Pan African Medical Journal

Prevalence and risk factors of brain atrophy and associated confusion state among adults from three hospitals in northern Tanzania

Leticia Joseph Kalumbilo — 2024-04-08

Introduction: brain atrophy is the reduction of brain volume often accompanied with cognitive changes. Despite the availability of computerized-tomography (CT) scanners in Tanzania, little is known about the magnitude of brain atrophy, its associated confusion state and the risk factors in adults. This study aimed to fill those knowledge gaps.

Methods: a retrospective cross-sectional hospital-based survey was conducted in northern Tanzania using a sample size of 384 CT images of adults who underwent brain CT scans in three referral hospitals. CT images were evaluated using a diagonal brain fraction (DBF) method to determine the presence of brain atrophy. Data for other covariates were also collected.

Results: we report a prevalence of 60.67% for brain atrophy and 35% for the associated confusion state. Association between confusion state and brain atrophy was statistically significant (χ² = 21.954, p<0.001). Brain atrophy was prognosticated by: age (adjusted OR: 1.11; 95% CI [1.05, 1.20], p<0.001), smoking (adjusted OR: 6.97; 95% CI [2.12, 26.19], p<0.001), alcohol-consumption (adjusted OR: 11.87; 95% CI [3.44, 40.81], p<0.001), hypertension (adjusted OR: 61.21; 95 CI [15.20, 349.43], p<0.001), type-2 diabetes mellitus (adjusted OR: 15.67; 95% CI [5.32, 52.77], p<0.001) and white matter demyelination (adjusted OR: 13.45; 95% CI [4.66, 44.25], p<0.001).

Conclusion: there is high prevalence of brain atrophy and associated confusion state among hospitalized adults in northern Tanzania. Reported prognostic factors for brain atrophy such as age, smoking, alcohol consumption, hypertension, type-2 diabetes mellitus and white matter demyelination could help focus interventions in this area.

Ocular toxoplasmic scar: a rare clinical image of an immunocompetent patient

Tanvi Guru — 2024-04-08

A thirty-six-year-old male patient came with complaints of diminution of vision in the right eye for 10 years. He did not give a history of ocular trauma, redness or pain in that eye, seizures or any previous treatment. He is a non-vegetarian. There is no history of contact with cats. Clinically, the anterior segment examination of both eyes was normal. His best corrected visual acuity (BCVA) in the right eye was 6/60, and his left eye was 6/9, and intraocular pressure in both eyes was within normal limits. Posterior segment evaluation by direct ophthalmoscopy revealed a chorioretinal scar in the right macular area, fundus photograph showing a chorioretinal scar in the right macular area, which was secondary to toxoplasmosis characterised by the presence of a lesion surrounded by a hyperpigmented edge and yellowish colour appearing at the centre characteristic of the atrophic scar. The rest of the fundus and vitreous in both eyes were normal. Enzyme-linked immunosorbent assay (ELISA) of serum for anti-toxoplasma IgG antibodies showed high titers, more than 1.11. ELISA for human immunodeficiency virus was negative. Our patient could not receive active treatment for the right eye macular scar as the visual loss is irreversible. The patient was advised a regular six-monthly follow-up to detect any recurrences.

Knowledge about diabetes mellitus and its associated factors among diabetic outpatients at Muhimbili National Hospital in Tanzania

Christine Luambano — 2024-04-08

Diabetes mellitus is emerging as one of the major public health threats that contributed to 2% of all deaths in Tanzania in 2016. Although adequate knowledge related to diabetes mellitus is associated with early case detection, prevention, and minimization of health complications and socioeconomic-related consequences, there is less evidence about the adequacy of the community´s knowledge of diabetes in Tanzania. This study aimed to determine knowledge about diabetes mellitus and its associated factors among diabetic outpatients. A cross-sectional study was conducted among 220 diabetic outpatients aged 18 years and above at Muhimbili national hospital in Tanzania between February and April 2017. Data were collected using a structured pretested questionnaire and were entered into Microsoft Excel and exported to SPSS Version 20 for analysis. Bivariate and multivariate logistic regression was used to determine the predictive variables. The significance of independent variables was declared at a 95% confidence level and p-value < 0.05. A total of 137 (64.01%) of the participants had adequate knowledge about diabetes mellitus. The majority (86.9% and 85.1%) reported having adequate knowledge of complications of diabetes and treatment options for diabetes respectively. The least level of knowledge reported was on signs and symptoms (48.6%) and type of diabetes (32.7%). The majority (54%) cited health facilities as the most common sources of information related to diabetes. Both bivariate and multivariate logistic regression analyses showed that there was a statistical association between knowledge related to diabetes and the level of education of study participants. The overall level of knowledge of participants about diabetes mellitus is was adequate, with a low level of knowledge related to signs and symptoms of diabetes, and type of diabetes. Health facilities were the most common sources of information related to diabetes. Policy and decision-makers and health care providers should take collective action to improve community knowledge about diabetes. Health education related to diabetes should be integrated into the educational curriculum at all levels in Tanzania, which would massively increase awareness of diabetes.

Pure squamous cell carcinoma of the pancreas: a rare and challenging diagnosis (case report)

Fatima Belabbes — 2024-04-08

Squamous cell carcinoma (SCC) of the pancreas is a rare exocrine ductal tumour with unknown pathophysiology and poor treatment options. We present a case of SCC in a 59-year-old male patient who presented with epigastric pain, vomiting, anorexia, asthenia, and weight loss. Abdomino-pelvic CT revealed a pancreatic mass with adenopathy satellites. Surgical biopsies were negative, and a trans-duodenal gastric endoscopy showed suspicious lymphadenopathies and a hypoechoic lesion invading the portal vein. An anapathological study confirmed SCC at the site of intense necrotic and inflammatory changes. The patient received radio-chemotherapy, but ultimately developed peritoneal carcinoma.

COVID-19 in-hospital mortality during the first two pandemic waves, at Helen Joseph Hospital, South Africa

Joanna Reid — 2024-04-08

Introduction: there has been significant global variation in Coronavirus Disease (COVID-19) mortality at different time points in the pandemic. Contributing factors include population demographics, comorbidities, health system capacity, prior infection with COVID-19, vaccinations, and viral variants. The study aims to describe COVID-19-related mortality of inpatients at Helen Joseph Hospital (HJH), over 12 months, during the first two waves of the COVID-19 pandemic in South Africa. The primary objectives were to describe the socio-demographic details, clinical characteristics, and hospital outcomes during the first and second waves of COVID-19. This included an assessment of the in-hospital case fatality ratio (CFR) of patients admitted with COVID-19. The secondary objectives were to compare the socio-demographic details, clinical characteristics, and outcomes between the two waves, and to determine risk factors associated with COVID-19-related mortality.

Methods: this is a retrospective cohort study of all inpatient laboratory-confirmed COVID-19 cases at HJH from 1^st May 2020 to 31^st April 2021. Data were collected by the National Institute for Communicable Diseases (NICD). Bivariate analysis was performed to describe and compare the socio-demographic characteristics, clinical characteristics, and hospital admission outcomes between the two waves. Multivariate logistic regression was used to determine risk factors for COVID-19-related mortality.

Results: overall, 1359 patients were admitted, 595 in wave one, and 764 in wave two. Patients were predominantly male (52.4%), of Black African race (75.1%) with a mean age of 54.6 (standard deviation 15.4) years. The median length of stay was 8 days (interquartile range 5-14 days). In total, 73.2% (995) of patients required oxygen, 5.2% (71) of patients received mechanical ventilation, and 7.1% (96) were admitted to the high care and Intensive Care Unit (ICU). The most common comorbid illnesses were hypertension (36.7%, n=499), diabetes mellitus (26.6%, n=362), Human Immunodeficiency Virus (HIV) (10.8%, n=147), and obesity (11.0%, n=149). The in-hospital CFR during the first wave was 30.4% (181/595) and 25.5% (195/764) (p<0.001) in the second wave, and overall, in-hospital CFR was 27.7% (376/1359). The adjusted odds of death were 79% higher among patients admitted during wave one compared to wave two (aOR=1.79; 95% CI:1.35-2.38). A one-year increase in age increased the odds of death by 4% (aOR=1.04; 95% CI:1.03-1.05). The need for oxygen (aOR=2.17, 95%CI:1.56-3.01) and ventilation (aOR=7.23, 95% CI:4.02-13.01) were significant risk factors for mortality.

Conclusion: prior to the availability of vaccines, COVID-19-related mortality was high and risk factors for mortality were consistent with national and international findings. This study reflects the impact of the pandemic on the South African public sector with limited resources and minimal ICU capacity.

Co-administration of rimonabant prevents glucose intolerance in Sprague-Dawley rats treated chronically with lopinavir/ritonavir and zidovudine: an experimental study design

Brian Lishenga Makamu — 2024-04-08

Introduction: treatment of HIV infection with Protease Inhibitors (PIs) and Nucleoside Reverse Transcriptase Inhibitors (NRTIs) can lead to insulin resistance and changes in body fat distribution. Overactivity of the endogenous cannabinoid system produces similar disturbances in metabolic syndrome within the general population. However, Cannabinoid receptor type 1 antagonism, in both human and animal studies, reverses many of these biochemical and physical derangements observed in the metabolic syndrome.

Methods: using an experimental study design, fifteen adult male Sprague-Dawley rats housed under standard conditions were randomized into three groups; Control, combined Anti-Retroviral Therapy (cART) only and cART + rimonabant. Drugs were administered daily by oral gavage for four weeks. After four weeks, insulin tolerance tests were conducted, the rats were euthanised and fat depots were excised and weighed. Experimental data were analysed using STATA 16.0 with the significance level set at p<0.05. The Shapiro-Wilk test determined normalcy. In cases of significance, post hoc analysis was performed by either the Dunn test or the Tukey HSD test.

Results: Sprague Dawley rats treated with cART + Rimonabant demonstrated better insulin sensitivity (p = 0.0239) and lower body weight (p = 0.044) than rats treated with cART alone. They had leaner body composition with 58% less adiposity than cART-only rats.

Conclusion: the study results suggest a role for the endogenous cannabinoid system in cART induced metabolic derangements and physical changes. Future studies can directly assay ECS activity in cART associated metabolic syndrome.

Opinion on weight management in the age of new technologies

Hamid Chamlal — 2024-04-08

In a Moroccan context characterized by the resurgence of metabolic diseases and over nutrition, an emergence of digital media in the daily life of individuals, has led to the expansion of the use of digital diets for therapeutic or aesthetic purposes. This work raises the question of the effectiveness of unguided nutritional approaches and the associated consequences, with potential effects on the health of individuals.

Severe acute polyradiculoneuritis revealing systemic lupus erythematosus: a case report

Assma Boudanga — 2024-04-08

Systemic lupus erythematosus (SLE) is a common disease with extremely heterogeneous neurological manifestations in its clinical expression. However, few cases have been reported in the last 50 years when the initial manifestation of SLE is Guillain-Barré syndrome (GBS). Our work highlights the importance of evoking SLE as a potential etiology in a patient presenting with acute polyradiculoneuritis. We report the case of a 41-year-old woman who presented with dyspnoea with a purely proxo-distal motor deficit in all four limbs with dermatological lesions such as generalized myxedema and alopecia. The clinical electrical and biological presentation confirms acute polyradiculoneuritis revealing systemic lupus erythematosus. The outcome was marked by clinical improvement, despite the severity of the clinical picture, after treatment with corticosteroid and cyclophosphamide boluses. In conclusion, neurological manifestations in lupus disease are common, whereas the form of acute polyradiculoneuropathy is very rare with a committed vital prognosis. Early diagnosis and management are essential.

COVID-19 during pregnancy: case report and literature review

Nadia Slimene — 2024-04-08

The current coronavirus disease 2019 (COVID-19) pneumonia pandemic, caused by the newly discovered coronavirus is a serious public health emergency and a highly infectious disease. Evidence to date suggests that there are groups of people who are at a higher risk of getting severe COVID-19 disease such as pregnant women and their fetuses. We reported 4 cases of pregnant women with COVID-19 admitted in the national containment center, Tunisia (3 imported cases and one local case). The age range of the patients was 27-35 years and the range of gestational weeks at admission was 16 weeks to 32 weeks. None of the patients had underlying diseases. All four cases were totally asymptomatic and presented no complications. Two of them gave birth one by vaginal and the other by cesarean delivery, neonates presented no symptoms and no adverse outcomes. The current report does not present significant differences in the disease prognosis in the pregnant women´s group compared with the general women´s population. Careful observation, data collection and consecutive research are necessary.

Successful management of life-threatening post-COVID-19 cryptosporidiosis in a renal transplant patient: a case report

Oadi Nawaf Shrateh — 2024-04-08

Worldwide, Cryptosporidium spp. is a common parasite that affects domestic and wild animals, including humans, and causes diarrhea in both immunocompetent and immunocompromised hosts. The fecal-oral pathway accounts for the majority of its transfer. Although C. parvum and C. hominis are the most common zoonotic species in humans, other zoonotic species can also infect immunocompetent and immunocompromised people. Patients undergoing renal transplants are more likely to contract cryptosporidiosis, which can cause severe and potentially fatal diarrhea. A 41-year-old male patient who presented to the emergency department complained of a sudden onset, severe and continuous fatigue, and a feverish sensation of two-day duration. Two days prior to the current admission, the patient started to complain of weakness affecting his whole body, as well as a fever of 39°C and continuous yellowish diarrhea occurring 4-5 times daily without blood. Stool analysis revealed a cryptosporidium infection. The patient underwent surgery for kidney transplantation. The donated kidney was the left one from his brother and was attached to the patient´s right groin. As illustrated by our example, cryptosporidiosis should be considered a significant cause of acute, persistent, watery diarrhea in immunocompromised kidney transplant recipients. Patients undergoing renal transplants should be instructed to wash their hands frequently, stay away from young animals, sick people, and swimming pools in order to lower their risk of infection.

Cutaneous leishmaniasis in Tabuk, Saudi Arabia: epidemiological trends from 2006 to 2021

Raafat Abdel Moneim Hassanein — 2024-04-08

Introduction: cutaneous leishmaniasis (CL) is a vector-borne protozoan skin disease that affects all human ages and can pose extreme social and psychological impacts. This study aimed to reveal the epidemiological trends of CL in the Tabuk region, the Kingdom of Saudi Arabia (KSA), during the period from 2006 to 2021.

Methods: patients with CL, who were detected and registered at the regional Vector-borne Diseases Control Unit of the Tabuk province, between January 2006 and December 2021, were analyzed in this retrospective study. The patients´ data included their nationality, gender, and age, and their annual and month-by-month recorded patterns.

Results: a total of 1575 CL patients were reported during the said period. They were 53.1% Saudis and 46.9% non-Saudi expatriates with a ratio around 1.1: 1.0; and they were re-categorized as 83.17% males and 16.83% females with a ratio of 4.9:1.0 (p <0.5). Additionally, the majority (1002/1575; 63.6%) of these CL patients were in age group of 15-45 years (p <0.5), and the lowest number was in age group of <5 years. Most importantly, there was a continuous annual and month-by-month record of these patients; reflecting CL endemicity in the Tabuk region of KSA.

Conclusion: the present findings imply that CL is endemic in the Tabuk region of KSA. As there is a recent increase in human immigration to this region, sustainable monitoring of CL and improving its control measures is warranted.

Implantation cochléaire au Sénégal: enjeux, limites et perspectives

Cheikh Ahmédou Lame — 2024-04-08

L´implant cochléaire est une prothèse auditive électronique qui s´adresse aux surdités sévères à profondes bilatérales. Il permet de stimuler directement les fibres du nerf cochléaire en court-circuitant les cellules ciliées. Cette technologie très performante apparue depuis 60 ans, s´est largement répandue à travers le monde et est régulièrement utilisée dans la réhabilitation auditive. Dans les pays en voie de développement, l´adoption et le développement de cet outil accusent encore du retard. Les auteurs analysent dans cet article les facteurs qui retardent la pénétration de l´implant cochléaire au Sénégal.

Disclosure of HIV status and adherence to antiretroviral treatment in children and adolescents from Lomé and Abidjan

Tchaa Abalo Bakai — 2024-04-08

Introduction: in Africa, the proportion of minors with AIDS is ever increasing and adherence to treatment protocols is still suboptimal. The study investigated the conditions of HIV status disclosure and adherence to treatment in patients < 19 in two West African cities.

Methods: in 2016, thirteen health professionals and four parents filled out questionnaires to identify problems and solutions relative to disclosure of HIV status and adherence to treatment in 208 children and adolescents seen at University Hospitals in Abidjan (Ivory Coast) and Lomé (Togo).

Results: medians (extrema) of patients' ages at start and end of status disclosure process were 10 (8-13) and 15 (13-17.5) years. In 61% of cases, disclosure was made individually after preparation sessions. The main difficulties were: parents' disapproval, skipped visits, and rarity of psychologists. The solutions proposed were: recruiting more full-time psychologists, improving personnel training, and promoting patients' "clubs". One out of three respondents was not satisfied with patients' adherence to treatments. The major reasons were: intake frequencies, frequent omissions, school constraints, adverse effects, and lack of perceived effect. Nevertheless, 94% of the respondents confirmed the existence of support groups, interviews with psychologists, and home visits. To improve adherence, the respondents proposed increasing the number of support groups, sustaining reminder phone calls and home visits, and supporting therapeutic mentoring.

Conclusion: despite persisting disclosure and adherence problems, appropriate measures already put into practice still need to be taken further, especially through engaging psychologists, training counsellors, and promoting therapeutic support groups.

Intérêt de la déxaméthasone en intrapéritonéale dans l´analgésie post cholécystectomie laparoscopique: étude prospective contrôlée randomisée en double aveugle

Ahmed Abdelhedi — 2024-04-08

Introduction: l´effet des corticoïdes administrés en intraveineux sur la douleur post opératoire a été bien démontré cependant peu de travaux se sont intéressés à l´intérêt de leur utilisation en intrapéritonéal après chirurgie laparoscopique. Le but de notre travail était d´évaluer l´effet de l´instillation intra péritonéale de dexaméthasone sur l´analgésie post opératoire après cholécystectomie laparoscopique.

Méthodes: nous avons mené une étude prospective randomisée contrôlée en double aveugle, incluant des patients proposés pour cholécystectomie laparoscopique programmée et randomisés en deux groupes: groupe D (ayant reçus 16 ml: 12 ml de sérum physiologique et 4 ml de solution contenant 16 mg de dexaméthasone) et groupe T (ayant reçus 16 ml de sérum physiologique). Le critère de jugement principal était: l´échelle visuelle analogique (EVA) de la douleur abdominale durant les 24 premières heures postopératoires. Les critères de jugement secondaires étaient l´incidence de la douleur de l´épaule, le délai de la première demande analgésique, la consommation de morphiniques en salle de surveillance post interventionnelle (SSPI), la consommation d´analgésiques non morphiniques et l´incidence des nausées et des vomissements durant les premières 24 heures postopératoires et la présence de complications.

Résultats: soixante patients ont été inclus et répartis en deux groupes de 30. Les paramètres démographiques, la durée de l´acte opératoire et de l´anesthésie ainsi que la consommation de fentanyl en per opératoire ont été comparables entre les deux groupes. Les valeurs de l´EVA de la douleur abdominale (p≤0,001), l´incidence des douleurs au niveau de l´épaule (p<0,001), la consommation d´opioïdes et d´analgésiques (p<0,001) et l´incidence des nausées (p=0,002) et des vomissements (p=0,012) durant les premières 24 heures postopératoires ont été significativement plus basses pour le groupe D. Aucune complication liée à l´administration de dexaméthasone n´a été notée.

Conclusion: la dexaméthasone en intra péritonéale a diminué les douleurs postopératoires après une cholécystectomie laparoscopique.

A high-resolution tomography (HRCT) scan showing classical "air crescent sign" in a case of pulmonary aspergilloma

Puja Upadhyay — 2024-04-08

A 45-year-old male presented to the hospital with complaints of hemoptysis for the last 3 weeks. He also had a cough with mucoid expectoration for 3 weeks. He denied a history of fever/loss of weight and appetite. The patient had a past history of sputum-positive pulmonary tuberculosis 20 years back for which he had taken AKT for 6 months. A suspicion of reactivation of pulmonary tuberculosis was made and sputum was sent for AFB (acid fast bacilli) and Nucleic Acid Amplification Test (NAAT) which was negative. On further investigation high-resolution computed tomography (HRCT) was done which revealed an irregularly shaped large cavitatory lesion in the left upper lobe. The cavity was filled with large soft tissue surrounded by air crescent suggestive of fungal ball formation (aspergilloma). This HRCT revealed a classic “air crescent sign” (marked by an arrow) seen in aspergilloma but is also found in pulmonary tuberculosis, hydatid cyst, and pulmonary abscess. In aspergilloma, this mass usually moves within the cavity when the patient changes position and the sign is called “Monod sign”. Aspergilloma most commonly occurs in the cavity formed secondary to tuberculosis and is a common sequelae of pulmonary tuberculosis. Most aspergilloma are asymptomatic and hemoptysis secondary to reactive vascular granulation tissue is the most common presentation. For this patient bronchial artery embolization (BAE) was done and he was started on antifungal treatment. Though in patients with recurrent or massive hemoptysis, surgical resection remains the gold standard. In our case, the patient did not have any more episodes of hemoptysis after BAE and was discharged in stable condition with the advice of regular follow-up.

Cerulean cataract

Meryem Benchekroun Belabbes — 2024-04-08

We report a case of a 34-year-old woman with a medical history of diabetes type 1 presented to our ophthalmology department due to a progressive diminution of vision in both eyes during the last year. No history of ocular trauma was reported. Her best corrected visual acuity was 20/50 in both eyes. Slit lamp examination of the lenses of both eyes revealed white tiny opacities forming concentric layers and a dense posterior subcapsular cataract (A, B). The posterior segment was unremarkable in both eyes with no sign of diabetic retinopathy. The patient underwent cataract surgery of the right eye and three months later of the left eye. The two surgeries proceeded without complications with a final visual acuity of 20/20 for both eyes. Cerulean cataract is a rare form of congenital cataract which usually presents as bilateral, blue-white opacities in the lens arranged in concentric layers. Armitage MM et al reported that it is a genetically inherited disease transmitted in an autosomal dominant pattern. Multiple causative mutations have been identified, including mutations in the beta-B2-crystallin gene (CRYBB2), gamma-D-crystallin gene (CRYGD), V-MAF avian musculoaponeurotic fibrosarcoma oncogene homolog gene (MAF), the major intrinsic protein of lens fiber gene (MIP). The treatment is surgical and consists of the removal of the cataract, if the visual acuity is reduced, with the placement of an artificial lens.

Beckwith-Wiedemann syndrome

Deeksha Mishra — 2024-04-08

A female infant aged 2-years, weighed 15 kg was brought to the outpatient department (OPD) with the chief complaint of difficulty in speech. She had a normal vaginal delivery at full term, weighing 3 kg, with no noteworthy family history. The infant had a device closure procedure after being diagnosed with patent-ductus-arteriosus at birth. Her syndromic face, macroglossia, and high arched palate were discovered during the examination, leading to a clinical diagnosis of Beckwith Wiedemann Syndrome. A 9.6 g/dl hemoglobin level, elevated alpha-fetoprotein levels, and normal liver and renal function tests were observed in the recent investigations. The child was scheduled for a median glossectomy for which we chose to perform nasal intubation. Prior to surgery, the child was kept nil by mouth (2 hours for water and 6 hours feed). Zero point forty-five percent (0.45%) dextrose-normal saline was administered as the maintenance fluid. A cart was maintained on hand for difficult airways that contained a laryngeal mask airway, various sized face masks, a nasopharyngeal airway and a bougie. Induction was initiated with injection ketamine and inhalation sevofluorane after premedication with injection glycopyrrolate and injection fentanyl. By inserting a nasopharyngeal airway, the initial difficulty in mask ventilation was resolved, which also helped us in checking the patency of the nostril. Finally, a 4.5 flexometallic tube was inserted through the right nostril, guided through the vocal cords with the help of Mc-Gills forceps. The position of the tube was confirmed through auscultation and capnograph. After the procedure, she was reversed and shifted to pediatric intensive care unit (PICU) with an endotracheal tube in situ to prevent post-operative tongue fall.

Composite aortic root replacement in African patients with type A aortic dissection: report of 12 cases

Charles Mve Mvondo — 2024-04-08

Type A aortic dissection (TAAD) is associated with high mortality in the absence of appropriate surgical therapy. The involvement of the aortic root by the intimal tear and the presence of severe aortic insufficiency will require a more radical approach with composite root replacement (CRR) in most of the patients. We briefly report our surgical experience following CRR in 12 patients presenting with TAAD in our department. Between November 2009 and January 2022, a total of twelve (n=12) patients diagnosed with TAAD were operated in our institution. Clinical data and surgical outcomes were retrospectively reviewed. The mean age at admission was 51.1 ± 12.43 years (range: 34-72). One patient met the criteria for Marfan´s disease (1/12, 8.3%). The operative mortality was 16.66% (2/12). Composite root replacement with a mechanical valved conduit was performed in the majority (11/12, 91.66%;) whereas a separated supracoronary graft replacement and aortic valve replacement were performed in one patient. Concomitant aortic arch surgery (hemi or total) was done in 9/12 patients (75%). The commonest postoperative complications were: chest re-exploration for bleeding in 2/12 (16.66%), transitory cerebral ischemia in 1/12 (8.33%) and low cardiac output syndrome in 2/12 (16.66%). The mean length of stay in the Intensive Care Unit (ICU) was 4.8±3.8 days (range: 2-17). Delayed referral of patients with TAAD was observed in the majority of patients as they were operated in the subacute or chronic phase. Composite root replacement in these patients is associated with acceptable outcomes despite complex anatomic-pathological lesions.

Profiling of antibiotic resistance among uropathogens isolated from patients attending Kericho County Referral Hospital

Gladys Chepkoech Mosonik — 2024-04-08

Introduction: urinary tract infection (UTI) comes second after respiratory infections in most communities and hospital settings, affecting people of all ages. Frequent use of antibiotics to manage UTI has resulted in development of resistance, calling upon policymakers to fast-track and enforce policies that guide the use of antibiotics in the country. This study intended to determine the current antibiotic resistance to uropathogens among patients attending Kericho County Referral Hospital.

Methods: three hundred urine samples from eligible participants were cultured and bacteria colonies identified using biochemical tests. Antibiotic sensitivity was done using Kirby Bauer disk diffusion method on Mueller Hinton Agar.

Results: the aetiological agents of UTI were Staphylococcus aureus, Enterococci faecalis, E. coli, Proteus spp and Klebsiella pneumonia. Antibiotic resistance was observed among these uropathogens to commonly used antibiotics namely; ampicillin (84.3%), azithromycin (71.9%) and augmentin (69.8%). However, there were some bacteria that were susceptible to all or some commonly used antibiotics. There was moderate resistance to norfloxacin (43%) except in Staphylococcus aureus which showed 64% resistance. The isolates showed less resistance to cefoxitine (13.2%), gentamycin (11.6%) and ciprofloxacin (10%). While most bacteria showed multiple resistance to 3 drugs, some showed resistance to at most 5 drugs tested in the study.

Conclusion: this study found Staphylococcus aureus to be the predominant aetiological agent of UTI. Cefoxitine, gentamycin and ciprofloxacin are good therapeutic choices for confirmed recurrent UTI when culture results are unavailable. There is need to have regular screening of aetiological agents of UTI and their resistance to antimicrobials.

Metastatic mastery: the uncommon journey of papillary thyroid carcinoma to the brain (a case report)

Deeksha Rana — 2024-04-08

Papillary thyroid carcinoma is one of the most common thyroid malignancy, often has excellent prognosis and low incidence of distant metastatic conditions. Brain metastases from papillary thyroid carcinoma has a rare occurrence, with patients presenting with non-specific symptoms such as headaches, cognitive changes etc., and poor survival outcomes. The standard protocol for diagnosis and treatment remains controversial. We report a patient who presented with cerebral metastasis prior to the diagnosis of papillary thyroid carcinoma, review the current literature, and explain our approach on the basis of clinical, pathological, and radiological data. A 60-year-old hypertensive male presented with lower back pain, bilateral lower limb weakness, occasional episodes of frontal headache and personality changes. The diagnostic evaluation included computed tomography (CT) scan, magnetic resonance imaging (MRI) with and without contrast enhancement, and color Doppler. Intra-axial complex solid cystic mass lesion in the right parieto-occipital region with significant perilesional oedema, and imaging characteristic of neoplastic etiology were observed. He was posted for excision of tumor and underwent right occipital craniotomy. Histopathological analysis of the surgical specimen confirmed papillary carcinoma of the thyroid gland. Brain metastases from thyroid malignancy is a sign of detrimental prognosis, hence, thorough clinical, radiological and pathological evaluation for rapid detection is critical. Neurosurgical removal along with radiotherapy should be considered as treatment of choice. The information obtained contributes towards better management and overall long-term outcomes.

Giant right hydronephrosis with underlying double malignancy: a case report

Shreyas Nellamkuziyil Michael — 2024-04-08

Giant hydronephrosis is mostly caused by ureteropelvic junction obstruction (UPJO). Giant hydronephrosis with concurrent malignancy is less common clinically and is easily misdiagnosed. We report a 77-year-old male who presented with sudden onset progressive abdominal distension in the last month. Abdominal computed tomography showed a right severe hydronephrotic kidney with loss of parenchymal thinning. Cystoscopy showed a 1x 1cm papillary lesion protruding from the right ureteric orifice. He underwent a right radical nephroureterectomy with bladder cuff excision with lymph node dissection. Histopathology showed low-grade urothelial carcinoma of the ureter and incidental pleomorphic rhabdomyosarcoma in the right kidney. The patient refused chemotherapy and died 6 months later due to lung metastasis. Incidental pathologic finding of renal rhabdomyosarcoma in adults with giant hydronephrosis and urothelial carcinoma is a rare occurrence with diverse clinical presentations, prognoses, and outcomes.

Seroprevalence of SARS-CoV-2 immunoglobulin G antibody during COVID-19 pandemic in Fayoum District, Egypt: a community-based pilot survey

Salwa Bakr — 2024-04-08

Introduction: controlling the worldwide pandemic, coronavirus disease (COVID-19), could be impossible due to the hesitancy about the available vaccines and the difficulty to implement strict restrictions. Little information is available about herd immunity in the highly vulnerable region of North East Africa, Egypt. The objective of this study was to assess the seroprevalence of SARS-CoV-2 during the pandemic in one of the highly vulnerable populations in Egypt, the Fayoum district of Fayoum Governorate. Additionally, to assess the predictive value of symptoms and other associated risk factors towards a positive COVID-19 test.

Methods: in this cross-sectional community-based pilot study, immunoglobulin G (IgG) antibodies that are specific for the SARS-CoV-2 spike (S1-RBD) protein were tested during the period from February 2021 to July 2021.

Results: out of 155 participants, 60.6% were SARS-CoV-2 seropositive. Out of symptomatic and asymptomatic individuals, 76.5% and 56.2% were seropositive, respectively. Surprisingly, only one individual had received the COVID-19 vaccine. Previous history of COVID-19; such as symptoms and gender are statistically significant predictors of high seroconversion independent of age, comorbidities, and level of education.

Conclusion: this study which disclosed unexpectedly high SARS-CoV-2 seroconversion among the Egyptians, might provide a clear insight into COVID-19 transmission patterns and state of immunity. Further study with a larger sample size on a large scale is required to represent the whole local population.

Waardenburg syndrome

Iyer Lavanya Ramakrishnan — 2024-04-08

Waardenburg syndrome (WS) is named after the Dutch ophthalmologist Petrus Johannes Waardenburg, who first described the syndrome in 1947. Waardenburg syndrome type-2 (WS2) is an autosomal disorder. It is a heterogeneous disorder of neural crest cell development with distinct cutaneous manifestations. Waardenburg syndrome is classified into 4 mean phenotypes. This syndrome is a result of multiple gene mutations, of which 6 genes are known. It is an auditory-pigmentary syndrome characteristically showing pigmentary abnormalities of the hair, skin and eyes, often associated with sensorineural hearing loss and absence of dystopia canthorum, which differentiates it from Waardenburg type-1. Mutations in the Microphthalmia-associated transcription factor (MITF) gene, which is located on chromosome band 3p14.1-p12.3, cause some cases of WS2 (15%). Our patient here presented at the age of 14 years with ocular abnormalities. On examination, the patient had a white forelock since birth associated with premature graying, right sided microphthalmia with inferior coloboma of iris on the right eye. The patient had no complaints of diminished hearing. Complete vision and hearing evaluation was done, which was normal. Though not genetically determined, the patient was given a working diagnosis of Waardenburg syndrome type 2. Differential diagnoses that can be considered are Piebaldism, Vogt-Koyanagi-Harada disease or Teitze syndrome.

Apert syndrome: a rare clinical image

Chundi Sai Samhitha — 2024-04-08

Apert syndrome is a rare congenital genetic deformity in which early fusion of skull bones, face, and limbs, hence this condition is also known as acrocephalosyndactyly. Patients with Apert syndrome typically have craniosynostosis, midface hypoplasia, and syndactyly. A 6-year-old female child was brought to our hospital with a fever for 1 day. On examination, the patient had hypertelorism, a steep forehead, a small nose, a depressed nasal bridge, flattened occiput (A), syndactyly of both hands with complete fusion of second, third, fourth, and fifth fingers (B) and syndactyly of toes (C) were seen. The fused fingers and toes had separate nails. There is no cleft lip or palate in this patient. Other symptoms like the cardiovascular system are normal and no murmur is heard. There were no abnormal findings in the echocardiogram and ultrasonography. Treatment includes surgery to release syndactyly fingers for improving functionality. Speech therapy should be started early for a better outcome.

Holt-Oram syndrome: a rare clinical image

Kshitij Aviraj Singh — 2024-04-08

Holt-Oram syndrome is a rare autosomal dominant disorder presenting skeletal abnormalities of the upper limbs (hands and arms) with an underlying structural and/or conduction heart defect. The diagnosis is often made on clinical presentation. An associated cardiac defect may consist of complex congenital heart defects, conduction defects, and arrhythmias. Patients with Holt-Oram syndrome have at least one skeletal deformity in the upper limb, which may include an abnormal or missing wrist bone on an X-ray. The skeletal deformity may vary in severity and presentation, and include a thumb that looks like a finger, a thumb missing on hand, unequal length or underdeveloped upper arm bones, a partial or complete absence of bones in the forearm, and collar bone or shoulder blade abnormalities. Here, we are reporting a case of Holt-Oram syndrome in a five-year male child with ventricular septal defect (VSD), unusual skeletal deformity of the hypoplastic humerus, along with radial and ulnar bone defect, and a unique feature of Holt-Oram syndrome seen in our case.

Antibiotic usage in a South African paediatric medical ward following the introduction of an antibiotic prescription chart

Habibat Dolapo Salau — 2024-04-08

Introduction: the global rise in antibiotic resistance (ABR), coupled with a dry pipeline for the discovery of new antibiotics requires the conservation of currently available antibiotics. Antimicrobial stewardship (AMS) interventions are being implemented to optimize antibiotic use including the use of antibiotic prescription charts. This study reviewed the use of antibiotics before and after the introduction of an antibiotic prescription chart in a paediatricmedical ward of an academic tertiary hospital in Johannesburg.

Methods: a cross-sectional retrospective review of patient records was conducted for patients admitted to a paediatric medical ward of an academic tertiary hospital over two study periods; before and after the introduction of an antibiotic prescription chart. Data were captured on a Microsoft® Excel (2010) spreadsheet and analyzed using Stata/IC 15.1 (StataCorp, USA).

Results: antibiotic use decreased significantly by 7.04% following the introduction of the antibiotic prescription chart (p= 0.027). Fields often left unfilled on the antibiotic prescription chart include age (100%), a record of renal function (GFR/CrCl) (97.46%), time of antibiotic prescribing (83.62%) and a record of culture and sensitivity results (80.17%).

Conclusion: the findings of this study show an improvement in antibiotic use, the frequency of culture and sensitivity testing and documentation of relevant parameters after the introduction of the antibiotic prescription chart. The use of an antibiotic prescription chart is a practical way to achieve optimal antibiotic use and to encourage proper detailing of the clinical components necessary for antibiotic selection in a hospital setting in a developing country.

