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. 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Statutory fair use and other rights are in no way affected by the above Sexualité des femmes ménopausées en Afrique sub-saharienne: exemple du Sénégal https://www.ajol.info/index.php/pamj/article/view/207910 <p><strong>Introduction:</strong>&nbsp;en Afrique, la vie sexuelle après la ménopause reste un domaine mal exploré du fait de son caractère tabou. L'objectif de cette étude était d'apprécier la qualité de la sexualité du couple au cours de la ménopause.&nbsp;<strong>Methodes</strong>: il s'agissait d'une une enquête transversale concernant un échantillon représentatif de 320 femmes ménopausées. Les critères d'inclusion étaient la ménopause naturelle. N'étaient pas incluses de l'étude les patientes ayant fait l'objet d'une ménopause précoce ou iatrogène. La fiche d'enquête était divisée en 4 chapitres : les caractéristiques socio-culturelles de la femme, les données cliniques, les données psycho-sexuelles et les données thérapeutiques. Nous avons utilisé la comparaison des proportions et le test du Chi 2 avec un seuil de signification inférieur à 0,05.&nbsp;<strong>Resultats</strong>: l'âge moyen des femmes était de 60 ans. L'âge moyen de survenue de la ménopause était de 48 ans et l'ancienneté de la ménopause était de 11,3 ans. Aucune femme de notre étude n'était épargnée par les manifestations du syndrome climatérique. Les bouffées de chaleur étaient présentes dans 85,9%, la sècheresse vaginale dans 62,8% et les troubles urinaires dans 52,5%. Seules les femmes mariées déclaraient avoir des rapports sexuels avec leurs conjoints (62,1%). Ces rapports sexuels étaient occasionnels dans 68,9% des cas alors que 18,1% des femmes n'avaient plus d'activité sexuelle. La diminution de l'activité sexuelle était due aux troubles de l'érection du conjoint (62% des couples) et au manque de désir sexuel (83,5% des femmes). Une absence d'excitation sexuelle et d'orgasme étaient également retrouvée respectivement dans 92% et 100%. Cependant, 93,5 % des femmes mariées jugeaient supportable leur vécu.&nbsp;<strong>Conclusion</strong>: le statut marital, la dyspareunie, la sècheresse vaginale et les troubles érectiles du conjoint ont un impact réel sur la sexualité de la femme ménopausée au Sénégal.</p> Abdoul Aziz Diouf Djibril Diallo Papa Youssou Niang Aminata Niass Cyr Espérance Koulimaya-Gombet Moussa Diallo Jean Charles Moreau Alassane Diouf Copyright (c) 2019-01-01 2019-01-01 32 1 Evaluation des performances du cytomètre « MUSE AUTO CD4/CD4% » vs « GUAVA AUTO CD4/CD4% » pour la mesure du taux de lymphocytes CD4 chez des patients infectés par le VIH au Cameroun https://www.ajol.info/index.php/pamj/article/view/207918 <p><strong>Introduction:&nbsp;</strong>nous avons évalué les performances du cytomètre MUSE®, par rapport au cytomètre de référence GUAVA®.</p> <p><strong>Méthodes:&nbsp;</strong>une étude expérimentale a été réalisée sur des échantillons de patients séropositifs au VIH. Les échantillons de sang veineux recueillis dans un tube K3 EDTA, ont été analysés dans un délai de 24-48h par les cytomètres MUSE® et GUAVA®, au Centre International de Diagnostic médical de Yaoundé.</p> <p><strong>Résultats:&nbsp;</strong>au total, 227 échantillons ont été analysés. Il y avait une forte corrélation intraclasse (p&lt;0,0001) entre les cytomètres MUSE® et GUAVA® avec un coefficient de 0,998 (95% IC: 0,998-0,999) pour les valeurs absolues et de 0,992 (95% IC: 0,989-0,994) pour les pourcentages. Une forte corrélation linéaire positive (p=0,000) a été retrouvée entre les cytomètres MUSE® et GUAVA® avec des pentes r2=0,98 (95% IC=0,97-0,99) pour les valeurs absolues et r2= 0,98 (95% IC= 0,96-1,00) pour les pourcentages. Les biais étaient de -4,80 cells/µl (-101,31-91,71) pour les valeurs absolues et de -0,89% (IC: -6,08-4,3) pour les pourcentages. Le pourcentage des points de données en dehors des limites d'accord était de 12/227 (5,29%) et de 10/227 (4,41%) respectivement pour les valeurs absolues et les pourcentages. Le coefficient Kappa de Cohen était de 0,92 et l'aire sous la courbe de 0,9975 (IC 95%: 0,99-1).</p> <p><strong>Conclusion:&nbsp;</strong>le cytomètre MUSE®AUTO CD4/CD4% est un appareil performant car ses résultats concordent avec ceux donnés par le cytomètre de référence, et peut de fait permettre le suivi des patients infectés par le VIH notamment dans les pays en développement.</p> Ginette Claude Mireille Kalla Esther Voundi Voundi Florence Mimo Tanghu Christiane Medi Sike Michel Noubom Joseph Mendimi Nkodo Justin Amougou Alexis Ndjolo Francois-Xavier Mbopi-Keou Copyright (c) 2019-01-03 2019-01-03 32 1 Enucléation d’un kyste hydatique du muscle psoas chez un enfant https://www.ajol.info/index.php/pamj/article/view/207929 <p>Le kyste hydatique (KH) du psoas est exceptionnel et se manifeste par un syndrome de masse sans aucune spécificité. La douleur ou les signes compressifs amènent le patient à consulter. L’aspect insidieux du développement explique les tailles importantes que peut prendre le kyste. L’échographie abdominale est l’examen fondamental. La TDM permet une meilleure étude des rapports du kyste avec les structures avoisinantes. La chirurgie reste la méthode thérapeutique de référence. La voie d’abord extra-péritonéale est souhaitable afin d’éviter toute contamination intra-abdominale. L’idéale est de réaliser une périkystectomie ou mieux encore une énucléation. Aussi la ponction, l’évacuation et la stérilisation du kyste sont d’autant plus efficaces que le kyste se développe en pleine épaisseur du muscle psoas. L’exérèse trop large peut compromettre les résultats fonctionnels. Le pronostic est généralement bon. Il s’agit d’une fillette de 5 ans, d´origine rural, qui consulte pour une masse douloureuse de la fosse iliaque droite apparue de façon progressive et insidieuse depuis 3 mois. Une échographie avait mis en évidence une lésion kystique de la FID de 55 x 38 mm à contenu anechogène évoquant un kyste hydatique (A). Le scanner (B) avait confirmé le kyste hydatique du psoas iliaque de 52x42x55 mm avec amincissement de l’os iliaque en regard. La patiente a été opérée par une mini laparotomie oblique extra-péritonéale. Une énucléation sans rupture du kyste a été réalisée (C et D). Le suivi clinique et échographique était satisfaisant.</p> Hicham Abdellaoui Youssef Bouabdallah Copyright (c) 2019-01-03 2019-01-03 32 1 Unusual case of lower back pain-piriformis myositis: a case report and literature review https://www.ajol.info/index.php/pamj/article/view/207933 <p>We present a case of a 37-year-old male security officer with fever, severe low back pain radiating to left lower leg and diminished mobility for 1 week. His Lumbar spine X-ray was unremarkable, but his inflammatory markers including CRP, ESR and Neutrophils were high. CT scan with contrast showed rim enhancing fluid collection within the left obturator foramen with inflammatory change in the mesorectal fat. Confirmatory MRI scans depicted inflammatory change in the left piriformis muscle and a localized collection without any abnormality in the spine. Urgent CT guided aspiration was performed and the sample sent for microbiological analysis. Intravenous antibiotics commenced and continued for two weeks with complete resolution</p> Ahmed Elhagar Ibrahim Kamar Mohamed Faisal Hassan Elsheikh Anant Mahapatra Tarig Fadlallah Altahir Ahmed Yogesh Acharya Khalid Khan Copyright (c) 2019-01-03 2019-01-03 32 1 Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy https://www.ajol.info/index.php/pamj/article/view/207939 <p><strong>Introduction:&nbsp;</strong>haematological reference values are very important for diagnostic orientation and treatment decision. The aim of this study was to establish haematological reference values for Malian healthy adults.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study including 161 male Malians aged between 19 and 54 years old was performed. Median and reference ranges were calculated for haematological and biochemical parameters. Parametric student's t-test was used to determine any statistically significant differences by age, smoker status, body mass index (BMI) and occupation. Ranges were further compared with those reported for other African, Afro-American and Caucasian populations.</p> <p><strong>Results:&nbsp;</strong>increased levels of MCV, MCH, PLT and EOS were found in younger Malians who had abnormal BMI and altered platelets parameters. Notably, significantly lower eosinophil and monocyte counts were observed in Malians compared to Europeans The smoking status did not seem to directly affect RIs.</p> <p><strong>Conclusion:&nbsp;</strong>this is the first study to determine normal laboratory parameters in Malian adult males. Our results underscore the necessity of establishing region-specific clinical reference ranges that would allow clinicians and practitioners to manage laboratory tests, diagnosis and therapies. These data are useful not only for the management of patients in Mali, but also to support European and American clinicians in the health management of asylum seekers and migrants from Mali.</p> Vita Serena Miglietta Alessandro Lopalco Maurizio Terrazzini Nadia Sargentini Valeria Cella Eleonora Bachetoni Alessandra Dicuonzo Giordano Angeletti Silvia Ciccozzi Massimo Ceccarelli Giancarlo Copyright (c) 2019-01-04 2019-01-04 32 1 Assessment of seasonality in soil-transmitted helminth infections across 14 schools in Jimma Town, Ethiopia https://www.ajol.info/index.php/pamj/article/view/207954 <p><strong>Introduction:&nbsp;</strong>up to date, the frequency of preventive chemotherapy based on the prevalence is the only strategy in the control programmes of soil-transmitted helminths (STHs). However, prevalence of STHs may be affected by climatic and/or seasonal changes, particularly when these are important determinants of transmission of STH infections. Our objective was to describe the prevalence and infection intensity and seasonal variation (mainly dry vs rainy season) of any STHs among school age children.</p> <p><strong>Methods:&nbsp;</strong>assessment of infection intensity and prevalence of STHs was carried out during dry season (February-March, 2012) and end of rainy season (September-October, 2012) across 14 primary schools in Jimma Town, Jimma, Ethiopia. A total of 1,680 school children (840 in each season) were included. All stool samples were processed by the McMaster egg counting method. Odds of infection and intensity was performed to assess any differences in prevalence and infection intensity between the schools and the two seasons. The pooled odd ratio and their 95% confidence interval was also computed and presented using the "metafor" package of the statistical software R. The level of significance was declared at p &lt; 0.05.</p> <p><strong>Results:&nbsp;</strong>infections with any STH were observed in 824/1,680 (49.0%) subjects.&nbsp;<em>T. trichiura</em>&nbsp;was the most prevalent (35.5%), followed by&nbsp;<em>A. lumbricoides</em>&nbsp;(23.4%) and hookworm (9.9%). Among the schools there were a huge variation in prevalence, ranging from 16.7% to 68.3% for any STH, 6.7% to 39.2% for&nbsp;<em>A. lumbricoides</em>, 10.8% to 55.0% for&nbsp;<em>T. trichiura</em>&nbsp;and 0 % to 28.3% for hookworms. A significant difference in prevalence (for&nbsp;<em>T. trichiura</em>) and in infection intensity (for&nbsp;<em>A. lumbricoides</em>&nbsp;and&nbsp;<em>T. trichiura</em>) across seasons was observed. Generally, STH infections were more prevalent in the dry season (52.4%) compared to the rainy season (45.7%) and as well intensity of all three STH infections was higher in the dry season.</p> <p><strong>Conclusion:&nbsp;</strong>our data suggested that there were huge variation in STH prevalence among schools and a significant difference in infection intensity and prevalence across seasons. This in turn might limits how national governments and international organizations define and target resources to combat the disease burden due to STH infection. Long term studies are needed to confirm the influence of seasonal factors and related ecological, environmental and socio-economic factors.</p> Zeleke Mekonnen Mestawet Getachew Johannes Bogers Jozef Vercruysse Bruno Levecke Copyright (c) 2019-01-04 2019-01-04 32 1 Premarital sex and condom use among trainee healthcare workers: an exploratory study of selected healthcare training institutions in Enugu State, Nigeria https://www.ajol.info/index.php/pamj/article/view/207956 <p><strong>Introduction:&nbsp;</strong>to assess the prevalence and causes of premarital sex and condom use among trainee healthcare workers in selected healthcare institutions in Enugu State, Nigeria; and to proffer solution to challenges identified.</p> <p><strong>Methods:&nbsp;</strong>we used a mixed study approach with qualitative and quantitative components. Informed consent was obtained from participants and data collected using self-administered structured questionnaires. Epi info® was used for data analysis.</p> <p><strong>Results:&nbsp;</strong>a total of 362 respondents (309 unmarried) from four healthcare training institutions participated in the study. Among unmarried respondents, 141(45.8%) were sexually active. Premarital sex was more common among Pentecostals and sexual activity increased with age (r=0.78; p &lt;0.05). Premarital sexual activity was more common among males and trainee nurses (p &lt;0.005). Although knowledge of condom use was high, actual use was poor (20.1%), with lowest rates among females, Catholics and age-group 30-35 years. Breakages, high failure rates and reduced sexual satisfaction were cited as major factors responsible for poor use. Use of non-specific terms such as "casual sex" and "casual or regular sex partners" hindered consistent, correct condom use.</p> <p><strong>Conclusion:&nbsp;</strong>there is a significant gap between knowledge of and actual use of condoms, despite high premarital sexual activity amongst healthcare workers. Furthermore, non-specific terminologies hinders appropriate condom usage. We propose the term: Committed Spousal Partner (CSP) defined as "a sexual partner who commits to fidelity (one sexual partner per time) and whose current HIV status is known through medical testing and is properly documented" in place of all non-specific terminology.</p> Obinna Ositadimma Oleribe Obehi Hilda Okojie Nicholas Jonathan Burstow Simon David Taylor-Robinson Copyright (c) 2019-01-04 2019-01-04 32 1 Adhésion médicamenteuse chez les coronariens âgés: expérience marocaine https://www.ajol.info/index.php/pamj/article/view/207958 <p>La prise en charge des coronaropathies a connu d'importants progrès. L’adhésion médicamenteuse chez les coronariens, en particulier chez les sujets âgés, demeure un défi majeur pour le contrôle de la maladie coronarienne et la prévention de ses complications. L’adhésion au traitement pourrait être influencé par la particularité démographique et socioéconomique précaire des pays africains. Nous avons réalisé une étude transversale de mars à octobre 2016 portant sur les patients âgés, suivis pour coronaropathie stable en ambulatoire. L'adhérence aux médicaments était évaluée par un questionnaire: Morisky Medication Adherence Scale. Les informations relatifs aux facteurs prédictifs d’adhésion médicamenteuse était dérivés d'un modèle d’adhésion multidimensionnel. Ont été inclus dans cette étude 115 patients âgés (âge &gt; 65 ans). L'adhésion médicamenteuse était de 72,2% selon Morisky Medication Adherence Scale. La sédentarité a été retrouvée dans 59% des patients, l'hypertension artérielle et le diabète dans 42,6% et 41,7% des patients respectivement. Les facteurs prédictifs de mauvaise observance étaient: l'absence d'une mutuelle de santé (p = 0,02), la sévérité de la symptomatologie (p = 0,001), les patients ayant présenté un syndrome coronaire aigue (p = 0,006), le niveau de support social (p = 0,011) et la dépression (p = 0,006). L’adhésion médicamenteuse reste un problème de santé au Maroc notamment chez les personnes âgées. Les fournisseurs de soins de santé doivent être conscients des facteurs associés à une plus grande probabilité d'arrêt de traitement, en particulier les facteurs variables afin de mettre en place des stratégies adaptées pour améliorer l'observance du traitement.</p> Imad Nouamou Monia El Mourid Yassine Ragbaoui Rachida Habbal Copyright (c) 2019-01-04 2019-01-04 32 1 A descriptive study of trauma cases encountered in the Grand M’Bour Hospital Emergency Department in Senegal https://www.ajol.info/index.php/pamj/article/view/207960 <p><strong>Introduction:&nbsp;</strong>this study analyzed the trends of trauma cases that presented to the Emergency Department (ED) in the Grand M'Bour Hospital. We examined demographics of patients, mechanisms of trauma and types of injuries that result and times from injury to arrival.</p> <p><strong>Methods:&nbsp;</strong>this was a descriptive study using prospective ED trauma cases. Patients were selected for the study if their chief complaint was related to a traumatic injury. A trauma flow sheet was developed to obtain information. Data was collected from 6/22/16-7/13/16, with 105 cases recorded. Abstracted data included date, time of arrival, time of injury, age, gender, mechanism of injury, injury sustained and disposition.</p> <p><strong>Results:&nbsp;</strong>patients presented to the ED for 13 different trauma-related reasons. 71% of the patients encountered had a mechanism of injury related to falls or motor vehicle accidents. The majority of patients who suffered from a fall-or motor vehicle-related injury were children, with ages 0-10 representing 31% and ages 11-20 representing 14% of the total patients. While 29% of patients were seen within 1 hour of the time of their injury, 10% of the patients were not seen until days after their injury.</p> <p><strong>Conclusion:&nbsp;</strong>we report that traumatic injuries are most commonly a result of fall-related and vehicle-related accidents. Children under the age of 20 years old are a vulnerable population for traumatic injuries. We observed that many patients were unable to seek care within a day of their injury. This was concerning that proper emergency transportation was not available, leading to potential complications or improper healing of injuries. Knowing these trends, an ED can be better prepared to treat these patients.</p> Kenneth John Farba Faye Rhonda Belue Copyright (c) 2019-01-07 2019-01-07 32 1 Adherence to combined Antiretroviral therapy (cART) among people living with HIV/AIDS in a Tertiary Hospital in Ilorin, Nigeria https://www.ajol.info/index.php/pamj/article/view/207962 <p><strong>Introduction:&nbsp;</strong>this study aims to assess the treatment adherence rate among People Living With HIV/AIDS (PLWHA) receiving treatment in a Nigerian tertiary Hospital.