https://www.ajol.info/index.php/pamj/issue/feed Pan African Medical Journal 2022-04-19T13:44:00+00:00 Dr Raoul Kamadjeu raoul.kamadjeu@gmail.com Open Journal Systems <p>We publish original scientific studies, comments on currents health initiatives, project and work reports, personal experiences, reviews of current health initiatives, educational articles and paper commenting on clinical, social, political, economical and all other factors affecting health. We are particularly interested in receiving articles and comments reflecting the point of view and experience of professionals working in Africa related to the impact of currents public health initiatives on their daily routine. The Journal is available online here: <a href="http://www.panafrican-med-journal.com/" target="_blank">www.panafrican-med-journal.com/</a></p><p><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--> <!-- /* Font Definitions */ @font-face {font-family:Tahoma; panose-1:2 11 6 4 3 5 4 4 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:1627421319 -2147483648 8 0 66047 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0pt; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-GB;} span.apple-style-span {mso-style-name:apple-style-span;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 90.0pt 72.0pt 90.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> <!--[if gte mso 10]> <mce:style><! /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0pt 5.4pt 0pt 5.4pt; mso-para-margin:0pt; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} --> <!--[endif] --></p> https://www.ajol.info/index.php/pamj/article/view/208549 Colobome irien bilatéral 2021-06-11T07:15:15+00:00 Nouha Zerkaoui nouha.zerkaoui1003@gmail.com <p>Les colobomes oculaires congénitaux sont dus à un défaut de fermeture de la fissure fœtale lors de l'organogénèse. L'atteinte oculaire pouvant être variable allant d'une simple fente irienne à une atteinte plus sévère du pôle postérieur (colobome du nerf optique, de la choroïde, de la rétine). Nous allons rapporter le cas d'un colobome typique irien bilatéral isolé. Il s'agit d'une femme de 55 ans qui lors d'un examen ophtalmologique fit la découverte d'un colobome typique irien infero-nasal sans atteinte cristallinienne ni atteinte du pôle postérieur.</p> 2018-05-02T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208550 Zika Virus infection and microcephaly: anxiety burden for women 2021-06-11T07:19:26+00:00 Ikenna Desmond Ebuenyi i.d.ebuenyi@vu.nl Soumitra Sudip Bhuyan i.d.ebuenyi@vu.nl Luchuo Engelbert Bain i.d.ebuenyi@vu.nl <p>The re-emergence of Zika virus in Brazil and other contiguous countries is a source of anxiety for pregnant women on account of its association with microcephaly. Adverse pregnancy outcome has huge mental health implications. It is essential for health providers to incorporate psychosocial care as part of pre and postnatal care for women in all countries affected by the Zika virus infection.</p> 2018-05-03T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208552 Rhabdomyosarcome cranio-facial de l’adulte: un cas de mauvais pronostic 2021-06-11T07:26:33+00:00 Adil Arrob arrob.adil@gmail.com Mohammed Kamal Fiqhi arrob.adil@gmail.com Abibou N’diaye arrob.adil@gmail.com Karim El Khatib arrob.adil@gmail.com Abdeljalil Abouchadi arrob.adil@gmail.com <p>Le rhabdomyosarcome est la tumeur mésenchymateuse la plus fréquente chez l'enfant et l'adolescent. Il représente 60 à 70% des tumeurs mésenchymateuses et environ 5% de l'ensemble des tumeurs solides à ces âges. Près de la moitié des rhabdomyosarcomes surviennent au niveau de la tête et du cou. Nous rapportons le cas d'un rhabdomyosarcome agressif à localisation temporo-pariétale. Chez un jeune adolescent de 20 ans avec une forme histologique nouvelle.</p> 2018-05-03T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208553 Pied diabétique: aspects épidémiologique, diagnostique, thérapeutique et évolutif à la Clinique Médico-chirurgicale du CHU Sylvanus Olympio de Lomé 2021-06-11T07:32:57+00:00 Awalou Mohaman Djibril edemmossi@gmail.com Edem Komi Mossi edemmossi@gmail.com Agbeko Kodjo Djagadou edemmossi@gmail.com Abago Balaka edemmossi@gmail.com Toyi Tchamdja edemmossi@gmail.com Razak Moukaila edemmossi@gmail.com <p><strong>Introduction:&nbsp;</strong>le pied diabétique est une complication fréquente et grave du diabète. Le but de cette étude est de déterminer le profil épidémiologique, diagnostique, thérapeutique et évolutif du pied diabétique en milieu hospitalier à Lomé (Togo).</p> <p><strong>Méthodes:&nbsp;</strong>étude rétrospective descriptive réalisée du 1<sup>er</sup>&nbsp;janvier 2011 au 31 décembre 2015 (5 ans) à la clinique médico-chirurgicale du CHU Sylvanus Olympio de Lomé. Etaient inclus dans l'étude, toute patiente hospitalisée pendant la période d'étude pour pied diabétique.</p> <p><strong>Résultats:&nbsp;</strong>la prévalence du pied diabétique était de 12,90%. L'âge moyen était de 60,74 ans (extrêmes: 39 ans et 86 ans). Le sexe masculin prédominait avec un sexe ratio de 1,38. Le diabète de type 2 était retrouvé chez 88,70% des patients. La durée moyenne d'évolution du diabète était de 11,67 ans (extrême: 1 an et 24 ans). Le point de départ des lésions du pied était un traumatisme générant une plaie surinfectée dans 70,97 % des cas. La gangrène (61,29%) et la nécrose ischémique (12,90%) étaient les principales lésions retrouvées. Le principal facteur étiopathogénique retrouvé était la neuropathie (61,29). La majorité des lésions (61,29%) était classée grade 4 et 5 de Wagner et 51,62% des patients avait bénéficié d'une amputation du membre pelvien.</p> <p><strong>Conclusion:&nbsp;</strong>les lésions du pied sont fréquentes chez les patients diabétiques à Lomé. La lutte contre ce fléau passe par l'éducation des patients et du personnel soignant et par une prise en charge multidisciplinaire et concertée.</p> 2018-05-03T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208554 Cholera outbreak in a naïve rural community in Northern Nigeria: the importance of hand washing with soap, September 2010 2021-06-11T07:52:29+00:00 Saheed Gidado gsosuccess@yahoo.com Emmanuel Awosanya gsosuccess@yahoo.com Suleiman Haladu gsosuccess@yahoo.com Halimatu Bolatito Ayanleke gsosuccess@yahoo.com Suleman Idris gsosuccess@yahoo.com Ismaila Mamuda gsosuccess@yahoo.com Abdulaziz Mohammed gsosuccess@yahoo.com Charles Akataobi Michael gsosuccess@yahoo.com Ndadilnasiya Endie Waziri gsosuccess@yahoo.com Patrick Nguku gsosuccess@yahoo.com <p><strong>Introduction:&nbsp;</strong>cholera outbreaks in rural communities are associated with high morbidity and mortality. Effective interventions to control these outbreaks require identification of source and risk factors for infection. In September, 2010 we investigated a cholera outbreak in Bashuri, a cholera naïve rural community in northern Nigeria to identify the risk factors and institute control measures.</p> <p><strong>Methods:&nbsp;</strong>we conducted an unmatched case-control study. We defined a case as any resident of Bashuri community two years and above with acute watery diarrhea with or without vomiting and a control as any resident two years and above without acute watery diarrhea and vomiting. We recruited 80 hospital-based cases and 80 neighborhood controls. We collected and analyzed data on demographic characteristics, clinical information and risk factors. Laboratory analysis was performed on 10 stool samples and 14 open-well samples.</p> <p><strong>Results:&nbsp;</strong>mean age was 29 years (± 20 years) for cases and 32 years (± 16 years) for controls; 38 (47.5%) of cases and 60 (75%) of controls were males. Compared to controls, cases were less likely to have washed hands with soap before eating (age-adjusted odds ratio (AAOR) = 0.27, 95% confidence interval (CI): 0.10-0.72) and less likely to have washed hands with soap after using the toilet (AAOR = 0.34, 95% CI: 0.15-0.75). Vibrio cholerae O1 was isolated from six stool samples but not from any open-well samples.</p> <p><strong>Conclusion:&nbsp;</strong>unhygienic hand washing practices was the key risk factor in this outbreak. We educated the community on personal hygiene focusing on the importance of hand washing with soap.</p> 2018-05-04T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208556 Familial adenomatous polyposis syndrome with colorectal cancer in two Nigerians: a report of two cases and review of literature 2021-06-11T08:03:46+00:00 Matthew Olumuyiwa Bojuwoye bojuwoyem26@yahoo.com Abdulfatai Bamidele Olokoba bojuwoyem26@yahoo.com Olumuyiwa Ayotunde Ogunlaja bojuwoyem26@yahoo.com Sulaiman Olayide Agodirin bojuwoyem26@yahoo.com Olatunde Kazeem Ibrahim bojuwoyem26@yahoo.com Kenechukwu Chukwuemeka Okonkwo bojuwoyem26@yahoo.com Aminu Mansa Aliyu bojuwoyem26@yahoo.com <p>Familial adenomatous polyposis syndrome is a rare condition characterized by the presence of numerous adenomatous polyps in the gastrointestinal tract and associated with risk for colorectal cancer. The disease is scarcely reported in Nigeria and this is the index report in Ilorin. Two cases were clinically diagnosed in our facility. They both presented with gastrointestinal bleeding and numerous rectal and colonic polyps were identified at colonoscopy. Histological examination of the polyps in the both cases revealed features in keeping with adenomatous polyps. This report highlights the occurrence of this precancerous condition.</p> 2018-05-04T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208558 Métastases génitales du cancer du sein: étude de 3 cas et revue de la littérature 2021-06-11T08:10:46+00:00 Olfa Zoukar amira.krir@outlook.com Anis Haddad amira.krir@outlook.com Amira Daldoul amira.krir@outlook.com Sonia Zaied amira.krir@outlook.com Amina Ben Salem amira.krir@outlook.com Ines Zouari amira.krir@outlook.com Raja Faleh amira.krir@outlook.com <p>Le cancer du sein est le cancer le plus fréquent chez la femme, et son pronostic dépend en grande partie de l'existence de métastases. Le foie, le squelette et les poumons en sont les sites les plus fréquents, alors que les métastases génitales semblent plus rares et moins connues. La découverte d'une masse ovarienne chez une femme présentant un antécédent de cancer du sein pose le problème de son origine primitive ou secondaire. La fréquence rapportée dans la littérature des métastases ovariennes est d'environ 20 à 30 %. Cependant, lorsque l'on découvre une masse ovarienne chez une femme atteinte de cancer du sein, il s'agit trois fois plus souvent d'une tumeur ovarienne primitive que d'une métastase. La localisation utérine cervicale ou corporéale est encore plus rare. Leur diagnostic est souvent tardif, en raison de leur latence clinique; l'échographie, notamment par voie endovaginale et couplée au Doppler couleur, et le Frottis cervico-utérin doivent être réalisés de première intention sachant que leur rendement pour leur dépistage des masses ovariennes semble très faible. L'augmentation des marqueurs tumoraux CA 15-3 et ACE doit conduire à la recherche de métastases, mais ne fournit pas d'orientation diagnostique vers un site métastatique précis. Enfin, c'est l'examen anatomopathologique qui permettra de poser le diagnostic avec certitude. Les auteurs rapportent 3 observations de métastases génitales de cancer primitif mammaire (deux ovariennes et une cervicale utérine) soulignent l'intérêt de l'examen génital précis et régulier dans la surveillance des cancers du sein et discutent les facteurs prédictifs de leur survenue.</p> 2018-05-04T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208560 Primary squamous cell carcinoma of endometrium: case report and literature review 2021-06-11T08:19:44+00:00 Fatima Zahra Farhane farhanefatimazahraa@gmail.com Zineb Alami farhanefatimazahraa@gmail.com Touria Bouhafa farhanefatimazahraa@gmail.com Abderrahmane Elmazghi farhanefatimazahraa@gmail.com Khalid Hassouni farhanefatimazahraa@gmail.com <p>In this paper, we report a case of primary squamous cell carcinoma of the endometrium (PSCCE) with a literature review. A 64-year-old woman, was admitted because postmenopausal bleeding. The gynecological exam found bleeding from the endocervix. The pelvic ultrasound objectified uterine regular contours, endometrial thickened was 10 mm, the presence of an intra cavitary lesion mesuring 56/70 mm. The diagnostic hysteroscopy revealed a whitish appearance taking all the uterine cavity making evoke a tumor of the endometrium. Pelvic MRI showed a tumor limited to the uterine corpus endometrium (invasion by more than 50% of the myometrium) without invasion of the cervix. Radical hysterectomy, bilateral salpingo-oophorectomy, and lymph nodes dissection were performed. Grossly, the endometrial carcinoma was polypoid tumor occupying the entire uterine cavity. Histologically, the diagnosis of SCC was retained. No adenocarcinoma element was recognized. Neither squamous metaplasia nor dysplasia was recognized. No ectopic cervical tissue was found. The SCC was found to invade into deeper one half of the myometrium. No tumor cells were seen in other sites including the cervix, ovaries, parametres, and lymph nodes. The patients was FIGO 2009 stage IB (pT1B, N0), and was treated with adjuvant radiation. The patient had a disease progression in the pelvis 3 months after the irradiation. We reported a case of PSCCE which can help to enrich the literature for the treatment and prognosis of this disease.</p> 2018-05-04T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208563 X-linked vitamin D-resistant rickets: 12 years of follow-up 2021-06-11T08:34:25+00:00 Ahmed Anas Guerboub docteur.guerboub@gmail.com Souad Moussaoui docteur.guerboub@gmail.com Jad Issouani docteur.guerboub@gmail.com Yassine Errahali docteur.guerboub@gmail.com Ghizlaine Belmejdoub docteur.guerboub@gmail.com <p>Rickets are abnormalities of mineralization that can lead to bone fractures and deformities. Vitamin-resistant rickets is defined as any rickets not prevented by regular, early and prolonged administration of vitamin D and not cured by a sufficient total dose. The aim of our work is to describe the clinical, paraclinical and therapeutic aspects of X-linked hypophosphatemic rickets (XLHR), which is the most common cause of hereditary rickets and on the other hand to highlight the interest not only of the early care but also the regular long-term monitoring of these children.</p> 2018-05-04T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208566 ’Malignant’ hypertension from hyperaldosteronism: a case report 2021-06-11T08:38:33+00:00 Krishna Mohan Baradhi Krishna-Baradhi@ouhsc.edu Thao Tran Krishna-Baradhi@ouhsc.edu Penchala Swamy Mittadodla Krishna-Baradhi@ouhsc.edu <p>Adrenocortical carcinomas (ACC) are rare with an incidence of 0.7-2 per million population per year and account for only 0.05%-2% of all malignant tumors. While majority of the functional ACC present as Cushing syndrome, recurrent hyperaldosteronism from metastatic ACC is exceedingly rare. We describe a 67-year old female presented with hypertensive urgency &amp; hypokalemia as a result of hyperaldosteronism from an 8-cm right ACC. She underwent a radical right nephrectomy with adrenalectomy that normalized her blood pressure. However, a few years later she presented again with resistant hypertension from hyperaldosteronism, raising the suspicion of recurrence of ACC. A contrast-enhanced CT scan showed a normal left adrenal gland but revealed pulmonary metastases of ACC based on a lung biopsy. Chemotherapy was complicated with side effects leading to refusal of further chemotherapy, henceforth requiring high dose of spironolactone for blood pressure control. Despite curative surgery, metastatic functional ACC should be considered in patients presenting with secondary hypertension from recurrent hyperaldosteronism, due to its high recurrence rate. Besides standard cancer surveillance after a curative surgery, meticulous monitoring of blood pressure is a simple yet crucial way to detect cancer recurrence early.</p> 2018-05-04T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208568 Particular shape of the tongue and benign migratory glossitis 2021-06-11T08:50:44+00:00 Cinzia Casu ginzia.85@hotmail.it Luca Viganò ginzia.85@hotmail.it <p>A 33-year-old male patient comes to our observation for a slight discomfort in the left side of the tongue. The patient reported good general health and that he have sometimes taken benzodiazepine in periods of stress. The dental abrasion showed the presence of bruxism. On an objective examination we could notice the simultaneous presence of a "toothed tongue" and a slightly area of erosion on the left side of the dorsal tongue, with an irregular white halo around it. This lesion, appeared from some days, is symptomatic. The diagnosis is compatible for benign migratory glossitis. The patient claimed to have never suffered of skin diseases strongly related to migratory glossitis. It is possible that the bruxism may have determined the presence of that lateral tongue shape and that stress may be the main cause of the appearance of migratory glossitis. The simultaneous presence of the two conditions has never been documented in the scientific literature and we do not exclude that there may be a correlation to the genesis of both lesions. Sometimes the presence of a tongue with this morphology could be the result of a trauma or a surgery. The lingual erosion can be placed in differential diagnosis with a heat burn or a chemical burn.</p> 2018-05-07T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208570 Kératoacanthome de l’avant-bras gauche 2021-06-11T08:57:54+00:00 Youssef Zemmez zemmez.youssef@gmail.com Naoufal Hjira zemmez.youssef@gmail.com <p>Une femme âgée de 54 ans ayant consulté pour une tuméfaction de l'avant-bras gauche apparaissant huit semaines auparavant et augmentant rapidement de volume. L'examen clinique retrouvait une lésion cutanée ulcéro-bourgeonnante de 2cm de grand axe, indolore et de couleur violacée (A). Une simple biopsie a été réalisée. L'examen histologique avait montré un épithélium hyperplasique dyskératosique et désorganisé avec présence d'atypies cytonucléaires évoquant un processus tumoral malin mais vu l'absence d'infiltration du chorion et la présence d'une hyperkératose, le diagnostic d'un kératoacanthome a été soulevé et la réalisation d'une exérèse de la tumeur a été indiquée pour confirmer ou infirmer ce diagnostic. L'étude histologique révélait une lésion tumorale saillante de nature épithéliale circonscrite par deux espèces de becs latéraux limitant un cratère surmonté d'importantes strates de kératine. L'épithélium bordant ce cratère est hyperplasique. La base du cratère comporte des projections papillomateuse inégales ainsi que quelques travées cellulaires qui semblent effilocher dans le derme sous-jacent. Celles-ci sont composées de cellules basophiles montrant un certain degré d'anomalies cytonucléaires disposées en une ou deux assises périphériques et en leur centre de cellules éosinophiles, kératinisées, d'aspect homogène, quelques mitoses ainsi que de nombreux globes cornés le plus souvent complètement kératinisés (B). Le diagnostic de keratoacanthome a été retenu. Le kératoacanthome est une entité anatomo-clinique bien définie, mais qui peut être très difficile à distinguer du carcinome épidermoïde, dont l'incidence est trois fois supérieure. La distinction entre ces deux lésions est nécessaire car la prise en charge est différente.</p> 2018-05-08T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208571 Les tumeurs du grêle: à propos de 27 cas 2021-06-11T09:05:46+00:00 Ihsane Mellouki melloukiihsane@yahoo.fr Khaoula Jellali melloukiihsane@yahoo.fr Adil Ibrahimi melloukiihsane@yahoo.fr <p>Les tumeurs gréliques représentent 5% de l'ensemble des tumeurs du tractus digestif. Leur pronostic reste sombre vu le retard diagnostic dû au manque de spécificité des manifestations cliniques et à la difficulté d'exploration bien que d'important progrès ont été fait sur le plan radiologique et endoscopique. Le but de ce travail est de préciser les aspects endoscopiques et histologiques des tumeurs gréliques. Il s’agit d’une étude rétrospective descriptive menée au Service d'Hépato-gastro-entérologie du CHU Hassan II de Fès sur une période de 11 ans (2002-2012). Nous avons analysé les aspects épidémiologiques, cliniques, endoscopiques et histologiques. 27 cas avaient été colligés. L'âge moyen était de 48 ans [21-80ans] avec une prédominance masculine (H/F: 2,4). La tumeur avait été révélée par des mélénas chez 55%, une masse abdominale chez 15% et un syndrome de Koenig ou syndrome occlusif chez 11%. Un antécédent de maladie cœliaque avait été retrouvé dans un cas. L’entéroscanner avait pu préciser le siège de la tumeur chez 18 cas. L’entéroscopie poussée pour les tumeurs proximales et l’entéroscopie double ballonnets pour les tumeurs à localisation distale avaient été réalisées chez 8 patients (30%), l'aspect endoscopique avait révélé une lésion ulcérée chez 37,5%, ulcérée sténosante chez 50% et ulcéro-bourgeonnante sténosante chez 25%. Dans 18 cas, c’est la chirurgie avec étude anatomopathologique de la pièce opératoire qui avait permis de poser le diagnostic. Le type histologique été dominé par les tumeurs stromales 14 cas (51%), suivi des adénocarcinomes 5 cas (18,5%), 4 cas (15%) de LMNH de type B, un cas de carcinome neuroendocrine jéjunal. Les tumeurs gréliques sont rares mais de pronostic sombre, les méthodes actuelles d'imageries (Entéroscanner et Entéro IRM) couplées aux examens endoscopiques, précisément l’entéroscopie double ballonnet, devraient permettre un diagnostic plus précoce et une diminution de la mortalité.</p> 2018-05-08T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208573 A child with fever, cough and Lancisi’s sign 2021-06-11T09:09:20+00:00 Antoine Lamblin antoine.lamblin@hotmail.fr Clément Derkenne antoine.lamblin@hotmail.fr <p>An 8-year-old boy from a rural town in Chad was referred to the emergency department following a one-month history of fever, otitis media and left thigh osteoarthritis. Venous jugular examination showed prominent systolic pulsations, also called Lancisi's sign. A chest X-ray (A) showed a right pneumothorax, which was immediately drained, before incision and drainage of the left distal thigh osteoarthritis. A CT-scan showed multiple pulmonary abcesses (B). After transthoracic echocardiography (M-TurboTM, Sonosite® Inc, Bothwell, WA, USA), large vegetations were seen on the tricuspid valve (C) and right ventricular systolic pressure was elevated. There was severe tricuspid regurgitation. Microbiological analysis found methicillin-sensitive Staphylococcus aureus in blood cultures and bacteriological samples from the thigh. This case demonstrates a presentation of right-sided endocarditis with septic pulmonary emboli (SPE) responsible for a right pneumothorax. Prominent systolic pulsations of the jugular veins, or Lancisi's sign, are a manifestation of severe tricuspid regurgitation. They result from a retrograde blood flow in the right atrium due to tricuspid incompetence during systole. Pneumothorax, secondary to SPE, is rare and Staphylococci are the infectious pathogens in all reported cases of secondary pneumothorax due to SPE, characterized by pulmonary inflammation with peripheral necrosis and multiple small cavities which involves the pleura; it may progress into the subpleural tissues or fistulize in situ. In this case, targeted antibacterial therapy was initiated until day 42. A rapid clinical improvement was observed. A follow-up transthoracic echocardiograph was performed at 3 months and revealed a reduction in vegetative growth and mild tricuspid regurgitation sequela.</p> 2018-05-08T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208574 Une tumeur de la valve mitrale 2021-06-11T09:13:30+00:00 Chahdi Hafsa h_chahdi@hotmail.com Damiri Amal h_chahdi@hotmail.com Oukabli Mohamed h_chahdi@hotmail.com Abderrahman Al Bouzidi h_chahdi@hotmail.com <p>Le fibroélastome papillaire est une tumeur cardiaque primitive bénigne rare pouvant entraîner des complications emboliques sévères. Nous rapportons un cas chez un homme de 69 ans. C’est dans le cadre du bilan étiologique d’une dyspnée que l’échocardiographie transthoracique a montré une masse sessile sur la petite valve mitrale. Cette masse a été excisée chirurgicalement et analysée histologiquement. Le diagnostic de fibroélastome papillaire était alors confirmé.</p> 2018-05-08T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208576 Erucism due to cup moth 2021-06-11T09:21:09+00:00 Andreia de Oliveira Alves f9filho@gmail.com Fred Bernardes Filho f9filho@gmail.com <p>A 12-year-old girl was assessed because of a 1-hour history of severe pruritus after contact with a cup moth (A). She has past history of anaphylactic shock to bee sting two years ago. The patient was sitting next to a mango tree and inadvertently put her left arm over a caterpillar. Physical examination revealed an erythematous infiltrated plaque with moderate swelling and an urticarial eruption with some excoriations on left upper limb (B, C); patient had a pulse rate of 78/min, blood pressure of 108/64 mmHg and respiratory rate of 15/min. The patient received prednisone 40 mg/day and loratadine 10mg/day for 5 and 10 days, respectively. Two weeks after the accident, on the final follow-up visit, the patient showed no late effects. Erucism, also called caterpillar dermatitis, is caused by envenomation by the larval or pupal stages of moths or butterflies. Caterpillars transmit their venom through urticating hairs, spines, or setae distributed over their bodies. Rash is the most common clinical manifestation and can range from a mild itching to a very painful sting. The lesions are provoked by caterpillar bristles filled with toxins that penetrate the skin. The bristles are hollow and when they enter the skin and break, toxins that contain thermolabile proteins, proteolytic enzymes and histamine are released. Treatment is supportive and includes washing the site with soap and water, applying cold water compresses, and administering topical or oral antihistamines or corticosteroids.</p> 2018-05-08T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208578 Effects of phloroglucinol on the active phase of labour (EPAL trial): a single blinded randomised controlled trial in a tertiary hospital in sub-Sahara Africa 2021-06-11T09:35:18+00:00 Charlotte Nguefack Tchente cnguefack2007@yahoo.fr Theophile Njamen Nana cnguefack2007@yahoo.fr Paul Nkemtendong Tolefac cnguefack2007@yahoo.fr Martin Hongieh Abanda cnguefack2007@yahoo.fr Francky Teddy Endomba Angong cnguefack2007@yahoo.fr Rita Frinue Tamambang cnguefack2007@yahoo.fr Gabin Ulrich Kenfack cnguefack2007@yahoo.fr Georges Nkwelle Mangala cnguefack2007@yahoo.fr Sagir Muhammad cnguefack2007@yahoo.fr Marie Solange Doualla cnguefack2007@yahoo.fr Eugene Priso Belley cnguefack2007@yahoo.fr <p><strong>Introduction:&nbsp;</strong>one of the most recognized factors of maternal and neonatal outcome pertaining to the peripartum period is the duration of labour. Finding a drug that will decrease the duration of labour with no effects on mother and foetus will be welcomed. Thereby in this study we aimed to evaluate the effects of phloroglucinol on the duration of the active phase of labour.</p> <p><strong>Methods:&nbsp;</strong>we did a single blinded placebo controlled randomised 1:1 parallel designed superiority trial between January and June 2017 in Douala general hospital. Participants greater than 18 years with singleton uncomplicated pregnancy who consented following randomisation, were administered either 80mg/8ml intravenous phloroglucinol or 8ml of sterile water when in active labour. The primary outcome was the duration of labour. Modified intention to treat analysis was done with the level of significance set at a p value of 0.05.</p> <p><strong>Results:&nbsp;</strong>122 participants received the intervention. The mean total duration labour in the treatment and placebo group were 216.8 ± 38.7 and 358.5 ± 65.8 respectively (p value = 0.243). The mean duration of the active phase of labour in the treatment and placebo group were 183.0±35.6 and 316.0±52.2 respectively (p value = 0.046). The mean rate of cervical dilatation in the treatment and placebo group were 2.1 ± 0.4 and 1.3 ± 0.4 respectively (p value = 0.322). There was no difference in maternal and foetal outcomes between the two groups.</p> <p><strong>Conclusion:&nbsp;</strong>phloroglucinol shortens the duration of active phase of labour by about 2 hours (42%). It is safe to mother and baby and does not cause adverse foetal or maternal outcomes.</p> 2018-05-09T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208581 Infection et descellement d’une prothèse totale de la hanche par listeria monocytogenes 2021-06-11T09:41:54+00:00 Abdelhafid El Marfi hafid_elmarfi@hotmail.fr Abdelghani Elayoubi hafid_elmarfi@hotmail.fr Mohamed El Idrissi hafid_elmarfi@hotmail.fr Mohamed Shimi hafid_elmarfi@hotmail.fr Abdelhalim El Ibrahimi hafid_elmarfi@hotmail.fr Abdelmajid Elmrini hafid_elmarfi@hotmail.fr Hassan Fokiladeh hafid_elmarfi@hotmail.fr <p>Le recours aux prothèses articulaires est de plus en plus fréquent dans notre pratique courante. Une des complications les plus redoutées est l’infection, le plus souvent due à des germes de la flore cutanée. Listeria monocytogenes étant rarement à l’origine d’une telle infection, nous rapportons le cas d’un patient porteur d’une prothèse de hanche infectée par ce germe: l’évolution a été favorable après antibiothérapie et changement de prothèse en un seul temps.</p> 2018-05-09T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208584 Le léiomyosarcome de la vessie: à propos de 3 cas 2021-06-11T09:54:11+00:00 Kadouri Youssef youcef.kadouri@gmail.com Ousmane Nago Dembele youcef.kadouri@gmail.com Ziani Idriss youcef.kadouri@gmail.com Hachem Elsayegh youcef.kadouri@gmail.com Ali Iken youcef.kadouri@gmail.com Lounis Benslimane youcef.kadouri@gmail.com Yassine Nouini youcef.kadouri@gmail.com <p>Le léiomyosarcome de la vessie est une tumeur rare hautement maligne. Il survient aussi bien chez l'enfant que chez l'adulte avec une incidence maximale au-delà de 60 ans. Il semble atteindre préférentiellement le sexe masculin avec un sexe ratio 3/1. Sa présentation clinique est non spécifique et dominée par l'hématurie. La résection endoscopique de la vessie avec un examen anathomopathologique permet de poser le diagnostic. Le traitement du léiomyosarcome de la vessie reste sujet à de nombreuses controverses du fait de la rareté des cas rapportés dans la littérature. Cependant le traitement de choix semble être une cystectomie totale précédée d'une chimiothérapie néo-adjuvante lorsque l'état général du patient le permet. Nous rapportons une série de 3 cas de léiomyosarcome vésical qui ont été traités tous par une cystectomie totale avec des suites opératoires simple.</p> 2018-05-09T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208585 Le lymphome malin Hodgkinien au cours de la grossesse; quelle modalité thérapeutique: à propos d’un cas et une revue de la littérature 2021-06-11T10:03:18+00:00 Zenab Alami zenabalami@gmail.com Touria Bouhafa zenabalami@gmail.com Abderrahmane Elmazghi zenabalami@gmail.com Khalid Hassouni zenabalami@gmail.com <p>Bien que le lymphome malin Hodgkinien ou (maladie de Hodgkin) ne représente que 10% de tous les lymphomes, c'est l'un des sous-types de lymphomes les plus communs diagnostiqués pendant la grossesse, en grande partie à cause de l'incidence maximale de la maladie qui coïncide avec l'âge de reproduction. La prise en charge d'une patiente enceinte atteinte d'une maladie de Hodgkin nécessite une approche multidisciplinaire, ainsi qu'une communication efficace avec le patient et sa famille. L'objectif est d'optimiser les chances de guérison de la mère tout en permettant l'accouchement d'un enfant en bonne santé. Nous rapportant un cas rare d'une patiente enceinte diagnostiquée pour une maladie de Hodgkin à 17 semaines d'aménorrhée.</p> 2018-05-09T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208691 Particularités radiologiques de la tuberculose pulmonaire à microscopie positive au Service de Pneumologie du Centre Hospitalier National Universitaire de FANN (CHNUF), Dakar (Sénégal) 2021-06-14T11:57:41+00:00 Ulrich Davy Kombila ukombila@gmail.com Yacine Dia Kane ukombila@gmail.com Fatimata Bintou Rassoule Mbaye ukombila@gmail.com Ndeye Fatou Diouf ukombila@gmail.com Waly Ka ukombila@gmail.com Nafissatou Oumar Touré ukombila@gmail.com <p>L’objectif était de déterminer les différents aspects radiologiques de la tuberculose pulmonaire à microscopie positive. Il s’agissait d’une étude rétrospective, analysant les clichés de radiographies des patients atteints de tuberculose pulmonaire à microscopie positive entre le 15 Novembre 2015 et le 15 Mars 2016. Soixante-six dossiers répondant aux critères d’inclusion ont été sélectionnés, composé de 81,8% des hommes. La moyenne d’âge était de 37,5 ± 14,9 ans. Les différentes lésions parenchymateuses, étaient variables et dominées par les infiltrats dans 84,8% (IC95%; 73,9 – 92,4%) des cas, suivi du syndrome alvéolaire dans 68,2% (IC95%; 55,5 – 79,1%) des cas. Elles étaient extensives dans 71,2% (IC95%; 58,7 – 81,7%) des cas et bilatérales dans 45,4% (IC95%; 31,1 – 58,1%) des cas. Ces anomalies radiologiques survenaient dans 52,2% (IC95%; 36,9 – 67,1%) des cas chez les patients dénutrie. Dans 22,7% (IC95%; 13,3 – 34,7%) des cas il s’agissait d’un second épisode de tuberculose pulmonaire. La consommation régulière de tabac a été retrouvée chez 34,8% (IC95; 23,5 – 47,5%) des patients avec une consommation moyenne de 17PA (±11,3). Les rechutes tuberculeuses étaient plus fréquentes chez les patients qui avaient fumés versus les non-fumeurs respectivement dans 26,1% et 20,9% (p &lt; 0,42). La sérologie rétrovirale profil 1, était positive dans 7,6% des cas. A travers cette étude, nous préconisons en zone d’endémie tuberculeuse d’orienter la démarche étiologique vers la recherche d’une tuberculose pulmonaire devant des images radiologiques infiltratives associées ou non à des lésions cavitaires chez un patient jeune, dénutrie et à fortiori fumeur.</p> 2018-05-09T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208693 A giant cutaneous squamous cell carcinoma of the neck 2021-06-14T12:01:52+00:00 Aziz Bazine bazineaziz@gmail.com Mohamed Fetohi bazineaziz@gmail.com <p>A 72-year-old man living in a mountain region presented with a painful giant tumor in the right laterocervical area, which had been observed 2 years previously and had started to grow rapidly over the past 6 months. The patient had a past history of heavy tobacco intake and suffered from arterial hypertension and diabetes mellitus. The physical examination revealed a bulky, exophytic tumor measuring 20 cm in length across the major axis, with a large ulcerated area, which bled easily and multiple fistulae discharged a malodorous secretion. The adjacent dermis was also infiltrated over several centimeters beyond the visible borders of the lesion. A biopsy of the tumor was performed. Histopathological examination revealed a well-differentiated squamous cell carcinoma. The computed tomography (CT) scan showed a heterogeneous mass in the right lateral region of the neck with irregular contours, a necrotic center and an infiltration of the internal jugular vein. The tumor appeared to adhere to the sternocleidomastoid muscle, the paralaryngeal soft tissues, the submandibular region, the parapharyngeal space and the parotid. No local adenopathy or distant metastatic disease was noted. The tumor was considered unresectable. The patient had an ECOG performance status rating of 2 and a normal renal function. Neoadjuvant chemotherapy with cisplatin and 5-fluorouracil was initiated. After the third cycle, the CT scan showed a progression of disease with increased-neck-mass size and appearance of pulmonary metastases. The general condition of the patient did not allow second-line chemotherapy and he died 1 month later.</p> 2018-05-15T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208694 Snail track ulcers of the tongue 2021-06-14T12:07:12+00:00 Andreia de Oliveira Alves f9filho@gmail.com Fred Bernardes Filho f9filho@gmail.com <p>A 36-year-old male, heterosexual, complained of a 4-week history of ulceration in the tongue left margin. He denied previous treatment and any systemic diseases. The patient reported multiple sexual partners and episodes of unprotected sex in the past 12 months. Oral findings showed irregular erythematous patches on the dorsum of the tongue and erosive plaques on the tongue left margin with snail track pattern. On physical examination, cutaneous lesions were absent, and a difuse micropolyadenomegaly was noted. The laboratory tests were positive for TPHA VDRL (1/64), and negative for HIV, hepatitis B and C. The diagnosis of snail track ulcers of secondary syphilis was performed. The patient was treated with two doses of intramuscular benzathine penicillin (total dose of 4,800,000 U IM) with an interval of seven days between each dose. The tongue lesions completely disappeared after the two doses of the penicillin. Although very rarely oral ulceration may be the only manifestation of infection. The two principal oral features of secondary syphilis are mucous patches and maculopapular lesions. The oral features of secondary syphilis can be painless or painful erythematous lesions, grayish-white mucous patches, or irregular linear erosions termed snail track ulcers. The resurgence of syphilis is mainly due to sexual risk behaviors. This cases illustrates the need for include syphilis in the differential diagnosis of oral ulceration and how clinical features should be valued in clinical semiotics.</p> 2018-05-15T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208697 Barriers for nurses’ participation in and utilisation of clinical research in three hospitals within the Kumasi Metropolis, Ghana 2021-06-14T12:16:05+00:00 Isaac Nkrumah samuel.cumber@gu.se Catherine Atuhaire samuel.cumber@gu.se Gunilla Priebe samuel.cumber@gu.se Samuel Nambile Cumber samuel.cumber@gu.se <p><strong>Introduction:&nbsp;</strong>scientific research results are a necessary base for high quality nursing practice. The level of implementation of research in the clinical setting, including nurses' participation in and knowledge of research results, have gained considerable attention internationally. However, the remarkable international increase of such studies does not apply to the Ghanaian context. We therefore set out to evaluate the degree of involvement of nurses in research, as well as their utilization patterns of research findings in Ghana. Objectives: the study sought to investigate the proportion of nurses involved in clinical research as well as barriers for nurses' participation and utilization of research findings, within the Kumasi Metropolis area, Ghana.</p> <p><strong>Methods:&nbsp;</strong>a descriptive and analytical cross-sectional study design was used in this study. A 47 item questionnaire elicited data on 158 participants' demographics, the proportion and the barriers to participation, which was then analyzed using SSPS version 17 software. Qualitative interviews with key informants complemented quantitative survey data. In-depth interviews with nurse managers at the hospitals in focus was conducted and analyzed thematically.</p> <p><strong>Results:&nbsp;</strong>the study shows that 36.1% of the nurses, included in the study, had participated in research and only 25.3% of these had (knowingly) used specific research results in clinical practice. However, the level of research participation differed greatly between nurses working at different hospitals. Nurses' participation in clinical research was shown to be associated with their perception of benefit of research to practice as well as their understanding of time as a factor for them engaging in reading scientific articles. In addition, barriers associated with nurses' integration of research findings into the daily practice was their perceived lack of support from the collegium and their perception of research as not part of the nursing role.</p> <p><strong>Conclusion:&nbsp;</strong>findings from the study suggest that there is a need to create institutional support to facilitate and encourage nurses' participation in research, yet also to formalize nurses' continuous professional development. This, could change nurses' attitudes towards research, and contribute to improving health care as it would increase nurses' role as agents for evidence based clinical practice.</p> 2018-05-15T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208698 Trichobézoard gastroduodénal: à propos d’un cas 2021-06-14T12:32:31+00:00 Khalid Mazine khalid.mazine@gmail.com Pierre Barsotti khalid.mazine@gmail.com Hicham Elbouhaddouti khalid.mazine@gmail.com Ouadii Mouaqit khalid.mazine@gmail.com Elbachir Benjelloun khalid.mazine@gmail.com Khalid Ait Taleb khalid.mazine@gmail.com Abdelmalek Ousadden khalid.mazine@gmail.com <p>Le trichobézoard gastroduodénal est une affection rare, dont le diagnostic est facile en présence d'un contexte évocateur. Nous rapportons le cas d'une jeune patiente âgée de 21 ans suivie pour une schizophrénie, admise pour douleur abdominale aiguë, vomissements et masse épigastrique, le scanner abdominal a permis de faire suspecter un bézoard en objectivant des lésions hétérogènes occupant tout l'estomac, ne prenant pas le contraste et semblant indépendante de la paroi gastrique. Un traitement chirurgical a été réalisé avec exérèse du trichobézoard par gastrotomie, sans complications et un transfert en service de psychiatrie.</p> 2018-05-15T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208699 Horseshoe kidney 2021-06-14T12:43:06+00:00 Guglielmo Mantica hilgard.ackermann@gmail.com Hilgard Ackermann hilgard.ackermann@gmail.com <p>A 21-year-old male presented with a one day history of right flank pain and signs of severe sepsis. The recorded vital signs included a temperature of 39.9° Celsius, blood pressure of 95/65 mmHg and heart rate of 165. The laboratory investigations confirmed a raised C-reactive protein (CRP) of 485 mg/l but it was interesting to note thatthe white cell count and creatinine were respectively normal (5.85 x 10<sup>9</sup>/l; 77 µmol/l). Microbiological investigations confirmed Klebsiella pneumoniae (&gt;10<sup>6</sup>&nbsp;cfu/mL) on urine culture whilst two blood cultures were negative. Intravenous fluid resuscitation was successful in restoring hemodynamic stability. Amoxicillin/clavulanic acid (1200mg) was administered and continued for seven days after confirmation on antibiotic sensitivity testing. After ultrasonography confirmed severe right hydronephrosis, a contrasted computed tomography (CT) scan confirmed a horseshoe kidney (A, B, C, D) with an obstructed right-sided renalmoiety secondary to right pelvi-ureteric junction (PUJ) obstruction (B) and urothelial enhancement suggestive of an infected collecting system. Horseshoe kidneys are the most common congenital renal abnormality with an incidence of 1:400-600. It is commonly asyptomatic and rarely require interventionunless treating complications such as ureteral obstruction (PUJ), urinary tract infections, urolithiasis andWilms Tumour. It is associated with Trisomy 18 and females with Turner syndrome. Our patient underwent a right percutaneous nephrostomy (PCN) and 500 millilitres of infected urine were aspirated. He made a complete recovery at discharge. An interval MAG3 renogram confirmed that both moeities had good and excretion. A pelvi-ureteric junction repair will be performed after 6 weeks.</p> 2018-05-15T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208700 Exploration of gynaecological cancer high dose-rate brachytherapy treatment: a pilot study 2021-06-14T12:49:44+00:00 Alicia Ehlers ehlers.alicia@gmail.com Chandra Rekha Makanjee ehlers.alicia@gmail.com <div class="BoxAbstract"> <p><strong>Introduction:&nbsp;</strong>performing brachytherapy on female patients with gynaecological cancer is a sensitive procedure, apart from it being an intricate investigation. The aim of this study: establishing gynaecological cancer patients' expectations, experiences and understandings of the high dose-rate brachytherapy treatment procedure. Exploring these patients' life-worlds provides further insights into improving their preparedness and experiences.</p> <p><strong>Methods:&nbsp;</strong>a qualitative research design with a descriptive phenomenological research approach was used. Recruitment entailed using purposive sampling. To obtain rich insights into the lived experiences, data was acquired through semi-structured interviews until data saturation.</p> <p><strong>Results:&nbsp;</strong>major challenges were experienced with mixed thoughts and feelings, from negative trauma to desires being fulfilled. These patients should have received more information regarding their upcoming brachytherapy treatment. This would have alleviated some of their fears and anxieties, which would in turn have provided them with a better brachytherapy treatment experience. Envisaged outcomes and desires are used to cope. Patients influence each other negatively, so they rather wanted to "see for themselves".</p> <p><strong>Conclusion:&nbsp;</strong>despite some disappointments and negative experiences throughout the brachytherapy continuum, the patients were left with a positive outlook, saying that it is an excellent and necessary treatment. Further studies should be done to elaborate on fulfilments of recommendations in the brachytherapy department of radiation oncology.</p> </div> 2018-05-15T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208702 Gestion des secours médicaux aux victimes des attentats terroristes au Mali 2021-07-13T12:03:29+00:00 Almeimoune Abdoulhamidou abdoulhamidoumaiga@gmail.com Mangane Moustapha abdoulhamidoumaiga@gmail.com Diop Madane Thierno abdoulhamidoumaiga@gmail.com Beye Seydina Alioune abdoulhamidoumaiga@gmail.com Démbele Seydou Aladji abdoulhamidoumaiga@gmail.com Diarra Kassim abdoulhamidoumaiga@gmail.com Diango Djibo Mahamane abdoulhamidoumaiga@gmail.com <p><strong>Introduction:&nbsp;</strong>les récents attentats suicides ont révélé un nouveau type d'afflux massif de blessés, unique en son genre, qui doivent être pris en charge au sein des formations hospitalières.</p> <p><strong>Méthodes:&nbsp;</strong>nous rapportons l'expérience du CHU Gabriel Toure de Bamako et de l'hôpital N. Fomba de Ségou dans la gestion des secours médicaux aux victimes des attentats terroristes au Mali.</p> <p><strong>Résultats:&nbsp;</strong>Soixante-quatre victimes des trois attentats ont été inclus dans notre étude parmi ceci 22 (34,4%) cas de décès constaté à l'arrivée. Les hommes avaient représenté 97% des victimes qui étaient de nationalité malienne dans 71% des cas. Dans 51% des cas il s'agissait de blessé grave avec des lésions prédominantes aux extrémités chez 35% d'entre eux. Aucune victime admise vivante n était décède au cours de la prise en charge hospitalière.</p> <p><strong>Conclusion:&nbsp;</strong>pouvoir disposer de données précises sur les mécanismes et la gravité des lésions, une prise en charge médicale pré hospitalière permettront de diminuer la morbi-mortalité liée à ces catastrophes.</p> 2018-05-15T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208703 Familial hypercholesterolemia revealed by multiple xanthomas 2021-06-14T13:08:50+00:00 Nassiba Elouarradi nassibaelouarradi@gmail.com Nawal El Ansari nassibaelouarradi@gmail.com <p>Familial hypercholesterolemia (HF) is a rare pathology characterized by a major elevation of LDL associated with tendinous and subcutaneous xanthomas. We report the case of a 16-year-old patient, born from a first degree consanguineous marriage, with no particular pathological antecedents, the patient reports appearance for 9 years of cutaneous lesions described as a swellings in the posterior face of the 2 elbows and the anterior surface of the 2 knees, painless, firm, and gradually increasing in volume. The patient consulted only at the age of 16 years in front of the aesthetic discomfort. The biological assessment objectified a hypercholesterolemia: total Cholesterol: 4.44g/l. HDL: 0.64g/l. LDL: 3.71g/l. and Triglycerides: 0.67g/l. The exploration of cardiac repercussion was without particularities.The patient was treated with dietary and lifestyle measures and atorvastatin 80 mg with good clinical and biological evolution.</p> 2018-05-16T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208704 Acute urinary retention due to benign prostatic hyperplasia associated with cystitis glandularis in a 22-year-old patient 2021-06-14T13:39:14+00:00 Skander Zouari zouari.skander@gmail.com Khaireddine Bouassida zouari.skander@gmail.com Khaled Ben Ahmed zouari.skander@gmail.com Ahlem Bdioui Thabet zouari.skander@gmail.com Mohamed Amine Krichene zouari.skander@gmail.com Chawki Jebali zouari.skander@gmail.com <p>A 22-year-old man has consulted in emergency for acute urinary retention and left renal colic. Bladder catheterization was performed. Symptomatic treatment was provided with no improvement. MRI showed a pseudotumoral bladder wall thickening associated with vesical floor budding with prostate median lobe infiltration. The patient got an endoscopy that concluded to an inflammatory aspect of the bladder mycosa and a solid mass in the bladder neck arising. The biopsy during examination concluded to a glandular cystitis. Ultrasonography performed six months later still showed an enlarged prostate of 60g volume, post void residue of 280ml and bilateral hydronephrosis. A second cystoscopy showed an obstructive prostate with a median lobe. A transurethral resection of this lobe was performed. The pathological examination concluded to a benign prostate hyperplasia. This case is likely to be the first reported so far about a BPH in a young male associated with Cystitis Glandularis. Neither etiology nor evidence of the cause behind this case has been identified so far. Although Benign Prostate Hypertrophia is rare among young males, its ethiopathogenesis is not well known, its relation with cystitis glanduralis in young patients has never been described before. Both medical and surgical approaches remain similar to the adults.</p> 2018-05-16T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208756 A tongue ulcer 2021-06-16T07:26:24+00:00 Aryé Weinberg aryeweinberg@gmail.com Ralf Siegert aryeweinberg@gmail.com <p>An 86-year-old man presented with a painful lesion on his left tongue measuring 0.6 x 0.6mm (A). The lesion has been growing over the last 2 weeks. The patient did not remember any trauma except that his teeth did sometimes scratch his tongue. Histology form the excised lesion revealed a pressure ulcer (B). Tongue ulcers can be caused by accidental bites, ill-fitting dentures, braces, citrus or acidic fruits and by a sharp tooth surface. In some other cases nutritional problems such as vitamin B12, iron or folic acid deficiency may cause tongue ulcers. Never the less malignancy needs to be excluded. Therefore, complete excision and diagnosis based on histology is recommended.</p> 2018-05-16T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208757 Treatment outcome of tuberculosis among Human Immunodeficiency Virus positive patients in Eastern Ethiopia: a retrospective study 2021-06-16T07:30:06+00:00 Fitsum Weldegebreal fwmlab2000@gmail.com Habtamu Mitiku fwmlab2000@gmail.com Zelalem Teklemariam fwmlab2000@gmail.com <p><strong>Introduction:&nbsp;</strong>tuberculosis is the leading cause of morbidity and mortality among people living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome worldwide. Although Human Immunodeficiency Virus related tuberculosis is both treatable and preventable, incidence rates continue to climb in developing countries where both infections are endemic. The aim of this study was to assess the treatment outcome of tuberculosis among Human Immunodeficiency Virus positive patients attending in three hospitals of Eastern Ethiopia.</p> <p><strong>Methods:&nbsp;</strong>a retrospective clinical record review was conducted for 627 Tuberculosis and Human immunodeficiency virus co-infected patients registered from January 2008 to January 2014 cards were reviewed in three hospitals of tuberculosis clinics of Eastern Ethiopia from December 2015 to February 2016. The three hospitals were selected based on their high patient load of TB-HIV co infection and the presence of ART and TB units. Data on patient's details and tuberculosis treatment outcome were collected using standardized report format of National Tuberculosis and Leprosy Control Programme (NTLCP). The collected data were analyzed by Statistical Package for Social Sciences (SPSS) software Version 16.</p> <p><strong>Results:&nbsp;</strong>the overall treatment success rate was 78.3%. Of the total TB-HIV co infected study participants, 17.9% cured, 60.4% treatment completed, 8.6% died, 0.6% failure, 1.8% defaulter and 10.7% transferred out. Those participants in the age groups of less than or equals to 18 years old (Adjusted Odds Ratio = 1.990, 95% Confidence Interval: 1.01, 3.350), extra pulmonary tuberculosis (Adjusted Odds Ratio = 1.51, 95% Confidence Interval = 1.12, 3.42), on antiretro viral therapy (Adjusted Odds Ratio = 1.54, 95% Confidence Interval = 1.252, 3.910) were more likely to have higher treatment outcome than each of the above variables counter parts.</p> <p><strong>Conclusion:&nbsp;</strong>the rate of treatment success in this study was lower than recommended rate by World Health Organization. Thus this study recommends improving counseling during tuberculosis treatment, providing home visits and motivation of patients, improving defaulter tracing and health information dissemination in order to reduce treatment interruption.</p> 2018-05-16T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208759 Carcinome basocellulaire: à propos d’un cas historique 2021-06-16T07:33:29+00:00 Mohamed El Amraoui med.elamraoui.dto@gmail.com Mohammed Boui med.elamraoui.dto@gmail.com <p>Un homme âgé de 80 ans, villageois, résidant dans l'une des zones les plus enclavées de notre royaume, située à plus de 2400 mètres d'altitude, et ayant un phototype clair (II). A consulté, lors d'une mission humanitaire, pour une tumeur ulcéro-nécrotique, infiltrant la racine du nez et l'orbite droits avec destruction totale de l'œil droit. La lésion évoluait, selon le patient, depuis deux ans et demi, par une petite papule saignante sur la racine du nez avec une extension orbitaire. L'aspect clinique et l'histologie étaient en faveur d'un carcinome basocellulaire infiltrant. Le bilan d'extension montrait un envahissement des plans osseux de la région naso-orbitaire droite. Une chirurgie carcinologique et mutilante a été indiquée mais que le patient a refusé. Le carcinome basocellulaire est réputé par son pronostic relativement bon, vue son évolution lente et locale, cependant, certaines formes notamment la forme infiltrante, dans certaines zones à haut risque, notamment dans la zone naso-orbitaire peuvent être rapidement délabrantes, mutilantes et spectaculaires avec des préjudices esthétiques et fonctionnelles et des difficultés de prise en charge.</p> 2018-05-16T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208760 The red ear 2021-06-16T07:37:01+00:00 Aryé Weinberg aryeweinberg@gmail.com Ralph Magritz aryeweinberg@gmail.com <p>A 5-year-old boy was presented to our out-patient clinic by his father with a painful swollen red left ear (A). The father stated that his son has been suffering from an upper- respiratory tract infection and that his left ear has been hurting since the other day. Hearing loss was denied. Clinical examination showed a painfull swelling of the left ear causing it to stick out. Behind the ear an insect bite was noticed, probably from a mosquito (B). Otoscopy showed a white transparent ear drum with no signs of infection. Thus an acute mastoiditis based on a middle ear infection was excluded. The patient was treated for a mosquito bite with a topical coricoidsteroid gel and cooling. The boy totally recovered after two days.</p> 2018-05-16T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208762 Exposition de l’homme aux éléments traces métalliques et altération du sperme: étude menée dans les zones minières du Haut-Katanga en République Démocratique du Congo 2021-06-16T07:49:28+00:00 Richard-A-Mutshimbe Mukendi mukendiamutshimbe@gmail.com Célestin Lubaba Nkulu Banza mukendiamutshimbe@gmail.com Clarence-A-Kaut Mukeng mukendiamutshimbe@gmail.com Jules Thaba Moyambe Ngwe mukendiamutshimbe@gmail.com Albert Ntambwe-A-Nkoy Mwembo mukendiamutshimbe@gmail.com Prosper Muenze Kayamba Kalenga mukendiamutshimbe@gmail.com <p><strong>Introduction:&nbsp;</strong>l'exposition à l'arsenic et au cadmium entraine des effets néfastes importants. L'objectif de cette étude est de déterminer les concentrations urinaires en arsenic et en cadmium chez les hommes et d'analyser leur profil en rapport avec les éléments du spermogramme.</p> <p><strong>Méthodes:&nbsp;</strong>il s'agit d'une étude analytique exposés-non exposés où les hommes exposés ont été recrutés dans une zone minière du Haut-Katanga, en RDC et les hommes non-exposés dans une zone loin de toute activité minière.</p> <p><strong>Résultats:&nbsp;</strong>nos résultats montrent que 48% des sujets exposés ont un pH du sperme en dessous de la valeur seuil de 7,2 contre seulement 16% des sujets non-exposés. Le risque d'abaissement du pH en deçà des normes étant de plus de 4 fois supérieur (OR=4,85 [1,9-12,39]) chez les exposés. La différence est statistiquement significative entre les moyennes du nombre global des spermatozoides à l'avantage des sujets non-exposés et celles des spermatozoides anormaux beaucoup plus chez les sujets exposés. On note une dégradation plus rapide de la mobilité des spermatozoides chez les sujets exposés. Par ailleurs, 44% des hommes exposés ont une concentration urinaire en arsenic &gt; 20 µg/l contre 8% des sujets non-exposés, le risque d'accumulation excessive d'arsenic est neuf fois plus élevé chez les hommes exposés que chez ceux non exposées (OR=9,04 [2,82-28,96]). Soixante pourcents des hommes exposés ont une concentration urinaire en cadmium ≥ 0,5 µg/ml contre 38% des sujets non-exposés avec un Odd Ratio de 2,45 [1,1-5,47], traduisant un risque d'accumulation excessive de cadmium chez les hommes exposés. D'autre part, on constate chez les hommes exposés que les fortes concentrations urinaires en arsenic et en cadmium entrainent une dégradation proportionnelle des éléments du spermogramme.</p> <p><strong>Conclusion:&nbsp;</strong>le présent travail montre bien d'une part de fortes concentrations urinaires d'arsenic et de cadmium et d'autre part l'altération plus rapide et plus sévère des éléments du spermogramme chez les hommes vivant en zone minière, suggérant une baisse de la fertilité masculine qui mérite d'être davantage documentée dans les travaux futurs.</p> 2018-05-16T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208763 L’arthroscopie de la hanche dans le conflit fémoro-acétabulaire: à propos de 2 observations 2021-06-16T07:59:35+00:00 Abdelhafid El Marfi hafid_elmarfi@hotmail.fr Badarou Chaibou hafid_elmarfi@hotmail.fr Kevin Parfait Bienvenue Bouhelo-Pam hafid_elmarfi@hotmail.fr Mohamed El Idrissi hafid_elmarfi@hotmail.fr Mohamed Shimi hafid_elmarfi@hotmail.fr Abdelhalim El Ibrahimi hafid_elmarfi@hotmail.fr Abdelmajid El Mrini hafid_elmarfi@hotmail.fr <p>Le conflit fémoro-acétabulaire (CFA) est une des causes de douleur de hanche chez les sujets jeunes et sportifs. Son diagnostic est basé sur des arguments cliniques et radiologiques. La prise en charge chirurgicale peut être conventionnelle ou arthroscopique. L'arthroscopie s'avère être une technique fiable dans les CFA, efficace sur la douleur, permettant d'améliorer la fonction de ces patients sportifs afin de reprendre leurs activités précocement. Nous rapportons l'expérience de notre service dans la prise en charge arthroscopique des CFA à travers deux observations. Le score de Harris modifié était nettement amélioré au dernier recul (24 et 18 mois).</p> 2018-05-17T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208765 Le syndrome de Miller Fischer: à propos d’un cas pédiatrique 2021-06-16T08:04:38+00:00 Noureddine Khiri khirinoureddine74@gmail.com Moussa Lazreg khirinoureddine74@gmail.com Houssam Bkiyar khirinoureddine74@gmail.com Soufiane Diyas khirinoureddine74@gmail.com Brahim Housni khirinoureddine74@gmail.com <p>Le syndrome de Miller Fisher (MF) représente une forme rare du syndrome de Guillain-Barré qui ne survient que dans 5% des cas chez l'adulte alors que les cas pédiatriques décrits dans la littérature sont encore plus rares. Nous présentons le cas d'un enfant de 12 ans chez qui on a posé le diagnostic de syndrome de Miller Fischer en se basant sur la présentation clinique avec une atteinte oculaire en premier plan et la positivité des anticorps anti-ganglioside. Notre patient est admis dans notre structure dans un tableau de détresse respiratoire nécessitant l'intubation orotrachéale et le recours aux immunoglobulines intraveineuses avec bonne évolution clinique.</p> 2018-05-17T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208766 Traitement des fractures de la diaphyse humérale par l’embrochage centro-médullaire rétrograde de Hackethal: à propos de 54 cas 2021-06-16T08:10:50+00:00 Ouahidi Mohamed Ouahidi.mohamed@gmail.com Hicham Bousbaa Ouahidi.mohamed@gmail.com Mourad Bennani Ouahidi.mohamed@gmail.com Toufik Cherrad Ouahidi.mohamed@gmail.com Hassan Zejjari Ouahidi.mohamed@gmail.com Jamal Louste Ouahidi.mohamed@gmail.com Khalid Rachid Ouahidi.mohamed@gmail.com Laarbi Amhajji Ouahidi.mohamed@gmail.com <p>Les auteurs rapportent 54 cas de fracture de la diaphyse humérale traités par embrochage de Hackethal. 3 cas avec paralysie du nerf radial ont été observé dont l'abstention thérapeutique en urgence a été l'attitude avec surveillance et qui ont abouti à une récupération. La technique de l'embrochage est relativement facile mais nécessite une technique rigoureuse et une bonne expérience de l'opérateur. Un taux de 7,84 % de pseudarthrose était observé. L'embrochage d'Hackethal peut être considérer comme un traitement orthopédique amélioré avec un coût modeste et une innocuité importante.</p> 2018-05-17T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208768 Xpert MTB/RIF assay did not improve diagnosis of pulmonary tuberculosis among child contacts in Rwanda 2021-06-16T08:17:23+00:00 Francine Mwayuma Birungi fbirungi@nursph.org Brian van Wyk fbirungi@nursph.org Jeannine Uwimana fbirungi@nursph.org Joseph Ntaganira fbirungi@nursph.org Stephen Michael Graham fbirungi@nursph.org <p><strong>Introduction:&nbsp;</strong>to report on the diagnostic yield using the Xpert MTB/RIF assay on gastric lavage samples from children (&lt;15 years) who were household contacts of tuberculosis (TB) cases in Kigali, Rwanda.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted among 216 child contacts of index cases with sputum smear-positive TB over a 7 month period, from 1<sup>st</sup>&nbsp;August 2015 to 29<sup>th</sup>&nbsp;February 2016. Child contacts with tuberculosis-related symptoms or abnormal chest X-ray had sputum collected by gastric lavage on two consecutive days and samples were examined by smear microscopy, Xpert MTB/RIF assay and solid culture.</p> <p><strong>Results:&nbsp;</strong>of the 216 child contacts, 94 (44%) were less than 5 years of age. Most of them 84 (89%) were receiving isoniazid preventive therapy at the time of screening. Thirty seven out of 216 children had TB-related symptoms. Only 4 (10.8%) were clinically diagnosed with TB; and none had bacteriologically confirmed tuberculosis.</p> <p><strong>Conclusion:&nbsp;</strong>the use of Xpert MTB/RIF assay did not contribute to bacteriological confirmation of active TB in child contacts in this study. The low prevalence of tuberculosis in child contacts in this study may reflect the high coverage of preventive therapy in young (&lt;5 years) child contacts. The low sensitivity of Xpert MTB/RIF assay in contacts may also suggest likely reflection of paucibacillary disease.</p> 2018-05-17T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208770 The related factors of compliance to professional codes of ethics from midwives' perspective working in healthcare centers of Tehran-Iran 2021-06-16T08:22:56+00:00 Leila Nasiriani Vaseghrh@tums.ac.ir Seyedeh Fatemeh Vasegh Rahimparvar Vaseghrh@tums.ac.ir Tahmineh Farajkhoda Vaseghrh@tums.ac.ir Naser Bahrani Vaseghrh@tums.ac.ir <p><strong>Introduction:&nbsp;</strong>professional ethics is an important issue in every organization. This study was designed to define compliance level to professional codes of ethics and some of its related factors in midwives working at healthcare centers.</p> <p><strong>Methods:&nbsp;</strong>this cross sectional study was conducted in 2013 Tehran Iran. 125 midwives from the governmental healthcare centers of Tehran were selected through stratified quota sampling method. Data gathering tool was a self-reporting questionnaire which included: demographic characteristics, Iranian version of ethical codes of reproductive health providers, applicability of these ethical codes and awareness about the professional codes of ethical. Data analysis was conducted using SPSS v.16. p level at 0.05.</p> <p><strong>Results:&nbsp;</strong>compliance to the professional ethical codes were directly correlated to the income level of the midwives, the applicability of the codes and the midwives' awareness about them.</p> <p><strong>Conclusion:&nbsp;</strong>it is necessary to pay attention to professional ethics and its teaching as such. It is also important to monitor compliance to the ethical codes. Moreover, living conditions of the midwives should be one of the priorities to enhance their performance.