Quality of life among adolescents with idiopathic scoliosis in Tunisia

Aymen Haj Salah — 2024-04-08

Introduction: our study aimed to assess the quality of life (QOL) among adolescents with adolescent idiopathic scoliosis (AIS) receiving nonoperative treatment, and to identify the demographic and clinical factors associated with poor QOL.

Methods: this is a cross-sectional study. We included adolescents followed in the department of Physical Medicine and Rehabilitation at Taher Sfar Hospital (Mahdia - Tunisia). The Quality-of-Life Profile for Spine Deformities (QLPSD), the Scoliosis Research Society 22 questionnaire (SRS-22) and the visual analogue scale objectifying the QOL (EVA QOL) were used. Correlations between the QOL domains and selected characteristics were performed.

Results: a total of 48 adolescents with AIS were included, with a mean age of 14.2 ± 2.1 years and a sex ratio (M/F) of 0.77. Adolescents who underwent rehabilitation treatment only had significantly better quality of life (QOL) scores than those with braces, as measured by three scales. Among brace wearers, we found a correlation between QOL and the degree of correction achieved by the brace, as measured by the EVA-QOL. We observed significant relationships between psychosocial status and age, correction angle, and treatment duration among braced patients, as measured by the QLPSD. Additionally, we found that dorsal flexibility was correlated with the correction angle and the treatment duration. According to the SRS-22, the overall QOL score of braced adolescents was significantly correlated with the correction obtained by the brace.

Conclusion: wearing a brace in adolescent with AIS leads to a significant decrease in QOL according to the three QOL assessment scales.

A cross-sectional study on the prevalence and drug susceptibility pattern of methicillin-resistant Staphylococcus aureus isolated from patients in the Buea Health District, Cameroon

Morgan Mokeo Ndedy — 2024-04-08

Introduction: Staphylococcus aureus, which is part of the normal flora accounts for most acute and chronic infections in humans, and treatment options are greatly limited, when infection is caused by methicillin-resistant Staphylococcus aureus (MRSA). This study was to determine the prevalence and antimicrobial susceptibility pattern of MRSA from clinical samples obtained randomly from patients in Buea Health District.

Methods: a total of 264 wounds, nasopharynx, and urine samples were collected from patients from different hospitals in Buea and transported to the laboratory in the University of Buea, for analysis. Samples were inoculated on mannitol salt agar for S. aureus isolation, characterized morphologically by gram staining and biochemically by catalase, coagulase, and hemolysis tests. Diagnosis of S. aureus was confirmed by molecular identification of the nuc gene. MRSA was identified from S. aureus by oxacillin screening and confirmed by molecular identification of the mecA gene. The data were analyzed using SPSS version 17.0.

Results: S. aureus was isolated from 70 (26.52%) and all were confirmed molecularly by nuc gene amplification. MRSA by oxacillin screening was 36 (13.64%) while MRSA detected by mecA gene amplification was 34 (12.88%). Antimicrobial susceptibility testing revealed 100% resistance to ampicillin, 88.24% to cefixime and 70.59% to ceftriaxone while low resistance was observed to meropenem (11.76%), doxycycline (14.71%), and vancomycin (17.67%).

Conclusion: MRSA isolated from Buea Health District are resistant to ampicillin, cefixime, and ceftriaxone. The antimicrobials (meropenem, doxycycline, and vancomycin) should be used to treat MRSA infections in Buea Health District.

Drug storage, polypharmacy and frailty syndrome in older people: an observational study

Maturin Tabué-Téguo — 2024-04-08

Introduction: the increasing prevalence of polypharmacy in the older population could lead to inappropriate storage of medicines at home. Since polypharmacy is associated with frailty, the main objective of the Karukera Study of Aging - Drug Storage (KASADS) study was to investigate the association between drug storage and frailty. If such an association exists, drug storage could be a simple tool for the identification of medication vulnerability by non-medical staff in the elderly.

Methods: observational, cross-sectional study in community-dwelling older adults (>65 years old). Drug storage was defined as any drug in excess compared to a medical prescription, any unused and/or expired drug, or any drug without a medical prescription. Frailty was measured with the Study of Osteoporotic Fractures (SOF) scale, and polypharmacy was defined as a prescription of at least 5 drugs. Bivariate and multivariate analyses were performed to study the associations between drugs storage, frailty, and polypharmacy.

Results: during the study period (01/10/2019 to 15/03/2020), 115 elderly people were interviewed in their own homes. The average age was 76.0 ± 7.8 years old. Seventy-two percent of the participants met the criteria for polypharmacy and 30.4% were prefrail/frail. They stored an average of 14.7 ± 18.2 boxes. Drug storage was associated with polypharmacy (17.5 boxes versus 10.0; p=0.031) but not with frailty (15.6 versus 14.3; p=0.724). In multivariate analysis, drug storage was associated with not having a school degree (OR: 1.78; 95%CI: 1.13-2.79), suffering from dyslipidemia (OR: 2.00; 95% CI:1.28-3.17) and suffering from cognitive disorders evaluated by the Mini Mental State Examination (MMSE) score (OR: 1.10; 95%CI:1.02-1.17).

Conclusion: drug storage was not significantly associated with frailty. Nevertheless, it was associated with polypharmacy and other medical outcomes, and could therefore represent a new area for research in geriatrics and pharmacy.

Prevalence of sexual harassment among female medical staff in Four Khartoum State tertiary hospitals

Omer Osman Kheir — 2024-04-08

Introduction: workplace harassment is hypothesized to cause a psychological impact on the welfare of the individual. The aim of this study is to estimate the prevalence of sexual harassment among female medical staff in Khartoum state tertiary hospitals.

Methods: this is a cross-sectional hospital-based study in hospitals of Khartoum, Omdurman and North Khartoum. Our study population comprised female medical staff working in the outpatient clinics, emergency clinics, referred clinics and wards. The data was collected by online Google form self-administered questionnaire. The first part includes demographic information. The second part involved information regarding sexual harassment. The third part obtained information about the psychological status (effect) after harassment. The questionnaire was adopted and utilized from previous studies.

Results: in this study, 325 participants were recruited. Among the participants, 51.4% were doctors, majority (81.2%) of the study population were single. The mean age was 26.29 and SD 3.865. Forty percent (40%) stated they had been sexually harassed at work. Forty-five percent (45%) reported the harassment occurred more than 3 times and 46.4% reported loss of desire for work. Action taken for investigation was only reported by 5.4%. The logistic regression revealed that female doctors were 1.45 times more prone to sexual harassment. Also, medical staff with low socioeconomic status were 83.2% chance not sexually harassed.

Conclusion: the prevalence of sexual harassment among female medical staff was high. Doctors were more vulnerable to sexual harassment. And, the reported incidents were scarce.

Squamous cell carcinoma in kidney with chronic pyelonephritis and pyelonephrosis: a rare case

Pragyamita Datta — 2024-04-08

Primary squamous cell carcinoma contributes around 0.5 to 15% of all urothelial malignancy. The predisposing factor and causative agents include renal calculi, infection and endogenous and exogenous chemicals, hormonal imbalance and vitamin A deficiency. A 56-year-old female presented with right flank pain on and off with fever for the last one-week duration, imaging study revealed dilated calyx containing pus material, one focus showing a small whitish nodule. On gross examination, there was a complete loss of architecture, and one portion of calyx showed a friable whitish area and one small nodule measuring 1 x 0.5 cm. Microscopically showing an irregular nest with sheets of malignant squamous cells, differentiating into keratin pearls and background is traversed stromal invasion.

Spatial factors for COVID-19 associated community deaths in an urban area of Lusaka, Zambia: an observational study

Amos Hamukale — 2024-04-08

We retrospectively analyzed spatial factors for coronavirus disease 2019 (COVID-19)-associated community deaths i.e., brought-in-dead (BID) in Lusaka, Zambia, between March and July 2020. A total of 127 cases of BID with geocoordinate data of their houses were identified during the study period. Median interquartile range (IQR) of the age of these cases was 49 (34-70) years old, and 47 cases (37.0%) were elderly individuals over 60 years old. Seventy-five cases (75%) of BID were identified in July 2020, when the total number of cases and deaths was largest in Zambia. Among those whose information regarding their underlying medical condition was available, hypertension was most common (22.9%, 8/35). Among Lusaka’s 94 townships, the numbers (median, IQR) of cases were significantly larger in those characterized as unplanned residential areas compared to planned areas (1.0, 0.0-4.0 vs 0.0, 0.0-1.0; p=0.030). The proportion of individuals who require more than 30 minutes to obtain water was correlated with a larger number of BID cases per 105 population in each township (rho=0.28, p=0.006). The number of BID cases was larger in unplanned residential areas, which highlighted the importance of targeted public health interventions specifically to those areas to reduce the total number of COVID-19 associated community deaths in Lusaka. Brought-in-dead surveillance might be beneficial in monitoring epidemic conditions of COVID-19 in such high-risk areas. Furthermore, inadequate access to water, sanitation, and hygiene (WASH) might be associated with such distinct geographical distributions of COVID-19 associated community deaths in Lusaka, Zambia.

Characterization of oral candidiasis according to antiretroviral treatment status, immunological and virological profiles among HIV infected patients in two health facilities in Yaounde Cameroon: a cross-sectional and analytical study

Joseph Fokam — 2024-04-08

Introduction: oral candidiasis in HIV-disease generally indicates immune incompetence both among antiretroviral treatment (ART) naive and experienced patients. To optimize oral healthcare among people living with HIV (PLHIV) in sub-Saharan Africa (SSA), we sought to evaluate the type and distribution of oral candidiasis with respect to ART-profile and immuno-virological parameters among PLHIV in the Cameroonian context.

Methods: a cross-sectional study was conducted among 163 patients (51 ART-naïve and 112 ART-experienced) residing in Yaounde Cameroon, from February through May 2019. Oral candidiasis was assessed, while viral load (VL) and CD4-count were measured on Abbott m2000rt and Cy-flow counter platforms, respectively. Data were analyzed using the Statistical Package for the Social Science (SPSS) v.21 with p<0.05 considered statistically significant.

Results: in all, 18 cases of two forms of oral candidiasis were identified (13 erythematous and 5 pseudomembranous), with the majority, 27.7% (11/51), observed among ART-naïve patients against 6.3% (7/112) in ART-experienced (p=0.006). With respect to immuno-virological profile, 77.8% (14/18) and 22.2% (4/18) of cases were identified among participants with CD4<200 cells/mm³ and CD4>200 cells/mm³, respectively (p<0.0001). In the light of viral load, the occurrence of oral candidiasis was largely observed among subjects with VL≥1000 copies/ml, 83.3% (15/18), against 16.7% (3/18) with VL<1000 copies/ml, irrespective of the candidiasis form (p<0.0001).

Conclusion: among PLHIV, erythematous and pseudomembranous candidiasis are commonly found in the absence of ART, driven by immunodeficiency and active viral replication. In spite of the protective role of ART, PLHIV experiencing immuno-virological failure should be referred for management of oral candidiasis.

Jejunal atresia type 4

Lavanya Ramakrishnan — 2024-04-08

Congenital gastrointestinal (GI) malformations like anorectal malformations (ARM), Hirschsprung's disease (HD), and intestinal atresias are conditions that are commonly presented. Though there is the possibility of some of them being detected antenatally in scans, they are usually missed or may even go undetected. Atresia is a congenital defect of a hollow viscus that results in complete obstruction of the lumen. Intestinal atresia is one of the most frequent causes of bowel obstruction in newborns and can occur at any point in the gastrointestinal tract. Cases of intestinal obstruction in neonates can be either congenital or acquired. Congenital causes involving obstruction of the digestive tract can be divided into high obstruction occurring above the level of the ileum and low-lying obstructions occurring in the ileum and the colon. Approximately one-half of the cases presenting with GI obstruction involve the duodenum. Amongst other congenital malformations of the GI tract, in the order of incidence, intestinal atresias are the most commonly presenting followed by anal atresia or anorectal malformations and lastly esophageal atresia as a part of the tracheo-esophageal fistula (TEF). Intestinal atresias contribute to nearly 50% of intestinal obstruction cases presenting in the neonatal period. About 20 percent of these are associated with chromosomal anomalies. Among the acquired causes of intestinal obstruction presenting in the neonatal period, midgut malrotation or midgut volvulus are seen, mostly in the first week of life. Here, we present a neonate brought to us on day 2 of life in view of feed intolerance at birth with bilious vomiting and abdominal distension. X-ray erect abdomen showed a classical triple bubble sign suggestive of jejunal atresia (A). The patient was taken up for explorative laparotomy and was found to have type high jejunal atresia with multiple, distal atretic segments, which falls into the type 4 category, the rarest form. Resection of 12 cm of the atretic jejunum and end-to-end anastomosis were done (B, C). All cases of obstruction, whether congenital or acquired, require radiological diagnosis as soon as one is suspected and surgical management in the neonatal period to avoid deleterious complications of gut ischaemia, perforation, and peritonitis. Most cases of neonatal GI obstruction have a good prognosis post-operatively, especially after the advent of parenteral nutrition with cautious its use and improved neonatal care facilities.

Knowledge and practices surrounding outbreaks and COVID-19 among community health workers in rural Rwanda: a cross-sectional mixed-methods study

Anne Niyigena — 2024-04-08

Introduction: Community Health Workers (CHW) are a critical resource for outbreak preparedness and response. However, CHWs´ ability to respond to outbreaks depends on their accurate knowledge of the disease and proper adoption of disease prevention practices. We explored knowledge and practices related to outbreaks in general, and COVID-19 among CHWs in Rwanda.

Methods: this cross-sectional multimethod study used stratified simple random sampling to recruit three cadres of CHWs (agents de santé maternelle, female Binomes, and male Binomes ) from three rural Rwandan districts. We used telephone-based data collection to administer quantitative surveys (N=292) and qualitative interviews (N=24) in September 2020. We calculated descriptive statistics and conducted thematic analysis of qualitative data. We assessed for associations between general outbreak-related knowledge and receipt of training using Chi-square tests and between COVID-19 related knowledge and CHW characteristics and adoption of prevention methods using linear regression models.

Results: only 56.2% of CHWs had received training on any health topic in 12 months prior to COVID-19 pandemic and only 19.2% had specifically received training on outbreak preparedness. Almost all CHWs reported preventing COVID-19 by wearing facemasks (98%), washing hands (95%), and social distancing in crowds (89%) with fewer reporting staying at home (50%), sneezing or coughing into an elbow (38%) or using hand sanitizer (18%). Almost all CHWs in our study knew that COVID-19 transmits through respiratory droplets (98%) and by infected surfaces (98%) and that asymptomatic spread is possible (91%). However, fewer than half of community health workers correctly affirmed that children were at low risk of becoming severely ill (48%) and only 32% correctly rejected the misconception that everyone with COVID-19 would become severely ill. There was no association between COVID-19-related knowledge and adoption of COVID-19 preventative practices. Qualitative findings suggested that while CHWs possessed lots of correct information about COVID-19 and reported good adherence to COVID-19 prevention practices, they also commonly held misconceptions that over-exaggerated the dangers of COVID-19.

Conclusion: gaps in knowledge, training, and access to information point to a need for additional investment in supervision and credible informational systems to support CHWs.

A typical picture of Kayser-Fleisher ring in an 8-yearold child with Wilson's disease

Mayuri Amol Deshpande — 2024-04-08

The mutations in the ATPP7B gene cause an autosomal recessive disorder known as Wilson's disease. It is also known as hepatolenticular degeneration and progressive lenticular degeneration. This disease, in the early stage, causes hepatic and neurogenic disorders. It may be present as hepatitis, cirrhosis, and hepatic decompensation. An episode of hepatitis may occur with or without jaundice which spontaneously regresses. Here is an image of Kayser-Fleisher ring which can be easily seen in a boy of age 8 years old. The boy was well oriented to space and time and didn´t show any symptoms except a brown-colored ring encircled cornea which is known as ''Kayser-Fleisher ring'' or ''copper ring''. Before 4-6 months the boy was hospitalized for hepatitis.

Fatal subacute sclerosing panencephalitis in an 8-year-old male: a case report

Fartun Abdullahi Hassan Orey — 2024-04-08

Subacute sclerosing panencephalitis (SSPE) is a chronic slow progressive neurodegenerative disease that is often associated with measles complications. The disease is characterized by seizures, behavioral changes, motor deficit and eventually death. In this case report we discuss the case of an 8-year-old male who developed SSPE and was presented to our hospital with a history of generalized tonic colonic convulsion followed by gait abnormality, episodes, abnormal behaviors, and cognitive regression. On clinical exploration, the child had a history of measles at 8 months of age and meningitis at 18 months. The electroencephalogram (EEG) investigation showed high amplitude spikes, with focal seizure and slowing, while the magnetic resonance imaging reveal signals synonymous with high fluid-attenuated inversion recovery (FLAIR), both of which are consistent with probable SSPE. The case was managed symptomatically; until his parents decided to take him back home, after which his condition deteriorated, and he sadly died. To the best of our knowledge, this is the first recorded case of SSPE in Mogadishu, Somalia. Hence, the need to further investigation to better understand the incidence of the disease in the population and propose better ways of managing the condition.

Unmet need for family planning and predictors among women in the extended postpartum period, southeastern Nigeria: a facility-based cross-sectional study

Chidinma Ihuoma Amuzie — 2024-04-08

Introduction: the ravaging COVID-19 pandemic has worsened the levels of unmet need (UMN) for family planning (FP). A pulse survey showed that FP services were interrupted during the lockdown in 68% of countries. There is a need to investigate the demand gap for FP among women in the postpartum period. This study aimed to determine the prevalence and predictors of UMN of FP among women in the extended postpartum period attending immunization clinics.

Methods: this was a facility-based cross-sectional study among 485 women recruited from 5 health facilities using a random sampling technique and proportional to size allocation. Data was collected using an interviewer-structured questionnaire. Analysis was done using IBM SPSS version 26. Adjusted odds ratios with 95% confidence intervals were computed. The level of significance was 5%.

Results: the total unmet need was 45.4% (95% CI: 40.2–50.7) with a higher need for child spacing (60.4%) compared to limiting pregnancies (39.6%). The mean age was 30.3 ± 6.1 years. The significant predictors included age [35-39 years (aOR=5.39, 95% CI:1.61-18.06); ≥ 40 years (aOR= 32.48, 95% CI: 6.48-162.77)], lower education status (aOR= 5.21, 95% CI:2.09-13.01), lower income (aOR =2.21, 95% CI:1.10-4.46), rural residence (aOR= 4.27, 95% CI: 2.15-8.47), denomination [Pentecostal (aOR= 4.09, 95% CI:1.77-9.43); Orthodox (aOR= 5.44, 95% CI: 2.03-14.58)] and poor knowledge of postpartum FP (PPFP) (aOR= 33.93, 95% CI:13.21-87.12). The commonest reason for FP non-use was fear of side effects.

Conclusion: close to half of the women in the extended postpartum period experienced UMN for PPFP. Policymakers should consider these factors when designing FP interventions.

Socio-demographic and reproductive characteristics of clients that accepted contraceptives at abortion center at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa: a cross-sectional study (January-July 2021)

Kennedy Baffour-Duah — 2024-04-08

Introduction: access to family planning services is an important preventive strategy against maternal mortality as it can considerably reduce unintended pregnancies and prevent sequelae of unsafe abortion. We aimed to describe the socio-demographic and reproductive characteristics of abortion seekers and investigate factors associated with uptake of contraceptives following induced abortion at Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.

Methods: this study was a cross-sectional study among women who had legal termination of unwanted pregnancy at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), from 1^st January 2021 to July 2021. Questionnaires were administered to 80 consenting consecutive clients after undergoing induced abortion. Information on socio-demographic and reproductive characteristics and pattern of contraceptive uptake of the respondents were obtained. Descriptive and bivariate analysis were conducted to determine the pattern and relationship of socio-demographic and reproductive characteristics and contraceptive uptake.

Results: the mean age of the 80 respondents was 25.6 ± 6.6 years. Majority of the participants were of the Black race (96.25%, n= 77/80), single (90.00%, n= 72/80), of the Christian faith (80.00%, n= 64/80) and unemployed. The median number of children alive among the clients was 1(0-2), with about 37.5% of the participants being nulliparous. About 16.25% of the participants had had at least one previous termination of pregnancy. The prevalence of post-abortion contraceptive uptake was 97.5% (95%CI: 90.36% - 99.39%, N=78/80). More than half chose injectable contraceptive (53.85%, 95%CI: 42.60% - 64.71%, N= 42/78), followed by oral contraceptive pills (21.79%, 95%CI: 13.90% - 32.49% N= 17/78). We found no association between socio-demographic and reproductive characteristics, and contraceptive uptake among the abortion clients (p values >0.05).

Conclusion: the immediate post-abortion contraceptive uptake in our facility is very high. Majority of the clients accepted injectable contraceptives. The demographic and reproductive characteristics of our clients did not affect uptake of post-abortion contraception. More education is needed to improve uptake of other long-acting contraceptives that may not require frequent contact with the health facility.

Plasma paraoxonase-1 activity levels in patients with type 2 diabetes mellitus in Lagos State University Teaching Hospital, Lagos, Southwest Nigeria: a cross-sectional study

Adeyemi Oluwaseun Dada — 2024-04-08

Introduction: paraoxonase 1 (PON1) is a high-density lipoprotein (HDL) associated enzyme that has anti-inflammatory, anti-atherogenic, and antioxidant functions. PON1 is noted to be a determinant of resistance to the development of atherosclerosis through hydrolysis of phospholipid and cholesteryl ester hydroperoxides. This study was designed to assess PON1 activity levels among patients with type 2 diabetes mellitus (T2DM) in Southwest Nigeria.

Methods: this was a cross-sectional study done over a period of six months. A total of 138 participants; 69 with T2DM and 69 apparently healthy controls were recruited for this study. Fasting plasma glucose (FPG), HDL cholesterol (HDL-c), and PON1 activity were analyzed in the participants. The comparison of the mean between the groups of participants was assessed using the independent student t-test while the Mann-Whitney U test was used to compare two medians. The p-value was set at 0.05.

Results: mean age for participants with T2DM was 54.90 ± 8.1 years and the healthy control group was 54.12 ± 8.4 years, with a p-value of 0.549. The male-to-female ratio was 0.47 for both participants with T2DM and healthy controls. Participants with T2DM had significantly higher median glucose concentration of 109.18 mg/dl compared with 82.58 mg/dl among controls, p-value <0.001. Median serum HDL-c was lower in diabetics compared to controls (52.66 mg/dl vs 57.92 mg/dl; p-value < 0.001). PON1 activity was lower in T2DM compared with that of the controls (690.11 pmol/min/ml vs 3379.7 pmol/min/ml; p-value <0.001). Paroxonase 1 showed a non-significant positive correlation with HDL-c and a negative correlation with FPG, and body mass index (BMI).

Conclusion: these findings suggest that PON1 activity is lower in T2DM compared to healthy controls and a lower PON 1 activity level was seen among female diabetics compared with the male diabetics.

Prevalence of multidrug-resistant and extensively drug-resistant phenotypes of Gram-negative bacilli isolated in clinical specimens at Centre Hospitalo-Universitaire Ibn Rochd, Morocco

Imane Zalegh — 2024-04-08

Introduction: antimicrobial resistance in gram-negative bacilli is one of the major concerns in public health. We aimed to evaluate gram-negative bacilli epidemiology, antimicrobial profiles, and the resistance´s mechanism for Enterobacteriaceae isolated from specimens of hospitalized patients in wards of University Hospital Center Ibn Rochd of Casablanca, Morocco.

Methods: a prospective study of the patient's specimens, collected from December 2016 to 31^st March 2017. Isolation and identification were performed using conventional biochemical tests. According to the European Committee on Antimicrobial Susceptibility Testing guidelines, antibiotic susceptibility was determined. Polymerase Chain Reaction (PCR) was used to detect β-lactamase and carabapenemase genes: CTX-M, SHV, TEM, OXA-48, NDM, and VIM among the Enterobacteriaceae.

Results: according to inclusion criteria, 38 Enterobacteriaceae, 25 Acinetobacter baumannii (A. baumannii), and 10 Pseudomonas aeruginosa (P. aeruginosa) were included during the study period; these bacteria were mainly responsible for bacteremia. Fifty-five percent of enterobacteria were extended-spectrum β-lactamase (ESBL), 42% EBSL and carbapenemase, and 3% carbapenemase, with high coresistances. Eighty-four percent of A. baumannii were XDR. All P. aeruginosa were MDR; amikacin showed the best activity (70% susceptibility). The genotypic approach revealed the presence of bla_CTX-M, bla_SHV, bla_TEM in 68%, 22%, and 11% respectively. Of the 22 carbapenemase-producers, 41% were bla_OXA-48 and 18% bla_NDM; none had bla_VIM. Furthermore, various genes coexistence were detected: bla_CTX-M+bla_OXA-48; bla_CTX-M+bla_NDM; bla_CTX-M+bla_SHV+bla_OXA-48; and bla_SHV+bla_OXA-48.

Conclusion: findings revealed highly resistance rate among isolates. This raises the need to control antibiotics and regular screening to identify dynamics promoting resistance. Thus, we recommend developing antimicrobial stewardship programs and improving hygiene systems to prevent the nosocomial spreading of these phenotypes in our center.

Arthroscopy and orthopedic residency: a cross-sectional study of training structure in a resource-constrained environment

Oladimeji Ranti Babalola — 2024-04-08

Introduction: orthopedic residency training was established in the West African sub-region a few decades ago, but sub-specialty in arthroscopy has only become established in the last decade. This study was aimed at evaluating available arthroscopy training resources and their impact on skill acquisition by orthopedic residents.

Methods: this was a cross-sectional study involving the use of a structured online survey of consultant orthopedic surgeons and orthopedic resident doctors. Details relating to the structure of training and challenges with training and recommendations for improved training were enquired.

Results: one hundred and two responses were received. There were 95% males (73) and 5% (4) females among the residents and 92% (23) males and 8% (2) females among the responding consultants. Of the residents, 47% (36) were registrars while 53% (41) were senior registrars. Seventy-six percent (77) were residents and twenty-five (24%) were consultants. Didactic lectures were the most impactful available training adjunct. Only 3% (2) of the residents had access to dry laboratory sessions with no specified number of practice hours attached. There was no computer simulation laboratory or cadaveric laboratory training facility for arthroscopy training in any of the training centres. Ninety-two percent (23) of the responding consultants would prefer a 6 - 12-month rotation in arthroscopy for residents. Fifty-three percent (41) of the residents had regular opportunities to participate in arthroscopic surgeries.

Conclusion: orthopedic residency in arthroscopy in Nigeria is emerging and can be improved upon by increasing the available training resources and trained personnel.

Epidemiology of posterior urethral injury among adults with traumatic pelvic ring disruptions: a 10-year retrospective review from a trauma care centre in Southeast Nigeria

Ikenna Ifeanyi Nnabugwu — 2024-04-08

Introduction: posterior urethral injuries can occur in polytrauma settings, and may contribute to morbidity post-trauma. The aim of this study is to determine the occurrence of pelvic fracture urethral injury (PFUI) in adult polytrauma patients who were successfully stabilized and to appraise the nature of associated injuries.

Methods: the medical records of stabilized polytrauma patients ≥ 18 years of age from January 2010 to December 2019 were retrospectively reviewed focusing on those presenting with bony pelvis disruptions. Injuries were categorized using the injury severity scale (ISS) while bony pelvis disruptions were classed according to the Young-Burgess classification. Data on the demography of the patient, mechanism of injury, nature, and severity of injuries, class of pelvic fracture-disruption, and urethral integrity were collected and analyzed accordingly.

Results: of 111 patients with bony pelvis disruptions, 95 of them had adequate information and were included in our analysis. The mean age of participants was 37.3 ± 11.8 years and most of them were males (87.4%). Blunt pelvic trauma occurred in 96.8%. Lateral compression pelvic injuries were prevalent at 39.0%. In 54.7% of the patients, the injury severity score (ISS) was ≥ 27. At 25.3% and 24.2% respectively, the abdomen and the lower extremities most frequently sustained a grade ≥ 3 injuries (abbreviated injury scale (AIS) ≥3). At a rate of 2.1%, spinal cord injury was the least observed. In the 10 years, there were 6 PFUI among 83 stabilized polytraumatized men with mean ISS of 35.5 ± 8.3. The incidence rate of PFUI was 0.6 per 8.3 pelvic disruptions in men per year. Symphysis pubis disruption or fracture of the pubis or both was consistently seen in all PFUI. Higher ISS significantly relates to PFUI (p <0.001). The mechanism of bony pelvis disruption and the class of bony pelvis injury are determined by the severity and trajectory of the impact apparently relates to PFUI only through fracture-disruption of the pubic symphysis or the pubis.

Conclusion: about 7.2% of men presenting with traumatic disruption of the bony pelvis in polytrauma setting sustain PFUI. In polytrauma settings, PFUI should be suspected in cases of fracture-disruption of the pubis or symphysis pubis from any mechanism.

Clinical presentation and persistent symptoms in patients at a post-COVID-19 clinic in Ghana

Hanson Gabriel Nuamah — 2024-04-08

Introduction: on March 11^th, 2020, the World Health Organization recognized COVID-19 as a pandemic. By March 31^st, 2021, the Ghana Health Service had recorded a cumulative 90,782 positive cases and 748 deaths in the country. Despite the significant resources and efforts being put into containing and treating individuals with COVID-19, there is a lack of information within sub-Saharan Africa on clinical presentations and factors associated with experiencing persistent symptoms of COVID-19.

Methods: in this retrospective study, we collected data obtained from patients with COVID-19 who were discharged from the post-COVID-19 clinic at the Ga East Municipal Hospital, Ghana, between April 1^st, 2020, and March 31^st, 2021, to assess clinical presentations and identify predictors of COVID-19 symptoms that persist beyond 14 days from the onset of the symptom.

Results: of the 253 patients who experienced symptoms of COVID-19, 81 (32.0%) experienced symptoms that persisted beyond 14 days. Cough (64.0%), headache (38.7%), and chest pain (28.1%) were the most common symptoms. After adjusting for covariates, the odds of patients presenting with COVID-19 symptoms that persist beyond 14 days are 98% higher among patients who experienced chest pain compared to those who did not and 2% increased for each additional year of their age.

Conclusion: patient´s age and experiencing chest pain were significant predictors of symptoms that persist beyond 14 days. The findings of our study highlight the need to continue to monitor and care for individuals with identified predictors of experiencing persistent symptoms of COVID-19.

Complementary feeding practices among mothers having children less than two years old attending well-baby clinics in Jazan City, Saudi Arabia

Aisha Awaf — 2024-04-08

Introduction: infant feeding practices are important determinants of growth and development not only in infancy but also in later life. The main objective of this study is to describe infant feeding practices and the factors affecting complementary feeding (CF) among mothers in Jazan City.

Methods: an observational cross-sectional study was conducted among 400 mothers having children less than 24 months old, attending the well-baby clinics in Primary Health Care Centers (PHCCs) in Jazan City, Saudi Arabia. A structured questionnaire was used to collect data in a face-to-face interview.

Results: on the mother’s level of knowledge regarding proper infant feeding, 49% scored high, 41% scored medium, and 9.75% scored low. The mother’s educational level, working status, family income, and knowledge source played a significant role in the knowledge scores (p < 0.05 for all). Overall, 15.8% of the mothers never breastfed (BF) their children, 39.8% BF less than six months, 17.5% BF 6-12 months, and 27% BF over 12 months. BF duration is significantly associated with maternal literacy and family income (p = 0.006 for both). Overall, approximately one-third of the women (36.2%) started CF at six months or later, while 63.8% started CF at 4-6 months.

Conclusion: Jazan women use some positive infant feeding practices, including breastfeeding. One-third of the women started CF at six months or later, which is considered the optimal time for the CF introduction. More nutrition education is necessary to raise maternal awareness regarding appropriate infant feeding and weaning practices.

Cutaneous lymphangioma circumscriptum

Adithya Kiran — 2024-04-08

An 11-year-old boy presented to the Out Patient Department (OPD) with a slow growing, asymptomatic lesion on his left shoulder region. The lesion was present since birth and had gradually increased in size over time. The patient reported no pain or discomfort associated with the mass. Physical examination revealed erythematous clusters of translucent intact vesicles, containing clear fluid of varying sizes (2 mm - 5 mm) with few crusts on the left shoulder (A). Few vesicles had ruptured, however there was no evidence of local inflammation or cellulitis. Few of these channels were filled with clear fluid (B). Dermoscopy revealed frogspawn like lesions with white lined structures (C). Hence, the diagnosis of lymphangioma circumscriptum was made. The patient was referred to a plastic surgeon for excision of the lesion. Post-operative healing was uncomplicated, and the patient made a full recovery and was discharged and monitored for recurrence. Cutaneous lymphangiomas are a rare congenital malformation of the superficial cutaneous lymphatic ducts. Lymphangioma circumscriptum (LC) is a lymphatic malformation that is composed of superficial lymphatic vessels, microcysts on the skin or mucous membrane. They occur as a result of an error in the morphogenesis of the lymphatic vessels, leading to a disorder of lymph drainage. It is clinically defined by a clustering of vesicles with varying content in blood. The symptoms may include pruritus, pain, burning, lymphatic drainage, infection, and aesthetic concerns. Although dermoscopy plays a major role in the diagnosis, histology remains the gold standard for diagnosis.

Menstruation behaviour influencer model: a grounded theory of menstrual experiences of shame, embarrassment, stigma and absenteeism among pubescent girls in semi-urban and rural secondary schools in Enugu State, Nigeria

Nneka Edith Ubochi — 2024-04-08

Introduction: severally, studies had identified menstrual-associated shame, embarrassment, stigma, and absenteeism among pubescents in school with resultant challenges on their bio psycho-social functioning. However, what is not clear is the contribution of the home and school to the experiences. The objectives of the study were to explore the experiences with menstruation and menstrual hygiene management; explore the experiences with menstrual-associated shame, embarrassment, stigma, and absenteeism among participants; explore the bio-psycho-social issues associated with the experiences; understand the meaning of the experiences and propose a mid-range theory that explains the influences on pubescents´ menstrual behaviours.

Methods: constructivist grounded theory design was used to explore the experiences of 20 purposively recruited pubescents from rural and semi-urban secondary schools. In-depth Interviews, focused group discussions, key informant interviews, and observations were employed to collect data until data saturation. Open and focused coding was conducted to identify emerging themes and sub-themes. These themes were returned to participants and literature for verification.

Results: four (4) categories and eleven (11) sub-categories emerged from the data and formed four (4) themes that influence pubescents´ menstrual behaviour. They include: 1) individuals´ bio-physiological status, knowledge of menstrual health and menstrual characteristics; 2) regimenting school through strict rule enforcement, punishment/motivation, forced participation, and compliance; 3) scheduling academic activities/examination, sporting and other extra curricula activities; and 4) providing menstrual support by individual and institutional efforts to pubescents. Based on the relationship with other themes, the menstrual behaviour influencer model was proposed.

Conclusion: menstrual influencers require the interaction between menstrual support and menstrual enablers by institutions for positive menstrual behavior. Failure to achieve this balance will lead to menstrual-associated shame, embarrassment, stigma, absenteeism, and school drop-out.

Embolie pulmonaire: indice de sévérité de l'embolie pulmonaire (ISEP) score et facteurs prédictifs de mortalité

Majed Hassine — 2024-04-08

Introduction: l´embolie pulmonaire constitue par sa morbi-mortalité demeurant élevée un véritable problème de santé publique. L´objectif de cette étude est d´évaluer l'impact de l'ISEP (indice sévérité de l'embolie pulmonaire) score sur le pronostic de l´embolie pulmonaire.

Méthodes: étude rétrospective qui a colligé 146 cas d'embolies confirmées de façon formelle. A partir de l´ISEP score calculé pour l´ensemble de cette population, nous avons subdivisé nos patients en 2 groupes: un groupe à bas risque (BR) regroupant les classes I et II: 83 patients; un groupe à haut risque (HR) regroupant les classes III, IV et V: 63 patients. Le critère de jugement primaire de l´étude (MACE) regroupait la survenue d´un état de choc, la nécessité de ventilation mécanique, et la survenue d'un décès en intra-hospitalier.

