Pan African Medical Journal
https://www.ajol.info/index.php/pamj
<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" rel="noopener">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:PunctuationKerning> <w:ValidateAgainstSchemas ></w:ValidateAgainstSchemas> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables ></w:BreakWrappedTables> <w:SnapToGridInCell ></w:SnapToGridInCell> <w:WrapTextWithPunct ></w:WrapTextWithPunct> <w:UseAsianBreakRules ></w:UseAsianBreakRules> <w:DontGrowAutofit ></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>African Field Epidemiology Networken-USPan African Medical Journal1937-8688Brief summary of the agreement Anyone is free: · to copy, distribute, and display the work; · to make derivative works; · to make commercial use of the work; Under the following conditions: Attribution · the original author must be given credit; · for any reuse or distribution, it must be made clear to others what the license terms of this work are; · any of these conditions can be waived if the authors gives permission. Statutory fair use and other rights are in no way affected by the aboveOutcomes and predictors of tuberculosis mortality in Kweneng West District, Botswana: a retrospective cohort study
https://www.ajol.info/index.php/pamj/article/view/238095
<p><strong>Introduction: </strong>Botswana is among the countries with the highest Tuberculosis (TB) notification rates in the world. However, there is paucity of data on the outcomes and predictors of TB mortality at district level in Botswana. This study was aimed at describing the TB outcomes and identifying the predictors of mortality in Kweneng West district, Botswana. <strong>Methods: </strong>this was a retrospective cohort study of TB outcomes in Kweneng West, from January 2008 to December 2016. All documented drug-sensitive TB (DS-TB) patients aged 16 years and above were included. The World Health Organization (WHO) definitions of treatment outcomes for DS-TB were used. Binary logistic regression was used to identify predictors of mortality. <strong>Results: </strong>there were 1475 TB notifications in the study period. The median age was 36 years and 41.5% were female. A total of 728 (49.4%) were HIV positive. Pulmonary TB (PTB) accounted for 87.3% of all cases. The overall treatment success rate (TSR) was 81.9% and the mortality rate was 9.4%. Compared to the 16-25 years age group, patients aged more than 65 years had the highest risk of mortality (AOR=9.63). Other significant predictors of mortality were male sex (AOR=1.63), no sputum microscopy (AOR=1.77), positive HIV (AOR=2.13) and unknown HIV status (AOR=4.47). Positive sputum microscopy (AOR=0.50) and extra-pulmonary TB (EPTB) (AOR=0.56) were associated with less mortality. <strong>Conclusion: </strong>while Botswana has relatively good TB treatment success rates, the mortality rates are high. Public health interventions should target the identified risk factors of mortality.</p>Keatlaretse SiamisangGoabaone Rankgoane-PonoTumisang Malebo MadisaTantamika MudiayiJohn Thato Tlhakanelo
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421Syndrome d’Ogilvie, une complication rare de la chirurgie du canal lombaire étroit: à propos de deux cas et revue de la littérature
https://www.ajol.info/index.php/pamj/article/view/238100
<p>Le syndrome d´Ogilvie est une pseudo-occlusion colique aiguë, caractérisée par une distension colique avec risque de perforation caecale en absence de tout obstacle mécanique. C´est une pathologie très rare après une chirurgie rachidienne. Nous rapportons deux cas enregistrés dans le service de neurochirurgie du CHU de Guadeloupe. Il s´agit d´une femme de 79 ans en surpoids (IMC=27kg/m²) et un homme de 56 ans présentant des lombosciatagies bilatérales mal systématisées avec réduction du périmètre de marche évoluant depuis plusieurs mois chez qui l´IRM lombaire avait révélé un canal lombaire étroit et hernie discale, avaient subi une intervention chirurgicale de décompression par laminectomie lombaire. Ils ont présenté une constipation avec arrêt des matières et gaz 48h après la chirurgie et un ballonnement abdominal. Le scanner abdominal et la radiographie de l´abdomen ont montré une importante distension intestinale sans obstacle faisant évoquer un syndrome d´Ogilvie. Un traitement conservateur avait été suffisant pour traiter ce syndrome et les patients avaient complètement récupéré. Dans la survenue du syndrome d´Ogilvie, la pathologie la plus fréquente pour laquelle le geste chirurgical rachidien est en cause, est la hernie discale lombaire. La présentation clinique est classique avec un arrêt des matières et des gaz, un météorisme abdominal témoignant d´une distension intestinale volumineuse. Le traitement médical conservatoire reste le traitement de choix lorsque le diagnostic est fait tôt.</p> <hr> <p><a role="button" href="https://www.panafrican-med-journal.com/content/article/42/2/full/#faqtable1" data-toggle="collapse" aria-expanded="false" aria-controls="collapseExample"><strong><em>English abstract</em></strong></a></p> <div id="faqtable1"> <p><em>Ogilvie´s syndrome is an acute colonic pseudo-obstruction, characterized by massive colonic distension in the absence of mechanical cause. It is a very rare pathology after spinal surgery. We report two cases in the neurosurgery department of the University Hospital of Guadeloupe. A 79-year-old woman overweight (BMI= 27kg/m²) and a 56-year-old man experienced history of non-systematized bilateral lumbar and sciatic pain with reduction in walking perimeter for few months. MRI of lumbar spine had revealed a lumbar stenosis with disc herniation. They had undergone decompression surgery with laminectomy. The surgical intervention was uneventful perioperatively. By 48 hours after surgery, they had complained of constipation with cessation of fecal and flatus with resultant abdominal distension. Abdominal CT scan and X-rays showed significant bowel distension with no mechanical obstruction, suggestive of Ogilvie´s syndrome. Conservative treatment had been sufficient to treat this syndrome and the patients completely recovered. In the occurrence of Ogilvie´s syndrome, the most frequent pathology is the lumbar disc herniation. The clinical presentation is typical with a cessation of fecal and gas elimination, and abdominal distension. Conservative treatment remains the treatment of choice when diagnosis is made early.</em></p> </div>Gbètoho Fortuné GankpéLaurent Do2, Mohammed Rabhi
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421Cataracte post traumatique rompue négligée
https://www.ajol.info/index.php/pamj/article/view/238102
<p>Nous rapportons le cas d´un patient âgé de 26 ans, sans antécédents médicaux particuliers, se disant victime 9 mois avant son admission, d´un traumatisme contusif négligé suite à une agression physique au niveau de son œil droit. Le patient s´est présenté aux urgences pour baisse d´acuité visuelle progressive et leucocorie. L´examen ophtalmologique à l´admission retrouvait une acuité visuelle réduite à « voit la main bouger » au niveau de l´œil traumatisé. A la lampe à fente, la cornée était claire, la chambre antérieure était de bonne profondeur, avec présence d´une cataracte rompue en chambre antérieure. Par ailleurs le tonus oculaire était de 15 mmHg au tonomètre de Goldmann. L´examen du fond d´oeil était inaccessible, et une échographie oculaire réalisée n´a pas objectivé d´anomalies vitréennes ni de décollement de rétine. L´examen de l´œil adelphe était sans anomalies. Le patient a été opéré pour sa cataracte par phacoémulsification et mise en place d´un implant de chambre postérieure, avec bonne évolution.</p>Loubna El KaissoumiBasma Mrini
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421Attitudes towards interprofessional education and associated factors among faculty at the college of health sciences in a public university in Kenya: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/238107
<p><strong>Introduction: </strong>conforming health professional´s curricula and training to emerging needs and exponential growth in medical information and education is key. Interprofessional education is one such conformity. Faculty attitudes towards interprofessional education is a good predictor to their engagement. The study purpose is to determine attitudes of faculty and associated factors towards interprofessional education (IPE) at the College of Health Sciences of Jomo Kenyatta University of Agriculture and Technology. <strong>Methods: </strong>a cross-sectional study among 71 faculty was conducted. A 5-point Likert scale with three attitude subscales on IPE were used to collect data using stratified sampling method. Attitude was dichotomized with >75% as cut-off for positive attitude. Data was analyzed using SPSS version 25.0 software at 95% confidence level. Logistic regression was used to identify relationship between bio-demographic characteristics and attitude of faculty. <strong>Results: </strong>there were more male faculty than females and the mean age was 42 years. The overall attitude score was positive (124.46 >75%), with attitudes of faculty towards IPE in academic settings subscale yielding negative attitude score (36.86 <75%). Age, gender, academic position, and expertise level were not significant in influencing faculty´s attitude. Application of interprofessional education was significant (P=0.036), with faculty who had applied Interprofessional education at the college more likely to have positive attitudes. <strong>Conclusion: </strong>faculty have overall positive attitudes towards interprofessional education but negative attitudes towards subscale 3-interprofessional education in academic settings. Behavior change training and IPE sensitization to avert negative attitudes among faculty is recommended.</p>Rosemary Kawira Kithuci Drusilla MakworoAlbanus MutisyaJustus SimbaPatrick Mburugu
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421Prenatal diagnosis and pregnancy outcome of acardiac amorphus twin
https://www.ajol.info/index.php/pamj/article/view/238112
<p>We report a case of a 35 years old primigravida patient, referred at 17 weeks of gestation to our consultation for suspicion of a twin pregnancy with vanishing twin. Ultrasound exam showed one fetus with appropriate for gestational age dimensions next to an amorphus mass of 59 mm (A,B). A reversal in arterial flow was noted on a Doppler study, coming from the apparently normal fetus to the mass, and the diagnosis of acardiac twin was made. In view of the absence of negative ultrasound signs (umbilical artery PI ratio, umbilical artery RI differences, weight ratio between acardiac mass and pump twin, heart function of pump twin and amniotic fluid volume) we decided to follow the pregnancy by fortnightly ultrasound checks. At 29 weeks of gestation, a bilateral ventriculomegaly was discovered at the cephalic level without any signs of heart decompensation. A fetal brain MRI was performed at 32 weeks of gestation and showed porencephaly and schizencephaly lesions related to anoxischemic and hemorrhagic sequelae. Intra-uterine fetal death occurred at 32 weeks of gestation. The examination after evacuation showed a stillborn of 1800g of normal morphology, an amorphous acardiac fetus with an outline of a limb weighing 200g (C).</p>Mahdi FarhatAbir Karoui
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421Emergence of universal antiretroviral therapy coverage in South Africa: applying the advocacy coalition framework to refine the narratives and inform epidemic responses
https://www.ajol.info/index.php/pamj/article/view/238113
<p>South Africa possesses the largest anti-retroviral therapy (ART) program in the world, but the path to this record was dramatic. There is scarce literature employing a comprehensive framework to explain this achievement and inform epidemic responses. This paper applies the Advocacy Coalition Framework (ACF) to analyse the interactions among diverse actors, institutions and networks that were associated with the AIDS policy change in South Africa. Post-apartheid, HIV/AIDS and AIDS-related mortality were serious public health problems. At the time, the discernible coalitions in the HIV/AIDS policy subsystem were the pro-science coalition and AIDS dissidents. In view of the availability of compelling scientific evidence on the pathogenesis of HIV/AIDS, the clinical usefulness of ART, the availability of funding for national ART roll-out, strong global advocacy to reduce the cost of ART, all of these in an era when access to adequate HIV treatment/care was increasingly considered a human right, the environment to establish an appropriate HIV/AIDS policy for the country was conducive. However, AIDS dissidents dominated the policy agenda via their control over key institutions, the use of various dimensions of power, biasing evidence to inform policy, and promoting the activities of strong interest groups that were not in support of ART. National ART roll-out finally emerged as a political priority because of external shocks (on the AIDS policy subsystem) which disfavoured the dominant coalition. As in this important experience in the history of HIV treatment, stakeholders involved in epidemic response tend to engage in intense ideological conflicts. An adequate appraisal of the outcomes of these conflicts in terms of population health gains and adopted public health and social measures to control epidemics would require the supplementation of complex system thinking with relevant public policy concepts, notably power dimensions, governance, emergence of global health networks and evidence use in policy.</p>Benjamin Momo KadiaChristian Akem DimalaKevin Pene Njefi
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421Hemostatic instantaneous coagulation on echocardiogram: a defining feature of the last heartbeat (a case report)
https://www.ajol.info/index.php/pamj/article/view/238115
<p>There is a paucity of detailed descriptions of echocardiographic features of the dying heart in the literature. A 64-year-old man on chronic hemodialysis presented with cardiac arrest after missing dialysis for three weeks. He received resuscitation efforts but died while his last heartbeats were fortuitously recorded by echocardiography. Rapid echo image acquisition during pulse check of a cardiopulmonary resuscitation attempt provided a unique opportunity for documenting the echocardiographic features of a dying heart. There was a rapid progressive dense echogenicity first in the left ventricular chamber and subsequently in all other chambers, which coincided with the final heartbeats. There is no prior documentation of this observation in the literature. We hereby illustrate and characterize this observation we term as Hemostatic Instantaneous Coagulation on Echo (HICE). HICE may be the defining feature of the dying heart and may guide the decision to discontinue resuscitation interventions.</p>Tokunbo David GbadeboDaniel Antwi-AmoabengAdemola Abiose
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421Knowledge, attitude and premarital screening practices for sickle cell disease among young unmarried adults in an urban community in Lagos, Nigeria
https://www.ajol.info/index.php/pamj/article/view/238118
<p><strong>Introduction: </strong>sickle cell disease (SCD) refers to a group of inherited blood disorders that are life-long and affect many people globally. An estimate of 2.3% of the Nigerian population suffer from SCD and about 25% of adults have the sickle cell gene. Premarital screening for sickle cell gene is considered one of the methods of preventing new births of children with SCD among the young adults. The study assessed the knowledge, attitude, willingness to take premarital screening test for SCD and factors influencing knowledge among young unmarried adults in an urban community in Lagos, Nigeria. <strong>Methods: </strong>the study was cross-sectional descriptive among 300 respondents who were selected using multistage sampling technique. Data were collected using a pre-tested, interviewer-administered questionnaire and analyzed using SPSS software, version 25. Univariate and bivariate analysis were conducted with level of significance at p ≤ 0.05. <strong>Results: </strong>the mean age of respondents was 21.2± 3.5 years, and most 188 (62.7%) were males. About 139 (46.3%) and 165 (55.0%) of the respondents respectively had good knowledge and positive attitude towards SCD and premarital screening. Only 43% of the respondents knew their haemoglobin phenotype, however, majority (92.4%) were willing to have Hb phenotype test done. Knowledge of SCD and premarital screening was statistically significant with age, level of education and occupation of respondents (p<0.001). <strong>Conclusion: </strong>this study found less than half of the respondents with good knowledge, about half had positive attitude and poor premarital screening practices of SCD. Therefore, community-based health education and awareness programs on SCD and premarital screening among young adults is recommended.</p>Esther Oluwakemi OluwoleChibuike Davidson OkoyeAdedoyin Oyeyimika OgunyemiOlusola Festus OlowoseluOlufemi Abiola Oyedeji
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421Connaissances, attitudes et pratiques relatives à la cataracte et au glaucome dans la population de Conakry en Guinée
https://www.ajol.info/index.php/pamj/article/view/238121
<p><strong>Introduction: </strong>le but de ce travail est d´évaluer les connaissances, attitudes et pratiques (CAP) relatives à la cataracte et au glaucome dans la population de Conakry Guinée. <strong>Méthodes: </strong>nous avions mené une étude prospective de type descriptif et analytique de trois mois à la clinique Bartimée. Etaient inclus, les patients qui ont accepté de répondre à notre questionnaire et ayant un âge≥18 ans. Les questions CAP sur cataracte et glaucome leur étaient posées. Les niveaux de connaissance ont été corrélés à l´âge, au sexe et au niveau d´instruction. <strong>Résultats: </strong>au total, 1000 personnes ont participé à l´étude. Le sex-ratio était de 1,10 et l´âge moyen 42,41 ans ± 21,74. Les Hommes de métiers étaient plus représentés 2,80%; 45,10% était analphabète; 47,50% avaient un très bon niveau de connaissance; 59,10% des patients savaient que le traitement de la cataracte est chirurgical. Pour le glaucome: 55,80% des patients pensaient que le traitement est chirurgical. Face à la cataracte et au glaucome 51,90% avaient déclaré partir à l´hôpital, 38,80% iront consulter un guérisseur traditionnel et 9,30% feront une automédication. Il existait un lien significatif entre l´âge, le sexe et le niveau d´instruction avec les connaissances sur la cataracte et le glaucome. <strong>Conclusion: </strong>à Conakry, les CAP sur la cataracte et le glaucome sont moins satisfaisantes. Des stratégies de sensibilisation devraient être entreprises pour améliorer ses résultats.</p>Maxime Dantouma SovoguiPierre Louis LamahChristophe ZoumaniguiTamba Elie TolnoKokou Vonor
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421Surgical excision of vaginal cysts presenting as pelvic organ prolapse: a case series
https://www.ajol.info/index.php/pamj/article/view/238125
<p>Vaginal cysts are rare, benign, predominantly cystic lesions of the anterior vaginal wall, with a prevalence of 1 in 200 women. Large vaginal cysts can occasionally present as symptomatic genital prolapse; these cases may be challenging to diagnose due to their rare clinical appearance. In symptomatic large vaginal cysts, surgical excision via vaginal approach is the recommended management with good anatomical results and patient satisfaction. The series of three consecutive adult women were referred for bothersome bulging prolapse. They were found to have a sizeable vaginal cyst at the anterior wall, associated with other symptoms. All patients (mean age 37±8.5 years) underwent total trans-vaginal surgical excision of the lesion. They were followed up in the out-patient department at six weeks and six months with no recurrences mentioned. Vaginal cysts are usually solitary, small, and asymptomatic; however, they can increase in size, easily mimic other pathologies, and are misdiagnosed as cystocele. Therefore, complete surgical vaginal excision of the symptomatic vaginal lesion is feasible and constitutes a good management option.</p>Sofia TsiapakidouIakovos Theodoulidis Grigoris GrimbizisThemistoklis Mikos
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421Anencephaly: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/238131
<p>Anencephaly is a lethal fetal neurological malformation. This malformation accounts for 40% of neural tube malformations. The diagnosis is based on the ultrasound of the first trimester between the 11<sup>th</sup> and the 14<sup>th</sup> weeks of amenorrhea by discovering an exencephaly which results in the visualisation of the ossification of the cranial box and, therefore, the impossibility of measuring the biparietal diameter. Here we present the case of anencephaly; a female patient comes to the gynaecology department for the delivery on the ultrasound sonography test (USG) examination to know the health status of the fetus show anencephaly. On the second day, patient delivery was done, and the patient´s newborn child was seen with low set ears and protruded eyeballs.</p>Mayur Bhaskar WanjariTejaswee Lohakare
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421Two-week prevalence of acute diarrhea and associated factors among under five years' children in Simada Woreda, South Gondar Zone, Northwest Ethiopia, 2021: a multi-central community based cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/238133
<p><strong>Introduction:</strong> even if there were different control and prevention strategies were implemented in worldwide in general and in Ethiopia in particular. Diarrheal disease was still one of the top ten leading causes of morbidity. Hence, this study aims to assess prevalence and associated factors of acute diarrhea among under five years' children in Simada District, Ethiopia, 2021.<strong>Methods:</strong> community based cross-sectional study design, simple and systematic random sampling technique was used to select 8 kebeles and 717 study unit respectively from August 1-15 /2021 in Simada District. Data were analyzed by Statistical Package for Social Science (SPSS), version 25. Binary logistic regression model was used to measure the association between dependent and independent variables. Bi-variables analysis at P < 0.05 was used to select independent variable to multi variable analysis. <strong>Results:</strong> two-week prevalence of acute diarrhea was 14.5% (CI: 12.3%-17.3%). Mothers/caregivers child whose latrine was not clean (AOR=11.48(5.64-23.35)). Mothers/caregivers who had not handwashing facility (AOR=7.07(3.84-13.03)), mothers/caregivers who did not practice handwashing at critical time (AOR=5.92(2.58-13.70), mothers/caregivers who store water at home by jerican (AOR=8.6 (1.51-48.84)), and mothers/caregivers child who start supplementary feeding before six months (AOR=6.49(2.01-20.96)) had significant association with acute diarrhea morbidity. <strong>Conclusion:</strong> two-week prevalence of acute diarrhea was low. Latrine cleanness, availability of handwashing facilities around latrine, handwashing practice at critical time for handwashing, knowledge on diarrhea transmission and prevention methods, storage of water by jerican and time of initiation of supplementary food had determinant factor of diarrheal disease's occurrence.</p>Dejen Getaneh FelekeErmias Sisay ChanieFitalew Tadele AdmasuShimels BahirAbraham Tsedalu AmareHailemichael Kindie Abate
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421Characterization and drug susceptibility pattern of Salmonella and Shigella in children below five years: a cross-sectional study conducted in Lodwar, Turkana County, in Northern Kenya
https://www.ajol.info/index.php/pamj/article/view/238137
<p><strong>Introduction:</strong> <em>Salmonella</em> and <em>Shigella</em> infections are waterborne associated infections globally known to cause serious illnesses in all age groups, but can be more devastating in children below five years. Antimicrobial resistance has been known to worsen the existing challenge in the management of <em>Salmonella</em> and <em>Shigella infections</em>. The aim is to isolate and identify <em>Salmonella</em> and <em>Shigella</em> among children less than five years with diarrhea and to determine resistance to commonly prescribed drugs at the Lodwar County and Referral Hospital in Northern Kenya. <strong>Methods:</strong> using a cross-sectional study design, a descriptive experimental study was conducted on 196 children with diarrhea using rectal swabs. A structured questionnaire was used to collect sociodemographic information. Samples were then received in the microbiology laboratory, and macroscopic and microscopic examinations were done before culture on specific selective media. Thereafter, biochemical confirmation of the growths done then confirmed results tabulated before analysis. <strong>Results:</strong> from the total samples collected (196) <em>Shigella dysenteriae</em> cases were 4 (5%), while <em>Shigella Flexneri</em> were 7 (9%), <em>Shigella sonnei</em> were 3 (4%), <em>Shigella boydii</em> were 4 (5%) and <em>Salmonella typhimurium</em> were 2 (2.4%). From these, about 70% of the isolated <em>Salmonella</em> and <em>Shigella</em> demonstrated high antibiotic resistance to Amoxilliclav and Ampicillin, both with high minimum inhibitory concentrations (MICs) values of about 8ug/ml. While over 80% drug susceptibility was noted in Amikacin (1ug/ml), Ciprofloxacin (2ug/ml), Ceftriaxone (4ug/ml) and Ceftazidime (4ug/ml). <strong>Conclusion:</strong> <em>Salmonella</em> and <em>Shigella</em> are among the common contributors of diarrhea among children less than five years. Drug resistance among the commonly used antibiotics is a serious indicator that possible misuse of antibiotics especially the beta lactam penicillin's.</p>Simion Kipchirchir LetingStanslaus Kiilu MusyokiGeoffrey Kattam Maiyoh
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421Clofazimine induced pigmentation in leprosy patches
https://www.ajol.info/index.php/pamj/article/view/238142
<p>Leprosy is a neurocutaneous infectious disease with a highest prevalence in African region in the world. With the introduction of newer monitoring strategies of identifying the cases and multidrug therapy the overall global burden of leprosy has reduced. However, early detection and treatment is still important in leprosy due to the rapidly developing nerve damage by the bacteria and the associated disability. Here, presenting a case of a 65-year-old male patient of leprosy in borderline pole, with complaint of hyperpigmentation over back, chest and arm in a ring like pattern from past 4 months. Patient has been on WHO multibacillary multidrug regimen (Rifampicin=600mg once a month, Clofazimine=100mg once a month + 50mg daily dose, Dapsone=100mg daily). On starting the treatment patient started noticing resolution in thickness of the lesion along with appearance of reddish-brown color of the lesion. On cutaneous examination, multiple geographic and annular patches with central clearing and shiny coppery reddish brown pigmentation in the peripheral margin of the lesion is seen. This case exemplifies the lesional hyperpigmentation, secondary to accumulation of ceroid lipofuscin pigment and Clofazimine inside the macrophage phagolysosome. Also, only marginal pigmentation with central clearing attributes to the punched-out lesion of the borderline lepromatous leprosy primarily which on histopathology typically shows presence of macrophage granuloma. Clofazimine induced pigmentation is reversible but takes months to years to clear after stopping the drug. As a dermatologist with leprosy moving towards elimination monitoring and managing the adverse effect of treatment and course of the disease is important.</p>Samiksha Deepak ChavhanSugat Jawade
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421Negative-pressure pulmonary edema after mammoplasty: a case report
https://www.ajol.info/index.php/pamj/article/view/238145
<p>Negative-pressure pulmonary edema (NPPE) is a rare but life-threatening postoperative complication that occurs due to the acute obstruction of the upper airway. In our case report, we present a 25-year-old female patient who underwent elective mammoplasty under general anesthesia and developed NPPE 4 hours after extubation. The patient had a preoperative mallampati score of 3. After routine anesthesia induction, the patient was intubated with an endotracheal tube with a guide wire. Aspiration wasn't observed during extubation. The patient was followed in the post-anesthesia care unit (PACU) for 30 minutes with a saturation of 95% and was subsequently transferred to the service. Four hours after the operation, the patient was re-examined due to dyspnea and shortness of breath. Due to oxygen saturation of 88% and pO<sub>2</sub> of 56mmHg despite mask ventilation, the patient was admitted to the intensive care unit (ICU). A computed tomography (CT) scan revealed extensive diffuse ground-glass opacities and consolidations in both lungs. She did not respond to mask ventilation and was given non-invasive ventilation with continuous positive airway pressure (CPAP). Forced diuresis was induced with furosemide. Tachypnea resolved within 2 hours after CPAP was initiated, the patient did not require oxygen support and COVID-19 polymerase chain reaction (PCR) testing was negative. Subsequently, the patient was discharged to the clinical ward on postoperative day 1. When considering NPPE, early diagnosis and respiratory support are associated with reduced mortality and rapid recovery. Patients who develop laryngospasm during extubation must be closely monitored, and in the case of pulmonary edema, NPPE should be considered in the differential diagnosis.</p>Didem OnkOnur IşıkFaruk SubaşıSoner KaraaliUfuk Kuyrukluyıldız
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421The putty kidney: a classic sign from past in genitourinary radiology
https://www.ajol.info/index.php/pamj/article/view/261224
<p>A 56-year-old woman with known genitourinary tuberculosis (GUTB) presented for follow-up evaluation with Computed Tomography (CT). Her urine referred acidic with few pus cells, but sterile on culture. Other laboratory tests were normal. A pigtail catheter is also referred to the left kidney. X-ray (actually CT-topogram) kidney, ureter and bladder (KUB) show multiple lobulated calcifications in the right renal region conglomerated into the shape of the kidney. This imaging finding were suggestive of the classical “putty kidney sign” of an end stage renal tuberculosis (TB). Radiological findings in renal TB depend on the extent of the disease process and are best demonstrated both on intravenous urogram and CT scan. Describing the condition, it is an extensive parenchymal calcification in a non-functioning kidney, forming its cast. The “putty kidney” or “autonephrectomy” is the end result of scarring, obstruction, and atrophy of the kidney due to TB which is complicated by dystrophic calcification with time. Tuberculosis of the kidney results from hematogenous seeding of M tuberculosis in the glomerular and peritubular capillary bed from primary pulmonary infection. Disease´s physiopathology and/or progression includes granuloma formation which causes necrosis with cavitation within the renal parenchyma, fibrosis, calcium deposition and stricture formation. Diagnosis of GUTB based on biochemical workup is often delayed and high index of suspicion required to avoid misdiagnosis. Thus, imaging has an important role in diagnosis. The present X-ray KUB and CT is a classic example of such “putty kidney” which first described in 1906 by Dr. F.Tilden Brown, a genitourinary surgeon.</p>Savas DeftereosSoultana Foutzitzi
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2023-12-192023-12-19421Dysplasie septo optique plus: à propos d´un cas
https://www.ajol.info/index.php/pamj/article/view/238508
<p>La dysplasie septo optique plus est une pathologie rare qui se voit chez l´enfant. Son diagnostic est radiologique, reposant sur l'imagerie par résonnance magnétique (IRM) cérébrale. Nous rapportons le cas d´un enfant âgé de 2 ans et 4 mois, sans antécédents pathologiques particuliers, qui a consulté pour un retard psycho moteur, un strabisme et des comportements de malvoyance. Un bilan biologique endocrinien explorant la fonction hypothalomo-hypophysaire a été réalisé, ne révélant pas d´anomalie. Le diagnostic de dysplasie septo-optique plus a été retenu sur les données de l´IRM encéphalique, devant l´agénésie du septum pellucidum et du splénium du corps calleux, l´hypoplasie des voies optiques et de la tige pituitaire ainsi que devant l´agénésie de la post hypophyse. Il s´y associait une schizencéphalie fermée. La dysplasie septo-optique est une malformation congénitale rare. Notre objectif est de rappeler sa sémiologie en imagerie et de souligner l´importance de l´IRM pour établir le diagnostic. La dysplasie septo-optique est une entité clinique rare associant classiquement des anomalies encéphaliques de la ligne médiane, une hypoplasie des nerfs optiques et une insuffisance hypophysaire. L´association à des malformations corticales comme la schizencéphalie et la polymicrogyrie désigne le terme dysplasie septo-optique plus. Les progrès de l´imagerie permettent actuellement un diagnostic précoce, ce qui est primordial pour une prise en charge adéquate. L´échographie anténatale peut suspecter la dysplasie, et l´IRM encéphalique confirme le diagnostic.</p>Lamiaa Chahidi El OuazzaniAbdelhamid JadibDalal LaoudiyiSara YoussefKamilia ChbaniSiham SalamLahcen Ouzidane
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421Predictors and time to recovery from COVID-19 among patients attended at the treatment centers in Ekiti State, South West, Nigeria
https://www.ajol.info/index.php/pamj/article/view/238518
<p><strong>Introduction: </strong>time to clinical recovery from COVID-19 infection and associated factors has not been explored in Nigeria. This study was conducted to assess the predictors and time to recovery from COVID-19 among patients attended to at the treatment centers in Ekiti State, South West. <strong>Methods: </strong>a facility-based retrospective cohort study was conducted between March 2020 to October 2021. Laboratory confirmed COVID-19 positive test result of 586 patients receiving treatment at the treatment centres in Ekiti were included. Data were extracted from COVID-19 intake forms and medical records of patients. Data were analysed using descriptive statistics and survival analysis methods including Cox proportional hazards regression model. Level of significance was set at 5%. <strong>Results: </strong>the mean age of the patients was 43.46 (SD 0.74) years. Forty-seven percent (47%) of the patients were aged 25-44 years, fifty-one percent (51%) were males. The median recovery time of COVID-19 patients was 21 days (IQR: 14-23). Being a male-patient (95% CI 20.46-21.54), older age (95% CI 20.14-21.86), not admitted in the hospital (95% CI 22.74-23.26), and associated multiple co-morbidities (95% CI 17.65-28.35) were associated with delayed recovery time. Predictors of recovery time of patients from COVID-19 infection were admission status (aHR:0.71, 95%CI 0.56-0.88; p=0.002) and symptoms on admission (aHR:0.81, 95%CI 0.66-0.99; p=0.020). <strong>Conclusion: </strong>patients with comorbidities, older and those not admitted were more likely to have a delayed clinical recovery from COVID-19. Knowledge of the predictors might help health professionals in risk stratification and better management of patients with COVID-19.</p>Oluwabunmi Samuel IbitoyeYusuff Akinkunmi OlasunkanmiTubosun Alex OlowolafeAderemi Temitayo OlabodeMobolaji Modinat SalawuRotimi Felix Afolabi
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421The magnitude of type 2 diabetes mellitus and cardiovascular disease risk factors among young adults in urban settings: a cross-sectional survey in Mwanza, Tanzania
https://www.ajol.info/index.php/pamj/article/view/238521
<p><strong>Introduction: </strong>traditionally, non-communicable diseases were diseases of public health concern in developed countries. Due to economic transition, they are becoming more prevalent in low and middle-income countries. Despite the trend, little has been done in the population of young adults of developing countries. This research aimed to explore the magnitude of type 2 diabetes mellitus, hypertension, dyslipidemia, and abdominal obesity among the young adult population in an urban setting of Tanzania. <strong>Methods: </strong>the current research used a cross-sectional community-based design, involving apparently healthy young adults aged 18 to 34 years, not known to have diabetes, hypertension, or dyslipidemia. Data on socio-demographic characteristics, medical history, anthropometry, blood pressure, and lipids were obtained per standard operating procedures and analyzed using STATA 13. Association between outcome variables (type 2 diabetes mellitus, hypertension, dyslipidemia, and abdominal obesity) and predictor variables (age, sex, education level, occupation, and economic status) were assessed by logistic regression. <strong>Results: </strong>245 young adults with a median age of 21 (interquartile range [IQR]:18-25) were recruited. Prevalence of diabetes mellitus and of impaired glucose tolerance (IGT) were 7.8% and 15.5% respectively. Abdominal obesity and dyslipidemia were present in 11.8% and 45.1% respectively. 34.3% had hypertension and the risk was significantly higher in males compared to females (OR 1.8, 95%CI 1.1, 3.1). The atherogenic coefficient was significantly associated with abdominal obesity; other atherogenic indices did not show significant associations with current disease conditions. <strong>Conclusion: </strong>alarmingly high prevalence of diabetes mellitus, impaired glucose tolerance, hypertension, abdominal obesity, and dyslipidemia were observed among young adults in Mwanza. This study highlights the need for concerted efforts for interventions targeting young adults in combating diabetes and cardiovascular disease (CVD) risk factors in Tanzania.</p>Evangelista Kenan MalindisaEmmanuel BalandyaFredirick MashiliShabani IddiMarina Njelekela
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421Prevalence, complications and factors associated with severely elevated blood pressure in patients with hypertension: a cross-sectional study in two hospitals in Yaoundé, Cameroon
https://www.ajol.info/index.php/pamj/article/view/238523
<p>Introduction: severely elevated blood pressure<br>significantly increases cardiovascular morbidity and<br>mortality in hypertensive Black patients. The<br>objective of this study was to determine the<br>prevalence, complications and factors associated<br>with severe high blood pressure in hypertensive<br>patients in Yaoundé, Cameroon. Methods: we<br>conducted a cross-sectional study in the outpatient<br>and cardiology units of two teaching hospitals in<br>Yaoundé. We included consenting hypertensive<br>patients aged over 18 years. We first measured<br>their blood pressure (BP), then we collected their<br>sociodemographic data, cardiovascular risk factors,<br>follow-up data, and ended with a complete physical<br>examination. We performed a regression analysis<br>to assess correlates of severe hypertension. Results:<br>we included a total of 153 patients with 33 (21.6%)<br>of them having severe hypertension. Among the 33<br>patients, 16 (48.5%) were male and 17 (51.5%) were<br>female. Their mean age was 60.52 ± 12.83 years.<br>Chronic kidney disease (78.8%), hypertensive<br>retinopathy (69.7%) and left ventricular<br>hypertrophy (48.5%) were the most common<br>complications. On multiple logistic regression<br>analysis, inadequate follow-up was independently<br>associated with severe hypertension (adjusted<br>OR=7.09; 95% CI [2.29-21.9]). Conclusion: severely<br>elevated BP is common among hypertensive<br>patients in our setting with important physical and<br>economic consequences. Increased patients<br>awareness and improving access to primary care<br>physicians and cardiologists, through health<br>insurance or other means, may be an effective<br>strategy for reducing cardiovascular morbidity and<br>mortality among hypertensive Black patients.</p>Jérôme BoombhiJoel Gabin Konlack MekontsoChris-Nadège Nganou-GnindjioEdwige Lea Nzoyem De HedzoGuy Loic Nguefang TchoukeuUlrich Igor Mbessoh KengneFabrice Ndzernyuy Dubilaabrice Leo Tamhouo NwaboYves Alain NotueYannick Kevin Tchiffo Foppa Alain Patrick Menanga
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2022-05-102022-05-10421Rapidly progressive glomerulonephritis in two Zambian children: a case report
https://www.ajol.info/index.php/pamj/article/view/238532
<p>Rapidly progressive glomerulonephritis (RPGN) is a rare syndrome which is marked by a sudden rise in serum creatinine and the presence of crescents on renal biopsy. If appropriate and timely treatment is not instituted, as many as 90% of affected patients may develop End Stage Renal Disease (ESRD). There is only limited access to renal replacement therapy in many low resource countries, thus it is important that awareness of this entity is raised. We narrate the clinical course of two children who were admitted with rising serum creatinine, hypertension and haematuria and who were subsequently diagnosed with crescentic glomerulonephritis on biopsy. Despite having received immunosuppressive therapy, both children had a poor renal outcome, perhaps due to delays in institution of appropriate treatment. It is imperative that all clinicians who manage children are made aware of this clinical syndrome so that timely referrals to nephrology are done. This will help to improve renal outcomes.</p>Chisambo MwabaChibamba Ngomalala MumbaMusyani SimukondeSomwe Wa Somwe
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2022-05-102022-05-10421Learning about cardiac arrest from 'Dr. Google': a pre- and peri-pandemic infodemiology study in Nigeria
https://www.ajol.info/index.php/pamj/article/view/238534
<p><strong>Introduction: </strong>the coronavirus pandemic and associated lockdowns restricted movement with non-essential hospital trips discouraged to prevent spread of the virus. Disruption of medical services can lead to increased seeking of medical advice and symptom management online. With COVID-19 known to worsen existing cardiovascular disease or precipitate a new one, we sought to explore online search trends of the Nigerian public regarding cardiac events before and during the COVID-19 pandemic. <strong>Methods: </strong>using Google Trends™, relative search volume for the terms 'cardiac arrest', 'heart attack', and 'heart arrest' were analyzed for the periods 27<sup>th</sup> February to 30<sup>th</sup> September in 2019 and 2020 respectively. Descriptive statistics, Mann-Whitney U test for relative search volume, search terms comparison in both years and Kendall´s correlation coefficient for examining relationships between time frames and search terms were used. <strong>Results: </strong>searches for terms 'heart attack' (p<0.001) and 'heart arrest' (p=0.01) were higher in 2020 compared to 2019, with a correlation between searches for 'cardiac arrest' and 'heart arrest' (p<0.001) and between 'heart attack' and 'heart arrest' (p=0.01). There was a strong positive correlation between search for 'heart attack' in 2019 and 2020 (tau b=0.35, p<0.001); and a moderate positive correlation for 'heart arrest' (tau b=0.13, p=0.01). <strong>Conclusion: </strong>increased online activity relating to cardiac arrest was recorded during the early months of the pandemic when compared to the year prior. Notable increases in search activity aligned with the timing of heart-related illnesses and deaths of Nigerian celebrities during the pandemic. Further understanding of health-related online search activity in Nigeria could inform the development of health promotion interventions and support health-related information seeking for cardiovascular diseases.</p>Tonia Chinyelu OnyekaIjeoma Uchenna ItanyiHilary Uchenna EzugwuMatthew Allsop
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2022-05-102022-05-10421Dietary iron intakes and odds of iron deficiency anaemia among pregnant women in Ifako-Ijaiye, Lagos, Nigeria: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/238578
<p><strong>Introduction: </strong>iron deficiency anaemia (IDA) in pregnancy is a prominent risk factor for maternal mortality and poor pregnancy outcomes in low- and middle-income countries, but studies on the significance of dietary iron intake (DII) in IDA in this population are limited. This study assessed the association of DII with odds of IDA among pregnant women attending primary health centres in Ifako-Ijaiye, Lagos, Nigeria. <strong>Methods: </strong>sociodemographic information and dietary intakes were assessed among 432 singleton pregnant women (without pre-existing medical complications) using a pre-tested questionnaire and 24 hr-dietary recall, respectively. Dietary iron intake (DII) was derived from the 24 hr-dietary recall using the West African food composition table. Haemoglobin (Hb) levels in blood samples were measured using the haemoglobin-cyanide technique, and IDA was defined using the World Health Organization criteria. Multivariable-adjusted odds ratios (OR) of IDA and 95% confidence intervals (CI) by energy-adjusted tertiles of DII were estimated using logistic regression with a two-sided P<0.05. <strong>Results: </strong>mean age of respondents was 28.5 ± 4.6 years, and the average gestational age was 31.3 ± 4.1 weeks. Mean DII was 20.3 ± 3.3 mg/day, and Hb concentration was 97.9 ± 12.9 g/L. Furthermore, 83.8% had IDA and multivariable-adjusted OR and 95% CI for odds of IDA across tertiles of energy-adjusted DII were 1.00, 0.32 (0.05, 1.77), 0.07 (0.01, 0.36) P for trend < 0.0001 adjusting for age, primigravidae status and monthly income. <strong>Conclusion: </strong>higher DII was inversely associated with the odds of IDA among pregnant women. Behavioural change communication promoting the consumption of iron-rich foods might be a viable dietary strategy to alleviate the high burden of IDA among women in this population.</p>Temitope Elizabeth AdeboyeIfeoluwa Omolara BodundeAkinkunmi Paul Okekunle
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2022-05-112022-05-11421Mandibular nerve schwannoma: a case report
https://www.ajol.info/index.php/pamj/article/view/238580
<p>Benign schwannomas are uncommon and their intraosseous location is even rarer counting for less than 1% of all benign primary bone tumors. They exceptionally occur in the oral cavity with the tongue being the most common site of involvement. We report here a case of intramandibular schwannoma derived from the inferior alveolar nerve, in a 57-year-old patient with a 3 months history of inferior left lip paresthesia. The oral examination showed a firm, painless and non-pulsatile swelling located in the inferior vestibule. The panoramic X-ray revealed a circumscribed and homogeneous radiolucent image. Treatment consisted of total excision of the tumor with preservation of the nerve bundles. The histological examination confirmed the diagnosis of schwannoma. The patient recovered a normal sensory function 6 months post-operatively without any recurrence up to 2 years after surgery. The treatment of intramandibular schwannoma is basically surgical with the conservative approach being the most advocated by majority of authors.</p>Jinane KharbouchZakaria AzizMohamed LahrachSalma AboulouidadMohamed El BouihiNadia Mansouri Hattab
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2022-05-112022-05-11421Deep vein thrombosis after insertion of a central venous catheter: a case report
https://www.ajol.info/index.php/pamj/article/view/238583
<p>A male patient aged 50 years, presented with a swelling in the right leg which had occurred five days before hospital admission. This was associated with pain in the swollen leg. The patient had a history of femoral double lumen catheter (DLC) insertion for hemodialysis. On physical examination, Wong Baker's scale was 3, Wells' score was 3, and the patient had edematous, red, and warm right lower extremity. Laboratory results showed anemia (Hb 11.4 g/dl), leukocytosis (27.99 x 10<sup>3</sup>/ul), increased blood urea nitrogen (BUN) (60 mg/dl), increased serum creatinine (9.93 mg/dl), hyperkalemia (6 mmol/l), urine leukocytes +3; 15-20/hpf. Lower extremity ultrasound revealed diffuse deep vein thrombosis (DVT). After the diagnosis of DVT, the patient was treated with fondaparinux injection and warfarin as an anticoagulant for six days. Our results show that treatment was effective in reducing swelling and pain in the right leg, that disappeared after a three months´ treatment.</p>Ihdinal MuktiArtaria Tjempakasari
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2022-05-112022-05-11421Rare metastatic sites of renal cell carcinoma: a case series
https://www.ajol.info/index.php/pamj/article/view/238586
<p>Renal Cell Carcinoma (RCC) is a lethal cancer with a propensity for wide metastasis. The patterns of metastases are not clearly defined, and patients can present with metastasis to unusual sites at the time of diagnosis of the primary tumor or years after radical nephrectomy. Individual diagnostic and surgical approaches are needed to achieve complete resection with disease-free margins, even in the presence of unusual metastatic sites, multifocality, or history of previous metastasectomy. This provides palliation for symptoms and an opportunity for meaningful disease-free and overall survival. Here we present five cases of RCC with metastasis to unusual sites (scalp, jaw, forearm, parotid, breast, and skeletal muscle). Patients were treated with cytoreductive nephrectomy and/or metastasectomy wherever feasible and/or targeted therapy. In conclusion, a high index of suspicion and accurate diagnosis is important as metastasis to unusual sites presents with atypical manifestations and may masquerade as local pathology, misleading the clinician and directly affecting prognosis and survival.</p>Anurag SinglaUmesh SharmaArun MakkarPirzada Faisal MasoodHemant Kumar GoelRajeev SoodArvind AhujaRavikant Singh
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2022-05-112022-05-11421Effect of intrauterine administration of human chorionic gonadotropin one day before fresh blastocyst transfer on clinical outcomes: a quasi-experimental study
https://www.ajol.info/index.php/pamj/article/view/238590
<p><strong>Introduction:</strong> embryo implantation is a crucial step for assisted reproductive technology (ART) achievement. Human chorionic gonadotropin (hCG) is one of the main regulators of the implantation process. Studies focusing on the impact of intrauterine hCG infusion at the time of embryo transfer on clinical ART outcomes have shown controversial results, mainly at blastocyst stage. In this study, we aimed to investigate whether intrauterine hCG infusion one day before human blastocyst transfer in fresh invitro fertilization (IVF) cycles enhances implantation and pregnancy rates. <strong>Methods:</strong> a total of 174 subfertile women undergoing autologous fresh blastocyst transfer were enrolled in this randomized prospective study. Patients were randomly divided into three groups; group 1 (n = 54) and group 2 (n = 59) received an intrauterine injection of respectively 500 IU and 1000 IU of hCG one day before blastocyst transfer and the control group (n= 61) did not receive any intrauterine injection. The pregnancy and implantation rates were compared between the three study groups. <strong>Results:</strong> no significant difference was found between the study groups. The bio chemical pregnancy rates were 25.9%, 30.5% and 29.5%, the clinical pregnancy rates were 24.1%, 27.1% and 27.9% and the implantation rates were 14.9%, 17.9% and 18.7% respectively in group 1,2 and control group. <strong>Conclusion:</strong> our results have shown that clinical outcomes in fresh IVF cycles cannot be improved through intrauterine hCG administration one day prior to blastocyst transfer, neither with 500 IU of hCG nor with a higher dose of 1000 IU of hCG.</p>Henda MustaphaMarwa LahimerMehdi MakniOns KaabiaMouna DerouichMohamed Aymen FerjaouiRamzi ArfaouiMonia ZaoualiMounir Ajina
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2022-05-122022-05-12421National and subnational variations in gender relations and the utilization of maternal healthcare services in Nigeria
https://www.ajol.info/index.php/pamj/article/view/238593
<p><strong>Introduction: </strong>poor maternal health outcomes remain a major public health issue in Nigeria. These have been shown to be affected by the low level of utilization of maternal healthcare services. This study investigates the levels of gender relations (GR) among Nigerian women and how these influence their utilization of maternal healthcare services. The relations are conceptualized as feminine (FGR), masculine (MGR) and egalitarian. <strong>Methods: </strong>data on household decision-making, antenatal care (ANC) visits, health facility delivery, and associated sociodemographic variables, were extracted from the 2018 Nigeria Demographic and Health Survey for 29,992 parous women aged 15-49 for a cross-sectional study. Associations were investigated using Chi-Square and regression analyses. <strong>Results: </strong>women with FGR constituted 5.7% of the population at the national level, while subnational variations ranged from 1.8% in the North-East to 12.8% in the South-South regions. The prevalence rates of the recommended minimum ANC visits (RMANC) and health facility delivery were 42.1% and 30.0% at the national level and were lowest in the northern regions. At both the unadjusted and adjusted levels, FGR was not significantly associated with RMANC and health facility delivery at the national level and in all the regions except the South-West. MGR was however significantly associated with increased odds of RMANC (OR: 2.235, CI: 2.043-2.444) and health facility delivery (OR: 2.571, CI: 2.369-2.791) at national level. Significant subnational variations in the association between gender relations and the utilization of maternal healthcare services were also recorded. <strong>Conclusion: </strong>sub-national variations in GR and their varying impacts on the utilization of maternal healthcare services in Nigeria suggest that gender-related policies to improve maternal health outcomes should be location-specific, rather than general. As FGR did not affect maternal healthcare services utilization, educating men on the benefits of supporting their wives to scale-up utilization is recommended.</p>Yemi AdewoyinClifford Obby OdimegwuTheresa BasseyOlukemi Funmilayo AwelewOluwakemi Akintan
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2022-05-122022-05-12421Rechute mammaire isolée d’un lymphome de Hodgkin: à propos d’un cas rare
https://www.ajol.info/index.php/pamj/article/view/242775
<p>La localisation mammaire isolée d´un lymphome de hodgkin est rare. Elle peut prêter à confusion avec les autres néoplasies et affections inflammatoires mammaires. Nous rapportons le cas d´une patiente âgée de 18 ans traitée pour lymphome de hodgkin à cellularité mixte, qui s´est présenté 6 mois après la rémission complète pour un nodule mammaire inflammatoire gauche. Le bilan anatomopathologique initial a été en faveur d´un abcès mammaire. Les investigations face à l´évolution défavorable malgré une antibiothérapie adaptée ont été en faveur d´une rechute du LH avec une localisation mammaire isolée. La patiente est actuellement sous 4<sup>ème</sup> ligne thérapeutique (polychimiothérapie). Les lymphomes hodgkiniens mammaires sont connus par leur pronostic défavorable. Les progrès thérapeutiques (thérapie ciblée) peuvent améliorer le devenir des patientes.</p>Najat LasriFatimazahra LahlimiMohammed Ilias Tazi
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2022-05-122022-05-12421Cancer du sein triple négatif: particularités anatomo-cliniques et moléculaires
https://www.ajol.info/index.php/pamj/article/view/242777
<p>Le cancer du sein triple-négatif (CSTN) représente un sous-groupe de cancers du sein très hétérogène. L´objectif de notre étude était de détailler les caractéristiques anatomo-cliniques et moléculaires du CSTN et les comparer aux données de la littérature. Notre travail consistait en une étude rétrospective menée au service d´Anatomie et Cytologie pathologiques du CHU Farhat Hached de Sousse entre janvier 2018 et décembre 2020 ayant porté sur 56 cas de CSTN. Sur le plan épidémio-clinique, on a noté une incidence de 5,62% avec un âge moyen des patientes de 50,36 ans. La découverte d´un nodule du sein était le motif de consultation le plus fréquent (98,21%). Le diagnostic de CSTN était documenté dans 24 cas (42,86%) sur des pièces de mastectomie. Le type histologique le plus fréquent était le carcinome infiltrant de type non spécifique dans 47 cas soit 82,5 %. La taille tumorale moyenne était de 35,5 mm avec des extrêmes de 2 et 120 mm. Le grade SBR III était le plus prédominant dans notre étude (78,6%). Les tumeurs étaient classées T2 dans la majorité des cas (65,38%). Les ganglions régionaux ont été classés N0 chez la majorité des patientes (61,53%). Les analyses génomiques du CSTN ont permis d´adapter des conduites thérapeutiques d´une manière efficace. Toutefois, il n'y a pas encore un test diagnostique établi ou vérifié cliniquement pour la classification de CSTN et donc une standardisation d´une approche thérapeutique claire.</p>Seifeddine Ben HammoudaNihed AbdessayedNouha Ben AbdeljelilHajer HanchiDorra H´midaMoncef Mokni
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2022-05-122022-05-12421Health research publications by South African authors from 1996 to 2015: a bibliometric analysis
https://www.ajol.info/index.php/pamj/article/view/242780
<p><strong>Introduction: </strong>research publications have a vital role in the scientific process, providing a strategic connection between the generation of new knowledge and its conversion into policy, practice, and positive health outcomes. There was a substantial increase in research funding in South Africa from the dawn of multi-party democracy in the mid-1990s to 2015. However, it is not known whether there was a corresponding increase in research publications from the country. Therefore, the objective of this bibliometric study was to assess trends and factors associated with health research publications from South Africa between 1996 and 2015. <strong>Methods: </strong>in July 2016, we searched Scopus for health science articles published between 01 January 1996 and 31 December 2015 with at least one author affiliated to an institution based in South Africa. We sought annual data on national-level indicators from Statistics South Africa and World Bank data. We used Poisson regression to examine trends in publication outputs and negative binomial regression to explore national-level factors associated with a change in the number of publications over time. <strong>Results: </strong>we identified 51,133 publications, with a mean of 2,557 publications per year. Four universities (University of Cape Town, University of the Witwatersrand, Stellenbosch University, and the University of Pretoria) contributed more than half of the publications. The top destination journals were the South African Medical Journal (14.57% of the articles), PLoS ONE (5.77%), South African Family Practice (4.68%), Journal of the South African Veterinary Association (2.48%), and The Lancet (2.37%). The annual number of publications increased five-fold from 1133 in 1996, with an upsurge after 2003, to 5820 in 2015. The average annual percentage growth in the number of publications rose from 3.31% in 1996-2000 to 13.63% in 2011-2015. Year of publication (incidence rate ratio 1.16, 95% confidence interval 1.14 to 1.18) and annual private expenditure on health (incidence rate ratio 1.08, 95% confidence interval 1.05 to 1.10) were independent predictors of publication output. <strong>Conclusion: </strong>the number of health research publications from South Africa grew substantially between 1996 and 2015, with wide variation in output among universities. Private expenditure on health may be a proxy of health research funding, which probably explains its association with publication output in this study.</p>Arlette Leufak MouakoMoleen ZunzaDuduzile NdwandweOlalekan Abdulrahman UthmanCharles Shey Wiysonge
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2022-05-122022-05-12421Maladie d´Erdheim Chester systémique agressive traitée par la cladribine avec une évolution favorable: à propos d´un cas
https://www.ajol.info/index.php/pamj/article/view/242783
<p>La maladie de Erdheim Chester (MEC) est une forme d'histiocytose non langerhansienne à prédominance masculine dont la physiopathologie est mal élucidée. Le tableau clinique est hétérogène. La présence des images de reins chevelus au scanner est pathognomonique. Le diagnostic est anatomopathologique. Nous rapportons le cas d´un patient âgé de 50 ans, qui s´est présenté pour des troubles d´équilibre et une lenteur de parole dans un contexte d´altération d´état général. L´examen clinique a trouvé une ataxie cérébelleuse. Les investigations radiologiques et anatomopathologique ont été en faveur de MEC systémique agressive. Un traitement à base de cladribine a été initié avec une évolution satisfaisante. La MEC est une entité extrêmement rare. Les formes systémiques sont en général de mauvais pronostic et réfractaires au traitement, contrairement à notre cas ayant bien évolué sous cladribine.</p>Najat LasriFatimaezzahra LahlimiMohammed Ilias Tazi
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2022-05-122022-05-12421SARS-CoV-2 precipitating a stroke in a child? A case report from Tanzania
https://www.ajol.info/index.php/pamj/article/view/242784
<p>There is scanty data on overall pediatric presentations with COVID-19 in sub-Saharan Africa and none reported related to stroke. Management of acute stroke in children has been challenging due to delays in presentation and difficulties in deducing the exact etiology. This is the first such case of a stroke in a child with COVID-19 infection reported in Tanzania to the best of our knowledge. A six-and-a-half-year-old male child of Asian origin with no history of chronic illness presented to our facility with fever, rash, gastrointestinal symptoms and conjunctivitis. Subsequently, he developed headache, irritability, altered mentation, loss of speech, facial nerve palsy and hemiparesis. He was provisionally diagnosed with bacterial meningitis with a differential diagnosis of viral encephalitis and received standard treatment for the same. On further investigations, magnetic resonance imaging (MRI) of the brain showed ischemic infarct along the territory of left middle cerebral artery and given the history of the child´s exposure to a relative with COVID-19 infection, child underwent a nasopharyngeal swab for polymerase chain reaction testing which was negative but the serum IgG for COVID was positive. Despite the severe presentation initially, early detection and appropriate management resulted in survival, regained speech and motor function. Due to constraints in health care systems in sub-Saharan Africa, it is difficult to exhaust the diagnostics in order to narrow down the list of differentials in a child with stroke. This case is reported to further describe the diverse presentations of COVID-19 particularly in children which has been under-represented especially in sub-Saharan Africa. Attending physicians should have a high index of suspicion for SARS-CoV-2 as the etiology for exposed children presenting with neurological symptoms.</p>Rukhsar Shabir OsmanSaliha Shafik DawoodSheliza Parvez ThawerShivangi Mukesh MandaniaMudassir Hussein AmiraliMaria Nathaniel BulimbaNahida Zahir Walli Edward Nkingwa KijaHussein Karim Manji
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2022-05-122022-05-12421Neutropénie fébrile chimio-induite dans une unité d´oncologie pédiatrique tunisienne
https://www.ajol.info/index.php/pamj/article/view/261225
<p>La localisation mammaire isolée d´un lymphome de Hodgkin est rare. Elle peut prêter à confusion avec les autres néoplasies et affections inflammatoires mammaires. Nous rapportons le cas d´une patiente âgée de 18 ans traitée pour lymphome de Hodgkin à cellularité mixte, qui s´est présenté 6 mois après la rémission complète pour un nodule mammaire inflammatoire gauche. Le bilan anatomopathologique initial a été en faveur d´un abcès mammaire. Les investigations face à l´évolution défavorable malgré une antibiothérapie adaptée ont été en faveur d´une rechute du LH avec une localisation mammaire isolée. La patiente est actuellement sous 4<sup>e</sup> ligne thérapeutique (polychimiothérapie). Les lymphomes Hodgkiniens mammaires sont connus par leur pronostic défavorable. Les progrès thérapeutiques (thérapie ciblée) peuvent améliorer le devenir des patientes.</p>Faten FedhilaSarra Ben AhmedElhem JbebliFatma MezghaniSamir HaddadSamar RhayemMonia Khemiri
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2023-12-192023-12-19421Oxidative stress is associated with markers of renal dysfunction in children aged 6-9 years old in a South African population
https://www.ajol.info/index.php/pamj/article/view/242794
<p><strong>Introduction: </strong>although studies have shown a relationship between albuminuria and oxidative stress in adults, limited information on the subject is available in children. The aim of this study was to assess the relationship between oxidative stress and albuminuria in South African children of African ancestry. <strong>Methods: </strong>a cross-sectional study involving 6-9 years old children in randomly selected rural and urban schools of the Eastern Cape Province of South Africa was conducted. Anthropometric measurements were done and urine samples were collected for the determination of titres of albumin, creatinine, 8-hydroxy-2-deoxy-guanosine (8-OHdG) and thiobarbituric acid reactive substances (TBARS). The urinary albumin to creatinine ratio (ACR) was calculated and used to determine albuminuria. <strong>Results: </strong>creatinine and 8-OHdG were significantly higher (p<0.05) in urban children than in rural children while albumin, ACR and TBARS were significantly higher (p<0.05) in rural compared to urban children. The prevalence of albuminuria was 14.05% of which microalbuminuria was 8.83% while macroalbuminuria was 5.22%. Albuminuria was higher in rural children than their urban counterparts and was more prevalent in females. TBARS was positively (p<0.05) associated with creatinine and albumin in the cohort as well as in females and urban children while 8-OHdG was positively associated with albumin in the cohort. <strong>Conclusion: </strong>findings of this study showed that oxidative stress was associated with markers of renal dysfunction with a 14% prevalence of albuminuria observed in South African children of African ancestry.</p>Edna Ngoakoana Matjuda Godwill Azeh EngwaMuhau Muhulo MungambaConstance Rufaro Sewani-RusikeBenedicta Ngwechi Nkeh-Chungag
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2022-05-132022-05-13421Inflammatory fibroid polyp causing ileo-ileal intussusception
https://www.ajol.info/index.php/pamj/article/view/242819
<p>Inflammatory fibroid polyp (IFP) or Vanek's tumor is a rare and idiopathic pseudotumor arising from the submucosa of the gastrointestinal tract. The underlying cause of IFP remains unclear. Many factors have been incriminated such as intestinal trauma or eosinophilic gastroenteritis. Small bowel involvement is the second most common location of IFP after the stomach. Intestinal IFP is most often revealed by intussusception or obstruction. The mainstay treatment is surgical, which consisted of a segmental intestinal resection. The histological appearance may be a differential diagnosis with other spindle cell lesions, especially with stromal tumors. The definitive diagnosis is confirmed by immunochemistry examination. Herein, we report the clinical case of a 62-year-old female, with no notable medical history, who presented with nausea and vomiting associated with abdominal acute pain and distension evolving for about seven days. The physical examination showed a heart rate of 90 beats per minute, blood pressure of 120/70 mmHg, and body temperature of 37.5°C. The abdominal examination revealed a slightly tympanic abdomen with diffuse tenderness. Computed tomography (CT) scan of the abdomen revealed dilated small bowel loops proximally of an ileo-ileal intussusception. The wall of the invaginated loop shows an irregular, symmetrical, and short parietal thickening, enhanced after contrast and measuring 36 x 24 mm. The patient underwent an urgent midline laparotomy. Surgical exploration revealed an ileo-ileal intussusception, localized at 70 cm proximal to the ileocecal valve and causing dilatation in the intestine proximal to the intussusception. Manual disinvagination revealed intraluminal polypoid mass (star) obstructing the lumen with parietal umbilication. Segmental resection of the intussuscepted ileum and side-to-side stapler ileal anastomosis were performed. The patient had an uneventful recovery. Histological findings showed bland spindled cells, small vessels, and eosinophil-rich mixed inflammatory infiltrates. Immunohistochemical staining was positive for CD34 and negative for CD 117, DOG1 and S-100 protein. Therefore, a final diagnosis of an inflammatory fibroid polyp was made.</p>Tarik SouikKhalid Mazaz
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2022-05-162022-05-16421Poorly differentiated carcinoma with neuroendocrine features in two patients with sinonasal tumours: a report of two cases
https://www.ajol.info/index.php/pamj/article/view/242820
<p>Neuroendocrine tumors can be described as rare, heterogeneous, epithelial tumours with principally neuroendocrine differentiation that can be harboured in the sinonasal cavities. Owing to the intermingling of its clinical, radiological and histopathological features, the diagnosis of poorly differentiated sinonasal carcinomas with neuroendocrine features is a daunting one. Many of these tumours have a poor prognosis. In our two cases, patients presented with nasal cavity obstruction and growth of 8 & 5-months duration, respectively. Intranasal growths with intracranial extensions were noted in computed tomography scans in both patients. Our first patient failed to complete his cycle of induction chemotherapy (Cisplatin and 5-fluorouracil) and died 8 months after presentation while our second patient completed his cycle of induction chemotherapy but died 1year, 6months, after presentation, as he was unable to get the planned radiotherapy. Indeed, late presentations, intracranial metastasis, and poor treatment compliance can contribute to the poor outcome of these tumours.</p>Victor Chimezie Okebalama John Ifeanyi NwadiokwuEhioghae OsazeAyeni Akinwunmi AyodejiObinna Mike Chinatu-Nwankwo
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2022-05-162022-05-16421First confirmed case of monkeypox in Adamawa, State Nigeria: a clinico-epidemiological case report
https://www.ajol.info/index.php/pamj/article/view/242825
<p>Monkeypox is a rare zoonotic infection caused by monkey pox virus. It is an emerging disease which has become the most prevalent orthopoxvirus since the global eradication of smallpox in 1980. It is a mild illness which is mostly characterized by a prodromal of fever, malaise and progressive appearance of vesiculo-papular skin lesions. We report a case of a 30-year-old military personnel who was referred from 23 Brigade Medical Centre (BMC) to Federal Medical Centre (FMC) Yola on account of fever and progressive eruption of widespread skin rashes. Following isolation from suspicion of monkeypox, he was confirmed by PCR and managed symptomatically and fully recovered within two weeks of onset. His five close contacts did not develop any symptoms during the period of follow-up. This is the first confirmed case of monkeypox in the state. This case will trigger an awareness, amongst clinicians and surveillance officers in Adamawa State, of the existence of monkeypox and heighten the suspicion to promptly detect, isolate and treat more cases to halt transmission.</p>Emmanuel PembiSati AwangSaheed Olalekan SalaudeenInnocent Adoyi AgabaSemeeh Omoleke