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional study that assessed self-reported treatment adherence among adults aged 18 years and above who were accessing drugs for the treatment of HIV. Systematic random sampling method was used to select 550 participants and data were collected by structured interviewer administered questionnaire.</p> <p><strong>Results:&nbsp;</strong>the mean age of respondents was 39.9±10 years. Adherence rate for HIV patients was 92.6%. Factors affecting adherence include lack of money for transportation to the hospital (75%), traveling (68.8%), forgetting (66.7%), avoiding side effects (66.7%), and avoiding being seen (63.6%).</p> <p><strong>Conclusion:&nbsp;</strong>the adherence rate was less than optimal despite advancements in treatment programmes. Adherence monitoring plans such as home visit and care should be sustained.</p> Chukwuma Anyaike Oladele Ademola Atoyebi Omotoso Ibrahim Musa Oladimeji Akeem Bolarinwa Kabir Adekunle Durowade Adeniyi Ogundiran Oluwole Adeyemi Babatunde Copyright (c) 2019-01-07 2019-01-07 32 1 Prevalence and risk factors of intestinal parasites among children under two years of age in a rural area of Rutsiro district, Rwanda – a cross-sectional study https://www.ajol.info/index.php/pamj/article/view/208153 <p><strong>Introduction:&nbsp;</strong>this study aimed to assess the prevalence and associated risk factors of intestinal parasite infections among children less than two years of age in Rutsiro, Rwanda.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional parasitological survey was conducted in Rutsiro in June 2016. Fresh stool samples were collected from 353 children and examined using microscopy to detect parasite. A questionnaire was administered to collect data on hygiene, sanitation, socio-demographic and economic characteristics.</p> <p><strong>Results:&nbsp;</strong>approximately one in two children (44.8%) were found to be infected with at least one intestinal parasite. Ascaris (28.5%) was the most prevalent infection followed by Entamoeba histolytica (25.95%) and Giardia lamblia (19.6%). Infection with more than one pathogen was noted e.g. presence of Ascaris and yeasts (8.9%), and amoeba with Trichocephale (4.4%), respectively. Children from non-farming families were less likely to be at risk of intestinal parasite infections (AOR = 0.41, p = 0.028) compared to children from farming families. Children from households with access to treated drinking water were less likely to contract intestinal parasite infections (AOR = 0.44, p = 0.021) compared with those who used untreated water. Children from families with improved sources of water were twice as likely to be diagnosed with intestinal parasitoses compared to those who did not. We postulate that the majority of families (50.1%) who have access to improved water sources do not treat water before consumption.</p> <p><strong>Conclusion:&nbsp;</strong>the high prevalence of intestinal parasitoses in children warrants strict control measures for improved sanitation, while treatment of drinking water should be considered.</p> Eric Butera Assumpta Mukabutera Etienne Nsereko Cyprien Munyanshongore Nadine Rujeni Ivan Emile Mwikarago Patricia Jean Moreland Manasse Nzayirambaho Manasse Copyright (c) 2019-01-07 2019-01-07 32 1 Burkholderia cepacia meningitis in the Central African Republic https://www.ajol.info/index.php/pamj/article/view/208154 <p>Burkholderia cepacia causes frequent infections in immunocompromised and hospitalized patients, with a significant mortality rate. This bacterial species has also been associated with epidemic outbreaks due to contamination of antiseptic solutions and parenteral and nebulized medications. In 2016, in the town of Bongonon in the north of the Central African Republic (CAR), a three-year-old boy with febrile meningeal syndrome (fever, neck stiffness and altered general condition) was admitted for a medical consultation provided by the nongovernmental organization MSF-Spain. On 20 March 2016, a sample of the boy’s cerebrospinal fluid was sent to the Bacteriology Laboratory of the Pasteur Institute of Bangui for analysis. Conventional bacteriology showed that the isolate was a Gram-negative bacillus, which was identified as B. cepacia by using API 20 NE, with 99.9%confidence. In addition, the strain presented an acquired re¬sistance to ticarcillin-clavulanate, ceftazidime and imipenem but remained susceptible to cotrimoxazole. As B. cepacia had never previously been isolated from cerebrospinal fluid in Africa, we chose to identify the strain by 16S rRNA gene sequencing. The molecular data showed that the isolate belonged to B. cepacia group.This is the first report of a case of meningitis caused by B. cepacia in CAR and developing countries.</p> Thierry Frank Alain Farra Pierre-Alain Rubbo Jean-Robert Mbecko Hugues Sanke Anne Le Flèche-Matéos Jean-Pierre Lombart Alain Berlioz-Arthaud Copyright (c) 2019-01-07 2019-01-07 32 1 Ipsilateral brain cavernoma under scleroderma plaque: a case report https://www.ajol.info/index.php/pamj/article/view/208157 <p>Scleroderma is a rare disease of unknown etiology, which is characterized by thickening and hardening of skin due to an increased collagen production. A 44-year-old female patient with a scleroderma on the scalp known by our department, also presented an ipsilateral brain lesion since 2015, which was showing growth without any clinical symptomatology and the patient wanted the lesion to be removed. This atypical lesion underneath the scleroderma shows that diagnosis can be missed without brain imaging and biopsy.</p> Vimal Raj Nitish Gunness David Munoz Pablo González-López Nabeel Alshafai Agdaliya Mikhalkova Julian Spears Copyright (c) 2019-01-08 2019-01-08 32 1 Interventions to increase the distribution of vaccines in sub-Saharan Africa: a scoping review https://www.ajol.info/index.php/pamj/article/view/208164 <p>Achieving universal access to immunization, as envisioned in the global vaccine action plan continues to be a challenge for many countries in sub-Saharan Africa. Weak immunization supply chain (iSC) has widely been recognized as a key barrier, hindering progress towards vaccination targets in this region. These iSCs, which were designed in the 1980s, have become increasing fragile and are now considered outdated. The objective of this review was to assess the effectiveness of system redesign and outsourcing to improve outdated iSC systems in Sub-Saharan Africa. We searched the following electronic databases from January 2007 to December 2017: Medline, EMBASE (Excerpta Medica Database), the Cochrane Library, Google Scholar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), WHOLIS (World Health Organization Library Database), LILACS (Latin American and Caribbean Literature on Health Sciences) and contacted experts in the field. Our search strategy yielded 80 records and after assessment for eligibility, seven papers met the inclusion criteria. Five studies evaluated the experiences of system redesign in three countries (Nigeria, Benin and Mozambique), two assessed outsourcing vaccine logistics to the private sector in Nigeria and South Africa. According to these studies, system redesign improved vaccine availability at service delivery points and reduce the cost of distributing vaccines. Similarly, outsourcing vaccine logistics to the private sector reduced the cost of vaccines distribution and improve vaccine availability at service delivery points.</p> Marius Zambou Vouking Christelle Monique Angoula Mengue Saidu Yauba Jean Marie Edengue Modibo Dicko Hamadou Modibo Dicko Charles Shey Wiysonge Copyright (c) 2019-01-09 2019-01-09 32 1 Unusual presentation of advanced prostate cancer in a black population of South-Western Nigeria https://www.ajol.info/index.php/pamj/article/view/208269 <p>There are growing concerns on the varying pattern of advanced prostate cancer (PCa) presentation across the world. We report some of the unusual presentations of PCa at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, South-Western Nigeria. A review of all patients with histologically confirmed PCa who had unusual presentations between January 2014 and December 2015 was done. Unusual presentation was defined as an atypical feature in the absence of lower urinary tract symptoms (LUTS), with the diagnosis of PCa only suspected after abnormal digital rectal examination (DRE) and/or elevated prostate specific antigen (PSA) assay. Thirteen patients had an unusual presentation in OAUTHC during the study period. Five (38.5%) had left supraclavicular swellings while four (30.8%) had haematochyzia and tenesmus. Other unusual presentations include large bowel obstruction requiring emergency colostomy (2;15.4%) and a scalp mass (1;7.7%). All patients had appropriate treatment for stage of CaP and are being followed up in the out-patient clinic. The change in presentations of PCa may suggest the need for DRE and serum PSA assay among all middle-aged and elderly men presenting at health facilities. Large scale studies on PCa across different population groups may also help at identifying related clinical, demographic and epidemiological factors as well as possible validation of some of these unusual presentations.</p> Abdulkadir Salako Tajudeen Badmus Akinwunmi Komolafe Rotimi David Martin Igbokwe Adeyinka Laoye Ibrahim Akinbola Rereloluwa Babalola Chigozie Onyeze Copyright (c) 2019-01-10 2019-01-10 32 1 Large spontaneous subcapsular hematoma of the liver: a rare case report https://www.ajol.info/index.php/pamj/article/view/208271 <p>Spontaneous subcapsular hematoma of the liver is an extremely rare but potentially life-threatening condition. We report a case of subcapsular hematoma of the liver without any apparent lesion and in the absence of coagulopathy or trauma. A CT scan of the abdomen demonstrated a huge subcapsular hematoma around the liver. The patient was treated conservatively and was discharged home after one week. Up to our knowledge, this is one of the very few reported cases of a spontaneous subcapsular hepatic hematoma.</p> Abdulrahman Al Tamimi Awad Ali Alawad Copyright (c) 2019-01-10 2019-01-10 32 1 Health care seeking behaviour for visual dysfunction among motor vehicle drivers in Osun State, Southwest Nigeria https://www.ajol.info/index.php/pamj/article/view/208272 <p><strong>Introduction:&nbsp;</strong>visual impairment is recognized as a public health problem worldwide. People and generally drivers do not often go for routine medical or eye examination based on varied reasons. This study assessed health care seeking behaviour for visual dysfunction among motor vehicle drivers in Osun state, Southwest Nigeria.</p> <p><strong>Methods:&nbsp;</strong>this was a comparative cross-sectional study among 120 male commercial and 120 government drivers, selected using multi-stage sampling technique in Osogbo, Osun State. Data on knowledge, attitude and health seeking behavior of drivers for visual dysfunction and barriers for not seeking medical treatment was collected using a pre-tested semi-structured questionnaire. Questions on awareness about visual functions and attitude of the respondents concerning visual problems were scored. Two sample independent t-test was used to elicit association between mean age/knowledge of government and commercial drivers and health seeking behavior for visual dysfunction.</p> <p><strong>Results:&nbsp;</strong>the mean age of government and commercial drivers was 44.53years ± 8.51 and 38.52years ± 8.60 respectively. The mean knowledge (p&lt;0.001) and attitude (p=0.001) differences of government and commercial drivers were associated with health seeking behavior for visual dysfunction. Of the 120 government drivers, 24 (20.0%) were aware of their current visual problems. Of the 24, government drivers, 10 (47.6%) visited the hospital for treatment. Busy workplace schedule (n = 5, 20.8%) and lack of awareness of visual defects ((n= 3, 12.5%) by commercial drivers were identified barriers for not seeking medical treatment for visual dysfunction.</p> <p><strong>Conclusion:&nbsp;</strong>knowledge and attitude towards visual dysfunction were higher among the government drivers compared to commercial counterparts. Government drivers had better health seeking behavior for visual dysfunction as compared to their commercial counterparts. We recommended routine eye medical check-up for early detection of visual dysfunction in motor vehicle drivers.</p> Adefisoye Oluwaseun Adewole Olufemi Ajumobi Saheed Gidado Copyright (c) 2019-01-11 2019-01-11 32 1 Lymphoepithelioma-like carcinoma of the breast: a case report and review of the literature https://www.ajol.info/index.php/pamj/article/view/208274 <p>Lymphoepithelioma-like carcinoma of the breast is uncommon with only 21 patients documented in the literature. It can wrongly be diagnosed as medullary carcinoma and certain types of lymphoma due to undifferentiated proliferation of malignant epithelial cells with prominent lymphoid infiltration. In this paper, we present a case of LELC of the breast in a 64-year-old female with breast LELC and a discussion based on a review of the literature.</p> Kouhen Fadila Abbad Faycal Jabri Lamiaa Belghiti Mohammed Ismaili Nabil Copyright (c) 2019-01-11 2019-01-11 32 1 Evaluation de l’état vaccinal contre l’hépatite B et portage de l’Ag HBs chez les militaires Béninois en mission en Côte d’Ivoire https://www.ajol.info/index.php/pamj/article/view/208275 <p><strong>Introduction:&nbsp;</strong>le but de cet étude est de déterminer le taux de couverture vaccinale anti-virus de l'hépatite B (anti-VHB) et la prévalence de l'AgHBs chez les soldats béninois en mission extérieure en Côte d'Ivoire.</p> <p><strong>Méthodes:&nbsp;</strong>cette étude transversale était réalisée au sein du bataillon béninois basé à Anankouakouté en Côte d'Ivoire. Les soldats de cette compagnie au décours d'une séance d'éducation sanitaire étaient soumis à un questionnaire sous forme d'interview. Il portait sur les données sociodémographiques, les facteurs de risques d'infection et les antécédents de vaccination contre l'hépatite B. Des prélèvements étaient faits à la recherche de l'Ag HBs et des anticorps antiHBs. En cas de positivité de l'Ag HBs, un complément de bilan était fait (alanines aminotransférase(ALAT), Ag HBe, AcantiHBe, AcAntiHBcIgM et ADN HBV par PCR).</p> <p><strong>Résultats:&nbsp;</strong>cent soixante-quinze militaire ont participé à cette étude (âge médian 31ans avec des extrêmes entre 23 et 52 ans; sex-ratio 5,73). Des taux protecteurs d'Ac Anti HBs étaient notés chez 41 militaires (23,4%). Cette immunité était post hépatitique B (25 cas/41) et post vaccinale (16 cas/41). Dix-huit militaires (10,3%) avaient une infection en cours par le VHB (Ag HBs+). L'infection était chronique (IgM anti HBc-et anticorps anti-HBc totaux + dans 18cas/18). Parmi les militaires infectés, 4 avaient une élévation des aminotransferases, 4 un Ag HBe positif et 4 une virémie élevée (ADN VHB &gt;2000UI/mL).</p> <p><strong>Conclusion:&nbsp;</strong>le portage de l'AgHBs chez les militaires Béninois en mission est élevé. La couverture vaccinale est faible. Des stratégies d'intervention sont préconisées pour traiter ceux qui répondent aux critères et vacciner les non immunisés.</p> Fanou Denis Sehonou Jean Vinasse Alfred Agniwo Jérôme Batcho Jimy Etekpo Thomas Tossou-Odjo Léon Copyright (c) 2019-01-11 2019-01-11 32 1 Congenital fistulisation of Meckel’s diverticulum in omphalocele sac: case report https://www.ajol.info/index.php/pamj/article/view/208280 <p>Fistulisation of Meckel's diverticulum in the top of an omphalocele sac is very rare. To our Knowledge, three cases were reported in the literature. We presente in this report a new case of this uncommon presentation.</p> Mohammed Tazi Charki Hicham Abdellaoui Saad Andaloussi Mohammed Amine Oukhouya Abdelhalim Mahmoudi Aziz El madi Khalid Khattala Youssef Bouabdallah Copyright (c) 2019-01-15 2019-01-15 32 1 Tuberculose tibiale chez l'enfant à l'IRM: à propos d'un cas https://www.ajol.info/index.php/pamj/article/view/208294 <p>La localisation osseuse isolée de la tuberculose est peu fréquente et survient surtout chez les adultes jeunes immunodéprimés. Elle peut simuler une infection à germe banal au début ou une atteinte tumorale lorsque l'évolution est chronique. Les auteurs rapportent le cas d'une patiente de 15 ans sans antécédent particulier ayant présenté une tuméfaction indurée et indolore du tiers supérieur de la jambe d'évolution chronique. Les explorations radiologiques conventionnelles ont permis d'objectiver une lésion lytique tibiale métaphysaire supérieure avec une réaction périostée. L'IRM a précisé une rupture corticale et une extension aux parties molles sous la forme d'une collection liquidienne avec une paroi épaisse, se rehaussant intensément après injection de gadolinium. Une biopsie chirurgicale avec analyse histologique a permis de retenir le diagnostic d'ostéite tuberculeuse. Ce cas clinique souligne l'intérêt de l'IRM dans l'exploration des pathologies musculosquelettiques.</p> Lynda Nadine Gui Bilé N'Dri Simon Dédé Raïssa Michelle Kabas Estelle Valérie Ohui-Acko Eric Kouadio Lolo Marc-Anicet Diambra Copyright (c) 2019-01-15 2019-01-15 32 1 Thrombose veineuse cérébrale de l’enfant: à propos d’une série de 12 cas https://www.ajol.info/index.php/pamj/article/view/208304 <p>La thrombose veineuse cérébrale (TVC) est rare chez l'enfant. Sa présentation clinique et ses étiologies sont variables. Le pronostic des patients reste redoutable devant le risque de décès et des séquelles neurosensorielles. L'objectif était d'étudier le profil clinique, radiologique et étiologique des TVC de l'enfant, et évaluer l'intérêt du traitement anti thrombotique. L'étude rétrospective menée au service de pédiatrie et de réanimation pédiatrique au CHU Med VI de Marrakech, Maroc, sur une période de 9 ans 10 mois (janvier 2008 à octobre 2018), colligeant tous les cas de TVC confirmés à l'imagerie, ayant un âge entre 1 mois et 15 ans. Nous avons recensé 12 cas. L'âge moyen était de 6,4 ans. Le sexe ratio était de 1.4. Le mode de début était aigu dans 7 cas. Les principales présentations cliniques étaient les convulsions (7 cas), les signes neurologiques focaux (7 cas), et les signes d'hypertension intracrânienne (HTIC) (6 cas). La tomodensitométrie (TDM) et / ou l'imagerie par résonance magnétique (IRM), ont révélé une atteinte du réseau veineux superficiel dans 8 cas, étendue dans 3 cas. L'étiologie était infectieuse chez 6 patients avec un cas de déshydratation, deux cas de maladie de système et une homocystinurie. Cependant, l'étiologie restait inconnue chez deux patients. Le traitement anti-thrombotique instaurait chez 7 enfants, avait permis une bonne évolution clinico-radiologique dans 5 cas. Le décès était survenu chez 2 enfants, et 3 autres avaient des séquelles neurologiques. Les TVCs chez l'enfant sont caractérisées par la grande diversité de leur présentation clinique et de leurs étiologies. L'impact des anticoagulants a été prouvé malgré l'absence de protocole thérapeutique standardisé.