Résultats: la mortalité intra-hospitalière totale était de 15,1%, significativement plus importante dans le groupe à HR (25,4% contre 7,2%, p=0,001). En analyse de régression logistique, l'appartenance au groupe HR (OR=5,1; IC à 95%: [1,637 - 16,093]; p=0,005) et l'insuffisance rénale (OR=4,5; IC à 95%: [1,457 - 14,075]; p=0,009) étaient les facteurs indépendants de survenue de MACE. Au bout d´un suivi moyen de 18 ± 8 mois, on a noté plus de décès dans le groupe HR (68,4% contre 33%, p=0,004).

Conclusion: les résultats de notre étude démontrent que l´ISEP score est corrélé à la sévérité de l´EP ce qui devrait encourager la généralisation de l´utilisation de ce score de risque.

Tenosynovial giant cell tumour of the finger: a case report

Ankit Jaiswal — 2024-04-08

Giant cell tumour most commonly occuring in epiphysis of the long bone, present and with pain, tenderness and swelling. It is a solitary lesion with restricted movement and tenderness over the lesion. The tendon sheath is where tenosynovial giant cell tumours typically develop. Because of its remarkably peculiar position, we present a case of giant cell tumour (GCT) tenosynovial of bone in the middle phalaynx in a 33-year-old female with complaints of swelling, pain in ring finger of left hand since 2 months which is rarely seen. After clinical, radiological, pathological investigations tenosynovial giant cell tumour was diagnosed. Following fine needle aspiration cytology, histopathology was utilized to confirm the tumour's diagnosis which was later treated as resection of excision of the tumour with allo/auto graft reconstruction. Our case report showed no evidence of recurrence in 2 years of follow-up. Hence, our case report proves that early and complete resection of the tumour shows evidence of regain of complete range of motion and decrease recurrence rate.

Non-healing trophic ulcer in leprosy: a case of failure at all levels of prevention

Himabindu Reddy — 2024-04-08

Hansen's disease, one of the neglected tropical diseases, is on the WHO agenda as ‘Towards zero leprosy strategy,’ aiming to eliminate disease disability and discrimination associated with leprosy by 2030. This year marks the 150^th anniversary of the discovery of the causative organism ‘Mycobacterium Leprae’. To achieve this target, it is crucial to target all angles of the epidemiological triad, i.e. to not just cure existing cases but also prevent new incidences or transmission of Leprosy. The image shows the right foot of a 65-year-old lady, with a case of multibacillary leprosy on multidrug therapy (MDT) for 1 year. She first noticed a wound on the plantar aspect of her foot (two toes autoamputated) six months back (A) for which she only took some herbal concoction from a local non-medical healer. She had been abandoned by her family over a year ago upon her leprosy diagnosis, so her predicament remained neglected. We came across this case during a health camp in the village. Upon examination, the wound was determined to be an 8cm x 5cm x 2cm ulceroproliferative lesion on the lateral aspect of the foot, with irregular margins, raised rolled-over edges, with slough and surrounding induration. It bled on touch (B) but was not associated with pain or tenderness. Loss of sensation and pain due to Hansen's, forgoing appropriate footwear due to lack of awareness, stigma towards leprosy patients and long distance to leprosy center (> 20km) caused a simple wound to progress to more than half her foot, thus debilitating her.

Prevalence and factors associated with incomplete immunization among children aged 12 to 35 months in Eswatini: analysis of the Eswatini multiple indicator cluster survey

Thatho Nolwazi Dlamini — 2024-04-08

Introduction: incomplete childhood immunization is a significant public health challenge as children continue to succumb to vaccine-preventable diseases in most developing countries. Studies on childhood immunization conducted in Eswatini are sparse. Therefore, the present study assessed the prevalence of incomplete childhood immunization in Eswatini and further explored associated factors among children aged 12 to 35 months.

Methods: using data from Eswatini multiple indicator cluster survey 5 (EMICS5), a cross-sectional analysis with 978 children aged 12 to 35 months was conducted. This is the latest available data in the public domain. The survey was conducted from July 2014 to October 2014. The primary outcome variable was incomplete immunization. Univariate and multivariate logistic regressions were used to examine the association between selected variables and incomplete immunization.

Results: the mean age of the children was 23.45±6.92 months, 50.2% were boys, and 74.1% lived in rural areas. The prevalence of incomplete immunization was 31.5%. Increased child´s age, being a girl, increased caregiver´s age, and increased number of children under-five years in the household and residing in the Manzini or Hhohho region were significantly associated with incomplete immunization.

Conclusion: the EMICS 5 revealed a high prevalence of incomplete immunization in Eswatini. Health promotion activities such as empowering women and caregivers of children through health education about child health should be emphasized. Where feasible, outreach services and door-to-door immunization should be strengthened to improve immunization coverage in the country and cover dropouts.

Une lésion labiale traumatique insolite

Romaric Beheton — 2024-04-08

Les traumatismes des lèvres occupent une place prépondérante des plaies faciales. La proéminence des lèvres et le rapport étroit contracté avec les dents, en font une unité esthétique vulnérable. Un élève de 20 ans a été reçu 02 heures après un traumatisme maxillo-facial suite à un accident de la circulation par collision frontale entre deux motocyclistes, avec chute et réception de la lèvre supérieure sur le guidon de sa moto. L´examen maxillo-facial notait un comblement du sillon naso-génien avec surélévation de l´aile nasale droite, une encoche de l´hémi-lèvre supérieure droite, bien colorée, et dont le prolongement endobuccal était enfoui dans le vestibule, donnant un aspect de « fente labiale unilatérale droite ». Le bilan radiologique a noté un niveau hydro-aérique avec une solution de continuité de la paroi médiale du sinus maxillaire droit. Le diagnostic d´incarcération traumatique de l´hémi-lèvre supérieure droite avec fracture du maxillaire droit non déplacée est retenu. Ceci peut se discuter avec une fente labiale supérieure droite unilatérale ou incomplète, ou une plaie avec perte de substance de l´hémi-lèvre supérieure droite. C´est une lésion très inhabituelle de la lèvre supérieure nécessitant une réparation en urgence vue le risque d´ischémie et de nécrose labiale. Sous anesthésie locorégionale, l´exploration notait l´hémi-lèvre supérieure droite enfouie et incarcérée à travers une fracture non déplacée située à hauteur de l´incisure nasale. La désincarcération est réalisée, occasionnant une perte de substance labiale minime avec un décollement vestibulaire, réparés par suture directe. L´évolution était bonne.

Evaluation des pratiques de l´automédication et leurs caractéristiques auprès des étudiants d´Uvira en République Démocratique du Congo

Henry Manya Mboni — 2024-04-08

Introduction: actuellement, l´automédication constitue une menace de la santé publique. Cette étude avait pour objectif d´évaluer les pratiques de l´automédication chez les étudiants d´Uvira en République Démocratique Congo.

Méthodes: il s´agit d´une étude descriptive transversale menée sous forme d´interview indirecte auprès de 700 étudiants grâce à un questionnaire d´enquête auto-administré. Les données ont été traitées avec XLSTAT.

Résultats: sur les 700 étudiants enquêtés, la prévalence de l´automédication représente 99,3% (n=695) dont 42,3% (n=294) l´ont débutée à l´adolescence. Du total, 57,4% (n=399) certifient faire recours à l´automédication chaque fois qu´ils tombent malades et qu´ils sont en manque d´argent (n=471, 67,7%) pour une consultation; la pathologie la plus citée au cours de cette pratique étant le paludisme (n=212, 30,5%). De tous les médicaments recourus, le Paracétamol occupe la première place (n=106, 15,3%) alors que le comprimé constitue la forme la plus usée par ces étudiants (n=598, 86%). Sur le plan de l´association médicamenteuse, on note en nombre de fréquence élevée le Fansidar-Coartem (n=106, 17,2%); la posologie dépendant de l´âge dans 65,6% (n=456) de cas. L´étude a aussi démontré que 37,4% (n=695) des étudiants interviewés recourent à la phytothérapie, surtout pour traiter le paludisme (n=124, 47,3%).

Conclusion: chez les étudiants d´Uvira, l´automédication est extrêmement pratiquée, surtout contre le paludisme. Des efforts dans la sensibilisation à l'usage rationnel des médicaments sont à entreprendre par les personnels de santé en connivence avec les décideurs politiques pour mieux contrôler voire éradiquer cette pratique néfaste à la santé.

Meckel´s diverticulum presenting as acute abdomen

Kiran Mastud — 2024-04-08

A 34-year-old female presented to us in the emergency room with acute abdomen since 2 days. Patient had tachycardia, fever, persistent vomiting, and complaint of not being able to pass stool for 2 days and flatus since 1 day. Per abdomen examination revealed a distended, tender abdomen with absent bowel sounds in all quadrants. X-ray erect abdomen was done which revealed multiple air fluid levels (more than 6) confirming the diagnosis of acute intestinal obstruction. Patient underwent an emergency exploratory laparotomy and was found to have a transition point from a mesodiverticular adhesion causing proximal dilatation of small bowel loop. A diagnosis of small bowel obstruction due to Meckel's diverticulum was made. Adhesion band was released, resection of Meckel's diverticulum and functional end-to-end anastomosis was performed. Meckel's diverticulum is a true diverticulum, containing all layers of the small bowel wall. It is failure of the vitelline duct to obliterate completely, which is usually located on the antimesenteric border of the ileum. It occurs in 2% of the general population and majority of patients remain asymptomatic. When it presents symptomatically it causes painless gastrointestinal bleeding. Nevertheless, in rare instances, it can cause acute intestinal obstruction as it did in our case. The average length of a Meckel´s diverticulum is 3 cm, with 90% ranging between 1 cm and 10 cm and the longest being 100 cm. Our case presents a large Meckel's diverticulum and the size of diverticulum was 4x2cm.

Facteurs associés à la pratique de l´allaitement maternel exclusif chez les mères d´enfants âgés de 6 à 12 mois dans la commune de Kaolack (Sénégal)

Boubacar Gueye — 2024-04-08

Introduction: l´allaitement maternel immédiat et exclusif est l´une des interventions majeures recommandées par l´Organisation mondiale de la Santé (OMS) permettant de réduire la malnutrition et la mortalité néonatale. L´objectif de cette étude est de déterminer le taux de prévalence de la pratique de l´allaitement maternel exclusif (AME) et d´identifier ses facteurs associés chez les mères d´enfants âgés de 6 à 12 mois à Kaolack.

Méthodes: c´est une étude transversale descriptive et analytique. La période d´étude s´étalait du 08 juillet 2020 au 08 février 2021. L´analyse multivariée a été faite grâce au modèle de régression logistique. La population cible était représentée par les mères d´enfants âgés de 6 à 12 mois résidant dans la ville de Kaolack rencontrées lors des séances de vaccination.

Résultats: au total 400 femmes ont été enquêtées. Parmi elles 51,8% ont pratiqué l´AME selon les recommandations de l´OMS. L´âge moyen de ces mères est de 27,42 ans; 56,3% sont des femmes au foyer et 82,7% ont fait au moins 4 consultations prénatales (CPN). La régression logistique a mis en évidence une association entre l´AME et les facteurs suivants: l´âge < 25 ans (OR=2,03 IC 95% [1,23-3,36]), la réception de conseils sur l´AME lors des CPN (OR=2,92 IC 95% [1,70-5,01]), la réception de conseils sur l´AME lors des consultations post-natales (CPON) (OR=4,33 IC 95% [2,51-7,45]), la présence permanente de la mère à côté de son bébé (OR=3,97 IC 95% [1,99-7,91]) et l´existence de bonnes connaissances sur l´AME (OR=4,54 IC 95% [1,96-10,51]).

Conclusion: ces facteurs modifiables peuvent permettre d´améliorer la pratique de l´AME dans la ville de Kaolack.

Newborn screening for sickle cell disease in Butembo and Beni: a pilot experience in a highland region of the Democratic Republic of Congo

Mupenzi Mumbere — 2024-04-08

Introduction: sickle cell disease is an inherited autosomal recessive hemoglobin disorder resulting in acute and chronic systemic complications. Despite the high burden of sickle cell disease in the Democratic Republic of the Congo, limited data on disease prevalence is available and systematic screening is not offered to newborns. This study aimed to provide neonatal prevalence and associated factors to the phenotypic manifestation of sickle cell disease in an eastern region of the Democratic Republic of the Congo.

Methods: the study was conducted from 20^th April 2021 to 20^th January 2022 in the cities of Beni and Butembo, involving live full-term newborns whose parents consented to participate. Blood was taken with heel pricks and analyzed using the point-of-care diagnostic tool HemoTypeSC™. We used Fisher´s exact test to compare frequencies between groups. P-value <0.05 was considered statistically significant.

Results: of the 1195 newborns screened, 1122 (93.9%) were tested as having hemoglobin AA, 71 (5.9%) hemoglobin AS, 2 (0.2%) hemoglobin SS and none hemoglobin C. The mother´s ethnicity was significantly associated with the phenotypic expression of sickle cell disease.

Conclusion: sickle cell disease prevalence is lower in Butembo and Beni than in other regions of the Democratic Republic of the Congo. However, it remains an alarming public health issue. Systematic newborn screening, parent/patient education and early management programs constitute an urgent need to be addressed by decision-makers.

Une rare triple association de panniculite mésentérique, appendicite aigüe et syndrome de Kœnig chez un patient opéré pour une occlusion intestinale aigüe fébrile: à propos d´un cas

Manix Ilunga Banza — 2024-04-08

La panniculite mésentérique est une affection primitive inflammatoire du mésentère associant de façon variable des lésions de nécrose, d´inflammation et de fibrose du tissu graisseux. Elle peut être idiopathique (primitive) ou secondaire (associée) à d´autres pathologies, asymptomatique et de découverte fortuite ou par une douleur abdominale ou des complications (occlusion intestinale ou une péritonite). Nous présentons le cas d´un patient de 53 ans, reçu pour douleur abdominale aigüe, arrêt de matières et de gaz dans un contexte fébrile. Aux antécédents, des douleurs abdominales chroniques sous forme d´un syndrome de Koenig avait été noté et des épigastralgies depuis plusieurs années. A l´examen physique, l´état général marqué par un faciès souffrant et l´examen abdominal avait noté un léger ballonnement, une sensibilité marquée dans la fosse iliaque droite (FID) et en péri-ombilical, sans défense ni contracture et des borborygmes à l´auscultation avec toucher rectal normal. Un diagnostic d´occlusion intestinale fébrile avait été retenu avec suspicion d´une appendicite mésocoeliaque. La radiographie de l'abdomen à blanc et l´échographie ont permis de confirmer le diagnostic d´occlusion abdominale. Au décours de la laparotomie exploratrice, une sténose fonctionnelle iléale (syndrome de Koenig) découvert à 1m20 de la jonction iléo-coecale; cette dernière étant le siège de multiples adhérences faisant découvrir à l´adhésiolyse un appendice hyperhémié, long de 15cm dont l´examen anatomopathologique révèle une muqueuse siège d´infiltrat inflammatoire et une paroi riche en polynucléaires; une infiltration du mésentère iléal sous forme de modification de coloration (rougeâtre et grisâtre par endroit) et de petites nodosités avec friabilité et déchirure à la simple manipulation a fait suspecter le diagnostic de panniculite mésentérique confirmée par les examens anatomopathologiques montrant une réaction inflammatoire dans le tissu graisseux prélevé avec infiltration par des macrophages, associée à des lésions de nécrose en plage et dégénérescence. Le traitement avait consisté en une vidange intestinale, une appendicectomie antérograde, et une association corticoïde (Dexamethasone 24 mg/jour) et chymotrypsine (10000 UI/jour). L´évolution était bonne et une sortie du patient au 10^e jour post-opératoire avec un suivi clinique et paraclinique pendant 3 mois à la recherche d´une autre pathologie associée méconnue ou pouvant survenir précocement.

Community perception of the determinants of unmet needs of family planning among married women in Buea Health District, Southwest Region, Cameroon

Layu Donatus — 2024-04-08

Introduction: in Cameroon, and more specifically in the Buea Health District of the Southwest Region, there are still a few unmet family planning needs. Many women desire to avoid getting pregnant, but do not use an effective form of birth control. A focus group discussion among married women in the Buea health district was necessary to explore the determinants of unmet family planning in order to promote access to and use of long-acting modern contraceptive methods because most research studies have only focused on the quantitative aspect.

Methods: focus groups were held in the community and in the medical facilities as part of the study's qualitative exploratory strategy. To invite the participants, invitations were sent out. A qualitative survey of 10-12 respondents was carried out by the researcher, in each Focus Group the discussed topics included factors that encourage the use of family planning(FP) methods, making the switch from traditional to modern FP methods, family planning methods decision-making, accessibility of FP in the context of the COVID-19 pandemic. Each focus group discussion lasted 1 hour 30 minutes, the perception was collected in an audiotape recorder and later transcript verbatim. The team conducted 10 Focus Group Discussions (FGDs) (four of each of the topic areas). The FGD team provided participants with light refreshments.

Results: a total of 10 focus groups were conducted, reaching a total participant of 107. The N-Vivo analysis software was used to analyze the data. The following are some of the key participant perceptions that have been reported. Perceptions of family planning; for health reasons as well as social expectations and pressures, having children earlier in marriage was a wise decision. While there are certain issues with having children early in life, such as the mother's maturity and financial stability, having a kid as soon as feasible is the best option. It is best to have children within the first two years of marriage, with a three-to-five-year gap between them. Reasons for changing from traditional to modern family planning; The most significant issues with current birth control techniques (such as condoms, pills (postinor-2), implants, injectables, and intrauterine devices (IUDs)) are those that affect a woman's body. Regardless of the issues, they experience with contraception, there are some benefits to utilizing it. Both modern and classic FP methods have the potential to fail. Making family planning decisions; extended families, particularly mothers-in-law, have a strong influence on family planning and size decisions, and family members assist in resolving FP issues and challenges. Participants want to know about the adverse effects of current birth control techniques, especially in the long run, and how contraceptives affect a future pregnancy. Accessibility of FP in the context of the COVID-19 pandemic; participants have mixed perceptions of whether the COVID-19 context influences their accessibility to family planning.

Conclusion: the focus groups demonstrated that participants have a nuanced and sophisticated awareness of pertinent topics that significantly impact them. While cultural and social conventions surrounding family planning difficulties and decision-making continue to put pressure on women, traditional and modern family planning methods are well-known. Participants also reported a strong desire to learn more about family planning alternatives, the effects of different methods on their bodies, and to have access to a wider selection of general and specialized family planning services. Fear was produced by the backdrop of COVID-19, but women are rapidly overcoming these fears to have access to family planning.

Levels and predictors of knowledge of epilepsy among patients attending the epilepsy clinic of a neuro-psychiatric facility in North-Eastern Nigeria

Mohammed Mahmood Yusuf — 2024-04-08

Introduction: significant numbers of patients with epilepsy have poor knowledge of their disease. Patients' knowledge of disease is related to their success in coping with the disease and adherence to medication; which is one of the key factors that determined the success of pharmacotherapy in patient with epilepsy. In this study, we evaluate the level of knowledge of epilepsy among patient with epilepsy in a tertiary mental health care facility.

Methods: using a cross-sectional design, 410 patients with epilepsy attending general outpatient clinic of Federal Neuropsychiatric Hospital, Maiduguri in Northeastern Nigeria were sampled randomly into the study after fulfilling the inclusion and exclusion criteria. Socio-demographic, clinical and epilepsy knowledge questionnaires were used for data collection. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 18.

Results: 263 (64.1%) had poor knowledge of epilepsy and 290 (70%) had less frequent seizures (having fewer than four seizure episodes in the last three months). Independent predictors of knowledge of epilepsy were intermediate skilled employment (O.R = 2.32, P = 0.022, 95% C I = 1.13 - 4.76); semi-skilled employment (O. R = 1/85, p = 0.001, 95% C I = 1.10 - 3.12); seizure frequency (O R = 1.72, p = 0.031, 95% C I = 1.31 - 3.24).

Conclusion: the level of knowledge of epilepsy among people with epilepsy was low with more than 64.1% percent of the participants had poor knowledge of epilepsy. Occupational status and seizure frequencies were independent predictors of knowledge of epilepsy. We therefore recommend psycho-educational programs be incorporated in the routine clinical care of the patients and for clinicians to pay more attention to providing information and education needs of patients.

Gastrointestinal tuberculosis: clinical image

Vikas Raghuvanshi — 2024-04-08

A 65-year-old male came to our hospital complaining of abdominal pain in the right lumbar region for 2 months with lethargy. He had history of loss of appetite for one month with no history of fever, diabetes, tuberculosis, weight loss, or any surgeries. He has been a chronic alcoholic for the last 30 years. He had a history of dark-colored stools for a week. Patient did not receive BCG vaccination at his birth. Pallor was present in the palpebral conjunctiva, cardiovascular and respiratory system has no abnormality. On abdominal examination, mild tenderness in the right lumbar region otherwise the abdomen was soft on palpation with no organomegaly. His haemoglobin level was 8%, peripheral smear showed normocytic, normochromic anemia with few microcytes, and stool examination revealed occult blood. HIV and HBsAg tests were negative. Colonoscopy showed a circumferential ulcerated, narrowed ileocecal valve with a pulled-up caecum suggestive of abdominal tuberculosis. Multiple biopsies were taken to rule out dysplasia. The anal canal, rectum, sigmoid colon, descending colon, transverse colon, and ascending colon were visualized and their mucosa appeared normal. Computed tomography of abdomen showed mesenteric lymph node enlargement suggestive of intestinal tuberculosis. Interferon-gamma release assay, polymerase chain reaction, and Mantoux test were positive suggestive of tuberculosis, and fecal calprotectin level was normal. Chest X-ray revealed no abnormalities. The patient started with antitubercular therapy (ATT) according to national protocol i.e. rifampicin, isoniazid, pyrazinamide, and ethambutol were prescribed for four months, followed by rifampicin and isoniazid for two months along with vitamin B6.

Epidémiologie et diagnostic de la lithiase urinaire: étude transversale dans une population camerounaise

Landry Oriole Mbouché — 2024-04-08

Introduction: la lithiase urinaire est une maladie multifactorielle qui se caractérise par la présence de concrétions dans les voies excrétrices. Le diagnostic de la lithiase urinaire repose sur la clinique et l´imagerie médicale. L´objectif de cette étude était de déterminer le profil épidémiologique et clinique des patients souffrant de lithiase dans la ville de Yaoundé.

Méthodes: il s´agissait d´une étude observationnelle descriptive de type transversale avec une collecte de données rétrospective. Ont été inclus dans notre étude, les dossiers des patients avec un âge >15 ans, les patients diagnostiqués de lithiase confirmés par une imagerie médicale. À partir d´un questionnaire préalablement établi, les variables étudiées étaient sociodémographiques, cliniques et paraclinique.

Résultats: au total 120 patients ont été inclus dans notre étude. L´âge moyen était de 40,46 ans ±12,62 ans avec des extrêmes de 19 à 74 ans. Le sexe masculin était prédominant à 60,8% (n=73). La colique néphrétique était la circonstance retrouvée dans 67,5% (n=81). L´examen physique était normal dans 55,8% (n=67). L´hydratation insuffisante était le facteur associé le plus retrouvé chez 45% (n=61). L´uroscanner a été l´examen le plus réalisé dans notre étude, soit 50,7% (n=61). La médiane de la densité des calculs était de 731 Unités Hounsfield [346 ; 1183,5]. Les calculs siégeaient majoritairement dans le haut appareil. La topographie rénale gauche était prépondérante dans 35% (n=42) des cas. L´examen cytobactériologique des urines retrouvait Escherichia Coli à 60% (n=15). Sur le plan métabolique, la calcémie, la phosphorémie et l´uricémie ont été demandées respectivement dans 15,8% (n=19), 0,8% (n=1) et 12,5% (n=15) des cas. Les résultats étaient normaux. En l´absence de laboratoire spécialisé dans l´analyse biochimique du calcul, une minorité des patients (n=3) a bénéficié d´une spectrophotométrie.

Conclusion: la lithiase urinaire est une maladie de l´homme de la quarantaine. La colique néphrétique est le principal signe révélateur. Le diagnostic est révélé par le scanner abdominal dans la moitié des cas. Le bilan métabolique et l´analyse constitutionnelle du calcul restent très faiblement demandés.

Multiple huge liver hydatid cysts in a child

Takwa Mili — 2024-04-08

A multiple cystic mass in the liver caused an 11-year-old girl who had a history of contact with animals to be referred to our unit. Abdominal ultrasound performed to investigate an abdominal mass revealed the disease. Physical examination revealed no icterus. There was a noticeable swelling in the right upper abdomen. The patient didn't exhibit any allergy symptoms like rhinitis or an urticarial rash. The liver had several low-density lesions, with the largest being a 12-cm-diameter unilocular hepatic cyst in segments IV, VII, and VIII. Two other unilocular cysts were detected in segments V and VI, which suggested liver hydatid cysts. Under general anesthesia, a syringe was used to aspirate intracystic fluid from the patient's largest unilocular hepatic cyst following liver exposure. The cyst was then opened, the internal capsule was taken out, and 15 minutes of hypertonic saline injection followed. Each cyst underwent a subtotal cystectomy with external draining of the remaining cavity. The residual cyst wall was examined intraoperatively for signs of bile leakage, and any apparent biliary holes were individually sutured in healthy tissue. Pathological analysis of the cyst tissue showed the presence of hydatid disease. The postoperative course was uncomplicated, and the patient had a good recovery following the procedure. Three months of ultrasonographic follow-up were carried out, and there was no sign of recurrence.

Étude interventionnelle sur le dolutégravir et les autres antirétroviraux dans l´athérosclérosclérose infra-clinique en milieu hospitalier de Kinshasa

Murielle Longokolo Mashi — 2024-04-08

Introduction: après 2016, l´Organisation mondiale de la Santé (OMS) a proposé le dolutégravir (DTG) comme alternative thérapeutique de traitement de première ligne chez l´adulte. Ainsi, l´objectif de la présente étude était d´identifier les biomarqueurs du risque cardiométabolique capable de démontrer l´effet bénéfique du dolutégravir (DTG) par rapport aux autres antirétroviraux dans la prédiction de l´athérosclérose chez les personnes vivant avec le VIH (PVVIH) en milieu hospitalier de Kinshasa.

Méthodes: il s´agissait d´une étude interventionnelle entre janvier 2017 et décembre 2021 chez les PVVIH sous traitement antirétroviral(TAR) durant au moins 6 mois, pris en charge dans les structures du Réseau Catholique du Bureau Diocésain des Oeuvres Médicales (BDOM) et aux Cliniques Universitaires de Kinshasa (CUK). L´athérosclérose infraclinique était définie par: une pression pulsée (PP) ≥60 mm Hg; une épaisseur intima-media carotidien (EIMc)> 0,8 mm et un index des pressions systoliques (IPS) <0,9. La régression logistique a été utilisée dans l'étude statistique des associations.

Résultats: au total, 334 PVVIH ont été recrutées dont 96,1% (n=321) sous TAR et 13,9% (n=13) naïfs de TAR. L´âge moyen des PVVIH était de 51±12 ans avec une prédominance féminine 70,4% (n=235); Les déterminants indépendants de l´athérosclérose infraclinique étaient les mariés (ORa: 4, IC95% 1,5-10,5; p<0,006), le niveau socioéconomique bas (ORa: 10,7, IC95% 2,3-48,7 p<0,002), la durée de l´infection par le VIH (ORa: 6,6, IC95% 2,8-16; p<0,0001), la durée du traitement antirétroviral ≥9 années (ORa: 0,3, IC 95% 0,2-0,7; p< 0,005) et le ratio cholestérol total/high density lipoprotein-cholesterol (CT/HDL-c)(ORa: 2, IC 95% 1,1-3,6; p=0,034). Les valeurs moyennes des variables traditionnelles et émergentes étaient significativement supérieures dans l´ancien régime TAR sans DTG que dans le nouveau régime avec DTG. Par contre la dyslipidémie a été identifiée du côté du nouveau régime avec DTG.

Conclusion: la dyslipidémie a été fréquente du côté de DTG. Les mariés, le niveau socioéconomique bas, la durée de l´infection par le VIH, la durée du traitement antirétroviral au-delà de 9 années et le ratio CT/HDL-c ont été identifiés comme déterminants de l´athérosclérose infraclinique chez les PVVIH sous TAR en milieu hospitalier de Kinshasa.

A mapping exercise to identify the strengths, and gaps in knowledge translation activities at Cochrane South Africa

Anelisa Jaca — 2024-04-08

Knowledge translation (KT) is a set of activities or processes for synthesising, disseminating, and applying research evidence in decision-making for the benefit of society. For KT to be successful, it is paramount for researchers to play an active role in encouraging evidence uptake and use in decision-making. We carried out a mapping exercise and interviews with research cluster heads at Cochrane South Africa (CSA) of the KT activities and processes being implemented (or are planned for implementation). We organized the mapping and interview results according to the KT themes described in the Cochrane KT framework. The KT framework comprises six themes, namely, (i) prioritization and co-production of research evidence; (ii) building a sustainable infrastructure for knowledge translation; (iii) engaging with audiences for knowledge exchange or dialogue; (iv) packaging, communication and dissemination which entails disseminating research to users; (v) building audience capacity to use evidence or training activities; and (vi) advocacy or improving the culture of using evidence. Through the mapping exercise and interviews, we learned that CSA researchers excelled in implementing activities and processes linked to most of the KT themes, including producing different types of systematic reviews and providing reliable evidence for health decision-making. Cochrane South Africa (CSA) researchers are also involved in mentoring and training postgraduate students and various health decision-makers (e.g., health professionals, guideline panels and policy-makers). While they excel in the above-mentioned activities, “packaging, communication, and dissemination of research evidence” (theme iv) was identified as an area of improvement.

A rare case of meconium peritonitis in a neonate: a rare clinical image

Adithya Kiran — 2024-04-08

Meconium peritonitis is an aseptic chemical inflammation caused by intrauterine bowel perforation. It is a rare but serious complication of meconium-stained amniotic fluid, occurring in 1 in 30,000 live births. It occurs when meconium enters the peritoneal cavity, usually through a defect in the bladder or a tear in the intestinal wall. Early recognition and prompt surgical intervention are crucial for a successful outcome. Perforation of the intestine in utero leads to leakage of meconium into the peritoneal cavity causing an inflammatory reaction and chemical peritonitis which subsequently seals with intra-abdominal calcifications. Possible causes include: mesenteric ischaemia, volvulus, intestinal atresia, meconium plugs, cystic fibrosis, intestinal hernias and Hirschsprung disease. Prenatal ultrasonography is diagnostic for meconium peritonitis. Diagnostic features of meconium peritonitis are abdominal calcifications, polyhydramnios, echogenic masses, meconium pseudocysts, ascites, and a dilated bowel or intestinal obstruction. We report a case of a term neonate who presented with meconium peritonitis and was successfully treated with exploratory laparotomy and antibiotics. The patient was a term neonate, male, born at 39 weeks gestational age to a primi mother via spontaneous vaginal delivery. He presented with meconium-stained amniotic fluid during delivery and was immediately intubated and suctioned. The baby was shifted to Neonatal Intensive Care Unit (NICU), started on IV fluids, and antibiotics cefotaxime and amikacin. On admission, the baby was active, tachypneic with mild intercostal retractions (Downe's score-2) with abdominal distension with a girth of 47cm and vulval edema. X-ray erect abdomen was done which showed calcifications over the liver and splenic areas with distended bowel loops (A), and ultrasound abdomen taken showed prominent large small bowel loops with internal echoes in the peritoneal cavity, suggesting bowel perforation. The diagnosis of meconium peritonitis was made. The neonate immediately underwent exploratory laparotomy with adhesiolysis with double loop ileostomy (B). The peritoneal cavity was found to contain meconium, which was suctioned out. Fecal matter with diffuse adhesions in between bowels and parietal peritoneum were also found. Dilated congested and perforated proximal bowel and collapsed distal bowel and ileal atresia at 30cm from ileo-cecal junction was noticed (C). The bladder was also drained. The neonate was closely monitored in the NICU and made a full recovery. The outcome of the disease depends on the promptness of the diagnosis and treatment, and neonates with meconium peritonitis have a high survival rate with appropriate management.

Etiologies des œdèmes papillaires en milieu hospitalier camerounais

Godefroy Koki — 2024-04-08

Introduction: l´œdème papillaire (OP) est le gonflement de la tête du nerf optique, signe d´appel majeur de nombreuses pathologies locales, locorégionales ou systémiques pouvant mettre en jeu le pronostic visuel ou vital. Il constitue une urgence diagnostique et thérapeutique présente dans nos services, dont il paraissait important et opportun de déterminer les étiologies les plus rencontrées en milieu hospitalier camerounais.

Méthodes: c´est une étude documentaire et descriptive des patients présentant un œdème papillaire, ayant consulté au service d´ophtalmologie de l´Hôpital d´Instruction, d´Application et de Référence des Armées de Yaoundé du 1^er octobre 2013 au 31 décembre 2016. Les variables étudiées portaient sur les données épidémiologiques (âge, sexe), cliniques (signes fonctionnels, acuité visuelle, aspect de la papille et signes associés selon la classification de Hoyt et Beesten), les examens complémentaires réalisés (angiographie à la fluorescéine, champ visuel, biologie, radiographie, tomodensitométrie) et le diagnostic étiologique retenu. Le logiciel Epi-info 3.5.3 a permis l´analyse statistique et le Chi-carré utilisé avec p < 5% significatif.

Résultats: l´œdème papillaire était présent chez 26 sur 5023 patients consultés pendant cette période d´étude, soit une fréquence de 0,5%. La moyenne d´âge était de 32,7 ± 10,9 ans avec des extrêmes de 7 et 79 ans, pour 13 femmes et 13 hommes. L´œdème papillaire était bilatéral chez 15 (57,7%) patients et unilatéral chez 11 (42,3%), soit 41 yeux atteints. Les étiologies étaient faites de 11 (42,3%) neuropathies optiques inflammatoires, 5 (19,2%) hypertensions artérielles, 4 (15,4%) occlusions de la veine centrale de la rétine, 3 (11,5%) contusions oculaires, 2 (7,7%) hydrocéphalies et 1 cas (3,9%) de neuro paludisme.

Conclusion: les neuropathies optiques inflammatoires et vasculaires constituaient les étiologies les plus fréquentes des œdèmes papillaires dans notre contexte.

Pattern of antimicrobial prescription in Africa: a systematic review of point prevalence surveys

Ijeoma Nkem Okedo-Alex — 2024-04-08

Introduction: inappropriate use of antimicrobials is a cause for concern and contributes to the global antimicrobial resistance crises especially in Africa. This review aims to summarize the available evidence on the point prevalence and pattern of antimicrobial and/or antibiotic prescription in Africa.

Methods: this review was carried out between April and September 2021 and identified published studies up until March 2021 on the point prevalence of antibiotic and/or antimicrobial use in Africa. Sources searched were OVID, PubMed, EMBASE, CINAHL, Web of Science, Google Scholar, Google, and African Journal Online (AJOL). Observational studies that reported prevalence published in English language were included. Covidence systematic review software was used for this review. A form for data extraction using domains culled from the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) was developed on Covidence. Screening of studies for eligibility was done independently by two reviewers. Critical Appraisal tool for use in Joanna Briggs Institute (JBI) Systematic Reviews for prevalence studies was used for quality appraisal.

Results: a total of 17 studies that met the inclusion criteria were included in the review. The overall prevalence of antimicrobial/antibiotic use among inpatients in these studies ranged from 40.7% to 97.6%. The median antimicrobial/antibiotic use was 61.3 [IQR= 45.5-72.1]. The highest use of antimicrobials was reported among studies from Nigeria with a prevalence of 97.6%. The most prescribed antibiotics were the beta-lactam penicillin (Amoxicillin, clavulanic acid) (86.9%), and third generation cephalosporins (55.0%). There was general preference for parenteral route of administration of the antimicrobial agents (40-70%). Use for community acquired infections (28.0-79.5%) was the main reason for use. Majority of the prophylactic use of antimicrobial agents was for surgical prophylaxis.

Conclusion: the high prevalence of antimicrobial use in Africa reinforces the need for continued surveillance and concerted efforts to institutionalize and support antimicrobial stewardship for prescribers in health institutions in the African region.

Health care worker carriage of drug-resistant bacteria and infection control practices at a tertiary care hospital in Uganda: a cross-sectional survey

Daniel Bulwadda — 2024-04-08

Introduction: bacterial carriage by health care workers (HCWs) is a major risk factor for transmission of healthcare-associated infections (HAIs). Often, these pathogens are multiple drug resistant (MDR) and are transmitted from hospital environments. We aimed to study the carriage of pathogenic bacteria among HCWs at a tertiary care hospital in Uganda.

