie au Togo. Toutefois, les &eacute;l&eacute;ments d'insatisfaction devraient faire l'objet d'une prompte attention et de v&eacute;ritables efforts de correction.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Saad Alaoui Mhammedi, Fathia Hamdi, Mohammed Benabdelhak, Yassamine Bentata, Intissar Haddiya [Brief] - L’observance th&eacute;rapeutique: un autre d&eacute;fi &agrave; relever chez l’h&eacute;modialys&eacute; chronique - 15 May 2019. http://www.panafrican-med-journal.com/content/article/33/28/abstract/ <b>La mauvaise observance th&eacute;rapeutique (OT) est fr&eacute;quemment rencontr&eacute;e dans la plupart des maladies chroniques. Elle accro&icirc;t la morbi-mortalit&eacute; et les d&eacute;penses de sant&eacute;. Les patients h&eacute;modialys&eacute;s chroniques ont souvent une OT peu satisfaisante. L'objectif de notre &eacute;tude &eacute;tait d'&eacute;valuer le niveau d'OT chez nos patients h&eacute;modialys&eacute;s chroniques et d'identifier les facteurs pr&eacute;dictifs de mauvaise compliance. Nous avons r&eacute;alis&eacute; une &eacute;tude transversale en novembre 2011 au centre hospitalier d'Oujda. L'OT f&ucirc;t mesur&eacute;e &agrave; l'aide d'un questionnaire: test d'&eacute;valuation de l'observance (TEO) tenant compte &agrave; la fois de l'adh&eacute;sion au traitement m&eacute;dicamenteux et au r&eacute;gime alimentaire. Un taux de 85 % &eacute;tait retenu arbitrairement comme seuil de bonne OT. Un taux entre 57 % et 85 % permet de situer le patient dans une zone d'observance partielle, et un taux inf&eacute;rieur &agrave; 57 % indique la mauvaise OT. Les diff&eacute;rents param&egrave;tres d&eacute;mographiques et clinicobiologiques ont &eacute;t&eacute; analys&eacute;s et nous avons d&eacute;gag&eacute; les facteurs pr&eacute;dictifs de bonne et mauvaise OT. Notre &eacute;tude a port&eacute; sur 101 patients h&eacute;modialys&eacute;s chroniques, le sexe ratio est de 1,2. La moyenne d'&acirc;ge 49,7 ± 15,6. Le TEO a objectiv&eacute; 23,4 % de bons observants, 39,4 % d'observance partielle et 37,2 % de mauvais observants. L'analyse statistique a montr&eacute; que la mauvaise OT est associ&eacute;e au bas niveau socio-&eacute;conomique et intellectuel et la pr&eacute;sence de comorbidit&eacute;s et la longue dur&eacute;e d'h&eacute;modialyse. La bonne OT a &eacute;t&eacute; observ&eacute;e chez les patients d'&acirc;ges extr&ecirc;mes aid&eacute;s par une tierce personne, le nombre r&eacute;duit de m&eacute;dicaments et le niveau intellectuel.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Hannah Iyabo Okunrinboye, Alexander Ndubusi Otakpor, Olayinka Stephen Ilesanmi [Research] - Depression and medication-adherence in patients with hypertension attending a tertiary health facility in South-West Nigeria - 15 May 2019. http://www.panafrican-med-journal.com/content/article/33/27/abstract/ <b>INTRODUCTION: In Nigeria, approximately 4.33 million adults suffer from hypertension and about a third of them do not adhere to prescribed medications. Depression has been reported to significantly predict poor medication adherence. The relationship between medication non-adherence and co-morbid depressive disorder in patients with hypertension has not been adequately explored in this environment. The study aimed to determine the prevalence of depression in patients with hypertension. The association between socio-demographic characteristics and presence of co-morbidity on medication adherence was also determined. METHODS: a cross-sectional descriptive research design was adopted for the study. A socio-demographic questionnaire, the modified Morisky Medication Adherence Scale (MMAS), the Hamilton Rating Scale for Depression (HAM-D) and the Mini International Neuropsychiatric Interview (MINI), were administered to four hundred patients with hypertension attending medical out-patient clinic between August and September 2012. RESULTS: about 43%(168) were aged 61 to 64 years the majority being females, with a female to male ratio of 1.63:1. The prevalence of comorbid depression was 22.8%, made up of mild (21.8%) and moderate (1.0%) depressive episodes only. Depression was commoner among females than males in a ratio of 3:1. A majority of the participants (96.8%) had high medication adherence; 2.8% and 0.4% had moderate and low adherence respectively. Depression was more among patients with good medication adherence. CONCLUSION: the occurrence of mild depressive disorder among hypertensives did not affect the level of medication adherence. Review of antihypertensive drugs should also be done often to ensure patients are not likely to have depressive illness as a side effect of drugs used.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Naomi Joan Faray Adeline, Claudia Geue, Mohsen Rezaei Hermami [Research] - Cost-effectiveness of treating hepatitis C in Seychelles - 15 May 2019. http://www.panafrican-med-journal.com/content/article/33/26/abstract/ <b>INTRODUCTION: Approximately eighty million people around the world are living with hepatitis C, and 700,000 people die every year, due to hepatitis C related complications. In Seychelles, a total of 777 cases of hepatitis C were reported from 2002 to 2016, but up to mid of 2016, the cases were not being treated. Treatment with Harvoni, a combination of sofosbuvir and ledipasvir (SOF/LDV), is now being offered on the condition that the patient does not, or has stopped, injecting drugs. This paper is the first to establish the cost effectiveness of treating all cases of Hepatitis C in Seychelles with Harvoni, as compared to no treatment. METHODS: Data extracted from literature was used to populate an economic model to calculate cost-effectiveness from Seychelles' Government perspective. The model structure was also informed by the systematic review and an accompanying grading of economic models using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) checklist. A Markov model was developed, employing a lifetime horizon and costs and benefits were analysed from a payer’s perspective and combined into incremental cost effectiveness ratios (ICERs). RESULTS: The direct-acting antiviral (DAA), Harvoni, was found to be cost-saving in Seychelles HCV cohort, as compared to no treatment, with an ICER of € 753.65/QALY. The treatment was also cost-saving when stratified by gender, with the ICER of male and female being € 783.74/QALY and € 635.20/QALY, respectively. Moreover, the results obtained from acceptability curves showed that treating patients with Harvoni is the most cost-effective option, even for low thresholds. CONCLUSION: Treating hepatitis C cases in Seychelles is cost-saving. It is worth developing a treatment programme to include all cases of hepatitis C, regardless of status of drug injection.