</p> 2018-05-17T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208771 Neurofibfrome plexiforme cervical: à propos d’un cas 2021-06-16T08:31:35+00:00 Lamiae Bouimetarhan Lamiae.bmtrn@hotmail.com Habib Bellamlih Lamiae.bmtrn@hotmail.com Issam En-nafaa Lamiae.bmtrn@hotmail.com Jamal El Fenni Lamiae.bmtrn@hotmail.com Touria Amil Lamiae.bmtrn@hotmail.com Bouchaib Radouane Lamiae.bmtrn@hotmail.com <p>Le neurofibrome plexiforme est une tumeur bénigne rare des nerfs périphériques aux dépens des cellules conjonctives du périnevre. Il est pathognomonique de la neurofibromatose de type 1 (NF1 ou maladie de Von Recklinghausen). L'IRM est d'une grande aide au diagnostic de cette pathologie. La confirmation anatomopathologique est parfois nécessaire en particulier en dehors d'un contexte évocateur d'une NF1. Nousrapportonsl'observation d'une petite fille atteinte de neurofibrome plexiforme cervical révélateur d'une neurofibromatose Type 1.</p> 2018-05-17T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208772 Prise en charge des corps étrangers du tiers supérieur de l’œsophage sans endoscope: un défi pour le médecin en situation isolée? 2021-06-16T08:38:17+00:00 Antoine Lamblin antoine.lamblin@hotmail.fr Clément Derkenne antoine.lamblin@hotmail.fr Antoine Schwartz antoine.lamblin@hotmail.fr Pierre Pasquier antoine.lamblin@hotmail.fr Romain Gorioux antoine.lamblin@hotmail.fr Pierre-François Wey antoine.lamblin@hotmail.fr <p>La prise en charge des corps étrangers du tiers supérieur de l'œsophage est bien codifiée et fait appel le plus souvent à un traitement endoscopique. Ce matériel spécifique, ainsi que des médecins gastro-entérologues entraînés à son utilisation fait parfois défaut dans les pays d'Afrique. D'autres moyens doivent alors être envisagés pour les médecins ayant à prendre en charge ce type de pathologie. L'objectif de cette étude était d'évaluer la prise en charge des corps étrangers du tiers supérieur de l'œsophage par des médecins anesthésistes-réanimateurs dans un centre médico-chirurgical du Tchad. 37 cas d'extraction chez des enfants de 0 à 15 ans étaient analysés. Il s'agissait de pièces de monnaie et de piles au lithium dans respectivement 92% et 8% des cas. La méthode employée était une sonde de Foley à ballonnet dans 43,2% et d'une pince à calcul sous laryngoscopie dans 56,8% des cas. Un cas d'échec ayant nécessité une cervicotomie était noté dans chaque groupe. Quatre complications mineures étaient rapportées dans le groupe « pince à calcul », aucune dans le groupe « Foley ». Les indications d'extraction de corps étrangers du tiers supérieur de l'œsophage doivent être bien connues des médecins amenés à les prendre en charge. En cas d'indisponibilité de l'endoscopie, d'autres techniques alternatives peuvent être utilisées avec un taux de succès satisfaisant. En cas d'échec un recours à la chirurgie peut être nécessaire.</p> 2018-04-18T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208774 Higher ascent, trouble breathing: High altitude pulmonary edema (HAPE) 2021-06-16T08:41:53+00:00 Simant Singh Thapa thapasimant@gmail.com Buddha Basnyat thapasimant@gmail.com <p>A 40 year old man started his trekking 4 days ago from Lukla (2800m) in the Everest region of Nepal. He reached Tengboche (3860 m) on third day where he was short of breath with moderate exertion and was easily fatigued. He ascended further ignoring his symptoms and reached Dingboche (4410m) on fourth day. He was extremely tired, short of breath at rest and appeared ill so helicopter evacuation was done from Dingboche to Kathmandu (1300m) and he was brought to our clinic. On initial evaluation, his vital signs were temperature 97.8 F, blood pressure 124/66 mmHg, pulse rate 89/min, respiratory rate of 26 breaths/min and saturation (SpO2) of 80% on room air at rest. Auscultation of the lungs revealed bilateral crackles. Finger to nose test and tandem gait was normal. The chest radiograph showed patchy infiltrates bilaterally. He was diagnosed as the case of HAPE. He was treated with bed rest and supplemental oxygen. On evaluation the next day, his pulmonary crackles had resolved and he was no more short of breath. His ambulatory SpO2 was 96% on room air. His dramatic clinical improvement following descent strongly supported our diagnosis. HAPE is a non-cardiogenic form of pulmonary edema. Its notable feature in contrast with other causes of pulmonary edema is fast reversibility following timely descent with or without oxygen.</p> 2018-05-18T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208775 Hidden dangers-prevalence of blood borne pathogens, hepatitis B, C, HIV and syphilis, among blood donors in Sierra Leone in 2016: opportunities for improvement: a retrospective, cross-sectional study 2021-06-16T08:50:10+00:00 Emmanuel Edmond Yambasu emmaedmoyamb@gmail.com Anthony Reid emmaedmoyamb@gmail.com Philip Owiti emmaedmoyamb@gmail.com Marcel Manzi emmaedmoyamb@gmail.com Mariama Jeanne Sia Murray emmaedmoyamb@gmail.com Ama Kyerewaa Edwin emmaedmoyamb@gmail.com <p><strong>Introduction:&nbsp;</strong>transmissible blood-borne infections are a serious threat to blood transfusion safety in West African countries; and yet blood remains a key therapeutic product in the clinical management of patients. Sierra Leone screens blood donors for blood-borne infections but has not implemented prevention of mother-to-child transmission for hepatitis B. This study aimed to describe the overall prevalence of hepatitis B and C, HIV and syphilis among blood donors in Sierra Leone in 2016 and to compare the differences between volunteer versus family replacement donors, as well as urban versus rural donors.</p> <p><strong>Methods:&nbsp;</strong>retrospective, cross-sectional study from January-December 2016 in five blood bank laboratories across the country. Routinely-collected programme data were analyzed; blood donors were tested with rapid diagnostic tests-HBsAg for HBV, anti-HCV antibody for HCV, antibodies HIV1&amp;2 for HIV and TPHA for syphilis.</p> <p><strong>Results:&nbsp;</strong>there were 16807 blood samples analysed, with 80% from males; 2285 (13.6%) tested positive for at least one of the four pathogens. Overall prevalence was: 9.7% hepatitis B; 1.0% hepatitis C; 2.8% HIV; 0.8% syphilis. Prevalence was higher among samples from rural blood banks, the difference most marked for hepatitis C. The proportion of voluntary donors was 12%. Family replacement donors had a higher prevalence of hepatitis B, C and HIV than volunteers.</p> <p><strong>Conclusion:&nbsp;</strong>a high prevalence of blood-borne pathogens, particularly hepatitis B, was revealed in Sierra Leone blood donors. The study suggests the country should implement the prevention of mother-to-child transmission of hepatitis B and push to recruit more volunteer, non-remunerated blood donors.</p> 2018-05-18T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208776 Complexité de prise en charge d’une macrodactylie au niveau de la main: entre préjudice esthétique et fonctionnel 2021-06-16T08:54:38+00:00 Mouna Ejjiyar mouna.ejjiyar@hotmail.fr Saloua Ettalbi mouna.ejjiyar@hotmail.fr <p>On définit la macrodactylie comme une malformation congénitale d'étiologie inconnue et d'incidence rare pouvant intéresser les doigts ou les orteils, et caractérisée par l'augmentation, dès la naissance ou de façon progressive, de la taille de tous les éléments d'un ou plusieurs rayons. Son retentissement social, esthétique, et surtout fonctionnel imposent une prise en charge précoce passant par plusieurs interventions chirurgicales voire même des amputations dans les formes évoluées. Nous rapportons le cas d'un jeune patient âgé de 18 ans, célibataire, sans profession, gaucher, admis au service de chirurgie plastique, réparatrice, esthétique et des brûlés du CHU Mohammed VI de Marrakech, pour prise en charge d'une forme progressive de macrodactylie intéressant les premier et deuxième rayons de la main droite. A l'examen, on retrouvait une hypertrophie des deux premiers rayons de la main droite, associée à une infiltration fibro-graisseuse prédominant en palmaire, ainsi qu'une déviation phalangienne en angulation à 90° au niveau du deuxième doigt. Devant cette forme sévère de macrodactylie, une amputation du 2<sup>ème</sup>&nbsp;rayon associée à une réduction de l'infiltration graisseuse au niveau palmaire a été proposée au patient, lui permettant de conserver une pince pollici-digitale, et de retrouver une vie sociale le plus proche possible de la normale.</p> 2018-05-18T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208778 Tatouage au henné noir: attention à l’eczéma de contact 2021-06-16T08:58:47+00:00 Ouiam El Anzi elanzi.ouiam@gmail.com Badreddine Hassam elanzi.ouiam@gmail.com <p>Le henné est un produit utilisé pour colorer les cheveux, mais aussi pour dessiner des tatouages labiles sur la peau. Le henné est souvent mélangé avec de la paraphénylènediamine (PPD). Nous rapportons l'observation d'une patiente qui a présenté un eczéma de contact à un tatouage labile contenant la PPD. Une jeune femme de 23 ans se fait tatouer sur le dos de la main et sur l'avant-bras des dessins esthétiques à base de henné noir. Ce tatouage labile contenait de la PPD. Deux jours plus tard, elle développe des lésions érythématovésiculeuses et œdémateuses très prurigineuses avec une sensation de cuisson. Les lésions siégeaient au site de tatouage et suivaient exactement le dessin initial. Elles étaient améliorées par un traitement à base de dermocorticoïdes topiques de classe 1 (propionate de clobetasol). La patiente refuse l'exploration allergologique par patch-tests et aucun test allergologique n'est effectué. Actuellement, le henné est très en vogue dans les pays occidentaux. La PPD est ajoutée pour diminuer le temps de fixation ou pour obtenir une coloration plus foncée. Elle peut entrainer de graves réactions systémiques. La réaction allergique la plus fréquente est la dermatite de contact. Le traitement repose sur la corticothérapie locale. Une meilleure législation sur la pratique du tatouage temporaire et le contrôle des préparations ainsi qu'une Information régulière annuelle du grand public sont indispensables. L'intérêt de notre observation est de montrer l'importance d'informer surtout les jeunes sur les risques d'un tatouage labile.</p> 2018-05-18T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208780 Récidive d’une pseudo-exfoliation capsulaire sur implant intraoculaire 2021-06-16T09:04:44+00:00 Bennis Ahmed ah_bennis@hotmail.com Benatiya Andaloussi Idriss ah_bennis@hotmail.com <p>Patient de 79 ans, opéré de cataracte par phaco-émulsification en 2000, avec une pseudo-exfoliation capsulaire ODG préopératoire. Présente un glaucome pseudo-exfoliatif avec une récidive sur l'implant.</p> 2018-05-18T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208781 Lymphangiome kystique intra-péritonéal et maladie de Crohn: à propos d’une association exceptionnelle 2021-06-16T09:11:30+00:00 Wafa Ben Ameur Wafabenameur1@hotmail.fr Lamia Kallel Wafabenameur1@hotmail.fr Houcine Maghrebi Wafabenameur1@hotmail.fr Slim Haouet Wafabenameur1@hotmail.fr Azza Filali Wafabenameur1@hotmail.fr <p>Le lymphangiome kystique est une tumeur bégnine malformative rare des vaisseaux lymphatiques à localisations diverses. La localisation intra-abdominale du lymphangiome kystique est moins fréquente comparée à la localisation cervico-axillaire. Sa présentation clinique est polymorphe. Le diagnostic est évoqué par l'imagerie mais il nécessite une confirmation histologique. Le traitement de choix est chirurgical. Nous rapportons ici un cas rare de lymphangiome kystique intrapéritonéale acquis suite à une colectomie subtotale chez une patiente porteuse de maladie de Crohn à géni évolutif sévère et ayant nécessité l'introduction des anti TNF alpha. La patiente s'est présentée pour une masse para médiane droite douloureuse irréductible et non impulsive à la toux faisant retenir le diagnostic d'une éventration étranglée sur cicatrice de laparotomie médiane et amenant à opérer la patiente en urgence. L'exploration chirurgicale a montré une masse multi-kystique intra péritonéale extériorisée en partie à travers l'éventration paramédiane droite. L'examen anatomo-pathologique a permis de confirmer le diagnostic de lymphangiome kystique. Devant une exérèse chirurgicale incomplète, la patiente a eu deux séances de ponction évacuatrice en post-opératoire. C'est le premier cas de lymphangiome kystique rapporté chez un patient sous Anti-TNF alpha. Ceci pourrait être expliqué par la perturbation du système immunitaire et plus spécifiquement la population lymphocytaire. Cette association n'a pas été jusque-là prouvée et des études expérimentales sont nécessaires pour affirmer ou infirmer cette hypothèse.</p> 2018-05-18T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208782 Physiological and psychosocial stressors among hemodialysis patients in the Buea Regional Hospital, Cameroon 2021-06-16T10:18:18+00:00 Odette Dorcas Manigoue Tchape samuel.cumber@gu.se Youth Brittany Tchapoga samuel.cumber@gu.se Catherine Atuhaire samuel.cumber@gu.se Gunilla Priebe samuel.cumber@gu.se Samuel Nambile Cumber samuel.cumber@gu.se <p><strong>Introduction:&nbsp;</strong>End Stage Renal Disease (ESRD) is an irreversible kidney condition and hemodialysis is the most frequent treatment option used for this condition. However, hemodialysis also has a detrimental impact on the quality of life and the individuals' physical and psychosocial wellbeing. The main objective of this study was to identify physiological and psychosocial stressors faced by patients undergoing hemodialysis in the Buea Regional Hospital in Cameroon.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was carried out (December 2016 - January 2017) among patients undergoing hemodialysis at the Buea regional hospital. Data were collected with the use of a structured questionnaire and analyzed using SPSS version 21.0. Quantitative variables were expressed as frequencies, percentages and means.</p> <p><strong>Results:&nbsp;</strong>among the patients undergoing hemodialysis, 28 (70.0%) were below 5-year dialysis while 12 (30.0%) had been on dialysis for five years and more. 21(52.5%) were male and 19(47.5%) female. Half of the patients were married 20(50%), 13(32.5%) were single, 6(15%) were divorced, and one (2.5%) was a widower. Also, 28 (70.0%) were below 5-year dialysis while 12 (30.0%) had been on dialysis for five years and more. All participants experienced at least one or more physiological and psychosocial stressors. Among physiological stressors, the most frequent were feeling tired (97%), followed by arterial and venous stick (88%) while itching (49.5%) was the least noted physiological stressor. Among psycho-social stressors, the most recurrent were transportation to and from the hospital (99.5%), cost of treatment (99.5%) and Limits on time and place of vacation (99%), followed by Limitation in physical activities, frequent hospitalizations, the length of time on dialysis, uncertainty about the future, changes in life style, increased dependence and sleep disturbances.</p> <p><strong>Conclusion:&nbsp;</strong>the topic of stressors is of importance among patients receiving dialysis, as these affect their psycho-social and physiological wellbeing. Thus, nephrologists, nurses and family members play an important role in providing patients with effective psycho-social and physiological support.</p> 2018-05-18T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208784 Status of Ebola Virus Disease (EVD) preventive practices among Health care workers (HCWs) in Benin City: a year after disease containment in Nigeria 2021-06-16T10:29:14+00:00 Amenze Oritsemofe Onowhakpor ogbeideamenze@yahoo.com Vincent Yakubu Adam ogbeideamenze@yahoo.com Oghenetega Ewomazino Sakpa ogbeideamenze@yahoo.com Lydia Ukamaka Ozokwelu ogbeideamenze@yahoo.com <p><strong>Introduction:&nbsp;</strong>Ebola Virus Disease (EVD) is of great public health importance. Health care workers (HCWs) in various health care facilities especially in developing countries such as Nigeria, are particularly vulnerable to the disease. It is therefore imperative that health care workers adopt the necessary preventive practices to reduce to the barest minimum the risk of infection transmission. The study assessed the factors associated with EVD preventive practices among HCWs in a tertiary institution in Benin City, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a total of 374 health care workers selected using a two-staged sampling technique participated in this descriptive cross-sectional study. Data were collected using structured, self-administered questionnaires and analyzed with IBM SPSS, version 21.0. Univariate and bivariate analysis were done. Level of significance was set at p &lt; 0.05.</p> <p><strong>Results:&nbsp;</strong>the mean age of respondents was 36.3 ± 8.0 years. All, 374 (100.0%) of the respondents were aware of EVD and 347 (92.8%) of respondents had good knowledge of EVD. More than half of the respondents, 228 (61.0%) and 201 (53.7%) had positive attitude towards EVD and good EVD preventive practices respectively. A higher proportion of respondents with positive attitude towards EVD were observed to have good preventive practice (p &lt; 0.05).</p> <p><strong>Conclusion:&nbsp;</strong>knowledge, attitude and preventive practices towards EVD among HCWs were generally good. Positive attitude towards EVD was significantly associated with good preventive practices.</p> 2018-05-21T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208785 Reasons for low level of skilled birth attendance in Afar pastoralist community, North East Ethiopia: a qualitative exploration 2021-06-16T10:38:11+00:00 Mohammed Ahmed Ibrhim mohafr2008@yahoo.com Meaza Demissie mohafr2008@yahoo.com Araya Abrha Medhanyie mohafr2008@yahoo.com Alemayehu Worku mohafr2008@yahoo.com Yemane Berhane mohafr2008@yahoo.com <p><strong>Introduction:&nbsp;</strong>Ethiopia has expanded the number of health facilities that offer maternal health services during the last two decades. However, the utilization of skilled birth attendants in health facilities is still very low especially among the pastoralist regions of the country. This study explored why women in the pastoralist region of Afar, Ethiopia still prefer to give birth at home.</p> <p><strong>Methods:&nbsp;</strong>a qualitative study approach was used to collect information from October to December 2015. A total of eighteen focus group discussions and twenty-four key informant interviews were conducted. Focus group discussions were separately conducted with mothers and male tribal or religious leaders. Key informant interviews were conducted with heads of Women's Affairs Bureau, district health office heads and traditional birth attendants. Data were coded and categorized using open code software for qualitative data management and analyzed based on a thematic approach.</p> <p><strong>Results:&nbsp;</strong>women preferred to deliver at home due to lack of awareness about the benefits of maternity health facilities, their nomadic lifestyle, lack of confidence and trust in health workers and their close affinity and easy access to traditional birth attendants. Supply-side barriers included distant health facilities, lack of transportation and poor health care.</p> <p><strong>Conclusion:&nbsp;</strong>demand and supply related factors were identified as barriers to utilization of skilled birth attendants. Increasing awareness, bringing the service closer, arranging maternity waiting area around health facilities, and creating client-friendly service were found critical. Future research to define and improve services and approaches suitable for pastoralist population is warranted.</p> 2018-05-21T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208786 Solitary epidural lipoma 2021-06-16T10:42:38+00:00 Omar Boulahroud omarboulahroud78@outlook.fr Tarik Ziadi omarboulahroud78@outlook.fr <p>Spinal epidural lipomatosis (SEL) is defined as normal adipose tissue that is pathologically overgrown in the epidural space of the spinal canal. It usually occurs in obese people, patients with history of corticosteroid use or endocrinopathy. They usually present with gradually progressing symptoms and are rarely associated with rapidly aggravated neurologic deficits. Radiologic assessments are mostly conducted by using MRI. A 65-year-old woman presented with isolated low back pain. She had no history of corticosteroid use, endocrinopathy or radicular pain. On examination, she was obese (height 155cm, weight 87kg) with a body mass index (BMI) of 56.1 kg/m<sup>2</sup>. Neurological exam was normal with no motor weakness and sensation was intact. Plain radiographs showed no evidence of abnormality, including instability and other pathologic findings. Magnetic resonance imaging (MRI) revealed an epidural mass posterior to the L5 vertebral body that was isosignal to subcutaneous fat and it compressed asymmetrically on the right side of the cauda equina and the exiting right L5 nerve root on sagittal (A) and axial (B) T2 weighted images. There was no evidence of spinal stenosis. The result of electromyography was normal. We recommended surgical intervention to relieve pain but the patient declined. Opioid analgesia has been prescribed and her symptoms became much improved. Weight reduction by physiotherapy and exercise resulted in complete loss of lumbar pain (the patient lost 30kg in 6 months) and MRI control showed a complete disappearance of the mass.</p> 2018-05-21T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208787 Metastasis of renal cell carcinoma to the pancreas 11 years postnephrectomy 2021-06-16T10:47:46+00:00 Faten Limaiem fatenlimaiem@gmail.com Saadia Bouraoui fatenlimaiem@gmail.com <p>The pancreas is an unusual site for tumor metastasis, accounting for only 2 to 5% of all malignancies affecting the pancreas. A 67-year-old woman with a past medical history of right renal nephrectomy for renal cell carcinoma, eleven years ago, presented with nausea, diarrhea and vertigo. On admission, the patient was pale. Laboratory tests showed a low hemoglobin level (6,4 grams per deciliter). Abdominal ultrasonography revealed a well-defined, hypoechoic, homogeneous, vascular, lobulated mass in the tail of the pancreas. Computed tomography scan demonstrated a hypervascularized tumor of the pancreatic tail. The patient subsequently underwent a distal pancreatectomy with splenectomy. Grossly, the pancreatic mass was well-delineated and encapsulated measuring 9,5 x 6,5 cm and showed extensive hemorrhage (A). Histological examination of the surgical specimen revealed that the pattern of the tumour growth was predominantly solid, with formation of large nests and acini of tumor cells separated by a stroma that was endowed with prominent sinusoid-like vessels (B). The tumour cells were large ranging from optically clear, with sharply outlined boundaries, to eosinophilic tumour cells. The final pathological diagnosis was metastatic clear-cell renal carcinoma to the pancreas. Four peripancreatic lymph nodes were free of the tumor but the pancreatic resection margins were invaded by the tumour. Postoperative course was uneventful. Renal cell carcinoma metastasis should be considered in patients with a pancreatic mass as it gives the past history of renal cell carcinoma. Awareness of this entity and a high index of suspicion would help in proper diagnosis and treatment.</p> 2018-05-23T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208788 Ectopie thyroïdienne hyoïdienne: à propos d’un cas chez une jeune fille malgache 2021-06-16T10:55:20+00:00 Sitraka Angelo Raharinavalona sitrakarah@gmail.com Iandry Michella Razafinjatovo sitrakarah@gmail.com Rija Eric Raherison sitrakarah@gmail.com Thierry Razanamparany sitrakarah@gmail.com Andriamparany Rasata Ravelo sitrakarah@gmail.com Andrinirina Dave Patrick Rakotomalala sitrakarah@gmail.com <p>L'ectopie thyroïdienne est une pathologie rare liée à une défaillance de migration de la glande thyroïde lors de son développement embryonnaire. Elle est le plus souvent asymptomatique. Nous rapportons un cas d'ectopie thyroïdienne à localisation hyoïdienne chez une jeune fille malgache, révélée par une gêne esthétique, associée à une hypothyroïdie infraclinique. Le diagnostic était confirmé par l'échographie cervicale et la scintigraphie au technétium 99m. Même si l'hypothyroïdie est infraclinique, une hormonothérapie substitutive est de règle permettant ainsi d'obtenir une euthyroïdie biologique et de maintenir la bonne évolution clinique.</p> 2018-05-24T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208789 Erratum: Food hygiene assessment in catering establishments in Hay Hassani district-Casablanca 2021-06-16T10:59:04+00:00 The Pan African Medical Journal editor@panafrican-med-journal.com <p>This erratum corrects article: “Food hygiene assessment in catering establishments in Hay Hassani district-Casablanca”. The Pan African Medical Journal. 2016;24:335. doi:10.11604/pamj.2016.24.335.9171.</p> 2018-05-24T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208791 Knowledge of Lassa fever and use of infection prevention and control facilities among health care workers during Lassa fever outbreak in Ondo State, Nigeria 2021-06-16T11:27:16+00:00 Ibidolapo Taiwo Ijarotimi ileolasteve@yahoo.co.uk Olayinka Stephen Ilesanmi ileolasteve@yahoo.co.uk Adeola Aderinwale ileolasteve@yahoo.co.uk Oluwadamilola Abiodun-Adewusi ileolasteve@yahoo.co.uk Ime-Maria Okon ileolasteve@yahoo.co.uk <p><strong>Introduction:&nbsp;</strong>hospital-acquired infections of Lassa fever (LF) has been described in many West African countries. We assessed the availability of Infection Prevention and Control (IPC) measures and their use in the health centres (HCs) at the affected Local Government Areas (LGAs) during an ongoing LF outbreak in Ondo State, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>we included all primary and secondary HCs and their healthcare workers (HCWs) in the affected Ose and Owo LGAs. We collected data from respondents using self-administered questionnaires and used a checklist to assess the IPC measures at the HCs. We generated frequencies and proportions and tested associations using odds ratios at 95% CI.</p> <p><strong>Results:&nbsp;</strong>one hundred and ninety HCWs from 59 HCs were surveyed of which 34 (57.6%) were located in Owo LGA. All HCs had soap for handwashing, 57(96.6%) had wash-hand basins but only 52(88.1%) had water. While 57(96.6%) had gloves and 53(89.8%) had sharps boxes, only 16(27.1%) had an isolation room. Only 44(23.2%) respondents had been trained in IPC. The majority, 144 (91.6%) always had gloves available for their use, 79(41.6%) always had facemask/shield and 71(37.4%) always had full personal protective equipment. At the last patient contact, only 151 (79.8%) washed their hands before the contact, 188(98.9%) washed their hands after and 183 (96.2%) wore gloves. While there was no association between availability of gloves and its use (OR: 0.21, 95%CI 0.04-1.17), there was significant association between having had training in basic universal precautions and having used gloves (OR: 3.64, 95%CI 1.21-19.40) and having washed hands after last patient contact (OR: 2.31, 95%CI 1.67-12.30).</p> <p><strong>Conclusion:&nbsp;</strong>among these HCs that serve as point of first contact with possible cases of LF in these endemic LGAs, none met the minimum standard for IPC. We recommend that IPC committee for each LGA and the whole state should be set up and IPC trainings made mandatory.</p> 2018-05-24T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208793 Tumeur évoluée du tronc d’origine lymphomateuse 2021-06-16T11:30:34+00:00 Mouna Ejjiyar mouna.ejjiyar@hotmail.fr Saloua Ettalbi mouna.ejjiyar@hotmail.fr <p>Les lymphomes malins constituent un groupe de cancers du tissu lymphoïde, ganglionnaire ou extra ganglionnaire, liés à la transformation néoplasique d'une cellule lymphocytaire. On distingue dans cette catégorie les lymphomes malins non hodgkiniens. Nous rapportons le cas d'une localisation cutanée évoluée et extrêmement agressive d'un lymphome malin non hodgkinien diffus. Il s'agit d'un patient âgé de 30 ans, marié et père d'un enfant, chauffeur de profession, suivi en hémato-oncologie depuis 2 ans pour lymphome malin non hodgkinien diagnostiqué devant des poly adénopathies axillaires et inguinales, ayant bénéficié de 13 séances de chimiothérapie. Le patient a été admis au service de chirurgie plastique, réparatrice, esthétique et des brûlés du CHU Mohammed VI de Marrakech, pour prise en charge d'une localisation cutanée de son lymphome sous la forme d'une tumeur évoluée de la région latéro-thoracique gauche augmentant rapidement de taille. A l'examen, on retrouvait un patient en assez bon état général, présentant une volumineuse masse latéro-thoracique gauche, adhérente à son plan profond avec blindage axillaire homolatéral. Une biopsie partielle réalisée a confirmé à l'examen anatomo-pathologique le diagnostic de lymphome malin non hodgkinien diffus à grandes cellules. L'étude immunohistochimique et génétique n'a pas été réalisée. Les sérologies étaient négatives. L'imagerie a permis de révéler sur les coupes tomodensitométriques la présence d'une volumineuse masse ganglionnaire à prédominance axillaire et thoracique antéro-latérale gauche mesurant 30cm de diamètre, faite d'une confluence de ganglions avec persistance de ganglions nodulaires en périphérie, ulcérations cutanées et zones de nécrose. Le patient a bénéficié, dans notre structure, d'une exérèse tumorale large de propreté puis d'une couverture par de la peau mince, réduisant ainsi le volume tumoral et assurant un meilleur confort pour le patient, qui fut adressé dès cicatrisation en hémato-oncologie pour bénéficier de son traitement complémentaire.</p> 2018-05-24T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208794 Corrigendum: Elderly woman with soft tissue ossification 2021-06-16T11:32:45+00:00 Fred Bernardes Filho f9filho@gmail.com <p>This corrigendum corrects article “Elderly woman with soft tissue ossification” and its publication references ie The Pan African Medical Journal. 2017;28:307. doi:10.11604/pamj.2017.28.307.14507.</p> 2018-05-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208795 Corrigendum: Bilateral plantar deep cleft 2021-06-16T11:35:17+00:00 Fred Bernardes Filho f9filho@gmail.com <p>This corrigendum corrects article “Bilateral plantar deep cleft” and its publication references ie The Pan African Medical Journal. 2017;28:312. doi:10.11604/pamj.2017.28.312.14502.</p> 2018-05-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208796 Corrigendum: Man with a swollen mass on sacrococcygeal region 2021-06-16T11:38:42+00:00 Fred Bernardes Filho f9filho@gmail.com <p>This corrigendum corrects article “Man with a swollen mass on sacrococcygeal region” and its publication references ie The Pan African Medical Journal. 2018;29:10. doi:10.11604/pamj.2018.29.10.14447.</p> 2018-05-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208797 HTLV-1, ATLL, severe hypercalcaemia and HIV-1 co-infection: an overview 2021-06-16T11:59:55+00:00 Abdullah Ebrahim Laher abdullahlaher@msn.com Osman Ebrahim abdullahlaher@msn.com <p>HIV and HTLV (Human T-ymphotropic Virus) are the only known retroviruses responsible for causing infection in humans. HTLV-1 and HIV-1 are frequent co-pathogens, however, despite its potential for accelerated progression of HIV disease and the risk of developing adult T-cell lymphoma/leukemia (ATLL), HTLV-1 is seldom considered for investigation in the HIV-1 positive individual. Severe/refractory hypercalcaemia, unresponsive to conventional calcium lowering therapy may complicate up to 70% of cases of ATLL. In addition, HTLV-1 and ATLL have both been associated with a rise in dysfunctional CD4 lymphocytes, thereby conveying a false sense of immune competence in the HIV-1 infected individual.</p> 2018-05-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208799 Corrigendum: Yellow and black-stained fingers in a patient with headache 2021-06-16T12:02:47+00:00 Fred Bernardes Filho f9filho@gmail.com <p>This corrigendum corrects article “Yellow and black-stained fingers in a patient with headache” and its publication references ie The Pan African Medical Journal. 2017;28:318. doi:10.11604/pamj.2017.28.318.14333.</p> 2018-05-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208800 Corrigendum: Neglected tumor in a female with albinism 2021-06-16T12:05:42+00:00 Fred Bernardes Filho f9filho@gmail.com <p>This corrigendum corrects article “Neglected tumor in a female with albinism” and its publication references ie The Pan African Medical Journal. 2017;28:195. doi:10.11604/pamj.2017.28.195.14122.</p> 2018-05-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208801 Chronic tophaceous gout 2021-06-16T12:10:45+00:00 Petros Ioannou petros_io@hotmail.com Symeon Panagiotakis petros_io@hotmail.com <p>A 98-year old caucasian woman with a history of gout presented to the emergency department due to diarrhea and joint pain. Her chronic medications included allopurinol and colchicine. Physical examination revealed abdominal tenderness without rebound tenderness and normal bowel sounds, as well as enlarged, deformed, painful digits at the upper and lower limbs. The laboratory exams revealed leukocytosis, an elevated Erythrocyte Sedimentation Rate of 82mm at the 1<sup>st</sup>&nbsp;hour and a serum uric acid of 8.4mg/dl. The patient was admitted due to presumed colchicine toxicity and uric acid arthritis and was treated with intravenous hydration and corticosteroids with improvement of the arthritis and the diarrheas. Uric acid is produced from the purine metabolism after the breakdown of the nucleic acids that are produced after cell destruction and exogenous intake. Since uric acid is the end product of this metabolic pathway, its concentration in the plasma reflects a balance between production and renal excretion; however, about 10% of people are genetically predisposed to have increased uric acid concentration and are predisposed to uric acid nephropathy, nephrolithiasis, gout and development of tophi, like in our patient. Tophi are deposits of monosodium urate in the synovial or soft tissues and in the bones near the joints. Their presence signifies the presence of gout, the commonest inflammatory arthritis in elderly in the Western world. Rarely, tophi may lead to skin ulceration and discharge of chalky uric acid crystals through the skin.</p> 2018-05-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208803 Awareness and opinions regarding contraception by women of reproductive age in North-West Nigeria 2021-06-16T12:18:28+00:00 Adewole Adebola Adefalu calebadefalu2006@yahoo.com Oladapo Alabi Ladipo calebadefalu2006@yahoo.com Oluwaseun Oladapo Akinyemi calebadefalu2006@yahoo.com Oluwafemi Akinyele Popoola calebadefalu2006@yahoo.com Olajimi Oluwatosin Latunji calebadefalu2006@yahoo.com Omowunmi Folake Iyanda calebadefalu2006@yahoo.com <p><strong>Introduction:&nbsp;</strong>North-west Nigeria is a traditionally high fertility setting. Increasing attention is being channeled into scaling up the various interventions that can reduce high fertility, including enhancing contraceptive uptake among women of reproductive age. However, in order to improve demand for contraception, understanding the level of awareness, knowledge and perception of WRA to contraceptive use is essential. This study examines the level of knowledge and perception of WRA to contraceptive use.</p> <p><strong>Methods:&nbsp;</strong>a descriptive cross-sectional study was carried out in December 2016 in Kebbi and Sokoto states, North-west Nigeria. Semi-structured questionnaires were administered to 500 women between the ages of 15-49 years in 4 randomly selected local government areas across the states. Data analysis included descriptive and bi-variate statistics.</p> <p><strong>Results:&nbsp;</strong>only 43.8% claimed to be currently using a modern form of contraception; 82.4% were aware of at least one form of contraception, while health personnel formed the major source of information. The most popular and least common modern contraceptive methods were the male condom (86.8%) and vasectomy (26.6%) respectively. A higher proportion of married respondents (88.8%) than those presently single (68.8%) had good knowledge of contraceptives. Perception of contraceptives was mixed, with majority believing that contraceptives should be made available to every woman, despite stating that it contradicted their religious beliefs.</p> <p><strong>Conclusion:&nbsp;</strong>these results underline the need for policy makers to focus on improving the knowledge of younger age groups on contraceptives and include other information channels such as peer-to-peer discussions to increase awareness.</p> 2018-05-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208806 Prevalence of enteric parasitic infections among people living with HIV in Abeokuta, Nigeria 2021-06-16T12:33:24+00:00 John Kehinde Amoo oojurongbe@lautech.edu.ng Akeem Abiodun Akindele oojurongbe@lautech.edu.ng Abimbola Oladipupo Joseph Amoo oojurongbe@lautech.edu.ng Akinwale Michael Efunshile oojurongbe@lautech.edu.ng Taiwo Adetola Ojurongbe oojurongbe@lautech.edu.ng Samuel Adetona Fayemiwo oojurongbe@lautech.edu.ng Bolaji Nun Thomas oojurongbe@lautech.edu.ng Olusola Ojurongbe oojurongbe@lautech.edu.ng <p><strong>Introduction:&nbsp;</strong>enteric parasitic infections have been increasingly recognized as etiology of life-threatening chronic diarrhea in PLWHA in sub-Saharan Africa. This study investigated the prevalence and burden of intestinal parasitic infection among PLWHA in Abeokuta, southwest Nigeria.</p> <p><strong>Methods:&nbsp;</strong>freshly passed stool samples were collected from PLWHA. Detection of&nbsp;<em>Cryptosporidium spp</em>&nbsp;and&nbsp;<em>Microsporidium</em>&nbsp;spp was carried out with Kinyoun's stain and Weber's Chromotrope-based stain respectively. Investigation of other intestinal parasites was done using the direct saline preparation and formol-ether concentration methods. CD4+ T cell count was measured using Partec flow cytometry technique.</p> <p><strong>Results:&nbsp;</strong>a total of 231 (males: females 96:135; mean age 31.81±11.40 years) PLWHA were recruited into the study, among whom 84 (36.4%) were infected with at least one intestinal parasites. Fifty two (22.5%) individuals were positive for&nbsp;<em>Cryptosporidium spp</em>&nbsp;and a significant association between&nbsp;<em>Cryptosporidium spp</em>&nbsp;and diarrhea was observed (p=0.006). Seven (3.0%) were positive for&nbsp;<em>Microsporidium</em>&nbsp;spp. Helminths recovered included&nbsp;<em>Ascaris lumbricoides</em>&nbsp;(20.8%), hookworm (6.5%),&nbsp;<em>Strongyloides stercoralis</em>&nbsp;(4.3%),&nbsp;<em>Trichuris trichiura</em>&nbsp;(5.6%) and&nbsp;<em>Taenia spp.</em>&nbsp;(5.6%).&nbsp;<em>Cryptosporidium spp</em>,&nbsp;<em>Microsporidium</em>&nbsp;spp and&nbsp;<em>S. stercoralis</em>&nbsp;were significantly associated with CD4+ count ≥ 200 cells/mm<sup>3</sup>&nbsp;(p&lt;0.05).&nbsp;<em>Cryptosporidium spp</em>&nbsp;and A. lumbricoides were significantly observed among patients that are anti-retroviral therapy (ART) naive.</p> <p><strong>Conclusion:&nbsp;</strong>high prevalence of opportunistic parasitic infection was significantly correlated with diarrhea, low CD4+ count and ART naïve individuals in the study. These findings re-emphasize the need for early diagnosis of opportunistic parasites and appropriate intervention among PLWHA.</p> 2018-05-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208826 Neurosarcoïdose cérébrale 2021-06-17T05:57:18+00:00 Maha Ait Berri mahaaitberri82@gmail.com Abdelhadi Rouimi mahaaitberri82@gmail.com <p>Nous rapportons l'observation d'un patient de 37 ans qui présenta une neuropathie optique droite. L'imagerie par résonnance magnétique (IRM) révéla la présence d'un hypersignal T2 de la ligne médiane rehaussé après injection de gadolinium (figure 1). L'examen du liquide céphalo-rachidien (LCR) retrouvait une méningite lymphocytaire à 64 éléments blancs avec hyperproteinorachie. Le scanner thoracique était en faveur d'une granulomatose inflammatoire type sarcoïdose stade 2. L'enzyme de conversion de l'angiotensine était élevée. Le patient a été mis sous traitement corticoïdes avec bonne évolution. La sarcoïdose est une granulomatose diffuse, multisystémique, d'étiologie inconnue. Une localisation neurologique est observée dans 5 à 15% des cas et révélatrice dans 10 à 30% des cas. Sa présentation clinique neurologique, très variée, est représentée essentiellement par la méningo-encéphalite et l'atteinte des nerfs crâniens. Le nerf facial est le plus fréquemment touché devant le nerf optique. L'IRM cérébrale permet de mieux visualiser les lésions sous forme de nodules infiltrant en isosignal T1 et en hypersignal T2, avec un rehaussement après injection de produit de contraste. La localisation préférentielle est suprasellaire avec atteinte de l'hypothalamus, du pédoncule hypophysaire et du chiasma optique. D'autres anomalies sont volontiers visualisées par le gadolinium, notamment un épaississement diffus ou nodulaire des leptoméninges avec un aspect de pachyméningite, des lésions du parenchyme cérébral (pariétal, frontal, cérébelleux) ou de la moelle épinière. Le diagnostic repose sur la combinaison de données cliniques, radiologiques, biologiques et histologiques. Le traitement repose sur la corticothérapie en première intention, en association parfois avec des immunosuppresseurs.</p> 2018-05-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208827 The role of abdominal ultrasound in the management of excessive crying in infants 2021-06-17T06:00:57+00:00 Brahim El Hasbaoui brahim.elhasbaoui@Aol.fr Lamia Karboubi brahim.elhasbaoui@Aol.fr Badr Sououd Benjelloun brahim.elhasbaoui@Aol.fr <p>Excessive or persistent crying is a common presentation to the pediatric emergency department, and often poses a diagnostic dilemma to emergency physicians. There are several reasons for excessive or persistent crying in children, ranging from benign causes like hunger to life-threatening causes such as intussusception. The objective of this work is to specify the place of abdominal ultrasound in the diagnosis and management of incessant cries in the infant. A cross-sectional investigation for 3 months about cases of infants admitted for excessive or persistent crying to the Paediatric Emergency Medical Department of the Rabat Children's Hospital. Thirty-nine cases of excessive crying. The average age of our patients was 5.7 months with a male predominance. The incessant cries constituted the main reason for consultation in all our patients. The abdominal ultrasound performed in all the patients and revealed six cases of "Intestinal intussusception", eight cases of colic with distention gas, one case of uretero-hydronephrosis, one case with lymphadenitis mesenteric whereas it was normal in twenty-three cases. Children presenting with excess or persistent crying with no clear historical and physical examination clues, pose a diagnostic challenge to emergency physicians. This survey illustrates that despite the fact that abdominal ultrasound was normal in 58% of the cases, it made possible to make an early diagnosis of 15% of acute intestinal intussusception and it has become the gold standard in management of excessive crying in infants.</p> 2018-05-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208828 La miliaire cristalline généralisée: à propos d’un cas 2021-06-17T06:08:15+00:00 Ouiam El Anzi elanzi.ouiam@gmail.com Badreddine Hassam elanzi.ouiam@gmail.com <p>La miliaire sudorale est une manifestation cutanée bénigne liée à l’obstruction sudorale généralement témoin d’une exposition excessive à la chaleur, à l’humidité ambiante ou d’une hyperthermie. Nous rapportons le cas d’une patiente de 70 ans, diabétique sous insuline, hospitalisée au service de réanimation pour un coma acidocétosique secondaire à une pyélonéphrite. La patiente a présenté des lésions vésiculeuses diffuses au niveau de tout le corps de contenu clair, fermes à la palpation, reposant sur une peau saine, correspondant à une miliaire cristalline. La miliaire sudorale est une manifestation cutanée bénigne liée à une rétention sudorale secondaire à une obstruction des canaux sudoraux. Selon le niveau d'obstruction, on distingue la miliaire cristalline par obstruction dans le stratum cornéum; la miliaire rouge par obstruction dans le stratum malpighi et la miliaire profonde par obstruction au niveau ou en dessous de la jonction dermo-épidermique. La miliaire cristalline guérit spontanément en quelques heures en laissant une desquamation, comme c'était le cas chez notre patiente après régression du syndrome fébrile.</p> 2018-05-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208829 Docetaxel induced severe palmar plantar erythrodysesthesia 2021-06-17T06:31:16+00:00 Saoussane Kharmoum saoussane.oncomed@gmail.com Hassan Errihani saoussane.oncomed@gmail.com <p>Docetaxel is an important chemotherapeutic agent used alone or in combination for the treatment of many solid tumors, it belongs to the taxane family and is known to have some side effects. Although palmar-plantar erythrodysesthesia (PPE) or hand-foot syndrome is a relatively common toxicity of many anticancer drugs (5-fluorouracil, capecitabine and liposomal doxorubicin), it occurs rarely with docetaxel. We report the case of a 43-year-old North African woman diagnosed with locally advanced breast cancer, received neoadjuvant chemotherapy with three cycles of FEC100 regimen: 5-fluorouracil (500 mg/m<sup>2</sup>), epirubicin (100 mg/m<sup>2</sup>) and cyclophosphamide (500 mg/m<sup>2</sup>). This combination was well tolerated. Then, chemotherapy was switched to docetaxel 100mg/m<sup>²</sup>. Three days after the first cycle, the patient developed an important painful erythema in her two feet, followed by a large desquamation and swelling, which interfered with her functional activities. This reaction was classified as grade 3 PPE according to the National Cancer Institute grading system, and was treated conservatively with emollients and analgesics. In agreement with the patient, the docetaxel chemotherapy was continued with dose reduction of 20%. Symptoms disappeared within 2 weeks following dose reduction.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208830 Caractéristiques épidémio-cliniques de la tuberculose génitale chez la femme tunisienne: une série de 47 cas 2021-06-17T06:46:16+00:00 Souheil Zayet souhail.zayet@gmail.com Aida Berriche souhail.zayet@gmail.com Lamia Ammari souhail.zayet@gmail.com Mariem Razgallah souhail.zayet@gmail.com Rim Abdelmalek souhail.zayet@gmail.com Mohamed Khrouf souhail.zayet@gmail.com Badreddine Kilani souhail.zayet@gmail.com Hanène Tiouiri Benaissa souhail.zayet@gmail.com <p>L'objet est de relever les caractéristiques épidémio-cliniques, diagnostiques, thérapeutiques et évolutives de la tuberculose génitale (TG) chez la femme en Tunisie. Nous avons mené une étude rétrospective, descriptive au service des maladies infectieuses de l'hôpital la Rabta de Tunis, sur une période de 15 ans et demi (janvier 2000-juin 2014). Nous avons inclus toutes les patientes hospitalisées pour une tuberculose génitale. 47 cas ont été colligés. L'âge moyen était de 42,2 ans. Dix-huit femmes étaient d'origine rurale. Un comptage tuberculeux a été retrouvé dans cinq cas. Pour tous les cas, le début était insidieux. Un ou plusieurs signes d'imprégnation tuberculeuse ont été rapportés dans 23 cas. L'intradermoréaction (IDR) à la tuberculine réalisée chez 35 femmes (74,8%), était positive dans 26 cas (74%). Trente-neuf patientes (83%) avaient eu une exploration radiologique par une échographie et / ou une tomodensitométrie (TDM) abdomino-pelvienne. Une cœlioscopie diagnostique a été réalisée dans 37 cas (75,5%). L'examen Anatomopathologique a permis de confirmer le diagnostic de TG dans 42 cas (89,3%) en retrouvant un granulome épithéloïde et giganto-cellulaire. Nous avons relevé 21 cas de TG isolée, alors que les 26 autres avaient une atteinte péritonéale associée. Toutes les patientes ont reçu une antibiothérapie spécifique associant l'Isoniazide, la Rifampicine, le Pyrazinamide et l'Ethamubutol pour une durée moyenne de 12 mois. Aucune patiente n'a reçu de corticothérapie et aucune chirurgie secondaire n'a été indiquée. L'évolution était favorable dans 39 cas, 8 patientes ont été perdues de vue. La TG est une pathologie rare qui ne représente que 0,5% de la tuberculose extra-pulmonaire, mais d'un grand polymorphisme clinique. La confirmation diagnostique est difficile et repose sur l'étude bactériologique et/ou histologique. Le diagnostic doit être évoqué devant toute symptomatologie abdomino-pelvienne trainante, devant une stérilité chez la femme, associé à un contexte épidémio-clinique évocateur.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208832 Perforation gastrique néonatale spontanée: à propos d’un cas 2021-06-17T06:54:04+00:00 Dimitri Kanyanda Nafatalewa dimitrikn2016@gmail.com Jeff Bukasa Misenga dimitrikn2016@gmail.com Eric Mbuya Musapudi dimitrikn2016@gmail.com Pascal Monga Yebalaya dimitrikn2016@gmail.com Didier Tshibangu Mujinga dimitrikn2016@gmail.com Guy Nday Ilunga dimitrikn2016@gmail.com <p>La perforation gastrique néonatale spontanée est rare. Nous rapportons un cas survenu chez un nouveau-né de 4 jours issu d'une grossesse à terme. L’enfant a nécessité une réanimation à sa naissance. Au deuxième jour de sa vie, une distension abdominale importante était notée. La radiographie de l'abdomen sans préparation a montré un pneumopéritoine. La laparotomie a objectivé une perforation au niveau de la petite courbure gastrique de 1,5cm de diamètre qui a bénéficié d’une suture simple chirurgicale. L'évolution était marquée par le décès au premier jour post opératoire.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208833 Risk factors and prevalence of use of different tobacco products among school adolescents in the North Central region of Morocco: a crosssectional study 2021-06-17T07:05:04+00:00 Belkacem Bendaou kacem201@gmail.com Btissame Zarrouq kacem201@gmail.com Khaoula El Kinany kacem201@gmail.com Badiaa Lyoussi kacem201@gmail.com Mohamed Chakib Benjelloun kacem201@gmail.com Chakib Nejjari kacem201@gmail.com Karima El Rhazi kacem201@gmail.com <p><strong>Introduction:&nbsp;</strong>the rising number of youth smokers is a major concern to public health in Morocco. The implementation of appropriate preventive measures would require information about the prevalence and determinants of tobacco use. Data on tobacco consumption among adolescents in the North Center of Morocco are scarce. Therefore, the current study aims at investigating the risk factors of smoking and the prevalence of the use of different forms of tobacco among school teenagers in the North-Centre region of Morocco.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted in North Central Region of Morocco among students in public secondary schools selected by stratified cluster random sampling. The statistical unit devised was a school class from the seventh to the twelfth grade of the Moroccan educational system.</p> <p><strong>Results:&nbsp;</strong>a total of 3020 students (53% were males) and an average age = 16 ± 2.1 years were included in the study. The prevalence of the use of cigarettes was 16.1% (95% CI: 14.8% - 17.4%).For other tobacco types such as hookah, snuff and tobacco chewing, the prevalence was respectively 70.6%, 42.8% and 35.0% for cigarettes smokers. The level of current tobacco use was noticeably higher among boys (15.0% vs. 2.5%, p &lt; 0,001) and high school students in comparison to middle school pupils (21.2% versus 11.9%; p &lt; 0,001).</p> <p><strong>Conclusion:&nbsp;</strong>among young people, all types of smoking are growing increasingly in our Moroccan society; this alarming result can contribute to help the decision-makers to make decisions and force us obviously to take preventive measures rapidly.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208836 Soil-transmitted Helminth infection in the Tiko Health District, South West Region of Cameroon: a post-intervention survey on prevalence and intensity of infection among primary school children 2021-06-17T07:41:02+00:00 Egbe Sarah Balle Tabi samuel.cumber@gu.se Esum Mathias Eyong samuel.cumber@gu.se Eric Achidi Akum samuel.cumber@gu.se Jesper Löve samuel.cumber@gu.se Samuel Nambile Cumber samuel.cumber@gu.se <p><strong>Introduction:&nbsp;</strong>soil-transmitted helminths (STH) infection remains a public health problem in sub-Saharan Africa with children being most vulnerable. STH infection may result in impairment, permanent disability or death. Annual mass deworming has been implemented in the Tiko Health District (THD), however, no study has assessed the current prevalence of STH infection. This study aimed to determine the prevalence, intensity of STH infections and associated risk factors among school children.</p> <p><strong>Methods:&nbsp;</strong>two months after the school deworming exercise, 400 children were sampled from 10 schools in THD. Stool samples were collected and analyzed using the Kato-katz technique. Data on socio-demographic and behavioral factors were collected using questionnaires. Data were analyzed using SPSS and intensity of infection categorized following WHO recommendations. Descriptive data were calculated with frequencies (n) and proportions (%), prevalence and 95% confidence interval calculated for gender and age respectively. Differences in prevalence for socio-demographic characteristics and behavioral variables were calculated with Chi square (χ<sup>2</sup>). Independent sample t-test was used to compare the means in the number of eggs in feces between male and female school children.</p> <p><strong>Results:&nbsp;</strong>the prevalence of STH was 1% (95% CI: 0.02-1.98).&nbsp;<em>Ascaris lumbricoides</em>&nbsp;was the only STH species detected and all cases were of low intensities. The arithmetic mean egg intensity was 3.1egg per gram of faeces. Rates of infection were similar between gender and age. Site of defecation showed an association with STH infection (χ<sup>2</sup>= 13.63, p=0.03).</p> <p><strong>Conclusion:&nbsp;</strong>these findings suggested a low prevalence of STH infection which could be explained by the prior deworming of children, modification in environmental and behavioral factors. Questions on effectiveness of annual mass deworming in achieving STH elimination targets need to be investigated further.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208838 Association rare: lichen scléroatrophique extragénital et vitiligo inflammatoire chez un enfant 2021-06-17T07:45:47+00:00 Ilhame Naciri ilhamenaciri@hotmail.com Leila Benzekri ilhamenaciri@hotmail.com <p>Le lichen scléroatrophique (LSA) et le vitiligo sont deux affections dépigmentantes qui peuvent survenir séparément, ou bien rarement coexister. Leur association peut sembler logique en raison de la suspicion d'une pathogénie auto-immune dans les deux entités. Une fillette âgée de 8 ans, sans antécédents pathologiques notables, consultait pour des macules achromiques et des lésions papuleuses non prurigineuses évoluant depuis 6 mois. L'examen clinique objectivait deux types de lésions (A). Des macules achromiques, ovalaires, de 1 à 3cm de grand axe, situées au niveau du front, du cou, des épaules, ainsi que la région péri-mamelonaire et génitale. Ces lésions présentaient par endroits un liseré inflammatoire périphérique légèrement surélevé, ainsi qu'une poliose. La patiente avait également des plaques papuleuses atrophiques de teinte blanc nacré, localisées au niveau des régions inter scapulaire et abdominale ainsi qu'à la face antérieure des genoux. Deux biopsies ont été pratiquées. L'examen histologique d'une macule achromique était en faveur d'un vitiligo avec réaction inflammatoire et celui d'une lésion infiltrée faisait évoquer le diagnostic de lichen scléroatrophique. Une nette amélioration clinique était obtenue grâce à un traitement local par dermocorticoïdes. Ainsi, cette association pathologique LSA et vitiligo chez notre patiente, met en évidence le rôle déterminant du processus inflammatoire lichénoïde épidermique, dans la disparition des mélanocytes, et éventuellement dans l'induction d'un processus auto-immun.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208839 Mothers’ dietary practices in the Amoron’i Mania region Madagascar 2021-06-17T07:56:24+00:00 Lantonirina Ravaoarisoa lantonirinadr@yahoo.fr Hasina Raherimandimby lantonirinadr@yahoo.fr Julio Rakotonirina lantonirinadr@yahoo.fr Jean de Dieu Marie Rakotomanga lantonirinadr@yahoo.fr Michèle Wilmet Dramaix lantonirinadr@yahoo.fr Philippe Donnen lantonirinadr@yahoo.fr <p><strong>Introduction:&nbsp;</strong>Madagascar has one of the highest prevalence's of malnutrition worldwide. Dietary practice is an important element to consider in the fight against malnutrition. This study aims to describe mothers' dietary patterns and dietary diversity and to identify characteristics associated with this dietary diversity.</p> <p><strong>Methods:&nbsp;</strong>a cross sectional study was carried-out among 670 non-pregnant mothers aged 18 to 45, who had delivered more than 6 months earlier and were living in the Amoron'i Mania region of Madagascar. The study was conducted during the post-harvest period. A food frequency questionnaire were used to assess the dietary pattern and the women's dietary diversity score was established from the 24-hour recall data.</p> <p><strong>Results:&nbsp;</strong>almost all (99%) of mothers ate rice every day and 59% ate green leaves. Fifty three percent of mothers had consumed fruit less than once per week, 55% for legumes, 67% for vegetables and 91% for meat. Dietary diversity score ranged from 1 to 7 and 88% of mothers had a low dietary diversity score (&lt;5). On multivariate analysis, factors significantly associated with low dietary diversity were: low education level (AOR=3.80 [1.58-9.02], p=0.003), parity higher than 3 (AOR=2.09 [1.22-3.56], p=0.007), birth interval ≥ 24 months (AOR=4.01 [2.08-7.74], p&lt;0.001), rice production availability ≤ 6 months (AOR=2.33 [1.30-4.17], p=0.013), low attendance at market (AOR=4.20 [1.63-10.83], p&lt;0.001) and low movable property possession score (AOR=4.87 [2.15-11.04], p&lt;0.001).</p> <p><strong>Conclusion:&nbsp;</strong>mother's experience poor diet diversity. Unfavorable socioeconomic conditions are associated with this poor food diversification.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208840 Scleroderma and type 1 diabetes: a rare association 2021-06-17T08:00:52+00:00 Nassiba Elouarradi nassibaelouarradi@gmail.com Nawal El Ansari nassibaelouarradi@gmail.com <p>The association of type 1 diabetes and systemic scleroderma is rarely reported in the literature, the pathogenesis of this association is unknown, interferon seems to have a major role in being an immunomodulator and inhibitor of collagen production, and it is also involved in autoimmune pathology. Note that this association could be at the origin of a difficulty of passage of the insulin in the sites of injections, responsible for a major glycemic imbalance. We report the case of a 26-year-old patient, who had been diabetic for 6 years on insulin, who was referred for a glycemic imbalance, who had a clinical examination objectifying multiple morphea lesions on the roots of the thighs, arms, abdomen and thorax. A cutaneous biopsy was performed, showing a sclerodermiform appearance with significant fibrosis without sign of malignancy, result rather in favor of a scleroderma.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208842 Epidermodysplasie verruciforme: à propos d’un cas 2021-06-17T08:05:09+00:00 Fatima-Zahra Agharbi aghmarifz@gmail.com <p>L'épidermodysplasie verruciforme, également appelée&nbsp;<strong>syndrome de Lutz-Lewandowsky</strong>&nbsp;ou la maladie de l'homme-arbre est une affection cutanée rare d'origine génétique. Elle se caractérise par une sensibilité anormale du revêtement cutané aux papillomavirus. L'affection commence habituellement entre 4 et 8 ans, le plus souvent avant l'âge de 20 ans mais peut exceptionnellement apparaitre plus tardivement. Elle se traduit par l'apparition de macules squameuses et de papules d'évolution parfois exubérante, pseudo-tumorale, essentiellement au niveau des mains et des pieds. Dans ces lésions, on retrouve des papillomavirus de type 5 et 8, virus que l'on retrouve chez 80% des sujets d'une population normale asymptomatique. D'autres types de papillomavirus peuvent être parfois identifiés. Felix Lewandowsky et Wilhelm Lutz ont fait la première description clinique de cette affection. La lésion cutanée la plus fréquemment observée est une éruption maculaire proche de celle connue dans le pityriasis versicolor; s'y associent des papules d'allure verruqueuses squameuses. Le risque de transformation particulièrement en carcinome épidermoïde est important. Plusieurs traitements ont été essayés (rétinoïdes, interféron, cimétidine) avec des succès peu ou pas reproductibles. Le plus important est la protection solaire, la surveillance clinique assidue et l'excision rapide de toute lésion en voie de dégénérescence carcinomateuse. Nous rapportons l'observation d'un homme de 30 ans qui consulte pour des lésions verruqueuses multiples des membres et tronc remontant à l'âge de 4 ans associés à des lésions pityriasis versicolor like. L'examen ne trouvait pas de lésions suspectes et un traitement à base de rétinoïdes a été démarré.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208843 The effect of training problem-solving skills for pregnant women experiencing intimate partner violence: a randomized control trial 2021-06-17T08:14:48+00:00 Ziba Taghizadeh m_poo_mw@yahoo.com Maryam Pourbakhtiar m_poo_mw@yahoo.com Sogand Ghasemzadeh m_poo_mw@yahoo.com Khadijeh Azimi m_poo_mw@yahoo.com Abbas Mehran m_poo_mw@yahoo.com <p><strong>Introduction:&nbsp;</strong>intimate partner violence (IPV) in pregnancy is considered as an additional threat to the maternal/fetal health. The present study was aimed to investigate the effectiveness of training problem-solving skills on IPV against pregnant women.</p> <p><strong>Methods:&nbsp;</strong>the present randomized clinical trial was conducted on 125 and 132 women visiting the health centers of Tehran as the intervention and the control groups, respectively; samples were selected using random stratified cluster sampling. The intervention group underwent four problem-solving training sessions. Three months later, both groups completed the revised Conflict Tactics Scale questionnaire. Data were analyzed using SPSS v.16.</p> <p><strong>Results:&nbsp;</strong>the mean (SD) ages of the participants were 27.51 (4.26) and 27.02 (4.26) years, respectively, in the control and the intervention groups. The rates of the physical and psychological violence were significantly reduced after the intervention in the intervention group. Risk differences of the physical, psychological and sexual violence before and after the intervention were 3% (95% CI: -8.23 to14.13, P = 0.6), 1.5% (95% CI: -4.93 to 8.03, P = 0.6) and 4.8% (95% CI: -7.11 to 16.52, P = 0.4) in the control group and 8.8% (95% CI: -3.47 to 20.71, P = 0.1), 25.4% (95% CI: 15.77 to 34.66, P &lt; 0.001) and 4.9% (95% CI: -7.38 to16.97, P = 0.4) in the intervention group, respectively.</p> <p><strong>Conclusion:&nbsp;</strong>it seems that training this skill as a part of the routine prenatal care could be effective in reducing intimate partner violence.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208846 Elderly woman with purple rash on eyelids 2021-06-17T08:24:19+00:00 Fred Bernardes Filho f9filho@gmail.com Breno Nery f9filho@gmail.com <p>A 62-year-old woman presented with purple rash on her eyelids, erythematous and violaceous rash over the lateral thighs, and proximal muscle weakness. On physical examination, she had a pulse rate of 90/min and blood pressure of 138/90 mmHg. Dermatological examination showed reddish-purple rash on the upper eyelids and violaceous erythema on the lateral surface of the thighs. Laboratory testing was remarkable for elevated creatine kinase at 4,460. White blood cells, liver enzymes, electrolytes, antinuclear antibodies, cranial, abdominal and thorax tomography were unremarkable. Serology tests for hepatitis B, and C, HIV, syphilis, spotted fever and Lyme borreliosis were negative. The diagnosis of dermatomyositis was performed and the treatment was started with prednisone 1mg/kg daily. Dermatomyositis is a connective tissue disease that combines myopathy and distinctive skin manifestations. Creatine kinase is the muscle enzyme most widely used to diagnose polymyositis/dermatomyositis and to follow therapeutic response. There are hallmark cutaneous signs described for dermatomyositis that may or may not parallel the inflammatory myopathy. These include: violaceous to dusky erythematous rash with or without edema on periorbital skin (heliotrope rash), scaly erythematous eruption on the dorsum of hands, metacarpophalangeal joints, proximal interphalangeal joints, knees and elbows (Gottron's sign), confluent macular violaceous erythema on the anterior neck and chest ("V" sign) and confluent macular violaceous erythema present on the lateral side of hip and thighs (Holster sign). The cutaneous disease in dermatomyositis is photodistributed and often photoaggravated. The importance of recognizing dermatological signs in dermatomyositis is due to the cutaneous lesions precede muscle disease in one third to one half of patients.