Methods: a cross-sectional study was done at Naguru Regional Referral Hospital from June 2017 to August 2017. Five finger imprints of both hands-on blood and MacConkey agar were done. We assessed pathogenic bacterial carriage by HCWs and characterized drug sensitivity and relatedness of these isolates. Genotyping of extended-spectrum beta-lactamase (ESBL) and Methicillin-resistant Staphylococcus aureus (MRSA) positive isolates was done to determine intra-hospital transmission. A survey of the hospital’s IPC program was done.

Results: one hundred and eight (108) HCWs were enrolled. Carriage of pathogenic bacteria was highest in surgical and emergency wards at 36% and 35.6% respectively, p-value of 0.00. The proportion of microbial carriage was highest among nurses 16 (34.8%) followed by medical officers 11 (23.9%). Among the isolated pathogenic bacteria, 25 (36.2%) were Gram-positive and 44 (63.8%) were Gram-negative. Fifty percent of Staphylococcus aureus were methicillin-resistant, and one isolate was vancomycin-resistant. Fifty-four percent (54.6%) of HCWs had never been trained on moments of hand hygiene, only 44.4% recognized the presence of an IPC program in the hospital and 49% were not aware of problems associated with poor IPC practices.

Conclusion: this study demonstrated that hands of HCWs at Naguru Regional Referral Hospital were colonized with pathogenic bacteria with varying prevalence, some with multidrug-resistant strains including MRSA and ESBL.

Une association d'un goitre ectopique basi-cervical et d'une glande thyroïde eutopique: à propos d'un cas

Ndongo Pilor — 2024-04-08

La glande thyroïde est une glande endocrine jouant un rôle majeur dans le métabolisme énergétique, phosphocalcique, entre autres. Sa position habituelle est cervicale antérieure et prétrachéale. Les ectopies thyroïdiennes sont des situations assez rares. Elles sont dominées par les ectopies basilinguales. Nous rapportons un cas d'association goitre en position cervicale normale (eutopique) et tissu thyroïdien ectopique en position basicervicale. Le nodule ectopique a été mis en évidence lors de la cervicotomie et le diagnostic confirmé à l'histologie. Ce cas clinique est un diagnostic différentiel des masses cervicales.

Physical activity counselling in women with HIV/AIDS and suicidal ideation: a secondary analysis of a real-world intervention in Ugandan HIV counselling centres

Davy Vancampfort — 2024-04-08

Introduction: people with HIV/AIDS have higher rate's of suicidal ideation than the general population. Consequently, HIV counselling settings should implement suicide risk reduction initiatives. Physical activity (PA) counselling could be a relevant add-on intervention. The aim of this secondary analysis from a single-arm pre- and post-study exploring the efficacy of PA counselling for HIV/AIDS patients with mental health problems was to investigate the efficacy of PA counselling on reducing suicidal ideation.

Methods: out of 41 participants in an 8-week PA counselling intervention, 15 participants reported suicidal ideation. These 15 (15♀, median age=42 years, interquartile range=24 years) participants completed the Patient Health Questionnaire-9 (PHQ-9), Alcohol Use Disorder Identification Test -10 (AUDIT-10), and the Simple Physical Activity Questionnaire (SIMPAQ) pre- and immediately post-intervention.

Results: the prevalence of suicidal ideation (PHQ-9 item 9≥1) dropped to 20% post-intervention, i.e. only three patients with HIV still reported suicidal ideation. Also, following the intervention significant (P<0.05) increases in walking and incidental PA (SIMPAQ) levels, and reductions in depressive and alcohol abuse symptoms were observed.

Conclusion: our data demonstrate that PA counselling might be promising in reducing suicidal ideation in most HIV patients in low-resourced settings. Randomized controlled trials are warranted to confirm these beneficial findings.

Normal dimensions of the lacrimal gland on magnetic resonance imaging in Indian adult population: a retrospective study

Vrushali Naresh Dalvi — 2024-04-08

Introduction: the lacrimal gland (LG) size is affected by a variety of pathologic conditions like inflammatory, infections, neoplastic, autoimmune and granulomatous disorders. Earlier, the dimensions of the gland were estimated by extracting lacrimal glands from cadavers, later ultrasonography and computed tomography studies were used, but had limited soft tissue differentiation. The aim of this study was to retrospectively evaluate Magnetic Resonance Imaging (MRI) data from normal orbits and determine lacrimal gland dimensions.

Methods: five hundred and twelve (512) consecutive MRI brain contrast scans (of 240 females, of 272 males; age range 40±20 years) for non-orbital diseases were evaluated retrospectively. The mean axial length (AL), axial width (AW), coronal length (CL), and coronal width (CW) of each lacrimal gland were measured separately.

Results: five hundred and twelve (512) MRI brain contrast scans of 272 men and 240 women, with mean age of 40 ± 20 years were included. Right and left LG dimensions were similar, mean AL (13.2±1.35 mm versus 13.11±1.24 mm), mean AW [3.5±0.99 mm versus 3.3±0.82 mm], mean CL [16.3±2.5 mm versus 16.10±2.4 mm], and mean CW (4.15±0.89 mm versus 4.11±0.85 mm). The AL of both lacrimal glands and the CL and CW of right but not left lacrimal glands were significantly lower in women than in men. Age showed significant correlations with the AL and CL of both LGs.

Conclusion: in this study, evaluation of normal morphometric parameters of the lacrimal gland in Indian population was established. LG dimensions are smaller in women than men, as well as correlating with side and age.

Social support from family, associated factors and relationship with glycemic control among diabetic patients in Uganda: a cross-sectional study

Jude Tadeo Onyango — 2024-04-08

Introduction: social support from family members in diabetes management is a predictor of optimal glucose control. There is limited evidence of the relationship in Uganda. The objective was to determine association of social support from family and glycemic control, and association of social demographic and clinical characteristics with family support among diabetic patients in eastern Uganda.

Methods: this was a cross-sectional study involving 405 adult patients attending diabetic clinics between May 2021 and June 2021. Socio-demographics, clinical characteristics, social support from family, and glycemic control data were collected. Descriptive statistics were done and associations were determined using Pearson chi-square and Fisher´s exact tests. Generalized linear model was used to determine independent association with social support from family.

Results: the mean age was 52 years, (60%) were female, majority (49.4%) were 45-64 years old. Perceived social support from family (PSS-fa) and good glucose control were found in; (95.3%) and (20.99%) respectively. PSS-fa was associated with good glucose control. Financial contribution from family members to cost of care, cohesion among family members in support of care, being (married/cohabiting) and monthly income ≥28 USD were associated with PSS-fa. Factors independently associated with PSS-fa were; female gender, financial contribution to cost of care and cohesion among family in support of care.

Conclusion: social support from family was associated with good glycemic control. Factors associated with PSS-fa were; female gender, financial contribution from family to cost of care and cohesion among family in support of care.

Giant leiomyoma management during elective cesarean section: a case report

Ottavio Cassardo — 2024-04-08

We present the unique case of a 44-year-old gravida 3 para 2 woman with complaints of monolateral perception of fetal movements who underwent elective cesarean section and hysterectomy for the presence of an exceptionally voluminous infralegamentary leiomyoma. Cesarean section required in-depth preoperative planning and was possible only after gravid uterus exteriorization. Myomectomy and hysterectomy were then necessary to reestablish the physio-anatomical pelvic environment. The patient was discharged after regular and uncomplicated postoperative time. In recent years, the paradigma of avoiding cesarean myomectomy due to fear of hemorrhage has been questioned by many authors and in certain cases cesarean myomectomy may even be undeferrable. We describe an innovative surgical technique which could be useful to obstetricians approaching similar uterine masses during cesarean sections.

A rare case of concurrent left ventricular aneurysm and ventricular septal rupture complicating an inferior myocardial infarction: a case report

Mariem Drissa — 2024-04-08

Complications following acute myocardial infarction (MI) such as ventricular septal rupture (VSR) and left ventricular (LV) aneurysm are rare and can be dreadful. Their simultaneous presence in the same patient is extremely rare. We aimed to present a rare case of concomitant association of ventricular aneurysm and VSR complicating an inferior myocardial infarction. We report the unusual case of Mr. A. D, a 63-year-old, active smoker, with a history of diabetes mellitus and hypertension, admitted for the management of inferior MI within 6 days. The MI was complicated by an LV aneurysm in the inferoposterior and the inferoseptal walls associated with a VSR in the inferoseptal wall. The patient had only signs of right heart failure on admission. This observation illustrates on the one hand the rarity of the association of VSR and LV aneurysm after an inferior myocardial infarction, and on the other hand the possibility of founding them at an early stage of MI without any signs of cardiogenic shock.

Epidemiological characteristics of crashes and pattern of motorcycle injuries presenting to hospitals in Kisumu City, Kenya: a cross-sectional study

Wilberforce Cholo — 2024-04-08

Introduction: motorcycle injuries comprise considerable morbidity, disability and mortality of road traffic casualties. The study aimed to assess the pattern and characteristics of motorcycle crash injuries that sought care at the Emergency Departments in Tier III hospitals in Kisumu City during a six-month period from May to November 2019.

Methods: this was a cross-sectional study of all motorcycle injury patients presenting to three tier III public and private hospitals in Kisumu City. Using a structured questionnaire, data were collected on human and injury characteristics. Multiple logistic regression model was used to determine the predictors of fatality. Statistical significance was set at p<0.05.

Results: a total of 1073 of motorcycle crash injury patients sought and obtained care at the hospitals. The majority (73.6%) were males. Seventy-three cases resulted in death (case-fatality rate of 6.80%. The age range was 2-84 years, with a mean of 29.6 years (± SD 12.19). Majority, (43.3%) were aged 21-30 years. Most of the crashes occurred during the daytime (79.1%). Of all motorcycle riders and pillion passengers 30.6% wore helmets at the time of the crash. Head injuries (43.6%) were the most common. Injury severity scores (ISS) ranged from 1 to 51. Glasgow comma scale <3, un-helmeted patients and major trauma (ISS > 16), significantly influenced mortality (P< 0.001).

Conclusion: these findings confirmed and strengthened the documented substantial morbidity, mortality that motorcycle crashes place on individuals and society, contribute to the body of literature on motorcycle injuries and potentially assist in policy decisions on motorcycle transport safety.

Assessment of 28-day survival of patients with sepsis based on vitamin D status: a hospital-based prospective cohort study in Indonesia

Rizka Humardewayanti Asdie — 2024-04-08

Introduction: sepsis is a potentially life-threatening condition caused by the body´s response to an infection. Recent studies have demonstrated a correlation between low vitamin D status and high mortality in septic patients. This study aims to evaluate the vitamin D status of septic patients at Dr. Sardjito Hospital and describe 28-day survival with very low vitamin D levels (< 8.1 ng/mL).

Methods: this prospective cohort study was conducted in the intensive care unit and internal medicine ward at Dr. Sardjito Hospital in septic patients admitted between December 2018 and October 2019. Vitamin D [25(OH)D] was prospectively measured within 24 hours of admission. Data collection used SPSS software for statistical analysis. In addition, the sample size was calculated using the sample size formula used in a comparative survival study intended to find the incidence rate in septic patients. The minimum sample for each group is 23 samples.

Results: sepsis-related mortality was higher in patients with low vitamin D. The analysis included 88 septic patients during the study period. The mean age was 56.09 ± 16.82 years and the proportion of males was 46.6%. 26 of 28 patients with vitamin D levels < 8.1 ng/mL died (92.6%), whereas 39 of 60 patients with vitamin D levels ≥ 8.1 ng/mL (65%) died. Multivariate Cox regression analysis showed that vitamin D concentrations < 8.1 ng/mL at admission (p=0.01) and sepsis shock (p=0.02) were associated with increased sepsis mortality. The hazard ratio of 28-day mortality was 1.95 (95% CI 1.15-3.29, p=0.01) for vitamin D levels < 8.1 ng/mL. The average survival was 9 days for patients with vitamin D levels < 8.1 ng/mL (median: 6 days) compared with 14 days for those with vitamin D levels ≥ 8.1 ng/mL (median: 10 days).

Conclusion: low serum vitamin D levels (< 8.1ng/mL) at admission were associated with increased 28-day mortality in septic patients.

Diabète insipide néphrogénique induit par le lithium au cours d´une intoxication aiguë: à propos d´un cas

Sara Echater — 2024-04-08

En cas de déshydratation, le lithium peut entraîner une intoxication aiguë, ce tableau se manifeste principalement par des troubles neurologiques pouvant aller jusqu´au coma, des troubles digestifs, des troubles hydroélectrolytiques, des troubles cardiovasculaires. Un diabète insipide néphrogénique peut également survenir. Nous rapportons le cas d´une patiente suivie pour trouble bipolaire depuis 20 ans et traitée par lithium depuis 14 ans et qui a présenté un diabète insipide induit par lithium lors d´une intoxication aiguë. Notre objectif est de souligner l´importance et la nécessiter d´une surveillance stricte de la lithémie surtout dans des situations favorisant la déshydratation.

Therapeutic drug monitoring of lithium therapy at a psychiatric hospital in Namibia

Bonifasius Siyuka Singu — 2024-04-08

This retrospective study of lithium therapeutic drug monitoring at the Psychiatry Department of Windhoek Central Hospital. 11 patients received lithium for bipolar mood disorder (5), bipolar schizoaffective disorder (4),and bipolar schizophrenic disorder (2). Baseline and final median dose were similar 750 mg (250-1000 mg), but final median plasma lithium concentration 0.5 mmol/L (0.03-1.37 mmol/L) was higher than baseline 0.25 mmol/L (0.18-1.00 mmol/L). Concentration ranges for toxicity markers were reported: T3 (1.54- 4.37 pmol/L), T4 (7.6-15.04 pmol/L), creatinine (63-113 micro mol/L), and sodium (136-143 mmol/L). In conclusion, lithium dose and plasma lithium concentrations in these patients were subtherapeutic.

Retrospective cross-sectional study of 34 cases of pernicious anemia at Mohammed V Military Training Hospital, Morocco

Youssra Azzouz — 2024-04-08

Introduction: pernicious anemia is an autoimmune disease characterized by atrophic gastritis due to malabsorption of vitamin B12. Certain oral manifestations, such as Hunter´s glossitis and burning mouth syndrome, may precede the onset of this anemia. The aim of this study is to describe the clinical presentation, para-clinical aspects, the treatment, and the evolution of the pernicious anemia (PA) after treatment.

Methods: retrospective study conducted at the Department of Haematology and Internal Medicine B of the Mohammed V Military Training Hospital in Rabat between January 2009 and December 2018. Thirty-four patients were enrolled with vitamin B12 deficiency, non-regenerative macrocytic anemia, a positive anti-intrinsic factor antibody and anti-parietal cell antibody and a histological diagnosis of atrophic gastritis in the presence or not of Helicobacter pylori. The qualitative variables were expressed in numbers and percentages, and the quantitative variables in mean and standard deviation. Multivariate analysis used the Fischer test; it was considered significant for a p < 0.05 value.

Results: thirty-four cases were studied; the population study consists of 56% (n=19) of men and 44% (n=15) of women. The average age was 54.88± 9.14. The clinical manifestations of pernicious anemia are dominated by megaloblastic anemia 85.3% (n=29), followed by digestive 58.8%(n=20) and oral 55.9% (n=19) signs. Neurological manifestations were rarely found in 41% (n=14). Hunter´s glossitis 37% (n=7), stomatodynia 11% (n=2) were the most common oral manifestations accompanying pernicious anemia. The evolution was favorable in 79.4% (n=27) patients under substitution therapy with vitamin B12.

Conclusion: dentists´ involvement in the diagnosis of pernicious anemia is based on changes in oral mucous membranes, which have been reported in 55.9% of all patients. These oral changes may occur in the absence of symptomatic anemia.

Distribution and antibiogram of Vibrio species from hospital wastewater in Southwest, Nigeria

Temitope Deborah Agboola — 2024-04-08

Introduction: the continuous generation of wastewater and its release into the environment with little or no treatment remains a threat to the environment and public health. We examined the prevalence and antibiotic susceptibility profiles of Vibrio species isolated from untreated wastewater samples from Ondo State Specialist Hospital Okitipupa, Nigeria, as part of the global efforts to provide information for containing the spread of resistant infections.

Methods: twelve hospital wastewater samples were collected aseptically and transported to the laboratory for analysis. The samples were processed on thiosulphate citrate bile salt sucrose agar and colonies typical of Vibrio species were selected for further identification. All isolates were confirmed by polymerase chain reaction (PCR) using Vibrio-specific primers and the PCR products were sequenced for species identification. The susceptibility profiles of the isolates were determined by the Kirby-Bauer disc diffusion method.

Results: twenty-nine (58%) of 38 presumptive isolates were confirmed as Vibrio by PCR, while 23 (60.5%) isolates were screened up to species level by sequencing. Six different species following the trend: 26.1% V. fortis and V. algivorus, 17.4% V. cholerae, 13.0% V. panuliri, 8.7% V. stylophorae and V. parahaemolyticus were identified. The isolates were commonly resistant (73.9%-91.3%) to doxycycline, tetracycline, erythromycin and meropenem. The least resistance rate (17.4%) was observed against amikacin and cotrimoxazole. All isolates were multidrug-resistant, with multiple antibiotic resistance (MAR) indices exceeding the 0.2 recommended limit.

Conclusion: this study has shown that untreated hospital wastewater is a reservoir for diverse strains of multiply resistant Vibrio species. Therefore, it is essential to adequately treat hospital wastewater to eliminate these emerging pollutants and set up a monitoring scheme to evaluate the treatment plants' effectiveness to reduce the pollutants' impact on the environment and the population.

Nevus of Ota in 8-year-old male

Srilekha Berelli — 2024-04-08

Occulodermal melanocytosis is also called nevus of Ota. It is a unilateral condition where pigmentation of the conjunctiva and episcleral is seen. It is caused due to increased melanin and melanocytes. These patients have higher chances of having malignant melanoma involving the eye and central nervous system. On slit lamp examination, superficial lesions are grey in colour and deep lesions are blue in colour. On fundus examination we can see hyperpigmented patches of choroid layer with or without optic disc involvement. Ultrasound bio-microscope is a useful imaging technique to see both anterior and posterior segment involvement. Four percent (4%) of patients with unilateral nevus of Ota have chances to develop malignant melanoma in the diseased eye. It is important to do dilated fundus examination in both eyes every six months along with systemic evaluation. Here is a case of 8-year-old male patient with complaints of discolouration in right eye since childhood. There is no dermal involvement at present. The patient gives 6/6 vision on Snellen's chart in both eyes. Hyperpigmented greyish colour areas are present in bulbar conjunctiva and episcleral patches present indicate high melanin and melanocytes. As there is 4% chance of developing choroidal melanoma, patient was advised to follow-up for every 6 months for detailed ocular examination and systemic evaluation.

Mediastinal lipomatosis in a patient with Bardet - Biedl syndrome: more diverse than previously thought

Eleni Paschou — 2024-04-08

A 52-year-old patient with end-stage renal disease (ESRD), undergoing intermittent hemodialysis for 20 consecutive years was recently diagnosed with Bardet-Biedl syndrome (BBS). His medical history included central obesity, hypogonadism, blindness due to pigmented retinopathy, neurological disorders (epilepsy, ataxia, peripheral neuropathy), learning disabilities, speech disorders, brachydactyly, and ESRD attributable to bilateral renal hypoplasia. A chest computed tomography was performed due to shortness of breath and revealed mediastinal lipomatosis (ML). ML is usually a benign and asymptomatic intrathoracic condition. It is associated with steroid use, obesity, hyperlipidemia, diabetes mellitus, metabolic syndrome, or Cushing syndrome. Occasionally it becomes symptomatic, manifesting with breathlessness, dry cough, dyspnea, thoracic pain, or supraventricular tachycardia. To the best of our knowledge, this is the first case of ML in a patient with BBS. Bardet-Biedl syndrome (BBS) is a rare multisystem autosomal recessive disease associated with disorders in the structure and function of primary cilia, characterized by high genotypic and phenotypic heterogeneity. Its prevalence is 1-9/1.000.000 in Western countries. Depending on the population origin, BBS1 and BBS10 are the most frequent genes, accounting for ~23% and 15% of genotyped BBS patients respectively. The diagnosis is based on the presence of four major criteria (pigmented retinopathy, polydactyly, chronic kidney disease (CKD), hypogonadism, mental retardation, central obesity) or three major and two minor criteria (brachydactyly/syndactyly, dental dysnormalities, anosmia, taste impairment, neuropathy, liver fibrosis, diabetes mellitus, congenital heart disease) confirmed by genetic testing. In BBS, the main cause of morbidity and mortality is CKD; its severity varies among patients leading potentially to ESRD requiring dialysis or transplantation.

Squamous cell carcinoma of the external ear

Xinrong Chen — 2024-04-08

Cutaneous squamous cell carcinoma can occur on any surface of the skin, including the head, neck, trunk, limbs, and oral mucosa, the diagnosis of which is mainly made upon histopathology. A 72-year-old patient suffering with progressive enlargement and pain in his left external ear for more than 5 years presented in the outpatient department. A dermatological examination revealed that his left external ear had been dilated by an area of about 4 x 3cm. Diagnosed as squamous cell carcinoma through histologic examination, he received surgical resection without recurrence.

Huge arachnoidal cyst with recent onset of seizure in an adult

Mohamed El Biadi — 2024-04-08

A 68-year-old right-handed man, having consulted for the occurrence of a first epileptic seizure. Brain computerized tomography (CT) scan and magnetic resonance imaging (MRI) showed a giant congenital supratentorial arachnoidal cyst occupying the anterior two-thirds of the right hemisphere, measuring 14.09x6.07 (APxT) cm and 11.67 cm high, compressing the right cerebral hemisphere and the right cerebral peduncle with a midline shift. Arachnoidal cysts are congenital malformations containing cerebrospinal fluid. They may be asymptomatic and discovered incidentally on imaging. When they are large, as in this patient, they can cause a mass effect.

The outcome of medical nutrition therapy on glycemic control among type 2 diabetic patients

Shimaa Elsayed Abdelsalam — 2024-04-08

Introduction: the global prevalence of type 2 diabetes in adults is estimated to be 6.4%. The current prevalence of type 2 diabetes in Egyptians aged 20 to 79 is approximately 15.6%. The objective of medical nutrition therapy (MNT) is to optimize the management of the "ABC" for diabetes control, glycated hemoglobin, blood pressure, and cholesterol. Our study aimed to assess the effect of MNT on glycemic control in patients with type 2 diabetes attending the family practice clinic.

Methods: a quasi-experimental intervention trial was conducted with 40 diabetic patients seeking medical service in the Suez Canal University Hospital family practice clinic. The participants were over 20 years old and had uncontrolled type 2 diabetes. Patients were surveyed using El-Gilany questionnaire to evaluate the socio-demographic traits, physical examination data, and laboratory investigations at baseline and after 12 weeks.

Results: medical nutrition therapy (MNT) significantly reduced glycated hemoglobin level (p<0.001); the median level of glycated hemoglobin was 10% with a minimum level of 7.5% vs. a maximum of 14% in the pre-intervention phase. In comparison, the median glycated hemoglobin level was 9.5%, with a minimum level of 5.6% vs. a maximum of 13.5% in the post-intervention phase. In addition, there was a significant improvement in blood pressure, weight, body mass index, fasting plasma glucose, and lipid profile.

Conclusion: there is evidence that MNT is a crucial component of type 2 diabetes therapy.

When little can do more: the case for investing in mental healthcare in Ghana

Joel Agorinya — 2024-04-08

Two reports, the World Health Organization- Assessment Instrument for Mental Health Systems (WHO-AIMS) 2020 and the World Health Organization Special Initiative for Mental Health Situational Assessment, detailing the state of mental healthcare in Ghana, were recently published. These reports show the lack of adequate investment in mental healthcare in Ghana, which has resulted in shortages in treatment coverage for most psychiatric disorders and a shortage of mental health workforce. We compare the progress made over the last ten years with the limited investment and show that Ghana can achieve much more in the mental health landscape with more investments.

Antibiotic sensitivity profile of bacterial isolates from stool samples among children below five years in Murang'a County, Kenya

Oliver Waithaka Mbuthia — 2024-04-08

Introduction: the discovery of antibiotics led to the optimistic belief of completely eradicating infectious diseases during the golden era following their discovery. Countries are grappling with the burden of microbial resistance bringing a near paralysis of all facets of mankind. Enterobacteriaceae and other hard-to-treat Gram-negative bacteria have become resistant to nearly all antibiotic options available, and this is a bad taste in the fight against microbial resistance.

Methods: during the months of April-October 2017, 163 children below five years presenting with diarrhea were randomly selected in Murang´a and Muriranja´s Hospitals. Bacterial agents were identified and antibiotic susceptibility profile was determined. Design: a cross-sectional study approach was used. Statistical analyses were performed using STATA v. 13.

Results: a total of 188 bacteria belonging to 11 genera were isolated, and identified and their antibiotic susceptibility profiles were determined. Susceptibility testing showed that almost all the Enterotoxigenic Escherichia coli (ETEC), Enteropathogenic Escherichia coli (EPEC), Enteroaggregative Escherichia coli (EAEC), Salmonella, Klebsiella, Shigella, Vibrio, Enterobacter, Proteus, Pseudomonas, Aeromonas, Citrobacter and Yersinia species were resistant to the following antibiotics: ampicillin, amoxicillin, chloramphenicol, ciprofloxacin, ceftriaxone and kanamycin. Other than ETEC (90.9%), all the rest of the isolates were resistant to nalidixic acid. Other than ETEC (9.1%), EAEC (33.3%) and Salmonella species (95.2%), all the rest of the isolates were resistant to gentamicin. Other than V. cholerae, all the other isolates were resistant to trimethoprim-sulfamethoxazole. Isolates were sporadically resistant to erythromycin, streptomycin, doxycycline, and ofloxacin.

Conclusion: the high resistance rate of enteric Gram-negative bacterial pathogens in Murang´a County is alarming. The need for urgent, efficient, and sustainable actions and interventions, such as culture and susceptibility testing, is needed and must be taken into account to minimize and prevent the establishment and spread of enteric pathogenic bacteria.

Pachydermoperiostosis with bilateral ptosis and its associated systemic comorbidities: a rare case report

Su Su Hlaing — 2024-04-08

Pachydermoperiostosis is a rare genetic disease known as primary or idiopathic hypertrophic osteoarthropathy (HOA)/Touraine-Solente-Gole syndrome. It is an autosomal dominant or recessive disorder comprising digital clubbing, periostosis, hyperhidrosis, and pachydermia (thickening of facial skin). Ocular manifestations are uncommon; however, blepharoptosis may occur. This case presented with severe bilateral ptosis due to the disease progression. A large 20 mm upper lid resection with levator advancement was performed to improve his ability to see. This is the first reported case of pachydermoperiostosis (PDP) in Jamaica. We present a rare case of pachydermoperiostosis with severe blepharoptosis, who attained a good result with surgical intervention.

Impact of mass distribution of long-lasting insecticide nets on the incidence of malaria in Lomami, Democratic Republic of Congo (DRC): a study based on electronic health record data (2018 - 2019)

Theddy Kazadi Kabeya — 2024-04-08

Introduction: holoendemic, malaria remains one of the major public health problems in Lomami Province in the Democratic Republic of Congo (DRC). To fight against it, a free mass distribution of long-lasting insecticide nets (LLINs) was organized in July 2019 throughout the province. The present study aimed to assess the incidence of malaria and its impact on anaemia of children from 0 to 59 months in this region before and after this intervention.

Methods: we had conducted a retrospective observational study from June to December 2018 and June to December 2019. The data were collected on District Health Information System version two (DHIS2) and analyzed with T-tests to compare the incidence rates before (second semester 2018) and after the distribution of LLINs (second semester 2019).

Results: the evolution of malaria cases immediately dropped after the distribution campaign. The incidence rates per 1,000 inhabitants in 2018 and 2019 were 106 and 107 respectively in the general population; 302 versus 305 in children aged 0 to 59 months and 219 versus 209 in pregnant women. The differences in incidence were not statistically significant with p values 0.497, 0.4602, and 0.3097 respectively. However, it was observed that the decrease in malaria cases led to a decrease in anaemia cases in general.

Conclusion: the LLIN distribution campaign did not decrease the incidence of malaria. The synergy of preventive interventions to reduce the incidence of malaria remains key.

Polio outbreaks in Cameroon following the COVID-19 pandemic

Andreas Ateke Njoh — 2024-04-08

Polio is an infectious and disabling life-threatening
disease caused by the poliovirus. This disease is
prevented through vaccination. Though this viral
infection has been eliminated in most parts of the
world, a few countries are still endemic to wild
poliovirus. In 2020, the World Health Organization
(WHO) African Region, including Cameroon, was
certified free of wild poliovirus. Some countries
recurrently report circulating vaccine-derived
poliovirus cases (cVDPV) despite recorded
achievements. Also, the risk of importing poliovirus
from endemic settings remains, particularly in the
context of coronavirus disease (COVID-19). This
study aimed to assess the state of polio in
Cameroon and identify the situation during COVID19. A data review was conducted from February to
March 2023. Data on polio cases and vaccination
coverage per region of Cameroon were reviewed
from 2014 to 2022. Data were analyzed with
Microsoft Excel, and the results were presented as
proportions. The last wild poliovirus was reported
in Cameroon in 2014, and the country benefitted
from a response. No case of poliovirus was
detected in the country from 2015 to 2018. After
that, an increasing number of type two cVDPV
were reported across 50% of the country's regions
from 2019 to 2022. The outbreaks benefitted from
responses with various oral polio vaccines,
including the type two novel oral polio vaccine
(nOPV-2). Though wild polioviruses have been
eliminated in most countries, including Cameroon,
cVDPV remains a significant problem. There is an
urgent need to strengthen disease surveillance and
vaccination to prevent cVDPV-2 in this country,
particularly in the COVID-19 context.

A rare case of centre sparing corneal opacity with unilateral Reis-Buckler dystrophy

Ankit Gupta — 2024-04-08

One of the main factors affecting eyesight is corneal opacity. There are 1.5 to 2.0 million occurrences of monocular blindness annually, which is attributed to corneal opacity brought on by trauma or corneal ulcers. Trauma, chemical burns, infections, surgeries, and secondary corneal illnesses or disorders, such as corneal dystrophies, can all cause corneal opacity. The primary criteria of whether corneal opacity might resolve spontaneously and the likely time course of resolution are the pathophysiologic mechanisms leading to the opacity following damage. This is a case of a 79-year-old female with complaints of a diminution of vision in both eyes for the past two years. The vision was 6/24P in the right eye and 6/60P in the left eye. Both eyes were pseudophakic. On slit lamp examination, both eyes have peripheral corneal opacity with arcus senilis. The patient had a history of cataract surgery in the right eye 4 years back and in the left eye 3 months back. Upon auto-refraction, the right eye had -1.12S -1.37S x 95 axis, and the left eye had no target due to corneal dystrophy. The fundus examination was within normal limits with no abnormality. The chosen course of treatment for penetrating keratoplasty is a conventional full-thickness corneal transplant technique, in which an opaque cornea is cut using a trephine (a circular cutting tool), and a correspondingly sized section of the donor cornea is taken with a second trephine. The corneal button refers to the portion of the donor cornea that has been removed. The patient's eye is subsequently stitched to the donor tissue. Penetrating keratoplasty can be used to treat dense corneal opacity, which covers the whole corneal layer.

Efficacy of rituximab in refractory polyarteritis nodosa: a case report

Iméne Boukhris — 2024-04-08

Polyarteritis nodosa (PAN) is a systemic vasculitis affecting medium and small-sized vessels resulting in multiple organ involvement. Refractory PAN requires a different therapeutic approach. We herein report the case of a 42-year-old male presenting a non-virus-related refractory PAN with a favorable outcome on rituximab. He presented significant weight loss, muscle weakness, peripheral axonal neuropathy, and medium-sized cutaneous vessel necrotizing vasculitis. The patient received high-dose corticosteroids and cyclophosphamide with no significant clinical improvement while developing adverse side effects such as hypertension and diabetes. Rituximab was prescribed as an alternative therapy at 1000 mg on day 0 and day 15. This allowed for complete and rapid control of disease activity with regression of cutaneous injury and substantial improvement of neurological symptoms. In conclusion, using chimeric anti-CD20 monoclonal antibodies, such as rituximab, although rarely reported in refractory non-virus-related PAN, may be an effective alternative therapy, as portrayed in our case.

Ovarian cyst torsion in a pre-menopausal woman causing intestinal obstruction: a case report

Vasiliki-Kalouda Tsapadikou — 2024-04-08

Intestinal obstruction due to adnexal torsion is a rare complication that can be occurred during torsion of an ovarian cyst. A premenopausal woman presented to the emergency department with complaints of abdominal distension, abdominal pain, and obstipation for 2 days. An abdominal radiograph showed signs of large bowel partial obstruction. Hence admission to the surgical department was ordered. Due to deterioration of the patient, a gynaecological evaluation took place. Ultrasonography demonstrated a large ovarian cyst, which was also confirmed by an abdominal computed tomography scan and thus immediate laparotomy was decided. Abdominal hysterectomy with bilateral salpingo-oophorectomy was performed due to torsion of a giant ovarian cyst, which caused intestinal obstruction by compression. The post-operative course of the patient was uneventful. Ovarian torsion should not be eliminated from differential diagnosis when it comes to female patients with clinical presentation relevant to small and/or large bowel obstruction.

Patients´ satisfaction with post-operative pain management in Ayder Comprehensive Specialized Hospital, Ethiopia: a cross-sectional study

Niguse Meles Alema — 2024-04-08

Introduction: surgical patients often suffer from inadequate treatment of post-operative pain which potentially results in numerous adverse medical consequences and is a recurring source of patients' dissatisfaction. Thus, this study aimed to investigate patient's satisfaction with their post-operative pain management and its determinants among surgically treated patients in a specialized hospital within Ethiopia.

Methods: an institutional-based prospective cross-sectional study was conducted in the surgical ward of Ayder Comprehensive Specialized Hospital. Data were collected using a semi-structured questionnaire, which was an adoption of the 2010 version of the American Pain Society Patient Outcome Questionnaire, and by reviewing the medical charts of the patients. A stepwise linear regression model was used to analyze the data.

Results: among the 144 patients approached in this study, 112 (77.8%) of them categorized their postoperative pain as moderate to severe. The mean patient satisfaction with their pain management was 7±2.3 on 0-10 numerical rating scale. Despite high levels of pain, the majority of patients (90.3%, n=131) were moderately or completely satisfied with their pain management. Stepwise linear regression analysis found that the determinants of patients' satisfaction were prior chronic pain, prior surgical history, and substance use (F (3,140) = 5.364, adjusted R₂ = 0.084, P=0.02).

Conclusion: the patients were moderately and completely satisfied with their pain management in spite of expressing moderate and severe level of pain intensity. Pain still remains a concern among surgical patients, and effective pain management strategies should be practiced to manage pain and its functional interferences more effectively.

Assessment of the direct hospital cost of medical care for patients hospitalized for a stroke in Gabon

Gaëtan Moukoumbi Lipenguet — 2024-04-08

While the incidence of stroke is increasing in developing countries, resulting in an extremely high economic burden, very few costing studies have been carried out to date. This study aims to measure the direct hospital costs of stroke management in Gabon. The study adopts a retrospective approach, based on a review of patient records in the Neurology and Cardiology Departments of the University Hospital of Libreville (CHUL) between January 2018 and December 2019. It focuses on all patients received for stroke at the CHUL during the study period, regardless of the outcome, analyzing direct hospital costs. Three hundred and thirteen (313) patients were admitted during the period in question, 72.52% in neurology and 27.48% in cardiology. The average age was 58.44 (±13.73 years). Fifty-six percent (56.23%) had health coverage. Ischemic stroke was more common than hemorrhagic stroke, at 79.55% and 20.45%, respectively. The average expenditure per patient was estimated at 619,633 CFA francs (€944.62). From the point of view of social security coverage, the average out-of-pocket expense per patient was 147,140 CFA francs (€224.31), for a reimbursement of 422,883 CFA francs (€644.68). The average direct cost of stroke is very high for both patients and administrations. This argues for the implementation of prevention programs for the disease. The results of this study may be useful for work on the efficiency of such programs.