</p> Naima Baddouh Safaa Elbakri Ghizlane Draiss Youssef Mouaffak Noureddine Rada Said Younous Mohammed Bouskraoui Copyright (c) 2019-01-15 2019-01-15 32 1 Grosse lithiase prostatique juvénile compliquée de fistule périnéale: à propos d'un cas à l'hôpital régional de Gao https://www.ajol.info/index.php/pamj/article/view/208307 <p>Les lithiases prostatiques correspondent aux calculs développés au sein du tissu prostatique (acini, canaux), elles sont rares chez l'enfant mais fréquentes chez l'homme. Nous rapportons le cas d'un patient de 24 ans présentant depuis quelques mois des troubles de la miction à type de pollakiurie et dysurie suivie d'une fuite urinaire périnéale lors de la miction. L'échographie réno-vésico-prostatique a montré une grosse calcification prostatique. La radiographie standard de l'arbre urinaire et la fistulographie de l'orifice périnéal ont montré une communication avec la vessie et montré une grosse calcification se projetant sur le pubis. Le diagnostic de lithiase prostatique a été retenu. La prise en charge a été faite par une antibiothérapie avant, pendant et après l'extraction chirurgicale de la grosse lithiase. Les suites opératoires ont été favorables.</p> Mahamadou Mallé Youssouf Fofana Mahamadou Diallo Lassine kéita Sokona Touré Copyright (c) 2019-01-16 2019-01-16 32 1 Ostéoblastome du cornet moyen: tumeur rare du massif facial à ne pas méconnaitre https://www.ajol.info/index.php/pamj/article/view/208310 <p><em>Osteoblastoma is a rare benign bone tumor, accounting for 1% of all bone tumors. It mainly occurs in the long bones, more rarely in the jaws. Osteoblastoma of the jaws mainly involves the mandible while nasosinusal involvement is very rare. The diameter of the tumor can grow to 10 cm. On X-ray, the tumor may appear as a well or poorly defined clear lesion, usually scattered with mineral patches. Recurrence rate is very low after surgical resection as well as the risk of malignant transformation. We report the case of a 13-year old female patient presenting with nasal obstruction evolving over the last 3 months associated with episodes of epistaxis and left blurred vision. Clinical examination showed voluminous nasal concha with polyploid mucosa filling all the left nasal fossa with left axial exophthalmos. CT scan of the facial massif showed left frontoethmoidal expansive process measuring 50*47*36 mm, spontaneously hypodense, heterogeneous, non enhanced after injection of the Contrast materials, responsible for destruction of the ethmoidal labyrinth, swelling of the bony walls with mass effect on the ipsilateral orbit. The suspected diagnosis was frontoethmoidal mucocele. Hence, the decision to perform endonasal surgery. Whitish thick liquid was collected by the cranial portion of the middle nasal concha sugesting infected mucocele. Resection of the middle nasal concha was performed. The histological examination showed osteoblastoma of the middle nasal concha . Outcome was marked by regression of the exophthalmos with no recurrence during 1-year follow up period.</em></p> Souha Kallel Moncef Sellami Copyright (c) 2019-01-16 2019-01-16 32 1 Non alcoholic fatty liver disease in a young male with celiac disease https://www.ajol.info/index.php/pamj/article/view/208323 <p>A young emaciated male, known case of celiac disease came with the complains of diarrhea along with 5kgs of weight loss in 3 months' time. He had severe electrolyte abnormalities along with low albumin, low calcium and a high phosphate with deranged liver function test. Ultrasound abdomen had shown fatty liver. Nutrition consult was sought and he was found to have a BMI of 6.8kg/m<sup>2</sup>. He was started on nutrition support along with supportive therapy, which resulted in weight gain and improvement in his condition.</p> Zain Majid Ghous Bux Somoro Muhammad Manzoor Ul Haque Raja Taha Yaseen Shoaib Ahmed Khan Inamullah Khan Achakzai Muhammad Ali Khalid Nasir Hassan Luck Copyright (c) 2019-01-16 2019-01-16 32 1 Liver abscess due to fish bone ingestion https://www.ajol.info/index.php/pamj/article/view/208326 <p>A 50-year-old previously healthy male presented with epigastric pain for 10 days and fever in the last three days. Laboratory testing was remarkable for elevated white blood cells at 19,580/mm<sup>3</sup>&nbsp;and C-reactive protein of 83.9 mg/dl. Abdomen computed tomography showed a small linear structure with calcium density, transfixing the wall of the gastric antrum and penetrating the left hepatic lobe; an oval massive hypodensity was observed in the surrounding liver parenchyma (A); pneumoperitoneum, free intra-abdominal fluid or vesicular changes were not observed. The hypothesis of gastric perforation due to ingestion of a foreign body with abscess formation was raised. In a new clinical interview, the patient reported a routine habit of fish consumption. Abdominal surgical approach was performed which confirmed the presence of a fish bone and the hepatic collection with purulent fluid (B). After seven days of surgery and treatment with intravenous ceftriaxone and metronidazole, the patient evolved with clinical and laboratory improvement and was discharged. Gastrointestinal perforation by an ingested fish bone resulting in hepatic abscess is very rare. In these cases, the site of perforation is usually in the stomach or duodenum with the abscess most commonly developing in the left hepatic lobe. The classic indicators of hepatic abscess, such as fever with chills, abdominal pain and jaundice are present in only a small number of patients. Among several causative objects that can perforate the gastrointestinal tract are included toothpicks, sewing needles, hairpins, wire, fish bones, chicken bones and dental plates.</p> Rodolfo Mendes Queiroz Fred Bernardes Filho Copyright (c) 2019-01-16 2019-01-16 32 1 Giant colonic lipoma causing intussusception: CT scan and clinical findings https://www.ajol.info/index.php/pamj/article/view/208330 <p>Colonic lipomas are uncommon and usually asymptomatic tumors. A 30-year-old woman with abdominal pain lasting 10 days was admitted to the surgical clinic. Her physical examination revealed sensitivity on the right upper quadrant and her bowel sounds were normal. A lesion and invagination findings in the colon were found in the ultrasound examination and CT was performed. CT scan revealed a lipoma and invagination in the colon and the patient has undergone surgery. Pathological diagnosis of the lesion was reported as submucosallipoma. In this case report, we present clinical and radiological findings of a submucosal colonic lipoma causing intussusception.</p> Ozkan Ozen Yilmaz Guler Yavuz Yuksel Copyright (c) 2019-01-16 2019-01-16 32 1 Integrating immunization services into nutrition sites to improve immunization status of internally displaced persons’ children living in Bentiu protection of civilian site, South Sudan https://www.ajol.info/index.php/pamj/article/view/208334 <p><strong>Introduction:&nbsp;</strong>the protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases. The study aimed at evaluating the effect of integrating immunization services with already established nutrition services on immunization coverage in resource-constrained humanitarian response.</p> <p><strong>Methods:&nbsp;</strong>a community and health facility based interventional study involving integration of immunization into nutrition services in two Outpatient Therapeutic Program(OTP)centers in Bentiu PoC between January-December 2017. The main hypothesis was that inclusion of immunization services during nutrition services both at the OTP and community outreaches be an effective strategy for reducing missed opportunity for immunizing all eligible children accessing nutrition services. Data analyzed using STATA version 15 and bivariate analysis using logistic regression was conducted to identify predictor of missed vaccinations.</p> <p><strong>Results:&nbsp;</strong>integration of immunization into the nutrition services through the OTP centres increased the number of children immunized with various antigens and the dropout rate was much lower and statistically significant among children who received immunization at the OTP centers than those in the Primary Health Care Centers (PHC Centers) in the study sites. Children who were vaccinated at the OTP centre in sector 2 were 45% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.45; 95%CI:0.36- 0.55), p&lt;0.05 while those vaccinated at the OTP sector in sector 5 were 27% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.27; 95%CI: 0.20 -0.35) p&lt;0.05).</p> <p><strong>Conclusion:&nbsp;</strong>this study indicated that immunization coverage improved effectively with integration with nutrition services as a model of an integrated immunization programme for child health in line with the Integrated Management of Childhood Illnesses (IMCI) and the Global Immunization Vision and Strategy (GIV).</p> Olusola Oladeji Penelope Campbell Chandrakala Jaiswal Dick Chamla Bibilola Oladeji Christopher Otti Ajumara Lydie Maoungou Minguiel Joseph Senesie Copyright (c) 2019-01-16 2019-01-16 32 1 Métastase oculaire révélant un carcinome canalaire du sein https://www.ajol.info/index.php/pamj/article/view/208340 <p>Nous rapportons le cas d'une patiente de 56 ans, sans antécédents pathologiques notables, ayant consulté aux urgences pour une baisse de l'acuité visuelle de l'œil droit, installée depuis 2 semaines. A l'examen ophtalmologique, on trouve une acuité visuelle réduite au mouvement de doigts, avec au fond d'œil un décollement de rétine séreux associé à une masse sous rétinienne comblant une majeure partie de la cavité vitréenne (A). Une échographie oculaire en mode B a été réalisée et a mis en évidence une masse choroïdienne isoéchogène (B) vascularisée prenant le doppler (C) sans excavation, mesurant 18 mm de grand axe associée un décollement séreux de la rétine, fortement évocatrice d'une métastase oculaire. Un bilan général a été réalisé et notamment une mammographie qui a révélé l'existence d'un nodule du sein droit stade 4 selon la classification BI RADS. Une Tomodensitométrie thoraco abdomino pelvienne, et cérébrale dans le cadre du bilan d'extension a montré la présence de nombreuses métastases cérébrale, osseuse et hépatique. Le diagnostic de cancer du sein métastatique a donc été posé, et la patiente a été référé en Oncologie pour prise en charge spécialisée. Les métastases oculaires sont les tumeurs intraoculaires les plus fréquentes. Les carcinomes mammaires représentent la principale cause des métastases choroïdiennes, justifiant un bilan exhaustif lors de la mise en évidence de ces tumeurs intra oculaires.</p> Saad Benchekroun Belabbes Kawtar Belkhadir Copyright (c) 2019-01-16 2019-01-16 32 1 Fistule œsotrachéale compliquant un lymphome non hodgkinien B médiastinal primitif: à propos d'un cas https://www.ajol.info/index.php/pamj/article/view/208345 <p>Le lymphome non hodgkinien médiastinal primitif (LNHMP) est un cancer rare, se complique exceptionnellement par des fistules trachéo-œsophagiennes reliant directement l'œsophage à la trachée, qui sont secondaires à l'atteinte tumorale œsophagienne ou à la chimiothérapie (l'intérêt de notre cas). Nous rapportons le cas d'une patiente de 24 ans, d'origine marocaine, suivie pour LNH médiatisnal primitif à grandes cellules B révélé par une dyspnée avec dysphagie et altération de l'état général. La patiente est mise sous chimiothérapie mais le tableau s'aggrave après la deuxième cure par l'apparition des infections pulmonaires à répétition avec notion de toux lors des repas responsable d'une impossibilité d'alimentation, le diagnostic de fistule trachéo-œsophagienne est retenu par fibroscopie œsogastroduodénale, mais l'évolution est marquée par le décès de la patiente malgré la mise en place de stent endoscopique et la bonne réponse à la chimiothérapie. La découverte précoce d'une fistule trachéo-œsophagienne chez le patient atteint de LNHMP est indispensable permettant la mise en route d'un traitement approprié.</p> Amine Benmoussa Mostafa Mechtoune Rajaa Tissir Ilias Tazi Lahoussine Mahmal Copyright (c) 2019-01-17 2019-01-17 32 1 Onycholysis an early indicator of thyroid disease https://www.ajol.info/index.php/pamj/article/view/208357 <p>Onycholysis is also referred to plummer's nails is a dermatological nail disorder characterized by spontaneous distal separation of the nail plate from the free margin and progressively proximally. We discuss a case of the 38-year-old man with onycholysis associated with hyperthyroidism due to Graves' disease. In this case review, we will discuss an association of onycholysis with thyroid disease and its diagnostic prognosis. Any unexplained onycholysis should prompt the clinician to investigate the client for asymptomatic hyperthyroidism.</p> Malumani Malan Zhe Dai Wu Jianbo Song Ji Quan Copyright (c) 2019-01-17 2019-01-17 32 1 Lyse des vertèbres dorsales révélant un anévrysme chronique rompu contenu: à propos d’un cas https://www.ajol.info/index.php/pamj/article/view/208361 <p>Les anévrismes chroniques rompus contenus représentent une entité extrêmement rare, qui peut faire suite à une rupture d'anévrisme. En effet, la complication la plus à craindre de l'anévrisme est la rupture, qui est souvent mortelle. Toutefois exceptionnellement, il se formera un hématome suite à la rupture, lequel sera contenu par les structures anatomiques avoisinantes; ce qui permettra en outre d'arrêter la fuite. Contrairement à la rupture classique, les signes de choc hémorragique seront absents; remplacés par une simple douleur modérée, et des signes souvent atypiques tels que la lyse du rachis dorsal par l'hématome constitué, découverte à l'imagerie dans notre cas. La connaissance de cette entité est importante, car la rupture chronique nécessite une prise en charge chirurgicale; du fait du risque de rupture ultérieure de l'hématome.</p> Diekouadio Fabrice Bellamlih Habib Laamrani Fatim Zahra Copyright (c) 2019-01-17 2019-01-17 32 1 Open abdomen management and outcomes: two case reports from western Kenya and a review of literature from Africa https://www.ajol.info/index.php/pamj/article/view/208365 <p>The open abdomen (OA) is clinically indicated for attenuating the effects of select intra-abdominal insults that may lead to high intra-abdominal pressure with fascial closure. Despite the high incidence of conditions warranting OA in Africa, there are few reports on its use and outcomes. A retrospective chart review was performed for two patients managed with an OA at the Moi Teaching and Referral Hospital. For comparison, a literature review on related studies from Africa was performed. One patient had an anastomotic leak, while the other had a perforated gastric ulcer. A Bogotá bag was used for temporary abdominal content containment. There was no mortality in our series and fascial closure was achieved in one patient. Upon review of studies from Africa, overall mortality stood at 44%, while 25% of surviving patients underwent fascial closure. The use of OA in Africa is associated with high mortality and low rates of fascial closure. Our limited experience shows this technique is a viable treatment option in an attempt to bridge a patient to abdominal closure during critical illness.</p> Clifford Mwita Ruth Negesa Marissa Boeck Andrew Wandera Copyright (c) 2019-01-17 2019-01-17 32 1 Une cardiomyopathie dilatée réversible induite par l’hypocalcémie secondaire à une hypoparathyroïdie post thyroïdectomie totale: à propos d’un cas https://www.ajol.info/index.php/pamj/article/view/208370 <p>Nous rapportons un cas de cardiomyopathie dilatée d'origine hypocalcémique secondaire à une hypoparathyroïdie, chez une femme de 38 ans. Sa calcémie était effondrée à 30 mg/L et l'échocardiographie avait montré une cardiomyopathie dilatée hypokinétique avec baisse de la fraction d'éjection du ventricule gauche à 31,4%. Elle a reçu une calcithérapie avec de la vitamine D3 et l'évolution était marquée par la normalisation de la taille des cavités cardiaques et de la fraction d'éjection ventriculaire gauche (FEVG) après normocalcémie.</p> Rakotoniaina Masinarivo Daniella Ramiandrisoa Ritchy Randriamihangy Avisoa Narindra Solofonirina Rakotoarimanana Nirina Rabearivony Copyright (c) 2019-01-17 2019-01-17 32 1 Les suppurations pariétales post-cesariennes au Centre Hospitalier Universitaire Yalgado Ouedraogo, Burkina-Faso: aspects epidemiologiques, cliniques, thérapeutiques et pronostiques https://www.ajol.info/index.php/pamj/article/view/208381 <p>Les infections des sites opératoires sont fréquemment rencontrées dans les pays en développement. La césarienne étant l'une des interventions chirurgicales la plus pratiquée chez les femmes dans le monde, nous avons initié cette étude sur les aspects épidémiologiques, cliniques, thérapeutiques et pronostiques des suppurations pariétales post-césariennes dans le département de gynécologie-obstétrique du CHU Yalgado Ouédraogo en vue de réduire leur survenue. Il s'est agi d'une étude transversale à visée descriptive menée du 1<sup>er</sup>&nbsp;avril 2015 au 30 septembre 2015 soit une période de 6 mois. Soixante-dix cas de suppurations pariétales ont été notés sur 1998 cas de césariennes soit une incidence de 3,5%. L'âge moyen des patientes était de 26,2 ans ± 6,1. Les patientes étaient majoritairement des femmes au foyer (77%). La césarienne a été réalisée en urgence chez toutes les patientes. La suppuration a été diagnostiquée surtout à la 1<sup>ère</sup>&nbsp;semaine (60%). Le germe identifié était le staphylocoque aureus dans 37,8% des cas. Une reprise chirurgicale de la paroi abdominale a été nécessaire dans 34,3% des cas. L'évolution a été favorable chez toutes les patientes. La suppuration pariétale post césarienne reste fréquente. La prise en charge nécessite parfois une reprise chirurgicale. Une meilleure identification des facteurs favorisant cette affection par d'étude plus poussée pourrait permettre de réduire de façon significative leur incidence et par conséquent améliorer le pronostic maternel.