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2022-05-162022-05-16421Discovery of a giant pulmonary hydatid cyst on thoracic deformation in a child
https://www.ajol.info/index.php/pamj/article/view/242826
<p>A 9-year-old girl without notable history presented with a right thoracic deformity in the context of apyrexia. On admission, she was hemodynamically stable, not dyspneic with no notion of hemoptysis or hydatid vomiting. The right hemithorax was bulging on inspection, associated with a right fluid effusion syndrome. The radiograph showed: the right pleurisy of great abundance, pushing back the trachea. The thoracic computed tomography (CT) scan: a giant hydatid cyst measuring 20 cm x 13 cm of great axis of the middle and upper lobar, associated with reactive pleurisy. The resection of the protruding dome and the extraction of the proligeral membranes were carried out. Blinding of the fistulas was continued by padding. After the stay in intensive care, respiratory physiotherapy was started. The postoperative course was simple, the control X-ray showed the re-expansion of the lung at the wall.</p>Hind CherrabiMohamed Amine Oukhouya
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2022-05-162022-05-16421Gallstone ileus: an unusual cause of mechanical intestinal obstruction in an elderly woman
https://www.ajol.info/index.php/pamj/article/view/242828
<p>Gallstone ileus is a rare cause of intestinal obstruction. It is due to biliary-enteric fistula complicating cholelithiasis. It occurs mostly in elderly women with a heavy history of associated comorbidities. The clinical presentation is characterized by insidious and intermittent obstructive symptoms, which often might delay diagnosis. The mainstay treatment is surgical, which consisted of an urgent enterolithotomy allowing prompt relief of obstruction. The management of bilio-enteric fistula is not mandatory in the same procedure and is discussed based upon patient characteristics. Herein, we report a female case of 80-year-old, with a history of diabetes mellitus and morbid obesity. The patient presented with an abdominal acute pain associated with vomiting evolving along five days. The physical examination showed a heart rate of 110 beats per minute, blood pressure of 110/70 mmHg and body temperature of 37.6°C. The abdominal examination revealed a slightly tympanic abdomen with diffuse tenderness. The initial biological blood assessment showed a slight increase of C-reactive protein at 21 mg/L, and leukocytosis of 14x10<sup>9</sup> elements/L. Other blood investigations were normal. The CT scan of the abdomen showed dilated small bowel loops upstream of a large gallstone with a calcified rim. These findings are consistent with gallstone ileus (A). After adequate resuscitation with intravenous fluids, the patient underwent an urgent midline mini-laparotomy. The surgical exploration revealed the presence of a gallstone in the ileus resulting in an intestinal obstruction (B). The gallstone was removed through longitudinal enterotomy and the defect was closed transversally (C). Given the high anesthetic risk for the patient and the need for a shortened laparotomy, it has been decided not to treat the cholecystitis and the enterobiliary fistula. The patient had an uneventful recovery and has no symptoms within 6 months follow-up.</p>Tarik SouikiKhalid Mazaz
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2022-05-162022-05-16421Prevalence and determinants of silent myocardial ischemia in patients with type 2 diabetes in Cameroon: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/244338
<p><strong>Introduction: </strong>diabetes mellitus is a major health problem worldwide. It is associated with high cardiovascular morbi-mortality especially coronary artery disease. Myocardial ischemia is often asymptomatic (silent myocardial ischemia) in people with type 2 diabetes mellitus thus making early diagnosis difficult. Silent myocardial ischemia is defined as the objective evidence of myocardial ischemia in the absence of chest discomfort or other angina equivalents. This study aimed to determine the prevalence and determinants of silent myocardial ischemia in a population of people with type 2 diabetes using exercise stress electrocardiography. <strong>Methods: </strong>we carried out a cross-sectional study between January and April 2019 at the National Obesity Centre of the Yaounde Central Hospital. Patients with type 2 diabetes underwent a complete clinical evaluation, blood test, resting electrocardiogram (ECG), and exercise stress ECG according to the Bruce protocol. A positive stress test was defined as horizontal or down-sloping ST depression ≥ 1mm or upsloping ST depression of 2 mm or more 0.06 to 0.08 seconds after the J point. <strong>Results: </strong>a total of 112 patients with diabetes (63 males and 49 females) were screened. The median age was 58 (IQR: 51 - 64) years. The median time from diabetes diagnosis was 8 (IQR: 5 - 12) years. Fifty-seven (50.4%) had hypertension, 78 (69.0%) had dyslipidemia, 66 (58.4%) were obese, 70 (61.9%) had poor glycemic control, and 23 (20.2%) were smokers. Sixty-five (58%) patients had a positive exercise stress ECG test. Factors independently associated with a positive stress test were abdominal obesity (aOR: 4.2, [95% CI: 1.4 - 12.8]) and Female sex (aOR: 2.5, [95% CI: 1.1 - 5.7]). <strong>Conclusion: </strong>the prevalence of silent myocardial ischemia was high in a population of asymptomatic patients. This was independently associated with abdominal obesity and female sex.</p>Liliane Mfeukeu-KuateVanessa Abongteh MeyanuiAhmadou Musa JingiValerie Ndobo-Koe Franck MballaMarie Ntep- GwethMartine Etoa EtogaJean Jacques NoubiapEugène Sobngwi
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2022-05-162022-05-16421Renal cell carcinoma coexistence with ipsilateral renal duplex system: a case report
https://www.ajol.info/index.php/pamj/article/view/244344
<p>The duplex kidney is one of the common congenital anomalies of the kidney and urinary tract. Meanwhile, renal cell carcinoma is also the most typical variant constituting more than 90% of cancers of the kidneys. However, renal cell carcinoma is rare in a duplicated collecting system, and literature regarding its association is very sparse. Herein, we present a 28-year-old male patient who presented with abdominal pain and haematuria and was diagnosed with left upper pole renal cell carcinoma coexisted with a duplicated collecting system by computed tomography scan. The patient underwent a left partial nephrectomy followed by meticulous suturing of opened pelvicalyceal system. The histopathology result showed clear cell carcinoma. The postoperative period was uneventful, and the patient was discharged without complications. In conclusion, the coexistence of the duplex system and renal cell carcinoma in the ipsilateral kidney is rare and maybe more than a coincidence, requiring a deeper insight and further elucidation.</p>Rajesh Domakunti Jay Dharamshi Abhijit Dhale
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2022-05-162022-05-16421Internal carotid artery occlusion mimicking artery of Heubner stroke
https://www.ajol.info/index.php/pamj/article/view/244346
<p>A 65-year-old male presenting with left upper and lower limbs weakness with twenty-four hours of onset was admitted to our hospital. The subject reported that the symptoms began after he rose quickly from a chair. He was a previously healthy farmer and his family history was negative for neurological diseases. The physical examination showed left hyperreflexia and plantar extension. Laboratorial tests were within normal limits. A cranial non-contrast CT scan was suggestive of infarct in the recurrent artery of Heubner (Axial (A)) view showing hypodense round area in right medial lenticulo-striate artery territory). Twenty-four hours after admission, the subject was apparently normal. Upon further questioning, he admitted that he had several similar episodes of weakness in the past year, which he thought were normal due to his age and daily work in agriculture. He only sought medical assistance this time because his daughter insisted. A cranial CT angiography revealed the complete occlusion of the right extracranial internal carotid artery (Axial (B), sagittal (C), and volume-rendered (D) views). This report supports the hypothesis that the internal watershed area is more affected by cerebral hypoperfusion than the area between the middle cerebral artery and anterior cerebral artery. Furthermore, it is proposed that any patient with a suggestive infarction of artery of Heubner should be thoroughly inquired about the recurrence of symptoms and the existence of triggers, since radiologic exams provide a presumptive diagnosis that should be carefully analyzed together with clinical manifestations.</p>Jamir Pitton RissardoAna Letícia Fornari Caprara
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2022-05-162022-05-16421A rare complication in adult undergoing chemotherapy for lung carcinoma: external jugular vein thrombophlebitis
https://www.ajol.info/index.php/pamj/article/view/244349
<p>A 40-year-old man who was diagnosed with a case of small cell lung carcinoma on chemotherapy (cisplatin and carboplatin) came with complaints of swelling and pain in the left neck and shoulder region for 5 days. On inspection, redness of skin was present in the neck region, and on palpation, it showed a local rise in temperature. The patient was further advised ultrasonography which revealed complete thrombosis of the external jugular vein on the left side with vessel wall thickening and surrounding inflammatory changes. The patient was started on anticoagulants further. After 6 months follow-up ultrasound sonography (USG) was done which revealed complete resolution of thrombus. Superficial vein thrombophlebitis is an extremely rare complication seen in patients having chemotherapy. Thrombosis in the external jugular vein is rare as compared to the internal jugular vein. Common etiologies of jugular vein thrombosis include trauma, central venous catheterization, infections, and extrinsic compression by tumors.</p>Yash Mohan JakhotiaAvinash Parshuram Dhok
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2022-05-172022-05-17421Dual contraceptive use and associated factors among women aged 15-49 years on antiretroviral therapy in Kayonza District, Rwanda: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/244354
<p><strong>Introduction:</strong> globally, 600,000 women died of complications due to pregnancies among more than 2 million women on antiretroviral treatment who get pregnant every year due to low utilization of dual contraception and unsafe sex. The failure rate of preventing of mother-to-child transmission of HIV/AIDS (PMTCT) in Rwanda was 2% in 2019. In Rwanda, there was no research done and published on this topic. To fill the gap, the study aimed to assess the use of dual contraceptives and associated factors among women aged 15-49 years on antiretroviral (ART) in Kayonza District, Rwanda. <strong>Methods:</strong> a cross-sectional design was conducted in October 2021. The sample was 345 participants selected by cluster simple random sampling from a targeted population of 1426 women. The interviews were conducted, and structured questionnaires were filled out before entering and analyzing data into Statistical Package Social Sciences (SPSS). Descriptive statistics analysis was used to determine frequencies and percentages, while multivariate seconded the bivariate regression analysis determine the factors associated to dual contraception by odds ratio with 95% CI. <strong>Results:</strong> the mean age of interviewees was 35.59 years and the majority of them were married women (60.9%). The dual contraception rate was 40%. The multivariate analysis of factors associated with dual contraception revealed that single women were most likely (AOR=38.123, 95% CI: 6.575-221.040, p<0.001) to use combinations of condoms and other methods. The odds of utilizing dual contraceptive methods were 7.347 times (AOR=7.347, 95% CI: 0.936-57.671, p=0.049) higher among women whose partners were casual laborers. Women who did not desire to have a baby were most likely (AOR=3.990, 95% CI: 1.796-8.865, p=0.001) to utilize dual contraception. The odds of utilizing dual methods were 5.634 times (AOR=5.634, 95% CI: 2.277-13.939, p<0.001) higher among women whose sexual partners did not desire a baby compared to those whose partners did. The odds of using dual methods were 1.354 times (AOR=1.354, 95% CI: 0.705-2.602) higher among women who disclosed their HIV status to their sexual partners compared to those who did not. The odds of using dual contraception were 5.526 times (AOR=5.526, 95% CI: 2.186-13.968, p<0.001) higher among women who were in HIV program for more than five years compared to those who were in the program for one year or less. <strong>Conclusion:</strong> the rate of dual contraception in this area is still low according to World Health Organization (WHO) recommendation and strategies to increase it are of paramount importance to be put in place by the Ministry of Health through Rwanda Biomedical Center, health facilities and partners in terms of training, health education, availability of dual methods at the level of the health system and men involvement in family planning.</p>Jean Nepomuscene RenzahoErigene Rutayisire
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2022-05-172022-05-17421Curbing an outbreak of circulating vaccine derived poliovirus type 2 in Dollo Zone, Somali Region, Ethiopia: response to outbreak
https://www.ajol.info/index.php/pamj/article/view/244359
<p><strong>Introduction: </strong>although the oral polio vaccine prevents virus transmission from person to person, it is crucial for poliovirus eradication. The continued use of live attenuated poliovirus poses an ongoing risk of circulating Vaccine Derived Poliovirus-2 (cVDPV2) outbreaks. This study assesses the response to the cVDPV2 outbreak in Dollo Zone, Somali Region, Ethiopia. <strong>Methods: </strong>after examining and verifying the occurrence of the outbreak, a team was established and prepared by resource mobilization, advocacy, and social mobilization. The group endorsed a four-step vaccination strategy, first the rapid response within 14-days by vaccinating a monovalent oral poliovirus-2 (mOPV2) to all under 5-year children in the Zone. The team further enhanced Supplementary Immunization Activities (SIA) for all under-five children with repeated doses of vaccines. At the same time, the team initiated community-based surveillance of Acute Flaccid Paralysis (AFP). <strong>Results: </strong>in the rapid-response immunization, an average of 91.4% of 0-11 months old and 90.2% of 12-59 months children were vaccinated. In SIA-1, the team vaccinated an average of 88% and 97%, and in SIA-2, 94.8% and 97.6% of children 0-11 months old and 12-59 months old, respectively. The active community-based surveillance of AFP revealed the existence of the disease in a sporadic form, of which two cases were found in Bokh district. <strong>Conclusion: </strong>the response to curb the outbreak of cVDPV2 has shown a flow of actions to combat the outbreak. Strengthening and formation of response teams at different levels, resource mobilization, advocacy, and social mobilization are all essential components in maximizing the response to the outbreak.</p>Legesse KidanneFilimona BisratMohammud MohammedNegussie Deyessa
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2022-05-172022-05-17421The attitudes of obstetric caregivers towards labour pain relief methods and associated factors at public health centers of East Gojjam zone, Amhara Region, Ethiopia: Institutional based cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/250472
<p><strong>Introduction: </strong>labour pain management is not labour pain relief is a key factor for maternal satisfaction during childbirth. However, in developing countries, a well-established service mainly due to negative attitudes of health care providers resulting in unmeasured suffering from childbirth for mothers. Thus, this study was aimed to assess attitude of obstetric caregiver towards labour pain management and associated factors at public health centers of East Gojjam zone. <strong>Methods: </strong>institutional-based cross-sectional study was conducted from March 1-30, 2018. Three hundred and nine sampled obstetric caregivers have participated, with a 96.8%(299) response rate. Data were collected with structured pretested questionnaires. Data were entered into Epi data 4.2 versions and bivariate and multivariate logistic regression was carried out using SPSS 23 versions with 95 % CI to determine the association between dependent and independent variables. <strong>Results: </strong>out of the study participants, 128 (42.8%) had a negative attitude towards managing labour pain. Knowledge (AOR =3.785, 95 % CI: 2.251,6.365), training (AOR=2.923, 95% CI: 1.266, 6.749) and Companion (AOR=1.834, 95% CI: 1.055, 3.189) had significantly associated with attitude of obstetric caregiver towards labour pain relief methods. <strong>Conclusion: </strong>the result of this study showed that there is still a negative attitude towards labour pain management among obstetric caregivers in the study setting. Providing knowledge-based in-service training for obstetric caregivers to change their attitude towards labour pain relief methods is advisable.</p>Keralem Anteneh BishawMisganaw Fikrie MelesseBewket Yeserah Aynalem
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2022-05-172022-05-17421Monomelic amyotrophy: a rare disease with unusual features
https://www.ajol.info/index.php/pamj/article/view/250473
<p>A 36 years old female presented with chief complains of right sided upper limb weakness which was gradual in onset and progressive in nature. When detailed history was taken, it was observed that she was also having complains of altered sensations and hyperhidrosis in both the palms. On further assessment we found that there was no history of trauma to cervical region or any cervical pain. She has no other past history such as allergies or any exposure to toxins. On neurological assessment we found that patient has muscle atrophy with increased tone in upper limb along with tremors (A) and uncertain atrophy like changes in cervical spine on MRI (Magnetic Resonance Imaging) (B). On further examination clonus was present over left calf with Babinski sign positive. When further investigations were done it was found out that patient has lower and upper motor neuron lesions.</p>Chaitanya KulkarniWaqar Mohsin Naqvi
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2022-05-122022-05-12421Particularités épidémio-cliniques, biologiques et radiologiques de la tuberculose pulmonaire chez les diabétiques à Antananarivo, Madagascar
https://www.ajol.info/index.php/pamj/article/view/250476
<p>La tuberculose pulmonaire est fréquemment associée au diabète sucré, avec parfois des présentations atypiques. Notre objectif était d´identifier les particularités épidémiologiques, cliniques, biologiques et radiologiques de la tuberculose pulmonaire chez les diabétiques par rapport aux non diabétiques. Ceci afin d´améliorer leur prise en charge. l´étude a été réalisée dans les services d´Endocrinologie et de Pneumologie du Centre Hospitalier Universitaire Joseph Raseta Befelatanana et le Service de Maladies Respiratoires du Centre Hospitalier de Soavinandriana à Antananarivo, Madagascar. Elle a concerné les cas de tuberculose pulmonaire à bacilloscopie positive enregistrés de janvier 2018 à janvier 2020 (25 mois). C´est une étude rétrospective transversale descriptive et analytique. Dans notre étude, la prévalence du diabète chez les tuberculeux était de 20,31%. Un âge plus avancé, une évolution clinique à bas bruit, un syndrome inflammatoire biologique important, moins de cavernes mais plus d´opacités systématisées, des lésions radiologiques à localisation basale ou diffuses, plutôt unilatérales droites, ont été constatés plus fréquemment chez les diabétiques comparés aux non diabétiques. La connaissance des particularités de la présentation de la tuberculose pulmonaire chez les diabétiques aidera les personnels de santé à ne pas passer à côté du diagnostic même devant une présentation atypique. Par ailleurs, comme la majorité des tuberculoses pulmonaires survient chez les diabétiques déséquilibrés, un bon équilibre glycémique permettra certainement de diminuer son incidence.</p>Miora Maëva Arielle AndrianiainaRija Eric RaherisoThierry RazanamparanySitraka Angelo RaharinavalonaAndrianirina Dave Patrick RakotomalalaRadonirina Lazasoa Andrianasolo
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2022-05-182022-05-18421Vulvar Buschke-Löwenstein tumor in a HPV 16 infected woman: case report
https://www.ajol.info/index.php/pamj/article/view/261228
<p>The Buschke-Löwenstein tumor is characterized by an exophytic lesion on the perianal region. It is considered benign but there is a high risk of recurrence and degenerative potential. It is commonly associated with human papillomavirus (HPV) especially subtypes 6 and 11, its evolution depends on the host´s immunity and the association with other sexually transmitted diseases. Surgical excision is the recommended treatment in most cases. We report the case of a 54-year-old woman with only diabetes history, who had verrucous vulvar lesion associated to HPV subtype 16 treated with large excision.</p>Safia ErnezMouna DerouichSalma ChachiaSassi Boughizane
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2023-12-192023-12-19421Myelinated retinal nerve fiber layer: an extensive presentation
https://www.ajol.info/index.php/pamj/article/view/250490
<p>Myelinated retinal nerve fiber layer is rare. It is estimated to occur in 0.5% to 1% of the population and is often detected on routine examination without symptoms. It consists of white or gray-white well-demarcated patches on the outermost surface of the retina that obscure the underlying retinal vessels. It can be associated with axial myopia, amblyopia, and strabismus. A 12-year-old girl with normal development presented with ocular deviation of the right eye. There was no past medical or ocular history. Automatic refraction found in the right eye -9 Pupilary Distance (PD) and -1 PD in the left eye. The best visual acuity was 20/600 in the right eye and 20/20 in the left one. Slit lamp examination of the right eye (A) revealed two vast whitish zones extending from the papilla towards the temporal sector sparing the posterior pole. These lesions covered the temporal vessels with fuzzy and scalloped boundaries. Fundus examination of the left eye was without abnormalities (B). Scan of Spectral Domain Optical Coherence Tomography (SD-OCT) showed isolated hyper reflectivity of the fiber optic layer, an abnormality of the vitreoretinal interface with posterior shadow cone effect (C).</p>Zeineb KallelMalek Kharrat
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2022-05-182022-05-18421Bacterial profile of diabetic foot infections and antibiotic susceptibility in a specialized diabetes centre in Cameroon
https://www.ajol.info/index.php/pamj/article/view/250493
<p><strong>Introduction: </strong>bacterial profile of diabetic foot infections and the antibiotic susceptibility are essential in the prescription of empirical antibiotics before the results of cultures of deep wound samples are available. The aim of this study was to determine the microbiological profile and antibiotic susceptibility of bacteria isolated from infected diabetic foot ulcers in patients attending the Yaoundé Central Hospital, Cameroon. <strong>Methods: </strong>we retrospectively analyzed the records of patients hospitalized between 2008 and 2013 for diabetic foot infections. The main outcomes were the bacteriological profile and susceptibility patterns of isolates from positive culture of deep wound sample before antibiotherapy, carried out in the national reference laboratory. Eligible clinical records of patients were retrieved from the hospitalization registry. <strong>Results: </strong>a total of 101 patient records were analyzed. The mean age of patients was 57.1 ± 9.1 years. There were more males (64.4%), mostly with type 2 diabetes (99%), with a median duration of 9 years (IQR: 4 - 14 years). Their median blood sugar on admission was 246 mg/dL. Five percent of patients died and 23% had a major amputation. Two hundred and twenty-five (225) germs were isolated, with an average of 2.25 germs per patient. Gram negative bacteria were more frequent (75.2%). These were mainly <em>Morganella morganii</em> (13.8%), <em>Klebsiella pneumoniae</em> (12%), <em>Escherichia coli</em> (11.6%), <em>Proteus spp.</em>(10.7%), and <em>Pseudomonas aeruginosa</em> (8.9%). Gram positive bacteria (24.8%) were mainly <em>Staphylococcus aureus</em> (9.3%), <em>Streptococcus spp.</em> (7.6%), and <em>Enterococcus spp.</em> (7.1%). Gram negative bacteria showed a high resistance to amoxicillin-clavulanic acid (78%), fluoroquinolones (55%), and gentamycin (50%). They were susceptible to imipenem (95%), amikacin (88%), and show moderate susceptibility to third generation cephalosporins (62%). Gram positive bacteria were susceptible to vancomycine (94%), and moderately susceptible to pristinamycine (82%) and fusidic acid (67%). <strong>Conclusion: </strong>Gram negative bacteria were more frequently associated with diabetic foot infections, and were frequently resistant to the usually prescribed antibiotics, but remain susceptible to imipenem and amikacin. Our findings should be considered when prescribing empirical anti-biotherapy for diabetic foot infections in our setting.</p>Mesmin Dehayem YefouAhmadou Musa JingiMartine Claude Etoa Etoga Francine Mendane MekobeBatakeh Ba AgoonsEliane NgassamEugène SobngwiJean-Claude Mbanya
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2022-05-182022-05-18421Scrotal calcinosis: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/250495
<p>Scrotal calcinosis is an uncommon benign disorder of the scrotal skin characterised by multiple calcified intradermal nodules that occur in the presence of normal calcium and phosphate metabolism. A thirty-two- years-old male comes to the outpatient department with the complaints of progressively increasing multiple painless nodules in the scrotum area in 6 months. He did not have any other medical comorbidities. There was no any discharge from the nodule. On physical examination, multiple nodules on the scrotum and nontender, subcutaneous nodules were studded within the scrotal wall.</p>Anjali AloneMayur Bhaskar Wanjari
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2022-05-182022-05-18421Endométriose de la paroi abdominale: à propos de deux cas
https://www.ajol.info/index.php/pamj/article/view/250496
<p>L'endométriose de la paroi abdominale est une maladie rare qui se développe généralement sur une cicatrice de césarienne. Bien que fréquemment observée dans le tissu adipeux cutané et sous-cutané en regard de la cicatrice de césarienne, sa localisation intramusculaire est possible mais reste rare. Le traitement repose sur l'exérèse chirurgicale de la lésion associée ou non à une thérapie hormonale. L´exérèse chirurgicale large reste le traitement de choix de la maladie mais expose au risque de hernie de la paroi abdominale. Nous rapportons deux cas d'endométriose pariétale survenant après cicatrice de Pfannstiel pour césarienne colligés au service de chirurgie de l'Hôpital régional de Zaghouan.</p>Mohamed HedfiNada Essid Ferdaous TrabelsiHakim Znaidi
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2022-05-182022-05-18421Magnetic resonance imaging of Joubert syndrome associated with Dandy-Walker malformation: pathognomonic imaging
https://www.ajol.info/index.php/pamj/article/view/250498
<p>An eight-month-old infant was referred to our institution to investigate psychomotor retardation. The clinical finding found ataxia. An Magnetic resonance imaging (MRI) was indicated and performed. Sequence T1 in the axial and coronal plane (A,B) revealed a long thick superior cerebellar peduncle (yellow arrow) and an interpeduncular fossa (white arrow), reminding the molar tooth sign (MTS). Furthermore, sequence T1 in the sagittal plane (C) showed hypoplasia of the vermis (red arrow) and global ascension of the tentorium cerebelli (red star). Finally, the diagnostic of Joubert syndrome associated with Dandy-Walker malformation was confirmed by pathognomonic imaging. The family patient was informed and received the best medical assistance. Joubert syndrome is a rare recessive ciliopathy, diagnosed by a triad in cross-sectional imaging (scanner/MRI): thick and straight superior cerebellar peduncles, deep interpeduncular fossa, and hypoplastic/dysplastic vermis forming the "molar tooth sign". Dandy-Walker syndrome is defined as rare malformation, presented in MRI as upward displacement of the tentorium, torcular and lateral sinuses and anterior-posterior enlargement of the posterior fossa. In effect, the association between the Joubert syndrome and Dandy-Walker malformation is even rarer. Joubert syndrome is often combined with liver, renal and eye disease. Its treatment is cumbersome as well as multidisciplinary depending on the organs affected, hence imaging is important to the precise diagnosis, thereby reduction its medical complications.</p>Jihane HabiMohamed Mahi
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2022-05-192022-05-19421Jejunal perforation and upward migration of double J stents during the cystoscopic procedure: a case report and review of literature
https://www.ajol.info/index.php/pamj/article/view/250500
<p>While double j (DJ) stenting is common worldwide in the urological procedure, it may associate with severe and catastrophic complications. Penetration of the jejunum and upward migration of double j (DJ) stents during cystoscopic DJ stent procedure are rare complications with few reported cases in the literature. We present a 65-year-old male presented with acute renal failure and peritonitis one week after failed cystoscopic removal of DJ stents. Radiographic investigations showed upward migration of the right DJ stent and a total displacement of the left DJ stent to the peritoneal cavity with peritonitis, bladder perforation, and jejunal injuries. The right DJ stent was removed via the ureteroscopic procedure. Then, open abdominal surgery was performed to remove the left DJ stent and repair the injured bladder wall and jejunal segment. In conclusion, synchronous upward DJ stent migration and peritoneal DJ stent malposition with jejunal and bladder injuries are rare and severe complications of the cystoscopic DJ stent procedure. The treatment should be performed depending on the time of diagnosis, nature of the injury, and general clinical conditions of the patient.</p>Faisal Ahmed Qasem AlyhariSaif GhabishaSaleh Al-wageehEbrahim Al-shamiMenawar DajenahWaleed AljbriFawaz MohammedFawaz Mohammed
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2022-05-192022-05-19421Biliary hamartoma: a report of two cases
https://www.ajol.info/index.php/pamj/article/view/261230
<p>Biliary hamartoma, also known as biliary micro hamartoma or Von Meyenburg complex, is a rare benign liver lesion, thought to be a ductal plate malformation rather than a true neoplasm. It is often seen incidentally on imagery or surgery as multiple small subcapsular nodules, scattered throughout the liver, making it likely to be mistaken for metastatic nodules. The histological presentation can also be deceptive, leading to the misdiagnosis of an adenocarcinoma of hepato-biliary differentiation or a metastasis. We hereby present two cases of biliary hamartoma, found incidentally on imagery and surgery, the first one in a 94-year-old woman, and the second in a 48-year-old man, which was initially misdiagnosed as an adenocarcinoma, along with a discussion of key clinical and pathological findings to help avoid this diagnostic pitfall.</p>Anass HalouiNassira KaricheAsmae AissaouiYouness NajjiouiEl Mehdi TiabiNoura SeghrouchniAmal Bennani
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2023-12-192023-12-19421Seroprevalence of Epstein-Barr virus, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus among patients with non-Hodgkin's lymphoma at the Yaounde General Hospital, Cameroon
https://www.ajol.info/index.php/pamj/article/view/251309
<p>The non-Hodgkin's lymphomas (NHLs) are a diverse group of malignancies that originate in lymphoid cells, heterogeneous in clinical behavior, morphology, cellular origin, etiology, and pathogenesis. A viral infectious etiology had been associated with them. This study aimed to investigate the seroprevalence of Epstein-Barr virus (EBV), Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency Virus (HIV) among patients with NHL at the Yaoundé General Hospital (YGH). Participants for this cross-sectional study were recruited at the medical oncology unit from October 2018 to December 2019. For each patient fulfilling the inclusion criteria, five milliliters of blood were drawn at the crook of their elbows in EDTA tubes. Then, EBV, HIV, HBV, and HVC screening were done using the Rapid Diagnostic Tests (RDTs); Bio-Rad EBV, Alere. Determine HIV-1/HIV-2, HBV the best diagnostic and HVC Wondfo biotech respectively. Participants were made up of sixty-three males (69.23%) and twenty-eight females (30.77%). Their ages ranged from nineteen to seventy-eight years, with a mean ± SD of 56.5 ± 15.5. There were eight HIV patients (8.8%) followed by five EBV or HBV patients (5.5%). Three patients were coinfected with HIV+EBV (3.3%) while only two patients (2.2%) had HCV. Only HIV and EBV were seen coinfected. The presence of HBV and HCV in patients with NHL reveals the need to understand how these viruses induce lymphoproliferative diseases, more precisely, the non-Hodgkin´s lymphoma.</p>Jacky Njiki BikoïEsther Del Florence Moni NdediEtienne Atenguena OkobalembaDonatien Serge MbagaChris André Mbongue MikangueAlexandra Emmanuelle MembangbiElsa Makue NguiffoJustin Olivier EssindiGeorge Ikomey MondindeSara Honorine Riwom Essama
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2023-12-192023-12-19421Osteochondroma of rib
https://www.ajol.info/index.php/pamj/article/view/251311
<p>Osteochondroma is also known as exostosis and is a benign bone tumour. It commonly presents in the first 3 decades of life with a male preponderance. The most common site for the development of these tumours is the metaphysis of long bones, with almost 30% of cases originating from the distal metaphysis of the femur. Origin from flat bones like ilium and scapula is rare, while origin from vertebrae and ribs is unheard of. A 21-year-old female presented with a history of swelling over the left upper back since 2 years, pain in the left upper back and shoulder with tingling since 4 months. On examination, a 3 cm by 3 cm, hard, immobile mass was palpable in the left paravertebral region of the 4<sup>th</sup> intercostal space. X-ray and computed tomography (CT) scan of the thorax revealed two irregular lesions arising from the neck of the 5<sup>th</sup> rib posteriorly and a Fine Needle Aspiration Cytology (FNAC) revealed the lesion to be of chondroid matrix origin, consisting of normal chondrocytes. Through a posterior approach, two pedunculated tumours of size 3.5 x 2 x 1 cm and 2 x 2 x 1 cm, along with the costovertebral junction of the 5<sup>th</sup> rib were resected. Histopathological examination confirmed the mass to be an osteochondroma of the rib. On 6 months follow up, the patient is stable, has no pain or tingling and there is no evidence of recurrence of the tumour.</p>Prateek Upadhyay
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2023-12-192023-12-19421Closed spinal dysraphism-lipomyelocele in an 18-year-old male
https://www.ajol.info/index.php/pamj/article/view/251314
<p>We are reporting a magnetic resonance imaging (MRI) finding of an 18-year-old male not a known case of any chronic medical illness presented with chief complaints of swelling over the lumbosacral region since birth with sensory loss over bilateral lower limb for 2 months. He also complained of unhealing ulcers over the dorsum of the great toe. Magnetic Resonance Imaging (MRI) findings revealed T2 hyperintensive mass (red arrow) of subcutaneous soft tissue in the posterior lumbosacral region extending into the spinal canal. Posterior spinal defect at the L3-L4 level with tethering of cord was noted, suggestive of Lipomyelocele. Following the removal of the Lipomyelocele and detethering of the chord, the patient suffered bladder dysfunction and right foot drop. For additional treatment, he was referred to a physiotherapist. He had weakness in his lower limbs ( Medical Research Council (MRC) grade 3), a foot drop on the right side, and considerable muscular loss on physical examination. Sensations were affected on both sides. Bladder training, sensory re-education, lower limb muscular strengthening, and foot drop management were all part of the physiotherapy rehabilitation. Foot drop was treated with an ankle-foot orthosis and dorsiflexion reflex stimulation, with an emphasis on activities in a weight-bearing position. It has been discovered that a multidisciplinary strategy involving medical, surgical, and physical therapy improves treatment outcomes.</p>Nikita Hitesh SethRagini Dadgal
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2023-12-192023-12-19421The validity of the upper limb neurodynamic test 2A in women with a clinical diagnosis of Carpal Tunnel syndrome: a prospective diagnostic accuracy study
https://www.ajol.info/index.php/pamj/article/view/251315
<p><strong>Introduction: </strong>the validity of the upper limb neurodynamic tests and especially the upper limb neurodynamic test 1 for diagnosing Carpal Tunnel syndrome has been the subject of several previous studies. However, the upper limb neurodynamic test 2A, which is also a test designated to assess the mechanosensitivity of the median nerve, has not been sufficiently studied, particularly for the diagnosis of Carpal Tunnel syndrome. <strong>Methods: </strong>we used the upper limb neurodynamic test 2A as the index test and nerve conduction studies as the reference standard. We considered the upper limb neurodynamic test 2A positive according to Nee <em>et al</em>. criteria. Sensitivity, specificity, positive likelihood, and negative likelihood were calculated. In addition, a receiver operating characteristics analysis was carried out. <strong>Results: </strong>ninety-four women (188 hands) suspected of Carpal Tunnel syndrome with a mean age of 48.87 years and SD of 12.09 participated in the study. The sensitivity of the upper limb neurodynamic test 2A was estimated at 73.4%, the specificity at 47%, the positive likelihood ratio was 1.38, the negative likelihood ratio was 0.57, and the Kappa agreement was 20.3%, and the area under the curve 60.1%. <strong>Conclusion: </strong>the upper limb neurodynamic test 2A does not seem to have value in the diagnosis of Carpal Tunnel syndrome when compared to nerve conduction studies. It could be alternatively used to detect an increased mechanosensitivity of the median nerve when the upper limb neurodynamic test 1 cannot be performed in case of a range of motion limitation of the shoulder abduction.</p>Hassan BeddaaBouchra KablyIkrame MouhiBasma MarzoukAbdelghafour MarfakSaid NafaiReda OuazzaniNazha Birouk
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2023-12-192023-12-19421Angiocholite sur kyste hydatique hépatique fistulisé dans la voie biliaire principale: à propos de 2 cas
https://www.ajol.info/index.php/pamj/article/view/251319
<p>Le kyste hydatique est une zoonose qui touche<br>fréquemment le foie, qui sévit à l´état endémique<br>dans plusieurs pays comme le Maroc. L´hydatidose<br>hépatique peut se compliquer d´une angiocholite<br>dont le traitement de choix est actuellement<br>la cholangio-pancréatographie rétrograde<br>endoscopique avec sphinctérotomie. Nous<br>rapportons deux cas cliniques d´angiocholite sur<br>kyste hydatique hépatique fistulisé dans la voie<br>biliaire principale qui ont été traités par voie<br>endoscopique avec une évolution favorable. Le<br>diagnostic précoce et la prise en charge adéquate<br>permettent l´amélioration du pronostic de ces<br>patients.</p>Hanane DelsaNajwa BenslimaImane RahmouniYasmine CherouaqiAmine BenfaidaLeila Abdallaoui MaaneMohamed Reda Cherkaoui JaouadFatima BelabbesAnass NadiFedoua Rouibaa
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2023-12-192023-12-19421Establishing event-based surveillance system in Nigeria: a complementary information generating platform for improved public health performance, 2016
https://www.ajol.info/index.php/pamj/article/view/251328
<p><strong>Introduction:</strong> event-based surveillance (EBS) is a surveillance method involving systematic and prompt data collection on incidents of public health importance, and complements the current indicator-based surveillance system and the Integrated Disease Surveillance and Response System (IDSR). It also promotes a rapid assessment and response to public health emergencies in Nigeria, although there is a lack of information regarding the status of EBS among Public Health Stakeholders in Nigeria; hence our study aimed to assess the awareness, availability, and utility of EBS among Nigerian public health stakeholders. <strong>Methods:</strong> we conducted a cross-sectional study to assess the awareness, availability, functionality, and utilization of EBS in the 36 States in Nigeria, plus the Federal Capital Territory (FCT). We interviewed 53 stakeholders in disease surveillance and response using a self-administered, semi-structured questionnaire to obtain responses on the awareness of the event-based surveillance system, availability, and functionality. We also assessed the common structures used to report health-related events and the availability of minimum requirements for an event-based surveillance system. We performed descriptive statistics for the data obtained. <strong>Results:</strong> the majority of respondents were males and 37.7% were disease surveillance and notification officers (DSNOs). Awareness of EBS was poor with about half, 49% of the respondents reported hearing of EBS, but only 17% described it correctly. The overall level of availability of the EBS reporting structure was inadequate, 28.2% and poorly utilised in the States. <strong>Conclusion:</strong> the awareness, availability, and utilization of event-based surveillance systems are low in Nigeria. The government should improve the feasibility and utility of EBS in the States to enhance early disease detection and response.</p>Rabi UsmanLawal BakareUbong Okon AkpanMahmood DalhatAugustine Olajide DadaIfeanyi OkudoRobinson Nnaemeka NnajiMuhammad Shakir BalogunSaheed GidadoPatrick Nguku
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2023-12-192023-12-19421Experience of burden of care among adult caregivers of elderly persons in Oyo State, Nigeria: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/251330
<p><strong>Introduction: </strong>caring for elderly persons is challenging for caregivers due to elderly persons´ increased dependence and reduced physical strength. This study assessed the burden of care experienced by caregivers of elderly persons in family settings. <strong>Methods: </strong>this cross-sectional study used a multistage cluster sampling technique to select 1,119 caregivers of elderly persons aged 18-59 years from one rural and one urban local government area in Oyo State, Nigeria. Interviewer-administered questionnaires collected information on caregiving arrangements and burden of care experienced (determined using the modified short version of the Zarit Burden Interview).</p> <p class="ParagraphSeparator"> </p> <p><strong>Results: </strong>caregivers´ mean age was 38.6 ± 8.7 years with 50.2% aged ≥40 years. There were more females (59.8%) than males (40.2%) and 78.4% were married. Only 47.8% were primary caregivers, 54% cared for their parents and 2% cared for non-relatives. Prior to their caregiving, 81% reported good relationships with the elderly. Although 80.3% of the elderly were reported to be fully independent for activities of daily living, 74.0% of the caregivers experienced burden of care with 28.2% reporting severe burden. The odds of burden of care were 10 times higher among rural than urban caregivers (OR=10.09, 95%CI=5.99-17.01); eight times higher among those with poor than those with good mental health status (OR=7.90, 95%CI=4.60-13.57) three times higher among those with dependent than independent elders (OR=2.74, 95%CI=1.68-4.47). <strong>Conclusion: </strong>experience of burden of care was high among caregivers in the rural area and those with poor mental health. Community-oriented support including daycare centres and old people´s homes will provide relief to caregivers.</p>Oludoyinmola Omobolade OjifinniObioma Chukwudi Uchendu
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2023-12-192023-12-19421Missing school during period: perspectives of adolescent schoolgirls in Cross River State, Nigeria
https://www.ajol.info/index.php/pamj/article/view/251331
<p><strong>Introduction: </strong>adolescent in-schoolgirls often experience stigmatization, physical and psychological stress during their menstrual period that causes them to miss school. Menstruation-induced school absenteeism is preventable. The purpose of the study was to assess the factors associated with school absenteeism by both urban and rural school-going adolescent girls during their period. <strong>Methods: </strong>adolescent female students in Junior and Senior Secondary classes, who have attained menarche, participated in the study. A researcher designed, pretested and validated self-administered questionnaire, consisting of questions related to perception about menstruation and reasons for missing school during menstruation was used for data collection. Data were analyzed using SPSS software. Descriptive data were presented using percentages, while the association between the variables of interest, were verified using Chi-Square test. <strong>Results: </strong>mean age of the girls was 14.4(±1.8) years while mean age at menarche was 12.2 (±1.3) years. Although respondents identified several factors as responsible for school absenteeism, however, only fear of ridicule by other students (p ≤ 0.001) and unavailability of sanitary towels (p = 0.006) were significantly associated with missing school. Lack of sanitary towels was significantly associated with location (p = 0.012) and socio-economic status of mothers (0.006); while perception of menstruation as a disease was associated with feeling of tiredness and discomfort (p = 0.017). <strong>Conclusion: </strong>findings have shown that school absenteeism during menstruation is a serious problem among respondents capable of adversely affecting their academic performance. Access to sanitary towels and WASH facilities should be provided in schools to create an enabling environment to motivate school attendance by the adolescent girls.</p>Olaide Bamidele EdetPhilip Etabee Macdonald BasseyEkpoanwan Esienumoh EsienumohAntor Odu Ndep
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2023-12-192023-12-19421Mid and long term follow up of 50 pediatric cardiac Chadians operated in France from 2003 to 2012
https://www.ajol.info/index.php/pamj/article/view/251336
<p><strong>Introduction: </strong>cardiac valvular diseases (CVDs) are the major cause of cardiovascular morbidity and mortality globally, with predominance of rheumatic heart disease (RHD) in developing countries. Congenital heart defects (CHD) diagnoses are delayed due to socioeconomic factors. This study aims to evaluate the post-operative surgical outcomes of CHD and valvular RHD. <strong>Methods: </strong>this study is conducted with 50 patients from Chad, operated on between 2003 and 2012. Post-operative outcomes are evaluated from 2010 to 2012. <strong>Results: </strong>with the follow-up of 19 RHD patients who underwent plasty, 8 (42.1%) had no complications, 4 (21%) presented with mild regurgitation, 7 (36.8%) required re-operation due to 6 mitral stenosis (MS) cases (mitral surface range from 0.7 to 1.2 cm<sup>2</sup>) and 1 severe mitral regurgitation (MR) case. While those patients with valve replacement, 2 (50%) had no complications, 1 (25%) had mild regurgitation and 1 (25%) patient died. Two patients with aortic regurgitation (AR) that underwent annuloplasty presented with severe regurgitation. Regarding AR with valve replacement, 3 (60%) had no complications, and 2 (40%) had mild regurgitation. Among the tricuspid regurgitation (TR) patients who had plasty, 6 (85.7%) had no complications, and 1 (14.3%) had severe regurgitation. The surgical repair was curative in all CHD patients. The loss to follow-up rate was 13/50 (26%). <strong>Conclusion: </strong>the annuloplasty on rheumatic valve disease (MR and AR) has proven to be disappointing. Plasty is debated without justified indication for AR. The Outcomes of CHD, mitral and aortic valve replacement are successful.</p>Neguemadji Ngardig NgabaJean Philippe LesbreNamrata HangeMaria Kezia Lourdes Ligsay PormentoMolly Sanjay JainManoj Kumar Reddy SomaguttaVikash JaiswalUzoego Nwakaku ChibuzoImteyaz Ahmad KhanSana Irfan Khan
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2023-12-192023-12-19421Idiopathic left-sided diaphragmatic hernia: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/251339
<p>Idiopathic diaphragmatic hernia, which occurs without a traumatic etiology, is a very unusual condition with a wide spectrum of medical symptoms. Cough, chest pain, dyspnea, upper abdomen pain, bowel bladder problems, and vomitus are some of the common respiratory and gastrointestinal symptoms. To minimize life-threatening morbidity and fatality, surgery is required. This is a case of idiopathic left-sided diaphragmatic hernia which is an extremely rare condition. A 60-year-old male with no history of trauma reported to have been experiencing pain in the left upper abdomen along- with breathing difficulties for the past 15 days. The pain was insidious in onset and progressive. On physical examination, chest expansion revealed differences of 2 cm, 2 cm, and 1 cm each along-with tenderness in the epigastric area. On auscultation, air entry was reduced bilaterally over lung fields. On investigation computed tomography (CT) impression of the abdomen and pelvis showed: 1) Large defect noted in left crus of the diaphragm with herniation of stomach to the left thoracic cavity. 2) There is a shift of mediastinum towards the right side. 3) Herniation of abdominal contents into the thoracic cavity. 4) Mild left-sided-pleural effusion with the consolidation of the left basal lung.</p>Anam Rajendra SasunRashmi Ramesh Walke
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2023-12-192023-12-19421Retained ureteral stents, an avoidable source of morbidity: 10 years' experience from a single tertiary care centre
https://www.ajol.info/index.php/pamj/article/view/251406
<p><strong>Introduction: </strong>ureteral stents are used in managing various urological conditions. When these stents are left indwelling for a prolonged time, it results in complications like stent migration, fragmentation, and encrustation. The aim of this retrospective observational study is to analyse the incidence, risk factors, and morbidity associated with retained ureteral stents. <strong>Methods: </strong>the retained/forgotten ureteral stents were defined as the stents with an indwelling period of more than six months. The records of all such patients from January 2010 to January 2020 were retrospectively reviewed. The primary reason for the placement of a stent, total indwelling time, the reason for prolonged indwelling time, and part(s) of the stent encrusted were retrospectively reviewed. Single/multistage endourological procedures were used to make the patients remove the retained stents and stone free. The type, number of procedures, and total number of sessions needed were noted. <strong>Results: </strong>data of 114 patients was reviewed retrospectively. Most patients presented with abdominal pain (62 patients, 54.4%), and dysuria (41 patients, 35.1%). An average of 1.7 sessions (range 1-4) were needed to make the patients’ stent and stone free. During these sessions, single/multiple procedures (endoscopic/open/combined) were performed. Nine patients (7.9%) had permanent loss of renal unit function and who needed a nephrectomy. Poor compliance (45.6%), unawareness (35.1%), and misconception that the stent would last a lifetime (12.3%), were the most common reasons for retained ureteral stents. The incidence rate of retained stents fell from 1.1% to 0.5% after the “three steps” prevention check method was in-cooperated to ensure timely follow-up of the patients. <strong>Conclusion: </strong>retained ureteral stents are a significant source of morbidity, which is avoidable by ensuring timely removal. Sincere efforts should be made to make patients aware of an indwelling foreign body. Prevention is the best strategy.</p>Mayank AgrawalVenkat Arjun GitePrakash SankapalMudit MaheshwariAkash ShahSabby DiasShashank Sharma
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2023-12-192023-12-19421Varied presentations of pancreatic insulinoma: a case report
https://www.ajol.info/index.php/pamj/article/view/251407
<p>An insulinoma is a rare functional pancreatic neuroendocrine tumour that is usually sporadic and solitary. The hallmark is hypersecretion of insulin, which leads to neuroglycopenia symptoms and uncontrolled sympathoadrenal activity. Neuroendocrine tumours can have a varied presentation, with symptoms often ascribed to a different diagnosis, thus delaying correct diagnosis and treatment. We present the case of a 26-year-old female who had a 3-year delay before diagnosing insulinoma after being initially assessed with epilepsy and schizophrenia. The case report below provides a detailed review of the diagnosis, tumour localization, and surgical interventions implemented for the patient during the COVID-19 pandemic.</p>Pueya Rashid NashidengoFrancis William QuaysonJohn Tabiri AbebreseLahja NegumboCornell EnssleFredrick Kidaaga
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2023-12-192023-12-19421Concomitant primary angiosarcoma and invasive carcinoma of the breast: a case report
https://www.ajol.info/index.php/pamj/article/view/251409
<p>Collision tumor is a rare entity composed of two different tumors that occur in close to one another and maintain distinct borders. Only few cases have been reported in the breast. We report the the first case of concomitant and adjacent primary angiosarcoma (PBAS) and invasive carcinoma of the breast (IBC), in a 45-year-old patient which presented with a lump in her right breast. Biopsy revealed PBAS. She underwent mastectomy. Gross examination showed a hemorrhagic and spongy tumor in contact with a second small grayish-white mass. Histologically, the hemorrhagic tumor was consistent with a high grade (HG) PBAS; the second mass was consistent with an IBC with no images of histological admixture. The diagnosis of a collision tumor composed of HG PBAS and IBC was established. During follow-up, the patient developed ovarian angiosarcomatous metastasis. The diagnosis of breast collision tumor is very uncommon and hence is challenging for pathologist. Careful gross and microscopic examinations help in establishing the appropriate diagnosis.</p>Mouna ZghalMeriam TrikiFatma KhanfirMarwa BouhamedDoulira LouatiTahya BoudawaraInes Saguem
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2023-12-192023-12-19421Acquired uterine arteriovenous malformation following dilation and curettage: a case report
https://www.ajol.info/index.php/pamj/article/view/251412
<p>Arteriovenous malformation of the uterus is a rare encounter with sporadic incidence. They are usually acquired following events like dilation and curettage or abortions. It should always be considered as a diagnostic possibility in women presenting with torrential vaginal bleeding. We report a case of 24-years-old woman presenting with excessive bleeding following dilation and curettage. She was diagnosed with an acquired uterine arteriovenous malformation after conducting Doppler angiography. She was meticulously managed by performing uterine artery embolization. Embolization technique for uterine arteriovenous malformation (AVM) is generally used in fewer crisis circumstances as well as in emergency situations. Management by selective arterial embolization reduces the morbidity of surgery and hospital stay.</p>Andela ManishaAmardeep Tembhare
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2023-12-192023-12-19421Seroprevalence of Toxoplasma gondii infection among babies in Jeddah Province, Saudi Arabia: a retrospective study
https://www.ajol.info/index.php/pamj/article/view/251414
<p><strong>Introduction: </strong>toxoplasmosis is an opportunistic protozoan disease caused by <em>Toxoplasma gondii</em> (<em>T. gondii</em>) infection. It affects all human ages, including children, and can pose serious health problems, particularly in developing countries. Nevertheless, the epidemiological status of neonatal and childhood toxoplasmosis remains largely unknown in Saudi Arabia. The present study aimed to determine the seroprevalence of <em>T. gondii</em> infection among Saudi babies residing in Jeddah Region of Saudi Arabia. <strong>Methods: </strong>this hospital-based retrospective study was conducted between January 2019 and March 2021 at three governmental hospitals in Jeddah Region: King Fahad, King Abdulaziz, and East Jeddah Hospital. It included 502 babies (269 boys and 233 girls; 0-4 years old), who were screened by enzyme linked immunosorbent assay (ELISA) for the detection of anti-<em>T. gondii</em> immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in their serum. <strong>Results: </strong>among the 502 studied babies, the overall seropositivity rate of <em>T. gondii</em> infection was 18.53% (93/502) subscribed as 90 babies (17.9%) with IgG seropositive and 3 babies (0.60%) with IgM seropositivity. The all IgG seropositive babies were IgM seronegative and vice versa. Additionally, the highest proportion of IgG seropositivity was detected in 0-6 month old babies (7.17%); followed by 5.38% and 4.98% in 7-12 and 13-18 months old babies, respectively, while the 3 babies with IgM seropositivity were 13-18 months old. <strong>Conclusion: </strong>the present findings highlighted the seroprevalence situation of toxoplasma infection among babies in some Saudi communities and raise the importance to increase the screening programs and preventative implements against toxoplasmosis in Saudi Arabia.</p>Raafat Abdel Moneim HassaneinAdel Galal El-ShemiMohammed Othman AlkurbiAmeer Ahmed AlahmadiWaslallah Saad Almatery
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2023-12-192023-12-19421Giant phyllodes tumor of the breast
https://www.ajol.info/index.php/pamj/article/view/251416
<p>A 50-year-old female presented to the Outpatient Department (OPD) with chief complaints of a lump in the left breast for 3 years. There was a history of a rapid increase in the size of the lump for 1 year. No history of associated pain or discharge from the nipple was present. On examination, a sizeable nodular lump was palpated in the left breast with intact overlying skin and nipple-areola complex. The patient was advised sonomammography of the left breast, which revealed a large loculated well-circumscribed lesion of approximate size 9.3 x 8.6 x 6.7 cm. It had a heterogeneous echotexture, with solid and cystic components within the lesion. Multiple thick interconnecting septae were noted within the lesion. The cystic component had posterior acoustic enhancement with multiple dense moving internal echoes within. No calcification was present within the lesion. The solid component and septae showed vascularity on color Doppler. No evidence of axillary lymphadenopathy or invasion into the underlying muscles or bone was noted. The lesion was diagnosed as a case of benign phyllodes tumor on sonomammography due to its peculiar characteristics. The patient was advised of surgical resection of the tumor and the mass was sent for histopathological evaluation, which confirmed the diagnosis of benign phyllodes tumor. Phyllode's tumor is also known as cystosarcoma phyllodes and is a rare fibroepithelial tumor of the breast. These tumors are mostly benign and have a resemblance to fibroadenomas on imaging in the early stages. However, fibroadenomas are usually small and stop growing in size beyond 3-5 cm whereas, phyllodes tumors are large at presentation and can grow up to an enormous size.</p>Suruchi DhawanAvinash Dhok
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2023-12-192023-12-19421Physical inactivity and perceived environmental factors: a cross-sectional study among civil servants in Abia State, Southeastern Nigeria
https://www.ajol.info/index.php/pamj/article/view/251419
<p><strong>Introduction: </strong>physical inactivity has been identified as the fourth leading risk factor for global mortality due to non-communicable diseases. Prevalence rates of 91.0% and 62.2%, have been documented among civil servants in the northern and southern parts of Nigeria, respectively. There is a paucity of data regarding the relationship between physical inactivity and environmental factors among civil servants in the State. This study assessed the prevalence and perceived environmental factors associated with physical inactivity among civil servants in Abia State Nigeria. <strong>Methods: </strong>we conducted a cross-sectional study in which we recruited 440 civil servants using a multistage sampling technique. We used an interviewer-administered structured questionnaire to collect data on sociodemographic, physical activity, and neighbourhood environmental attributes. Descriptive, bivariate and multivariate analysis were done. The level of significance was set at 5%. <strong>Results: </strong>the mean age of the respondents was 39.0±9.2 years, and 61% were females. The prevalence of physical inactivity was 48.4% (95%CI:43.7%-53.2%). The putative environmental factors included perceptions of low residential density areas, perceived absence of neighbourhood sidewalks, perceived unavailability of bicycling facilities and the perception of an unsafe neighbourhood due to night crimes. The predictor of physical inactivity was the perceived absence of neighbourhood sidewalks (aOR=2.02, 95%CI:1.10-3.73). <strong>Conclusion: </strong>in this study, physical inactivity is prevalent among civil servants in Abia State. The need for the stakeholders in collaboration with the Ministry of Environment to focus on the provision of sidewalk facilities, layout of residential areas and limit security risks in the State to enhance physical activity is highlighted.</p>Chidinma Ihuoma AmuzieIkeOluwapo AjayiEniola BamgboyeChukwuma David UmeokonkwoChristian Obasi AkpaUgonma Okpechi AgboUche Ngozi NwamohMichael Izuka
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2023-12-192023-12-19421Furuncular myiasis affecting the glans penis of a young boy caused by the larvae of Cordylobia anthropophaga (the tumbu fly): a case report
https://www.ajol.info/index.php/pamj/article/view/251421
<p>Cutaneous myiasis is endemic in West Africa, and it is most commonly caused by the larvae of <em>Cordylobia anthropophagia</em>. In English literature, recorded cases of this cutaneous myiasis affecting the glans penis are rare. This rarity calls for a need to consider this as a differential when looking at furuncular lesions of the glans penis. This awareness is important for practitioners who may come across this case. We report a case of furuncular myiasis of the glans penis due to the larvae of <em>C. anthropophaga </em>of an 11-year-old boy living in Lagos, Nigeria. The patient presented with a lesion on his glans penis, initially thought to be a boil. Upon examination, the lesion contained a single larva of <em>C. anthropophaga</em>. It was extracted, and the area healed well. Although endemic, furuncular myiasis of the glans penis is a very rare condition, likely related to the living circumstance of the patient. An awareness of the clinical features is important to prevent misdiagnoses of foruncular lesions that occur on the glans penis, especially in people with identified risk factors. Health education and promotion of good hygiene are important in reducing the incidence of <em>Cordylobia anthropophagia</em> infestation.</p>Damilola Alexander JesuyajoluPaul Jesuyajolu
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2023-12-192023-12-19421Proportion and factors associated with fetal adverse birth outcome among mothers who gave birth at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar city, Northwest, Ethiopia 2019
https://www.ajol.info/index.php/pamj/article/view/251430
<p><strong>Introduction: </strong>fetal adverse birth outcomes are abnormal outcomes such as prematurity, low birth weight, stillbirth, and birth defects. It is the main cause of neonatal and child deaths in the world and is the major public health problem in developing countries including Ethiopia. This study aims to assess the proportion and factors associated with fetal adverse birth outcomes among mothers who gave birth at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar city, North-west, Ethiopia 2019. <strong>Methods: </strong>institution-based cross-sectional study was conducted from March 1- to April 30 in 2019 among 371 delivered mothers. The data were collected by systematic random sampling technique, entered into a computer using Epi data 3.5, and analyzed using Statistical Package of Social Sciences version 23.0. Bivariate and multivariable logistic regression analyses were done to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05 considered statistically significant. <strong>Results: </strong>in this study, the proportion of fetal adverse birth outcome was 33.2%. Mothers who lived in rural area [AOR=4.37, 95% CI=2.44-7.83], < 4 antenatal care visit [AOR=1.91, 95% CI=1.08-3.40], bad obstetrical history [AOR=2.01, 95% CI=1.03-3.93], complication in the antepartum period [AOR=4.32, 95% CI=2.44-7.65], medical illness [AOR=2.44, 95% CI=1.25-4.79], and maternal hemoglobin level < 11 mg/dl [AOR=4.63, 95% CI=2.40-8.93] were significantly associated with fetal adverse birth outcomes. <strong>Conclusion: </strong>the proportion of fetal adverse birth outcomes in this research was high. Living in a rural area, the number of antenatal care visits, bad obstetrical history, current pregnancy complications, medical illness, and hemoglobin levels less than or equal to 11 mg/dl were significantly associated with fetal adverse birth outcomes. Getting full service of antenatal care visits and advance in the quality of maternal health services could minimize fetal adverse birth outcomes.</p>Bezawit Abeje AlemayehuSelamawit Lake Fentahumiye Shiferaw GessesseTigist Wubet GezahegnEden Asmare KassahunWondu Feyisa Balcha
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2023-12-192023-12-19421Apoprotein L1 risk variants and kidney transplantation: a protocol for systematic review and meta-analysis
https://www.ajol.info/index.php/pamj/article/view/251435
<p>Graft survival after kidney transplantation may be influenced by both donors' and recipients' Apoprotein 1 (APOL1) risk variant status. There are several conflicting reports on screening, eligibility, and inclusion of APOL1 risk variant testing in the Kidney donor risk index. We developed a search strategy that included medical subject headings (MeSH), text words, and entry terms in order to search nine databases. The primary measurable outcome is the recipient's post-transplant graft survival time from APOL1 high-risk variant donors. The secondary outcomes are the proportion of APOL1 high-risk variants in end-stage kidney disease requiring a kidney transplant, the proportion in graft recipients and kidney donors; the effect of APOL1 high-risk variant on donor's kidney function post-kidney donation, recipient kidney allograft survival in APOL1 low and high-risk recipients. Confidence and comprehensive meta-analysis software will be used for the meta-analysis. Methodological, clinical, and statistical heterogeneity will be assessed. Publication bias will be visually assessed using the funnel plot. Results will be presented in forest plots with pooled survival time, standard error, and variance. Sub-group analysis will be performed using moderators such as sociodemographic characteristics, hypertension, HIV status, forms of rejection and other environmental factors. The primary outcome effect size is the standardized mean difference in survival time for APOL1 high risk variants in kidney transplants. The differences in kidney function between donors and recipients before and after transplantation would be examined. The suitability of donors with APOL1 high risk variants will be explored in terms of graft survival time, donor kidney function, and the aforementioned moderators.</p>Michael Abel AlaoYemi Raheem RajiOnyenunachi AsinobiAdeolu Oladayo AkinboroSamuel Osobuchi NgeneIbrahim Rasheed OlayinkaIfeoma OkoyeEmmanuel Nna
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2023-12-192023-12-19421Pulmonary rehabilitation in Africa: where are we? a multimethod study
https://www.ajol.info/index.php/pamj/article/view/251440
<p>Pulmonary rehabilitation (PR) is an integral part of the management of patients with chronic respiratory diseases. However, there is limited information available on the effectiveness and practice of PR in Africa. This study was conducted to examine the prevalence, structure, and organization of PR in Africa, as well as its substance and claimed efficacy. We conducted a multimethod study involving systematic review of PR studies (obtained from PubMed, Google Scholar, and Cochrane databases) and a web-based survey of African healthcare professionals engaged in PR (using a standardized questionnaire). The review included papers on at least one component of PR in Africa and excluded those on PR from other continents or assessing pulmonary disorders in general without PR, cardio-rehabilitation, or physiotherapy practice in general in Africa. The Cochrane risk of bias and the Newcastle Ottawa scale instruments were used to assess the quality of included studies. We narratively synthesised data across the studies to produce a holistic picture. Of the 14 studies included for qualitative synthesis, seven were randomized controlled trials on the effectiveness of PR treatments with a total number of 333 participants. Of the 39 surveys mailed to health professionals working in Africa, only 14 (35.8%) were returned. We found aerobic exercise and breathing exercises were the most used technique and that quality of life, exercise capacity, and lung function improved significantly after PR treatments. There were differences in the duration, frequency, and length of the programs across the continent. Half of the respondents indicated that their institutions had one or more PR programs for inpatient, outpatient, maintenance, and/or home-based programs. Additionally, aerobic activities, upper and lower extremity strength training were the most frequently used exercise modalities in PR programs, followed by breathing exercises. Pulmonary rehabilitation is understudied in Africa, but it has been linked to improved lung function, exercise capacity, and quality of life. There is a need to invest in techniques tailored to the continent to enhance the implementation of pulmonary rehabilitation in Africa.</p>Abbi-Monique Mamani BilungulaPatrick KatotoRik GosselinkJean-Marie Ntumba KayembeDaniel Langer
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2023-12-192023-12-19421Determination of salt content in traditional and industrial Moroccan white bread by inductively coupled plasma mass spectrometry
https://www.ajol.info/index.php/pamj/article/view/251448