Medical laboratory accreditation status and associated factors in selected private and government health facilities of Addis Ababa, Ethiopia

Meseret Tesema — 2024-04-08

Introduction: quality medical laboratory service(s) is a key to patient safety with a great emphasis on medical diagnoses and treatment. ISO 15189 laboratory accreditation is an effective way to demonstrate competency. Despite the benefits, there are considerable exigent efforts towards achieving its target, mainly in sub-Saharan Africa. Hence, determining those factors that hinder laboratory quality services and the process of accreditation is important to address and resolve. Thus, this study aimed to assess medical laboratory accreditation process and in selected private and government health facility laboratories in Addis Ababa, Ethiopia.

Methods: institutional-based cross-sectional study design was conducted in Addis Ababa from July 1 to August 30, 2018. Data was entered into EPI-data version 3.1 and analyzed by SPSS version 23. Data from focus group discussions were categorized and discussed thematically. Additionally, logistic regression analyses were computed to examine the relationship between the explanatory and response variable.

Results: a total of 411 professionals participated in this study, of which 117(28.8%) participants were female, 280 (68.2%) participants with a bachelor´s degree, and 352 (85.6%) participants had information about accreditation. The current laboratory accreditation status in Addis Ababa is 3.6%. The primary identified factors were gaps related to method verification/validation, equipment calibration, and continual program quality improvement.

Conclusion: strengthening laboratory management standards towards accreditation (SLMTA) will significantly improve the accreditation process. However, there are internal and external factors may hinder the current accreditation process. Therefore, all responsible agencies/services should give more attention to solving those identified major barriers to achieving accreditation.

Tumeurs stromales gastro-intestinales: une étude rétrospective

Habib Zidane — 2024-04-08

Introduction: bien que rares, les tumeurs stromales gastro-intestinales (GIST) constituent les tumeurs mésenchymateuses les plus fréquentes du tube digestif. Le but de ce travail est d´étudier les aspects cliniques, paracliniques, thérapeutiques et évolutifs des GIST.

Méthodes: étude rétrospective descriptive, monocentrique (avril 2017-avril 2021) colligeant tous les patients ayant un GIST traités au niveau du service d´oncologie médicale du CHU de Mostaganem.

Résultats: notre étude a colligé sur une période de 4 ans, 23 patients, avec un âge médian de 54,4 ans, sex ratio de 1,8. La douleur abdominale était le symptôme le plus fréquent (78,3%, n=18), la tumeur se localisait dans 47,8% des cas (n=11) au niveau de l´intestin grêle. Le diagnostic a été fait à un stade précoce dans 69,6 % des cas (n=16). Le traitement chirurgical a été fait chez 20 patients sur les 23 dont 18 avec R0. Des 15 patients opérés ayant un stade localisé; 13 ont reçu un traitement médical en adjuvant (Imatinib). L´évolution sous imatinib a été marquée par 3 progressions où on est passé vers une 2^e ligne (Sunitinib). Durant la période de l´étude tous les patients sont vivants sauf deux qui sont décédés après progression de la maladie.

Conclusion: le diagnostic des GIST repose principalement sur l'histologie et l'immunohistochimie qui est souvent non faite par nos pathologistes. La biologie moléculaire permet de prédire le pronostic et en conséquence adapter les thérapeutiques. L´évolution des GIST est souvent favorable mais marquée par les récidives malgré un traitement supposé curatif imposant une surveillance prolongée.

Prevalence and predictors of virological failure in pediatric patients on HAART in sub-Saharan Africa: a systematic review and meta-analysis

Nchimunya Machila — 2024-04-08

Antiretroviral treatment failure has emerged as a challenge in the management of pediatric human immunodeficiency virus (HIV) patients, especially in resource-limited countries despite accessibility to Highly Active Antiretroviral Therapy (HAART). A systematic review and meta-analysis was conducted to synthesize virological failure (VF) prevalence and ascertain its predictors in children in sub-Saharan Africa. An electronic database search strategy was conducted from January to September 2021 on PubMed, EMBASE, SCOPUS, HINARI, and CINAHL. Further, manual searching was conducted on non-indexed journals. Utilizing the JASP© version 0.17.2 (2023) statistical software, a meta-analysis of pooled prevalence of VF was estimated using the standardized mean differences. Further, selection models were used to assess the risk of bias and heterogeneity. The pooled odds ratios were estimated for the respective studies reporting on predictors of VF. The overall pooled estimate of the prevalence of VF in sub-Saharan Africa among the sampled population was 29% (95% CI: 27.0-32.0; p<0.001). Predictors of VF were drug resistance (OR: 1.68; 95% CI: 0.88-2.49; p < 0.001), poor adherence (OR:5.35; 95% CI: 5.26-5.45; p < 0.001), nevirapine (NVP)-based regimen (OR: 5.11; 95% CI: 4.66-5.56; p < 0.001), non-usage of cotrimoxazole prophylaxis (OR: 4.30; 95% CI: 4.13-4.47; p < 0.001), higher viral load at the initiation of antiretroviral therapy (ART) (OR: 244.32; 95% CI: 244.2-244.47; p <0.001), exposure to the prevention of mother to child transmission (PMTCT) (OR: 8.02; 95%CI: 7.58-8.46; p < 0.001), increased age/older age (OR: 3.37; 95% CI: 2.70-4.04; p < 0.001), advanced World Health Organization (WHO) stage (OR: 6.57; 95% CI: 6.17-6.98; p < 0.001), not having both parents as primary caregivers (OR: 3.01; 95% CI: 2.50-3.53; p < 0.001), and tuberclosis (TB) treatment (OR: 4.22; 95% CI: 3.68-4.76; p <0.001). The mean VF prevalence documented is at variance with studies in other developing countries outside the sub-Saharan region. The high prevalence of HIV cases contrasting with the limited expertise in the management of pediatric ART patients could explain this variance.

A cross-sectional study on the association between varied social support modalities and glycemic levels amongst diabetic patients residing in Machakos County, Kenya

Jackline Njeri Kiarie — 2024-04-08

Introduction: diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. While there's increasing evidence that social support from caregivers improves health outcomes in chronic illness management, the potential associations of the different types of social support and glycemic control among Type II diabetes clients have largely been ignored in Kenya. This cross-sectional study sought to establish the association between tangible, emotional, and informational social support and glycemic levels among clients diagnosed with Type II diabetes in Machakos County, Kenya.

Methods: semi-structured interviews were conducted with 726 randomly selected Type II diabetes clients enrolled in diabetes care and treatment programs in government-owned public health facilities in Masinga and Matungulu sub-counties, Machakos, Kenya. Descriptive statistics and multinomial logistic regression were conducted to elucidate any associations.

Results: seventy-three percent (73%) of the respondents were female, and 27% were male, with the majority (77.9%) being above 50 years and having lived with diabetes for over 3 years (61.5%). Opportunities for social support existed, with 62% of the respondents living with more than 2 persons above 18 in their households. From the Random Blood Glucose test analysis, 38.9% of the clients had high glycemic levels, partly because the majority (66.9%) of the respondents did not practice good diabetes self-management practices at the time of the study. While all three types of social support were reported as provided, only 30.6% reported receiving adequate social support. An association was found between social support and glycemic levels with respondents receiving adequate informational- P<0.05, OR 1.92, emotional -P<0.05, OR 3.7, and tangible support -P<0.05, OR 4.1 more likely to have better glycemic control than those with inadequate support.

Conclusion: clients receiving adequate informational, emotional, and tangible social support were 2, 4, and 4 times, respectively, likely to have better glycemic control than those with inadequate support. Of the three types of social support, tangible support was most needed. Ultimately, a greater understanding of these interactions through longitudinal studies is required to identify solutions and optimize glycaemic control for diabetes clients in Kenya and beyond.

Rapidly increasing prostheto-prosthetic pseudoaneurysm 26 years after cabrol procedure in a patient with Marfan syndrome: a case report

Othmane Haddani — 2024-04-08

A 63-year-old female with Marfan syndrome had undergone an initial operation of replacement of the ascending aorta and aortic valve with a composite graft and reconstruction of the coronary artery by the Cabrol procedure for aortic root dilatation and aortic valve regurgitation. During a follow-up of 16 year, a decreased ejection fraction was observed on transthoracic echocardiography with the onset of chest pain and dyspnea. Computer tomography angiography revealed a prostheto-prosthetic pseudoaneurysm, initially measured 21x16x23 mm, rapidly increased at 1-year follow-up at 27x24x33 mm. Coronary angiography showed the presence of turbulent flow inside the pseudoaneurysm with a decreased coronary perfusion. We resected the pseudoaneurysm and a new prostheto-prosthetic anastomosis was performed. The postoperative course was uneventful without any complications. We report this case because in literature there has been few reports regarding prostheto-prosthetic pseudoaneurysm after Cabrol procedure.

Chondroblastoma of proximal tibia diagnosed by arthroscopy-guided biopsy: a case report

Viresh Kannure — 2024-04-08

Chondroblastoma considered a rare form of osseous neoplasm contributes less than 1% of all bone tumours. It is typically found in young patients with chief complaints of moderate pain with joint stiffness. It develops as a lytic lesion in the epiphysis of long bones which might spread to the metaphysis. We report a case of an 18-year-old patient who presented with progressive right knee pain which aggravated with movements. Investigations included X-ray, magnetic resonance imaging (MRI), and biochemical assessment. A focal, well-defined, lesion in the upper end of the tibia with surrounding marrow oedema was observed and diagnostic arthroscopy was taken for management. Histopathology of specimen observed chondroblasts proliferation with areas of mature cartilage, and giant cells confirming intrasynovial chondroblastoma. Usually, surgery is the treatment of choice; however, possibilities of the secondary bone cyst, haemosiderin deposition on the joint, etc., make treatment approaches uncertain. Diagnostic arthroscopy is a rare but essential modality in such cases due to better visuals, complete tumour excision, and combination with adjuvant therapies. Chondroblastoma, if untreated, proves detrimental, hence, a thorough evaluation is critical for overall better outcomes.

BRCA1 and BRCA2 mutations and their clinical relevance in selected women diagnosed with triple-negative breast cancer in Kenya: a descriptive cross-sectional study

Josephine Nyabeta Rioki — 2024-04-08

Introduction: triple-negative breast cancer (TNBC) is a heterogeneous breast cancer type with a poor prognosis. About 25% of TNBC patients carry breast cancer susceptibility genes 1 and 2 (BRCA1 and BRCA2) mutations. Screening for BRCA mutations would facilitate early detection and initiation of personalized therapy, thus improving prognosis. However, this has not been explored in our population. We aimed at identifying BRCA1 and BRCA2 gene mutations and their clinical relevance among selected women with TNBC in Kenya.

Methods: six participants enrolled in a larger descriptive cross-sectional study who met the inclusion criteria were selected. Structured questionnaires were used to obtain qualitative data. Deoxyribonucleic acid (DNA) was extracted from saliva. Whole exome sequencing of BRCA1 and BRCA2 genes using a next-generation sequencer was done.

Results: overall, 83.3% of BRCA1 and BRCA2 gene mutations with clinical relevance were detected. Most of the variants (63%) were found in BRCA1 whereas 37% were found in BRCA2. Pathogenic mutations in BRCA1 gene included c.5513T>A, c.5291T>C, c.5297T>G, c.110C>A, c.5212G>C, c.122A>C, c.5117G>A, c.5095C>T, c.5054C>T, c.5053A>G, c.115T>A, c.5143A>G, and c.130T>G. Those in BRCA2 gene were c.7878G>A, c.9154C>T, c.8243G>A, c.7976G>A, c.8165C>G, c.8167G>C, and c.8168A>T. One variant (c.5352delG: p. Leu1785Terfs) not matching any in the BRCA Exchange and ClinVar databases was detected.

Conclusion: our study revealed BRCA mutations that could be common among our population. Further, it has shown that BRCA1 and BRCA2 genetic mutations identified are of clinical relevance and there is a need to screen for these mutations in breast cancer patients to understand their implication in patient management outcomes.

Audit of essential knowledge of diabetes in patients with diabetes in Zimbabwe

Åsa Ernersson — 2024-04-08

Introduction: in Zimbabwe, the organized diabetes education in the governmental health care system is limited, but the Diabetes Association has some educational activities in which persons with diabetes can participate. In this study, the purpose was to measure essential knowledge of diabetes and its management in persons with diabetes living in Zimbabwe.

Methods: a cross-sectional descriptive study design was used to audit essential knowledge of diabetes and its management in persons with type 2 diabetes through a survey of 64 persons attending meetings at the Zimbabwe Diabetes Association. Both descriptive and analytic statistical methods were used.

Results: in general respondents have acceptable knowledge of diabetes, whereas their knowledge of glycaemic control is low (45%), likewise their knowledge of how to manage medical treatment when ill. Knowledge concerning lifestyle-related issues was generally low. Respondents had limited knowledge about changes in blood glucose during physical activity (18%) and their knowledge about appropriate food for people with diabetes was low (67%). Most respondents were aware of the importance of regular examinations to avoid long-term complications related to diabetes (>87%) but their knowledge of how to prevent foot complications and perform daily preventive foot care was limited (73%).

Conclusion: there is limited knowledge of diabetes in Zimbabwean persons with type 2 diabetes even if they have participated in educational activities at the patient associations. This further supports the need for development of education for patients in health care which requires increased competence in the field among health care staff.

A retrospective study on veterinary antimicrobial use in Nigeria, 2014 to 2017

Dooshima Kwange — 2024-04-08

The global antimicrobial usage in food animals was estimated at 63,000 tons annually in 2015 and projected to increase by almost 70% in 2030. Reliable data on antimicrobial use (AMU) is crucial for policy formulation and regulation. We determined the quantity and pattern of AMU in Nigeria from 2014-2017. We conducted a retrospective study on imported antimicrobials for veterinary use in the country from 2014-2017. Import data from the National Food and Drug Administration and Control (NAFDAC) was used for this study. We determined the classes and the quantity of active ingredients of antimicrobials imported into the country as described in the OIE guidance. A total of 1,392,578 kg (1392.6 tons) of antimicrobials (AM) were imported to Nigeria during the period under review. The year 2015 had the highest AMU (515,892 kg) while 2014 had the least AMU (207000 kg), only seven-month data was collected in 2014. Data indicates a sharp decrease in the amount of AMU in 2016 compared to 2015 (185,084 kg difference) with a slight increase in 2017. Eleven AM classes were imported for the period under review; Tetracyclines, Fluoroquinolones, Macrolides, Penicillin, Sulfonamides, Polypeptides, Aminoglycosides, Amphenicols, Glycopetides, Pleuromutilins and Nitrofurantoin. Tetracyclines (45.18%) accounted for most of the imported AM for the period of study. Nitrofurantoin and pleuromutilin were only imported in 2016. Penicillin was not imported in 2015 while amphenicols and glycopeptides were not imported in 2016 and 2017. Data collected on AMU in the current study can be used in policy formulation with regards to the use of antimicrobials in the country. We recommend the collection of data on AMU for antimicrobials produced locally or purchased through informal markets across the border as well as from veterinary hospitals/clinics, veterinary outlets and farms which were not reflected in the study; to improve on AMU reporting and more effective AMU policy formulation in the country.

Determinants of early interruption of exclusive breastfeeding at Dollo Ado refugee camps, Dollo Ado district, Ethiopia

Dawit Getachew — 2024-04-08

Introduction: nearly three-quarters of infants younger than six months were not exclusively breastfed globally. Despite some research indicating what factors influence early exclusive breastfeeding interruption in Ethiopia's stable population, there is little evidence indicating what factors influence exclusive breastfeeding interruption in vulnerable populations such as refugee camps. Therefore, this study aimed to determine the factors that contributed to the early termination of exclusive breastfeeding in Ethiopian refugee camps in the Dollo Ado district.

Methods: a case-control study was conducted at the Dollo Ado refugee camps from April 05^th to 25^th 2017. The eligible 112 cases and 224 controls were identified using the 24-hour recall method. The information was gathered using an interviewer-administered questionnaire that was pretested and organized. Logistic regression analysis was computed to assess the effect of independent variables.

Results: the determinants for early interruption of exclusive breastfeeding were not counseled about infant feeding during antenatal care follow-up (adjusted odds ratio (AOR =5.87, 95% CI [2.61-13.1]), not counseled about infant feeding during postnatal care service use (AOR= 4.33, 95% CI [2.71-10.8), breastfeeding problem (AOR= 5.62, 95% CI[4.55-15.2]) and late initiation of breastfeeding (AOR= 4.79, 95% CI [28-10.1]).

Conclusion: in this study, early termination of exclusive breastfeeding was caused by breastfeeding problems and late commencement of breastfeeding, as well as not receiving infant feeding advice during antenatal care or postnatal care. The results of this study highlight the significance of concentrating on newborn and young child feeding counseling during prenatal and postnatal care services in order to promote exclusive breastfeeding. In addition, health providers should educate parents on the significance of starting exclusive breastfeeding on time and obtaining help right away if there is a problem, such as breast soreness or the infant refusing to eat due to oral trash, to avoid early exclusive breastfeeding interruption.

Évaluation de la prévention des infections associées aux soins dans des cabinets dentaires à Rabat

Marrouk Wiam — 2024-04-08

Introduction: en dentisterie, plusieurs traitements sont invasifs et peuvent être responsables d'apparition des infections. L'objectif de cette étude était d'évaluer la prévention des infections associés aux soins au cabinet dentaire de Rabat.

Méthodes: une enquête sur la prévention des infections associées aux soins dans des cabinets de Rabat a été menée auprès de 324 praticiens. Un questionnaire auto-administré a été utilisé afin d'évaluer leurs formations, l'hygiène, la protection, l'organisation des locaux, l'asepsie, antisepsie et l'utilisation des dispositifs médicaux. Les données ont été collectées sur JAMOVI version 1.8.4, les tests Χ² et Fisher ont été utilisés pour comparer les variables, le niveau significatif est P<0.05.

Résultats: seuls 80 ont participé à l'étude. Tous les dentistes disposent de moyens de protection, cependant 68 (85%) n'ont pas la fiche de conduite à tenir en cas d'accident d'exposition au sang. Quarante-un praticiens (62,1%) ont des assistants diplômés, 36,4% ont une équipe vaccinée contre l'hépatite B et 61,3% des praticiens et des assistants ont été formés pour le traitement des dispositifs médicaux réutilisables. Soixante-seize cabinets ont des salles d'examen isolées, 41 disposent d'un stérilisateur à vapeur ainsi qu'une zone de tri disposant d'un collecteur d'objet piquant coupant et tranchant. Cependant 35,1% disposent d'un contrat d'enlèvement des déchets d'activités des soins à risque infectieux.

Conclusion: les résultats de cette étude montrent que la plupart des praticiens exerçant à Rabat respectent la majorité des normes d'asepsie et d'hygiène de la dentisterie. Cependant des efforts doivent être renforcés en ce qui concerne la vaccination du personnel.

Successful conservative management of a large 12-week-old cervical ectopic pregnancy in a nulliparous woman: a case report

John Jude Kweku Annan — 2024-04-08

Cervical ectopic pregnancy (CEP) accounts for less than 0.1% of all ectopic pregnancies. CEP is associated with high morbidity and mortality potential due to the associated life-threatening hemorrhage. When it is large, detected late, and occurs in a nulliparous woman, management is more challenging as it requires the need to preserve the uterus. We present a case of a 33-year-old nulliparous woman with a large live cervical ectopic pregnancy at 12 weeks + 1 day gestation and a very high serum β-HCG of 126,750 Miu/ml. She was successfully managed with suction curettage and cervical encerclage tamponade in order to preserve the uterus. The treatment was associated with significant hemorrhage and a prolonged period of follow-up. In low-resource settings, uterine-conserving management of CEP can be challenging, and curettage with cervical encerclage tamponade can be a cost-effective treatment modality even though it is associated with significant haemorrhage and prolonged treatment period.

McGrath® versus Macintosh laryngoscopes on hemodynamic response to intubation in elderly patients: a randomized clinical trial

Salma Ketata — 2024-04-08

Introduction: laryngoscopy and tracheal intubation induce catecholaminergic release. Our study aimed to evaluate the hemodynamic impact of orotracheal intubation by McGrath® compared to the Macintosh laryngoscope in the elderly.

Methods: we conducted a prospective randomized clinical trial that included elderly patients proposed for a scheduled surgery under general anesthesia with orotracheal intubation and divided into 2 groups: patients who were intubated using the McGrath® (group V) and patients who were intubated using the Macintosh direct laryngoscope (group M). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP), were recorded before induction of anesthesia (baseline), and at 1 min, 3 min, and 5 min after intubation. Our outcomes were the increase of SBP (∆ SBP), MAP (∆ MAP), and HR (∆ HR) between the two groups, during the 5 minutes following the start of the orotracheal intubation, intubation time and the incidence of its related complications.

Results: sixty patients were included and randomized into 2 groups of 30. The average age of our sample was 70±6 years with a sex ratio of 1.22. Most of the patients were operated on for orthopedic, urologic, or abdominal surgery. There were no statistically significant differences between the two groups in terms of demographic characteristics and the duration of anesthesia (p> 0.05). The intubation time was significantly increased in group M (p≤0.001). There was a significant difference in SBP, MAP, and HR values at 1 min after orotracheal intubation compared with the baseline values in Group V(P<0,05) and Group M (p < 0.05). There was a significant increase in the first minute after tracheal intubation in terms of SBP (151±42 vs 134.5±26 mmHg, p=0.012), MAP (114±4 vs 102±17 mmHg, p=0.015), DBP (89±32 vs 84±16 mmHg, p=0.01), and HR (99.5±10 vs 94.5±2 b/min, p=0.008) when group M was compared to group V. The ∆SBP was significantly different between group M (∆SBP = 36.2±23.5mmHg) and group V (∆SBP= 30.77±21.6mmHg) (p = 0.005). There were 4 ventricular arrhythmias in group M versus zero in group V (p <0.0001). The postoperative sore throat was significantly decreased in group M vs V (p=0.036).

Conclusion: the McGrath® videolaryngoscope decreased the hemodynamic fluctuations due to endotracheal intubation in elderly patients.

Association between Human Leukocyte Antigen (HLA) DQB106 and HLA DQB103 and adverse outcomes in a group of critically ill patients with COVID-19 in Tunisia: a cross-sectional study

Amène Ben Bnina — 2024-04-08

Introduction: Human Leukocyte Antigen (HLA) system is a highly polymorphic genetic system associated with the prognosis of several infectious diseases. The aim of this study is to investigate the association of HLA polymorphism with the outcome of coronavirus disease 2019 (COVID-19) in Tunisian critically ill patients.

Methods: this retrospective cross-sectional study included 42 consecutive patients hospitalized in intensive care unit (ICU) for COVID-19 in March 2021. Genotyping of HLA loci was performed by LABType™ sequence-specific oligonucleotide (SSO) typing kits (One lambda Inc, USA). Statistical analyses were performed using Statistical Package for Social Sciences (SPSS®) version 23.0. A p-value <0.05 was considered significant. Multivariable regression analysis was performed for the association between HLA polymorphism with adverse outcomes with adjustment for potential confounders such as age, sex, co-morbidities and blood type.

Results: patients included in our study had a mean age of 64.5 ± 11.5 (34-83) years and were mainly men (64.3%; (n=27)). The most common cardiovascular risk factors were obesity (61.9%; (n=26)) and hypertension (26.2%; (n=11)). Thirty-two patients died (76.2%). Eleven patients (26.2%) required intubation during hospitalization. We found that HLA DQB1*06 allele was significantly associated with protection against mortality aOR: 0.066, 95% CI 0.005-0.821; p = 0.035. HLA DQB1*03 allele was significantly associated with protection against intubation aOR: 0.151, 95% CI 0.023-0.976; p = 0.047.

Conclusion: it was found that there are 2 protective HLA alleles against COVID-19 severity and mortality in critically ill patients. This could allow focusing on people genetically predisposed to develop severe forms of COVID-19.

Left ventricular hypertrophy in African children infected with HIV/AIDS: a case-control study

Ijeoma Ogugua Arodiwe — 2024-04-08

Introduction: left ventricular hypertrophy (LVH) measured by echocardiography seen in human immunodeficiency virus/acquired immunodeficiency disease (HIV/AIDS) affects the morbidity and mortality. The hemodynamic and metabolic changes in (HIV/AIDS) affect the heart adversely causing hypertrophic remodeling with left ventricular hypertrophy. The aim of this study was to determine the prevalence and risk factors associated with LVH in African children with HIV/AIDS.

Methods: an analytical case - control study was conducted using echocardiography to assess cardiac function. Descriptive statistics was used to determine percentages and univariate analysis to find association between dependent variable and independent variables. Independent variables that had an association in a univariate were included in the multivariate model to determine strength of association.

Results: the mean age of the study population was 7.8 ± 2.07 years for controls and 8.3 ± 3.04 years for cases respectively. They were made up of 51.2% (n= 86) males and 48.8% (n = 82) females (M: F=1.05:1). We studied eighty-four (n= 84) cases, and LVH was seen in 67.7% (n= 56) of the patients. Mean left ventricular mass index (g/m²) was significantly higher in the cases (90.37± 35.50) than controls (89.37 ± 14.25, p= 0.04.) Relative wall thickness (mm) was within normal in the control, 0.35 ± 0.06 and high in the cases, 0.67 ± 0.17, p= 0.01. Eccentric hypertrophy was the most common type seen in 36.9% (n= 31) of the patients. Multiple linear regression analysis, revealed that the presence of LVH was associated with 0.212 (95% CI: 0.001 - 0.014; p= 0.001) lower Body mass index (BMI) for age and 0.396 (95% CI; 0.002 - 0.066; p= 0.03) lower CD4+ cell count as predictors of LVH.

Conclusion: the prevalence of LVH was high. Lower body mass index (BMI) and CD4+cells count predicted LVH. This supports the recommendation by the National Heart, Lung and Blood Institute (NHLBI) working group on research priorities for cardiovascular complications in HIV/AIDS, for baseline and periodic echocardiography in the management of children with HIV/AIDS.

Overtreatment of malaria in the Nigerian healthcare setting: prescription practice, rationale and consequences

Emmanuel Temitope Anjorin — 2024-04-08

Nigeria is one of the countries in the world with the highest burden of malaria, accounting for a quarter of all cases in Africa. According to the Centers for Disease Control and Prevention, microscopic examination remains the gold standard for laboratory confirmation of malaria. However, the policy and practice of presumptive treatment of malaria for all febrile illnesses has been widely advocated in sub-Saharan Africa. Presumptive management of fevers and/or other symptoms of malaria results in over-diagnosis, and consequently overtreatment. This article discusses the overtreatment of malaria as practiced in Nigeria and other African regions against standard treatment guidelines, highlights a wide range of its associated effects on patients and proffers possible solutions to curb the unethical practice of malaria overtreatment.

Body image dissatisfaction, nutritional status and weight control strategies among university undergraduates in Lagos: a descriptive cross-sectional study

Foluke Adenike Olatona — 2024-04-08

Introduction: body image dissatisfaction has been associated with poor nutritional status and unhealthy weight management strategies. This study determined the prevalence and relationships between body image dissatisfaction, nutritional status, and weight management strategies among university undergraduate students in Lagos, Nigeria.

Methods: a descriptive cross-sectional study employed a multi-stage sampling technique to select 865 undergraduates in Lagos. A pretested self-administered questionnaire was used to assess the variables. Stunkard figure rating scale was used to determine body image dissatisfaction. Body mass index (BMI) was calculated to determine nutritional status. A standard weight control strategy scale was adopted to determine weight management strategies. SPSS (version 23) was used for analysis and the association between variables was determined using Chi-square. The level of significance was set at P= <0.05.

Results: the prevalence of body image dissatisfaction was high (63.5%) but not associated with gender. The majority (65.1%) had normal BMI, 10.6% were overweight and 7.2% were obese. Majority of the respondents (93.3%) engaged in weight management practices with dietary control being the most employed strategy. The most commonly employed unhealthy practice is strict dieting (37.7%). Body image dissatisfaction was significantly associated with overweight/obesity (P=0.001) but not with weight management practices. Age and overweight/obesity were predictors of BID.

Conclusion: prevalence of body image dissatisfaction, overweight and obesity, and unhealthy weight management strategies were high. Body image dissatisfaction was associated with obesity but not associated with weight management strategies. All undergraduates need health education on body image and appropriate weight management strategies.

Case studies of multi-disciplinary team management of atypical gastric cancer: challenges and lessons learned (about two cases)

Mbang Kooffreh-Ada — 2024-04-08

There is a paradigm shift towards adopting a multidisciplinary team (MDT) model in the care of cancer patients, with increasing evidence to support its effectiveness. Cancers are biologically distinct, patients present in diverse ways and require, different therapeutic approaches in their management. Patient symptoms and treatment side-effects as well as physical and psychological impact vary according to cancer location and treatment plan. The varied clinical scenarios cancer patients present further buttress the need for MDT practice in hospitals to improve the quality of patient care, in contrast to the outdated concept of holistic treatment offered by a single physician. Unlike Europe, United States of America and Australia which have implemented successful MDT cancer care programs, Nigeria is just coming on board. We present two cases of gastric cancer (seen two months apart) with atypical presentation and the role of MDT in their evaluation and management. These case studies highlight the role of MDT in the management of cancer patients in Nigeria lending credence to the urgent need to implement this model of care in our cancer patients in a bid to improve the quality of care and outcome.

Etude du profil épidémio-clinique du cancer du col utérin au Maroc: cas de la région du Gharb

Mohamed Zraidi — 2024-04-08

Le papillomavirus humain (HPV) est un virus sexuellement transmissible qui est le principal facteur de cancer du col de l'utérus (CC). Notre étude vise à développer un système d'évaluation sur les formes appropriées de dépistage et les méthodes de diagnostic au Maroc. 297 femmes atteintes de cancer (âge moyen 51,98 ±11,68 ans), de trois régions : kenitra, Sidi kassem, Sidi Sliman, en intention, participant à nos travaux de détection précoce du CC entre 2013 et 2021. les résultats montrent que 69 % (n = 198) ont un carcinome épidermoïde et 20 % (n = 57) des patients ont des lésions précancéreuses, tandis que 45,7 % de ces patients ont réalisé au moins un test PAP. Dans notre échantillon, le test de régression montre que le profil des facteurs de couverture et l'âge de la première grossesse sont des facteurs de risque de sévérité de la dysplasie. Malgré les efforts entrepris, doivent encore être mis en œuvre. CV Le papillomavirus humain (HPV) est considéré parmi les virus sexuellement transmissibles.il est l'agent principal du cancer du col utérin (CCU). Sa persistante se développe en cancer du col de l'utérus. Notre travail a porté sur 297 femmes malades de CCU provenant de trois provinces Kenitra, Sidi-kacem et Sidi-sliman et consultants le Centre de référence de la santé reproductive (CRSR) entre 2013 et 2021. Les résultats sont apparus que 69% (n =198) ont un carcinome épidermoïde et 20 % (n=57) des patients ont présenté des lésions précancéreuses alors que 45,7 % de ces patients ont réalisé au moins un test FCV. le test de régression montre que les facteurs mode de couverture et l'âge de la première grossesse sont deux facteurs de risque pour la sévérité de la dysplasie. Malgré les efforts entrepris, il reste à généraliser le vaccin pour tous les adolescents de la population marocaine. Ainsi que le passage vers le dépistage par le test génomique.

Human papillomavirus vaccination in view of the National Cancer Control Plan 2020-2029 in Morocco

Mohamed Zraidi — 2024-04-08

In Morocco, cervical cancer represents a major public health problem. It ranks second, after breast cancer in Moroccan women, in terms of incidence and mortality. Each year, more than 3,300 new cases and nearly 2,500 deaths are recorded. A Moroccan national program to fight against cervical cancer (CC) based on the practice of visual inspection after application of acetic acid was set up in 2010, allowing screening and possibly of immediate treatment of premalignant lesions of the cervix. In September 2022, a partnership circular between the Ministry of Health and Social Protection (MSPS) and the Ministry of National Education, Preschool and Sports was launched. it announces that the MSPS will integrate the HPV vaccine using the quadrivalent vaccine into the Moroccan National Immune Program (PNI), the vaccination will be aimed to 11-year-old girls, mainly those in school, who will receive two doses separated by at least a period of 6 months.

Fraud within the Nigerian health system, a double threat for resilience of a health system and the response to the COVID-19 pandemic: a review

Monica Ewomazino Akokuwebe — 2024-04-08

As Nigeria battles the COVID-19 pandemic, systemic fraud within the health system may undermine the efforts to halt the devastating effect of the disease and the fight against COVID-19. Fraud is a major concern worldwide, especially in developing countries such as Nigeria, where it is widespread within the health system. The vulnerability of the Nigerian health system despite several efforts from relevant stakeholders, has consistently been underscored before the pandemic arose, raising serious concerns. These concerns include fraud, embezzlement, and mismanagement of funds, exploitation, lack of transparency in policymaking, cutting corners in procurement processes, and taking advantage of the healthcare workforce for personal benefits. Also, other involvements in the vulnerability of the Nigerian health system that are worrisome include stakeholders using the pandemic to their advantage to increase their private benefits, a short supply of vital health resources, fraudulent recruitment of the health workforce, and ineffective crisis management. This study explores fraud within the Nigerian health system, its impact and implications for health-system resilience as well as its response to the COVID-19 pandemic. Guided by agency theory, causes and impacts of fraud in the health system and its implications on the response to COVID-19 were explained. Systematic review method was employed; out of 1462 articles identified and screened dated from 1991 to 2021, sixty articles were included in the analysis and interpretation. Specific fraud interventions should focus on a weak and vulnerable health system, service delivery, high-risk institutionalized health workforce, and addressing issues of fraud within and outside the health system in order to curb the dreaded COVID-19 and its variants in Nigeria.

Determinants of neonatal jaundice among neonates admitted to neonatal intensive care unit in public hospitals of Sidama Region, Sidama, Ethiopia, 2022: an unmatched case-control study

Biniyam Demessie Sisay — 2024-04-08

Introduction: neonatal jaundice appears in most neonates as “physiological jaundice” in the first few weeks of life; however, pathological jaundice is associated with an increased risk of long-term complications and mortality only a few studies have been conducted on the determinants of neonatal jaundice in Ethiopia. The aim of this study was to identify the determinants of neonatal jaundice (pathological) among neonates admitted to neonatal intensive care units in Sidama Region general and referral public hospitals.

Methods: a hospital-based unmatched case-control study was conducted among 270 neonates in public hospitals of Sidama Region from June 23 to August 8, 2022. We used a pre-tested interviewer-administered questionnaire and collected by open data kit (ODK) then the data was downloaded and exported to Microsoft Excel worksheets (XLS) and imported to SPSS version 26 for further analysis. Bi-variable logistic regression analysis was performed. Variables with a P-Value of less than 0.25 were included in multivariable logistic regression. Multi-variable logistic regression was performed and Adjusted Odds ratio (AOR) with a 95% confidence interval was computed and statistical significance was declared at a p-value <0.05.

Results: a total of 270 neonates with mothers (90 cases and 180 controls) with a response rate of 100% were included in this study. Factors significantly increased the odds of developing neonatal jaundice were multiparty (AOR=2.869(95%CI 1.426-5.769)), prolonged duration of labor (AOR=4.618(95%CI 1.689 - 12.625)). ABO incompatibility (AOR=3.362(95%CI, 1.185 - 9.537)). Preterm (AOR=2.936(95%CI, 1.2456.923)), birthasphyxia (AOR=2.278(95%CI,1.1454.531)) and polycythemia (AOR=3.397(95%CI, 1.147-10.061)).

Conclusion: in this study multiparty, prolonged duration lobour, ABO incompatibility, preterm gestational age, birth asphyxia, and polycythemia were factors that significantly increased the odds of developing neonatal jaundice.