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mahmoud Amine Laffinti, Jalal El Ouadoudi, Hicham Guennouni Hassani, Rachid Najib, Abdeslam Benali [Case report] - Cortico&iuml;des et culture: un cas d'&eacute;pisode psychotique aigu cortico-induit - 15 May 2019. http://www.panafrican-med-journal.com/content/article/33/25/abstract/ <b>Les effets secondaires psychiatriques des cortico&iuml;des sont d&eacute;crits depuis longtemps. Certaines r&eacute;actions sont s&eacute;v&egrave;res et concernent environ 5% des patients. Ces effets secondaires sont plus difficiles &agrave; &eacute;valuer lorsque le recours aux cortico&iuml;des sort du cadre th&eacute;rapeutique habituel et s'int&egrave;gre dans une autom&eacute;dication en lien avec certaines influences culturelles. Nous rapportons le cas d'une jeune femme ayant pr&eacute;sent&eacute; un &eacute;pisode psychotique aigu dans les suites d'une auto-prise de cortico&iuml;des dans un but de gain de poids. Nous discutons l'int&eacute;r&ecirc;t d'un diagnostique et d'une prise en charge pr&eacute;coce ainsi que l'importance du volet pr&eacute;ventif multidisciplinaire, en particulier devant l'implication de l'aspect culturel dans l'observation pr&eacute;sent&eacute;e.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Asmaa Sqalli Houssaini, Badreddine Hassam [Images in medicine] - M&eacute;susage des dermocorticoides: une image vaut mille mots - 14 May 2019. http://www.panafrican-med-journal.com/content/article/33/24/abstract/ <b>Les dermocortico&iuml;des (DC) constituent le traitement de premi&egrave;re intention du psoriasis l&eacute;ger &agrave; mod&eacute;r&eacute;. Malgr&eacute; leur relative innocuit&eacute;, l'utilisation &agrave; long terme et surtout par auto-m&eacute;dication pourrait exposer &agrave; un risque d'atrophie cutan&eacute;e. Nous rapportons le cas d'une patiente de 50 ans, suivie pour psoriasis depuis plusieurs ann&eacute;es avec application chronique de DC, qui pr&eacute;sentait une peau tr&egrave;s fine laissant apparaitre le r&eacute;seau veineux sous-jacent, des t&eacute;langiectasies, ainsi que des vergetures t&eacute;moignant de l'atrophie dermo- &eacute;pidermique. L'atrophie cutan&eacute;e est l'effet ind&eacute;sirable des DC le plus fr&eacute;quent ; elle s'explique par leur effet antiprolif&eacute;ratif sur les k&eacute;ratinocytes, les m&eacute;lanocytes et les fibroblastes qui synth&eacute;tisent le collag&egrave;ne. Elle s'accompagne de retard de la cicatrisation et de diverses complications infectieuses d'o&ugrave; l'importance de l'&eacute;ducation th&eacute;rapeutique.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mamadou Ibrahima Kampo, Seydou Sogoba [Images in medicine] - Volumineux œd&egrave;me vulvaire comme mode de r&eacute;v&eacute;lation d'une grossesse m&ocirc;laire: &agrave; propos d'un cas - 14 May 2019. http://www.panafrican-med-journal.com/content/article/33/23/abstract/ <b>La grossesse m&ocirc;laire est une maladie trophoblastique b&eacute;nigne d&eacute;couverte habituellement dans un contexte de m&eacute;trorragie et de fausse couche pr&eacute;coce. Nous rapportons un cas de grossesse m&ocirc;laire associ&eacute;e &agrave; une pr&eacute;-&eacute;clampsie s&eacute;v&egrave;re chez une primigeste de 18 ans consultant pour une tum&eacute;faction vulvaire d'installation rapide en trois jours. La patiente rapporte des m&eacute;trorragies, des c&eacute;phal&eacute;es, un prurit vulvaire depuis une semaine. L'examen d'admission r&eacute;v&egrave;le une hypertension art&eacute;rielle s&eacute;v&egrave;re &agrave; 150/110 mmHg avec une prot&eacute;inurie positive &agrave; 2 croix &agrave; la bandelette urinaire et un discret œd&egrave;me des membres inf&eacute;rieurs. La hauteur ut&eacute;rine &eacute;tait de 20 cm. L'examen gyn&eacute;cologique &eacute;tait marqu&eacute; par une volumineuse tum&eacute;faction vulvaire prenant le godet, sensible &agrave; la palpation (A, B). Le bilan sanguin a montr&eacute; un groupe sanguin A rh&eacute;sus positif, un taux d'h&eacute;moglobine &agrave; 8,2 g/dl et des ²HCG qualitatifs positifs. L'&eacute;chographie note l'absence d'embryon, un aspect multikystique en « nid d'abeilles » et des kystes lut&eacute;iniques ovariens bilat&eacute;raux. Nous n'avons pas retrouv&eacute; d'argument en faveur des diagnostiques diff&eacute;rentiels tels une r&eacute;action allergique ou une cause infectieuse herp&eacute;tique vulvaire. Une aspiration &eacute;lectrique intra-ut&eacute;rine ram&egrave;ne des d&eacute;bris trophoblastiques v&eacute;siculaires. L'examen anathomo-pathologique a confirm&eacute; le diagnostic de grossesse molaire. Une transfusion d'une unit&eacute; de sang total est faite dans les suites imm&eacute;diates ainsi qu'un traitement anti-hypertenseur. Une surveillance clinique, biologique et &eacute;chographique est instaur&eacute;e avec des suites simples et une r&eacute;gression de l'œd&egrave;me vulvaire.