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208847 Considerations for the development and implementation of electronic immunization registries in Africa 2021-06-17T08:28:35+00:00 Apophia Namageyo-Funa aen5@cdc.gov Anita Samuel aen5@cdc.gov Peter Bloland aen5@cdc.gov Adam Macneil aen5@cdc.gov <p>While paper-based immunization registries are the prevalent form of documenting individual-level immunization service delivery in Africa, some countries are interested in transitioning to electronic immunization registries (EIRs) which have the potential to transform immunization data into useable information for decision making to optimize the performance of immunization programs. This report discusses opportunities and challenges in the adoption of EIRs in the African continent.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208856 Hypoparathyroïdie et démence d’installation rapide: penser au syndrome de Fahr 2021-06-17T09:32:14+00:00 Ines Kechaou kechaou.ines@topnet.tn Imène Boukhris kechaou.ines@topnet.tn <p>Le syndrome de Fahr est une entité rare dont la prévalence est inférieure à 0,5%. Ses manifestations cliniques sont variables allant des simples troubles du comportement aux crises de tétanie et aux manifestations neuropsychiatriques sévères. Il peut être idiopathique ou secondaire à de nombreuses étiologies dominées par les anomalies du métabolisme phosphocalcique dont la principale cause est l'hypoparathyroïdie. Son diagnostic positif est radiologique. Nous rapportons l'observation d'une patiente âgée de 78 ans hypertendue aux antécédents d'hypothyroïdie, d'hypoparathyroidie post thyroïdectomie totale il ya 30ans. Elle est traitée par levothyrox®100 µg 2 cp/j, un-alpha®1 µg 3cp/j et calperos® 2cp/j avec euthyroidie clinique et biologique et un bilan phosphocalcique sans anomalie. L'évolution a été marquée par l'apparition en 2010 de troubles cognitifs d'aggravation rapide avec installation d'une véritable démence en quelques mois. L'examen neurologique avait objectivé un syndrome extrapyramidal. Le scanner cérébral avait mis en évidence des calcifications étendues des noyaux gris centraux, à la jonction substance blanche substance grise linéaires, du bulbe cérébral et du cervelet. Le diagnostic d'un syndrome de Fahr, révélé par une démence suite à une hypoparathyroidie ancienne, a été alors retenu.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208857 Pustular dermatosis of the scalp due to topical minoxidil 5% 2021-06-17T09:35:02+00:00 Ouiam El Anzi elanzi.ouiam@gmail.com Badreddine Hassam elanzi.ouiam@gmail.com <p>Topical minoxidil, the only approved treatment for female pattern hair loss (FPHL), has been associated with scalp allergic contact dermatitis (ACD). We report the case of a female patient who developed ACD from minoxidil solution. A 30-year-old women presented with pruriginous and pustular lesions over an erythematous area on the scalp and forehead. These lesions had appeared after 1 week of treatment with 5% minoxidil solution (Foligan®)[minoxidil 5%, ethanol, propylene glycol and purified water], for androgenetic alopecia. Physical examination revealed multiple millimetric papulovesicles and papulopustules over an erythematous oedematous area on the frontal scalp and forehead. The patient refused to have a biopsy taken. With these clinical lesions a diagnosis of pustular contact dermatitis was made. Minoxidil solution was stopped and topical corticosteroid therapy twice a day was started. A complete clearance of the lesions could be observed after 5 days. Topical 2,6-diamino-4-piperidinopyrimidine 1-oxide (minoxidil) has been shown to be effective in the treatment of androgenetic alopecia for over 15 years. Minoxidil 5% solution has a favorable safety profile, with adverse effects limited to the site of application (5.7% of patients) and signed by pruritus, erythema, scaling and dryness. The most common causes of these symptoms include irritant contact dermatitis, allergic contact dermatitis, or exacerbation of seborrheic dermatitis. Although cases of pustular allergic contact dermatitis have been anecdotally reported. We conclude that our case is interesting in that it represents an uncommon reaction to a drug used very frequently in dermatology.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208859 Carcinome épidermoide primitif du sein mimant un abcès 2021-06-17T09:46:48+00:00 Hafsa Chahdi h_chahdi@hotmail.com Babahabib Abdellah h_chahdi@hotmail.com <p>Les cancers du sein de type épidermoïde appartiennent au cancer de type métaplasique, avec un pronostic défavorable se rapprochant des formes de phénotype basal. Son diagnostic est souvent fait au stade de masse palpable volumineuse, échappant aux campagnes de dépistage. On saura se méfier des abcès survenant chez certaines patientes comme c'est le cas de notre patiente âgée de 44ans, qui a consulté pour une masse du sein gauche diagnostiquée à la mammogr0aphie couplée à l'échographie comme une formation kystique d'allure abcédée mesurant 5,4cm x 5cm (A). Une biopsie chirurgicale a été réalisée et dont l'examen anatomopathologique trouvait une prolifération tumorale faite de larges lobules carcinomateux avec une différenciation malpighienne nette estimée à plus de 90%(B). Les cellules tumorales étaient très atypiques et montraient de nombreuses figures mitotiques. A l'étude immunohistochimique les cellules tumorales exprimaient les cytokératines 5/6 (C). L'indexe de prolifération était estimé à 85% (D). Les récepteurs hormonaux et l'hercept test étaient négatifs. Le diagnostic retenu était celui d'un carcinome métaplasique de type carcinome épidermoide. Notre patiente a bénéficié d'une mastectomie gauche avec curage axillaire et d'une chimiothérapie adjuvante suivie de radiothérapie. L'évolution avec un recul de neuf mois n'a pas révélé de récidive ou de métastase.</p> 2018-05-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208860 Intimate partner violence and current modern contraceptive use among married women in Uganda: a cross-sectional study 2021-06-17T09:55:03+00:00 Stephen Ojiambo Wandera swandera@gmail.com Betty Kwagala swandera@gmail.com Clifford Odimegwu swandera@gmail.com <p><strong>Introduction:&nbsp;</strong>this paper examined the relationship between Intimate Partner Violence (IPV) and current modern contraceptive use (MCU) among married women in Uganda.</p> <p><strong>Methods:&nbsp;</strong>we used the 2011 Uganda Demographic and Health Survey (UDHS) data, selecting a weighted sample of 1,307 married women from the domestic violence module. Chi-squared tests and multivariate complementary log-log (clog-log) regressions were used to examine the relationship between IPV and current MCU, controlling for women's socio-demographic factors.</p> <p><strong>Results:&nbsp;</strong>significant predictors of current MCU (25.3%) among married women were: women's reported ability to ask a partner to use a condom, number of living children and wealth index. The odds of current MCU were higher among women who could ask their partners to use a condom (aOR = 1.87, 95% CI: 1.26-2.78), had more than one child (aOR = 2.05, 95% CI: 1.07,3.93) and were from better wealth indices for example the richest (aOR = 2.52, 95% CI: 1.25-5.08). IPV was not associated with current MCU independently and after adjusting for women's socio-demographic factors.</p> <p><strong>Conclusion:&nbsp;</strong>in Uganda's context, IPV was not associated with current MCU. Interventions to promote MCU should enhance women's capacity to negotiate MCU within union and target women of lower socio-economic status.</p> 2018-05-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208861 Utilization of Kenya’s free maternal health services among women living in Kibera slums: a cross-sectional study 2021-06-17T09:59:28+00:00 Angela Owiti julias.oyugi9@gmail.com Julius Oyugi julias.oyugi9@gmail.com Dirk Essink julias.oyugi9@gmail.com <p><strong>Introduction:&nbsp;</strong>this study was aimed at determining factors affecting utilization of public health facilities by pregnant Kenyan women living in Kibera slums, Nairobi since the implementation of the Free Maternal Service (FMS) Program in 2013.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional study done on 396 women who delivered between 2014 and 2015. Interview questions addressed socio-demographic characteristics, perception of quality of care in public health facilities, awareness of the FMS Program, antenatal care (ANC) and delivery service utilization.</p> <p><strong>Results:&nbsp;</strong>43.9% delivered in a public health facility, 30.3% in a private non-profit health facility (NGO), 22.7% in a private health facility and 3.0% at home. Of the 97% of the women who delivered in a health facility, only 43.9% delivered in a public health facility despite these facilities having free maternal services. Factors that favoured the Free Maternal Service uptake included a positive perception of the public health facility, living within close proximity, learning about the Program from a support group and a short waiting time before being examined by the doctor. On the other hand, safe delivery, quality of service, accessing a health facility on foot, ANC attendance at a private and a non-profit health facility were associated with low uptake of the free maternal services.</p> <p><strong>Conclusion:&nbsp;</strong>the uptake of the Free Maternal Service program can improve if the Kenyan government directs its efforts towards changing women’s perception on quality of care in public health facilities and to improve access to health facilities in slum areas of Nairobi.</p> 2018-05-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208862 Fracture de l’épicondyle médial et latéral associée a une luxation du coude chez l’enfant (à propos d’un cas) 2021-06-17T10:48:02+00:00 Sara Hachri ChirPed87@gmail.com Hind Abouljaoud ChirPed87@gmail.com Hind Cherrabi ChirPed87@gmail.com Karima Atarraf ChirPed87@gmail.com Lamiae Chater ChirPed87@gmail.com My Abderrahmane Afifi ChirPed87@gmail.com <p>La luxation du coude est une lésion relativement rare chez l’enfant. Elle représente 3 a 6% des traumatismes du coude, On constate souvent des fractures associées à cette luxation, ce sont le plus souvent des fractures de l’épicondyle médial, l’association d’une fracture de l’épicondyle latéral et médial à la fois à une luxation reste exceptionnelle. Nous rapportons le cas d’un enfant âgé de 13 ans victime d’un traumatisme du coude gauche par un mécanisme indirect. L’examen locomoteur a objectivé un coude gauche tuméfié, déformé avec une impotence fonctionnelle totale. La radiographie a mis en évidence une luxation posteroexterne du coude associée à une fracture de l’épicondyle latéral et de l’épicondyle médial qui se trouve incarcéré en intra articulaire. La prise en charge a consisté en une réduction de la luxation sous anesthésie, avec un contrôle scopique objectivant une bonne réduction, une fracture de l’épicondyle latéral jugée stade 1 selon la classification de Lagrange et Rigault après réduction et une fracture de l’épicondyle médial stade 2 selon la classification de Watson-Jones, d’où la décision d’opérer cette dernière, avec un abord postéromédial du coude. Le contrôle radiologique post opératoire immédiat et à distance jugé satisfaisant avec une ablation de l’attelle faite à 3 semaines, et une ablation de matériel d’ostéosynthèse faite à 6 semaines, une rééducation du coude était prescrite, avec un bon résultat clinique.</p> 2018-05-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208871 Spontaneous hematoma of the rectus sheath following percutaneous transluminal coronary angioplasty and stent placement 2021-06-17T10:53:11+00:00 Rodolfo Mendes Queiroz f9filho@gmail.com Fred Bernardes Filho f9filho@gmail.com <p>A 74-year-old female with hypertension, coronary artery disease, was hospitalized due to an acute myocardial infarction. A percutaneous transluminal coronary angioplasty (PTCA) and stenting were performed successfully. After six hours of PTCA, an intense abdominal pain localized on right iliac fossa started. On physical examination, a palpable, painful, firm, nonpulsatile abdominal mass was observed. Fothergill’s and Carnett’s signs were present; there were not Cullen's and Grey Turner's signs. Abdominal computed tomography (CT) showed oval collection, isodense in relation to the muscular planes, located in almost all the extension of the rectus abdominis muscle on the right, measuring in its greater axial axes 8.6 x 6.0 cm. Patient did not present drop of the hemoglobin levels nor hemodynamic instability. The diagnosis of hematoma of the rectus sheath was performed and conservative management was elected. Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain and can be life threatening if diagnosis and management is delayed. RSH occurs due to the accumulation of blood within the rectus abdominis sheath secondary to bleeding from damaged inferior or superior epigastric arteries, or through direct tears of the rectus abdominis muscle. Abdominal pain and fall in hemoglobin with presence of risk factors (especially systemic anticoagulation drugs like warfarin and intravenous heparin) constitute important clinical clues to the diagnosis. Management is guided by the size of the haematoma and haemodynamic stability of the patient. Clinicians should consider RSH in the differential diagnosis of acute abdominal pain.</p> 2018-05-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208873 The effect of kangaroo mother care on physiological parameters of premature infants in Hamadan City, Iran 2021-06-17T11:23:44+00:00 Parisa Parsa karimi.midwife.65@gmail.com Simin Karimi karimi.midwife.65@gmail.com Behnaz Basiri karimi.midwife.65@gmail.com Godratalah Roshanaei karimi.midwife.65@gmail.com <p><strong>Introduction:&nbsp;</strong>breast-feeding and being with mother have positive effects on the preterm infant's health status. Therefore, this study was conducted to evaluate the effect of Kangaroo Mother Care (KMC) on physiological parameters of premature infants in Fatemiyeh Hospital in Hamadan in 2016.</p> <p><strong>Methods:&nbsp;</strong>this was a quasi-experimental study. One hundred newborns who were admitted to in neonatal intensive care unit of Fatemiyeh Hospital in Hamadan city, Iran were selected by convenience sampling. They were randomly divided into two groups (experimental group, n = 50 and control group, n = 50). In the experimental group, newborns were taken daily KMC for an hour during 7 days. In the control group, routine care was performed in the incubator. The data gathering tool was questionnaire of infants and mother characteristics, checklists of vital signs and oxygen saturation. Data analysis was performed by SPSS 19 software using descriptive and inferential statistics (Independent t -test, Paired t-test, Chi-square, ANOVA).</p> <p><strong>Results:&nbsp;</strong>before intervention, there was no significant difference between the physiological parameters of the infants (heart rate, respiratory rate, arterial blood oxygen saturation and temperature) in experimental and control groups. However, after intervention, there was a significant difference between the two groups in terms of physiological indices (p &lt; 0.001).</p> <p><strong>Conclusion:&nbsp;</strong>the findings of this study indicate the effect of KMC on enhancement of physiological indices. Therefore, it is recommended that KMC is taken as one of the routine care of premature infants.</p> 2018-05-31T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208878 Métastases cérébrales d’un léiomyosarcome utérin 2021-06-17T11:27:16+00:00 Hafsa Chahdi h_chahdi@hotmail.com Mohamed Oukabli h_chahdi@hotmail.com <p>Une patiente de 46 ans, ayant comme antécédents une hystérectomie totale en 2011 pour léiomyosarcome utérin suivie de séances de radiothérapie, a présenté brutalement un déficit hémicorporel droit et chez qui l'examen clinique a trouvé un syndrome pyramidal droit. L'imagerie par résonance magnétique (IRM) cérébrale a montré la présence d'un processus tumoral agressif extra axial fronto-parietal gauche (A). La patiente a bénéficié d'une exérèse chirurgicale de la lésion cérébrale. L'examen anatomopathologique a objectivé l'existence d'une prolifération tumorale d'architecture fusocellulaire (B). Les cellules tumorales sont d'allures musculaires discrètement atypiques, quelques figures de mitose sont notées ainsi que des foyers de nécrose. Cette prolifération tumorale infiltrait l'os, les parties molles et la dure-mère. Une étude immunohistochimique a été réalisé et a objectivé un marquage positif des cellules tumorales par l'anti h-caldesmone (C) et l'anti actine muscle lisse. Le diagnostic de métastase cérébrale d'un leiomyosarcome a été retenu. La patiente a subi des séances de radiothérapie avec comme résultat actuel une amélioration du déficit moteur.</p> 2018-05-31T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208879 Malnutrition among HIV infected children under 5 years of age at the Laquintinie hospital Douala, Cameroon 2021-06-17T12:02:49+00:00 Calixte Ida Penda idapenda@yahoo.fr Else Carole Eboumbou Moukoko idapenda@yahoo.fr Nicolas Policarpe Nolla idapenda@yahoo.fr Nadia Olivia Abomo Evindi idapenda@yahoo.fr Paul Koki Ndombo idapenda@yahoo.fr <p><strong>Introduction:&nbsp;</strong>the aim of this study was to assess the prevalence of malnutrition among HIV infected children under five years of age followed up at the Laquintinie Hospital Douala (LHD).</p> <p><strong>Methods:&nbsp;</strong>medical records of children aged 13 days-59 months enrolled at initiation of antiretroviral treatment in the Day Care Unit/LHD, were reviewed for a period of 14 years (from 2002 to 2015). We used standard Z-scores, with cut-off point of &lt;-2 SD to define low height-for-age (HAZ), low weight-for-height (WHZ) and low weight-for-age (WAZ). Factors associated with malnutrition were assessed according to World Health Organization (WHO) criteria.</p> <p><strong>Results:&nbsp;</strong>overall, 217 medical records were included and 52.5% were records of boys. The median weight, height and age of the children was 9.5 kg (range: 2.5-20), 76 cm (range: 46- 117) and 22 months (range: 0.03-59), respectively. The overall prevalence of malnutrition among HIV-infected children was 68.7%; 63.6% were stunted (HAZ&lt;-2), 37.8% were underweight (WAZ&lt;-2) and 18.4 % were wasted (WHZ&lt;-2). Severe and advanced immunological stages of HIV according to WHO were found in 42.4%, (39/92) and 17.4%, (16/92) of children respectively, and most of them (21.7%) were aged 12-36 months. The overall prevalence of anemia, oropharyngeal candidiasis and pulmonary tuberculosis were 34.6%, 12% and 8.8%, respectively. Oropharyngeal candidiasis was a risk factor independently associated with severe underweight and wasting (OR = 4.9, 95% CI: 1.8-13.5, p = 0.002) and (OR = 5.1, 95% CI: 1.5-17.1, p = 0.007).</p> <p><strong>Conclusion:&nbsp;</strong>HIV infection negatively affects the nutritional status of children under five years of age. Early detection of malnutrition is necessary and adequate nutrition should be integrated into the management of pediatric HIV.</p> 2018-05-31T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208890 Asystolie au cours d’une chirurgie pour tumeur de l’intestin grêle: anaphylaxie ou crise carcinoïde 2021-06-22T06:18:45+00:00 Ismail Aissa aissa660@gmail.com Aziz Benakrout aissa660@gmail.com Mohamed Meziane aissa660@gmail.com Mustapha Bensghir aissa660@gmail.com Salim Jaafar Lalaoui aissa660@gmail.com <p>L'arrêt cardiaque au bloc opératoire est un événement redoutable, ces étiologies sont multiples. Nous rapportons le cas d'une patiente de 53 ans sans antécédents pathologiques particuliers, programmée pour cure chirurgicale d'une tumeur de l'intestin grêle. 20 minutes après l'induction anesthésique la patiente a présenté une asystolie rapidement réversible après les mesures de réanimation, l'association d'un rush cutané du visage et du thorax a fait suspecter une réaction anaphylactoïde tardive. L'amélioration rapide de la patiente a permis l'autorisation d'une reprise de l'intervention. Le début de la manipulation tumorale a occasionné une deuxième bradycardie extrême rapidement résolutive après 0,5 mg d'atropine, une réapparition du rush cutané au niveau du visage et du thorax a été observée, cette deuxième complication a rapidement fait suspecter une crise carcinoïde conduisant à l'administration du sandostatine. Aucun incident n'a été signalé ultérieurement, la patiente a passée 24 heures en réanimation sous une perfusion de sandostatine. Les valeurs du 5-HIAA urinaire étaient très élevées et l'examen histologique de la pièce opératoire a confirmé la nature carcinoïde de la tumeur. Nous soulignons la rareté de cette entité et l'intérêt de penser à une crise carcinoïde devons la survenue de complications peropératoires au cours d'une anesthésie pour tumeur de l'intestin grêle.</p> 2018-05-31T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208997 Plasma hemoglobin concentration among pregnant and non-pregnant women in Mwanza: are we using correct reference values to diagnose anemia in pregnancy? 2021-06-22T06:28:26+00:00 Haruna Dika hdika2001@yahoo.co.uk Elizabeth Masawe hdika2001@yahoo.co.uk Shabani Iddi hdika2001@yahoo.co.uk Richard Rumanyika hdika2001@yahoo.co.uk <p><strong>Introduction:&nbsp;</strong>the definition of anemia has attracted considerable interest because several studies have demonstrated that hematologic profile vary with ethnicity in addition to age, sex and altitude. This has led scholars to recommend the use of population specific hematologic reference values in diagnosing blood disorders. However, there is limited information about Tanzanians population specific hemoglobin (Hb) levels which can be used to set cut-off points to define anemia. This study aimed to determine plasma Hb concentrations among healthy Tanzanian women.</p> <p><strong>Methods:&nbsp;</strong>this cross sectional study was done in Mwanza. Sociodemographic data were collected using questionnaires and plasma Hb concentrations were measured by calorimetric method. Data were analyzed using SPSS.</p> <p><strong>Results:&nbsp;</strong>a total of 215 (162 pregnant, 53 non-pregnant) women with a mean age of 28.2 ± 6.54 years participated in the study. The mean plasma Hb concentrations were 12.0 ± 1.43 mg/dl and 11.9 ± 1.15 mg/dl for pregnant and non-pregnant women respectively. The Hb levels did not significantly vary between pregnant and non-pregnant women. Using WHO reference values, 45.3% non-pregnant and 26.5% pregnant women were found to be anemic while using the population specific reference, only 1.9% of pregnant and none of non-pregnant women would be classified as anemic.</p> <p><strong>Conclusion:&nbsp;</strong>most Tanzanian women who are diagnosed to have anemia during pregnancy, often had developed lower Hb before pregnancy and operational thresholds for diagnosis of anemia observed in this study are lower than WHO recommended references values. We recommend a large scale study to determine hematological profile of Tanzanian.</p> 2018-05-31T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/208999 Imagerie de la cellulite orbitaire chez l’enfant: à propos de 56 cas 2021-06-22T06:33:53+00:00 Dounia Basraoui douniabasraoui@gmail.com Ayoub Elhajjami douniabasraoui@gmail.com Hicham Jalal douniabasraoui@gmail.com <p>Les cellulites orbitaires de l'enfant sont rares mais potentiellement graves, le diagnostic est principalement basé sur l'examen clinique et l'imagerie (tomodensitométrie ou IRM). Le but de ce travail est d'illustrer le rôle de l'imagerie, essentiellement la TDM, dans le diagnostic et la prise en charge de cette pathologie. Il s'agit d'une étude rétrospective portant sur 56 cas de cellulite orbitaire, colligés durant six années au service de radiologie de l'hôpital mère-enfant du CHU Mohammed VI de Marrakech (de janvier 2011 à octobre 2017), explorés par TDM crânio-orbitaire. L'âge moyen des patients était de 5 ans, avec une légère prédominance féminine. La porte d'entrée était dominée par l'atteinte sinusienne retrouvée chez 22malades. L'analyse des résultats tomodensitométriques a noté 37 cas de cellulite préseptale (66%), 3 cas de cellulite rétroseptale isolée (5%), 16 cas de cellulite mixte (28%), 8 cas d'exophtalmie (14%) et 4 cas d'abcès sous-périosté (7%). Les cellulites orbitaires de l'enfant sont des infections graves, entravant le pronostic vital à court terme et le pronostic fonctionnel visuel à moyen et long terme, le diagnostic positif est clinique. L'imagerie joue un rôle important dans le diagnostic topographique et étiologique, ainsi que pour guider le traitement.</p> 2018-05-31T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209000 Ecthyma gangrenosum 2021-06-22T06:38:34+00:00 Ahlam Abdou ahlam.siham.abdou@gmail.com Badredine Hassam ahlam.siham.abdou@gmail.com <p>Ecthyma gangrenosum (EG) est une infection cutanée sévère, potentiellement mortelle qui évolue séquentiellement d’abord à type d’éruption maculo-papuleuse, puis une bulle hémorragique, puis vers une ulcération nécrotique entourée d’un érythème EG se produit généralement chez les patients immunodéprimés (aplasie secondaire à la chimiothérapie, infection par le VIH, neutropénie ou déficit fonctionnel des polynucléaires neutrophiles, agammaglobulinémie). Rarement, il affecte les individus en bonne santé. Le diagnostic différentiel inclut la leishmaniose, le pyoderma gangrénosum, les escarres et les tuberculides papulo-nécrotiques. Les hémocultures et/ou le prélèvement local permettent d’isoler le germe en cause qui est toujours un&nbsp;<em>P. aeruginosa</em>. Le traitement repose en une antibiothérapie parentérale adaptée à l’antibiogramme (céphalosporine de troisième génération, fluoroquinolones). Nous présentons le cas d’un enfant de 2 ans sans antécédents pathologiques notables qui a présenté de multiples ulcérations nécrotiques localisées au niveau du dos avec une bordure érythémateuse le tout évoluant dans un contexte fébrile. L’hémoculture n’a pas mis en évidence de germe. Le bilan biologique a objectivé une VS élevée à 30mm, une CRP à 80mg/l. Un prélèvement bactériologique du pus a révélé le pseudomonas aeruginosa. Le diagnostic d’ecthyma gangrénosum a été posé. Le patient a été mis sous céphosporine troisième génération par voie parentéale. La guérison complète avec cicatrisation a eu lieu après 4 semaines.</p> 2018-06-05T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209001 Challenges faced by marginalized communities such as transgenders in Pakistan 2021-06-22T06:56:37+00:00 Hassan Bin Usman Shah hassanbinusman@hotmail.com Farah Rashid hassanbinusman@hotmail.com Iffat Atif hassanbinusman@hotmail.com Muhammad Zafar Hydrie hassanbinusman@hotmail.com Muhammad Waleed Bin Fawad hassanbinusman@hotmail.com Hafiz Zeeshan Muzaffar hassanbinusman@hotmail.com Abdul Rehman hassanbinusman@hotmail.com Sohail Anjum hassanbinusman@hotmail.com Muhammad Bin Mehroz hassanbinusman@hotmail.com Ali Haider hassanbinusman@hotmail.com Ahmed Hassan hassanbinusman@hotmail.com Hassaan Shukar hassanbinusman@hotmail.com <p><strong>Introduction:&nbsp;</strong>stigmatization, social exclusion and consequent banishment from the society makes transgender's life even tougher; isolating, pushing and forcing them into inappropriate conducts/habits like selling sex. This study investigates the association of social exclusion/victimization with high-risk behaviors among transgender community of Rawalpindi and Islamabad (Pakistan).</p> <p><strong>Methods:&nbsp;</strong>through a cross-sectional study design, a sample of 189 transgender community living in twin cities of Rawalpindi and Islamabad was selected using snowball sampling technique. A validated close ended questionnaire was used to estimate the high-risk behaviors. Multivariate logistic regression was used to explore the competing outcomes associated with suicidal risk, selling sex and substance abuse.</p> <p><strong>Results:&nbsp;</strong>majority study participants 77.8% experienced physical attacks with institutional discrimination even higher (91.5%). Commercial sex work and drug abuse was reported in 39.2% and 37.6% respectively. The prevalence of suicide ideation was high (38.6%) however, suicide attempted rate was less (18.5%). In the multivariate logistic regression, compared to those with no risk, being physically attacked increased the odds of both attempting (OR=2.18) and contemplating suicide and selling sex (OR=4.10). Nevertheless, the relative impact of institutional victimization on suicidal behavior was higher among those who were targeted on the basis of their gender identity or expression (AOR = 6.20, CI = 1.58-24.29, p=0.009).</p> <p><strong>Conclusion:&nbsp;</strong>the transgender community is socially excluded by the Pakistani society where they experience high levels of physical abuse and face discriminatory behavior in daily life. Such attitudes make them vulnerable for risky behaviors; forcing them to become commercial sex workers, begging, drugs use and even suicidal ideation.</p> 2018-06-05T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209003 Hypertension prevalence and risk factors in rural and urban Zambian adults in western province: a cross-sectional study 2021-06-22T07:01:58+00:00 Kathy Lynn Rush Kathy.rush@ubc.ca Fastone Matthew Goma Kathy.rush@ubc.ca Jessica Amelia Barker Kathy.rush@ubc.ca Rachel Ann Ollivier Kathy.rush@ubc.ca Matthew Scott Ferrier Kathy.rush@ubc.ca Douglas Singini Kathy.rush@ubc.ca <p><strong>Introduction:&nbsp;</strong>hypertension is a longstanding problem in Zambia, yet little is known about its prevalence and risk factors, particularly in rural and urban settings. Identifying geographical variations in hypertension is important to enhance the health of adult Zambians regardless of where they live. Therefore, the purpose of this study was to compare the prevalence of hypertension and related risk factors between rural (n = 130) and urban (n = 131) communities in Western Province, Zambia.</p> <p><strong>Methods:&nbsp;</strong>this cross-sectional study included urban and rural adult Zambians attending health checks who completed a modified World Health Organization (WHO) survey, and had blood pressure and anthropometric measurements completed. Descriptive statistics were used to summarize demographic and risk factor variables. Chi-square tests of association were used to analyze relationships between categorical variables, t-tests to analyze relationships between continuous variables and logistic regression to examine associations of hypertension with selected risk factors.</p> <p><strong>Results:&nbsp;</strong>the prevalence of hypertension in rural Zambians was double (46.9%) that of urban Zambians (22.9%). Increasing age, not engaging in walking/biking, and alcohol intake within the last 30 days were associated with an increased likelihood of hypertension in rural Zambians while eating vegetables more days during the week was associated with a decreased likelihood of hypertension in rural Zambians. Body Mass Index (BMI) was significantly associated with an increased likelihood of hypertension in urban Zambians.</p> <p><strong>Conclusion:&nbsp;</strong>modifiable risk factors (such as BMI, dietary intake, and physical activity) are associated with hypertension prevalence in this population, indicating opportunities for screening and other prevention measures.</p> 2018-06-05T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209005 Prevalence of inflammatory back pain and radiologic sacroiliitis is increased in patients with primary Sjögren’s syndrome 2021-06-22T07:07:55+00:00 Rafet Eren drrafeteren@gmail.com Meryem Can drrafeteren@gmail.com Fatma Alibaz-Öner drrafeteren@gmail.com Sibel Yilmaz-Oner drrafeteren@gmail.com Baris Yilmazer drrafeteren@gmail.com Ayse Cefle drrafeteren@gmail.com Haner Direskeneli drrafeteren@gmail.com Pamir Atagündüz drrafeteren@gmail.com <p><strong>Introduction:&nbsp;</strong>the prevalence of Sjögren's syndrome (SS) in patients with the diagnosis of SpA has been reported to be higher than normal population. Yet, the vice-versa is unclear. In this study, we aimed to investigate the prevalence of IBP, radiologic sacroiliitis and SpA in patients with primary SS.</p> <p><strong>Methods:&nbsp;</strong>85 patients followed at the rheumatology clinics of the Marmara and Kocaeli Universities with the diagnosis of primary SS between November 2011 and August 2012 were included in this study. The control group consisted of 100 age-and gender-matched patients. Inflammatory back pain and axial SpA were diagnosed according to the assessment of spondylo arthritis International Society (ASAS) criteria.</p> <p><strong>Results:&nbsp;</strong>83 patients were (97%) female and 2 (3%) were male. Mean age of the patients was 49.1 (±11) years. Mean disease duration was 7.3 (±4) years. The patient and control groups were comparable in terms of age and gender (p &gt; 0.05). Inflammatory back pain was observed in 21 (24.7%) of 85 primary SS patients and in 4 (4%) of 100 control subjects (p &lt; 0.001), radiographic sacroiliitis was demonstrated in 9 (10.5%) of primary SS patients and 2 (2%) of the control subjects (p = 0.025). Remaining SpA findings were not encountered in either group.</p> <p><strong>Conclusion:&nbsp;</strong>inflammatory back pain and radiologic sacroiliitis is increased in patients with primary SS. Whether IBP, SI joint inflammation and radiologic sacroiliitis is due to the co-existence of SpA and primary SS or IBP is an underdiagnosed clinical feature of SS deserves further studies of large patient numbers.</p> 2018-06-05T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209006 Femoral bifurcation and bilateral tibial hemimelia: case report 2021-06-22T07:14:15+00:00 Joshua Ondari jondari59@gmail.com James Kinyanjui jondari59@gmail.com Paul Miano jondari59@gmail.com Edward Sang jondari59@gmail.com Ezekiel Oburu jondari59@gmail.com Michael Maru jondari59@gmail.com <p>Femoral bifurcation and tibial hemimelia are rare anomalies described as a variant of Gollop-Wolfgang complex. This article presents a case of Gollop-Wolfgang complex without hand ectrodactyly. A 5-year old patient presented with bilateral tibial hemimelia and left femoral bifurcation. The patient's left limb lacked knee extensor mechanism, disarticulation was done. The right leg which had Jones type 2 tibia hemimelia was treated with tibiofibular synostosis. Currently patient is ambulant with prosthesis on the left limb and ankle foot orthosis on the right. In the absence of proximal tibial anlage, especially in patients with femoral bifurcation, the knee should be disarticulated. Tibiofibular synostosis is a good choice in the presence of a proximal tibial anlage with good quadriceps function.</p> 2018-06-05T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209008 Oxygénothérapie hyperbare dans la prise en charge du pied diabétique: expérience d’un service de médecine interne à propos de 80 cas 2021-06-22T07:18:56+00:00 Mohamed Jira jiramohamed@yahoo.fr Naoual El Omri jiramohamed@yahoo.fr Youssef Sekkach jiramohamed@yahoo.fr Fadoua Mekouar jiramohamed@yahoo.fr Taoufik Amezyane jiramohamed@yahoo.fr <p>L'oxygénothérapie hyperbare (OHB) est un procédé thérapeutique dans la prise en charge des lésions chroniques menaçant le pied chez les patients diabétiques. Dans le but d'évaluer ce traitement, les auteurs proposent une analyse rétrospective des patients diabétiques présentant une ou plusieurs lésions chroniques aux niveaux des membres inférieurs et ayant bénéficier de l'OHB. Il s'agit de 80 patients, hospitalisés dans un service de médecine interne sur une période de 10 entre janvier 2006 et décembre 2016. Ces patients ont bénéficié de 20 ± 5 séances d'OHB à raison de 2,5 atmosphères absolues sous oxygène pur pendant 90 minutes par séance et par jour associées à une insulinothérapie, une antibiothérapie adaptée, des soins locaux quotidiens. L'évolution des lésions a été évaluée par l'examen clinique avec des mesures répétées de la taille des lésions à la cinquième, quinzième et vingtième séance d'OHB. Notre étude a inclus 80 patients dont 72 hommes et 8 femmes, leur age moyen était de 56,2 ± 4,62 ans, 77,5% présentaient un diabète type 2, évoluant depuis 13,9±3,3 ans. Ils avaient des lésions chroniques du pied (grade 2, 3 ou 4 de Wagner). Une réduction significative de la surface de la plaie a été observée dés la dixième séance avec cicatrisation complète et guérison chez 56 (70%) de nos patients au terme de 20 séances d'OHB. L'amputation a été notée chez 20 (25%) patients. L'OHB est reconnue dans le traitement des lésions chroniques du pied chez le diabétique, elle permet de réduire considérablement l'incidence des amputations.</p> 2018-06-05T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209009 The pharmacist’s role in managing and ameliorating childhood’s asthma care: a descriptive and transversal study about 104 pharmacists in the city of Rabat in Morocco 2021-06-22T07:23:16+00:00 Bousayna Iraqi dr.iraqibousayna@gmail.com Imane Jroundi dr.iraqibousayna@gmail.com Amina Iraqi dr.iraqibousayna@gmail.com Chafiq Mahraoui dr.iraqibousayna@gmail.com <p>This work aims at enhancing the management of childhood asthma, with a focus on pharmacists in particular, by evaluating their knowledge of childhood asthma and assessing their attitude while they are providing asthma medicines. Consequently, it will look at the necessity of introducing training days about childhood asthma for pharmacists. This is a transversal and descriptive study which lingered from August to October 2015. Data has been collected using a questionnaire that was self-administered to every surveyed pharmacist in the city of Rabat. The 104 pharmacists who replied to the questionnaire have an average general understanding about asthma and its treatment. Only a quarter of them managed an asthma crisis in their pharmacy before directing the child to the emergency. 50% of them do not know the difference between the basic asthma therapy and the asthma attack therapy. However, all of them recommended the parents to see a physician regarding their child’s asthma. 75% advise the systematic use of an asthma spacer with the inhaler. 87.5% of them give advice to parents regarding the good measures for environmental control, and 98% estimate that the therapeutic education is important in childhood asthma management. 88.5% among them are interested in training days about childhood asthma.This study shows the necessity of further pharmacists’ education about asthma and its management.</p> 2018-06-06T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209010 La dentisterie holistique au service de la santé globale 2021-06-22T07:26:21+00:00 Saida El Khayati azisa2020@hotmail.fr Amal El Yamani azisa2020@hotmail.fr <p>Les amalgames dentaires constituent des matériaux d'obturation utilisés pour le traitement des lésions carieuses depuis plus de 150 ans. Cependant le mercure servant de base à la préparation des amalgames est universellement considéré comme un toxique très dangereux pour l'être humain. L'objectif de ce travail est de monter à travers un cas clinique certains signes locaux et généraux d'intoxication au mercure, les précautions à prendre lors de la dépose des amalgames, ainsi que les solutions de remplacements actuels qu'on doit proposer à nos patients. En réalité la toxicité des amalgames n'est que la partie émergée de l'iceberg. Les autres métaux employés en dentisterie peuvent également provoquer des problèmes importants en induisant des effets galvaniques, des intolérances, des allergies, des réactions d'intoxication ou de sub-intoxication. En matière de santé publique, ces motifs justifient amplement l'intérêt que tout thérapeute doit accorder aux alternatives prothétiques n'incluant pas de métal.</p> 2018-06-06T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209012 Angioedema, an unusual reaction to hair dye 2021-06-22T07:34:37+00:00 Reginald Mzudumile Ngwanya ladu@vodamail.co.za Zandile Spengane ladu@vodamail.co.za Nonhlanhla Khumalo ladu@vodamail.co.za <p>Angioedema is a type-1 hypersensitivity reaction that can be life threatening. It affects the skin airways and the gastrointestinal tract. Henna is a green powder used to dye skin and nails. We report a 29 year old patient who presented with angioedema Her patch test was positive to paraphenynlenediamine. She was discharged after successful treatment with intravenous steroids and later topical steroids.</p> 2018-06-06T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209013 Corrigendum: Abcès tuberculeux de la face postérieure de la cuisse: à propos d’un cas 2021-06-22T08:04:13+00:00 Mohammed Chahbouni chahbouni.mohammed1981@gmail.com Issam Eloukili chahbouni.mohammed1981@gmail.com Moulay Omar Lamrani chahbouni.mohammed1981@gmail.com Mohamed Kharmaz chahbouni.mohammed1981@gmail.com Farid Ismail chahbouni.mohammed1981@gmail.com Mustapha Mahfoud chahbouni.mohammed1981@gmail.com Ahmed El Bardouni chahbouni.mohammed1981@gmail.com Mohamed Saleh Berrada chahbouni.mohammed1981@gmail.com Mouradh El Yaacoubi chahbouni.mohammed1981@gmail.com <p>This corrigendum corrects article “Abcès tuberculeux de la face postérieure de la cuisse: à propos d’un cas. The Pan African Medical Journal. 2014;19:50. doi:10.11604/pamj.2014.19.50.4683.</p> 2018-06-06T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209014 Lymphome colique révélé par invagination iléo-caecale chez l’adulte: à propos d’un cas 2021-06-22T08:11:06+00:00 Mohamed Said Belhamidi belhamidimohamedsaid@gmail.com Abdessamad Kaoukabi belhamidimohamedsaid@gmail.com Hicham krimou belhamidimohamedsaid@gmail.com Mohamed Menfaa belhamidimohamedsaid@gmail.com Fouad Sakit belhamidimohamedsaid@gmail.com Karim Choho belhamidimohamedsaid@gmail.com <p>L'invagination intestinale est une affection très fréquente en pédiatrie, alors que chez l'adulte, elle reste une entité clinique rare et ne représente que 10% de l'ensemble des invaginations et 4% des occlusions intestinales. Un lymphome colique révélé par invagination intestinale est une entité très rare. Nous rapportons le cas d'une femme de 21 ans, admise aux urgences de l'hôpital Militaire Mouly Ismail à Meknes, Maroc pour une subocclusion intestinale. Le scanner abdominal a montré la présence du boudin d'invagination ainsi que la cause organique au niveau colique. La résection chirurgicale était le traitement choisi, avec un examen anatomopathologique de la pièce opératoire qui montre la présence d'un lymphome B de type diffus à grandes cellules. Après la chirurgie, une chimiothérapie est indiquée dans le but d'améliorer le pronostic et d'éviter une éventuelle rechute.</p> 2018-06-11T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209015 Anévrisme de l’artère iliaque primitive droite 2021-06-22T08:15:13+00:00 Mohamed Jira jiramohamed@yahoo.fr Taoufik Amezyane jiramohamed@yahoo.fr <p>Il s'agissait d'un patient âgé de 55 ans, ses antécédents étaient marqués par une aphtose buccale récidivante. Il était hospitalisé pour une douleur pelvienne d'installation brutale et l'examen clinique trouvait une masse pelvienne sensible, pulsatile et soufflante. A l'auscultation évoquant une origine vasculaire, l'examen des organes génitaux externes trouvait une cicatrice d'aphtose scrotale. Le bilan biologique objectivait un syndrome inflammatoire avec CRP à 80 mg/l, la sérologie syphilitique était négative, l'écho-doopler pelvienne était en faveur d'un anévrisme de l'artère iliaque primitive droite et l'artériographie confirmait le diagnostic. Le diagnostic de la maladie de Behçet était retenu devant l'aphtose bipolaire et l'atteinte vasculaire. Le traitement comportait une exérèse chirurgicale de l'anévrisme, corticothérapie en bolus de trois jours puis en relai par voie orale et une perfusion mensuelle de cyclophosphamide. L'évolution était favorable.</p> 2018-06-11T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209017 Un traumatisme scrotal négligé révélant un rhabdomyosarcome embryonnaire para-testiculaire: à propos d’un cas 2021-06-22T08:48:16+00:00 Mustapha Ahsaini drahsaini@gmail.com Adil Mellouki drahsaini@gmail.com Khalid Ouattar drahsaini@gmail.com Hamid Azelmad drahsaini@gmail.com SoufianeMellas drahsaini@gmail.com JalaleddineAmmari drahsaini@gmail.com Mohammed Fadl Tazi drahsaini@gmail.com Mohammed Jamal Fassi drahsaini@gmail.com Moulay Hassan Farih drahsaini@gmail.com <p>Le rhabdomyosarcome paratesticulaire embryonnaire est une tumeur mésenchymateuse rare qui représente une urgence diagnostique et thérapeutique. Les formes localisées sont de pronostic favorable et un traitement multimodal fait appel à la chirurgie, à la polychimiothérapie et à la radiothérapie permettant d'aboutir à d'excellents taux de survie globale. Nous rapportons un cas colligé dans notre service de rhabdomyosarcome embryonnaire para testiculaire à cellules fusiformes, caractérisé par une confusion clinique, chez un jeune patient de 17ans, et à l'occasion du quel nous reprendrons l'ensemble des caractères spécifiques de cette pathologie.</p> 2018-06-11T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209018 Assessment of nurses knowledge and skills following cardiopulmonary resuscitation training at Mbarara Regional Referral Hospital, Uganda 2021-06-22T08:52:46+00:00 John Bosco Tamu Munezero samuel.cumber@gu.se Catherine Atuhaire samuel.cumber@gu.se Sara Groves samuel.cumber@gu.se Samuel Nambile Cumber samuel.cumber@gu.se <p><strong>Introduction:&nbsp;</strong>cardiopulmonary resuscitation (CPR) is considered a core emergency skill in which all health care professionals must be proficient. CPR remains a new procedure in developing compared to develop countries. The objective of this study was to assess Nurses Knowledge and Skills following Cardiopulmonary Resuscitation Training at Mbarara Regional Referral Hospital.</p> <p><strong>Methods:&nbsp;</strong>a prospective pre/post intervention design was adopted. CPR knowledge and skills of 32 nurses from MRRH were assed using two tools.&nbsp;<strong>Tool I</strong>&nbsp;consisted of 17 item of multiple choice questions that assessed CPR knowledge.&nbsp;<strong>Tool II</strong>&nbsp;involved an observation checklist of 15-point skills questions. A penalty score of 5 or 10 or 20 was set for each question, based on the guideline.</p> <p><strong>Results:&nbsp;</strong>the average score prior to instruction was 53.8 for knowledge and posttest 82.5, and for skills was 46 pre-instruction and 81.5 post instruction. There was a statistically significant (p &lt; 0.001) improvement in the CPR knowledge and (p = 0.02) for CPR skills. The percentage change in respondent's knowledge and skills ranged from 16.8% to137.2% with a mean of 59.9% for knowledge and from 19.18% to 2115.6% with a mean of 159.8% for the skills assessment.</p> <p><strong>Conclusion:&nbsp;</strong>respondents had inadequate CPR knowledge and skills at pretest. The study revealed statistically significant improvement in both knowledge and skills of CPR for all nurses post training. There was a significant change in nurses' skills than in knowledge post training.</p> 2018-06-11T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209019 Unusual feature of neonatal hypernatremic dehydration due to microvillus inclusion disease: a case report 2021-06-22T09:22:02+00:00 Fatma Khalsi khalsif@gmail.com Mohamed Riadh Boukhris khalsif@gmail.com Ines Brini khalsif@gmail.com Jean Pierre Hugot khalsif@gmail.com Patsy Dominique Berrebi khalsif@gmail.com Khedija Boussetta khalsif@gmail.com <p>All over the causes of intractable diarrhea of infancy, microvillous inclusion disease is a rare congenital defect of intestinal brush border of unknown aetiology. An autosomal recessive inheritance is suggested by cases occurring in siblings and high incidence of consanguinity. The prognosis of the disease is extremely poor, as life can be sustained only by total parenteral nutrition. The authors report a preterm male newborn of 35 weeks gestation presenting severe hypernatremic dehydration on day 4 after birth caused by a secretory profuse diarrhea and discuss the tools allowing the light microscopic and genetic diagnosis. The final diagnosis of microvillus intestinal disease (MVID) was made on the third month after extensive investigations using electron microscopic examination of intestinal biopsy and genetic confirmation, finding a mutation at the homozygous status of MYO5B gene. The infant died on the fourth month in spite of optimal electrolytic support and parenteral prolonged nutrition. Although MVID is extremely rare, it remains a possible cause of intractable secretory diarrhea leading to severe hypernatremic dehydration and metabolic acidosis in neonates.</p> 2018-06-11T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209021 Comparison between self sampling and provider collected samples for Human Papillomavirus (HPV) Deoxyribonucleic acid (DNA) testing in a Nigerian facility 2021-06-22T09:30:15+00:00 Olusegun Kayode Ajenifuja Ajenifujako@yahoo.com Nzechukwu Zimuod Ikeri Ajenifujako@yahoo.com Olawale Victor Adeteye Ajenifujako@yahoo.com Adekunbiola Aina Banjo Ajenifujako@yahoo.com <p><strong>Introduction:&nbsp;</strong>the multiple visits required for an effective Pap smear screening program is difficult to replicate in many developing countries. This precludes early diagnosis and care for patients with cervical cancer and contributes to its high mortality in these countries. HPV screening has higher specificity and high negative predictive value and has the advantage that materials can be self-collected, which permits the screening of women who for various cultural and religious reasons would be reluctant to come to the clinic to expose themselves for screening. The aim of the study was to assess the degree of agreement between self sampling for HPV DNA with samples collected by a health provider.</p> <p><strong>Methods:&nbsp;</strong>each respondent selected from women presenting for cervical cancer screening underwent both self- and provider sampling for HPV DNA testing using Hybribio GenoArray.</p> <p><strong>Results:&nbsp;</strong>of the 194 women screened, 12 (6.2%) and 19 (9.8%) had HPV on self sampling and provider col-lected samples respectively. The commonest HPV type seen using both techniques was HPV 58 (2.6%). Multiple HPV genotypes were seen in 1 (0.5%) and 5 cases (2.6%) of provider and self-collected samples respectively. The high risk-HPV detection rate was 7.2% when self sampled and 6.8% when sampled by the provider. There was moderate correlation between both sampling techniques (κ = 0.47, 95% CI: 21.3 - 72.3%, P &lt; 0.05).</p> <p><strong>Conclusion:&nbsp;</strong>our study shows moderate correlation between both sampling techniques. Larger multicentre studies will be needed to provide results generalisable to the Nigerian population. Keywords: Pap smear, HPV screening, cervical cancer, sample collection, self-sampling, provider collected, PCR, HPV DNA, Ile-Ife Nigeria.</p> 2018-06-12T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209023 Athérome coronaire éctasiant 2021-06-22T09:44:53+00:00 Abdelmajid Bouzerda abdelmaji7@hotmail.fr Laila Bendriss abdelmaji7@hotmail.fr Ali Khatouri abdelmaji7@hotmail.fr <p>Les ectasies coronaires sont des pathologies relativement rares et mal connues. Leur étiologie chez l'adulte est le plus souvent athéromateuse. Ces anomalies exposeraient au risque de thrombose intracoronaire par stase sanguine, elles sont le plus souvent associées à des lésions sténosantes qui conditionnent le pronostic. Nous rapportons trois observations de patients hospitalisés pour un syndrome coronarien aigu ST positif avec un aspect de mégacoronaires noté à la coronarographie et nous discutons une revue de la littérature concernant ce type de lésions.</p> 2018-06-12T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209025 Femur neck fracture in young adults, is it really an urgent surgery indication: retrospective clinical study 2021-06-22T10:02:40+00:00 Seyitali Gumustas bayramtosun@hotmail.com Haci Bayram Tosun bayramtosun@hotmail.com Mehmet Isyar bayramtosun@hotmail.com Sancar Serbest bayramtosun@hotmail.com Kadir Oznam bayramtosun@hotmail.com Güven Bulut bayramtosun@hotmail.com <p><strong>Introduction:&nbsp;</strong>femur neck fracture comprises a significant part of intracapsular femur fracture in the intracapsular area of proximal femur and it is mostly seen in elder people. However, these kinds of fractures may be seen in young adults. The present study aims to search factors that affect femoral neck fractures in young adults after surgery carried out by internal determination method.</p> <p><strong>Methods:&nbsp;</strong>files of patients who were applied internal determination through closed reduction and cannulated screw because of intracapsular femur neck fractures between 2010 and 2015 were analyzed retrospectively. Fractures were evaluated by means of Garden classification, which is based on radiological appearance. The cases were examined in terms of timing of surgery in two groups. Cases operated in the first 24 hours after trauma consisted of group 1 and after 24 hours group 2. Radiological staging in femoral head avascular necrosis was evaluated by&nbsp;<em>Ficat-Arlet classification system</em>&nbsp;whereas acetabular fractures and hip functionality was evaluated by&nbsp;<em>Letournel and Judet system</em>, which is based on direct graph of fracture line.</p> <p><strong>Results:&nbsp;</strong>mean age at the time of surgery for 31 cases included in the study was 40.04 ± 9.63 year. The average duration from injury to surgery was 6.6 (1-20) days. Thirty nine percent of fractures was nondisplaced whereas 61% was displaced. The average follow-up period was 4.9 ± 1.35 years. The rate of nonunion was found 16% and femoral head avascular necrosis 6.4%. According to&nbsp;<em>Judet System,&nbsp;</em>67.7% of cases showed excellent/good and 32.3% moderate/bad functional results. Six cases had a secondary surgery. Cases who had displaced fractures statistically showed worse functional results and underwent more secondary surgery than patients with nondisplaced fractures (P&gt;0.05). As a result of logistic regression analysis, presence of displacement was a factor negatively affecting the judet score but did not affect the rate of complication. There were no significant differences between the two groups according to the surgical timing in terms of functional outcomes and complications.</p> <p><strong>Conclusion:&nbsp;</strong>Because of surgical treatment of femoral neck fractures in the first 24 hours does not affect functional outcomes and complication rate, surgery is recommended in optimal conditions. In the case of displacement, care must be taken in terms of poor functional results.</p> 2018-06-12T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209026 Comparison of motorcycle taxi driver’s respiratory health using an air quality standard for carbon monoxide in ambient air: a pilot survey in Benin 2021-06-22T10:29:54+00:00 Lawin Herve hervelawin@yahoo.fr Ayi Fanou Lucie hervelawin@yahoo.fr Kpangon Arsene hervelawin@yahoo.fr Hinson Vikkey hervelawin@yahoo.fr Balmes John hervelawin@yahoo.fr Wanjiku Jacqueline hervelawin@yahoo.fr Ale Boni Maxime hervelawin@yahoo.fr Fayomi Benjamin hervelawin@yahoo.fr <p><strong>Introduction:&nbsp;</strong>ambient air quality standards are not designed to protect people occupationally exposed to outdoor air pollution on a routine basis. This study aimed to assess the effect of exceeding the US ambient air quality standard for carbon monoxide (CO) on motorcycle taxi drivers respiratory health.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study of 85 current motorcycle taxi drivers with at least 5 years of job tenure in Cotonou (Benin) was conducted. Personal CO was measured with a portable CO data logger for 8 hours per day during working hours. A questionnaire on respiratory symptoms was administered to participants and spirometry was performed. Participants were divided into two groups, those with exposure to CO &gt;9 ppm and ≤9 ppm, according to the US Environmental Protection Agency (EPA) National Ambient Air Quality Standard which is an 8-hour average of 9ppm. 8 and 10 ppm were also used an exposure limit. Analysis was done using these two groups.</p> <p><strong>Results:&nbsp;</strong>socio-demographic characteristics were well balanced between the two study groups. The drivers with a CO exposure of more than 9ppm had non-significantly more respiratory symptoms (OR=1.67; 95%CI:0.26,10.74), lower FVC and FEV1 compared to the less exposed group but they have a significant lower PEF (-10%, p=0.02). When we used an exposure limit of 8 or 10 ppm the results were not statistically different.</p> <p><strong>Conclusion:&nbsp;</strong>drivers with a CO exposure &gt;9 ppm tend to have more respiratory problems. More research is needed to reinforce this result in order to improve air quality standards to protect workers occupationally exposed to outdoor air pollution.</p> 2018-06-12T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209029 Etiologies des accidents vasculaires cérébraux ischémiques chez les jeunes: apport de l’interniste 2021-06-22T10:36:07+00:00 Abire Allaoui abire.allaoui@gmail.com Khadija Echchilali abire.allaoui@gmail.com Mina Moudatir abire.allaoui@gmail.com Fatim Zohra Alaoui abire.allaoui@gmail.com Hassan Elkabli abire.allaoui@gmail.com <p>Les ischémies cérébrales chez les jeunes sont différentes par leurs étiologies et leur pronostic. Le profil étiologique en médecine interne est particulier vu le niveau tertiaire de recrutement. L'objet de notre travail est de faire connaître certaines étiologies particulières de cette pathologie chez le sujet jeune. Etude rétrospective des dossiers de jeunes patients au service de médecine interne à Casablanca, sur une période de 2000-2014. Tous les patients ont bénéficié d'une imagerie cérébrale avec des séquences angiographiques, précisant la nature et la topographie de l'AVCI. Un bilan étiologique dicté par la clinique a été mené. Vingt et cinq patients ont été colligés, avec un sex-ratio à 0,73 et un âge moyen de 36±7. Le tabagisme était présent dans 32% des cas, le diabète et l'hypertension artérielle ont été notés dans 8% des cas. Les épisodes d'amnésie et de migraine ont été notés dans 24%. La prise d'oestroprogestatifs et l'antécédent de fausses couches ont été notés dans 12%. Les étiologies étaient dominées par: lupus systémique aigu (32%) associé à un syndrome des antiphospholipides (80%), maladie de Behcet (16%), maladie de Takayasu (12%). En plus de l'antiagrégation, 76% de nos patients ont eu un traitement aux corticoïdes et immuno-suppresseurs. La médecine interne participe à la prise en charge des AVCI, notamment dans le volet étiologique. Les étiologies des ischémies cérébrales du sujet jeune sont multiples, la recherche doit être rigoureuse afin d'identifier des causes particulières, évaluer le risque de récidive et préciser la stratégie thérapeutique.</p> 2018-06-12T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209030 Could nodding syndrome in Northern Uganda be a form of autism spectrum disorder? an observational study design 2021-06-22T10:41:04+00:00 Denis Anywar Arony klagoro@gmail.com Suzanne Gazda klagoro@gmail.com David Lagoro Kitara klagoro@gmail.com <p><strong>Introduction:&nbsp;</strong>nodding syndrome (NS) is associated with high anion gap, biotinidase and acetyl carnitine deficiency, vitamin B6 and D deficiency and internal displacement. The objective of this study was to conduct a metabolic analysis on NS children and review literature on its similarities with ASD.</p> <p><strong>Methods:&nbsp;</strong>we conducted biochemical analysis on blood and urine of NS children at Hope for HumaNs (HfH) centre in 2014 and reviewed literature on its similarities with ASD. Ethical approval was obtained from an IRB. Data analysis was conducted using STATA version 12 and a p-value less than 0.05 was considered significant.</p> <p><strong>Results:&nbsp;</strong>we found biotinidase deficiency in NS with a mean 1.98 95% CI(1.61, 2.34; p &lt; 0.001); Acetyl carnitine deficiency 16.92 95% CI(16.10,17.75; p&lt;0.001); Low BMI-for-age 16.92 95% CI(16.10,17.75; p = 0.42); Age 14.08 95% CI(0.78,4.660; p = 0.007); IDP duration 4.82 95% CI(4.48, 5.21; p = 0.92); Age at NS onset 8.02 95% CI(7.03, 9.01; p = 0.001); NS associated with multiple nodding episodes (χ<sup>2</sup>)=22.15, p=0.005; NS siblings with NS (χ<sup>2</sup>) = 9.68, p = 0.004; NS were in IDPs (χ<sup>2</sup>) = 22.15, p = 0.005.</p> <p><strong>Conclusion:&nbsp;</strong>these findings are indicative that NS is associated with biotinidase and acetyl carnitine deficiency, IDPs, and environmental exposures. There are no new cases of NS reported by Ugandan MOH and WHO since 2012 when the IDP camps were disbanded and communities resettled in their own communities and feed on their own grown foods. Perhaps NS may be akin to Autism Spectrum Disorder (ASD). This finding will help support all efforts towards the treatment and rehabilitation of NS children.</p> 2018-06-12T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209032 Rhinosclérome du cavum avec expression ganglionnaire cervicale: à propos d’un cas 2021-06-22T10:52:59+00:00 Omar Lassikri omar_lsi@hotmail.fr Jalila Benayad omar_lsi@hotmail.fr Omar Lachhab omar_lsi@hotmail.fr Ali El Ayoubi omar_lsi@hotmail.fr Mohamed Anas Benbouzid omar_lsi@hotmail.fr Leila Essakalli omar_lsi@hotmail.fr <p>Le rhinosclérome est une affection granulomateuse spécifique et chronique d'évolution insidieuse, dont l'agent pathogène est le Klebsiella rhinoscleromatis. Il touche avec prédilection les fosses nasales, et pose parfois un problème de diagnostic positif. Nous rapportons le cas d'une patiente de 19 ans, qui présente un rhinosclérome atypique par sa localisation nasopharyngée rare, et son association exceptionnelle à une adénopathie cervicale sous angulo-mandibulaire droite. La mise en évidence des cellules de MIKULICZ à l'examen anatomo-pathologique a permis de poser le diagnostic. La patiente a été mise sous traitement antibiotique à base de ciprofloxacine pendant 16 semaines, associée à un nettoyage des fosses nasales par sérum physiologique. L'évolution était favorable avec un recul de 14 mois.</p> 2018-06-12T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209034 Clinical presentation of autoimmune hepatitis in Pakistani children 2021-06-22T10:58:12+00:00 Ghous Bux Somroo daar@hotmail.com Ayesha Aslam Rai daar@hotmail.com Nasir Hassan Luck daar@hotmail.com Zaigham Abbas daar@hotmail.com <p><strong>Introduction:&nbsp;</strong>autoimmune hepatitis (AIH) is one of the most common disorder resulting in end stage liver disease (ESLD) among children. Scarce data is available in this regard from Pakistan. In this study we have analyzed clinical and biochemical parameters of children suffering from this disorder.</p> <p><strong>Methods:&nbsp;</strong>it was a cross sectional study conducted in the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT) Karachi from January 2005 to June 2016. Patients aged up-to 18 years were included. AIH was diagnosed by using International Autoimmune hepatitis group (IAIHG) pre-treatment and simplified AIH score. Patients with both probable and definite score were included. Biochemical, serological, sonographic and demographics were recorded at the time of diagnosis, liver biopsy was also performed in most of the cases. Data was analyzed by using SPSS ver.20 and p-value of &lt; 0.05 was considered significant.</p> <p><strong>Results:&nbsp;</strong>total 51 patients were enrolled most of them were females (68.6%). Mean age of presentation was around 10 years. Males had statistically significant earlier age of presentation, p-value = 0.007. The most common presenting complain was jaundice. Hypergammaglobulinemia is seen in almost all patients. Type I AIH was the most common entity while Type II AIH was statistically more significant in males p-value = 0.019. Raised GGT was also seen in male patient specifically in Type II AIH, p-value = 0.001.</p> <p><strong>Conclusion:&nbsp;</strong>autoimmune hepatitis predominantly affects female children who have late age of presentation as compare to the males. Type I AIH was the most common while Type II AIH was more common in males and they also had raised GGT.</p> 2018-06-12T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209035 Clostridium sordelli causing malignant edema in a trauma patient: a case report and review of literature 2021-06-22T11:19:58+00:00 Sanjiv Fitz-Morris Gray sanjivfg@gmail.com Beatrice Esther Dieudonne sanjivfg@gmail.com <p>Clostridium&nbsp;<em>sordelli</em>&nbsp;infection is a rare but potentially lethal infection associated with abortions, injury, contaminated wounds, and illicit drug use. It causes a recognizable syndrome with marked leukocytosis. Rapid diagnosis and aggressive sepsis management is required for optimal outcome. We report a case in a trauma patient with delayed presentation after sustaining facial trauma with soil contamination. The critical care management is summarized and a review of the literature.</p> 2018-06-12T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209128 Dermatitis herpetiformis in an African woman 2021-06-23T11:18:10+00:00 Musonda Sharon Machona owen_ngalamika@yahoo.com Mehak Gupta owen_ngalamika@yahoo.com Victor Mudenda owen_ngalamika@yahoo.com Owen Ngalamika owen_ngalamika@yahoo.com <p>Dermatitis herpetiformis (DH) is an autoimmune blistering disease of the skin. It is a result of hypersensitivity to dietary gluten. Diagnosis of DH can be challenging in a low prevalence, resource-limited population. We present the case of an African woman who presented with clinical features of DH.