Case of hyperpigmentation due to excessive androgen in a child

Archana Thaware — 2024-04-08

During infancy and early childhood, low amounts of adrenal androgens are produced, and their secretion steadily rises with age, paralleling the expansion of the zonareticularis. The mechanism(s) through which this zone develops with age and how its secretion is regulated are not completely understood. Plasma concentrations of adrenal androgens rise throughout this process, while cortisol levels stay steady, implying that mechanisms other than corticotropin are at work. The mysterious androgen-stimulating factor could be one of them. The exact cause of premature pubarche is unknown. The early maturation of the zonareticularis, which leads to a rise in adrenal androgens to levels seen in early infancy, is thought to be the cause. It has also been suggested that an increase in androgen biosynthesis could be owing to the enzyme P450c17 being preferentially hyperphosphorylated due to an autosomal dominant activating mutation in the kinase responsible for the enzyme's serine/threonine phosphorylation. This is a rare case of hyper-androgen depicted in the figure with a hairy patch of hyperpigmentation.

Hormonal, clinical, and genetic profile of infertile patients with azoospermia in Morocco

Chaymae Rochdi — 2024-04-08

Introduction: azoospermia affects more than 10%-15% of infertile male subjects attending the infertility center. In Morocco, there have been no studies on male infertility with azoospermia. Thereby, our objective was to evaluate the clinical, hormonal, and genetic characteristics of infertile men with azoospermia in Morocco.

Methods: we conducted a retrospective descriptive study performed with a convenience sample of 80 infertile men from 2021 to 2022, in the Assisted Reproductive Technology Unit of the Mohammed VI University Hospital Center in Oujda-Morocco. All patients with azoospermia were subjected to a quantitative hormone assay to evaluate the functionality of the sertolic and leydigial compartments. Human karyotyping and AZF microdeletion analysis are routinely performed in azoospermic patients.

Results: the results show that the mean age of patients in the study was 45.7 ± 3.5 years. Primary infertility accounts for the majority, with a rate of 96% (n=77). There were 12 cases of azoospermia of secretory origin, 22 cases of excretory origin, and 3 of undetermined origin. Azoospermia was associated with hydrocele in 29% (n=27) of cases. The average levels of FSH, LH, testosterone, and inhibin B were 15.54 ± 5.5 mIU/mL, 7.71 ± 2.7 mIU/mL, 405.09 ± 6.13 ng/dl and 38.44 ± 5.13 pg/ml, respectively. The prevalence of chromosomal abnormalities was 30.7%. Of these, the sex chromosome aneuploidy with 47, XXY karyotype (Klinefelter syndrome) accounted for 11% (n=9). The incidence of microdeletions of azoospermia factors (AZF) was 9%, and AZFc deletion was the most common at the rate of 3%.

Conclusion: our research shows that hydrocele, varicocele, and chromosomal abnormalities are the leading causes of azoospermia. In the Moroccan population, azoospermia is essentially of excretory origin.

Knowledge, attitudes, practices and intention to get vaccinated against COVID-19: results from a cross-sectional survey in three peri-urban communities in South Africa

Renay Weiner — 2024-04-08

Introduction: South Africa has the largest number of confirmed cases of COVID-19 in Africa. Data to inform public health strategies to mitigate the spread of new variants and severity of disease is needed, including information on knowledge, attitudes and practices (KAP) regarding COVID-19, factors associated with intention to get vaccinated, and viewpoints on reliable sources of data.

Methods: we investigated these topics as part of the COVID-19 healthcare utilization and seroprevalence (HUTS) cross-sectional survey in three communities in South Africa: Mitchell´s Plain (Western Cape Province), Pietermaritzburg (KwaZulu-Natal Province) and Klerksdorp (North West Province) during and after the second wave of COVID-19 prior to vaccine availability.

Results: primary caregivers from 5799 households participated in the study, 41.1% from Pietermaritzburg, 34.2% from Klerksdorp and 24.7% from Mitchells Plain. Two-thirds and 94.7% of respondents had correct knowledge on the cause and spread of COVID-19, respectively. Knowledge measures were significantly associated with age less than 65 years, the highest level of education and site (Mitchells Plain). Desired preventive behaviors were associated with higher socio-economic status. While 64.7% of people intended to get vaccinated, those over 64 years of age were more likely to intend to vaccinate (aOR: 1.25, 95% CI:1.06-1.47). Vaccine intention related to protection of self (58.4%) and family (40.0%). The most trusted source of COVID-19 information was television (59.3%) followed by radio (20.0%).

Conclusion: these data can be used to design targeted public health campaigns for the current COVID-19 and future epidemics, ensuring that socio-economic constraints and preference for trusted information are considered.

Prospecting for yaws in the Mbaïki Health District in the Central African Republic

Germain Piamale — 2024-04-08

Introduction: yaws is endemic in the Central African Republic. The last cases of yaws notified by CAR to WHO date back to 2012. The objective of this study was to measure the prevalence of yaws in the health district of Mbaïki and to describe its clinical and epidemiological characteristics.

Methods: this is a descriptive cross-sectional study, conducted from April 10 to 18, 2020 in the Mbaïki health district. Yaws cases were sought in 570 households in the 38 selected villages of the district. Any consenting individual over the age of one year with yaws-like skin lesions was a suspected case of yaws and included in the study. Blood was taken from suspected cases for serological testing (TDR, RPR and TPHA). Any suspected case of yaws with positive RPR and TPHA was considered a confirmed case.

Results: a total of 1967 people were examined, of whom 113 were considered suspected cases of yaws. All suspected cases were RPR-positive, 41 TPHA-positive and 13 RDT-positive. Forty-one cases of yaws were confirmed in 18 (47.37%) villages. The prevalence of yaws in the Mbaïki health district was 2.08%. Among the cases, 38.94% were children aged 1 to 14. The sex ratio was 1.69. Lesions clinically suggestive of yaws were papilloma-like in 77.00% of cases, followed by micropapules (8.00%) and ulcerations (5.00%).

Conclusion: eight of the nine communes in the Mbaïki health district are yaws-endemic. This result suggests the need to implement the Morges strategy in the Mbaïki health district.

Post-COVID-19 related bleeding at unusual sites: add paravertebral hematomas to the list

Nikolaos Sabanis — 2024-04-08

A 76-year-old man with a history of end-stage renal disease on hemodialysis and heparin-induced thrombocytopenia was affected by moderate COVID-19 pneumonia. He was supported with low-flow nasal cannula oxygen and received therapy with dexamethasone, ceftriaxone, remdesivir, clopidogrel and fondaparinux at prophylactic dose. During hospitalization, he experienced a new-onset of atrial fibrillation and the initial prophylactic dose of fondaparinux switched to therapeutic one. Thereafter, he remained uneventful and discharged home. After 14 days, the patient complained of progressively worsening back pain accompanied by clinical signs of hemorrhagic shock and an extended ecchymosis on the right paravertebral region. Laboratory tests revealed severe anemia with no evidence of thrombocytopenia, hypofibrinogenemia, disseminated intravascular coagulopathy or prolonged anti-Xa activity. Chest and abdominopelvic computed tomography showed multiple bilateral hematomas located in the erector spinae muscles, with no evidence of active bleeding. Conservative treatment was efficient and gradual absorption of hematomas was observed. Non-traumatic soft tissue hematomas at unusual sites have been described in limited cases of COVID-19 affected patients with multiple underlying comorbidities, early in the course of the disease and predominantly in association with critical illness and systemic anticoagulation use. Therefore, this is a unique case of delayed onset of multiple paravertebral hematomas in association with treatment with fondaparinux, in a post-COVID-19 hemodialysis patient.

Critical care in developing nations: what has the COVID-19 pandemic revealed?

Luiz Alberto Cerqueira Batista Filho — 2024-04-08

The COVID-19 pandemic has altered the lives of millions of individuals, resulting in over 600 million cases and over 6 million fatalities worldwide. In developing nations, mortality rates for intubated patients with viral pneumonia were as high as 80%, compared to 30% in developed countries. This article intends to discuss the causes of this disparity, focusing on the main problems shared by nations with limited resources.

Management of a pancreatic tail hydatid cyst: a case report

Anis Hasnaoui — 2024-04-08

The case report describes a 73-year-old woman, with a history of diabetes, who presented with left hypochondrium pain. Interrogation revealed a long-term history of living with Echinococcus granulosus endemic area, associated to close contact with sheep and dogs. Upon physical examination, a painless mass of the left hypochondrium, fixed to the deep plane. Abdominal ultrasonography (USG) showed a 9 cm encapsulated mass in contact with the tail of the pancreas. Further investigation was carried out by performing an abdominal computed tomography (CT) scan showing: large cystic mass with a partially calcified thickened wall, containing multiple vesicles, measuring 11.5 cm, located at the tail of the pancreas. The patient was put under Albendazole for a week and then operated on. During laparotomy, a hydatid cyst was located in the tail of the pancreas. Conservative treatment was done sparing the healthy pancreatic parenchyma and avoiding major surgery for a diabetic patient.

Age assessment services in public dental health facilities in Kenya: burden and sources of referral (a cross-sectional study)

Eunice Njeri Kihara — 2024-04-08

Introduction: the need for age assessment remains relevant due to unregistered births or lack of identification documents as a result of political and socioeconomic conflicts. Dentists play a significant role in age assessment. In order to establish the need for capacity building and collaboration, the study set out to determine the proportion of dental patients referred for age assessment and their sources of referral.

Methods: a cross-sectional study, based on 5-year records (2014-2018) of dental patients and a selected sample of 316 patients who visited for age assessment in 2019-2020 in the same hospitals. The study centers were 8 county hospitals. Variables included gender, dental visits, health facility, and sources of referral. One-way Analysis of Variance (ANOVA) and Fisher´s Exact test were used to identify a significant association between variables.

Results: from the records, 12,738 (5.7%) patients sought age assessment services. Females 6,410 (50.3%) and males 6,328 (49.7%) were nearly equal. There was a statistically significant difference in the average number of patients who required age assessment services from different facilities, p=0.000. The selected sample comprised of 186 (58.9%) and 130 (41.1%) males and females respectively. Sources of referral included; court of law (267, 84.5%), prior to acquiring identification documents (47, 14.9%), and others (2, 0.6%).

Conclusion: an average of 5% of dental patients seek age assessment services signifying the need for sustained capacity building so as to ensure competent service delivery. The majority of the sampled patients were referrals from the court of law. Further research on how the dental fraternity can collaborate with the Judiciary to ensure justice in age disputes is recommended.

A propos d´un hémangiome cutané compliqué traité en ambulatoire

Hajar El Kouarty — 2024-04-08

Les hémangiomes cutanés sont des tumeurs
vasculaires bénignes, ils peuvent se compliquer
d´ulcères très hémorragiques et rarement
d´infection. Le traitement oral par bétabloquants a
révolutionné la prise en charge des hémangiomes
cutanés compliqués. Nous rapportons le cas d´un
nourrisson de 4 mois sans antécédents notables,
ayant consulté pour ulcération d´un hémangiome
cutané de la partie supérieur du thorax avec issu
de pus et fièvre depuis 3 jours. L´examen clinique
retrouve un nourrisson fébrile à 39°C,
l´hémangiome de 10cm de grand diamètre
présente une nécrose centrale (A). L´indication de
l´hospitalisation pour prise en charge a été
indiquée, mais refusée par les parents. Le bilan a
révélé une CRP à 124mg/l avec hyperleucocytose à
15700/mm³ à prédominance PNN. Nous avons
donc démarré le traitement en ambulatoire: soins
locaux quotidiens de l´ulcération infectée,
antibiothérapie par voie orale: amoxicilline + acide
clavulanique pendant 10 jours et antalgiques
(paracétamol). Devant l´aspect hémorragique de
l´ulcération mesurant 3cm de grand diamètre (B),
nous avons démarré les bétabloquants, en
ambulatoire, par voie orale, après réalisation d´un
ECG normal. (1mg/kg/j puis 2mg/kg/j en deux
prises après la 1
ère
semaine puis 3mg/kg/j la
troisième semaine). La surveillance biquotidienne
de la glycémie capillaire, de la tension artérielle et
de la fréquence cardiaque, était réalisée à chaque
augmentation de dose. L´amélioration clinique
était spectaculaire avec involution importante de
l´hémangiome (C) après 2 mois de traitement par
Propranolol. Cette observation rappelle
l´importance de l´introduction des bétabloquants
devant des hémangiomes compliqués ainsi que la
possibilité de leur prise en charge en ambulatoire.

Ankle tuberculosis: an unusual presentation

Hardik Rasiklal Patel — 2024-04-08

Tuberculosis a leading cause of ill-health. Skeletal tuberculosis is a less common extrapulmonary manifestation of the disease which can cause monoarticular involvement. Isolated involvement of joints encompasses a spectrum of differential diagnoses such as infectious, inflammatory or neoplastic processes, where a high degree of suspicion is necessary for the diagnosis of tuberculous involvement. Here, we report a rare presentation of ankle joint monoarthritis due to tuberculosis without pulmonary involvement. Ankle and foot tuberculosis (AFTB) is very uncommon (<5%) of osteoarticular tuberculosis. Tuberculosis disease (TB) is more common among males than females. A 30-year-old male patient was brought to the orthopedics outpatient department with complaints of pain and discharging sinus in his left ankle for 1 year which was increasing over the period of time, with a history of evening rise of temperature, loss of weight, loss of appetite and no history of trauma. On examination, there was soft tissue swelling on the left ankle, a discharging sinus was present and caseous material was seen oozing from the sinus. The patient was taken in emergency operation for debridement and curettage and caseous material was sent for histopathological examination and culture and sensitivity test which was positive for mycobacterium tuberculosis.

A 40-year-old female with III-degree utero cervical descent

Dharti Khewale — 2024-04-08

Inside the pelvis the uterus (or womb) is normally situated with various muscles, tissue, and ligaments. These muscles get weak after pregnancy, childbirth, and difficult labor in women. A prolapsed uterus is a disorder that occurs when a woman's uterus drops into the vaginal canal as she ages or due to a natural depletion of the hormone oestrogen. We report the case of a 40-year-old female who was brought by her son to the hospital. The patient reported that something coming out of the vagina for 2 years, and it was progressive in nature. The cervical biopsy was done, and the histopathology report showed chronic cervicitis with hyperkeratosis and the ultrasonography shows severe cystitis and bilateral hydronephrosis. The vaginal examination revealed the patient had 3^rd degree utero cervical descent. A hysterectomy was done, and postoperatively she was treated with intravenous analgesics, and antibiotics during hospitalization.

The impact of lockdown measures during the SARS-CoV-2 pandemic on the management of diabetes in a Northern Gauteng Region of South Africa

Tatenda Nyasha Mujuru — 2024-04-08

Introduction: coronavirus disease 2019 (SARS-CoV-2), a global pandemic, popularised the term “lockdown” due to its rapid spread around the world. “Lockdown” was used as an emergency measure to temporarily prevent people from entering or leaving their communities in an effort to reduce the spread of the virus. The effects of the “lockdown” measures on the management of chronic medical conditions in African populations have been inconsistent. This study aimed to assess the effects of the lockdown on glycaemic control in patients with diabetes.

Methods: retrospective study that examined metadata from 1^st January 2019 to 31^st December 2021, to assess the impact of the national SARS-CoV-2 response on the quantity and average level of haemoglobin A1c and random glucose in patients with diabetes at Dr. George Mukhari Academic Hospital. The data was retrieved from the National Health Laboratory Services corporate data warehouse.

Results: from 2019 to 2021, a total of 9,039 tests were performed, with females accounting for 63.21% (n = 5,714) and males for 36.08% (n = 3,261), while 0.7% (n = 70) did not have an assigned gender. Mean age was 49, with a standard deviation (SD) of 21.71. The testing rate (TR) in 2019 was 10.74 per day, 2020 had a TR of 6.07, and 2021 had a TR of 7.95. During the pandemic phase, all other age groups had TRs below 1.85, except the 50-59, 60-69, and 70+ year-old groups.

Conclusion: the study revealed that SARS-CoV-2 lockdown measures were linked to poor diabetes control in patients. As a result, the consequences of managing SARS-CoV-2 had a direct influence on diabetes management.

A meta-analysis of cases of Rosai Dorfman disease reported on the African continent and a description of two cases from a tertiary academic hospital in Johannesburg, South Africa

Garrick Edouard Laudin — 2024-04-08

Rosai-Dorfman-Destombes disease (RDD) is a rare non-Langerhans cell histiocytosis characterized by the accumulation of activated histiocytes within affected tissues. The original haematopathological description of RDD has links to the late South African born haematopathologist, Ronald Dorfman and a descriptive account of two cases of the disease treated at Chris Hani Baragwanath Academic Hospital are described herein. Alongside the two case descriptions is a meta-analysis of 149 published cases from the African continent. Sequential literature searches were performed on Google Scholar and PubMed with the search terms “sinus histiocytosis with massive lymphadenopathy”, “Rosai-Dorfman disease”, “Rosai-Dorfman Destombes” and “lymphadenopathy” together with the name of each individual country on the African continent, from Algeria to Zimbabwe. All possible cases of RDD reported in published literature from Africa were captured on a Microsoft Excel spreadsheet recording details, where available, of demographics, nodal (nodal groups) or extra-nodal disease as well as treatment. Of the 54 African countries on the continent, published data was available from half of these countries (n=27). Nigeria (35), Tunisia (25) and South Africa (23) contributed to the majority of cases for data collection with a clear paucity of reportable information available from Central Africa. Of the 149 cases from the African continent, the majority were from patients aged ten years and younger with a decrease in reported cases in patients with increasing age. The mean age at diagnosis was 25.66 years [95% CI: 21.81-29.51] with a median age of diagnosis of 24.5 years. The youngest patient in the series was 3 months old and the oldest patient aged 72 (range 71.75 years, IQR 31). The cases reported were fairly split between males and females with a male-to-female ratio of 1.07:1. HIV seropositivity was reported in seven patients (4.8%) and no HIV results were available in 104 patients (71.2%). Disease presentation was split between nodal disease in 43% of patients (n=64), Extra nodal (EN) disease in 32.9% (n=32), mixed (nodal/EN) disease in 11.4% (n=17) and unknown in 12.8% (n=19). Fever was present in 18.1% (n=27) of cases. Hepatic enlargement was noted in nine patients (6%) and splenic enlargement in four patients (2.7%). Commonly ascribed sites of EN disease, in descending order, were skin and soft tissue, ocular, ear/nose/throat (ENT), abdominal organ(s), bone, lung/pleura, brain parenchyma (including dura), endocrine glands, spine, breast, pericardium, pseudotumour formation (unspecified site), joint(s), peripheral nerves and genitourinary tract disease. The upfront administration of glucocorticosteroids was seen in the majority of cases. Rosai-Dorfman-Destombes, although a rare disorder, should be considered as a differential diagnosis in patients with massive bilateral cervical lymphadenopathy and is confirmed with accompanying pathological changes on microscopic and immunohistochemical examination of biopsy specimens. The role of infection, particularly HIV infection, is considered to be a possible contributor to the pathogenesis of RDD and HIV testing in patients from areas of high HIV endemicity with co-existing RDD should be undertaken. Consideration for mycobacterium tuberculosis infection in patients with generalized significant lymphadenopathy still remains an important differential for massive lymphadenopathy, and too requires confirmation by appropriate microbiological investigations. The treatment landscape in RDD is limited in many resource-poor settings, with the upfront use of glucocorticosteroids employed routinely in the majority of cases.

Prevalence of periodontitis and oral hygiene practices among diabetic and non-diabetic patients in a tertiary hospital in Lagos: a cross-sectional study

Kehinde Olubukola Ojo — 2024-04-08

Introduction: periodontitis is the sixth leading long-term complication of diabetes mellitus which can impair diabetic patients' metabolic control. Patients with both diabetes mellitus and periodontal disease present with the challenge of managing these two chronic diseases, each of which may impact the other. The aim of this study was to determine and compare the prevalence of periodontitis and oral hygiene practices among diabetic and non-diabetic patients attending a large tertiary hospital in Lagos, Nigeria.

Methods: this was a cross-sectional comparative study involving 110 diabetics and 110 non-diabetic patients aged 40 years and above. They were recruited from the diabetes and general medical out-patient clinics respectively in a large tertiary hospital in Lagos using a systematic sampling method. Data was collected using an interviewer-administered questionnaire. In addition, blood tests for glycated haemoglobin and oral examination using a simplified periodontal examination were conducted. The prevalence and severity of periodontitis and oral hygiene practices were compared between both groups. Data were analyzed with IBM SPSS version 21 Software.

Results: the prevalence of periodontitis was higher among the diabetics 100 (90.9%) compared to the non-diabetic patients 79 (71.8%), and this was statistically significant (p<0.001). Severity of periodontitis among both groups was also statistically high 54 (49.1%) vs. 35 (31.8%) p<0.001.

Conclusion: the prevalence of periodontitis was higher and more severe among diabetics compared to non-diabetics. Oral hygiene practices in both groups are not statistically significant p>0.05. Oral health education programs targeted at diabetic patients should be carried out to prevent and control periodontitis.

Necrotizing pneumonia in intensive care unit

Rui Soares Correia — 2024-04-08

An 81-year-old woman with a history of type 2 diabetes and hypertension presented with dyspnea, progressing rapidly with hypoxemic respiratory failure, requiring invasive mechanical ventilation. The initial study, in addition to high inflammatory markers, identified Streptococcus pneumoniae antigen in the urine. The patient was started on antibiotics and admitted to the Intensive Care Unit. Blood culture also identified Streptococcus pneumoniae and chest CT-scan showed consolidation of the right lung parenchyma with cavitated areas, suggesting necrotizing pneumonia. Given the diagnosis of necrotizing pneumonia, antibiotic therapy was prolonged, with progressive clinical and imaging improvement. We find this image relevant because no physician should forget the complications of frequent diseases such as community-acquired pneumonia. Necrotizing pneumonia is a rare but exuberant complication and despite its association with Staphylococcus aureus , Streptococcus pneumoniae is not an unusual causing pathogen. This complication requires prolonged antibiotherapy and clinical and imaging surveillance.

Strengthening surveillance, disease detection, and outbreak response through Guinea-Bissau's Frontline Field Epidemiology Training Program: a cross-sectional descriptive study

Mamadú Camará — 2024-04-08

Introduction: the goal of the Field Epidemiology Training Program (FETP) - Frontline is to strengthen the country's surveillance capacity at the district level to prepare and respond to health emergencies, including outbreaks, by training a skilled frontline public health workforce. We describe the FETP - Frontline program, including implementation, structure, achievements, impact, and its role in improving the epidemiological workforce capacity of Guinea-Bissau.

Methods: this cross-sectional descriptive study uses 2015-2019 program data collected through record reviews and historical narratives from FETP students and graduates. We generated descriptive summary statistics using the Guinea-Bissau's FETP-Frontline program database, student assignments, and investigation reports, after reviewing the FETP standardized curriculum and program guidelines.

Results: since its inception in 2016, FETP Frontline has implemented 14 cohorts and trained 198 frontline surveillance officers. Program participants improved surveillance data quality, investigated 51 outbreaks at national and regional levels, and contributed to disease research and surveillance in 227 separate field investigations. Participants frequently responded to priority health emergencies, including clusters or outbreaks of Zika, microencephalies, dengue, yellow fever, anthrax, malaria, and tuberculosis.

Conclusion: Guinea-Bissau's FETP - Frontline program provides a practical example of an effective strategy to strengthen health systems through a well-prepared workforce trained to quickly detect and respond to health threats.

Assessment of infraorbital foramen position using computed tomography-scan in a cohort of Cameroonian adults: landmarks in facial surgery and anesthesiology

Akaba Désiré — 2024-04-08

Introduction: the infraorbital foramen (IOF) is a hole located in the maxillary bone and delivering passage to the infra orbital vascular-nervous bundle. It is an essential structure in the management of orofacial pathologies. Its precise location allows optimal anesthesia of the infraorbital nerve during cleft lip and palate surgery or alcoholization during the management of essential V2 neuralgia. The aim of our research was to determine the morphology and morphometry of the infraorbital foramen in a sample of the Cameroonian population.

Methods: we included 208 CT-scans of patients meeting our search criteria. We determined the shape of the IOF and evaluated the transverse and vertical diameters of the IOF. We assessed the distance of the IOF from the maxillary alveolar crest and the infraorbital margin. The Student test was used to determine the association between different variables. The P-value of 0.05 was considered significant and the confidence interval was 95%.

Results: male subjects represented 52.4% (n=109) of our participants and the mean age of our population was 26 years ± 7.3. The mean transverse diameter of the left IOF was 1.97 mm ± 0.51 while 1.78 mm ± 0.53. The IOF was more often medial to the lateral palpebral commissure-nasal wing line on the left and right (78.8% and 72.6%, respectively). Our sample showed that in 54.6% (n=113) of subjects, the IOF was oval on the left side, whereas on the right side, the IOF was oval in 52.3% (n=109) of patients.

Conclusion: our study showed that to locate the IOF in a Cameroonian individual, one must palpate the vestibular mucosa opposite the maxillary first molar. Then, one must follow the line passing over this tooth, the IOF is located at about 7 mm from the infra-orbital border and 16 mm from the lateral nasal wall. We have shown that the IOF is located medial to the line connecting the nasal wing to the external palpebral commissure.

Cervical pre-cancer screening by visual inspection of the cervix after application of acetic acid in rural Burkina Faso: evaluation of women’s knowledge, screening practice habits, acceptability and prevalence of risk factors and lesions in Boussé health

Souleymane Tassembedo — 2024-04-08

Introduction: cervical cancer is a major public health problem among women in sub-Saharan Africa. The disease can be controlled through early diagnosis through simple cost-effective methods such as visual inspection of the cervix after application of acetic acid or lugol´s iodine. However, screening for cervical cancer is still underused particularly in rural areas of Burkina Faso. The objective was to estimate the prevalence of cervical pre-cancer cancer in rural health district of Boussé, Burkina Faso.

Methods: we conducted a cross-sectional study in the health district of Boussé in Northern-Central Burkina Faso from July to August 2014. Women aged 23-50 years were interviewed about their knowledge of cervical cancer and their screening practice and subsequently screened for cervical cancer by VIA.

Results: a total of 418 participants were included with a median age of 34 years IQR (30-40 years). Two² hundred participants (48%) had never heard about cervical cancer. About 134 participants (32%) knew at least one risk factor of cervical cancer. Only 37 women (9%) reported ever being screened for cervical cancer. Twenty-two percent reported concurrent sexual partnerships. The majority of the women (92%) are willing to pay to get screened for cervical pre-cancer by VIA. Overall, 21 participants (5%) were diagnosed with a cervical lesion by VIA and all of them accepted treatment with Loop electro surgical procedure.

Conclusion: screening by VIA is feasible in rural Burkina Faso, but there is a poor knowledge on cervical cancer amongst the women. There is a need to set up a comprehensive, systematic, affordable and efficient cervical cancer program including an information campaign and making screening accessible in rural remote areas.

Primary hyperparathyroidism secondary to parathyroid adenoma mimicking rickets - an unusual presentation

Hardik Patel — 2024-04-08

In rare cases, a parathyroid adenoma can mimic the signs and symptoms of rickets or contribute to ricket-like changes in the body. Parathyroid adenomas are benign tumors that develop in the parathyroid glands, which are responsible for regulating calcium and phosphate levels in the body. When an adenoma overproduces parathyroid hormone (PTH), it can disrupt the normal balance of calcium and phosphate, leading to ricket-like manifestations. Here are some ways in which a parathyroid adenoma can mimic rickets: 1) bone demineralization: excessive production of PTH by a parathyroid adenoma can cause increased bone resorption, resulting in bone demineralization. This can lead to weakened bones, similar to the under mineralization seen in rickets; 2) skeletal deformities: parathyroid adenomas causing hyperparathyroidism can lead to skeletal deformities, such as bowing of the long bones or other abnormalities, resembling the bone deformities seen in rickets; 3) growth delay: hyperparathyroidism resulting from a parathyroid adenoma can disrupt normal growth and development, causing growth delay in children; 4) vitamin D deficiency: in some cases, parathyroid adenomas can lead to vitamin D deficiency. Deficiency of vitamin D can contribute to ricket-like changes, as observed in rickets; 5) electrolyte imbalances: hyperparathyroidism caused by a parathyroid adenoma can disrupt the balance of calcium and phosphate in the body, leading to abnormal serum levels. These electrolyte imbalances can contribute to the development of ricket-like changes. If ricket-like changes are suspected, it is important to thoroughly evaluate the underlying cause. This typically involves conducting blood tests to assess calcium, phosphate, PTH, and vitamin D levels, as well as imaging studies to identify the presence of a parathyroid adenoma. Treatment of the adenoma usually involves surgical removal, which can help restore normal parathyroid function and resolve the ricket-like symptoms. Primary hyperparathyroidism (PHPT) is a rare disorder in pediatric age, with an estimated incidence of 2-5 cases in 100,000 live births. A 17-year-old male patient was brought to the orthopedics outpatient department (OPD) with complaints of joint pain and deformity for 2 years which were increasing over the period of time with no history of trauma. On examination, there were X-ray changes seen like mimicking rickets which were thinning and increased translucency of occipital bone of skull, rachitic rosary (beaded appearance of ribs) and cupping and flaring of the rib ends, physeal widening, epiphyseal cupping and fraying, metaphyseal fraying and splaying of distal radius and ulna and of the distal humerus and proximal radius and ulna and also looser zones (pseudo fractures), bowed or distorted long bones, delayed bone age seen.

Oral manifestations of monkeypox and potential tools for their management

Cinzia Casu — 2024-04-08

To the editors of the Pan African Medical Journal

Short-term neurological and functional outcome of surgical intervention in spinal cord injuries: a single center prospective observational study

Tuhin Purkayastha — 2024-04-08

Introduction: the management of an acute spinal cord injury remains controversial. The patient of acute spinal cord injury undergoes several phases of care beginning with the initial trauma management, surgical intervention, and perioperative medical management. The aim of this study was to evaluate the neurological and functional outcome of operative management of traumatic spinal cord injury patients admitted to a tertiary care centre in Northeast India.

Methods: thirty patients with spinal cord injury admitted to a tertiary care centre from December 2019 to November 2021, and treated with instrumented stabilisation for spinal cord injury were evaluated until 6 months postoperatively. Patients were evaluated with validated neurological (American Spinal Injury Association scale) and functional outcome measures (Barthel index). Demographic details, mode of injury, morphology, patterns of fractures, neurological level, and management methods in the hospital were recorded and analysed using the Statistical Package for the Social Science (SPSS) version 27.0.

Results: thoracolumbar spinal cord was more commonly injured with 16 (53.3%) patients compared to cervical spinal cord injury patients at 14 (46.7%). Eight patients had complete recovery, 7 patients had incomplete recovery and 15 patients had no recovery. At 6 months post-injury, 18 (60%) patients had favourable functional outcome. American Spinal Injury Association (ASIA) grade at admission was found to be significantly associated with the functional outcome.

Conclusion: after surgery half of the patients had an improvement in their neurology, and functional outcome was favorable which suggests that surgery still holds the key to a better functional and rehabilitation outcome.

Etude transversale du statut martial au cours de la grossesse à l'Hôpital Militaire d'Instruction Mohamed V, Rabat

Raoul Karfo — 2024-04-08

La carence en fer est la maladie nutritionnelle très répandue dans le monde. L'anémie au cours de la grossesse est fréquente dans les pays en voie de développement. Notre objectif était de suivre l'évolution du statut martial au cours de la grossesse par l'évaluation des indicateurs biologiques de la carence martiale. Elle était réalisée au service de gynéco-obstétrique à l'Hôpital Militaire d'Instruction Mohamed V (HMIMV) sur 66 patientes que nous avons suivies au cours des trois trimestres de grossesse. Les analyses biochimiques notamment la ferritine, le fer sérique, la protéine C reactive (CRP) et les numérations sanguines ont été effectuées. L'âge moyen était de 28,3 ans avec un écart type de 5,2. La prévalence de la carence martiale a été de 15,2% (n = 10), de 25,8% (n = 17) et de 42,2% (n = 28) respectivement aux premier, deuxième et troisième trimestre. L'anémie gravidique a évolué dans le même sens en passant de 10% (n = 7), 24% (n = 16) à 42% (n = 28). La comparaison des moyennes évolutives des trois trimestres par ANOVA, de la ferritine et du fer sériques, de l'hémoglobine ainsi que de l'hématocrite a montré une différence significative avec p = 0,001. Il existe une forte prévalence de la carence martiale au cours de la grossesse surtout au troisième trimestre qui justifierait la supplémentation systématique en fer.

Supernumerary lacrimal puncta: case series and review of the literature

Omar Mahmoud Solyman — 2024-04-08

We report a case series of supernumerary puncta-canaliculi, a very rare congenital anomaly, and describe different clinical presentations and new treatment options. This is a retrospective chart review of patients diagnosed with supernumerary lacrimal puncta during the time between June 2015 and December 2021 at the Research Institute of Ophthalmology, Giza, Egypt. Four patients (two females and two males) with a mean presenting age of 54 ± 14 years had unilateral double puncta. Of those four patients, three had double puncta on the right lower eyelid whereas one had double puncta on the left upper and lower eyelid. In one of the three patients, the double puncta anomaly was an incidental finding, and the patient was asymptomatic. The other three patients had associated epiphora. All four patients were found to have patent double puncta with no mechanical obstruction. No surgical interventions were necessary for all four patients as one resolved after discontinuing the topical eye drops. Another patient resolved after the diagnostic probing of the puncta, and the third asymptomatic patient required no interventions. Epiphora in the fourth patient resolved with botulinum toxin injection in the lacrimal gland. Accessory lacrimal puncta can present in patients as an incidental asymptomatic finding or patients may present with epiphora. Patients who present with unilateral epiphora, dry eye, or canaliculitis should be carefully evaluated with a detailed slit-lamp examination using lid eversion to appreciate potentially easily missed supernumerary lacrimal puncta.

Acral lentiginous melanoma with multiple bone metastasis: case report

Pei Ting Chen — 2024-04-08

Acral lentiginous melanoma (ALM) is a type of melanoma that is traditionally seen on the soles of the feet, palms of the hand, and under the fingernails or toenails. It is the least frequently diagnosed melanoma among the four histologic subtypes of cutaneous melanoma, accounting for less than 5% of all cases. ALM is frequently diagnosed at late stages and has higher incidences in non-white populations in relation to the other forms of cutaneous malignant melanoma. The most common sites of metastases in melanoma are the skin and subcutaneous tissue followed by lung, liver, brain, and bone. Bone metastases from malignant melanoma usually occur in patients who already have widespread metastases. We present this paper as a unique case study of ALM lesion in an 84-year-old African American male presenting originally in the base of right fifth toe plantar aspect then found multiple bone metastases without any other organ involved.

Health care seeking behaviors of pregnant women in rural Amhara, Ethiopia: a qualitative study of perceptions of pregnant women, community members, and health care providers

Fisseha Shiferie — 2024-04-08

Introduction: in Ethiopia, increasing access to basic antenatal and neonatal health services may improve maternal and newborn survival. This study examined perceptions regarding antenatal health seeking behaviors from pregnant women, their families, community members, and health care providers in rural Amhara, Ethiopia.

Methods: the study was conducted in four rural districts of the Amhara region of Ethiopia. A total of forty participants who were living and working within the catchment areas of the selected health centres were interviewed from 3^rd October through 14^th October 2018. A phenomenological qualitative study design was used to understand participants’ perceptions and experiences about pregnant women's health care seeking behaviors.

Results: early disclosure of pregnancy status was not common in the study area. However, the data from the present study further provided new information, suggesting that some women did disclose their pregnancy status early but preferentially only to their partners and close relatives. Most women did not seek care unless sick or experienced new discomfort or pain. Some reasons for the low utilization of available antenatal services include long distance to health facilities, lack of transportation, difficult topography, and discomfort with male providers.

Conclusion: despite the rapid expansion of health posts and deployment of health extension workers since 2003, there are still critical barriers to accessing facility-based care that limit women’s health care seeking practices.

Treatment expectation among patients with diabetes and hypertension in a tertiary hospital, Ekiti State, Southwest Nigeria: a cross-sectional study

Abigael Adeoye — 2024-04-08

Introduction: patients' satisfaction is an important aspect in determining the quality of health care since it reveals how staff are progressing toward the patients' objectives. Objective: the study determined the treatment perception and expectations among diabetes and hypertensive patients in a teaching hospital in Ekiti State, Nigeria.

Methods: the study employed a cross-sectional design approach with a sample size of 200 participants. Descriptive analyses were used to answer the research questions while inferential statistics were used to test hypotheses at a significant level of p < 0.05.