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Bangaly Traor&eacute;, Moussa Koulibaly, Aissatou Diallo, Malick Bah [Case series] - Molecular profile of breast cancers in Guinean oncological settings - 14 May 2019. http://www.panafrican-med-journal.com/content/article/33/22/abstract/ <b>Breast cancer is a complex disease characterized by the accumulation of multiple molecular alterations giving each tumor phenotype and an own evolutionary potential. This study aimed to describe the distribution of the profile and molecular subtypes of breast cancers followed at Surgical Oncology Unit of Donka National Hospital. This was retrospective and descriptive study on cases of breast cancer in which the hormone receptor status and expression of the HER2 oncogene have been performed from 2007 to 2016. We recorded 58 cases including 56 (96.6%) women and 2 (3.4%) men. The average age was 48.2 ± 10.9. Invasive ductal carcinoma accounted for 50 (86.2%) cases. The SBR grade was II in 31(53.4%) cases, III in 21 (36.2%) cases and I in 6 (10.3%) cases. The tumor was classified as T4 in 36 (62.1%) cases; it was metastatic in 11(19.0%) cases. Estrogen receptors were positive in 29 (50.0%) cases, progesterone receptors positive in 25 (43.1%) cases, the Her2 oncogene was overexpressed in 22 (39.3%) cases. The distribution of molecular sub-types was: 20 (34.5%) luminal A, 15 (25.9%) triple negative, 13 (22.4%) Her2 overexpressed, 8 (13.8%) luminal B and 2 (3.2%) undetermined. This preliminary study showed the poor accessibility of immunohistochemistry for the molecular diagnosis of breast cancer in our country. Luminal A subtypes and triple negatives were more common. The determination of molecular subtypes is a rational basis for hormone therapy and targeted therapy, thus personalizing the treatment of breast cancer.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Alemayehu Gebremariam Agena, Lebitsi Maud Modiba [Research] - Maternal and foetal medical conditions during pregnancy as determinants of intrapartum stillbirth in public health facilities of Addis Ababa: a case-control study - 14 May 2019. http://www.panafrican-med-journal.com/content/article/33/21/abstract/ <b>INTRODUCTION: Globally, intrapartum stillbirth accounts for 1 million deaths of babies annually, representing approximately one-third of global stillbirth toll. Intrapartum stillbirth occurs due to causes ranging from maternal medical and obstetric conditions; access to quality obstetric care services during pregnancy; and types, timing and quality of intrapartum care. Different medical conditions including hypertensive & metabolic disorders, infections and nutritional deficiencies during pregnancy are among risk factors of stillbirth. Ethiopia remains one of the 10 high-burden stillbirth countries with estimated rate of more than 25 per 1000 births. METHODS: a case-control study using primary data from chart review of medical records of women who experienced intrapartum stillbirth in 23 public health facilities of Addis Ababa during the period July 1, 2010 - June 30, 2015 was conducted. Data were collected from charts of all cases of intrapartum stillbirth meeting the inclusion criteria and randomly selected charts of controls in two to one (2:1) control to case ratio. RESULTS: chronic medical conditions including diabetes, cardiac and renal diseases were less prevalent (1%) among the study population whereas only 6% of women experienced hypertensive disorder during the pregnancy in review. Moreover, 6.5% of the study population had HIV infection where being HIV negative was protective against intrapartum stillbirth (aOR 0.37, 95% CI 0.18-0.78). Women with non-cephalic foetal presentation during last ANC visit were three times more at risk of experiencing intrapartum stillbirth whereas singleton pregnancy had strong protective association against intrapartum stillbirth (p<0.05). CONCLUSION: untreated chronic medical conditions, infection, poor monitoring of foetal conditions and multiple pregnancy are among important risk factors for intrapartum stillbirth.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Bacha Dhouha, Walha Maroua, Baccouch Seifeddine, Talbi Ghofrane, Gharbi Lassaad, Bayar Rached, Mzabi Rgaya [Case report] - Lipome g&eacute;ant pelvien mimant un liposarcome - 14 May 2019. http://www.panafrican-med-journal.com/content/article/33/20/abstract/ <b>Le lipome g&eacute;ant (LG) est une entit&eacute; rare, de si&egrave;ge ubiquitaire. Sa localisation pelvienne est rare avec moins de 10 cas rapport&eacute;s dans la litt&eacute;rature. Le principal diagnostic diff&eacute;rentiel est le liposarcome bien diff&eacute;renci&eacute; de type lipoma like. Nous rapportons le cas d'une patiente &acirc;g&eacute;e de 50 ans, qui avait consult&eacute; pour une g&ecirc;ne pelvienne depuis 3 mois avec l'apparition d'une masse ischio rectale gauche. Le scanner abdomino-pelvien avait montr&eacute; une masse lipomateuse homog&egrave;ne hypo dense en situation pr&eacute; sacr&eacute;e de 10 x18 cm. A l'imagerie par r&eacute;sonance magn&eacute;tique (IRM), cette masse &eacute;tait hyper intense en pond&eacute;ration T1 et T2 avec des cloisons fines et atteignait la hauteur de la 2&egrave;me vert&egrave;bre sacr&eacute;e. Une ex&eacute;r&egrave;se totale a &eacute;t&eacute; r&eacute;alis&eacute;e par une double voie abdominale et p&eacute;rin&eacute;ale sans rupture de sa capsule. L'examen anatomopathologique a confirm&eacute; le diagnostic de LG. Le but de ce travail &eacute;tait de rapporter un nouveau cas de LG pelvien pr&eacute; sacr&eacute; qui se prolonge dans la fosse ischio rectale gauche.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Jean Claude Romaric Pingdwind&eacute; Ou&eacute;draogo, Serge Ouoba, Mamoudou Savadogo, Moussa Sawadogo, Edmond Nikiema, Hamad&eacute; Ou&eacute;draogo, Emmanuel Sawadogo, Panba Sama, Issouf Yam&eacute;ogo, Flora Coulibaly, Dieu-Donn&eacute; Ou&eacute;draogo [Case series] - Morbi-mortalit&eacute; de la varicelle en milieu hospitalier: &agrave; propos de 19 cas collig&eacute;s au Centre Hospitalier Universitaire Yalgado Ouedraogo, Burkina Faso - 13 May 2019. http://www.panafrican-med-journal.com/content/article/33/19/abstract/ <b>La varicelle est une virose dont l'&eacute;pid&eacute;miologie est mal connue au Burkina Faso. Cette &eacute;tude s'est donn&eacute;e pour objectif de d&eacute;crire le profil hospitalier de la pathologie dans le service des Maladies Infectieuses du Centre Hospitalier Universitaire Yalgado Ouedraogo (CHU-YO). Il s'est agi d'une s&eacute;rie de 19 patients hospitalis&eacute;s entre le 1er janvier 2005 et le 31 d&eacute;cembre 2014. Ont &eacute;t&eacute; inclus, tous les patients avec un dossier complet et exploitable, dont le diagnostic positif de varicelle a &eacute;t&eacute; fait. La proportion p&eacute;riodique de varicelle &eacute;tait de 6,2% et a repr&eacute;sent&eacute; 14,6% des &eacute;ruptions f&eacute;briles. Elle &eacute;tait plus