<p><strong>Introduction: </strong>evaluating the sodium content of staple foods is essential for implementing a salt reduction strategy. In Morocco, bread is a major contributor to sodium intake. However, currently few studies have been carried out to assess the salt content in bread. Our study aimed to estimate the sodium and salt content of white bread available in artisanal and industrial bakeries in the twelve regions of Morocco. <strong>Methods: </strong>it is a cross-sectional study of the sodium content of white bread available for sale in artisanal and industrial bakeries in Morocco (N=120). Inductively coupled plasma mass spectrometry (ICP-MS) was used to quantify the sodium content of the bread. The percentage of samples meeting the recommendations and bread contribution to the daily salt intake was calculated. <strong>Results: </strong>the results of our study show that the mean levels of sodium and salt added to bread samples were 5.7 ± 1.5 g/Kg and 14.5 ± 3.7 g/Kg, respectively. With an average of 4.4 ± 0.5 g/Kg and 11.2 ± 1.2 g/Kg for artisanal bread and an average of 7.0 ± 0.8 g/Kg and 17.8 ± 2.1 g/Kg for industrial bread, respectively. Daily salt intake from bread consumption (500 g/d/person) is estimated at 5.6 g/d (52.8% of total salt intake) for artisanal bread and 8.9 g/d (84% of total salt intake) for industrial bread. <strong>Conclusion: </strong>bread salt content in Morocco exceeds the recommended threshold of the national federation of bakery and pastry and health authorities. Further efforts are necessary to increase knowledge and awareness of bakers and to teach them how to reduce salt content without affecting the flavor and the quality of their products.</p>Meryem BouhamidaMeryem LazrakHouria LahmamSara Ait LachguerYasmine GuennounLaila El AmmariAbdelhakim YahyaneNour Eddine ElhalouiNaima SaeidNada BenajibaRadouan SaadiKhalid El KariRadhouene DogguiAyoub Al JawaldehHasnae BenkiraneHassan Aguenaou
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2023-12-192023-12-19421Prevalence and correlates of undiagnosed hypertension among staff of a Nigerian university community
https://www.ajol.info/index.php/pamj/article/view/251467
<p><strong>Introduction: </strong>the prevalence of hypertension in Nigeria is high, with a considerable proportion of it being undiagnosed. Nevertheless, early identification of influencing variables for hypertension in different population groups is important for several reasons. This study aimed to determine the prevalence and correlates of undiagnosed hypertension among staff of a university community in Nigeria. <strong>Methods: </strong>a purposive sample of 281 staff of Bauchi State University, Gadau, Nigeria, fulfilled the inclusion criteria and were enrolled in this cross-sectional study. Demographics, blood pressure, height, weight, socioeconomic status and physical activity were measured. Diagnosis of hypertension was defined based on a systolic and diastolic blood pressure of ≥140 mmHg and ≥90 mmHg, respectively. Data obtained was analysed descriptively, and by means of Chi-square, univariate and multivariate statistics using SPSS v24 software. <strong>Results: </strong>the mean age and body mass index (BMI) of the participants was 34.5 years and 23.1 ± 5.17 Kg/m<sup>2</sup>, respectively. The prevalence rate of undiagnosed hypertension was 27.8%. Normotensives significantly differed from participants with undiagnosed hypertension in most of the clinical and demographic variables (p<0.05). Univariate and multivariate analyses revealed that a positive family history of hypertension had the highest odds of having undiagnosed hypertension (aOR: 0.833, 95%CI: 16.55-432.87, p= 0.000). Next, a higher BMI score (aOR: 0.425, 95%CI: 0.085-0.447, p= 0.000), male gender (aOR: 0.451, 95%CI: 0.141-0.829, p= 0.018), job cadre (aOR: 0.515, 95%CI: 0.073-0.550, p= 0.002) and low physical activity level (aOR: 0.572, 95%CI: 5.296-49.777, p=0.000) were other factors with about 50% odds for having undiagnosed hypertension among the participants. Lastly, smoking status and socioeconomic status of the participants were not significantly associated with undiagnosed hypertension (p>0.05). <strong>Conclusion: </strong>a high percentage of the studied population have undiagnosed hypertension that is mainly associated with non-modifiable (especially positive family history) and a few modifiable risk factors. These variables can be used for early identification and in designing appropriate preventive strategies.</p>Babangida Shehu BappahAishat ShittuJibrin Sammani UsmanJibril Mohammed NuhuFarida Garba SumailaAisha Ahmad AhmadJibril Mohammed
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2023-12-192023-12-19421A letter to the editors discussing the following article: “Complicated COVID-19 in pregnancy, maternal and neonatal outcomes: a case report” by MOUNA GARA et al
https://www.ajol.info/index.php/pamj/article/view/251475
<p class="ArticleParagraph">I'm an avid reader of The Pan African Medical Journal and It´s with a great interest that I have read this following article: “Complicated COVID-19 in pregnancy, maternal and neonatal outcomes: a case report” [<a href="https://www.panafrican-med-journal.com/content/article/42/81/full/#ref1">1</a>]. Physiological, mechanical, and immunologic alterations in pregnancy could potentially affect the susceptibility to and the severity of COVID-19 during pregnancy [<a href="https://www.panafrican-med-journal.com/content/article/42/81/full/#ref2">2</a>]. Owing to the lack of comparable incidence data and the challenges with disentangling differences in the susceptibility from different exposure risks, the data are insufficient to determine whether pregnancy increases the susceptibility to SARS-CoV-2 infection. Evidence is accumulating that SARS-CoV-2 infection during pregnancy is associated with a number of adverse pregnancy outcomes including preeclampsia, preterm birth, and stillbirth, especially among pregnant persons with severe COVID-19 disease [<a href="https://www.panafrican-med-journal.com/content/article/42/81/full/#ref2">2</a>,<a href="https://www.panafrican-med-journal.com/content/article/42/81/full/#ref3">3</a>].</p> <p class="ParagraphSeparator"> </p> <p class="ArticleParagraph">While several treatments such as Remdesivir and Dexamethasone are either available or in development for severe COVID-19 [<a href="https://www.panafrican-med-journal.com/content/article/42/81/full/#ref3">3</a>], early testing and treatment remains the key for a better prognosis. The patient described in this case report waited about a week of showing COVID-19 symptoms. COVID-19 should be treated early and hard: this approach has been proven to be successful in thousands of patients. The earlier you treat, the better the outcomes. If you wait five days after experiencing symptoms before being treated, your chance of being hospitalized can rise from zero to 10% or more [<a href="https://www.panafrican-med-journal.com/content/article/42/81/full/#ref4">4</a>]. The only hospitalizations we´ve seen in practice are when the patient waits too long before seeing his or her doctor, can´t get a prescription filled in a timely manner, doesn´t take the drug, or the drug quality is an issue. The first two are the most common. The later you start treatment, the longer it may take you to recover and your outcomes will be more unpredictable. If you wait more than 48 hours beyond the onset of first symptoms, drug treatment will take longer to have a positive effect, higher doses and more drugs will be needed, and your outcomes will be more unpredictable [<a href="https://www.panafrican-med-journal.com/content/article/42/81/full/#ref3">3-5</a>].</p> <p class="ParagraphSeparator"> </p> <p class="ArticleParagraph">In 2022 and two years after its release, the COVID-19 vaccine is considered to be the number one tool to bring this pandemic to an end. A large share of the world needs to be immune to the virus. Vaccines are a technology that humanity has often relied on in the past to bring down the death toll of infectious diseases [<a href="https://www.panafrican-med-journal.com/content/article/42/81/full/#ref6">6</a>]. The vaccinal status of the patient described in this article hasn´t been revealed. This leads us to think that the patient is not fully nor partially vaccinated. An ounce of prevention is worth a pound of cure. Safe and effective vaccines are a game-changing tool: but for the foreseeable future we must continue wearing masks, cleaning our hands, ensuring good ventilation indoors, physically distancing and avoiding crowds. Although the data are sparse, they are so far reassuring. For this reason, regulatory bodies in the United Kingdom, European Union and United States have recommended that pregnant people should be offered the vaccine where the benefits outweigh the potential risks: pregnant workers on the frontline and those with pre-existing conditions are now receiving the vaccine [<a href="https://www.panafrican-med-journal.com/content/article/42/81/full/#ref6">6</a>]. The U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the following vaccines along with the Indian Central Drugs and Standards Committee (CDSCO) in the type of COVID-19 vaccines authorized for emergency use for pregnant women): Pfizer-BioNTech - Moderna - Janssen Biotech, Inc. (Johnson & Johnson)- Serum Institute of India (Covishield) - Bharat Biotech (Covaxin) [<a href="https://www.panafrican-med-journal.com/content/article/42/81/full/#ref7">7</a>].</p> <p class="ParagraphSeparator"> </p> <p class="ArticleParagraph">While during pregnancy women's immunological, cardiovascular, and respiratory systems undergo significant physiological changes, perhaps a little amount of stress can exacerbate the disease severity. Pregnancy, on the other hand, produces hypercoagulability, endangering lives due to venous and arterial thromboembolism. According to early evidence and observational research, COVID-19 patients have a higher risk of thrombosis. Respiratory viral infections during pregnancy have been linked to factors such as low birth weight and preterm birth in several studies [<a href="https://www.panafrican-med-journal.com/content/article/42/81/full/#ref6">6</a>]. Additionally, high fever in early pregnancy may increase the chances of certain birth defects. In terms of vaccine effectiveness, studies indicate that the administration of the mRNA vaccines results in a robust maternal humoral response. Although the antibody response to vaccination among pregnant persons has not been rigorously compared with the response among nonpregnant persons, there is no reason to expect differences [<a href="https://www.panafrican-med-journal.com/content/article/42/81/full/#ref7">7</a>]. Furthermore, maternal immunoglobulin G antibodies efficiently cross the placenta, resulting in relatively high titers in the fetus [<a href="https://www.panafrican-med-journal.com/content/article/42/81/full/#ref6">6</a>,<a href="https://www.panafrican-med-journal.com/content/article/42/81/full/#ref7">7</a>].</p>Soukaina AbidiYoussra AzzouzSaliha Chbicheb
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2023-12-192023-12-19421Brain abscess a grave complication of tetralogy of fallot: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/251479
<p>A three-year-old female child presented to our Outpatient Department (OPD) with complaints of multiple episodes of seizure in one day. On examination, she had tachycardia and tachypnea; saturation was 60 % to 76% in all four limbs, Deep Tendon Reflex (DTR) was exaggerated, plantar jerks were extensor, central cyanosis, and grade III clubbing, and systolic ejection murmur on auscultation. She had no previous history of dyspnea and seizure. A complete blood count was suggestive of a white blood count of 17300 with neutrophilic predominance. A 2D echo done was suggestive of tetralogy of fallot. The patient was planned for magnetic resonance imaging of the brain. MRI brain was suggestive of a multi-located lesion in the left frontotemporal lobe suggestive of cerebral abscess, causing a midline shift of 4mm to the right side. The patient was started on ceftriaxone at 75mg/kg/day, amikacin at 15mg/kg/day and injection leverage at 20mg/kg/day, propranolol at 2mg/kg/day. A neurosurgery opinion was taken. She was planned and taken for surgery. Left frontal craniotomy was done with excision of the abscess wall. Histopathological examination confirmed the diagnosis of brain abscess. She was kept in PICU post-surgery, and antibiotics were continued for 14 days. Post-surgery she had no new episode of seizure. She was planned for cardiac surgery 1 and half months after craniotomy (A, B, C).</p>Arjun JaiswalAmar Taksande
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2023-12-192023-12-19421Connaissances, attitudes et pratiques des médecins de première ligne en matière d´aide au sevrage tabagique à Sfax (Tunisie), 2020
https://www.ajol.info/index.php/pamj/article/view/251485
<p><strong>Introduction: </strong>le médecin de première ligne doit jouer un rôle clef dans la lutte antitabac. Les objectifs de cette étude étaient d´évaluer les connaissances, les attitudes et les pratiques des médecins de première ligne en matière d´aide au sevrage tabagique, évaluer leur statut tabagique et déterminer les obstacles auxquels ils font face dans l´aide au sevrage tabagique. <strong>Méthodes: </strong>nous avons mené une étude transversale, durant le mois de novembre 2020, auprès d´un échantillon représentatif de médecins de première ligne exerçant au niveau du gouvernorat de Sfax. <strong>Résultats: </strong>au total, 115 médecins de première ligne étaient inclus avec un sex ratio (H/F) de 0,91. L´âge médian était de 43 ans (Intervalle interquartile = [34-55 ans]). Parmi les répondants, 26 (22,6%) ont déclaré être des fumeurs. Nous avons noté que 98 médecins enquêtés (85,2%) n´ont pas eu de formation en postuniversitaire sur l´aide au sevrage tabagique. Cependant, 71 (61,7%) avaient une idée sur la thérapie de substitution nicotinique. Concernant les attitudes, 73 répondants (63,5%) étaient convaincus qu´il est de la responsabilité des médecins d´aider leurs patients à arrêter de fumer. Par rapport aux pratiques, 45 médecins (39,1%) interrogeaient systématiquement tous les patients sur leurs habitudes tabagiques. Les activités les moins exécutées de la stratégie des 5A étaient les composantes «Aider» (14%) et «Organiser un suivi» (17,4%). Le désintérêt des patients était jugé, par 61 médecins enquêtés (53%), un obstacle important pour l´aide au sevrage tabagique. <strong>Conclusion: </strong>il est nécessaire d´évaluer et d´améliorer l´application de la stratégie nationale de lutte anti-tabac, surtout en ce qui concerne la formation des médecins de première ligne.</p>Maroua TriguJihen JdidiYosra MejdoubHouda Ben AyedMariem Ben HmidaMaissa Ben JmaaRaouf KarraySourour YaichHabib FkiJamel DamakMondher Kassis
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2023-12-192023-12-19421Thirty years of experience with anti-neutrophil cytoplasmic antibody glomerulonephritis in Charles Nicolle Hospital-Tunisia: a retrospective cohort study
https://www.ajol.info/index.php/pamj/article/view/251494
<p><strong>Introduction: </strong>antineutrophil cytoplasmic antibodies (ANCA) associated Glomerulonephritis (GN) is rare but a life-threatening disease especially, particularly in patients with advanced renal failure at presentation. This study aims to evaluate the epidemiological, clinical and histopathological features of renal involvement and investigate factors associated with ESRD. <strong>Methods: </strong>patients with renal biopsy-proven ANCA associated glomerulonephritis were included retrospectively over a thirty years period. The renal survival, defined as time to reach ESRD, was evaluated based on clinical parameters, histopathological classification as well as the renal risk score. <strong>Results: </strong>a total of 65 patients with crescentic GN were included in the study. The mean age was 47.9 years ± 22.4 years (range:18-78) with an M/F sex ratio at 1.13. Hematuria, proteinuria and oliguria were found in respectively 100%, 81.5% and 56.2% of cases. Sixty patients (92.3%) had renal failure at presentation, and 30 patients (46%) required initial hemodialysis (HD) therapy. The pattern of glomerular injury was categorized as mixed in 43.7% of cases, sclerotic in 34.3%, crescentic in 16.6%, and focal class in 6%. Regarding renal risk score, patients were classified in the category low risk, intermediate risk and high risk with respectively 16.9%, 44.6% and 38.4%. All patients received corticosteroids and immunosuppressive treatment. Complete, partial remission and relapses were noted in respectively 15.3%, 18% and 72% of cases. Factors associated with ESRD were serum creatinine level >500 μmol/l (P=0,0016), CRP level >60 mg/l (P = 0,0013), interstitial fibrosis (P=0,0009) and glomerulosclerosis> 10% of total glomeruli (P=0,001). The survival rate was 89%, 60.9% and 32.8% at respectively 1, 5 and 10 years. Death occurred in 10 cases (15%) caused mostly by infections (40%). Initial serum creatinine level>140 μmol/l (P=0,02), alveolar hemorrhage (P=0.001) and infections (P=0,0001) were associated with mortality. <strong>Conclusion: </strong>in our cohort of ANCA GN, confirms the data showing improved patient survival but constantly high relapse risk. In addition, we observed that ANCA GN classification was predictive, as the risk of progressing to ESRD increased with the ascending category of focal, crescentic, mixed and sclerotic GN.</p>Meriam HajjiSamia BarbouchRim GouchaFethi Ben HamidaImen GorsaneEzzeddine Abderrahim
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2023-12-192023-12-19421An internet-based cross-sectional study on infection control practices and drug use for COVID-19 prevention in Nigerian adults
https://www.ajol.info/index.php/pamj/article/view/251498
<p><strong>Introduction: </strong>COVID-19 has affected several millions of people globally and various means have been employed to curb the spread. This nationwide survey investigated adherence to infection control protocols and drug uptake among Nigerian adults. <strong>Methods: </strong>this was a descriptive cross-sectional survey using an internet-based questionnaire to investigate adherence to infection control practices and drug use among adults, who have been resident in Nigeria for at least 6 months. The data was analyzed using Stata software version 16 with levels of significance at p<0.05. <strong>Results: </strong>a total of 1235 adults participated in the study. The respondents were aged 18-78 years with a mean age of 36.3 ±11.1 years. Over half (53.0%) of the participants were between 31-50 years. The male to female ratio was 1:1.45. Majority (92.6%) had a minimum of tertiary educational qualification. One hundred (27.1%) reported a positive test result for COVID-19. A total of 1,204 (97.5%) admitted to wearing of face masks, 1,125 (91.1%) washed hands regularly, 1,142 (92.5%) used hand sanitizers while physical distancing was maintained in 985 (79.8%). A total of 854 (69.2%) were on at least a drug or herbal based therapy. Herbal based remedies were used in 112 (9.1%), supplements in 763 (61.8%), antibiotics in 210 (17%), ivermectin in 205 (16.6%), and antimalarials in 128 (10.4%) participants. <strong>Conclusion: </strong>adherence to behavioural measures was high among the population, with widespread uptake of supplements, antibiotics, and antimalarial drugs. The high uptake of antibiotics emphasizes the need to step up regulatory policies for antibiotic use.</p>Adedoyin Oyeyimika OgunyemiAdedunni Wumi OlusanyaAdesina Paul ArikaweOluwarotimi Bolaji OlopadeUyiekpen Ima-EdomwonyiRoland Oluwapelumi Ojo
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2023-12-192023-12-19421Cause inhabituelle de syndrome du canal tarsien chez une fille de 15 ans: à propos d'un cas
https://www.ajol.info/index.php/pamj/article/view/251500
<p>Le syndrome du canal tarsien; c´est l´ensemble des manifestations causées par une compression ou lésion de nerf tibial postérieur (NTP) qui passe dans un canal osteofibreux retromalléolaire appelé le canal tarsien. Dont les étiologies sont très diverses entre autres les tumeurs des nerfs périphériques. Que faut-il savoir suspecter devant ce syndrome résistant au traitement médical et aux infiltrations? Nous rapportons un cas original d´une fille de 15 ans qui présentait un syndrome de canal tarsien révélant un neurofibrome de NTP, diagnostiqué à tort comme une fascite plantaire et une radiculopathie de S1.</p>El Hassani AbdelkrimHicham DoumaOussama BarchahMoustapha ElkassehAmine BoumaizSaad BelkyalHanane El HaouryMohamed MadharRachid ChafikYoussef Najeb1
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2023-12-192023-12-19421Idealism versus realism: the case of overcrowding in railways amidst COVID-19 pandemic
https://www.ajol.info/index.php/pamj/article/view/251566
<p>The image is a display of the stark reality of travelling in a general railway coach amidst the COVID-19 pandemic. This image was captured during a visit to Madhya Pradesh from Maharashtra five months ago. The government removed the COVID-19 restrictions from April 1<sup>st</sup>, 2022, which is three months after this image was taken. Overcrowding is an important public health problem which not only facilitates the disease transmission process but also expedites it. This issue gets further complicated while travelling in trains. Within the overcrowded coaches of the train, it is highly likely for the diseases to spread. While infections spreading through aerosols and droplets are a concern, especially for conditions like COVID-19, it must also be considered that the trains have multiple stops at multiple stations, which also leads to an exchange of travelers who may be infected asymptomatic as well as symptomatic patients. This pre disposes the travelers to a substantial risk of getting exposed to the pathogens due to greater opportunities for such exposure to happen. This image mocks the gap between the idealism of what should be done during the pandemic and reality. While it is the responsibility of the government to implement stringent public health interventions to prevent the spread of communicable diseases, it may be challenging to provide practical solutions to achieve a balance between idealism and realism in a developing country with such a large population. However, this image advocates the need for deliberations on how to effectively implement the public health intervention strategies.</p>Shiv Hiren JoshiAditya Suhas Dhonde
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2023-12-192023-12-19421Comparison of three different surgical treatment methods in humeral shaft fractures
https://www.ajol.info/index.php/pamj/article/view/251569
<p><strong>Introduction: </strong>in this study, we aimed to compare the clinical and radiological results of single 4.5 mm locking compression plate (LCP), dual 3.5 mm LCP and intramedullary nailing (IMN) methods applied to the surgical treatment of humeral shaft fractures. <strong>Methods: </strong>the study included 77 patients (41 males, 36 females; mean age 46.38 years; range 18-74 years) with humeral shaft fractures treated with a single 4.5 mm LCP, dual 3.5 mm LCP and IMN between January 2016 and December 2020. Single 4.5 mm LCP (Group A) was applied to 31 (40.3%) patients, dual 3.5 mm LCP (Group B) to 20 (26%) patients and IMN (Group C) to 26 (33.8%) patients. The preoperative and postoperative data of the patients were analyzed from the hospital registry system. A short version of the disabilities of the arm, shoulder and hand (QuickDASH) questionnaire was used to evaluate functional outcomes. <strong>Results: </strong>as a result of the comparison of the rates of nonunion between the groups, a significantly lower rate of nonunion was observed in group B patients (p=0.027). While the rate of nonunion was 14% in the cases included in the study, no cases of nonunion were encountered in group B. There was no difference between the three groups in terms of demographic data and other postoperative complications. <strong>Conclusion: </strong>dual 3.5 mm LCP method is a suitable alternative to other surgical methods in the treatment of humeral shaft fractures, due to similar functional results and lesser nonunion.</p>Bekir KaragozMustafa ErdemMustafa CukurluIsmail Agir
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2023-12-192023-12-19421Application of random forest model to predict the demand of essential med
https://www.ajol.info/index.php/pamj/article/view/251571
<p><strong>Introduction:</strong> recent initiatives in healthcare reform have pushed for a better understanding of data complexity and revolution. Given the global prevalence of Non-Communicable Diseases (NCD) and the economic and clinical burden they impose, it is recommended that the management of essential medicines used to treat them be renovated and optimized through the application of predictive modeling such a RF model. <strong>Methods:</strong> in this study, a series of data pre-processing activities were used to select the top seventeen (17) NCD essential medicines most commonly used for treating common and frequent NCD. The study focused on machine learning (ML) applications, whereby a random forest (RF) model was applied to predict the demand using essential medicines consumption data from 2015 to 2019 for approximately 500 medical products. <strong>Results:</strong> with a seventy-eight (78) percent accuracy rate for the training set and a 71 percent accuracy rate for the testing set, the RF model predicted the trend in demand for 17 NCD essential medicines. This was achieved by entering the month, year, district, and name of the NCD essential medicine. Based on historical consumption data, the RF model can thus be used to predict demand trends. Our findings showed that the RF model is talented to commendably perform as a predicting model. <strong>Conclusion:</strong> the study concluded that RF has the ability to optimize health supply chain planning and operational management by boosting the accuracy in predicting the demand trend for NCD essential medicines.</p>François MbonyinshutiJoseph NkurunzizaJaphet NiyobuhungiroEgide Kayitare
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2023-12-192023-12-19421Impact of COVID-19 on renal replacement therapy: perspective from a Nigerian renal transplant centre
https://www.ajol.info/index.php/pamj/article/view/251572
<p><strong>Introduction: </strong>COVID-19 has had a huge impact on the health system and the world at large. Patients with kidney failure are a select group which have been affected significantly by the scourge of the disease. In the COVID-19 era, renal replacement therapy (RRT) in the form of dialysis and kidney transplantation required modifications in many centres in order to maintain high quality care and reduce infection rates among this susceptible group of patients. The objectives were to describe some of the challenges experienced in one of the leading renal care centres in Nigeria during the height of the COVID-19 pandemic and analyse the impact of practice changes on select outcomes. <strong>Methods: </strong>a retrospective cross-sectional review of haemodialysis activities and kidney transplantation among chronic kidney disease patients was done over a 15-month period ranging from April, 2019 to June, 2021. Data was extracted from the electronic media record (EMR) and analysed using SPSS version 22. <strong>Results: </strong>there was an initial significant drop in the number of haemodialysis sessions and kidney transplant surgeries by 16.7% and 66% respectively in the first 2 months of COVID-19 in our centre following the national lockdown. The mean monthly kidney transplant rate was 9±3.29 before the COVID-19 and the national lockdown, this figure reduced to 3.0±0.1 during the lockdown. Activities however normalized at 6 months following the initial lockdowns have remarkable exceeded pre-COVID numbers as at early 2021. <strong>Conclusion: </strong>after the initial drop in numbers of patients for haemodialysis and renal transplantation, there was an increase in numbers in the following months. It was instructive to put several steps in place in order to continue to offer high level RRT in the COVID-19 pandemic. RRT can safely be practiced in the COVID-19 pandemic.</p>Martin Chukwudum IgbokweStephen Olabode AsaoluMichael Obinna MuokaOlalekan Olayinka Olatise
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2023-12-192023-12-19421Caregiver's perception of the home-based management of childhood malaria in Baneghang and Fombap Health Areas in the West Region of Cameroon
https://www.ajol.info/index.php/pamj/article/view/251575
<p><strong>Introduction: </strong>adequate community perception of malaria is crucial to improving prevention, diagnosis, and treatment. This study aimed to determine the caregiver´s perception of the home-based management of childhood malaria in Baneghang and Fombap health areas, Cameroon. <strong>Methods: </strong>a cross-sectional study was carried out to assess the knowledge, attitudes, and practices of home caregivers (HCGs) in Baneghang, a health area under Community Directed Intervention (CDI), and Fombap, a CDI-free health area. Community health workers (CHWs) conducted a census to identify households with under-five children that constituted a sample frame, and then a systematic random sampling was used to select HCGs. Analysis of variance was used to compare the mean score perceptions of HCGs in the management of childhood malaria at the two sites. <strong>Results: </strong>out of 420 HCGs interviewed, 161 (38.3%), 226 (53.8%), and 271 (64.5%) displayed correct knowledge, positive attitude, and good practice, respectively, towards childhood malaria prevention, diagnosis, and treatment in both study sites. The mean score knowledge of HCGs in Baneghang was significantly higher than that of those in Fombap (7.33 versus 6.94, p < 0.001). The mean score of attitudes of HCGs towards childhood malaria was also higher in Baneghang than in Fombap (6.59 versus 6.29, p=0.013). However, the mean scores of good practices of HCGs on childhood malaria in both health areas were similar (5.94 versus 5.92, p=0.921). <strong>Conclusion: </strong>home-based management of childhood malaria seems to have contributed to good knowledge and positive attitudes of HCGs on malaria prevention, diagnosis, and treatment.</p>Esther Kenfack DongmoNicholas TendongforAbdel Jelil NjouendouDickson Shey Nsagha
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2023-12-192023-12-19421Usual interstitial pneumonia
https://www.ajol.info/index.php/pamj/article/view/251578
<p>This clinical scenario includes a male, aged 83 years, a retired railway worker with complaints of breathlessness (modified Medical Research Council scale grade V), cough with expectorations (thick yellow-colored), and chest pain (sudden in onset, gradually progressive, and retrosternal in nature). He was a known case of hypertension for 15 years on medications, tuberculosis 10 years back for which he was managed with antitubercular treatment. He also suffered from a cerebrovascular event 4 years back and is currently on medications. On examination, the chest was a barrel-shaped and tracheal deviation to the right side. The movements of the chest wall were diminished bilaterally, more diminished on the left side along with the use of accessory muscles of the respiration with reduced chest expansion. On percussion, the dull note was present over lower intercostal spaces bilaterally. On auscultation, air entry on bilateral lung fields was reduced, with crepitations present on lower zones bilaterally. High-resolution computed tomography (HRCT) scan of the thorax was done which revealed - tractional bronchiectasis and multiple fibrotic changes in bilateral lung fields showing apicobasal gradient (A and C), with honeycombing pattern (D) and patchy areas of consolidation and thickening of the septa in bilateral lung fields (B). Findings are suggestive of the Usual Interstitial Pneumonia (UIP) pattern. He was advised medical management along with physiotherapy rehabilitation, which specifically included palliative care and supervised pulmonary rehabilitation.</p>Divya Manoj BadjateMoli Jain
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2023-12-192023-12-19421Evolution intra-hospitalière et à trois mois des thromboses veineuses cérébrales auprès du service de neurologie de Befelatanana, Madagascar: une étude de cohorte rétrospective
https://www.ajol.info/index.php/pamj/article/view/251579
<p>Le pronostic des thromboses veineuses cérébrales (TVC) est bien meilleur que celui des infarctus cérébraux d´origine artérielle. Nos objectifs étaient de décrire l´évolution intra-hospitalière et à trois mois des TVC auprès du Service de Neurologie de Befelatanana ainsi que la place de l´anticoagulation dans les TVC sans et avec suffusion hémorragique. Nous avons mené une étude de cohorte rétrospective des patients ayant eu une TVC du 1<sup>er</sup> janvier 2014 au 31 décembre 2019 (72 mois). Leurs caractéristiques cliniques, leurs évolutions intra-hospitalière et après 3 mois ont été collectés. Les données ont été analysées avec le logiciel R en comparant les patients ayant une TVC avec et sans suffusion hémorragique avec un p significatif ≤ 0,05. Nous avons enregistré 21/4227 (0,49%) de cas de TVC dont onze patients (52,38%) ont eu une TVC avec suffusion hémorragique. L´âge moyen était de 38,05 ans. La tranche d´âge de 18 à 34 ans (47,62%) était plus représentée. Le genre féminin prédominait dans 76,19% (n=16). A l´admission, le NIHSS < 10 était de 85,71% (n=18) et le mRS < 3 était de 61,90% (n=13). Tous les patients étaient sous anticoagulation. A la sortie de l´hôpital, le NIHSS < 10 était stable (90,47% (n=19)) avec une augmentation de patient avec un mRS < 3 (85,71% (n=18)) dont 3 étaient du groupe avec suffusion hémorragique. Le séjour hospitalier moyen était de 16,04 jours. Un patient du groupe sans suffusion hémorragique décédait pendant l´hospitalisation. A trois mois de leur sortie, seul 9 patients étaient joignables. Leur état neurologique s´améliorait (NIHSS < 10 dans 100% (n=9), mRS à 0 dans 88,89% (n=8)). Aucune différence statistiquement significative n´était trouvée entre les deux groupes en terme de handicap (p=0,757) avec un RR à 0.91 IC [0.04; 6.55] et de décès (p=0,282) (0 décès dans un groupe) entre les deux groupes mis et non mis sous anticoagulant. La mortalité et le handicap liés à la TVC anticoagulée au cours de son évolution sont très faibles. L´accessibilité à un angioscanner cérébral à faible coût permettra une meilleure prise en charge des TVC dans notre service de Neurologie.</p>Lala Andriamasinavalona RajaonarisonNomena Finiavana RasaholiarisonNaliniaina Robert RandrianantoandroManitra Niaina RabeonyJulien RazafimahefaNoël ZodalyAlain Djacoba Tehindrazanarivelo
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2023-12-192023-12-19421The pattern of paediatric otorhinolaryngological disorders seen at the Rivers State University Teaching Hospital, South-south Nigeria: a 3-year review
https://www.ajol.info/index.php/pamj/article/view/251580
<p><strong>Introduction: </strong>otolaryngological disorders vary among children due to diverse underlying aetiologies and pathologic processes.This study audits the pattern of paediatric ear, nose and throat diseases seen at the Rivers State University Teaching Hospital. <strong>Methods: </strong>a cross-sectional retrospective review of medical records of children (aged 0 - 17 years) seen between 1<sup>st</sup> January 2018 and 31<sup>st</sup> December 2020 were retrieved and analysed using IBM SPSS version 25.0. Results were presented as frequencies and percentages for categorical variables and mean and standard deviation for continuous variables. <strong>Results: </strong>a total of 5,533 paediatric visits were documented over the study period, making up 36.7% of all patients seen. There were 2,516 completed paediatric medical records. Males slightly predominated, accounting for 1,369 (54.5%), mean age was 6.77 years (SD ± 5.10) and ranged 2 weeks to 17 years. Age groups 0-4 years were the most affected. Ear disorders were the commonest disorders found (1637, 65.1%), followed by throat/neck disorders (650, 25.8%) and then nose disorders (229, 9.1%). The top 2 disorders based on regions were as follows: Cerumen Auris (426, 16.9%) and Otitis Externa (252, 10.2%) for ear disorders; Chronic / Allergic rhinosinusitis (107, 4.3%) and foreign body in the nose (72, 2.9%) for nose disorders and Adenotonsillar hypertrophy (544, 21.6%) and speech disorders (23, 0.9%) for throat disorders respectively. <strong>Conclusion: </strong>among the paediatric group of patients, ear disorders predominated. Cerumen Auris, Adenotonsillar hypertrophy and chronic/allergic rhinosinusitis were the commonest ENT disorders.</p>Datonye Christopher BriggsVictor Ohaka IkengaUreh Annabel OparaoduEbong Mbak
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2023-12-192023-12-19421The effectiveness of health care finance in promoting health: does the condition of health get better by spending more
https://www.ajol.info/index.php/pamj/article/view/251583
<p>Medical research in the United States remains a global reference, endowed with unrivalled financing, a source of endless advancements, and recognized with many accolades; with 45 per cent of the winners, the United States outrageously dominates the Nobel Prize for Medicine. The volume of health spending in the United States is far more than any other country; however, the health outcomes are far below expectation. An American child Born in 2016 will live on average 78.6 years, which places the country around the thirty-fifth place in the world, somewhere between Cuba and Qatar; the United States has other modest results, as evidenced by the ranking of countries in terms of infant mortality in 2015, which placed the country 33<sup>rd</sup> out of 35 member countries, ahead of only Turkey and Mexico. Although the United States ranks 35th out of 190 countries based on infant mortality in 2015, it is still far behind Cuba, which was 30<sup>th</sup> and the first "non-high" income country. In 2016, US health expenditures/gross domestic product (GDP) exceeded 16%, with an average of 10,000 USD/inhabitants, while Cuban health expenditures/GDP did not exceed 11% during the same period. We aim through the present work to show that the state of health doesn't improve by spending more. However, it improves by spending more on programs that we know from the evidence can improve health outcomes.</p>Nasreddine Aissaoui, Lamia HamaiziaLamia HamaiziaSaid Khalfa Mokhtar BrikaAhmed Laamari
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2023-12-192023-12-19421The burden of orthopaedic disease presenting to a tertiary referral center in Moshi, Tanzania: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/251586
<p><strong>Introduction: </strong>as road traffic crashes (RTCs) continue to rise in the developing world, the current growth rate and true burden of orthopaedic injuries are unknown. In 2015, we characterized the orthopaedic burden at Kilimanjaro Christian Medical Center (KCMC) in Tanzania. In this study, we re-evaluated the burden and growth-rate over three years in the absence of any system level changes. Additionally, we calculated the percentage of orthopaedic patients that received definitive fixation for their orthopaedic injury when surgery was indicated. <strong>Methods: </strong>we prospectively collected data for 190 patients admitted to the orthopaedic ward at KCMC during June/July 2018. We also retrospectively reviewed available records for patients presenting to the KCMC Emergency Department, Orthopaedic Outpatient Clinic and Orthopaedic Ward. <strong>Results: </strong>prospective data: 231 patients were admitted to the orthopaedic ward. Forty-one (17.7%) isolated spine patients were excluded, leaving 190 patients in the final study cohort. RTC (89, 46.8%) represented the most common mechanism of injury requiring orthopaedic ward admission, followed by falls (60, 31.6%) and infections (14, 7.4%). Femur fractures were the most common injury (62, 31.0%), followed by tibia fractures (27, 13.5%), isolated fibula fractures (23, 11.5%), and foot fractures (23, 11.5%). Almost 96% of admitted patients were indicated for surgical fixation, but only 44.5% received definitive fracture treatment. Retrospective data: KCMC treated an average of 15,117 orthopaedic patients per year, representing a 35.3% growth in the orthopaedic burden compared to 2015. <strong>Conclusion: </strong>the burden of orthopaedic surgical disease at KCMC is increasing. Without innovative strategies to address this situation, the discrepancy between the need for orthopaedic care and surgical care capacity at KCMC and in similar settings will continue to grow.</p>William Mack HardakerMubashir JusabaniHonest MassaweAnthony PallangyoRogers TemuNathaniel FessehaieAnchi NumfoMatthew WintertonAjay PremkumarNeil Perry Sheth
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2023-12-192023-12-19421Macrophage activation syndrome during Crohn´s disease: a case report
https://www.ajol.info/index.php/pamj/article/view/251588
<p>The macrophage activation syndrome (MAS) is a rare but potentially fatal disease. We report two cases of Crohn´s disease, one under 5-aminosalicylic acid and the other under corticosteroid, having developed MAS. The first was a male patient hospitalized for high fever, clinical examination found fever and left inguinal lymph node. The second case was a female patient hospitalized for asthenia, clinical examination found fever and oral mycosis. The biology tests revealed bi/pancytopenia, hyperferritinemia, hypofibrinogenemia. The myelogram showed hemophagocytosis. The identified infectious cause was Klebsiella pneumoniae in the urinary tract in one patient and oral Candida albicans in the other one. Thoraco-abdomino-pelvic computer tomography (CT) scan showed a thickening of the bladder in the male patient, and eliminated a deep infection and tumour cause in the female patient. The diagnosis of MAS was made, and both patients were placed on broad-spectrum antibiotic, in addition to local antifungal treatment and corticosteroid for the female patient, but the evolution was fatal for both. In conclusion, the management of MAS should be fast and multidisciplinary, based on treatment of the causal infectious agent, immunomodulatory treatment of haemophagocytosis, symptomatic treatment and replacement of organ failure.</p>Oussama KharmachNawal LagdaliImane BenelbarhdadiMohammed BorahmFatima-Zohra Ajana
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2023-12-192023-12-19421Bladder rupture after pembrolizumab immunotherapy for bladder cancer: a case report
https://www.ajol.info/index.php/pamj/article/view/251590
<p>Pembrolizumab is a promising checkpoint inhibitor for advanced urothelial carcinoma. Like other immunotherapies, it can cause rare immune-related adverse events. The spontaneous rupture of the urinary bladder after the intravenous injection of pembrolizumab is rare and has not been reported. Here, we present a 74-year-old man patient case of locally advanced transitional cell carcinoma of the urinary bladder who presented severe abdominal pain the same day of the second dose of pembrolizumab administration. The exploratory laparotomy revealed intraperitoneal rupture of the urinary bladder associated with peritonitis. After surgical repair, the patient's condition improved. The purpose of this report is to discuss the possible association of bladder perforation in bladder cancer with pembrolizumab immunotherapy, its management, and the importance of early recognition to prevent more fatal complications.</p>Ahmed BadheebOmar AlkhanbashiSlah RakroukiTahir MahmoodMashhoor AlqannasMohamed BadheebFaisal Ahmed
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2023-12-192023-12-19421Managing terminal restlessness, anxiety, and distress during the dying process with Yintang (EX-HN 3) point acupuncture or acupressure: a case series of 19 palliative care patients from a hospital in Germany
https://www.ajol.info/index.php/pamj/article/view/251592
<p>This is a case series report of 19 palliative care patients where 23 acupuncture sessions were performed which included Yintang (EX-HN 3) acupuncture or acupressure for the relief of terminal restlessness, anxiety or psychological distress present during the dying process. There was an observable relief from the restlessness, anxiety and distress both in sessions where only Yintang (EX-HN 3) point acupuncture or acupressure was performed (observed in 10 out of 11 sessions) as well as in sessions where Yintang (EX-HN 3) point acupuncture or acupressure was performed together with additional interventions, such as other points acupuncture, ear acupuncture or benzodiazepine treatment (observed in 10 out of 12 sessions). In total relief was observed in 20 out of 23 sessions (86.9%). A hypothesis that might worth further testing is whether Yintang (EX-HN 3) acupuncture or acupressure has an anxiolytic, tranquillising or sedative effect in dying patients. If confirmed this could be potentially useful in the fields of palliative care or disaster/triage medicine.</p>Angeliki KonstantinouLykourgos Christos Alexakis
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2023-12-192023-12-19421Detection and quantitation of hepatitis B surface antigen (HBsAg) on dried blood spots: a solution for easy access for hepatitis B diagnosis and elimination in remote areas
https://www.ajol.info/index.php/pamj/article/view/251594
<p>Hepatitis B virus (HBV) is generally endemic in resource-limited countries, which are characterized by a deficit of technical facilities that could delay diagnosis and treatment. To facilitate the accessibility to diagnostic and connection to treatment, evaluation, and promotion of alternatives and/or simplified strategies and inexpensive tools such as dried blood specimens need to be investigated and implemented. This study aimed to evaluate dried blood spots (DBS) for the detection and quantification of HBsAg. This study included 100 DBS from subjects tested positive for HBsAg, and 50 DBSs from subjects tested negative for HBsAg by the automate Architect i1000sr (Abbott Diagnostics, Ireland). Hepatitis B surface antigen detection was performed with determine HBsAg Alere® tests (Alere International Limited, Ireland) and Architect® HBsAg Qualitative II Assays (Abbott, Diagnostics, Ireland) after 15 and 30 days (D15, D30). For HBsAg-positive subjects, the quantification of HBsAg was performed at day zero (D0) from plasma and at D15 and D30 from the DBSs. At D15, the sensitivity and specificity were 96% and 100% for the Determine® tests and 100% and 100% for the Architect® tests, respectively. At D30, the sensitivity and specificity were 96% and 100% for the Determine® tests and 100% and 100% for the Architect® tests, respectively. For HBsAg quantification, the agreement rates were 96%, 96% and 100% between D0-D15, D0-D30 and D15-D30, respectively. This work showed that DBSs can be very useful for HBsAg detection and quantification and therefore in the management of HBV infection in resource-limited settings.</p>Anna Julienne Selbé NdiayeHalimatou Diop-NdiayeGora LoAminata DiaMba El Hadji Bambo DiakhabyAissatou SowAssane DiengSouleymane MboupCheikh Saad Bouh BoyeCoumba Touré Kane
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2023-12-192023-12-19421Estimation of infant vaccination coverage at national and region level in Ethiopia: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/251736
<p><strong>Introduction: </strong>an increasing trend of routine immunization performance has generally been observed over the past decade in Ethiopia. However, inconsistencies were observed over time and among different sources of data. This review analyzed systematically data from various sources and produced regional and national coverage estimates for antigens offered in the infant immunization program in Ethiopia. <strong>Methods: </strong>we collated data from administrative reports, population-based surveys and other sources to produce annual estimates of vaccination coverage. We obtained relevant data for each of the 9 Regional States and 2 city administrations, for the period 2007-2016. Region level estimates were produced based on survey results, interpolation between or extrapolation. We aggregated the resulting region level estimates, using a population –weighted approach, to give national estimates. <strong>Results: </strong>we found that the national Penta 3 coverage of Ethiopia increased from 59% in 2007 to 71% in 2016. For the 110 vaccination estimates produced at region level, 71 were based on interpolation or extrapolation from empirical anchor points; 18% were based on surveys and 17% were based on administrative data. <strong>Conclusion: </strong>while we recognize the critical importance of improving the quality of information on vaccination coverage from administrative reporting systems, we are also cognizant of the expected continued need for region level surveys and improved rapid-monitoring exercises.</p>Aschalew Teka BekeleMulat NigusLiya WondwossenThomas KarengeraEphrem TeklePamela MitulaLemlem AssefuTeklay KidaneWoldemichael Yonas
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2023-12-192023-12-19421Uremic stomatitis: oral manifestations
https://www.ajol.info/index.php/pamj/article/view/251739
<p>A 26-year-old male patient presented to Dental Clinic of Jouf University, Saudi Arabia with a chief complaint of white patches and burning sensation in his mouth for 2 weeks. Patient also reported with an accidental tongue biting that lead to a painful ulcer on the left lateral border of the tongue a few days before consultation. He had a history of vitamin D deficiency and renal weakness since 10 years back. History of drugs taken as allopurinol, omeprazole, prednisolone and antifungal drugs. History of present illness revealed difficulty while eating food and pain for two weeks. Extra-oral examination revealed no abnormality. Intra-oral examination showed white plaque-like lesions on the dorsal, lateral (A, B), ventral surfaces of tongue, buccal mucosa and on the lower labial mucosa (C). The lesions were present bilaterally on the tongue and buccal mucosa. Also, some wart-like projections were seen on the left buccal mucosa at the occlusal line (D). Further intra-oral examination revealed an ulcer measuring approximately 0.5x0.5 cm on the left lateral surface of the tongue (E). The ulcer was characterized of a reddish, well-defined border with slight elevation. The patient started orthodontic treatment using fixed braces. Laboratory investigation showed blood urea nitrogen abnormally high (BUN) as 200 mg/dl (normally; 9-20 mg/dl), creatinine level 18 mg/dl (normally range; 0.7-1.5 mg/dl). Pathological report was unavailable because the patient declined biopsy.</p>Sultan Meteb AlshammariRakhi Issrani
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2023-12-192023-12-19421Maxillary and mandibular odontogenic myxomas: case report
https://www.ajol.info/index.php/pamj/article/view/251740
<p>Maxillary myxomas are rare benign odontogenic tumors with a high potential for infiltration and destruction. Clinical and radiological manifestations are variable and non-specific and often lead to confusion with other benign and malignant lesions. We present here two cases of odontogenic myxoma of different localization (maxilla and mandible). In both cases, the patient presented with a progressively enlarging facial swelling without any neurologic disturbance or lymph nodes. On computed tomography, the lesions appeared as a large unilocular, homogeneous image causing a cortical thinning and rupture along with repression of surrounding tissues. The clinical and radiological features were poorly suggestive of precise nature, and only histological examination of biopsy specimen was able to reveal the diagnosis of myxoma. Given the large size of the tumors and the locally aggressive pattern, we have opted for large maxillecetomy and marginal mandibulectomy. In conclusion, myxoma is a slow growing but locally aggressive tumor that the clinician should keep in mind. As there is a lack of consensus regarding their treatment, we can suggest a conservative treatment for small non-extensive lesions, which consists of enucleation and curettage of the tumor; and a radical excision in case of large tumors given the high risk of recurrence.</p>Jinane KharbouchZakaria AzizZahira BenzenzoumMohamed Salah Koussay HattabSalma AboulouidadSaad FawziNadia Mansouri Hattab
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2023-12-192023-12-19421An evaluation of the isoniazid preventive therapy program performance for under-fives in Kwekwe City, January 2019 - December 2020: a descriptive cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/251741
<p>Childhood tuberculosis (TB) is underserved in resource-constrained endemic areas. Zimbabwe National Tuberculosis Program recommends tuberculosis prevention treatment for children aged <5 years who are close contacts of smear-positive TB cases. The Isoniazid Preventive Therapy (IPT) program performance had never been evaluated since its inception in 2010. We therefore, assessed the IPT program's inputs, processes, outputs, and outcomes. We conducted a process evaluation using the logic model in Kwekwe City. We recruited twenty-seven health care workers from all the five municipal health facilities. Smear-positive guardians of under 5 children, health care workers, and registers were the study population. Data were collected using a questionnaire and checklists and presented as frequencies and proportions. The IPT program met requirements in provision of guidelines (10/10), screening tools (15/15) and on-the-job trainings done in all five health facilities. Isoniazid tablets supply and quarterly budgeting did not meet program requirements. Fifty-nine out of 231 (25.5%) children contacts of sputum-positive TB patients were screened. Fifty-one of the 59 (86.4%) children were initiated on IPT, 42/51 (82.4%) completed the course, one developed TB, 3/51 were still on treatment and 5/51 were lost to follow up. No dropouts and deaths were recorded. Unavailability of drugs was a barrier to the IPT and negatively impacts the TB elimination program. Contact screening was the bottleneck in the successful implementation of the program. Adequate staff and provision of drugs might improve the program. We recommended the recruitment of more healthcare workers and the budget for the program.</p>Nyashadzashe Cosmas MakovaMary MuchekezaJoconiah ChirendaAddmore ChadambukaEmmanuel GovhaTsitsi Patience JuruNotion Tafara GombeMufuta Tshimanga
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2023-12-192023-12-19421Management of retained transanal foreign body: a case report
https://www.ajol.info/index.php/pamj/article/view/251746
<p>Management of retained trans-anal foreign bodies is yet to be standardized. We present a case of how a retained trans-anal colonic body spray can affect the anal sphincter and its effect on management. A male adult presented with a retained trans-anal body spray can in the colon and a weakened anal sphincter. A plain abdominal X-ray and colonoscopy confirmed the diagnosis. After a failed endoscopic removal, a non-operative manual removal was done. Sphincter tone improved 3 days later. The article describes anal sphincter weakness, patient categorization, and non-operative management of the retained colonic foreign body.</p>Edward AsumanuClement Nii Akwei AkweAbdullai SaeedJermaine Addai
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2023-12-192023-12-19421Knowledge, perception and practice of pharmaceutical waste disposal among the public in Lagos State, Nigeria
https://www.ajol.info/index.php/pamj/article/view/251750
<p><strong>Introduction:</strong> increased consumption of pharmaceuticals has been reported to cause a high level of their discharge into the environment, and even small quantities in the environment have the potential to cause harm. <strong>Methods:</strong> a descriptive cross-sectional questionnaire-based study was conducted between April and May 2021. The questionnaire was made available online through social media platforms. <strong>Results:</strong> a total number of 534 respondents were surveyed. Two hundred and fifty respondents (46.8%) were presently on one or more medications. Many participants have not received advice on pharmaceutical waste from health professionals (413, 78.3%). There is fair knowledge about pharmaceutical waste 234 (43.8%). Many of the respondents think there is a lack of adequate information on what to do with them (500, 93.6%) and there should be a program/ strategy to retrieve all unused, leftover, or expired medicines (475, 88.9%). A lot of respondents throw unused medicines away in household garbage (391, 73.2%). <strong>Conclusion:</strong> there is fair knowledge, positive perception, and poor pharmaceutical waste disposal practice. There is a need for the implementation of a "medication take-back program" for appropriate waste disposal practice.</p>Halimat Adedeji-AdenolaAfusat AdesinaMargaret ObonTitilayo OnedoGladys Ukamaka OkaforMichealin Longe
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2023-12-192023-12-19421Morphological and functional abnormalities of the orofacial sphere associated with thumb sucking in children aged 3 to 10 years old in Yaounde, Cameroon
https://www.ajol.info/index.php/pamj/article/view/251752
<p><strong>Introduction: </strong>thumb sucking is one of the most common oral habits in infants and children. In our context, little is known about the effects of prolonged thumb sucking on the orofacial sphere. Objective: determine the prevalence of thumb sucking and, identify the morphologic and functional abnormalities of the orofacial sphere associated with the duration and frequency of thumb sucking in children aged 3 to 10 years. <strong>Methods: </strong>a cross-sectional and analytical study was carried out in the pediatric units of the District Hospitals of Biyem-assi and Efoulan from February to June 2020 in children aged 3 to 10 years. Recruitment was consecutive, not probabilistic. After obtaining informed parental consent, a clinical examination was performed and the criteria retained were based on the ANGLE classification of the malocclusions. Socio-demographic, socio-economic, clinical characteristics were collected and morphological and functional abnormalities were observed. Statistical analysis was performed using SPSS software version 23.0. The significance threshold was set at 5%. <strong>Results: </strong>of the 116 enrolled children; 74 girls (63.79%) and 42 boys (36.21%) with a mean age of 4.80 ± 0.5 years. The highest proportion of thumb sucking was found in firstborn children (n=46, 39.65%), and in those who breastfed for less than 6 months (n=99, 85.62%). The prevalence of thumb sucking was 17.4%. Using the multivariate analysis, class II division 1 canine occlusion [OR 1.52 (1.27-2.68), p=0.03] and decreased overbite [OR 4.5 (2.5-9.3), p=0.001] while class II division 1 canine occlusion [OR 2.59 (1.3-10.1), p=0.009] and increased overjet [OR 1.89 (1.06-6.75), p=0.005] were independent morphologic abnormalities significantly associated with the frequency and the duration of thumb sucking respectively. There was no association between the duration and frequency of thumb sucking and the functional abnormalities. <strong>Conclusion: </strong>thumb sucking is more common in girls and the likelihood of thumb sucking decreases with age. The prevalence of thumb sucking was 17.4%. The malocclusions observed in our population are class II division1 canine relationship, decreased overbite and increased overjet.</p>Ginette Claude Mireille KallaEunice Danielle Medou TiomoJules OnanaFrancois-Xavier Mbopi-KeouCharles Bengondo Messanga
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2023-12-192023-12-19421Nodules de Lisch: marqueur ophtalmologique de la neurofibromatose de type 1
https://www.ajol.info/index.php/pamj/article/view/251754
<p><em>Von Recklinghausen disease or neurofibromatosis type I (NF1) is the most common phacomatosis. It is inherited in an autosomal dominant manner. Lisch nodules are the most common ophthalmic manifestation of NF1. They are reported in 73-95% of cases. We here report the case of a 49-year-old female patient referred for a consultation with an ophthalmologist for routine eye check-up after the onset of the following symptoms: coffee-with-milk colored spots and multiple neurofibromas (A). She reported similar family history. Visual acuity was 10/10 P2 in both eyes. Examination of the anterior segment showed several Lisch nodules in both irises. They were scattered over the entire iris surface and varied in size (B). Fundus examination was unremarkable. CT scan of the brain and the orbit as well as thoracoabdominal CT scan showed no associated lesion. The patient met NIH diagnostic criteria for NF1. Lisch nodules are small brown dome-shaped lesions developing on the surface of the iris, with well-defined edges, embedded in the stroma and lighter than iris pigmentation. Differential diagnosis includes iris mammillations, iris naevi, iris melanoma, iris granulomatous nodules. Unlike skin signs, the presence of multiple Lisch nodules are considered a specific indication of NF1. These nodules may occur in childhood and their prevalence and number increase with age. Thus, periodic eye examinations in subjects with suspected neurofibromatosis type I may help to improve early diagnosis.</em></p>Kawtar BouirigLalla ouafae Cherkaoui
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2023-12-192023-12-19421Aspects épidémiologiques et cliniques des cancers du col de l´utérus au Cameroun: expérience de l´Hôpital Général de Douala
https://www.ajol.info/index.php/pamj/article/view/251761
<p><strong>Introduction: </strong>le cancer du col de l´utérus est un problème de santé publique au Cameroun, avec le 2<sup>e</sup> rang en termes d´incidence. Notre étude avait pour objectif de décrire les caractéristiques épidémiologiques et cliniques des patientes avec cancer du col de l´utérus à l´Hôpital Général de Douala, au Cameroun. <strong>Méthodes: </strong>il s´est agi d´une étude rétrospective, pendant la période du 1<sup>er</sup> janvier 2016 au 31 décembre 2017. <strong>Résultats: </strong>trois-cent-cinquante-sept (357) femmes ont été incluses. L´âge variait de 25 à 88 ans avec une moyenne de 52,82 ± 12,36 ans. Les patientes originaires de la région de l´Ouest étaient les plus représentées avec un pourcentage de 42,2% (n= 124/294). Il s´agissait majoritairement de ménagères, sans emploi avec une fréquence de 57,3% (n=200/341). L´âge au premier rapport sexuel était renseigné chez seulement 37% (n=133/357) de la population, avec une moyenne de 16,73 ± 2,16 ans; tandis que la moyenne d´âge au premier accouchement était de 18,92 ± 3,44 ans. Par ailleurs, 6,5% (n= 11/169) de la population est tabagique tandis que 44 % (n=73/166) est alcoolique. Le carcinome épidermoïde était le type histologique le plus fréquent (85,6%, n=255/298). Les stades les plus fréquents au diagnostic étaient les stades IIB (22,3%, n=71/319) suivis des stades IIIB (21,6%, n=69/319). <strong>Conclusion: </strong>le cancer du col de l´utérus au Cameroun est une pathologie de la femme adulte, sans emploi, avec des stades avancés au diagnostic. D´où la nécessité d´améliorer la sensibilisation sur la prévention et le diagnostic précoce des cas.</p>Berthe Sabine Esson MapokoAnne Marthe Maison MayehRuth Rosine Mekah MapenyaEsther Dina Bell MbassiEtienne Atenguena OkobalembaAnne Juliette Flora SangoSidonie Ananga NoaAmbroise NtamaZacharie SandoPaul NdomMartin Essomba BiwoleAlbert Mouelle Sone
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2023-12-192023-12-19421Assessment of antiphospholipid antibodies profiles based on severity of COVID-19 pneumonia
https://www.ajol.info/index.php/pamj/article/view/251812
<p><strong>Introduction: </strong>thrombotic events are the most severe complications of the coronavirus disease 2019 (COVID-19). It is known that anti-phospholipid antibodies (APL) could be involved in thrombosis mechanism. Thus, APL profiles were studied particularly in patients with severe and critical COVID-19, and their clinical impact. <strong>Methods: </strong>a retrospective study of 54 COVID-19 hospitalized patients (34 in intensive care unit (ICU) and 20 in non-ICU) was conducted. These COVID-19 patients were tested for the presence of LAC (lupus anticoagulant) using the ACLTOP750®, anti-cardiolipine (ACL) and anti-β2glycoprotéine I (anti-β2GPI) IgG/IgM/IgA by enzyme-linked immunosorbent assay (ELISA). IgA isotype was tested in only 25 patients. <strong>Results: </strong>anti-phospholipid antibodies were present in 74.1% of tested patients. LAC positivity was the highest (60.8%) among all patients, followed by IgM aCL (18.5%) and IgM anti-β2GPI (14.8%). Besides, LAC and anti-β2GPI IgA were the most predominant APL regarding the 25 patients tested for IgA isotype (52% and 24% respectively). Nine patients had thrombotic events, among them 6 were positive in APL and 5 were positive in LAC. However, there was any significant association between APL positivity or titers and thrombosis. There was also no significant difference between the two COVID-19 groups regarding APL profiles. <strong>Conclusion: </strong>given the relatively high frequency of APL and especially LAC, and given the multitude of thrombotic risk factors in these severely and critically ill COVID-19 patients, a prophylactic anticoagulation remains essential.</p>Amène Ben BninaRefka Ben DhiaSahar GnabaAlaa AnnabiSyrine ChouchaneWalid NaijaHouyem SaidAbderraouf OueslatiAmina Bouatay
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2023-12-192023-12-19421Prevalence and trends of sexually transmitted infections among pregnant women in Mizan Tepi University Teaching Hospital, Southwest Ethiopia: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/251813
<p><strong>Introduction: </strong>sexually transmitted infections are the most common causes of illness in Africa. They are public health important diseases because of their magnitude, potential complications, and interactions with HIV/AIDS during pregnancy. In our country, especially in our study area, limited studies have been conducted to assess the magnitude and trends of sexually transmitted infections among pregnant women. Therefore, this study aimed to assess the prevalence and trends of sexually transmitted infections (STIs) among pregnant women. <strong>Methods:</strong> an institution-based cross-sectional study design was conducted in Tepi University Teaching Hospital in Southwest Ethiopia from August 1-30, 2019. Three hundred women were selected using a simple random sampling method from the women's registry book who visited the hospital for antenatal care (ANC) follow-up in the last five years. The data was collected by using checklists. Finally, the data were entered into Epi Info 7 and analyzed with statistical package for the social sciences (SPSS) version 25.0. <strong>Results:</strong> the prevalence of sexually transmitted infections was 50 (16.7%). HIV infection was 15 (5%), genital candidiasis 11 (3.7%), <em>T. vaginitis</em> 10 (3.3%), Hepatitis B virus 9 (3.0%), Hepatitis C virus 2 (0.7%), and Chlamydia 3 (1.0%). The trend of sexually transmitted infections over the last five consecutive years was increasing, decreasing, and again increasing. <strong>Conclusion:</strong> this study showed that the prevalence of sexually transmitted infections in pregnant women was relatively higher than in other similar studies conducted in different study areas. The trend of sexually transmitted infections in the last five years was not constant.</p>Abiyot Wolie AsresMesenbet Muluken EndalewSerawit Yirdaw Mengistu
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2023-12-192023-12-19421A rapidly enlarging thyroid mass
https://www.ajol.info/index.php/pamj/article/view/251814
<p>We report the case of a 67-year-old woman who presented with a six-week history of a neck mass, mild dysphagia and dyspnea, which were accompanied by night sweats and low-grade fever. On physical examination, the thyroid gland was hard/non-tender on palpation and diffusely and asymmetrically enlarged (especially to the right). Laboratory evaluation revealed a thyroid-stimulating hormone level of 9.97 mIU/L (normal range: 0.38-5.33), a free thyroxine level of 0.6 ng/dL (normal range: 0.6-1.49) and thyroid peroxidase antibody titer > 600 IU/mL (normal < 50). Technetium-99m thyroid scintigraphy showed decreased radiotracer uptake throughout the thyroid (A). The laboratory test results and scintigraphic findings were suggestive of Hashimoto´s thyroiditis. Nevertheless, a core biopsy of the thyroid mass was done, due to the clinical suspicion of malignancy, revealing a diffuse large B-cell lymphoma. Subsequent gallium-67 scintigraphy demonstrated abnormal intense uptake only in the region of the thyroid mass (B, C). The thoracic and abdominal computerized tomographies were normal. The patient was treated with chemotherapy (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone), followed by radiotherapy. Six months after treatment, she is in good health. Primary thyroid lymphoma (PTL) is rare: it represents less than 5% of all thyroid malignancies and less than 3% of extra-nodal lymphomas. Differentiation of PTL from other thyroid neoplasias is necessary; it is treated differently and has a relatively good prognosis. The differential diagnosis of PTL includes goitrous Hashimoto´s thyroiditis, anaplastic thyroid carcinoma or other infiltrative thyroid neoplasms.</p>Georgios MeristoudisIoannis Ilias
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2023-12-192023-12-19421Evaluation of the measles case-based surveillance system in Kwekwe city, 2017-2020: a descriptive cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/251815
<p><strong>Introduction: </strong>in 2011, WHO African region set a target for elimination of measles by 2020. During period 2017-2020, Kwekwe city, with an estimated population of 117,116, detected one case of suspected measles. This was against a target of 2 cases per year. We evaluated the system to establish why it was failing to detect at least 2 cases per year. <strong>Methods: </strong>we conducted a descriptive cross-sectional study using the Centre for Disease Control (CDC) Updated Guidelines. Nineteen health facilities were selected and fifty-seven health workers were randomly recruited. An interviewer-administered questionnaire and checklists were used to collect data. We generated frequencies, proportions, and means. <strong>Results: </strong>the mean years in service was 22.8 years (SD=12.6). Thirty (52.6%) respondents had fair knowledge. Fourteen (73.7%) of the nineteen respondents who had ever completed case investigation forms took between 10-20 minutes to complete. Only two (10.5%) of the nineteen facilities had case investigation forms. The majority of the respondents 54 (93%) were willing to continue participating in the measles Community Base Surveillance System (CBSS). None of the health facilities had used the system to inform decision-making. Reasons highlighted for poor suspected measles case detection included lack of health worker training 28/57 (49.1%). <strong>Conclusion: </strong>despite the high age in service, knowledge of the surveillance system was mostly fair. The system was found to be simple, not stable and not useful. The main reason for the system failure was lack of health worker training. We recommend retraining on Integrated Disease Surveillance and Response (IDSR) and case investigation forms distribution.</p>Nyashadzashe Cosmas MakovaMary MuchekezaEmmanuel GovhaTsitsi Patience JuruNotion Tafara GombeMaurice Omondi
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2023-12-192023-12-19421Determinants of the psychomotor development delay in children aged 12 to 59 months infected with HIV in Yaounde, Cameroon
https://www.ajol.info/index.php/pamj/article/view/251819