</p> Yobi Alexis Sawadogo Evelyne Komboigo Sibraogo Kiemtore Hyacinthe Zamane Issa Ouedraogo Dantola Paul Kain Boubakar Toure Charlemagne Ouedraogo Ali Ouedraogo Blandine Thieba Copyright (c) 2019-01-18 2019-01-18 32 1 Neglected zoonotic diseases in Nigeria: role of the public health veterinarian https://www.ajol.info/index.php/pamj/article/view/208393 <p>Zoonotic diseases accounts for about 75% of emerging infectious disease and can be devastating to both human and animal health globally. A subset of zoonotic diseases is referred to as "neglected zoonotic diseases - NZDs" as they mainly affect poor populations who live in close proximity to domestic or wild animals often in areas where access to health and adequate sanitary facilities are not available. Furthermore, underestimation of the burden of NZD has continually led to its further neglect in least developed countries such as Nigeria. Controlling zoonotic infections including NZDs in animals is crucial in reducing human infections. Veterinarians provides an understanding of the epidemiology of infectious diseases in animal population and are therefore integral for the overall reduction in global burden of NZDs worldwide. Due to the current lack of and in some cases weak involvement of Veterinarians in policy issues related to zoonotic diseases, there is need to elucidate their importance in NZDs control in Nigeria. This review therefore summarises the neglected zoonotic diseases so far documented in Nigeria and also highlight the important role of the Veterinarian in their prevention and control within both human and animal population. Important recommendations to strengthen the role of the public health Veterinarian for sustainable control of NZDs were made.</p> Nusirat Elelu Julius Olaniyi Aiyedun Ibraheem Ghali Mohammed Oladapo Oyedeji Oludairo Oladapo Oyedeji Oludairo Ismail Ayoade Odetokun Kaltume Mamman Mohammed James Olaniyi Bale Saka Nuru Copyright (c) 2019-01-18 2019-01-18 32 1 Determinants of poor adherence to antiretroviral treatment using a combined effect of age and education among human immunodeficiency virus infected young adults attending care at Letaba Hospital HIV Clinic, Limpopo Province, South Africa https://www.ajol.info/index.php/pamj/article/view/208402 <p><strong>Introduction:&nbsp;</strong>sustained viral suppression using antiretroviral treatment (ART) occurs with adherence to treatment of at least 95%. Non-adherence promotes the development of drug-resistance and treatment failure in individuals infected with Human Immunodeficiency Virus. In Limpopo Province, the adherence rate is approximately 61%, but the prevalence and the factors associated with adherence at Letaba hospital HIV clinic are not well established. Therefore, the aim of this study was to identify the factors associated with adherence among HIV-infected young adults, aged 18-35 years, attending the clinic.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional survey was conducted in Letaba HIV clinic among young adults of 18-35 years old. Logistic regression analysis was performed to determine factors associated with ART adherence. We reported odds ratios with the corresponding 95% confidence intervals and p-values. A p-value &lt; 0.1 was considered as statistically significant. ART adherence was defined as taking more than 95% of the prescribed treatment, 3 days prior to completion of the questionnaire.</p> <p><strong>Results:&nbsp;</strong>a total of 281 participants were enrolled with 163 (58.0%) females and more than three quarter, 222 (79.0%) between the ages of 18 and 29 years. The overall ART adherence stood at (87.2%) (95% CI: 63.0%-89.0%) representing 245 participants. Non-adherers to treatment, 36 (12.8%): patients reported no reason (3.9%), forgetting (3.2%), feeling good (3.2%), fear and running out of treatment (2.5%) as some of the reasons for not taking treatment within the three days prior to data collection. The following factors: tertiary education (p = 0.07), age (30-35; p-value: 0.07), drug availability (p-value: 0.07), were only marginally significantly associated with ART adherence.</p> <p><strong>Conclusion:&nbsp;</strong>the study found unsatisfactory ART adherence among our participants. Our study suggests that factors other than sociodemographic and clinical factors might better explain differences in adherence. This highlights the need for a more complex study that would look at the entire system in which these patients are navigating as well as their mental models.</p> Kuhlula Mabunda Emery Ladi Ngamasana Joseph Omoniyi Babalola Moleen Zunza Peter Nyasulu Copyright (c) 2019-01-18 2019-01-18 32 1 Thymoma associated myasthenia gravis with atypical presentation of lipomatous tongue atrophy: a case report https://www.ajol.info/index.php/pamj/article/view/208408 <p>A 28-year-old female patient came to the outpatient dental clinic for multiple teeth extractions and full mouth rehabilitation suffer from myasthenia gravis (MG) primary presentation as tongue atrophy and facial muscles weakness and the symptoms became worries, the patient unable to speak as well and change her voice and complaining of dysphagia and dysarthria. Oral symptoms, treatment schedule and protocol, the selection, prescription and impacts of medications, and prevention of myasthenic crisis are all important aspects should be considered by dentists and oral health care providers. Weakness of facial and oropharyngeal muscle is considered very popular at disease onset and therefore oral health providers are often the first medical professionals to observe these patients. Myasthenic patients seek particular approach and consultation in order to ensure ideal and proper dental management.</p> Suzan Salem Islam Saad Rana Alamri Copyright (c) 2019-01-21 2019-01-21 32 1 Lichen nitidus https://www.ajol.info/index.php/pamj/article/view/208411 <p>Lichen nitidus (LN) is chronic papulosquamous disorder characterized by multiple, 1-2 mm, flesh-colored, shiny, dome-shaped papules. Its incidence is 0.034% in a study of skin diseases in blacks over a 25-years period.Skin lesions classically involves the genitalia, upper extremities, chest and abdomen. Infrequently, the lower extremities, palms, soles, face, nails, and mucous membranes may be affected. Majority of cases are common in children and young adults. Various clinical variants of lichen nitidus are - linear, confluent, vesicular, haemorrhagic, spinous follicular, perforating, generalised, palmar and plantar. We report the observation of a 6-month-old infant who presented translucent papules of the back of the hands whose histological study was in favor of a lichen nitidus.</p> Fatima-Zahra Agharbi Copyright (c) 2019-01-22 2019-01-22 32 1 Une pneumopathie interstitielle diffuse révélant un syndrome des antisynthétases: à propos de 2 cas https://www.ajol.info/index.php/pamj/article/view/208414 <p>Le syndrome des antisynthétases (SAS) est une myopathie inflammatoire fréquemment associée à une atteinte pulmonaire, surtout parenchymateuse (pneumopathie infiltrante diffuse). Les manifestations extrathoraciques associées à l'atteinte pulmonaire peuvent orienter le diagnostic: myalgies, polyarthralgies, syndrome de Raynaud, hyperkératose érythémateuse palmaire fissuraire et fièvre. Devant un tableau clinique et radiologique évocateur, la présence d'anticorps anti-ARN-t synthétases permet de confirmer notamment les anti-Jo-1. L'atteinte pulmonaire constitue un facteur pronostic majeur d'où l'indication une thérapie immunosuppressive intensive fondée sur la corticothérapie, les immunosuppresseurs ou l'association des deux. Une meilleure sensibilisation pour cette affection à révélation pulmonaire permettra d'adopter une prise en charge rapide et adéquate, et d'améliorer par conséquent le pronostic.</p> Nizar El Bouardi Amina Alaoui Meriem Haloua Youssef Lamrani Meryem Boubbou Mustapha Maaroufi Baderdine Alami Copyright (c) 2019-01-22 2019-01-22 32 1 Tuberculose multifocale compliquée d’un syndrome d’activation macrophagique: à propos de deux cas https://www.ajol.info/index.php/pamj/article/view/208439 <p>Le syndrome d'activation macrophagique (SAM) est une manifestation rare liée à une stimulation inappropriée des macrophages dans la moelle osseuse et les organes lymphoïdes. Il est défini par des critères cliniques, biologiques et cyto-histologiques. Ce syndrome peut être primaire essentiellement chez l'enfant, ou secondaire à diverses affections: hématologiques, infectieuses ainsi qu'à des maladies auto-immunes variées. Le pronostic est sombre, avec une mortalité de près de 50% toutes causes confondues .Le traitement repose sur le traitement spécifique de l'agent causal du SAM et dans certaines indications, sur l'étoposide, les corticosteroides et les immunogobulines qui doivent alors être administrés précocement. Le SAM est rarement décrit en association avec la tuberculose, nous rapportons deux observations de deux patientes, l'une immunodéprimée et l'autre immunocompétente présentant une tuberculose multifocale compliquée d'un syndrome d'activation macrophagique. Nous insistons à travers ce travail sur la difficulté du traitement du syndrome d'activation macrophagique associé à une tuberculose, la nécessité de l'évaluation du rapport bénéfice risque, en raison du risque d'immunosuppression lié à l'utilisation des corticoïdes ou des immunosuppresseurs, avec possible aggravation de la tuberculose.</p> Rajae Azzeddine Fatimazahra Elyassir Jamal Eddine Bourkadi Copyright (c) 2019-01-22 2019-01-22 32 1 Six ans de survie sans progression après chimiothérapie pour une tumeur neuro-ectodermique périphérique rénale métastatique https://www.ajol.info/index.php/pamj/article/view/208440 <p>Les tumeurs neuro-ectodermiques périphériques (PNET) rénales sont extrêmement rares, souvent diagnostiquées à un stade tardif compte tenu de leurs présentations cliniques aspécifiques. Le traitement des stades métastatiques repose sur la chimiothérapie palliative, nous rapportons un cas de PNET rénale métastatique d’emblée au niveau ganglionnaire et cutané, qui a présenté une bonne réponse clinique et radiologique et sans signe de progression depuis 6 ans après la fin d’une polychimiothérapie par vincristine, doxorubicine et cyclophosphamide.</p> Ali Sbai Zineb Dahbi Farid Naciri Fouad Elmejjatti Amine Guerouaz Kawtar Lakhmis Mohammed Guezzar Fadwa Allouch Loubna Mezouar Copyright (c) 2019-01-23 2019-01-23 32 1 Histoplasmosis, heart failure, hemolysis and haemophagocytic lymphohistiocytosis https://www.ajol.info/index.php/pamj/article/view/208488 <p>Histoplasmosis is an endemic mycosis with global distribution, primarily reported in immunocompromised individuals. A 29-year old immunocompetent male presented with fever, hepatosplenomegaly and pancytopenia. His peripheral blood showed features suggestive of intravascular hemolysis and echocardiography showed features suggestive of pulmonary arterial hypertension. Bone marrow showed yeast with morphology suggestive of&nbsp;<em>Histoplasma capsulatum</em>. Further investigations revealed hyperferritinemia, hypofibrinogenemia and increased triglycerides. With a diagnosis of progressive disseminated histoplasmosis with secondary Haemophagocytic lymphohistiocytosis, he was successfully treated with amphotericin B followed by itraconazole. We report this case to highlight the atypical and rare manifestations of histoplasmosis.</p> Nitin Gupta Kutty Sharada Vinod Ankit Mittal Aswin Pius Ajay Kumar Arvind Kumar Naveet Wig Copyright (c) 2019-01-23 2019-01-23 32 1 Le traitement du décollement de rétine du pseudophaque: vitrectomie sans indentation épisclérale VERSUS Chirurgie Ab externo https://www.ajol.info/index.php/pamj/article/view/208494 <p>Plusieurs facteurs prédisposent à la survenue d'un décollement de rétine rhegmatogène, notamment la chirurgie de cataracte, la myopie, les lésions dégénératives de la périphérie rétinienne ainsi que la notion de traumatisme oculaire. L'objectif de notre étude est de comparer les résultats anatomiques et fonctionnels des deux techniques chirurgicales (Ab interno Vs Ab externo) au sein de notre structure. Il s'agit d'une étude descriptive rétrospective, réalisée au sein du service d'ophtalmologie du CHU Mohamed VI de Marrakech, étalée sur 3 ans, allant de janvier 2013 à décembre 2015, comparant deux groupes d'étude , le premier groupe opéré par voie externe (Cryo application des déhiscences avec une indentation épi sclérale) et le 2<sup>ème</sup>&nbsp;opéré par voie endo-oculaire. Le groupe A ou groupe ab externo était constitué de 26 yeux (26 patients) contre 22 yeux (22 patients) dans le groupe B ou groupe vitrectomie avec tamponnement interne. Dans le groupe ab externo, l'âge moyen était de 54,92 ans contre 51,64 ans dans le groupe ab interno, avec une légère prédominance masculine dans les 2 groupes. La réapplication rétinienne après la 1<sup>ère</sup>&nbsp;intervention était obtenue chez les deux groupes sans différence significative, aux alentours de 80,76% chez les patients du groupe A versus 81,82% du deuxième groupe. Les causes d'échec dans les deux groupes étaient dues à la présence d'une prolifération vitréorétinienne avancée (4 cas), d'une déchirure de novo (3 cas) et de déchirures non vues à l'examen initial (2 cas). Tous ces cas ont été repris par un abord ab interno, consistant chez les patients du groupe A en une vitrectomie complète avec révision de l'indentation +/- pelage de membrane limitante interne avec tamponnement interne par gaz et chez les patients du groupe B en un complément de vitrectomie avec dissection de la PVR et un tamponnement interne par huile de silicone. Après un recul moyen de 12 mois, l'acuité visuelle finale de nos patients était sans différence significative entre les 2 groupes, avec plus que le tiers des patients avaient retrouvé une acuité visuelle entre 1/10 et 5/10, aux alentours de 34,61% au niveau du groupe ab externo, et 36,36% pour le groupe ab interno. Certes, avec les avancées technologiques en terme de vitrectomie, la tendance actuelle est la chirurgie endo oculaire, cependant la chirurgie ab-externo garde sa place principalement lors des DR avec des déchirures visibles, bien accessibles à l'indentation sans prolifération vitréorétinienne avancée (PVR A-Bà).</p> Ahmed Ghazza Maha Bakhsh Ibtissam Hajji Abdeljalil Moutaouaki Copyright (c) 2019-01-24 2019-01-24 32 1 Mastocytome solitaire de l'enfant: à propos d'un cas https://www.ajol.info/index.php/pamj/article/view/208496 <p>Le mastocytome solitaire est la forme la plus fréquente de mastocytose chez l'enfant. Son pronostic est bon comme toutes les autres formes de mastocytoses de l'enfant avec possibilité de régression spontanée. Les dermocorticoïdes peuvent accélérer cette régression comme c'est le cas chez notre patient.</p> Fatima-Zahra Agharbi Copyright (c) 2019-01-28 2019-01-28 32 1 Fracture triplane de l’extrémité supérieure du tibia: une lésion rare (étude d’un cas et revue de la littérature) https://www.ajol.info/index.php/pamj/article/view/208498 <p>Nous rapportons le cas d’une fracture triplane de l’extrémité supérieure du tibia chez un jeune de 16 ans survenue dans les suites d’un accident de sport lors d’une course de vélo. La tomodensitométrie (TDM) a été réalisée pour une meilleure analyse lésionnelle. Après l’identification de tous les fragments nécessitant une ostéosynthèse, il a été réalisé à foyer fermé une réduction avec fixation des différents fragments fracturaires par des vis canulées. Au dernier recul, les résultats radiologiques et fonctionnels étaient excellents.</p> Mohamed-Lemine Lehreitani Hatim Abid Florian Marcaillou Maanouk Rachid Abdelhalim El Ibrahimi Abdelmajid El Mrini Stephane Blanc Copyright (c) 2019-01-28 2019-01-28 32 1 Folie à deux ou le partage de symptômes comme modalité relationnelle: à propos d’un cas https://www.ajol.info/index.php/pamj/article/view/208501 <p>Le trouble psychotique partagé ou Folie à deux (FD) est une entité rare et controversée qui pose des problèmes d’ordre phénoménologique, nosographique et psychopathologique. Elle interroge la nature du délire et sa survenue en dehors d’une structure psychotique ainsi que la question de la contagion du symptôme en psychiatrie. Nous proposons l’analyse sémiologique d’un cas intrafamilial de Folie à deux, cas dont la particularité clinique est le partage de symptômes délirants mais aussi d’éléments psychotiques non délirant (déficitaires). A travers quoi nous revenons sur les caractéristiques épidémiologiques et les facteurs communs avec les autres cas rapportés dans la littérature dans différentes cultures. Nous dressons ensuite l’historique de l’entité et son évolution au fil des classifications depuis sa première description par Legrand jusqu’au DSM 5. Et de là, nous soulignons le caractère insuffisant d’une approche purement descriptive et mettons l’accent sur le lien possible avec d’autres situations cliniques plus fréquentes avec comme point commun la transmission entre deux ou plusieurs personnes de symptômes psychiques. Puis, nous proposons une réflexion psychopathologique qui s’axe essentiellement sur le partage du symptôme et non sa nature tout en interrogeant la fonction du délire au sein d’un couple délirant.</p> Amine Bout Nabil Berhili Hayat Hlal Rachid Aalouane Ismail Rammouz Copyright (c) 2019-01-28 2019-01-28 32 1 Hernie interne du ligament falciforme: une cause rare d'occlusion intestinale https://www.ajol.info/index.php/pamj/article/view/208504 <p>Les hernies internes sont une cause rare d'occlusion intestinale aiguë. La hernie à travers le ligament falciforme est une forme exceptionnelle dont le diagnostic est souvent fait en peropératoire. La tomodensitométrie abdominale, pratiquée en urgence, peut aider au diagnostic en préopératoire et permet de guider l'attitude thérapeutique. Aussi, nous a-t-il paru opportun de rapporter ce cas colligé dans le service de chirurgie viscérale A du CHU Hassan II de Fès. Nous rapportons l'observation d'un patient âgé de 48 ans, sans antécédent particulier, admis aux urgences avec un tableau d'occlusion évoluant depuis 4 jours. La radiographie d'abdomen sans préparation objectivait de multiples niveaux hydro-aériques de type grêlique dont certains se projetaient en regard de l'air hépatique, ainsi que la présence d'une anse intestinale plate en continuité avec un segment intestinal distendu. La tomodensitométrie abdominale n'a pas été réalisée vu une fonction rénale qui était altérée. Le patient était alors opéré en urgence après mise en condition et le diagnostic d'une hernie interne du ligament falciforme était fait en peropératoire. La hernie interne à travers le ligament falciforme est une cause rare d'occlusion intestinale aiguë de l'adulte dans notre pratique quotidienne. Le diagnostic est le plus souvent fait en peropératoire. Il faut savoir y penser devant le jeune âge, l'absence d'antécédents de chirurgie abdominale ou de processus infectieux intra péritonéal et la présence de niveaux hydro-aériques dans l'hypocondre droit.</p> Hamza Hasnaoui Ouadii Mouaqit El Bachir Benjelloun Abdelmalek ousadden Khalid Ait Taleb Hicham El Bouhaddouti Copyright (c) 2019-01-28 2019-01-28 32 1 Prévalence du surpoids et de l’obésité chez l’adolescent en milieu scolaire à Lubumbashi, République Démocratique du Congo https://www.ajol.info/index.php/pamj/article/view/208506 <p><strong>Introduction:&nbsp;</strong>le surpoids et l’obésité au cours de l’adolescence constituent un problème préoccupant de santé publique à l’échelle mondiale en raison de leur retentissement potentiel sur la santé et de leur fréquence croissante. La présente étude avait pour objectif de déterminer la prévalence du surpoids et de l’obésité chez les adolescents scolarisés dans les établissements publics et privés à Lubumbashi, en République Démocratique du Congo.