Results: the findings revealed that 50% (n=196) and 57.1% (n=196) of the patients with diabetes and hypertension were above 60 years with mean age and standard deviation being 3.36 ± 0.72, while 63.3% (n=196) and 64.3% (n=196) of the patients with diabetes and hypertension were females. Overall, the results revealed a significant difference between the domains of participants´ expectations and perceptions, with the expectations domains being significantly higher for both diabetes and hypertensive patients with mean score and standard deviation being (-5.14 (±1.62) and -4.55 (±1.83)) respectively. However, the difference in the gap scores between the participants with diabetes and those with hypertension across the domains of patients´ expectations and perceptions was significant. Furthermore, apart from the tangible domain 19.76 (±0.87) (p < 0.05), the findings from the study showed that participants with diabetes had significantly higher expectation scores, when compared with those with hypertension in all domains. Additionally, the participants with diabetes showed the highest level of perception in the tangible 15.75 (±1.43) and empathy 20.50 (±1.20) domains while those with hypertension showed the highest level of perception in the reliability, responsiveness, and assurance domains (21.66 (±2.45), 16.58 (±1.38) and 21.43 (±2.03) p < 0.001 respectively).

Conclusion: efforts should be intensified by nurses and all other stakeholders to exceed patients´ expectations by continually improving the quality of health care and services offered to patients.

Contrast media-induced nephropathy in Tunisia: prospective case-control study with cardio-nephrological monitoring

Meriam Hajji — 2024-04-08

Introduction: vascular opacification using iodinated contrast media (ICM) is often the primary diagnostic and therapeutic approach. However, the risk of post-injection nephrotoxicity of ICM is significantly higher in patients with underlying nephropathy. This study aimed to determine the incidence of Contrast Media Induced Nephropathy (CMIN) and identify predictive factors for its occurrence in patients from a cardiology department.

Methods: our prospective study involved 158 patients who underwent coronary angiography or angioplasty at the cardiology department between December 2017 and May 2018. Two types of ICM were used in our study: Iopromide and Iohexol. All patients received either physiological serum (9‰) or bicarbonate serum (14‰) intravenously for hydration. We defined impaired renal function as an increase in creatinine ranging from 10 to 26 µmol/L, while CMIN was defined as an increase in serum creatinine exceeding 26.5 µmol/L. We investigated the factors associated with CMIN using logistic regression analysis.

Results: the mean age of our patients was 60 ± 11 years (range: 29-82), with a predominance of men 63.9% (n=101). The most common cardiovascular risk factors were tobacco (36.1%, n = 57), diabetes (48.1%, n =76), hypertension (55%, n = 87). Pre-procedural creatinine averaged 81.1 ± 47.3 µmol / L with extremes ranging from 39 to 600 µmol / L. The median Mehran risk score was 3.2 (range :0- 15). The interventional cardiology act consisted of coronary angiography in 86.2% (n=136) of cases, coronary angioplasty in 2.5% (n=4) of cases. We used iohexol and iopromide in 57.6% (n=91) and 42.4% (n=67) of cases, respectively. The overall incidence of CMIN was 9.5% (n=9). The multivariable regression analysis identified 4 risk factors independently linked to the occurrence of CMIN which were Pre-existing renal failure (OR: 6.05, 95%CI [1.23-29.62], p = 0.026), anemia (OR: 0.043, CI [1.03-8.96], p = 0.043), the toxic dose of PC (OR: 4.7, CI [1.28-17.7], p=0.02), and at a Mehran score = 11 (OR: 3.7, CI [0.88-15.6], p=0.036).

Conclusion: the most effective approach for CMIN is prevention, which focuses on addressing modifiable risk factors to minimize the risk especially in patients with pre-existing renal failure.

Assessing the associated medical, legal, and social issues in medical tourism and its implications for Nigeria

Adeponle Olayode Adeoye — 2024-04-08

Medical tourism is thriving in Nigeria among both elites and non-elites with over $1 billion annual expenditure on medical tourism. Inadequate healthcare infrastructure caused by economic problems, corruption and low budgetary allocation to the country’s health sector, and lack of trust in the country's healthcare systems to handle complex medical procedures have contributed to this trend. This article discusses the trend of medical tourism in Nigeria and the associated medical, legal, and social issues in medical tourism generally, relying on relevant literature. The paper concludes that medical tourism is not inherently dangerous; however, unequal economic and power status may influence the quality of hospitals where patients receive treatment and the quality of treatment received. This unequal power and economic status may also determine justice in cases of substandard treatment in foreign hospitals. The study recommends that the Nigerian government should improve healthcare systems in the country to reverse the trend of medical tourism and to reduce the financial burden that medical tourism exerts on average Nigerians who need a high level of care but cannot access it in their country. It is also recommended that a regulatory framework that ensures protection from substandard hospitals and justice for Nigerians who fall victim to substandard care abroad must be put in place by the Nigerian government. Relevant health stakeholders should also continue to sensitize the public about the complications that may be associated with some medical procedures sought outside Nigeria especially cosmetic surgery which may result in follow-up challenges.

Verrucous epidermal nevus

Gerardo Rivera-Silva — 2024-04-08

A 9-year-old male presented with an asymptomatic, confluent, and hyperpigmented skin lesion on the right lateral trunk region presented at birth. No changes in color and consistency are reported, except that the lesion enlarged in proportion to the patient's growth. The mother informed us that the patient was diagnosed with anxiety one year ago. Physical examination revealed a large, hyperpigmented, and confluent patch of overgrown skin with a dimension between 20cm long and 15cm wide associated with painless verrucous plaques located on the right lateral trunk region (A). The laboratory investigations revealed a H1047R mutation in the PIK3CA gene. The anatomopathological study showed hyperkeratosis, acanthosis, and papillomatosis compatible with verrucous epidermal nevi (hamartomas). Anteroposterior (B) and lateral (C) neck radiographs revealed left convexity scoliosis. Based on the clinical, pathologic findings, the lesion was diagnosed as verrucous epidermal nevus (VEN). This malady is benign and congenital and could be associated with abnormalities in neurologic, ophthalmologic, or skeletal systems. When this type of nevi is located on the trunk, is associated with alterations in the bone curvatures of the spine, and/or in the bones of the arms or legs due to mutations in the PIK3CA gene, as in our case. The treatment was a shave excision followed by a phenol peeling medical; although, it is not possible to predict when skin lesions will recur.

Immunohistochemical expression of T-cell subsets (CD4 and CD8) in oral lichen planus

Hiba Jassim Rassol — 2024-04-08

Introduction: oral lichen planus (OLP) is a common oral mucosal disease with various clinical manifestations. The most predominant types are reticular and erosive. Despite extensive research on the causes of OLP, the exact etiology remains unclear. However, it is believed that a T-cell-mediated response, which triggers the apoptosis of oral epithelial cells, may contribute to the development of this disorder. This study aims to investigate the different types of T-cells (specifically CD4 and CD8) present in OLP tissue samples. By using immunohistochemistry, the expressions of cluster of differentiation 4 (CD4) and cluster of differentiation 8 (CD8) will be evaluated in biopsy samples taken from OLP patients who exhibit various clinical presentations.

Methods: this study was a retrospective analysis study. Oral lichen planus was established histologically in forty paraffin-embedded tissue samples. Blocks of OLP were diagnosed and characterized as reticular or erosive. Immunohistochemical staining was conducted using a monoclonal antibody for (CD4) and a polyclonal antibody for CD8. Semi-quantitative techniques were used to analyze the patterns of positively stained cells.

Results: forty biopsies of OLP cases were obtained from 24 females and 16 males. The mean age was (49.15±11.39) years. Using an immunohistochemical method, the proportion of CD4 expression: CD8 expression among the epithelial-connective tissue interface was shown to be 24 (60%) cases with a predominance of CD8, 9 (22.5%) cases with no difference, and only 7 (17.5%) cases with a predominance of CD4. The proportion of CD4: CD8 among perivascular parts was shown to be 8 (20%) cases with a predominance of CD8, 20 (50%) cases with no difference, while only 12 (30%) cases had a predominance of CD4. The CD4 perivascular expression was significantly stronger in (71.4%) of erosive OLP than in reticular cases.

Conclusion: T-cell subsets (CD4 and CD8) were found in the OLP infiltrates. The correlation may have contributed to the pathogenesis of OLP.

Unusual intravesical foreign bodies: a report of two cases

Abdoul-Karim Pare — 2024-04-08

The introduction of a foreign body into the urethra is an exceptionally rare occurrence. It is often secondary, either to erotic curiosity or to psychiatric disorders. The symptomatology is multiple and the diagnosis is aided by radiologic imaging. The extraction is most often done by endoscopic. The management of these patients must be done systematically and will need psychiatric assessment. We report the case of two patients who inserted a foreign body into their urinary bladder. One was 22-year-old and the second was 20-year-old and all with no history of psychiatric disorders. The first accidentally inserted a pencil into the urethra while trying to flatten a vulvar papule. The second inserted a piece of broom through playful games. The foreign bodies were extracted endoscopically in both cases under rachianesthesia. The postoperative course was uneventful and both patients were referred to a psychiatric clinic for evaluation after discharge.

Adherence to labor and delivery care quality standards and associated factors among nurse-midwives in two public teaching and referral hospitals in Kenya: a cross-sectional survey

Domisiano Koome Impwii — 2024-04-08

Introduction: maternal mortality is a major health concern, especially in low and middle-income countries. In Kenya, about 362 maternal deaths occur in every 100,000 live births. Seventy- five percent of these deaths can be prevented through the provision of quality care, especially during labor and delivery as per the quality standards. The objective of this study was to establish the level of adherence to labor and delivery care quality standards among nurse-midwives, and the factors hindering the adherence.

Methods: a descriptive, cross-sectional survey was carried out in the maternity units of Embu and Meru Teaching and Referral hospitals in Kenya. A total of 51 Nurse-midwives were involved in the study. Data on adherence was collected through direct observation using an observation checklist, whereas that of factors hindering adherence was collected through face-to-face interviews using a semi-structured questionnaire. Data were checked, coded, and entered into EPI Info version 7.1.2. SPSS Version 25.0 was used to analyze data. Associations between variables were tested using Pearson correlation and Fisher's exact tests at 95% CI.

Results: most of the participants (60.7%, n=31) were diploma holders, and a half (51%, n=26) were aged 20-29 years. About half (51%, n=26) had practiced for between 1 and 9 years and 43.1% (n=22) had worked in the maternity unit for more than a year. Out of the 12 quality standards assessed, only 5 (41.7%) were adhered to. Major implementation challenges include unavailability of standards (n=98.0%, n=50), inadequate supplies (96.1%, n=49), inadequate knowledge (88.2%, n=45), and an overwhelming workload (86.3%, n=44). There is a significant correlation between the highest level of qualification and lack of knowledge of quality standards (r=-0.279, p=0.05).

Conclusion: adherence to labor and delivery care quality standards is low among nurse-midwives. Stakeholders must allocate more resources for training and the provision of adequate supplies. The facilities should also source for and customize the quality standards to promote greater adherence.

Burden and clinical profile of genetic eye diseases in children in Nigeria: a descriptive cross-sectional study

Henrietta Ifechukwude Monye — 2024-04-08

Introduction: ophthalmic genetics is rapidly evolving globally but is still nascent in much of sub-Saharan Africa, with gaps in knowledge about the burden in the region. This study evaluated the burden and manifestations of genetic eye diseases in children in Ibadan, Nigeria.

Methods: this was a hospital-based cross-sectional study in which new and follow-up paediatric eye clinic patients were recruited consecutively at the University College Hospital, Ibadan. Children with genetic eye diseases had comprehensive ocular and systemic examinations, and their pedigrees were charted to determine the probable modes of inheritance. The main outcome variables were the proportion of study participants with genetic eye diseases, the probable modes of inheritance, and the clinical diagnoses. Summary statistics were performed using means and standard deviations for numerical variables and proportions for categorical variables.

Results: fifty-two (12%) of 444 children had genetic eye diseases, and their mean (SD) age was 88.8 ± 50.4 months. Thirteen different phenotypic diagnoses were made following the evaluation of the 52 children, including primary congenital glaucoma (13, 25%) and familial non-syndromic cataracts (8, 15%). The probable modes of inheritance were derived from the pedigree charts, and 30 (58%) conditions were presumed to be sporadic.

Conclusion: this study demonstrated a significant burden and a wide range of paediatric genetic eye diseases in this tertiary referral centre in Nigeria. This information provides invaluable evidence for planning ophthalmic genetic services.

Peritoneal tuberculosis: a benign differential diagnosis of ovarian cancer with peritoneal carcinomatosis (a case report)

Anas Ahallat — 2024-04-08

Peritoneal tuberculosis is a rare form of tuberculosis which gives a non-specific clinical picture which can be confused with several digestive pathologies. It can also mimic ovarian cancer at the stage of peritoneal carcinomatosis, hence the interest sometimes of a diagnostic laparoscopy which makes it possible to make the diagnosis which is confirmed by an anatomo-pathological study. This is the case of our patient who was initially diagnosed with ovarian cancer and the diagnosis was corrected in peritoneal tuberculosis after a laparoscopy.

Antifungal resistance and stewardship: a call to action in Zambia

Steward Mudenda — 2024-04-08

Antimicrobial resistance (AMR) is a silent pandemic that poses a global threat without regard to borders. In Zambia, considerable research attention has been devoted to the resistance of microorganisms to antibiotics, antivirals, and antimalarials, while antifungal resistance remains conspicuously unexplored. Here, we offer a perspective to shed light on the current situation regarding antifungal resistance and stewardship in Zambia. We delve into the implications of this unaddressed issue, discussing potential consequences, and exploring the benefits of increased research and policy intervention.

Prevalence and distribution of primary glomerular diseases in Africa: a systematic review and meta-analysis of observational studies

Udeme Ekpenyong Ekrikpo — 2024-04-08

Glomerulonephritis (GN) is a predominant cause of kidney failure in Africa. The prevalence of primary GNs varies widely across Africa depending on the relative proportion of secondary GNs and genetic predispositions. We assessed the overall and sub-regional prevalence of primary GN and its histologic subtypes in Africa. We searched PubMed, EMBASE and African Journals Online for studies of biopsy-proven primary GNs across all age groups in Africa published between 2010 and 2022. Data for primary GNs [minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), mesangioproliferative GN (MesPGN), membranoproliferative GN (MPGN), post-infectious GN (PIGN), IgA Nephropathy (IgAN), and crescentic GN (CresGN)] were extracted. Pooled prevalence was determined using the random effects model. Seventeen eligible articles (n = 6,494 individuals) from 8 African countries met the inclusion criteria. The overall pooled prevalence of FSGS, MCD, MN, MPGN, MesPGN, PIGN, IgAN and CresGN was 26.10%, 22.40%, 8.40%, 6.40%, 6.40%, 2.60%, 2.60%, 1.40%, respectively. Only 4 studies (23.5%) used light microscopy (LM), immunofluorescence (IF), and electron microscopy (EM) for diagnosis. There were significant differences in the distribution of histologic subtypes in the paediatric compared to the adult population and across geographic sub-regions, with West Africa having a higher prevalence of FSGS. Overall, the dominance of FSGS across most regions and age groups has implications for disease diagnosis and ongoing care. Research efforts to understand the impact of this trend on kidney disease outcomes and efforts to improve kidney biopsy practice as a means of early disease detection are needed in Africa.

Unrepaired tetralogy of Fallot in a 58-year-old female: factors contributing to the observed survival (case report)

Assia Elouardi — 2024-04-08

Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. Less than 3% of all patients with uncorrected TOF reach their 40^th year of life. We present the case of a 58-year-old woman female with uncorrected TOF. The main factors contributing to her longevity are the early development of aortopulmonary collaterals channels and the relatively gradual narrowing of the right ventricular outflow tract.

Characteristics of cases and deaths arising from SARS-CoV-2 infection in Zambia: March 2020 to April 2021

Stephen Longa Chanda — 2024-04-08

Introduction: since March 2020, Zambia has been experiencing a SARS-CoV-2 epidemic. Little data has been reported on cases and deaths arising from COVID-19 in Africa. We described the demographic characteristics of these cases and deaths in Zambia.

Methods: we analyzed data on all persons testing positive for SARS-CoV-2 from 18^th March 2020 to 25^th April 2021 in Zambia. COVID-19 cases were identified through port-of-entry surveillance, contact-tracing, health-care-worker testing, health-facility-based and community-based screening and community-death screening. All diagnoses were confirmed using real-time-polymerase-chain-reaction and rapid-antigen-test-kits of nasopharyngeal specimens. We analyzed age, sex, and date-of-reporting according to whether the cases or deaths occurred during the first wave (1^st July to 15^th September 2020) or the second wave (15^th December 2020 to 10^th April 2021). We computed Mann-Whitney-U-test to compare medians of continuous variables and chi-square tests to compare differences between proportions using R.

Results: a total 1,246 (1.36%) deaths were recorded among 91,378 confirmed cases during March 2020-April 2021 in Zambia. Persons who died were older than those who did not (median age 50 years versus 32.0 years, p< 0.001). Although only 4.7% of cases were among persons aged >60 years, most deaths (31.6%) occurred in this age group (p<0.001). More deaths (83.5%) occurred in the community than in health facilities (p<0.001).

Conclusion: during the SARS-CoV-2 epidemic in Zambia, most deaths occurred in the community, indicating potential gaps in public health messaging about COVID-19. Improving health-seeking behaviors for COVID-19 through public messaging campaigns and engaging key community stakeholders in Zambia might reduce avoidable mortality. As the group most impacted by COVID-19 mortality, older persons might need enhanced outreach and linkage to care.

Improving the distribution of antiretroviral medicines through centralised dispensing: perspectives of HIV+ patients and nurses at a chronic dispensing unit in Ekurhuleni, Gauteng Province, South Africa

Virginia Apandju Osako Ngende — 2024-04-08

Introduction: South Africa’s public healthcare facilities are continuously inundated with arduous challenges. A Chronic Dispensing Unit (CDU) can help to alleviate these challenges by reducing the workload of nurses at Primary Health Care clinics, decrease patient waiting time, and enhance accessibility of antiretroviral treatment (ART) for HIV+ patients through the dispensing, packaging, and distribution of chronic medicines to stable patients. Determining the effectiveness of a CDU is therefore critical as it can benefit both the patients and the CDU as a service provider. This study ascertained the efficiency of the Germiston CDU in Ekurhuleni, Gauteng Province, in distributing ART to clinics in order to make possible recommendations for quality improvement. No such study has so far been conducted at this CDU.

Methods: an exploratory quantitative research design was adopted. Data collection techniques consisted of researcher-assisted and self-administered questionnaires. The sample included 60 patients and 11 nurses who volunteered to participate in the study.

Results: main findings showed that patient participants believed there was a noteworthy reduction in patients’ waiting time at clinics. They were also highly satisfied with the CDU’s level of service delivery. Responses from nurse participants indicated an increase in accessibility of ART since the induction of the CDU. However, emerged challenges linked to CDU service delivery warrant a closer inspection of the CDU processes as it revealed shortfalls within the system that may hamper quality of service delivery.

Conclusion: in general, services rendered by CDU were deemed effective. However, as a recommendation, challenges linked to CDU service delivery must be addressed.

Driving the implementation of the National Health Act of Nigeria to improve the health of her population

Olayinka Stephen Ilesanmi — 2024-04-08

The Nigerian government has previously implemented policies to achieve universal health coverage, however, only few are health-insured. In 2022, the President of the Federal Republic of Nigeria passed the bill for the National Health Insurance Act. As a result of this development and the ensuing target of providing health insurance to all Nigerians by 2030, efforts to combat the high prevalence of poverty caused by out-of-pocket medical expenses while engaging with State Health Insurance Agencies are now more feasible than ever. Health insurance is now required for all Nigerians and legal residents. This article thus aimed to outline strategies to ensure that the National Health Insurance Act contributes positively to the health and well-being of Nigerians.

A challenging diagnosis of plasmablastic lymphoma: importance of integrating morpholgy immunohistochemistry and flow cytometry findings (case report)

Zahra Kmira — 2024-04-08

Plasmablastic lymphoma (PBL) is a rare clinicopathological entity that still raises many diagnostic and management difficulties, particularly due to the overlap between plasmablastic lymphomas and myeloma features. We report a clinical presentation of PBL affecting bone marrow in a 43-year-old patient who was admitted for B symptoms, hepatosplenomegaly, and bicytopenia investigation. Based on these findings, acute leukemia was suspected. Bone marrow morphology immunohistochemistry and flow cytometry contributed to establishing the diagnosis of medullary PBL. The patient deteriorated and died due to septic shock. This pathology requires collaboration between clinicians, pathologists, and biologists to confirm the diagnosis early. Nevertheless, a delayed diagnosis may contribute to worsening the prognosis particularly due to advanced stage consultation. Our reported case illustrates a rare clinical presentation affecting bone marrow. In our context, a confrontation between flow cytometry and immunohistochemistry was of interest as it helped to detect the immunological features of this neoplasm.

A typical case of flood syndrome

Anjana Ledwani — 2024-04-08

A 45-year-old male patient, with a case of cirrhosis with portal hypertension, massive ascites, and a large umbilical hernia with ulceration presented to the hospital with sudden rupture of the hernia with drainage of ascitic fluid from the abdomen. The spontaneous rupture of an umbilical hernia with a sudden gush of fluid is known as flood syndrome. This syndrome is an uncommon consequence of chronic ascites and end-stage liver disease and is named for the surge of fluid that follows the spontaneous rupture of an umbilical hernia. An abrupt rise in intra-abdominal pressure that is accompanied by coughing, vomiting, straining, or getting up from a chair may be followed by rupture. Umbilical hernia rupture is typically preceded by the development of cutaneous ulcerations (80% of the time). The development of cellulitis, peritonitis, and sepsis are complications of umbilical hernia rupture, as well as bowel imprisonment, and hypotension brought on by large-volume spontaneous paracentesis. Urgent surgical referral should be made if an umbilical hernia develops an ulcer or necrosis over it as this is a serious sign that indicates an impending rupture. In the present case, the patient’s condition worsened during the course of the hospital as he developed high-grade fever and hypotension, his blood parameters showed an elevated white blood cell count (WBC) of 18,000/cu.mm and he was started on intravenous antibiotics and vasopressors. The patient was taken up for Transjugular Intrahepatic Portosystemic Shunt (TIPS) after which the patient became hemodynamically stable. Abdominal hernia repair was postponed owing to his poor medical condition. The patient improved symptomatically upon the treatment of his massive ascites and was discharged in stable condition with the advice of regular follow-up.

Delayed presentation of spinal cord injury without radiographic abnormality (SCIWORA): a case report

Hedhli Hana — 2024-04-08

Spinal Cord Injury without Radiographic Abnormality (SCIWORA) is an unprecedented event to occur in adults but may lead to serious complications including permanent neurological impairments and death. In this article, we report a case of a 60-year-old male presenting to the emergency for a head and neck trauma after a motorbike accident, who reported only a neck ache and a normal primary neurological exam. The evolution was marked by the occurrence of paraplegia with a diminished sphincter tone and hypoesthesia beneath the T12 dermatome level after six hours, confirmed by the Magnetic Resonance Imaging (MRI). He underwent a deferred laminectomy within 30 days after receiving methylprednisolone, with partial neurological improvement after two months. An early recognition of the diagnosis was a challenge for the emergency physician, given the wide variability of clinical presentations. Magnetic resonance imaging (MRI) is a key examination to guide the diagnosis and the management of these patients.

Heterogeneous effects of socio-economic and cultural factors on fertility differentials in Burundi and Morocco during their fertility transition periods: a retrospective, cross-sectional and comparative study

Jean Claude Nibaruta — 2024-04-08

Introduction: few studies have examined the factors influencing fertility differentials and the variation in their effects in countries with different socioeconomic and cultural backgrounds and different fertility transition paces. To address this gap, our study sought to first identify the factors that influenced fertility differentials in Morocco and Burundi during their fertility transition periods, and then to compare the effects of these factors between the two countries.

Methods: using data from the 2003-4 Morocco and 2010 Burundi Demographic and Health Surveys, bivariable and multivariable Poisson regression analyses offset by the natural logarithm of the women´s age were performed to identify the socioeconomic and cultural factors that influenced fertility differentials in Morocco and Burundi during their fertility transition.

Results: our main findings showed that the total number of children ever born ranged from 0 to 17 with a mean of 2.71 ± 2.89 in Burundi and from 0 to 16 with a mean of 1.88 ± 2.80 in Morocco. In Burundi, both socioeconomic and cultural factors like rural residence adjusted incident rate ratio (AIRR) = 1.159, 95% CI: 1.103 - 1.217, P=0.020), women´s illiteracy (AIRR=1.465, 95% CI: 1.241- 1.729, P <0.001) and agricultural profession (AIRR=1. 332, 95% CI: 1.263 - 1.401, P = 0.004), household poverty (AIRR= 1.381, 95% CI: 1.223 - 1.431, p<0.001), infant mortality (AIRR= 1.602, 95% CI: 1.562 - 1.643, p<0.001), early marriage (AIRR= 1.313, 95% CI: 1.264 - 1.364, p<0.001), lack of knowledge of any contraceptives (AIRR= 1.263, 95% CI: 1.125 - 1.310, p = 0.003) and failure to use modern contraceptives (AIRR= 1.520, 95% CI: 1.487 - 1.611, p<0.001) were associated with high number of children ever born. However, in Morocco socioeconomic factors like residence place, women´s agricultural profession and household poverty were not significant. In this country, women´s illiteracy (AIRR=1.428, 95% CI: 1.315 - 1.551, P <0.001), lack of access to mass media (AIRR= 1.241, 95% CI: 1.108 - 1.375, p = 0.006), infant mortality (AIRR=1.222, 95%CI: 1.184 - 1.361, p<0.001), early marriage (AIRR1.481, 95% CI: 1.435 - 1.529, p<0.001), lack of knowledge of any contraceptives (AIRR1.508, 95% CI: 1.409 - 1.613, p<0.001) and failure to use modern contraceptives (AIRR1.745, 95% CI: 1.627 - 1.863, p<0.001) were associated with high fertility but with different effects than in Burundi.

Conclusion: the evidence from this study suggests that interventions to accelerate the fertility transition processes in Burundi and many other countries with slow fertility transitions should be designed and implemented according to each country's local context.

Isoniazid-induced lichenoid eruption reaction

Aishwarya Kishor Kedar — 2024-04-08

A 50-year-old male patient presented with complaints of cough with mucoid expectoration and breathlessness for 6 months, along with multiple raised erythematous and hyperpigmented plaques all over the body for 1 month. He was vitally stable. He had a history of radiologically diagnosed pulmonary tuberculosis in October 2021 for which he took category 1 directly observed treatment short course [Tab Isoniazid 300 mg, Tab Rifampicin 450 mg, Tab Ethambutol 800 mg, Tab Pyrazinamide 750 mg] from October 2021 to March 2022. At the end of March 2022, he developed multiple raised erythematous, to begin with later violaceous, hyperpigmented itchy plaques all over the body. The patient's skin biopsy was taken from the back area and sent for histopathological examination. He was diagnosed to have an isoniazid-induced lichenoid eruption reaction. His systemic examination revealed reduced chest movements on the right side and the trachea was shifted to the right side [trail sign was positive] and had bilateral rhonchi and crepitations present all over the chest area. The patient was immediately admitted and his anti-tubercular medications were withheld. He was treated with low-dose oral glucocorticoid (Tab Prednisolone), glycerine and olive oil lotion, Tab Desloratadine along with intravenous antibiotics, nebulization, bronchodilator, and other supportive treatment. Later patient's sputum examination was tested which came out to be negative for acid-fast bacilli and he was discharged with symptomatic treatment after a reduction in the intensity of erythema and itching and was asked to follow up each month.

Biomedical waste segregation compliance scoring system: to analyze, strengthen, monitor, and step up waste management in healthcare facilities

Girisha Pindi — 2024-04-08

Introduction: segregation of biomedical waste (BMW) is the foremost and prime step for effective BMW management. This study was taken up to assess the BMW segregation compliance in patient care areas using a checklist-based scoring system to analyze the segregation compliance and establish feedback-based training programs.

Methods: this study was conducted between January 2020 to December 2021 at a government tertiary care hospital in Hyderabad. The compliance was calculated by giving a score of one for each day, such that if there was no noncompliance (NC) the score was 100% for a given location at the end of the month. A score of minus one was given for each day a noncompliance was noted and transfigured into percentages. A score of 100% was considered good, and below 95% was considered an action point necessitating root cause analysis and training.

Results: the BMW segregation compliance scores of the hospital for the year 2020 (96.5%) were compared with 2021 scores (97.5%). The outpatient department (OPD) and ICU had the poorest compliance rate of 93.7% and 93.6% respectively, compared to wards (96.2%). The most common factors influencing NC in BMW segregation were the joining of new staff, relocation, or new establishment of wards. The most common segregation error was found in the yellow disposal bags pertaining to the disposal of personal protective equipment.

Conclusion: this easy and simple scoring system was established to improve the segregation compliance of BMW. End of each month an area wise compliance is easily made such that areas with low scores could be trained.

Total Lisfranc dislocation without associated fracture

Mohammed Hajjioui — 2024-04-08

Lisfranc dislocation is a serious injury that it is important to recognize early and start treatment promptly because failure to recognize and treat these will lead to midfoot arthritis, chronic pain, and functional instability. An 18-year-old man was brought to the emergency department after a foot trauma, causing pain, swelling, and deformity of the foot. The dorsum of the foot was swollen and deformed with excruciating pain. The mechanism was direct due to high-energy direct, blunt force applied by a heavy object to the dorsum of the foot. The posterior tibial pulse was felt normally. Clinical diagnosis of tarsometatarsal dislocation was evocated. Radiologic findings revealed tarsometatarsal dislocation without fractures. Under anesthesia spine, a closed reduction in the emergency was performed in the axis of the first metatarsal to dislodge its mortise base between the medial and lateral cuneiform with control under an image intensifier by pulling. Post-reduction X-rays confirmed reduction. The foot and ankle were immobilized for six weeks with a complete cast followed by rehabilitation and the functional result was good after a year of decline. In this case, we emphasize the importance of not missing out on the diagnosis and the importance of treating this lesion urgently to avoid complications.

Assessment of psychotropic medications prescribing pattern in Gebretsadik Shawo General Hospital, South West Ethiopia

Jafer Siraj — 2024-04-08

Introduction: due to the widespread prescription of antipsychotic medications, their usage is cumulative. Evidence on the trends of medication use in Ethiopia and other parts of the world is lacking. The scant information on prescription trends and medication usage suggests that drug use is generally not sensible in both industrialized and emerging nations. So, the aim of this study was to assess the psychotropic medications prescribing pattern in Gebretsadik Shawo General Hospital, South West Ethiopia.

Methods: from June 1^st to July 31^st, 2019, a cross-sectional study on prescriptions for psychiatric drugs was conducted at Gebretsadik Shawo General Hospital. Using systematic random sampling, prescription records were obtained from the pharmacy dispensing book. Version 21 of the statistical program for social science was used to code and analyze the data.

Results: the study included 355 prescription records containing psychotropic drugs in total. The bulk of those taking the psychotropic medication were aged 20 to 49. The most often administered classes of drugs remained antipsychotic, followed by tricyclic antidepressants, antiepileptics, anxiolytics/sedatives, anticholinergic and selective serotonin reuptake inhibitors. The most often ordered antipsychotic medication, which included 102 (23.18%) medications, was chlorpromazine. Tricyclic antidepressants, which included 56 medicines (12.73%) and 24 medications (5.45%), included amitriptyline and imipramine.

Conclusion: the results of this investigation showed that psychiatrists preferred traditional psychotropic medications, such as Antipsychotic tricyclic, antidepressants (TCAs) and phenothiazines, in high amounts possibly because these medications were readily available in this hospital and their prices suited patients' needs. Health care workers' interdisciplinary relationships and coherence would improve for the benefit of patients and services of higher quality.

Mental health and disability research in Ghana: a rapid review

Grace Mwangi — 2024-04-08

The objective of this rapid review was to explore the current evidence base for mental health and disability research in Ghana. The PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist was followed. Online databases were used to identify primary studies, systematic reviews, meta-analyses, rapid reviews, or guidelines published between 2010 and 2020. All relevant published (both peer-reviewed articles and grey literature) on mental health and/or disability research conducted in or on Ghana between 2010 and 2020 were included in this review. 4,791 articles were identified in the initial search. After the removal of duplicates, followed by title and abstract screening, 930 articles were selected for full-text review. An additional 8 articles identified from reference lists of included articles were also included in full-text review. After review, 375 articles were selected for inclusion; 234 (62%) were on mental health while the remaining 141 (38%) were on disability. There is an increasing trend in the absolute number of mental health and/or disability studies. Most of the mental health studies included in this review were either observational quantitative studies (n=132; 56%) or observational qualitative studies (n=79; 34%). There were very few interventional studies (n=6; 3%). A similar finding was noted for the disability studies. External funding accounted for 51% of mental health articles. Although there was a steady year-on-year increase in the absolute number of mental health and/or disability studies conducted between 2010 to 2020, there is a need for more intervention studies to evaluate what mental health and/or disability interventions work, for whom, and under what circumstances. These should include evaluations of the cost, benefits, effectiveness, and acceptability of various interventions for policy and planning. Further, there is a need for the Ministry of Health to prioritize research funding for mental health and disability and enhance technical and methodological capacity of researchers to conduct disability and mental health research in Ghana.

Attitudes, beliefs, and practices toward end-of-life care among physicians in sub-Saharan Africa

Noah Rosenberg — 2024-04-08

Introduction: as the opportunity to receive life-sustaining treatments expands in sub-Saharan Africa (SSA), so do potential ethical dilemmas. Little is known regarding the attitudes, beliefs, and practices of physicians in SSA regarding end-of-life care ethics.

Methods: we used validated survey items addressing physician end-of-life care views and added SSA-context specific items. We identified a convenience sample using the authors' existing African professional contacts and snowball recruitment. Participants were invited via email to an anonymous online survey.

Results: we contacted 78 physicians who practice critical care in Africa, and 68% (n=53) completed the survey. Of those, 66% were male, 55% age 36-45, 75% Christian. They were from Kenya (30%), Zambia (28%), Rwanda (25%), Botswana (11%), and other countries (6%). Most (75%) agreed that competent patients can refuse even life-saving care. Only 32% agreed that their hospital had clear policies regarding withdrawing and withholding care, 11% agreed that their country had legal precedent for end-of-life care, and 43% believed that doctors could face legal or financial consequences for allowing patients to die by forgoing treatment. Pain control at the end of life, even if it may hasten death was supported by 83%. However, 75% felt that clinicians undertreat pain due to fear of hastening death.

Conclusion: participants strongly supported patient autonomy and end-of-life pain control but expressed concern that inadequate policy and legal frameworks exist to guide care and that pain is undertreated. Humane and actionable end-of-life care frameworks are needed to guide decisions in SSA.

Sacro pit: a rare clinical image

Dharti Meshram — 2024-04-08

A pit or indentation in the coating of the lower back is known as a sacral dimple. Small and shallow sacral dimples are the norm. 1.8%-7.2% of newborns have a sacral dimple. If a dimple is evident, less than 0.5 cm in size, and has one midline lesion, it has allegedly been described as a typical benign lesion. A sacral dimple is not known to have any known causes. Treatment for spinal issues depends on what caused them in the first place. Sacral dimples are often not problematic. A sacral dimple may occasionally indicate an underlying spinal condition. These include tethered spinal cord and spina bifida. Despite some claims to the contrary and scant scientific investigation of dimples. Therefore, it is unknown which genes may contribute to dimples. Most sacral dimples are harmless and do not require any care. We here reported 6 months of infant female who came to paediatric OutPatient Department (OPD) with mother and known case of a congenital sacro pit in the skin on the lower back buttocks. Where is no any history of irritation, discharge, pain, passage of fluids or fever. Patient came for further management. Physical examination done and found that sacro pit. The patient is conscious. Call was noted to neurosurgeon and paediatric surgeon. Ultrasonographic (USG) and Magnetic Resonance Imaging (MRI) done noted that 3mm sacro pit. Treatment given in hospital Syp. Zincovit Syp. Vit D3. Patient general condition is good. No any other management given to child regarding sacro pit. Patient was discharged. Doctor Advice to patient family do regular follow-up if any issues occur regarding this. Patient is healthy.