<p><strong>Introduction:</strong> children infected with HIV are at increased risk of impaired neurodevelopmental, due to several environmental factors. <strong>Methods:</strong> we conducted a cross-sectional analytical study on ''HIV''infected children aged 12 to 59 months, followed up in five hospitals in Yaounde, Cameroon. Sociodemographic, clinical, and biological variables as well as the antecedents were collected. Data analysis was performed using Statistical Package for the Social Sciences ( SPSS ) version 25 software. The Denver test was used to assess the psychomotor development of these children. Global psychomotor delay, defined as a global development quotient of less than 70 with an alteration in at least two of the four domains of the test, was retained as the primary endpoint. The significance threshold was set at 5%. <strong>Results:</strong> one hundred and eighty-one children were included in the study. The sex ratio was 0.6. The age range 48-59 months was the most represented. None of these children had a known chronic pathology other than HIV infection. The proportion of global psychomotor delay was 11.04%, with language (16%) and fine motor skills (16%) being the most affected domains of psychomotor development. The independent factors significantly associated with global psychomotor delay were birth weight below 2500 grams (OR= 17.61 [1.76-181.39], p= 0.022), growth retardation (OR= 17.64 [1.63-190.24], p= 0.018) and elevated viral load (OR= 22.75 [2.78-186.02], p= 0.004). <strong>Conclusion:</strong> psychomotor delay affects about one out of ten children living with HIV. Its occurrence is linked to various factors that must be taken into account in the development of public health policies in connection with the management of HIV infection in children.</p>Ginette Claude Mireille KallaUrsule Larissa Temgoua DongmoJules Clément Nguedia AssobNelly Kamgaing NoubiFrancois-Xavier Mbopi-KeouFrancisca Monebenimp
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2023-12-192023-12-19421Large retroperitoneal cystic lymphangioma mimicking mesenteric cyst: a case report
https://www.ajol.info/index.php/pamj/article/view/251821
<p>Cystic lymphangioma is a benign tumour that occurs secondary to obstruction of lymphatic channels. Its appearance in the paediatric age group is quite common, but adulthood presentation is infrequent. Common locations are head and neck areas, whereas intra-abdominal occurrence is rare. To date, a few retroperitoneal cystic lymphangioma cases have been reported. A pre-operative clinical detection is always confusing, and most often, the diagnosis rests over the intraoperative findings and histopathological examination. The cyst's complete surgical resection remains the treatment of choice in patients with bulky, rapidly growing lesions or symptoms. Herein, we report a large retroperitoneal cystic lymphangioma that mimicked the mesenteric cyst clinically.</p>Deepak RajputKandhala SrikanthAmit GuptaArvind KumarSanketh EdemLena Elizabath DavidKrishna Sai Bhukya
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2023-12-192023-12-19421Rare presentation of autosomal dominant polycystic kidney disease in horseshoe kidney ultrasound evaluation: a case report
https://www.ajol.info/index.php/pamj/article/view/251823
<p>Horseshoe kidney is a renal fusion anomaly during embryogenesis and adult polycystic kidney disease is a hereditary disorder which is transmitted in autosomal dominant pattern. Polycystic and horseshoe kidney are two separate disease entities, only about 20 cases of polycystic kidney disease in horseshoe kidney disease have been described in the literature, with an incidence ranging from 1 in 134 000 to 1 in 8 000 000 live births. We are presenting ultrasound findings of a patient who was incidentally diagnosed with polycystic horseshoe kidney on routine screening.</p>Vadlamudi NagendraSuresh Vasant PhatakRohan Kumar SinghShivesh Subodh PandeyRishabh Gupta
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2023-12-192023-12-19421Ligation of injured subclavian vessels saved a young life: a case report
https://www.ajol.info/index.php/pamj/article/view/251825
<p>We describe a rare life-saving case of penetrating subclavian vessel injury that was managed successfully at King Saud Medical City, a major trauma center in Riyadh, Saudi Arabia. The patient was a healthy 21-year-old Saudi male who was presented initially at Al-Aflaj Hospital, 300 km away from King Saud Medical City, following a stab with a knife to the left side of his lower neck. He was transferred to King Saud Medical City for definitive surgical management after having temporary bleeding control at Al-Aflaj Hospital. The patient was successfully managed with a median sternotomy, left supraclavicular extension, and clavicular division. Hemostasis was achieved by ligating the injured subclavian vessels in a situation of extremes to save a life. His postoperative course was uneventful. He was discharged on the eleventh postoperative day with an intact neurovascular condition of the left upper limb.</p> <p class="ParagraphSeparator"> </p>Sharfuddin ChowdhuryAbdallah Alferdaus
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2023-12-192023-12-19421Profil clinico-thérapeutique des états de mal épileptiques dans le service de neurologie de l´Hôpital Befelatanana, Antananarivo: une étude transversale descriptive
https://www.ajol.info/index.php/pamj/article/view/251827
<p><strong>Introduction: </strong>l´état de mal épileptique (EME) constitue une urgence diagnostique et thérapeutique. Notre objectif était de décrire le profil clinique et thérapeutique des patients présentant un EME au service de Neurologie de Befelatanana. <strong>Méthodes: </strong>c´est une étude rétrospective, descriptive de janvier au juin 2015. Les caractéristiques sociodémographique, clinique et thérapeutique des patients ont été collectées et analysé sur Epi info 7. <strong>Résultats: </strong>nous avons retenu 53 patients dont 54,71% étaient épileptiques (n = 29). Les patients de moins de 65 ans prédominaient dans 86,79%. L´âge moyen était de 43,09 ans avec un sex-ratio de 1.30. L´EME convulsif prédominait dans 98,11% (n=52). Il était de type convulsif généralisé dans 66,03%. Le STESS inférieur à 3 (77,35%) prédominait. L´EEG standard dans les 24h de l´EME était dépourvu d´anomalie épileptique pour tous les patients. Une rupture de traitement antiépileptique (9,43%) et une privation de sommeil (18,86%) ont été rapportées comme facteur déclenchant de l´EME. Une absence de crise épileptique dans les 72h de la mise sous notre protocole était notée dans 84,90% des cas. Nous n´avons pas trouvé d´association significative entre le statut épileptique ou non avec le STESS (p = 0,302), le protocole de traitement (p = 0,532) et la rémission des crises dans les 72 heures (p = 0,211). <strong>Conclusion: </strong>l´EME touche une population jeune et épileptique. Notre protocole a permis une rémission des crises dans les 72h dans la plupart des cas. Une étude sur la validation de ce protocole d´EME est nécessaire.</p>Lala Andriamasinavalona RajaonarisonNomena Finiavana RasaholiarisonJemissair Glorien LemahafakaRahamefy Odilon RandrianasoloSantatra RazafindrasataNoël ZodalyAlain Djacoba Tehindrazanarivelo
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2023-12-192023-12-19421Mineral trioxide aggregate a boon for prevention of external root resorption
https://www.ajol.info/index.php/pamj/article/view/251830
<p>External root resorption is a lytic process occurring in the cementum and/or dentine of the roots of teeth. Although till date the predisposing factor is yet to be discovered, the suspected causes are considered to be peri radicular inflammation due to trauma, granuloma, central jaw tumors, excessive forces, impaction of teeth, and systemic diseases. A 23-year-old male reported to the department of conservative dentistry and endodontics with a chief complaint of pain and food lodgement in lower left mandibular region since 5-6 months. On clinical examination, grossly decayed tooth (#36) which was tender on vertical percussion and was not associated with any mobility. Intraoral periapical radiographic revealed external root resorption in distal root, which was concomitant with mild bone loss. Taking into account the extent and the severity of the resorption the treatment course was planned that included Root Canal Treatment. The distal and two mesial canals were obturated using mineral trioxide aggregate and gutta-percha respectively. After completion of obturation, it was followed by post endodontic composite restoration. The patient was followed-up after 1 year and the tooth was functional without sensitivity to percussion or palpation. Tooth showed normal physiologic mobility and no periodontal pockets on probing. Radiographic findings revealed no periapical changes and no further progression of External root resorption.</p>Akash Jitender SibalAkshay Ajay Jaiswal
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2023-12-192023-12-19421Impact of COVID-19 pandemic in adolescents on HIV treatment
https://www.ajol.info/index.php/pamj/article/view/251831
<p>The COVID-19 pandemic and concomitant lockdown restrictions in South Africa pose critical challenges for adolescents living with HIV (ALHIV) and on ART, impacting their ability to remain engaged in care and adherent to antiretroviral therapy (ART). Not only has this pandemic directly impacted the health care that ALHIV receive, but it has also consequently had devastating effects on society and has negatively affected the mental health and well-being of ALHIV. The challenges associated with the impact of the COVID-19 pandemic on disadvantaged groups such as ALHIV on ART need to be further explored as it may offer hope to ALHIV and restore confidence in the health system.</p>Brian Van WykYolanda Mayman
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2023-12-192023-12-19421COVID-19 information seeking pattern and perceived benefits in Nigeria: a cross-sectional survey
https://www.ajol.info/index.php/pamj/article/view/251833
<p><strong>Introduction: </strong>access to COVID-19 related information is fundamental to making accurate decisions and performing evidence-based actions aimed to control its spread and improve health. This study assessed pattern and perceived benefits of COVID-19 related information in Nigeria. <strong>Methods:</strong> a descriptive cross-sectional survey was carried out among adult Nigerian residents aged 18-years and above in the geopolitical zones using multistage sampling strategy. Questionnaire developed by World Health Organization (WHO) was adapted and pretested. Descriptive statistics were carried on the data and presented in frequencies, percentages, mean and standard deviation. Inferential statistics (Chi-square) was used to test differences between some categorical variables. Data obtained were analysed using statistical package for the social sciences (SPSS) software version 22. <strong>Results:</strong> from responses, 498 (47.9%) of participants highly desired information on COVID-19, while 311 (29.9%) frequently sought COVID-19 information. Majority 647 (62.3%) were interested in getting information on treatment protocols/home remedies for COVID-19 prevention. Also, 934 (89.9%) found information on COVID-19 beneficial. A significant difference existed between male and female respondents regarding government guidelines on public interaction (p=0.026) and home remedies to prevent COVID-19 infection (p=0.013). Consistently, more urban residents than rural sought information on majority of the COVID-19 related information. <strong>Conclusion:</strong> information on COVID-19 is highly sought by Nigerian residents and such should be widely disseminated regularly through authentic and verified social media channels. Nigerians are highly desirous of information on treatment protocols and home remedies to prevent COVID-19. Adequate provision of accurate and timely information by authorities through trusted sources will improve health literacy and help curb the spread of COVID-19.</p>Lovelyn Ndubuisi-OkoroeziJennifer Ikechukwu-OkoroeziLinda OdikpoChinenye Ifeoma UbahChisom Joy Mbadugha
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2023-12-192023-12-19421A rare combination of tibial artery aneurysm and traumatic arteriovenous fistula: a case report
https://www.ajol.info/index.php/pamj/article/view/251965
<p>Aneurysms of the tibial arteries are rare, and they most commonly occur due to trauma of the lower extremities. Acquired arteriovenous fistulas of the tibial arteries are a recognized complication of trauma of the lower extremity and they are related to the mechanism of the injury. Although the natural history of stable arteriovenous fistula is relatively benign, the aneurysms of the tibial arteries should be repaired with autologous vein bypass grafts, if there is distal ischemia. Endovascular repair has been reported as an effective alternative treatment for traumatic tibial artery aneurysms. The case of a 60-year-old male with the rare combination of a tibial artery aneurysm and traumatic arteriovenous fistula of the left lower extremity is reported in view of its rarity and the modern holistic endovascular approach used for treatment. A covered stent graft in the anterior tibial artery was used for the treatment of both the aneurysm and the arteriovenous fistula. The patient was discharged under dual antiplatelet treatment for three months, continued by clopidogrel as monotherapy. At the six-month follow-up, the patient has restored palpable peripheral pulses and no sign of recurrence or complication was recognized. A total endovascular approach can be an effective treatment for these complicated traumatic aneurysms.</p>Chrysanthi PapageorgopoulouKonstantinos NikolakopoulosIoannis NtouvasSpyros PapadoulasNeoklis Kritikos
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2023-12-192023-12-19421Childhood diarrhoea: a cross-sectional survey on maternal knowledge, hygienic practices and use of oral zinc for home management in a Nigerian community
https://www.ajol.info/index.php/pamj/article/view/251974
<p><strong>Introduction: </strong>diarrhoea is the second leading cause of morbidity and mortality in young children. The aim was to assess maternal knowledge, hygienic practices and home management (HM) of diarrhoea with oral rehyrdation therapy (ORT) and oral zinc in children aged 6-23 months in western Nigeria. Predictors of good knowledge and practice were also assessed. <strong>Methods: </strong>this was a community based analytic cross-sectional study. Multistage sampling was used to select mothers of children 6-23 months of age. Data were collected using pre-tested, interviewer administered questionnaires and analyzed using SPSS version 20. Bivariate analysis and multiple logistic regression for predictor variables were done. Level of significance was set at 0.05. <strong>Results: </strong>three hundred and seventy one (371) respondents were interviewed (mean age 30.4 ± 5.02 years). 305 (82.2%) had good knowledge of diarrhoeal diseases, 208 (56.1%) had good knowledge of home management of childhood diarrhoea, 274 (73.9%) had good maternal hygienic practices and 161 (61.2%) of the 263 mothers who had managed diarrhoea in their children, had good practice. Only 34 (12.9%) of them used zinc tablets and 11 (32.4%) did not complete the full course. Maternal age 30-39 years predicted good knowledge (AOR 3.19 CI 2-6.05). Predictors of good home management practices were: maternal age 30-39 years (AOR 2.78 CI 1.44-5.37), >40 years (AOR 5.55 CI 1.54-20.01) and younger age of the index child, 6-11 months (AOR 4.83 CI 2.29-10.18). <strong>Conclusion: </strong>mothers had poor knowledge of the role of zinc supplementation in childhood diarrhoea and use of zinc tablets for diarrhoea was very low. Community based health education should be carried out.</p>Ifeoma Peace OkaforOlufunsho Tope AkinyemiBarine Nene Wika-KobaniTope Olubodun
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2023-12-192023-12-19421The role of care-seeking behavior and patient communication pattern in online health information-seeking behavior - a cross-sectional survey
https://www.ajol.info/index.php/pamj/article/view/251979
<p><strong>Introduction: </strong>online health information-seeking behaviour has been on the increase and patients are seeking more responsibility in decisions about their health. Previous studies have mostly predicted online health information-seeking behaviour with demographic characteristics and not current behaviours driven by improving online information. The study attempts to bridge the gap between fast-developing patient online health information-seeking behaviour and health behaviour research. <strong>Methods: </strong>a cross-sectional survey was conducted in the Ghanaian city of Accra. Descriptive statistical analysis was used to reveal frequencies and range of scores on measurement scales. All measurement scales used in the study were tested for reliability. Univariate analysis was used to find correlations and key properties of the dependent and independent variables. Multivariate analysis was used to test hypotheses. <strong>Results: </strong>one hundred and eighteen (118) adults were surveyed. Cronbach alpha reliabilities of measurement scales ranged from .71 to .91. The hypothesis that care seeking behaviour and patient communication pattern predict online health information seeking behaviour, was supported (r = .45, standard error = 5.84) by a multiple linear regression. <strong>Conclusion: </strong>patients are engaged in online health information seeking because they want to be more active in decisions about their health. Findings further suggest that patients rely on online information to direct communications with their caregivers.</p>Martin Gameli Akakpo
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2023-12-192023-12-19421Maxillary 1st molar with three canals in mesiobuccal root
https://www.ajol.info/index.php/pamj/article/view/251984
<p>A comprehensive knowledge of the root and canal configuration is a prerequisite before initiating any endodontic procedures. A 32-year-old male reported to the department of conservative dentistry and endodontics with a complaint of pain associated with tooth #16 (maxillary first molar). Patient was experiencing pain since more than 25 days and was on medication for symptomatic relief. Initial clinical examination revealed the probability of periapical or phoenix abscess as the tenderness on percussion test was positive and the pulp showed no response during the pulp vitality test. However, the intraoral periapical radiograph depicted distoproximal caries but no signs of abscess or radiolucency in the periapical region associated with #16, and the patient was diagnosed with symptomatic irreversible pulpitis. Root canal therapy was planned for the patient. During access cavity preparation an unusual occurrence of three canals in the mesiobuccal root of #16 was found. So, there was a total of five canals in the three rooted #16. All canals were biomechanically prepared and obturated to achieve a hermetic seal. The current case presentation emphasizes on the high possibility of unexpected variations in the root and its canal morphology. Awareness regarding such variations will minimize the intra-operative complications during root canal therapy and will avoid root canal failure.</p>Akash Jitender SibalShriya Ravindra Singi
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2023-12-192023-12-19421Periodontal status and oral hygiene practices among adults in a peri-urban fishing community in Ghana
https://www.ajol.info/index.php/pamj/article/view/251990
<p><strong>Introduction: </strong>fisherfolk play a major role in emerging economies such as Ghana. While many fishing communities are noted to be underdeveloped, fisherfolk are considered to neglect their oral hygiene, while being prone to certain conditions due to peculiar risks. The purpose of this study was to determine the periodontal health status of adults in a selected fishing community in Ghana. <strong>Methods: </strong>a descriptive cross-sectional study was carried out to assess the periodontal status of adults in Jamestown, a peri-urban area in Ghana. Data acquisition was by means of a structured questionnaire and periodontal examination. Information obtained consisted of demographic data (age, sex, education and occupation category) oral hygiene practices (type of teeth cleaning materials, methods of tooth cleansing, frequency of dental visits and reasons for the visit) and periodontal clinical parameters (plaque index, and community periodontal index of treatment needs).<strong>Results: </strong>a total of 276 participants were included in the study, with ages ranging from 21 to 70 years. The participants were made up of 138 fisherfolk and 138 non-fisherfolk. Males had worse scores for periodontal disease compared to females. Plaque score did not vary among age groups, but changed significantly between educational level and occupational categories. CPITN varied significantly between educational levels, age categories and occupational categories. <strong>Conclusion: </strong>the study found inhabitants of the fishing community of Jamestown to have a generally unsatisfactory periodontal status, but worse for the fisherfolk in the community.</p>Daniel TormetiHarold Nii-AponsahJosephine SackeyfioPaa Kwesi BlanksonNeil Quartey-PapafioMichael ArthurTom Akuetteh Ndanu
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2023-12-192023-12-19421Diabetic ulcer with diabetic neuropathy: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/251994
<p>A diabetic ulcer is a non-healing ulcer seen in people with uncontrolled blood sugar. High blood sugar causes the formation of sorbitol from sugar, which causes demyelination of large nerve fibers. Here we reported a case of a 62-year-old male who came to the medicine outpatient department with the complaint of a large ulcer over the anterior aspect of the right leg. In diabetic patients, there is an altered immune system and poor blood flow. On physical examination, there is loss of epithelium with granulation tissue formation and decreased sensation, doctors suggested a diagnosis of diabetic ulcer with diabetic neuropathy. On lab investigation, the patient was diagnosed with type II diabetes with an uncontrolled blood sugar of chronic duration.</p>Kapil SharmaSwarupa Chakole
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2023-12-192023-12-19421A rare case of post infectious radial hemimelia of right forearm
https://www.ajol.info/index.php/pamj/article/view/251996
<p>A problem in the development of components that make up the radial half of the forearm is known as radial longitudinal deficiency (RLD). Radial hemimelia, radial dysplasia, radial meromelia, and radial club hand are all words used to describe the condition. It's an uncommon condition that affects between 1/30,000 and 1/100,000 live births. In nearly half of the instances, there is bilateral involvement. We describe an atypical instance of radial hemimelia in which the radius was significantly hypoplastic while the thumb and carpal bones were normal in size, form, and joint connections. A 16-year-old female presented to orthopedics out patient department (OPD) with complaints of deformity since birth and tingling sensation of right upper limb for 1 year. Patient had history of perinatal infection. On local examination of right upper limb radius was grossly small and deformed in lower one third position. Ulnar head was grossly deformed and prominent, movements were restricted with dorsiflexion and planter flexion of about each 0-10 degrees. The patient was managed with osteotomy of radius and ulna. Proximal ulna was aligned with distal radius with K wire and bone grafting at the osteotomized site. Patient was discharged on dynamic cock-up splint for finger range of movement exercises for 3 weeks and follow up advised sequentially.</p>Devank LohiyaParth Shah
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2023-12-192023-12-19421Facteurs prédictifs de fistule anastomotique après colectomie pour cancer
https://www.ajol.info/index.php/pamj/article/view/251998
<p><strong>Introduction: </strong>en chirurgie du cancer colique, la fistule anastomotique (FA) est la complication la plus redoutée. Le but de cette étude était de déterminer les facteurs prédictifs de fistule anastomotique après résection pour cancer colique ainsi de décrire l´impact de cette complication sur la mortalité et la durée du séjour postopératoire.<strong>Méthodes: </strong>nous avons mené une étude rétrospective, descriptive et analytique, allant du 1<sup>er</sup> janvier 2013 au 31 d écembre 2020, dans le service de chirurgie générale de l´hôpital Habib Bourguiba de Sfax, Tunisie.<strong>Résultats: </strong>nous avons colligé 163 malades opérés pour cancer colique. L´âge moyen était de 62,7 ans avec un sexe ratio de 1,36. Les suites opératoires étaient simples dans 64,4% des cas et compliquées dans 35,6%. La morbidité chirurgicale était essentiellement représentée par les fistules anastomotiques, identifiées chez 22 malades. Au terme de notre travail, il ressort que les facteurs prédictifs de la survenue de cette complication sont: le diabète avec un p = 0,04, le tabagisme avec un p = 0,01, l´hypoalbuminémie avec un p = 0,01, l´hémoglobine préopératoire inférieure à 10g/dl avec un p < 0,01, la localisation au niveau de l´angle colique gauche avec un p = 0,02, la transfusion peropératoire avec un p <0,01 et une durée opératoire supérieure à 180 min avec un p = 0,04. Par ailleurs, la survenue de FA était accompagnée d´un taux de mortalité spécifique de 9% et avait prolongé de façon significative la durée de séjour postopératoire. <strong>Conclusion: </strong>la prévention de la FA doit s´inscrire dans le cadre d´une prise en charge multimodale du patient avec essentiellement un apport nutritionnel et une correction d´une éventuelle anémie en préopératoire.</p>Amine ZouariAbderrahmen MasmoudiFatma KhanfirSalma KetataHaithem RejabAhmed BouzidIssam LoukilImen ZribiSkander TalbiAmine AbdelhediBassem AbidSalah Boujelben
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2023-12-192023-12-19421The frequency of acid-base disorders on admission to the intensive care and its association with in-hospital outcome, Cape Town, South Africa: a retrospective cohort study
https://www.ajol.info/index.php/pamj/article/view/252002
<p><strong>Introduction: </strong>acid-base disorders are very common in critically ill patients and contribute significantly to morbidity and mortality. The aim of this study was to identify the types of acid-base disorders at the time of admission to the intensive care unit (ICU) and its associated ICU and in-hospital mortality. <strong>Methods: </strong>we conducted a retrospective cohort study of all adult patients that were admitted to the ICU and had an arterial blood gas sample at the time of admission from 1 January 2019 to 31 December 2019. Using the traditional approach, acid-base disorders were categorised into six disorders. Variables predicting in-hospital death were identified using logistic regression. <strong>Results: </strong>a total of 375 patients were included. The median age for the entire cohort was 39 (IQR 30–52) years and 48.3% (n=181) were female. Mixed acid-base disorders were the most common at 48.8% (n=183), followed by no disorder at 24.8% (n=93), metabolic acidosis at 9.3% (n=35), metabolic alkalosis at 6.7% (n=25), respiratory acidosis 6.1% (n=23) and respiratory alkalosis at 4.3% (n=16). A total of 94 (25.0%) patients died. There were no differences in ICU (p = 0.35) or in-hospital death (p = 0.32) by acid-base disorder. Male sex (aOR: 5.8, 95% CI 1.55-21.42; p < 0.01), APACHE II score (aOR: 1.17, 95% CI 1.06-1.30; p < 0.01) and the corrected anion gap (aOR: 1.14, 95% CI 1.02-1.27; p = 0.02) were identified as predictors of in-hospital death using multivariable logistic regression. <strong>Conclusion: </strong>there was no association between acid-base disorders at the time of ICU admission and ICU or in-hospital death. Therefore, in our setting, acid-base disorders at the time of ICU admission should not be used to predict the outcome of patients requiring intensive care.</p>Nokwanda SitholeUsha LallaMogamat Razeen DavidsMogamat-Yazied Chothia
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2023-12-192023-12-19421Spleen metastases secondary to gastric neuroendocrine carcinoma “case report”
https://www.ajol.info/index.php/pamj/article/view/252004
<p>Neuroendocrine carcinoma (NEC) in the stomach represents a rare and rapidly growing type of gastric tumors. They are considered a distinct entity of neuroendocrine tumors characterized by an aggressive behavior and high metastases rate. On the other hand, spleen metastases of neuroendocrine tumors are extremely rare. We report the first case of spleen metastases of gastric neuroendocrine carcinoma. The patient was a 54-year-old male who presented with a 10-month history of epigastralgia. Upper gastro-intestinal endoscopy revealed a 5 cm ulcerative lesion located in the greater gastric curvature. Biopsies with immunohistochemical staining revealed gastric neuroendocrine carcinoma. Abdominal computed tomography showed thickening of the stomach with two large solid spleen lesions. Abdominal MagNETsic Resonanace Imagine and 18-fluorodexyglucose positron-emission tomography revealed peritoneal carcinosis and splenic metastases with splenic vein invasion. Clinicians should keep in mind that splenic metastases can arise from gastric neuroendocrine tumours (NETs).</p>Sahar NasAmal KhsibaMoufida MahmoudiAsma Ben MohamedMehdi BouasidaLamine Hamzaoui
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2023-12-192023-12-19421Endoscopic removal of a bullet from the parapharyngeal space just anterior-lateral to the first vertebral body: case report
https://www.ajol.info/index.php/pamj/article/view/252008
<p>In all head and neck bullet injuries, treatment has to be individualized, as there is no universal protocol for all cases. Five important steps of management should be taken: securing airways, hemorrhage control, recognizing other injuries, foreign body removal when necessary, and repair of facial wounds. In this report, the case of a 28-year-old male patient will be presented and discussed. The patient was referred from a surgery clinic to an ear, nose and throat (ENT) outpatient clinic complaining of right neck pain, throat pain, and foreign body sensation in the throat for 2 months following a firearm injury to his face. The entry wound was observed on the left alar cartilage of his nose, which was almost healed and had left a scar. A sinus computed tomography scan showed a bullet in the right parapharyngeal space about 3 mm in front of the first vertebral body. The bullet was successfully removed using a trans-nasal endoscopic approach with the support of an image-guided navigational system and frequent fluoroscopy. These 2 methods help to replace the old traditional open approaches.</p>Wardeh AlhusbanQais AljfoutYousef AlsardiaNabeela TawalbehMohammad AboromanAmer Abu-ain
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2023-12-192023-12-19421Sexual maturation of HIV-infected and uninfected male children in Abakaliki, South-East, Nigeria: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/252012
<p><strong>Introduction: </strong>HIV infection, through various mechanisms causes a derangement in sexual maturation. This study compared the Marshal and Tanner staging of HIV-infected and uninfected males. The aim of the study was to determine the sexual maturation in male children infected with HIV on HAART in Abakaliki. <strong>Methods: </strong>this was a cross-sectional and comparative study involving 80 HIV-infected boys aged 8-17 years and 80 uninfected counterparts matched for age and socio-economic class. Stages of sexual maturation (testicular size and pubic hair) were determined according to the method proposed by Marshall and Tanner. The testicular size was measured using an orchidometer. Data analysis was done with SPSS version 20. Structured questionnaire was used to collect information on socio-demographics. <strong>Results: </strong>assessment of pubic hair development, showed that 45 (56.2%) of the subjects were in the pre-pubertal stage compared to 27 (33.8%) among the controls, this relationship was statistically significant (p=0.005, OR = 2.5, C.I=1.3-4.8). The mean testicular volume among subjects was found to be 8.29 ± 8.26mls compared to 11.57 ± 8.26mls found in controls. This relationship was also statistically significant. There were significant statistical relationships between duration on HAART and clinical stages of disease with both pubic hair development and testicular volume of subjects and controls. <strong>Conclusion: </strong>HIV-infected males had significantly delayed onset and progression of sexual maturation. Routine assessment of the sexual maturation of HIV-infected children as well as addressing the modifiable variables influencing sexual maturity is recommended.</p>Chijioke Ogodo OgehMaria-Lauretta OrjiKenechukwu Kosisochukwu IlohChijioke Joel NwekeOgochukwu Nneka IlohIfeoma Josephine Emodi
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2023-12-192023-12-19421Have we forgotten the non-COVID-19 diabetic patients? Impact of lockdown on daily life, sleep and mental health: cross-sectional study in Moroccan diabetic patients
https://www.ajol.info/index.php/pamj/article/view/252014
<p>The main objective of this work is to describe the impact of lockdown on daily life, sleep and the mental health of Moroccan diabetics patients. The secondary objective is to study the factors affecting compliance with lockdown and deterioration of sleep in diabetic patients while lockdown. It´s a cross-sectional study including diabetic patients followed up at the Endocrinology department of Casablanca. Patients answered a questionnaire about Socio-demographic characteristics, Sleep-related characteristics and predominant activities during the lockdown. The psychological impact was assessed by the score of Anxiety and Depression Assessment Scale (HDAS). Statistical analysis was carried out using SPSS 20 software. Bedtime was shifted by 53 minutes during the lockdown. Waking time was also 1 hour 18 minutes later, while sleep duration increased from 8 hours 20 minutes before lockdown to 8 hours 30 minutes during it (p=0.24) with a deterioration in sleep quality reported by 53 patients. Sleep deterioration was not correlated with anxiety or duration of screen exposure, but was more related to age between 50 and 65 years old. HAD score showed anxiety in 29 patients which were correlated to the female gender. The study included 100 patients with an average age of 48 years. 38 patients had a professional activity before lockdown, 5 of them kept working face-to-face, 3 teleworked and 30 were unemployed. Only 59 % of them respected lockdown. This respect was correlated with female gender, educational level and the number of members under the same roof when it is more than 6. Deterioration in sleep, a change in bedtime and waking time and an increase in anxiety was observed in diabetic patients during the lockdown. Therefore, the psychiatric care system needs to adapt to provide psychological support not only to infected persons but also to other vulnerable communities including diabetic patients.</p>Soukaina LaidiNassim Essabah HarajSiham El AzizAsma Chadli
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2023-12-192023-12-19421Primary pulmonary leiomyosarcoma with coexistent pulmonary aspergillosis: a case report
https://www.ajol.info/index.php/pamj/article/view/252015
<p>Coexisting primary pulmonary leiomyosarcoma (PPL) with pulmonary Aspergillosis in immunocompetent patients is a rare occurrence. Here, we presented a 54-year-old woman presented with a dry cough for two months. Bronchoscopy revealed pulmonary aspergillosis. The patient was treated with antifungal therapy for one month without improvement. To evaluate further, a chest computed tomography (CT) scan showed a large heterogeneous enhancing mass in the lower lobe of the left lung with left atrium thrombosis. Computed tomography-guided biopsy was performed, and histopathology demonstrated the diagnosis of PPL. The metastasis workup staging showed multiple metastases in vertebrae, scapula, rib, and liver. The patient was treated with chemotherapy followed by tumor bed radiotherapy. Unfortunately, her general condition worsened, and she passed away with overall survival of fourteen months. In conclusion, clinicians should be alert to underlying malignant disease if airway Aspergillus infection is suspicious in patients without strong risk factors for invasive fungal infection.</p>Ahmed BadheebNasser Al GharemShehab Al HammadiSaid ElsagheerMohamed BadheebFaisal Ahmed
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2023-12-192023-12-19421Performance of Xpert HIV-1 viral load test in Senegal: a country of high circulation of CRF02_AG
https://www.ajol.info/index.php/pamj/article/view/252017
<p><strong>Introduction: </strong>the introduction of the point-of-care in HIV-1 viral load quantification appears to be a complementary strategy to the existing conventional system of the acceleration plan for the achievement of the three 90s in Senegal. The objective of this study was to evaluate the performance of the Xpert® HIV-1 viral load in the context of circulation of non-B, non-C subtypes. <strong>Methods: </strong>two hundred samples, were tested on Xpert® HIV-1 Viral Load using 1 ml of plasma in comparison to 600 μl on Abbott Real-time HIV-1 assay. The difference between viral load values was considered significant for Dlog >0.5 log copies/ml. <strong>Results: </strong>a good correlation (r=0.985) was noted and confirmed using passing-bablok regression (slope 1.048; 95% CI:1.036 to 1.069) for 188 samples with samples. A mean difference of 0.0075 log10 copies/ml for a 95% confidence interval (CI) of 0.002 log10 copies/ml to 0.013 log10 copies/ml was obtained. Sensitivity and specificity were respectively 93.6% and 93.5% at the threshold of 1.6 log10 copies/ml and 100% and 99% at the threshold of 3.0 log10 copies/ml. <strong>Conclusion: </strong>these results show that Xpert® HIV-1 Viral Load has excellent performance. In Senegal, and can be used for HIV viral load monitoring.</p>Pauline Yacine SéneHalimatou Diop-NdiayeAissatou Sow NdoyeBrianan KiernanKhadidiatou CoulibalyOusseynou NdiayeSada DialloAnna Julienne Selbe NdiayeMengue FallAdjiratou Aissatou BaMakhtar CamaraCheikh Saad Bouh BoyeNdeye Fatou NgomCharlotte LejeuneCheikh Tidiane NdourCoumba Toure Kane
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2023-12-192023-12-19421Evaluation of the Mozambique Antiretroviral Therapy (MozART) database as an antiretroviral therapy patient surveillance system, 2017-2018
https://www.ajol.info/index.php/pamj/article/view/252020
<p><strong>Introduction: </strong>Mozambique antiretroviral therapy is a database used to monitor patients receiving antiretroviral treatment (ART). This study's objective was to evaluate the system for the purpose to monitor patients receiving ART. <strong>Methods: </strong>data from 287,052 patients who started ART from January to December 2017 were verified, and retention in care was assessed for 2018 in Mozambique. The Centers for Disease Control and Prevention guidelines for evaluating public health surveillance systems were used to conduct the evaluation. Simplicity, flexibility, data quality, representativeness and stability attributes were evaluated. <strong>Results: </strong>a total of 93% (266,880/287,052) of patients on ART were adults ≥15 years old, and 65% (186,677/287,052) were female. The system was complex, it involved four organisations and its management was online. Data quality was moderate with 19% (1,533,885/8,037,456) of empty variable fields, 0.04% (123/287,052) observations with birth date later than the initial ART date, 0.2% (424/287,052) and 23% (68,039/287,052) with initial ART date and diagnosis date, later than the next ART pickup date. Nationally, 19%(31/161) of the districts did not have data in the information system. MozART cover health facilities with electronic patient tracking systems. Hence did not represent all patients on ART. While it was not possible to add variables of the electronic patient tracking, the system was stable as neither data or server interruptions were reported.<strong>Conclusion: </strong>the system was useful, stable, with moderate data quality, complex, not flexible and not representative. We recommend to health facilities and partners to develop and distribute procedures for data validation and completeness and report all patient tracking variables in the system.</p>Neusa Vanessa Fernandes Abdul FatahaSandra GavetaJosé Carlos LangaAuria Ribeiro BanzeErika Valeska RossettoCynthia Semá BaltazarTimothy Allen KelloggJahit Sacarlal
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2023-12-192023-12-19421Prevalence and factors associated with post-partum depression in a rural area of Cameroon: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/252026
<p><strong>Introduction: </strong>post-partum depression is one of the many challenges associated with childbirth. In Cameroon, the focus is more on post-partum obstetric complications resulting in underdiagnosis and misdiagnosis of this condition. The current socio-political crisis plaguing the English-speaking part of Cameroon has increased the stressors that may inherently increase the prevalence. There is no published data describing post-partum depression in a rural setting in Cameroon. We seek to determine the prevalence and factors associated with PPD in women attending the Tubah District hospital, North West Region, Cameroon. <strong>Methods: </strong>we conducted a cross-sectional hospital-based study at the Tubah District Hospital. A consecutive convenience sampling technique was used to recruit participants. Our main outcome was post-partum depression which was assessed using the Edinburgh Post-partum Depression Scale. <strong>Results: </strong>a total of 207 post-partum women took part in this study with a mean age of 27.54 ± 5.78 years. The prevalence of depression was 31.8%. Gender-based violence (OR: 4.67, P = 0.013), financial stress (OR:3.57, P = 0.002) and male baby (OR: 2.83, P < 0.001) were independent psychosocial factors associated with PPD. Independent psycho-clinical factors of post-partum depression include family history of mental health illness (OR: 4.34, P = 0.04) and previous history of depression (OR: 4.17, P = 0.02). <strong>Conclusion: </strong>the prevalence of post-partum depression in women attending the Tubah District Hospital, Northwest Region, Cameroon is high. The factors associated with PPD are many. Identification of risk factors, early diagnosis and proper management can prevent PPD, disabling morbidity, and suicide in mothers.</p>Therence Nwana DinganaStewart Ndutard NgasaNeh Chang NgasaLeticia Armelle Sani TchoudaChristabel AbandaEric Wah SanjiMbianyor BillJuste Ongeh NibaCarlson-Sama Babila
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2023-12-192023-12-19421Prevalence and therapeutic management of snakebite cases in the health facilities of the Bouenza department from 2009 to 2021, Republic of Congo
https://www.ajol.info/index.php/pamj/article/view/252031
<p><strong>Introduction: </strong>few studies exist of snake bites in the Republic of Congo. This study reports epidemiological and management data on snake bites in the Bouenza department of the Republic of Congo. <strong>Methods: </strong>this is a retrospective and descriptive study based on questionnaire and analysis of files of snakebite victims over a period of 13 years (2009-2021). We collected data on incidence, age, gender, site of the bite, the season of the bite, deaths and treatment. <strong>Results: </strong>we identified 81 cases of bites recorded in 14 healthcare facilities: 54.32% of cases (44/81) at Nkayi Base Hospital; 11.11% (9/81) at Madingou Base Hospital; 1-5% (1-4/81) at each of the remaining facilities. Eight deaths were recorded in four health facilities. The sex ratio of snakebite victims was 1 (41 males: 40 females). The age most affected was 25-55 years (54.32% or 44/81). The lower limb was the bite site most reported at 13.98% (but in 84% or 68/81 cases the site was not recorded). More bites occurred during the rainy season (80.25%; 65/81). All victims received only symptomatic treatment based on antibiotics, anti-inflammatories and analgesics, as anti-venom serums are unavailable. The recorded incidence of snake bites in Bouenza was 18.62 per 100,000 of population. <strong>Conclusion: </strong>our study offers a preliminary report from a little-studied region. The incidence of snakebites recorded in Bouenza is lower than expected compared with studies from other African countries, and with earlier (20 years ago) studies from Congo. This may reflect incomplete record-keeping in under-resourced healthcare facilities.</p>Lise Bethy MavoungouKate JacksonJoseph Goma-Tchimbakala
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2023-12-192023-12-19421Stroke units in Nigeria: a report from a nationwide organizational cross-sectional survey
https://www.ajol.info/index.php/pamj/article/view/252034
<p><strong>Introduction: </strong>stroke is one of the leading causes of death and disability in Nigeria. Stroke unit care is crucial for reducing mortality and morbidity in stroke. This study describes the stroke units' structure, organization, and care process in Nigerian tertiary hospitals. <strong>Methods:</strong> this study is a cross-sectional descriptive organizational survey-based study using an online structured questionnaire to collect information on the stroke units. <strong>Results:</strong> five (8.6%) out of 58 hospitals had a stroke unit. The number of beds ranged between 10 and 27 with the coverage of hospital stroke patients ranging from 24% to 100%. All the centers had a multidisciplinary team for their unit. The basic required investigations like computerized tomography and electrocardiography were available in the centers. Thrombolytic therapy coverage was suboptimal in all the centers due to prolonged onset-to-arrival times and inaccessibility of thrombolytic medications. <strong>Conclusion:</strong> there has been some progress in stroke unit availability since the country´s first stroke unit was established over a decade ago. However, there is still the need to create more stroke units in Nigeria and improve reperfusion therapy coverage.</p>Babawale ArabambiOlajumoke OshinaikeShamsideen Abayomi OgunChukwuemeka EzeAbiodun Hamzat BelloSteven IgeteiYakub Yusuf
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2023-12-192023-12-19421Capecitabine plus oxaliplatin in the treatment of metastatic colorectal cancer at Tygerberg Hospital: a retrospective study
https://www.ajol.info/index.php/pamj/article/view/261231
<p><strong>Introduction:</strong> a capecitabine and oxaliplatin drug combination regimen has shown a survival benefit in patients with advanced colorectal cancer, yet its administration represents an attractive option for low resource settings. This study aimed to describe the therapeutic utility, efficacy and safety of a capecitabine plus oxaliplatin drug combination in patients with colorectal cancer.</p> <p><strong>Methods</strong>: a review of medical records of sixty adult patients with histological diagnosis of colorectal cancer at Tygerberg Hospital between June 2012 and June 2017 was conducted. The overall response rate was assessed after a three cycle regime of capecitabine and oxaliplatin with the progression-free survival (PSF) results estimated using the Kaplan-Meier methods.</p> <p><strong>Results</strong>: among the 60 participants identified over the study period, the median age was 53 years with 45% being female (n=27). Records showed that 58.33% of patients had the colon as the primary site and 68.33% of patients had synchronous liver metastases at presentation. On average, all patients received 6 cycle regimes of capecitabine and oxaliplatin. Sixty percent of the patients received this treatment regime with palliative intent while in the radical-intent group, equal numbers of patients received the regime as either neoadjuvant or adjuvant. A liver resection was also performed in 20 patients (31.8%). The overall response rate was 69.6% with 13 patients attaining a complete response. Disease progression was reported in 30.4% and the 1-year progression free survival was 44.5% (95% CI: 0.31-0.57) while the 2-year progression free survival was 25.1% (95% CI: 0.14-0.38). Regarding safety, thrombocytopenia was the most frequent adverse event (18.5%) and overall, 15.1% of patients experienced grade 3 and 4 toxicity.</p> <p><strong>Conclusion: </strong>a drug combination of capecitabine and oxaliplatin showed a good overall response rate and survival particularly in patients with resectable colorectal liver metastases.</p>Solomon KibuddeWaleed Begg
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2023-12-192023-12-19421Effect of placebo versus prophylactic postoperative amoxicillin on post-(adeno)tonsillectomy morbidity in Tanzanian children: a two-centre, double-blind randomized controlled non-inferiority trial
https://www.ajol.info/index.php/pamj/article/view/252043
<p><strong>Introduction: </strong>to date in Africa, there is limited evidence regarding the role of prophylactic antibiotics to prevent post (adeno)tonsillectomy ( (A)TE) morbidity in children. As (A)TE is the most performed surgery in the pediatric population, the use of prophylactic antibiotics is likely a major factor in the development of AMR. In Tanzania, as in many other settings with limited resources antibiotics are misused and overprescribed. Potential reasons include limited stewardship and widespread use of postsurgical prophylactic antibiotics. Misuse of antibiotics might contribute significantly to the development of antimicrobial resistance (AMR). <strong>Methods: </strong>a two-centre, double-blinded randomized controlled non-inferiority trial. Subjects included children from 2-14 years of age with recurrent chronic tonsillitis and/or obstructive sleep apnoea due to adenotonsillar hypertrophy who were electively scheduled for (A)TE in two tertiary hospitals. Participants were randomly allocated to receive either placebo or amoxicillin for five days postoperatively. Primary outcome was non-inferiority of placebo compared with amoxicillin for postoperative haemorrhage (margin 5%; at 14 days) postoperative fever (margin 5%; at 7 days), and pain (margin 1 point; at 7 days). Secondary outcomes included the times required for resumption of normal diet and normal activities, and microbial recolonization of the tonsillar beds. Data were analysed according to intention-to-treat principle. Follow-up was 14 days. <strong>Results: </strong>between March 13, 2019 and September 20, 2019 270 children were enrolled. All children were randomly assigned to receive placebo (n = 136) or amoxicillin (n = 134). By 14<sup>th</sup> day post-operatively, total of 8 children were lost to follow-up in each arm. No major postoperative haemorrhage was registered. By 14<sup>th</sup> day post-operatively, 22 (17.5%) children in the amoxicillin arm and 19 (14.8%) children in the placebo arm had reported minor haemorrhage (risk difference (RD) -2.6% (95%CI -10.2 - 5.0); p<sub>non-inferiority</sub> = 0.045). By 7<sup>th</sup> day post operatively, 8 (6.3%) children in amoxicillin arm and 4 (3.1%) children in placebo arm reported fever during the first week (RD -3.2% (95%CI -7.6 - 1.2); p<sub>non-inferiority</sub> = 0.001). By 7<sup>th</sup> day post operatively, mean pain score (mean (SD)) was 3.25 (1.53) in the amoxicillin arm and 3.56 (1.68) in the placebo arm (mean difference 0.31, (95% CI -0.02 - 0.65); p<sub>non-inferiority</sub> < 0.001). No statistically significant differences between the two groups were found in any of the secondary outcomes. Findings shows, placebo is non-inferior to amoxicillin for post-operative morbidities in Tanzanian children undergoing (A)TE. <strong>Conclusion: </strong>it is recommended that antibiotics should only be used when clinically necessary to treat a specific infection. Unnecessary use of antibiotics contributes to the development of antimicrobial resistance. Trial Registration: Pan African Clinical Trials Registry PACTR201905466349317. Retrospectively registered on 15 May 2019.</p>Denis KatunduDesderius ChussiBalthazar NyombiRune PhilemonHadija SemvuaGerjon HanninkNiels van Heerbeek
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2023-12-192023-12-19421Bladder stone caused by misplaced intrauterine contraceptive device: a case report
https://www.ajol.info/index.php/pamj/article/view/252048
<p>Intrauterine Contraceptive Device (IUCD) when placed in the uterine cavity is used for contraception or treatment of intrauterine adhesion, but it has become a cause of unintended bladder stone due to wrongful placement or migration. It may cause blood in urine and painful urination. Pelvic ultrasound and X-ray were used to make the diagnosis of the bladder stone with the embedded IUCD, which was removed by open vesicolithotomy through a Pfannenstiel suprapubic incision. Cases such as this are highly preventable if post procedure and routine annual pelvic ultrasonography are emphasized as standard practice following IUCD insertions.</p>Boniface Uji AgoGlen Enakirerhi
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2023-12-192023-12-19421Helicobacter pylori resistance to metronidazole and its association with virulence factors in a Moroccan population
https://www.ajol.info/index.php/pamj/article/view/252053
<p><strong>Introduction</strong>: surveillance data on <em>Helicobacter pylori (H. pylori)</em> antibiotic susceptibilities in Morocco are limited, despite resistance being the key factor in treatment failure. Virulence factors of <em>H. pylori</em> are associated with carcinogenesis and may be also associated with the efficacy of treatment. The aim of our study is to determine the prevalence of <em>H. pylori</em> metronidazole resistance in a Moroccan population infected with <em>H. pylori</em> and to study the impact of their virulence factors CagA and VacA on their resistance to metronidazole. <strong>Methods</strong>: the susceptibility to metronidazole of 185 isolates was determined by PCR. The isolates were also genotyped for CagA and VacA genes by PCR. <strong>Results</strong>: the metronidazole resistance rate was 62.70%. No association between resistance to metronidazole and social factors was detected. Regarding the virulence factors, we remarked that the moderate virulent strains s1/m2/i1/d1 with a CagA negative were the most resistant to metronidazole with a rate of 84% compared to the less virulent strains bearing the CagA negative VacA s2m2i2d2 genotype with a rate of 58% and the high virulent strains s1/m1/i1/d1-CagA positive with a rate of 47.06%. <strong>Conclusion</strong>: our study revealed a very high prevalence of resistance to metronidazole in our population. The resistance ability of <em>H. pylori</em> maybe affected by its virulence intensity. <em>H. pylori</em> eradication regimens should therefore be reevaluated in this setting.</p>Essaidi ImaneBounder GhizlaneJouimyi Mohamed RedaBoura HasnaElyounsi IlhameBenomar HakimaBadre WafaZerouali khalidMaachi Fatima
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2023-12-192023-12-19421Chronic purulent pericarditis: case report
https://www.ajol.info/index.php/pamj/article/view/252059
<p>Purulent pericarditis is an infection of the pericardial space that produces pus that is found on gross examination of the pericardial sac or on the tissue microscopy. In this case report, we will discuss a 31-year-old male who presented with a chief complaint of low-grade fevers, dry cough and difficulty breathing for about two weeks which preceded after removing of dental also two weeks prior. He was admitted and treated as COVID-19 in the isolation ward, he later developed cardiac tamponade and during pericardiocentesis thick pus was discharged. Pus culture and Gene Xpert tests were all negative. After his condition improved, the patient was transferred to the general ward with the pericardial window still discharging pus. Pericardiectomy was chosen as definitive management. The key takeaway in this report is that Empirical treatment with RHZE (rifampin, isoniazid, pyrazinamide, and ethambutol) in resource-limited settings is recommended due to difficulty in identifying the exact cause at a required moment.</p>Proches VaraDiana UrassaBoniface TembaKajiru KilonzoAlex MremiAdnan SadiqFuraha Lyamuya
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2023-12-192023-12-19421Lumbar rachischisis associated with diastematomyelia: prenatal diagnosis and fetopathological examination
https://www.ajol.info/index.php/pamj/article/view/252066
<p>We report the case of a 29-year-old female patient who presented for a routine ultrasound scan at 17 weeks of gestation. Sonography showed, on an axial view of the fetal brain, flattening of the frontal bones resulting in a lemon like deformity of the cephalic pole (A). Biparietal diameter and head circumference were below 3<sup>rd</sup> percentile (A). The examination of lumbar spine showed vertebral and skin defect on a sagittal view (B). The diagnosis of Chiari II malformation was suspected. An additional midline echogenic focus (B, C) attracted our attention. Sonography showed widening of the spinal canal in the coronal view (C). Associated diastematomyelia was suspected. Magnetic resonance imaging (MRI) confirmed the presence of lumbar rachischisis associated with diastematomyelia. The couple decided to interrupt the pregnancy. Fetopathological examination confirmed the abnormalities described on ultrasound (A, B, C) and showed an associated ventricular septal defect.</p>Mahdi FarhatiAbir Karoui
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2023-12-192023-12-19421Peri-orbital Masson´s tumor: a case report and literature review
https://www.ajol.info/index.php/pamj/article/view/252072
<p>Masson tumor is a benign vascular lesion characterized by an intravascular papillary endothelial hyperplasia. Peri orbital locations are rare. We report a case of Masson tumor localized in the upper internal angle of the left orbit revealed by progressive ocular proptosis. Orbital computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a vascular mass in the left internal canthus mimicking an arterioveinous malformation. The patient underwent total removal of the lesion with a favorable postoperative follow up. Histological examination found an intravascular papillary endothelial hyperplasia without atypical features corresponding to Masson tumor. A thorough literature review of Masson tumor is presented with a discussion of clinical findings and management.</p>Lamia BenantarSarah BelghmaidiEl Mehdi HamidiYassine Ait M'barekYassine El GhaniIbtissam HajjiAbdeljalil MoutaouakilKhalid Aniba
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2023-12-192023-12-19421Testicular necrosis as a complication of severe epididymo-orchitis: a case report
https://www.ajol.info/index.php/pamj/article/view/252077
<p>The symptoms of epididymo-orchitis (EO) are usually mild, but serious complications such as abscess and testicular necrosis can occur. There are a few cases of testicular necrosis secondary to EO to our knowledge. We present a case of a 60-year-old diabetic male patient who presented with left scrotal pain and fever in the last week. The scrotal ultrasonography (US) revealed increased flow of the left testicle in favour of the left EO. After seven days of antibiotic therapy, the patient´s condition worsened and developed into a scrotal abscess. The scrotal US showed scrotal abscess with the absence of left testicular arterial vascularity in favour of testicular necrosis. For that, a left orchiectomy was performed, and a histopathology report confirmed the diagnosis. In conclusion, testicular necrosis secondary to EO is a rare occurrence. When there is a suspicion of EO, medical therapy should be started as soon as possible to avoid significant complications.</p>Faisal AhmedFayed Al-YousofyQasem AlyharIman AlyabaryShams AlzubairiSaleh Al-WageehEbrahim Al-ShamiMenawar DajenahAhmed Al-Hitari
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2023-12-192023-12-19421Puberté précoce: expérience de l´unité d´endocrinologie pédiatrique à l´Hôpital d´Enfant de Rabat
https://www.ajol.info/index.php/pamj/article/view/252079
<p><strong>Introduction: </strong>la puberté précoce est définie par le développement des caractères sexuels avant l´âge de 8 ans chez la fille et de 9 ans chez le garçon. L´objectif de notre étude était de décrire le profil clinique, paraclinique et étiologique de la puberté précoce. <strong>Méthodes: </strong>il s´agit d´une étude descriptive rétrospective s´étalant de 1999 à 2017 à l´unité d´endocrinologie pédiatrique à l´Hôpital d´Enfant de Rabat. <strong>Résultats: </strong>quatre-vingt-dix-neuf (99) enfants ont été inclus. L´âge moyen des filles était de 4,25 ± 2,6 ans, celui des garçons était de 3,6 ans ± 1,8. Nous avons noté une prédominance féminine dans 90% (90 filles). Les signes révélateurs chez la fille étaient dominés par le développement mammaire (77,77%). Chez le garçon, le motif de consultation le plus fréquent était la pilosité pubienne (70%). Sur le plan biologique, dans les pubertés précoces centrales, le taux moyen du pic de LH après stimulation par GnRH était élevé à 17 UI/L avec un rapport moyen pic LH/ pic FSH de 1,30. Les étiologies étaient comme suit: pubertés précoces dissociées (60,60%), pubertés précoces pathologiques (39,40%). Dans cette dernière, nous avons noté une prédominance des pseudo-pubertés précoces (58,98%). Pour la puberté précoce centrale, la forme idiopathique était l´étiologie la plus fréquente chez la fille (62,5%). Alors que chez tous les garçons, une lésion du système nerveux central était objectivée. <strong>Conclusion: </strong>notre étude confirme que la puberté précoce pathologique centrale est souvent liée à une lésion du système nerveux central chez le garçon justifiant ainsi la réalisation systématique d´une imagerie cérébrale.</p>Kaoutar RifaiYoussra El KhayatAhmed Gaouzi
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2023-12-192023-12-19421Chronic recurrent multifocal osteomyelitis mimicking a malignant bone tumor: a case report
https://www.ajol.info/index.php/pamj/article/view/252081
<p>Chronic recurrent multifocal osteomyelitis (CRMO) is an unusual form of non-microbial chronic osteomyelitis. It is an exclusion diagnosis that can only be considered after ruling out infectious osteomyelitis and bone tumors. We report the case of a 13-year-old girl who was admitted for a painful swelling of the left thigh. Biological examinations did not find an inflammatory syndrome. X-rays and Magnetic Resonance Imaging were very suggestive of malignant bone tumor. But the biopsy disclosed a nonspecific osteomyelitis. Considering the strong suspicion of a malignant origin, a second biopsy was performed and confirmed the diagnosis of osteomyelitis. During the hospital stay, the patient developed a second location in the left humerus. Thus, the diagnosis of CRMO was retained. The patient was treated by NSAIDs with good clinical and radiological outcomes. This case report reminds the diagnostic challenge of this pathology that can mimic malignant tumor.</p>Oumnia BencharefTarik SalamaElmouhtadi AghoutaneRedouane Elfezzazi
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2023-12-192023-12-19421A case of secondary syphilis
https://www.ajol.info/index.php/pamj/article/view/252085
<p>Syphilis is a chronic inflammatory disease caused by the organism <em>Treponema pallidum (T. pallidum)</em>. Secondary syphilis is characterized by a rash that emerges around 3 to 6 weeks after the chancre forms, and may appear before the chancre heals in some cases. Other systemic symptoms may appear, indicating that the infection has migrated to other parts of the body. During the secondary stage, a person is extremely contagious. A 40-year-old man presented to our outpatient department with complaints of generalized weakness, headache, nausea, and arthralgia for the past few weeks. The patient had a history of having sex exclusively with men and had been in a monogamous relationship for the past 8 months. Physical examination revealed macular rash with scarred painless lesions over the glans penis and bilateral submandibular lymphadenopathy. Investigations revealed a positive reactive venereal disease research laboratory (VDRL) test. A fluorescent antibody test for <em>T. pallidum </em>showed positive for <em>T.pallidum</em> specific immunoglobulin G (IgG) antibody. HIV test was negative. For treatment, a single dose of 2.4 million units of Benzathine penicillin G was given intramuscularly and advised for follow-up. Patients with syphilis should have their sexual contacts assessed. Regardless of the results of serology testing, exposure within 90 days of a patient's diagnosis necessitates therapy.</p>Krishna Prasanth BaalannMahalakshmi Krishnan
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2023-12-192023-12-19421Repair of total penile skin loss after ritual circumcision using a scrotal flap: a case report
https://www.ajol.info/index.php/pamj/article/view/252977
<p>Ritual circumcision is associated with a high rate of complications, mainly if performed by an untrained practitioner. Furthermore, excessive skin removal is a rare complication of this procedure that results in penis "trapping" underneath the skin and future sexual dysfunction. Here, we presented a 45-day-old Yemeni newborn with a trapped penis due to total loss of penile skin during a ritual circumcision performed by a traditional untrained practitioner using the guillotine technique one month ago. The patient underwent surgical exploration, and the penis was deliberated, released, and the skin defect was repaired with a single-step scrotal flap advancement over the penile shaft. At the six-month follow-up, the outcome was both functional and cosmetically satisfying. In conclusion, we recommend that the circumcision procedure be performed at the very least by an educated and skilled health professional. Additionally, a scrotal advancement flap is still an option in significant penile skin loss cases.</p>Sultan QaidFaisal AhmedEbrahim Al-shamiQasem AlyhariSaif GhabishaMohammad Reza AskarpourZakaria Al-mekhlafyEssam Hadwan
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2023-12-192023-12-19421Giant retroperitoneal lymphangioma in a 70-year-old male: a case report
https://www.ajol.info/index.php/pamj/article/view/252985
<p>Lymphangiomas are relatively rare benign congenital tumors of the lymphatic system. They are usually discovered during childhood and typically occur in the neck and axillary regions. Retroperitoneal lymphangiomas are a rare occurrence and represent 1% of all cases. Here, we presented a 70-year-old male who presented with abdominal discomfort and chronic constipation in the last three years. A computerized tomography scan showed a giant abdominal hypodense cystic mass measuring 195 x 145 mm, which laminates the abdominal aorta, the left iliac vessels, and the left ureter. The patient underwent surgical exploration. Due to the giant cystic volume, it was carefully opened, aspirated, and removed. The histopathological examination showed a retroperitoneal lymphangioma. In conclusion, giant retroperitoneal lymphangioma in an adult is a rare occurrence. The primary treatment is complete surgical excision. Histopathological examination is essential for diagnosis confirmation.</p>Aymen MabroukFarouk EnnaceurYasser KarouiEya Ben NejmaLaila JedidiMounir Ben Moussa
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2023-12-192023-12-19421Radiofrequency ablation of varicose veins in combination with ultrasonic-assisted wound debridement and platelet-rich plasma as well as Platelet-rich fibrin technologies in treatment of lower extremity venous ulcers in office-based surgery
https://www.ajol.info/index.php/pamj/article/view/252984
<p><strong>Introduction: </strong>for the treatment of varicose ulcer performed clinical and laboratory reasoning of the use of ultrasonic-assisted venous ulcer debridement and platelet-rich plasma with radiofrequency ablation in an outpatient setting, was carried out. <strong>Methods: </strong>ultrasonic-assisted debridement of trophic ulcer were performed for 50 patients with lower extremity varicose veins at decompensation stage. The effectiveness of ultrasonic-assisted debridement was evaluated by indicators of bacteriological, morphological, cytological study and assessment of trophic ulcers according to the MEASURE system. After ultrasonic-assisted debridement, the patients were divided into two groups: 30 patients, who underwent combined platelet-rich plasma to stimulate wound regeneration and 20 patients, for whom the Granuflex hydrocolloid bandage was applied for the same purpose. <strong>Results: </strong>a comparative analysis of ulcer regeneration in two groups of patients proved that in cases of platelet rich plasma the time of transition from inflammatory-regenerative type to regenerative one is much shorter than when using a hydrocolloid dressing. In 28 patients undergoing platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), the radiofrequency ablation of the principal superficial and perforating veins was performed. Another 22 patients performed autodermoplasty of trophic ulcers after radiofrequency ablation. <strong>Conclusion: </strong>our experience has shown that in a one day inpatient surgical clinic such a multidisciplinary approach to treatment of venous ulcers, including ultrasonic-assisted debridement that is stimulation of wounded process by platelet-rich plasma with further surgeries to remove the causes of decompensated chronic insufficiency, is promising regarding low costs of treatment and rehabilitation of these patients.</p>Volodymyr GoshchynskyYrij SviderskyBogdan MigenkoOleg Pyatnychka
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2023-12-192023-12-19421Thoracic impalement injury by the barrel of a locally fabricated gun in 2 patients: case report
https://www.ajol.info/index.php/pamj/article/view/252986
<p>Thoracic impalement injuries are uncommon among civilians. When it occurs, it´s usually a severe and dramatic form of chest injury that requires immediate operative intervention. The common mechanisms usually encountered involves either a patient falling from a height onto a pole, being driven into a pole following ejection during a road traffic accident or being impaled when a spear/an arrow is thrown at the patient or from long fragments following a blast. Impalement by a retrograde ejected barrel of a gun during recoil is a very uncommon mechanism. We report 2 recently managed patients. The first patient presented with an overt impaling mass and an initially missed tension pneumothorax. The second patient had a covert impalement chest injury. Both patients had surgical interventions with satisfactory outcomes. Our report aims to highlight this unusual mechanism of thoracic impalement injury and the principles of management. We also want to emphasize the importance of adhering to the advanced trauma life support (ATLS) management algorithm, as immediately life-threatening conditions may be missed when exploratory thoracotomy is the only focus.</p>Ukwuani Solomon IfeanyiAbubakar Umar, Salisu IsmailAbdullahi Abdulkarim AitekIbrahim GaladimaIsah AbdullahiSulieman Kehinde AyubaRay Bayo
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2023-12-192023-12-19421Complete non-puerperal uterine inversion caused by uterine hemangioma: about a case report
https://www.ajol.info/index.php/pamj/article/view/252988