</p> <p><strong>Méthodes:&nbsp;</strong>il s’agissait d’une étude transversale menée auprès de 5.341 adolescents âgés de 10 à 19 ans, dont 2.858 (53,5%) filles et 2.483 (46,5%) garçons ont constitué notre échantillon. Pour chacun d’eux, nous avons mesuré le poids et la taille puis calculé l’indice de masse corporelle (IMC).</p> <p><strong>Résultats:&nbsp;</strong>la moyenne du poids était de 43,78 ± 11,62 kg (soit 42,39 ± 12,11 kg pour les garçons et 44,95 ± 11,04 kg pour les filles), celle de la taille était de 151,30 ± 13,09 cm (soit 151,20 ± 14,64 cm pour les garçons et 151,38 ± 11,58 cm pour les filles) et celle de l’IMC était de 18,82 ± 3,15 kg/m<sup>2</sup>&nbsp;(soit 19,39 ± 3,39 kg/m<sup>2</sup>&nbsp;pour les garçons et 18,17 ± 2,71 kg/m<sup>2</sup>&nbsp;pour les filles). La prévalence du surpoids était de 8% et celle de l’obésité était de 1%. Les filles étaient significativement plus touchées par le surpoids (10,7% filles contre 5% garçons) et l’obésité (1,5 % filles contre 0,4% garçons) que les garçons.</p> <p><strong>Conclusion:&nbsp;</strong>le surpoids et l’obésité chez les adolescents en milieu scolaire s’avèrent une réalité à Lubumbashi. La détermination de la prévalence du surpoids et de l’obésité pour cette catégorie d’âge au plan national est recommandable pour leurs préventions et prises en charges.</p> Jacques Mbaz Musung Emmanuel Kiyana Muyumba Dophra Ngoy Nkulu Placide Kambola Kakoma Olivier Mukuku Berthe Kon Mwad Kamalo Clarence Kaut Mukeng Christian Ngama Kakisingi Francoise Kaj Malonga Faustin Mukalenge Chenge Oscar Numbi Luboya Copyright (c) 2019-01-28 2019-01-28 32 1 Un cas de gigantomastie gravidique bilatérale https://www.ajol.info/index.php/pamj/article/view/208510 <p>Il s'agissait d'une patiente de 29 ans, sans antécédent pathologique, II gestes II pares. La symptomatologie évoluait depuis 2 mois, marquée par la survenue d'une augmentation mammaire bilatérale gênant les activités quotidiennes. L'examen physique montrait des seins hypertrophiés, des ulcérations mammaires bilatérales. Elle présentait une aménorrhée de 28 semaines. L'examen anatomopathologique des ulcérations est revenu en faveur d'un bourgeon charnu. La prolactinémie était élevée (1345 µUI/ml). Les taux de FSH et de LH étaient normaux. Un traitement à base de bromocriptine a été réalisé sans succès. L'évolution était marquée par une diminution de la taille et la régression des ulcérations cutanées six mois après l'accouchement par voie basse. La gigantomastie gravidique est une hypertrophie mammaire dont le volume dépasse 1500 cm<sup>3</sup>&nbsp;durant la grossesse. L'étiologie n'est pas connue. Le traitement radical repose sur la mastectomie bilatérale.</p> Adja Coumba Diallo Mouhamadou Bachir Ba Copyright (c) 2019-01-29 2019-01-29 32 1 Daily tobacco use and problem drinking among urban adults in South Africa: a longitudinal study https://www.ajol.info/index.php/pamj/article/view/208511 <p><strong>Introduction:&nbsp;</strong>there is a lack of longitudinal studies investigating daily tobacco use and problem drinking in Africa. The aim of this study was to explore the prevalence of daily tobacco use and problem drinking and to determine the factors associated with daily tobacco use and problem drinking among urban dwellers in a longitudinal study in South Africa.</p> <p><strong>Methods:&nbsp;</strong>electronic interview data were collected from 2213 adults (mean age 45.7 years, SD=15.1; range 20-97) at time 1 (baseline assessment) and Time 2 (12 months follow-up assessment) from one urban centre in South Africa.</p> <p><strong>Results:&nbsp;</strong>daily tobacco use only, was at time 1 24.0% and at time 2 23.4%, a decrease of 0.5%. Problem drinking only was at time 1 19.6% and at time 2 21.1%, an increase of 1.5%. Concurrent daily tobacco use and problem drinking increased from time 1 9.5% to 10.3% at time 2, an increase of 0.8%. In longitudinal regression analyses, being male and being born in current city were significantly associated with all three substance use indicators (daily tobacco use; problem drinking; and concurrent daily tobacco use and problem drinking). In addition, older age, not currently married, lower education, underweight and higher levels of perceived stress were associated with daily tobacco use and younger age was associated with problem drinking.</p> <p><strong>Conclusion:&nbsp;</strong>high prevalence of daily tobacco use and problem drinking were found among urban dwellers and several socio-demographic (being male, being born in the city, not married and lower education) and health variables (being underweight and perceived stress) were identified which can guide substance use intervention programmes for this population.</p> Karl Peltzer Li-Wei Chao Shandir Ramlagan Helena Szrek Copyright (c) 2019-01-29 2019-01-29 32 1 Non-operative management of blunt splenic injury: is it really so extensively feasible? a critical appraisal of a single-center experience https://www.ajol.info/index.php/pamj/article/view/208523 <p><strong>Introduction:&nbsp;</strong>the spleen is one of the most commonly injured organ following blunt abdominal trauma. Splenic injuries may occur in isolation or in association with other intra-and extra-abdominal injury. Nonoperative management of blunt injury to the spleen has become routine in children. In adult most minor splenic injuries are readily treated nonoperatively but controversy exists regarding the role of nonoperative management for higher grade injuries above all in multi-trauma patients. The aim of this study is the assessment of splenic trauma treatment, with particular attention to conservative treatment, its limits, its efficiency, and its safety in multi-trauma patient or in a severe trauma patient.</p> <p><strong>Methods:&nbsp;</strong>the present research focused on a retrospective review of patients with splenic injury. The research was performed by analyzing data of the trauma registry of St. Andrea University Hospital in Rome. The St. Andrea University Hospital trauma registry includes 1859. The variables taken into account were spleen injury and general injuries, age, sex, cause and dynamic of trauma, hemoglobin, hematocrit, white blood cells count, INR, number and time blood transfusion, hemodynamic stability, type of treatment provided, hospitalization period, morbidity and mortality. Assessment of splenic injuries was evaluated according to Abbreviated Injury Scale (AIS).</p> <p><strong>Results:&nbsp;</strong>the analysis among the general population of spleen trauma patients identified 68 patients with a splenic injury representing the 41.2% of all abdomen injury. The Average age was of 37.01 ± 17.18 years. The Average ISS value was of 22.88 ± 12.85; mediana of 24.50 (range 4-66). The average Spleen AIS value was of 3.13 ± 0.88; mediana 3.00 (range 2-5). The overall mortality ratio was of 19.1% (13 patients). The average ISS value in patients who died was of 41.92 ± 12.48, whereas in patients who survided was of 23.33 ± 10.15. The difference was considered to be statistically significant (p &lt;0.001). The relashionship between the ISS and AIS values in patients who died was considered directly proportional but not statistically significant (Pearson test AIS/ISS = 0.132, p = n.s.). The initial management was a conservative treatment in 27 patients (39.7%) of them 4 patients (15%) failed, in the other 41 cases urgent splenectomies were performed. The average spleen AIS in all the patients who underwent splenectomy was 3.61 ± 0.63 whereas in the patients who were not treated surgically was 2.42 ± 0.69. The difference was deemed statistically significant (p &lt;0.001).</p> <p><strong>Conclusion:&nbsp;</strong>splenic injury, as reported in our statistic as well as in literature, is the most common injury in closed abdominal trauma. Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The preference of a conservative treatment must be based on the hemodynamic stability indices as well as on the spleen lesion severity and on the general trauma severity. The conservative treatment represent a feasible and safe therapeutic alternative even in case of severe lesions in politrauma patients, but the choice of the treatment form requires an assessment for each singular case.</p> Pietro Fransvea Gianluca Costa Giulia Massa Barbara Frezza Paolo Mercantini Genoveffa BaIducci Copyright (c) 2019-01-30 2019-01-30 32 1 Prevalence and pattern of lower extremity injuries due to road traffic crashes in Fako Division, Cameroon https://www.ajol.info/index.php/pamj/article/view/208527 <p><strong>Introduction:&nbsp;</strong>low and middle income countries are disproportionately affected with road traffic injuries and the lower extremity is one of the most affected anatomical body parts. There exist very limited data on the pattern of lower extremity injuries in the Cameroon especially in the South West Region. We therefore, hypothesized that lower limb injuries are common in road traffic crashes and motorized two wheelers are the commonest cause.</p> <p><strong>Methods:&nbsp;</strong>this was a hospital based prospective, cross sectional study. It involved four hospitals (Limbe and Buea Regional Hospitals, Baptist hospital Mutengene and Tiko District Hospital) in the Fako Division. It was carried out for three months. Victims of road traffic crashes received at emergency department of these hospitals during this period were assessed. Crash characteristics and injury characteristics were assessed and recorded.</p> <p><strong>Results:&nbsp;</strong>we analyzed 411 crash victims, 197(47.93%) had lower extremity injuries. The male to female ratio was 1.4:1. Majority of crash victims were in their 3<sup>rd</sup>&nbsp;and 4<sup>th</sup>&nbsp;decades of life. The mean age of patients who had lower limb injuries was 33.30(±16.04). The most vulnerable road users were pedestrians (26.52%) and passengers on motor bikes (38.44%) and the commonest mechanism by which crash victims sustained injuries were: bike-car collisions (22.84%), and bike-pedestrian collisions (19.29%). Commercial motor bikes (62.77%) and taxis (22.38%) were the road users most involved in road traffic collisions. The leg 98(49.75%), thigh 23(11.68%), and knee 20(10.15%) were the most injured anatomical parts of the lower extremity. Fractures 68 (34.52%), lacerations 53(26.90%), and bruises 49(24.87%) were the most recurrent pattern of lower extremity injuries.</p> <p><strong>Conclusion:&nbsp;</strong>in view of our findings we conclude therefore as follows: The prevalence of lower extremity injuries from Road Traffic Crashes in our study area was 47.93%. Associated risk factors to the road traffic crashes as identified by the victims were bad roads (10.15%) and bad weather (5.05%). The safety gargets were not adequately utilized by our victims, with 87.72% confirming that they did not wear the helmet and 87.50% affirming that they did not wear the seat belt at the time of the crash. The occupations mostly affected in our series were pupils and students (20.3%) and business people (19.2%), then the bike riders (15.23%). We thus recommend that the laws on the use of road safety gargets, especially helmets and seatbelts, be enforced, with riding and driving speeds reduced to below 60km/hour. Road usage should be avoided in bad weather and pedestrians lanes and zebra crossings be provided to minimize pedestrian-car or -bike collision.</p> Palle John Ngunde Asang Christian Ngwa Akongnwi Chichom Alain Mefire Fokam Puis Eleanor Gounou Ngwayu Claude Nkfusai Udoamaka Glory Nwarie Samuel Nambile Cumber Copyright (c) 2019-01-30 2019-01-30 32 1 A case of twin reversed arterial perfusion (TRAP) sequence managed conservatively https://www.ajol.info/index.php/pamj/article/view/208530 <p>The TRAP sequence, also known as acardiac twinning is a rare complication that is unique to monochorioinic multiple pregnancies affecting 1% of monochorioinic pregnancies and about 1 in 35000 of all pregnancies. In TRAP, blood flows from the umbilical artery of the pump twin to the umbilical artery of the perfused twin through artery to artery (AA) anastomosis. The perfused twin has poor development of the upper extremities and the normal or pump twin is at risk of a poor perinatal outcome. This is a report of a patient with TRAP sequence diagnosed in the second trimester who was managed conservatively and had a good outcome for the normal twin.</p> Enesia Mudenha Ziki Zvavahera Mike Chirenje Mugove Gerald Madziyire Copyright (c) 2019-01-30 2019-01-30 32 1 Fast track extubation in paediatric cardiothoracic surgery in developing countries https://www.ajol.info/index.php/pamj/article/view/208540 <p>In recent years, low-dose, short-acting anesthetic agents, which replaced the former high-dose opioid regimens, offer a faster postoperative recovery and decrease the need for mechanical ventilatory support. In this study, the aim was to determine the success rate of fast-track approach in surgical procedures for congenital heart disease. There is some evidence, mostly from retrospective analyses, that fast tracking can be beneficial. Ninety-one cases with moderate complex cardiac malformations were operated with fast-track protocol during cardiothoracic charitable missions. The essential aspects of early extubation in our cohort included: selected patients with good preoperative status, good surgical result with hemodynamic stability in low dose of inotropic drugs at the end of bypass, no active bleeding. In this setting a carefull choice and dosing of anesthetic agents, alongside a good postoperative analgesia are mandatory. The authors found that an early extubation (&lt; 4 hours) can be both effective and safe as it reduces intubation and ventilator times without increasing post-operative complications in pediatric congenital heart disease. This study supports a wider use of fast-track extubation protocols in paediatric patients submitted for congenital cardiac surgery in developing countries.</p> Federica Iezzi Michele Di Summa Paolo Del Sarto Copyright (c) 2019-01-30 2019-01-30 32 1 Aspects épidémiologiques, nutritionnels et anatomopathologiques des cancers colorectaux dans la région du grand Casablanca https://www.ajol.info/index.php/pamj/article/view/208541 <p><strong>Introduction:&nbsp;</strong>le cancer colorectal constitue un problème majeur de santé publique. L’objectif de notre étude est d’analyser le profil épidémiologique, nutritionnel, clinique et anatomo-pathologique des cancers colorectaux recrutés au CHU de Casablanca.</p> <p><strong>Méthodes:&nbsp;</strong>notre étude cas-témoins a porté sur les patients pris en charge pour un cancer colorectal durant l’année 2015, comparés à des témoins non suivi pour un cancer.</p> <p><strong>Résultats:&nbsp;</strong>l’âge moyen des patients était de 56,65 ans avec un écart type de 14,64. Le type histologique le plus fréquent chez nos patients était représenté par l’adénocarcinome Lieberkhünien avec une proportion de 82 %. L’analyse de l’indice de masse corporelle a permis de retrouver une obésité chez 50% des patients contre 20% des témoins et un diabète chez 19% des patients versus 8% des témoins (p &lt; 0,019). Par ailleurs, l’étude du régime alimentaire des patients comparé à celui des témoins semble montrer que la moyenne de la fréquence de consommation hebdomadaire de viandes rouges est plus élevée chez les patients que chez les témoins (4,24 vs 3,26; p = 0,009) et inversement pour la consommation du poissons (0,97 contre 1,76; p = 0,0001). En revanche, la moyenne de consommation des légumes et des fruits est plus faible chez les patients que chez les témoins (5,00 vs 9,50; p = 0,0001). Concernant les habitudes toxiques de nos patients, 32% des patients étaient fumeurs vs 13 % des témoins.</p> <p><strong>Conclusion:&nbsp;</strong>nos résultats montrent que la prise de conscience à propos du régime alimentaire et des changements dans nos habitudes de vie pourrait réduire l’incidence du cancer colorectal et par conséquent la mortalité et la morbidité.</p> Fatima Ezzahra Imad Houda Drissi Nezha Tawfiq Karima Bendahhou Nadia Tahiri Jouti Driss Radallah Copyright (c) 2019-01-31 2019-01-31 32 1 Talar body fracture combined with medial malleolar fracture: a case report and literature review https://www.ajol.info/index.php/pamj/article/view/208542 <p>Fracture of the talar body is rare, it reaches articular congruence and determines the ankle's functional prognosis. The authors report a case of a combination of a sagittal talar body fracture with fracture of the medial malleolus in a 52-year-old following a road traffic accident. The association talus body fracture with a medial malleolus fracture is exceptional. Stable internal fixation can yield good functional results.</p> Kamal Lahrach Khalid Ibn El Kadi Amine Marzouki Fawzi Boutayeb Copyright (c) 2019-01-31 2019-01-31 32 1 Vitiligo et phénomène de Koebner suite à des injections de plasma riche en plaquettes https://www.ajol.info/index.php/pamj/article/view/208546 <p>Le vitiligo est un trouble commun et acquis de la pigmentation cutanée caractérisé par une perte sélective et souvent continue de mélanocytes épidermiques. Nous rapportons le cas d'une patiente ayant développé un vitiligo de la face suite à des injections de plasma riche en plaquettes. Le diagnostic de phénomène de Koebner a été retenu pour expliquer la survenue de vitiligo sur les zones mêmes d'injection de plasma riche en plaquettes.</p> Mouna Ejjiyar Mehdi Sahibi Mehdi El Gueouatri Abdelkoddous Bhihi Mehdi Mahrouch Imane Yafi Moulay Driss El Amrani Yassine Benchamkha Copyright (c) 2019-02-04 2019-02-04 32 1 Lessons learned from implementing alternative rites in the fight against female genital mutilation/cutting https://www.ajol.info/index.php/pamj/article/view/208547 <p><strong>Introduction:&nbsp;</strong>historically, programs aimed at making communities abolish female genital mutilation or cutting (FGM/C) consisted mainly of awareness campaigns on sexual reproductive health and rights and the enforcement of newly implemented laws. These types of programs or interventions appear to be only partially effective and sometimes yield unintended results, such as actually strengthening commitment to FGM/C or transforming it into a secret practice. A newer approach to change that is intended to account for the cultural meanings ascribed to FGM/C are alternative rites of passage (ARP). Amref Health Africa started adopting this approach in 2007. Since then, by a trial-and-error process lessons have been learned, that will be reflected upon in this paper.