fr&eacute;quente en 2011, de janvier &agrave; mars. L'&acirc;ge m&eacute;dian &eacute;tait de 19 ans, et la moiti&eacute; des patients avaient entre 6 et 30 ans. Les comorbidit&eacute;s &eacute;taient domin&eacute;es par l'infection &agrave; VIH et l'herp&egrave;s. Sur le plan clinique, la fi&egrave;vre et le prurit &eacute;taient les sympt&ocirc;mes communs et la v&eacute;sicule la principale &eacute;ruption. A l'admission, les principales complications &eacute;taient pulmonaires, h&eacute;matologiques et cutan&eacute;es. La dur&eacute;e m&eacute;diane d'hospitalisation &eacute;tait de 5jours, avec des extr&ecirc;mes de 0 et 13 jours. Les principaux traitements &eacute;taient antiviral dans 9 cas, antipyr&eacute;tique dans 19 cas, local dans 17 cas et antihistaminique dans 11 cas. Sur 19 cas de varicelle, 14 ont gu&eacute;ri et deux sont d&eacute;c&eacute;d&eacute;s, dont un adulte sur 10 et 1 enfant sur 9. Si la varicelle est une affection habituellement b&eacute;nigne, elle peut &ecirc;tre fatale chez l'adulte et l'enfant en cas de complications graves.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Olujide Oladele Soyele, Olajumoke Ajibola Effiom, Ahmed Oluwatoyin Lawal, Mark Chukwuemeka Nwoga, Kehinde Emmanuel Adebiyi, Adetayo Aborisade, Abiodun Saheed Olatunji, Adetokunbo Babajide Olawuyi, Adeola Mofoluwake Ladeji, Robinson Okiti Okiti, Henry Ademola Adeola [Research] - A multi-centre evaluation of malignant odontogenic tumours in Nigeria - 10 May 2019. http://www.panafrican-med-journal.com/content/article/33/18/abstract/ <b>INTRODUCTION: Odontogenic tumors originate from neoplastic transformation of the remnants of tooth forming apparatus. There are varying degrees of inductive interactions between odontogenic ectomesenchyme and epithelium during odontogenesis, leading to lesions that vary from benign to malignant. Malignant odontogenic tumours (MOTs) are very rare and are classified according embryonic tissue of origin. Recently, there has been a few changes to the classification of MOTs according to the World Health Organization's (WHO) classification in 2017. This study aims to evaluate and reclassify MOTs, using a multi-centre approach in some major tertiary dental hospitals in Nigeria. METHODS: this study reviewed the clinicopathological data on 63 cases of MOT diagnosed over 25 years in five major tertiary dental hospitals in Nigeria. All MOT cases were reclassified according to the recent revision to the 2017 WHO classification of odontogenic tumours. RESULTS: from a total of 10,446 biopsies of oral and jaw lesions seen at the 5 study centres over the 25-year study period, 2199 (21.05%) cases were found to be odontogenic tumours (OTs), of which 63 were MOT. MOTs constituted (0.60%) of the total biopsy cases and 2.86% of OTs. Odontogenic carcinomas presented with a mean age higher than odontogenic sarcomas. According to our 2017 WHO reclassification of MOTs, odontogenic carcinomas, ameloblastic carcinomas and primary intraosseous carcinomas were found to be the top three lesions, respectively. Carcinosarcomas were found to be extremely rare. CONCLUSION: using a multi-centre approach is a robust way to reduce diagnostic challenges associated with rare maxillofacial lesions such as MOTs.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ifeyinwa Chizoba Akamike, Ijeoma Nina Okedo-Alex, Ugochukwu Chinyem Madubueze, Chukwuma David Umeokonkwo [Research] - Does community mobilisation improve awareness, approval and uptake of family planning methods among women of reproductive age in Ebonyi State Nigeria? Experience from a quasi-experimental study - 10 May 2019. http://www.panafrican-med-journal.com/content/article/33/17/abstract/ <b>INTRODUCTION: Family planning programmes have helped in increasing the prevalence of contraceptive use and reducing total fertility rate in developing countries from six to three births per woman. However, its uptake is lower in the rural areas compared to urban areas. This study seeks to elucidate the effect of community mobilisation on awareness, approval and use of family planning among women of reproductive age in the rural areas of Ebonyi state, Nigeria. METHODS: We conducted a quasi-experimental study among women aged 15 to 49 years in two rural communities in Ebonyi state. Using simple random method, we recruited 484 women for the study. We used pre-tested interviewer-administered questionnaire to collect information from the participants. Community awareness and distribution of information, education and communication materials were carried out within one month. We estimated the effect of the intervention on the level of awareness, approval and uptake of family planning methods. RESULTS: Level of awareness increased by 19% (p<0.001) while uptake of family planning increased by 16.7% (p<0.001) in the intervention group. The approval rate was higher in the intervention group compared to the control group (p=0.008). The most commonly used method of family planning was the natural method in intervention and control arms. CONCLUSION: Although uptake of family planning increased significantly in the study population, the rate is generally low. Given the critical role of the community in family planning programmes, community mobilisation may be deployed to increase uptake of family planning in similar rural communities.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Saer Diadie, Ma&iuml;mouna Sow, Maodo Ndiaye, Boubacar Ahy Diatta, Diop Khadim, Suzanne Oumou Niang [Case report] - Apport des signes cutan&eacute;s sur le diagnostic pr&eacute;coce d'une maladie p&eacute;riodique: &agrave; propos d'un cas - 10 May 2019. http://www.panafrican-med-journal.com/content/article/33/16/abstract/ <b>Les auteurs rapportent l'observation d'une maladie p&eacute;riodique diagnostiqu&eacute;e &agrave; l'aide de placards &eacute;rysip&eacute;lato&iuml;des r&eacute;cidivants et persistants sous antibioth&eacute;rapie. L'interrogatoire, les tests g&eacute;n&eacute;tiques et l'&eacute;volution favorable sous colchicine ont permis d'asseoir le diagnostic.