<p>Uterine inversion is a rare postpartum complication. It is a rare condition in which the internal surface of the uterus protrudes through the vagina. Non-puerperal uterine inversion (NPUI) is extremely rare. In most instances, it is linked to uterine tumors. Among these tumors, leiomyoma is the most frequent cause reported in data. This condition may not be noticed until time of surgery. Malignancy is suspected in most cases. Nevertheless, uterine inversion can be diagnosed preoperatively using radiology. Difficulties in diagnosing NPUI makes this clinical case a challenge in gynaecology and not commonly reported in literature. We report our experience in the diagnosis and treatment of a complete non-puerperal uterine inversion associated with uterine angioleiomyoma. The patient's age was 44, gravida 2 para 1 presented with intermittent vaginal bleeding for four months and an acute abdominal cramping pain. On examination, a large mass lesion was observed which occupies the vaginal cavity and the contour of the uterine cervix could not be reached. Biopsies and Immunohistochemistry matched with an angioleiomyoma. She underwent a transvaginal surgical reposition technique: Spinelli’s. It is important to diagnose accurate non-puerperal uterine inversion. Surgery provides good prognosis and it is necessary. We report a case of NPUI caused by angioleiomyoma. Nevertheless, malignancy must be eliminated in first place.</p>Skander AbidGhassen Ben DhaouGhada AbdelmoulaAhmed Ben SmidaMohamed Raouf Ben AbdesslemOns MradMouna DerouicheLatifa Lassoued
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2023-12-192023-12-19421Economic attributes and childhood stunting in Rwanda: case study of the City of Kigali
https://www.ajol.info/index.php/pamj/article/view/252989
<p><strong>Introduction: </strong>stunting in under five children is a great concern in low and middle-income countries including Rwanda. While over the past decades different developing countries have made remarkable efforts improving their economic growth, there is mixed evidence and lack of consensus on the impact of economic development on nutrition improvement. The objective of this study was to assess the relationship between economic attributes and childhood stunting in the City of Kigali. <strong>Methods: </strong>this was a retrospective cross-sectional and comparative study documenting the period 2010-2017. Stunting in under five children was analyzed in relation to the economic attributes which include the household consumption per capita, annual household income and level of poverty. The analysis was done at the level of district. Official reports from the National Institute of Statistics of Rwanda provided data on both economic attributes and stunting. <strong>Results: </strong>in some situations, the improvements in economic attributes such as increase in average household consumption per capita and increase in annual household income are followed by the reduction of stunting in under five children. However, in some other situations, the reduction of the level of poverty and the increase of annual household income was not translated into the reduction of stunting. <strong>Conclusion: </strong>improvements in some economic attributes do not necessarily translate into reduction of stunting in under five children. Further studies are needed to understand possible lead forces underlying this situation including establishing the proportion of household income spent on children´s nutrition as well as possible inequity and inequality in wealth distribution.</p>Manassé NzayirambahoAimable NsabimanaVincent ManirakizaPierre Claver RutayisireKato Njunwa
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2023-12-192023-12-19421Management of impacted maxillary central incisor and abnormality of labial frenulum in children: case report
https://www.ajol.info/index.php/pamj/article/view/252993
<p>Deposition of the maxillary permanent central incisor is a rare occurrence in dental practice. It is a difficult condition to treat due to its importance to facial esthetics. If complications are to be avoided, early detection of such teeth is important. The present case report of impacted maxillary central incisor encased within an abnormally thickened labial frenulum. A 9-year-old boy, came with his parents to the Pediatric Dentistry Specialist, Dental and Oral Hospital, Airlangga University (UNAIR) with a chief complaint that his left maxillary front teeth did not grow while his right front teeth had grown perfectly. From the anamnesis, the patient had experienced a falling trauma when he was young, which caused the deciduous tooth to fall out. Good general health, no history of allergies, and no medical history of case management. This is a fixed orthodontic treatment with surgical exposure of impacted teeth and frenectomy of labial frenulum. After the crown of the impacted incisor was surgically exposed, eruption ball chain was bonded to traction the incisor. The left maxillary incisor fully erupted and normally to percussion, mobility, and sensitivity testing with good attached gingiva in the next 9 months. Management abnormality of labial frenulum in this case with frenectomy by using electrocautery for minimalized trauma in children. Fixed orthodontic therapy was continued to achieve proper alignment leading to good esthetic and functional rehabilitation. The treatment of an unerupted tooth will depend on its state, position, and presence of enough space in the dental arch to accommodate.</p>Tiarisna Hidayatun NisaPrawati NurainiSindy Cornelia NelwanSeno PradopoSoegeng WahluyoBetadionUdijanto TedjosasongkoIlvana AdiwirastutiBarnabas Bonardo
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2023-12-192023-12-19421Multisystemic sarcoidosis revealed by a Heerfordt syndrome: case report
https://www.ajol.info/index.php/pamj/article/view/252994
<p>Heerfordt syndrome is a rare clinical form of sarcoidosis with a favorable evolutionary profile in the majority of cases. In its classical form, it associates uveitis, parotidomegaly, facial paralysis and fever. We report a case of multisystemic sarcoidosis type II revealed by a Heerfordt syndrome in a 51-year-old female patient.</p>Glad Smart Moussounda MpikaPaulvon Phérol KoumekaLamyae Amro
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2023-12-192023-12-19421Evaluation of venous thromboembolism (VTE) risk assessment and thrombo-prophylaxis practices in hospitalized medical and surgical patients at Aga Khan Hospital Dar es Salaam: single-centre retrospective study
https://www.ajol.info/index.php/pamj/article/view/252995
<p><strong>Introduction:</strong> venous thromboembolism is a complication among admitted medical and surgical patients. International guidelines recommend patients are assessed upon admission and appropriate thromboprophylaxis should be initiated. However, studies have shown that thromboprophylaxis for patients at risk of venous thromboembolism is underutilized.</p> <p class="ParagraphSeparator"> </p> <p><strong>Methods:</strong> this was a retrospective study conducted on hospitalized medical and surgical patients at Aga Khan Hospital Dar es salaam from January to June 2019. Patient´s medical records were reviewed and data was collected for analysis of venous thromboembolism assessment and compliance with Caprini risk assessment model. The data was entered into statistical package for the social sciences (SPSS) 25 and categorized into risk groups, frequency of patients' demographic and clinical characteristics data was calculated and the main study outcomes were analyzed with Fisher´s exact test or Pearson chi-square test for categorical variables and student t-test for continuous variables. Regression analyses were done to identify significant risk factors where by P ≤ 0.05 was considered statistically significant. <strong>Results:</strong> compliance of venous thromboembolism assessment among medical and surgical patients was similar at 78% and 80%, respectively, with a baseline 22% of all admitted patients considered at risk of venous thromboembolism, hence needing thromboprophylaxis following the Caprini risk assessment modelscore. Thromboprophylaxis practices was identified at just 25% of at-risk individuals received pharmacological prophylaxis with enoxaparin; the most commonly used agent (92%). Identified risk factors for venous thromboembolism were advancing age (>60 years), history of prior major surgery, Major surgery lasting > 60 minutes, obesity, and immobilization. <strong>Conclusion: </strong>risk assessment for venous thromboembolism should be emphasized upon admission of both surgical and medical patients. Adequate thromboprophylaxis should be prescribed upon identification of patients at risk.</p>Allyzain IsmaiNikhil JadawjiPhilip AdebayoAhmed JusabaniKamran HameedAli Akbar ZehriWilly KiviriAthar Ali
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2023-12-192023-12-19421Not all the bowlegs are rickets! (a case report)
https://www.ajol.info/index.php/pamj/article/view/252997
<p>Bowing of the legs is common in childhood. Most times it is considered to be rickets without considering other possibilities. Blount´s disease is a close differential diagnosis which is developmental deformity characterized by intorsion of tibia leading to varus angulation. This case report aims to encourage pediatricians to expand their vision and consider other possibilities when a case of bowing of legs is encountered. Here we report a case of a four-year-old boy with bowing of both legs noticed first at 2.5 years of age. There was no history suggestive of trauma. Development of the child was age appropriate in all domains. He was receiving treatment for rickets for 1.5 years in form of oral vitamin D3 and calcium supplementations. He had no other clinical signs of rickets like frontal bossing, widening of wrists, and rachitic rosary except bowing of legs. His biochemical parameters did not show any alterations that would support the diagnosis of rickets. Weight-bearing radiographs of lower limbs showed medial intorsion of bilateral tibia with metaphyseo-diaphysial angle to be 25º on the right side and 20º on the left side, which was beyond the physiological normal angulation, therefore he was diagnosed as a case of Blount´s disease, stage III as per Langenskiöld classification. All the bowlegs are not always rickets in pediatric practice. Therefore, various differential diagnoses should be kept in mind as early diagnosis and intervention can change a child´s life.</p>Keta VaghaPatel Zeeshan JameelJayant VaghaAshish VarmaSiddhartha MurhekarParameshwar ReddySpandana Madirala
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2023-12-192023-12-19421A rare case of palatal perforation due to tertiary syphilis
https://www.ajol.info/index.php/pamj/article/view/252999
<p>Syphilis is a chronic inflammatory disease which is caused by the spirochete <em>Treponema pallidum</em> and is often sexually transmitted. Around 15% to 30% of people infected with syphilis who don´t get treated will develop complications known as tertiary syphilis. Later stages of the disease may cause damage to brain, nerves, bones and joints. These problems may occur several years after the primary untreated infection. A 56-year-old male patient came with complaints of purulent discharge from nose and nasal regurgitation of food for the past 6 months. On examination a 4x3 cm circular perforation was noted on the mid palate. Blood investigations revealed a positive reactive Venereal Disease Research Laboratory (VDRL) test. Dark field microscopy was done which revealed characteristic cork-screw shaped <em>Treponema pallidum</em> organisms, that confirmed the diagnosis of syphilis. The patient was advised palatal obturator and antibiotics, but the patient did not follow up owing to financial reasons. Palatal perforation secondary to syphilis is uncommon with recent advances in antibiotic therapy.</p>Surya Besant NatarajanKrishna Prasanth Balaann
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2023-12-192023-12-19421Incidence of patients leaving against medical advice in government-subsidized hospitals: a descriptive retrospective study
https://www.ajol.info/index.php/pamj/article/view/253001
<p><strong>Introduction: </strong>this study aimed to determine the prevalence of Leaving Against Medical Advice (LAMA) in the local context and the associated predictors to help develop effective strategies to reduce its likelihood. <strong>Methods: </strong>this study employed a retrospective approach using medical records of the 16233 patients between 2016 and 2020 at various government-subsidized hospitals in the Hail region of Saudi Arabia. <strong>Results: </strong>the prevalence of LAMA was the highest in 2019 (91.9%) and 2017 (21.45%) among insured and non-insured patients, respectively. Furthermore, it was the highest among patients aged 20-25 years and the lowest among patients aged 46 years and above. The incidence of LAMA was the highest (15.48% for males and 29.53% for females) in 2016. In 2016-2019, the most common reason for LAMA was "wanted medication only," while in 2020, the "fear of infection with COVID-19" was the main reason. High blood sugar was the most common diagnosis among the patients under consideration during the study period. Significant association was found between LAMA and patient's insurance status (t = 4.3123; p < 0.002); however, no association was found between LAMA and age (t = -0.8748; p > 0.658) and gender of patients (t = 1.9008; p > 0.302). <strong>Conclusion: </strong>strategies such as developing a suitable environment for patients and taking due care of their needs, providing individual consulting services, enhancing staff relations, and providing support to patients in need are vital. The likelihood of LAMA can be minimized by informing hospitalized patients and their relatives about the adverse effects of LAMA.</p>Eddieson Astodello Pasay-anRomeo Patague MostoleSandro Costanilla VillarealReynita Biong Saguban
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2023-12-192023-12-19421COVID-19 vaccinations in The Gambia: efforts, challenges, and future directions
https://www.ajol.info/index.php/pamj/article/view/253002
<p>On March 11, 2020, the novel coronavirus disease (COVID-19) was declared a pandemic. Since the declaration, countries have implemented response measures to stop the spread of the virus, while multiple vaccines combatting the virus have also been developed. However, vaccine rollout and providing vaccine access has been very challenging in many African countries, including The Gambia. This article briefly assesses the efforts and challenges facing The Gambia´s COVID-19 vaccine rollout and implementation. The article also provides recommendations that policymakers and program implementers can use to address the low COVID-19 vaccination rate in The Gambia. It is based on a narrative review of existing literature on COVID-19 vaccination efforts and challenges in The Gambia.</p>Mat LoweNicolas EdgarDon Eliseo Lucero-Prisno
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2023-12-192023-12-19421A well-hidden esophageal foreign body in an 11-year-old boy treated for gastroesophageal reflux disease: a case report
https://www.ajol.info/index.php/pamj/article/view/253004
<p>Symptoms of gastroesophageal reflux disease (GERD) in children with developmental disorders could be often confusing. Especially when considering accidental foreign body ingestion, with no acute signs or symptoms of choking. We hereby present a case of an 11-year-old male with a well-hidden esophageal foreign body who was already treated for GERD and finally diagnosed with a hidden foreign esophageal object, ingested 12 months ago. Ingestion of objects of any kind, especially in certain groups of children, must always raise high suspicion for the clinical pediatric specialties, regardless of the presence or absence of classic symptoms.</p>Dimitrios GodosisMaria FotoulakiChrysostomos KepertisIoannis Spyridakis
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2023-12-192023-12-19421Hemiarhinia: a rare presentation of the unilateral absence of nasal structure
https://www.ajol.info/index.php/pamj/article/view/253005
<p>Hemiarhinia is a rare congenital malformation of unknown aetiology, unilateral nasal aplasia that includes the absence of an external nose and internal nasal cavity. Around 75 cases have been reported to date. Here we presented a case of 2 years child who comes to the outpatient department with complaints of nose deformity since birth. There were no associated symptoms with the deformity. There were no associated anomalies. The child was mentally normal, and their growth was within normal limits.</p>Divya RamamoorthySachin Damke
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2023-12-192023-12-19421Aetiology, antimicrobial susceptibility and outcome of children with sepsis, admitted at Muhimbili National Hospital, Dar es Salaam
https://www.ajol.info/index.php/pamj/article/view/253006
<p><strong>Introduction: </strong>sepsis is defined as a systemic inflammatory host response syndrome (SIRS) to infection, commonly bacterial. The global prevalence of sepsis is 8.2% with a mortality rate of 25%, whilst in Tanzania the prevalence is 6.6%. Treatment of sepsis involves early initiation of antibiotics based on local sensitivity patterns. However, there is an increase in antimicrobial resistance to commonly used antibiotics. Hence to promote rational use of antibiotics, we aimed at establishing the etiology, local susceptibility patterns and outcome of children with sepsis aged 2 months to 15 years, admitted at Muhimbili National Hospital (MNH), Dar es Salaam. <strong>Methods: </strong>a hospital based prospective cross sectional study was conducted among 245 participants who were consecutively recruited. A standardized structured questionnaire was used to collect information. Blood cultures and complete blood counts were done. Antimicrobial susceptibility was also done on positive cultures using disc diffusion method. Data were analyzed using SPSS version 20. Frequencies and proportions were used to summarize categorical data, whilst median and interquartile range was used to summarize continuous data. Student T test was used to compare means of data which were normally distributed and the differences in proportions were tested using Chi square test or Fisher’s exact test. A p value of = 0.05 was considered to be statistically significant. <strong>Results: </strong>there was predominance of male participants (67.5%) with a median age was 2 years and an interquartile range (IQR) 10 months to 4 years. Culture positive sepsis was detected among 29.8% of the participants, and the common Gram-positive bacterial isolates were <em>S.aureus</em> (39.7%) Coagulase Negative Staphylococcus (<span class="ArticleParagraph"><em>CoNS</em></span>) (35.6%) and Gram-negative isolates were <em>E.coli</em> (12.3%), <em>Klebsiella spp</em> (6.8%) and <em>Pseudomonas aeruginosa</em> (5.5%). All bacteria showed a high resistance to ampicillin (80%- 100%) followed by ceftriaxone (40 - 70%). All <em>Pseudomonas aeruginosa</em> were 100% resistant to ampicillin, gentamycin and ceftriaxone but were sensitive to amikacin. There was less than 40% resistance to co-amoxiclav, meropenem, ciprofloxacin, amikacin, and clindamycin. The overall case mortality rate from sepsis was 9.4%. Among children discharged 59.3% had prolonged hospital stay of more than 7 days. Age group 1 to 5years, prior use of antibiotics, tachycardia, and leukocytosis were significantly associated with high mortality. <strong>Conclusion: </strong>bacterial sepsis is prevalent at Muhimbili National Hospital contributing to 9.4% of mortality and a prolonged hospital stay of more than 7 days among 59.3% of the participants. Gram-positive bacteria were found to be predominant cause of sepsis, whereas both Gram-positive and Gram-negative bacteria had a high resistance to first and second line antimicrobials including: ampicillin, gentamycin, and ceftriaxone.</p>Evance GodfreyEdna MajaliwaEvelyne Neema Assenga
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2023-12-192023-12-19421De Winter T waves: an ominous sign of ST-elevation myocardial infarction
https://www.ajol.info/index.php/pamj/article/view/253007
<p>A 46-year-old gentleman presented with sudden retrosternal gripping pain. Creatinine Kinase was >6000 units/L. Patient was diagnosed as Non-ST Elevation Myocardial Infarction (NSTEMI). The presenting electrocardiogram (ECG) was shared with us (A). Our response was, “This is not a NSTEMI. ECG manifests de Winter T Waves. The de Winter complex is an upsloping J-point ST depression (STD) that continues into a tall, positive symmetrical T Wave. Do not be misled by the STD. This is a STEMI without the signature ST-segment elevation (STE). De Winter T Waves is a STEMI equivalent; it signifies acute occlusion of the proximal left anterior descending artery (LADA).” de Winter T Waves was first reported by in 2008. Unfortunately, knowledge of de Winter T Waves is not widespread and it is often misdiagnosed as NSTEMI. Failure to carry out emergent reperfusion will negatively impact morbidity and mortality. ECG in (A) manifests the following features which points to de Winter T Waves: (1) de Winter T Waves occur in a pain state; (2) ST segment showed a 1-3 mm upsloping STD at the J point in precordial leads; this is best exemplified by V4; (3) upsloping STD continues into tall, positive symmetrical T Waves; (2) and (3) are seen in (C) part of image; (4) ST segment elevation (STE) in aVR, V1; (5) loss of anterior R waves (V1 to V4) and (6) reciprocal STD seen in leads II, III, aVF. De Winter T Waves is a unique ECG sign. Do not be deceived by the STDs into diagnosing NSTEMI. It is a STEMI pointing to acute occlusion of the LAD.</p>Sze Shian WeeKian Seng Ng
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2023-12-192023-12-19421Effect of in-hospital training in newborn resuscitation on the competence of health-care workers in resuscitating newborn infants at birth at Mboppi Baptist Hospital, Douala, Cameroon
https://www.ajol.info/index.php/pamj/article/view/253008
<p><strong>Introduction: </strong>neonatal mortality accounts for the most significant proportion of under-five mortality worldwide, as in Cameroon. Birth asphyxia is the leading cause of neonatal deaths in Cameroon. Training of health care workers (HCWs) in newborn resuscitation reduces neonatal morbidity and mortality. In this study, we evaluated the effect of in-hospital training on the competence (knowledge and skills) of HCWs in newborn resuscitation at Mboppi Baptist Hospital, Douala, Cameroon. <strong>Methods: </strong>this was a quasi-experimental study done in five weeks, in which we compared knowledge and skills before and after training. Assessment of knowledge and skills of HCWs in newborn resuscitation was done before training (simulations) and a week after training using World Health Organization (WHO) adapted Emergency Triage Assessment and Treatment (ETAT+) standard tool. Three key informant interviews (KIIs) and a focused group discussion (FGD) were held to determine barriers to effective newborn resuscitation. Data were analyzed using R software version 3.6.2. McNemar test and Cohen´s Kappa were used to analyze quantitative data, while major themes from KIIs and FGDs were selected for qualitative data. <strong>Results: </strong>we enrolled 30 HCWs, each HCW was observed twice, a total of 60 deliveries observed before and 60 after training. Sixteen HCWs (53%) showed adequate knowledge before and after training. Median scores for skills significantly increased by 28% (p<0.00054) for real-life observations and 26% (p=0.0004) for newborn resuscitation scenario simulations. The main barriers to adequate newborn resuscitation were inadequate knowledge, equipment, shortage of trained staff and poor teamwork between midwives and anesthetists. <strong>Conclusion: </strong>in-hospital training on newborn resuscitation improved the skills of HCWs but had no significant effect on their knowledge on newborn resuscitation. We would recommend that in-hospital training in newborn resuscitation be done often for HCWs.</p>Hildegarde NvonakoEdnah OjeeMoses MasikaArsène SandieDalton WamalwaAggrey Wasunna
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2023-12-192023-12-19421Supravalvular aortic stenosis in a case of Williams syndrome
https://www.ajol.info/index.php/pamj/article/view/253011
<p>Williams syndrome (also known as Williams-Beuren syndrome) is a autosomal dominant disorder associated with deletion of multiple genes on the long arm of chromosome 7. It affects one in every 25000 live births and is associated with elfin facies, cardiac abnormalities like supra valvular aortic stenosis and mental impairment. Williams syndrome is diagnosed in about sixty percent patients of supravalvular aortic stenosis. This patient presented to us with the characteristic ‘elfin facies´ which is shown in the image as having a large mouth, widely spaced eyes, maloccluded teeth, patulous lips broad forehead with a short and upturned nose. Supravalvular aortic stenosis (SVAS) involves a narrowing of the ascending aorta above the level of coronary arteries. Narrowing of the peripheral pulmonary arteries is also present in SVAS with Williams syndrome but it does not progress over time. Clinical findings on examination showed an ejection systolic murmur with no associated ejection click. There was a disparity in the blood pressure between both upper limbs, the right arm systolic blood pressure exceeded that of the left arm by 24 mmHg. The chromosomal defect results in deficiency in elastin. This also results in lax skin and stiff joints with a hoarse voice. Supravalvular AS eventually requires valve replacement when the patient becomes symptomatic.</p>Yash GupteSourya Acharya
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2023-12-192023-12-19421A typical case of neurofibromatosis
https://www.ajol.info/index.php/pamj/article/view/253012
<p>Neurofibromatosis type 1, also known as Recklinghausan´s disease, is an autosomal dominant disorder. The mutation causes large number of nodules all over the body. A patient of 42 years old age came to the Outpatient Department (OPD) of Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H), Wardha, Nagpur, Maharashtra, India with tingling and numbness over palm and foot. The patient has taken lots of medicine for the neurofibromas, but the medicinal trials were gone in vain. So he abandonned the therapeutics for the neurofibromas. He said that he had these lumps from the age of 8 years. Neurofibromatosis with numerous flesh coloured neurofibromas on chest and abdomen (A). Neurofibromatosis with numerous flesh coloured neurofibromas on back (B). Neurofibromatosis with numerous flesh coloured neurofibromas on the anterior aspect of forearms (C). Neurofibromatosis with numerous flesh coloured neurofibromas on the posterior aspect of forearms (D).</p>Mayuri Amol DeshpandeAmol Madhav Deshpande
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2023-12-192023-12-19421Etude rétrospective sur 70 cas d´hystérectomie d´hémostase dans le département de gynécologie obstétrique de l´Hôpital de Ben Arous, Tunisie
https://www.ajol.info/index.php/pamj/article/view/253677
<p><strong>Introduction: </strong>l´hystérectomie d´hémostase constitue le traitement radical de l´hémorragie du postpartum. Notre objectif était d´étudier les facteurs de risque, les indications et les complications de l´hystérectomie d´hémostase et de déterminer les facteurs influençant le choix du type d´hystérectomie.<strong>Méthodes: </strong>nous avons mené une étude rétrospective monocentrique descriptive et analytique dans le service de gynécologie obstétrique de l´hôpital régional de Ben Arous de 2003 jusqu´à 2019. Les patientes ont été classées selon le type d´hystérectomie totale ou subtotale.<strong>Résultats: </strong>soixante-dix patientes ont été incluses. Le taux d´hystérectomie d´hémostase était de 1,3 ‰. L´âge moyen était de 34,5 ans (± 5,1). Les indications d´hystérectomie d´hémostase étaient dominées par le placenta accréta dans 39% des cas (n=27), l´inertie utérine dans 34% (n=24) et la rupture utérine dans 16% des cas (n=11). Le taux de morbidité peropératoire était de 34% (n=24). Les complications les plus fréquentes étaient l´état de choc hémorragique dans 17% (n=12), la coagulation intravasculaire disséminée dans 6% (n=4) et les lésions vésicales dans 6% (n=4). Nous avons déploré six cas de décès maternel soit 8% (n=6). Une hystérectomie subtotale était réalisée chez 79% patientes (n=55) et 21% des femmes (n=15) ont eu une hystérectomie totale. Le placenta accréta était associé de manière significative au groupe hystérectomie totale (ORa: 6,93, IC 95%: 1,07-44,80, p=0,042) et la durée moyenne de l´opération était significativement plus courte en cas d´hystérectomie subtotale (ORa: 1,023, IC 95%: 1,009-1,03, p=0,01). <strong>Conclusion: </strong>l´hystérectomie est indispensable précisément dans certains cas d´hémorragie sévère du post partum. Le placenta accréta représente la principale indication d´hystérectomie. L´hystérectomie totale n´est pas associée à un risque accru de complications par rapport à l´hystérectomie subtotale.</p>Idriss AbidHajer BettaiebNesrine SouayehWael MbarkiMohamed FrikhaRahma BouhmidaHedhili OueslatiNajeh HsayaouChaouki Mbarki
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2023-12-192023-12-19421COVID-19 and Burkholderia cepacia co-infection in pregnancy associated with fetal demise: a case report
https://www.ajol.info/index.php/pamj/article/view/253679
<p>Since the global pandemic of the 2019 coronavirus disease (COVID-19), few studies have reported on the relevance of bacteria co-infection on outcome of COVID-19 patients. Little is known about the clinical presentation among pregnant women, mother-to-child transmission, and fetal outcomes. This report shows a 24-year-old nulliparous woman who was 32 weeks pregnant and was admitted to the University Hospital, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi Ghana with symptoms of fever (40.3°C), cough and breathlessness of two weeks duration. Her nasopharyngeal sample tested positive for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and blood culture isolated <em>Burkholderia cepacia</em>. She was given medications but went into pre-term labour and delivered a stillborn baby. This rare case of COVID-19 and <em>Burkholderia cepacia</em> co-infection emphasizes the need for a thorough assessment and appropriate treatment of patients presenting with fever and respiratory symptoms in order to mitigate poor outcome.</p>Brenda Abena AmpahNana Kwame Ayisi-BoatengAugustina Angelina SylverkenJaphet SenyoBetty Nkansah Osei MensahGodfred AcheampongMichael Owusu
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2023-12-192023-12-19421Users' perspectives on the quality of family planning services in Mozambique: a case study
https://www.ajol.info/index.php/pamj/article/view/253683
<p><strong>Introduction:</strong> users'satisfaction assessment has been increasingly important in ensuring health care quality and guidance in the health sector. Africa is the region in the world with the lowest prevalence of contraception use. Universal access to family planning has one of the highest rates of benefits for cost among strategic options for development. Family planning can reduce mortality associated with pregnancy, childbirth, and postpartum, and family planning consultations are available in primary health care in Mozambique since 1980, with services delivered at all different levels of the national public health system. In 2017 this country had a high maternal mortality rate and one of the known causes was the low use of family planning. Among other causes for low utilization is the bias introduced by health professionals in the prescription of contraceptives and service deficiencies. We intended to assess the users' opinion about family planning visit quality at the Marrere Health Center, to understand how we might consequently increase the use and quality of these services. This study was designed as a planned intermediary evaluation, as part of a larger implementation research project, aiming to reduce maternal and newborn mortality rates in Natikiri neighbourhood, in Nampula peri-urban area.<strong>Methods:</strong> we carried out a descriptive cross- sectional quantitative case study, where the target population was users' of family planning services at a local health center. A random sample of 137 individuals answered a survey consisting of satisfaction, and we consulted family planning service statistical indicators. users' were considered satisfied if they answered “satisfied” or “very satisfied” on questions. Frequencies were calculated with statistical package for the social sciences (SPSS) 22.0 with a confidence interval of 95% and a 5% margin of error. The study protocol was approved by Lúrio University and the University of Saskatchewan (Canada) Ethics Committees. <strong>Results:</strong> almost all respondents (93%), were adult women with low levels of education. They stated, in general (88%), they were satisfied with the quality of care in the family planning consultation. There was minor participation of men in family planning. However, health professionals were found to not generally follow a patient-centered service protocol, with weaknesses in communication and information sharing, more commonly with adolescent clients. <strong>Conclusion:</strong> most family planning visits users' were adult women, satisfied with the service provided. Successful changes in family planning practice require broad support from political, religious and community sectors. Additionally, proper technical and professional training of health professionals is necessary to achieve a positive impact on individuals, families, communities, and government. Family planning promotion in primary health care is recommended as an important strategy for achieving universal health coverage, protecting the lives of women, and promoting the country's development.</p>Paulo PiresMartins MupuelequeCynthia MacaringueDavid ZakusRonald SiemensCelso Belo
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2023-12-192023-12-19421Retrait endoscopique d'un dispositif intra-utérin perforant le côlon sigmoïde: à propos d´un cas
https://www.ajol.info/index.php/pamj/article/view/253685
<p>Le dispositif intra-utérin (DIU) reste le pilier principal des mesures de planification familiale dans les pays en développement, néanmoins il est associé à des complications graves telles que les saignements, les perforations et les migrations vers des organes adjacents. Bien que la perforation de l'utérus par un DIU ne soit pas rare, la migration vers le côlon sigmoïde est exceptionnelle. Nous rapportons ici un cas de migration d'un stérilet vers le côlon sigmoïde qui a été retiré par voie endoscopique basse. Il s´agit d´une femme de 45 ans, porteuse d'un stérilet, se présente 6 ans plus tard, avec des douleurs pelviennes à type de pesanteur. L´examen clinique était sans anomalies et l´exploration scannographique avait objectivé le DIU qui était incrusté dans la paroi du colon sigmoïde. Une laparoscopie à visée diagnostique et thérapeutique a été réalisée; elle avait objectivé une perforation intestinale par le dispositif, qui était partiellement incrusté dans le côlon sigmoïde, mais elle avait échoué de l´extraire. Le dispositif avait été retiré lors d´une coloscopie par une anse diathermique (15mm de diamètre).</p>Cyrine MakniSalma SouissiAhmed SaidanAnis BelhajOlfa BousninaImen RideneFaouzi ChebbiLamia Kallel
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2023-12-192023-12-19421Unusual case of parietal metastasis from papillary thyroid carcinoma: a case report
https://www.ajol.info/index.php/pamj/article/view/253688
<p>Parietal metastasis is a very rare secondary location of papillary thyroid carcinoma. It associated with poor prognosis. We report a case of a 61-year-old woman with parietal metastasis from papillary thyroid carcinoma. The patient presented a parietal nodule on the back. In her past history, she had been diagnosed papillary thyroid carcinoma after total thyroidectomy and also reoperated for local recurrence. The CT scan performed has revealed metastasis to the lungs, bones, lymph nodes and adrenal glands. The parietal nodule was excised and submitted for histopathological examination. The histologic and immunohistochemical findings confirmed the thyroid origin. Although papillary thyroid carcinoma is a relatively indolent tumour, it can exhibit an unusual metastatic behaviour.</p>Evrard NiyonkuruZineb SamiFadwa BouyalikSamira BenayadMohamed El KarroumiMehdi Karkouri
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2023-12-192023-12-19421Giant asymptomatic left renal oncocytoma in a 40-year-old man: a case report
https://www.ajol.info/index.php/pamj/article/view/253691
<p>Renal oncocytoma is a benign tumor that arises from epithelial cells of the distal renal tubules. It is naturally presented with a small-sized mass, and giant oncocytoma is uncommon. Renal oncocytoma is frequently asymptomatic and challenging to distinguish preoperatively from renal cell carcinoma (RCC). We present a 40-year-old man who presented with intermittent abdominal pain in the last two years. Abdominal computed tomography (CT) scan showed a large, heterogenous left renal mass measured 15 x 16 x 19.5 cm and associated with central calcifications suspected of RCC. The patient underwent a left radical nephrectomy without complication. The histopathological study revealed typical oncocytoma features. There was no detected recurrence or distant metastasis on six months follow-up. In conclusion, it is challenging to distinguish renal oncocytoma from RCC via preoperative radiology images, especially when a giant mass is present. The only histopathology examination of the removed specimen can provide a definitive diagnosis.</p>Sultan QaidRadman GhalebFaisal AhmedEbrahim Al-shamiQasem AlyhariSaleh Al-wageehMohammad Reza Askarpour
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2023-12-192023-12-19421A post-lockdown online cross-sectional survey on knowledge, attitude and anxiety levels of Nigerian youths towards COVID-19 disease
https://www.ajol.info/index.php/pamj/article/view/253695
<p><strong>Introduction:</strong> COVID-19, also known as Coronavirus disease, was detected in Wuhan, Hubei, China in December 2019. Since then, the virus has been designated a global pandemic, affecting all nations. Nigeria as a whole has recorded 255,937 cases of COVID-19. Studies on COVID-19 anxiety level, knowledge, and attitude have not been focused on youths after the lockdown. This research explored COVID-19-related knowledge, attitudes, and anxiety levels among Nigerian youths after the lifted pandemic lockdown. <strong>Methods:</strong> after the COVID-19 pandemic lockdown, an online descriptive cross-sectional survey was performed among 818 young people aged 18 to 35 in South-Eastern Nigeria. The Statistical Package for Social Science (SPSS) version 25 technique was used to analyze the descriptive statistics. The Chi-square test, bivariate, and multivariate binary logistic regression were used to measure the associations. A p-value of 0.05 was statistically significant at a 95% confidence level. <strong>Results:</strong> the majority of respondents 723 (88.39%) demonstrate a high degree of COVID-19 knowledge. Just a few respondents (0.49%) expressed a negative understanding of the virus. 556 (67.97%) had a positive attitude towards the virus. More than half of the respondents had a low anxiety level, 471 (57.58%) and 108 (13.20%) had a high level. Educational level, place of residence, and family income showed a statistically significant relationship with their anxiety levels (p = 0.001, 0.002, 0.01, respectively). <strong>Conclusion:</strong> the infection, transmission, and symptoms of COVID-19 were well-understood by young people after the pandemic, who also displayed optimistic attitudes and low levels of fear. Higher levels of education, family income, and dwelling location were connected with COVID-19 knowledge and lower anxiety levels. This knowledge will assist health professionals in fighting current and future related outbreaks.</p>Batholomew Chibuike JamesChinazaekpere Mary ArohStephen Sunday EdeFelix Emeka AnyiamMichael Ikechuwu UhuoKanokwan ChullapantEsthinsheen OsirimMathias Nwojiji
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2023-12-192023-12-19421COVID-19 vaccine hesitancy in six geopolitical zones in Nigeria: a cross-sectional survey
https://www.ajol.info/index.php/pamj/article/view/253905
<p><strong>Introduction: </strong>the high expectations that heralded the development of COVID-19 vaccines has been plagued with vaccine hesitancy (VH). The prevalence and associated factors of COVID-19 VH in the six geopolitical zones in Nigeria are explored. <strong>Methods: </strong>using a cross-sectional survey, a pre-tested and validated questionnaire on a “Google form” was distributed via social media platforms and hard copies in the six geopolitical zones of Nigeria. Included, using a chain-reference sampling technique, were healthcare workers (HCW), university students and adults in the general population. Participants who expressed unwillingness to receive COVID-19 vaccine in the event of an available vaccine were considered to have vaccine hesitancy. Frequency and percentage were used to describe categorical variables. Multivariable logistic regression analysis was used to assess for factors associated with VH. Level of significance was set at 5% on two-sided tails test. <strong>Results: </strong>among 1615 respondents, mean (standard deviation) age was 36.7 (11.3) years, and 847 (52.4%) were males. More than half were healthcare workers (943; 58.4%), 97.4% had at least secondary level of education, and majority 60.5% belonged to the upper social class. The prevalence of VH was 68.5% (1107/1615), and 67.2% preferred foreign manufactured COVID-19 vaccines. On multivariable regression analysis, residence in Northeast (AOR 6.01, 95% CI 2.24, 16.10) and Northwest (AOR 3.33, 95% CI 1, 48, 7.48) geopolitical zones, the Igbo ethnic group (AOR 1.88, 95% 1.10, 3.22), Christians (AOR 1.86, 95% 1.10, 3.14), nurses (AOR 3.50, 95% CI 1.25, 9.80), pharmacist (AOR 5.82, 95% CI 2.12, 16.32) and participants without confidence in foreign vaccines (AOR 4.13, 95% CI 2.99, 5.72) were at higher likelihood of VH. <strong>Conclusion: </strong>vaccine hesitancy is high among adults in Nigeria, with higher likelihood among the Igbo ethnic group, Christian faith, residence in Northeast and Northwest geopolitical zones and those with an aversion to foreign-made vaccines. Targeted interventions are required for the desired COVID-19 vaccine uptake rate and herd immunity.</p>Babatunde Oluwatosin OgunbosiMichael Abel AlaoOlayinka Rasheed IbrahimAdaeze Chikaodinaka AyukRasheedat Mobolaji IbraheemDavid Chibuike IkwukaPatricia AkintanOreOluwa MorakinyoAyomide Toluwanimi AdeyemiRidwan Muhammad JegaTemitayo Folorunso OlowookereOlaseinde Emmanuel BelloBilkis Iyabo OwolabiAbejegah ChukwuyemLawan Maryah BukarAliu RasakiAmudalat IssaAtana Uket EwaRegina OladokunOlusegun Olusina Akinyinka
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2023-12-192023-12-19421Role of plasma homocysteine levels and other associated factors with coronary artery disease among Palestinian patients in North Palestine: a case control study
https://www.ajol.info/index.php/pamj/article/view/253922
<p><strong>Introduction:</strong> coronary artery disease (CAD) is one of the leading causes of death worldwide, only two thirds of cases can be explained by CAD´s classical risk factors. There is an increase in attention to homocysteine as a causal of CAD. In Palestine, CAD is more common than that in regional surrounding areas. Coronary artery disease is considered the leading cause of death in the West Bank, according to Palestinian Ministry of health annual reports. The study was conducted to determine the level of homocysteine in individuals with no history of CAD and to determine the relationship between CAD and total homocysteine levels and classical risk factors of CAD. <strong>Methods:</strong> our study is a hospital-based case-control study. A sample size of 84 cases and 81 controls were included in the study. <strong>Results:</strong> there is a statistically significant increase in plasma total homocysteine level in cases compared to controls (P=0.04) with Odds ratio= 2. There is also a statistically significant association between plasma total homocysteine levels and age of 50 years and above and male gender among both study groups (P= 0.002 and 0.007, respectively). The study showed no significant association between plasma total homocysteine level and the CAD´s classical risk factors among the case group measured in the study, which are diabetes mellitus, hypertension, and smoking (P=0.5, 0.1, and 0.5, respectively). <strong>Conclusion:</strong> there is a significant difference in homocysteine levels between case and control groups. Coronary artery disease patients have double homocysteine levels compared to those healthy individuals with OR= 2. Healthy Palestinian individuals have a homocysteine level that is lower than that of regional communities. Homocysteine levels increase with advanced age and male gender. There is no significant relation between hyperhomocysteinemia and diabetes mellitus, hypertension, and smoking.</p>Issa AlawnehAbulkareem SaymehMuath DaraghmehDima JabriLiana Yaseen
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2023-12-192023-12-19421Awareness, perceived efficacy, and utilization of assisted reproductive technologies among women attending fertility clinic in a Nigerian tertiary health institution: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/253928
<p><strong>Introduction: </strong>infertility is a source of distress for couples considering the high accolade placed on having children in family settings in Nigeria. Assisted reproductive technologies (ARTs) offer a chance for parenthood to couples. However, studies on knowledge of ARTs abound in Nigeria but no previous studies exist on the extent of utilization of assisted reproductive technologies. This study thus explored the level of awareness, perceived efficacy, and utilization of ARTs among women attending fertility Clinics in a Nigerian Tertiary Health Institution. <strong>Methods: </strong>this cross-sectional study which utilized a self-administered questionnaire was adopted for this study. The questionnaire contains five sections with sections A to E bordering on demographics, awareness, perceived efficacy, utilization, and factors influencing utilization respectively. <strong>Results: </strong>one hundred and seven women with infertility problems, aged between 26 and 35 years with a mean age of 31.46 ±5.72 participated in the study. Sixty-two patients (57.9%) were aware of ARTs while 97 (90.7%) believed that ART cannot address male infertility. Only 27 (25.2%) admitted to having used ART procedures before while 82 patients (76.6%) stated that the cost of the procedure was the major hindrance to use. <strong>Conclusion: </strong>awareness of ARTs is average while there is low utilization and perceived efficacy of ART. The high cost of the procedure remains the major setback to its utilization.</p>Paulina Chigwara ChikemeChikaodili Ndidiamaka Ihudiebube-SplendorLilian Bekuochi Arinze
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2023-12-192023-12-19421A household-based survey of the morbidity profile of under-five children in Port Harcourt Metropolis, Southern Nigeria
https://www.ajol.info/index.php/pamj/article/view/253999
<p><strong>Introduction: </strong>the commonest causes of childhood morbidity and deaths are avoidable and curable, and have been well reported in country-wide surveys. This study was conducted to validate the locality-specific childhood morbidity profile among households in urban Port Harcourt Metropolis in the oil-rich South-South Nigeria. <strong>Methods: </strong>an observational, cross-sectional survey was conducted involving 806 mother/under-five children pairs that were randomly selected by a modified cluster sampling design. Data were collected using a pre-tested, interviewer-administered structured questionnaire that was adapted from the Nigeria Demographic and Health Survey instrument (2018), which explored information on common causes of morbidity by verbal autopsies. Analysis was done with the Statistical Package for Social Sciences, version 21. <strong>Results: </strong>the under-five children were 406 males (50.4%) and 400 females (49.6%) with an average age of 27.7 ± 17.9 months. Fever was the most frequent morbidity, reported in 364 (45.2%, 95% CI = 0.4175-0.4861) of the children, followed by cough in 362 (44.9%, 95%CI = 0.4150-0.4836), fast breathing in 49 (6.1%, 95%CI = 0.0458-0.0789), and diarrhoea in 17 (2.1%, 95%CI = 0.0139-0.0308). Symptoms of fever (chi-square = 31.117, P-value=0.001) and cough (chi-square=21.416, P-value = 0.001), were higher in the 48-59month age group. <strong>Conclusion: </strong>febrile illness, acute respiratory tract infection, and diarrhoea disease were found to be common in under-five children in the metropolitan city of Port Harcourt. Tailored community-based health interventions and surveillance are needed to reduce the frequency of childhood morbidity and prevent mortality in this age group.</p>Tondor Cleopatra UzosikeIshmael Daniel Jaja
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2023-12-192023-12-19421Longstanding unrepaired tetralogy of Fallot
https://www.ajol.info/index.php/pamj/article/view/254000
<p>A fifty-six-year-old asymptomatic woman referred to our outpatient department with incidental finding of grade 3/6 pansystolic murmur at left lower sternal border. Transthoracic echocardiography was performed (A) showing severe pulmonary stenosis, non-restrictive perimembranous ventricular septal defect with a bidirectional shunt (B, C), overriding aorta and mildly thickened right ventricle in keeping with tetralogy of Fallot. As the patient was asymptomatic, she was managed conservatively with close follow up at the specialist Grown Up Congenital Heart clinic. Tetralogy of Fallot (TOF) is the most common form cyanotic congenital heart disease, but few patients reach adulthood without surgical correction. Survival in uncorrected patients is estimated at 11% at 20 years and 3% at 40 years, making this case unusual. With repair, the prognosis is very good. While mitral and tricuspid regurgitation and isolated VSD are more frequent causes of pansystolic murmur, TOF should not be forgotten as a rare cause in adults and is easily diagnosed on echocardiography.</p>Muhammad Saadiq MoollaWarren Muller
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2023-12-192023-12-19421Pemphigus vulgaris: a case report
https://www.ajol.info/index.php/pamj/article/view/254001
<p>Pemphigus vulgaris (PV) is an autoimmune mucocutaneous disorder of the oral cavity and is the most common subtype of pemphigus. The etiology remains obscure, although the disease is characterized by autoantibodies directed against the desmoglein component of the keratinocytes. It manifests clinically as vesicle, bullae or erosions of skin and mucous membrane and histopathologically shows the presence of acantholysis. The presence of exclusive oral lesions initially increases the chances of misdiagnosing the disease as another condition, posing diagnostic, therapeutic and prognostic difficulties, consequently prompt diagnosis and treatment can prevent untoward consequences. Demonstration of IgG antibodies against desmoglein in Immunofluroscence confirms the diagnosis. In here we report a case of a 55-year-old female patient suffering from PV emphasizing the significance of clinical examination, pertinent investigations, treatment rendered and its outcome.</p>Janumpally Varshitha ThanmaiGantala RamlalKatne TejaswInukonda Lakshmi Mounica
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2023-12-192023-12-19421Profil épidémiologique, aspects diagnostiques et évolutifs des patients tuberculeux au centre de diagnostic de la tuberculose et des maladies respiratoires de Settat, Maroc
https://www.ajol.info/index.php/pamj/article/view/254002
<p><strong>Introduction</strong>: la tuberculose demeure un problème de santé publique au Maroc. Ce travail vise à étudier le profil épidémiologique, les aspects évolutifs et diagnostiques de la tuberculose à Settat, Maroc. <strong>Méthodes</strong>: il s´agit d´une étude rétrospective descriptive et analytique, étalée sur la période allant du 1<sup>er</sup> janvier 2015 au 31 décembre 2019, réalisée par l´exploitation des dossiers d´une cohorte de patients tuberculeux pris en charge au centre de diagnostic de la tuberculose et des maladies respiratoires de Settat au Maroc. <strong>Résultats</strong>: nous avons répertorié un total de 1270 cas de tuberculose. L´atteinte pulmonaire était plus fréquente que l´atteinte extrapulmonaire. La tuberculose ganglionnaire était prédominante parmi les cas de tuberculose extrapulmonaire. Les formes graves étaient représentées par 10 cas de méningite tuberculeuse et 10 cas de la miliaire tuberculeuse. Le diagnostic était confirmé bactériologiquement chez la grande part des patients (84,09%). Les âges extrêmes et le sexe féminin étaient plus touchés par la tuberculose extrapulmonaire. La guérison était déclarée chez 35,12% des patients et elle était plus importante chez les malades à tuberculose pulmonaire par rapport aux patients à tuberculose extrapulmonaire (62,18% vs 0,37%; P<0,001). Les perdus de vue étaient plus importants parmi les patients touchés par la tuberculose pulmonaire (19,33% vs 10,81%; P<0,001). Le décès était survenu au presque même degrés d´importance chez les patients atteints de tuberculose pulmonaire et extrapulmonaire (2,52% vs 2,56%). <strong>Conclusion</strong>: des efforts, sur tous les plans, restent encore à déployer si le pays souhaite atteindre l´objectif de l´élimination de la tuberculose d´ici 2030.</p>Mohamed ChahbouneMohamed BarkaouiYounes IderdarNadia AlwachamiYassmine MourajidMohamed IflehKarima BoumendilKhadija BacharSaad El Madani
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2023-12-192023-12-19421Desmogleins 1, 3, and E-cadherin immunohistochemical expression within mucocutaneous pemphigus vulgaris
https://www.ajol.info/index.php/pamj/article/view/254007
<p><strong>Introduction: </strong>pemphigus vulgaris (PV) is an autoimmune condition characterized by the loss of adhesion between the epithelial cells and blister formation. The production of autoantibodies against desmosomal proteins, namely, desmoglein (DSG) 1 and DSG3, is considered a main event of PV. A full understanding of the role of adhesion molecules in the pathogenesis of PV is not fully elucidated yet. This study aimed to evaluate and correlate the immunohistochemical expression of E-cadherin (E-cad), DSG1, and DSG3 proteins in oral and skin PV. <strong>Methods: </strong>this study was a retrospective analysis study. Positive PV cases were stained with anti-E-cad, anti-DSG1, and anti-DSG3 antibodies. The expression of each marker was determined by two pathologists according to an established scoring system: (E-cad: negative, weak, moderate, and strong), (DSG1: negative, weak, and strong), and (DSG3: negative and positive). The Chi-square and Pearson´s correlation tests were used to statistically analyze the data. <strong>Results: </strong>forty-three biopsies (26 skin and 17 oral tissue samples) from 22 males and 21 female PV patients were included. The median age was 40.50 years. In total, the immunohistochemical expression was negative for DSG3, E-cad, and DSG1 in 81.4%, 18.5%, and 16.4%, respectively. DSG1 expression was significantly higher in males than females. A statistically significant correlation was found between E-cad and DSG3 expressions. <strong>Conclusion: </strong>a significant difference in the expression of markers of both oral and skin PV was absent. Downregulation of DSG3 expression was the hallmark feature that also showed a positive correlation with E-cad expression.</p>Muhanad Lebnan AlshamiFawaz AswadBashar Abdullah
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2023-12-192023-12-19421Colonic polyps: a rare clinical manifestation of schistosomiasis (a case report)
https://www.ajol.info/index.php/pamj/article/view/254008
<p>Schistosomiasis is caused by parasitic blood flukes. It is one of the neglected tropical diseases (NTDs) and has variable manifestations depending on the species involved. Eggs and not adult worms are mostly responsible for the resultant pathologies commonly involving the small intestines. Colon polyps resulting from schistosomiasis represent a rare entity despite the endemicity of <em>Schistosoma mansoni</em> in the tropical regions. Praziquantel is the mainstay of treatment. Case presentation is of a 28 year old male with complaints of bloating, mild abdominal pain and loose stools over two weeks.On examination, the patient´s abdomen was soft on palpation with a liver span of 8 cm and a non-palpable spleen. Preliminary tests included stool microscopy which was negative for ova and cysts, negative for stool <em>H.pylori</em> antigen. Colonoscopy revealed a polyp at the caecum and pan-colonic erosions. Microscopy of the polyp showed numerous schistosome ova. The indolent picture of this particular patient makes it a unique case as the likelihood of the diagnosis not being schistosomiasis is greater than other differential diagnoses. The take-home message is that a high index of suspicion is needed in the diagnosis of colonic polyps resulting from schistosomiasis as it presents with non-specific manifestations and inconclusive laboratory and endoscopic findings.</p>Kelvin OrareAbdinoor MohamedAllan RajulJoseph Gatheru
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2023-12-192023-12-19421Knowledge, attitudes and practices of cervical cancer screening among rural women in KwaZulu-Natal, South Africa
https://www.ajol.info/index.php/pamj/article/view/254011
<p><strong>Introduction:</strong> cervical cancer continues to be a major cause of morbidity and mortality among women in the developing world. Despite the national cervical cancer screening programme, findings show low levels of knowledge and practices of cervical cancer screening among rural women in South Africa (SA). The purpose of this study was to determine the knowledge, attitudes and practices of cervical cancer screening among rural women in KwaZulu-Natal, SA. <strong>Methods:</strong> an observational cross-sectional study was performed. The study was conducted at three rural clinics. A systematic sampling technique was used to select 283 women, aged 18-65 years. Data were collected using a standardised structured self-administered questionnaire. Data were analysed using descriptive and analytic statistics. <strong>Results:</strong> findings showed a high level of awareness of cervical cancer (93.3%, n=264) and the Pap smear test (95.1%, n=269). Knowledge of cervical cancer-associated factors, symptoms, screening methods and treatment was poor (28.0%, n=79). An overwhelming majority (81.8%, n=231) displayed a positive attitude towards cervical cancer screening. The practice of cervical cancer screening was fairly good (66.8%, n=189). The results showed that socio-demographics were not statistically significantly associated with knowledge of cervical cancer and cervical cancer screening. <strong>Conclusion:</strong> despite the inadequate knowledge of women, attitudes towards cervical cancer and screening were generally positive. Health care practitioners are encouraged to focus not only on creating awareness but also on improving knowledge so as women will not only undergo screening but appreciate the importance of cervical cancer screening.</p>Oluwatosin OmoyeniJoyce Tsoka-Gwegweni
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2023-12-192023-12-19421Anterior staphyloma of right eye: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/254015
<p>Staphyloma is a thinning (ectasia) of the globe's uvea and scleral layers. It causes globe expansion with a focal bulge, commonly in the posterior wall. Anterior staphyloma can form as a consequence of an inflammatory/infectious event or as a result of a developmental abnormality caused by defective anterior mesoderm differentiation. The congenital form is uncommon. We present a case of an 8-year-old female child who was brought to the outpatient department with a complaint of pain and loss of vision from the right eye. As narrated by her parents she was alright 2 years, back then she had a trauma on her right eye while playing; after which she started developing ulceration over the right eye and, it kept increasing in size. After physical examination of the eye, discharge was present from the right eye, vision loss and redness in eyes. The patient was referred to the ophthalmologist for further examination and investigation, where an anterior staphyloma of the right eye was diagnosed. The patient was referred to the ophthalmology department for further management.</p>Tejaswee LohakareKhushbu Meshram
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2023-12-192023-12-19421Intravenous lidocaine versus dexamethasone to prevent postoperative vomiting in children tonsillectomy: a prospective randomized controlled trial
https://www.ajol.info/index.php/pamj/article/view/254018
<p><strong>Introduction:</strong> we evaluate the effectiveness of lidocaine infusion compared to the intravenous dexamethasone and placebo on postoperative vomiting and first oral intake in children post tonsillectomy. <strong>Methods:</strong> we conducted a prospective double-blinded randomized and controlled clinical trial involving children aged between 3 and 13 years proposed for elective tonsillectomy without or with adenoidectomy under general anesthesia. They were randomized into 3 groups: lidocaine group included patients who received intravenous bolus of 2 mg/kg lidocaine over 5 minutes after the induction of anesthesia. Then, they received an infusion of 1.5 mg/kg/h until the end of the surgical procedure, dexamethasone group included patients who received intravenous dexamethasone 0.15 mg/kg administrated over 5 minutes after the induction of anesthesia followed by an identical rate of 0.9% saline and the saline group included patients who received an equivalent volume of 0.9% saline. For data analysis, we tested the normality of variables using the Shapiro-Wilk test. We used analysis of variance (ANOVA) or the Kruskal-Wallis test for between-group comparisons, as appropriate. The X<sup>2</sup> test and Fisher´s exact test were used for inferences on proportions. A two-sided P-value was considered significant when p≤0.05. All analyses were performed with IBM SPSS≤ 25.0.0 for windows. <strong>Results:</strong> eighty-three (83) children were analyzed in our study and randomized into 3 groups: 27 children for each lidocaine and dexamethasone group and 29 children for the Saline group. The demographic data were not significantly different between the three groups such as age (p=0.246), gender (p=0.378), and body mass index (BMI) with p=0.233. The duration of surgery and anesthesia was also comparable in the 3 groups (p=0.893). Patients of the lidocaine and dexamethasone group had at least one episode of retching, vomiting, or both less than the saline group in the post-anesthetic care unit with p respectively 0.015 and 0,035, and in the ward with p respectively 0.004 and 0,038 Without a significant difference between the dexamethasone and the lidocaine group. The time to the first oral intake was significantly shorter in the dexamethasone group and the lidocaine group compared with the saline group (p=0.0001) with no statistical difference between the dexamethasone and lidocaine groups. <strong>Conclusion:</strong> lidocaine infusion is as effective as intravenous dexamethasone on postoperative vomiting as well as on oral intake in children post tonsillectomy.</p>Imen ZoucheAyoub Ben SalemSalma KetataMariem KeskesAbdelhamid Karoui
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2023-12-192023-12-19421Systemic lupus erythematosus: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/254022
<p>Systemic lupus erythematosus (SLE), is the most common type of lupus. Systemic lupus erythematous is an autoimmune disease in which the immune system attacks its tissues, causing widespread inflammation and tissue damage in the affected organs. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels. A 12-year-girl visited the outpatient department with the complaint of skin lesions (red color) over sun-exposed areas on the hand, feet, and face. Oral mucosal bleeding, joint pain including knee, shoulder, elbow, and wrist. On physical examination, photosensitive rash and oral bleeding were observed. Laboratories investigation revealed the patient had systemic lupus erythematosus. The patient was referred to the dermatology department for further medical management.</p>Tejaswee LohakareKavita Gomase
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2023-12-192023-12-19421World Health Organization meningioma grade II
https://www.ajol.info/index.php/pamj/article/view/254026
<p>We are presenting to you a Magnetic Resonance Imaging (MRI) finding of a 65 years old female who presented to us with a complains of headache which was over the frontal region and on and off in nature. The patient also complains of imbalance during walking and tingling, numbness and weakness in the left upper and lower extremities. She gives a history of 2 episodes of seizures. Contrast magnetic resonance imaging findings revealed a well-defined extra-axial lesion measuring approximately 4.1*3.9cm (red arrow and green arrow) in the parafalcine region at the right frontoparietal lobes with mass effect (blue arrow). In contrast, the lesion shows avid peripheral enhancement with tiny non-enhancing central core features suggesting neoplastic etiology (yellow arrow), i.e., World Health Organization meningioma grade II. Meningiomas, classified as grade 2 by the World Health Organization, are aggressive tumors with a high recurrence rate that necessitates multiple surgical procedures and can significantly worsen a patient's neurological condition. The lesion is hyperintense and homo-dense near the coronal suture. She underwent surgical excision of the right frontoparietal parasagittal tumor and is under regular physiotherapeutic and medical management for the residual weakness.</p>Rutuja Bhaskar ParkhiSnehal Subrat Samal
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2023-12-192023-12-19421Syntélencéphalie: variant inter hémisphérique médian de l´holoprosencéphalie
https://www.ajol.info/index.php/pamj/article/view/254032
<p><em>Holoprosencephaly (HPE) is a congenital malformation occurring very early in pregnancy and due to abnormal diverticulation of the prosencephalon. This defect in primary brain cleavage may be total or partial, which explains the anatomopathological variants of holoprosencephaly. The main forms of holoprosencephaly include alobar, semilobar and lobar HPE. Syntelencephaly also known as middle interhemispheric variant (MIHV) is a very rare type of HPE. While in the three most common variants, cleavage defect has antero-posterior gradient of severity, syntelencephaly does not follow this rule. The latter is characterised by abnormal communication between cerebral hemispheres in the posterior and parietal frontal regions, with normal inter-hemispheric separation of the anterior frontal lobes, of the occipital regions and central grey nuclei. The trunk of the corpus callosum is achieved at the level of the knee of the corpus callosum (allowing differentiation from lobar HPE) and of the splenium. An azygos cerebral artery is common, consisting of a fusion of the A1 segments of the anterior cerebral arteries to form a single arterial trunk. Other cerebral malformations may be associated with syntelencephaly, the most frequent being cortical dysplasia and grey matter heterotopia. Facial abnormalities are less common in syntelencephaly compared to classic forms of HPE. Prognosis depends mainly on these malformative associations in the brain and other organs, and even on chromosomal aberrations.</em></p>Daoud BentalebSiham Salam
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2023-12-192023-12-19421Evaluation of HIV-1 rapid diagnostic tests in the context of viral genetic diversity in Libreville
https://www.ajol.info/index.php/pamj/article/view/254034
<p><strong>Introduction: </strong>in order to promote rapid care of HIV-positive people and to reduce the human immunodeficiency virus (HIV) transmission in Gabon, the national screening algorithm is essentially based on rapid diagnostic tests (RDTs). However, most of these RDTs are not evaluated. Their sensitivities and specificities remain unknown locally. The aim of this study was to determine the diagnostic performance of 3 RDTs used for HIV-1 screening in Gabon. <strong>Methods: </strong>of the one hundred and sixteen (116) samples tested, 60 plasmas were HIV-1 positive with known genotypes and viral loads; 51 sera were HIV-1 negative while 5 had an undetermined serological status. All the samples were tested by quantitative RT-PCR (Gold standard) and by the following RDTs: Vikia, Alere Combo and Alere Determine. The sensitivities and specificities of the different RDTs were calculated using Epi Info version 6.04dfr. The level of agreement between tests was determined by Cohen´s Kappa test. <strong>Results: </strong>the three RDTs´ sensitivity according to HIV-1/M subtypes was 100% (95% CI: 92.6-100) while their specificities ranged from 94.6% (95% CI: 84.2-98.6) for the Vikia test to 96.4% (95% CI: 86.6-99.4) for the Alere Combo and Alere Determine tests, respectively. The concordances between the three RDTs were excellent with kappa values ranging from 0.931 (95% CI: 0.864-0.977) to 0.948 (95% CI: 0.890-1.00). <strong>Conclusion: </strong>the three RDTs showed a maximum sensitivity of 100% and specificities ranging from 94.6% to 96.4%. The specificities obtained with these RDTs are lower than those recommended by the WHO for their inclusion in an HIV-1 screening algorithm.</p>Yann Vital Sima BiyangSoulemane ParkoudaBerthold Bivigou-MboumbaBerthe Amélie IroungouAugustin Mouinga OndemeCyrille Bisseye
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2023-12-192023-12-19421Primary solitary hydatid disease of brain in a 16-year-old girl: a case report
https://www.ajol.info/index.php/pamj/article/view/254039
<p>Isolated involvement of brain with hydatid disease is a rare manifestation and occurs in only 1-2% of all <em>Echinococcus granulosus</em> infections. Here we present a young female of 16 years with primary intra cranial hydatid cyst without any extracranial involvement in the liver or lung. The patient was managed surgically and anti-helemthic medications were given, and the patient was discharged. The objective is to report a rare case of primary solitary hydatid cyst of brain. The incidence of isolated hydatidosis of brain is rare and should be considered as a differential diagnosis in endemic areas. Isolated Hydatidosis of brain is managed surgically and has to be removed carefully without spillage with postoperative medication to reduce the risk of recurrence.</p>Prateek PulavartyParesh KordeSagar RathodJuhi PatnaikRajesh DomakuntiShivansh Pratap Singh
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2023-12-192023-12-19421Five good quality blastocysts retrieved via the physiological intracytoplasmic sperm injection dish HA binding method in a 50-year-old female
https://www.ajol.info/index.php/pamj/article/view/254308
<p>Physiological Intracytoplasmic Sperm Injection (PICSI) is a scientific approach used to aid the embryologist in the selection of sperm in Intracytoplasmic Sperm Injection (ICSI), a specific kind of In Vitro Fertilization (IVF). A polystyrene culture dish with three microdots of hyaluronan adhered to the inside bottom serves as the PISCI sperm selection device. The cumulus coating of the oocyte (egg) contains hyaluronan, and the head of a mature sperm contains a hyaluronan-specific receptor that permits mature sperm to bind to hyaluronan. Immature sperm, on the other hand, do not bind. The PICSI Sperm Selection Device allows you to choose mature sperm based on their capacity to bind to a specific target hydrogel of hyaluronan. The PICSI Sperm Collection the Selection Device imitates the natural binding process transferring mature sperm to the oophorous cumulus, a crucial phase in the natural selection process fertilisation. After that, the sperm is deposited on a specific plate. This plate includes a few drops of a synthetic substance that coats the oocytes spontaneously, comparable to hyaluronic acid. The embryologist will be able to quickly identify those spermatozoa of acceptable quality and sufficient maturity that remain attached to these drops for microinjection of the oocytes.</p>Aasisjot KaurAkash More