</p> <p><strong>Methods:&nbsp;</strong>desk research was conducted on organizational data regarding all Amref Health Africa's efforts to end FGM/C. Ninety-four in-depth formal interviews were held with members from Maasai and Samburu communities in Kenya targeted through maximum variation sampling. And participant observation of significative events as well as daily pastimes took place during school holiday season at the end of 2016. Furthermore extensive informal talks were held with project donors, activists, journalists, members of other non-governmental organizations, members of community services organizations, local government officials, high-ranking Dutch and US diplomats and senior members of the Anti-Female Genital Mutilation Board, which is part of the Kenyan Ministry of Public Service, Youth and Gender Affairs. On the basis of these data a framework on different positions on FGM/C was developed and published in early 2018. By reviewing the data again from a particular change management and public health perspective, by peer-debriefing within a multi-disciplinary research team and by explicating the lessons learned this paper adds to an overview that is of crucial importance to practitioners working to end FGM/C.</p> <p><strong>Results:&nbsp;</strong>risk of exclusion, perceived loss of cultural identity, changing meanings ascribed to cultural practices, lack of precise knowledge about subjective (sexual) experience and negative stereotyping are reasons not to adhere to anti-FGM/C programs. Areas of concern are the role confusion with following-up on policing, perceived outsider interference and the intended prolonging of the transition phase into womanhood not being explicated and embedded with ARP. Aspects to enhance to lever change more effectively are education and school curriculum development, male involvement, new stylization of love relationships, monitoring and evaluation and inclusive aspects of religion.</p> <p><strong>Conclusion:&nbsp;</strong>changing a culturally embedded practice such as FGM/C is inherently complex. Because the cultural meanings ascribed to this practice are also evolving, any intervention that is effective at present might become superfluous in the future so, a Holy Grail approach to change simply does not exist. Change needs to be levered in a variety of ways while working on the alignment of all these efforts by regular and thorough quantitative and qualitative assessments of effects and side-effects and reflections on lessons learned.</p> Ernst Patrick Graamans Tara Rava Zolnikov Eefje Smet Peter Ngatia Nguura Lepantas Charles Leshore Steven ten Have Copyright (c) 2019-02-04 2019-02-04 32 1 Predictors of tuberculosis knowledge, attitudes and practices in urban slums in Nigeria: a cross-sectional study https://www.ajol.info/index.php/pamj/article/view/208557 <p><strong>Introduction:&nbsp;</strong>Nigeria is among six countries responsible for the majority of tuberculosis (TB) cases in the world. The Nigerian government has emphasized community-based case finding to increase detection of TB. This process requires efforts to improve knowledge, attitudes and practices (KAP) of TB, particularly in the poorest of communities. This study presents data from a KAP survey administered in two underserved Nigerian communities.</p> <p><strong>Methods:&nbsp;</strong>a structured survey was administered by trained interviewers among adult residents in two slum communities in Lagos, Nigeria. Participants were selected through multistage random sampling. KAP scores were computed and the predictors of higher scores were assessed.</p> <p><strong>Results:&nbsp;</strong>a total of 504 respondents were surveyed. The mean KAP scores were relatively low: 9.8 ± 7.1 for knowledge (out of a maximum 34), 5.3 ± 3.4 for attitude (maximum = 10), and 5.2 ± 1.5 for practice (maximum = 7). The predictors of good knowledge were increasing age, post secondary education and professional occupation. The predictors of positive attitude were post secondary education and good TB knowledge. Good knowledge was a predictor of good practice.</p> <p><strong>Conclusion:&nbsp;</strong>our findings underscore the need to improve the education about TB in underserved communities. Improving KAP scores will ultimately lead to higher rates of TB detection and treatment.</p> Mobolanle Rasheedat Balogun Adekemi Oluwayemisi Sekoni Seema Thakore Meloni Oluwakemi Ololade Odukoya Adebayo Temitayo Onajole Olukemi Arinola Longe-Peters Folasade Tolulope Ogunsola Phyllis Jean Kanki Copyright (c) 2019-02-04 2019-02-04 32 1 Prevalence, knowledge and practices of shisha smoking among youth in Kampala City, Uganda https://www.ajol.info/index.php/pamj/article/view/208562 <p><strong>Introduction:&nbsp;</strong>globally tobacco use kills more than seven million people annually, a figure expected to rise to 8 million deaths every year by 2030. Though perceived as safe, shisha smoking is reported to have the same or worse health effects as cigarette smoking yet, this practice has gained popularity especially among youths globally. We assessed shisha smoking and factors associated with shisha smoking to support public health interventions.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted among 663 systematically selected youths aged between 18-30 years attending bars in two divisions of Kampala city Uganda. Data was analyzed using Stata version 12 and logistic regression model run to establish factors independently associated with shisha smoking.</p> <p><strong>Results:&nbsp;</strong>we found that 458 (86.4%) youths had low knowledge of the health effects of shisha and 193 (36.4%) smoked shisha. Majority of the respondents, 184 (97.4%) smoked flavoured and sweetened tobacco, 69 (36.5%) smoked on a weekly basis, 163 (86.2%) smoked in the company of friends, 162 (85.7%) shared shisha pipes. Factors associated with shisha smoking include smoking cigarettes adjusted odds ratio [aOR]: 5.91, 95% Confidence Interval (CI): 3.86-9.05); positive attitude (aOR: 3.89, 95% CI: 2.50-6.05); urban residence (aOR: 3.98, 95% CI: 1.99-8.00) and older age [25-30 years] (aOR: 2.13, 95% CI: 1.37-3.22).</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of shisha smoking is high with three in ten youths smoking shisha yet their knowledge about the health effects associated with shisha smoking was low. Shisha smoking ban should be implemented in all bars in Kampala as stated by the newly enacted tobacco law.</p> Christine Aanyu Daniel Kadobera Rebecca Rachael Apolot Angela Nakanwagi Kisakye Peter Nsubuga William Bazeyo John Bosco Ddamulira Copyright (c) 2019-02-05 2019-02-05 32 1 Prise en charge thérapeutique des paragangliomes malins: revue de littérature à travers un cas illustratif https://www.ajol.info/index.php/pamj/article/view/208565 <p>Les paragangliomes malins présentent un réel challenge pour les praticiens. Il s'agit de tumeurs rares, de caractérisation complexe et très hétérogènes dans leur évolution et pronostic. Devant la rareté de ce groupe tumoral, il n'existe pas de consensus sur la prise en charge thérapeutique. A travers ce cas illustratif, nous rapportons l'observation d'une patiente de 29 ans suivie pour un paragangliome malin traitée initialement par chirurgie. Après six mois d'intervalle, récidive multifocale fixant à l'Octreo PET-CT (Positron Emission Tomography-Computer Tomography), la patiente a été mise sous injection mensuelle de Somatuline pendant un an puis arrêté suite à une progression. Une 2<sup>ème</sup>&nbsp;chirurgie de cytoréduction a été réalisée suivie d'une radiothérapie. Après un an, la patiente a présenté une progression massive. Une chimiothérapie à base de Dacarbazine a été initiée et dont l'évaluation a montré une réponse métabolique quasi complète après huit cures. Le but de ce travail est d'exposer les différentes options thérapeutiques possibles dans la prise en charge des paragangliomes malins.</p> Leila Afani Hassan Errihani Ahmad Awada Copyright (c) 2019-02-05 2019-02-05 32 1 Sex differences in physical activity among Ghanaian patients with sickle cell disease https://www.ajol.info/index.php/pamj/article/view/208567 <p><strong>Introduction</strong>: musculoskeletal pain and functional limitations experienced by patients with Sickle Cell Disease (SCD) impact their physical activity and social behaviour. Yet, we know little about physical activity behaviour in patients with SCD. The aim of this study was to investigate gender differences in physical activity, sedentary time and measures of fitness among Ghanaian adults with SCD. The study also determined the association between outcome variables in this population.</p> <p><strong>Methods</strong>: patients with SCD attending a sickle cell clinic in a tertiary hospital in Accra, Ghana participated in this cross-sectional study. Physical activity, sedentary time, body composition, flexibility and cardiovascular endurance were assessed. Demographic data were also collected by self-report.</p> <p><strong>Results</strong>: fifty three participants enrolled in the study. Of these, more than half were females (60.4%) and the average age of the participants was (M: 26.8, SD: 8.5 years). The total physical activity reported by the participants was different between males and females (t = 2.610, p = 0.012). However, there were no gender differences in sedentary time, body composition, flexibility and cardiovascular endurance. A moderately significant association was found between sedentary time and cardiovascular endurance (r = 0.437, p = 0.001).</p> <p><strong>Conclusion</strong>: the findings suggest that gender differences in physical activity are apparent in patients with SCD. Investigations into the mechanisms underpinning these differences are warranted. Additionally, longitudinal observations of objectively measured physical activity may be useful to validate these results in a larger sample.</p> Gifty Gyamah Nyante Catherine Oppong Emmanuel Bonney Copyright (c) 2019-02-05 2019-02-05 32 1 Older persons’ perceptions about advanced directives and end of life issues in a geriatric care setting in Southwestern Nigeria https://www.ajol.info/index.php/pamj/article/view/208569 <p><strong>Introduction:&nbsp;</strong>advanced directives enable the planning of care and support services independent of the older person’s ability to make the decision. There is a paucity of information regarding the views and preferences regarding advanced directives and other end of life issues among older persons in low and middle-income countries such as Nigeria. The study aimed to explore the knowledge, attitude and belief of older persons regarding decision making surrounding end of life and advance directives.</p> <p><strong>Methods:&nbsp;</strong>data were collected through focus group discussions at a monthly social gathering of outpatients in a geriatric center in Oyo State, Nigeria. Discussions were audiotaped, transcribed and analyzed manually using a thematic approach.</p> <p><strong>Results:&nbsp;</strong>respondents’ knowledge about the end of life care and advanced directives as prescribed in high income settings were sparse and did not include choices about treatment options or any medical directives. The predominant perceptions among the participants bordered mainly on the arrangements for place of death, burial and property sharing. Participants listed in order of preference the major decision makers in the advanced directive process mainly, the oldest male child, religious leaders and legal practitioners.</p> <p><strong>Conclusion:&nbsp;</strong>our findings imply the need for improving knowledge and awareness about the benefits of advanced directives among older persons with a focus on opportunities for their active participation.</p> Eniola Olubukola Cadmus Lawrence Adekunle Adebusoye Olufemi Oluwole Olowookere Adebowale Taiwo Olusegun Oluwagbemiga Oyinlola Raimi Olalekan Adeleke Olubukola Christianah Omobowale Temitope Oluwagbenga Alonge Copyright (c) 2019-03-05 2019-03-05 32 1 Hailey-Hailey disease: the role of azathioprine an immunomodulator https://www.ajol.info/index.php/pamj/article/view/208598 <p>Hailey-Hailey disease (HHD) is a rare autosomal dominant hereditary blistering and erosions disorder affecting the intertriginous regions of the body. There is still no treatment protocol for this disease thus clinicians are highly advised to draw up individualized treatment plan. In this case report we discuss a case of HHD in a 58-year-old Chinese man who was successfully treated with azathioprine in Hubei province.</p> Malumani Malan Wu Xuejingzi Jiang Si Song Ji Quan Copyright (c) 2019-02-05 2019-02-05 32 1 Une base de connaissance multilingue et dynamique en ligne pour la médecine générale et les soins primaires https://www.ajol.info/index.php/pamj/article/view/208599 <p><strong>Introduction:&nbsp;</strong>la classification internationale des soins primaires, deuxième version (CISP-2) alignée sur la classification internationale des maladies dixième révision (CIM-10) est un standard pour le recueil épidémiologique en soins primaires. La CISP-2 convient aussi pour identifier les thèmes cliniques dont discutent les médecins de famille. Les domaines contextuels de connaissances spécifiques à la médecine de famille et aux Soins Primaires comme les structures, la gestion, les catégories de patients, les méthodes de recherche, les aspects éthiques ou environnementaux ne sont pas standardisés et reflètent le plus souvent des vues d'experts.</p> <p><strong>Méthodes:&nbsp;</strong>une méthode de recherche qualitative, appliquée à l'analyse de plusieurs congrès de médecine de famille a permis d'identifier, en plus des items cliniques, un ensemble de concepts contextuels abordés par les médecins de famille lors de leurs échanges pendant les congrès. Assemblés sous forme hiérarchique, ces concepts ont trouvé leur place au côté de la CISP-2, sous le nom de Q-codes version 2.5, sur le serveur sémantique multilingue multi-terminologique du Département d'Information et d'Informatique médicale (D2IM) de l'Université de Rouen, France. Les deux classifications sont éditées sous le sigle 3CGP pour&nbsp;<em>Core Content Classification of General Practice</em>. Ce serveur d'accès libre permet de consulter la CISP-2 en 22 langues et les Q-codes en dix langues.</p> <p><strong>Résultats:&nbsp;</strong>le résultat de l'utilisation conjointe de ces deux classifications, comme descripteurs dans des congrès, pour identifier des concepts dans des textes, ou indexer la littérature grise en médecine de famille et soins primaires est présenté ici dans différentes utilisations pilotes. La validité et la généralisabilité de 3CGP semble bonne au vu des traductions déjà réalisées par des collègues du monde entier et de l'applicabilité de la méthode des deux côtés de l'Atlantique. Toute fois la reproductibilité et la variation inter-codeurs restent encore à tester pour les Q-codes. La question de la maintenance reste posée.</p> <p><strong>Conclusion:&nbsp;</strong>grâce à cette méthode, on peut mettre en évidence l'extension conceptuelle, la complexité et la dynamique du métier de médecin généraliste et de famille et de médecin de soins primaires.</p> Marc Jamoulle Daniel Knupp Augusto Miguel Pizzanelli Ariana de Oliveira Tavares Melissa Resnick Julien Grosjean Stefan Darmoni Copyright (c) 2019-02-05 2019-02-05 32 1 The HIV pandemic will not end by the year 2030 in low and middle income countries https://www.ajol.info/index.php/pamj/article/view/208601 <p>The recent Lancet Commission-International AIDS Society report: Advancing Global health and strengthening the HIV response in the Era of the Sustainable Development Goals; clearly highlights the fact that the world is NOT on track in ending the HIV pandemic by 2030. Emphasis on massive and early diagnosis and placement on Combined Anti- Retroviral Therapy (cART) remain key cornerstones in reaching these goals. Effective viral load informed care remains very promising in reducing drug resistance, and improving outcomes in infected persons. The authors argue that the current funding trends, management paradigms, research agendas, data collection and information system models, as well as the overall appreciation of the evolution of the pandemic in low and middle- income countries, lead to a logical conclusion that this pandemic will not end, especially in these countries by 2030. Major action areas are proposed for policy makers and researchers for appreciation.</p> Luchuo Engelbert Bain Elvis Enowbeyang Tarkang Ikenna Desmond Ebuenyi Raoul Kamadjeu Copyright (c) 2019-02-07 2019-02-07 32 1 Primary hepaticobiliary tuberculosis mimicking gall bladder carcinoma with liver metastasis: a case report https://www.ajol.info/index.php/pamj/article/view/208602 <p>Primary hepatic tuberculosis is a rare presentation and sporadically reported in the literature, mostly from our part of the world. Sometimes the presentation can be atypical and mimics hepatic tumor and poses diagnostic challenge. We, herein, present a case of a 58-year-old man who presented to us with abdominal pain and weight loss. Raised serum alkaline phosphatase (ALP) and imaging raised a suspicion of gall bladder carcinoma with hepatic invasion. Peroperative frozen section revealed hepatic chronic granulomatous inflammation with caseous necrosis consistent with the diagnosis of hepatic tuberculosis. Surgery was postponed and he was put on antituberculous treatment. It is important to consider tuberculosis in the differential diagnosis of the space occupying lesion of liver in a patient with vague symptoms and abnormal findings on imaging.</p> Muhammad Manzoor Ul Haque Rajesh Kumar Whadva Nasir Hassan Luck Muhammed Mubarak Copyright (c) 2019-02-07 2019-02-07 32 1 Incidence de l'epilepsie après un accident vasculaire cerebral à Parakou en 2014 https://www.ajol.info/index.php/pamj/article/view/208603 <p><strong>Introduction:&nbsp;</strong>les accidents vasculaires cérébraux (AVC) constituent une des principales causes acquises de l'épilepsie de l'adulte mais peu de données sont disponibles sur l'incidence de l'épilepsie après un AVC en Afrique. L'objectif de cette étude était d'estimer l'incidence de l'épilepsie chez les patients victimes d'AVC à Parakou.</p> <p><strong>Méthodes:&nbsp;</strong>il s'est agi d'une étude de type cohorte dynamique ayant inclus 203 patients victimes d'AVC et hospitalisés dans le service de neurologie du CHU de Parakou. Les patients aux antécédents d'épilepsie étaient exclus du suivi. Les patients étaient suivis sur une période de 21mois allant du 1<sup>er</sup>&nbsp;Janvier 2013 au 30 Septembre 2014. L'épilepsie était définie selon les critères de la Ligue Internationale contre l'Epilepsie.</p> <p><strong>Résultats:&nbsp;</strong>ils étaient âgés de 18 à 99 ans avec une moyenne de 58,4 ans ± 14,2 ans. Le délai moyen de consultation après l'installation des symptômes était de 54,3h (+/-112,9h). Les AVC ischémiques représentaient 45,8%, les hémorragiques 31% et 23,2% d'indéterminés. L'incidence cumulée de l'épilepsie était de 17. La densité d'incidence de l'épilepsie était de 9,8 pour 100 personnes-années. Les facteurs associés à la survenue de l'épilepsie étaient le niveau d'instruction, la durée d'hospitalisation et le score de BARTHEL.