A rare case of right renal ectopia with ureteral triplication in a 37-year-old male: a case report

Sejal Sanjeev Joshi — 2024-04-08

Ureteral triplication is one of the least encountered congenital malformations of the upper urinary tract. We report a case of a 37-year-old male patient with right renal ectopia with triplication of the ureter which was diagnosed via computed tomography (CT) urography. This is an intriguing example because, as we discovered after reviewing the literature, the presentation is distinctive.

Prevalence and correlates of Schistosoma haematobium infections among school going-children aged 5 to 17 years in Kawama, Ndola, Zambia

Chileshe Sandema — 2024-04-08

Introduction: schistosomiasis is a neglected tropical disease and remains a disease of public health concern. Despite its relative importance, paucity of information on schistosomiasis in urban settings such as Ndola remains. Here, we present findings on the prevalence and factors associated with Schistosoma haematobium (S. haematobium) infections among School-going children in the Kawama in Ndola district in Zambia, an urban area in the Copperbelt Province, Zambia.

Methods: we employed a cross-sectional study design among 354 school going-children between 5 and 17 years of age between November 2020 and February 2021. A Multivariate forward step-wise logistic regression model was used to determine the associations of risk factors. Adjusted odds ratios and 95% confidence intervals are reported.

Results: of the 354 school-going children included in the analysis, 13.3% had S. haematobium infection. Children who swam in the stream/dam were more likely to have S. haematobium infection as compared to those who did not (aOR 6.531, 95% CI: 2.90-14.69).

Conclusion: S. haematobium infection is endemic among school-going children in an urban setup of the Kawama area of Ndola City, Zambia. There is a need for targeted interventions to mitigate infections among this population.

Sebaceous horn: a rare clinical image

Rajiv Sonarkar — 2024-04-08

Sebaceous horn, also known as a cutaneous horn, is a relatively rare skin lesion that typically appears as a cone-shaped, hard, and keratinous growth on the skin's surface. While it can occur on various body parts, it most commonly appears on the face, ears, nose, and back of the hands. This image shows a sebaceous horn on the lateral aspect of the left thigh, a rare place to occur. The first step in diagnosing a sebaceous horn is a thorough clinical examination of by a clinician. They will visually be inspecting the lesion, noting its size, shape, colour, and texture. A detailed medical history from the patient may include information about the lesion's duration, any changes over time, and associated symptoms such as pain, itching, or bleeding. Dermoscopy can help identify specific features, such as vessels, scales, and other characteristics, that aid in diagnosing sebaceous horns and ruling out other conditions If there is uncertainty about the diagnosis or if the sebaceous horn is large, has irregular features, or shows any signs of malignancy, a biopsy may be recommended. Sebaceous horns can sometimes resemble other skin conditions or tumors, including actinic keratosis, squamous cell carcinoma, verruca vulgaris, or seborrheic keratosis. Therefore, it is important to consider these possibilities and use the diagnostic tools mentioned above to differentiate sebaceous horns from other lesions. Once the diagnosis is confirmed, the treatment plan can be developed. Treatment options for sebaceous horns may include surgical excision, cryotherapy, and laser therapy.

Digital health: a tool for mitigating health workforce brain drain in Africa

Oluwaseun Omolade Adekoya — 2024-04-08

Letter to the editors

Contribution of community-based organizations in the improvement of Joint United Nations Program on HIV and AIDS 90-90-90: case of the Yaoundé Central Hospital

Charles Kouanfack — 2024-04-08

Community-based organizations (CBOs) are one of the initiatives implemented in Cameroon to improve access to antiretroviral treatment and influence retention in treatment centers. Despite its importance in the decongestion of patients in health facilities, we do not have data to evaluate the overall impact of these organizations. We conducted a two-part observational study. The first part was a descriptive cross-sectional study, where we included patients screened and initiated on anti-retroviral treatment (ART) either by the approved Treatment center (ATC) of Yaoundé Central Hospital (YCH) or by any of our CBOs in 2020. Then, the second part was a retrospective cohort-type study including patients from the 2015 cohort followed up from 2018 to 2020 in order to assess viral load suppression. As regards the first “90”, 7,234 screening tests were performed by CBOs in 2020 out of the 28,302 screening tests registered at the YCH, giving a contribution of 25.6%. From the 7,234 screening tests performed by CBOs, 314 people had an HIV-positive result and 230 (73.34%) were linked to ART through CBOs. From the 28,302 screening tests performed at YCH, 1,089 people had an HIV-positive test, and only 354 (32.50%) were linked to ART, giving a significant difference in the link to ART (P-value < 0.00). Concerning the 3^rd ''90'', the viral load suppression rates were respectively in CBOs and at YCH of (95.12% vs 90.54%, RR= 0.51; P-value= 0.27 at 12 months); (95.96% vs 95.34%, relative risk (RR)= 0.85; P-value= 0.81 at 24 months); and (96.91% vs 94.15%, RR= 0.52; P-value = 0.24 at 36 months). In conclusion, we say that the follow-up of patients living with HIV in the community does not negatively affect the evolution of the disease as one might think.

Association synchrone de deux tumeurs pulmonaires primitives: à propos d´un cas clinique

Ahmed Id M´barek — 2024-04-08

Les tumeurs pulmonaires multiples primitives synchrones représentent une entité relativement rare avec une incidence en augmentation croissante ces dernières années grâce au développement des moyens de l´imagerie thoracique et des techniques de l´immunohistochimie. La deuxième lésion est considérée dans la plupart des cas comme une localisation secondaire ce qui explique en partie la baisse de l´incidence de cette entité. Nous rapportons l´observation d´un patient âgé de 74 ans présentant deux tumeurs pulmonaires primitives synchrones, un adénocarcinome et un carcinome épidermoïde. A travers cette observation clinique nous soulignons la difficulté du diagnostic des tumeurs synchrones et sur l´intérêt majeur des nouvelles modalités d´imagerie et de l´immunohistochimie pour la prise en charge optimale de ces tumeurs.

Acquired cystic kidney disease in patients on maintenance hemodialysis, prevalence and associated factors: a cross-sectional study

Denis Georges Teuwafeu — 2024-04-08

Introduction: Acquired Cystic Kidney Disease (ACKD) is a known complication in patients on maintenance hemodialysis, and it is associated with a high risk of malignant transformation. There is a paucity of data on ACKD in sub-Saharan Africa. Objectives: To determine the prevalence and factors associated with acquired cystic kidney disease in patients on maintenance hemodialysis.

Methods: patients on maintenance hemodialysis were screened for ACKD. Patients with hereditary cystic kidney disease were excluded. Renal ultrasounds were performed by two radiologists. Acquired Cystic Kidney Disease (ACKD) was defined as 3 or more bilateral renal cysts in a small or normal-sized kidney. Associated factors were determined using logistic regression. A p-value <0.05 was significant.

Results: a total of 158 participants were enrolled and 61.4% (97) were male. Their mean (SD) age was 45.8 (14.9) years. The median dialysis vintage was 33.5 [10.7-63.2] months. The mean (SD) length of the kidneys was 85.1 (17.5) mm on the left and 81.2 (17.1) mm on the right. The prevalence of ACKD was 31.6% (n=50). Septated cysts (4), calcification of the wall of the cysts (2), irregular thick calcified wall (1), septated cysts with calcification (1) and hemorrhagic cyst (1) cysts were also observed. Dialysis vintage > 36 months (OR 7.1, 95% CI: 3.3 - 15.5) and male sex (OR 2.6, 95% CI: 1.2-5.6) were independently associated with ACKD.

Conclusion: the prevalence of ACKD is high in a population of Cameroonians on maintenance. This result calls for the implementation of strategies to screen for the condition and its complications.

Monod´s sign in a rare case of aspergilloma

Souvik Sarkar — 2024-04-08

A fifty-year-old male came to the casualty with fever, chills, blood in cough, breathlessness, and right-sided chest pain for 2 months. He had a few episodes of hemoptysis approximately 5-10 ml per episode, of bright red colour. The patient was a chronic alcoholic and also had a history of tuberculosis 11 years back for which he took treatment of 6 months. On examination, he was thin built, febrile, had a pulse rate of 116 beats per minute, a blood pressure of 100/60 mmHg. On respiratory system examination a bronchial breath sound was heard in the right mammary region. A chest X-ray was done of the patient which showed fibro-bronchiectatic changes in the right upper zone. The patient also underwent high resolution computed tomography of the lungs which showed a round enhancing lesion with a surrounding air shadow seen in the superior basal segment of the right lower lobe measuring 2.5 cm x 1.6 cm in size which also changed in orientation with a change in position of the patient; Monod´s sign. Typical Monod´s sign along with air crescent sign. The patient´s serum IgE antibody for Aspergillus fumigatus was positive, and thus a diagnosis of fungal ball or aspergilloma was confirmed. The patient was started on oral Itraconazole, oral tranexamic acid which controlled the hemoptysis in a week's duration and was then referred to a thoracic surgeon for pneumonectomy.

Profil épidémio-clinique et séminal de l´homme consultant pour désir de procréation: état des lieux à Lubumbashi, en République Démocratique du Congo

Jean Jimmy Kalfando Mwamba — 2024-04-08

Introduction: A Lubumbashi tout comme dans les milieux huppés où les explorations de la fertilité sont bien futées, le spermogramme demeure l´analyse indispensable dans le diagnostic de l´infertilité masculine. Celle-ci est à l´origine de 40% d´infertilité du couple. Le spermogramme constitue la première étape dans l´identification des anomalies séminales. L´objectif de cette étude était de déterminer le profil épidémio-clinique et séminal de l´homme consultant pour désir de procréation à Lubumbashi.

Méthodes: il s´était agi d´une étude descriptive transversale avec un volet analytique. Nous avions reçu 202 sujets de différents cabinets de consultations de Lubumbashi et dont le spermogramme avait été réalisé au laboratoire des Cliniques Universitaires de Lubumbashi du 1^er août 2020 au 31 juillet 2021. Les paramètres spermatiques ont été étudiés et interprétés selon les normes de l´Organisation mondiale de la Santé (OMS) (2010) avec études des facteurs associés à leur perturbation. Les analyses bivariées et multivariées avaient été réalisées. Le seuil de signification statistique avait été fixé à p < 0,05.

Résultats: le profil épidémio-clinique des enquêtés était le suivant:la tranche d´âge la plus représentée était de 30 à 39 ans; l´infertilité était primaire dans 80,69% des cas; la durée du désir de paternité était de 2 ans au plus dans 44,55% des cas. Les anomalies spermatiques retrouvées étaient: l´oligozoospermie (40,09%), l´azoospermie (11,38%), l´asthénozoospermie (18,31%) et la tératozoospermie (10,39%). L´oligozoospermie était significativement associée à la varicocèle (ORa = 10,9 [3,0-39,5]; p < 0,0001), à l´infection génitale (ORa =2,7 [1,0-7,2]; p = 0,041) et à l´obésité (ORa = 2,6 [1,0-7,9]; p = 0,020) alors que l´azoospermie l´était à la cure de la hernie inguinale (ORa = 4,2 [1,0-17,2]; p = 0,049) et à la dénutrition (ORa =6,0 [1,2-29,7]; p = 0,027). L´asthénozoospermie était significativement associée à la tranche d´âge de 40 à 49 ans (ORa = 6,6 [1,2-37,4]; p = 0,034), au tabac (ORa =7,5 [2,77-21,0]; p = 0,000), à la dénutrition (ORa = 7,7 [1,0-61,9]; p = 0,045) et au surpoids (ORa =3,8 [1,3-11,5]; p = 0,019). La tératozoospermie était significativement associée au tabac (ORa = 5,6 [1,8-17,7]; p = 0,003) et au surpoids (ORa =5,3 [1,2-23,3]; p = 0,027).

Conclusion: plus de la moitié des enquêtés avaient sur les trois principaux paramètres de fertilité, au moins un qui était perturbé. La numération des spermatozoïdes était le paramètre le plus atteint. L´alcool, le tabac, l´infection génitale et la malnutrition étaient les facteurs de risque les plus fréquents des anomalies observées.

A twelve days´ male baby with clinodactyly: a rare clinical image

Sangita Nade — 2024-04-08

Clinodactyly is defined as a congenital curvature of a digit distal to the metacarpal phalangeal joint in the coronal plane. Curvatures with an angular deviation of fewer than 10 degrees can be seen as a normal physiologic variant. Clinodactyly is defined when the coronal angulation of the affected digit is greater than 10 degrees. The curvature arises due to the abnormal trapezoidal or triangular shape of one or more phalanges, which leads to malalignment of the associated interphalangeal joint. This abnormal shape leads to asymmetric longitudinal growth in a direction deviated from the normal longitudinal axis of the finger resulting in the visible curvature of the digit. The patient b/o Pooja Shinde Fch day of life 12 Referral from Rural Hospital, Digras I/V/O feeding difficulty. The baby was admitted to NICU private hospital after birth for a week cry /lscs/birth weight 3kg/ current weight 2.4 kg was on O₂ support for 3 days on intragastric feed since birth. On admission RBS-101 mg/dl, SPO₂-94 on room air, heart rate-160, high arch palate clinodactyly. Kept NBM with maintenance fluid with antibiotics. Mother has a history of PIH with 1 abortion (rupture of ectopic pregnancy).

Alcohol consumption and associated factors among undergraduate regular students in Wolaita Sodo University, Southern Ethiopia, 2021: a cross-sectional study

Getahun Boltana — 2024-04-08

Introduction: alcohol consumption is a major of public health problem in the worldwide. It has been linked to risk of nutritional related chronic diseases and one of the most common risks taking behaviors among young population in University students. Objectives: aimed to assess the prevalence of alcohol consumption and associated factors among undergraduate graduating regular students in Wolaita Sodo University.

Methods: a cross-sectional study design was conducted at Woliata Sodo University among undergraduate graduating regular students. Structured, self- administered questioner used to collect data by multistage sampling technique. Data were entered, cleaned and analyzed by using SPSS version 24. Multivariate logistic regression analysis used to decide variables with p<0.05) as statistically significant.

Results: four hundred and forty-six (446 (60.7%) of respondents consumes alcohol out of 735 respondents. The associated factors for of alcohol consumption were being female respondents AOR 0.34 95% CI: (0.21-.54), family history members consumes alcohol 4.8 times (AOR= 4.83, 95% CI: (2.68-8.70), who don´t know well about the effect of consuming alcohol were around 2.7 times (AOR= 2.71, 95% CI:( 1.67-4.50) being drunker friend were (AOR=0.03, 95% CI: 0.02-0.06), being chew “chat” use (AOR=0.45, 95% CI: (0.32-0.63), being smoking cigarettes use (AOR= 0.49, 95% CI: 0.29-0.88) were found to be significantly associated.

Conclusion: the prevalence of alcohol consumption was relatively high compared to previous study. Attention should be given to counseling and peer education training and Anti-psychoactive substance club and sensitization therapy that are designed to change students´ perceptions on alcohol consumption.

A sustainable solution to address the unmet need for specialist and general surgical services of children in under-resourced contexts

Diaaeldinn Yaseen Salman — 2024-04-08

A Hub and Spoke Model is a realistic option to fill the gap between children living in low and high-resource contexts in accessing dedicated surgical services. General surgeons in peripheral facilities may deal with less complex conditions after specific training. They should also be able to stabilise and properly refer major cases to a specialist tertiary Centre.

Giant stone in a urinary bladder diverticulum in a 69-year-old male: a case report

Syarif Syarif — 2024-04-08

The stone formation could occur due to urine stasis in the bladder diverticulum. However, the stones are usually smaller in size and can pass spontaneously. However, a giant stone inside vesical diverticulum is considered a rare entity. We report a 69-year-old male, with a two-year history of lower urinary tract symptoms along with a recurrence of urinary tract infection. An abdominal computed tomography scan revealed the presence of a giant bladder diverticulum and a large bladder stone. The patient underwent a transurethral bladder neck incision followed by diverticulectomy with stone extraction. The diverticulum size measures 6x4x3.8 cm and diverticulum stone size of 4x3x3 cm. Fortunately, the patient recovered well after the operation. In conclusion, giant stones inside large vesical diverticulum are a rare occurrence and should be considered in patients with lower urinary tract symptoms. Early diagnosis and optimal management of the obstruction are the principles to prevent long-term complications.

Operated case of adolescent idiopathic scoliosis at dorsal spine with recurrence of deformity: an unusual presentation

Hardik Rasiklal Patel — 2024-04-08

Adolescent idiopathic scoliosis is a coronal plane spinal deformity which most commonly presents in adolescent girls from ages 10 to 18 (A). Diagnosis is made with full-length standing posteroanterior (PA) and lateral spine radiographs. Treatment can be observation, bracing, or surgical management depending on the skeletal maturity of the patient, magnitude of deformity, and curve progression. In scoliosis cases, surgical intervention is typically considered when the curvature progresses to a certain degree or when it causes significant pain, respiratory problems, or other complications (B, C). The goal of scoliosis surgery is to correct the curvature and stabilize the spine. However, despite surgical intervention, there is a small risk of recurrence or progression of the deformity. Factors that may increase the risk of recurrence include inadequate surgical correction, incomplete fusion of the spinal segments, failure of implants or instrumentation, and continued growth of the spine in skeletally immature individuals. Here, we report a rare presentation of operated case of adolescent idiopathic scoliosis at dorsal spine with recurrence of deformity (D). Recurrence of deformity is very uncommon (<0.5 %). A 22-year-old female patient was brought to the orthopedics outpatient department (OPD) with complaints of pain and deformity in his upper back region since 5 years which were increasing over the period of time (E). On examination there, was a scar of previous surgery present over midline approximately 15 cm in length at dorso lumbar level, recurrence of deformity over right side convex curve and no neurodeficit present and power in bilateral upper limb and lower limb v/v.

Incomplete vascular ring of the aortic arch presenting with dysphagia in an adult: case report

Ndubueze Ezemba — 2024-04-08

Anomalies of the arterial branches of the arch of the aorta are rare, with the aberrant right subclavian artery being the most common of this anomaly. The majority of the anomalies are asymptomatic and often discovered as incidental findings. In the great majority of the symptomatic cases, the presentation may be either with breathlessness or dysphagia or both. This is in addition to the nature of the intrinsic arterial disease of the aberrant vessel, especially in adult patients; and unless borne in mind, the diagnosis is often missed leading to delays and wrong treatment. In this report we present a case of dysphagia in an adult male Nigerian initially diagnosed as œsophageal stricture from herbal potion ingestion but review of his imaging investigations gave a final diagnosis of dysphagia lusoria from an aberrant right subclavian artery. The difficulty in making a diagnosis and the need for a multidisciplinary review of the imaging investigations are highlighted. The patient was successfully treated by a combined trans-thoracic and cervical approach with division and re-implantation of the aberrant vessel unto the right common carotid artery. He has remained symptom-free for 2 years after surgery. Although the great majority of these anomalies are often asymptomatic, it is important they are borne in mind both in imaging investigations as well as in procedures involving structures in the upper visceral mediastinum. Various surgical approaches have been documented in the management of symptomatic ones; it is however recommended that options that ensure revascularization of the affected limb be selected.

Sociodemographic predictors of non-communicable diseases risk-related knowledge and behaviours: a cross-sectional study of in-school adolescents in a southern Nigerian State

Patrick Oyibo — 2024-04-08

Introduction: the adolescence period is a significant phase in development of non-communicable diseases. Public health interventions that reduce risky behaviors among adolescents are beneficial across the life course. This study assessed the level of non-communicable diseases (NCDs´) risk-related knowledge, the prevalence of NCDs´ risk behavior, and the sociodemographic predictors of NCDs´ risk-related knowledge and behaviors among in-school adolescents in a Southern Nigerian State.

Methods: a cross-sectional study design was employed to assess the NCDs´ risk-related knowledge and behaviors among a random multistage sample of 607 students age between 10 and 19 years. Data were collected using an interviewer-administered semi-structured questionnaire adapted from the WHO STEPS questionnaire. Descriptive and inferential analyses of data collected were carried out using the IBM SPSS version 22 software.

Results: the mean age of the students was 14.7 (SD=1.52) years, 57.2% (n=347) of which were females, and 42.8% (n=260) were males. The proportion of students with good overall NCDs risk-related knowledge was 22.7% (n=138). Age, place of residence, family's socioeconomic status, and mother's level of education were significant sociodemographic predictors of good overall NCD risk-related knowledge. Among the students, 66.2% (n=402) self-report inadequate physical activity, 65.7% (n=399) self-report consumption of unhealthy diets, 29.2% (n=177) self-report current alcohol use, and 3.3% (n=20) self-report they were current cigarette smokers.

Conclusion: a significant proportion of the surveyed students had poor overall NCDs risk-related knowledge and engaged in NCDs risk behaviors. The relevant stakeholders concern with prevention of NCDs in government and non-governmental organizations should target adolescents in NCD control strategies in the study setting.

Coping with hypertensive treatment at Bono Regional Hospital in Sunyani, Ghana: a prospective observational cohort study

Prince Owusu Adoma — 2024-04-08

Introduction: the stress associated with hypertension treatment makes using coping strategies inevitable. However, most patients with hypertension apply inefficient coping strategies, leading to uncontrolled blood pressure (BP). The study analyzed coping strategies associated with hypertension treatment and determined how these coping strategies predicted the current BP of patients with hypertension.

Methods: the study was a prospective observational cohort conducted between January and December, 2020. Consecutive sampling technique was used to enumerate 508 patients who consistently sought treatment at the healthcare facilities. A sphygmomanometer was used to measure BP to determine controlled and uncontrolled BP based on Ghana Health Service standards. A questionnaire was adapted from Coping Inventory for Stressful Situations-2 to measure patients' coping strategies. Descriptive statistics, cut off percentage and multiple linear regression were applied in analyzing the data at a 0.05 level of significance.

Results: females were two-thirds (74%) of the study population and the mean age was 58.40 ± 11.72. All patients with hypertension used the three coping strategies: emotion-oriented coping (EOC), task-oriented coping (TOC) and avoidance coping (AC). However, EOC was highly used (61.2%), followed by TOC (58.5%) and AC (46.2%). Also, the study found coping with treatment regimens to be relatively poor since it was only physical exercise (79.5%) that they effectively observed. The multiple linear regression results revealed that the three coping strategies were significant predictors of current BP levels [F (3, 117) = 12.390 at p < 0.001]. Thus, AC, TOC, and EOC explained 37.4% of the variability of current BP status (R2 adj=0.374). Specifically, patients who use TOC (66.3%) were more likely to have a controlled BP than those using EOC (53.7%) and AC (35.8%).

Conclusion: patients' coping strategies were inadequate for hypertension treatment since treatment regimens were poorly observed. Meanwhile, EOC is most likely to negatively affect a patient's treatment, leading to uncontrolled BP. Our study recommends the need to encourage patients to combine their EOC with TOC to enable them control their BP better.

A looming epidemic: combating the recurrent outbreaks of diphtheria in Nigeria

Olufemi Nicholas Olulaja — 2024-04-08

Nigeria has endured several diphtheria outbreaks over the last few decades, mirroring a suboptimal population immunity across several demographics within the country. The country's northern region has been affected mainly by this infectious disease; it directly depicts the effect of poor DPT vaccine uptake amongst children in this region compared to other geopolitical zones in Nigeria. Whilst pharmaceutical intervention and surveillance activities have commenced as directed by the NCDC, to combat this public health menace, top leaders of the Nigerian healthcare system - public and private sectors, must understudy the predisposing factors gearing the recurrence of diphtheria in Nigeria and provide robust, research-based and scientific mechanisms to arrest the root causes of the incessant outbreaks. This article discusses the factors promoting the recurrent diphtheria outbreaks in Nigeria, the preexisting interventions with their existential deterrents, and new strategies recommended to curb the further resurgence of the disease.

Parasitic etiology of diarrhea and associated factors among under-five-year children attending Mizan-Tepi University Teaching Hospital, Southwest Ethiopia

Teshale Worku — 2024-04-08

Introduction: globally, an estimated two billion cases of diarrhea occur every year, and an estimated 1.7 million children under the age of five years, mostly in developing countries die due to diarrheal cases. It is caused by different enteropathogens such as bacteria, viruses, and parasites. Diarrhea caused by parasitic etiology is common in under-five-year children in sub-Saharan Africa. The objective was to investigate the parasitic etiology of diarrhea among under-five-year children in Mizan-Tepi University Teaching Hospital, Southwest Ethiopia.

Methods: institution-based cross-sectional study was conducted from September to November 2021. A total of 300 under-five-year children presenting with diarrhea in Mizan-Tepi University Teaching Hospital were included in the study. Data used to assess associated factors for intestinal parasitic infections (IPIs) was collected using a structured questionnaire. Stool specimens were collected from the study participants for investigations of the parasitic etiology of diarrhea. The specimens were processed microscopically using direct wet mount and formol ether concentration techniques. Modified Ziehl-Neelsen staining of formol-ether concentrated specimens was also performed. Data was entered using Epi-Data version 4.6.0 and analyzed using Stata/SE version 14.0. Crude odds ratio and adjusted odds ratio were used to determine the association.

Results: from a total of 300 children who participated in this study, 68 (22.67%) were positive for at least one intestinal parasite. E. histolytica 23(7.67%) and G. lamblia 17(5.67%) were the predominant parasitic etiologies and 28(9.33%) were positive for intestinal helminthic parasites; 11(3.67%) Ascaris lumbricoides, 10(3.33%) Trichuris trichiura, 4(1.33%) Hymenolepsis nana, and 3(1%) were double infection with Trichuris trichuria and Ascaris lumbricoides. Multivariable analysis revealed the age group category 2-3 years of age children was more attributable to intestinal parasitic infections (AOR= 0.466, 95% CI: 0.204-0.976).

Conclusion: the overall prevalence of intestinal parasitic infections (IPIs) in this study was 22.67%. Diarrheal etiology of intestinal parasites among under five years of children identified in this study were significantly associated with maternal/ guardians´ educational status, (AOR=94.900, 95% CI: 24.664-365.155) use of unprotected water for drinking, (AOR =25.189, 95% CI: 4.671-135.847).

Unawareness of breast cancer family history among African women

Babatunde Adedokun — 2024-04-08

Introduction: comprehensive cancer risk assessment services are lacking in most sub-Saharan African countries and the use of accurate family history (FH) information could serve as a cheap strategy for risk evaluation. The aim of this study is to determine the proportion of women unaware of family history of cancer among female relatives and associated socio-demographic characteristics.

Methods: using case-control data on breast cancer among 4294 women in Nigeria, Uganda and Cameroon, we investigated the proportion of women unaware of family history of cancer among their female relatives. The association between participants ‘response to their awareness of female relatives’ cancer history and socio-demographic characteristics was analysed according to case-control status, family side and distance of relation.

Results: the proportion of women unaware if any relative had cancer was 33%, and was significantly higher among controls (43.2%) compared to 23.9% among cases (p<0.001) (Adjusted Odds Ratio (OR) = 2.51, 95% CI = 2.14 - 2.95). Age, education and marital status remained significantly associated with being unaware of FH among controls on multiple regression.

Conclusion: about a third of women interviewed did not know about cancer history in at least one of their female relatives. Efforts aimed at improving cancer awareness in sub-Saharan Africa (SSA) is needed. Our findings could be useful for future studies of cancer risk assessment in SSA.

Patient satisfaction with post-operative surgical services and associated factors at Addis Ababa City government tertiary hospitals´ surgical ward, cross-sectional study, 2022

Ermias Algawork Kibru — 2024-04-08

Introduction: patient satisfaction is an attitude resulting from a person's general orientation towards the total experience of health care. The study was done with the aim of evaluating post-operative patient satisfaction level with the quality of service provided at the surgical wards; determining how much factors related to physicians, nursing, laboratory, and information provision service influence satisfaction level; and determining factors impacting patient satisfaction level.

Methods: a hospital-based quantitative cross-sectional study design was conducted in six Addis Ababa City Government tertiary hospitals from November 4^th to December 13^th, 2022. Patients who had major operations done at the government hospitals from November 21^th to December 5^th, 2022, were included in the study population. A pre-tested, structured, and Amharic-version questionnaire was used to interview patients. A bivariate and multivariate logistic regression model was used to identify the variables that had an association with the dependent variable. P-values less than 0.05 were considered statistically significant.

Results: a total of 287 patients participated in the research, providing a response rate of 95%. Of the total participants, 144 were males (50.8%) and 143 were females (49.5%). The overall patient satisfaction level with surgical ward service is 96.2%. The level of patient satisfaction with nursing services is 94.8%, with physician's services it is 98.6%, with the facility it is 92.3%, and with the provision of information about post-operative complications it is 69.7%. Those who have above-first-degree educational status are less satisfied (66.7%) than patients with other levels of educational status. Only the patients' residency showed a small level association (r= 0.145, p=0.014) with overall patient satisfaction with surgical ward service among the demographic components. The two variables that are strongly correlated with patient satisfaction are the adequacy of the time ward nurses spent with patients during evaluation and treatment (r = 0.503, p = 0.000) and adequate nurses' response to patients' calls (r = 0.498, p = 0.000). Post-operative patient satisfaction with surgical ward nursing service, physician service, hospital facilities, and the provision of information about post-op complications explain about 40.9 percent of the variation in the overall patient satisfaction with post-op care provided at the surgical ward. Patient satisfaction with nursing service has more significant effect with overall patient satisfaction than the other variables (β = 0.266, p =0.0002).

Conclusion: post-operative patients at Addis Ababa City Government Tertiary Hospitals expressed a very high degree of satisfaction with the care they received in the surgical wards. The study also found that patients were generally less satisfied with the information they were given on drugs, side effects, and available treatment options. Another factor identified in the study that caused unhappiness was the unavailability of some pharmacy and laboratory services.

Evaluation of acute flaccid paralysis surveillance performance before and during the 2014-2015 Ebola virus disease outbreak in Guinea and Liberia

Grace Umutesi — 2024-04-08

Introduction: the number of wild poliomyelitis cases, worldwide, dropped from 350,000 cases in 1988 to 33 in 2018. Acute flaccid paralysis (AFP) surveillance is a key strategy toward achieving global polio eradication. The 2014 Ebola virus disease (EVD) epidemic in West Africa infected over 28,000 people and had devastating effects on health systems in Guinea, Liberia, and Sierra Leone. We sought to assess the effects of the 2014 Ebola outbreak on AFP surveillance in Guinea and Liberia.

Methods: a retrospective cross-sectional analysis was performed for Guinea and Liberia to evaluate EVD´s impact on World Health Organization (WHO) AFP surveillance performance indicators during 2012-2015.

Results: both Guinea and Liberia met the WHO target non-polio AFP incidence rate nationally, and generally sub-nationally, prior to the EVD outbreak; rates decreased substantially during the outbreak in seven of eight regions in Guinea and 11 of 15 counties in Liberia. Throughout the study period, both Guinea and Liberia attained appropriate overall targets nationally for “notification” and “stool adequacy” indicators, but each country experienced periods of poor regional/county-specific indicator performance.

Conclusion: these findings mirrored the negative effect of the Ebola outbreak on polio elimination activities in both countries and highlights the need to reinforce this surveillance system during times of crisis.

Universal test and treat in Cameroon: a comparative retrospective analysis of mortality and loss to follow-up before and after a strategic change in approach to HIV care

Cavin Epie Bekolo — 2024-04-08

Introduction: an increasing number of persons living with HIV (PLHIV) are accessing antiretroviral therapy (ART) since the adoption of the universal test and treat (UTT) policy by Cameroon in 2016. We sought to evaluate the effectiveness of the UTT approach to keep this growing number of PLHIV on a lifelong treatment.

Methods: a retrospective cohort analysis was conducted at the Nkongsamba Regional Hospital between 2002 and 2020, using routine data to compare the cumulative incidence of loss to follow-up (LTFU) and mortality between PLHIV initiated on ART under UTT guidelines and those initiated under the standard deferred approach. Chi-squared test was used to compare the risk of attrition between the guideline periods while multiple logistic regression modelling was used to adjust for confounders.

Results: of 1627 PLHIV included for analysis, 756 (46.47%) were enrolled during the era of UTT with 545 (33.54%) initiated on ART on the same day of HIV diagnosis. The transition to the UTT era was associated with an overall reduction in the risk of LTFU by 73% (aOR = 0.27, 95%CI: 0.17 - 0.45). There was modest evidence that the odds of mortality had increased under the UTT policy by about 3-fold (aOR = 2.86, 95%CI: 0.91-8.94). Same-day initiation had no overall effect on LTFU or mortality. LTFU was lower among the same-day initiators in the first 24 months but increased thereafter above the rate among late initiators.

Conclusion: overall ART programme implementation under the UTT has led to a significant decline in LTFU though mortality appeared to have increased. Ongoing efforts to keep patients on lo

Intra-uterine packing: an effective and affordable tool in the management of post-partum hemorrhage - cohort study

Ahmed Halouani — 2024-04-08

Introduction: postpartum hemorrhage is the main cause of maternal death worldwide. Uterine balloon packing has shown promising outcomes in PPH management. Nevertheless, its usage is limited in low- and middle-income countries due to associated costs. Uterine packing using gauzes presents a potentially efficient and cost-effective alternative. This study aims to assess the safety and efficacy of intra-uterine packing with gauzes in managing postpartum hemorrhage.

Methods: this was a retrospective study over a period of two years and six months. All patients who experienced PPH due to uterine atony during vaginal delivery, with no response to medical first-line treatment, were included. IUP using gauze was employed as a second-line intervention. The primary outcome was the success of postpartum hemorrhage management. Secondary outcomes included patient vitals, the need for blood transfusion, change in hemoglobin levels (delta Hemoglobin), and maternal morbidity (post-partum infection, Sheehan syndrome, and retained gauzes).

Results: the study included 63 patients. The mean age was 30.06 ± 5.6, the mean gravida was 2.65 ± 1.9 and the mean para was 2.12 ± 1.31. None of these patients experienced major complications following gauze insertion. Three patients underwent laparotomy and conservative surgical management was performed. Hysterectomy was not required for any participant, and no maternal deaths were recorded.

Conclusion: intra uterine packing is a valuable tool in managing postpartum hemorrhage due to uterine atony.

Laryngeal tuberculosis: about 04 cases

Abdelilah Mouhsine — 2024-04-08

The purpose of this study is to present epidemiological, clinical, radiological, histological characteristics and treatment of laryngeal tuberculosis. It is also aimed at making the point about diagnosis difficulties. This retrospective study was conducted over three years; it concerned 4 cases, 3 males and one female. The average age was 35 years. Three of the 4 cases have had a cervical CT scan. All patients have had a laryngoscopy with biopsy and anatomopathological study. The onset modes of the disease have been progressive for all the patients. Topographical study has shown two epiglottic locations, one at the vocal cords and the other one at the posterior commissure. The diagnosis was orientated in the 3 cases by the CT scan and confirmed by anatomopathological exam in all cases. All patients have received anti-TB drugs with good evolution. The laryngeal location of tuberculosis is unusual. The clinical picture is nonspecific, raising the issue of differential diagnosis with tumor pathology. Sectional imaging and CT scan can guide the diagnosis and a positive diagnosis is often discovered on the occasion of a tumor biopsy of a pseudo-tumor lesion. Treatment is based on anti-TB drugs.

Funnel chest (pectus excavatum): a rare clinical image

Minal Dambhare — 2024-04-08

Congenital chest wall abnormality called "pectus excavatum," or "funnel chest" is characterized by an inward dip of the sternum and surrounding ribs. In this condition, the breastbone is sunken inward, creating a concave or "funnel-like" appearance on the front of the chest. Pectus excavatum is the most congenital prevalent chest wall deformity, affecting one in 300-400 people. The condition is more prevalent in males and often becomes noticeable during early childhood or adolescence, although the precise cause of funnel chest is unknown, it is believed to involve a combination of genetic and environmental factors. The Nuss procedure is a widely accepted surgical technique for the correction of severe pectus excavatum. A 16-year-old male presented to our clinic with a noticeable depression in the center of his chest and complaints of exercise intolerance and shortness of breath. A physical examination is usually sufficient to diagnose funnel chest. The physical examination results showed a severe pectus excavatum with a Haller index of 4.5. Tests of pulmonary function revealed a pattern of restriction with decreased forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). In severe cases, imaging procedures like X-rays, computed tomography scans, or magnetic resonance imaging are utilized to assess the severity of the situation and determine any associated consequences on the heart and lungs. Certain exercises and physical therapy techniques can help improve posture, strengthen the chest muscles, and potentially minimize the appearance of pectus.