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Precious Afriyie, Elvis Enowbeyang Tarkang [Research] - Factors influencing use of modern contraception among married women in Ho West district, Ghana: descriptive cross-sectional study - 10 May 2019. http://www.panafrican-med-journal.com/content/article/33/15/abstract/ <b>INTRODUCTION: The use of modern contraception helps couples and individuals realize their basic right to decide freely and responsibly if, when and how many children to have. The current study assessed the factors influencing the use of modern contraception among married women in Ho West District, Ghana. METHODS: The study adopted a descriptive cross-sectional design, using a standardized validated pretested interviewer-administered questionnaire adapted from previous studies to collect data from a systematic sample of 225 married women and analysing them using Stata version 14 software program at the level 0.05. RESULTS: The majority, 202 (89.8%) had used modern contraception before, and the proportion currently using some form of FP was 130 (64.4%), majority (46.2%) of whom were currently using injectable. Majority (66.1%) used modern contraception in order to ensure proper care of children. Most (64.2%) of the women who were not using modern contraception were not doing so because of their partner's disapproval. Private employees were 0.20 times less likely to use modern contraception (AOR=0.20 (95% CI: 0.04-0.91); p=0.038) compared to housewives, while women who did not have problems with decision-making were 4 times more likely to use modern contraception (AOR=4.40 (95% CI: 1.25-14.44); p=0.021) compared to their counterparts who had problems with decision-making at home. CONCLUSION: The use of modern contraception is low. Health promotion interventions to increase modern contraception use among married women in Ho West District of Ghana should focus on the privately employed and those with problems in decision-making at home.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Segun Isaac Olaniyan, Oluyemi Fasina, Charles Obu Bekibele, Ayobade Oluwole Ogundipe [Research] - Relationship between dry eye and glycosylated haemoglobin among diabetics in Ibadan, Nigeria - 08 May 2019. http://www.panafrican-med-journal.com/content/article/33/14/abstract/ <b>INTRODUCTION: Dry eye is a fairly common ocular surface disorder which significantly affects the quality of life of patients. This study aimed to determine the prevalence, and relationship between dry eye and glycosylated haemoglobin (HbA1c) among patients with diabetes mellitus. METHODS: This was a descriptive hospital-based study conducted among patients diagnosed with diabetes mellitus and attending the Diabetic Clinic at a tertiary health facility in Ibadan, south-western Nigeria. Dry eye was assessed using the standardized Ocular Surface Disease Index Questionnaire administered to the eligible respondents on dry eye symptoms. Detailed ocular examination including the tear break-up time (TBUT) and Schirmer I test were carried out; and, a recent glycosylated haemoglobin value was also obtained. RESULTS: One hundred and eighty-nine Type 2 diabetic patients were studied, with 68.8% female and a mean age of 60.2 ± 10.3 years. The frequency of dry eye among patients was 21.7% (95% CI, 15.8-27.6). The most commonly reported symptom of dry eye was "feeling of gritty sensation" (78%, 95% CI, 65.4-90.7) and "blurred vision" (73.2%, 95% CI, 59.6-86.7) while "discomfort in windy areas" (61%, 95% CI, 46.0-75.9) was the most common environmental trigger. No statistically significant correlation was noted between dry eye and HbA1c (r = 0.086, p= 0.239), and age (r = 0.096, p = 0.190). CONCLUSION: Dry eye is fairly common among patients with diabetes mellitus with most frequent symptoms being gritty sensation and blurred vision. No significant correlation was noted between dry eye and glycosylated haemoglobin (HbA1c).</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com William Tasiame, Sherry Johnson, Vitus Burimuah, Ernest Akyereko, Esther Amemor [Research] - Dog population structure in Kumasi, Ghana: a missing link towards rabies control - 08 May 2019. http://www.panafrican-med-journal.com/content/article/33/13/abstract/ <b>INTRODUCTION: Dog-mediated human rabies remains a major public health threat in Ghana. Dog population structure surveys are pre-requisites for appropriate planning for rabies vaccination; however, this information is unavailable in Ghana. This study describes dog population structure in Kumasi, Ghana. METHODS: A household cross sectional survey was conducted from January through April 2016 in Ayeduase and Kwame Nkrumah University of Science and Technology (KNUST) campus using a structured questionnaire. RESULTS: A total of 1319 households were surveyed out of which 35.1% (463/1319) kept dogs. We recorded 816 dogs from 463 households, giving dog to household ratio of 1.8:1. Respondents acquired 71% (579/816) of dogs through purchase. Of 2065 persons in Ayeduase, 406 owned dogs, resulting in man to dog ratio of 5.1:1. Male dogs represented 62.9% (513/816) while those aged a year and above recorded 70%. Most of the dogs were not restricted (80.3%) and 49.9% were allowed to enter neighbors’ households. Dog rabies vaccination coverage was 28.1% and 64.9% in Ayeduase and KNUST campus respectively. Respondents (87.8%) from Ayeduase knew dog bite was the main means of rabies transmission, however, about 65% believed in traditional ways of treatment such as concoction, herbs and consumption of offending dogs' organs. CONCLUSION: The high dog to household-human ratio, increased roaming dog population and low vaccination coverage is of concern to rabies. Respondents' knowledge on their dogs is an indication of accessibility for vaccination. Obtained results can be useful for rabies vaccination planning in Kumasi and other comparable settings in Ghana.