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2023-12-192023-12-19421Concomitant existence of left atrial ball thrombus and mural thrombus of left appendage in patient with rheumatic mitral stenosis: a case report
https://www.ajol.info/index.php/pamj/article/view/254310
<p>Valvular heart disease, and in particular, rheumatic mitral stenosis is frequently associated with intra-cardiac thrombus. Moreover, almost all types of thrombus can be founded in the left atrium whereas the ball shaped thrombus remains very rare. The following case report describes a successful surgical management of an unusual case with a concomitant left atrial free-floating ball thrombus and mural one in a patient who has rheumatic mitral stenosis with atrial fibrillation. However, this patient did not present any cerebral or peripheral embolic events. Left atrial ball thrombus is relatively a rare case. Once the diagnosis was made, the surgical removal should be done immediately to avoid embolic complications and deterioration of hemodynamics.</p>Ismail OughebbiSaid BenlamkaddemReda BzikhaMustapha Harandou
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2023-12-192023-12-19421Serofibrinous pleural effusion revealing a large hydatid cyst of the liver
https://www.ajol.info/index.php/pamj/article/view/254313
<p>Hydatid cyst of the liver remains a serious public health problem in Morocco. It is frequently endemic due to poor environmental sanitation. This benign affection can sometimes cause fatal complications, such as the intrathoracic rupture of a cyst. This is a case of a huge liver hydatid cyst, revealed by serofibrous pleurisy, which is an extremely rare condition. A 9-year-old boy, with no past medical history, was presented to the emergency department for respiratory distress, cough, and right chest pain. The pain was insidious, onset, and progressive. There was no history of fever, hemoptysis or vomica. Physical examination revealed diminished respiratory sounds, with dullness to percussion at the right lung, along-with tenderness in the right hypochondrium area. Chest X-ray film confirmed the presence of right-sided pleural effusion. Thoracoabdominal computed tomography (CT) scan was performed, and it shows a large hydatid cyst of segment VIII of the liver with a huge pleural effusion with no lung lesion. A thoracentesis revealed a yellow fluid. The hydatid cyst was treated by laparotomy and partial excision of the cyst, the diaphragmatic fistula was closed, and the pleural effusion was treated by pleural drainage. After 2 weeks, a chest X-ray showed an encysted pleural effusion, which was later treated by thoracotomy and lung decorticating.</p>Ahmed EL MoulouaLeila Kartout
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2023-12-192023-12-19421Short interpregnancy interval and its predictors in Ethiopia: implications for policy and practice
https://www.ajol.info/index.php/pamj/article/view/254328
<p><strong>Introduction: </strong>interpregnancy interval (IPI) is the time elapsed between the birth of one live child and the conception of subsequent pregnancies. Several studies in Ethiopia indicated a high prevalence of a short interbirth interval - a proxy indicator of IPI. However, these studies were prone to selection bias as they did not include women who did not go on to have another pregnancy. Therefore, this study estimated the incidence of short IPI (< 24 months) and its risk factors among women who had at least one child in Ethiopia. <strong>Methods: </strong>we used a retrospective analysis of a cross-sectional study from the nationally representative Ethiopian Mini Demographic and Health Survey (EMDHS) conducted in 2019. The event was defined as the conception of the subsequent pregnancy within 24 months following the last child. A weighted Cox Proportional Hazard model was used to estimate the adjusted hazard ratios (aHR) and 95% confidence intervals (CIs). <strong>Results: </strong>the incidence of short IPI was 6%. Rural residence, being young age, low educational attainment, having the last child died and having female last birth were the risk factors for short IPI. However, having higher parity, attending Antenatal Care (ANC) visits, being delivered at a health facility, and receiving Postnatal Care (PNC) visits were the protective factors for short IPI. <strong>Conclusion: </strong>the incidence of short IPI in Ethiopia was considerable. Sociodemographic and health service-related factors determine the short IPI. Hence, considering the immediate and long-term health and socioeconomic consequences of short IPI, the Ethiopian government should implement holistic and multisectoral interventions.</p>Kalayu Brhane MrutsGizachew A TessemaNigussie Assefa KassawAmanuel Tesfay GebremedhinJane A ScottGavin Pereira
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2023-12-192023-12-19421Atrésie rectale membraneuse: présentation tardive à propos d´un cas
https://www.ajol.info/index.php/pamj/article/view/254382
<p>L´atrésie rectale et la sténose rectale sont des formes rares de malformations anorectales représentant seulement un à deux pourcent des cas vus. Nous rapportons un cas d´atrésie rectale. Il s´est agi d´un nouveau-né de sexe féminin accouché à terme par voie basse pesant 3600g à la naissance qui était admis à J6 de vie pour absence d´émission de méconium, ballonnement abdominal et fièvre. L´examen avait permis de noter une température à 39<sup>º</sup>C, un abdomen distendu, un anus normalement situé et perméable, laissant prolabée une masse bien rosée, sans signe de nécrose. L´introduction d´un stylet entre la masse et la muqueuse rectale butait à environ 3cm de la marge anale. La radiographie de l´abdomen sans préparation montrait des anses distendues et des niveaux hydro-aériques sans signe de perforation d´organes creux. Devant la suspicion d´une atrésie rectale membraneuse complète, une ponction avec un cathéter 16 gauge à travers la membrane avait ramené le méconium dont l´aspiration d´une quantité abondante de méconium avait permis un affaissement considérable de l´abdomen. Nous avons ensuite réalisé une exérèse chirurgicale de la membrane. Les suites opératoires immédiates ont été simples et le nouveau-né était sorti à J3 post opératoire de l´hôpital. Des dilatations anales ont été faites pour traiter une sténose anale. Avec un recul de 6 mois, le résultat est excellent. L´atrésie rectale présentée sous forme d´absence d´émission de méconium associée à une masse prolabée par l´anus ne semble pas encore décrite. La ponction à travers la membrane rectale atrésique a permis de confirmer le diagnostic. La résection de la membrane donne de bons résultats.</p>Octave Excupère Désiré Miaffo DongmoPauline ManthoMissoki Azanlédji BoumEric BitchokaDominique EnyamaIrène KounaThéophile KamguepJean Paul Ndamba Engbang
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2023-12-192023-12-19421L´érythroblastopénie et la myélofibrose primitive: association très rare (à propos d´un cas)
https://www.ajol.info/index.php/pamj/article/view/254385
<p>L´association de l´érythroblastopénie et la myélofibrose primitive est très rare. Nous présentons dans ce papier un cas inhabituel d´un patient âgé de 76 ans d´origine marocaine suivi depuis 2018 pour une érythroblastopénie idiopathique traitée initialement par la corticothérapie puis la ciclosporine. Deux ans plus tard, le patient rapporte l´installation de douleurs osseuses avec une splénomégalie. Un bilan comprenant le myélogramme, la biopsie ostéo-médullaire et la biologie moléculaire a révélé une myélofibrose. Le bilan étiologique de la myélofibrose est revenu négatif concluant à la nature primitive. Le patient est mis sous ruxolitinib avec un support transfusionnel. L´évolution était favorable marquée par une amélioration de son état général, sa splénomégalie et du rythme transfusionnel. L´association de l´érythroblastopénie et d´un syndrome myéloprolifératif reste exceptionnelle et jusqu´à présent seulement quelques cas sont rapportés dans la littérature.</p>Nora EL MaachiMahtat El MehdiImane Ait FilaliSelim JennaneHicham El MaaroufiKamal Doghm
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2023-12-192023-12-19421Post COVID-19 rhinocerebral mucormycosis: a case report and literature review
https://www.ajol.info/index.php/pamj/article/view/254393
<p>The pandemic of coronavirus disease 2019 (COVID-19) still remains on an upsurge trend. The second and the waves of this disease have led to panic in many countries, and some parts of the world suffering from the fourth wave. In the midst of this pandemic, COVID-19 patients are acquiring secondary infections such as mucormycosis also known as “black fungus disease”. Mucormycosis is a serious, but rare opportunistic fungal infection that spreads rapidly, and hence prompt diagnosis and treatment are necessary to avoid mortality and morbidity rate. We report in this paper, a case of a diabetic patient who presented with bilateral nasal obstruction, anosmia, and frontal headache diagnosed with rhinocerebral mucormycosis developing after COVID-19 infection with a favorable outcome after a medico-surgical treatment. Through this case, we aim to aware patricians of this possible association and the importance of early diagnosis to optimize treatment outcomes.</p>Amel El KorbiSalma BharEmna BergaouiKhaled HarrathiJamel Koubaa
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2023-12-192023-12-19421Puzzling painful nodules on back: a case report
https://www.ajol.info/index.php/pamj/article/view/254398
<p>Cutaneous leiomyomas are known to arise from three locations viz, arrector pili muscle, dartos muscle in the scrotal sac, and smooth muscle layer of blood vessels. Cutaneous piloleiomyoma (arising from arrector pili) is an uncommon benign skin tumor presenting clinically as a single or numerous painful nodules. They can either appear diffuse or zosteriform/segmental in rare cases. We report an unusual case of multiple tender papulonodular lesions on the right infrascapular region. Histology from one of the nodules showed a dermal tumor consisting of interlacing fascicles of spindle cells, consistent with the diagnosis of piloleiomyoma. We prescribed our patient with oral calcium channel blocker, amlodipine, to provide symptomatic relief from pain and which can be considered used it to treat similar cases.</p>Meghana PendamBhushan MadkeSamyak GanjreMeenakshi ChandakAdarsh Lata Singh
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2023-12-192023-12-19421Implementation of the COVID-19 laboratory testing certification program (CoLTeP), Zimbabwe, 2021
https://www.ajol.info/index.php/pamj/article/view/254402
<p>The Africa Union (AU) Trusted Travel Initiative was introduced in 2021 to support Africa Union member states enhance their current health screening systems. Trusted Travel offers an online digital platform for the verification and authentication of COVID-19 results based on a collaborative effort across a network of participating COVID-19 testing laboratories. In this paper, we describe the certification process of laboratories to qualify for listing on the AU Trusted Travel platform as approved and recognized COVID-19 testing facilities. A checklist prepared from the ISO15189: 2012, ISO15190: 2020 and World Health Organization Laboratory Safety Manual, 4<sup>th</sup> edition was used to audit laboratories. Approved auditors completed the audit checklist through reviewing laboratory documents and records, observing laboratory operations whilst asking open-ended questions to clarify documentation seen and observations made. A laboratory was recommended for certification after scoring at least 90%. Between May and September 2021, a total of 26 (19%) of the 134 medical laboratories authorized for SARS-CoV-2 testing had been audited for CoLTeP certification in Zimbabwe. The majority 16 (62%) attained 5 stars rating with 10 (38%) attaining 0-4 stars. Performance was highest in the area of test result and data management (mean score 93%, SD 9.1). The least performance of the laboratories was on the laboratory biosafety and biosecurity (mean score 73%, SD 17.0) and Quality Control and Assurance (mean score 71%, SD 15.0). There is need for laboratories to commit their resources to quality assurance programs and training of laboratory personnel in biosafety and biosecurity as part of continuous quality improvement.</p>Tendai ChipendoTakudzwa MaremboClayton MunemoHumphrey ChituriEdwin ShumbaDonewell BangureTalkmore Maruta
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2023-12-192023-12-19421Undiagnosed hypertension in Sudan: results of the cross-sectional national STEPS survey in 2016
https://www.ajol.info/index.php/pamj/article/view/254410
<p><strong>Introduction: </strong>the rate of hypertension has been increasing in Africa. The study aimed to estimate the prevalence and associated factors of undiagnosed hypertension (HTN) among adults in Sudan. <strong>Methods: </strong>cross-sectional data were analyzed from 7,226 persons (18-69 years, median 37 years, interquartile range 27-49 years, 4557 were females) who participated in the 2016 Sudan STEPS survey, had complete blood pressure measurement and non-pregnant, and responded to a questionnaire, physical measures, and biomedical tests. Logistic regression was used to determine the predictors of undiagnosed HTN. <strong>Results: </strong>the prevalence of undiagnosed HTN was 26.2% (n=2057) (79.2% of total HTN), diagnosed HTN 6.9% (n=690) and total HTN 33.1% (n=2747). In multivariable analysis older age (50-69 years) (adjusted risk ratio-aRR: 2.49, 95% CI: 2.02-3.09; p<0.001), obesity (aRR: 2.51, 95% CI: 1.97-3.21; p<0.001), diabetes (aRR: 1.59, 95% CI: 1.17-2.16; p=0.002) and elevated total cholesterol (aRR: 1.48, 95% CI: 1.19-1.84; p<0.001) were positively associated and health care advice (aRR: 0.79, 95% CI: 0.64-0.98; p=0.036) was negatively associated with undiagnosed HTN versus no HTN. Male sex (adjusted odds ratio-aOR: 2.22, 95% CI: 1.63-3.01; p<0.001) was positively associated, and older age (50-69 years) (aOR: 0.31, 95% CI: 0.21-0.46; p<0.001), married (aOR: 0.45, 95% CI: 0.33-0.62; p<0.001), urban residence (aOR: 0.70, 95% CI: 0.51-0.96; p=0.022), health care advice (aOR: 0.32, 95% CI: 0.22-0.45; p<0.001), ever cholesterol measured (aOR: 0.43, 95% CI: 0.27-0.67; p<0.001), overweight (aOR: 0.63, 95% CI: 0.47-0.85; p=0.003) and heart attack or stroke (aOR: 0.31, 95% CI: 0.17-0.55; p<0.001) were negatively associated with undiagnosed HTN versus diagnosed HTN. <strong>Conclusion: </strong>one in four adults in Sudan had undiagnosed HTN (eight in ten of total HTN) and several associated factors that can help guide interventions were identified.</p>Supa PengpidKarl Peltzer
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2023-12-192023-12-19421Chromophobe renal cell carcinoma with liposarcomatous dedifferentiation: a case report
https://www.ajol.info/index.php/pamj/article/view/255132
<p>Chromophobe renal cell carcinoma with liposarcomatous dedifferentiation is a very extremely rare tumor and only few cases have been reported in the literature. Here we report a case of a 37-year-old woman who presented with a pain and a palpable mass in the right flank. The abdominal CT scan found a renal tumor and the patient underwent a right radical nephrectomy with adrenal gland resection. After the histological examination of the specimen completed by immunohistochemical and molecular study, a diagnosis of chromophobe renal cell carcinoma with liposarcomatous dedifferentiation was made. The patient received adjuvant chemotherapy. Afterwards, she developed bone metastasis and died 13 months after the surgery. Chromophobe renal cell carcinoma with liposarcomatous dedifferentiation is a rare tumor associated with a poor prognosis and a metastatic potential.</p>Asmaa El Kebir
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2023-12-192023-12-19421Familial occurrence of concomitant imperforate hymen and transverse vaginal septum: a case report
https://www.ajol.info/index.php/pamj/article/view/255136
<p>The imperforate hymen and transverse vaginal septum are female reproductive tract abnormalities. Their concurrent occurrence is rare. So far, no manifestation of both anomalies within the same family has been reported in the literature. We report the first familial case of two sisters having both mentioned abnormalities. Our patient was the youngest sister of a 14-year-old, who presented with cyclic lower abdominal pain. Clinical and imaging examinations showed an imperforate hymen with hematometrocolpos. In addition, the surgery confirmed a low transverse vaginal septum, which was resected using a virginity-preserving procedure. In conclusion, the presence of both mentioned abnormalities between siblings reflects a potential genetic etiology, also in order to avoid late diagnostics of such anomalies, the imperforate hymen must be screened in the birth room.</p>Zineb AboueddahabKhalid GuelzimJaouad Kouach
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2023-12-192023-12-19421Late onset Darier´s disease in a genetically predisposed individual: a case report
https://www.ajol.info/index.php/pamj/article/view/255221
<p>Keratosis follicularis also called as Darier's disease, is a rare autosomal dominant cutaneous disease. It is characterized by greasy keratotic sometimes crusted red to brown papules and plaques over seborrheic areas and in flexures with nail abnormalities. It is well established that the disease begins between the ages of 6 and 20 years, with a peak onset during puberty. The disease tends to manifest early, especially with the family history of the disease. Hereby, we report a case of Darier's disease with a special interest in its late onset presentation despite having significant family history of the disease, along with clinicopathological and dermoscopic features. We also highlight the use of non-invasive investigative technique of dermoscopy as a tool to diagnose the disease.</p>Manoharan DhanaraGeo Celestin DannyShreya SrinivasanSowmya Nagaraju
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2023-12-192023-12-19421Determinants of primary healthcare services utilisation in an under-resourced rural community in Enugu State, Nigeria: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/255244
<p><strong>Introduction: </strong>primary health care (PHC) is essential towards achieving universal health coverage. Improving PHC services require understanding context-specific factors influencing utilisation. We assessed the factors influencing utilisation of PHC services in a rural community in Enugu, Nigeria. <strong>Methods: </strong>we conducted a cross-sectional community-based survey between May and June, 2017. Information on socio-demographic characteristics, utilisation of PHC services, community- and PHC facility-related factors associated with utilisation of PHC services was obtained from 335 adult residents aged ≥ 18 years using a pre-tested semi-structured interviewer-administered questionnaire. Data were analyzed using descriptive and inferential statistics at 5% level of significance. <strong>Results: </strong>of the 335 respondents, 155 (46.2%) reported utilisation of PHC services the last time they were sick. Of 178 respondents who did not utilise PHC services, 51 (28.7%) reported poor quality health services, 41 (23.0%) unavailability of medical doctors, 31 (17.4%) long patient waiting time and 25 (14.0%) unavailability of drugs as reasons for non-utilisation. Being a female (AOR = 2.3 (95% CI 1.3 - 4.0)), affordability of health services (AOR = 2.4 (95% CI 1.3 - 4.6)), inadequacy of healthcare staff (AOR = 0.3 (95% CI 0.1 - 0.5)), shorter hospital waiting time (AOR = 2.2 (95% CI 1.2 - 4.3)) and satisfaction with PHC services during previous visit (AOR = 2.6 (95% CI 1.1 - 6.3)) influenced utilisation of PHC services. <strong>Conclusion: </strong>PHC services utilization was low. Improving utilization would require addressing cost of health services, adequacy of healthcare staff, patient waiting time and ensuring patient satisfaction with PHC services.</p>Ugochukwu Uzoechina NwokoroOnyekachi Michael UgwaAdanma Chidinma EkennaIzuchukwu Frank ObiChinemerem Daniel Onwuliri
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2023-12-192023-12-19421Mental health and lifestyle in mental health nurses: a cross-sectional, nation-wide study from Uganda during COVID-19 times
https://www.ajol.info/index.php/pamj/article/view/255253
<p><strong>Introduction:</strong> mental health nurses (MHNs) work in potentially high-stress settings, in particular in low-income countries during the COVID-19 pandemic the risk might be high. This multi-centre, cross-sectional study explored the prevalence of psychological distress and post-traumatic stress disorder (PTSD) symptoms among Ugandan MHNs and investigated associations between these mental health outcomes and lifestyle factors.<strong>Methods:</strong> in this cross-sectional study, participants completed the Kessler-6 (K-6), PTSD checklist for DSM-5 (PCL-5), simple physical activity questionnaire (SIMPAQ), physical activity (PA) vital sign (PAVS), Pittsburgh sleep quality index (PSQI, and alcohol use disorder identification test-concise (AUDIT-C). Spearman Rho correlations and Mann Whitney U tests were applied. <strong>Results:</strong> of 108 included MHNs (age =34.8±10.0 years; 55.6% female) 92.6% had psychological distress (K-6≥13), 44.4% elevated PTSD symptoms (PCL-%≥41), 74.1% was physically inactive (less than 150min/week on PAVS), 75.9% reported poor sleep quality (PSQI>-5) and 24.4% harmful drinking (AUDIT-C≥3 for women and -≥4 for men). SIMPAQ exercise correlated with K-6 (rho =-0.36, P<0.001) and PCL-5 (rho=-0.24, P=0.013), SIMPAQ walking with PCL-5 (rho =-0.31, P<0.001). Mental health nurses meeting the PA guidelines reported lower PCL-5 scores than those who did not (P<0.005). <strong>Conclusion:</strong> in Uganda, the mental health burden is high during the COVID-19 pandemic among MHNs and associated with an unhealthy lifestyle. The effectiveness and efficacy of resilience programs for MHNs focusing on unhealthy lifestyle patterns should be explored.</p>Davy VancampfortJames Mugisha
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2023-12-192023-12-19421Subcutaneous metastasis of rectal adenocarcinoma: an unusual and fatal metastatic localization
https://www.ajol.info/index.php/pamj/article/view/255258
<p>Subcutaneous metastasis of colorectal cancer is extremely rare. It is typically associated with a poor prognosis. Herein, we present a case of a 38-year-old young woman, diagnosed with stage III of rectal adenocarcinoma. She received neoadjuvant chemoradiation and was scheduled for total mesorectal excision after eight weeks of delay. During the week preceding surgery, she complained of the occurrence of two subcutaneous nodules, the first one in the abdominal wall, at the left hypochondrium, and the second in the low part of the chest wall. The physical examination showed well-defined, mobile, tender subcutaneous nodules without epidermal changes. The thoracoabdominal-pelvic computed tomography (CT) scan showed two enhanced nodules localized in the abdomen (A) and in the chest walls (B), measuring respectively 10 mm and 8 mm. Given the young age of the patient, it has been decided to perform mesorectal total excision associated with biopsy excision of subcutaneous nodules (C). The histological study of the rectal specimen showed a complete pathological response and safe margins (PT0N0). However, results in nodule specimens revealed poorly differentiated adenocarcinoma that was cytokeratin CK-20 and CDX2 positive (D). These results suggested a metastasis from the lower gastrointestinal tract. Unfortunately, the patient's general condition deteriorated rapidly in the first postoperative month. New subcutaneous nodules appear in the abdominal wall, the chin, and the cuisse. Besides, body CT and 18-Fluorodeoxyglucose positron emission tomography scans revealed disseminated disease including pancreas, adrenal, and peritoneum. The patient started chemotherapy but died after two cycles from a widely disseminated disease.</p>Tarik SouikiKhalid Mazaz
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2023-12-192023-12-19421Concomitant Guillain-Barré syndrome and cerebral venous thrombosis complicating a SARS-CoV-2 infection: a case report
https://www.ajol.info/index.php/pamj/article/view/255262
<p>Cerebral venous thrombosis associated to acute inflammatory axonal polyneuropathy during infection with SARS-CoV-2 (coronavirus-2) is unusual. We describe the case of a 66-year-old patient with typical clinical and electrophysiological criteria of acute axonal motor neuropathy, who was positive for SARS-CoV-2. The symptoms started with fever associated with respiratory symptoms, and complicated one week later by headaches, and general weakness. The examination showed bilateral peripheral facial palsy, predominantly proximal tetraparesis, and areflexia with tingling of limbs were found. The whole was concomitant with the diagnosis of an acute polyradiculoneuropathy. Electrophysiologic evaluation confirmed the diagnosis. Cerebrospinal fluid examination showed albuminocytologic dissociation, and brain imaging revealed sigmoid sinus thrombophlebitis. Neurological manifestations improved during treatment with plasma exchange and anticoagulants. Our case draws attention to the occurrence of cerebral venous thrombosis and Guillain-Barré syndrome (GBS) in patients with COVID-19. The neuro-inflammation induced by the systemic immune response to infection, can lead to neurological manifestations. Further studies should be conducted on the full clinical spectrum of patients with COVID-19 with neurological symptoms.</p>Hajar QorchiNajib KissaniMohamed Chraa
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2023-12-192023-12-19421Management of caustic pharyngoesophageal injuries in Korle Bu Teaching Hospital, Accra, Ghana: a 12-year retrospective review of 29 cases
https://www.ajol.info/index.php/pamj/article/view/255264
<p><strong>Introduction:</strong> caustic pharyngoesophageal strictures are life-threatening injuries with important management difficulties, lacking clear therapeutic guidelines. The aim of this study is to evaluate the surgical procedures and outcomes of severe caustic pharyngoesophageal strictures in our institution. <strong>Methods:</strong> a total of 29 patients who underwent surgery for severe caustic pharyngoesophageal injury at the National Cardiothoracic Center from June 2006 to December 2018 were retrospectively reviewed. The age distribution, sex, management procedures, complications after surgery, and the outcome were analyzed. <strong>Results:</strong> there were 17 males. The mean age was 11.7 years (range 2- 56 years). All patients accidentally swallowed caustic soda, except the oldest patient who ingested an unidentified substance. The treatment procedures included colopharyngoplasty in 15 (51.7%) patients, colon-flap augmentation pharyngoesophagoplasty (CFAP) in 10 (34.5%), and colopharyngoplasty with tracheostomy in 4 (13.8%). There was one case of graft obstruction from a retrosternal adhesive band and one case of postoperative reflux with nocturnal regurgitation. No cervical anastomotic leak occurred. Rehabilitative training for oral feeding was required for less than a month in most patients. Follow-up period ranged from one to twelve years. Four patients died within this period; two were immediate post-operative deaths and two occurred late. One patient was lost to follow-up. <strong>Conclusion:</strong> outcome of surgery for caustic pharyngoesophageal stricture is satisfactory. Colon-flap augmentation pharyngoesophagoplasty reduces the need for tracheostomy before surgery, and our patients start eating early without aspiration.</p>Mark TetteyFrank EdwinMartin TamateyKelechi OkontaKow Entsua-MensahInnocent AdzamliErnest Aniteye
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2023-12-192023-12-19421Amputation totale du gland lors de la circoncision en milieu non hospitalier: rapport de cas
https://www.ajol.info/index.php/pamj/article/view/255267
<p>L´amputation du gland au cours de la circoncision est une complication tragique dont la responsabilité incombe à l´opérateur. Le traitement de référence de cette lésion repose sur la réimplantation microchirurgicale par anastomose vasculaire et nerveuse. Nous rapportons deux cas d´amputation totale du gland chez deux enfants: le premier âgé de cinq ans admis en urgence à la suite d´une circoncision et dont la réimplantation a été faite dans l´heure suivant l´accident, sans anastomose microchirurgicale; et le second était âgé de 11 ans reçu 3 ans après l´accident, géré psychologiquement jusque-là; il est en attente d´une chirurgie plastique. Le résultat obtenu après prise en charge du premier avait été jugé bon tant sur le plan urinaire, sur le plan de la sensibilité, de l´aspect cosmétique du gland et sur le plan érectile.</p>Dimitri Kanyanda NafatalewaAugustin Kibonge MukakalaIgor Mujinga wa MujingaNasser Amisi LuboshaSerge Ngoy YumbaManix Ilunga BanzaVincent de Paul KaomaPrince Muteba katambwaEric Mbuya MusapudiJeff Bukasa MisengaPitchou Mbey Mukaz
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2023-12-192023-12-19421Prévalence et facteurs associés aux candidoses vulvovaginales chez les femmes admises en consultation à l´Hôpital de Zone de Mènontin
https://www.ajol.info/index.php/pamj/article/view/255273
<p><strong>Introduction: </strong>les candidoses vulvovaginales (CVV) sont des affections cosmopolites, très fréquentes et très récidivantes, lié à la rupture de l´équilibre vaginal et du mécanisme de l´immunité locale. L´objectif de cette étude est de déterminer la prévalence et les facteurs associés aux CVV chez les femmes admises en consultation à l´hôpital de Ménontin. <strong>Méthodes: </strong>il s´est agi d´une étude transversale à visée descriptive et analytique menée au Service de Gynéco-obstétrique de mars à août 2020. Les données sociodémographiques et médico-gynécologiques ont été collectées chez 1336 sujets. L´identification des espèces de candida s´est basée sur les tests microbiologiques conventionnels. <strong>Résultats: </strong>la prévalence des candidoses est de 56,25% chez femmes présentant une leucorrhée. Elle n´est pas associée aux facteurs sociodémographiques tels que la tranche d´âge, au statut matrimonial et à l´IMC. Au niveau de facteurs gynécologiques, l´état gestationnel, la couleur du col de l´utérus ainsi que la quantité et la consistance des leucorrhées sont en lien avec la survenue des candidoses. Les espèces les plus fréquentes sont <em>Candida dubliniensis</em> (36,11%), <em>Candida albicans</em> (29,17%). <strong>Conclusion: </strong>il existe huit espèces de candida responsable des CVV au sud du Bénin. La connaissance des facteurs associés permettra la mise en place des stratégies de lutte appropriées de ces affections.</p>Brice Armand FanouJean-Robert KlotoeVictorien DougnonAmamath MonteiroCharles Hornel KoudokponFrédéric Loko
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2023-12-192023-12-19421Pulmonary hypertension among patients hospitalized with acute heart failure in Buea, South West Region of Cameroon
https://www.ajol.info/index.php/pamj/article/view/255995
<p><strong>Introduction: </strong>pulmonary hypertension (PH) is a common and severe complication in patients with heart failure (HF). It is associated with increased morbidity and mortality. There is limited data in Cameroon on the prevalence of PH in hospitalized HF patients and its impact on outcome. <strong>Methods: </strong>we analyzed data from consecutive adult patients hospitalized with. Pulmonary hypertension (PH) was defined as pulmonary artery systolic pressure (PASP) ≥ 35mmHg. <strong>Results: </strong>eighty-six (86) consecutive patients were hospitalized and 66(76.7%) had measurable PASP on echocardiography. Of those with echocardiographically measurable PASP (66), there were 39 (59.1%) females. The median (IQR) age was 60 (42-76) years. The prevalence of PH was 93.9%. PH was present in all (100%) patients with right heart failure (RHF) and in 62 (93.9%) patients with left heart failure (LHF). Severe PH (PASP ≥55 mmHg) was seen in 45 (68.2%, [95% CI: 55.6-75.1]) patients. The mean PASP was significantly higher in those with isolated RHF compared with those who had isolated left or bi-ventricular failure. Factors likely associated with moderate-to-severe PH (PASP ≥ 45 mmHg) were female sex, RHF, and right atrial dilatation. After adjusting for sex, right atrial dilation was independently associated with moderate-to-severe PH. In-hospital death occurred in 7 (10.6%, [95% CI: 4.4-20.6]) patients. The median (IQR) time to death was 6 (3-7) days and ranged from 2 to 8 days. All deaths (100%) occurred in those with moderate-to-severe PH. <strong>Conclusion: </strong>the prevalence of pulmonary hypertension in hospitalized heart failure patients was high with two third of the patients having severe PH, and most commonly occurred in females. All deaths occurred in patients with moderate-to-severe PH.</p>Clovis NkokeAhmadou Musa JingiJean Jacques NoubiapAnastase Dzudie
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2023-12-192023-12-19421Syndrome de la pince aorto-mésentérique sur cancer gastrique: à propos d´un cas
https://www.ajol.info/index.php/pamj/article/view/256004
<p>Responsable d´un tableau d´occlusion intestinale haute aiguë ou chronique, le syndrome de la pince aorto-mésentérique ou syndrome de Wilkie résulte de la compression du troisième duodénum entre l´artère mésentérique supérieure et l´aorte. La tomodensitométrie abdominale facilite le diagnostic. La dénutrition sévère est le principal facteur étiologique. Son traitement peut être médical par aspiration gastrique et nutrition parentérale. En cas d´échec, la chirurgie s´impose. Nous rapportons le cas d´un patient de 46 ans, tabagique, reçu pour vomissements bilieux et alimentaires post-prandiaux abondants. Il présentait un amaigrissement de 7% sur 6 mois. La fibroscopie digestive haute retrouvait une masse tumorale antro-pylorique non sténosante. L´histologie était en faveur d´un adénocarcinome tubuleux peu différencié de l´estomac. Le bilan d´extension était négatif et a permis de découvrir un syndrome de pince aorto-mésentérique avec un angle de 8°C. Il a bénéficié d´une nutrition parentérale pendant 10 jours suivie d´une gastrectomie polaire inférieure et d´une anastomose gastro-jéjunale sur anse en oméga. Les suites étaient simples. Une chimiothérapie adjuvante a été indiquée.</p>Abdou NiassePapa Mamadou FayePapa Mamadou FayeSerge Ramou KuadjoviAbdoulaye LeyeNgoné Diaba DiackMohamadou Lamine GueyeOusmane ThiamMamadou NdiayeAhmed DioufIbrahima Sitor Souleymane SarrAlpha Oumar ToureMamadou SeckMamadou CisseMadieng Dieng
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2023-12-192023-12-19421Reporting and recording of adverse drug reactions of highly active antiretroviral therapy by HIV infected patients and healthcare professionals respectively in the Ethekwini Metropolitan of Kwa-Zulu Natal, South Africa: a cross-sectional and retrospective
https://www.ajol.info/index.php/pamj/article/view/256117
<p><strong>Introduction:</strong> even though Highly Active Antiretroviral Therapy (HAART) is effective in managing Human Immuno-deficiency Virus (HIV) infection, it is not without its adverse drug effects (ADE) and or adverse drug reactions (ADRs). The study of ADRs associated with HAART in hospitals and clinics is crucial in gauging the burden of the severity of morbidity and mortality in such facilities, hence the reporting of such ADRs is important. <strong>Methods: </strong>the study was divided into 2 phases: the 1<sup>st</sup> phase entailed collecting data from HIV infected patients using a questionnaire on ADR experienced, whilst the 2<sup>nd</sup> phase was a retrospective analysis of respective patients´ medical files to record if an ADR was experienced. Three antiretroviral clinics linked to public sector facilities in EThekwini Metro, Kwa-Zulu Natal were the study sites. <strong>Results: </strong>seventy-two percent of patients reported at least one ADR after HAART initiation. Skin rash (11%) was the most commonly stated ADR by patients, whilst anemia (29%) and cardiovascular disease (23%) were the most commonly recorded ADRs on the patients´ medical files. Of those patients who reported ADRs, 57% were on the first line regimen consisting of Tenofovir, Emtricitabine and Efavirenz. Thirty-six patients reported that they were admitted to hospitals due to ADRs, however none resulted in death. These ADRs were experienced by patients on different regimens, with 10 admissions from the same regimen. <strong>Conclusion: </strong>adverse drug reactions were experienced by South African patients, however the reporting of ADRs by patients were inconsistent with what was recorded on their medical files.</p>Sindiswa Landile ZondiPanjasaram Naidoo
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2023-12-192023-12-19421Impact of the updating of clinical guidelines for RSV bronchiolitis on the use of diagnostic testing and medications in tertiary hospitals in Colombia
https://www.ajol.info/index.php/pamj/article/view/256118
<p><strong>Introduction:</strong> the incidence of Respiratory Syncytial Virus (RSV) infection and their variability in the clinical management, make this disease a candidate for monitoring adequate use of resources. The objective of this study was to evaluate the impact of the updating of clinical guidelines for RSV bronchiolitis on the use of diagnostic testing and medications in tertiary hospitals in Colombia. <strong>Methods:</strong> we performed a cross-sectional study, evaluating the frequencies of drug prescription and medical tests, before (January-December 2016) and after (January to December 2019) of updating and dissemination of a new protocol for the treatment of RSV bronchiolitis in two tertiary hospitals in Colombia. <strong>Results:</strong> a total of 108 patients with RSV bronchiolitis were included. The demographic characteristics and clinical manifestations were similar in both groups. The length of hospital stays was similar in both groups. We did not find statistically significant differences in the frequency of medical tests. There was a decrease in the use of salbutamol (67.3% pre-protocol vs 51.8% post-protocol; P < .01). There were also significant reductions in the use of nebulized hypertonic saline solution (91.6% vs 82.6% P = 0.004). <strong>Conclusion:</strong> our results demonstrate that the updating of clinical guidelines for RSV bronchiolitis was effective, as it achieved decreases in the use of bronchodilators and nebulized hypertonic saline solution. It is necessary to continue developing new strategies targeted to increase adherence to guidelines and evaluate the impact on the use of resources.</p>Jefferson Antonio BuendíaDiana Guerrero Patiño
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2023-12-192023-12-19421Méningo-encéphalite à Haemophilus influenzae type b chez le grand enfant: à propos d´un cas
https://www.ajol.info/index.php/pamj/article/view/256120
<p>Les infections invasives à <em>Haemophilus influenzae</em> de type b (Hib) sont devenues rares après la généralisation de la vaccination. Nous rapportons le cas d´un garçon âgé de 9 ans admis dans un tableau d´état de mal convulsif dans un contexte de fièvre avec altération de l´état de conscience. L´examen initial avait trouvé un enfant comateux, score de Glasgow à 9/15, une fièvre à 38,2, des réflexes ostéo-tendineux vifs sans syndrome méningé franc. Le bilan biologique avait montré une hyperleucocytose à polynucléaires neutrophiles (PNN) avec une CRP à 45,8. L´étude du liquide céphalorachidien avait montré un aspect trouble, une pléiocytose à 6760 éléments blancs/mm<sup>3</sup> avec une prédominance neutrophile (PNN = 90%, Lymphocytes = 10%). L´examen direct a montré des bacilles polymorphes, l´antigène soluble était positif à l´<em>Haemophilus influenzae</em> de type b. La glycorachie était effondrée à 0.04 mmol/Let la protéinorachie était franchement élevée à 4.097 g/L. L´imagerie cérébro-médullaire par résonance magnétique a montré un aspect évocateur d´encéphalite de topographie sous et sus tentorielle avec des anomalies de signal cortico-sous corticales pariéto-occipitales et cérébelleuses bilatérales. L´évolution était favorable sous Céfotaxime. Devant ce tableau d´infection invasive à Hib, la vérification du carnet de santé de notre patient a montré une absence de vaccination contre le Hib durant la petite enfance. Après un recul de 3 ans, il est asymptomatique ne présentant pas de séquelles neurosensorielles. Le développement d´une infection sévère à Hib doit faire obligatoirement vérifier la réalité de la vaccination ou rechercher un déficit immunitaire sous-jacent.</p>Ines TrabelsiMouadh Ben AliManel Ben RomdhaneHanen SmaouiKhadija Boussetta
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2023-12-192023-12-19421Bladder mucinous adenocarcinoma as a diagnostic challenge: a case report
https://www.ajol.info/index.php/pamj/article/view/256125
<p>Primary bladder adenocarcinoma (PBA), especially the mucinous subtype, is a rare cancer that represents less than 2% of all bladder malignancies. Overlapping histopathological and immunohistochemical (IHC) features of PBA with metastatic colonic adenocarcinomas (MCA) make the final diagnosis very hard. We presented a 75-year-old woman presenting with hematuria and severe anemia in the last two weeks. The abdominal computed tomography scan showed a tumor-sized 2x2 cm right to the bladder dome. The patient underwent partial cystectomy without postoperative complication. The histopathologic and IHC showed mucinous adenocarcinoma and could not distinguish between the PBA from MCA. Investigations to exclude MCA revealed no other primary malignant site and suggested PBA. In conclusion, mucinous PBA requires ruling out any possibility of a metastatic lesion that could arise from other organs. Treatment should be considered an individual approach based on the tumor location and size, the patient´s age, general condition, and comorbidities.</p>Sofronievska Glavinov MajaKostadinova Kunovska SlavicaAbdiu SuadJovanovic Rubens
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2023-12-192023-12-19421Antihyperglycemic effect of Vernonia amygdalina and in vitro evaluation of its antiproliferative activity on human osteosarcoma MG-63
https://www.ajol.info/index.php/pamj/article/view/256320
<p><strong>Introduction: </strong>the leaves of <em>Vernonia amygdalina (V. amygdalina)</em> are consumed as food in sub-Saharan Africa (SSA). In traditional medicine, this plant is widely used in the treatment of cancer and diabetes mellitus. In the present study, we evaluated the antihyperglycemic and the antiproliferative activities of the hydroalcoholic extract of <em>V. amygdalina</em> leaves (HAEVa). <strong>Methods: </strong>we conducted an experimental descriptive and analytical study with a prospective data collection from May 2019 to July 2020. For the in vivo study, the experiments were carried out on albino male rats of Wistar strain (<em>Rattus norvegicus</em>). Antihyperglycemic activity was performed in vivo in dexamethasone-induced insulin-resistant rats using the oral glucose tolerance test (OGTT). The biocompatibility and the antiproliferative activity of extract were performed in vitro respectively on rabbit primary dermal fibroblasts (RPDF) and human osteosarcoma MG-63 cells using the 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The data were analyzed with the GraphPad Prism software version 5.0.3. The statistical analyses were obtained by the analysis of variance (ANOVA), followed by Bonferroni´s post-test. P<0.05 was considered as the minimal level of statistical significance. <strong>Results: </strong>regarding to the antiproliferative investigation, extract at 125, 250 μg/mL exhibited a significant cytotoxic effect on human osteosarcoma MG-63 compared to the vehicle (p<0.001) in a dose-response manner after 24h, 48h of exposure to HAEVa. Interestingly, HAEVa in concentrations of 125 and 250 μg/ml showed no cytotoxicity (p>0.05) on RPDF after the different times of exposure. However, HAEVa in a high concentration of 500 μg/mL wasn´t biocompatible with RPDF. HAEVa also prevented postprandial blood glucose level in dexamethasone-induced insulin-resistant rats at both doses tested (p>0.05 and p<0.01 at doses of 50 and 100 mg/kg respectively). <strong>Conclusion: </strong>the results of this study suggest that HAEVa has antiproliferative properties on MG-63 osteosarcoma in vitro and also inhibits in vivo the postprandial blood glucose level in dexamethasone-induced insulin-resistant rats.</p>Barnabé Lucien Nkono Ya NkonoAblassé RouambaIoana Alexandra DuceacLiliana Verestiuc
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2023-12-192023-12-19421Primary huge gastric leiomyosarcoma with multiple metastases in a 60-year-old female: a case report
https://www.ajol.info/index.php/pamj/article/view/256330
<p>The incidence of leiomyosarcomas (LMS) has declined drastically. In fact, the introduction of immunohistochemistry (IHC) helped to differentiate LMS from other gastrointestinal stromal tumors (GIST) by receptor tyrosine kinase (KIT)-mutation detection making gastric LMS a sporadic tumor recently. We report a 60-year-old female who presented with a three-week history of abdominal pain. An abdominal computed tomography scan showed a large exophytic mass (22 ×19 ×15 cm) arising from the greater curvature of the stomach with multiple metastases. A biopsy was taken, and the initial histopathological examination was suggestive of GIST. However, further histopathological examination confirmed a high-grade gastric LMS. The patient refused any surgical intervention. Therefore, the patient had only received chemotherapy. On 9-month follow-up, the patient is still alive without disease progression. In conclusion, gastric LMS is a rare tumor. Due to the possibility of being misdiagnosed with other GIST, extensive pathological evaluation through specialized experts and IHC analysis is recommended.</p>Fayed Al-YousofGamal AlshargabiFaisal AhmedAbdullatif AlmohtadiMuneer FazeaAbdulfattah Altam
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2023-12-192023-12-19421A rare case of secondary syphilis
https://www.ajol.info/index.php/pamj/article/view/256462
<p>The organism <em>Treponema pallidum</em> causes syphilis, a chronic inflammatory disease. Secondary syphilis is distinguished by the appearance of a wart-like sore 2 to 6 weeks after the chancre forms and, in some cases, before the chancre heals. The presence of other systemic symptoms indicates that the infection has spread to other parts of the body. During the secondary stage, a person is highly contagious. A 38-year-old man presented at the outpatient department with complaints of fever, weight loss patchy hair loss, and sore throat for the past five weeks. Physical examination revealed diffuse lymphadenopathy, hepatosplenomegaly, and the presence of reddish wartlike sores over the glans penis. Blood investigations showed a positive venereal disease research laboratory test (VDRL). <em>Treponema pallidum</em> particle agglutination assay (TP-PA) was positive for <em>T.pallidum</em> specific immunoglobulin G (IgG) antibody. For treatment, a stat dose of 2g of azithromycin was given orally and was advised for follow-up. Sexual contact of syphilis patients should be evaluated.</p>Surya Besant NatarajanKrishna Prasanth Baalann
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2023-12-192023-12-19421State-wide situation analysis of availability of basic resuscitation devices and essential drugs in primary and secondary healthcare facilities in Cross River State, Nigeria
https://www.ajol.info/index.php/pamj/article/view/256519
<p><strong>Introduction: </strong>Provision of Basic Life Support (BLS) to victims of cardiac arrest and other common causes of sudden death, is a key function of healthcare systems. Such life-saving service, which is lacking in many low- and middle-income countries (LMIC), is highly dependent on consistent availability of BLS devices and essential drugs. These devices are used to secure airway, deliver oxygen, gain intravenous access for infusions, provide cardiac defibrillation and monitor the cardiorespiratory systems. This study was aimed at evaluating the current state of availability of these devices and essential drugs in healthcare facilities in a developing country setting, within the context of urgent need to curb increasing burden of preventable sudden death. <strong>Methods: </strong>descriptive cross-sectional study design was employed to assess availability of each of the aforementioned subgroups of resuscitation devices and drugs, in each primary and secondary healthcare facility in all eighteen (18) Local Government Areas (LGAs) of Cross River State, in Southern Nigeria. Quantitative data was obtained using structured proforma, which was used to document presence and quantity of physically seen device(s) and drugs in each facility. The proportion of health facilities with presence of the devices and drugs, was compared between the three districts using chi-square test. P-value was set at 0.05. <strong>Results: </strong>two hundred and five (205) health care facilities across the eighteen (18) LGAs of Cross River State were assessed. Approximately one-tenth of health facilities had oropharyngeal airway (10.2%) and laryngoscope (9.3%). Only 5.4% and 3.9% had nasopharyngeal and endotracheal tubes, respectively. None of all of these airway devices was found in all health facilities within four LGAs (22.2%). The most commonly available breathing device was self-inflation bag (SIB), which was found in 51.7% of facilities. Seven LGAs (38.9%) had all of their health facilities not having either oxygen delivery devices, oxygen supply or both. Most health facilities had each of the IV access devices and infusion fluids, but only five facilities had automated external defibrillator (AED). Most health facilities had stethoscope (91.2%) and sphygmomanometer (72.2%), but only 15.1% and 9.3% had pulse oximeter and airway nebulizer, respectively. Less than one-fifth (18.5%) of facilities had atropine, and only 3.9% had amiodarone. Except for amiodarone, there was significantly higher proportion of health facilities that had each of the other essential drugs, in northern compared with other districts (p<0.05). <strong>Conclusion: </strong>devices and essential drugs required for provision of resuscitation are lacking in most health facilities in Cross River State. This situation significantly limits the health system’s capacity to save lives, especially during emergencies. The implications of these state-wide findings, as well as modalities and options for improvement in availability of these essential devices and drugs are discussed in this article.</p>Queeneth Ndukwe KaluTeresa Abang EdentekheOgban Ezukwa OmoronyiaBassey Etim NakandaArit Ayi Archibong
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2023-12-192023-12-19421Aspergillose sterno-costale après angioplastie coronaire: à propos d´un cas
https://www.ajol.info/index.php/pamj/article/view/256522
<p>L´aspergillose sternale est extrêmement rare. Parmi tous les cas d´aspergillose invasive rapportés dans la littérature, l´incidence de l´ostéomyélite est inférieure à trois pour cent. L´aspergillose survient préférentiellement sur un terrain d´immunodépression. La présentation clinique et radiologique est peu spécifique. La contamination se fait essentiellement par inhalation de spores, mais elle peut aussi atteindre directement une zone vulnérable après un acte médical. Le diagnostic est souvent difficile à faire et peut nécessiter plusieurs semaines. Surtout si le médecin ne pense pas à un Aspergillus. Le diagnostic positif est orienté par l´imagerie mais sa confirmation est anatomopathologique et/ou mycologique. Le pronostic dépend essentiellement de la précocité d´administration du traitement. Nous présentons un patient de 63 ans, diabétique, ayant une ostéomyélite à Aspergillus de localisation sterno-costale survenue après une angioplastie coronaire.</p>Ahd OuladlahsenSanaa JebbaLaila BenkiranLatifa MarihMustapha SodqSoussi-Abdellaoui MahaZouhair ChefchaouiniBrahim IdaliChaoui Zouhair
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2023-12-192023-12-19421L´hépatite virale B en milieu de soins: facteurs associés à la vaccination chez les élèves professionnels de santé de l´Ecole nationale de santé publique de Ouagadougou, Burkina Faso
https://www.ajol.info/index.php/pamj/article/view/256524
<p><strong>Introduction: </strong>l´hépatite B est une maladie grave évitable par la vaccination. Pourtant, peu de professionnels de santé sont vaccinés contre cette maladie au Burkina Faso. Cet article examine les facteurs associés à la vaccination chez des élèves professionnels de santé. <strong>Méthodes: </strong>l´étude a été conduite auprès des élèves professionnels de santé de l´école nationale de santé publique de Ouagadougou au Burkina Faso. La collecte de données s´est déroulée du 26 mai au 1<sup>er</sup> juin 2020. Les participants aléatoirement choisis ont été soumis à un questionnaire auto-administré. Les facteurs associés à la vaccination ont été déterminés à l´aide d´une régression logistique multivariable et les résultats ont été présentés sous forme de odds ratio ajustés avec des intervalles de confiance à 95%. <strong>Résultats: </strong>au total, 410 élèves professionnels de santé ont participé à l´étude. Ils étaient majoritairement de sexe féminin soit 68,8% (293/410) et leur âge moyen était de 25,71 ans (± 3,57). Parmi ces élèves, 31% (127/410) était complètement vaccinés contre l´hépatite B. Dans le modèle multivariable, la connaissance du mode de transmission, des complications de la maladie, et des risques d´expositions en milieu de soins étaient associées à la vaccination contre l´hépatite B. <strong>Conclusion: </strong>la faible couverture vaccinale des élèves professionnels de santé est liée à une insuffisance de connaissances sur l´hépatite B. Le renforcement des connaissances de ce groupe à risque sur cette maladie s´avère nécessaire.</p>Pengdewendé Maurice SawadogoLarba LankoandéDésiré Lucien DahourouKoiné Maxime Drabo
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2023-12-192023-12-19421Assessment of visceral adiposity index and lipid accumulation product index as markers of chronic kidney disease among diabetic and hypertensive patients at the Bamenda Regional Hospital, Cameroon: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/256529
<p><strong>Introduction:</strong> very limited studies have emphasized the importance of visceral adiposity index (VAI) and lipid accumulation product index (LAPI) in the prevention and management of chronic kidney disease (CKD) especially in diabetic and hypertension patients in developing countries including Cameroon. This study aimed at assessing whether VAI and LAPI are markers of CKD among diabetic and hypertensive patients at the Bamenda Regional Hospital, Cameroon. <strong>Methods:</strong> this analytical cross-sectional study was conducted at Bamenda Regional Hospital and involved 200 diabetic and/or hypertensive patients, including 77 males and 123 females. The participant´s anthropometric indices, biochemical parameters, VAI, LAPI, and glomerular filtration rate were investigated. A structured questionnaire was used to assess some risk factors of CKD and participant lifestyle. <strong>Results:</strong> the overweight (41%) and obesity (34%) statuses were prevalent in the population. A considerable proportion of subjects had elevated total cholesterol (46%), low-density lipoprotein (LDL) cholesterol (37.50%), triglycerides (24.5%), urea (40.5%) and creatinine (53.5%) levels. Stage 1 to 3 CKD was largely present in the elderly (>54-year-old) affecting the majority of patients (57.5%). Low education level and lack of physical activity were significantly associated with the prevalence of CKD (p < 0.001). On the contrary to creatinine (unadjusted OR = 1.36; 95% CI: 1.13-1.62), urea (unadjusted OR = 1.02; 95% CI: 1.01-1.03), HDL (unadjusted OR = 0.87; 95% CI: 0.78-0.97), total cholesterol/HDL ratio (unadjusted OR = 1.38; 95% CI; 1.12-1.71), VAI (unadjusted OR = 1.13; 95% CI: 1.05-1.22) and LAPI (unadjusted OR = 1.00; 95% CI: 1.00-1.00) were significantly associated with CKD status of the patients while HDL was negatively associated (unadjusted OR = 0.87; 95% CI: 0.78-0.97). The 9.905 and 5679 cut-offs of VAI and LAPI respectively for CKD discrimination obtained high sensitivity (75.0%) and specificity (≥79.6%). <strong>Conclusion:</strong> visceral adiposity index and LAPI were associated with CKD among diabetic and hypertensive patients. Visceral adiposity index and LAPI could be user-friendly tools for the early diagnosis of CKD among these categories of patients in Cameroon.</p>Aphrodite Tchewonpi ChoumessiBrice Ulrich Foudjo SahaLifoter Kenneth NavtiAteh Sheron TibiAnweck Thecla NjeckEdouard Akono Nantia
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2023-12-192023-12-19421Overlap of psoriasiform and primary syphilis: an atypical manifestation of secondary syphilis (a case report)
https://www.ajol.info/index.php/pamj/article/view/256534
<p>Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum (T. pallidum) with an increasing incidence in recent years. Secondary syphilis is called 'the great imitator' due to its various clinical presentations. Psoriasiform syphilis is an atypical presentation of secondary syphilis. The coinfection of syphilis with HIV has been linked to more severe clinical presentations increased risk of neurosyphilis, decreased CD4+ count, and an interesting phenomenon of overlapping primary and secondary syphilis. A 35-year-old male presented with generalized thick, scaly erythematous plaques, including the soles of the palms and feet, diffuse alopecia on the scalp and eyebrows, and multiple painless ulcers on the penis. The venereal disease research laboratory and Treponema pallidum hemagglutination assay examination showed positive results and the patient was treated with an intramuscular injection of 2.4 million units of Benzathine penicillin G. At the seventh-day follow-up, the patient showed significant clinical improvement marked by plaque thinning and reduced erythema. This case emphasizes that secondary syphilis may present with varied clinical presentations which can be further affected with HIV coinfection. Detailed history taking, physical examination, and a high level of suspicion are crucial in recognizing and establishing the right diagnosis.</p>Rizki Amelia NoviyanthiIvan KurniadiMuji IswantySafruddin AminAnni AdrianiMuhlis
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2023-12-192023-12-19421Syndrome de Rapunzel chez une enfant trisomique 21: à propos d´un cas
https://www.ajol.info/index.php/pamj/article/view/256537
<p>Le trichobezoard est une pathologie rare, elle correspond à la présence de cheveux et ou de fibres au niveau du tube digestif, conséquence d´une attitude compulsive (trichotillomanie) et d´un trouble de comportement alimentaire (trichophagie). Le trichobézoard gastrique est le plus fréquent, peut s´étendre à l´intestin grêle arrivant parfois à la dernière anse iléale, voire au côlon transverse, réalisant ainsi le syndrome de Rapunzel. Nous rapportons un cas de trichobézoard gastroduodénal et grêlique chez une jeune fille de 6 ans avec faciès trisomique, consulte pour des douleurs abdominales récidivantes depuis 01 mois avec une suspicion de lymphome digestif chez qui le diagnostic de trichobézoard est fait en per opératoire. Notre but est de donner un aperçu sur l´historique de cette affection rare et de préciser les modalités diagnostiques et thérapeutiques.</p> <hr> <p><a role="button" href="https://www.panafrican-med-journal.com/content/article/42/230/full/#faqtable1" data-toggle="collapse" aria-expanded="false" aria-controls="collapseExample"><strong><em>English abstract</em></strong></a></p> <p><strong><em>Trichobezoard is a rare condition characterized by a gastric mass composed of hair or fibers due to a compulsive attitude (trichotillomania) and an eating disorder (trichophagia). Gastric trichobezoar is the most common form and may extend into the small bowel, sometimes reaching the last ileal loop, or even the transverse colon, resulting in Rapunzel syndrome. We here report a case of gastroduodenal and small intestine trichoboozoar in a 6-year-old girl with facies of trisomy, presenting with recurrent abdominal pain lasting for one months and suspected gastrointestinal lymphoma. The diagnosis of trichoboozoar was based on surgery. The purpose of this study is to give an overview of the history of this rare condition and to clarify the diagnostic and therapeutic approaches used.</em></strong></p>Rabab Atae-AllahYousra El BoussaadniKawtar KhabbacheAziz ElmadiAbdallah Oulmaati
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2023-12-192023-12-19421Syndrome du canal carpien bilatéral modéré amélioré par la mobilisation neurodynamique du nerf médian: à propos d´un cas
https://www.ajol.info/index.php/pamj/article/view/256539
<p>Le syndrome du canal carpien est la neuropathie canalaire la plus fréquente affectant le membre supérieur. Plusieurs approches thérapeutiques sont utilisées pour traiter ce syndrome, dont le traitement conservateur souvent de première ligne. Nous rapportons l´observation d´une patiente de 61 ans, qui s´est présentée au service de neurophysiologie clinique de l´hôpital de spécialités de Rabat pour un syndrome du canal carpien sensitif modéré et bilatéral confirmé par électroneuromyogramme (ENMG). L´intervention a consisté en une thérapie manuelle incluant une mobilisation neurodynamique du nerf médian en bilatéral. L´évolution a été marquée par une disparition de l´engourdissement nocturne et l´ENMG de contrôle a montré une nette amélioration des paramètres de conduction nerveuse. D´après ce résultat positif, la mobilisation neurodynamique du nerf médian pourrait être considérée comme une piste envisageable dans le cadre du traitement conservateur du syndrome du canal carpien.</p>Hassan BeddaaBouchra KablyBasma MarzoukYouness AzemmourIsmail Bouzekraoui Alaoui
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2023-12-192023-12-19421Tenosynovial giant cell tumour in Hoffa fat pad: a case report
https://www.ajol.info/index.php/pamj/article/view/256541
<p>Giant cell tumour is a benign lesion classified as a fibrocystic tumour whose localization in Hoffa's fat pad is very rare. Clinical symptoms are insidious and non-specific causing a frequent confusion and delay in diagnosis therefore it should be distinguished radiologically from other similar conditions such as Hoffa´s disease and lipomas. We report a case of a 37-year-old patient, with no relevant history, who complained of a right knee pain for 5 years. Magnetic resonance imaging showed a small nodular mass in Hoffa's pad which was excised through a direct approach. Histologic examination of the specimen revealed a giant cell tenosynovial tumour. One year after surgery, the patient was asymptomatic with no local recurrence. The surgical removal of the tumour is the ideal treatment. The choice between open surgery and endoscopy depends on the site, size, and extent of the tumour.</p>Youssef OthmanYahia AlouiFiras ChaouchSaber RabhiMakram ZrigAbderrazek Abid
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2023-12-192023-12-19421Prevalence of cardiovascular risk factors and their association with renal impairment in elderly patients with type 2 diabetes mellitus in a Nigerian tertiary hospital: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/257083
<p><strong>Introduction: </strong>the population of elderly with type 2 Diabetes Mellitus (T2DM) has been on the increase. The burden of cardiovascular disease and renal impairment may also increase due to the relationship between cardiovascular risk factors and ageing in those with T2DM. The prevalence of cardiovascular risk factors and their association with renal impairment in elderly with T2DM were determined. <strong>Methods: </strong>this is a cross-sectional study that involved 96 elderly patients with T2DM and 96 elderly individuals without DM as control. The prevalence of cardiovascular risk factors was determined among the study participants. Binary logistic regression was used to determine the significant cardiovascular factors associated with renal impairment among the elderly with T2DM. P-value <0.05 was taken as significant. <strong>Results: </strong>the mean age of the elderly with T2DM and control group were 66.73±5.18 years and 66.78±5.25years, respectively. The male: female ratio was 1:1 for both groups. The prevalence of the cardiovascular risk factors in the elderly with T2DM and control were; hypertension (72.9%vs39.6%; p ≤0.001), high glycated haemoglobin (77.1% vs 0%; p ≤0.001), generalized obesity (34.4%vs1.0%; p ≤0.001), central obesity (50.0%vs11.5%; p ≤0.001), dyslipidemia (97.9%vs89.6%; p=0.016), albuminuria (69.8% vs 11.2%; p ≤0.001), anaemia (53.1%vs18.8%; p ≤0.001). Renal impairment was present in 44.8% of the elderly T2DM. On multivariate analysis, the cardiovascular risk factors significantly associated with renal impairment in elderly with T2DM were high glycated haemoglobin (aOR: 6.21,95% CI:1.61-24.04; p=0.008), albuminuria (aOR:4.77, 95% CI:1.59-14.31; p=0.005) and obesity (aOR:2.78,95%CI 1.04-7.45; p=0.042). <strong>Conclusion: </strong>cardiovascular risks factors were highly prevalent and closely associated with renal impairment in elderly with T2DM. Early cardiovascular risk factor modification may reduce both renal and cardiovascular disease burden.</p>Oladimeji Adedeji JunaidOlubukola Ayoola OjoOluseyi Ademola AdejumoFolorunsho Mansally JunaidSunday Samson OwoladeOlalekan Ezekiel OjoBabatope Ayodeji KolawoleTemidayo Rosemary Ikem
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2023-12-192023-12-19421A traumatic injury leading the lipoma of neck: a rare image
https://www.ajol.info/index.php/pamj/article/view/258229
<p>A 58 years old male visited our hospital with the complaint of swelling over the posterior aspect of the neck after sustaining a trauma as a result of a fall of a cement slab over him 5 years back. The patient is under a combination of metoprolol and telmisartan medication for the rectification of hypertension for 10 years. The patient got admitted to the hospital for the above complaint and has undergone a histopathology report, MRI, and USG investigation. In the histopathology report, we received a single container labelled as a resected specimen of large lipoma. On the cut section, a solid, yellowish, homogenous area was identified. MRI investigation reported a lesion over the nape of the neck size measuring from 25x20x8cm in size. USG report stated a lesion over the nape of the neck and occipital region with the dimensions of the left side as 53x25mm approximately, right side as 58x31.5 mm approximately. After both MRI and USG investigation, the patient was diagnosed with lipoma over the nape of the neck and occipital region. The patient had gone through two separate operations in a spare of 11 days. Complete excision of Excessive fibrofatty tissue size 10x15 cm lipoma was done. Flap was approximated and romovac drian no 14 placed. Closure was done with ethilon2-0 ac. PPd debridement was done with secondary suturing. Hemostasis was confirmed and Patient stable. Shifted to ward and got discharged after 1 week with prescribed medications and physiotherapy exercise.</p>Heena Hussain PathanSanskarsingh Vijaysingh Banafar
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2023-12-192023-12-19421Ambulatory hernia repair: a study of 1294 patients in a single institution
https://www.ajol.info/index.php/pamj/article/view/258237
<p><strong>Introduction: </strong>ambulatory surgery is continuously expanding in global reach because of its several advantages. This study aimed to describe the experience of our department in outpatient hernia surgery, evaluate its feasibility and safety, and determine the predictive factors for failure of this surgery. <strong>Methods: </strong>we conducted a monocentric retrospective cohort study on patients who had ambulatory groin hernia repair (GHR) and ventral hernia repair (VHR) in the general surgery department of the Habib Thameur Hospital in Tunis between January 1<sup>st</sup>, 2008 and December 31<sup>st</sup>, 2016. Clinicodemographic characteristics and outcomes were compared between the successful discharge and discharge failure groups. A p-value of ≤ 0.05 was considered significant. <strong>Results: </strong>we collected data from the record of 1294 patients. One thousand and twenty patients hadgroin hernia repair (GHR). The failure rate of ambulatory management of GHR was 3.7%: 31 patients (3.0%) had unplanned admission (UA) and 7 patients (0.7%) had unplanned rehospitalization (UR). The morbidityrate was 2.4% while the mortality rate was 0%. On multivariate analysis, we did not identify any independent predictor of discharge failure in the GHR group. Two hundred and seventy-four patients underwent ventral hernia repair (VHR). The failure rate of ambulatory management of VHR was 5.5%: 11 patients (4.0%) had UA and 4 patients (1.5%) had UR. The morbidity rate was 3.6% and the mortality rate was zero. On multivariate analysis, we did not identify any variable predicting discharge failure. <strong>Conclusion: </strong>our study data suggest that ambulatory hernia surgery is feasible and safe in well-selected patients. The development of this practice would allow for better management of eligible patients and would offer many economic and organizational advantages to healthcare structures.</p>Mohamed HajriDhafer HaddadHaithem ZaafouriMouna CherifAlia ZouaghiNizar KhedhiriAli MrabetAnis Ben Maamer
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2023-12-192023-12-19421Evaluation of the health information system for monitoring and evaluating the voluntary medical male circumcision program in Mozambique, 2013-2019
https://www.ajol.info/index.php/pamj/article/view/258241
<p><strong>Introduction: </strong>the prevalence of human immunodeficiency virus (HIV) in Mozambique has increased from 11.5% in 2009 to 13.2% in 2015. The Mozambique Ministry of Health (MOH) developed a 5-year strategy (2013-2017) for male voluntary medical circumcision (VMMC) to increase in the provinces where there is the greatest number of HIV. We aimed to evaluate the health information system for monitoring and evaluating VMMC in Mozambique from 2013-2019. <strong>Methods: </strong>we reviewed the records of the National Health Information System for Monitoring and Evaluation (SIS-MA) database for VMMC of the MOH. The evaluation was based on the updated guidelines for the evaluation of public health surveillance systems of the Centers for Disease Control and Prevention. <strong>Results: </strong>the coverage rate for VMMC in Mozambique in the period under study was (89%) (1,784,335/2,000,000). The system was expected to circumcise for the year 2019 (162,052) and 390,590 was reached, exceeding the target 241.0% (390,590/162,052). Of the total number of men circumcised, 0.7% (12,391/1,784,335) were HIV-positive (previously tested) and 0.4% (6,382/1,784,335) had a record of adverse events in the period under review (2013-2019). Zambézia Province had the highest VMMC coverage (in numbers) at 16.0% (396,876/2,476,395) while Maputo City had the least 19.7% (107,104/543,096). The system was able to operate both online and offline and continue functioning with introducing new changes (e.g. the new male circumcision complication reporting). <strong>Conclusion: </strong>the system was representative, flexible, simple, with good data quality and low acceptability. We recommended continuous and routine entry of quality data into the system, guide organizations for improved functioning.</p>Hélio Inácio EliasJosé Carlos LangaJudite Monteiro BragaZandile NukeriErika Valeska RossettoCynthia Sema Baltazar
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2023-12-192023-12-19421Psychological impact of coronavirus disease (COVID-19) on health professions students at the University of Zambia: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/258243