</p> 2018-06-12T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209129 Dress syndrome secondaire à l’allopurinol 2021-06-23T11:21:56+00:00 Youssef Zemmez zemmez.youssef@gmail.com Naoufal Hjira zemmez.youssef@gmail.com <p>Patiente âgée de 60 ans, ayant comme antécédents pathologiques une hyper-uricémie depuis un mois traitée par Allopurinol, qui a consulté en dermatologie pour éruption cutanée aigue intéressant la face et les membres inférieurs dans un contexte de fièvre d’arthralgies et de myalgies. L’examen clinique a objectivé un érythème maculeux de la face siégeant au niveau des joues d’une façon symétrique avec un œdème discret (A), des placards érythémateux au niveau des 2 jambes avec espaces de peau saine s’étendant progressivement d’une façon ascendante, ces lésion étaient très prurigineuses avec une sensation de cuisson (B). L’examen de la cavité buccale a montré des lésions érosives au niveau de la face interne des joues très douloureuses. Les aires ganglionnaires étaient libres. Le bilan paraclinique a objectivé une hyperleucocytose à 20000, élévation des transaminases &gt; 100 UI, éosinophilie à 1500, sérologie HHV6 était négative. Le diagnostic d’un DRESS Syndrome a été retenu. Une corticothérapie a été instaurée à une dose de 1 mg/Kg/jr associé à un traitement symptomatique. L’évolution était marquée par une amélioration spectaculaire après 06 jours de traitement (C et D) avec régression des lésions cutanées et normalisation progressive des paramètres biologiques.</p> 2018-06-12T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209130 Diffuse pulmonary small nodular and patchy infiltrates on chest X-ray with hemoptysis: TB or not TB?-a call for scale up of respiratory medicine services in African TB high burden countries: a case of idiopathic pulmonary hemosiderosis 2021-06-23T11:29:03+00:00 Kerclin Danielle de Klerk gunarguenther@gmx.de Steffen Bau gunarguenther@gmx.de Gunar Günther gunarguenther@gmx.de <p>Tuberculosis is still one of the most common respiratory diseases in Africa and worldwide and miliary tuberculosis is a regular manifestation of it. Idiopathic pulmonary hemosiderosis is a rare disease entity, presenting in children as well as adults. It is characterized by the triad of recurrent episodes of alveolar hemorrhage, presenting as hemoptysis, iron deficiency anemia and bilateral pulmonary infiltrates seen on chest X-ray. These symptoms and signs can easily be confused for other diseases i.e. miliary tuberculosis, delaying appropriate management. The etiology of idio-pathic pulmonary hemosiderosis remains unclear. Diagnosis is established by lung biopsy, re-vealing hemosiderin laden macrophages in the alveoli. Treatment during an acute episode in-cludes corticosteroids and/or immunosuppressive therapy, as well as supportive measures. Long-term follow-up is essential.</p> 2018-06-13T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209131 Medical students’ knowledge of ultrasonography: effects of a simulation-based ultrasound training program 2021-06-23T11:32:30+00:00 Oguz Eroglu oguzerogluacil@gmail.com Figen Coskun oguzerogluacil@gmail.com <p><strong>Introduction:&nbsp;</strong>the use of simulation devices in medical education is becoming more prevalent with each passing day. The present study aimed to teach medical students to perform ultrasonography via a simulation-based ultrasound training program.</p> <p><strong>Methods:&nbsp;</strong>the study was prospectively conducted on final year medical students who had not received previous ultrasound training and who came to the Emergency Department of the Kirikkale University Faculty of Medicine between July 2015 and July 2016. Ultrasound training was provided by two emergency department specialists who are qualified in this field. The training time was determined to be 20h (4h for theoretical lessons, 16h for hands-on). The students were evaluated by a theory test and practical application exam both before and after training. Results obtained were compared using the paired sample t-test, and p &lt; 0.05 was considered to be significant.</p> <p><strong>Results:&nbsp;</strong>Ninety-six final year medical students were included. Their mean age was 24.1 ± 2.1 years. The mean test score obtained in the theoretical exam before training was 7.9 ± 2.2, while that after training was 17.1 ± 1.6 (p &lt; 0.0001). The mean score obtained in the practical application exam before training was 1.1 ± 0.9 points and that after training was 10.9 ± 0.2 points (p &lt; 0.0001).</p> <p><strong>Conclusion:&nbsp;</strong>medical students can learn to use an ultrasound device within a short period of time via simulation-based training programs. New studies must be conducted for the inclusion of ultrasound training programs in the medical education curriculum.</p> 2018-06-13T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209132 Frequency of gallstones and mean BMI in decompensated cirrhosis 2021-06-23T11:39:33+00:00 Ayesha Aslam Rai daar@hotmail.com Aisha Nazeer daar@hotmail.com Nasir Hassan Luck daar@hotmail.com <p><strong>Introduction:&nbsp;</strong>the aim of the study was to determine the frequency of gallstones in patients with decompensated cirrhosis and to know about mean Body mass index (BMI) in patients of decompensated cirrhosis i.e End stage liver disease (ESLD) with and without gallstones.</p> <p><strong>Methods:&nbsp;</strong>it is a cross sectional descriptive study, conducted at the department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi from 1<sup>st</sup>&nbsp;August 2014 to 28 February 2015. Two hundred patients were enrolled from outpatient clinics of Hepato-gastroenterology that fulfilled the defined selection criteria. Questionnaire was filled for data collection. SPSS version 20.0 was used to analyze data. Mean value of age and BMI was calculated by mean ± S.D. values. Mean ± SD was also calculated for BMI in patients with and without gallstones. Stratification of the age, gender, and liver disease severity were done and Chi-Square test was applied. P-values less than 0.05 considered statistically significant.</p> <p><strong>Results:&nbsp;</strong>two hundred consecutive patients were enrolled among them 112(56%) were male. Mean age was 46.89 ± 11.9, BMI 23.59 ± 4.7 and CTP score was 9.7 ± 1.9. Most of the patient had child class 'B' cirrhosis 102(51%), most common etiology was found to be hepatitis C 133 (66.5%), cholelithiasis was found in 59(29.5%), sludge in 36 (18%) and both stone and sludge in 24(12%) of the cases. Advanced liver disease that is, more CTP score and child class 'C' was associated with increased frequency of gall stone formation (p-value = 0.012), and advancing age on age stratification (p-value = 0.024) however no relation was observed with increase BMI, gender, ethnicity, cause or duration of disease in this population.</p> <p><strong>Conclusion:&nbsp;</strong>gallstone formation is associated with advanced stage of cirrhosis and hepatitis C virus related CLD, contrary to the established risk factors, no relation of gender or BMI was found in decompensated liver disease.</p> 2018-06-13T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209134 Synovialosarcome de l’avant-bras droit 2021-06-23T11:42:20+00:00 Youssef Zemmez zemmez.youssef@gmail.com Adnane Arrami zemmez.youssef@gmail.com <p>Patiente âgée de 60 ans, suivie pour cardiomyopathie hypertensive depuis 04 ans, qui a consulté en dermatologie pour une masse de l’avant-bras droit évoluant depuis un an et augmentant progressivement de taille. L’examen clinique a objectivé une lésion tumorale molle, arrondie, volumineuse mesurant 8 centimètres au grand diamètre, indolore, fixe par rapport aux deux plans, à surface ulcéro-crouteuse et siégeant au niveau du tiers moyens de la face postéro-latérale de l’avant-bras droit (A). La radiographie standard a objectivé une masse opaque homogène respectant la corticale en regard (B). L’Imagerie par résonnance magnétique était en faveur d’un volumineux processus cutanéo-sous cutané à double composante tissulaire et kystique multi-cloisonnée infiltrant la graisse sous cutanée et arrivant en contact intime avec les muscles extenseurs (C). L’histologie a objectivé une prolifération sarcomateuse peu différenciée à cellules pléomorphes (D) complétée par une étude Immuno-histochimique qui a confirmé le diagnostic d’un Synovialo-sarcome. La patiente a été adressée en chirurgie plastique pour bénéficier d’un traitement chirurgical.</p> 2018-06-13T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209135 Prevalence and risk factors of HTLV-1/2 and other blood borne infectious diseases among blood donors in Yaounde Central Hospital, Cameroon 2021-06-23T11:47:33+00:00 Michel Kengne kengnemichel70@gmail.com Dorine Carol Wouado Tsata kengnemichel70@gmail.com Thérèse Ndomgue kengnemichel70@gmail.com Julius Mbekem Nwobegahay kengnemichel70@gmail.com <p><strong>Introduction:&nbsp;</strong>transfusion-transmissible infectious microorganisms including bacteria and viruses are among the greatest threats to blood safety for the recipient. The prevalence and risk factors of HTLV-1/2 and other blood borne infectious diseases were determined among blood donors in Yaounde Central Hospital, Cameroon.</p> <p><strong>Methods:&nbsp;</strong>design: cross sectional study. Setting: The blood bank unit of Yaounde Central Hospital, Cameroon. Subjects: a consecutive sample of 265 apparently healthy adult blood donors. Investigations: Search for the presence of hepatitis B surface antigen (AgHBs) and antibodies to human T-lymphotropic virus type 1 (anti-HTLV-1/2), human immunodeficiency virus (anti-HIV), hepatitis C virus (anti-HCV) and syphilis and to determine the epidemiological correlates, if any, in the occurrence of HTLV infection.</p> <p><strong>Results:&nbsp;</strong>77 (29.05%) of the blood donors had serological evidence of infection with at least one pathogen and 4 (5.2%) had dual infections with HTLV-1/2. The overall prevalence of HTLV-1/2, HIV, HCV, HBV and syphilis were 5.7%, 5.3%, 2.6%, 11.7%, 3.8% respectively. Surgical history (Chi<sup>2</sup>=4.785; P=0.029), scarification (Chi<sup>2</sup>=6.359; P = 0.012), piercing (Chi<sup>2</sup>&nbsp;= 16.353; P = 0.000) and intravenous drug use (Chi<sup>2</sup>&nbsp;= 15.660; P = 0.000) were identified as risk factors for HTLV-1/2 infection.</p> <p><strong>Conclusion:&nbsp;</strong>a relative high prevalence of viral infections and syphilis was recorded among the study participants especially for HTLV-1/2 for which none blood donation is routine screened in our set up. Therefore, a routine screen of blood prior to transfusion should include anti-HTLV-1/2 tests.</p> 2018-06-13T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209139 Traumatisme fermé de l’abdomen occasionnant une pancréatite aiguë: présentation de cas 2021-06-23T11:52:07+00:00 Youssef Khaoula youssef_khaoula@yahoo.fr Jawhar Mokni youssef_khaoula@yahoo.fr Aloui Feten youssef_khaoula@yahoo.fr Beizig Ameni youssef_khaoula@yahoo.fr Maksoudi Chedly youssef_khaoula@yahoo.fr <p>La pancréatite aiguë est une affection grave de pronostic réservé, son étiologie est soit biliaire ou alcoolique et l'origine traumatique est extrêmement rare et souvent associée à d'autres lésions intra abdominale. Nous présentons le cas d'un homme 56 ans aux atcds psychiatriques sous neuroleptiques et aux ATCDS de néphrotomie gauche et qui consulte dans les suites d'une chute d'un escalier 3 jours auparavant pour sd occlusif, à l'examen état hémodynamique respiratoire et neurologique correct, sensibilité épigastrique, une TDM pratiqué montre une pancréatite stade E traumatique avec au bilan de nombreuses perturbations: élévation des amylases, de la glycémie, des GB et de la CRP; l'évolution était défavorable avec le décès du patient 72 H plupart par une défaillance multi viscérale suite à un choc septique malgré une réanimation approprié. La pancréatite aiguë traumatique étant une affection grave, pourvue qu'elle est très rare et parfois difficile à diagnostiquer vue la non spécificité des signes cliniques, il faut savoir y penser afin la prendre en charge à temps.</p> 2018-06-13T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209140 Etude des relaparotomies précoces aux Hôpitaux Universitaires de Lubumbashi: aspects épidémiologiques, cliniques et thérapeutiques 2021-06-23T12:01:45+00:00 Catherine Saleh Ugumba bibidadacatia2016@gmail.com Marc Kashal Kasong bibidadacatia2016@gmail.com Cedrick Sangwa Milindi bibidadacatia2016@gmail.com Gabriel Wakunga Warach bibidadacatia2016@gmail.com François Tshilombo Katombe bibidadacatia2016@gmail.com Etienne Odimba Bfkoshe bibidadacatia2016@gmail.com <p>Les relaparotomies précoces pour péritonite post opératoire (PPO) sont des urgences chirurgicales de pronostic grave. L'objectif de la présente étude est de décrire le profil épidémiologique, clinique et thérapeutique des relaparatomisés précoces soignés dans les hôpitaux universitaires de LUBUMBASHI. Il s'agit d'une étude descriptive transversale réalisée dans deux hôpitaux du district sanitaire du haut KATANGA; à savoir les cliniques universitaires (CUL) et l'hôpital général de référence JASON SENDWE (HGR JS). Cette étude a porté sur 56 patients réopérés à l'abdomen 68 fois du 01/Janvier/2012 au 31/Décembre/2013. Ont été inclus, les dossiers des patients réopérés d'abdomen précoce deux fois de suite au moins, de sexe confondu, âgés de 07 jours à 83 ans qui ont été réopérés de l'abdomen. Les données épidémiologiques, cliniques, thérapeutiques et les suites opératoires ont été recueillies puis saisies et analysées grâce au logiciel Epi info 2011. Au cours de cette étude 304 patients avaient subi une laparotomie dont 248 avaient évolué normalement; 56 patients par contre avaient été relaparatomisés 68 fois (38 hommes et 18 femmes). L'âge moyen était de 34,6±19 ans. Le séjour moyen d'hospitalisation était de 56,26 ± 51,82 jours. Les comorbidités associées ont été l'hypertension artérielle, le cancer et le mauvais état général d'avant la laparotomie classifié ASA 3 et 4 avec respectivement 34,62% (n = 9); 26,92% (n = 7) et 41,38% (n = 12). Les malaises généraux, la circonférence abdominale avec augmentation de plus de 2 cm par jour au niveau de l'ombilic ainsi que la douleur abdominale diffuse et provoquée ont été retrouvées respectivement dans 94,64% (n = 53), 98,21% (n = 55) et 83,93% (n = 47) des cas. Pour laparotomie initiale 51 (91,07%) patients étaient opérés en urgences. Les infections associées avaient constitué l'indication principale de réintervention avec 55,36% des cas (n = 31). La laparotomie initiale a été conduite par un chirurgien non qualifié dans 60,71% des cas (n = 34). Douze patients réopérés sont décédés soit un taux de létalité de 17,65%. Les relaparotomies précoces pour PPO sont couramment pratiquées dans les hôpitaux universitaires du HAUT KATANGA. Le retard dans le diagnostic aggrave le pronostic.</p> 2018-06-13T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209142 Strangulation du pénis: à propos de deux cas en milieu rural 2021-06-23T12:10:40+00:00 Ibrahima Dara Damé daraurol@yahoo.fr Ibrahima Diallo daraurol@yahoo.fr Modou Ndiaye daraurol@yahoo.fr Mamadou Beye daraurol@yahoo.fr Diaga Seck Ndour daraurol@yahoo.fr Tiennou Hafing daraurol@yahoo.fr Samba Thiapato Faye daraurol@yahoo.fr Ibrahima Bocar Welle daraurol@yahoo.fr Yaya Sow daraurol@yahoo.fr Boubacar Fall daraurol@yahoo.fr <p>La strangulation du pénis est une pathologie nécessitant une prise en charge en urgence. Plusieurs objets métalliques ou non, peuvent être placés sur le pénis pour augmenter les performances sexuelles ou pour des fins auto-érotiques. Nous rapportons les observations de deux patients schizophrènes de 25 et 33ans reçus aux urgences pour une strangulation du pénis par anneau métallique. L'anneau était placé au niveau du sillon balanopénien depuis 3 jours chez l'un et au niveau de la racine de la verge depuis 2 jours chez l'autre. Il n'y avait pas de trouble urinaire chez les deux patients. L'ablation de cet anneau a été réalisée par taxis sous anesthésie locale chez l'un et sous sédation à la fentanyl suivie d'une double section de l'anneau à l'aide d'un engin électrique dans le 2<sup>ème</sup>&nbsp;cas. A travers cette observation nous rapportons la prise en charge non chirurgicale de ces cas pathologique.</p> 2018-06-13T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209146 Post-operative peritonitis due to a KPC-producing <i>Klebsiella pneumoniae</i>: the canvas of antibiotic resistance 2021-06-23T12:15:00+00:00 Marianneta Chatzopoulou mariannetachatz@gmail.com Maria Tsiakalou mariannetachatz@gmail.com <p>Emergence of multidrug-resistant nosocomial pathogens has risen as one of the most critical public health issues globally. The present smear of peritoneal fluid graphically illustrates the dramatic course of an ultimately fatal case of post-operative peritonitis due to a KPC-producing&nbsp;<em>K. pneumoniae</em>. A 60-year-old patient was admitted for a scheduled sigmoidectomy. After a brief stay in the Intensive Care Unit he was transferred to the ward where he showed signs and symptoms of peritonitis. A peritoneal fluid film was stained with May-Grünwald-Giemsa technique and examined microscopically in the laboratory. The intensity of infection is reflected by the abundance of bacilli surrounding and invading neutrophils. The particular&nbsp;<em>K. pneumoniae</em>&nbsp;strain was merely susceptible to tigecycline and colistin. Aggressive antibiotic treatment was not effective in reversing the fulminant clinical course and the patient finally succumbed.</p> 2018-06-13T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209147 Interprétation délicate de l'immunofixation des protéines sériques 2021-06-23T12:23:01+00:00 Raoul Karfo rkarf006@yahoo.fr Elie Kabré rkarf006@yahoo.fr Nadia Safir rkarf006@yahoo.fr Mounya Bouabdellah rkarf006@yahoo.fr Laila Benchekroun rkarf006@yahoo.fr Jean Sakandé rkarf006@yahoo.fr Layachi Chabraoui rkarf006@yahoo.fr <p>L'immunofixation est actuellement très utilisée dans les laboratoires d'analyses médicales. L'interprétation des résultats est en général facile, mais il existe des cas qui posent des problèmes d'interprétation. Nous vous rapportons deux observations d'interprétation délicate. Dans la première observation, nous présentons un cas de précipitation non spécifique de la protéine sur toutes les pistes, dans la deuxième observation un cas présentant une double bande monoclonale à l'immunofixation. Pour ces deux observations, l'utilisation de la solution réductrice de β2-mercaptoéthanol nous a permis de résoudre le problème et de conclure à un diagnostic. La confrontation des données cliniques, radiologiques et biologiques est nécessaire avant de conclure à une immunoglobuline monoclonale.</p> 2018-06-14T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209151 Madura foot: a case report 2021-06-23T12:25:57+00:00 Ahmed Bouhamidi docteurbouhamidi@gmail.com Mohammed Boui docteurbouhamidi@gmail.com <p>A 24-year-old girl, without any significant medical history. with seven months' history of a painful tumefaction of his left foot. Physical examination revealed a tumefaction that discharges a purulent exudate containing black granules via skin fistulas. Direct microscopic examination of grains suggests a fungal infection. Standard X-rays of his foot showed no lesion of the bone. So with the combination of the clinical specific lesions and typical grains, a diagnosis of Madura foot was made and the patient treated with surgical debridement, followed by Ketoconazole for 12 months, she is under regular monitoring. Mycetoma is characterized by a clinical triad of chronic induration, draining sinuses and discharge of granules. It is either actinomycotic or eumycotic in etiology. It is endemic in tropical and subtropical countries.</p> 2018-06-14T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209154 Hamartome sébacé de la face: à propos d’un cas 2021-06-23T12:29:34+00:00 Jawad El-Azhari j.elazhari@gmail.com Mohammed Boui j.elazhari@gmail.com <p>Le nævus sébacé (ou hamartome sébacé) est une lésion congénitale localisée principalement au cuir chevelu, dont le diagnostic clinique et histologique est généralement aisé. Il est diagnostiqué dès la naissance dans la grande majorité des cas, mais peut parfois passer inaperçu et donner l'impression d'apparaître plus tardivement. Cette lésion peut se compliquer de tumeurs bénignes ou de façon plus rare malignes. Nous rapportons le cas d'un patient de 45 ans, suivi depuis 15 ans pour anémie de Biermer (traitée par injection mensuelle d'HYDROXOCOBALAMINE) et une pelade ophiasique, et qui consulte pour des plaques pigmentées apparues il y'a plus de 10 ans; bilatérales et symétriques, augmentant progressivement de taille. A l'examen clinique, il s'agit de plaques temporales et sous-auriculaires, d'aspect verruqueux brunâtre à surface lisse (A, B). L'étude histologique objectivait une acanthose, une papillomatose, et des glandes sébacées volumineuses et situées anormalement hauts dans le derme, en faveur d'un hamartome sébacé. Un traitement par laser CO<sub>2</sub>&nbsp;a été proposé au patient.</p> 2018-06-14T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209155 Reducing the risk of nosocomial Hepatitis B virus infections among healthcare workers in Nigeria: a need for policy directive on pre-employment screening and vaccination 2021-06-23T12:39:17+00:00 Olorunfemi Akinbode Ogundele femiaoo@yahoo.com <p>Healthcare workers (HCWs) are at increased risk of contracting Hepatitis B virus (HBV) infection and other vaccine-preventable diseases, especially if they are not protected by immunity derived from previous infection or vaccination. Sub-Sahara Africa countries including Nigeria is reported to have the highest rate of HBV. Vaccination of HCWs is essential in protecting them from acute and chronic sequelae of HBV or any other form of vaccine-preventable diseases; however, HCWs vaccination remains a challenge for many developing countries including Nigeria due to lack of policy directive on pre-employment screening and vaccination. Poor political will and inadequate funding of healthcare in the country also impacts negatively on the implementation of effective pre-employment screening and vaccination programmes needed to protect HCWs. The aim of this opinion paper is to promote policy direction on pre-employment screening and vaccination in other to protect HCWs from nosocomial HBV infection. The most appropriate time perhaps for promoting the importance of employee immunisation is during pre-employment screening. The policy options are either for employers to allocate financial resources towards HCWs pre-employment screening and vaccination or alternatively initiate a programme where new HCWs provide evidence of protection against HBV or other vaccine-preventable diseases specified in the policy directive. Protecting HCWs form nosocomial HBV infection requires well-articulated policy directive, proper implementation, supported by adequate funding and good political will on the part of employers and government.</p> 2018-06-14T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209160 Pure large cell neuroendocrine carcinoma of the bladder without urological symptoms 2021-06-23T12:50:53+00:00 Ekrem Akdeniz ekrem.akdeniz@saglik.gov.tr Mustafa Bakirtas ekrem.akdeniz@saglik.gov.tr Mustafa Suat Bolat ekrem.akdeniz@saglik.gov.tr Sevda Akdeniz ekrem.akdeniz@saglik.gov.tr Ismail Özer ekrem.akdeniz@saglik.gov.tr <p>Neuroendocrine carcinoma is one of the uncommonly seen pathologies of the urinary bladder. Macroscopic hematuria is frequently encountered<br>symptom in patients with neuroendocrine carcinoma. We report a 45-year-old man with left solitary kidney and oliguria for five days the<br>development of acute renal failure (ARF) with the impaired general condition. The underlying cause being identified as pure type large-cell<br>neuroendocrine carcinoma of the bladder. Large-cell neuroendocrine carcinoma of the bladder is an uncommon fatal tumor. No macroscopic<br>hematuria or urological symptom was observed in our case. Advanced ectasia was not observed in the kidney, and the patient's clinical status was<br>complicated with ARF. It must not be forgotten that in some bladder tumors, the patient's general condition may be impaired without urological<br>symptoms.</p> 2018-06-14T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209162 True superior gluteal artery aneurysm with neurovascular compromise of the lower limb: a case report and review of the therapeutic options 2021-06-23T12:59:38+00:00 Tunde Nureini Oyebanji dhulnurein@yahoo.com Ismail Mohammed Inuwa dhulnurein@yahoo.com Jameel Ismail Ahmad dhulnurein@yahoo.com <p>Few cases of true superior gluteal artery (SGA) aneurysms have been described in the English-language literature. This is the twenty-second reported case. SGA aneurysms can pose diagnostic problems, specifically when they are non-pulsatile and also therapeutic challenges when they are large. Although more aneurysms are being subjected to endovascular therapies, SGA aneurysmectomy or aneurysmorrhaphy still remain valid therapeutic options, especially in resource-poor settings. Surgery provides quick symptom resolution and still is the only means by which tissue for definitive histological diagnosis can be obtained.</p> 2018-06-14T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209163 Paederus dermatitis 2021-06-23T13:02:43+00:00 Ahmed Bouhamidi docteurbouhamidi@gmail.com Mohammed Boui docteurbouhamidi@gmail.com <p>There were two patients, having crushed insects on their bodies, described as a two-colored big ant with three black segments (head, center and end of the abdomen) and two orange segments, which were in their accommodation. They presented with a dermatitis characterized by initial marked erythema and pruritus, with vesicles and blisters in cervical region developing after 48 hours post exposure for the first patient, while the second patient developed similar chest lesions and skin ulceration after 72 hours of exposure. Based on clinical and epidemiological features, the diagnosis of Paederus dermatitis was retained. Treatment is made with topical Trolamine, oral antihistamines, and intensive washing. The lesions improved over several days, with resolution of lesions without sequelaes 10 to 15 days later. Paederus dermatitis is a contact dermatitis that occurs due to physical contact with rove beetles of the genus Paederus. The diagnosis is based on the presence of typical clinical features combined with compatible epidemiological features. This condition is prevalent in some tropical and subtropical regions, such as Guinea-Bissau, and especially in the rainy season.</p> 2018-06-18T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209165 L’anneau de Kayser-Fleischer dans la maladie de Wilson 2021-06-23T13:07:27+00:00 Qariani Hajare q.hajare@gmail.com Khmamouche Mehdi q.hajare@gmail.com <p>La maladie de Wilson est une toxicose cuprique caractérisée par une surcharge en cuivre tissulaire: essentiellement hépatique, cérébrale et péricornéenne .elle résulte de mutations sur l'ATP7B qui incorpore le cuivre à la céruléoplasmine dans le foie et libère le cuivre excédentaire dans la bile. Cette maladie peut être traitée de manière efficace si elle est diagnostiquée précocement. L'enjeu est d'en faire le diagnostic au stade initial de la maladie hépatique, avant qu'elle ne devienne multisystémique. Nous rapportons le cas d'une patiente de 19 ans qui présente une atteinte multisytémique dans le cadre de la maladie de wilson: une pâleur cutanéo-muqueuse, tremblement intermittent des mains depuis l'âge de 16 ans, une hépatite compliquée d'ascite, des troubles neurologiques à type d'un tremblement postural des bras et des jambes. L'examen ophtalmologique à la lampe à fente a objectivé au niveau des deux yeux l'anneau de Kayser-Fleischer (A,B) qui est un dépôt de cuivre à la périphérie de l'endothélium cornéen plus précisément sur la zone frontalière entre la cornée et la sclérotique(C). le bilan biologique trouve un taux de céruléoplasmine bas à 0,03 g/l; La cuprémie totale à 0,4 mg/l. l'excrétion urinaire de cuivre élevée à 11,6 μmol. L'imagerie par résonance magnétique cérébrale de la patiente a révélé un changement de signal généralisé, une gliose et une atrophie des thalamus et du tronc cérébral.</p> 2018-06-18T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209168 Type B lymphomatoid papulosis 2021-06-23T13:10:51+00:00 Ahmed Bouhamidi docteurbouhamidi@gmail.com Badreddine Hassam docteurbouhamidi@gmail.com <p>A 28-year-old woman with no notable medical history. Who presented with a 3-month history of pruritic erythematous purplish papules at the axilla, elbow folds, flanks, inner thigh and popliteal. On physical examination, there were multiple papular lesions with irregular pigmentation at the axilla (A), associated with maculopapular erythematous plaques on elbow folds, flanks, inner thigh and popliteal (B). There was no lymphadenopathy or mucosal involvement. Skin biopsy was in favor of type B lymphomatoid papulosis with the presence of rare large cells, with CD30 expression confined to the cell membrane and Golgi region (C, D). All the staging investigations were normal. The diagnosis of type B lymphomatoid papulosis was retained and the patient treated with topical corticosteroids with a good improvement, she is under regular monitoring. Lymphomatoid papulosis is characterized by erythematous papulonodular lesions, often evolving into a crust and spontaneously disappear in a few weeks, leaving a depressed and sometimes pigmented scar. Type B lymphomatoid papulosis histology consists of an infiltrate of lymphocytes with cerebriform nuclei, the infiltrate includes large cells that can express the CD30 antigen. lymphomatoid papulosis has a good prognosis but can be associated with or progress to malignancy. Therefore, it is important to monitor these patients.</p> 2018-06-18T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209245 La conjonctive tarsale une localisation exceptionnelle du carcinome épidermoïde conjonctival 2021-06-24T07:44:42+00:00 Bennis Ahmed ah_bennis@hotmail.com Benatiya Andaloussi Idriss ah_bennis@hotmail.com <p>Patient de 48 ans de teint clair, ayant la notion de 5 décès dans la famille par des cancers de localisations variables, qui présente depuis une année une tuméfaction de la conjonctive palpébrale inférieure augmentant progressivement de volume, de forme nodulaire ulcéro-bourgeonnante, mesurant 2cm de grand axe, occupant la moitié interne de la conjonctive tarsale inférieure présentant un contact intime avec le point lacrymal inférieur (A). La biopsie de la tumeur est en faveur d’un carcinome épidermoïde de la conjonctive bien différencié. Le traitement a consisté en une exérèse tumorale (B) avec marges de sécurité larges revenant saines après étude anatomopathologique.</p> 2018-06-19T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209248 Angiokératome acquis de la face 2021-06-24T07:54:48+00:00 Jawad El-Azhari j.elazhari@gmail.com Naoufal Hjira j.elazhari@gmail.com <p>Les angiokératomes sont des dilatations vasculaires (papules télangiectasiques) dont la surface est kératosique et qui résultent de la dilatation des capillaires de la papille dermique, due à une hyperpression veineuse, à une malformation vasculaire ou à une fragilité capillaire. Le plus souvent bénins et seulement inesthétiques, ils peuvent parfois révéler une redoutable maladie de surcharge comme la maladie de Fabry. Nous rapportons ici le cas d’un patient de 56 ans, sans antécédents notables, qui consulte pour des papules érythémateuses groupées en bouquet au niveau de la région malaire gauche, non prurigineuses, et saignant au contact, apparues depuis 4 mois sans notion de traumatisme antérieur et sans symptomes extra-cutanés. A l’examen les papules étaient partiellement vidées à la vitropression et la surface était kératosique. Les diagnostics évoqués étaient un kaposi, un mélanome, un carcinome ou un angiokeratome. L’histologie était en faveur d’un angiokeratome, et le traitement proposé était l’électrocoagulation.</p> 2018-06-19T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209251 Lymphome T/NK nasal: à propos de deux cas rare 2021-06-24T08:01:47+00:00 Najoua Bouayad bouayadnajoua@gmail.com Naoual Oubelkacem bouayadnajoua@gmail.com Wafaa Bono bouayadnajoua@gmail.com Ouafae Masbah bouayadnajoua@gmail.com Touria Bouhafa bouayadnajoua@gmail.com Abderrahman Elmazghi bouayadnajoua@gmail.com Hassouni Khalid bouayadnajoua@gmail.com <p>Le lymphome T/NK est une affection grave et rare en Afrique et en Europe. Le traitement repose sur la radiothérapie et la chimiothérapie. Les auteurs rapportent deux observations de patients âgés respectivement de 55 et 52 ans, qui présentent une obstruction nasale bilatérale avec une rhinorrhée purulente, chez eux l'examen clinique a mis en évidence la présence d'une fente palatine. Le diagnostic n'a pu être posé qu'après une étude immuno-histochimique des biopsies. Les 2 patients ont bénéficié d'une chimiothérapie type CHOEP suivi d'une cure de radiothérapie. Le lymphome T/NK nasal est une forme agressive de lymphome non hodgkinien comportant des caractéristiques clinicopathologiques qui lui sont spécifiques. L'association de la chimiothérapie pour les stades avancés ne semble pas améliorer la survie par rapport à la radiothérapie seule qui reste le traitement de choix surtout pour les stades localisés. La localisation nasal du lymphome T /NK est rare. Le diagnostic repose sur l'étude immunohistochimique. Le traitement comprend chimiothérapie et radiothérapie. Ce type lymphome est de mauvais pronostic globalement, y compris sous traitement.</p> 2018-06-19T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209252 Le vaccin antipaludique RTS,S/AS01 chez les enfants âgés de 5 à 17 mois au moment de la première vaccination 2021-06-24T08:17:32+00:00 Pascale Vandoolaeghe lode.schuerman@gsk.com Lode Schuerman lode.schuerman@gsk.com <p>Le vaccin antipaludique RTS,S/AS01 a reçu un avis scientifique favorable de l’Agence Européenne des Médicaments (EMA) en juillet 2015. L’Organisation Mondiale de la Santé (OMS) a recommandé l’introduction pilote de ce vaccin chez des enfants âgés d’au moins 5 mois en utilisant un schéma de vaccination comprenant 3 doses initiales espacées d’au moins un mois et une 4<sup>ème</sup>&nbsp;dose administrée 15 à 18 mois après la 3<sup>ème</sup>&nbsp;dose. Des essais cliniques et des modèles mathématiques ont montré que la protection partielle contre le paludisme conférée par le vaccin RTS,S/AS01 pourrait avoir un impact substantiel sur la santé publique si le vaccin est utilisé en association avec d’autres mesures de lutte antipaludique, en particulier dans les zones hautement endémiques. L’impact le plus important a été observé chez les enfants âgés de 5 mois ou plus ayant reçu 4 doses de RTS,S/AS01. Le vaccin sera ensuite évalué en situation réelle afin de déterminer son impact sur la mortalité, son innocuité dans le cadre d’une vaccination de routine, et la faisabilité opérationnelle d’administrer 4 doses du vaccin dont certaines nécessitant de nouveaux contacts dans le calendrier de vaccination. En cas de succès, cela permettra une mise en œuvre à plus grande échelle.</p> 2018-06-19T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209254 Les infections nosocomiales en milieu de réanimation: incidence annuelle et aspects cliniques au Service de Réanimation Polyvalente, Kairouan, Tunisie, 2014 2021-06-24T08:27:02+00:00 Latifa Merzougui latifamerzougui72@yahoo.fr Tarek Barhoumi latifamerzougui72@yahoo.fr Tayeb Guizani latifamerzougui72@yahoo.fr Hafed Barhoumi latifamerzougui72@yahoo.fr Hajer Hannachi latifamerzougui72@yahoo.fr Elyess Turki latifamerzougui72@yahoo.fr Wael Majdoub latifamerzougui72@yahoo.fr <p>Bien que les réanimations ne comprennent en général qu’une faible proportion des lits hospitaliers; elles constituent la scène d’une forte proportion des infections nosocomiales La gestion du risque infectieux en réanimation constitue aujourd’hui une priorité; l’un des axes stratégiques prioritaires est la mise en place d’un système de surveillance épidémiologique. Nos objectifs étaient de déterminer l’incidence et les Aspects Cliniques afin d’identifier les facteurs de risque. Il s’agit d’une étude descriptive longitudinale d’incidence incluant les patients ayant dépassés 48 heures dans le service de réanimation polyvalente à l’hôpital Ibn El Jazzar de Kairouan sur une période d’une année allant de 01/03/2013 jusqu’au 28/02/2014. L’enquête a porté sur 265 patients dont l’âge moyen était 39±20 ans (18 à 93 ans) et le sexe ratio (H/F) a été de 2,48. Nous avons identifié 125 épisodes d’infections nosocomiales chez 81 malades soit une incidence de 30,6%. La densité d’incidence était de 55 infections pour 1000 jours d’hospitalisation. On a notifié une nette prédominance des pneumopathies avec une incidence de 27,73%, suivies des infections urinaires de 9,73%, des infections liées au cathétérisme veineux central 6,25% et des infections du site opératoire de 2,34%. Le taux de mortalité parmi les enquêtés a été de 28,7% avec une différence significative entre les patients infectés (44,7% des cas) et ceux non infectés (29,07%) (p &lt; 10<sup>-3</sup>). Les microorganismes étaient des BGN dans 80% des cas. La prévention ne peut se concevoir que sous la forme d’une action globale et multidisciplinaire.</p> 2018-06-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209257 Gamasoidosis (bird mite dermatitis): dermanyssus gallinae in a young boy 2021-06-24T09:03:02+00:00 Marcos Davi Gomes de Sousa f9filho@gmail.com Fred Bernardes Filho f9filho@gmail.com <p>A 6-year-old boy presented with a 4-day history of a pruritic eruption associated with excoriated erythematous papules over his limbs. He had no known medical conditions and was on summer school vacation 15 days ago. He had a healthy domestic dog without fleas or ticks. On physical examination, multiple erythematous papules and lesions with corkscrew morphology on his legs and feet were observed. In a visit by the first author to the site, many mites on the internal walls and windows, as well as the beds, were observed. Several nests of sparrows (<em>Passer domesticus</em>) were found and removed from the roof. Three representative mites were collected and subsequently were examined precisely; the causative agent of disturbance was recognized as&nbsp;<em>Dermanyssus gallinae</em>. The patient was treated with topical hydrocortisone 1% cream and loratadine (5 mg, once daily) for three days. Avian mites infest humans accidentally, causing a dermatitis characterized by widespread pruritic lesions. It has a worldwide distribution, and is more common in spring and summer. It is haematophagous and feeds at night, leaving its host during the day to hide in close proximity to the bird's nest. Removal of these birds from nesting or roosting sites in the vicinity of afflicted patients, with or without subsequent acaricide treatment of the area, is sufficient to arrest infestations. Cutaneous reactions are nonspecic and difficult to diagnose without a degree of clinical suspicion. Clinically, the condition presents as itching, which intensifies at night, with development of erythematous maculopapules or papulovesicles. When the clinical presentation is nonspecific and the arthropod cannot be found, the only hope for a correct diagnosis lies in a thorough environmental anamnesis.</p> 2018-06-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209263 Les traumatismes urétéraux compliquant une chirurgie gynécologique 2021-06-24T09:23:11+00:00 Fatnassi Ridha ridha.fatnassimohamed@rns.tn Merzougui Latifa ridha.fatnassimohamed@rns.tn Rebhi Ines ridha.fatnassimohamed@rns.tn Hajji Maamar ridha.fatnassimohamed@rns.tn Braiek Salem ridha.fatnassimohamed@rns.tn <p>Les lésions urétérales iatrogènes peuvent succéder à toute chirurgie pelvienne. Elles sont graves pouvant mettre en jeu le pronostic fonctionnel du rein et même le pronostic vital. But du travail: est de préciser les aspects cliniques et les modalités thérapeutiques de cet accident. Il s’agit d’une étude rétrospective sur six observations de lésion urétérale iatrogène, après chirurgie gynécologique ou obstétricale, colligées dans le service d’urologie de Kairouan sur une période de 4 ans (2012-2016). L’âge moyen de nos patientes est de 46 ans. Elles sont toutes des multipares. La symptomatologie clinique est variable selon le type lésionnel. L’urographie intraveineuse demeure très utile au diagnostic, nous l’avons pratiqué dans 4 cas revenues toutes anormales. Le traitement a consisté en une montée de sonde dans un cas et 5 réimplantations urétéro-vésicales. Les suites opératoires sont émaillées par une néphrectomie. Les lésions urétérales iatrogènes sont devenues rares. Elles sont corrélées au degré de médicalisation du pays. La chirurgie gynécologique ou obstétricale est la plus grande pourvoyeuse. Leur pronostic est conditionné par la précocité du diagnostic et l’état anatomique de l’uretère.</p> 2018-06-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209271 Malformation de la charnière cervico-occipitale et vitiligo 2021-06-24T09:37:19+00:00 Omar Boulahroud omarboulahroud78@outlook.fr Jalal El Benaye omarboulahroud78@outlook.fr <p>Le vitiligo est une dermatose relativement fréquente (0,5% - 2% de la population générale) d'origine polygénétique et de physiopathologie multifactorielle caractérisé par une dépigmentation cutanée pouvant êtres segmentaire ou non segmentaire. La malformation de Chiari est une maladie congénitale de la charniére cervico-occipitale qui consiste en une migration d'une partie du cervelet dans le trou occipital. Association de ces deux pathologies est exceptionnelle et pose une problématique de cause à effet. Notre cas concerne une femme de 45 ans sans antécédent particulier qui présente depuis 2 mois des névralgies cervico-brachiale bilaterale associé à des troubles sensitif de type dissociation thermo-algique. L'examen cutané trouve une lesion maculaire hypopigmentaire au niveau du cou et la face postérieure de l'avant bras droit résistante au traitement local à base de corticoides fort (A). L'IRM cerébrale objective une malformation de chiari type II (B flèche rouge) avec cavité syringomyélique en regard de C6 (B flèche blanche). La patiente a bénéficié d'une décompression ostéo-durale de la fosse cérébrale postérieure avec une bonne amélioration neurologique et repigmentation des plaques après 6 mois. Quelques cas dans la littérature témoignent de cette association. Les arguments en faveur sont: la localisation des lésions en regard des dermatomes concernés par la malformation et la notion de régression après chirurgie. L'étiopathogénie du vitiligo n'est pas claire et plusieurs théories ont été proposés pour expliquer son apparition; théorie autoimmune, théorie d'adhésion épidermique, théorie biochimique et théorie neuronale. Cette dernière nous parait la plus probable pour expliquer cette association dans notre cas elle suppose que l'apparition des lésions cutanées est due à la sécrétion au niveau des neurones soufrant de substances qui détruisent spécifiquement les mélanocytes.</p> 2018-06-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209276 Macro-chéilite granulomatose révélant une maladie de Crohn 2021-06-24T09:58:49+00:00 Khaoula Jellali dockhaou@yahoo.fr Ihsane Mellouki dockhaou@yahoo.fr Adil Ibrahimi dockhaou@yahoo.fr <p>De nombreuses affections du tube digestif comportent des manifestations cutanées qui peuvent être révélatrices, ce qui place le dermatologue en première ligne pour orienter le patient vers la consultation de gastroentérologie. A l’inverse, le gastroentérologue est souvent confronté à des lésions cutanéo-muqueuses pour lesquelles se pose la question d'une éventuelle relation avec une maladie digestive déjà connue. Les maladies inflammatoires chroniques de l'intestin représentent l’exemple type de cette nécessaire collaboration entre les deux spécialités. Nous rapportons un cas de maladie de crohn révélée par une Chéilite granulomateuse. Il s'agit d'une patiente âgée de 30 ans. Suivie en dermatologie pour une chéilite granulomateuse. L’examen somatique était sans particularité mise à part les lésions dermatologiques (un œdème facio-labiale blanc, induré et une gingivite diffuse). La biopsie de la lésion labiale a objectivé des granulomes épithélioides et gigantocellulaire à disposition péri-vasculaire sans nécrose caséeuse. Devant la suspicion d’une colite inflammatoire une iléo-coloscopie a été réalisée ayant objectivé une valvule de Bauhin béante et ulcérée avec une muqueuse iléale légèrement érythémateuse, dont l’étude anatomopathologique avait révélé un aspect histologique en faveur d'une maladie inflammatoire chronique de l’intestin type crohn iléo-colique. L’évolution était marquée par l'installation, 6 mois après, de quelques épisodes de réctorragies avec lésions ano-périnéales: large fissure anale antérieure avec une ulcération aphtoide à 5 cm de la marge anale, compliquée quelques semaines après par l'installation d'un abcès péri-anale fistulisé ayant nécessité un drainage chirurgicale avec mise en place de Sétons, d’où l’indication de démarrer un traitement de fond de sa maladie de crohn après assèchement de l’abcès. Les lésions dermatologiques observées lors des MICI sont très variées. Dans certains cas, elles apparaissent au cours d'une MICI connue alors que, dans d'autres, elles précédent ou accompagnent les manifestations digestive, permettant le diagnostic d'une affection intestinale parfois cliniquement latente.</p> 2018-06-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209281 Advanced squamous-cell carcinoma of the lower lip 2021-06-24T10:02:12+00:00 Fred Bernardes Filho f9filho@gmail.com Priscila Vinhal Grupioni f9filho@gmail.com <p>A 37-year-old male patient was admitted at the emergency room with headache, severe pain and bleeding in the tumor. He had a previous diagnosis of squamous-cell carcinoma of the lower lip two years before, however, despite having been informed of the need to excise the initial lesion, he refused treatment due to religious beliefs. The patient returned to seek treatment after 18 months of diagnosis, however the tumor already had great extent, being unresectable. The lesion did not respond to chemotherapy. On examination, the tumor affected all of the right hemiface, with ocular and nasal destruction; jaw and tongue exposure and severe bleeding were present. Unfortunately the patient died 12 days after the hospital admission. Although informed consent allows patients to make treatment decisions based on the most information possible and patient's right to determine his or her treatment, there are a small number of adherents to religious faiths that proscribe conventional care. Despite the efforts for early diagnosis, patients continue to neglect seeking timely treatment. In our case, this was directly responsible for the patient's poor prognosis.</p> 2018-06-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209282 Une dermatose auto provoquée de l’épaule 2021-06-24T10:05:05+00:00 Mohamed El Amraoui med.elamraoui.dto@gmail.com Badredine Hassam med.elamraoui.dto@gmail.com <p>Les dermatoses auto provoquées sont de plus en plus fréquentes chez les adolescents toxicomanes avec des difficultés adaptatives. Nous présentons un cas de lésions bulleuses de l'épaule auto provoquées chez un adolescent ayant révélé un état dépressif majeur avec des idées suicidaires. Jeune homme âgé de 22 ans, sans antécédents pathologiques notables, ayant un tabagisme chronique, un cannabisme et un alcoolisme occasionnels, ses parents sont divorcés avec des conflits avec son père. A consulté pour une éruption bulleuse de l’épaule gauche faite de bulles, d’érosions post bulleuses et des croutes, siégeant sur une peau saine. L’aspect monomorphe des lésions, l’accessibilité (la localisation sur l’épaule gauche chez un droitier), les antécédents du patient et ses difficultés psychiatriques ont rapidement orienté l’enquête vers la possibilité d’une dermatose auto-provoquée ou une pathomimie. Le patient avouait la prise de psychotropes et que les lésions ont été auto provoquées par des brulures de cigarette. Ce premier abord psychologique a révélé également la présence d’idées suicidaires et un comportement d’auto et d’hétéro agressivité. Le patient a été mis sous émollients et crèmes cicatrisantes et adressé en consultation de psychiatrie de l’hôpital pour complément de prise en charge.</p> 2018-06-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209284 An overview of civil society organizations’ roles in health project sustainability in Bauchi State, Nigeria 2021-06-24T10:12:04+00:00 Umar Ibrahim umarsap@yahoo.com Sharifa Ezat Wan-Puteh umarsap@yahoo.com <p><strong>Introduction:&nbsp;</strong>this study sets out to assess the roles of Civil Society Organizations (CSOs) in post donor health project sustainability in Low and Middle Income Countries (LMICs), the case of the Bauchi State, Nigeria. This study equally investigated the CSOs strategies and roles in health project sustainability.</p> <p><strong>Methods:&nbsp;</strong>for quantitative data collection, the random, purposive, and convenient sampling techniques were used and 156 respondents selected from relevant organizations operating in Bauchi State, Nigeria, and 15 respondents for Key Informant Interviews (KIIs). A Semi-structured questionnaire was the study instrument, and consent from the participants as well as ethical clearances were duly obtained.</p> <p><strong>Results:&nbsp;</strong>the study revealed that 87.8% of the respondents indicate un-friendly operational policies, while 88.9% of them identified lack of resources (human, money and machineries) as impediments to project sustainability. Also, 74.3% of the respondents said partnership among key stakeholders and 86.6% of them affirmed that community participation and use of available (local) resources ensure health project sustainability. The study further revealed that CSOs fund health projects, support government efforts and encourage development of project sustainability road map in the state.</p> <p><strong>Conclusion:&nbsp;</strong>hence, health project sustainability plan should form part of a project right from inception through the donor period and thereafter. In addition to the above, internal income framework, community involvement, enabling policies and partnership among stakeholders, especially with the host government, should always guide project implementation, because without these in place, project sustainability will remain a mirage.</p> 2018-06-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209286 A giant mass in the neck of a young men: a case of anaplastic thyroid cancer 2021-06-24T10:19:08+00:00 Carlos Eduardo Salazar-Mejía carlos.salazarmj@uanl.edu.mx Luis Alberto Pérez-Arredondo carlos.salazarmj@uanl.edu.mx <p>A 29-year-old man presented with a 4-month history of a mass in the left lateral region of the neck that was painful to palpation. Growth of this mass caused a change in his tone of voice, dysphagia to solids that progressed to liquids, and dyspnea. He also referred a weight loss of 3 kg. He had no previous medical history. Physical examination of the neck showed a left ganglionar conglomerate, which covered all areas of the neck and the supraclavicular hollow and that extended to the opposite side with limitation of cervical movement. There was involvement of the left cranial nerves XI and XII. Laboratory tests revealed a TSH serum level of 5.19 uU/ml (0.27-4.2 uU/mL), a free T4 level of 0.80 ng% (0.93-1.7 ng%), and a thyroglobulin of 12.2 ng/ml (1.40-78.0 ng/ml). Histopathological analysis showed an anaplastic carcinoma of the thyroid. Due to the great extension of the disease and metastasis to the lung demonstrated by tomography, it was decided to initiate a chemotherapy regimen based on cisplatin and doxorubicin. Despite this treatment, the patient died three months later. Anaplastic thyroid cancers are extremely aggressive undifferentiated tumors with rapid progression and very poor outcome with a median overall survival of less than six months. For unresectable disease in patients who desire active therapy, radiation and/or chemotherapy is the preferred option for local control of the disease. Palliative care is important in this setting and should be added to any treatment plan.</p> 2018-06-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209295 Psychomotor regression due to vitamin B12 deficiency 2021-06-24T12:01:27+00:00 Amal Bousselamti brahim.elhasbaoui@yahoo.com Brahim El Hasbaoui brahim.elhasbaoui@yahoo.com Hanae Echahdi brahim.elhasbaoui@yahoo.com Yamna Krouile brahim.elhasbaoui@yahoo.com <p>A vitamin B12 deficiency in infants is rare, but may sometimes be seen in breastfed babies of strict vegetarian mothers. Vitamin B12, also known as cobalamin, is only found in meat and other animal products. Most babies have a sufficient supply as long as the mother was not deficient herself. Symptoms and signs of vitamin B12 deficiency appear between the ages of 2 to 12 months and include vomiting, lethargy, failure to thrive, hypotonia, and arrest or regression of developmental skills. Urinary concentrations of methylmalonic acid and homocystine are characteristically elevated in vitamin B12 deficiency. Early treatment for a vitamin B12 deficiency in an infant involves immediate administration of vitamin B12 to the baby and the breastfeeding mother. The infant and mother will each receive an injection of vitamin B12 containing 1,000 mcg or more of the vitamin, and the mother will continue to receive injections every month to raise her own stores. After the initial injection, the baby will often receive future vitamin B12 through food sources. We present a case of vitamin B12 deficiency in a 9-month-old girl presented with psychomotor regression, hypotonia and lethargy. The child was exclusively breast-fed from birth by a mother who was on strict vegetarian diet and belong to a low socio-economic status. Laboratory data revealed bicytopenia with macrocytic anemia and methylmalonic acid in the urine, consistent with vitamin B12 deficient anemia. The Brain CT revealed a cerebral atrophy and delayed myelination. Vitamin B12 supply was effective on anaemia and psychomotor delay. This case figures out the importance of an early diagnosis in front of psychomoteur regression and hypotonia, given the risk of incomplete neurologic recovery due to vitamin B12 deficiency mainly in the setting of maternal nutritional deficiency.</p> 2018-06-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209296 Pucker sign in irreducible posterolateral knee dislocation 2021-06-24T12:05:58+00:00 Sanjiv Fitz-Morris Gray sanjivfg@gmail.com Beatrice Esther Dieudonne sanjivfg@gmail.com <p>A 24 years-old male seen in the trauma bay involved in a motor vehicle accident with rollover landing on its roof. He was partially ejected with his right leg hyperflexed and entrapped. The patient was stable with complaints of right knee pain. There was dimpling of the right distal medial thigh (A, B). After unsuccessful attempts at closed reduction, the patient was taken for open reduction. There was entrapment of the femoral condyle in the extensor mechanism. The soft tissues were released and the condyle reduced back into its normal position. The extensor mechanism was then repaired. The patient had palpable posterior tibial and dorsalis pedis pulses after completion of the procedure. The mechanism for posterolateral knee dislocation is valgus and rotational stress during knee flexion. The medial cruciate ligament, anterior cruciate ligament, and the posterior cruciate ligament are usually injured in posterolateral knee dislocation with incarceration of the capsule and ligamentous structures in the intercondylar notch. Early open reduction is indicated as it is generally considered irreducible by closed reduction. The "pucker sign" is considered pathognomonic. On Radiographs with attention to the patella shows the patella maintaining its in-line attachments to the tibial tuberosity and is reduced with respect to the proximal tibia but dislocated with respect to the distal femur. At the follow up the patient is ambulatory after rehabilitation.</p> 2018-06-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209297 Tumeur stromale à localisation rétro-rectale: entité macroscopique et difficultés chirurgicales 2021-06-24T12:16:01+00:00 Driss Erguibi fahmi-yassine@hotmail.com Abdelilah El bakouri fahmi-yassine@hotmail.com Yassine Fahmi fahmi-yassine@hotmail.com Bouchaib Kadiri fahmi-yassine@hotmail.com <p>Les tumeurs stromales gastro-intestinales sont des tumeurs mésenchymateuses peu fréquentes dont la localisation rectale est extrêmement rare, et posent en pré-opératoire un problème de diagnostic et de prise en charge thérapeutique. Nous rapportons le cas d’une tumeur stromale à localisation rétro-rectale afin de bien étayer les particularités cliniques, radiologiques et thérapeutiques de cette entité rare.</p> 2018-06-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209300 Hepatitis B virus infection among sexually active individuals in Nigeria: a cross-sectional study 2021-06-24T12:26:42+00:00 Yewande Nejo adedayoraji@yahoo.com Adedayo Omotayo Faneye adedayoraji@yahoo.com Babatunde Olusola adedayoraji@yahoo.com Solomon Bakarey adedayoraji@yahoo.com Adebowale Olayinka adedayoraji@yahoo.com Babatunde Motayo adedayoraji@yahoo.com PERVI Study Group adedayoraji@yahoo.com <p><strong>Introduction:&nbsp;</strong>Hepatitis B virus (HBV) infection is a major health challenge in sub-Saharan African countries. Chronic HBV infection is a risk factor for severe disease progression. Perinatal and sexual transmissions of Hepatitis B virus are the main routes of infection in HBV endemic countries like Nigeria. However, there is paucity of data as regards the major contributory route of transmission to chronic HBV infection in this region. Also, in Nigeria, not everyone at high risk of the infection has been identified. Therefore our study investigated the prevalence of HBV infection among sexually active individuals in Nigeria.</p> <p><strong>Methods:&nbsp;</strong>blood samples collected from 463 participants (360 sexually active individuals and 103 teenagers) recruited from health institutions across the country were tested for the presence of HBsAg, and HBV nucleic acid related antigen (HBVNRAg) by ELISA. Positive samples were further tested for the presence of HBeAg and antiHBe by ELISA. Data were analyzed using Chi-square and binary logistic regression at p = 0.05.</p> <p><strong>Results:&nbsp;</strong>HBsAg and HBVNRAg were detected in 10.4% and 7.6% of the participants respectively. STI clinic attendees had the highest prevalence for HBsAg (17%; p = 0.002). Teenagers had the lowest HBsAg (1.9; p = 0.002) and HBVNRAg (2.9%; p = 0.0001) prevalence rates. Male gender (p = 0.01) and reproductive age group (p=0.009) were the major predictors of chronic HBV infection.</p> <p><strong>Conclusion:&nbsp;</strong>sexual transmission was identified as the major contributor to chronic HBV infection. Sexually active individuals especially those with STIs are high risk groups for chronic HBV infection. Interventions targeted at this group is therefore recommended.</p> 2018-06-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209305 Caractéristiques des accidents du travail et devenir des victimes: à propos de 133 cas déclarés auprès de la Caisse de Sécurité Sociale de Dakar (Sénégal) 2021-06-24T12:56:23+00:00 Sidy Akhmed Dia azhar1er@gmail.com Azhar Salim Mohamed azhar1er@gmail.com Fatou Sy Gaye azhar1er@gmail.com El Hadj Oumar Ndoye azhar1er@gmail.com Mame Coumba Gaye Fall azhar1er@gmail.com Mouhamed Manibolio Soumah azhar1er@gmail.com Mor Ndiaye azhar1er@gmail.com <p><strong>Introduction:&nbsp;</strong>les accidents du travail (AT) ont des répercussions sur le système de sécurité social du pays, sur les victimes elles-mêmes ainsi que leurs proches. L’objectif de notre étude est de décrire les différentes caractéristiques des AT déclarés auprès de la Caisse de Sécurité Sociale (CSS) de Dakar et le devenir socio-professionnel des victimes.</p> <p><strong>Méthodes:&nbsp;</strong>étude rétrospective et transversale sur une période de 5 ans, de 2002 à 2006. Ont été colligés 133 cas sur 9.308 AT déclarés à la CSS. Divers paramètres ont été étudiés: caractéristiques socio-professionnelles des victimes et aspects lésionnels des accidents. Les victimes ont été interrogées pour recueillir leur vécu socio-professionnel, la situation professionnelle.</p> <p><strong>Résultats:&nbsp;</strong>l’âge moyen des sujets était de 37,55 ans avec une prédominance masculine (99,22%). Les secteurs du BTP (22,6%) et de la pêche (15%) étaient les plus touchés. Près des deux tiers des accidents survenaient au lieu du travail (77,4%). Ces accidents entrainaient des fractures dans 51,7% des cas et touchaient la main dans 30,1% des cas. Près de deux tiers des accidentés (60,9%) avaient repris la même profession. On notait 31 cas de licenciement et 12 cas de reclassement professionnel. La durée d’incapacité temporaire totale moyenne était de 236,7 jours. Le montant annuel moyen de la rente était de 1.640.329 Francs CFA (2 504,31 Euros).</p> <p><strong>Conclusion:&nbsp;</strong>les AT au Sénégal ne présentent pas de grandes particularités comme décrites partout ailleurs. Les faibles ressources allouées aux victimes et l’absence de politique d’accompagnement social expliquent les différentes souffrances des victimes et leurs familles.</p> 2018-06-21T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209313 Application of the Canadian C-Spine rule and nexus low criteria and results of cervical spine radiography in emergency condition 2021-06-24T13:06:04+00:00 William Ngatchou willyngatchou@yahoo.fr Jeanne Beirnaert willyngatchou@yahoo.fr Daniel Lemogoum willyngatchou@yahoo.fr Cyril Bouland willyngatchou@yahoo.fr Pierre Youatou willyngatchou@yahoo.fr Ahmed Sabry Ramadan willyngatchou@yahoo.fr Regis Sontou willyngatchou@yahoo.fr Maimouna Bol Alima willyngatchou@yahoo.fr Alain Plumaker willyngatchou@yahoo.fr Virginie Guimfacq willyngatchou@yahoo.fr Claude Bika willyngatchou@yahoo.fr Pierre Mols willyngatchou@yahoo.fr <p><strong>Introduction:&nbsp;</strong>the Canadian C Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (Nexus) low criteria are well accepted as guide to help physician in case of cervical blunt trauma.</p> <p><strong>Methods:&nbsp;</strong>we aimed to evaluate retrospectively the application of these recommendations in our emergency department. Secondly we analyzed the quality of cervical spine radiography (CSR) in an emergency setting.</p> <p><strong>Results:&nbsp;</strong>281 patients with cervical blunt trauma were analyzed retrospectively. The CCR and the NEXUS rules were respected in 91.2% and 96.8% of cases respectively. No lesions were found in 96.4% of patient. A lesion was present in 1.1% of patient and suspected in 2.5% of patient. The quality of CSR was adequate in only 37.7% of patient. The poor quality of CSR was due either to the lack of C7 vertebrae visualization in 64.6% or other lower vertebrae in 28%. Other causes included the absence of open mouth view (8%), the absence C1 vertebrae visualization (3.4%), artifact in 2.3% and the absence of lateral view in 0.6% of patient.</p> <p><strong>Conclusion:&nbsp;</strong>CCR and NEXUS are widely used in our emergency department. The high rate of inadequate CSR reinforces the debate about it’s utility in emergency condition.</p> 2018-06-21T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209315 Pathology of lymph node tuberculosis in Yaounde: diagnostic agreement based on the Kappa coefficient 2021-06-24T13:16:43+00:00 Joseph Marie Mendimi Nkodo mendimajo@gmail.com Roger Ateba mendimajo@gmail.com Christiane Judith Ngo Pambe mendimajo@gmail.com Angèle Clarisse Kabeyene Okono mendimajo@gmail.com Jean Louis Essamé Oyono mendimajo@gmail.com <p><strong>Introduction:&nbsp;</strong>lymph node tuberculosis remains widespread in Cameroon. Our goal was to compare the diagnostic agreement between the hematein-eosin coloration technique and the Ziehl-Neelsen technique.</p> <p><strong>Methods:&nbsp;</strong>this study is a retrospective and comparative study realized in the Yaounde University Teaching Hospital over a period of 5 years. We needed to specify the diagnostic agreement for tuberculosis, first inter observer and secondly between the standard and special colorations. The data we collected allowed us to determine the agreement rates observed and the kappa (k) coefficients with linear weighting.</p> <p><strong>Results:&nbsp;</strong>the 186 samples of the 1726 cases of tuberculosis of all locations represented a proportion of 10.78%. There were more male patients (65.05%) with a sex ratio (M:F) of 1.30. The average age was 24.21 ± 15.5 with the extremes from 5 to 68 years. The most represented age group was from 10 to 39 years. The two observers agreed in 93 cases using hematein eosin coloration (P<sub>0</sub>&nbsp;= 83.87 %; k = 0.8109) and on 73 samples using the Ziehl-Neelsen coloration (P<sub>0</sub>&nbsp;= 89.78 %; k = 0.7734). The two coloration techniques presented an agreement on 104 samples (P<sub>0</sub>&nbsp;= 88.17 %; k = 0.8783).</p> <p><strong>Conclusion:&nbsp;</strong>the routine choice of the hematein eosin coloration technique not paired with the coloration technique of Ziehl-Neelsen can effectively alleviate the program for fighting tuberculosis in an environment of limited resources.