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Monia Ghammam, Jihene Houas, Mouna Bellakhdher, Mohamed Abdelkefi [Case report] - A huge retropharyngeal lipoma: a rare cause of dysphagia: a case report and literature review - 07 May 2019. http://www.panafrican-med-journal.com/content/article/33/12/abstract/ <b>Dysphagia is commonly seen after a cerebral vascular accident. It is rarely caused by lipomas of the retropharyngeal region which are rare benign mesenchymal neoplasms. We report a case of a 53-year-old man who presented with a history of ptyalism and dysphagia occurring after a brain stroke. Flexible nasal endoscopy revealed a pooling of saliva in both pyriform sinuses. Cervical and neurological examinations were unremarkable. Computed tomography (CT) scan suggested the diagnosis of retropharyngeal lipoma. The mass was resected by trans-cervical approach. The histological examination confirmed the diagnosis of a retropharyngeal lipoma. The postoperative course was unremarkable. Although lipomas in the retropharyngeal space are rare, clinicians should evoke this diagnosis when treating a patient presenting with dysphagia, even if there is a medical history of cerebral vascular accident.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mouhcin Daoudi, Laila Herrak, Mustapha El Ftouh, Leila Achachi [Case report] - Pseudo-syndrome de Demons Meigs secondaire &agrave; un cystad&eacute;nome s&eacute;reux de l'ovaire: cas clinique - 07 May 2019. http://www.panafrican-med-journal.com/content/article/33/11/abstract/ <b>Le pseudo-syndrome de Demons Meigs, associe une tumeur ovarienne, b&eacute;nigne (tous types histologiques inclus) ou maligne (ovarienne primitive ou m&eacute;tastase ovarienne d'un autre primitif) ou une tumeur pelvienne (non n&eacute;cessairement ovarienne, ut&eacute;rine par exemple), &agrave; une ascite et &agrave; une pleur&eacute;sie (non m&eacute;tastatiques en cas de tumeur maligne), ces &eacute;panchements disparaissent apr&egrave;s r&eacute;section de la tumeur. Une patiente de trente sept ans a &eacute;t&eacute; admise dans notre service pour une dyspn&eacute;e et un point de c&ocirc;t&eacute; gauche. Les examens radiologiques ont objectiv&eacute; une pleur&eacute;sie gauche de moyenne abondance, une ascite de faible abondance et une masse pelvienne. L'exploration chirurgicale a r&eacute;v&eacute;l&eacute; une tumeur ovarienne, apr&egrave;s ablation, la pleur&eacute;sie s'&eacute;tait r&eacute;solue spontan&eacute;ment. C'est dire l'int&eacute;r&ecirc;t, en pneumologie, de penser &agrave; ce syndrome chez une femme qui se pr&eacute;sente pour une pleur&eacute;sie dont le bilan &eacute;tiologique demeure n&eacute;gatif, et de prescrire un examen simple qui est l'&eacute;chographie abdomino-pelvienne permettant une orientation diagnostique.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Muwada Bashir Awad Bashir, Samuel Nambile Cumber [Letter to the editors] - The quality of life and inequalities in health services for epilepsy treatment among patience in the urban cities of Sudan - 07 May 2019. http://www.panafrican-med-journal.com/content/article/33/10/abstract/ <b>Epilepsy in Sudan accounts for 1.6 annual mortality rates and 238.7 disability adjusted life years per 100 000. These figures are higher among females; children and young adults. It is associated with notable stigma and social burdens. Patients of epilepsy are subjected to various forms of social discrimination that affect their quality of life. They are isolated, neglected and deprived of their education and employments rights and not able to achieve normal social and family life. Aiming at highlighting social implications of epilepsy among Sudanese patients, this study found that social encumbrances due to epilepsy in Sudan are more prevalent among highly vulnerable groups like women, children and poor populations living in remote areas. Lack of trained medical personnel in neurology and the medical equipment's required for proper diagnosis and treatment of epilepsy in Sudan are key reasons aggravating social and health burden of epilepsy both among patients and their caregivers.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Olusola Peter Aduloju, Akinyemi Akinsoji Akintayo, Tolulope Aduloju [Research] - Prevalence of bacterial vaginosis in pregnancy in a tertiary health institution, south western Nigeria - 07 May 2019. http://www.panafrican-med-journal.com/content/article/33/9/abstract/ <b>INTRODUCTION: Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women of child bearing age. Bacterial vaginosis has emerged as a global health issue due to the adverse outcome in pregnancy and in the puerperium. The study determined the prevalence of BV and outcome of delivery among pregnant women. METHODS: Socio-demographic data and vaginal swab samples were obtained from 362 consecutive pregnant women with abnormal vaginal discharge attending antenatal clinic in Ekiti State University Teaching Hospital, Ado-Ekiti. Data were analysed using SPSS statistical software 21 and association between variables was compared using Chi square. RESULTS: The prevalence of BV among pregnant women with abnormal vaginal discharge in this study was 16.6%. Age group 25-34yrs, multiparity and higher education were significantly associated with BV, p < 0.05. Symptoms such as vulvar itching, dyspareunia, lower abdominal pains and characteristic of vaginal discharge such as colour and consistency were significantly associated with BV, p < 0.05. Women with bacterial vaginosis significantly had prelabour rupture of fetal membrane and their babies were born prematurely with low birth weight and Apgar score of less than 5 at one minute, p < 0.05. However, there was no difference statistically in rate of admission into special care baby unit among the women, p > 0.05. CONCLUSION: The findings of this study suggest that there should be screening for BV in pregnant women presenting with abnormal vaginal discharge so that they could be treated accordingly. This will mitigate the complications arising from bacterial vaginosis.