<p><strong>Introduction: </strong>the coronavirus disease 2019 (COVID-19) has negatively impacted the mental health of students across the globe. In Zambia, little is known about the psychological impacts of COVID-19 on healthcare students. This study assessed the psychological impact of COVID-19 on health professions students at the University of Zambia. <strong>Methods: </strong>this cross-sectional study was conducted from August 2021 to October 2021. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). The multivariable logistic regression model was used to identify the factors associated with anxiety and depression among the participants. Data were analysed using Stata 16.1. <strong>Results: </strong>of the 452 students, 57.5% were female, with the majority aged between 19 and 24 years. Overall, 65% (95% CI: 60.5-69.4) experienced anxiety, while 86% (95% CI: 82.7-89.3) experienced depression. Participants whose income was affected were more likely to experience anxiety (aOR; 2.09, 95% CI: 1.29-3.37) and depression (aOR; 2.87, 95% CI: 1.53-5.38). Anxiety was associated with difficulty in observing the COVID-19 preventive measures (aOR; 1.84, 95% CI: 1.21-2.81). Being depressed was associated with having a chronic condition (aOR; 3.98, 95% CI: 1.67-9.50) or a relative or friend who died from COVID-19 (aOR: 1.98, 95% CI: 1.06-3.70). <strong>Conclusion: </strong>many students experienced anxiety and depression during the COVID-19 third wave of infections. This calls for mitigation measures because continued anxiety and depression can affect the academic performance of students. Fortunately, most of the associated factors are modifiable and can easily be targeted when formulating interventions to reduce anxiety and depression among students.</p>Steward MudendaMukuka ChombaMoses MukoshaVictor DakaMisheck ChilesheRoland Nnaemeka OkoroJoseph FadareSadeq Al-FayyadhSody MunsakaMartin KampambaJosephine ChaliRuth Lindizyani MfuneChristabel Nang'andu Hikaambo
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2023-12-192023-12-19421Volvulus gastrique aigu compliquant une hernie diaphragmatique congénitale chez un nourrisson de 3 mois: à propos d´un cas
https://www.ajol.info/index.php/pamj/article/view/258248
<p>Le volvulus gastrique est un mode de révélation rare de la hernie diaphragmatique congénitale. Il s´agit d´une pathologie rare et de diagnostic difficile en pédiatrie. Nous rapportons le cas d´un nourrisson de trois mois ayant présenté une dyspnée aiguë d´aggravation rapide. La radiographie thoracique a montré une large clarté thoracique avec une poche à air gastrique ascensionnée. La tomodensitométrie thoraco-abdominale a objectivé un volvulus gastrique sur une hernie diaphragmatique congénitale gauche. Le traitement chirurgical a consisté en une dévolvulation gastrique puis réduction complète des viscères herniés et fermeture du défect diaphragmatique. L´évolution était favorable. La hernie diaphragmatique congénitale compliquée par un volvulus gastrique doit être considérée comme une urgence diagnostique et thérapeutique et ce du fait du risque de nécrose gastrique menaçant le pronostic vital.</p>Takwa MiliYosra Ben AhmedIntissar ChibaniTarek BoukesraFaouzi NouiraAwatef ChariegSaid Jlidi
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2023-12-192023-12-19421Bilateral camptodactyly
https://www.ajol.info/index.php/pamj/article/view/258258
<p>Greek for "camptodactyly" is "bent finger," and Smith and Kaplan's exhaustive review lists all of its numerous synonyms (1968). It refers to a non-traumatic flexion contracture of the proximal interphalangeal joint, typically of the little finger, in surgical practise. A post-traumatic aetiology rather than camptodactyly is suggested by involvement of the distal interphalangeal joint or the metacarpo-phalangeal joint. Prevalence less than 1%. It can be unilateral (33%) or bilateral (66%), if bilateral, can be symmetric or asymmetric. Camptodactyly should not be confused with clinodactyly or Kirner's deformity. A 12-year-old child presented to the outpatient department with painless contracture of bilateral small finger at the level of proximal interphalangeal joint (PIP) with minimal involvement of the ring and middle finger. The deformity was noticed during the recent growth spurt of the child. On examination there was flexion contracture present in bilateral small finger at the level of PIP joint. As the contracture was passively correctable with PIP flexion less than 30 degrees, the patient was educated regarding the passive stretching and splinting. He is currently under regular follow up. If we notice worsening of the deformity during the follow up, we will plan for operative management in the form of flexor digitorum superficialis (FDS) tenotomy, or FDS transfer to radial lateral band.</p>Aditya Laxmikant KekatpureAashay Kekatpure
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2023-12-192023-12-19421Glucose-6-phosphate dehydrogenase (G6PD) deficiency in girls: a diagnosis not to be missed: a case report
https://www.ajol.info/index.php/pamj/article/view/258453
<p>Glucose-6-phosphate dehydrogenase (G6PD) is a polymorphic enzyme encoded by the X chromosome. It protects the cell against hydrogen peroxide-induced damage and ensures an oxidative balance profile within the cell. The disease is more frequent in males, and rare cases are described in girls. We report an observation of a 7-month-old Moroccan girl hospitalized for acute hemolysis after consuming fava beans. The diagnosis of a G6PD deficiency was retained after an assay of the enzymatic activity that returned collapsed. After initial conditioning, a transfusion of phenotyped retinal ganglion cells (RGCs) is performed. The rapid evolution is favorable, and the child is discharged after therapeutic education sessions for the parents on the products to be avoided. Through this observation, we insist on the importance of neonatal screening in regions with a high prevalence of hemolysis in order to avoid diagnostic delays and also to prioritize the evaluation to be requested in an acute hemolysis state, to propose an education articulated around a preventive approach in children with this disease.</p>Yousra El BoussaadniAbdelhakim AboulfouyoulKaoutar KhabbacheHanan KhalkiAbdallah Oulmaati
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2023-12-192023-12-19421Manifestations neuropsychiatriques au cours du lupus érythémateux systémique: à propos de 108 cas au Cameroun
https://www.ajol.info/index.php/pamj/article/view/258458
<p>Peu de données sur les atteintes neuropsychiatriques au cours du lupus érythémateux systémique (NPSLE) sont disponibles en Afrique subsaharienne. Le but de cette étude était de déterminer leur fréquence et d´en décrire les caractéristiques au Cameroun. Il s´agit d´une étude rétrospective menée dans 3 hôpitaux du Cameroun colligeant tous les dossiers de patients lupiques de l´unité de rhumatologie de 2009 à 2019. L´évaluation de l´activité lupique était réalisée à l´aide du systemic lupus erythematosus activity index (SLEDAI). Au total, 108 dossiers de patients d´âge moyen de 40,2 ± 13,7 ans étaient inclus. La fréquence du NPSLE était de 55,5% (n = 60). Les NPSLE étaient présentes au diagnostic initial du LES chez 37,0% (n = 40) et survenaient chez 20 patients (18,5%) au cours de la première année. Lorsque le NPSLE était inaugural, l´atteinte du système nerveux central était dominante avec le syndrome démyélinisant 27,8% (n=30) et les céphalées 21,3% (n=23). La mononeuropathie était l´atteinte du système nerveux périphérique la plus importante soit 15,7% (n=17). Les facteurs associés à la survenue des NPSLE étaient le rash malaire (p=0,024), l´alopécie (p=0,024), l´activité lupique très élevée (p=0,011), l´arthralgie (p<0,001), le facteur anti-nucléaire (p=0,002). La présence des NPSLE ne semblait influencer ni l´activité lupique (log rank p=0,227), ni la probabilité de survenue d´une nouvelle poussée lupique (log rank p=0,233). Plus de la moitié de nos patients présentait un NPSLE au cours de la première année. La présence de signes cutanés et articulaires, d´une activité lupique élevée, et de facteur anti-nucléaire étaient associés à la survenue de NPSLE.</p>Mapoure Njankouo YacoubaSame Bebey FrancineBalla Nde Jean FrancoisEloundou Onomo PaulKenmegne CarolineGams Massi DanielDoumbe JacquesNgandeu Singwe Madeleine
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2023-12-192023-12-19421Extrapelvic endometriosis located individually in the rectus abdominis muscle: a rare cause of chronic pelvic pain
https://www.ajol.info/index.php/pamj/article/view/258462
<p>Endometriosis of the rectus abdominis muscle is an extremely rare form of extrapelvic localization of the disease. It is usually iatrogenic and develops after caesarean section or gynecological surgery. Preoperative diagnosis is very difficult and a challenge for gynecologists and surgeons; thus, the diagnosis is histological. The treatment of choice consists of wide local excision of the lesion on healthy margins. We cite a case of isolated endometriosis in the rectus abdominis muscles in a 46-year-old patient with a previous caesarean section, the diagnosis of which was made randomly when performing abdominal total hysterectomy for the treatment of chronic pelvic pain. Histological examination of the surgical specimen confirmed the diagnosis. Simultaneously, the surgical specimen of the uterus and ovaries was free of endometriosis. Postoperatively, the patient mentioned discharge of her symptoms. No further therapeutic intervention was deemed necessary, as it was considered that a complete resection of the endometrial tissue implantation from the muscles of abdominal wall was performed. The present case report lay emphasis on the significant difficulties involved in the preoperative diagnosis of endometriosis of the rectus abdominis muscle. Concurrently, it is pointed out that, despite its rarity, individual extrapelvic endometriosis located in the rectus abdominis muscle should be included among other pathological entities in the differential diagnosis of chronic pelvic pain in women of reproductive age, who gave birth by caesarean section or underwent gynecological surgery with abdominal or laparoscopic access.</p>Anna ThanasaEfthymia ThanasaEvangelos KamaretsosEvangelos-Ektoras GerokostasIoannis Thanasas
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2023-12-192023-12-19421Main challenges of the detection in the context of global health security: systematic review of Joint External Evaluation (JEE) reports
https://www.ajol.info/index.php/pamj/article/view/258466
<p><strong>Introduction: </strong>since 2016, Joint External Evaluation (JEE) missions have been organized in various countries. This systematic review of the JEE reports is intended to identify the main challenges (MC) of detection in WHO regions.<strong>Methods: </strong>we accessed JEE reports on the WHO website. Challenge was defined as a variable of the indicators of detection where there was a need of improvement. MC was a challenge common to at least one-third of countries in each region and globally. For consistency, we assessed challenges reported under “Areas which need strengthening/challenges” in reports.<strong>Results: </strong>we analyzed 96 JEE reports. African Region (91.7%), Eastern Mediterranean Region (80.9%) and South East Asia Region (72.7%) had the highest rates of JEE completion. The MC were 24 in European Region, 26 in Mediterranean Region, 30 in Western Pacific Region, 33 in South East Asia Region and 34 in African Region. 24 MCs were identified at global level. National laboratory system and Real time surveillance had the highest number of MC. Eleven MCs were common to all WHO regions and global level. These include insufficient capacity for core test confirmation, insufficient specimen referral system, weak quality management system, issues in laboratories licensing and accreditation, weak data management, weak electronic reporting system, absence /weak mechanism of information exchange between International Health Regulation and animal health focal points, insufficient health professional specialists, the need of workforce strategy, the need of field epidemiology and insufficient workforce retention capacity.<strong>Conclusion: </strong>the MCs identified should be addressed through a global approach.</p>Vincent Dossou SodjinouPaul Ahoumènou AyeloAlfred DoubaDona Edgard-Marius Ouendo
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2023-12-192023-12-19421An unusual case of metaphyseal osteonecrosis of humerus in a post covid patient: a case report
https://www.ajol.info/index.php/pamj/article/view/258473
<p>Osteonecrosis of the metaphysis is often rare as it is a highly vascular region. Here we report an unusual case of non-traumatic osteonecrosis of the humerus predominantly involving the metaphysis in a post covid elderly female. The patient had a pathological fracture of humerus during the post-operative period of intertrochanteric femur fracture surgery. She was evaluated for the causes of pathological fracture and the fracture was managed with hemi replacement of the shoulder because of the extensive bone loss. The pathology here could only be explained as some sequelae of hyper inflammatory state associated with COVID-19 infection. The possible differentials are also discussed here. This case report will help clinicians to consider COVID-19 infection as a cause for non-traumatic osteonecrosis among other reported causes of osteonecrosis.</p>Ajayakumar ThankappanNizaj NasimudeenArun ThomasJyothi KarikkanthraJojo Pullockara
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2023-12-192023-12-19421Eradicated and bygone Hansen´s disease with unusual features
https://www.ajol.info/index.php/pamj/article/view/258476
<p>A 70-years pueblo female was admitted to the dermatology and venerology department with serious complaints of pain, swelling, yellowish discharge from fingers, fever, malaise, and blackish discoloration of the skin of the left lower limb, and arthralgia for 1 month. As per the history of the relative, she was hypertensive and diabetic for 15 years and on the medications for the same. There is no associated family history. There is a significant history of loss of appetite and weight loss. On further physical examinations, the patient was febrile at 38.8°C (102 F), with multiple sites of skin infections with loss of sensation in the upper limbs as well as lower limbs with multiple ulcerated lesions at bilateral hands and fingers with yellowish discharge (A) and lower limb. According to the histopathology and hematology report, the patient had an active infection with mycobacterium leprae and was diagnosed with a case of Hansen´s disease (Leprosy). As the infection was spreading progressively to the left foot and ankle patient was operated for left below-knee amputation (B). The patient was then referred to the physical therapy department for further therapeutic management.</p>Chaitanya Ajay KulkarniPrasad Pramod Dhage
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2023-12-192023-12-19421The predictive value of intravesical prostatic protrusion on the outcome of trial without catheter in patients with acute urinary retention from benign prostatic hyperplasia at Jos University Teaching Hospital, Nigeria: a prospective observational study
https://www.ajol.info/index.php/pamj/article/view/258482
<p><strong>Introduction: </strong>acute urinary retention represents a significant and painful event in the natural history of benign prostatic hyperplasia. This study was to determine the value of intravesical prostatic protrusion in predicting the outcome of trial without catheter in patients presenting with acute urinary retention from benign prostatic hyperplasia. <strong>Methods: </strong>this was a prospective observational study carried out over a one-year period among 78 patients with acute urinary retention from benign prostatic hyperplasia who presented at the Accident and Emergency Department of Jos University Teaching Hospital. They were clinically evaluated, and a urethral catheter was passed to relieve the retention. Trans-abdominal ultrasound assessment of intravesical prostatic protrusion, was performed after relief of acute urinary retention. Patients were placed on tamsulosin tablets 0.4mg daily for three days and they had a trial without catheter on the third day. A receiver operating characteristic curve was used to determine the predictive power of intravesical prostatic protrusion on the outcome of trial without catheter in patients with acute urinary retention from benign prostatic hyperplasia. A p value of <0.05 was considered as significant.<strong>Results: </strong>seventy-eight patients were enrolled in the study. The mean age and was 65.00 (SD 7.28) years. The mean intravesical prostatic protrusion, voided volume and maximum flow rate were 13.04 (SD 10.94) mm, 89.46 (SD 6.14) mls and7.63 (SD 5.69) ml/s respectively. Intravesical prostatic protrusion (area under the curve= 0.843, p=0.001) predicted the outcome of trial without catheter with a cut off mark of <7.4, using the receiver operating characteristic curve.<strong>Conclusion: </strong>intravesical prostatic protrusion significantly predicted the outcome of trial without catheter in patients with benign prostatic hyperplasia presenting with acute urinary retention. It is a useful tool in the initial evaluation of patients with benign prostatic hyperplasia presenting with acute urinary retention.</p>Ayodele Olufikayo OshagbemiChimaobi Gideon OfohaIdorenyin Cletus AkpayakSamaila Ibrahim ShuaibuNuhu Kutan DakumVenyir Mamzhi Ramyil
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2023-12-192023-12-19421Post-operated case of mucormycosis: a rare image
https://www.ajol.info/index.php/pamj/article/view/258485
<p>Mucormycosis also known as black fungus, it is relatively rare, but also very serious. It commonly infects the nose, sinuses, eye, and brain resulting in a runny nose, one-sided facial swelling and pain, headache, fever, blurred vision, bulging or displacement of the eye (proptosis), and tissue death. Other forms of disease may infect the lungs, stomach and intestines, and skin. In India, prevalence of mucormycosis is approximately 0.14 per 1000 population. A 58-year-old male came with the complaints of severe headache since a week, nasal congestion, black lesion on nasal bridge and upper inside of mouth that progressively became severe within 2 weeks. Physician inspected the patient and suggested for computed tomography (CT) and magnetic resonance imaging (MRI) scans. After all investigations patient was diagnosed as a case of mucormycosis and had undergone endoscopic debridement.</p>Himanshi Krushna SathawaneManjusha Mahakalkar
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2023-12-192023-12-19421Synchronous occurrence of papillary thyroid carcinoma and early esophageal squamous cell carcinoma in a 45-year-old female: a case report and review of the literature
https://www.ajol.info/index.php/pamj/article/view/258666
<p>Papillary thyroid cancer (PTC) coexistent with esophageal squamous cell carcinoma (SCC) is of rare occurrence. We report a 45-year-old female who presented with painless anterior neck swelling for the past year. Ultrasonography showed a left hypoechoic thyroid mass measured 20x13 mm without lymph node enlargement. The fine-needle aspiration cytology was suggestive of PTC. Consequently, total thyroidectomy with bilateral neck dissection was performed. Incidentally, a small mass measuring 4x2 cm arising from the esophageal wall was identified and resected. Postoperatively, the patient developed a small esophageal fistula which was treated conservatively. The histopathological examination confirmed the diagnosis of PTC and SCC of esophageal mass. The patient underwent radiotherapy, and radioactive iodine therapy, and had acceptable conditions within two years of follow-up. In conclusion, even though the coexistence of PTC and esophageal SCC is rare, the possibility of concurrence of both tumors should be considered if an incidental mass was identified intraoperatively.</p>Abdulfattah AltamAhmed AlsaaidiWaleed AljbriFaisal AhmedQasem AlyhariMohamed Badheeb
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2023-12-192023-12-19421Disability and its determinants among individuals with onchocerciasis in Southeast Nigeria: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/258674
<p><strong>Introduction: </strong>although onchocerciasis is rarely a life-threatening disease, it causes chronic morbidity which ultimately leads to disability due to late detection and treatment of the infected people. Disability in Onchocerciasis results in activity limitation and social exclusion of the affected individuals through stigma. This study aimed at assessing the level of disability and its determinants among persons with onchocerciasis. <strong>Methods: </strong>multi-stage sampling technique was used to recruit 340 respondents from the randomly selected wards. Disability was assessed using WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) tool. Chi-square test and multivariate analysis using binary logistic regression were used to determine factors associated with disability. The level of statistical significance was determined by a p-value of < 0.05.<strong>Results: </strong>the highest proportion (35.6%) of the respondents was 55 years and above with a mean age of 46.8±17.5. About three-quarters (76.2%) of them had some form of disability and the disability domains mainly affected were participation in community activities (61.8%) and getting along with other people (54.1%) while the least affected were self-care (26.2%) and life activities including domestic responsibilities (45.0%). The Predictor of disability included being ≥48 years old, (AOR=0.2; 95%CI: 0.1-0.4). <strong>Conclusion: </strong>most people with onchocerciasis experience some form of disability and the major determinant for disability is being in the older age group. Thus, there is a need for stakeholders in the onchocerciasis control program to formulate and implement disability screening programs in the communities for early detection of onchocerciasis-associated disability, especially among the older age group.</p>Adah Emmanuel OtacheIfeyinwa Lilian EzenwosuEdmund Ndudi OssaiElias Chikee AniwadaStephen Obekpa AbahBenjamin Chudi Uzochukwu
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2023-12-192023-12-19421The congenital melanocytic nevus: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/258675
<p>Congenital melanocytic nevus affects around 1% of newborns. Facial melanocytic nevus may be linked to an increased risk of pediatric cancer. Furthermore, because the lesions reveal hair and dark pigmentation, the cosmetic and emotional impacts might be substantial. A 6-year-old female was brought to the outpatient department with complaints of black discoloration of the left side of the face and excessive hair growth on a particular site. After detailed history collection and physical examination, it reveals that the black discoloration is since birth. The physician diagnosed her with congenital melanocytic nevus and hence referred them to the dermatology department for further management.</p>Darshana KumariTejaswee Lohakare
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2023-12-192023-12-19421Encéphalocèle occipitale et anomalies associées: colobome palpébral bilatéral, fente labio-palatine bilatérale, bride amniotique sur la jambe droite avec absence des orteils sur pieds droit et gauche aux Cliniques Universitaires du Graben Butembo 2021
https://www.ajol.info/index.php/pamj/article/view/258810
<p>L´encéphalocèle est une malformation due à un défaut de fermeture du tube neural associé à une hernie du tissu cérébral et/ou des méninges à travers ce défect crânien congénital. La taille d´une encéphalocèle varie de quelques centimètres à une énorme masse appelée «encéphalocèle géante». Habituellement le contenu de la malformation est composé de tissus nerveux dégénératif, des méninges et une partie kystique. Un nourrisson de 4 mois, de sexe féminin, née des parents non consanguins, nous était référée d´une structure sanitaire de la place pour prise en charge d´une masse occipitale congénitale. A l´arrivée dans notre consultation (4 mois après sa naissance), l´examen avait révélé un poids de 3500g, un périmètre crânien de 33 cm avec une fontanelle antérieure non bombée. Elle avait une énorme masse occipitale rénitente de 43 x 25 cm et d´une taille de 15 cm. une absence des deux paupières; deux fissures labiopalatines; une constriction à la jambe droite, une absence des orteils des pieds droit et gauche. Ainsi était posé le diagnostic d´une maladie des brides amniotiques avec comme composantes : encéphalocèle occipitale associée à un colobome palpébral bilatéral, une fente labio-palatine bilatérale, et des brides amniotiques sur la jambe droite, et amputation des orteils des pieds droit et gauche.</p>Matthieu Aza SumaiAlexandre Amini MitamoJoël Bosomi YawiAlpha Kavuyiro MuhindoJackson Musumba KambaleFaida Muliwavyo KavughoAlexis Kahatane KahindoClaude Masumbuko Kasereka
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2023-12-192023-12-19421Knowledge and attitude of hepatitis B infection among patients with the infection in the main liver clinic in The Gambia
https://www.ajol.info/index.php/pamj/article/view/258815
<p><strong>Introduction: </strong>adequate knowledge on hepatitis B virus (HBV) infection is important among patients with the infection as this impacts their health-seeking behavior. This study therefore assessed the knowledge and attitude among patients infected with HBV in The Gambia. <strong>Methods: </strong>this cross-sectional study was conducted at the main liver clinic, Medical Research Council Gambia at London School of Hygiene and Tropical Medicine (MRCG@LSHTM). A questionnaire was administered on a one-on-one basis to assess the level of knowledge and attitude of people with chronic HBV. <strong>Results: </strong>a total of 152 HBV patients were recruited into the study. Majority of the participants were male 136 (89.5%), within the 30-39 years age group. Sixty-four (42.1%) of the patients attained secondary education and 72 (47.4%) were working as civil servants. The mean knowledge score was 11.09/20 (standard deviation = 4.89). HBV patients having tertiary level education (p-value =0.001) or HBV diagnosis greater than 1 year (p-value =0.031) were more likely to have adequate knowledge of HBV infection. No significant associations were found between the socio-demographic and clinical characteristic variables and attitude. However, majority of the participants (56.6%) reported been worried about having HBV infection ever since being diagnosed. <strong>Conclusion: </strong>this study has highlighted the need for more patient health education especially for those with lower levels of education and newly diagnosed patients. It also further confirms the need for cultural and appropriate language consideration in providing education and information for HBV patients in The Gambia at the point of diagnosis.</p>Landing JarjuSheikh Omar BittayeAbdoulie KeitaSaydiba TambaRamou Njie
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2023-12-192023-12-19421Cervical prolapse in pregnancy
https://www.ajol.info/index.php/pamj/article/view/258816
<p>Cervical prolapse during pregnancy is extremely rare but can cause complications in antepartum or intrapartum period and can have long term sequelae-for mother and fetus. A 32-year-old grand multipara (previous 4 vaginal deliveries) with moderate anaemia (Hb-7.6gm/dl) and poor nutritional status (BMI-17kg/m<sup>2</sup>), presented with 35 weeks´ pregnancy and preterm labor pains with a prolapsed hyperemic cervix 4-5cm dilated protruding out of introitus. We proceeded with fluid and blood products´ resuscitation and close monitoring of labor till delivery of 2100gm male baby with APGAR score 8. Active management of third stage of labor was done with oxytocics to prevent post-partum haemorrhage. After manually repositing the cervix and uterus inside for the time being, the woman was sent to post-natal ward. Daily dressing of prolapse with magnesium sulphate done. A supportive ring pessary with ideal fit for the lady was placed against symphysis pubis resting in the posterior fornix on post-partum day 8. We counseled the lady for interval sterilisation to prevent future pregnancies and telephonic follow up was taken. Here, multiple vaginal deliveries, anaemia, poor nutritional status were significant contributing factors in both preterm labour pains and cervical prolapse. These etiological factors contribute to major health hazards in developing nations. Surveillance and correction of these comorbidities is of utmost importance in pre-conceptional and antepartum period itself.</p>Aarshika SinghAshirwad Sankhe
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2023-12-192023-12-19421Common coronary artery occlusions in patients with myocardial infarction
https://www.ajol.info/index.php/pamj/article/view/258817
<p><strong>Introduction: </strong>coronary artery disease (CAD) is a significant cardiovascular disease (CVD) that affects people worldwide. This study aimed to determine the main occluded coronary arteries in patients with myocardial infarction in Najran, Kingdom of Saudi Arabia (KSA). <strong>Methods: </strong>a retrospective cross-sectional study conducted between March 2020 and March 2021 and involving 661 myocardial infarction patients recruited from two hospitals (King Khalid Hospital and Prince Sultan Centre for Healthcare in Najran) used sampling for enrolled patients. Patients over the age of 15 years, current residents of KSA, and diagnosed with coronary artery occlusion based on at least one identifiable coronary lesion on a coronary angiography were considered eligible. We created generalized linear mixed models to investigate patients´ clinical and coronary angiographic features and identify statistically relevant components.<strong>Results: </strong>there were 661 CAD cases in this study: 548 (82.9%) males and 113 (17.1%) females, with a mean and standard deviation (SD) age of 4.03 ± 1.370 years. Ages of the 661 participants ranged from 15 to 85, who had been diagnosed with myocardial infarction were evaluated. It was found that most of the patients were in the 55-64 age range. The majority of cases (366 (55.4%) had ST-segment elevation myocardial infarction (STEMI), 187 (28.3%) had non-ST-segment elevation (NSTEMI), 101 (15.3%) had acute coronary syndrome-non-ST-segment elevation (ACS-NSTEMI), and 7 (1.1%) had acute coronary syndrome-ST-segment elevation (ACS-STEMI).<strong>Conclusion: </strong>the left anterior descending artery (LAD) is the commonest lesion found in both ST-segment elevation and non-ST-segment elevation myocardial infarction patients.</p>Itedal Abdelraheem Mohamed AhmedNagla Hussein Mohamed KhalidAhmed Elsir Mokhtar Abd-ElmagidMawahib Ahmed Mohammed AbdullahAmna Mohammed Idris MusaNisreen Oudah AL-Qarni
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2023-12-192023-12-19421Intraoperative surprise evidence of bronchial rent during lung surgery: a case report
https://www.ajol.info/index.php/pamj/article/view/258820
<p>Among multiple causes of tracheobronchial rent, most common is iatrogenic factor. Whenever there is surprise evidence of bronchial wall tear while doing lung surgery, tracheal tube extubation and postoperative management pose a challenge. We report a 16-year-old girl, weighing 27 kg, a case of pulmonary Koch's who presented with hydropneumothorax on left side. She had a prolonged course on mechanical ventilation, was gradually weaned off and extubated in intensive care unit (ICU) with implantable cardioverter defibrillator (ICD) in-situ. However, chest X-ray continued to show loss of bronchovascular markings and high-resolution computed tomography (HRCT) thorax revealed multiple cavitatory lesions, hydropneumothorax from upper to lower lobe, ground glass opacities on left side and mediastinal shift towards right side. Hence, she was posted for left lung decortication. Decortication was done using one lung ventilation protocol with 28 Fr left sided double-lumen endobronchial tube (DLT). While checking for leaks before closure, it was noted that exhaled tidal volume was unacceptably low and a rent on left main bronchus of around 2x2 cm with scarred borders was detected. The rent was repaired with tissue patch suturing by the surgeons. After the procedure, DLT was exchanged with endotracheal tube (ETT) no 6. Patient was managed with elective ventilation post-operatively in ICU for 48 hours and extubated uneventfully. A vigilant monitoring of vital parameters and close communication with surgeons is important for detecting and managing any perioperative complication during lung surgery. Elective ventilation could play a significant role for healing a big rent in trachea-bronchial area.</p>Ravi Damodhar NikhadeCharuta Pravin GadkariAishwarya Santosh Pingley
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2023-12-192023-12-19421Late diagnosis of Lassa fever outbreak in endemic areas lead to high mortality, Kenema District, Sierra Leone, February - March 2019
https://www.ajol.info/index.php/pamj/article/view/258824
<p><strong>Introduction:</strong> the Kenema District Surveillance team in Sierra Leone received notifications of patients with suspected Lassa fever on February 20<sup>th</sup> and March 2<sup>nd</sup>, 2019. On that day, an investigation started to confirm the diagnosis and search for additional cases. <strong>Methods:</strong> we used the Lassa fever surveillance case definition and collected demographic and exposure information from suspected cases through interviews and clinical records. Blood samples were collected from the cases to confirm the diagnosis. Active case finding was conducted in the community and health facility. <strong>Results:</strong> on February 10, 2019, an eight-year-old male developed a fever (>39.5°C) and a sore throat. On February 18, 2019, he was admitted to a hospital and treated for malaria and pneumonia. On February 20, 2019, Lassa fever was suspected because the patient was bleeding from orifices and testing. On February 15, a 5-year-old female developed fever and headache and was treated with anti-malarial drugs. On February 26<sup>th</sup> the high fever re-emerged with severe bleeding from the orifices. She was admitted and treated with antibiotics, confirmed for Lassa fever, and died on March 2, 2019. <strong>Conclusion:</strong> the two children had Lassa fever, and no additional cases were identified. We sensitized clinicians on suspicion of Lassa fever to improve early detection and treatment.</p>Umaru SesayLeonard HakizimanaAdel Hussein EldumaAdel Hussein EldumaAlden HendersonGebrekrstos Negash Gebru
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2023-12-192023-12-19421Postoperative meningocele after anterior cervical discectomy and arthroplasty on a case report
https://www.ajol.info/index.php/pamj/article/view/258826
<p><em>Anterior dural tears complicated by cerebrospinal fluid (CSF) leakage with anterior meningocele are rare. Indeed, in the literature, cases are described during anterior arthrodesis, but no cases of post-cervical arthroplasty are described. The management of this type of complication is poorly described and not consensual. We present a case of a patient who underwent cervical arthroplasty complicated by an anterior meningocele at 1 month after the first surgery. Imaging revealed a compressive anterior meningocele in relation to the clinically progressive worsening. Revision surgery consisted of a combination of closure of the gap with a fatty patch covered with a TachoSil patch, followed by reinsertion of a new cervical prosthesis. At the last follow-up at 1 year, the patient showed no residual effects of the complication, and the mobility of the disc prosthesis was not impaired by it. Clinical results of the arthroplasty are also very satisfactory. Although these types of complications are rare, it is important to have a consensus on the management of anterior meningocele. In our experience, TachoSil appears to be a satisfactory option for the management of these complications.</em></p>Paul LavantesThierry Dufour
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2023-12-192023-12-19421Spina bifida: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/258828
<p>Spina bifida is an uncommon neural tube disease (NTD) that affects about one in every 1000 births in Europe. These defects are caused by a teratogenic process that results in the embryonic neural tube's failure to close and aberrant differentiation. Spina bifida occulta, meningocele, myelomeningocele, encephalocele, anencephaly, and dermal sinus are the most common neural tube defects. It occurs within the first 25 days of pregnancy. Although the disease cannot be cured, new medical interventions have allowed many people with spina bifida to live to a ripe old age with a high quality of life. However, long-term monitoring is essential. Women from lower socioeconomic backgrounds are more likely to be affected. A daily intake of folic acid two months prior to conception and two months after conception can prevent approximately 70% of spina bifida. Prenatal diagnosis and terminations of pregnancies, not primary prevention, helped spina bifida become an uncommon condition. Here, we report a case of a one-day-old male neonate who was born at full term and had respiratory distress and a congenital abnormality. A complete local and systemic examination was performed, and meningocele, a severe form of spina bifida, was diagnosed. The patient was referred to a neurosurgeon and was advised an ultrasound abdomen and an magnetic resonance imaging (MRI) spine, but neither of these tests were performed because the patient was transferred to another hospital for treatment.</p>Kalpesh GulveVaishali Kuchewar
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2023-12-192023-12-19421Traitement chirurgical mini-invasif d´une fracture vertébrale par compression avec atteinte bi-pédiculaire: un case report
https://www.ajol.info/index.php/pamj/article/view/258902
<p>Les fractures par compression vertébrale représentent une part importante de la traumatologie quotidienne en chirurgie du rachis. Leur prise en charge est codifiée grâce aux différentes classifications dont nous disposons. L´association d´une fracture tassement et d´une atteinte bi-pédiculaire de la même vertèbre conduit généralement à une prise en charge chirurgicale lourde. L´objectif principal de ce rapport de cas est de partager notre expérience d´une technique d´ostéosynthèse mini-invasive réalisée sur ce type de fracture. Le patient, âgé de 61 ans, était tombé d´un toit de 3,5 m de haut. Cliniquement, il n´avait pas de déficit sensitivo-moteur. Il présentait une douleur dorsale à 8/10 sur une échelle visuelle analogique (EVA). La tomodensitométrie a révélé une fracture par compression de la 4e vertèbre lombaire (L4) de type A.3 selon la classification de l´AO. Il y avait également une atteinte bi-pédiculaire de L4. Il a bénéficié d´une prise en charge chirurgicale mini-invasive consistant en une kyphoplastie associée à une ostéosynthèse intra-pédiculaire percutanée bilatérale isolée. Nous avons observé une sédation rapide de la douleur avec une EVA de 2/10 au premier jour post-opératoire et de 0/10 à 3 mois. La consolidation osseuse était obtenue à 3 mois au scanner. A 18 mois, il n´y avait pas de signe de déplacement secondaire du matériel. L´équilibre sagittal et frontal était satisfaisant. Le patient avait retrouvé un état clinique semblable à celui d´avant l´accident. L´objectif de ce cas était de proposer une alternative chirurgicale moins invasive pour la gestion des fractures vertébrales par compression associée à une atteinte bi-pédiculaires. Dans notre cas, la combinaison d´une kyphoplastie avec une ostéosynthèse intra-pédiculaire percutanée bilatérale isolée a permis une récupération rapide après la chirurgie et un retour à l´état antérieur à l´accident.</p>Nicolas PointeLudmilla BazinBenjamin Augereau
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2023-12-192023-12-19421Warm autoimmune haemolytic anaemia complicated by simultaneous arterial and venous thromboses: a case report
https://www.ajol.info/index.php/pamj/article/view/258904
<p>The novelty described in this case report is the simultaneous development of arterial and venous thrombosis in a previously healthy Caucasian 37-year-old male with newly diagnosed warm autoimmune haemolytic anaemia (WA-AIHA). Clinical presentation included sensorimotor dysphasia, right arm paresis, abdominal pain, and swelling of the left leg. Computed tomography angiography showed partial occlusion of the left middle cerebral artery and multiple infarcts of the kidneys and spleen, while Doppler ultrasound revealed thrombosis of the left popliteal vein. A therapeutic dose of low-molecular-weight-heparin was instituted together with rituximab, leading to the complete serological and haematological remission. The exact thrombotic risk factors in WA-AIHA are still not completely identified and no generally accepted guidelines on thromboprophylaxis exist. The severe onset of the WA-AIHA might point towards a close association between haemolysis itself and thrombosis, raising the question of the necessity of prophylactic anticoagulation.</p>Ela ĆurčićOzrenka ZlopašaSara ŠundalićMia RoraRadovan RadonićAna Vujaklija Brajković
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2023-12-192023-12-19421A report of two cases of Bednar tumour, an uncommon tumour of the skin: a report of two cases
https://www.ajol.info/index.php/pamj/article/view/258928
<p>Pigmented dermatofibroma sarcoma protuberance (DFSP) is a rare variant of DFSP which is an intermediate-grade tumour due to its tendency for local recurrence. Morphology of this variant imposes a differential diagnosis that is must know for a pathologist. We describe two cases that presented with pigmented papulo-nodular form involving the back and lower limb in middle-aged to an elderly female. Histopathology coupled with immunohistochemistry yielded a diagnosis of Bedner tumour. A surgical histopathologist needs to have knowledge of all differential pigmented neoplasms of skin just to ensure not to skip this rare entity.</p>Tushar KaloniaAditi DhantaAshok SinghArvind KumarAkanksha MalikNeha Kumari
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2023-12-192023-12-19421Diagnostic role of stool TB-PCR in suspected tuberculous colitis patient at Dr Cipto Mangunkusumo National Central General Hospital: a cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/258933
<p><strong>Introduction: </strong>the signs and symptoms of tuberculous (TB) colitis were similar with other diseases, such as inflammatory bowel disease. Therefore, finding the diagnostic modality to help differentiate TB colitis with other diseases was a challenge. In this study we aimed to find the proportion of positive stool TB-PCR in suspected TB colitis subjects and also the diagnostic value of the stool TB-PCR if compared to colonoscopy, histopathology and clinical evaluation. <strong>Methods: </strong>a cross-sectional study was done on subjects suspected to have TB colitis who undergone colonoscopy and histopathology examination between February-April 2019. Stool samples from those subjects were collected and extracted with the QIAamp® Fast Stool DNA Mini Kit. The TB-PCR was done using artus® M. tuberculosis RG PCR kit, which targeted on 16s rRNA gene. The results of stool TB-PCR then were compared with the combination of colonoscopy, histopathology and clinical evaluation as the gold standard. <strong>Results: </strong>from sixty subjects who were recruited, there were 26/60 (43.3%) subjects with positive stool TB-PC. It was consisted of 7/8 TB colitis subjects and 19/52 non-TB colitis subjects. The diagnostic value of the stool TB-PCR was: sensitivity 87.5%, specificity 63.5%, positive predictive value 26.9% and negative predictive value 97.1%. <strong>Conclusion: </strong>stool TB-PCR has good sensitivity but low specificity for diagnosing TB colitis. Therefore, stool TB-PCR could be utilized as a screening test for TB colitis.</p>Siskawati SuparminNuri Dyah IndrasariKaka RenaldiSuzanna ImmanuelYusra YusraMerci Monica br Pasaribu
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2023-12-192023-12-19421Primary malignant multiple osteogenic sarcomas: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/258952
<p>We present the case of a 12-year-old male patient, who came to the emergency department with a complaint of pain in bilateral knee joints, pain in bilateral lower legs, multiple swelling over the bilateral knee joint and in the leg region, difficulty in walking, stiffness in the bilateral knee joint since he was one year. There is no medical significant history regarding the disease condition. On physical examination, the swelling was in the region of the metaphysic of the distal end of the bilateral femur and proximal end of the bilateral tibia, skin over the swelling was shiny with tenderness and margins were irregular, on the biopsy and X-ray findings patient was diagnosed as primary malignant multiple osteogenic sarcomas. The patient was referred to the dermatology department for further management.</p>Sonu RajwadeShweta Parwe
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2023-12-192023-12-19421Resection of a solitary bone metastasis using preoperative computed tomography (CT)-guided hook wire localization: a case report
https://www.ajol.info/index.php/pamj/article/view/258954
<p>Secondary bone metastasis are a common evolution of many types of cancer. In some instance, it is needed to remove those metastases to improve the prognosis of the patient. Bone metastasis that are invisible and non-palpable during the intervention are difficult to remove while being sure to respect safe resection margins. We present the case of a woman suffering from breast cancer. Despite the treatment of the primitive lesion, she presented a solitary bone metastasis on her iliac crest. The lesion was removed surgically but could not be seen or touched during the procedure due to its location. To be certain to remove this lesion during surgery, while respecting safe resection margins, we performed a pre-operative computed tomography (CT)-guided hook wire localization. Using this method, the anatomopathological examination confirmed the tumoral nature of the lesion and that the resection margins were in a safe zone. This technique frequently used to target soft lesion in cases of breast or lung cancers could therefore be used the same way with solid bone lesion.</p>Benjamin AugereauNicolas PointetPier-Olivier DuboeTanguy Vendeuvre
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2023-12-192023-12-19421Scalp psoriasis: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/258958
<p>Psoriasis is a skin condition that affects about 2-3 percent of people worldwide, according to the National Psoriasis Foundation. But scalp psoriasis occurs in rare conditions. Scalp psoriasis is a long-lasting autoimmune disease having thick scales on clearly-defined, erythematous skin. Frequently, the scales are silvery white. The hairline may be partially covered by psoriasis. Even though the hair frequently serves as an effective covering for scalp psoriasis, the flaking of the scales and excessive 'dandruff' make it a common cause of social disgrace. Scalp psoriasis might be asymptomatic or can cause severe itching. Even though its severity frequently changes over the course of several years, it typically persists. The line of treatment for scalp soriasis includes topical therapy, intralesional therapy, systemic therapy, and photochemotherapy. According to ayurved, all skin disorders are included under kustha disease. Scalp psoriasis can be considered Ekkustha which is one of the types of kustha disease. A 26-year-old male student came with complaints of a red, scaly patch with itching on the lower occipital and neck region for 4-5 months. On clinical examination candle, grease sign, and auspitz sign were positive with normal blood count and blood glucose level. From this, it was diagnosed as scalp psoriasis as shown in the image. Therapeutic purification therapy and the palliative treatment mentioned in Ayurveda were given for 2 months. After 2 months of follow-up, complete remission was observed. This image is useful for differential diagnosis between seborrheic dermatitis, lichen planopilaris, and scalp psoriasis.</p>Praveen NandalSadhana Misar Wajpeyi
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2023-12-192023-12-19421Coûts médicaux directs de traitement du cancer du sein à l´Institut Joliot Curie de l´Hôpital Aristide Le Dantec de Dakar, Sénégal
https://www.ajol.info/index.php/pamj/article/view/258979
<p><strong>Introduction:</strong> en 2020, l´incidence du cancer du sein s´élevait à 2 261 419 cas dans le monde; 186 598 cas en Afrique et 1 817 cas au Sénégal. Toutefois, les coûts directs médicaux du traitement des cancers en général ne sont pas connus au Sénégal. Pour une meilleure allocation des ressources, il est important d´estimer leurs coûts. L´objectif de cet article est d´analyser les coûts médicaux directs de traitement du cancer du sein à l´Institut Joliot Curie de Dakar.<strong>Méthodes:</strong> c´est une étude rétrospective menée sur des patientes diagnostiquées d´un cancer du sein entre janvier et décembre 2017 à l´Institut Joliot Curie. Une enquête par questionnaire et des entretiens semi-structurés ont été faits auprès des personnes malades et de leurs proches pour reconstruire le coût direct médical.<strong>Résultats:</strong> le coût moyen direct médical estimé du traitement de cancer du sein à l´Institut Joliot Curie est de $ 3 713.45 avec un minimum de $1 495.15 et un maximum de $10 662.97 sur une durée moyenne de 31 mois. Ce coût est constitué de 29% de la chimiothérapie; de 15% du diagnostic et de 15% de la chirurgie. Les coûts de la radiothérapie et les médicaments sur ordonnance représentent 13% pour chaque acte. Ce coût médical est lié d´une part au niveau d´étude (p=0,05) et au stade de la maladie (p=0,03).<strong>Conclusion:</strong> le coût médical direct du traitement du cancer du sein est très élevé au Sénégal. Le coût médical direct du traitement maximum est de $10 662.97 et le minimum est à $1 495.15, soit un coût moyen de $3 713.45.</p>Mory DialloDieynaba FallIbrahima MballoCheikh Ibrahima NiangMohammed Ezzet Charfi
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2023-12-192023-12-19421Stereotactic radiosurgery with Cyberknife®: first case in the United Arab Emirates
https://www.ajol.info/index.php/pamj/article/view/258980
<p>A 64-year-old gentleman was referred to the department of oncology with severe pain in the right ear radiating to the right side of the face. Imaging revealed a large extra-axial expansile lesion, surrounding and encasing the right cavernous sinus extending to the right middle cranial fossa. The patient consulted several neurosurgeons and was recommended stereotactic radiosurgery with Cyberknife® as the best non-invasive modality. The proximity to the critical structures, such as the brainstem, made it challenging for any surgical approach. The patient completed stereotactic radiosurgery with Cyberknife® and is doing well one month after treatment.</p>Nandan Maruti ShanbhaChristos AntypasAbdul Karim MsaddiTeekendra SinghSinead Catherine MurphyBenjie Baguitan
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2023-12-192023-12-19421Medico-demographic characteristics and outcomes of COVID-19 patients admitted to a provincial hospital in Center-West of Morocco
https://www.ajol.info/index.php/pamj/article/view/258981
<p>The current Coronavirus Disease 2019 (COVID-19) pandemic that emerged in December 2019 in China continues to claim a thousand lives worldwide. This study aimed to report characteristics and in-hospital outcomes of a Moroccan COVID-19 cohort, and identify factors which predispose patients to hospitalization and mortality from COVID-19. We conducted a cross-sectional study of symptomatic COVID-19 patients referred to COVID-19 ward of the Settat Provincial Hospital, during October 2020. A confirmed COVID-19 case was defined by a positive detection of SARS-CoV-2 genome using real-time RT-PCR assay performed on nasopharyngeal swabs. Patients´ demographic and clinical characteristics were collected and analyzed using SPSS V22.0. Univariate followed by multivariate logistic regression analysis was performed to identify factors associated with mortality due to COVID-19. In total, 269 patients were reported. The median age was 64 years [IQR 54-73], 48.7% were elderly (≥ 65 years), 51.7% were men, and the case-fatality rate (CFR) was 5.58%. Males had a higher CFR (6.5%) than females (4.6%). In deceased people: 60% males, 73.3% were elderly, and oxygen saturation values of 90% or less on admission were more frequent (86.7%) than in recovered ones (10.9%). Most patients (80.3%) had at least one comorbidity: 100% of deaths, 59% older than 60 years, CFR was 6.94% and the most prevalent diseases were diabetes (54.6%), hypertension (41.7%), and cardiac disease (40.7%). The most common symptoms on presentation were dyspnea (67.7%), fever (65.4%) and cough (58.4%). Multivariable logistic regression analysis showed that only older age (AOR: 10.860, 95% CI: 3.382-34.86; p<0.001) and cardiac disease (AOR: 0.244, 95% CI: 0.074-0.799; p=0.02) were associated with higher mortality rates. Categorizing patients at admission according to risk factors identified by multivariate and also univariate analyses (mainly dyspnea) is essential to help in deciding the hospitalization priority and the strategy that will eventually reduce death risk.</p>Samira NatoubiRachid AmgounNezha BaghdadMohamed Ait ElkhadirAbdelhak LafafRadouane MouqhachAhmed BouaziziItto Maroui
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2023-12-192023-12-19421Primary diffuse large B-cell lymphoma of the right kidney: a case report
https://www.ajol.info/index.php/pamj/article/view/258987
<p>The existence of primary renal lymphoma (PRL) in the kidney has long been debated due to its extranodal location and lack of lymphatic channels. Primary renal lymphoma is extremely rare, accounting for less than 1%, and is frequently misdiagnosed as renal cell carcinoma (RCC). We present a 50-year-old man presenting with right flank pain in the last week. The computed tomography scan showed a large isodense right renal mass with a small para-aortic lymph node suspected of RCC. The patient underwent right radical nephrectomy and lymphadenectomy with an uneventful postoperative outcome. The histopathology and immunohistochemistry showed diffuse large B-cell lymphoma. Then, the patient received five-cycle chemotherapy and regional radiotherapy. Within five years of follow-up, no symptoms of recurrence. In conclusion, even though PRL is a rare tumor type. An effort should be made to make a preoperative diagnosis because PRL can be treated with systemic chemotherapy instead of other renal tumors requiring nephrectomy.</p>Hamid NasrollahiAli EslahiFaisal AhmedBita GeramizadehMansour Ansari
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2023-12-192023-12-19421Autosomal dominant polycystic kidney
https://www.ajol.info/index.php/pamj/article/view/258990
<p>Polycystic kidney disease is a hereditary illness that causes cystic growth of the kidneys, resulting in increasing kidney enlargement and renal insufficiency, as well as a variety of extrarenal symptoms. The illness has autosomal dominant and recessive inheritance patterns, characterized by gradual but increasing enlargement of the kidneys, with renal failure developing by the fifth to sixth decade of life. A 46-year-old male patient with abdominal discomfort in the flanks for the past 6-7 years, an old medical record suggesting chronic kidney disease, a recent ultrasonography (USG) abdomen, and pelvis confirming polycystic kidney disease, Sr. creatinine has risen to 08 mg/dl. A kidney transplant was advised for the patient. His nephrectomy was recently completed, and he is now on dialysis and supportive drugs, with an emphasis on an early transplant.</p>Rugaved Raghavendra GudadheGaurav Rajendra Sawarkar
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2023-12-192023-12-19421A rare clinical image of fourth-degree bedsore
https://www.ajol.info/index.php/pamj/article/view/258993
<p>Stage four bedsores are the most severe form of bedsores, also called pressure sores, pressure ulcers, or decubitus ulcers. A stage four bedsore is a deep wound reaching muscles, ligaments, or bones. They often cause residents to suffer extreme pain, infection, and invasive surgeries. Its major etiological factors are poor circulation, Immobility due to spinal cord injury, Excessive moisture, skin irritants like urine and feces, and friction. It mainly occurs in men and women, both aged 20 to 80 years. With early diagnosis and treatment, further complications can be prevented. We report a case of the 29-year-old patient; who came to the surgical intensive care unit with the complaints of swelling over the buttocks, in size of 20 x 20 x 8 cm bedsore covering both buttocks, foul-smelling he was apparently alright five years back when he noticed swelling and skin off on buttocks with itching and burning pain which was the insidious onset and progressive. Initially, the size was 20 x 20 x 8 cm, gradually increasing to the current size of 24 x 24 cm. He also complains of pain over the buttock, a throbbing type of pain. A blood investigation and skin biopsy were done, and the patient was referred to the surgical intensive care unit for further management.</p>Minal DambhareDeeplata Mendhe
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2023-12-192023-12-19421Colonic obstruction secondary to lithobezoar in a child
https://www.ajol.info/index.php/pamj/article/view/258994
<p>A nine-year-old girl with no history of abdominal surgery was presented to the emergency department with a seven-day-lasting abdominal pain, yellow vomiting and constipation; the stool was brownish mixed with small stones. There was no history of fever or similar episodes. Her development history revealed multiple episodes of earth and stone-eating since her 3 years. The physical examination revealed a well-developed child with stable vital signs, the abdomen was slightly distended and tense in its lower part. There was a palpable lump in the hypogastric area and in left iliac fossa. Rectal examination demonstrated a rectal ampulla full of small stones. Abdominal X-ray showed gravel inside the large bowel and rectum with a distended transverse and left colic angle. Manual evacuation and colonic lavage were done and repeated twice daily for three days. Ont the fourth day, an abdominal X-ray showed clearance of all stones from the colon and no signs of colonic obstruction or perforation.</p>Ahmed El Mouloua
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2023-12-192023-12-19421Mycetoma of the right foot: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/258999
<p>Mycetoma is a disease caused by certain bacteria and fungi found in soil and water. These bacteria and fungi may enter the body through a break in the skin, often through the foot. We are presenting a case of a 42 years old male farmer, who comes to the emergency department with a complaint of swelling over on the foot. On inspection of the patients´ foot, there was swelling over the foot with the fungal inspection. Skin biopsy and laboratory investigation were suggestive of a mycetoma of the foot. On the confirmation, the patient was referred to the surgery department for further management.</p>Mohammed Kamran ShaikhSonali Borkar
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2023-12-192023-12-19421Long-term outcomes of coracoid bone block osteolysis: case report
https://www.ajol.info/index.php/pamj/article/view/259002
<p>Latarjet procedure is reliable and reproductible procedure for treatment of anterior shoulder instability. Results are durable but complications can occur: neurological injury, non-union, infection, stiffness, osteolysis of coracoid bone block, recurrence of dislocation, osteoarthritis. We present the case of two patients with complication not described in the literature: osteolysis of the neck of the scapula around screws discovered at 8 and 20 years after initial surgery. These patients presented with previous pain which motivated consultation. Imaging showed coracoid bone block osteolysis, extensive geode weakening articular surface of scapular glenoid, around screws which are not bi-cortical. Screws were removed, osteolysis was filled with iliac cancellous bone graft and joint capsule was re-tensioned. Results of this procedure at one year were clinical and radiological satisfactory.</p>Arthur FloquetSteven RouletLuc Favard
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2023-12-192023-12-19421Toxoplasma gondii infection in HIV-infected pregnant women: epidemiology and risks of mother-to-child transmission
https://www.ajol.info/index.php/pamj/article/view/259003
<p><em>Toxoplasma gondii (T. gondii)</em> infects approximately one third of the world’s population. Globally there are an estimated 13.1 million cases of <em>T.gondii</em> co-infection in HIV-infected people with 87.1% of these individuals living in sub-Saharan Africa. The risk of <em>T. gondii </em>infection in HIV-infected women rises significantly with lower CD4+ T cell counts (particularly under 100 cells/μl). Mother-to-child transmission (MTCT) occurs in approximately 30% of cases of maternal <em>T. gondii</em> infection during pregnancy. The global prevalence of latent toxoplasmosis in HIV-infected pregnant women is 47.5% but the overall risk in HIV-infected mothers of MTCT of <em>T. gondii</em> is however, estimated to be low at < 5%. MTCT in HIV-infected mothers not only occurs due to <em>T. gondii </em>primary infection in pregnancy but also due to reactivation. Infants with congenital toxoplasmosis born to HIV-infected mother may have a more rapid onset and greater dissemination of disease thus having potentially devastating effects. This article discusses the key risks for MTCT of <em>T. gondii </em>infection in HIV-infected mothers as well highlighting the many knowledge gaps for which further study is required</p>Temi Lampejo
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2023-12-192023-12-19421Lead poisoning with encephalic and neuropathic involvement in a child: case report
https://www.ajol.info/index.php/pamj/article/view/259004
<p>Lead is a toxic substance in our environment that affects adults and children of all socioeconomic backgrounds, lead poisoning is one of the most common exposures that can cause inter alia significant neurological and functional damage in humans. Children are particularly vulnerable because of the effects of the toxicity on their developing nervous systems with potentially irreversible consequences. We report a case of severe lead poisoning encephalo-neuropathy in a 3-year-old girl, admitted for progressive paraplegia, swallowing disorders, and aphasia. A multitude of investigations undertaken could not explain her atypic symptoms, so anamnesis was redone in the sense of a toxic origin, we found a notion of pica, and a traditional herbalist father, so probably consumption of medications based on traditional medicine products. A venous blood lead level (BLL) was extremely elevated at 176.4 μg/l. The child was treated with an oral chelator succimer (SUCCICAPTAL). During the two following months in the intensive care unit, the child showed progressive respiratory distress and worsening signs of the nervous system. Despite treatment and the use of lead chelators, the patient died due to septic shock. Lead is highly toxic even at very low exposure levels, at high levels of exposure, it can damage the reproductive organs, immune system, liver, kidneys. in children, it can affect neurocognitive and behavioral development that could be irreversible. Peripheral and central nervous system damage should be considered as a possible manifestation of lead poisoning.</p>Latifa RouziHecham ElhamriSamira kalouchSiham SalamBouchra El MoutawakilHanan ChaouiNarjis BadraneMohammed FekhaouiZineb Jouhadi
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2023-12-192023-12-19421Sexual and procreation preferences of adolescents and young adults infected perinatally with HIV in Southeast Nigeria: a hospital-based cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/259009
<p><strong>Introduction: </strong>children with perinatal human immunodeficiency virus (HIV) infection now survive to adolescence and adulthood and so are confronted with issues related to sexuality and sexual reproductive health. This study is aimed at determining the sexual knowledge and behaviours of these adolescents, determining their procreation intention and the impact of their age, gender and understanding of the mother to child transmission risk on their procreation intention. <strong>Methods: </strong>a hospital-based cross-sectional study of adolescents and young adults aged 15-24 years infected with HIV in the perinatal period, accessing tertiary care in Enugu. A pretested questionnaire was used to obtain information about socio-demographic variables, sexual knowledge and behaviour, procreation intention and knowledge of prevention of mother-to-child transmission of HIV. Data analysis was descriptive and a test association using fisher´s chi square was done on the variables. <strong>Results: </strong>seventy-one adolescents were studied. The majority (95.8%) were less than 20 years of age. Mean age was 17.01 ± 1.80 years with M: F ratio of 1:1.7. Nineteen (26.8%) were sexually active with 15 (78.9%) having single partners. About 80% had their first sexual activities before the age of 18 years. Fifty-six (78.9%) received some form of sex education. Only gender and socio-economic status was significantly related to marriage and procreation intentions of respondents.<strong>Conclusion: </strong>there´s need for sustained/intensive education programs and policy on sexual practices with focus on perinatally infected adolescents who may not be well informed on risk and consequences of their sexual preferences.</p>Kenechukwu Kosisochukwu IlohIjeoma Nnenne Obumneme-AnyimChidiebere Donatus Ignatius OsuorahOgochukwu Nneka IlohObianuju Ojinika IgbokweCheta Orji-OkaforIfeoma Josephine Emodi
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2023-12-192023-12-19421Surinfection d'une endocardite de libman-sacks chez une patiente lupique: rapport de cas
https://www.ajol.info/index.php/pamj/article/view/259011
<p>L'endocardite de Libman-Sacks constitue une manifestation cardiaque peu fréquente de la maladie lupique au cours de laquelle il existe une végétation non infectieuse au niveau des valves cardiaques. La plupart des patients sont asymptomatiques. Cependant, dans la présentation clinique, la forme aigue peut imiter celle de l'endocardite infectieuse et compliquer à la fois le diagnostic différentiel et le traitement. Nous rapportons l'observation d'une patiente de 28 ans, suivie pour lupus érythémateux depuis 2018; qui présentait des signes et symptômes compatibles avec une endocardite infectieuse, et dont les différentes explorations ont permis de conclure à une endocardite de Libman-Sacks surinfectée. l'évolution était fatale malgré le traitement associant une bi-antibiothérapie et des corticoïdes.</p>Nuance Divine Tchiloemba TchibindaFatimatou Zahra CoulibalyChimène Willer Kitihoun MamadouRajae BennaniNadia FellatRokya Fellat
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2023-12-192023-12-19421Conditions to eliminate cholera in Mozambique - the pathway for the development of the national cholera plan
https://www.ajol.info/index.php/pamj/article/view/259015
<p>Cholera disproportionately affects the most vulnerable segments of the population, particularly those who have low or no access to basic water, sanitation, and hygiene (WASH). Despite some improvements in WASH conditions, cholera still represents a persistent challenge in Mozambique, where outbreaks occur almost every year, with high case fatality rates, posing a threat to the country's economic development. The Government of Mozambique has started developing a revised National Cholera Plan (NCP), which aligns with “ending cholera-a global roadmap to 2030” launched by the Global Task Force on Cholera Control (GTFCC) in 2017. Ending cholera represents a critical step towards achieving the sustainable development goals and requires effective prevention and control interventions, ensuring that no one is left behind. The NCP must use a multi-sector approach and broad stakeholder collaboration with well-coordinated roles and functions of different partners to address major areas for cholera elimination - water and sanitation, health care services and management, epidemiology and surveillance, and health and hygiene promotion. Every cholera death is preventable. In this review, we reiterate the need for effective coordinated actions to control and eliminate cholera in Mozambique and decrease the cholera burden, enabling a healthy population over the generations.</p>Cynthia Semá BaltazarLiliana Dengo BaloiNaira LuizJucunu Elias ChitioIgor CapitineMajor SitoeSimões MalaJosé Paulo LangaLorenzo Pezzoli
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2023-12-192023-12-19421Aneurysmal bone cyst D4-D5 level
https://www.ajol.info/index.php/pamj/article/view/259020
<p>Presenting a magnetic resonance image (MRI) finding of a 11-year-old female child who presented to us with the chief complaints of pain at thoracic spine and bilateral lower limbs. Magnetic resonance findings as per imaging protocol (sagittal TSE T2W1) revealed a multiocular cystic lesion which is noted in D5 vertebral body extended into both lamina and spinous process showing fluid-fluid level compressing spinal cord at D4 and D5 level likely s/o aneurysmal cyst. Aneurysmal cyst is rare. In 16% of cases it commonly affects the spine. The patient narrated that the weakness was rapidly increased within 4 days and she started walking with support. For these complaints the parents took her to a private practitioner where nerve conduction velocity (NCV) was done which was normal. The patients had more weakness at right lower limb as compared to left lower limb. She was admitted for the same and post-surgery after 3 days´ physiotherapy had been started. Post-operative physiotherapy assessment shows decreased superficial sensations, reflexes and strength (MMT grade 3/5 at right lower limb and grade 4/5 at left lower limb). Strengthening exercises of lower limb had started along with bedside mobilization. Before discharge, she had a grade of 4+ on the muscle power assessment (MRC) grading scale. Early medical and surgical management along with post-operative rehabilitation is the way to recovery in such patients.</p>Snehal Subrat SamaSubrat Narendra Samal
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2023-12-192023-12-19421Myelomeningocele, a congenital defect with severe form of spina bifida: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/259023
<p>Myelomeningocele is a severe form of spina bifida in which the spinal cord and nerves develop outside of the body and are contained in a fluid-filled sac that is visible outside of the back area. Spina bifida is a neural tube defect with average incidence of 1-2 cases per 1000 population with female to male ratio of 1.2:1. These defects occur as a result to a teratogenic process that causes failed closure and abnormal differentiation of the embryonic neural tube. We report a case of 27-year-old multigravida, whose ultrasound findings showed lumbosacral myelomeningocele at 23<sup>rd</sup> weeks. At 30-weeks gestation, preterm labor due to premature amniorrhexis and placental abruption, led to the emergency caesarean-section. A female child was born with birth weight of 520 gm, required immediate oxygen and incubator support. A clinical diagnosis of myelomeningocele, a severe form of spina bifida was made. Newborn was referred to neonatal intensive care for further management.</p>Ashna GledinaRanjana Sharma
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2023-12-192023-12-19421Epidemiological characteristics of a protracted and widespread measles outbreak in the Democratic Republic of Congo, 2018 - 2020