</p> 2018-06-22T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209518 Profil épidémiologique et anatomopathologique du cancer colorectal: à propos de 36 cas 2021-06-28T07:46:52+00:00 Mohamed Said Belhamidi belhamidimohamedsaid@gmail.com Mohamed Sinaa belhamidimohamedsaid@gmail.com Abdessamad Kaoukabi belhamidimohamedsaid@gmail.com Hicham Krimou belhamidimohamedsaid@gmail.com Mohamed Menfaa belhamidimohamedsaid@gmail.com Farid Sakit belhamidimohamedsaid@gmail.com Abdelkrim Choho belhamidimohamedsaid@gmail.com <p>Le cancer colorectal est classé parmi les cancers les plus fréquents au monde (3<sup>ème</sup>&nbsp;rang après le cancer du sein et celui de la prostate), deuxième cancer digestif au Maroc après celui de l'estomac. Cependant son incidence dans notre pays reste moins élevée que celle des pays occidentaux (2.5 à 3.3/100 000 ha) mais rejoint celle des pays du Maghreb dont ce cancer touche les sujets jeunes dans 27% des cas. Le cancer colorectal (CCR) est un des meilleurs exemples du processus multi étape de cancérogenèse. La connaissance des caractéristiques anatomopathologique du CCR conditionnera certainement nos attitudes thérapeutiques. Nous avons mené une étude rétrospective épidémiologique et anatomopathologique au service de chirurgie viscérale de l'hôpital militaire Moulay Ismail à Meknès sur une période de 5 ans allant du mois de janvier 2012 au mois de Décembre 2016 (36 cas: 14 femmes et 22 hommes). À la lumière de cette étude, l'objectif de ce travail est d'analyser le profil épidémiologique et les aspects anatomopathologiques des cancers colorectaux. L'analyse de nos résultats montre un profil épidémiologique particulier qui se caractérise par un âge plus jeune, une répartition selon le sexe en faveur des hommes, les carcinomes sporadiques sont largement prédominants avec une répartition topographique recto sigmoïdienne fréquemment observée. Sur le plan pronostique, le faible degré de différenciation des adénocarcinomes et le type mucineux sont corrélés à un stade TNM et d'Aster Coller avancés, avec un statut ganglionnaire péjoratif. Cette approche multidisciplinaire sera une première nationale, rendant ainsi notre structure de pratique et de recherche médicale l'une des plateformes de prise en charge multidisciplinaire du cancer colorectal au Maroc.</p> 2018-06-22T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209521 Caregiver delay in seeking healthcare during the acute phase of pediatric illness, Kigali, Rwanda 2021-06-28T07:50:58+00:00 Christian Umuhoza crissumuh@gmail.com Angelique Charlie Karambizi crissumuh@gmail.com Lisine Tuyisenge crissumuh@gmail.com Peter Cartledge crissumuh@gmail.com <p><strong>Introduction:&nbsp;</strong>delay in seeking healthcare contributes significantly to under-five mortality. Multiple socioeconomic and demographic factors have been reported as predictors of such delay. There is no published research in this area in Rwanda. Our aim was to describe the caregivers' delay in seeking healthcare during the acute phase of a childhood illness among under-five children admitted in a tertiary hospital, Rwanda.</p> <p><strong>Methods:&nbsp;</strong>this was an analytical, descriptive cross-sectional study conducted at University Teaching Hospital of Kigali. Bivariate analysis and logistic multivariate regression were used to analyze factors associated with delayed care-seeking behavior, defined as seeking care after the first 48 hours of illness onset.</p> <p><strong>Results:&nbsp;</strong>among 275 admitted children under age five, care-seeking delay occurred in 35% (97/275) of cases. The most significant predictors of delay in seeking care were use of traditional healers (AOR = 14.87, 95% CI: 3.94-56.12), the recognition of illness as mild (AOR = 8.20, 95% CI: 4.08-16.47), use of un-prescribed medicine at home (AOR = 2.00, 95% CI: 1.01-3.91), use of special prayers provided by ministers of God before seeking healthcare (AOR = 6.42, 95% CI: 2.50, 16.48), and first consultation at public institutions (AOR = 4.00, 95% CI:1.54-10.39).</p> <p><strong>Conclusion:&nbsp;</strong>even though Rwanda has made tremendous achievements in strengthening the community-based health systems, delayed care-seeking is a reality. Health education and behavior change communication interventions are needed at the community level to address the factors that lead to delay in seeking healthcare.</p> 2018-06-22T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209522 A chronic myeloid leukemia case with a variant translocation t(11;22)(q23;q11.2): masked Philadelphia or simple variant translocation? 2021-06-28T07:53:37+00:00 Kadir Acar burakuz78@gmail.com Burak Uz burakuz78@gmail.com <p>Chronic myeloid leukemia (CML) is characterized by the presence of the Philadelphia chromosome (Ph), usually due to a reciprocal translocation, t(9;22)(q34;q11.2). The remaining cases (2-10%) have variant translocation, and more rarely (~1%) a cryptic rearrangement is present which can be detected by fluorescence in situ hybridization analysis in a CML patient with a Ph-negative karyotype (Masked Ph). We present a masked/variant BCL-ABL-positive CML patient showing a t(11;22)(q23;q11.2) which was detected using a combined approach of conventional cytogenetics and reverse transcription polymerase chain reaction. In February 2013, the patient was diagnosed as having CML. Imatinib mesylate (400 mg/day), was then started. Under imatinib therapy a complete hematologic and cytogenetic response was attained. In December 2013, an increment in BCR-ABL/ABL transcript levels according to the International Scale (from 0.0471% to 1.4034%), indicating imatinib failure, was documented. Administration of nilotinib (400 mg twice daily) resulted in durable molecular response after 3 months. The patient is still on nilotinib treatment throughout the observation period with no sign of recurrence and adverse events.</p> 2018-06-22T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209523 Knowledge and experience with Cochrane and evidence based medicine among health professionals in Debreberhan Referral Hospital in Ethiopia: a cross-sectional survey 2021-06-28T07:58:32+00:00 Omar Abdulwadud omarabdulwadud@yahoo.com Fiseha Tadesse omarabdulwadud@yahoo.com Getachew Yilma omarabdulwadud@yahoo.com Metti Midekssa omarabdulwadud@yahoo.com Irina Ibraghimova omarabdulwadud@yahoo.com <p><strong>Introduction:&nbsp;</strong>Cochrane generates and disseminates high-quality systematic reviews through the Cochrane Library. We surveyed Ethiopian health professionals' knowledge and experience with cochrane, the Cochrane Library and Evidence Based Medicine (EBM).</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional survey was conducted using a convenient sample of health professionals in DebreBerhan Referral hospital in Ethiopia. Participants completed a pre-tested self-administered survey before EBM training. Data were analyzed using Fisher's exact or Chi-Squared test with Yates' correction. The strength of association between variables was quantified using odds ratios with 95% confidence intervals.</p> <p><strong>Results:&nbsp;</strong>the response rate was 71.4% (35/49). Over half (54.3%) of the sample were males; 68.6% aged ≤ 30 years; 54.3% were physicians and 37.1% were nurses. Up to 65.7% had heard about Cochrane and only two knew cochrane South Africa as their reference centre. Nearly 48.6% were aware of the Cochrane Library, of whom 46% accessed it however; none used it for lacking awareness, search skills, access to internet and time constraints. Majority had a positive attitude towards EBM; 45.7% had heard of EBM; 74.3% rated their EBM knowledge as low; 74.3% lacked EBM training; and 88.6% were keen to attend EBM course. Adequate EBM knowledge was correlated with prior training (OR = 3.7, 95% CI 1.9-6.9, P&lt;0.001], high self-assessment of EBM knowledge (OR = 0.27, 95% CI 0.14-0.51, P&lt;0.001), male gender (P = 0.04), a positive attitude towards EBM (P = 0.001) and awareness of Cochrane (P = 0.004).</p> <p><strong>Conclusion:&nbsp;</strong>Ethiopian health professionals have unmet training needs and want support through professional development workshops and an improved education system to provide high-quality evidence-based healthcare.</p> 2018-06-22T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209526 Arthrose post-traumatique carpo-métacarpienne du cinquième doigt traitée par arthroplastie stabilisée: à propos de deux cas et revue de la littérature 2021-06-28T08:35:08+00:00 Wassim Zribi zribi.wassim@yahoo.fr Mohamed Zribi zribi.wassim@yahoo.fr Mohamed Ben Jemaa zribi.wassim@yahoo.fr Wajdi Bouaziz zribi.wassim@yahoo.fr Ameur Abid zribi.wassim@yahoo.fr Abdesslem Naceur zribi.wassim@yahoo.fr Yosr Hantati zribi.wassim@yahoo.fr Moez Trigui zribi.wassim@yahoo.fr Zoubayer Ellouze zribi.wassim@yahoo.fr Kamel Ayedi zribi.wassim@yahoo.fr Hassib Keskes zribi.wassim@yahoo.fr <p>Les fractures-luxations anciennes de la base du cinquième métacarpien peuvent se compliquer d'une arthrose post-traumatique gênante sur le plan fonctionnel et de prise en charge difficile. La technique d'arthroplastie stabilisée comporte une résection arthroplastique de la base du cinquième métacarpien associée à une arthrodèse diaphyso-métaphysaire latérale entre le quatrième et le cinquième métacarpien. A travers deux observations, nous présentons les objectifs de cette technique d'arthroplastie stabilisée et ses particularités par rapport aux autres techniques destinées au traitement des séquelles des fractures-luxations de la base du M5.</p> 2018-06-22T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209534 Méningite à Haemophilus influenzae de type non b chez un nourrisson: cause rare à pronostic réservé 2021-06-28T08:47:01+00:00 Meriem Rachidi toubibrachidi@gmail.com Fatima Azzahraa Moussair toubibrachidi@gmail.com Naima Daoudi toubibrachidi@gmail.com Nabila Soraa toubibrachidi@gmail.com <p>Les souches d’<em>Haemophilus influenzae</em>&nbsp;de type non b représentent une cause rare de localisations secondaires invasives chez les jeunes enfants. Cette observation rapporte le cas d’une méningite à&nbsp;<em>Haemophilus influenzae</em>&nbsp;de sérotype non b, bacilles gram négatif polymorphe encore exceptionnellement décrit dans la littérature chez un nourisson de 11 mois dont l'origine est restée indéterminée et dont l’évolution était fatale. Les cliniciens et les microbiologistes doivent penser davantage à ces sérotypes non fréquents surtout sur un terrain particulier.</p> 2018-06-22T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209535 Corrigendum: Schwannome bénin du nerf grand sciatique, à propos de 2 cas 2021-06-28T08:58:22+00:00 Mohammed Chahbouni chahbouni.mohammed1981@gmail.com Issam Eloukili chahbouni.mohammed1981@gmail.com Mohamed Ali Berrady chahbouni.mohammed1981@gmail.com Moulay Omar Lamrani chahbouni.mohammed1981@gmail.com Mohamed Kharmaz chahbouni.mohammed1981@gmail.com Farid Ismail chahbouni.mohammed1981@gmail.com Mustapha Mahfoud chahbouni.mohammed1981@gmail.com Ahmed El Bardouni chahbouni.mohammed1981@gmail.com Mohamed Saleh Berrada chahbouni.mohammed1981@gmail.com Mouradh El Yaacoubi chahbouni.mohammed1981@gmail.com <p>This Corrigendum corrects “Schwannome bénin du nerf grand sciatique, à propos de 2 cas” The Pan African Medical Journal. 2014;18:252. doi:10.11604/pamj.2014.18.252.4684.</p> 2018-06-25T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209547 Socio-economic and demographic determinants of tobacco use in Kenya: findings from the Kenya Demographic and Health Survey 2014 2021-06-28T10:12:35+00:00 Peter Magati ptrmagati@gmail.com Jeffrey Drope ptrmagati@gmail.com Leopold Mureithi ptrmagati@gmail.com Raphael Lencucha ptrmagati@gmail.com <p><strong>Introduction:&nbsp;</strong>every year, more than 6,000 Kenyans die of tobacco related diseases (79 men and 37 women die per week), while more than 220,000 children and more than 2,737,000 adults continue to use tobacco each day. Some suggest that these numbers will rise without concerted efforts to strengthen the implementation of tobacco control measures. To date, there remains much to be learned about what contributes to tobacco consumption in Kenya. This study analyses the socio-economic and demographic determinants of tobacco use in Kenya.</p> <p><strong>Methods:&nbsp;</strong>to analyze the determinants of tobacco use in Kenya, this study uses the 2014 Kenya Demographic and Health Survey. A logistic regression is used to estimate the probability of an individual smoking, given a set of socio-economic and demographic characteristics.</p> <p><strong>Results:&nbsp;</strong>results suggest that the overall smoking and smokeless prevalence rate is 17.3% and 3.10% respectively among men. Women have low rates with smoking and smokeless prevalence standing at 0.18% and 0.93% respectively. However, for both genders, tobacco use is influenced by age, marital status, residence, region, educational status and gender.</p> <p><strong>Conclusion:&nbsp;</strong>socio-economic, demographic and geographic disparities on tobacco use should be explored in order to ensure prudent allocation of resources used for tobacco control initiatives. Allocation of resources for tobacco control including monitoring advertisements, sales to underage persons and general distribution of human resource for tobacco control should be based on socio-economic and demographic dynamics.</p> 2018-06-25T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209549 Non-clinical isolates as potential reservoirs of antibiotic resistance in Port Harcourt, Nigeria 2021-06-28T10:24:58+00:00 Kome Otokunefor kome.otokunefor@uniport.edu.ng Paul Agbude kome.otokunefor@uniport.edu.ng Tosanwumi Vincent Otokunefor kome.otokunefor@uniport.edu.ng <p><strong>Introduction:&nbsp;</strong>multidrug resistance (MDR) is a growing problem worldwide. This type resistance often arises due to the sequential acquisition of drug resistance determinants and subsequent clonal spread. It is therefore important to determine possible reservoirs of these MDR gene to help set out control strategies. This study was aimed at analysing susceptibility patterns of various non-clinical Gram negative bacterial strains to determine their potential as reservoirs of MDR.</p> <p><strong>Methods:&nbsp;</strong>thirty-five non-clinical Gram negative bacteria were identified and susceptibility profile determined using standard methodologies.</p> <p><strong>Results:&nbsp;</strong>findings showed a preponderance of&nbsp;<em>Pseudomonas aeruginosa</em>&nbsp;and&nbsp;<em>Escherichia Coli</em>. Resistance rates of above 80% were noted in 50% of antibiotics, though none of the isolates were resistant to Ofloxacin. Majority of isolates (68.6%) had a multiple antibiotic resistance (MAR) index greater than 0.5, but only 20% of&nbsp;<em>Escherichia Eoli</em>. were found in this category. A high level of MDR was noted in this study (71.4%), but again only 20% of these were&nbsp;<em>Escherichia Coli</em>.</p> <p><strong>Conclusion:&nbsp;</strong>Gram negative bacteria are the most common group of bacteria frequently encountered in clinical microbiology. In more recent years, infections with these organisms have been further complicated by the phenomenon of drug resistance. Non-clinical isolates have been postulated as possible reservoirs. Findings from this study of widespread multidrug resistance support this idea. This study however highlights the lack of MDR in&nbsp;<em>Escherichia Coli</em>, which is promising. More extensive studies will need to be carried out to properly assess the role of non-clinical isolates as reservoirs of MDR determinants.</p> 2018-06-25T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209557 Pneumothorax catamenial: resultats de 18 cas opérés 2021-06-28T11:11:14+00:00 Raphael Ouede oued70raphael@yahoo.fr Blaise Demine Alexandre oued70raphael@yahoo.fr Ayegnon Kouakou Gregoire oued70raphael@yahoo.fr Landry Kohou-kone oued70raphael@yahoo.fr Edouard N’guessan oued70raphael@yahoo.fr Maurice Gabin Kouacou oued70raphael@yahoo.fr Jean-Marcel Ahui Brou oued70raphael@yahoo.fr Flavien Kouassi Kendja oued70raphael@yahoo.fr Yves Tanauh oued70raphael@yahoo.fr <p>L'objectif de notre étude était de proposer une approche thérapeutique du pneumothorax cataménial à partir des résultats de nos 18 cas opérés. Il s'agit d'une étude rétrospective de Janvier 1994 à Décembre 2016 qui a concerné 18 patientes âgées en moyenne de 32,2 ans opérées d'un pneumothorax cataménial droit (16 cas) et bilatéral (2 cas). Les patientes ont été réparties en 3 groupes en fonction de l'évolution dans le temps de notre attitude chirurgicale: le groupe 1 (G1) de janvier 1994 à juin 2006, le groupe 2 (G2) de juillet 2006 à février 2008 et le groupe 3(G3) de mars 2008 à décembre 2016, ces groupes contenaient respectivement 5, 2 et 11 patientes. Ces patientes toutes nullipares avaient une dysménorrhée depuis la puberté associée dans 11 cas à des douleurs thoraciques cataméniales. La radiographie standard du thorax a été systématique et complétée dans 8 cas par un scanner thoracique qui a objectivé en plus du pneumothorax, des bulles apicales (5 cas). L'exploration par mini thoracotomie postéro-latérale (16 cas) et par vidéothoracoscopie (2 cas de G3) a retrouvé des fenestrations diaphragmatiques (18 cas) et des bulles (5 cas). La biopsie des lésions et la résection des bulles a été systématique. Vis-à-vis des fenestrations diaphragmatiques, la chirurgie a consisté dans le groupe 1 en une résection-suture avec abrasion pleurale, dans le groupe 2 une couverture par un patch de Gore-tex avec abrasion pleurale et dans le groupe 3 une couverture par un patch avec talcage pleural. Une hormonothérapie (triptoreline) de 6 mois a été prescrite à chaque patiente en postopératoire pour suspendre les menstrues. Le résultat de la chirurgie a été apprécié sur la base de la survenue ou non d'une récidive du pneumothorax à la reprise des menstrues. La mortalité a été nulle. Le séjour hospitalier post opératoire moyen était de 9,32 jours. Les examens anatomopathologiques ont confirmé l'endométriose thoracique dans 9 cas. Après un suivi moyen de 5,3 ans, le résultat était bon chez 12 patientes (3/5 de G1, 1/2 de G2 et 8/11 de G3), 3 patientes de G3 ont continué de présenter des épisodes de dyspnée minime au début de quelques menstrues sans récidive radiologique, 3 patientes (2 de G1 et 1 de G2) ont récidivé et ont fait l'objet de reprise chirurgicale. En cas de pneumothorax cataménial avec fenestrations diaphragmatiques, nous proposons une phrénoplastie de recouvrement au patch associée à un talcage pleural et une hormonothérapie complémentaire concomitante de 6 mois.</p> 2018-06-25T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209561 Anomalies electrocardiographiques et echocardiographiques au cours de la cirrhose virale b: a propos de 60 cas au service d’hepato-gastroenterologie de l’Hopital Aristide Le Dantec de Dakar (HALD) 2021-06-28T11:35:20+00:00 Mamadou Ngoné Guèye mamadoungone@yahoo.fr Bassène Marie Louise mamadoungone@yahoo.fr Bodian Malick mamadoungone@yahoo.fr Diallo Salamata mamadoungone@yahoo.fr Thioubou Mame Aïssé mamadoungone@yahoo.fr Halim Ambdil mamadoungone@yahoo.fr Fall Marième Polèle mamadoungone@yahoo.fr Cissé Cheikh Ahmadou Bamba mamadoungone@yahoo.fr Dia Daouda mamadoungone@yahoo.fr Mbengue Mouhamadou mamadoungone@yahoo.fr Ba Serigne Abdou mamadoungone@yahoo.fr Diouf Mamadou Lamine mamadoungone@yahoo.fr <p>L’objectif de cette étude est d’évaluer les anomalies électrocardiographiques et échocardiographiques chez les patients atteints de cirrhose virale B et identifier leurs déterminants. Il s’agissait d’une étude prospective sur 8 mois aux services de d’Hépato-Gastroentérologie et de Cardiologie de l’hôpital Aristide Le Dantec de Dakar. Tous les patients atteints de cirrhose B virale et n’ayant pas de cardiopathie pré existante connue ont été inclus. Nous avons collecté et analysé les données épidémiologiques, cliniques, biologiques, échographiques, endoscopiques, électrocardiographiques et échocardiographiques (2D et Doppler) de tous les patients. Les données ont été saisies sur tableau Excel 2007 et analysées à l’aide du logiciel Sphinx version 5. La comparaison des variables a été faite par les tests de Chi 2 standard et Fisher. Le seuil de significativité a été arrêté à p&lt; 0,05 pour ces 2 tests statistiques. Soixante patients ont été inclus. La prévalence de la cirrhose virale B était de 3,4%. L’âge moyen était de 41 ans et le sex ratio de 1,6 (37 hommes). La cirrhose était classée Child-Pugh B chez 29 patients (49%), Child-Pugh C et Child Pugh A respectivement chez 20 patients (33%) et 11 patients (18%). Les anomalies électrocardiographiques les plus fréquentes étaient l’hypertrophie ventriculaire gauche et l’allongement de l’intervalle QTc objectivés respectivement chez 27 patients (45%) et 24 patients (40%). L’analyse statistique a montré une association entre l’intervalle QTc prolongé et la gravité de la cirrhose (p = 0,01, RR = 2, IC = 0,24 à 0,341). Les anomalies échocardiographiques étaient dominées par la dilatation ventriculaire gauche (58,3%) et l’hyperdébit cardiaque (43,3%) avec un débit moyen de 6,05 l/min. L’analyse stastistique mettait en évidence une association significative entre la gravité de la cirrhose et l’hyperdébit cardiaque (p = 0,003; IC: 95% (de 2,883 à 38,58; RR = 2). Au total, 14 patients (23,3%) avaient une cardiomyopathie cirrhotique latente. La cirrhose virale B peut induire des anomalies cardiaques diverses et variées. Ces anomalies sont morphologiques et/ou électrophysiologiques et leur gravité semble corrélée à la sévérité de la cirrhose.</p> 2018-06-25T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209567 Factors associated with postpartum depression among adolescents in Uganda 2021-06-28T11:41:51+00:00 Catherine Atuhaire samuelcumber@yahoo.com Samuel Nambile Cumber samuelcumber@yahoo.com <p>Postpartum depression (PPD) is a common and disabling public health complication of the postpartum period in women. It is believed to occur three times more commonly in developing countries than in the developed world and is more prevalent among women in the first six weeks after birth. Research suggests that postpartum depression is more commonly diagnosed among adolescents and may be a risk factor for poor growth and development in children born to these mothers. Therefore, adolescents are a special age group that requires specific health care maternal interventions in order to detect and treat post-partum depression.</p> 2018-06-25T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209571 Marfan syndrome: a case report and pictorial essay 2021-06-28T12:04:17+00:00 Poobalan Naidoo poobalan1naidoo@yahoo.com Naresh Ranjith poobalan1naidoo@yahoo.com Zuzile Zikalala poobalan1naidoo@yahoo.com Scott Mahoney poobalan1naidoo@yahoo.com Kevin Ho poobalan1naidoo@yahoo.com <p>We report a case of Marfan syndrome (MFS) in a South African patient, which is extraordinary because of the large constellation of clinical, radiological and vascular anomalies in a single patient. A literature search from 1950 to date did not show a similar report of such extensive clinical characteristics of MFS.</p> 2018-06-25T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209576 Autosomal recessive polycystic kidney disease (ARPKD) in a Nigerian newborn: a case report 2021-06-28T12:20:00+00:00 Olufunke Bolaji adebamiolusegun@gmail.com Olagoke Erinomo adebamiolusegun@gmail.com Olufunmilayo Adebara adebamiolusegun@gmail.com Julia Okolugbo adebamiolusegun@gmail.com Bartholomew Onumajuru adebamiolusegun@gmail.com Taiwo Akanni adebamiolusegun@gmail.com Olusegun Adebami adebamiolusegun@gmail.com <p>Autosomal recessive polycystic kidney disease (ARPKD) is a rare genetic disorder but even rarer in Africans and it is one of the causes of nephropathies in childhood. Although isolated cases of adult PKD have been reported in Nigerians; to the best of our knowledge, this case is the first to be reported in the paediatric age group in Nigeria. A case of autosomal recessive polycystic kidney disease presenting with severe perinatal asphyxia and severe respiratory distressis here by presented. Fetal ultrasonography during the pregnancy missed the diagnosis. The difficulty in making diagnosis and management is discussed. Autopsy helped to unravel the diagnosis in this case report.</p> 2018-06-25T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209579 Africa is on the verge of a major health crisis and the need for nutrition and health surveys is imperative 2021-06-28T12:26:10+00:00 Seth Selorm Klobodu ssklobodu@csuchico.edu Sarah Kessner ssklobodu@csuchico.edu Levi Johnson ssklobodu@csuchico.edu <p>The African region may be reaching a tipping point for a major health crisis. Over the last few decades for example, there has been a significant increase in the prevalence of obesity and associated comorbidities. This alarming trend is attributed to the rapid urbanization, increase in income, and unhealthy lifestyles among many others. Most importantly, managing and treating non-communicable diseases (NCDs) is expensive and proving to be beyond the reach of ordinary Africans. Interestingly, Africa has not fully eradicated undernutrition particularly micronutrient malnutrition especially among women and children. Additionally, HIV/AIDs, malaria, diarrheal diseases and other preventable infectious diseases continue to pose serious threat to the health of the populace. The management of NCDs is challenging and costly as most healthcare systems on the continent are largely built for the provision of curative care for communicable diseases. This article proposes the institution of nutrition and health surveys in individual countries to monitor trends. We believe this approach, in addition to addressing lifestyle and behavioral factors may be effective in curbing the rising phenomenon of obesity and NCDs.</p> 2018-06-26T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209580 Rupture spontanée d’un kyste hydatique du foie dans la cavité péritonéale avec une membrane proligère intacte: à propos d’un cas et revue de la littérature 2021-06-28T12:32:45+00:00 Baccouch Seifeddine seifeddinebaccouch@gmail.com Challakhi Amel seifeddinebaccouch@gmail.com Talbi Ghofrane seifeddinebaccouch@gmail.com Bacha Dhouha seifeddinebaccouch@gmail.com Gharbi Lassaad seifeddinebaccouch@gmail.com Bayar Rached seifeddinebaccouch@gmail.com Khalfallah Mohamed Taher seifeddinebaccouch@gmail.com <p>La rupture intrapéritonéale du kyste hydatique du foie avec une membrane proligère intacte est rare. Nous rapportons le cas d'une patiente âgée de 63 ans qui avait consulté pour douleur de l'hypochondre droit sans fièvre ni ictère. L'imagerie trouvait un kyste hydatique du segment IV du foie associé à une lésion kystique pelvienne de 12cm x 06cm. L'exploration chirurgicale trouvait un kyste hydatique univésiculaire du foie rompu avec une membrane proligère intacte et libre dans la cavité péritonéale. Le but de ce travail est de rapporter un nouveau cas de rupture intrapéritonéale d'un kyste hydatique du foie avec membrane proligère intacte et de préciser les difficultés diagnostiques et thérapeutiques rencontrées au décours de cette complication.</p> 2018-06-26T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209583 Physical activity profile of Nigeria: implications for research, surveillance and policy 2021-06-28T12:44:56+00:00 Adewale Luqman Oyeyemi alaoyeyemi@yahoo.com Adetoyeje Yoonus Oyeyemi alaoyeyemi@yahoo.com Babatunji Abayomi Omotara alaoyeyemi@yahoo.com Aliyu Lawan alaoyeyemi@yahoo.com Kingsley Kolapo Akinroye alaoyeyemi@yahoo.com Rufus Adesoji Adedoyin alaoyeyemi@yahoo.com Andrea Ramírez alaoyeyemi@yahoo.com <p>Appraising the status of physical activity surveillance, research and policy in Nigeria is relevant to national and regional public health actions on physical activity promotion and non-communicable disease control. This study aimed to 1) evaluate the physical activity profile of Nigeria and 2) propose strategies for improving physical activity in the country. The Global Observatory for Physical Activity-GoPA! with inputs from local experts systematically collected sociodemographic and physical activity surveillance, national policy and research indicators data for Nigeria in 2014. The Nigerian Country Card highlighting the status of these indicators was developed in 2015 and launched in 2016. Prevalence of physical activity among Nigerian adults was 78% (female=76%, male=79%). There was no physical activity surveillance system and national plan, and no empirical data on the proportion of all deaths directly due to physical inactivity in Nigeria. Few (n=7) articles related to physical activity and public health were published in 2013 and the country occupied the 38<sup>th</sup>&nbsp;position in the global research ranking, contributing about 0.24% to physical activity research worldwide. Implementing national physical activity plans and multi-sectorial collaborations between government and non-governmental partners are needed to improve physical activity surveillance, research and policy in Nigeria and other African countries with similar physical activity gaps.</p> 2018-06-26T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209586 Les connectivites en milieu hospitalier à Lomé: étude rétrospective de 231 cas 2021-06-28T12:55:02+00:00 Julienne Noude Teclessou tjulie06@yahoo.fr Bayaki Saka tjulie06@yahoo.fr Séfako Abla Akakpo tjulie06@yahoo.fr Houassou Matakloe tjulie06@yahoo.fr Abas Mouhari-Toure tjulie06@yahoo.fr Kousaké Kombate tjulie06@yahoo.fr Inoussa Oniankitan tjulie06@yahoo.fr <p>Le but de cette étude était de documenter le profil épidémiologique, clinique, thérapeutique et évolutif des connectivites en milieu hospitalier à Lomé. Il s'agissait d'une étude rétrospective descriptive menée du 1<sup>er</sup>&nbsp;Janvier 1993 au 31 Décembre 2012. Elle a porté sur les dossiers des malades ayant souffert d'une connectivite dans cinq services de dermatologie et de rhumatologie des centres hospitaliers de Lomé. Au cours de la période d'étude, nous avons recensé 231 cas de connectivites dans les cinq centres d'étude, ce qui correspondait à une fréquence de 0,19% des consultations. L'âge moyen des patients était de 36,96±15 ans et la sex-ratio de 0,2. Les principales connectivites étaient la maladie lupique (50,22%); les sclérodermies (21,64%) et la polyarthrite rhumatoïde (20,35%). Sur le plan clinique, les principales manifestations cliniques des connectivites étaient les lésions de lupus discoïde (87,50%) et la photosensibilité (82,50%) chez les patients ayant un lupus érythémateux systémique; la sclérose cutanée (90,48%) chez les patients ayant une sclérodermie systémique; et une atteinte articulaire distale (100%) chez les patients ayant une polyarthrite rhumatoïde. La corticothérapie générale était le traitement de base des patients ayant un lupus érythémateux systémique (92,5%) et une polyarthrite rhumatoïde (73,47%). Les connectivites sont des affections rares à Lomé, avec une prédominance de la maladie lupique. Elles sont plus fréquentes chez la femme jeune. La corticothérapie générale reste leur traitement de base.</p> 2018-06-26T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209611 Magnitude, causes and characteristics of trauma victims visiting Emergency and Surgical Units of Dilchora Hospital, Eastern Ethiopia 2021-06-29T08:24:31+00:00 Lemma Negesa Bulto lemmittikenya@yahoo.com Yadeta Dessie lemmittikenya@yahoo.com Biftu Geda lemmittikenya@yahoo.com <p><strong>Introduction:&nbsp;</strong>in developing countries, approximately sixteen hundred people die every day from all types of injuries, making injury the third most common cause of all mortalities in the region. The objective of this study was to examine the magnitude, causes and types of traumatic injuries in patients visiting Dilchora Hospital in Dire Dawa Administration of Eastern Ethiopia.</p> <p><strong>Methods:&nbsp;</strong>we conducted a cross-sectional study which was supplemented with qualitative data. Descriptive and thematic analyses were used to characterize the trauma in terms of victims, causes and types.</p> <p><strong>Results:&nbsp;</strong>a total of 382 patients were identified within a two-month period of data collection. The most common causes of traumatic injuries identified were conflict (42.67%), road traffic accidents (35.07%), falls (13.35%) and burn injuries (8.90%). Soft tissue injuries (57.6%), abrasion (29.3%) and fractures (22.3%) were the three most common types of injuries experienced. Most of the victims were males, those people in the productive age bracket and those living in urban areas. Poor road structure, poor adherence to traffic rules and the use of old and poorly maintained vehicles were the main reasons for the road traffic accidents. Substance use behaviors in urban areas and farmland boundary issues in rural areas were the common causes of conflicts, and females were the most common victims of burn injuries.</p> <p><strong>Conclusion:&nbsp;</strong>a high magnitude of injuries was observed such that, on average, six trauma victims visited the hospital each day. Conflict and road traffic accidents were the two most common causes of traumatic injuries. Poor vehicular conditions and poor road design were the main reasons identified for road traffic accident related trauma, which requires multilevel interventions.</p> 2018-06-27T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209612 Predictors of loss to follow up among HIV-exposed children within the prevention of mother to child transmission cascade, Kericho County, Kenya, 2016 2021-06-29T08:44:18+00:00 Hudson Taabukk Kigen taabukk@gmail.com Tura Galgalo taabukk@gmail.com Jane Githuku taabukk@gmail.com Jacob Odhiambo taabukk@gmail.com Sara Lowther taabukk@gmail.com Betty Langat taabukk@gmail.com Joyce Wamicwe taabukk@gmail.com Robert Too taabukk@gmail.com Zeinab Gura taabukk@gmail.com <p><strong>Introduction:&nbsp;</strong>HIV-exposed infants (HEI) lost-to-follow-up (LTFU) remains a problem in sub Saharan Africa (SSA). In 2015, SSA accounted &gt;90% of the 150,000 new infant HIV infections, with an estimated 13,000 reported in Kenya. Despite proven and effective HIV interventions, many HEI fail to benefit because of LTFU. LTFU leads to delays or no initiation of interventions, thereby contributing to significant child morbidity and mortality. Kenya did not achieve the &lt;5% mother-to-child HIV transmission target by 2015 because of problems such as LTFU. We sought to investigate factors associated with LTFU of HEI in Kericho County, Kenya.</p> <p><strong>Methods:&nbsp;</strong>a case-control study was conducted in June 2016 employing 1:2 frequency matching by age and hospital of birth. We recruited HEI from HEI birth cohort registers from hospitals for the months of September 2014 through February 2016. Cases were infant-mother pairs that missed their 3-month clinic appointments while controls were those that adhered to their 3-month follow-up visits. Consent was obtained from caregivers and a structured questionnaire was administered. We used chi-square and Fisher's Exact tests to compare groups, calculated odds ratios (OR) and 95% confidence intervals (CI), and performed logistic regression to identify independent risk factors.</p> <p><strong>Results:&nbsp;</strong>we enrolled 44 cases and 88 controls aged ≥3 to 18 months: Cases ranged from 7.3-17.8 months old and controls from 6.8-17.2 months old. LTFU cases- caregivers were more likely than controls- caregivers to fear knowing HEI status (aOR= 12.71 [CI 3.21-50.23]), lack knowledge that HEI are followed for 18 months (aOR= 12.01 [CI 2.92-48.83]), avoid partners knowing their HEI status(OR= 11.32 [CI 2.92-44.04]), and use traditional medicine (aOR= 6.42 [CI 1.81-22.91]).Factors that were protective of LTFU included mothers knowing their pre-pregnancy HIV status (aOR= 0.23 [CI 0.05-0.71]) and having household health insurance (aOR= 0.11 [CI 0.01-0.76]).</p> <p><strong>Conclusion:&nbsp;</strong>caregivers' intrinsic, interpersonal, community and health system factors remain crucial towards reducing HEI LTFU. Early HIV testing among mothers, disclosure support, health education, and partner involvement is advocated. Encouraging households to enroll in health insurance could be beneficial. Further studies on the magnitude and the reasons for use of home treatments among caregiver are recommended.</p> 2018-06-27T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209613 Testing a proof of concept model for group couples counseling in family planning in Northern Uganda 2021-06-29T08:49:28+00:00 Lillian Ojanduru lillianojanduru.irh@gmail.com Dickens Ojamuge lillianojanduru.irh@gmail.com Lauren DuComb lillianojanduru.irh@gmail.com Jeannette Cachan lillianojanduru.irh@gmail.com Esther Spindler lillianojanduru.irh@gmail.com <p><strong>Introduction:&nbsp;</strong>the post-conflict Acholi sub-region of Uganda is undergoing a period of transition that is influencing access, acceptability and use of family planning (FP). Low FP use and high unmet need for FP in Uganda's northern region provides a unique opportunity to test a community-based group counseling approach to reduce unintended pregnancies among young couples. We share findings from a proof of concept testing model in delivering fertility awareness methods (FAM) to groups of couples by trained non-health community youth agents.</p> <p><strong>Methods:&nbsp;</strong>the group counseling model was developed for couples interested in two FAM-standard days method (SDM) and TwoDay Method-within rural communities in Northern Uganda. WALAN was tested in a three-month proof of concept phase, employing 24 direct observations of group counseling sessions; quantitative interviews with 9 couples using either SDM or TwoDay method; 2 focus group discussions with youth facilitators, and; 9 key informant interviews with providers and leaders.</p> <p><strong>Results:&nbsp;</strong>the proof of concept results suggest model feasibility and acceptability among participating communities. Couples learned how to use FAM correctly. All 9 interviewed female users reported 100% correct knowledge of method use. Couples also reported high levels of satisfaction for both methods. SDM and TwoDay Method participants reported comfort and satisfaction in learning about FAM in small groups with other couples.</p> <p><strong>Conclusion:&nbsp;</strong>the proof of concept phase confirmed intervention feasibility, albeit with some model adjustments. The results were used to inform the pilot intervention, launched in April 2016 within 15 other villages in the same region.</p> 2018-06-27T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209614 Prévalence de l’hépatite B chronique selon le statut sérologique VIH à Parakou au Bénin 2021-06-29T09:16:10+00:00 Salimanou Ariyoh Amidou salmaneamidou@gmail.com Comlan Albert Dovonou salmaneamidou@gmail.com Corine Houehanou salmaneamidou@gmail.com Arsène Amadohoué Kpangon salmaneamidou@gmail.com Rhonel Ahanhanzo-Glele salmaneamidou@gmail.com Julie Hounnouga Kpangon salmaneamidou@gmail.com Khadidjatou Saké Alassan salmaneamidou@gmail.com Attinsounon Cossi Angelo salmaneamidou@gmail.com Blaise Tchaou salmaneamidou@gmail.com Kabibou Salifou salmaneamidou@gmail.com Thierry Adoukonou salmaneamidou@gmail.com Djimon Marcel Zannou salmaneamidou@gmail.com Dismand Stephan Houinato salmaneamidou@gmail.com <p><strong>Introduction:&nbsp;</strong>la prévalence de l’hépatite B est très variable à travers les espaces géographiques et semble influencée par l’infection à VIH. La présente étude vise à comparer la prévalence de l’hépatite B en fonction du statut sérologique VIH en milieu hospitalier à Parakou au Bénin.</p> <p><strong>Méthodes:&nbsp;</strong>il s’agissait d’une étude transversale incluant les adultes de 18 ans et plus reçus au Centre Hospitalier Universitaire et Départemental de Parakou entre Mai 2011 et Juin 2012. Le diagnostic de l’hépatite B a été fait par la recherche de l’antigène HBs et celui du VIH par des tests rapides sur des prélèvements de sang veineux. Les données ont été analysées avec le logiciel EpiInfo. Un modèle de régression logistique multivariable a été développé pour explorer les facteurs associés à la présence de l’hépatite B.</p> <p><strong>Résultats:&nbsp;</strong>sur un total de 1516 sujets inclus, 744 étaient séropositifs au VIH. L’âge moyen était de 31,3 +/- 11,1 ans et 65,1% étaient des femmes. La prévalence de l’hépatite B dans l’ensemble de l’échantillon a été estimée à 13,9% [IC95%: 12,2%-15,7%]. Cette prévalence était plus élevée chez les sujets séropositifs au VIH (16,9% vs 10,9%; p &lt; 0,0006), mais la différence n’est cependant plus significative en analyse multivariée, en dehors du groupe des sujets originaires du Borgou/Alibori (p &lt; 0,02). Une association constante a toutefois été observée entre la tranche d’âge de 24 à 44 ans (p &lt; 0,03), le sexe masculin (p &lt; 0,01), le niveau d’étude primaire (p &lt; 0,02) et une prévalence élevée de l’hépatite B.</p> <p><strong>Conclusion:&nbsp;</strong>la prévalence de l’hépatite B était plus élevée chez les sujets séropositifs au VIH. Elle est influencée par l’âge, le sexe, le niveau d’instruction et l’origine géographique.</p> 2018-06-27T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209622 Corps étranger intra irien 2021-06-29T09:19:49+00:00 Saloua Azennoud saloua_az-2000@hotmail.com Mohamed Zarrouki saloua_az-2000@hotmail.com <p>Nous rapportons un cas d’un jeune homme âgé de 28 ans victime d’un traumatisme oculaire OG, l’examen ophtalmologique objectif au niveau de l’œil atteint une acuité visuelle à 8/10 sans correction, une taie cornéenne à 7h (A) avec un corps étranger intra irien en regard de la taie (B).</p> 2018-06-27T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209624 Bursite tuberculeuse de l’épaule chez une insuffisante rénale chronique: à propos d’un cas 2021-06-29T11:14:14+00:00 Mohamed Ben Jemaa mohamedbj@hotmail.fr Wassim Zribi mohamedbj@hotmail.fr Emna Elleuch mohamedbj@hotmail.fr Wajdi Bouaziz mohamedbj@hotmail.fr Ameur Abid mohamedbj@hotmail.fr Soumaya Yaich mohamedbj@hotmail.fr Mourad Aoui mohamedbj@hotmail.fr Kamel Ayedi mohamedbj@hotmail.fr Mounir Ben Jemaa mohamedbj@hotmail.fr Mohamed Zribi mohamedbj@hotmail.fr Hassib Keskes mohamedbj@hotmail.fr <p>La tuberculose de l'épaule est rare. Elle regroupe toutes les atteintes tuberculeuses des tissus articulaires et péri-articulaires de l'épaule. Son évolution insidieuse mimant les pathologies inflammatoires et dégénératives, explique la fréquence de son retard diagnostique. Nous rapportons un cas rare d'une bursite tuberculeuse de l'épaule chez une femme de milieu rural, insuffisante rénale et traitée pour une tuberculose péritonéale et du psoas. Des signes d'imprégnation tuberculeuse ont été notés à l'anamnèse. L'examen clinique trouvait une tuméfaction douloureuse de l'épaule avec raideur. L'IRM de l'épaule était en faveur d'une bursite infectieuse. L'origine tuberculeuse était confirmée par l'examen histologique d'une biopsie synoviale écho-guidée. Un traitement antituberculeux lui a été instauré avec bonne évolution. Au recul de 9 ans, elle retrouve une fonction articulaire satisfaisante avec absence de récidive infectieuse.</p> 2018-06-27T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209646 Difficultés de prise en charge de la maladie de Basedow chez l’enfant: à propos d’un cas 2021-06-29T11:17:52+00:00 Nassiba Elouarradi nassibaelouarradi@gmail.com Ghizlane El Mghari nassibaelouarradi@gmail.com Nawal El Ansari nassibaelouarradi@gmail.com <p>La prise en charge adéquate de la maladie de Basedow chez l'enfant reste un sujet de controverse en endocrinologie pédiatrique et la durée optimale du traitement médical pour induire une rémission de la maladie ainsi que les indications des thérapeutiques alternatives, restent à définir. Nous rapportons l'observation d'une enfant âgée de 11 ans, sans antécédents pathologiques particuliers, qui consulte pour un amaigrissement progressif associé à des diarrhées. C'est devant la survenue d'une tuméfaction cervicale antérieure constatée par l'entourage que les parents décident de consulter. Les données cliniques et paracliniques ont permis de retenir le diagnostic de la maladie de Basedow. La patiente a été mise sous traitement médical : Carbimazole. L'évolution a été marquée par l'apparition d'une thrombopénie suggérant une administration prudente du traitement médical et devant l'absence de rémission après 4 ans de traitement, une irathérapie a été indiquée. Bien que rare, la maladie de Basedow reste la première cause de l'hyperthyroïdie chez l'enfant. Son diagnostic positif est facile mais sa prise en charge peut poser d'énormes problèmes. Le traitement médical se base sur les antithyroïdiens de synthèse mais qui n'est pas toujours anodin comme pour le cas de notre patiente. la thyroïdectomie subtotale ou le traitement par iode radioactif sont les deux alternatives thérapeutiques. De diagnostic positif facile, la maladie de Basedow est une maladie rare et sévère chez l'enfant et qui pose surtout des difficultés de prise en charge.</p> 2018-06-27T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209647 Infarctus splénique révélant une endocardite infectieuse chez une femme enceinte: à propos d’un cas et brève revue de littérature 2021-06-29T11:21:07+00:00 Chtioui Mamoun mamoun.mc@gmail.com Fagouri Houda mamoun.mc@gmail.com <p>Le diagnostic d’infarctus splénique est rarement évoqué chez la femme enceinte. L’incidence actuelle de ces atteintes notamment au cours des endocardites infectieuses ainsi que les moyens diagnostiques utilisés sont mal précisés dans la littérature. Une femme de 26 ans, sans antécédent particulier ni facteur de risque cardio-vasculaire, au terme de 14 semaines d’aménorrhée, consulte en urgence, pour un syndrome fébrile évoluant depuis 10 jours et l’apparition récente de douleur abdominale au niveau de l’hypochondre gauche. L’examen retrouve une fièvre à 39,5°C, une sensibilité de l’hypochondre gauche, et des panaris au niveau de la paume de la main gauche et de la plante du pied gauche. L’examen gynécologique était strictement normal. Devant ce tableau, une échographie abdominale réalisée retrouve une image anéchogène médiosplénique à sommet hilaire et à bords périphériques en faveur d’un infarctus splénique. Dans le cadre du bilan étiologique, une échocardiographie réalisée révèle une greffe oslérienne sur la valve mitrale qui est épaissie et remaniée, avec une végétation au niveau de la grande valve et une IM grade II. Des hémocultures ont été réalisées lors des pics fébriles qui étaient revenues positives au staphylocoque doré. L’évolution était marquée par la survenue d’un accident vasculaire cérébral ischémique étendu et aggravation de son état neurologique, conduisant au décès après plusieurs embolies systémiques. L’atteinte splénique chez une femme enceinte est très rare. Toutefois, devant une douleur abdominale aigue de l’hypochondre gauche, l’examen clinique et radiologique ne doit pas omettre l’exploration de la rate. Dans le cas présent, la douleur de l’hypochondre gauche associée à une fièvre et des faux panaris d’Osler s’est révélée être un infarctus splénique en rapport avec une endocardite infectieuse. Une antibiothérapie probabiliste de première intention lors de l’endocardite infectieuse est justifiée et devra être secondairement adaptée aux résultats bactériologiques. Rare, l’infarctus splénique peut avoir des conséquences sévères telles que des abcès ou une rupture, ce qui doit appeler à une certaine vigilance.</p> 2018-06-27T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209648 A double jeopardy: transection of the aero-digestive tract after penetrating neck trauma 2021-06-29T11:24:24+00:00 Pietro Fransvea pietro.fransvea@gmail.com Zamira Keyser pietro.fransvea@gmail.com <p>A 32-year-old male patient presented to emergency department after sustained gunshot injury to the neck. Patient according to the advanced trauma life support (A.T.L.S.®) protocol appeared stable. The patient complained of dysphagia and odynophagia. Local examination revealed a gunshot entrance wound the left posterior neck triangle and no exit wound. A cervical bruising, subcutaneous emphysema was also noted. CT angiography of neck revealed a cut off of the right vertebral artery and extensive surgical emphysema which was suspicious for injury either the pharynx, oesophagus or trachea (A). A contrasted swallow revealed contrast extravasation consistent with hypopharyngeal/oesophageal injury (B). Given these findings, the patient was shifted to the operating room were a primary repair of the oesophagus and trachea was done with sternocleiod and omoiodeus muscle flap (A &amp; B). Gunshot wound are still common worldwide especially in areas with high levels of criminal activities, gangsterism and lawlessness. In the past few years there has been a decline in the number of gunshot wounds seen at most major hospital but penetrating neck injuries are still commonly seen. Although many are minor injuries, they may deceptive in appearance and life threatening and the morbidity and mortality associated with blood loss and aerodigestive injuries remain significant.</p> 2018-06-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209649 Corrigendum: Étude ethnobotanique des plantes utilisées dans le traitement du diabète dans la médecine traditionnelle de la région Maritime du Togo 2021-06-29T11:42:43+00:00 Holaly Efui Gbekley simplicekarou@hotmail.com Damintoti Simplice Karou simplicekarou@hotmail.com Charlemagne Gnoula simplicekarou@hotmail.com Kodjovi simplicekarou@hotmail.com Agbodeka Kokou Anani simplicekarou@hotmail.com Tchadjobo Tchacondo simplicekarou@hotmail.com Amegnona Agbonon simplicekarou@hotmail.com Komlan Batawila simplicekarou@hotmail.com Jacques Simpore simplicekarou@hotmail.com <p>Ce Corrigendum modifie l’article original « Étude ethnobotanique des plantes utilisées dans le traitement du diabète dans la médecine traditionnelle de la région Maritime du Togo ». The Pan African Medical Journal. 2015;20:437. doi:10.11604/pamj.2015.20.437.5660.</p> 2018-06-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209650 Chromomycose cutanée à Fonsecaea Pedrosoi: à propos d’un cas 2021-06-29T11:53:54+00:00 Kenza Baline kenzabaline@gmail.com Fouzia Hali kenzabaline@gmail.com <p>Nous rapportons le cas d’une patiente de 13 ans d’origine rurale qui présentait une lésion papulo-nodulaire de 4/3cm du tiers inférieur de la jambe droite, évoluant depuis deux années. La biopsie cutanée montrait une hyperplasie papillomateuse avec des micro-abcès à polynucléaires neutrophiles et des spores. L’étude mycologique objectivait des corps fumagoides à l’examen direct et isolait Fonsecaea Pedrosoi à la culture. La patiente a bénéficié d’un traitement médico-chirurgical (terbinafine 250mg/j pendant 6 mois + exérèse puis greffe cutanée) avec une bonne évolution, le recul actuel étant de deux années sans récidive. La chromomycose est une infection fongique chronique de la peau, fréquente en zones tropicales et subtropicales et rare au nord de l’Afrique. Au Maroc, jusqu'à juin 2014, sept cas seulement ont été rapportés dans la littérature. Elle est contractée par inoculation du germe après contact avec le sol ou les matières organiques. Les agents responsables sont des champignons pigmentés du groupe des dématiés. Compte tenu de sa rareté, elle peut mimer d’autres dermatoses comme la leishmaniose ou la tuberculose. Malgré la rareté de cette infection, il faut y penser devant des lésions cutanées chroniques (verruqueuses, végétantes, nodulaires, en plaque) surtout si elles sont localisées au niveau des zones exposées à d’éventuels traumatismes végétaux comme les membres inférieurs. Ceci dit, la place de l’étude mycologique parait indéniable pour confirmer le diagnostic. Le traitement de choix est la chirurgie ou l’association chirurgie et antifongiques systémiques car l’utilisation des antifongiques seuls peut se solder par des résistances ou des récidives.</p> 2018-06-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209653 Large cell neuroendocrine carcinoma of the nasal cavity: an extremely rare and new distinct entity 2021-06-29T11:59:24+00:00 Jawad LahmaJawad Lahma jawadsama@gmail.com Reda Hejjouji jawadsama@gmail.com Philippe Gicquel jawadsama@gmail.com Leila Essakalli jawadsama@gmail.com <p>Large cell neuroendocrine carcinoma (LCNEC) is a rare but distinct entity of nasal cavity carcinomas. Only a very few cases have been reported in the nasal cavity. Its treatment is not well established. We report the case of a LCNEC in a 70 years old patient who presented with right nasal obstruction and epistaxis since 2 months. Diagnosis was confirmed by histological and immunohistochemical study. The patient underwent complete endoscopic removal of the tumor combined to adjuvant chemoradiotherapy. After 6 month follow-up, the patient was in complete clinical and radiological remission. We will discuss in this paper the various epidemiology, clinical features, pathological findings, differential diagnosis, and evolution of treatment of this uncommon malignancy in the light of current knowledge. Optimal treatment strategies are yet to be determined for this rare malignancy with poor prognosis including surgery and chemoradiotherapy.</p> 2018-06-29T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209655 Complications of traditional bone setters (TBS) treatment of musculoskeletal injuries: experience in a private setting in Warri, South-South Nigeria 2021-06-29T12:10:23+00:00 David Odoyoh Odatuwa-Omagbemi odatuwa@live.com Thomas Odafe Adiki odatuwa@live.com Cornelius Itodo Elachi odatuwa@live.com Anirejuoritse Bafor odatuwa@live.com <p><strong>Introduction:&nbsp;</strong>complications arising from the practice of traditional bone setting is a major contributor to the challenges the orthodox orthopaedic practitioner in Nigeria faces. We share our experience at a multi-specialist private health facility in Warri, South-south, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>case notes of patients with musculoskeletal injuries who had prior treatment by traditional bone setters with resulting complications before presenting at our health facility for treatment were reviewed and relevant information extracted and entered in an already prepared proforma. Data were analysed using SPSS version 17 and results presented in form of means, percentages, ratios and tables.</p> <p><strong>Results:&nbsp;</strong>43 cases were reviewed in a period of 8 years. There were 21 males and 22 females. The average age of patients was 44.8 + 20.3 years. The most frequent age group affected was that of 40-49 years. 45.8% of the initial injuries were due to road traffic accidents while 39.5% resulted from falls. Femoral fractures and humeral fractures formed 20.4% and 14.8% of cases respectively. 40.8% of traditional bone setters complications observed were non-union of fractures of various bones followed by mal-union in 24.5% of cases.</p> <p><strong>Conclusion:&nbsp;</strong>the observed complications of traditional bone setters practice in this study were similar to those previously reported in the literature. These complications constitute a significant challenge to the orthopaedic practitioner in Africa with associated negative socioeconomic impact on our society. Government and other relevant stakeholders need to unite and take decisive actions to mitigate this problem.</p> 2018-07-02T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209658 Particular dental erosion 2021-06-29T12:14:23+00:00 Giovanna Mosaico ginzia.85@hotmail.it Cinzia Casu ginzia.85@hotmail.it <p>A 30-year-old smoker female patient in good systemic health came to our attention for the professional oral hygiene session. On clinical observation, the patient had a severe erosion of the enamel, dentinal hypersensitivity and excessive pigmentation of eroded areas. These lesions on the enamel, with consequent exposure of the dentin, was caused by exogenous acids: in fact the patient reported having taken lemon juice for about a year during main meals and as a snack. Every morning, for the whole period indicated, she had taken water and lemon juice; at lunch and dinner and during snacks, based exclusively on fruit. She reported having made use of lemon and vinegar juice on salads and fruit, and finally she drank the lemon juice with great frequency after meals. Rubbing the teeth with more force, in the attempt to remove the pigmentations a chain mechanism has been triggered between acidic demineralization and mechanical abrasion of the enamel with increasingly evident dentine exposure. The patient will be subjected to remineralizing agents and to a conservative prosthetic rehabilitation. The differential diagnosis arises with damage from chemical trauma produced by other fruits such as orange juice and lime; alterations of salivary pH, excessive use of bleaching agents. The anamnesis was decisive in this case.</p> 2018-07-02T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209659 Evaluation des pratiques d’antibioprophylaxie chirurgicale dans un Hopital Universitaire du Centre Tunisien 2021-06-29T12:25:56+00:00 Hayett Harbi latifamerzougui72@yahoo.fr Latifa Merzougui latifamerzougui72@yahoo.fr Mohamed Hafedh Barhoumi latifamerzougui72@yahoo.fr Hedi Rebai latifamerzougui72@yahoo.fr Sofiene Abdelkefi latifamerzougui72@yahoo.fr Rafik El Kamel latifamerzougui72@yahoo.fr Tarek Barhoumi latifamerzougui72@yahoo.fr <p>L'antibioprophylaxie (ATBP) est l'une des mesures spécifiques de prévention des infections du site opératoire dont l'impact a été quantifié dans les interventions chirurgicales propres et propres contaminées. L'objectif de notre étude est d'évaluer la conformité des pratiques d'ATBP et le respect des prescripteurs des protocoles adoptés au sein de notre établissement. Notre travail est une étude observationnelle rétrospective, de type « Audit Clinique », évaluant les pratiques d'ATBP dans notre établissement durant le mois de mars 2015. Le critère de jugement principal était la conformité globale des pratiques observées aux 5 critères majeurs définis par la haute autorité française de santé (HAS). Nous avons adopté le référentiel de la société française d'anesthésie réanimation parue en 2010. Nous avons inclus 150 patients opérés des services de chirurgie générale, d'orthopédie et d'urologie. Le taux de conformité globale était de 33,3%. La conformité de chacun des 5 critères majeurs définis par la HAS était de 74% pour l'indication; 84% pour le délai injection-incision; 60% pour le choix de l'ATB; 89,3% pour la dose de 1<sup>ère</sup>&nbsp;injection et 72% pour la durée de l'ATBP. La conformité était variable selon le service, meilleure en urologie ; en cas de chirurgie programmée et quand le prescripteur est un réanimateur. Une stratégie globale intégrant organisation, éducation et restriction, pourrait permettre une réelle amélioration des taux de conformité des pratiques d'ATBP. La réalisation d'audits successifs devrait s'inscrire dans une démarche régulière, afin d'évaluer l'impact des actions entreprises.</p> 2018-07-02T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209756 Urgences drépanocytaires au Service des Maladies du Sang du Centre National Hospitalier Universitaire-Hubert Koutoukou Maga de Cotonou, Benin 2021-06-30T13:24:01+00:00 Roger Dodo comlanz@yahoo.fr Alban Zohoun comlanz@yahoo.fr Tatiana Baglo comlanz@yahoo.fr Josiane Mehou comlanz@yahoo.fr Ludovic Anani comlanz@yahoo.fr <p><strong>Introduction:&nbsp;</strong>l'évolution de la drépanocytose est marquée par la survenue de complications aigues dont certaines constituent de véritables urgences pouvant mettre en jeu le pronostic vital ou fonctionnel. Notre travail avait pour objectif d'étudier la fréquence et l'évolution des urgences drépanocytaires dans le Service des Maladies du Sang (SMAS) du Centre National Hospitalier Universitaire-Hubert Koutoukou Maga (CNHU-HKM) de Cotonou.</p> <p><strong>Méthodes:&nbsp;</strong>nous avons mené une étude rétrospective et descriptive de janvier 2014 à décembre 2015 et portant sur l'ensemble des patients hospitalisés pour une urgence drépanocytaire. Nous avons exclu les patients hospitalisés pour des complications drépanocytaires chroniques.</p> <p><strong>Résultats:&nbsp;</strong>deux cent quatre (204) urgences drépanocytaires pour un nombre total de 813 hospitalisations ont été enregistrés (prévalence de 25%). L'âge moyen des patients était de 24,2 ans. La tranche d'âge la plus représentée était celle de 20-30 ans (45,6%). Le sexe masculin prédominait à 60,8%. Les élèves/étudiants étaient les plus représentés à 55,9%. La douleur aigue était le motif principal d'hospitalisation à 63,7%. L'homozygotie SS était majoritairement représentée à 72,1%. Les complications vaso-occlusives ostéo-articulaires prédominaient à 70,1%. Les complications infectieuses documentées étaient dominées par le paludisme (27,5%). La décompensation anémique était notée à 30,4%. Sur le plan thérapeutique, l'hydratation a été utilisée à 85,3%. La durée moyenne de séjour était de 5,4 jours. L'évolution a été favorable dans 96,5% des cas. La létalité était de 2,5%.</p> <p><strong>Conclusion:&nbsp;</strong>les urgences drépanocytaires sont fréquentes. Elles nécessitent un diagnostic rapide et une prise en charge précoce et efficace. La formation continue du personnel médical à la prise en charge des urgences drépanocytaires s'avère nécessaire pour réduire leur mortalité.</p> 2018-07-03T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209759 Contrôle de qualité virologique du sang transfusé dans la ville de Bukavu, Sud Kivu, République Démocratique du Congo 2021-06-30T13:31:55+00:00 Théophile Mitima Kashosi mtkashosi@gmail.com John Kivukuto Mutendela mtkashosi@gmail.com David Lupande Mwenebitu mtkashosi@gmail.com Jeff Kabinda Maotela mtkashosi@gmail.com Kanigula Mubagwa mtkashosi@gmail.com <p><strong>Introduction:&nbsp;</strong>le sang transfusé à Bukavu est sélectionné par des tests de diagnostic rapide (TDR). Ces tests sont réalisés facilement sans moyens techniques importants. L'objectif de ce travail était d'évaluer la qualité virologique du sang qualifié comme transfusable par ces tests rapides.</p> <p><strong>Méthodes:</strong>&nbsp;pendant un mois, dans 5 formations sanitaires, un échantillon de sang était prélevé dans un tube sec de 4ml sur chaque poche de sang. Une contre analyse était faite sur chaque échantillon par les tests rapides et par Elisa.</p> <p><strong>Résultats:&nbsp;</strong>trois cent douze échantillons ont été colligés; 5 échantillons étaient positifs à l'un ou l'autre marqueur virologique alors que 307 échantillons étaient négatifs à tous les tests. L'Elisa des 307 échantillons négatifs aux TDR avait révélé 15 autres prélèvements positifs dont 3 échantillons positifs au VIH, 3 au VHC et 9 au VHB. En plus, l'Elisa a confirmé certains cas positifs aux TDR et en a infirmé d'autres. La sensibilité et la valeur prédictive positive pour les tests de diagnostics rapides étaient très basses. La fiabilité de ces tests était satisfaisante, moyenne ou faible.</p> <p><strong>Conclusion:&nbsp;</strong>le sang qualifié par les TDR présente un risque infectieux viral non négligeable. L'usage de tests plus fiables et plus performants s'avère nécessaire dans notre milieu.</p> 2018-07-04T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209760 Comparative in vitro activity of ciprofloxacin and levofloxacin against isolated uropathogens in Ghana: a pilot study 2021-06-30T13:37:04+00:00 Daniel Kwame Afriyie dspdan77@yahoo.com Linda Brakowaah Adu dspdan77@yahoo.com Marc Dzradosi dspdan77@yahoo.com Seth Kwabena Amponsah dspdan77@yahoo.com Prince Ohene-Manu dspdan77@yahoo.com Francis Manu-Ofei dspdan77@yahoo.com <p><strong>Introduction:&nbsp;</strong>studies on urinary tract infections (UTIs) in West Africa from 1990 to 2012 have showed moderate to high antimicrobial resistance to commonly prescribed antibiotics. Fluoroquinolones have been the main stay in the management of UTIs, but recent reports show emergence of resistance. Levofloxacin and ciprofloxacin still remain the commonest fluoroquinolones prescribed for UTIs in many settings. objective: this study sought to compare activity of ciprofloxacin and levofloxacin against clinical isolates obtained from patients with suspected UTI at the Ghana Police Hospital.</p> <p><strong>Methods:&nbsp;</strong>midstream urine samples from 153 suspected UTI patients who visited the Ghana Police Hospital from July 2016 to March 2017 were examined. Urine samples were cultured and isolates identified by standard biochemical and serological methods. The Kirby-Bauer disc diffusion method was used to determine susceptibility of isolates to ciprofloxacin and levofloxacin.</p> <p><strong>Results:&nbsp;</strong>UTI prevalence was significantly (p &lt; 0.05) higher among female patients (74.5%) than male patients (25.5%). Clinical uropathogens isolated from urine samples were&nbsp;<em>Escherichia coli</em>&nbsp;(28.1%),&nbsp;<em>Coliform spp</em>&nbsp;(43.2%),&nbsp;<em>Klebsiella spp</em>&nbsp;(26.1%) and&nbsp;<em>Staphylococcus aureus</em>&nbsp;(2.6%). Overall sensitivity of the uropathogens to ciprofloxacin and levofloxacin were 77.1% and 62.8%, respectively.&nbsp;<em>Staphylococcus aureus</em>&nbsp;showed greater resistance to levofloxacin (75%) compared to ciprofloxacin (25%). All Gram-negative isolates showed a higher sensitivity to ciprofloxacin compared to levofloxacin:&nbsp;<em>Escherichia coli</em>; 69.8% vrs 62.8%,&nbsp;<em>Coliform sp</em>p; 80.3% vrs 65.2%, and&nbsp;<em>Klebsiella spp</em>; 80% vrs 62.5%.</p> <p><strong>Conclusion:&nbsp;</strong>this study revealed emergence of resistance of uropathogens to quinolones. The isolates showed higher sensitivity to ciprofloxacin compared to levofloxacin. Rational prescribing and use of these fluoroquinolones following local susceptibility data is thus recommended.