</p> <p><strong>Conclusion:&nbsp;</strong>l'incidence de l'épilepsie reste très élevée et la prise en compte des facteurs associés dans les stratégies de prise en charge pourrait permettre de réduire sa charge globale.</p> Adoukonou Thierry Accrombessi Donald Agbétou Mendinatou Houinato Dismand Copyright (c) 2019-02-07 2019-02-07 32 1 Hématome rétro-péritonéal consécutif à une envenimation vipérine: à propos d’un cas https://www.ajol.info/index.php/pamj/article/view/208604 <p>Les envenimations ophidiennes constituent un problème de santé publique en Afrique, entrainant 20 000 décès annuels. Cette mortalité traduit les difficultés de prise en charge des complications en particuliers hémorragiques. Nous rapportons le cas de Mr SL 35 ans, agriculteur, victime d'une morsure de vipère entrainant un syndrome hémorragique, suivi d'un abdomen aigu d'installation progressive. L'échographie objectivait un épanchement de grande abondance, dont la ponction ramenait du sang incoagulable. Devant la reconstitution de l'hémopéritoine après trois doses de sérum antivenimeux et la coagulation des prélèvements sur tube sec, une laparotomie exploratrice était réalisée à J9. Elle a retrouvé un hématome retro péritonéal bombant dans le méso-colon et qui s'écoulait dans la cavité péritonéale. Le geste a consisté à une évacuation de 1500ml de sang, et un toilettage au sérum physiologique. Les suites opératoires ont été simples. Le patient était transféré en secteur d'hospitalisation de chirurgie à J3 post opératoire puis sortie d'hôpital à J19.</p> Boubacar Diallo Mohamed Keita Hammadoun Dicko Mamadou Karim Toure Seydina Alioune Beye Joseph Kone Daouda Diallo Abdoul Hamidou Almeimoune Moustapha Issa Mangane Sory Traore Abdoulaye Traore Birama Togola Diénéba Doumbia Youssouf Coulibaly Copyright (c) 2019-02-08 2019-02-08 32 1 Severe odontogenic infections: a 5-year review of a major referral hospital in Ghana https://www.ajol.info/index.php/pamj/article/view/208745 <p><strong>Introduction:&nbsp;</strong>odontogenic infections are fairly common in healthcare settings. However, late presentations such as Ludwig's angina, facial cellulitis, necrotizing cervical fasciitis (NCF), among others could lead to mortality. In view of suggestions that the occurrence of severe, near-fatal odontogenic infections is declining, this study set out to determine the incidence of such severe odontogenic infections over the past 5 years at the Korle-Bu Teaching Hospital, a major referral centre in Ghana.</p> <p><strong>Methods:&nbsp;</strong>a retrospective review was done, involving all patients with severe odontogenic infection, thereby requiring admission, per stated criteria at the Department of Oral and Maxillofacial Surgery (Dental clinic), Korle-Bu Teaching Hospital, in the period between July 2012 and July 2017. The cumulative incidence for the respective years were then computed for the years of review.</p> <p><strong>Results:&nbsp;</strong>a total of 243 patients were included in the study. This consisted of 121 males and 122 females, with an average age of 42.9 years (SD = 16.6), ranging from 18 months to 91 years. Incidence proportions for the years of the review were 8.2, 8.9, 17.7, 17.9 and 27.7 people per 1000 cases of tooth-related infections for the respective years. With a fatality rate of 5.8%, the incidence of odontogenic infections among patients attending the outpatient Dental clinic of the hospital is 40.3%, while that of dentoalveolar abscess is 6.2%. Ludwig's angina was the commonest (52%) form of presentation of spreading odontogenic infection.</p> <p><strong>Conclusion:&nbsp;</strong>this study highlights the importance of persisting severe, near-fatal odontogenic infections in Ghana. Not only is there a need to assess the public, professional and institutional strategies to management, but for more evidence-based studies in our local setting to aid in management.</p> Paa-Kwesi Blankson Grace Parkins Matthew Owusu Boamah Alhassan Emil Abdulai Abdul-Majeed Ahmed Sarah Bondorin Isaac Nuamah Copyright (c) 2019-01-12 2019-01-12 32 1 An unusual presentation of appendicitis: a 23 cm long appendix in Morocco https://www.ajol.info/index.php/pamj/article/view/208746 <p>The appendix is a diverticulum attached to the caecum. It can have variable lengths and locations. Acute inflammation from long appendix is a diagnostic challenge with unusual signs and symptoms. A 35 years old man admitted to the emergency department for an acute abdominal pain with low-grade fever which had been present for 03 days. The abdomen Ultrasound showed minimal effusion in the right iliac fossa. He underwent an appendicectomy which revealed a very long appendix (23 cm in length) with tip reaching the sub hepatic area. The surgeon must kip in mind all anatomical variations of the appendix for making diagnosis and decisison to operate acute appendicitis because the increasing risk of morbidity.</p> Hicham Laraqui Mohamed Lamgari Mohamed Essarghini Aziz Zentar Copyright (c) 2019-02-12 2019-02-12 32 1 ABO blood group in Malagasy patients with cancer: which group predominates https://www.ajol.info/index.php/pamj/article/view/208747 <p>The blood group of Malagasy patients with cancer have never been the subject of previous publications. Our objective was to determine the blood group of Malagasy patients with cancer followed in the Medical Oncology Unit of the Soavinandriana Teaching Hospital, Antananarivo. This was a one-year retrospective study (November 2012 to October 2013) in patients over the age of 15 with histological or pathological evidence of their cancer. One hundred and thirty of the 258 patients identified had an ABO blood group determination (50.39%). Among these 130 patients, 114 patients (87.69%) had solid tumors and 16 patients (12.31%) had hematologic malignancies. Thirty seven (28.49%) patients were transfused and 93 (71.54%) not transfused. There were 57 men and 73 women (sex ratio = 0.78), the average age was 55.11 +/- 14.76 years. With regard to their blood group, 52 patients (40%) were blood group B, 44 (33.84%) group O, 27 (20.76%) group A and 7 (5.38%) group AB. The order of blood group frequency of cancer patients in our series differs from other studies. This study has allowed us to know the proportion of each blood group in our Unit and thus help us in the management of stocks of labile blood products in our hospital.</p> Nomeharisoa Rodrigue Emile Hasiniatsy Elodie Emile Batavisoaniatsy Valéry Refeno Mamy Andriambololona Andriatsihoarana Voahary Nasandratriniavo Ramahandrisoa Florine Rafaramino Copyright (c) 2019-02-12 2019-02-12 32 1 Ostéochondrome solitaire de la symphyse pubienne de découverte fortuite https://www.ajol.info/index.php/pamj/article/view/208748 <p>L'ostéochondrome est la tumeur osseuse bénigne la plus fréquente. Elle touche habituellement les métaphyses des os longs, particulièrement autour du genou et de l'humérus proximal. Il touche très rarement la symphyse pubienne avec fréquemment une symptomatologie atypique. Nous rapportons le cas d'un ostéochondrome de la symphyse pubienne empiétant sur la branche osseuse ilio-pubienne chez un homme de 35 ans, de découverte fortuite. Les explorations radiologiques, l'examen macroscopique et histologique confirment le diagnostic ainsi que l'absence de signe de malignité.</p> Dhouha Bacha Asma Sassi Sana Ben Slama Mouadh Nefiss Lassad Gharbi Saadia Bouraoui Ahlem Lahmar Copyright (c) 2019-02-12 2019-02-12 32 1 Extra bone chondroma of the shoulder: a case study and literature review https://www.ajol.info/index.php/pamj/article/view/208749 <p>Extra-osseous chondroma is a benign and rare tumor. It usually sits at the extremities, we report an exceptional case of a chondroma of the soft parts of the shoulder in a 28 year old woman who manifested by a painless swelling of the left shoulder. The histology confirmed the diagnosis on the excision piece. Clinical and radiological follow-up after a 24-month follow-up did not show a sign of recurrence.</p> Soumaya Nasri Narjisse Aichouni Mounir Yahyaoui Omar Agoumi Imane Kamaoui Imane Skiker Copyright (c) 2019-02-12 2019-02-12 32 1 Subcutaneous calcinosis: a rare complication of chronic hypercalcemia https://www.ajol.info/index.php/pamj/article/view/208802 <p>Subcutaneous calcinosis is a rare entity that may be secondary to either tissue damage, phosphocalcic disturbance or idiopathic origin. In the context of hypercalcemia, subcutaneous calcinosis remains a rare complication with few cases reported in the litterature. We report the case of a 27-year-old patient admitted for chronic hypercalcemia with right femur fracture and renal failure. Clinical examination found hard, painless, non-inflammatory subcutaneous nodules at the 2 elbows and at the lower gum (Panel A), the elbow radiography showed radiopaque structures in favor of subcutaneous calcinosis (Panel B). The etiological investigations of hypercalcemia showed a parathyroid hormon at 2200ng/ml (15-65), with cervical ultrasound showing a right inferior parathyroid nodule of 3cm * 1.6cm, in favor of primary hyperparathyroidism. The evolution was marked by the decrease of the size of the lesions in 15 days after normalization of the phosphocalcic balance after a symptomatic treatment based on intravenous rehydration, diuretics, corticosteroid bolus and bisphosphonate. Although hypercalcemia can reach very high serum levels in primary hyperparathyroidism, it is rarely accompanied by subcutaneous calcinosis. Indeed, it is hyperphosphoremia which represents the main factor involved in the development of cutaneous calcinosis in the context of phosphocalcic disturbances, and this independently of the level of hypercalcemia. Lesions tend to resolve spontaneously when calcium and phosphate levels normalize.</p> Fatima Zahra Zaher Nawal El Ansari Copyright (c) 2019-02-12 2019-02-12 32 1 Le pseudokyste du pancréas chez l’enfant: à propos de 7 cas https://www.ajol.info/index.php/pamj/article/view/208804 <p>Le pseudokyste du pancréas est une affection bénigne, rare, en particulier chez l'enfant. Ce sont des collections de suc pancréatique, dépourvues de revêtement épithélial, et dont la localisation peut être intra ou extra pancréatique. Nous rapportons une étude rétrospective de 7 enfants colligés au service de chirurgie pédiatrique du centre hospitalier universitaire Hassan II de Fès, durant une période de 11 ans, allant du 1<sup>er</sup>&nbsp;janvier 2005 au 31 décembre 2016. Tous les enfants étaient de sexe masculin, l'âge moyen était de 6,6 ans (15 mois-12 ans). Un antécédent de traumatisme abdominal était retrouvé dans 4 cas, le ballonnement abdominal, la douleur, les vomissements et les troubles du transit étaient les principaux motifs de consultation. L'examen clinique retrouvait chez tous les enfants une sensibilité épigastrique et une altération de l'état général, l'échographie abdominale et le scanner abdominal réalisés respectivement ont permis de poser le diagnostic de pseudo kyste du pancréas avant l'intervention chirurgicale. Six malades sur sept ont été opérés ; Nous avons opté pour la dérivation interne (anastomose gastro-kystique) dans 4 cas, une dérivation externe dans 2 cas, et l'abstention thérapeutique dans le dernier cas. Les Pseudo kystes du pancréas sont des affections rares, néanmoins, ils sont de loin les plus fréquents (80% des lésions kystiques du pancréas étant des pseudo kystes, et sont la conséquence d'une pancréatite aigüe et/ou chronique, d'un traumatisme pancréatique, ou d'une obstruction canalaire pancréatique.</p> Hind Cherrabi Hind Aboueljaoud Abdoulaye Diallo Harouna Aziz El Madi Khalid Khattala Youssef Bouabdallah Copyright (c) 2019-02-12 2019-02-12 32 1 Syndrome de sécrétion inappropriée d’hormone antidiurétique secondaire à la rispéridone et la carbamazépine: à propos d’un cas https://www.ajol.info/index.php/pamj/article/view/208807 <p>Le syndrome de sécrétion inappropriée de l'hormone antidiurétique (SIADH) représenterait environ 50% des tous les cas diagnostiqués d'hyponatrémie. Seule une faible proportion de SIADH serait d'origine médicamenteuse. Nous rapportons le cas d'une patiente suivie pour un trouble schizo-affectif qui a développé le SIADH après avoir commencé un traitement à base de la rispéridone et la carbamazépine. Les résultats des tests biochimiques suggéraient un SIADH secondaire à l'utilisation de la rispéridone et la carbamazépine. La patiente a été traitée avec succès par l'arrêt des deux médicaments et une restriction hydrique. Après correction de la natrémie la décision thérapeutique était de mettre la patiente sous clozapine. Elle est actuellement sous 400mg avec des taux de natrémie stables. Les psychiatres doivent être conscients du risque d'hyponatrémie sévère associé aux médicaments psychotropes. Il est donc primordial de surveiller les électrolytes, en particulier le sodium, chez les patients prenant des antipsychotiques et des anticonvulsivants.</p> Assia Fadili Nadia Attouche Boubaker Charra Khadija Mchichi Alami Mohamed Agoub Copyright (c) 2019-02-13 2019-02-13 32 1 Adhérence des prestataires du secteur privé à la politique de prise en charge des cas de paludisme simple à Madagascar https://www.ajol.info/index.php/pamj/article/view/208809 <p><strong>Introduction:&nbsp;</strong>cette étude se propose d’évaluer l’adhérence des professionnels de santé du secteur privé à l'utilisation du TDR-palu (Test de Diagnostic Rapide-palu) et à la prescription de l’ACT (Artemisinin-based combination therapy) en cas de paludisme simple.</p> <p><strong>Méthodes:&nbsp;</strong>une approche évaluative rétrospective et transversale a été menée en septembre et octobre 2015 auprès de 11 districts sanitaires repartis dans les quatre faciès épidémiologiques existant à Madagascar. Au total, 43 prestataires de soins issus de 39 formations sanitaires privées (FSP) ont été interviewés et visités.</p> <p><strong>Résultats:&nbsp;</strong>les prestataires déclarent avoir lu le manuel de prise en charge du paludisme dans 16,3% des cas (4/43). Seul le quart (25,6%) des prestataires dispose de TDR dans leur bureau. L’ACT a été cité par 83,7% des prestataires comme médicament de première intention pour traiter le paludisme simple. Dans la pratique, 55,6% des prestataires émettent des doutes sur les résultats des TDR. L’utilisation des antipaludéens malgré les résultats négatifs des TDR (38,2%) est plus fréquente chez ceux ayant émis des doutes (p = 0,03). Inversement, malgré un TDR positif, la moitié des prestataires ne prescrit pas d’ACT (50%). La non-participation aux revues périodiques du District sanitaire (p = 0,05) influence négativement l’adhérence aux politiques.</p> <p><strong>Conclusion:&nbsp;</strong>la faible adhérence des prestataires de soin du secteur privé aux directives nationales sur la prise en charge des cas de paludisme simple interpelle sur l’intérêt d’encadrer davantage ce secteur.</p> Fidiniaina Mamy Randriatsarafara Vatsiharizandry Mandrosovololona Jean Claude Andrianirinarison Antsa Nomenjanahary Rakotondrandriana Armand Eugene Randrianarivo-Solofoniaina Arsène Ratsimbasoa Jean de Dieu Marie Rakotomanga Copyright (c) 2019-02-14 2019-02-14 32 1 A disconcerting false gastric diverticulum mimicking malignancy https://www.ajol.info/index.php/pamj/article/view/208845 <p>Gastric diverticula are the most uncommon form of gastrointestinal diverticula. They can either be of true or false type with different pathogenesis. They may be very challenging to diagnose as symptoms are nonspecific and imaging can simulate a malignant lesion. We report an unusual case of pre-pyloric diverticulum in a 69-year-old man, leading to severe gastric obstruction with a poor general condition. As subsequent endoscopy and imaging were alarming and couldn't exclude malignancy, the patient underwent an antrectomy. The final diagnosis was made on pathological examination. We discuss, through this case, the clinical and pathological features of gastric diverticula with an emphasis on the pathogenesis of this rare entity and the risk of a malignant transformation.</p> Dhouha Bacha Asma Sassi Seifeddine Baccouche Ghofrane Talbi Sana Ben Slama Lassad Gharbi Saadia Bouraoui Ahlem Lahmar Copyright (c) 2019-02-14 2019-02-14 32 1 Cutaneous tuberculosis with an unusual appearance and location https://www.ajol.info/index.php/pamj/article/view/208848 <p>Tuberculosis is a bacterial disease caused by mycobacterium tuberculosis. Its cutaneous form accounts for 2% of all extrapulmonary tuberculosis. We report a case of 30-year-old woman with nodules evolving for two years. Examination showed gums of genital and inguinocrural location, and scrofulous scars. Several diagnoses were discussed including tuberculosis, syphilis, actinomycosis, or cutaneous lymphoma. Skin biopsy revealed an epithelial giganto-cellular granuloma with caseating necrosis; the culture of a cutaneous fragment was positive for Mycobacterium Tuberculosis. Our case is original and unusual due to the uncommon clinical appearance and location of the nodules grouped in the inguinocrural region. The multiplicity of the clinical forms of cutaneous tuberculosis sometimes makes the diagnosis difficult. Gums and scrofulodermas remain the most frequent forms of cutaneous tuberculosis in Morocco. According to the immuno-anatomo-clinical classification, tuberculous gum is part of the multi-bacillary forms and is seen mostly in immunocompromised patients.</p> Sqalli Houssaini Asmaa Badreddine Hassam Copyright (c) 2019-02-18 2019-02-18 32 1 Challenges of diagnosing and managing bronchiectasis in resource-limited settings: a case study https://www.ajol.info/index.php/pamj/article/view/208850 <p>Bronchiectasis, once an orphan disease is now gaining renewed attention as a significant cause of morbidity and mortality. It is a morphologic term used to describe abnormal, irreversibly dilated and thick-walled bronchi, with many etiologies. The management of bronchiectasis can be challenging because its pathogenetic mechanisms is still evolving. Its diagnosis and management is particularly more demanding especially in resource-limited settings like Nigeria because of delayed diagnosis and improper management with devastating consequences, hence this case study.</p> Adebola Adetiloye Gregory Erhabor Olayemi Awopeju Olufemi Adewole Ebimobowei Onini Oladapo Adewuya Copyright (c) 2019-02-18 2019-02-18 32 1 Understanding the bricks to build better surgical oncology unit at Maputo Central Hospital: prevalent surgical cancers and residents knowledge https://www.ajol.info/index.php/pamj/article/view/208853 <p><strong>Introduction:&nbsp;</strong>cancer is a growing concern in Mozambique. However, the country has limited facilities and few oncologists. Surgical oncologists are an unmet need. The aim of this study was to assess residents' knowledge in prevalent cancer domains and to identify and characterize prevalent cancers treated by surgery at Maputo Central Hospital, the largest hospital in Mozambique. The expectations were that the findings shall inform the development of a comprehensive curriculum in surgical oncology fellowship fit for the Hospital.