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Susanta Meher, Nishant Debta [Images in medicine] - Acute massive gastric distension in acute pancreatitis - 07 May 2019. http://www.panafrican-med-journal.com/content/article/33/8/abstract/ <b>A 43 year old male patient presented to our emergency department with complain of severe abdominal pain for five days associated with fever, vomiting and non-passage of flatus and stool. The pain started in the epigastric region which became diffused in the subsequent days. Last two days patient had history of breathlessness and decreased urination. On examination patient was looking toxic with tachycardia (124/min) and tachypnea (26/min) with rapid and shallow breathing. Abdominal examination revealed a rigid abdomen with tympanic notes with absent bowel sound. Laboratory investigations showed leukocytosis (15,000/cmm) with raised serum urea (235mg/dl) and creatinine (5.3mg/dl). There was no gas under diaphragm on abdominal X-Ray (A). With high degree of suspicion of perforation peritonitis, a diagnostic peritoneal tapping was done from right lower abdomen and altered colored bilious fluid was aspirated. Patient was resuscitated and planned for emergency laparotomy, which revealed a massively distended stomach covering almost whole of the abdomen (B, C). Duodenum and proximal part of jejunum was also dilated without any mechanical obstruction. Pancreas appeared edematous and bulky with saponification near the root of mesentery. Post-operative serum amylase (494u/l) and lipase (211u/l) as well as peritoneal fluid amylase (826u/l) levels were high, suggestive of acute edematous pancreatitis. Peritoneal tapping is sometime used to detect sealed perforation in cases with signs of peritonitis but without evidence of free gas on radiological investigation. Massive gastric distension in acute pancreatitis is very rare, however peritoneal tapping in such conditions can give a false impression of free fluid (bilious) in the peritoneal cavity</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Nuraddeen Ibrahim, Abubakar Sani Lugga, Olayinka Rasheed Ibrahim [Case report] - Diabetic-ketoacidosis in a nine-year-old child with homozygous sickle cell anaemia: a rare case report - 07 May 2019. http://www.panafrican-med-journal.com/content/article/33/7/abstract/ <b>Sickle cell anaemia (SCA) and type 1 diabetes mellitus (type 1 DM) are chronic medical conditions whose co-existence is uncommon in childhood. Furthermore, complications of SCA such as mesenteric crisis typically present with abdominal pain, which is also common in children with diabetic ketoacidosis (DKA) and this may possess diagnostic challenge. Herewith in, we report a rare case of a nine-year-old child with homozygous sickle cell anaemia, who presented with features of mesenteric crisis and diabetic ketoacidosis. The DKA was diagnosed based on the presence of hyperglycaemia (32.2 mmol/L), ketonaemia (4.6 mmol/L) and acidosis (11.6 mmol/L). The fluids deficit was corrected over 24 hours, with improvement in the vaso-occlusive crises (VOC) without precipitating cerebral oedema.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Mohamed Amine Oukhouya [Images in medicine] - T&eacute;ratome de la langue &agrave; r&eacute;v&eacute;lation n&eacute;onatale: &agrave; propos d’un cas - 06 May 2019. http://www.panafrican-med-journal.com/content/article/33/6/abstract/ <b>Nous rapportons le cas d'un nouveau-n&eacute;, admis &agrave; notre formation pour prise en charge d'une masse de la partie ant&eacute;rieure de la langue. A l'examen clinique la masse mesure 8x9 cm de consistance dure avec une surface muqueuse intacte et en partie recouverte de peau et de cheveux, le nouveau-n&eacute; &eacute;tait stable sur le plan respiratoire. La masse a &eacute;t&eacute; compl&egrave;tement r&eacute;s&eacute;qu&eacute;e et envoy&eacute;e pour &eacute;tude anatomo-pathologique qui a confirm&eacute; le diagnostic de t&eacute;ratome. L'&eacute;volution post-op&eacute;ratoire &eacute;tait simple et le nouveau-n&eacute; est sorti apr&egrave;s 13 jours sans difficult&eacute;s ni respiratoires ni alimentaires. A et B montrent l'image clinique du t&eacute;ratome de la langue chez un nouveau-n&eacute; &agrave; 7 heures de vie. C montre l'&eacute;tat final apr&egrave;s 3 mois.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Sana Bekri, Wijd&egrave;ne Trifi, Amel Labidi, Chaima Bizani, Lamia Mansour [Case report] - Full-mouth rehabilitation of an acromegaly disease patient with removable prostheses: a clinical case report - 06 May 2019. http://www.panafrican-med-journal.com/content/article/33/5/abstract/ <b>Acromegaly is a rare disease that can have serious consequences. This disease is not widely known by stomatologists, although cranio-facial manifestations are important and rapid changes in the oral cavity are frequent and sometimes dramatic. The prosthetic management of patients with acromegaly is not easy because it is necessary to wait for the stabilization of the disease. If this is not the case, the bone changes prevent the stability of prostheses over time. Moreover, because of bone remodeling, some treatments are contra-indicated, which limits our therapeutic choices. Through this clinical case, we will focus on the oral manifestations of patients with acromegaly and the method of prosthetic management.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Ishandree Pillay, Ozayr Haroon Mahomed [Research] - Prevalence and determinants of self referrals to a District-Regional Hospital in KwaZulu Natal, South Africa: a cross sectional study - 06 May 2019. http://www.panafrican-med-journal.com/content/article/33/4/abstract/ <b>INTRODUCTION: Self-referrals to inappropriate levels of care result in an increased patient waiting time, overburdening of higher levels of care, reduced primary healthcare utilisation rate and increasing healthcare costs. Furthermore, self-referral places an additional encumbrance on various levels of care as allocation of resources and infrastructure cannot be accurately planned, based on the facility catchment population. The aim of this study was to determine the prevalence and determinants of patient self-referral at the out-patient department of Stanger Hospital, KwaZulu-Natal between January and June 2017. METHODS: a cross-sectional study was conducted at the out-patient department in Stanger Hospital, using interviewer administered questionnaires to collect information from 385 patients, through convenience sampling, between January and June 2017. Multivariable regression analysis was used to test for factors associated with self-referral. RESULTS: of the 385 patients interviewed 36% (n = 138) were self-referrals. Most of the self-referrals were male (51.5%) and of the African race (57.2%). Five institutional factors namely: care received from healthcare workers (91.3%); waiting times (88.4%); help offered (87%); treatment and attitude of healthcare workers (63%) and availability of medication (55.8%) were considered as the main drivers of self-referral. Multivariable regression analysis established a significant positive association between patient self-referral and age (40 years and below), attitude of healthcare workers, quality of care received form healthcare workers, waiting times and the availability of diagnostic tests. CONCLUSION: this study indicates that most patients attending Stanger Hospital do comply with the prescribed referral pathway, however a significant proportion still bypass the referral system.