</p> 2018-07-05T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209763 Infertility in the Moroccan population: major risk factors encountered in the reproductive health centre in Rabat 2021-06-30T13:42:51+00:00 Amal Benbella amalben.25@gmail.com Siham Aboulmakarim amalben.25@gmail.com Houyam Hardizi amalben.25@gmail.com Asmaa Zaidouni amalben.25@gmail.com Rachid Bezad amalben.25@gmail.com <p>Infertility is responsible for a major cost burden for patients and health care systems. Therefore identifying preventable risk factors for infertility may contribute to the development of more cost-effective approaches to solving the infertility problem. However, such investigations have never been conducted in Morocco. Thereby, the objective of the present study was to determine the occurrence and distribution of these factors among Moroccan infertile couples. This retrospective study included 1265 infertile couples who attended the Assisted Reproductive Technology Unit of the Reproductive Health Centre of the University Hospital Ibn Sina in Rabat. All couples had been infertile for at least 1 year and both partners were fully investigated. Couples had primary and secondary infertility in 77.2% and 22.8% of cases, respectively. Women were overweight in 47.9% of cases and obese in 25.8% of cases while men were overweight in 44.6% of cases and obese in 14.7% of cases. 18.9% of women and 17.5% of men had a previous abdominopelvic or urogenital surgery. A history of sexually transmitted infection was reported by 7% of men and 5.8% of women. A history of tuberculosis was found 9.3% of women and 4.8% of men. In addition, 31.7% of men were cigarette smokers and 8.4% consumed alcohol. The study showed that preventable risk factors of infertility are common among Moroccan infertile couples. However, additional studies are required to investigate each factor and its relation to infertility in the Moroccan population.</p> 2018-07-05T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209764 A man with facial disfigurement 2021-06-30T13:47:15+00:00 Phatharaporn Kiatpanabhikul Thiti.S@chula.ac.th Thiti Snabboon Thiti.S@chula.ac.th <p>A 21-year-old man presented with progressive facial disfigurement along with intermittent pain over his prominent mandible and forehead. Examination revealed asymmetrical facial figures especially the forehead and his left side (A). CT skull demonstrated typical features of fibrous dysplasia (FD) including multiple expansile lesions with heterogeneous pattern including radiolucency interspersed with ground glass opacity involving all craniofacial bones (B). No periosteal reaction or soft tissue involvement is noted. Extensive bone survey and hormonal assessments were unremarkable. The patient preferred conservative treatment with pain relief and undergoing regular follow-up. FD is a benign and progressive disorder in which the bone is replaced and expanded by fibro-osseous tissue, leading to fractures and deformities. It may affect a single (monostotic) or multiple (polyostotic) bones. The latter may be associated with endocrine dysfunctions and cafe' au lait spots (McCune-Albright syndrome) or soft tissue myxomas (Mazabraud syndrome). Craniofacial bone involvement has been reported in about one-fourth of the FD case. Its manifestations are varied depending on the involving bones including painless swelling with facial asymmetry, malocclusion, headache, visual or hearing impairment, nasal obstruction or neurological deficit. Diagnosis is based on the clinical ground and typical radiographic findings. Biopsy is reserved for cases suspicious of malignant change or indeterminate diagnosis. Treatment is aimed to alleviate cosmetic or functional problems, ranging from observation, medical treatment with bisphosphonates, to extensive surgery. Regular follow-up is mandatory to detect disease progression or malignant change.</p> 2018-07-05T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209765 Collection de la cuisse révélant une fistule vésicale après radiothérapie pour cancer de la prostate 2021-06-30T13:50:09+00:00 Soufiane Ennaciri soufenna@hotmail.com Toufik Michel Bitard soufenna@hotmail.com <p>Les fistules urinaires sont une complication tardive rare après une radiothérapie pour le cancer de la prostate. Nous décrivons le cas d'un patient âgé de 76 ans, ayant eu quatre ans auparavant une prostatectomie radicale suivie d'une radiothérapie externe pour un cancer de la prostate. Le patient s'est présenté pour une tuméfaction de la cuisse récidivante. L'examen clinique a montré une masse rénitente et indolore au niveau de la partie médiale de la cuisse droite. Le bilan radiologique fait d'une échographie puis d'un scanner a objectivé une grosse collection liquidienne homogène de la face interne de la cuisse exerçant un léger effet de masse sur les vaisseaux fémoraux. Un drainage chirurgical a été réalisé ramenant 900ml de liquide louche dont l'examen bactériologique était négatif. Les suites post opératoires ont été marquées par une diminution brutale de la diurèse, par contre le drain a continué à ramener régulièrement des quantités importantes de liquide clair. Devant ce tableau, nous avons réalisé un test au bleu de méthylène puis une cystographie rétrograde qui ont confirmé qu'il s'agissait d'une fistule provenant de la jonction urétro-vésicale. L'assèchement de la collection a été obtenu grâce à un sondage à demeure pendant plusieurs semaines.</p> 2018-07-05T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209766 Chemotherapy-induced liver injury in metastatic colorectal cancer: about 48 cases 2021-06-30T13:53:40+00:00 Faten Limaiem fatenlimaiem@yahoo.fr Saadia Bouraoui fatenlimaiem@yahoo.fr <p>Neoadjuvant chemotherapy of colorectal liver metastases can induce hepatotoxicity in noncancerous liver. The aim of the present study was to describe the chemotherapy-induced major changes in the hepatic parenchyma and their prognostic impact. We undertook a retrospective study of 48 cases of colorectal liver metastases treated with neoadjuvant therapy followed by liver resection. These cases were collected at the Pathology Department of Mongi Slim Hospital over a 2-year period (July 2015-February 2018). Our series consisted of 27 men and 21 women with a sex-ratio (M/F = 1.28). The average age of our patients was 57.68 years old with extremes ranging from 30 to 75 years old. All patients received chemotherapy with FOLFOX. From a total of 48 operative specimens examined, we found 24 cases (50%) of non-systematized steatosis, grade 1 sinusoidal obstruction syndrome (n = 12) and grade 2 sinusoidal obstruction syndrome (n = 12), regenerative nodular hyperplasia (n = 3), portal and/or lobular inflammatory infiltrate (n = 6). In three cases, no abnormalities were reported in the liver parenchyma. Surgical margins were &lt; 1 mm in seven cases and were invaded in four cases. Preoperative chemotherapy is associated with regimen-specific liver injury. The presence of such an injury may have a negative impact on the functional reserve of the liver, thereby increasing the risk of surgical morbidity and mortality.</p> 2018-07-05T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209768 The role of faith leaders in influencing health behaviour: a qualitative exploration on the views of Black African christians in Leeds, United Kingdom 2021-06-30T14:00:54+00:00 Nii Lante Heward-Mills samuel.cumber@gu.se Catherine Atuhaire samuel.cumber@gu.se Chris Spoors samuel.cumber@gu.se Ngambouk Vitalis Pemunta samuel.cumber@gu.se Gunilla Priebe samuel.cumber@gu.se Samuel Nambile Cumber samuel.cumber@gu.se <p><strong>Introduction:&nbsp;</strong>Black African communities in the U.K suffer from health disparities compared to the general population. This has been attributed to the lack of culturally sensitive interventions that are meaningful to them. Faith leaders are an integral part of the community and are known to have immense influence on health behaviour of congregants and community members. However, their role in health behaviour change (alcohol and tobacco use) has been largely neglected. The aim of this study is to explore the views of Black African Christians on the role of their faith leaders in their health behaviour, with particular focus on the extent of influence and mechanisms that foster this.</p> <p><strong>Methods:&nbsp;</strong>eight (8) semi-structured interviews were conducted with Black African Christians between the ages of 25-44, from two churches in Leeds, UK. Data were analysed using the principles of thematic analysis.</p> <p><strong>Results:&nbsp;</strong>findings revealed that faith leaders could play a very important role in the health behaviour of their congregants. Faith leaders are able to influence health behaviour not only on the individual level but also on a socio-cultural and environmental level. They exert such influence through several mediators including through scriptural influence, social influence and by serving as a role models. However, no single mediator has been found to be exclusively associated to health behaviour change.</p> <p><strong>Conclusion:&nbsp;</strong>congregants view faith leaders as having an immense influence on their health behaviour. As a community resource, faith leaders could be better positioned to organize and foster community participation in health matters. Health promoters should thus consider collaborations with faith leaders to enhance the health of their community.</p> 2018-07-06T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209769 Evaluation externe de la qualité de la numération des lymphocytes T-CD4 au laboratoire d’immunologie et hématologie du CHU de Cocody 2021-06-30T14:08:10+00:00 Koffi N’guessan koffi.nguessan@live.fr Yekayo Benedicte Koné koffi.nguessan@live.fr Oppong Richard Yéboah koffi.nguessan@live.fr Amah Patricia Goran-Kouacou koffi.nguessan@live.fr Séry Romuald Dassé koffi.nguessan@live.fr <p><strong>Introduction:&nbsp;</strong>le taux de lymphocytes T-CD4 (LT4) est un paramètre crucial de suivi et de décision thérapeutique au cours de l'infection au Virus de l'Immunodéficience Humaine (VIH). Sa détermination doit être fiable et précise. Pour fournir des résultats de qualité, le laboratoire d'immunologie et hématologie du Centre Hospitalier et Universitaire (CHU) de Cocody participe à l'Evaluation Externe de la Qualité (EEQ) de la numération des LT4 du QASI&nbsp;<em>(Quality Assessment and Standardization for Immunological Measures relevant to HIV/AIDS)</em>. L'objectif de notre travail était d'évaluer la performance du laboratoire dans la numération des LT4.</p> <p><strong>Méthodes:&nbsp;</strong>une étude rétrospective a été menée sur les rapports de performance d'EEQ du laboratoire. Les indicateurs de performances SDI (indice de déviation standard), CV (coefficient de variation) ont été évalués.</p> <p><strong>Résultats:&nbsp;</strong>le taux de participation au programme était de 83,33%. Les indicateurs de performance étaient satisfaisants. Les SDI étaient en majorité inclus dans l'intervalle de confiance [-2; +2]. Les CV des échantillons de valeurs normales de CD4 étaient dans les normes. Les taux de conformité des résultats CD4 rendus étaient respectivement de 89,58% et 91,87% pour le compte absolu et le compte relatif. Seuls les CV des échantillons de faible taux de CD4 étaient au-delà des normes (&gt; 15%).</p> <p><strong>Conclusion:&nbsp;</strong>l'EEQ était un outil indispensable qui permettait au laboratoire de surveiller la qualité de ses analyses. Toutefois des mesures correctives devraient être renforcées dans le suivi-évaluation pour pérenniser et améliorer la qualité des analyses.</p> 2018-07-06T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209770 Halitose: approches diagnostiques et thérapeutiques pluridisciplinaires 2021-06-30T14:16:38+00:00 Roger Sombié flarjean@yahoo.fr Arnaud Jean Florent Tiendrébéogo flarjean@yahoo.fr Wendpouiré Patrice Laurent Guiguimdé flarjean@yahoo.fr Alice Guingané flarjean@yahoo.fr Souhouto Tiendrébéogo flarjean@yahoo.fr Kampadilemba Ouoba flarjean@yahoo.fr Alain Bougouma flarjean@yahoo.fr <p><strong>Introduction:&nbsp;</strong>l’halitose, état morbide caractérisé par une mauvaise haleine, présente à la fois un aspect pathologique et social. Dans notre contexte, l’halitose pose de nombreux problèmes de prise en charge aux plans diagnostique et thérapeutique en pratique clinique. Le but de notre travail était d’étudier les aspects diagnostiques et thérapeutiques de l’halitose.</p> <p><strong>Méthodes:&nbsp;</strong>il s’agit d’une étude transversale sur une année. Ont été inclus, les patients âgés de plus de 15 ans qui ont consulté pour halitose au centre hospitalier universitaire Yalgado Ouédraogo. Ont été exclus les patients avec mauvaise haleine mais consultant pour un autre motif. L’haleine a été évaluée par un praticien selon le test organoleptique de Rosenberg.</p> <p><strong>Résultats:&nbsp;</strong>au total 35 patients ont été inclus pour un sex-ratio de 1,2. L’âge moyen était de 31,9 ans. Dans 57,1% des cas, la plainte venait du patient lui-même. La durée moyenne de l’halitose était de 4,3 ans. Dix-neuf patients avaient un score de Mel Rosenberg ≥ 2. La carie dentaire (07 cas), la sinusite (07 cas), l’infection à&nbsp;<em>Helicobacter pylori</em>&nbsp;(09 cas) et l’ulcère gastro-intestinal (10 cas) étaient associés à l’halitose. Le traitement a été étiologique dans 82.9% des cas avec une amélioration satisfaisante à deux semaines de l’ordre de 71,8%.</p> <p><strong>Conclusion:&nbsp;</strong>l’halitose reste une pathologie peu étudiée et pose un problème de diagnostic positif, mais aussi étiologique dans notre contexte. Le rôle de l’odontologiste est crucial dans la recherche de la cause de l’halitose. Cependant, une prise en soins pluridisciplinaire de l’halitose permettra d’y apporter une réponse plus efficace.</p> 2018-07-10T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209888 Pattern and outcomes of paediatric medical admissions at the Living Word Mission Hospital, Aba, South East Nigeria 2021-07-04T08:37:23+00:00 Nneka Chioma Okoronkwo nnekaceo@rocketmail.com Chukwuemeka Ngozi Onyearugha nnekaceo@rocketmail.com Chioma Akunnaya Ohanenye nnekaceo@rocketmail.com <p><strong>Introduction:&nbsp;</strong>there is a decline in child mortality rate globally, courtesy of the erstwhile Millennium Development Goals. However, under-five mortality is still high in the African sub-regions. The need to review the morbidity and mortality pattern among children admitted into private health settings, where 60% of the medical conditions of the masses are being attended to in the sub-regions, cannot be overemphasized. This study aimed at documenting the morbidity pattern and outcomes of admissions among children admitted into the Living Word Mission Hospital (LWMH), Aba, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>this was a retrospective descriptive study over a 3 year period. The study population comprised of all children aged 1 month to 15 years that were admitted into the paediatric wards of the Living Word Mission Hospital, Aba, Nigeria. The age, gender, diagnoses and disease outcome of these patients, were all retrieved from the paediatric ward registers and hospital medical records. The data were analyzed using SPSS, version 20.0.</p> <p><strong>Results:&nbsp;</strong>there were 2278 paediatric medical cases admitted over the study period. Males were 1364 and females were 914, giving a male: female ratio of 1.5:1. More than 90% of these patients were aged &lt; less than 5 years. Severe malaria (31.1%), septicaemia (16.6%), bronchopneumonia (15.4%), uncomplicated malaria (11.9%), acute watery diarrhea (10.5%) and meningitis (3.7%) were the leading causes of admission. Mortality rate was 5.7%, with 87.5% of these deaths occurring in under-fives. Septicaemia (34.6%) and Severe malaria (23.2%) were the leading causes of death.</p> <p><strong>Conclusion:&nbsp;</strong>there is a high rate of paediatric admissions at Living Word Hospital, Aba. The under-five population remains a vulnerable group to both childhood morbidity and mortality. Septicaemia, malaria, bronchopnuemonia and acute watery diarrhoea were the leading causes of morbidity and mortality. Childhood mortality at LWMH is lower than observed in most government hospitals in Nigeria.</p> 2018-07-10T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209889 Intravenous urography findings in women with ureteric fistula 2021-07-04T08:45:14+00:00 Ileogben Sunday-Adeoye maradona4real2002@yahoo.com Kenneth Chinedu Ekwedigwe maradona4real2002@yahoo.com Maradona Ehikioya Isikhuemen maradona4real2002@yahoo.com Monday Osaze Eliboh maradona4real2002@yahoo.com Emmanuel Nyan Yakubu maradona4real2002@yahoo.com Babafemi Charles Daniyan maradona4real2002@yahoo.com <p><strong>Introduction:&nbsp;</strong>ureteric fistula is one of the major morbidities that can arise from pelvic surgeries. It mainly results from gynaecological and obstetric procedures. Intravenous urography is an imaging modality for the upper urinary tract. Its features may be suggestive of ureteric fistula and it is of great value when medicolegal issues arise. It is however expensive and requires expertise. There are other useful and cheap methods for evaluating ureteric fistula including the use of dye test. There is need to determine if IVU (Intravenous urography) should be recommended for women with this disease. The aim of this study was to determine the features of intravenous urography among women with ureteric fistula and therefore determine its relevance in the management of such patients.</p> <p><strong>Methods:&nbsp;</strong>this was a retrospective study conducted at the National Obstetric Fistula Centre, Abakaliki between January 2012 and March 2017. All patients with ureteric fistula during the study period who were assessed with intravenous urography before surgery were included in this study.</p> <p><strong>Results:&nbsp;</strong>the mean age was 38 ± 16 years. Twelve (92.3%) were Christians. IVU showed hydroureters in 46.15% hydronephrosis in 53.85%, non-functioning kidney in 46.15% and ureteric stricture in 7.69%. IVU gave an insight into the side with ureteric fistula except in one who had normal result.</p> <p><strong>Conclusion:&nbsp;</strong>hydronephrosis, hydroureters and silent (non-functioning) kidneys are features of IVU in women with ureteric fistulas, however these features are not pathognomonic for the disease.</p> 2018-07-10T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209890 Infertility in the Moroccan population: an etiological study in the reproductive health centre in Rabat 2021-07-04T08:56:14+00:00 Amal Benbella amalben.25@gmail.com Siham Aboulmakarim amalben.25@gmail.com Houyam Hardizi amalben.25@gmail.com Asmaa Zaidouni amalben.25@gmail.com Rachid Bezad amalben.25@gmail.com <p>The causes of infertility vary widely and differ between regions and within countries. There is no report on this subject in Morocco. Therefore, the aim of this study was to determine the causes of infertility in Moroccan infertile couples and to compare the findings with data from the various published studies. This retrospective study included 1265 infertile couples who attended the Assisted Reproductive Technology Unit of the Reproductive Health Centre of the University Hospital Ibn Sina in Rabat. All couples had been infertile for at least 1 year and both partners were fully investigated. The median duration of infertility was 5 ± 4 years. Couples had primary and secondary infertility in 77.2% and 22.8% of cases, respectively. Among the 1265 couples, 39.6% had a female factor, 28.2% had a male factor, 17% had both male and female factors and in 15.2% of couples, the cause of infertility was undetermined. The most common causes of male infertility were varicocele (14.3%), obstructive azoospermia (7%), Congenital anomalies (5.5%) and male accessory gland infection (4%). Results showed that 54.8% of men had a normal semen analysis. Among women, infertility factors were ovulatory disorders (27.5%), tubal factor (26.6%), uterine factor (12.6%), endometriosis (4.1%), and 43.4% of women were normal. The causes of infertility in this study are comparable with those reported by the World Health Organization and other studies. However, the substantial delay before attending an infertility clinic highlighted by the study needs additional consideration.</p> 2018-07-10T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209891 Low laser therapy as an effective treatment of recurrent aphtous ulcers: a clinical case reporting two locations 2021-07-04T09:12:38+00:00 Narjiss Akerzoul narjiss.akerzoul87@gmail.com Saliha Chbicheb narjiss.akerzoul87@gmail.com <p>Apthous ulcers, commonly referred to as canker sores, are the most common ulcerative lesions of the oral mucosa. These are usually painful and are associated with redness and occasional bleeding from the affected area(s). Low Level Laser Therapy (LLLT) has shown excellent results in relieving the pain and complete remission of the oral ulcers. Through a clinical case, we report two locations of oral ulcers treated successfully with diode laser.</p> 2018-07-10T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209892 A case series of benign transient hyperphosphatasemia from a pediatric endocrinology reference health facility in Turkey 2021-07-04T09:17:11+00:00 Fatma Dursun fatmadursun54@yahoo.com Heves Kirmizibekmez fatmadursun54@yahoo.com <p><strong>Introduction:&nbsp;</strong>benign transient hyperphosphatasemia (BTH), even a known condition, is not very well managed by primary care physicians. The diagnostic criteria for BTH were alkaline phosphatase (ALP) levels above 3-5 times greater than the age adjusted upper limit of normal among children under 5 years with no evidence of liver or bone disease whose ALP values resolved within 4 months.</p> <p><strong>Methods:&nbsp;</strong>this study involved 15 patients aged 0-5 years, who were referred to the pediatric endocrinology clinic for elevated ALP levels. They were diagnosed with BTH. We examined demographic and biochemical parameters including ALP and ALP isoenzymes, liver enzymes, calcium, phosphate, and parathormone (PTH) levels to rule out liver or bone disease as a cause for hyperphosphatasaemia.</p> <p><strong>Results:&nbsp;</strong>of 15 patients 7 were male and 8 were female. Mean age was 2.45 ± 1.09 (range 1.2-4.6) years. Mean serum ALP level was 2315 ± 1028 IU/L (1102-4662), while liver enzymes, calcium, phosphate, PTH and vitamin D3 levels were in normal ranges. The mean normalization period of ALP was 2.4 ± 1.1 (0.5-4) months, and all were normal at the end of 4 months without any treatment.</p> <p><strong>Conclusion:&nbsp;</strong>this study and literature knowledge related to BTH has shown that being aware of BTH is very important for a primary care physician. Paediatricians can conveniently manage the differential diagnosis and follow up this period of elevated ALP.</p> 2018-07-11T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209893 Exophtalmie unilatérale révélant un géant anévrysme intra caverneux rompu de la carotide interne 2021-07-04T09:26:50+00:00 Qariani Hajare q.hajare@gmail.com Aachak Meriem q.hajare@gmail.com <p>L'anévrysme géant de la carotide intra-crânienne est une pathologie relativement rare et qui peut présenter des complications redoutables. Les lésions du sinus caverneux sont habituellement révélées par une symptomatologie ophtalmologique, principalement, les paralysies oculomotrices. Nous rapportons le cas d'une patiente de 39 ans qui présente une exophtalmie unilatérale d'installation rapidement progressive (A,B) et une diplopie binoculaire associées à des céphalées en hémi-casque avec un seul épisode de vomissements évoluant dans un contexte d'apyrexie et de conservation d'état général. L'examen ophtalmologique retrouve une paralysie isolée du droit externe droit (déficit d'abduction) avec un examen stato-dynamique des paupières normal. L'acuité visuelle corrigée est à 5/10. L'examen à la lampe à fente montre une dilatation des vaisseaux conjonctivaux (C) cornée claire ne prenant pas la fluorescéine, reflexe photomoteur direct et consensuel conservé, une pression intra-oculaire à 15mmhg, et des tortuosités veineuses au fond d'œil sans anomalies papillaires (D). le bilan neuroradiologique à savoir l'angio-IRM révèle un anévrysme de la portion intra-caverneuse de la carotide interne droite, compressif, avec une exophtalmie stade 3. L'angiographie cérébrale est en faveur d'un anévrysme sacculaire géant carotido-caverneux droit rompu dans le sinus caverneux (E) avec drainage veineux antérieure et postérieure associé à un anévrisme du syphon carotidien gauche (F).</p> 2018-07-13T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209894 Sacrococcygeal chondroid chordoma: a case report and literature review 2021-07-04T09:38:22+00:00 Fatima Zahra Farhane zenabalami@gmail.com Zineb Alami zenabalami@gmail.com Touria Bouhafa zenabalami@gmail.com Abderrahmane Elmazghi zenabalami@gmail.com Khalid Hassouni zenabalami@gmail.com <p>In this paper, we report a case of primary squamous cell carcinoma of the endometrium (PSCCE) with a literature review. A 64-year-old woman was admitted because of postmenopausal bleeding. The gynecological exam found bleeding from the endocervix. The pelvic ultrasound objectified uterine regular contours, endometrial thickened was 10 mm, the presence of an intra cavitary lesion mesuring 56/70 mm. The diagnostic hysteroscopy revealed a whitish appearance taking all the uterine cavity making evoke a tumor of the endometrium. Pelvic MRI showed a tumor limited to the uterine corpus endometrium (invasion by more than 50% of the myometrium) without invasion of the cervix. Radical hysterectomy, bilateral salpingo-oophorectomy, and lymph nodes dissection were performed. Grossly, the endometrial carcinoma was polypoid tumor occupying the entire uterine cavity. Histologically, the diagnosis of SCC was retained. No adenocarcinoma element was recognized. Neither squamous metaplasia nor dysplasia was recognized. No ectopic cervical tissue was found. The SCC was found to invade into deeper one half of the myometrium. No tumor cells were seen in other sites including the cervix, ovaries, parametres, and lymph nodes. The patients was FIGO 2009 stage IB (pT1B, N0), and was treated with adjuvant radiation. The patient had a disease progression in the pelvis 3 months after the irradiation. We reported a case of PSCCE which can help to enrich the literature for the treatment and prognosis of this disease.</p> 2018-07-16T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209896 Prevalence, clinical presentations, associated risk factors and recurrence of laryngeal papillomatosis among inpatients attended at a Tertiary Hospital in Northern zone Tanzania 2021-07-04T10:22:38+00:00 Marco James jamesmarco98@yahoo.com Denis Katundu jamesmarco98@yahoo.com Desderius Chussi jamesmarco98@yahoo.com Peter Shija jamesmarco98@yahoo.com <p><strong>Introduction:&nbsp;</strong>although Laryngeal papillomatosis is a rare disease and can be conventionally managed through surgical excision as well as adjuvant therapy yet Laryngeal papillomatosis has high tendency to recur raising its prevalence in the community, airway involvement warrants dangerous complications requiring emergency tracheostomy, especially if clinical course is poorly understood and misdiagnosis is common. The study aims to determine the prevalence, clinical features, risk factors and recurrence of Laryngeal Papillomatosis among patients attending ENT department at KCMC from 2005 to 2015.</p> <p><strong>Methods:&nbsp;</strong>this was a 10 year experience/ Descriptive hospital based cross-sectional study conducted based on patients' medical record at KCMC. Information was recorded into data collection sheets, entered and analyzed through SPSS version 20, summarized and presented in tables and charts, proportions and percentage used to compare groups.</p> <p><strong>Results:&nbsp;</strong>51 patients were identified over the 10 years study period corresponding to a prevalence of 0.09%. 26 were males and 25 females, ages ranging from 1 to 67 years. The median age of onset was 6 years. Children less than 5 years accounted for 19 (37.3%) and 58.8% had repeated surgeries. Clinical presentation ranged from hoarseness in 43 (84.3%) patients to weight loss 3 (5.9%) and 96.1% showed complete or partial presence of the clinical triad of risk factors.</p> <p><strong>Conclusion:&nbsp;</strong>laryngeal papillomatosis is a rare disease that carries severe morbidity due to its highly recurring nature. It is primarily a paediatric disease, generally affecting more males; its clinical features highly resemble other airway obstructive diseases and therefore a careful thorough clinical evaluation is required in order to correctly diagnose Laryngeal papillomatosis.</p> 2018-07-16T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209897 Historic sequelae of lung tuberculosis 2021-07-04T10:33:58+00:00 Hanane Asri asri_hanane@hotmail.fr Adil Zegmout asri_hanane@hotmail.fr <p>The patient is a 22-year-old woman who presented for the evaluation of chronic exertional dyspnea. Her past medical history was significant for tuberculosis lung five years ago. Lung auscultation revealed diminished respiratory sounds on the left hemithorax. Chest radiography (A) demonstrated shift of the mediastinal structures to the left with volume loss of the left lung and hyperlucency of the right lung. Pulmonary function tests demonstrated moderate restrictive lung disease. Computed tomography of the chest (B) revealed left bronchial stenosis with passive collapse of the left lung and attraction of the heart and mediastinal elements, compensatory emphysema of the right lung. Bronchoscopy showed obstruction of left main bronchus orifice with normal mucosa. The patient was diagnosed with calcified fibrothorax, believed to be secondary to chronic lung tuberculosis. She was managed conservatively, with no surgical intervention. Fibrothorax can be secondary to empyema or hemothorax, tuberculous pleurisy, asbestos exposure, collagen vascular isease and drug-induced pleuritis. Pleural fibrosis and thickening also may develop as a result of pleurodesis performed to therapeutically obliterate the pleural space treatment should be aimed at the underlying cause, with removal of offending agents if possible. Corticosteroids often are administered and surgical decortication is sometimes attempted; effectiveness of neither approach is established.</p> 2018-07-16T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/209899 Vanishing spleen syndrome post right partial nephrectomy in a sicklemic patient 2021-07-04T11:06:02+00:00 Khuram Khan Khurram112@gmail.com Ofelia Leroux Khurram112@gmail.com Saqib Saeed Khurram112@gmail.com Farhana Iqbal Khurram112@gmail.com Leaque Ahmed Khurram112@gmail.com Brian Davis-Joseph Khurram112@gmail.com <p>Splenic infarction after contralateral laparoscopic renal surgery has not, to our knowledge, been reported. The spleen is the most affected organ in sickle cell disease and the mechanism of auto infarction is thought to result from the crystallization of abnormal hemoglobin during periods of hypoxia or acidosis resulting in parenchymal ischemia and ultimately tissue necrosis. We report a case of 45 year old female with sickle cell disease who had an unremarkable spleen at the time of a laparoscopic right partial nephrectomy and was subsequently found to have marked diminution in her splenic volume.</p> 2018-07-16T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210319 Acute appendicitis complicating pregnancy: a 33 case series, diagnosis and management, features, maternal and neonatal outcomes 2021-07-11T08:56:07+00:00 Mohamed Amine El Ghali amine.elghali@gmail.com Ons Kaabia amine.elghali@gmail.com Zaineb Ben Mefteh amine.elghali@gmail.com Maha Jgham amine.elghali@gmail.com Amel Tej amine.elghali@gmail.com Asma Sghayer amine.elghali@gmail.com Amine Gouidar amine.elghali@gmail.com Afra Brahim amine.elghali@gmail.com Rafik Ghrissi amine.elghali@gmail.com Rached Letaief amine.elghali@gmail.com <h3>The occurrence of acute appendicitis during pregnancy may pose diagnostic and therapeutic difficulties. In fact pregnancy can make the clinical diagnosis delicate and the use of morphological examinations is still subject to controversy. The debates concerning the ideal surgical approach during pregnancy continue. On the other hand, in some cases the occurrence of acute appendicitis, especially in its complicated form, which is frequent in pregnant women, exposes to obstetrical complications and an increased risk of premature delivery We aims to describe the clinical and management features of acute appendicitis in pregnant women and the maternal and neonatal outcomes and carry out a review of the literature on this topic. It is a retrospective analysis of a series of 33 cases of appendicitis in pregnant women who were diagnosed and managed, in collaboration between the departments of General and digestive surgery, Gynecology and Obstetrics and Anaesthesia at Farhat Hached Universitary Hospital Sousse Tunisia between January 2005 and December 2015. The average age of the patients was 29 (20-40). Fourteen patients were in the first trimester, twelve in the 2<sup>nd</sup>&nbsp;and seven in the third trimester. The main symptom was pain in the right iliac fossa. The mean delay between consultation and surgery was 2.7 days. Twenty five patients had a preoperative ultrasound. Eight of the 33 pregnant patients presented complicated appendicitis with localized or generalized peritonitis. Thirty patients underwent laparotomic appendectomy: 28 with a Mc Burney incision and 2 with a midline incision and only three patients underwent laparoscopy. Preventive tocolysis was given to 14 patients, maternal mortality was null. Twenty four pregnancies were followed until delivery: one case of premature birth and one case of preterm labor were observed. Pregnancy makes it difficult to diagnose appendicitis, which explains the high rate of complicated acute appendicitis in our series. An early treatment improves maternal and fetal outcome.</h3> 2018-07-16T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210321 No, it is not a third breast that grows! 2021-07-11T09:00:58+00:00 Erdogan Nohuz enohuz@yahoo.fr Marie-Claire Bui enohuz@yahoo.fr <p>Dermatofibrosarcoma protuberans (DFSP) is a rare slow growing skin neoplasm which is characterized by a low potential of malignancy. It rarely shows metastasis to local lymph nodes or distant sites. However, it appears locally aggressive with a tendency to peripheral tumor extensions and recurrence. While DFSP can occur in all ages, it affects in the majority of cases the patients between the third and the fifth decades of age. A high index of suspicion should be taken when facing unusual lesion with a history of slow but persistent growth. DFSP involves most commonly the trunk and extremities but can also be located at any site such as scalp, head, neck, breast, pubic area and vulva. Here, we present a case of recurrent DFSP in a 52-year-old woman with a slow enlarging mass in the upper of the thorax, between the two breasts. She was previously managed by surgery several years before for a DFSP developed at the same site. Complete resection including wide surgical margins of at least 3 cm followed by immediate reconstruction is the treatment of choice to minimize recurrence rate. Marked propensity of DFSP to recur necessitates referral to a specialized center to achieve optimal oncological resection and avoid unnecessary re-operation. However, the minimum resection margin required remains undefined. Radiation and chemotherapy have been tried with limited success, although adjuvant radiotherapy may be used in advanced cases where surgery is no longer feasible. Imatinib can contribute to disease control in patients with locally advanced or metastatic DFSP.</p> 2018-07-16T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210322 Hernie de Littré ombilicale étranglée chez l’enfant: complication rare d’une malformation fréquente de l’intestin grêle 2021-07-11T09:43:13+00:00 Sourou Bruno Noukpozounkou ismaillawani@gmail.com Ismaïl Lawani ismaillawani@gmail.com Ogounrila Thomas Armel Elegbede ismaillawani@gmail.com Djifid Morel Seto ismaillawani@gmail.com Beaudelaire Romulus Assan ismaillawani@gmail.com Amoussou Sèdjro Clotaire Roméo Houegban ismaillawani@gmail.com Houenoukpo Koco ismaillawani@gmail.com Michel Armand Fiogbe ismaillawani@gmail.com <p>Le diverticule de Meckel est l'anomalie congénitale la plus fréquente de l'intestin grêle. Bien qu'il s'agisse d'une anomalie courante dans la population générale, sa présence dans un sac herniaire, en particulier au niveau ombilical est une situation peu fréquente et constitue la hernie de Littré. Nous rapportons le cas d'un nourrisson de 6 mois de sexe féminin, admis pour une tuméfaction ombilicale douloureuse et irréductible. Le diagnostic de hernie ombilicale étranglée a été posé. En per opératoire, il était découvert dans le sac herniaire un diverticule de Meckel inflammatoire. On procéda à une résection cunéiforme du diverticule suivie de la fermeture de la brèche intestinale par une suture en surjet et de la réfection pariétale. Le diagnostic clinique de la hernie de Littré est difficile et l'attitude thérapeutique varie selon les équipes.</p> 2018-07-17T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210323 Mélanose de friction et habitudes vestimentaires 2021-07-11T09:48:14+00:00 Jawad El-Azhari j.elazhari@gmail.com Mohammed Boui j.elazhari@gmail.com <p>La mélanose de friction est un trouble pigmentaire acquis touchant principalement les sujets jeunes sur les zones situées en regard des saillies osseuses, en particulier la zone claviculaire et le haut du dos. Les traumatismes répétés de frottement des vêtements contre la peau recouvrant les protubérances osseuses seraient fondamentaux dans sa pathogénie. D'autres facteurs, tels que le phototype foncé et la variabilité individuelle, peuvent également jouer un rôle dans la pathogenèse. Nous rapportons le cas d’une patiente de 40 ans sans antécédents notables, phototype V, qui consulte pour une hyperpigmentation brunâtre évoluant depuis plusieurs années, non prurigineuse et intéressant le front, les joues, le menton et le cou. Cette femme est originaire du Sahara marocain, et porte régulièrement une tenue traditionnelle appelée "melhfa"; tissu ample d’environ 4 mètres qui est enroulé autour du corps pour finalement couvrir les cheveux. L’examen du reste du tégument et des muqueuses ainsi que le reste de l’examen clinique et le bilan biologique sont normaux. Les diagnostics évoqués étaient un lichen plan pigmentogène, une photodermatose, une amylose maculeuse ou une mélanose de friction. Une biopsie cutanée a été effectuée objectivant une hyperpigmentation de la couche basale sans dépôts amyloïdes dans le derme supérieur, la coloration Rouge Congo était négative. Le diagnostic de mélanose de friction a été retenu, et la patiente a été mise sous hydroquinone crème topique à 2% en évitant le port fréquent de la melhfa.</p> 2018-07-17T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210324 Burden of post-traumatic stress disorder acute exacerbations during the commemorations of the Genocide against Tutsis in Rwanda: a cross-sectional study 2021-07-11T09:56:16+00:00 Jean Damascene Kabakambira celestin.hategeka@alumni.ubc.ca Gladys Uwera celestin.hategeka@alumni.ubc.ca Marthe Hategeka celestin.hategeka@alumni.ubc.ca Marie Louise Kayitesi celestin.hategeka@alumni.ubc.ca Célestin Kaputu Kalala Malu celestin.hategeka@alumni.ubc.ca Celestin Hategeka celestin.hategeka@alumni.ubc.ca <p><strong>Introduction:&nbsp;</strong>following the 1994 genocide against Tutsis in Rwanda, the prevalence of post-traumatic stress disorder (PTSD) is high. In a period of seven days every year in April, Rwandans gather to mourn the victims of the genocide. During this commemoration period, survivors living with chronic PTSD experience PTSD acute exacerbations (PAE). We assessed factors associated with severe PAE during the annual commemoration period of the genocide against Tutsis in Rwanda.</p> <p><strong>Methods:&nbsp;</strong>we carried out a retrospective cross-sectional study that included people who had PAE during the commemoration week in April 2011 across Huye District in Rwanda. Our outcome measure was PAE categorized into three levels: &lt; 15 minutes, 15-30 minutes, and &gt; 30 minutes. Ordinal logistic regression analyses were performed to identify factors associated with severe PAE.</p> <p><strong>Results:&nbsp;</strong>we enrolled 383 people with PAE, of whom 71.8% were female and 53.5% were aged 20-45 years. All participants reported history of PAE, of which 59.8% had experienced more than two PAE during the previous commemoration periods. 33.2% had PAE that lasted &gt; 30 minutes. History of PAE (&gt; twice) (OR = 1.86; 95% CI = 1.27-2.75) and having lost a partner in genocide (OR = 2.19; 95% CI = 1.01-4.81) were associated with severe PAE, after adjusting for sex and age.</p> <p><strong>Conclusion:&nbsp;</strong>our findings suggest that PAE is frequent during the commemoration periods. People who reported having more prior PAE and being widow (er) were more likely to have severe PAE. While history of PAE and bereavement status are non-modifiable factors, our findings could help identify and target these people who are at risk for severe PAE.</p> 2018-07-17T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210325 Ghostwriters in the scientific world 2021-07-11T10:11:02+00:00 Sankalp Yadav drsankalpyadav@gmail.com Gautam Rawal drsankalpyadav@gmail.com <p>The scientific world is facing a constant problem of ghostwriters. These ghostwriters are often attached to the medical publishing houses and are involved in writing an article for a pharmaceutical company which may, in turn, use the name of an established or a famous scientist as an author to the article. Often, such articles are published in well-known journals and are circulating widely. Many a time the adverse effects are overlooked in such papers. This will result in a corrupt practice of prescribing a drug which is not scientifically useful or may have life-threatening side effects. In this present article, the authors discuss this evil practice of ghostwriting in the context of the present day scientific publishing.</p> 2018-07-18T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210326 Ethnobotanical survey of herbs used in the management of diabetes mellitus in Southern Katanga Area/DR Congo 2021-07-11T10:19:19+00:00 Bakari Amuri ubepharma@live.be Mwamba Maseho ubepharma@live.be Lumbu Simbi ubepharma@live.be Pierre Duez ubepharma@live.be Kahumba Byanga ubepharma@live.be <p><strong>Introduction:&nbsp;</strong>diabetes is becoming a public health burden for sub-Saharan countries due to its prevalence which is growing rapidly. Traditional medicine is more and more used to treat diabetes in RD Congo as well as in other African countries. This study was undertaken in order to list plants used in the management of diabetes by traditional healers in four agglomerations of southern area of Katanga in the Democratic Republic of Congo.</p> <p><strong>Methods:&nbsp;</strong>forty-nine traditional healers were randomly met and interviewed about diabetes treatment in traditional medicine. The survey concerned the plant identification, their part used, method of preparation and the route of administration. The inquest concerned also traditional medicine users.</p> <p><strong>Results:&nbsp;</strong>ninety-five plants from 47 families were indicated as antidiabetic. Fabaceae (24.2%), Euphorbiaceae (7.4%), Apocynaceae and Strychnaceae (4.2 each) are the more representative families. This inventory showed that the root is the most used part of the cited plants, the decoction with water as the main preparation method and the oral administration as the principal way to give antidiabetic traditional formulations.</p> <p><strong>Conclusion:&nbsp;</strong>in Lubumbashi region, many plant species are used to treat diabetes either through traditional praticians or by anyone from well-known ancestral knowledge.</p> 2018-07-18T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210327 Syndrome de régression caudale: à propos d’un cas 2021-07-11T10:41:24+00:00 Charaf Tilfine charafmed@live.fr Fatima Zahrae Laamrani charafmed@live.fr Rachida Dafiri charafmed@live.fr <p>Le syndrome de régression caudale est un syndrome malformatif rare associant à des degrés variables une agénésie des vertèbres sacrées et coccygiennes, avec raccourcissement des membres inférieurs, et anomalies gastro-intestinales, génito-urinaires et cardiovasculaires. Sa relation avec le diabète maternel est bien établie. Mais sa cause exacte reste toujours mal établie. Nous présentons un cas rare de ce syndrome chez un nourrisson de 8 mois dont la mère est connue diabétique, et qui présente en plus du syndrome polymalformatif, une constipation chronique.</p> 2018-07-19T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210328 Le méningiome intra osseux: à propos de deux cas 2021-07-11T11:33:31+00:00 Siham Nasri nasri_siham@hotmail.fr Zineb Marzouki nasri_siham@hotmail.fr Imane Kamaoui nasri_siham@hotmail.fr Imane Skiker nasri_siham@hotmail.fr <p>Les méningiomes intra osseux primitifs sont des méningiomes ectopiques rares, qui constituent 1 à 2% de tous les méningiomes. Le but de ce travail est d'illustrer les différents aspects à l'imagerie contribuant à une approche diagnostique et de discuter leurs différents diagnostics différentiels. Nous rapportons, à ce propos, deux cas de méningiomes intra osseux à localisation ptérionale, documentés par TDM et IRM.</p> 2018-07-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183616 Les transcrits bcr-abl et leurs corrélations avec l’hémogramme au cours de la leucémie myéloïde chronique (LMC) au Togo 2022-04-19T13:42:05+00:00 Essohana Padaro raoul.kamadjeu@gmail.com Hèzouwè Magnang raoul.kamadjeu@gmail.com Yao Layibo raoul.kamadjeu@gmail.com Irénée Messanh Kuéviakoé raoul.kamadjeu@gmail.com Kossi Agbétiafa raoul.kamadjeu@gmail.com Ahoéfa Vovor raoul.kamadjeu@gmail.com This study aims to describe the different bcr-abl gene transcript variants in order to determine their frequency and to study their influence on CBC diagnostic test. We conducted a cross-sectional study of 34 patients with chronic myeloid leukemia in Togo. The search for fusion transcripts was performed in the laboratory of biological haematology at the Henri Mondor Hospital, Créteil (France). The average age of patients was 42,32±14,87 years ranging between 9 and 65 years. Most patients were male, with a sex- ratio of 1.61 (21 men and 13 women). Molecular examination showed b3-a2 transcript and b2-a2 transcript. Nineteen patients (55.88%) expressed b3-a2 transcript, 13 patients (38.24%) b2-a2 transcript (32.10%) and two patients expressed both b3-a2 and b2-a2 transcripts (5.88%). At diagnosis, mean hemoglobin level, the average number of white blood cells and the average number of platelets in patients expressing b3-a2 transcript were 99,2g/L; 207,63g/l and 451,28g/l respectively. In patients expressing b2-a2 transcript values were 104,6g/l, 114,32g/l and 486,11g/l. In patients with both transcripts, values were 67g/L, 867g/l and 780g/l respectively. CBC parameters are more significantly altered in patients with both transcripts b3-a2 and b2-a2.<br /><br /><strong>Keywords:</strong> Chronic myeloid leukemia, bcr-abl, Lomé (Togo) 2019-02-18T15:45:35+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183614 Pied varus équin de l’adulte traité par arthrodèse tibiocalcanéenne: à propos de deux cas (3 pieds) 2022-04-19T13:42:09+00:00 Mohamed Mahmoud El Hacen raoul.kamadjeu@gmail.com Yacoub Mohamed Sghair raoul.kamadjeu@gmail.com Noura Biha raoul.kamadjeu@gmail.com Abdoulay Aw raoul.kamadjeu@gmail.com Moez Trigui raoul.kamadjeu@gmail.com Chekh Né raoul.kamadjeu@gmail.com Inveterate clubfoot (inveterate talipes equinovarus, ITEV) is a vicious attitude of the foot which doesn’t rest on the floor through its normal base of support but weight is thrown to the outer side of the foot and to the foot point. When this vicious attitude persists a long time, it results in severe osteoarticular deformities in adults. Fixed ITEV is a good indication for tibiocalcaneal arthrodesis. In the majority of cases this provides painless and stable plantigrade foot. This study aims to assess the clinical and radiological outcomes of astragalectomy with tibiocalcaneal fusion. This case series involves 2 adult patients undergoing tibiocalcaneal arthrodesis due to severe and annoying equinovarus rearfoot deformity. Outcome was satisfactory with painless and stable plantigrade foot. At 90-day follow-up the patient with bilateral clubfoot had no inequality while the patient with unilateral clubfoot had a shortening of 2 cm compensated by right sole. In the majority of cases with severe and fixed deformities of the ankle and of the ITEV, tibiocalcaneal arthrodesis allows for painless and stable plantigrade foot, without vascular or cutaneous risk.<br /><br /><strong>Keywords:</strong> Talipes equinovarus, adult, tibiocalcaneal arthrodesis 2019-02-18T14:58:26+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183611 La pyélonéphrite emphysémateuse à évolution favorable après traitement médical: à propos de 3 observations 2022-04-19T13:42:13+00:00 Abdelouahed Lasri raoul.kamadjeu@gmail.com Amine Saouli raoul.kamadjeu@gmail.com Othmane Yddoussalah raoul.kamadjeu@gmail.com Tarik Karmouni raoul.kamadjeu@gmail.com Khalid Elkhader raoul.kamadjeu@gmail.com Abdellatif Koutani raoul.kamadjeu@gmail.com Ahmed Ibn attya Andaloussi raoul.kamadjeu@gmail.com Emphysematous pyelonephritis is a necrotic infection of the kidney characterized by the presence of gas within the renal parenchyma, the secretory cavities or the perirenal spaces. It is a severe condition that could be life-threatening. Patient’s management remains controversial and is based either on surgery or on medical treatment. Percutaneous drainage can be also used for the treatment of these patients. We report 3 cases with EPN treated with only antibiotics. Patients’ evolution was favorable. These results show that medical treatment could be sufficient.<br /><br /><strong>Keywords:</strong> Emphysematous pyelonephritis, diabetes, uroscanner, medical treatment 2019-02-18T14:49:41+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183608 Dépistage néonatal du déficit en glucose 6 phosphate déshydrogénase (G6PD) en Mauritanie 2022-04-19T13:42:15+00:00 Ghaber Sidi Mohamed raoul.kamadjeu@gmail.com Salem Mohamed Lemine raoul.kamadjeu@gmail.com Shagh Cheibetta raoul.kamadjeu@gmail.com Aminetou Mohamed raoul.kamadjeu@gmail.com <strong>Introduction:</strong> We conducted a cross-sectional descriptive study aiming to identify risk factors associated with G6PD deficiency, its frequency and geographic distribution in Nouakchott, in order to provide useful informations to monitor it. As this disease has never previously been studied in Mauritania, we tried to define the epidemiological profile and the burden of morbidity related to G6PD deficiency in a newborn population in two health structures in the city of Nouakchott. <br /><br /><strong>Methods:</strong> This study was conducted in two hospitals in Nouakchott, at the Maternity and Infant Hospital and at the Health Center in Sebkha between August and October 2015. A sampling of 523 newborns having different sexes was enrolled in the study. Screening was based on BinaxNow G6PD test, followed by quantitative confirmation in positive patients. Statistical analysis was performed using SPSS20.<br /><br /><strong>Results:</strong> G6PD deficiency was higher in male newborns (15% vs 7% p = 0.007) and, in particular, in black children (15% vs 8% p = 0.001). The prevalence of G6PD deficiency in the study population was 11.09% (58/523).<br /><br /><strong>Conclusion:</strong> To our knowledge, this is the first study on G6PD deficiency in the Mauritanian population. It provides important informations on the epidemiological features of G6PD deficiency in the region of Nouakchott. A degree of variability exists in the occurrence of G6PD deficiency in the ethnic groups.<br /><br /><strong>Keywords:</strong> G6PD deficiency, neonatal screening, consanguinity, Mauritania 2019-02-18T14:40:09+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183607 Récidive d'un pseudomyxome péritonéal avec métastases hépatique et splénique: à propos d'un cas rare avec revue de littérature 2022-04-19T13:42:18+00:00 Mustapha Azzakhmam raoul.kamadjeu@gmail.com Fouad Zouaidia raoul.kamadjeu@gmail.com Ahmed Jahid raoul.kamadjeu@gmail.com Kaoutar Znati raoul.kamadjeu@gmail.com Zakia Bernoussi raoul.kamadjeu@gmail.com Najat Mahassini raoul.kamadjeu@gmail.com Pseudomyxoma peritonei (PMP) is a clinicopathologic syndrome characterized by mucinous ascites and pools of mucin resulting in neoplastic mucinous epithelium in the peritoneal cavity. PMP is uncommon and it is characterized by clinical and unusual pathologic manifestations posing diagnostic and therapeutic problems. Involvement of abdominal viscera and lymph node metastases are rare and sporadic cases have been reported in the literature. We here report the case of a 56-year old patient who had undergone two operations for PMP of appendicular origin presenting with progressive abdominal pain five years after his last treatment. Scanner objectified a recurrence of peritoneal pseudo-myxoma with liver and splenic intraparenchymatous lesions. Anatomopathological examination showed intrasplenic and hepatic recurrence of low-grade peritoneal pseudo-myxoma confirming the metastases.<br /><br /><strong>Keywords:</strong> Peritoneal pseudo-myxoma, splenic metastasis, liver metastasis 2019-02-18T14:31:10+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183605 Morbihan disease: treatment difficulties and diagnosis: a case report 2022-04-19T13:42:21+00:00 Alaa Aboutaam raoul.kamadjeu@gmail.com Fouzia Hali raoul.kamadjeu@gmail.com Kenza Baline raoul.kamadjeu@gmail.com Meryem Regragui raoul.kamadjeu@gmail.com Farida Marnissi raoul.kamadjeu@gmail.com Soumiya Chiheb raoul.kamadjeu@gmail.com Morbihan disease (MD) is a rare entity. Its nosography is unclear and its therapeutic management is difficult. We report a new case of MD. We report a case of a 51-year-old patient consulted in our department for a one year facial edema, erythema and papules reported by him, for which the patient was treated with cyclins, local and general corticotherapy, without improvement. The clinical examination found an important edema of the front and eyelids with an erythema of the cheeks covered with a few telangiectasias. The clinical, biological and histological findings lead to a diagnosis of Morbihan disease after excluding other diseases. Due to previous therapeutic failures, the patient was put on isotretinoin and furosemide with slight improvement. The particularity of our observation lies in the rarity and especially in the therapeutic difficulties encountered during this disease.<br /><br /><strong>Keywords:</strong> Morbihan disease, edema, face, treatment 2019-02-18T14:23:16+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183604 Extensive anogenital warts: a multidisciplinary surgical management 2022-04-19T13:42:23+00:00 Kostas Chondros raoul.kamadjeu@gmail.com Konstantinos Graikos raoul.kamadjeu@gmail.com Athanasios Klambatsas raoul.kamadjeu@gmail.com Nikolaos Dimasis raoul.kamadjeu@gmail.com Genital warts are a major worldwide healthcare problem of sexually active population. Apart from direct association with cervical cancer, male patients experience HPV-related condylomata in several locations in the anogenital area. Extensive growth, multifocality and difficult accessibility wart sites are demanding and often require multidisciplinary surgical management. In our case, we present a male patient with extensive anogenital warts treated by a team of surgeons in several steps.<br /><br /><strong>Keywords:</strong> Anogenital warts, condylomata acuminata, anus obstruction, HPV infection 2019-02-18T14:17:15+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210332 Cesarean scar pregnancie 2021-07-11T12:03:45+00:00 Majdouline Boujoual pr.majdouline@hotmail.fr Driss Rahali Moussaoui pr.majdouline@hotmail.fr <p>A 35 years old woman presented at 8-week gestation for her first prenatal visit. She had no complaints at the time. While her past obstetrical history showed two prior cesarean sections. Transvaginal ultrasound was performed showing fortuitously a cesarean scar ectopic pregnancy with a gestational sac implanted in the myometrium between the bladder and the anterior wall of the uterus (A) and associated with a periovulatory hyper-vascularization in color doppler (B). This aspect was confirmed in 3D Ultrasound which showed a gestational sac bulging through the anterior wall of the uterus into the bladder with diminished myometrial layer between the bladder and the sac (C). The outcome was favorable after conservative surgical treatment by laparotomy associated with a triple preventive ligation because of the high risk of bleeding. Cesarean scar pregnancy is so a rare iatrogenic complication of cesarean section; however, her incidence is actually growing due to the increase in cesarean section rates. The diagnosis is usually made via ultrasound showing an empty uterine cavity and cervical canal, a gestational sac located anteriorly at the isthmus, and evidence of a functional trophoblastic/placental circulation on color Doppler. Early diagnosis is crucial to avoid severe vital and functional complications such as hemorrhage, early uterine rupture and hysterectomy, so its recognition is important to keep fertility of young woman.</p> 2018-07-26T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183602 Practice of antimalarial prescription to patients with negative rapid test results and associated factors among health workers in Oyo State, Nigeria 2022-04-19T13:42:24+00:00 Akinfemi Oyewumi Akinyode raoul.kamadjeu@gmail.com IkeOluwapo Oyeneye Ajayi raoul.kamadjeu@gmail.com Muhammed Sani Ibrahim raoul.kamadjeu@gmail.com Joshua Odunayo Akinyemi raoul.kamadjeu@gmail.com Olufemi Olamide Ajumobi raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Contrary to World Health Organizations recommendations, health workers (HWs) still prescribe antimalarials to malaria rapid diagnostic test (mRDT)-negative patients, thus increasing overuse and the risk of parasite resistance to the antimalarials. The reasons for this are not clear. We identified factors associated with antimalarial prescription to mRDT-negative patients.<br /><br /><strong>Methods:</strong> We conducted a cross-sectional study among 423 HWs. Data on socio-demographic characteristics, training, supervision experience and fever management practices were collected. We tested associations between independent variables and prescription of antimalarials to mRDT-negative patients using Chi square and logistic regression at p &lt; 0.05. <br /><br /><strong>Results:</strong> The HWs were mostly community health workers (58.6%), with mean age of 41.0 (±8.8) years and 13.6 (± 9.0) years of professional practice. Females were 322 (76.1%) and 368 (87%) were married. Of the 423 HWs interviewed, 329 (77.8%) received training on mRDT use, 329 (80.6%) received supervision and 129 (30.5%) had good knowledge of causes of fever. Overall, 110 (26.0%) of the HWs prescribed antimalarials to mRDT-negative patients. A higher proportion of non-trained vs trained HWs [Adjusted Odds Ratio (aOR) = 4.9; 95% Confidence Interval (CI) (2.5-8.3)], and HWs having poor knowledge vs HWs having good knowledge of causes of fever [aOR = 1.9; 95% CI (1.0-3.5)], prescribed antimalarials to mRDT-negative patients. <br /><br /><strong>Conclusion:</strong> HWs' lack of training on mRDT use and poor knowledge of causes of fever were associated with prescription of antimalarials to mRDT-negative patients. We recommend training on management of fever and mRDT use to reduce such inappropriate antimalarial prescriptions.<br /><br /><strong>Keywords:</strong> Rapid diagnostic tests, antimalarial, prescriptions, Nigeria 2019-02-18T14:12:17+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183600 Surgical treatment of intestinal perforation in Behçet Syndrome: an unusual presentation 2022-04-19T13:42:27+00:00 Carla Sofia Vicente raoul.kamadjeu@gmail.com António Dias Freitas raoul.kamadjeu@gmail.com Behçet syndrome is a chronic, recurring, systemic disorder characterized by the histopathologic finding of nonspecific vasculitis in multiple organs. Behçet syndrome involves the gastrointestinal tract in 10-50% of patients; The main sites of involvement are the terminal ileum and cecum. In patients with Behçet syndrome, CT is advocated for early detection of complications as well as for exclusion of other abdominal pathologic conditions but there is no specific exam. The report of histology in conjunction with the clinical history and the presence of oral ulcers, uveitis and suspected cutaneous lesions suggests the diagnosis. The optimal medical treatment of Behçet syndrome has not yet been well established. In rare cases surgery must be required to control the disease. The authors report one case of Behcet Syndrome presenting with intestinal perforation.<br /><br /><strong>Keywords:</strong> Behçet, vasculitis, intestinal perforation 2019-02-18T14:03:07+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183599 Anemia revealing a collagenous gastritis in a young Tunisian man 2022-04-19T13:42:29+00:00 Imen Akkari raoul.kamadjeu@gmail.com Karim Skandrani raoul.kamadjeu@gmail.com Atef Ben Abdelkader raoul.kamadjeu@gmail.com Soumaya Mrabet raoul.kamadjeu@gmail.com Elhem Ben Jazia raoul.kamadjeu@gmail.com Collagenous gastritis is a rare entity, characterized by the deposition of a subepithelial collagenous band with an inflammatory infiltrate in the mucosa. We report the first Tunisian case revealed by severe anemia. Lesions were limited to the stomach and remained unchanged on 3 series biopsies during a 24 month follow up despite treatment with corticosteroids. The cause of the disease remains unknown; our findings suggest that lesions of collagenous gastritis may result from a local immune process.<br /><br /><strong>Keywords:</strong> Gastritis, collagen diseases, endoscopy, anemia, iron deficiency 2019-02-18T13:58:41+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183596 Mode de révélation inhabituel d’une hyperparathyroïdie primaire du sujet jeune: à propos de deux cas 2022-04-19T13:42:30+00:00 Dhoha Ben Salah raoul.kamadjeu@gmail.com Nabila Rekik raoul.kamadjeu@gmail.com Lilia Affes raoul.kamadjeu@gmail.com Mouna Elleuch raoul.kamadjeu@gmail.com Fatma Mnif raoul.kamadjeu@gmail.com Mouna Mnif raoul.kamadjeu@gmail.com Mohamed Abid raoul.kamadjeu@gmail.com Primary hyperparathyroidism usually affects the elderly. Juvenile hyperparathyroidism is rare and poses specific diagnostic and therapeutic problems. We report the case of two young female patients, aged 14 and 19 years, with primary hyperparathyroidism detected due to femoral head involvement. One of those patients had slipped upper femoral epiphysis. Hyperparathyroidism only affected bone in both cases. No patient had a family history of this disease. Primary hyperparathyroidism was associated with solitary and benign parathyroid adenoma in both patients. They underwent complicated adenomectomy by persistent hypocalcaemia. This last was associated with hypoparathyroidism exacerbated by hungry bone syndrome, requiring substitutive vitaminocalcic therapy. It is well known that primary hyperparathyroidism rarely occurs in young subjects. Renal involvement is the most common clinical manifestation of hyperparathyroidism. Bone involvement and, in particular, slipped femoral epiphyses are an uncommon mode of revelation.<br /><br /><strong>Keywords:</strong> Juvenile primary hyperparathyroidism, hypercalcemia, slipped upper femoral epiphysis 2019-02-18T13:48:05+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183594 Assessment of knowledge, attitudes and practices of HIV post exposure prophylaxis among the doctors and nurses in Princess Marina Hospital, Gaborone: a cross-sectional study 2022-04-19T13:42:33+00:00 Peter Bareki raoul.kamadjeu@gmail.com Tenego Tenego raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Botswana is one of the HIV/AIDS hardest hit countries in Sub-Saharan Africa with a prevalence of 17.6 percent while incidence is estimated to be 2.9 percent. The average risk of HIV transmission after a percutaneous exposure to HIV-infected blood has been estimated to be approximately 0.3% posing a threat to health care workers. This has resulted in HIV post exposure prophylaxis (PEP) being very important in the healthcare setting. The aim of this study was to assess knowledge, attitudes and practices of health care workers towards HIV PEP. <br /><br /><strong>Methods:</strong> A cross-sectional study was conducted at Princes Marina Hospital (PMH) in Gaborone from the 26th March-2nd April 2014. Inclusion criteriaregistered medical doctors and nurses. Collected sample size was 199. Data was collected using self-administered questionnaires. <br /><br /><strong>Results:</strong> The majority of respondents 70.7% of the respondents had adequate knowledge about PEP, with 191(97.4%) of the study participants being aware of HIV PEP while 82.2% of the respondents had a positive attitude toward PEP. A significant number had been exposed 107(53.7%) to risky exposures. Of the exposed, 80(74.8%) took PEP, while 27(25.2%) did not take PEP. From the respondents that took PEP 21(26.6%) did not complete PEP, with 15(71.4%) quitting because of adverse side effects, 1(4.76%) assuming it was enough treatment and 1(4.76%) doubting drug efficacy. <br /><br /><strong>Conclusion:</strong> The participants were knowledgeable of the existence of HIV PEP and had a positive attitude toward the HIV PEP program. Although the participants were knowledgeable, they showed inadequate practices with regard to HIV PEP.