https://www.ajol.info/index.php/pamj/article/view/259127
<p><strong>Introduction: </strong>measles is a highly contagious viral disease. Since 2011, the Democratic Republic of Congo (DR Congo) has had the first dose measles vaccination coverage of less than 80% according to the World Health Organization - United Nations International Children's Emergency Fund (WHO-UNICEF) coverage estimates, and measles mass vaccination coverage of less than the required coverage level of 95% by survey. Starting in August 2018, the country experienced an increase in measles case reports which continued through to early 2020. Epidemiological aspects of the outbreak are described in this article. <strong>Methods: </strong>we analysed aggregate weekly passive surveillance data from the DR Congo for the years 2018 - 2020 to understand the trends of occurrence of suspected measles cases. We also analysed the measles case-based surveillance database to understand the epidemiological characteristics of confirmed cases of measles and rubella during the same period of time. <strong>Results: </strong>a total of 458,156 suspected measles cases and 8,127 deaths were reported between 1<sup>st</sup> January 2018 and 31<sup>st</sup> December 2020, with the majority of cases and deaths reported in 2019. Only 2.9% of these cases were reported through the case-based surveillance system, with 31,639 cases being confirmed as measles by the laboratory, by epidemiological linkage and on clinical compatibility. Children less than 5 years of age were most affected with a cumulative incidence of 960 cases per 1,000,000 inhabitants. Only 41% of the confirmed cases were vaccinated. Maindombe and Tshopo provinces had the highest cumulative incidence levels. There was a distinct geographic progression of the outbreak between provinces during the course of the three years. A total of 1760 lab confirmed rubella cases were confirmed in various provinces among the cases investigated with blood specimens, 93% of whom were less than 15 years of age. <strong>Conclusion: </strong>the recent gaps in vaccination coverage, the age pattern of confirmed cases and the lack of vaccination history in the majority of cases is suggestive of failure to vaccinate as the likely cause of this large and protracted outbreak. Efforts to improve vaccination coverage and the measles surveillance system are needed in order to prevent the occurrence of future outbreaks and to avert measles-related deaths.</p>Vincent Dossou SodjinouMarcellin Nimpa MengouoAlfred DoubaPatricia TanifumMoise Desire YapiKanyiga Robert KuzanwaJohn Samuel OtombaBalcha Masresha
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2023-12-192023-12-19421Clinical and histopathological pattern of lung cancer in Morocco
https://www.ajol.info/index.php/pamj/article/view/259129
<p><strong>Introduction:</strong> lung cancer is the most common cancer and the leading cause of cancer death worldwide. This study aimed to provide an overview of the epidemiology of primary lung cancer in Morocco. The distribution of histological subtypes by sex and smoking status was also assessed. <strong>Methods:</strong> this was a retrospective and descriptive study using medical records of patients with primary lung cancer, diagnosed at two university hospitals in Morocco between 2014 and 2017. <strong>Results:</strong> a total of 606 patients (average age = 58.5 ± 10.64 years, men = 521) were included. Four hundred and forty-three men had a history of smoking against sex women. Most patients (85.68%) had respiratory symptoms at diagnosis. Over half of patients (53.03%) had a performance status <2 and 38.94% had at least another pulmonary disease at presentation. Chronic obstructive pulmonary disease (COPD) and tuberculosis were present in 23.43% and 18% of patients, respectively. The majority (72.27%) of men practiced an occupation associated with a significant risk of lung cancer. Adenocarcinoma was the main histological type in our series with 60.40%. Most (79.55%) patients were diagnosed at stage IV. Only 7.83% of patients benefited from surgery. The distribution of histological subtypes by sex and smoking habits showed that adenocarcinoma was more frequent in women (p=0.011), and squamous cell carcinoma in men (p=0.014). No differences between smokers and non-smokers were noted. <strong>Conclusion:</strong> our results showed a decrease in the age of diagnosis and a late stage of the disease. Adenocarcinoma was the most frequent histological type.</p>Ouassima ErefaiAbdelmajid SoulaymaniAbdelrhani MokhtariHinde Hami
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2023-12-192023-12-19421Gallbladder carcinosarcoma with two heterologous components: a case report
https://www.ajol.info/index.php/pamj/article/view/259131
<p>Carcinosarcoma of the gallbladder is a rare cancer characterized by presence of a carcinomatous and a sarcomatous component. In our work, we report the case of a 66-year-old male patient, presenting with isolated abdominal pain evolving for more than 6 months. contrast-enhanced computed tomography enabled identification of a gallbladder mass, invading liver, duodenum and abdominal wall. A cholecystectomy, extended to liver, duodenum and abdominal wall was performed. The final diagnosis of gallbladder carcinosarcoma was obtained by pathological assessment. Gallbladder carcinosarcoma has a poor prognosis. Since it is rare, no established chemotherapy or radiation protocols exist. Further studies about case series are needed to establish better therapeutic protocols. Gallbladder carcinosarcoma is a rare cancer with a rapid progression making therapeutic decisions difficult. All these factors contribute to the poor prognosis of this cancer.</p>El Mehdi TiabiAchraf MiryAnas HalouiMohammed BouzianeImane SkikerNassira KarichAmal Bennani
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2023-12-192023-12-19421Pityriasis rubra pilaris with rickets: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/259132
<p>Pityriasis rubra pilaris (PRP) manifests as well-defined erythematous scaly plaques with follicular keratosis mainly over the elbows and knees. We present a case of a 15-years-old boy who comes to the dermatology department with complaints of itching, dryness, burning sensation, photosensitivity, erythematous skin with exfoliation over face and neck, hyperpigmentation over bilateral hand and trunk fissuring over bilateral feet, ectropion of bilateral lower lids from 3 months. On physical examination, the patient face had lesions and redness on the eyebrow. Skin biopsy and blood investigation revealed the received single, irregular, whitish tissue piece with skin and hair attached measuring 0.2x0.2 cm section shows histopathological features suggestive of pityriasis rubra pilaris. Ortho review call and review of investigations and X-rays advised the patient diagnosed with rickets. The patient was referred to the dermatology department for further management.</p>Sangita ShendeRanjana Sharma
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2023-12-192023-12-19421Le déficit immunitaire commun variable compliqué d'une amylose: à propos d'un cas
https://www.ajol.info/index.php/pamj/article/view/259134
<p>Le déficit immunitaire commun variable (DICV) est le plus fréquent des déficits immunitaires symptomatiques de l'adulte mais reste toutefois rare. Il est caractérisé par son spectre phénotypique extrêmement hétérogène. Nous rapportons le cas d'un patient âgé de 39 ans, qui a consulté pour des diarrhées chroniques avec une fistule anale. Le bilan biologique a révélé un syndrome inflammatoire, un sydrome de malabsorption, hypo-gammaglobulinémie à l'électrophorèse de protéines, hypo-gammaglobulinémie globale au dosage pondéral des immunoglobulines et un taux bas de lymphocytes à l'analyse des sous-populations lymphocytaires permettant ainsi de confirmer le diagnostic du déficit immunitaire commun variable (DICV) compliqué d'une amylose systémique type AA identifié par des dépôts amyloïdes sur des biopsies. L'intérêt de ce cas clinique est de ne pas méconnaitre les différentes présentations digestives du déficit immunitaire qui sont fréquentes et de l'évoquer devant une symptomatologie résistant au traitement habituel.</p>Ibtissam JbaraSophia BouamamaFouad HaddadFatima Zahra El RhaoussiMohamed TahiriWafaa HliwaAhmed BellabahWafaa Badre
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2023-12-192023-12-19421A prospective study of ‘circumferential purse-string approximation’ vs. primary linear skin closure in stoma reversal
https://www.ajol.info/index.php/pamj/article/view/259138
<p><strong>Introduction: </strong>surgical site infection (SSI) is one of the most common complications that can occur after stoma closure. To date, there is no consensus on the ideal closure technique of the stoma wound to minimize postoperative SSI and multiple techniques have been proposed. We performed this study to assess the clinical outcome of wound healing after ‘Primary Linear Closure’ (PC) and ‘Circumferential Purse-String Approximation’ (CPA) techniques. <strong>Methods: </strong>this prospective observational study included all patients admitted to our tertiary care center, fulfilling the inclusion criteria for elective stoma closure from 1<sup>st</sup> March 2018 to 1 March 2020 and prospective study was conducted on wound healing after stoma closure to compare difference in SSI rate between the PC group and the CPA group and to discuss the differences in patient satisfaction with wound healing. The following study was carried out with 36 patients in purse-string group and 66 patients in linear closure group.<strong>Results: </strong>surgical site infection (SSI) was observed only in primary linear closure group in 24% patients as opposed to 0% in purse string closure group. (p=0.039). Although the mean healing time of wound in linear closure group was significantly less than the purse string group (10.76 ± 5.68 days and 14.17 ± 2.04 days respectively), the overall total satisfaction score was higher in the purse string group. The purse string closure group showed significantly higher satisfaction score for expectations regarding appearance of scar/cosmesis, level of postoperative pain and difficulty of wound care (p>0.05). <strong>Conclusion: </strong>in our study, ‘Circumferential Purse-String Approximation’ is a superior technique than Primary Linear Closure for Stoma reversal in terms of rate of SSI and better overall patient satisfaction. CPA is a good alternative option, but further prospective randomized trials involving more patients are necessary before a definitive conclusion can be drawn.</p>Manavdeep Singh BainsAmandeep Singh NarHarmandeep Singh JabbalAtul MishraAkashi MishraPriyanka Sharma
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2023-12-192023-12-19421A clinical image: posterior meningocele
https://www.ajol.info/index.php/pamj/article/view/259140
<p>Posterior meningocele is a rare neural tube closure defect characterized by the herniation of a cerebrospinal fluid-filled sac, that is lined by dura and arachnoid mater, through a posterior spina bifida and covered by a layer of skin of variable thickness, which may be dysplastic or ulcerated. They are most commonly located in the lumbar or sacral region. A 1-year-old male child was brought to the outpatient department with the complaint of swelling in the back, swelling increases gradually and to the present size. After detailed history collection and physical examination, it reveals that he is having swelling in the sacral region since birth. The physician diagnosed him with posterior meningocele and hence referred them to the inpatient department for further surgical management.</p>Anushri KaleBibin Kurian
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2023-12-192023-12-19421Diphenhydramine induced acute dystonia: a case report
https://www.ajol.info/index.php/pamj/article/view/259142
<p>Acute dystonia has notably been a challenge in the emergency unit. Drug-induced dystonia is reported in a limited number of cases in the literature. Rarely, diphenhydramine was found to be the culprit. We report the case of a 25-year-old female patient who developed an acute dystonic reaction following the administration of 25 mg of intravenous diphenhydramine as a treatment for an allergic reaction. The patient was given 5 mg diazepam, admitted for monitoring, and discharged home. Diphenhydramine-induced acute dystonia is a user drug-induced threatening reaction that warrants further investigation on the metabolism of these drugs and the contributing phenotypes to this adverse reaction.</p>Danielle Abou KhaterRafi DaouAli Al DailatyMariana Helou
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2023-12-192023-12-19421Case of a 30-year-female with systemic lupus erythematosus: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/259145
<p>Systemic lupus erythematosus is a chronic and autoimmune disease that causes inflammation in connective tissue such as cartilage and the lining of blood vessels in which the immune system attacks its tissues. The aetiology factors are unknown but are linked to environmental, genetic, and hormonal factors; they can affect the joints, skin, brain, lungs, kidneys and blood vessels. We here report the case of a 30-year-female patient, who came to the dermatology ward with the complaints of flat red rash across the cheek and bridge of the nose, fluid-filled lesion all over the body, pain and itching, burning associated with the lesion, pedal oedema, oral ulcer, she was apparently alright four days back when she developed fluid-filled lesion which was sudden in onset and gradually progressive, the lesion occurred after ingestion of drug for fever. Initially, blood, electrocardiogram (ECG), chest X-ray investigation done, ultrasound sonography test (USG) done, which was suggestive of mild hepatosplenomegaly with the dilated portal vein and minimal free fluid in the pouch of Douglas, raised cortical echotexture of kidneys, skin biopsy done, and it shows atrophied epidermis, histopathological features suggestive of erythema multiform. The patient was referred to the dermatology and medicine department for further management.</p>Switi JawadePratibha Wankhede
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2023-12-192023-12-19421Right hydrocelectomy with right orchidectomy in a case of right hydrocele since last 15 years
https://www.ajol.info/index.php/pamj/article/view/259149
<p>A 72-year-old male patient came to the outpatient department (OPD) of Mahatma Gandhi Ayurveda College, Hospital and Research Center, Salod, Wardha with a complaint of swelling in the scrotum and buried penis for 15 years. On examination, it was found to be a right-sided huge hydrocele with a hard sac of a coconut size with trans-illumination test negative and folding test positive. On ultrasonography, it was reported to be a huge hydrocele (bilateral). All hemodynamic parameters were within normal limits. The patient has advised surgery (right hydrocelectomy with orchidectomy) under spinal anesthesia. After taking orchidectomy consent patient was posted for surgery. The patient was operated upon with an incision parallel to the median raphe and after adequate dissection of the huge sac within the layers of the scrotum, the whole sac of the right hydrocele was excised with drainage of dirty white fluid from the most fluctuant part. Gross calcification of the hydrocele sac was observed with gross necrosis of the right testis. Right hydrocelectomy with orchidectomy was performed, and the scrotum was closed in layers with an assurance of complete hemostasis. After the procedure, the hydrocelectomy sac was dissected for visualizing the contents and the whole calcified hard sac with necrotic testes and dirty white fluid was found. The specimen was sent for histopathological evaluation. The patient was kept in the ward for seven days for post-operative management. He had a low-grade fever on the first post-operative day. Given intravenous antibiotics for five days and other medications like analgesics Intravenous fluids and scrotal support. The patient was discharged after seven days and later called for stitch removal after five days. Patient is absolutely free of symptoms now.</p>Sheetal AsutkarSuraj Rathod
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2023-12-192023-12-19421Lipome géant du dos: rapport de cas avec revue de la littérature
https://www.ajol.info/index.php/pamj/article/view/259153
<p>Le lipome est une tumeur bénigne des parties molles. Il s´agit d´une prolifération bénigne d´adipocytes matures. Il est qualifié de géant lorsque son poids dépasse 1 kg ou son diamètre supérieur à 5 cm. La gêne fonctionnelle et esthétique peut être un motif principal d´exérèse chirurgicale. Ils peuvent se localiser partout, mais surtout au niveau de la face postérieure du thorax. Nous rapportons un cas de lipome géant de la face postéro-supérieure gauche du thorax.</p>Abdou NiassePapa Mamadou FayeAbdourahmane NdongOusmane ThiamOusmane GueyeMouhamadou Lamine GueyeIbrahima Sitor Souleymane SarrYacine SeyeAlpha Oumar ToureMamadou SeckMadieng Dieng
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2023-12-192023-12-19421Quelle chimiothérapie dans les tumeurs phyllodes métastatiques du sein? rapport de cas
https://www.ajol.info/index.php/pamj/article/view/259206
<p>Les tumeurs phyllodes (TP) du sein sont rares. Elles peuvent revêtir un caractère bénin, borderline ou malin. La forme maligne représente 20-30% des TP avec des métastases à distance dans 10-26% des cas. La chimiothérapie est l´une des principales armes thérapeutiques des tumeurs phyllodes métastatiques (TPM). Nous rapportons quatre cas de TPM du sein prises en charge au centre Mohamed VI de Casablanca pour le traitement des cancers de janvier 2015 à d écembre 2017. L´âge de nos patientes était compris entre 25 et 45 ans. Le mode de révélation clinique est représenté, dans la majorité des cas, par l´apparition d´une énorme masse mammaire et le diagnostic histologique a été porté chez toutes les patientes sur la pièce de mastectomie. Trois patientes étaient métastatiques au niveau du poumon, deux avaient des métastases ganglionnaires axillaires, deux avaient des métastases osseuses et une seule avait des métastases hépatiques. Toutes les patientes ont reçu une chimiothérapie. Les drogues utilisées étaient: la doxorubicine en monothérapie et l´association doxorubicine-ifosfamide (AI). Une seule patiente a eu une évolution très favorable avec une réponse radiologique complète après 3 cures d´AI. Les TPM du sein sont de mauvais pronostic. L´intérêt d´une chimiothérapie systémique reste à définir surtout qu´on ne dispose pas jusqu´à présent de données concernant la chimiothérapie optimale.</p>Imane Ait KaikaiMouna BourhafourMeriem HaffadiZineb BouchbikaNadia BenchakrouneHassan JouhadiNezha TawfiqSouha SahraouiAbdellatif Benider
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2023-12-192023-12-19421Chronic comorbidities in persons living with HIV within three years of exposure to antiretroviral therapy at Pantang Antiretroviral Center in Ghana: a retrospective study
https://www.ajol.info/index.php/pamj/article/view/259211
<p><strong>Introduction: </strong>uptake of antiretroviral therapy (ART) and retention in care are associated with increased life expectancy but increased the risk of comorbid conditions in persons living with HIV (PLWH) and taking antiretroviral drugs. This study describes comorbid conditions among PLWH in Ghana.<strong>Methods: </strong>PLWH (n=222) out of a sample population of 900, randomly selected at Pantang ART Center participated in the study from June to July of 2020. Socio-demographic characteristics, HIV biomarkers, medication type and adherence, and diagnostic confirmed chronic conditions were extracted from medical records of PLWH. Cox proportional-hazard models and Kaplan-Meier curves graphing risk of experiencing comorbid conditions were performed. Log-rank test was performed at p<0.05.<strong>Results: </strong>fifty three point two percent of PLWH (222) experienced a comorbid condition including, respiratory conditions (17.6%), anaemia (12.2%), hypertension (12.2%), cardiovascular diseases (10.8%),and neurological conditions (10.8%).Factors associated with some of these conditions were medication adherence (aHR=0.43, 95% CI: 0.21-0.90) and visual changes (aHR=2.64, 95% CI: 1.08-6.45) for respiratory conditions, age (aHR=10.03, 95% CI; 1.22-82.37) for hypertension, and World Health Organization (WHO) clinical stages (stage II (aHR=13.36, 95% CI=1.54-115.63) and III (aHR=11.71, 95% CI=1.41-97.26))for peripheral neuropathy. Kaplan-Meier curves show significant risk of comorbid conditions for age, CD4 count ≤350 cells/mm³, WHO clinical stages III and IV, and ART non-adherence. <strong>Conclusion: </strong>understanding the types of comorbidities in PLWH is integral to providing feedback to primary care providers to monitor.</p>Martha KoteyYakubu AlhassanJames AdomakoGodwin Nunoo-MensahFarzana KapadiaBismark Sarfo
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2023-12-192023-12-19421Atypical emphysema formation in a never-smoker with scleroderma-related interstitial pneumonia: a case report
https://www.ajol.info/index.php/pamj/article/view/259213
<p>Scleroderma is an autoimmune connective tissue disorder which is characterized by fibrosis of visceral organs, blood vessels and skin. The most common manifestations of lung disease in systemic sclerosis are interstitial lung disease and pulmonary hypertension and, together, are the leading cause of mortality in systemic sclerosis. Recently, we notice a new pattern called Combined-pulmonary emphysema and lung fibrosis. Most patients with this entity are male smokers or ex-smokers. This entity is characterized by the coexistence of both centro-lobular and para-septal emphysema in the upper lobes and interstitial lung disease in the lower lobes. Here, we present a case of a nonsmoker adult woman with systemic sclerosis, in which High Resolution Computed Tomography of lung showed combined fibrosis and emphysema with atypical radiological presentation and unusual distribution. This case outlines the importance of recognizing the presence of combined fibrosis and emphysema in patient with systemic sclerosis even without smoking history.</p>Rahma Ben JaziaJihene AyachiRaja GhzelAmeni KacemIteb Ben LimemAmira FaidiDhouha Ben BraiekFarouk ChatbouriAnis Maatallah
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2023-12-192023-12-19421Satisfaction in conventional acrylic complete denture patient with and without denture liners - a systematic review
https://www.ajol.info/index.php/pamj/article/view/259215
<p>To make a new complete denture, a series of steps is needed, and it is a time-consuming process. Which is not possible in every patient due to financial and medical reasons. The old denture can be relined by denture liners in less clinical and laboratory steps and can successfully increase the efficiency of ill-fitting dentures however, patient satisfaction with denture liners is doubtful. This systematic review was organized from the preferred reporting items for systematic reviews' checklist, and the methods were registered on the international prospective register of systematic reviews (PROSPERO- CRD42020210227). The main systematic review is to assess satisfaction in convectional acrylic complete denture with or without denture liners. Search engines such as PubMed, Science Direct, Cochrane, Ovid, and Google Scholar were used to extract information. The risk of bias was measured with the help of the Cochrane collaboration tool. Initially we found 1711 articles out of which 6 were finalised as per PICO criteria. Patient satisfaction was evaluated by using a visual analogue scale and questionnaire method, which shows denture liners group has more patient satisfaction. Acrylic denture liner and silicon denture liner shows better patient satisfaction compared to the conventional acrylic denture. Among denture liners, there is no significant difference.</p>Jayesh ShindeTushar MowadePriya GuptaRahul TekaleNeelam PandeKalyani DeshmukhTwinkle LokhandeUsha Radke
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2023-12-192023-12-19421Depression and chronic kidney disease: a cross-sectional study based at Bugando Medical Centre, Northwestern Tanzania
https://www.ajol.info/index.php/pamj/article/view/259218
<p><strong>Introduction: </strong>psychosocial distress such as depression is prevalent among chronic kidney disease (CKD) patients. It is often overlooked despite of reducing the patient´s quality of life. <strong>Methods: </strong>this was a cross-sectional study aimed to determine the prevalence and factors associated with depression among CKD patients, whereby a practical sampling technique was used among patients attending Bugando Medical Centre, a tertiary level hospital in Mwanza, Tanzania. A total of 376 CKD patients were recruited and interviewed by using patient health questionnaire-9 (PHQ-9). <strong>Results: </strong>the mean age of the participants was 52.78 years, ranging from 18 to 85 years, 67.02% were males; 33.24% were more than 60 years of age and 32.45% of the participants were attending hemodialysis at BMC Nephrology Unit. The prevalence of depression was 73.93%. Participants who were 53-96 months since diagnosis, were not affected by modification of lifestyle and who were not sexually active were less likely to develop depression. <strong>Conclusion: </strong>the results showed a high prevalence of depression among CKD patients. This emphasizes the need for measures such as earlier screening and management. Which would reduce the burden of morbidity and mortality and improve the quality of life of CKD patients.</p>Hulda MunisiIrene SylvesterIsaya MwakalebelaSaid KanendaLadius RudovickMatiko MwitaElias Nyanza
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2023-12-192023-12-19421Gastroschisis, a congenital anterior abdominal wall defect: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/259223
<p>Gastroschisis is a relatively rare birth defect in which the baby´s intestines (stomach, large or small intestines) extends outside of the abdominal wall or exit their body from a 2 to 5 cm hole, most often on the right side beside their belly button during fetal development. It occurs in about 1 in every 2,000 babies. We report a case of a large gastroschisis containing intestinal loop. A 29-year-old, primigravida, was referred to the centre for childbirth. Antenatally, at 24<sup>th</sup> weeks the fetus was diagnosed with a congenital malformation of the anterior abdominal wall. The ultrasound at 30 weeks, confirmed the diagnosis. At 37 plus weeks, she was taken for emergency caesarean section. A male child was born with the confirmation of presence of gastroschisis. Birth weight 3.2 Kg, height 54 cm with appearance, pulse, grimace, activity, and respiration (APGAR) score 8/9. At birth gastroschisis contained intestinal loop. Newborn was referred to neonatal intensive for further management.</p>Ashna GledinaSeema Singh
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2023-12-192023-12-19421Cervical Pott's disease: case report and review of the literature
https://www.ajol.info/index.php/pamj/article/view/259224
<p>Tuberculosis is a major public health problem in the world. Spinal tuberculosis (Pott disease) is a frequently encountered extrapulmonary form of the disease. Cervical spinal tuberculosis is relatively rare. We report the case of a 66-year-old patient admitted for cervical Pott's disease managed surgically and the positive outcome. A patient with a history of pulmonary tuberculosis present 3 months ago persistent neck pain with tingling and heaviness in both upper limbs. The neurological examination was normal without any sensory or motor deficit. Spinal cord magnetic resonance imaging (MRI) showed a lesion centered on the vertebral body of C4 with spinal cord compression and epiduritis without signs of spinal cord injury. The patient underwent a corpectomy of C3 and C4 with an iliac graft and anterior cervical plate. The anatomopathological examination revealed a Pott disease. He was therefore put on antituberculous chemotherapy for 12 months. Three months later the neck pain and tingling disappeared in the upper limbs. Cervical Pott's disease is relatively rare. Surgical management is indicated in the case of spinal instability or spinal cord compression.</p>Dognon Kossi François de Paule AdjiouMichèle Yolande MouneFresnel Lutèce Ontsi ObameJosé Dimbi MakosoNourou Dine Adeniran BankoleMustapha HemamaNizare El FatemiMouley Rachid El Maaqili
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2023-12-192023-12-19421Des localisations inhabituelles des lipomes sous cutanés: rapport de cas
https://www.ajol.info/index.php/pamj/article/view/259227
<p>Les lipomes sous-cutanés sont des tumeurs, très fréquentes qui siègent préférentiellement au niveau du cou et du tronc. Cependant, d´autres localisations peuvent se voir, bien qu´elles soient rares et inhabituelles, et le médecin doit penser au lipome, devant toutes tuméfactions sous cutanées y siégeant. Les auteurs rapportent 3 cas de localisations rares des lipomes, tout en détaillant le diagnostic et le traitement dont ces patients ont bénéficié. Ces localisations sont la première commissure interdigitale de la main, le doigt de pied et le canthus externe de l´œil.</p>Yassamina RibagAbdelhafid AchboukJalal HamamaMohamed Karim EL Khatib
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2023-12-192023-12-19421Distribution and trends of cancer in Buffalo City, Eastern Cape Province, 1991-2009: a retrospective study
https://www.ajol.info/index.php/pamj/article/view/259229
<p>Despite interventions, cancer remains a global public health concern. Cancer burden continues to grow globally, demanding the implementation of important preventative and control initiatives. Informative reports on existing routine cancer data are therefore required. This study describes the distribution and trends of cancer in Buffalo City (BFC) population, Eastern Cape (EC) Province for the period 1991-2009. Cancer patients were retrospectively surveyed in the database of Frere Hospital Oncology-Radiation Unit. Proportion by sex, race, geographical distribution in the province and top cancer sites were calculated. Direct method of standardisation was used to calculate Age Standardised Rates (ASR) for a subpopulation of patients residing at BFC; age-specific rates were applied to the reference population (World Standard Population). Trends in rates with 95% Confidence Intervals (CI) for two most common cancers in males and females over time adjusted for age and sex and interactions between time and race were assessed using Poisson Regression. A total of 19 737 patients´ records were analysed; 38.8% (7 656) males and 61.2% (12 081) females. Most patients were Black Africans (81.5%), followed by Whites (13.5%), Mixed Race (4.5%) and Asians (0.5%). A larger proportion (46.0%) of the patients were from Buffalo City, while the rest were distributed in other municipalities served by Frere Hospital. Top five cancers in males were lung [22.5%, ASR 21.0], prostate [14.7%, ASR 9.2], larynx [5.8%,ASR 5.0], mouth [4.4%, ASR 3.7] and tongue [3.8%, ASR 2.9 per 100 000] in females; cervix [20.9%, ASR 23.0], breast [23.6%, ASR 20.2], lung [3.4%, ASR 4.7], ovary [2.1%, ASR 3.0] and corpus uteri [3.4%, ASR 2.8]. Trends showed a decrease in lung and prostate cancers in males, while cervix and breast remained stable in females. White males were two times (95% CI: 1.87-2.49) more likely to have lung cancer and five times (95% CI: 3.90-6.21) more likely to have prostate cancer than Black Africans. White females were 0.43 (95% CI: 0.44-0.73) less likely to have cervical cancer and three times (95% CI: 2.45-3.14) more likely to have breast compared to Black Africans. In conclusion, the availability of routine cancer data at Frere Hospital contributes to strengthening of the national cancer notification regulation, as the results of this study suggest that the burden of cancer in the EC Province remains high.</p>Nomfuneko SitholeThemba Geoffrey GinindzaNontuthuzelo Iris Muriel Somdyala
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2023-12-192023-12-19421Le profil des urgences urologiques dans un hôpital régional au Sénégal: étude rétrospective de 20 mois
https://www.ajol.info/index.php/pamj/article/view/259231
<p><strong>Introduction: </strong>les urgences urologiques sont diverses et variées, et sont fréquemment rencontrées en pratique urologique. L´objectif de ce travail était d´étudier les aspects épidémiologiques et la prise en charge des urgences urologiques au centre hospitalier régional de Kolda, Sénégal.<strong>Méthodes: </strong>nous avons réalisé une étude rétrospective et descriptive d´une durée de 20 mois (janvier 2020 et le 31 août 2021) colligeant les dossiers de tous les patients reçus pour une urgence urologique.<strong>Résultats: </strong>les urgences urologiques représentaient 3,6% des patients admis au Service d´Accueil des Urgences (SAU) et 20,4% des consultations urologiques. L´âge moyen des patients était de 51,9 ± 21,5 ans avec des extrêmes de 1 an et de 98 ans. La rétention d´urine vésicale a été l´urgence urologique la plus fréquente, observée dans 249 cas (57,3%), suivie des infections urogénitales 89 (20,5%). La colique néphrétique avait concerné 48 (11%) des patients. Pour la prise en charge des urgences, le sondage vésical a été réalisé chez 193 patients (44,3%). Les actes chirurgicaux les plus fréquents étaient le cathétérisme sus-pubien 42 (51,9%) et l´exploration scrotale en urgence 15 (18,6%). <strong>Conclusion: </strong>les urgences urologiques sont dominées dans notre contexte par la rétention d´urine vésicale en rapport avec les affections prostatiques et de rétrécissement de l´urètre. Les urgences traumatiques sont peu fréquentes.</p>Thierno Oumar DialloIbrahima DiabatMamadou BarryOumar Raphiou Bah
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2023-12-192023-12-19421Perinatal tuberculosis: a diagnostic and treatment challenge in a remote area of Asmat Regency of South Papua, Indonesia
https://www.ajol.info/index.php/pamj/article/view/259232
<p>Perinatal tuberculosis (TB) is a rare infectious disease. The diagnosis of perinatal TB is challenging due to its nonspecific clinical manifestations make it difficult to differentiate from other infections, resulting in a high mortality rate of 40-60%. Here we report a 26-day-old neonate with fever, cough, fast breathing, poor feeding, subcostal retraction, bilateral crackles, hepatomegaly, and signs of shock. Clinically, septic shock and pneumonia were suspected. Respiratory distress worsened despite broad-spectrum antibiotics, and kept getting worse up to the point that intubation and assisted mechanical ventilation were needed. The examination of acid-fast bacteria (AFB) stain on the endotracheal aspirate showed a positive result. The patient was diagnosed as having perinatal TB, then treated with anti-TB regimens (isoniazid, rifampicin, pyrazinamide, ethambutol), as well as prednisone and other supportive medical care. Recurrent septic shock, laryngeal edema, and a possibility of ventilator-associated pneumonia (VAP) worsened the patient’s condition. The patient eventually passed away on the 71<sup>st</sup> day of care. In conclusion, perinatal TB should be suspected in any neonates with fever, respiratory distress, and hepatosplenomegaly, particularly in those from endemic areas, which fail to respond to broad-spectrum antibiotics. Early diagnosis and treatment are crucial to improve the prognosis of perinatal TB.</p>Sitanaja RaymondHelen Mayasari SubektiAbed Ricky Hernando Sitompul
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2023-12-192023-12-19421Mini-laparotomy for cholecystectomy in resourced limited settings: a 10-year retrospective hospital-based study
https://www.ajol.info/index.php/pamj/article/view/259233
<p>Cholecystectomy is a commonly performed abdominal procedure, the gold standard currently is the laparoscopic approach and, however, the facilities and expertise for laparoscopy are not available widely, especially in developing countries. A Mini-laparotomy cholecystectomy is an additional approach that is performed through an incision that is less than 5 cm thus minimizing the complications of the traditional open cholecystectomy and the postoperative hospital stay. The study aims to evaluate the outcome of mini-laparotomy cholecystectomy in terms of operative duration, complications, and hospital stay in a rural hospital. This is a retrospective study conducted in El-Dwaim Teaching Hospital, Sudan. All cases of mini-laparotomy cholecystectomy conducted from March 2009 to December 2020 were included and retrospectively studied. Descriptive statistics were applied using SPSS version 25. A total of 512 mini-laparotomy cases were involved in the study, of those 442 aged more than 40 years. The operation lasted less than 60 minutes for 486 of the participants, and the most frequent cholecystitis complication observed intraoperatively was mucocele, occurring in 70 (13.6%) participants. Intraoperative complications due to mini-laparotomy occurred in 4 (0.8%) cases, in the form of bleeding and none of the observed cases converted into open cholecystectomy. Postoperative complications occurred in the form of wound infection in 7 participants, biliary leak in 1 participant, and fistula formation in 1 participant. Post-operative hospital stay was 24 hours for 458 participants. Mini-laparotomy cholecystectomy is a safe minimally invasive approach with low rates of complications and short postoperative hospital stay, making it an optimum approach in facility-deprived countries.</p>Samir Ismail BashirRayan Bakari Adam MohamedKhalid Abbas OwishAbdalla Mohamed AbdallaAbdullah Misbah AbdullahYasir Babiker Ali
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2023-12-192023-12-19421Gingival overgrowth during orthodontic treatment and its management
https://www.ajol.info/index.php/pamj/article/view/259239
<p>An increase in plaque retention and ineffective dental hygiene practices lead to gingival enlargement (GE). A 24-year-old female came to the department of periodontics with chief complaint of proclined teeth in the front region of the jaw, and accordingly planned for orthodontic treatment. After 10 months of orthodontic therapy, it was observed that there was GE in the upper anterior region of the teeth. Following comprehensive scaling and dental hygiene instructions, the patient was summoned back three weeks later for another evaluation and a gingivectomy operation was scheduled. The administration of local anaesthetic was carried out under all septic safeguards and circumstances. Pocket markers were used to identify bleeding spots. Then, using a no. 15 BP blade or Kirkland knife, external bevel cuts were made beyond the markings. As the lesion extended interproximally, the Orban knife was then utilized intradentally. Using a curette and scissors, tissue tags were taken off. By applying pressure packs with wet gauze or cotton infused with local anaesthetic, the bleeding was managed. Following the establishment of hemostasis, a scalpel gingivoplasty involving the thinning of the connected gingiva, tapering of the gingival edge, and shaping of the interdental papilla was carried out. Periodontal dressing was applied when the bleeding was stopped. Analgesics and an antiseptic mouthwash were prescribed for the patient as part of the postoperative instructions.</p>Aishwarya Deepaksingh RathodPriyanka Jaiswal
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2023-12-192023-12-19421Fungal necrotizing external otitis: diagnosis, management and outcomes of 15 cases
https://www.ajol.info/index.php/pamj/article/view/259240
<p>Fungal necrotizing external otitis (NEO) is a rare disease. It is an aggressive and potentially fatal infection. The most commonly reported pathogen is <em>Candida</em>. We aim through this study to share our experience in the management of fungal necrotizing external otitis and discuss its diagnosis tools, anti-fungal treatment choice, and outcomes. We included fifteen patients with diagnosis criteria of fungal NEO; clinical features of NEO with positive culture swabs and/or positive serologic test to a fungal pathogen. The mean age was of 70 years with a prevalence of males. The main symptoms were otalgia (n=15) and otorrhea (n=7). Facial palsy was observed in four cases. Fungal pathogens were <em>Candida</em> (n=10) and <em>Aspergillus</em> (n=5). Complications were observed in eight cases: extension to the temporo-mandibular (n=4), abscess in the retropharyngeal space (n=2), abscess in the parapharyngeal space (n=1) and thrombophlebitis of the internal jugular vein (n=1). Six patients were treated with fluconazole, eight with voriconazole, and one patient with itraconazole. After a mean duration of 52 days of antifungal therapy, fourteen patients have been cured with normalization of the ear symptoms, biological, and imaging features. One patient died of septic shock. No recurrence of the disease was observed after a follow-up of 12 months in all cases.</p>Amel El KorbiJihene HouasNaourez KolsiRachida BouatayMehdi FerjaouiAdnene ToumiKhaled HarrathiJamel Koubaa
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2023-12-192023-12-19421Knowledge, attitude and adherence to COVID-19 prevention among community health workers in Nigeria
https://www.ajol.info/index.php/pamj/article/view/259248
<p><strong>Introduction: </strong>community health workers play important roles in curtailing the spread of COVID-19. This study therefore investigated the knowledge, attitude and adherence to practice of COVID-19 prevention-protocols among community health workers in selected States of Nigeria. <strong>Methods: </strong>purposive sampling method was adopted. A cohort of community health workers testing and enrolling human immunodeficiency virus (HIV) positive-clients into care were involved in the study. Questionnaire on Microsoft forms was completed by 366 participants. Data was analyzed using descriptive and inferential statistical methods. <strong>Results: </strong>key findings revealed that 87.80% have good knowledge of COVID-19; 96.10% positive attitude towards COVID-19 prevention-protocols and 97.20% adhere to the protocols. Demographics variables have significant positive effect on adherence to COVID-19 prevention-protocol among the respondents as follows: marital status (X<sup>2</sup>: 21.91; p: <0.05), gender (X<sup>2</sup>: 9.01; p: 0.003), ethnic group (X<sup>2</sup>: 17.45; p: <0.05), State of residence (X<sup>2</sup>:32.51; p: <0.05), education status (X<sup>2</sup>:18.44; p: 0.005). Findings revealed there is no significant relationship between knowledge of COVID-19 and the anxiety status of community health workers (p=0.90). There is positive relationship between knowledge of COVID-19 and attitude to guidelines and adherence to COVID-19 prevention-protocols. R=0.20 (<0.05) and 0.195 (<0.05) respectively.<strong>Conclusion: </strong>the high knowledge of COVID-19, positive attitude and adherence to the prevention-protocols among community health workers provides assurance of their ability to provide factual information to the community and their ability to promote good attitude and adherence to the prevention-protocols. Key sociodemographic variable like marital status, gender, ethnic groups, educational status and State of residents play significant roles in adherence to COVID-19 prevention-protocols.</p>Oluyemi Peter AtibiokeFatimah Adepoju-OlajuwonOluwaseun Ayoola OjomoAdeyemi Olalekan OladejiOluwakemi Bolatito OripeloyeKehinde Adesola OsinowoAdemola Johnson Ajuwon3Oladapo Alabi Ladipo
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2023-12-192023-12-19421Aberrant left main coronary artery (ALMCA) arising from the right sinus of Valsalva with interarterial course
https://www.ajol.info/index.php/pamj/article/view/259253
<p>Here, we report a case of an 80-year-old man with a history of hypertension and recurrent episodes of syncope and chest pain. First, he underwent a coronarography with revascularization of the right coronary artery and stent placement. The exploration of the left main coronary artery (LMCA) was not performed because of catheterization difficulties. A coroscanner was performed for suspicion of an anomalous of the left coronary artery. The coroscanner showed an uncommon case of left main coronary artery (LMCA) arising from the right sinus of Valsalva. The proximal part of the interventricular artery has an intraarterial course between the aorta and the pulmonary outflow tract, with narrowing of this artery at this level (2.2 mm in diameter). Left main coronary artery (LMCA) or left anterior descending coronary artery (LAD) arising from the right sinus of Valsalva or right coronary artery (RCA) is referred to as an anomalous aortic origin of a coronary artery (AAOCA). The subsequent course is mostly between the aorta and the pulmonary artery on its way to the left ventricle. Different theories have been postulated as a cause of sudden death in these patients. The most accepted theory is the higher incidence of occlusion of the osmium secondary to a more slit-like orifice and occlusion during physical activity due to compression between the major arteries.</p>Badr BoutakiouteAnass Chehboun
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2023-12-192023-12-19421Human African trypanosomiasis (HAT) in the Republic of Congo: why the Congolese population is reluctant to screening?
https://www.ajol.info/index.php/pamj/article/view/259255
<p><strong>Introduction: </strong>human African trypanosomiasis (HAT) is a neglected tropical infection, and surveillance of the disease relies on community participation in screening. This study aimed to identify the main factors associated with low community uptake of the HAT screening in endemic districts in the Republic of Congo. <strong>Methods: </strong>a cross-sectional survey was carried out during a sensitisation campaign about HAT in the districts of Mpouya, Ngabé and Loudima, which are endemic for the disease. After signing the informed consent form, participants were organized into groups of 10 for focus group discussions (FGDs). A list of questions was used for guiding the discussion, addressing understanding of the disease and reasons for refusing screening.</p> <p class="ParagraphSeparator"> </p> <p><strong>Results: </strong>out of 220 recruited individuals (corresponding to 22 FGDs), 58.6% were men. The majority of the respondents described HAT as a rural disease (48.2%) or as a witchcraft (22.3%). Among the clinical signs cited by the participants, sleep disorder (40%) was the most common answer, followed by prolonged fever (19.5%) and madness (14.1%). The main reasons for non-adherence to HAT screening was the fear of lumbar puncture (45.9%) and stigmatisation (22.3%). <strong>Conclusion: </strong>the findings of this study suggest that more effort should be put into raising awareness of HAT and the benefits of screening amongst the Congolese population, in order to strengthen the national disease control program.</p>Viny Andzi ElengaAbel LissomChristevy VouvounguiTsengue-TsengueGabriel AhomboFrancine Ntoumi
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2023-12-192023-12-19421Preparation for birth and complication readiness: rural-urban disparities among pregnant women in communities in Enugu State, Nigeria
https://www.ajol.info/index.php/pamj/article/view/259258
<p><strong>Introduction:</strong> birth preparedness and complication readiness (BPCR) is a key component of safe motherhood programs. The study aimed to determine the rural-urban disparities in BPCR and its predictors among pregnant women. <strong>Methods:</strong> this study was a community-based comparative cross-sectional study carried out among 366 pregnant women living in rural and urban areas in Enugu State, Nigeria. A multistage sampling technique was used to select the participants. Data analysis was carried out using descriptive statistics and inferential statistics at a significant level of p < 0.05. <strong>Results:</strong> among the respondents, 213 (58.2%) had good knowledge of the components of BPCR. However, a significantly higher proportion of those in urban areas had better knowledge of these components than those in rural areas (p=0.01). Generally, there was a poor practice of BPCR among both groups of respondents. However, between both groups of respondents, good practice of BPCR was statistically significantly higher in respondents from urban areas 69 (37.7%) than those in rural areas 47 (25.7%) (X<sup>2</sup>=6.108, p=0.013). Several factors were found to be associated with good practice of BPCR among the respondents however, the only predictor of good practice of BPCR among the urban respondents was being aware of free maternal and child health services in the State while for the rural respondents, it was having an assisted delivery in the last stages of pregnancy.<strong>Conclusion:</strong> there are rural-urban disparities in BPCR. Most pregnant women are knowledgeable about its components but the majority do not practice it appropriately.</p>Ifeoma Maureen ObionuMiriam AjubaEmmanuel Nwabueze Aguwa
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2023-12-192023-12-19421Contribution de la dérivation AVR dans le diagnostic de la cardiopathie ischémique: à propos d´un cas à l´Institut de Cardiologie d´Abidjan
https://www.ajol.info/index.php/pamj/article/view/259290
<p>Des anomalies dans la dérivation aVR fourniraient des informations utiles sur le risque de maladies coronariennes. Ce présent cas clinique en est une illustration. En effet, il s´agit d´un patient de 60 ans, tabagique actif et diabétique ancien type 2 qui a présenté une douleur thoracique d´allure angineuse avec une épreuve d´effort positive. L'électrocardiogramme initial a montré un discret sus-décalage du segment ST et une onde Q de nécrose en aVR avec des signes en miroir en territoire inférieur. Une cardiopathie ischémie à fraction d´éjection ventriculaire altérée a été objectivée. La coronarographie diagnostique a objectivé une atteinte pluritronculaire coronaire. En définitive, la dérivation aVR fournit des informations cliniques précieuses et plaide en faveur d´une attention particulière à cette dérivation souvent oubliée.</p>Loa Ambroise GnabaKassi Anicet AdoubiKouakou Florent DibyIsabelle KouaméPinnin Evelyne Adjara OuattaraManga DiomandMbe Matokoma DaniogoKeumian Gabin TroKoudré Serge Armel DakoiAka Roland N´Guetta
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2023-12-192023-12-19421Retrospective analysis of the role of retrobulbar amphotericin-B injection in the management of COVID-19 associated rhino-orbito-cerebral-mucormycosis
https://www.ajol.info/index.php/pamj/article/view/259293
<p><strong>Introduction: </strong>Rhino-orbito-cerebral-mucormycosis (ROCM) is the most common form of mucormycosis observed during the second wave of COVID-19 where a steep rise in the number of cases was seen. The orbital form is almost always associated with fungal sinusitis. Among the various treatment modalities available, the role of retrobulbar Amphotericin-B injections is under-reported. This study is conducted to determine the role of transcutaneous retrobulbar amphotericin-B (TRAMB) in the management of COVID-19 associated ROCM.<strong>Methods: </strong>a retrospective analysis of 61 patients of COVID-19 associated ROCM was done, who met the inclusion criteria and presented to a tertiary care center, between May to August 2021. These patients were administered TRAMB (deoxycholate/emulsion form) along-with systemic amphotericin B. All the patients were evaluated for clinical improvement.<strong>Results: </strong>out of 61 patients, 58 (95.08%) showed overall improvement. 40 patients (65.57%) stabilized or improved clinically and 3 patients succumbed to the illness due to advanced systemic mucormycosis and acute kidney failure. Sixteen out of 58 patients underwent orbital exenteration. Out of remaining 43 patients, 35 showed complete recovery of orbital and ocular disease and the disease stabilized in eight patients. Seven patients demonstrated TRAMB associated ocular complications which however completely resolved in six patients.<strong>Conclusion: </strong>to the best of the author´s knowledge, regression of orbital mucormycosis with improvement in ptosis, proptosis, ocular motility and stabilization of visual acuity are scarcely reported in literature. Further TRAMB as a globe non-deforming treatment modality is an option available for ROCM.</p>Rekha YadavSiddharth MadanJolly RohatgiAnam AnsariRahul SharmaPriyanka GautamPuja RaiGopal Krushna DasPramod Kumar SahuVipin Arora
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2023-12-192023-12-19421A typical case of herpes zoster on lower limb
https://www.ajol.info/index.php/pamj/article/view/259307
<p>Herpes zoster is caused by varicella zoster virus. After the previous attack of chickenpox, it remains dormant in body and reactivation causes herpes zoster or shingles. There is prodromal of pain for 1-4 days. Erythema and oedema are followed by formation of groups of vesicles. The crust form in 15 days without scars or minimal scars. Thoracic intercostal nerves and ophthalmic division of trigeminal nerve most frequently affected. Other spinal nerves also involved. A 64-year-old lady come to Outpatient Department (OPD) with vesicles on waist and right thigh with complaint of burning and severe pain in lumbar area. The patient had taken pain killers/anti-inflammatory drugs over the counter but of no use.</p>Amol Madhav DeshpandeMayuri Amol Deshpande
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2023-12-192023-12-19421How does the experience of the medical encounter with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome impact women in Africa?
https://www.ajol.info/index.php/pamj/article/view/259308
<p><strong>Introduction: </strong>the MRKH syndrome is a rare congenital malformation in women. As most rare conditions, this syndrome usually causes confusion in patients and even in physicians. The medical encounter of young girls with the syndrome is intertwined in a complex matrix of social, economic and cultural factors that only contribute in creating more confusion in the young girl. <strong>Methods: </strong>the study is qualitative and designed to describe the first encounter of women with the MRKH syndrome at the physician. To that effect, an interview guide was designed for in-depth interviews with 05 MRKH women from varied African countries (Cameroon, Côte-d’Ivoire, and Senegal) selected using the snowball technique. <strong>Results: </strong>findings from this study revealed that most women go to the hospital and return more confused as no clear information is given to them on their condition. Also, cultural, social and religious beliefs on the one hand seems to blur the physician’s judgment to provide appropriate remedies like instrumental dilatation for rudimentary vagina, surrogacy for uterine infertility factor, adoption, etc. and on the other hand, these beliefs also act as a barrier for these young girls who are not strangers to the culture. <strong>Conclusion: </strong>the study suggests that, physicians give to the patients all necessary information for them to take elective decisions on their health. It also suggests that awareness should be raised on this condition.</p>Rose-Danielle Ngoumou
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2023-12-192023-12-19421Abnormally large malignant breast tumor with breast abscess: a rare clinical image
https://www.ajol.info/index.php/pamj/article/view/259311
<p>Breast cancer develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, fluid coming from the nipple, a newly inverted nipple, or a red or scaly patch of skin. A 36-year-old female without any significant history came with the complaint of the sudden growth of breast tissues without pain in the last one month followed by pus discharge for one week along with red patches around the nipple. On physical examination, the tumor measured about 18cmx14cm. After investigations and biopsy, the patient was diagnosed with a malignant breast tumor.</p>Shrushti Yogeshwar GawandeJaya Gawai
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2023-12-192023-12-19421Bilateral cleft lip, alveolus, and palate deformity in an infant
https://www.ajol.info/index.php/pamj/article/view/259312
<p>A 20-day-old infant reported with his parents a complaint of an opening over the lip and trouble in feeding. The weight of the baby at birth was 2.8 kg and medical history was not remarkable. Clinical examination manifested bilateral cleft lip, alveolus, and palate deformity. A single natal tooth in the upper anterior segment was present. The nasal rim was collapsed and the premaxilla was deviated and rotated to the left side. The alveolar segments were underdeveloped. Extraction of the natal teeth was advised followed by pre-surgical nasoalveolar molding for approximation of the lips, alveolus, and palate.</p>Sharayu Vinod NimonkarVikram Murlidhar Belkhode
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2023-12-192023-12-19421Caesarean section: epidemiology and indications at General Provincial Hospital of Kananga
https://www.ajol.info/index.php/pamj/article/view/259313
<p>The aim of our study is to describe the epidemiological profile and indications for caesarean section at the maternity ward of the Provincial General Hospital of Kananga from January 1<sup>st</sup> 2014 to December 31<sup>st</sup> 2020. This is a descriptive study of a series of cases from the medical records of cesarean patients and based on non-probabilistic sampling of suitability for cases selection. The sample of our study is composed of 1395 cases. The frequency of caesarean section is 16.10% with an annual average of 199.30 (SD 18.20) cases per year, the average age of patients is 25.39 years (SD 1.23), the primiparity is the most affected with 27.38 %, hemorrhagic placenta previa is the most common indication in 26.86%, maternal complications is present in 46.73% and the maternal mortality rate due to cesarean section is 531 per 100.000 live births. The practice of caesarean section constitutes a real problem and our results can serve as a basis for in-depth studies on indications and maternal complications of caesarean section in order to reduce the risks associated with the practice of caesarean section in our environment.</p>Antoine Tshimbundu KayembeSylvain Mulumba Kapuku
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2023-12-192023-12-19421Cervical cancer screening practice and associated factors among women employees in Wolaita Zone hospitals, Southern Ethiopia, 2017: cross-sectional study
https://www.ajol.info/index.php/pamj/article/view/259315
<p><strong>Introduction: </strong>cervical cancer is a global public health problem affecting women worldwide. There is very low participation rate in screening practice for cervical cancer in low-resource countries like Ethiopia. So the aims of this study is to assess cervical cancer screening practice and associated factors among women employees in Wolaita Zone hospitals, Southern Ethiopia. <strong>Methods: </strong>facility based cross-sectional study design was conducted from March 1-April 30, 2017. Simple random sampling technique was employed to select 401 study participants. Pre-tested self-administered questionnaire was used. Logistic regression was performed to assess association between dependent and independent variables with 95% confidence interval (CI) and p-value less than 0.05 was set to declare association. <strong>Results: </strong>about 120 (30.5%) participants were screened for cervical cancer. Age, source of information from health professions, being adherence supporter, sex with more than one partner, sexual transmitted infection, increase in attitude and knowledge score were significant predictors of cervical cancer screening practice. <strong>Conclusion: </strong>magnitude of cervical cancer screening practice among age eligible women is still low. Age, being adherence supporter, source of information from health care professionals, history of multiple sexual partners, sexually transmitted infection, knowledge and attitude were important predictors of cervical cancer screening practice. Hospitals in collaboration with town administration should put priority on cervical cancer prevention by establishing cervical cancer screening campaign.</p>Getachew TesfayeShifera YedenekaMillion AberaMihretu LakewTilahun WodaynewAbebe Mamo
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2023-12-192023-12-19421Medicinal plants used in the traditional treatment of diabetes in Ksar Elkebir Region
https://www.ajol.info/index.php/pamj/article/view/259316
<p><strong>Introduction:</strong> the number of people with diabetes continues to increase worldwide. In Morocco, two million adults are estimated to be diabetic in 2018. The Moroccan population is known for the use of medicinal plants and natural recipes for the treatment of chronic diseases including diabetes. The present study aimed to make an inventory of plant species used in folk medicine for the treatment of diabetes mellitus by diabetic patients in Ksar Elkebir City (North-west, Morocco). <strong>Methods:</strong> an ethnobotanical study was carried out among 250 diabetic patients by means of a semi-structured questionnaire by direct interviews. <strong>Results:</strong> a total of 29 species of plants belonging to 23 families were identified. The most represented families were <em>Lamiaceae</em>, <em>Apiaceae</em>, <em>Aasteraceae</em>, <em>Fabaceae,</em> and <em>Lauraceae</em>. While the most frequently cited plant species were <em>Olea Europaea l</em>, <em>Trigonella foenum graecum </em>, <em>Origanum compactum benth l</em> and <em>Salvia officinalis l</em>. Leaves were the most used part of plants and the decoction was the most cited mode of preparation used by the population included in the study. <strong>Conclusion:</strong> people with diabetes in Ksar Elkebir Region use a variety of herbal remedies in several ways to treat diabetes. This result can be an important database for the following studies to confirm the efficiency of these plants in vitro and in vivo.</p>Ibrahim HinadYoussef S'hihAboubaker ElhessniAbdelhalim MesfiouiMoulay laarbi Ouahidi
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2023-12-192023-12-19421Clandestine abortions: epidemiology at Provincial General Hospital of Kananga
https://www.ajol.info/index.php/pamj/article/view/259318
<p>This study aim is to describe the epidemiological profile of pregnant women who performed clandestine abortions in the gynecological department of the Provincial General Hospital of Kananga. This is a descriptive study of a series conducted from the medical files of pregnant women who secretly aborted in the gynecology department of the Provincial General Hospital of Kananga from January 1<sup>st</sup> 2015 to December 31<sup>st</sup> 2019. It is based on the no probabilistic sampling of suitability. We recorded 58 cases of clandestine abortions upon 1667 patients. The frequency of clandestine abortions is of 3.48% with an average age of pregnant women of 26.96 years, 70% of pregnant women under 30 years old, nulliparity is more concerned (34.48%), pupils and students as well as unemployed are more concerned in 55.12%, nurses are the abortionists encountered in 37.70%, cervical dilation and curettage is the most used abortion method (69.07%) and the maternal mortality rate linked to clandestine abortion is 13.79%. The fight against clandestine abortions requires the promotion of sex education in school and academic circles, and the sensitization of women and couples to the use of contraceptive methods and family planning. Our results serve as the basis for in-depth studies on clandestine abortions and their complications with a view to improving their management in our environment.</p>Antoine Tshimbundu KayembeGérard Kabatantshi MukengabantuSylvain Mulumba Kapuku
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2023-12-192023-12-19421Patterns, facilitators and barriers to physical activity among Nigerian pregnant women
https://www.ajol.info/index.php/pamj/article/view/259319
<p><strong>Introduction:</strong> pregnancy is associated with sedentary behaviors and/or low levels of physical activity (PA). This study aimed to assess patterns, barriers, and facilitators of PA among pregnant women. <strong>Methods:</strong> a convergent parallel mixed method design study involving a concurrent collection of quantitative (n=198) and qualitative (n=36) data was carried out. Respondents were drawn from five selected health care facilities in Ile-Ife, Osun state, South-West, Nigeria. Physical activity was assessed using the pregnancy physical activity questionnaire. Focus group discussions were used to qualitatively explore barriers and facilitators of PA. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were analyzed using thematic content analysis. <strong>Results:</strong> the mean total PA score for the population was 118.663±81.522 mets-min/wk. While it was 118.743±92.062 mets-min/wk, 113.861±72.854 mets-min/wk, and 25.429±87.766 mets-min/wk for the first, second, and third trimester respectively. The respondents engaged more in moderate (44.27±37.07) than vigorous (13.89±18.87) intensity PA. Respondents in the third trimester had the highest and the least scores for household-related PA (45.7±33.0) and vigorous-intensity PA (10.0±14.0) respectively. Major themes that emerged on enablers and barriers of PA engagement during pregnancy were related to intrapersonal, interpersonal, availability of specialized health personnel and policy for PA, good built environment/neighborhood factors, and pervading cultural beliefs and myths about pregnancy. <strong>Conclusion:</strong> moderate intensity and household-related PA were most common among Nigerian pregnant women. Contextual facilitators and barriers to PA during pregnancy were largely related to intrapersonal, interpersonal, environmental or organizational, policy, and cultural factors.</p>Chidozie Emmanuel MbadaDolapo Adeola OjoOlabisi Aderonke AkinwandeOkechukwu Ernest OrjiAdebanjo Babalola AdeyemiKikelomo Aboyowa MbadaEsther Kikelomo Afolabi
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2023-12-192023-12-19421Expression of cytokeratin-7 and cytokeratin-19 on newborn mice induced rhesus rotavirus as biliary atresia model
https://www.ajol.info/index.php/pamj/article/view/259326
<p><strong>Introduction: </strong>biliary atresia (BA) is a progressive inflammation that causes obstruction and fibro-obliteration of the bile ducts during the perinatal period. Biliary atresia occurs in about 1 in 5000 to 8000 live births, and 50% require liver transplantation. This study aims to iinvestigate the influence of induction and duration of illness after rhesus rotavirus (RRV) exposure to changes in the expression of cytokeratin-7 (CK-7) and cytokeratin-19 (CK-19) in mice models of AB. <strong>Methods: </strong>a total of 48 Balb/c less than a day after birth was included as model of BA. The overall sample was split randomly by using the randomization table into 4 control groups and 4 treatment groups. Groups 1,2,3, and 4 composed of 24 infant mice Balb/c (each group of 6 tails) with blue color code get a placebo (buffered saline) intraperitoneallyless than a day after birth. Groups 5, 6, 7, and 8 were composed of 24 mice Balb/c (eachgroup of 6 tails) with red color code get induction RRV 1.5 x 106 plaque forming units (PFU) as treatment groups. <strong>Results: </strong>there are influence of the RRV induced changes in the expression of CK-7 murine model of BA day 3, 7, 14 and 21 after induction compared to the control (p<0.05). There was interaction between induction effects and duration of illness after RRV exposure to CK-7 expression in murine models of BA on days 3, 7, 14 and 21 (p<0.001). There was difference in the value of CK-19 expressions progressively between trial group and control group seen from day-3 and day 21. <strong>Conclusion: </strong>induction and duration of illness after rhesus rotavirus exposure effect on the expression of cytokeratin-7 and cytokeratin-19 mice models of biliary atresia.</p>Bagus SetyoboediAhmad RofiiAnang EndaryantoSjamsul Arief
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2023-12-192023-12-19421Facteurs prédictifs de l´encéphalopathie hépatique au cours de l´atteinte hépatique aiguë sévère
https://www.ajol.info/index.php/pamj/article/view/259329
<p><strong>Introduction: </strong>l´atteinte hépatique aiguë sévère (AHAS) est une inflammation aiguë du foie avec des perturbations des marqueurs d´atteinte hépatique et des signes d´insuffisance hépatocellulaire (ictère et INR supérieur à 1,5) selon définition de l´association européenne pour l'étude du foie.Le facteur qui conditionne le pronostic de l´AHAS reste l´apparition d´une encéphalopathie hépatique (EH). L´objectif de ce travail est de rechercher les facteurs prédictifs du développement de l´EH au cours de l´AHAS. <strong>Méthodes: </strong>il s´agit d´une étude observationnelle rétrospective entre janvier 2000 et décembre 2019. Nous avons réalisé une étude analytique comparant les deux groupes en fonction de l´apparition ou non d´une EH. <strong>Résultats: </strong>cinquante-neuf patients ont été colligés. La survenue d'une EH était observée chez 15 patients (25,4%). Les facteurs prédictifs de la survenue d´une EH en analyse univariée étaient un délai de consultation supérieur à 9 jours, un taux d´INR supérieur à 2,45, un taux de bilirubine supérieur à 230 μmol/l, créatininémie supérieur à 60,5 μmol/l, un taux d'urée supérieur à 5,5 mmol/l et un score MELD supérieur à 26,5 (p=0,023, p = 0,017, p = 0,0001, p=0,049, p = 0,0001, p = 0,0001 respectivement).L´hépatite auto-immune et la cause indéterminée étaient associées à l´apparition d´une EH (respectivement p=0,003 et p=0,044). En analyse multivariée, l´étiologie auto-immune et un taux d´urée supérieur à 5,5 mmol/l étaient significativement associés à la survenue d´une EH. <strong>Conclusion: </strong>la survenue de l´EH est le résultat de l´interférence de plusieurs facteurs associant des paramètres biologiques comme l´INR, la bilirubinémie, la fonction rénale et l´étiologie en cause.</p>Amal KhsibaSamir BradaiMoufida MahmoudiMouna MedhioubLamine HamzaouiMohamed Mousadek Azouz
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2023-12-192023-12-19421Case of leprosy in child
https://www.ajol.info/index.php/pamj/article/view/259332
<p>A 7-year-old male patient was brought to outpatient department (OPD) by his parents with complaints of swelling of all fingers with blackish-colored multiple ulcers seen on the fingers and nails. Nail beds were lost on the same fingers as shown in <a><strong>Figure 1</strong></a> and no complaints of pain or tenderness in the cuboidal region. These symptoms were present consistently since six years started at the age of 8 months. In family history, positive contact history confirmed as his uncle had the same complaints. Based on the typical symptoms such as no pain sensation in the fingers, thickness of the nerve at the cuboidal site, multiple ulcerative lesions on and off on the fingers, and positive family history of contact, patient is clinically diagnosed with leprosy. The treatment started as WHO recommended multi-drug therapy (MDT) regimen. It consists of medicines and respective doses of Dapsone (2 mg/kg daily), Rifampicin (10 mg/kg once a month) and Clofazimine (50 mg twice weekly) for 6 months continuously along with wound care, eye care, taking proper treatment and maintaining hygiene and prevention of more wounds by advising to use gloves, socks, and shoes. We suggested consuming enough nutritious food. After 15 days of starting treatment, some symptoms like reduced swelling of fingers and slight better wound healing state observed. The oral medication was continued for the next six months to prevent a relapse of the disease. Initially few follow-up were taken for every 15 days till two months, then monthly for four months and observed the remission. The final diagnosis was leprosy, while the differentials included Leash Nyhan syndrome, Proteus syndrome and Systemic sclerosis.</p>Archana ThawareRenu Rathi
Copyright (c) 2023
2023-12-192023-12-19421