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Fah Bouar&eacute;, Mohamed Lmejjati, Davis Mpando [Case report] - Spontaneous atlanto-axial dislocation and trisomy 21: causal factors and management - 06 May 2019. http://www.panafrican-med-journal.com/content/article/33/3/abstract/ <b>Spontaneous atlanto-axial (C1-C2) dislocation is an atlanto-axial instability, found in 10 to 30% of trisomy 21 patients, the majority of whom are asymptomatic. We report a case of a 21 years-old woman, with trisomy 21, admitted in our department presenting a spinal cord compression syndrome with right hemiparesis associated with a cervicalgia evolving for 3 months of admission without trauma. Standard cervical radiography showed a C1-C2 dislocation with posterior displacement of the odontoid process. A cervical computerized tomography revealed a C1-C2 dislocation with significant recoil of the odontoid process. A magnetic resonance imaging (MRI) confirmed the bulbo-medullar junction compression on the dislocation. It must be early detected. The surgical treatment consisted of a cervico occipital fixation. The laxity of the transverse ligament is one of the principal causes of C1-C2 dislocation; hypoplasia, malformation or complete absence of the odontoid process; are also predisposing factors. The treatment of choice is surgical also by arthrodesis of C1 to C4 + graft and enlargement of the occipital foramen or occipito-cervical arthrodesis by synthetic graft and Cotrel-Dubousset system or occipito-C4 + C1 laminectomy and enlargement of the occipital foramen.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Jehanne Aasfara, Wafa Regragui, Loubna El Ouardi, El Hachmia Ait Ben Haddou, Ali Benomar, Mohammed Yahyaoui [Case report] - A case of bilateral thalamic infarct complicating tuberculous meningoencephalitis - 06 May 2019. http://www.panafrican-med-journal.com/content/article/33/2/abstract/ <b>Ischemic stroke can result from multiple etiologies. It can also be a complication of tuberculous meningoencephalitis and determine its outcome. stroke secondary to tuberculous meningoencephalitis, occurs in 30% cases in the basal ganglia region, unusually in the thalamus. The mechanism of stroke in this condition is vasculitis. We report an unusual case of bilateral thalamic infarcts complicating tuberculous meningoencephalitis. Ischemic stroke in tuberculous meningoencephalitis is unpredictable with poor prognosis despite antituberculous drug treatment, emphasising the importance of primary prevention, particularly in tuberculosis endemic areas.</b><br/> text/html 2019-08-23T20:12:38+01:00 http://www.panafrican-med-journal.com Younes Barbach, Fatima Zahra Mernissi [Images in medicine] - La maladie de Fox Fordyce p&eacute;ri sternale: un cas rare et atypique - 02 May 2019. http://www.panafrican-med-journal.com/content/article/33/1/abstract/ <b>La maladie de Fox-Fordyce (FF), &eacute;galement appel&eacute;e milaria apocrine, est une maladie chronique rare caract&eacute;ris&eacute;e par des papules folliculaires prurigineuses localis&eacute;es dans des zones glandulaires apocrines. La physiopathologie consiste en l'obstruction du canal de la glande apocrine par l'insertion d'un bouchon de k&eacute;ratine dans la paroi des poils, cela provoque une r&eacute;tention de s&eacute;cr&eacute;tion avec rupture cons&eacute;quente de la structure glandulaire et une inflammation secondaire du derme. L'extravasation du contenu glandulaire peut &ecirc;tre la cause du prurit. Cliniquement, les l&eacute;sions sont des papules uniformes, fermes, folliculaires, qui peuvent toucher les aisselles, les zones anog&eacute;nitales et p&eacute;ri-ar&eacute;olaires, les l&egrave;vres, l'ombilic, le p&eacute;rin&eacute;e et plus rarement le sternum comme dans notre cas. Le diagnostic de la maladie FF est bas&eacute; sur des caract&eacute;ristiques cliniques caract&eacute;ristiques, ainsi que des caract&eacute;ristiques histopathologiques non sp&eacute;cifiques comprenant la dilatation de l'infundibulum folliculaire avec hyperk&eacute;ratose, acanthose et spongiose de l'&eacute;pith&eacute;lium infundibulaire et l'infiltration p&eacute;rifolliculaire des lymphocytes et des histiocytes, qui conduisent &agrave; la perte de cheveux. Divers traitements pour la maladie FF ont &eacute;t&eacute; sugg&eacute;r&eacute;s avec une am&eacute;lioration limit&eacute;e, y compris l'administration de contraceptifs oraux, les corticost&eacute;ro&iuml;des topiques, intral&eacute;sionnels ou syst&eacute;miques, les r&eacute;tino&iuml;des topiques et oraux, la clindamycine topique comme prescrite dans notre cas, le pim&eacute;crolimus, la phototh&eacute;rapie, les traitements chirurgicaux comme l'&eacute;lectrocoagulation et le curetage avec liposuccion. Nous rapportons le cas d’un patient &acirc;g&eacute; de 34 ans, sans ant&eacute;c&eacute;dent pathologique notable, consultait pour la prise en charge de l&eacute;sions prurigineuses du tronc &eacute;voluant depuis 5 ans. L’examen dermatologique avait objectiv&eacute; la pr&eacute;sence de multiples papules couleur chair faisant environs 0,5cm de grand axe si&eacute;geant au niveau de la r&eacute;gion p&eacute;ri sternale prurigineuses et indolores. La dermoscopie montrait la pr&eacute;sence de papules folliculaires, des poils terminaux traumatis&eacute;s et des points noirs. Le patient avait b&eacute;n&eacute;fici&eacute; d’une biopsie cutan&eacute;e revenue en faveur d’une maladie de Fox Fordyce, puis mis sous clindamycine topique.</b><br/>