<br /><br /><strong>Keywords:</strong> Post exposure prophylaxis, health care workers, HIV- Human immunodeficiency virus 2019-02-18T13:36:01+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183593 Determinants of childhood diarrhea in West Gojjam, Northwest Ethiopia: a case control study 2022-04-19T13:42:36+00:00 Meskerem Girma raoul.kamadjeu@gmail.com Tesfaye Gobena raoul.kamadjeu@gmail.com Girmay Medhin raoul.kamadjeu@gmail.com Janvier Gasana raoul.kamadjeu@gmail.com Kedir Teji Roba raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Childhood diarrhea is a global public health problem that affects both developed and developing countries including Ethiopia. The objective of this study was to assess determinants of childhood diarrhea among children under-five years of age in West Gojjam Zone, northwest Ethiopia. <br /><br /><strong>Methods:</strong> A community-based case control study was conducted in four districts of West Gojjam in the northwest of Ethiopia from July to August, 2015. A randomly selected sample of 118 cases and 351 controls who met the inclusion criteria were included in this study. Data were collected using a structured questionnaire through face to face interview. Independent variables which had p-value less than 0.2 at an unadjusted model were candidate for the final model. Adjusted odds ratio was used to control confounding effects and to determine predictors of an outcome. <br /><br /><strong>Results:</strong> Unimproved water sources (AOR, 1.88; 95 % CI: 1.17-3.03), lack of hand washing at critical times (AOR, 2.38; 95 % CI: 1.42-3.99) and a deepening method to take water from a water storage container (AOR, 2.11; 95 % CI: 1.28-3.47), presence of two or more young siblings (AOR, 4.15; 95 % CI: 2.57-6.70), rural residence (AOR,2.11 95 % CI: 2.21-3.68), and not using latrine for disposal of child feces (AOR, 1.90; 95 % CI: 1.12-3.22) were predictors of diarrhea among children under the age of five. <br /><br /><strong>Conclusion:</strong> The majority of the causes of childhood diarrhea in the study area were preventable. Thus, health extension workers should give tailored health information to mothers or caregivers on the importance of sanitation, personal and environmental hygiene and drinking water handling methods.<br /><br /><strong>Keywords:</strong> Childhood diarrhea, hygiene, water, determinant, case control, Ethiopia 2019-02-18T13:29:30+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183590 Bacterial meningitis in Niger: an analysis of national surveillance data, 2003-2015 2022-04-19T13:42:38+00:00 Lawaly Maman Manzo raoul.kamadjeu@gmail.com Sani Ousmane raoul.kamadjeu@gmail.com Dan Dano Ibrahim raoul.kamadjeu@gmail.com Maman Zaneidou raoul.kamadjeu@gmail.com Jean Testa raoul.kamadjeu@gmail.com Halima Boubacar Maïnassara raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Bacterial meningitis (BM) is one of the most severe infectious disease in Niger republic. To best describe the trends of BM disease, meningitis surveillance data from the Centre de Recherche Medicale et Sanitaire (CERMES) and the Direction of Surveillance and Response to Epidemics (DSRE) were reviewed and analyzed. <br /><br /><strong>Methods:</strong> Data on number of notified cases of BM and on pathogens were analyzed during 2003-2015. Excel 2013 was used for trend analysis on the etiology of BM prevalence and incidence. <br /><br /><strong>Results:</strong> A total of 10051 cerebrospinal fluid (CSF) samples collected were confirmed by laboratory methods. The main etiologies of meningitis detected were <em>N. meningitidis</em> (82.1%), <em>S. pneumonia</em> (12.1%) and <em>H. influenza</em> (3.4%). N. meningitidis mostly affected children in the age groups of 5-9 years (32.9%) and 10-14 years (24.9%) with respective mean incidence of 14.9 and 11.3. The percentage estimate of <em>N. meningitidis</em> serogroup A (NmA) meningitis fell to 0% in 2015 while during the same year that of N. meningitidis serogroup C (NmC) and <em>N. meningitidis</em> serogroup W (NmW) reached 82.9% and 17% respectively. <br /><br /><strong>Conclusion:</strong> Overall, the epidemiological trends of the BM in Niger were dynamic. The emergence of NmC strains suggests that there may be an urgent need for serogroup C containing vaccines in Niger in the coming years.<br /><br /><strong>Keywords</strong>: Niger, epidemiology, bacterial meningitis, surveillance 2019-02-18T13:21:02+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183582 Pregnancy and delivery in woman with implantable cardioverter-defibrillator: what we should know 2022-04-19T13:42:41+00:00 Mohamed Amine Bouslama raoul.kamadjeu@gmail.com Fehmi Ferhi raoul.kamadjeu@gmail.com Faten Hacheni raoul.kamadjeu@gmail.com Kaabia Ons raoul.kamadjeu@gmail.com Khlifi Abdeljelil raoul.kamadjeu@gmail.com Khaled Ben Jazia raoul.kamadjeu@gmail.com Hedi Khairi raoul.kamadjeu@gmail.com We report the observation of a 25-year-old pregnant patient of 39 weeks of amenorrhea proposed for elective cesarean section. This patient suffers from hypertrophic cardiomyopathy since the age of 12. She has an implantable cardioverter defibrillator (ICD). The peculiarities of the ICD in the parturient and the perioperative management of the patient are being reported in this paper.<br /><br /><strong>Keywords:</strong> Pregnancy, implantable cardioverter-defibrillator, anesthesia 2019-02-18T12:39:44+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210334 Giant epidermoid cyst: a rarity or negligence? 2021-07-11T14:43:23+00:00 Rakesh Sharma raksy.222@gmail.com Biren Padhy raksy.222@gmail.com <p>A 35 year old male presented to our outpatient department with a slow growing swelling over the left gluteal region for more than 10 years. There was no history of pain, tenderness, fever or previous trauma. On examination there was a 10 cm x 10cm swelling in the upper outer quadrant of left gluteal region. It was soft, cystic, mobile swelling and adherent to overlying skin with a punctum. Ultrasonography revealed a well-defined hypoechoic heterogenous cyst suggestive of an inclusion epidermoid cyst (A). FNAC was done for confirmation. A complete excision of the whole cyst (B) was done with uneventful post-operative recovery. Histopathology showed no signs of malignancy. Epidermoid cyst is one of the commonest benign lesions of skin. Size may vary from a few millimetres to few centimetres but cysts more than 5 cm are known as giant epidermoid cysts and are rare clinical occurrence. Giant epidermoid cyst up to 17 cm in greatest dimension have also been reported. They are slow growing lesions and patients tend to neglect them only to present at a later time. These cysts are usually seen over gluteal region but may be seen over the extremities and scalp. Malignant transformation is a known complication leading to squamous cell carcinoma, basal cell carcinoma or melanomas (C). Clinical examination, USG, FNAC will clinch the diagnosis in most cases. MRI gives additional information in cases of atypical or suspected malignant lesions. Complete excision is the treatment of choice.</p> 2018-07-31T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210337 Syndrome de Ballantyne compliqué d’eclampsie: à propos d’un cas et revue de la littérature 2021-07-11T14:50:30+00:00 Fatima El Mangoub fatima.elmangoub@yahoo.fr Rachid Ait Bouhou fatima.elmangoub@yahoo.fr Zakaria Idri fatima.elmangoub@yahoo.fr Jaouad Kouach fatima.elmangoub@yahoo.fr Khalid Guelzim fatima.elmangoub@yahoo.fr Driss Moussaoui Rahali fatima.elmangoub@yahoo.fr <p>Le syndrome de Ballantyne ou préeclampsie en miroir est une entité clinique rare. Son ethiopathogénie reste encore mal élucidée. Son diagnostic doit être évoqué devant un syndrome œdémateux maternel associé à un état d'anasarque fœtal. Le pronostic fœtal réservé auquel peut s'associer une forte morbidité maternelle expliquent l'intérêt de poser un diagnostic précoce en identifiant son étiologie afin d'établir un traitement anténatal pouvant améliorer ainsi le pronostic materno-fœtal. Nous rapportons et discuterons à la lumière d'une revue de la littérature, le cas d'un probable syndrome de Ballantyne secondaire à un syndrome malformatif fœtal compliqué d'éclampsie chez la mère.</p> 2018-07-31T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183576 Evaluation of non-adherence to anti-retroviral therapy, the associated factors and infant outcomes among HIV-positive pregnant women: a prospective cohort study in Lesotho 2022-04-19T13:42:42+00:00 Ngomba Kadima raoul.kamadjeu@gmail.com Tejan Baldeh raoul.kamadjeu@gmail.com Kyaw Thin raoul.kamadjeu@gmail.com Lehana Thabane raoul.kamadjeu@gmail.com Lawrence Mbuagbaw raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Success in addressing prevention of mother-to-child transmission of HIV depends largely on good adherence to anti-retroviral therapy (ART) by pregnant women. Knowledge of the levels of ART adherence among pregnant women is essential to inform strategies to prevent or reduce HIV transmission rates, particularly in African settings. <br /><br /><strong>Aim:</strong> the primary objective of this study was to measure adherence to antiretroviral therapy (ART) among pregnant women living with human immunodeficiency virus (HIV). The secondary objectives were to determine: i) the rate of new infections among children at Mabote Filter Clinic in Maseru, Lesotho whose mothers were enrolled in PMTCT, and ii) the factors associated with non-adherence to ART among pregnant women. <br /><br /><strong>Methods:</strong> In this prospective cohort study, HIV-positive pregnant women receiving antiretroviral therapy (ART) for prevention of mother to child transmission (PMTCT) were followed up to delivery and their children were tested for HIV. We collected socio-demographic information, knowledge of PMTCT and adherence to ART (three-day recall and pill count) including reasons for non-adherence. We also used logistic regression to explore factors associated with non-adherence. <br /><br /><strong>Results:</strong> One hundred and seven women were included. The mean (standard deviation) age of the participants was 28.2 (5.7) years. Most, 81.3% (87/107), were married, only 9.3% (10/107) had a postsecondary education. Two-thirds (63.6%: 68/107) of the participants started ART because of PMTCT. Only 78.5% (84/107) of the participants had adequate knowledge of the importance of PMTCT. The three-day self-reported non-adherence rate at the first visit was 7.5% (95% confidence interval (CI): 3.7, 13.1), but up to 43.4% (95% CI: 35.2, 51.9) using pill count. The most frequently reported reasons for not adhering were: running out of pills (7.5%), nausea (5.6%) and to avoid side-effects (3.7%). Women who were employed (odds ratio (OR) 4.35; 95% CI: 1.38,14.29; p = 0.012) and at a higher gestational age (OR = 1.43; 95% CI: 1.11, 1.85; p = 0.006) were more likely to be nonadherent. Only 1 of the 77 exposed infants was found to be positive for HIV at 6 weeks after birth. <br /><br /><strong>Conclusion:</strong> We found a higher nonadherence rate for participants with pill count compared to a three-day adherence self-report. However, mother to child HIV transmission was relatively low. Lack of employment and high gestational age were found to be predictive factors of non-adherence.<br /><br /><strong>Keywords:</strong> Adherence, transmission, antiretroviral therapy, prevention of mother-to-child transmission 2019-02-18T12:30:09+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183571 Survey of magnetic resonance imaging availability in West Africa 2022-04-19T13:42:45+00:00 Godwin Inalegwu Ogbole raoul.kamadjeu@gmail.com Adekunle Olakunle Adeyomoye raoul.kamadjeu@gmail.com Augustina Badu-Peprah raoul.kamadjeu@gmail.com Yaw Mensah raoul.kamadjeu@gmail.com Donald Amasike Nzeh raoul.kamadjeu@gmail.com <strong>Introduction:</strong> The availability and utilization of MRI units across sub-Saharan Africa countries remain poor and its distribution is largely unknown. A cross-sectional survey was conducted to determine the distribution and utilization of MRI facilities across the West African sub-region. <br /><br /><strong>Methods:</strong> An interview and online search survey was conducted from September 2015 to September 2016, to determine the MRI facilities (Government/Public and Private) available in the West African sub-region. In Nigeria and Ghana, face-to-face interviews were conducted while for other West African countries, telephone interviews with radiologists and other health professionals as well as a Google online search were conducted to ascertain the distribution of the MRI facilities in the region. The number of MRI units in West Africa per million population was calculated and compared with other parts of the world from available published data. <br /><br /><strong>Results:</strong> Eighty-four MRI units serve a combined population of 372,551,411 in the West African sub-region at the time of this report. Nigeria accounted for more than two-thirds (58 (69%)) of the available units. Of these, 45 (77.6%) of the units were low-field strength systems. Ghana's 14 MRI units were fairly equally distributed between the private (57%) and the public sectors (43%). Ghana with 0.48 units/million population had the highest number of MRI units/ million population followed by Nigeria with 0.30 units/million population. <br /><br /><strong>Conclusion:</strong> Though there is an increase in the number of available MRI units in the West African sub region in the last decade, the numbers remain appallingly small for the population. Infrastructural and maintenance limitations constitute a major impediment to the use of high filed systems in the region. There may be need for greater cooperation between public and private enterprises for future improvement of MRI utilization in the region.<br /><br /><strong>Keywords:</strong> MRI, West Africa, survey, utilization, partnership 2019-02-18T12:16:55+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210340 Sarcoidosis with oral involvement 2021-07-11T15:46:56+00:00 Hakima Elmahi elmahi.hakima@gmail.com Fatima Zohra Mernissi elmahi.hakima@gmail.com <p>Sarcoidosis is a multisystem granulomatous disease in which pulmonary involvement is the most characteristic feature. Even though extrapulmonary manifestations occur infrequently in the area of the head and neck, an occasional patient will have oral involvement. Oral involvement generally appears in patients with chronic multisystem sarcoidosis and seldom occurs in the acute stage. The oral lesions may be solitary, multiple or part of a generalized disease. In some cases, oral involvement is the first, or only, manifestation of the disease and appears as a nontender well-circumscribed brownish red or violaceous swelling, as papules, or as submucosal nodules that can occasionally either show superficial ulceration or be symptomatic. Gingival involvement presents as red gingival enlargement. Although the etiology of sarcoidosis is unknown. The diagnosis of sarcoidosis is established when clinical features are supported by histopathological evidence of typical non-caseating epithelioid granulomas and other laboratory tests. The differential diagnosis of oral soft tissue lesions must consider other granulomatous conditions, such as infections (tuberculosis, leprosy, tertiary syphilis, systemic mycoses, and cat-scratch disease), Crohn's disease, Melkersson-Rosenthal syndrome (including Mieschers cheilitis or cheilitis granulomatosa), Wegener's granulomatosis, foreign body reactions and hairy cell leukemia. Management of oral sarcoidosis has been variable, ranging from no treatment to radiation therapy. Surgical excision and curettage were found to be the most common therapies, followed by systemic therapy such as steroids, methotrexate, hydroxychloroquine and minocycline. We report a case of sarcoidosis limited to oral involvement in a 12-year-old girl, treated with corticosteroid.</p> 2018-07-31T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183570 Performance of malaria rapid diagnostic test in febrile under-five children at Oni Memorial Children’s Hospital in Ibadan, Nigeria, 2016 2022-04-19T13:42:47+00:00 Nurudeen Ayobami Adebisi raoul.kamadjeu@gmail.com Hannah Odunola Dada-Adegbola raoul.kamadjeu@gmail.com Magbagbeola David Dairo raoul.kamadjeu@gmail.com IkeOluwapo Oyeneye Ajayi raoul.kamadjeu@gmail.com Olufemi Olamide Ajumobi8 raoul.kamadjeu@gmail.com <strong>Introduction:</strong> The World Health Organization (WHO) recommends testing of suspected malaria cases before treatment. Malaria rapid diagnostic test (mRDT) has been recommended for this purpose in endemic countries where microscopy is not accessible. However, its diagnostic performance remains a concern in clinical settings. We assessed diagnostic performance of RDT among febrile under-five children (U5) presenting at Oni Memorial Children's Hospital, Ibadan (OMCH).<br /><br /><strong> Methods:</strong> A cross-sectional study was conducted among 370 febrile U5 attending OMCH February to May, 2016. We examined their finger prick blood samples for malaria parasitaemia using CareStartTM histidine rich protein II (HRP-2) RDT and microscopy. The sensitivity, specificity, positive and negative predictive values (PPV, NPV), false positive (FP), invalid rates (IR), likelihood ratio of positive and negative tests (LRP and LRN), were calculated. <br /><br /><strong>Results:</strong> Mean age of the children was 28.17 ± 15.59 months. Malaria prevalence was 21.6% and 15.1% by mRDT and microscopy, respectively. Sensitivity of CareStartTM HRP-2 RDT was 94.6% (95% confidence interval (CI): 84.2-98.6), specificity: 91.4% (CI: 87.6-94.2), PPV: 66.3% (CI: 54.7-76.2), NPV: 98.9% (CI: 96.8-99.7), FPR 6.5%, IR 8.1%, LRP:10.6 and LRN:0.1. <br /><br /><strong>Conclusion:</strong> Diagnostic performance of CareStartTM used in the study met the ≥ 95% sensitivity at 100 parasites/μL recommended by WHO. This finding provides clinical evidence that testing before anti-malarial treatment as recommended by WHO will identify cases of malaria infection and reduce unnecessary use of drugs. Healthcare workers should be educated on diagnostic accuracy of mRDT and adhere to the WHO's test-treat strategy for anti-malaria therapy.<br /><br /><strong>Keywords:</strong> Malaria, rapid diagnostic test, microscopy, parasitemia, sensitivity, specificity 2019-02-18T11:40:31+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183567 Prévalence et connaissances de l’hypertension artérielle chez les personnes âgées: étude transversale menée à Bobo-Dioulasso, Burkina Faso 2022-04-19T13:42:49+00:00 Somnoma Jean-Baptiste Tougouma raoul.kamadjeu@gmail.com Hervé Hien raoul.kamadjeu@gmail.com Adjongba Bruno Aweh raoul.kamadjeu@gmail.com Aimé Arsène Yaméogo raoul.kamadjeu@gmail.com Ziemlé Clément Méda raoul.kamadjeu@gmail.com Yibar Kambiré raoul.kamadjeu@gmail.com Georges Rosario Millogo raoul.kamadjeu@gmail.com Georges Kinda raoul.kamadjeu@gmail.com Samba Sidibé raoul.kamadjeu@gmail.com Macaire Ouédraogo raoul.kamadjeu@gmail.com This study aims to determine the prevalence of arterial hypertension (AH) in the elderly people as well as their knowledge of this disease. We conducted a cross-sectional, descriptive study in the town of Bobo-Dioulasso from October to November 2015 at the intervention sites of the Association of Medical Assistance to elderly people "KAFOLI". Patients aged 60 years and more, with or without hypertension, who wished to participate in the study were included. Subjects were considered to be hypertensive when they had systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥90 mmHg or when they were under antihypertensive treatment. Socio-demographic and clinical data as well as the risk factors associated with the disease were collected. Knowledges on arterial hypertension were based on general knowledges about arterial hypertension as sources of information about it. A total of 88 subjects were included in this study. The study involved 56 women and 32 men (sex ratio 0.57). The average age of patients was 71 years (IQR:66-76). The prevalence of arterial hypertension was 61,36% and it was associated with knowledges about AH and with alcohol consumption; 68.18 % of patients had knowledge of AH. The majority of them were followed up in firstlevel health care nursing centres (64,81%). This study highlighted a high prevalence of hypertension in elderly people living in Bobo-Dioulasso. The majority of these persons were aware of this disease. In the majority of cases follow-up was ensured by nursing staff.<br /><br /><strong>Keywords:</strong> Hypertension, elderly, Bobo-Dioulasso 2019-02-18T11:22:45+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183566 Syndrome de résistance à l’Adrénocorticotrophine Hormone (ACTH): à propos d’un cas 2022-04-19T13:42:52+00:00 Morgiane Solange Tognidé Sêlomin Houngbadji raoul.kamadjeu@gmail.com Babacar Niang raoul.kamadjeu@gmail.com Djibril Boiro raoul.kamadjeu@gmail.com Aminata Mbaye raoul.kamadjeu@gmail.com Abdoulaye Seck raoul.kamadjeu@gmail.com Abdoulaye Aliou Ndongo raoul.kamadjeu@gmail.com Indou Deme Ly raoul.kamadjeu@gmail.com Ousmane Ndiaye raoul.kamadjeu@gmail.com Adrenocorticotropic hormone (ACTH) insensitivity syndrome is one of the rare causes of adrenal insufficiency in children. All described inherited ACTH insensitivity forms are of autosomal recessive origin. In our resource-poor Countries, many of these rare diseases are ignored or not diagnosed due to inadequate technical equipments. We report the case of a 4-month old infant hospitalized for refractory hypoglycaemias. Despite the patient had generalized and severe melanodermia, digestive disorders and ion channel disorders the diagnosis of cortisol deficiency was only diagnosed retrospectively during respiratory arrest with favorable outcome under hydrocortisone therapy. This study aims to highlight the clinical, laboratory and therapeutic features of peripheral cortisol deficiency, without enzymatic blocks, including this adrenocorticotropic hormone (ACTH) insensitivity syndrome.<br /><br /><strong>Keywords:</strong> ACTH resistance, cortisol deficiency, hypoglycaemia 2019-02-18T11:13:02+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183565 Les communications interauriculaires chez l’enfant: diagnostic et prise en charge à propos de 49 cas aux CHU pédiatriques de Dakar 2022-04-19T13:42:55+00:00 Idrissa Basse raoul.kamadjeu@gmail.com Amadou Lamine Fall raoul.kamadjeu@gmail.com Ndiogou Seck raoul.kamadjeu@gmail.com Djiril Boiro raoul.kamadjeu@gmail.com Aïssatou Ba raoul.kamadjeu@gmail.com Ndiémé Ndiaye Diawara raoul.kamadjeu@gmail.com Fatou Niang raoul.kamadjeu@gmail.com Dina Cyrienne Obambi Diop raoul.kamadjeu@gmail.com Aliou Abdoulaye Ndongo raoul.kamadjeu@gmail.com Abou Ba raoul.kamadjeu@gmail.com Lamine Thiam raoul.kamadjeu@gmail.com Ndéye Rama Diagne/Guéye raoul.kamadjeu@gmail.com Mouhamadou Ndiaye raoul.kamadjeu@gmail.com Interauricular communication (IAC) is the second most important congenital heart disease in children. It accounts for 6-8% of congenital cardiac malformations in children. However, many questions are still open about this pathology. Thus, this study aims to report the prevalence rate of IAC in hospital but especially to describe its clinical, paraclinical and therapeutic aspects. For this purpose, we conducted a retrospective descriptive study. Data were collected by means of a questionnaire and then entered and analyzed in Sphinx (V5). The prevalence in Hospital was 2x1000. The average age of patients was 37 months, the sex-ratio was 0,75. No prenatal diagnosis was made. Parental consanguinity was detected in 30% of cases. Respiratory infections were found in 24% of cases. Cardiomegaly was found in 35 cases with hypervascularization in 63% of cases. Ultrasound showed a predominance of ostium secundum; wide IAC was found in 63% of cases. Pulmonary stenosis was the most important associated heart attack. Pulmonary arterial hypertension was found in 63% of the cases. Treatment was based on diuretics, which were largely used and only 7 children underwent surgery. Evolution was favorable in 39 patients reflecting a rate of 79%. Early diagnosis of IAC should be improved as well as surgical treatment of IAC affecting infants.<br /><br /><strong>Keywords:</strong> Heart disease, interauricular communication, ultrasound 2019-02-18T11:04:05+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183563 ECG changes in patients with primary hyperthyroidism 2022-04-19T13:42:58+00:00 Ishtiaque Hussain Baladi raoul.kamadjeu@gmail.com Ayesha Aslam Rai raoul.kamadjeu@gmail.com Syed Masroor Ahmed raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Thyroid hormones plays key role in regulating cardiovascular system. Its imbalance leads to various electrophysiological changes in cardiovascular system. This study was done to determine the frequency of electrocardiographic (ECG) changes in patients with primary hyperthyroidism. <br /><br /><strong>Methods:</strong> It was a descriptive cross-sectional study conducted in the Department of Medicine, Medical Unit III, Ward-7, Jinnah Postgraduate Medical Centre, Karachi, from October 2013 to April 2014. A total of 103 patients newly diagnosed with primary hyperthyroidism were included in this study. Venous blood samples were collected for T3, T3, TSH analyzed by radioimmunoassay. ECG was performed. Outcome variables were the ECG changes i.e. sinus tachycardia and atrial fibrillation. <br /><br /><strong>Results:</strong> The average age of the patients was 30.09±5.57 years (95%CI: 29 to 31.18). Out of 103 cases, 19 (18.45%) were male and 84 (81.55%) were female. Sinus tachycardia was observed in 60.19% (62/103) patients whereas atrial fibrillation was found in 11.65 (12/103) of cases. <br /><br /><strong>Conclusion:</strong> In this study frequency of electrocardiographic changes in term of sinus tachycardia was high. This report has emphasized the importance of thyrotoxicosis as a cause of cardiac morbidity and mortality in patients with thyrotoxicosis. These cardiac complications are readily reversible if timely optimal treatment is offered.<br /><br /><strong>Keywords:</strong> Cardiovascular, electrocardiographic, hyperthyroidism 2019-02-18T10:45:21+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183561 Entirely thoracoscopic resection of a giant emphysematous bulla 2022-04-19T13:42:59+00:00 Agustín Buero raoul.kamadjeu@gmail.com Walter Sebastian Nardi raoul.kamadjeu@gmail.com Gustavo Alejandro Lyons raoul.kamadjeu@gmail.com Silvia Quadrelli raoul.kamadjeu@gmail.com Domingo Javier Chimondeguy raoul.kamadjeu@gmail.com A 38-year-old man with longilinear shape, smoker (38 packs/year) and no other relevant medical history was referred to our department due to the finding of left pulmonary hyperlucency on a chest x-ray. A computed tomography (CT) was performed and a giant emphysematous bulla with thin-walled partitions inside was shown that replaced almost the entire left upper lobe, The patient underwent an exploratory thoracoscopy. Intraoperatively a giant bulla was seen that initially impressed to replace the entire upper lobe. Despite the large size we decided to attempt thoracoscopic resection preserving the remaining healthy parenchyma. Bullectomy was done using linear endoscopic stapling devices. To our knowledge this is the only case with such a large bulla resected entirely by VATS.<br /><br /><strong>Keywords:</strong> giant bulla, bullectomy, VATS 2019-02-18T10:22:04+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183560 Descriptive analysis of colorectal cancer in Zambia, Southern Africa using the National Cancer Disease Hospital Database 2022-04-19T13:43:01+00:00 Akwi Wasi Asombang raoul.kamadjeu@gmail.com Richard Madsen raoul.kamadjeu@gmail.com Michelo Simuyandi raoul.kamadjeu@gmail.com Gilbert Phiri raoul.kamadjeu@gmail.com Matthew Bechtold raoul.kamadjeu@gmail.com Jamal Ahmad Ibdah raoul.kamadjeu@gmail.com Kennedy Lishimpi raoul.kamadjeu@gmail.com Lewis Banda raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Colon cancer is preventable. There is a plethora of data regarding epidemiology and screening guidelines, however this data is arse from the African continent. <br /><br /><strong>Objective:</strong> we aim to evaluate the trends of colorectal cancer (CRC) in a native African population based on age at diagnosis, gender and stage at diagnosis. <br /><br /><strong>Methods:</strong> We conducted a retrospective analysis of the Cancer Disease Hospital (CDH) registry in Zambia, Southern Africa. Results: 377 charts were identified in the CDH registry between 2007 and 2015, of which 234 were included in the final analysis. The mean age at diagnosis was 48.6 years and 62% are males. Using descriptive analysis for patterns: mode of diagnosis was surgical in 195 subjects (84%), histology adenocarcinoma in 225 (96.5%), most common location is rectum 124 (53%) followed by sigmoid 31 (13.4%), and cecum 26 (11%). 122 subjects (54%) were stage 4 at diagnosis. Using the Spearman rank correlation, we see no association between year and stage at diagnosis (p = 0.30) or year and age at diagnosis (p = 0.92). <br /><br /><strong>Conclusion:</strong> Colorectal cancer was diagnosed at a young age and late stage in the Zambian patients.<br /><br /><strong>Keywords:</strong> Colorectal cancer, non-communicable diseases, colon cancer, rectal cancer, cancer in Africa 2019-02-18T10:15:01+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183559 Estimation des valeurs normales de l’hémogramme à Marrakech: étude préliminaire au CHU Med VI de Marrakech 2022-04-19T13:43:03+00:00 Dounya Bounid raoul.kamadjeu@gmail.com Khalil Haouach raoul.kamadjeu@gmail.com <strong>Introduction:</strong> The full blood count (FBC) is one of the most commonly requested and useful test in common medical practices. Abnormalities can indicate the presence of many disorders. A correct interpretation is then essential to guide the diagnosis. This study aims to determine the reference ranges for full blood count (FBC) in a population of healthy adults in the city of Marrakech. <br /><br /><strong>Methods:</strong> We conducted a study analysis of 500 full blood count (FBC) data from adult donors at the Center for blood transfusion Ibn Tofail in Marrakech. The samples were analyzed using XE-5000 automated hematology system and the results were analyzed using SPSS statistical software. <br /><br /><strong>Results:</strong> Reference values obtained: white blood cells 3,9.103/ μl - 10,23.103/ μl (women) and 5,11.103/ μl -9,99.103/ μl (men); neutrophils 1,53.103/ μl - 6,05.103/ μl (women) and 1,56.103/ μl - 5,97.103/ μl (men); lymphocytes 1,28.103/ μl - 3,72.103/ μl (women) and 1,17.103/ μl - 3,69.103/ μl (men); hemoglobin 12,94-14,7g/dl (women) and 11,77-18,17g/dl (men); platelets 132.103/ μl - 384.103/ μl (women) and 140.103/ μl -356.103/ μl (men). <br /><br /><strong>Conclusion:</strong> Study data provide preliminary reference ranges for full blood count (FBC) in our study population which could be used to guide the treatment of patients and the interpretation of clinical trial results and which could potentially improve the quality of clinical care provided to patients.<br /><br /><strong>Keywords:</strong> Reference values, blood cell count, Marrakech 2019-02-18T10:02:29+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183558 A three-year-old boy with hypodipsic hypernatremia syndrome 2022-04-19T13:43:04+00:00 Bousayna Iraqi raoul.kamadjeu@gmail.com Rachid Abilkassem raoul.kamadjeu@gmail.com Nezha Dini raoul.kamadjeu@gmail.com Aomar Agadr raoul.kamadjeu@gmail.com We describe a three-year-old boy who had a growth and psychomotor retardation associated with inappropriate lack of thirst and vasopressin secretion in the presence of chronic plasma hyperosmolarity. Computed brain tomography revealed bilateral supratentorial sub-ependymal and cortical calcifications. Dissociation in the plasma vasopressin response to osmotic change was demonstrated in this patient. Treatment with a vasopressin analogue, desamino-D-arginine vasopressin (DDAVP) and forced intake of water restored plasma osmolality and serum sodium levels to normal.<br /><br /><strong>Keywords:</strong> Brain calcifications, child, hypodipsic hypernatremia syndrome 2019-02-18T09:56:38+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183557 Répercussions métaboliques et cardiovasculaires de la substitution glucocorticoïde au cours de la maladie d’Addison 2022-04-19T13:43:06+00:00 Dhoha Ben Salah raoul.kamadjeu@gmail.com Nadia Charfi raoul.kamadjeu@gmail.com Mouna Elleuch raoul.kamadjeu@gmail.com Faten Hadj Kacem raoul.kamadjeu@gmail.com Nabila Rekik raoul.kamadjeu@gmail.com Mouna Mnif raoul.kamadjeu@gmail.com Fatma Mnif raoul.kamadjeu@gmail.com Mohamed Abid raoul.kamadjeu@gmail.com Recent studies conducted in patients with Addison’s disease (AD) highlighted that this disease, even after treatment, is a significant cause of morbi-mortality. This study aims to determine the cardiovascular and metabolic deleterious impact of long-course glucocorticoid substitution therapy. We conducted a retrospective study of 28 patients with treated Addison’s disease evolving for more than 15 years. The average age of patients was 58, 53 years, with a female predominance (65%). The average follow-up period was 17, 87 years. Initial dose of hydrocortisone was 32, 5 mg/day (20.52 mg/m<sup>2</sup>) and 27, 9 mg/day (16,41mg/m<sup>2</sup>) at the time of the study. The prevalence of the metabolic syndrome (MS) in patients with AM was 35.71% after a period of treatment longer than 15 years. At the end of the follow-up period, 28.57% of patients were obese; 25% of patients had developed AH (arterial hypertension) and type 2 diabetes. The prevalence of dyslipidemia went from 3.57% to 42.85%. Only one patient had myocardial infarction at 25-year follow-up. Factors favoring the onset of MS in our study were history of disease and weight loss at the moment of diagnosis. Adjustment of substitution therapy is a challenge in patients with Addison’s disease due to morbi-mortality associated with overdose. A regular follow-up and a personalized therapeutic approach are necessary to improve patients’ prognosis.<br /><br /><strong>Keywords:</strong> Addison’s disease, hydrocortisone, morbidity, metabolic syndrome, cardiovascular risk 2019-02-18T09:50:33+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210341 Les deux complications majeures du tabac en une seule image! 2021-07-11T15:55:53+00:00 Hanane Asri asri_hanane@hotmail.fr Adil Zegmout asri_hanane@hotmail.fr <p>Le tabagisme est la première cause de mortalité évitable dans le monde, il est responsable de 90% de cancers bronchopulmonaire et c'est la principale cause de bronchite chronique et d'emphysème, deux troubles qui composent la maladie pulmonaire obstructive chronique (MPOC). Patient âgé de 58 ans, grand tabagique chronique non sevré qui présente depuis 2 mois des douleurs abdominales diffuses, le tout évoluant dans un contexte d'altération général. L'examen clinique a trouvé une patient en mauvais état général, pleuro pulmonaire a objectivé une diminution des murmures vésiculaires dans l'hémi champs thoracique droit, et sensibilité diffuse abdominale et énorme adénopathie sus claviculaire gauche. La tomodensitométrie thoraco-abdominale a objectivé la présence d'une infiltration tissulaire pleurale et abdominale intra et rétro péritonéale et emphysème pulmonaire diffus bilatéral (Figure). La fibroscopie bronchique a trouvé un bourgeon obstruant l'orifice de la bronche apicale de bronche lobaire supérieure droite. L'étude anatomopathologique de la biopsie bronchique et la biopsie ganglionnaire étaient en faveur d'un carcinome non différencié et l'évolution était marquée par le décès du patient après deux semaines. On rapporte à partir de cette observation l'évolution fatale par les deux complications du tabac chez le même patient d'où l'intérêt de la prévention qui repose sur la sensibilisation des dangers du tabac et sevrage tabagique.</p> 2018-08-06T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210343 Polyarthrite rhumatoïde vieillie avec poumon rhumatoïde: une observation caricaturale 2021-07-11T15:59:55+00:00 Ines Kechaou kechaou.ines@topnet.tn Imène Boukhris kechaou.ines@topnet.tn <p>La polyarthrite rhumatoïde du sujet âgé se définit par un âge de début supérieur à 60 ans. Le pronostic est surtout fonctionnel, dépendant du stade évolutif de la maladie, de l'installation ou pas de déformations articulaires. Nous rapportons l'observation d'une patiente âgée de 70 ans aux antécédents d'hypertension artérielle, d'hypothyroïdie et de syndrome de Sjögren diagnostiqué en 2005. Elle a été perdue de vue et hospitalisée dans notre service en 2016 pour polyarthralgies diffuses des grosses articulations avec syndrome inflammatoire biologique. A l'examen, la patiente était cachectique (BMI: 17,6Kg/m<sup>2</sup>). Elle avait des déformations articulaires: main rhumatoïde avec un aspect en dos de chameau et de coup de vent cubital (A) et au niveau des pieds, des orteils en griffe et un hallux valgus évolué bilatéral (B). L'auscultation pulmonaire a révélé la présence de râles crépitant diffus aux deux champs pulmonaires. La patiente n'était pas dyspnéique. L'auscultation cardiaque était normale et il n'y avait pas de signes d'insuffisance cardiaque. La radio thorax avait montré un aspect réticulo-micro-nodulaire diffus (C) avec au scanner thoracique un aspect de pneumopathie infiltrante diffuse compatible avec une pneumopathie interstitielle usuelle (UIP) (D). L'échographie cardiaque avec doppler avait montré une hypertension artérielle pulmonaire modérée à 40mmHg. Les gaz du sang ont révélé une hypoxie à 81mmHg avec une saturation à 96%. Le diagnostic de polyarthrite rhumatoïde vieillie compliquée d'une atteinte pulmonaire a été alors retenu. Cette patiente présente un pronostic fonctionnel réservé devant ces déformations articulaires très importantes.</p> 2018-08-06T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183556 Highly prevalent at-risk sexual behaviours among out-of-school youths in urban Cameroon 2022-04-19T13:43:07+00:00 Elvis Enowbeyang Tarkang raoul.kamadjeu@gmail.com Lilian Belole Pencille raoul.kamadjeu@gmail.com Emana Dadah raoul.kamadjeu@gmail.com Melanie Mbungo Nzegge raoul.kamadjeu@gmail.com Joyce Komesuor raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Cameroon has a high prevalence of out-of-school youths. Therefore, research relating to out-of-school youths and HIV/AIDS is imperative, since they might engage in high risk sexual behaviours. The current study investigated the highly prevalent at-risk sexual behaviours among out-of-school youths in urban Cameroon. <br /><br /><strong>Methods:</strong> A cross-sectional design was adopted using a self-administered questionnaire to collect data from a cluster sample of 405 out-of-school youths, aged 15-24 years. Statistics was calculated using SPSS version 20 at the level 0.05. <br /><br /><strong>Results:</strong> By age less than 16 years, more females, 90.2% than males, 71.8% had experienced sex (p &lt; 0.001); more females, 40.4% than males, 23.2% used condoms during first sex (p &lt; 0.01); more males, 70.8% than females, 46.0% had multiple sequential sexual partners during the last one year prior to this study (p &lt; 0.001); more males, 42.6% than females, 18.0% had multiple concurrent sexual partners during the study period (p &lt; 0.01); more youths who did not belong to a well-defined social network, 80.8% had experienced sex than those who belonged, 55.8% (p &lt; 0.001); more youths who did not belong to a well-defined social network had multiple sequential sexual partners, 46.7% than those who belonged, 32.3% (p &lt; 0.01); more youths who belonged to a well-defined social network, 24.3% used condoms consistently than those who did not belong,15.4% (p &lt; 0.01). <br /><br /><strong>Conclusion:</strong> Sexual risk behaviours exist among out-of-school youths in urban Cameroon. There is need for campaigns and interventions to bring about sexual behaviour change especially among those with low socioeconomic status. Youths should be encouraged to join well-defined social networks.<br /><br /><strong>Keywords:</strong> HIV/AIDS, out-of-school youths, socio-demographic characteristics, sexual risk behavior, urban Cameroon 2019-02-18T09:41:05+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183555 Accouchement sur utérus cicatriciel dans les pays à faibles ressources: circuit de prise en charge et devenir materno-foetal 2022-04-19T13:43:09+00:00 Valère Mve Koh raoul.kamadjeu@gmail.com Henri Essome raoul.kamadjeu@gmail.com Julius Dohbit Sama raoul.kamadjeu@gmail.com Pascal Foumane raoul.kamadjeu@gmail.com The rate of uterine scars, an established risk factor for obstetric morbidity, is increasing worldwide. In developing countries, spontaneous uterine ruptures may constitute 87.4% of cases. Tratment is a problem in modern obstetrics, in particular in these countries. This study aims to describe healthcare chain and materno-fetal follow-up of post-partum women with uterine scar in three university hospitals in the city of Yaoundé in order to highlight morbidity management problems in low-resource countries at the dawn of sustainable development goals. We conducted a cross-sectional descriptive study based on the collection of prospective data over a period of six months in 2014. The study included all consenting post-partum women with uterine scar, having given birth to a gestational at a gestational age greater than or equal to a total of 28 weeks of amenorrhea. The sampling was consecutive and exhaustive. Chi square test statistic was applied in all research areas, with a reliability threshold of p≤ 0.05. Data on 252 women with uterine scars, reflecting a rate of 8% (252/3145), were collected during the study period. Prenatal consultations were performed by inadequate staff in an inadequate sanitary structure in 30% of cases. Women were referred due to delivery complications after first admission to an inadequate sanitary structure in 25% of cases (6 uterine ruptures and 7 dead fetus before admission). There was indication for cesarean section/laparotomy on admission in 39% of cases; the rate of vaginal delivery was of 23%; there was indication for trial of scar in 30% of cases, with a success rate of 76.3%. Vaginal delivery was related to parity, a history of vaginal delivery, fetal macrosomia and was inversely related to the number of scars. Maternal mortality was zero and cesarean section was related to materno-fetal morbidity. The poor quality of prenatal consultations and the management of delivery are the main determinants of problems during vaginal birth after cesarean section in our environment. The establishment of a system facilitating access to skilled health care practitioners/adequate health care facilities for pregnant women with uterine scar would improve the prognosis of post-partum women with uterine scar.<br /><br /><strong>Keywords:</strong> Uterine scae, healthcare chain, Yaoundé 2019-02-18T09:28:32+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210344 Un énorme adénome de la prostate 2021-07-11T16:04:39+00:00 Abdelilah El Alaoui abdo_elalaoui@hotmail.com Hicham El Boté abdo_elalaoui@hotmail.com <p>Il s'agit d'un patient âgé de 75 ans, qui présente un syndrome obstructif du bas appareil urinaire fait de dysurie, pollakiurie nocturne et miction goutte à goutte. L'examen clinique trouve un patient en bon état général; au toucher rectal, la prostate est souple, indolore et augmenté de volume avec effacement du sillon médian. Le PSA est à 2,1ng/ml, le poids de la prostate a l'échographie est estimé à 240g. Le patient est opéré: adénomectomie par taille vésicale avec extraction d'un énorme adénome qui pèse 246g. L'histologie est en faveur d'un adénomyofibrome.</p> 2018-08-06T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210345 Volumineuse hydrocèle unilatérale avec ulcération scrotale: à propos d’un cas à l'hôpital Régional de Gao 2021-07-11T16:08:18+00:00 Mahamadou Mallé mahamadoumalle910@gmail.com Aliou Moussa Coulibaly mahamadoumalle910@gmail.com <p>L'hydrocèle est une accumulation de liquide entre les deux feuillets de la vaginale testiculaire. Elle peut être de très grande abondance. Elle demeure une pathologie fréquemment retrouvée en région tropicale. Nous rapportons un cas d'hydrocèle de très grande abondance avec épaississement de la vaginale chez un sujet âgé de 56 ans en zone sahélienne avec ulcération de la bourse. Il s'agit de Monsieur YM âgé de 56 ans ayant consulté pour grosse bourse avec une sensation de pesanteur, gênante à la marche, évoluant depuis un an environ avec une augmentation progressive du volume. À l'inspection, on retrouve une volumineuse bourse gauche (A,B) avec une plaie de 3 cm (A) . Nous avions évoqué deux hypothèses diagnostiques, une hydrocèle volumineuse et une tumeur scrotale ulcérée. Une échographie des bourses réalisée a montré un épanchement de grande abondance dans la vaginale estimée à 3000 ml avec un épaississement de la tunique vaginale dont le diamètre mesure 7 mm. Le diagnostic d'hydrocèle unilatérale de très grande abondance fut retenu avec pachy-vaginalite. L'intervention chirurgicale a extrait 2,8 L de liquide teinte (C) avec une suite opératoire favorable (D) sous triple antibiothérapie.</p> 2018-08-07T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183554 Prolapsus d’une colostomie périnéale pseudo continente: une complication exceptionnelle 2022-04-19T13:43:11+00:00 Abdelouhab El Marouni raoul.kamadjeu@gmail.com Ahmed Zerhouni raoul.kamadjeu@gmail.com Karim Hassani Ibn Majdoub raoul.kamadjeu@gmail.com Stoma prolapse is an exceptional and late complication of pseudocontinent perineal colostomy. Very rare cases have been described in the literature. We here report the case of a 75 year old patient with no particular past medical history as well as our therapeutic approach. The patient initially underwent surgery for non-metastatic rectal adenocarcinoma measuring 1 cm from the anal margin after radiochemotherapy. Laparoscopic abdominoperineal resection was performed with confection of a continent perineal colostomy. During follow up, clinical examination showed colon prolapse through the stoma orifice for which he was admitted to hospital for surgery. The complications of pseudocontinent perineal colostomy are mainly related to operative morbidity due to rectal resection (infections and perineal eventrations), to stoma complications (necrosis, prolapse, herniation). Stoma prolapse is an exceptional complication of continent perineal colostomy. Monitoring and patient education on irrigation technique are usually sufficient. Surgery is necessary in patients with bulky hardly reducible voluminous prolapse, embarrassing the patient and with weeping. Surgery is based on simple peristromal resection of the prolapsed segment. It has been reported that prolapsed segment grafting under simple sedation can be performed. Abdominoperineal resection is a mutilating procedure which is poorly perceived by patients. Pseudocontinent perineal colostomy is a simple safe and reproducible technique associated with a relatively low morbidity. Stoma prolapse is a rare and easily treated complication.<br /><br /><strong>Keywords:</strong> Pseudocontinent perineal colostomy, stomial prolapse, easy surgical treatment 2019-02-18T09:12:55+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183553 Accident vasculaire cérébral ischémique révélant un syndrome de Fahr 2022-04-19T13:43:13+00:00 Nawfal Doghmi raoul.kamadjeu@gmail.com Abdelghafour Elkoundi raoul.kamadjeu@gmail.com Amine Belghiti raoul.kamadjeu@gmail.com Abdelouahed Baite raoul.kamadjeu@gmail.com Charki Haimeur raoul.kamadjeu@gmail.com Fahr’s syndrome is defined as the presence of bilateral intracerebral, symmetrical, nonarteriosclerotic calcifications involving the basal ganglia. Their detection during stroke is exceptional. Phosphocalcium metabolism should be investigated with human parathyroid hormone (HPH) dosage. Diagnosis is based on the evaluation of clinical and laboratory data as well as on radiological imaging. Long-term antiepileptic treatment can cause basal ganglia calcification resulting in Fahr’s syndrome. Prognosis is favorable. The correction of phosphocalcium metabolism usually leads to significant improvement.<br /><br /><strong>Keywords:</strong> Fahr’s syndrome, epilepsy, ischemic stroke, phosphocalcium metabolism 2019-02-18T09:08:10+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183552 Un sacré sacrum! 2022-04-19T13:43:15+00:00 Dhia Kaffel raoul.kamadjeu@gmail.com Amal Ben Ouhiba raoul.kamadjeu@gmail.com Wafa Hamdi raoul.kamadjeu@gmail.com Kaouther Maatallah raoul.kamadjeu@gmail.com Hend Riahi raoul.kamadjeu@gmail.com Mouna Chelly Bouaziz raoul.kamadjeu@gmail.com Mohamed Fethi Ladab raoul.kamadjeu@gmail.com Mohamed Montacer Kchir raoul.kamadjeu@gmail.com Post-fracture osteolysis of the sacrum is a rare radiological entity mimicking a serious disease. We report the case of a female patient lost to follow-up after biopsy indication. She presented again after 4 months. During multi-stage bone registration prior to the biopsy, we noticed a change in the appearance of the lesion, associating a linear image (corresponding to the fracture line) with condensation at the edges. Patient’s evolution was good after a period of rest at 6-months follow-up. This study highlights the atypical imaging appearance and the diagnostic difficulties associated with post-fracture osteolysis of the sacrum. The particularity of our patient is that symptoms were masked by disc-related nerve root impingement with right L5 root and that the sacrum osteolysis was unexpectedly discovered on CT scan.<br /><br /><strong>Keywords</strong>: Post-fracture osteolysis, sacrum, pseudotumor 2019-02-18T08:49:43+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183329 Colobome chorioretinien bilateral: à propos d’un cas 2022-04-19T13:43:16+00:00 Seydou Diallo raoul.kamadjeu@gmail.com Seydou Bakayoko raoul.kamadjeu@gmail.com Brainima Coulibaly raoul.kamadjeu@gmail.com Mohamed Kole Sidibe raoul.kamadjeu@gmail.com Nouhoum Guirou raoul.kamadjeu@gmail.com Chorioretinian coloboma often raises clinical issues leading sometimes to some confusion. Nevertheless, diagnosis must be as accurate as possible for several reasons: the association of some congenital anomalies of the papilla with other neurologic, endocrine and systemic disorders as well as issues in differential diagnosis between it and other ophthalmic disorders. We report a clinical case of a 6 year old child, the first boy in a family with 2 children, with bilateral papillar coloboma and without other associated malformations. Patient?s history: normal birth and updated immunisation status. His father and his 4-year-old sister underwent ophthalmic examination which was unremakable. However his mother had diverge strabismus in the right eye.<br /><br /><strong>Keywords:</strong> Chorioretinian coloboma, bilateral, child 2019-02-11T18:46:31+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183328 Consumer perceptions and purchasing of packaged water products in Sierra Leone 2022-04-19T13:43:17+00:00 Mohamed Falilu Jalloh raoul.kamadjeu@gmail.com Ashley Rhoderick Williams raoul.kamadjeu@gmail.com Mohammad Bailor Jalloh raoul.kamadjeu@gmail.com Paul Sengeh raoul.kamadjeu@gmail.com George Saquee raoul.kamadjeu@gmail.com Jamie Bartram raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Access to improved sources of drinking water remains a complex challenge in Sierra Leone and other low and middle income<br />countries. We aimed to qualitatively examine consumer perceptions and purchasing behaviors of packaged water products in Sierra Leone.<br /><br /><strong>Methods:</strong> We conducted 25 focus groups with 178 consumers and petty traders of packaged water across the four geographic regions of Sierra Leone. Discussions were recorded, transcribed, and coded into themes. The Health Belief Model guided the thematic data analysis.<br /><br /><strong>Results:</strong> Packaged water was broadly perceived as safe, accessible, and convenient. Participants who lived outside of the capital city, Freetown, were more likely to report cost as a barrier. Personal experiences with a brand moderated trust levels. Self-reported handling behaviors of PW products were generally unhygienic. There was widespread belief that packaged water keeps newborn babies healthy. Consumers desired a simple mechanism to better identify government approved PW products. <br /><br /><strong>Conclusion:</strong> Perceived risks, benefits, barriers, self-efficacy, and reinforcing cues to action qualitatively influenced consumers’ purchasing behavior of packaged water. Government regulators should provide consumers with reliable means to identify approved packaged water products. Consumer education efforts should include hygienic handling of packaged water products in order to minimize post-production contamination.<br /><br /><strong>Keywords:</strong> Packaged water, Sierra Leone, consumer perceptions and behavior 2019-02-11T18:42:08+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210346 Erythème flagellé secondaire à la Bléomycine: à propos de deux observations 2021-07-11T16:16:33+00:00 Asmae Lahlou lahlouasmae@gmail.com Salim Gallouj lahlouasmae@gmail.com Fatima-Zohra Mernissi lahlouasmae@gmail.com <p>La bléomycine est un antibiotique antitumoral. Elle peut être responsable d'effets secondaires variables en particulier cutanés et pulmonaires. Certains sont rares, mais spécifiques de la bléomycine. Nous rapportons l'observation de deux malades âgés respectivement de 35 et 38 ans ayant présentés une toxidermie à la bléomycine a type d'érythème flagellé après administration de bléomycine pour un choriocarcinome et un lymphome malin non hodgkinien L'érythème flagellé est spécifique de la bléomycine, il complique 10 à 30% des traitements dans un délai de quelques heures à 9 semaines. Il est indépendant de la dose, de la voie d'administration et de la nature de la lésion traitée. Ces lésions apparaissent après une dose cumulative de 90 à 285 mg. Cliniquement, il s'agit de bandes linéaires avec un aspect flagellé prédominantes sur tout le tronc et les parties proximales des membres. L'éthiopathogénie est incertaine. L'évolution est marquée par une résolution spontanée des lésions à l'arrêt du traitement parfois au prix d'une pigmentation linéaire cicatricielle, ou une sclérose résiduelle.</p> 2018-08-07T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210347 The antifibrotic effect of isolate tagitinin C from tithonia diversifolia (Hemsley) A. Gray on keloid fibroblast cell 2021-07-11T16:21:30+00:00 Imaniar Ranti niarranti@gmail.com Mae Sri Hartati Wahyuningsih niarranti@gmail.com Yohannes Widodo Wirohadidjojo niarranti@gmail.com <p><strong>Introduction</strong>: keloids characterized by fibroblast hyperproliferation and depositions of collagen which similar to cancer cells. Tagitinin C is a class of sesquiterpene lactones (SLS) was isolated from the leaves of the moon flower&nbsp;<em>Tithonia diversifolia</em> (Hemsley) A. Gray. The previous studies show that tagitinin C has a cytotoxic effect on selective skin cancer cell. The study aim is to evaluate the effects of tagitinin C from&nbsp;<em>Tithonia diversifolia</em>&nbsp;to keloid fibroblasts (KF).</p> <p><strong>Methods</strong>: monolayer cultures of keloid fibroblast (three passages) were treated with 8 serial concentration of tagitinin C (0.015 to 2) μg/mL during 72 and 120 hours. A positive control using mitomycin C. Cellular viabilities were measured by MTT assay. Collagen depositions were measured by Sirius Red assay for nonsoluble collagen.</p> <p><strong>Results</strong>: the reading of the result was conducted by ELISA reader. Data were analyzed by probit regression with SPSS 19 for Windows. The result showed that tagitinin C can inhibit keloid fibroblasts (KF) viability with IC<sub>50</sub>&nbsp;0.122 μg/mL (incubation 72h) and 0.039 μg/mL (120h), whereas mitomycin C IC<sub>50</sub>&nbsp;0.120 μg/mL (72h) and IC<sub>50</sub>&nbsp;of 0.100 μg/mL (120h). At IC<sub>50</sub>&nbsp;concentration of tagitinin C on keloid collagen deposition 53.1% (72h) and 44.3% (120h), whereas the IC<sub>50</sub>&nbsp;concentration of mitomycin C on keloid collagen deposition 60.4% (72h) and 52.1% (120h). Selectivity index tagitinin C on normal fibroblasts (NF) is 287 for 72h incubation and 791 for 120h incubation.</p> <p><strong>Conclusion</strong>: it can be concluded that the ability of tagitinin C inhibits KF viability and decreasing keloid collagen deposition is consistent with the concentration (concentration-dependent) and incubation time (time-dependent). Tagitinin C has a low toxicity level on NF with high selectivity index.</p> 2018-08-08T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210349 Plaies abdominales par arme à feu: expériences des urgences CHU Hassan II, Fès, Maroc 2021-07-11T16:27:09+00:00 Ahmed Zerhouni zerhouni1906@gmail.com Imane Toughrai zerhouni1906@gmail.com <p>Jeune couple, un homme de 30 ans et sa femme de 21 ans victimes d’une fusillade suite à un conflit familiale, par un fusil de chasse autorisé au Maroc lors de la saison de chasse aux gibiers. A leur arrivée au centre hospitalier, l’homme est inconscient, tachycarde à 120 b/min avec une tension artérielle a 70/30 mmHg. A l’inspection de son abdomen on a observé la présence de plusieurs plaies pénétrantes au niveau du pubis du Scarpa et la face antérieure de la cuisse droite, un hématome en regard et abolition du pouls fémorale homolatérale, après la mise en condition, l’exploration chirurgicale a montré une plaie de l’artère fémorale droite. L’hémostase est obtenue après la résection de la partie lésée. Une exploration de la cavité abdominale a révélé la présence de plusieurs plaies grêliques. Le geste a consisté à une résection de la partie perforée avec confection d’une anastomose iléo-iléale. Pour la jeune dame, à son admission elle était stable sur le plan hémodynamique, la présence de plusieurs plaies au niveau de l’abdomen. Vu l’état stable de la patiente on a complété par une tomodensitométrie qui a objectivé la présence de plusieurs projectiles pénétrant le tube digestif avec présence d’un pneumopéritoine. L’exploration chirurgicale a objectivé la présence d’une partie jéjunale crible de projectile ainsi le colon transverse le geste a consisté à une résection du grêle perforé ainsi la résection du colon transverse avec confection d’une anastomose grelo-grelique et une autre anastomose colo-colique.</p> 2018-08-08T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183326 Les caractéristiques de la population couverte par le régime de l’assurance maladie obligatoire au Maroc 2022-04-19T13:43:19+00:00 Amal Yassine raoul.kamadjeu@gmail.com Abdelkader Jalil El Hangouche raoul.kamadjeu@gmail.com Naoufel El Malhouf raoul.kamadjeu@gmail.com Siham Maarouf raoul.kamadjeu@gmail.com Jamal Taoufik raoul.kamadjeu@gmail.com <strong>Introduction:</strong> in Morocco, Compulsory Medical Insurance (CMI) entered into force in 2005. Insurance first covered health expenses of employees in public and private sectors, then of students. It was gradually expanded to independent workers. This study aims to determine the profile of the population covered by CMI in Morocco. <br /><br /><strong>Methods:</strong> We conducted a descriptive study of the population covered by CMI based on data collected from the National Health Insurance Agency in Morocco and from the Health Insurance funds. <br /><br /><strong>Results:</strong> A total of 8.428.218 persons were covered by CMI at the end of 2014, reflecting a rate of 34% of the general population. People having long duration disease (LDD) did not exceed 2.78% of the population covered by CMI. Active insured accounted for 81% of the population covered. In the private sector, gross salary of active affiliates ranged, on average, between $ 140 and $ 500 per month while gross salary pensions was less $280 per month. In the public sector, gross salary of active affiliates ranged, on average, between $ 280 and $ 825 per month while gross salary pensions ranged between $ 140 and $ 500 per month.<br /><br /><strong> Conclusion:</strong> Knowledge of the characteristics of the population covered by Compulsory Health Insurance in Morocco is necessary to ensure regulation and sustainability in the insurance sector.<br /><br /><strong>Keywords:</strong> Compulsory health insurance, long duration disease, financial resources, Morocco 2019-02-11T18:28:33+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210350 Une cause rare d’abdomen aigu: l’appendagite épiploique 2021-07-11T16:40:47+00:00 Yassine Nhamoucha yassine_bogo@hotmail.fr Youssef Bouabdellah yassine_bogo@hotmail.fr <p>L’appendagite épiploïque primitive regroupe les torsions et les inflammations primitives des appendices épiploïques. Ces événements pathologiques considérés comme rares, ont longtemps été exceptionnellement diagnostiquées en période préopératoire. Les progrès de l’imagerie médicale permettent, désormais, d’éviter des interventions chirurgicales inutiles. C’est ce qu’illustre l’observation présentée ici. Il s’agit d’un enfant de 14 ans, sans antécédents pathologiques notables, qui s'était présenté aux urgences pédiatriques de l’hôpital, pour des douleurs de la fosse iliaque gauche évoluant depuis six jours et d’aggravation progressive. Il ne souffrait ni de troubles du transit, ni de signes fonctionnels urinaires associés et était apyrétique. La palpation abdominale mettait en évidence une défense de fosse iliaque droite. On notait, par ailleurs, un surpoids avec un IMC à 29. Biologiquement, la CRP était à 11 mg/l (N &lt; 1), les leucocytes à 10.000 par millimètre cube à prédominance polynucléaires neutrophiles. L’examen cytobactériologique des urines était négatif. La radiographie de l’abdomen sans préparation ne mettait en évidence ni niveau hydroaérique, ni calcification en projection des voies urinaires. L’échographie abdominale a montré au niveau du flanc droit une petite masse hyperéchogène, ovoïde, non dépressible, entourée d’un halo hypoéchogène contenant en son sein quelques vaisseaux fins sans dilatation des voies urinaires ni d’épanchement intra-abdominal. Le complément scannographique révélait une infiltration de la graisse à la jonction coeco-appendiculaire, avec image graisseuse en navette entourée d’un anneau hyperdense, évocatrice d’une torsion d’appendice épiploïque. Il était décidé de traiter le malade par des antalgiques, des antispasmodiques, un mois plus tard le patient n’avait plus de douleur abdominale spontanée ou provoquée.</p> 2018-08-08T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183325 Uncommon metastases of invasive lobular breast cancer to the endometrium: a report of two cases and review of the literature 2022-04-19T13:43:21+00:00 Raja Briki raoul.kamadjeu@gmail.com Ons Cherif raoul.kamadjeu@gmail.com Badra Bannour raoul.kamadjeu@gmail.com Samir Hidar raoul.kamadjeu@gmail.com Sassi Boughizane raoul.kamadjeu@gmail.com Hedi Khairi raoul.kamadjeu@gmail.com Although it is known that breast cancer can metastasize to many organ sites, metastasis to the uterus is uncommon and usually occurs during widespread metastatic disease. Lobular carcinoma is not the most common histological subtypes of breast carcinoma, but it is the most frequent histologic type that causes gastrointestinal, gynecological and peritoneal metastases. The main symptoms of the uterine metastasis depend on the anatomic involvement site. Abnormal uterine bleeding is by far the most important symptom.We highlight the importance of the follow up of patient with breast cancer. A rapid endometrial sampling for confirmation of the diagnosis, should be performed when the routine gynecological follow-up revealed any abnormality. We report two original observations of endometrium metastases of invasive lobular carcinoma of the breast which we detected during follow-up.<br /><br /><strong>Keywords:</strong> Invasive lobular breast carcinoma, endometrium, metastases 2019-02-11T18:20:08+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/224133 Les tubérculomes intracrâniens à Nouakchott, Mauritanie 2022-04-19T13:16:42+00:00 Sidi Salem-Memou fkct@hotmail.com Samy Dadah fkct@hotmail.com Ahmedou Moctar fkct@hotmail.com Sidelhadj Dah fkct@hotmail.com Ahmed Jeddou fkct@hotmail.com Ahmedsalem Kleib fkct@hotmail.com Sidimohamed Salihy fkct@hotmail.com Outouma Soumare fkct@hotmail.com Mouhamadou Diagana fkct@hotmail.com Najat Boukhrissi fkct@hotmail.com <p>La tuberculose constitue un problème majeur de santé publique dans les pays en voie de développement. Le tuberculome cérébral est une masse de tissu granulomateux tuberculeux ayant été contenu et limité par les défenses immunitaires de l'hôte. Les objectifs poursuivis par ce travail sont de décrire les caractéristiques et d'apprécier le profil évolutif des tuberculomes intracrâniens en Mauritanie. Trente-quatre observations de tuberculome intracrânien ont été colligées de façon rétrospective dans plusieurs hôpitaux de la ville de Nouakchott entre Janvier 2005 et Juin 2017. L'aspect évolutif sous traitement de tous les patients a été analyse. Il s'agissait d'une étude rétrospective ayant porté sur 34 cas de tubérculome intracrânien dont 20 hommes et 14 femmes (sexe ratio de 1,4). L'âge moyen de nos patients est 28.7 ans avec le tiers de la série (12 cas) d'un âge inferieur ou égal a 16 ans. Les signes d'hypertension intracrânienne et les crises convulsives ont dominés la symptomatologie avec respectivement 27 cas (79.41%) et 20 cas (58.82 %). L'intradermoréaction à la tuberculine était positive chez 14 (41.17%). La localisation de la lésion est sus-tensorielle chez 24 patients (70.58%). Sur le plan thérapeutique, tous nos patients avaient bénéficiés d'une une poly chimiothérapie anti tuberculeuse pendant une durée variable supérieure ou égal à 12 mois. 12 de nos patient (35.29%) ont bénéficiés d'un traitement chirurgical. L'évolution a été favorable avec guérison complète sans séquelles dans 23 cas soit 67.64%. Compte tenu de la nature non spécifique de l'imagerie dans le diagnostic du tuberculome intracrânien et de l'absence de la biopsie stéréotaxique dans notre pays où la maladie est endémique, nous recommandons un test thérapeutique de deux mois pour les lésions suspectes.</p> 2018-08-09T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210370 The sign of leser-trélat: think in the adenocarcinoma of the lung 2021-07-12T06:15:29+00:00 Hanane Asri asri_hanane@hotmail.fr Mouna Soualhi asri_hanane@hotmail.fr <p>The Leser-Trelat sign is the sudden appearance and rapid increase in the size and number of seborrheic keratoses in association with an underlying malignant disease. It is usually associated with adenocarcinoma, most frequently of the colon, breast, or stomach, exceptionally of the lung. We reported a case of patient 70-year-old man; one year ago, an increasing number of pruriginous skin lesions suddenly appeared. The progression was marked 4 months later by deterioration of the general state and dyspnea of exercise. Dermatologic examination revealed multiple seborrheic keratoses, a chest radiograph depicting complete right lung ate revealed a white lung, chest CT scan showing right lung atelectasis with obstruction of right main bronchus and right pleural effusion. The histopathologic study of the biopsy bronchial fibroscopy reported a lung adenocarcinoma. Patient was dead one week later. Our observation report association of the sign of leser-trélat with occult adenocarcinoma of the lung. Eruption of seborrheic keratoses has also been observed with benign neoplasms, pregnancy, human immunodeficiency virus infections, which indicate that the leser-trélat sign is not very specific. Despite these concerns, the eruption of multiple seborrheic keratoses should continue to trigger the thought of an internal malignancy in the differential diagnosis.</p> 2018-08-10T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183322 Healthcare utilization for common infectious disease syndromes in Soweto and Klerksdorp, South Africa 2022-04-19T13:43:22+00:00 Karen Kai-Lun Wong raoul.kamadjeu@gmail.com Claire von Mollendorf raoul.kamadjeu@gmail.com Neil Martinson raoul.kamadjeu@gmail.com Shane Norris raoul.kamadjeu@gmail.com Stefano Tempia raoul.kamadjeu@gmail.com Sibongile Walaza raoul.kamadjeu@gmail.com Ebrahim Variava raoul.kamadjeu@gmail.com Meredith Lynn McMorrow raoul.kamadjeu@gmail.com Shabir Madhi raoul.kamadjeu@gmail.com Cheryl Cohen raoul.kamadjeu@gmail.com Adam Lauren Cohen raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Understanding healthcare utilization helps characterize access to healthcare, identify barriers and improve surveillance data interpretation. We describe healthcare-seeking behaviors for common infectious syndromes and identify reasons for seeking care. <br /><br /><strong>Methods:</strong> We conducted a cross-sectional survey among residents in Soweto and Klerksdorp, South Africa. Households were interviewed about demographic characteristics; recent self-reported episodes of pneumonia, influenza-like illness (ILI), chronic febrile respiratory illness and meningitis in individuals of all ages; recent diarrhea in children aged &lt; 5 years; and consultation with healthcare facilities and providers. <br /><br /><strong>Results:</strong> From July-October 2012, we interviewed 1,442 households in Klerksdorp and 973 households in Soweto. Public clinics were consulted most frequently for pneumonia, ILI and diarrhea in a child &lt;5 years old at both sites; public hospitals were most frequently consulted for chronic respiratory and meningitis syndromes. Of all illness episodes reported, there were 110 (35%) in Klerksdorp and 127 (32%) in Soweto for which the person did not seek care with a licensed medical provider. Pharmacies were often consulted by individuals with pneumonia (Klerksdorp: 17, 16%; Soweto: 38, 22%) or ILI (Klerksdorp: 35, 24%; 44, 28%). Patients who did not seek care with a licensed provider reported insufficient time (Klerksdorp: 7%; Soweto, 20%) and lack of medications at the facility (Klerksdorp: 4%; Soweto: 8%) as barriers.<br /><br /><strong> Conclusion:</strong> Public government healthcare facilities are commonly consulted for infectious syndromes and pharmacies are frequently consulted particularly for respiratory diseases. Improving<br />medication availability at healthcare facilities and streamlining healthcare delivery may improve access of licensed providers for serious illnesses.<br /><br /><strong>Keywords:</strong> Diarrhea, health services, meningitis, respiratory tract infections, South Africa 2019-02-11T17:49:33+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183321 Maternal, reproductive and obstetric factors associated with preterm births in Mulago Hospital, Kampala, Uganda: a case control study 2022-04-19T13:43:27+00:00 Elizabeth Ayebare raoul.kamadjeu@gmail.com Peter Ntuyo raoul.kamadjeu@gmail.com Oliver Ombeva Malande raoul.kamadjeu@gmail.com Gorrette Nalwadda raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Preterm birth, a leading cause of neonatal mortality accounts for 35 percent of all neonatal deaths worldwide. Uganda's high preterm birth rate of 13.6 per 1000 live births ranks 28th in the world. Efforts at reducing these pre-term births must entail interventions that target any associated risk factors. This study therefore aimed at identifying and describing the risk factors for preterm births among mothers delivering in Mulago Hospital. <br /><br /><strong>Methods:</strong> This was a case control study among postpartum women in Mulago Hospital. Ninety nine women with preterm newborns were recruited as cases and 193 with full term babies were the controls. A semi-structured questionnaire was used to collect data. Data was entered into Epidata version 3.1 and exported to STATA 11 for univariate analysis and multivariate analysis by logistic regression.<br /><br /><strong>Results:</strong> Risk factors for preterm birth included maternal height less than 1.5 meters (OR 131.08 (20.35-844.02)), rural residence (OR 6.56(2.68-16.10)) and failure to attend antenatal care clinic (OR 8.88(1.44-54.67)). Pregnancy related risk factors included PPROM (OR 287.11(49.26-1673.28)), antepartum haemorrhage (OR 7.33(1.23-43.72)) and preeclampsia/eclampsia (OR 16.24(3.11-84.70)). <br /><br /><strong>Conclusion:</strong> Preterm birth is more likely to occur in women of short stature, living in rural areas and those who do not attend antenatal care clinic. The preterm birth risk is higher for women who get PPROM, APH and preeclampsia/eclampsia in pregnancy. Early recognition and management of these high risk conditions among pregnant women may lead to a reduction in preterm birth rates.<br /><br /><strong>Keywords:</strong> Preterm birth, postpartum, risk factors, newborn, Uganda 2019-02-11T17:34:38+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210371 Impetigo herpetiformis: a rare dermotosis of pregnancy 2021-07-12T06:23:11+00:00 Amal El Fiboumi elfiboumi.amal@gmail.com Soumya Chiheb elfiboumi.amal@gmail.com <p>Impetigo herpetiformis (IH) is a rare pustular dermatosis. It is actually considered as a rare subtype of generalized pustular psoriasis occurring in pregnancy. It can be life threatening for both mother and fetus and often causes therapeutic problems. It is manifested by generalized erythematous plaques lined with sterile pustules with alteration of general state. It must be distinguished from specific dermatosis of pregnancy (polymorphic eruption of pregnancy, pemphigoid gestationis) and the other pustular lesions occurring during acute generalized exanthematous pustulosis and hypocalcemiae or infection. Early diagnosis and treatment is recomanded. We report a case of a 30 year-old patient who presented at 27 weeks of her first pregnancy, erythematous macular lesion in the inguinal fold, extending in a week to the rest of the body with fever and asthenia. Physical examination found well-defined erythematous plaques bordered by pustules in the face, limbs and large folds and confluent at the trunk without mucosal involvement. Laboratory test showed sedimentation rate at 30mm, CRP at 50mg/l, leucocytes at 9000e/l and slight hypocalcemia due to a hypoalbunimia. Bacteriological sampling of pus was negative. Histopathology revealed spongiform pustule in the epidermis consistent with IH. Prenatal ultrasaound did not show growth retardation. We prescribed oral prednisone at the dose of 0.5mg/kg/day with serious monitoring of the fetus. After 2 weeks she had improved and delivered later a healthy female baby with normal birth weight at 37 weeks of pregnancy.</p> 2018-08-10T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183320 Fracture de Galeazzi chez l’enfant: à propos de 5 cas et revue de la littérature 2022-04-19T13:43:29+00:00 Yassine Nhamoucha raoul.kamadjeu@gmail.com Mohammed Tazi raoul.kamadjeu@gmail.com Othmane Alaoui raoul.kamadjeu@gmail.com Othmane Alaoui raoul.kamadjeu@gmail.com Hicham Abdellaoui raoul.kamadjeu@gmail.com Karima Atarraf raoul.kamadjeu@gmail.com Lamyae Chater raoul.kamadjeu@gmail.com Mounir Arroud raoul.kamadjeu@gmail.com Abderrahmane Afifi raoul.kamadjeu@gmail.com Galeazzi fracture describes a fracture of the radial diaphysis in association with distal radioulnar dislocation (most often dorsal). We conducted a retrospective study in the Department of Pediatric Orthopedic Trauma at the Mother-Child Hospital CHU Hassan II in Fez (Morocco). The study involved five male children. Four children underwent orthopedic treatment while one child underwent surgical reduction. Mean follow-up was 24 months (8-30).<br /><br /><strong>Keywords:</strong> Distal radioulnar articulation, Galeazzi fracture, Morocco 2019-02-11T17:24:38+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183318 Intraneural perineurioma: a retrospective study of 19 patients 2022-04-19T13:43:30+00:00 Jaber Alkhaili raoul.kamadjeu@gmail.com Adeline Cambon-Binder raoul.kamadjeu@gmail.com Zoubir Belkheyar raoul.kamadjeu@gmail.com Intraneural perineurioma is a benign neoplasm of peripheral nerve sheath with perineurial cell origin that typically affects teenagers and young adults and tends to result in a motor-predominant neuropathy. The aim of our study is to present the epidemiology, clinical presentation, way of diagnosis and management plan in a consecutive patient series. Ninteen patients diagnosed as having intraneural perineurioma were retrospectively chart reviewed. Diagnosis was done by MRI and/or biopsy with morphological, immunohistochemical staining study confirmation. Patients assessments included gender, age, symptoms, tumor localization, radiological aspect, management and pathological confirmation.Sex ratio was 10 males to 9 females with mean age of 31.2 (15-64). All the patients presented with motor deficit, ten with sensory deficit. Upper limb was involved in 11 cases (among them 4 lesions of brachial plexus), the lower limb in 8 cases. On magnetic resonance imaging, 16 patients showed a nerve enlargement whereas 5 presented with atypical fusiform tumor. Eighteen patients were operated for excision biopsy and/or palliative treatment for their motor deficit. Anatomopathological analysis confirmed the diagnosis in seventeen cases with a morphological pseudo-onion bulb shape and/or specific immunohistochemical assay. One patient had only palliative treatment without excision biopsy. Our data confirmed the equal penetration of intraneural perineurioma to both sex and affected limb. Because of the benignity of the tumor, the surgical treatment focused on optimizing the functional outcome. A prospective study with long term follow-up is required for this under-diagnosed tumor.<br /><br /><strong>Keywords:</strong> Intraneural perineurioma, hypertrophic neuropathy, pseudo-onion bulbs 2019-02-11T17:06:40+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210373 Co-infection VIH chez les tuberculeux suivis au service des maladies infectieuses du CHU Ibn Rochd-Casablanca 2021-07-12T06:42:50+00:00 Assiya El Kettani assiyaelkettani@gmail.com Sanae Jebbar assiyaelkettani@gmail.com Brahim Takourt assiyaelkettani@gmail.com Fakhreddine Maaloum assiyaelkettani@gmail.com Othman Diraa assiyaelkettani@gmail.com Brahim Farouqi assiyaelkettani@gmail.com Khalid Zerouali assiyaelkettani@gmail.com Kamal Marhoum El Filali assiyaelkettani@gmail.com <p>L'objectif du travail est de déterminer la prévalence de l'infection par le VIH chez les tuberculeux hospitalisés au service des maladies infectieuses du CHU Ibn Rochd-Casablanca et de chercher les facteurs associés à la co-infection Tuberculose-VIH. Nous avons mené une étude transversale rétrospective menée en Novembre 2016, en se basant sur l'exploitation de la base de données du service des maladies infectieuses, des laboratoires de microbiologie et d'immunologie du CHU Ibn Rochd. Etaient inclus les patients ayant une tuberculose confirmée par culture positive sur milieu de Lowenstein Jensen et une infection à VIH confirmée par Western Blot entre Janvier 2013 et Décembre 2015. Au cours de la période de l'étude, 117 cas de tuberculose ont été confirmés par culture. Parmi ces patients, 46 (39,3%) avaient une infection à VIH confirmée. Trente-quatre patients co-infectés (73,9%) avaient une tuberculose extra pulmonaire (cette forme était associée à la co-infection (p=0,04)). Tous les patients ont été mis sous traitement antituberculeux et antirétroviral selon l'indication. L'évolution était favorable chez 32 patients (69,6%) et 10 décès ont été enregistrés (21,7%). La mortalité était plus élevée chez les co-infectés que chez les tuberculeux non atteints par le VIH (8,4%), (p=0,04). Cette étude a objectivé une prévalence relativement élevée de l'infection par le VIH parmi les tuberculeux. La co-infection Tuberculose-VIH est associée aux formes graves de la tuberculose et à une augmentation de la mortalité chez les tuberculeux, d'où l'intérêt du renforcement des activités conjointes de lutte contre cette co-infection.</p> 2018-08-16T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183317 Perceptions of and support for national health insurance in South Africa’s public and private healthcare sectors 2022-04-19T13:43:32+00:00 Frederik Booysen raoul.kamadjeu@gmail.com Charles Hongoro raoul.kamadjeu@gmail.com <strong>Introduction:</strong> For the purpose of effective implementation of a National Health Insurance (NHI) policy it is necessary to have an understanding of the awareness and perceptions of and support for such policy among clients using the healthcare system. <br /><br /><strong>Methods:</strong> The South African National Health and Nutrition Examination Survey asked household heads a series of questions on healthcare utilisation and access and collected information on knowledge and perceptions of and support for national health insurance. Comparisons are drawn between private sector healthcare users with medical aid and public sector healthcare users without medical aid, using descriptive and regression analysis. <br /><br /><strong>Results:</strong> Inequalities in access to quality healthcare remain stark. Only 8.5% of private users had postponed seeking healthcare compared to 23.9% of public users (p &lt; 0.001). Only 11.9% of public users were very satisfied with the quality of healthcare services compared to 50.2% of private users (p &lt; 0.001). More than eighty percent of healthcare users however were of the opinion that NHI is a top priority. However, for healthcare users to sacrifice choice required a national health insurance that provides better quality healthcare, increasing the probability of support for an NHI with lower cost and full coverage by 10.1%. <br /><br /><strong>Conclusion:</strong> It is imperative to provide better quality healthcare services in the public sector for private sector users to be supportive of national health insurance. Concerted efforts are also required to develop a proper communication strategy to disseminate information on and garner support for national health insurance, both in the public and private healthcare sectors.<br /><br /><strong>Keywords:</strong> Healthcare, medical aid, national health insurance, South Africa 2019-02-11T16:58:46+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/224134 Etude des anomalies du rythme cardiaque fœtal observées à l’examen cardiotocographique à Lubumbashi: cas suivis aux Cliniques Universitaires de Lubumbashi et à l’Hôpital Général du Cinquantenaire Karavia 2022-04-19T13:27:31+00:00 Joseph Chola Mwansa choladr@gmail.com Albert Mwembo Tambwe choladr@gmail.com Jules Ngwe Thaba choladr@gmail.com Arthur Munkana Ndoudule choladr@gmail.com Baudouin Yumba Museba choladr@gmail.com Thérèse Mowa Thabu choladr@gmail.com Prosper Kalenga Muenze choladr@gmail.com <p>L'usage du cardiotocographe (CTG) est très récent à Lubumbashi mais aucune étude approfondie n'est encore menée pour dégager son impact sur la morbi-mortalité périnatale. L'objectif de cette étude est de déterminer la fréquence des anomalies du rythme cardiaque fœtal (RCF), d'en rechercher les facteurs associés afin de proposer une prise en charge appropriée. Il s'agit d'une étude descriptive transversale réalisée durant 19 mois (de mars 2015 à décembre 2016) chez 411 parturientes. En présence des anomalies pathologiques du RCF, la sensibilité et la valeur prédictive positive de l'examen cardiotocographique, dans le dépistage de la souffrance fœtale aigue étaient respectivement de 82,95 et 45,35%. Les anomalies du RCF étaient retrouvées chez deux parturientes sur cinq. Les décélérations étaient les plus fréquentes de toutes les anomalies du RCF observées (50,8%) avec une prédominance remarquable des décélérations tardives (22,1% de toutes les anomalies). Les facteurs associés aux anomalies pathologiques du RCF étaient le travail prolongé (OR = 14,64, IC = 3,91-54,81), la chorioamniotite (OR = 14,56, IC = 3,83-55,34), l'anémie chronique maternelle (OR = 4,99, IC = 1,48-16,85), La primiparité (OR = 2,69, IC = 1,49-4,85), la prématurité (OR = 2,90, IC = 1,51-5,54) et la grossesse prolongée (OR = 3,22, IC = 1,38-7,52). Le Retard de Croissance Intrautérin et l'hypertension artérielle étaient associés particulièrement aux tracés plats et aux décélérations tardives (OR = 7,79, IC = 2,50-24,30 et OR = 2,74, IC = 1,31-5,72). Le CTG est un outil de dépistage de la souffrance fœtale aigue mais avec un taux élevé de faux positifs (55%); il convient de lui associer les autres moyens de dépistage de la souffrance fœtale aigue de seconde ligne en vue de réduire ce taux. Les facteurs associés aux anomalies pathologiques du RCF sont souvent à l'origine des causes de la souffrance fœtale aigue et exigent ainsi une analyse rigoureuse des tracés du CTG.</p> 2018-08-17T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183314 The diagnosis of pulmonary embolism without contrastis not always Challenging: be aware of hyperdense lumen sign 2022-04-19T13:43:33+00:00 Eylem Kuday Kaykisiz raoul.kamadjeu@gmail.com Erden Erol Unluer raoul.kamadjeu@gmail.com Utku Eser raoul.kamadjeu@gmail.com Acute pulmonary embolism (PE) diagnosis is a challenging task, despite the advanced diagnostic methods for both clinicians and radiologists. Awareness of the "hyperdense lumen sign" in patients obtained un-enhanced computarized tomography (CT) of chest mayhelp to establish an acute PE diagnosis, especially in clinically non suspected PE patients. A 78-year-old woman was brought to our emergency department (ED) with an aphasia complaint. The patient's dizziness improved in ED. Neurological examination returned to base line status but sinus tachycardia and low saturation value on room air were continuing. Un-enhanced CT of the chest demonstrates hyperdense material within the right main pulmonary artery. Contrast-enhanced CTPA demonstrated hypodense filling defect within the rigth main pulmonary artery consistent with PE. Independent of the patient's complaint, the measurement of all vital signs is important especially in elderly patients. Emergency physicians have to be aware of that the "hyperdense lumen sign" may point out PE and should be prevented from delayed recognition.<br /><br /><strong>Keywords:</strong> Pulmonary embolism, CTPA, unenhanced thorax CT 2019-02-11T16:34:45+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210375 Particular swelling on the palate 2021-07-12T06:52:24+00:00 Cinzia Casu ginzia.85@hotmail.it Riccardo Botta ginzia.85@hotmail.it <p>A 75-year-old patient came to our observation for a follow-up visit. We note the presence on the soft palate of a big swelling and the patient reported the presence of this lesion for about 10 years. At the dental level it was possible to see some residual dental elements and the result of recent dental extractions. The anamnesis reported a slight hypertension, osteoporosis and difficulty in swallowing probably linked to the presence of swelling, which however was asymptomatic. It was decided to perform an ultrasound exam to discover the nature of the injury. The ultrasound showed an echogenic area of 37 x 20mm in diameter, with a well-defined oval structure and borders, widely vascularize. The report was compatible with vascular injury. The patient underwent surgery at a hospital, where the lesion was aspirated. We do not have the needle aspiration report and we have not seen the patient after. The differential diagnosis is with an infection and inflammation, oral lymphoma, salivary glands tumors.</p> 2018-08-20T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183313 Successful spinal anaesthesia for caesarean section in an African patient with Takayasu’s arteritis 2022-04-19T13:43:35+00:00 Mamo Woldu Kassa raoul.kamadjeu@gmail.com Tadele Melese Benti raoul.kamadjeu@gmail.com Alemayehu Ginbo Bedada raoul.kamadjeu@gmail.com Takayasu's arteritis (TA) is a rare chronic inflammatory disease affecting mainly the aorta and its main branches. We report a case of a 24-year-old primigravida, an African patient, with TA planned for caesarean section at 37 weeks of gestation. Clinically, she has involvement of aortic arch and its branches and abdominal aorta. She underwent caesarean section and delivered an alive baby boy under successful spinal anaesthesia with insignificant complications. Although it is rare in the African continent, anesthesiologists should be up-to-date with the knowledge of perioperative anesthetic management of TA in pregnant cases requiring operative delivery.<br /><br /><strong>Keywords:</strong> African patient, caesarean section, spinal anaesthesia, Takayasu´s arteritis 2019-02-11T16:28:03+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183308 Iatrogénie médicamenteuse chez la personne âgée: à propos de deux cas d’insuffisance rénale favorisée par les tricycliques 2022-04-19T13:43:36+00:00 Sodjehoun Apeti raoul.kamadjeu@gmail.com Mawufemo Yawovi Tsevi raoul.kamadjeu@gmail.com Matchonna Kpatcha raoul.kamadjeu@gmail.com Eyram Yoan Amekoudi raoul.kamadjeu@gmail.com Akomola Kossi Sabi raoul.kamadjeu@gmail.com Prostatic hyperplasia is a common condition in people over the age of 50 and its incidence increases with age. It gives particular cause for concern when it is symptomatic. Drugs with potential adverse effects on lower urinary tract can induce symptoms. Among those, anticholinergic drugs causing primary or secondary effects, such as tricyclics, are often associated with symptoms. These are contraindicated in patients with subvesical obstruction because they can induce or worsen urinary symptoms and complications resulting from them. Renal failure having health and economic consequences on elderly subjects Who often suffer from multiple disorders is the most severe complication. We report two cases of tricyclics-related adverse effects on the urinary tract in patients with prostatic hyperplasia ranging between 80 and 92 years. Given the lack of semiologic signs, imaging techniques and bladder TC scan enabled etiological diagnosis allowing adequate management. Study results justify a systematic performace of rectal examination, bladder CT scan or even ultrasound in any elderly with acute renal failure or with a worsening of chronic renal failure based on the frequency of prostatic pathologies and polypharmacy in this age.<br /><br /><strong>Keywords:</strong> Iatrogenia, elderly, tricyclics, benign prostatic hyperplasia, renal failure 2019-02-11T14:19:39+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183307 The increased of MMP-9 and MMP-2 with the decreased of TIMP-1 on the uterosacral ligament after childbirth 2022-04-19T13:43:38+00:00 Rahajeng Rahajeng raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Pelvic floor dysfunction is one of the causes of morbidity that have very active role in the degradation of collagen and elastin through an intermediary changes in matrix metalloproteinases (MMP) and its regulation. This research to evaluate level of MMP-9, MMP-2 and TIMP-1 expression on uterosacral ligament in women after vaginal delivery. <br /><br /><strong>Methods:</strong> This research was conducted by collecting samples in consecutive sampling of biopsy uterosacral ligament from primigravida who underwent cesarean section because of obstructive labor at stage 1 and 2. As control, biopsy samples were taken from uterosacral ligament of primigravida a term who have not entered the labor phase and undergoing elective caesarean section surgery. The method in this study was cross sectional. The examination of MMP-9, MMP-2, and TIMP-1 expression by immunohistochemistry based on comparison of the sample and the control differences. <br /><br /><strong>Results:</strong> There are differences in the levels of Matrix Metalloproteinase-9, Matrix Metalloproteinase-2, and TIMP-1 in the uterosacral ligament of primigravida women in labor compared with women who are never in labor. <br /><br /><strong>Conclusion:</strong> There are increased levels of Matrix Metalloproteinase-9 and Matrix Metalloproteinase-2 with the decreased of TIMP-1 in the uterosacral ligament of primigravida women who underwent cesarean section because of obstructive labor at stage 1 and 2.<br /><br /><strong>Keywords:</strong> MMP-9, MMP-2,TIMP-1, primigravida 2019-02-11T14:14:05+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210378 Corrigendum: Diagnostic moléculaire du complexe Mycobacterium tuberculosis résistant à l’isoniazide et à la rifampicine au Burkina Faso 2021-07-12T07:29:10+00:00 Désire Ilboudo ildesi@yahoo.fr Cyrille Bisseye ildesi@yahoo.fr Florencia Wendkuuni Djigma ildesi@yahoo.fr Souba Diande ildesi@yahoo.fr Albert Théophane Yonli ildesi@yahoo.fr Jean Telesphore Valerie Bazie ildesi@yahoo.fr Rebeca Tégwindé Compaoré ildesi@yahoo.fr Charlemagne Gnoula ildesi@yahoo.fr Tamboura Djibril ildesi@yahoo.fr Rémy Moret ildesi@yahoo.fr Virginio Pietra ildesi@yahoo.fr Damintoti Simplice Karou ildesi@yahoo.fr Martial Ouedraogo ildesi@yahoo.fr Jacques Simpore ildesi@yahoo.fr <p>Ce Corrigendum modifie l'article original: Diagnostic moléculaire du complexe Mycobacterium tuberculosis résistant à l’isoniazide et à la rifampicine au Burkina Faso. The Pan African Medical Journal. 2015;21:73. doi:10.11604/pamj.2015.21.73.5494.</p> 2018-08-23T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210465 Eruption cyst associated with right maxillary deciduous first molar 2021-07-13T05:41:14+00:00 Thorakkal Shamim shamu3duad@gmail.com Koyakkunjakath Padinhare Ottayil Shabeer shamu3duad@gmail.com <p>A one and half-year-old boy presented to dental outpatient department with a soft tissue mass hanging from the right upper back milk tooth region for the past 2 days. The patient was asymptomatic and there was no fluid discharge. On clinical examination, it was found that the mass is friable with a size of 0.5 x 0.5cm and the roof of the mass was seen ruptured and hanging from the sides of the erupting right deciduous maxillary first molar (Figure 1). A diagnosis of eruption cyst was made. Eruption cyst usually present as solitary swelling on the alveolar ridge mucosa. The treatment of the intact eruption cyst will be surgical excision and exposure of the unerupted primary teeth. In our case, eruption cyst is ruptured and wait and watch instruction was given and in the next follow-up, cyst was disappeared and the tooth was seen erupting normally.</p> 2018-08-23T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183309 Uropathogens antibiotic resistance patterns among type 2 diabetic patients in Kisii Teaching and Referral Hospital, Kenya 2022-04-19T13:43:39+00:00 Vincent Mogaka Mageto raoul.kamadjeu@gmail.com Mathenge Scholastica Gatwiri raoul.kamadjeu@gmail.com Wachuka Njoroge raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Non-insulin dependent diabetes mellitus is a major risk factor for urinary tract infections. Irrational use of antibiotics has led to the emergency of uropathogens resistant to available antibiotics. The main objective was to determine the bacterial causative agents of urinary tract infections and their antibiotic resistance patterns. <br /><br /><strong>Methods:</strong> One hundred and eighty (180) type 2 diabetic patients were recruited to take part in the study. Urine samples were collected and cultured for urinary tract infections diagnosis and antibiotic sensitivity. <br /><br /><strong>Results:</strong> A total of 35 isolates were obtained from the study. All the isolates were sensitive to gentamicin. All 21 (100%) isolates of <em>E. coli</em> were sensitive to gentamicin and cephalexin. All 10 (100%) <em>K. pneumoniaeisolates</em> were sensitive to gentamicin and nitrofurantoin. Out of the 21 <em>E. coli</em> isolates, five of them showed resistance to ampicillin, three <em>E. coli</em> isolates showed resistance to nitrofurantoin and another three <em>E. coliisolates</em> showed resistance to cotrimoxazole. Out of 10 K. pneumoniae isolates, two of them were found to be resistant to ampicillin, one <em>K. pneumoniae</em> isolate was resistant to cephalexin and two<em> K. pneumoniaeisolates</em> were resistant to co-trimoxazole. Out of the four<em> P. mirabilis</em> isolates, there were three cases where one isolate was each resistant to ampicillin, nitrofurantoin and co-trimoxazole. <br /><br /><strong>Conclusion:</strong> There is a need to have a regular screening of bacterial isolates causing urinary tract infection in diabetic patients and their antibiotic sensitivity in order to have effective therapy. Present findings show that there is increased resistance to the commonly prescribed antibiotics.<br /><br /><strong>Keywords:</strong> Type 2 diabetes mellitus, urinary tract infections, antibiotic sensitivity, <em>E. coli, K. pneumoniae</em> 2019-02-11T14:27:25+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183305 Knowledge and perceptions of tuberculosis among patients in a pastoralist community in Kenya: a qualitative study 2022-04-19T13:43:40+00:00 Grace Wambura Mbuthia raoul.kamadjeu@gmail.com Charles Owour Olungah raoul.kamadjeu@gmail.com Tom Gesora Ondicho raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Tuberculosis awareness is crucial to the success of control and prevention of tuberculosis. However, the knowledge and perceptions of tuberculosis patients in rural Kenya is not well documented. The study sought to explore the knowledge and perceptions of TB patients in West Pokot County Kenya. <br /><br /><strong>Methods:</strong> This was a qualitative descriptive study conducted between January-March 2016. A total of 61 pulmonary tuberculosis patients took part in the study which comprised 6 focus group discussion and 15 in-depth interviews. Thematic analysis was used to analyse the data. <br /><br /><strong>Results:</strong> Participants perceived TB as a serious contagious disease that is hard to diagnose and treat. They attributed tuberculosis to smoking, drinking alcohol, dust, cold air, witchcraft, trauma to the chest, contact with livestock and genetic factors. They believed that TB was transmitted through casual contact with TB patients and sharing of utensils. <br /><br /><strong>Conclusion:</strong> The study showed a lot of misperceptions among tuberculosis patients. The tuberculosis program should heighten patient education to improve patient knowledge and put more effort to dispel misinformation about the cause and mode of transmission of the disease.<br /><br /><strong>Keywords:</strong> Tuberculosis, knowledge, qualitative study, Kenya 2019-02-11T14:08:29+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183304 Labour pain perception: experiences of Nigerian mothers 2022-04-19T13:43:42+00:00 Adebayo Adekunle Akadri raoul.kamadjeu@gmail.com Oluwaseyi Isaiah Odelola raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Labour pain perception is influenced by a variety of factors; hence women experience and cope with labour pain differently. This study was designed to assess labour pain perception among parturient.<br /><br /><strong> Methods:</strong> A cross-sectional study involving 132 pregnant women who had vaginal delivery at two tertiary hospitals in south west Nigeria. A structured questionnaire was administered to women within 24 hours of delivery to record details of labour and delivery. Labour pain perception was assessed using the Visual Analogue Score (VAS). Data analysis were done using IBM-SPSS Statistics for Windows version 21.0 (IBM Corp., Armonk, NY, USA). <br /><br /><strong>Results:</strong> The mean age of the parturients was 30.6±4.8 years. The mean pain perception of the parturients as assessed by VAS was 7.0 with range of 1.2-10.0. Sixty-six (50%) parturients rated labour pain to be severe (VAS &gt; 7.1). Majority of the respondents 114(86.4%) desired some form of pain relief. The Body Mass Index (BMI) of respondents and birth weight of their babies had statistically significant association with pain perception (p = 0.010; p = 0.038 respectively). Factors associated with increased odds of having severe pain perception include unbooked status, secondary level education, BMI &lt; 30, and gestational age ≥ 37 weeks. <br /><br /><strong>Conclusion:</strong> Women in south west Nigeria perceived labour pain as severe and many desired pain relief during labour. Occupation, BMI, gestational age and baby’s birth weight were significant mediating variables in women's experience of labour pain. Modern methods of labour analgesia should be offered to parturients who express desire for it. This will lead to improvements women's childbirth experience.<br /><br /><strong>Keywords:</strong> Analgesia, labour pain, obstetric, perception 2019-02-11T14:00:03+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183301 Can training of health care workers improve data management practice in health management information systems: a case study of primary health care facilities in Kaduna State, Nigeria 2022-04-19T13:43:43+00:00 Bilkisu Nwankwo raoul.kamadjeu@gmail.com Mohammed Nasir Sambo raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Reliable and accurate public health information is essential for monitoring, evaluating and improving the delivery of healthcare services. The objective of this study was to assess the effect of training health care workers on data management practice in health management information systems in primary health care (PHC) centers in Kaduna state. <br /><br /><strong>Methods:</strong> The study was quasi-experimental with baseline, intervention and end point components. It was carried out in two local government areas, a study and a control. Eleven PHC facilities were selected in each LGA. The intervention was carried out among 76 PHC workers in the study LGA. Data were collected using a health facility checklist and a focused group discussion (FGD) guide. Data analysis was done using SPSS version 20.0 and statistical significance of the difference between baseline and end-line data were determined using chi-square or fisher's exact test where applicable at p &lt; 0.05. <br /><br /><strong>Results:</strong> There was a statistically significant increase in completeness of reporting (p = 0.02), overall accuracy rate (p &lt; 0.001), timeliness rate of reporting (p = &lt;0.001) and feedback (p = 0.012). No improvement was found in the control group. During the baseline FGDs, PHC workers in both study and control LGAs expressed difficulty in filling registers/forms, data analysis and use of data. At end point, those in the study LGA said their practice had improved but those in the control LGA still expressed difficulty in data management. <br /><br /><strong>Conclusion:</strong> Health management information system training achieved an improvement in the data management practice of PHC workers. In-service training and re-training should be done to improve data management practice of health workers.<br /><br /><strong>Keywords:</strong> Data management, practice, healthcare workers, training 2019-02-11T13:52:35+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210467 Intermittent Wolff-Parkinson-White 2021-07-13T06:01:17+00:00 Mickyas Aberham jjt3@buffalo.edu Jeffrey John Thompson jjt3@buffalo.edu <p>A 16-year-old female presented to the emergency department with complaints of palpitations of two hours duration. She had similar episodes in the past brought on by stress, anger, chocolate, or coffee. The ECG obtained in the course of her medical work-up led to the diagnosis of Wolff-Parkinson-White (WPW) syndrome. The characteristic short PR segment and delta wave are best seen in the lead I rhythm strip. In this rare example, the electrocardiographic morphology alternates between multiple beats of WPW and beats of normal sinus rhythm (A). It is important to recognize the characteristic features of pre-excitation syndromes such as WPW as patients may require treatment with antiarrhythmic drugs and/or radiofrequency ablation. Furthermore, emergency management of tachyarrhythmias in patients with a known history of WPW may differ from those without. However, as demonstrated in this example, such findings may be intermittent thus making an accurate and timely diagnosis challenging. Once it is apparent, proper documentation with copies of the ECG or rhythm strip in the patient record is imperative. In this case, the patient was also provided with a copy of her ECG to show the cardiologist which proved to be important since a repeat ECG at the cardiology clinic later the same day was unremarkable (B).</p> 2018-08-24T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183300 Tumeurs cérébrales de l’enfant: à propos de 136 cas 2022-04-19T13:43:44+00:00 Fatima-Ezzahra Hazmiri raoul.kamadjeu@gmail.com Fatima Boukis raoul.kamadjeu@gmail.com Said Ait Benali raoul.kamadjeu@gmail.com Najat Cherif Idrissi El Ganouni raoul.kamadjeu@gmail.com Hanane Rais raoul.kamadjeu@gmail.com Brain tumors are the most diagnosed solid tumors in children under the age of 15 years worldwide. However, the epidemiological and anatomopathological profile of these tumors has been poorly described in African and, particularly, in Moroccan literature. This study highlights the epidemiological and anatomopathological peculiarities of primary brain tumors in children living in the region of Marrakech (south Morocco). We conducted a retrospective study in the Division of Anatomic Pathology at the Mohammed VI University Hospital, Marrakech from 2004 to 2016. One hundred and thirty-six patients were diagnosed with primary brain tumor, a mean of 11.33 cases per year. The average age of patients was 8.28 years. Sex-ratio (M/F) was 1.6 with a slight male predominance. Infratentorial tumors were found in 61,53% of cases while supratentorial tumors were found in 38.47% of cases. Infratentorial tumors mainly occurred in the cerebellar hemisphere (61.4%). Eighteen histological types were diagnosed. Astrocytoma and medulloblastoma accounted for 46,32% (29.41% and 16.91%, respectively). In our context, the majority of brain tumors in children was predominant in both age groups: 5-9 years and 10-15 years. The epidemiological data of these tumors from south Morocco are mostly consistent with those already published in North Country’s literature and in other non-african countries’ literature.<br /><br /><strong>Keywords:</strong> Brain tumors, child, epidemiology, histopathology 2019-02-11T13:47:39+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210470 Health: redefined 2021-07-13T06:44:31+00:00 Obinna Ositadimma Oleribe njb12@ic.ac.uk Omole Ukwedeh njb12@ic.ac.uk Nicholas Jonathan Burstow njb12@ic.ac.uk Asmaa Ibrahim Gomaa njb12@ic.ac.uk Mark Wayne Sonderup njb12@ic.ac.uk Nicola Cook njb12@ic.ac.uk Imam Waked njb12@ic.ac.uk Wendy Spearman njb12@ic.ac.uk Simon David Taylor-Robinson njb12@ic.ac.uk <p>For many years the definition of 'health' has remained unchanged as a narrow concept, encompassing physical wellbeing from a medical context. This somewhat focused definition has attracted criticism from individuals and professional bodies alike. Recent attempts have been made to redefine health, each offering an alternative viewpoint from sociological, environmental, societal and economic standpoints. We summarize and contextualize these definitions and provide an alternative, new, all-encompassing definition of health.</p> 2018-08-24T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183299 Factors associated with tuberculosis treatment failure in the Central East Health region of Burkina Faso 2022-04-19T13:43:45+00:00 Adama Diallo raoul.kamadjeu@gmail.com Désiré Lucien Dahourou raoul.kamadjeu@gmail.com Ter Tiero Elias Dah raoul.kamadjeu@gmail.com Souleymane Tassembedo raoul.kamadjeu@gmail.com Romial Sawadogo raoul.kamadjeu@gmail.com Nicolas Meda raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Tuberculosis treatment failure results in increased risk of morbidity, drug resistance, transmission and mortality. There are few data about tuberculosis treatment outcomes in Burkina Faso. The current study investigated the factors associated with tuberculosis treatment failure in the central east health region of Burkina Faso.<br /><br /><strong> Methods:</strong> We conducted a case-control study. All cases of pulmonary tuberculosis failing first-line treatment matched to those who were cured (controls) in the Central Eastern Region were sampled from January 2010 to December 2014. Predictors of treatment failure were determined using multiple conditional logistic regression.<br /><br /><strong> Results:</strong> A total of 381 patients with positive microscopic pulmonary tuberculosis were included. Of these 76 cases failed first-line treatment while 305 controls were cured. Weight loss between diagnosis and first sputum-smear examination was significantly associated with the tuberculosis treatment failure [aOR: 2.5, 95% CI: 1.3-4.7]. In addition, the delay from between treatment initiation to first sputum-smear examination, and high bacillary load at the first sputum-smear examination were significantly associated with treatment failure (p&lt;0.001). <br /><br /><strong>Conclusion:</strong> Strengthening the relationship between health care services and local communities to improve the follow-up of tuberculosis patients, and improving adherence to tuberculosis treatment among tuberculosis patients with weight loss between treatment initiation and 2-month sputum-smear examination could be useful to reduce the risk of unsuccessful outcome.<br /><br /><strong>Keywords:</strong> Tuberculosis, treatment, failure, Burkina Faso 2019-02-11T13:38:27+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210476 A rare cause of lower limb deformity 2021-07-13T07:06:23+00:00 Lieven Dossche lieven.dossche@ping.be <p>During an orthopaedic mission in a district hospital in Rwanda, a 10 year old girl was referred for treatment of a bilateral clubfoot. The girl was able to walk. Clinical evaluation (A) showed bilateral marked endotorsion of the lower limb with 90° internal rotation of the foot. There was no equinovarus deformity of the foot with a bilateral plantigrade foot. X-ray evaluation was performed. AP view (B) showed marked bowing and torsion of both tibia and fibula. Lateral lower leg views showed (C) crossing of tibia and fibula with significant diastasis between both bones distally. The diagnosis of congenital diastasis of the inferior tibiofibular joint was made. This is an extremely rare variant of dysplastic tibial anomaly of which the exact etiology is unknown. It is usually associated with equinovarus deformity of the foot and limb shortening. Possible treatments include serial casting if the patient is seen at a very young age, various soft tissue and bony procedures for foot repositioning, Syme amputation and progressive correction with the use of an Ilizarov-external fixator. The girl in the described case had plantigrade feet; given the bilateral presentation, there was no significant leg length discrepancy. Since she was able to walk and local treatment facilities were limited, it was decided to abstain from treatment and accept the deformity.</p> 2018-08-28T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183298 Prise en charge des lésions traumatiques de membres au cours des missions de pacification au Nord du Mali 2022-04-19T13:43:46+00:00 Akloa Komlavi Ehlissou Kolima raoul.kamadjeu@gmail.com Kombate Noufanangue Kanfitine raoul.kamadjeu@gmail.com Lamboni Damessane raoul.kamadjeu@gmail.com Gnandi-Piou Fare raoul.kamadjeu@gmail.com Sama Hamza Dolès raoul.kamadjeu@gmail.com Akpoto Messanvi Yaovi raoul.kamadjeu@gmail.com Assenouwe Sarakawabalo raoul.kamadjeu@gmail.com Assogba Komi raoul.kamadjeu@gmail.com Abalo Anani raoul.kamadjeu@gmail.com In February 2016, the camp of the United Nations Multidimensional Integrated Stabilization Mission in Mali (MINUSMA), in Kidal, was attacked and many people were wounded and killed. This study aims to determine the nature of extremity traumas and to describe their treatment. We conducted a descriptive cross-sectional study of extremity traumas in the victims of the attack on the camp of MINIUSMA in Kidal. The parameters studied were age, sex, admission delay, seat of the lesions and type of emergency surgical treatment performed. The study involved 60 wounded patients: 57(95%) men and 3(5%) women. The average age of patients was 28.9 years; 127 lesions were identified, of which 109 (85.8%) on the limbs. Clinical and radiological examinations revealed 32 (29.3%) musculocutaneous disruptions, 11 (10.1%) open fractures, 15 (13.7%) burns, 8 (7.3%) vascular and nervous injuries and 7 sprains. Severely wounded patients underwent resuscitation upon admission. Four of them underwente mergency surgery. The remaining wounded patients underwent surgery after restoration of hemodynamic stability with resuscitation. Six patients (10%) were transferred to a Level 3 Hospital for further treatment. Four wounded patients (6.7%) died. Extremity traumas are frequent but not life-threatening when isolated. They have a higher risk of infection and gangrene which can result in amputation.<br /><br /><strong>Keywords:</strong> Treatment, lesions, limbs, Mali 2019-02-11T13:30:46+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183297 Syndrome du défilé thoraco-brachial neurologique chez l’enfant: à propos d’un cas 2022-04-19T13:43:49+00:00 Ghizlan El Amri raoul.kamadjeu@gmail.com Mohammed Zalagh raoul.kamadjeu@gmail.com Ali Jahidi raoul.kamadjeu@gmail.com Fouad Benariba raoul.kamadjeu@gmail.com Thoracic Outlet Syndrome (NTOS) encloses the whole set of clinical manifestations associated with the compression of the trunks of the brachial plexus and/or of the subclavian vessels as they cross the thoracic outlet (cervico-thoraco-brachial junction). It rarely affects children. We here report the case of a young girl treated for neurologic NTOS caused by supernumerary cervical rib.<br /><br /><strong> Keywords:</strong> Supernumerary cervical rib, thoracic outlet syndrome, child 2019-02-11T13:19:12+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210483 Evaluation of a laboratory capacity strengthening project: a case of the summative assessment of the African Field Epidemiology Network (AFENET) laboratory project 2010 - 2016 2021-07-13T07:37:18+00:00 Humphrey Kabugo hkabugo@afenet.net Davis Ashaba hkabugo@afenet.net Fausta Mosha hkabugo@afenet.net Rebecca Babirye hkabugo@afenet.net Christine Kihembo hkabugo@afenet.net Mercy Maeda hkabugo@afenet.net Kerine Hay hkabugo@afenet.net Olivia Namusisi hkabugo@afenet.net Peter Nsubuga hkabugo@afenet.net <p><strong>Introduction:&nbsp;</strong>between September 2010 and September 2016, the African Field Epidemiology Network (AFENET) implemented laboratory strengthening initiatives through a cooperative agreement with the International Laboratory Branch of the US Centers for Disease Control and Prevention (CDC). This project aimed at improving laboratory Quality Management Systems (QMS) towards accreditation in Africa and the Caribbean region and was implemented in 11 countries in the Caribbean and seven African countries. This paper describes the results of a summative evaluation that was commissioned at the end of the project.</p> <p><strong>Methods:&nbsp;</strong>the evaluation team comprised an external consultant who led the evaluation design and implementation and AFENET project staff. The evaluation was done in all 11 Caribbean and seven African countries where the project was implemented. We formulated three evaluation questions to focus and guide the exercise: 1) Were project activities implemented as originally intended? 2) Did the project achieve the objectives it was intended to accomplish over its life? 3) Are the impacts of project interventions likely to survive in the long run? We developed 14 sub-questions from the three evaluation questions and obtained data using a set of online questionnaires. We conducted validation visits to six participating countries; four in Africa and two in the Caribbean.</p> <p><strong>Results:&nbsp;</strong>out of 14 sub-questions that were used to evaluate the project, six (43%) were fully achieved, six (43%) were partially achieved, and two (14%) were not achieved. In effect, &gt; 80% of the sub-questions were either fully achieved or partially achieved. The most frequently mentioned success was the introduction of QMS in participating laboratories, which led to quality improvement in laboratory processes, participation in SLMTA (Strengthening Laboratory Management Towards Accreditation)/SLIPTA (Stepwise Laboratory Quality Improvement Process Towards Accreditation) and attainment of accreditation by some of the project laboratories. However, there were neither clear plans nor budget lines to mainstream activities that were supported under the project into regular activities of the ministries of health of participating countries.</p> <p><strong>Conclusion:&nbsp;</strong>the evaluation team concluded that there were adequate numbers of laboratorians trained in the FELTP laboratory track but only in Kenya. The DTS testing and biosafety programs were implemented and expanded in participating countries. HIV laboratory networks were strengthened in all participating countries and laboratory information systems were implemented in the Caribbean countries, but the basic laboratory information systems in the African countries were not implemented beyond pilot stages. There were no clear plans and budget lines provided by respective ministries of health to mainstream the activities that were supported under the project. The evaluation team recommended that AFENET develops a new laboratory strategic plan that could leverage the activities that were funded and implemented in the project.</p> 2018-08-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210487 The yellow hairy tongue 2021-07-13T07:53:13+00:00 Aryé Weinberg aryeweinberg@gmail.com Andreas Eberhard Albers aryeweinberg@gmail.com <p>A 36-year-old woman presented herself to our out-patient clinic because she noticed that her tongue turned turned partially hairy. She has been smoking 25 cigarettes a day for the last 17 years. Otherwise the patient was healthy. Clinical exam showed a soft yellowish tongue with a hairy center. The rest of the clinical exam was normal. A hairy tongue is a commen benign clinical condition caused by proliferation of the papillae facilitating the collection of bacteria and debris and finially in discoloartion. The discoloration can vary from black, brown to yellow. Contributing factors are smoking, excessive consumation of coffee, alcohol, poor oral hygienes, hyposalivation, eating a soft diet and the use of certain antibiotics such as tetracyclines. The treatment consists of the correction of the contributing factors. In our case the cessation of smoking and the improvement of oral hygiene was recommended.</p> 2018-08-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210501 La luxation pure du coude post traumatique: quels résultats? 2021-07-13T09:26:18+00:00 Redouane Hani haniredouane10@gmail.com Mohamed Ben-aissi haniredouane10@gmail.com Reda Allah Bassir haniredouane10@gmail.com Mohamed Saleh Berrada haniredouane10@gmail.com <p>Les luxations du coude sont très fréquentes. Cette étude rétrospective a porté sur 40 cas de luxations du coude, colligés entre 2013 et 2015. Tous les patients ont bénéficié d'une réduction en urgence, sous sédation ou sous anesthésie générale. Le traitement a été complété par une immobilisation antalgique pendant une dizaine de jours suivie d'une mobilisation active. Après un recul moyen de 24 mois, un secteur de mobilité en flexion-extension supérieur à 100<sup>ο</sup>&nbsp;a été obtenu chez plus de 80% des patients et seuls deux cas ont gardé une raideur sévère. Les résultats globaux, évalués selon le Mayo Elbow Performance Score, ont été bons à très bons chez 35 patients, moyens chez trois patients et mauvais dans deux cas seulement.</p> 2018-08-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210505 Carcinome basocellulaire térébrant 2021-07-13T10:01:02+00:00 Jawad El-Azhari j.elazhari@gmail.com Mohammed Boui j.elazhari@gmail.com <p>Le carcinome basocellulaire (CBC) est le plus fréquent des cancers avec une localisation strictement cutanée et jamais muqueuse. Il possède une malignité locale et son risque métastatique est exceptionnel. Il possède la mortalité la plus faible. Cependant en l'absence de diagnostic et chirurgie précoces, le CBC a un potentiel invasif local qui peut entraîner une destruction tissulaire importante. Le CBC peut s'ulcérer et avoir une évolution extensive et destructrice: on parle de formes térébrantes pouvant atteindre les structures musculaires et osseuses. Nous rapportons le cas d'une femme de 80 ans, habitant en zone rurale enclavée, consulte pour une lésion ulcéro-bourgeonnant; prenant les régions prétragienne et parotidienne; exsudative et nauséabonde. L'examen locorégional était sans particularités et l'histologie était en faveur d'un CBC infiltrant. Le bilan d'extension n'a pas montré d'envahissement osseux. La patiente a été adressée au service de chirurgie plastique pour une prise en charge carcinologique.</p> 2018-08-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183296 Kounis syndrome induced by oral intake of aspirin: case report and literature review 2022-04-19T13:43:50+00:00 Abdelkader Jalil El Hangouche raoul.kamadjeu@gmail.com Ouiame Lamliki raoul.kamadjeu@gmail.com Latifa Oukerraj raoul.kamadjeu@gmail.com Taoufiq Dakka raoul.kamadjeu@gmail.com Nawal Doghmi raoul.kamadjeu@gmail.com Jamila Zarzur raoul.kamadjeu@gmail.com Mohammed Cherti raoul.kamadjeu@gmail.com The Kounis-Zavras syndrome is defined as the coincidental occurrence of acute coronary events and hypersensitivity reactions following an allergic reaction including a mast-cell degranulation of vasospastic mediators. This report describes a case of Kounis-Zavras syndrome in the setting of aspirin-induced asthma also known as Samter-Beer triad combining nasal polyps, asthma, and aspirin allergy leading to vasospasm and myocardial infarction. All physicians should be aware of The Kounis syndrome and always keep that unique clinical entity in mind to recognize it promptly and direct the therapy at suppressing the allergic reaction.<br /><br /><strong>Keywords:</strong> Kounis, zavras syndrome, samter´s triad, myocardial infarction, aspirin allergy, coronary spasm 2019-02-11T13:10:46+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183293 Characterization of pharmaceutical medication without a medical prescription in children before hospitalization in a resource-limited setting, Cameroon 2022-04-19T13:43:51+00:00 Calixte Ida Penda raoul.kamadjeu@gmail.com Else Carole Eboumbou Moukoko raoul.kamadjeu@gmail.com Julien Franck Ngomba Youmba raoul.kamadjeu@gmail.com Emmanuel Mpondo Mpondo raoul.kamadjeu@gmail.com <strong>Introduction:</strong> The use of different therapeutic approaches is common among sick children in Cameroon. The main objective of this study was to characterize the use of non-prescription drugs and describe the therapeutic itineraries of sick children before admission to the hospital.<br /><br /><strong> Methods:</strong> A cross-sectional and prospective study was conducted from January to May 2017. A closed-ended questionnaire (CEQ) consisting of one or several response options was administered to the parents/guardians of the children on admission to the hospital in the pediatric ward of the Laquintinie Hospital in Douala (LHD) and the Cité des Palmiers District Hospital (CPDH) of the city of Douala. Inclusion of participants was made consecutively for adolescents who gave their consent and parents or guardians who signed the informed consent for all children. The confidentiality of the data was ensured by the replacement of the names by codes. <br /><br /><strong>Results:</strong> Overall, 295 hospitalized children were included with an average age of 3.1 (SD: 3.3) years in the study. More than half of these children (58.6%) came from LHD. More than 90% of parents had at least one therapeutic recourse (TR). The ratio of boys to girls 3/1. Self-medication (74.1%) and medical consultation (16.9%) were the main therapeutic paths in 1st recourse. The medical consultation (80.2%) and the pharmaceutical advice (16.9%) were used frequently in 2nd recourse. The mean lapse time to see a medical professional was 2.7 days (min-max: 0-14 days). The main symptoms associated with TR were fever (76.6%), vomiting (24.7%) and diarrhea (22.7%). The most frequently used drugs were Analgesics/antipyretics (47.6%), antimalarials (15.0%) and antibiotics (10.2%) and the family medicine box was the highest source of drugs. <br /><br /><strong>Conclusion:</strong> Self medication remains the first therapeutic path, followed by medical consultation as second therapeutic path taken when the disease is perceived as serious.<br /><br /><strong>Keywords:</strong> Therapeutic itineraries, children, self-medication, hospitalization, Cameroon 2019-02-11T12:59:05+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183292 Postpartum family planning utilization in Burundi and Rwanda: a comparative analysis of population based cross-sectional data 2022-04-19T13:43:53+00:00 Gideon Rutaremwa raoul.kamadjeu@gmail.com Allen Kabagenyi raoul.kamadjeu@gmail.com <strong>Introduction:</strong> Promotion of modern family planning is a major policy action for Africa to harness the demographic dividend. Family planning is an important public health intervention for maternal and child health. <br /><br /><strong>Methods:</strong> Analysis was based on data from Demographic and Health Surveys conducted in 2010 on samples of women from Burundi (3396) and Rwanda (4670). Descriptive and multivariate logistic regression analyses to examine the contribution and comparison of the various predictors of uptake of modern contraceptives during the postpartum period (PPFP) in the two countries were carried out using STATA statistical software. <br /><br /><strong>Results:</strong> Descriptive findings show only 20% of the samples of women in Burundi used while more than half of the women (51%) were using PPFP. Utilization of PPFP was significantly associated with primary (OR = 1.3, 95% CI = 1.1-1.6) and higher education (OR = 2.2, 95% CI = 1.6-3.1) in Burundi. Similarly in Rwanda increased use of PPFP in primary was (OR = 1.4, 95% CI = 1.2-1.6) while secondary education (OR = 1.6, 95% CI = 1.2-2.1). Protestant women were less likely to use PPFP in both Burundi (OR = 0.75, 95% CI = 0.6-0.9) and Rwanda (OR = 0.69, 95% CI = 0.6-0.8). Other significant variables in the regression models of both countries included wealth status, age of woman, number of living children and exposure to media. Professional birth delivery assistance was significant only in Rwanda. <br /><br /><strong>Conclusion:</strong> Enhancing postpartum contraceptive use should target women with low education, low wealth status, and that the media has an important role to play in this transformation. Policies and programs must be put in place to ensure that the rural urban differences are eradicated.<br /><br /><strong>Keywords:</strong> Postpartum, family planning, contraception, utilization, Burundi, Rwanda, women 2019-02-11T12:51:32+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183288 Prevalence and perception of cigarette smoking among out of school adolescents in Birnin Kebbi, North-western Nigeria 2022-04-19T13:43:54+00:00 Godwin Jiya Gana raoul.kamadjeu@gmail.com Suleiman Hadejia Idris raoul.kamadjeu@gmail.com Kabiru Sabitu raoul.kamadjeu@gmail.com Mansur Oche Oche raoul.kamadjeu@gmail.com Aisha Ahmed Abubakar raoul.kamadjeu@gmail.com Patrick Mboya Nguku raoul.kamadjeu@gmail.com <strong>Introduction:</strong> cigarette smoking is on the increase among adolescents' especially in developing countries and is a leading cause of premature morbidity and mortality worldwide. Adolescents incorrectly perceive that cigarette smoking is less risky than other behaviors such as alcohol consumption and drug use. This study assessed the prevalence and perception of out of school adolescents on cigarette smoking in Birnin kebbi metropolis of Kebbi state.<br /><br /><strong> Methods:</strong> This is a cross-sectional mixed methods study. For quantitative data, respondents were selected using twostaged sampling technique. Semi structured interviewer-administered questionnaire was used. Univariate and bivariate analysis was done as appropriate using Epi-info software. Focus Group Discussion guide was used for qualitative data collection. Narrative synthesis was used for qualitative data analysis. <br /><br /><strong>Results:</strong> The proportion of respondents who had ever smoked cigarettes was 32.2% while 20.8% currently smoke. Most of the respondents (84.1%) perceived that cigarette smoking was harmful and that passive smoking was dangerous to their health (70.8%). Smokers had a significantly lower risk perception about smoking compared to non-smokers (p &lt; 0.005). <br /><br /><strong>Conclusion:</strong> The prevalence of cigarette smoking among out of school adolescents is high with smokers having lower risk perception compared to non-smokers. There is an urgent need to create awareness about the specific dangers associated with cigarette smoking, the transient nature of its perceived benefits and the fact that the risks associated with smoking are severe.<br /><br /><strong>Keywords:</strong> Adolescents, peer smoking, tobacco, cigarettes, youth, addiction, NCDs 2019-02-11T12:38:41+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/210509 Intoxication au plomb révélant une drépanocytose 2021-07-13T10:12:42+00:00 Ahmed Mougui a.mougui88@gmail.com Imane El Bouchti a.mougui88@gmail.com Imane El Bouchti a.mougui88@gmail.com <p>Patient de 18 ans, ayant deux frères décédés par drépanocytose. Présente depuis 5 jours des douleurs osseuses diffuses. Il avait bu une préparation contenant du plomb dans un but antalgique, sans amélioration. Le bilan radiographique montre, une condensation liée à la présence du plomb dans le tube digestif, avec une ostéonécrose aseptique des deux têtes fémorales sur la radiographie du bassin face (A), et des vertèbres en H sur la radiographie du rachis dorsolombaire profil (B). Ces signes sont évocateurs de la drépanocytose. Le diagnostic est confirmé par l'électrophorèse d'hémoglobine montrant une hémoglobine S à 79%.</p> 2018-08-31T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/pamj/article/view/183286 Case report<br>Large ossifying fibroma of jaw bone: a rare case report 2022-04-19T13:43:58+00:00 Vinay Kharsan raoul.kamadjeu@gmail.com Ramnik Singh Madan raoul.kamadjeu@gmail.com Pankaj Rathod raoul.kamadjeu@gmail.com Abhishek Balani raoul.kamadjeu@gmail.com Sumit Tiwari raoul.kamadjeu@gmail.com Saurabh Sharma raoul.kamadjeu@gmail.com Ossifying fibroma (OF) is classified as, and behaves like, a benign bone neoplasm. It is often considered to be a type of fibro-osseous lesion (FOL). It can affect both mandible and the maxilla, particularly the mandible. This bone tumour consists of highly cellular, fibrous tissue that contains varied amounts of bone or cementum resembling calcified tissue. Present case is an unusual report of central ossifying fibroma involving the left side of mandible in an 18 year old female patient, who presented to the department with a painless hard swelling. The lesion was treated by surgical resection and reconstruction.<br /><br /><strong>Keywords:</strong> Ossifying fibroma, fibro-osseous lesion, cemento-fying fibroma 2019-02-11T12:05:43+00:00 Copyright (c)