</p> <p><strong>Methods:&nbsp;</strong>to identify and characterize prevalent cancers, we performed a retrospective analysis of individual cancer patient registries of Maputo Central Hospital (MCH), Mozambique. Information was recorded into data collection sheets and analyzed with SPSS<sup>®</sup>&nbsp;21. To assess MCH residents oncologic knowledge, we invited Twenty-six junior residents (49% of all residents) of different specialties to take a 30 item multiple choice written test used elsewhere in previous studies. The test focused on the domains of Basis of oncology, Radiotherapy, Pathology, Chemotherapy, Pain management, Surgical oncology and Clinical Pathway. The test was administered anonymously and without prior notice. We analyzed the overall test and topic performance of residents.</p> <p><strong>Results:&nbsp;</strong>the study covered a period of 3 years and 203 patients. The most prevalent malignant tumors treated by general and thoracic surgery in MCH cancer registry were esophageal (7%), female breast (6.5%) and colorectal cancer (2.8%). Globally these malignancies were diagnosed at an advanced stage of the disease and required a multimodal treatment. The mean percent correct score of residents was 37.3%. The dimension with the highest percent correct score were clinical management (46%) and surgical oncology (28%) showed the lowest correct score.</p> <p><strong>Conclusion:&nbsp;</strong>in Maputo, Mozambique esophageal, breast and colorectal cancer were the most prevalent malignancies treated, with surgery, by thoracic or general surgery in MCH. The test scores suggest that, among residents, the knowledge in oncology needs to be improved, rendering support to the need of a surgical oncology training tailored to suit the local needs. Specific training should take into account local cancer prevalence, resources, their quality and the support of surgical oncology services with volume and experience.</p> Atílio Morais Jotamo Come Carlos Selemane Germano Pires Adriano Tivane Matchecane Cossa Satish Tulsidás Luís Antunes Manuel João Costa Moshin Sidat Maria do Rosário Martins Carla Carrilho Lúcio Lara Santos Copyright (c) 2019-02-18 2019-02-18 32 1 Knowledge, beliefs and practices regarding sickle cell eye disease of patients at the sickle cell unit, Jamaica https://www.ajol.info/index.php/pamj/article/view/208875 <p><strong>Introduction:&nbsp;</strong>sickle cell disease can result in visually threatening eye disease (proliferative sickle cell retinopathy). This can be prevented with timely eye screening. It is important for patients to understand their role. Our research is to determine the knowledge, beliefs and practices (KBP) regarding eye disease of Sickle Cell patients and the impact of genotype, demographic and socio-economic status.</p> <p><strong>Methods:&nbsp;</strong>cross-sectional study at the Sickle Cell Unit, Jamaica during May 2016. Consecutive non-pregnant adults (&gt;18 years of age) attendees, who were not acutely unwell, were invited to participate. A 26-item single interviewer administered questionnaire was used to obtain socio-demographic data, highest level of education completed, employment status, sickle cell genotype, if known, frequency of clinic attendance and patients' knowledge, beliefs and practices. Ten of these were yes/no questions, whereas eight required that they choose correct answers from four choices.</p> <p><strong>Results:&nbsp;</strong>one hundred subjects were recruited, 72% had homozygous SS disease. Their ages ranged from 18-63 years (mean 34.1 years, SD11.3). Fifty six percent were female. Most (75%) had achieved at least secondary education. The majority (62%) were unemployed. The mean belief score was 3.6/6(60%) and the mean knowledge and practice scores were 3.3/7(47%) and 2.2/5(44%) respectively. Milder genotypes had higher knowledge scores vs the more severe genotypes (4.0 vs 3.2, P=0.013). Only 28% had regular eye examinations; less than 50% had seen an ophthalmologist in the past year. Practice scores were higher in employed than in unemployed patients (2.6 vs 1.9, (P=0.04)). Employed patients were more likely than the unemployed to see their eye doctor for regular eye "examinations" (42.1% vs 19.4%, χ2=6.0, P=0.02). The practice and knowledge scores correlated (r<sup>2</sup>=0.363, P&lt;0.001) and belief score (r<sup>2</sup>=0.304, P =0.002), except where 98% believed they should see an ophthalmologist annually, but only 42% did, and 21% had never.</p> <p><strong>Conclusion:&nbsp;</strong>knowledge scores were fair, however, the practice was not always in keeping with knowledge.</p> Lizette Mowatt Ayodeji Ajanaku Jennifer Knight-Madden Copyright (c) 2019-02-19 2019-02-19 32 1 Histological surprise of parotid tuberculosis: about two cases https://www.ajol.info/index.php/pamj/article/view/208881 <p>Parotid tuberculosis remains a very rare localization in the Department of Otolaryngology and Cervico-Facial Surgery (ENT) sphere. It is presented in the form of a deceptive clinical picture causing confusion with other pathologies of the parotid gland, including tumor pathology. In addition, its lack of knowledge by practitioners increases the risk of missing the diagnosis. Often, the diagnosis is a histological surprise on a piece of excision after an exploratory parotidectomy. However, its treatment is primarily medical if the positive diagnosis is well established. We report medical observation of two new cases aged 44 and 45 respectively, who consult our center for parotid swelling. Radiological examinations were in favor of intraparotid cystic lesions. Both patients benefited from an excision whose histopathological study was in favor of primary parotid tuberculosis. The subsequent evolution was favorable under antituberculous treatment.</p> Hamza Belatik Lotfi Aouinti Nabil Touiheme Hicham Attifi Karim Nadour Ali El Boukhari Copyright (c) 2019-02-20 2019-02-20 32 1 Occurrence and challenges in the management of severe chronic plaque type psoriasis in a limited resourced setting: a case report https://www.ajol.info/index.php/pamj/article/view/208887 <p>Plaque-type psoriasis is a major dermatosis with significant effects on quality of life. Case complexity is often high in low-resourced settings such as in Africa where the incidence has been on the rise. Despite major advancements and newer therapeutic modalities over the last decade, an insight into the real-life, day to day challenges in low resourced settings reveal an interplay between the difficulty in obtaining these drugs and use of alternative traditional indigenous agents. We report the case of a 50 year old immunocompetent male who presented with chronic and extensive well demarcated plaques covered with silver-white scales occupying about 61% of his body surface area. Patient was however lost to follow up for about 8 months during which time, the lesions responded to some unknown homemade indigenous medications which was preferred to a systemic medication. Paramount importance on proper counselling and the need to retain patients in care is warranted by physicians and allied health personnel. Also, incentives aimed at subsidizing the newer systemic agents for patients in low resourced cohorts will go a long way to combat this multi-faceted disorder which is often unrecognized and under diagnosed.</p> Calypse Asangbe Ngwasiri Ngo-Mbaki Charmaine Kwangsa Martin Hongieh Abanda Leopold Ndemnge Aminde Copyright (c) 2019-02-20 2019-02-20 32 1 African voices and leadership is imperative for the global AIDS response https://www.ajol.info/index.php/pamj/article/view/208895 <p>This position paper is written in reference to the recent extensive media coverage of the report of the Independent Panel describing Harassment, Including Sexual Harassment, Bullying and Abuse of Power at UNAIDS Secretariat by several newspapers and authoritative journals such as&nbsp;<em>Science</em>&nbsp;and&nbsp;<em>The Lancet</em>. Unfortunately, none of these publications provide any clear evidence to support the accusations and merely repeat what are, in our view, unsubstantiated statements made in the report. Given the critical role that Africans have played in dealing with one of the most severe epidemics that the world has seen and the gravity of these charges, we believe it is essential to reaffirm that African voices and leadership is imperative for the global AIDS response.</p> Francois-Xavier Mbopi-Keou Brian Williams Laurent Bélec Ginette Claude Mireille Kalla Ibra Ndoye Mamadou Henri Konate Tina Gifty Mensah Copyright (c) 2019-02-22 2019-02-22 32 1 Traumatic anterior hip dislocation with associated bilateral femoral fractures in a child: a case report and review of the literature https://www.ajol.info/index.php/pamj/article/view/208897 <p>Traumatic anterior hip dislocation is rare, because the hip joint is a highly stable joint. It is extremely rare for the anterior hip dislocation with combined bilateral femoral fracture in children. We present a case of 7-year-old boy with traumatic anterior hip dislocation with associated bilateral femoral fractures. Radiographic examination showed the right femoral head was dislocated anteroinferiorly. The ipsilateral femoral shaft showed a transverse femoral shaft fracture and proximal and distal femoral bifocal fractures of the contralateral femur. The dislocation of the right hip was reduced 10 hours after the injury in local hospital. One week later, the right femoral shaft fracture and left proximal femoral fracture were open reduced and internally fixed with plate and screws and the distal left femoral fracture was closed reduced and fixed with Kirschner wires. Postoperatively, active hip flexion and extension to recover hip and knee movement were then permitted but without weight bearing for 3 months. Radiographs at 3 months, at 6 months showed the fractures healed well and hardware were removed respectively. However, irregularities of the femoral head meaned avascular necrosis of the femoral head. This case stresses the importance of a rapid evaluation and treatment for the dislocation of the hip, providing a stable reduction and a firm internal fixation of the associated fractures.</p> Zongbing Cao Dong Zhu Chen Li Yan-Hui Li Lei Tan Copyright (c) 2019-02-25 2019-02-25 32 1 Mésusage traditionnel du camphre: un danger oublié pour les enfants (à propos de 2 cas) https://www.ajol.info/index.php/pamj/article/view/208898 <p>Dans notre pays, le recours aux recettes de médecine traditionnelle et aux produits cosmétiques artisanaux est très fréquent en raison du taux élevé d'analphabétisme, du faible pouvoir d'achat et du grand nombre d'herboristes. Le camphre est un produit peu coûteux, facilement accessible et omniprésent dans presque toutes les maisons, le rendant potentiellement toxique en cas de mauvaise utilisation, en particulier chez les enfants. Nous rapportons ici l'histoire de 2 cas d'intoxication consécutifs à une recette de beauté à base de camphre en poudre. L'anamnèse donne des informations sur un empoisonnement par une poudre synthétique à base de camphre importé de Chine chez 2 enfants. Patiente 1: fille âgée de 2 mois, sans antécédents, admise aux urgences pédiatriques dans un état de pleurs incessants avec refus de manger. L'examen clinique est sans caractéristique particulière. Le test biologique standard était normal. Le nourrisson était sous surveillance neurologique, digestive et cutanée. Patiente 2: jeune fille de 6 ans admise à la suite d'une crise atonique avec syncope et mousse, suivie d'une douleur abdominale accompagnée d'une douleur abdominale accompagnée de vomissements alimentaires consécutifs à l'ingestion de lait. L'évolution était favorable après 48 heures de prise en charge symptomatique. L'entretien avec les mères a révélé qu'il s'agissait de deux voisins qui avaient reçu une recette traditionnelle pour le soin des cheveux d'un troisième voisin, après quoi ils avaient mélangé du camphre en poudre avec de l'huile d'olive, puis l'avaient appliquée pendant 1 heure sur les cheveux de leurs enfants, provoquant ainsi l'apparition de ces signes.</p> Naoual Nchinech Afaf Elgharbi Fatima Zahra Aglili Yamna Kriouile Yahia Cherrah Asmaa Aaloui Mdaghri Samira Serragui Copyright (c) 2019-02-26 2019-02-26 32 1 Cervical cancer in the Bamenda Regional Hospital, North West Region of Cameroon: a retrospective study https://www.ajol.info/index.php/pamj/article/view/208900 <p><strong>Introduction:&nbsp;</strong>cervical cancer is ranked the 7<sup>th</sup>&nbsp;most common cancer in the world. Cancer of the cervix is the second most commonly diagnosed cancer after breast cancer and the third leading cause of cancer deaths among females in less developed countries. Incidence rates are highest in countries with low income. Nearly 90% of cervical cancer deaths occur in developing parts of the world. The study researchers therefore, carried out a retrospective study to determine the proportion of cervical cancer among other types of cancer in the cancer registry of the Bamenda Regional Hospital.</p> <p><strong>Methods:&nbsp;</strong>the objective of this study was to determine the proportion of cervical cancer among other types of cancers in the cancer registry of the Bamenda Regional Hospital, North West Region of Cameroon from past records. We reviewed all records from the registry of patients who attended the Bamenda Regional Hospital to screen and/or be operated upon for cervical cancer and other types of cancer. Socio-demographic and clinical characteristics of cases were captured using a data collection sheet: age, type of cancer, stage of cancer, type of surgery carried out and date of surgery. Data were entered and analysed in Statistical Package for Social Sciences (SPSS) version 25 software.</p> <p><strong>Results:&nbsp;</strong>59 cancer cases were received in the center between 2012 and 2017. Of these, 31 (52%) had cervical cancer. Most patients who screened positive for cancer of the cervix were of the 50-54 age groups. Most of these patients (47.5%), were received at late stages (stages 3 and 4).</p> <p><strong>Conclusion:&nbsp;</strong>over half (52%) of the patients receiving cancer care in this center have cervical cancer and generally turn up late for management.</p> Ngwayu Claude Nkfusai Samuel Nambile Cumber Takang Williams Judith K Anchang-Kimbi Brenda Mbouamba Yankam Cho Sabastine Anye Joyce Mahlako Tsoka-Gwegweni Enow-Orock George Enow Damian Nota Anong Copyright (c) 2019-02-26 2019-02-26 32 1 Gallbladder schistosomiasis: rare but possible, a case report and review of the literature https://www.ajol.info/index.php/pamj/article/view/208939 <p>After Malaria, schistosomiasis remains the most important tropical disease in large parts of the world. It affects mainly the colon and the urinary tract. The hepatic involvement is significantly frequent, particularly by the mansoni species. Still one of the extremely rare locations is the gallbladder. Our case is about a 51 year old woman from Tunisia, which is no longer considered an endemic country, with no particular medical history, underwent surgery for symptomatic cholelithiasis. She had a laparoscopic cholecystectomy. Post operative period was uneventful. Histology of the gallbladder showed fibrosis in the mucosa and schistosomal ova in the wall. As a conclusion we can see that due to the lack of specific clinical and radiological signs, the diagnosis of gallbladder schistosomiasis is established only after the histological examination.</p> Mohamed Hedfi Mehdi Debaibi Senda Ben Iahouel Surgery Department, Fsi Hospital Marsa, Tunisia Copyright (c) 2019-02-26 2019-02-26 32 1 Complications traumatiques et psychosociales des chutes chez le sujet âgé tunisien https://www.ajol.info/index.php/pamj/article/view/208942 <p><strong>Introduction:&nbsp;</strong>les chutes chez le sujet âgé constituent un problème de santé majeur de par les complications traumatiques et psychosociales qui peuvent entrainer une perte de l'autonomie et un état de dépendance. L'objectif de notre travail est d'étudier les circonstances et les conséquences traumatiques et psychosociales des chutes chez les sujets âgés.</p> <p><strong>Méthodes:&nbsp;</strong>nous avons mené une étude rétrospective réalisée entre septembre 2014 et janvier 2016 incluant 40 patients âgés de 65 ans et plus ayant fait au moins une chute l'année précédente recrutés parmi les patients hospitalisés ou suivis à la consultation externe du service de Médecine Interne B de l'hôpital Charles Nicolle. Les circonstances et les conséquences des chutes ont été recueillies par l'interrogatoire rétrospectif des patients et de leur entourage à distance de la chute.</p> <p><strong>Résultats:&nbsp;</strong>l'âge moyen des patients chuteurs était de 75,7 ans avec une prédominance féminine nette (30F/10H). Des facteurs précipitants étaient retrouvés chez 38 patients. Ils étaient de type extrinsèque dans 78,9% des cas et intrinsèques dans 50% des cas. Un séjour prolongé au sol était noté dans 10% des cas. Les fractures étaient plus fréquentes chez les femmes (12F/1H) intéressant surtout les membres supérieurs (61,5%). Les conséquences psychosociales ont été plus fréquentes chez les femmes. Un syndrome post chutes a été noté chez 5 patients.</p> <p><strong>Conclusion:&nbsp;</strong>la correction des facteurs précipitants intrinsèques et extrinsèques des chutes et l'apprentissage du relever du sol en post chutes permettra de prévenir le risque de chute ainsi que ses conséquences graves.</p> Ines Kechaou Eya Cherif Ben Salem Sana Imène Boukhris Lamia Ben Hassine Copyright (c) 2019-02-26 2019-02-26 32 1 Stigma on epileptic patients attending the outpatient clinic of Soba University Hospital and the National Center for Neurological Science (NCNS) Khartoum, Sudan https://www.ajol.info/index.php/pamj/article/view/208944 <p><strong>Introduction:&nbsp;</strong>epilepsy is one of the most prevalent neurological conditions for people of different age group, race, gender and socio-economic status in various nations, affecting 50 million people around the world; 80% of them living in developing countries. In Sudan, literature has well documented epilepsy stigma and it related elements of labelling, negative typecasting, isolation, devaluing and discrimination that are significantly affecting patients living standards and social life. This study focuses on understanding the prevailing, different types of stigma among people living with epilepsy (PWE) in Sudan and to determine its frequency in connection with demographic factors and patients coping ability of PWE.</p> <p><strong>Methods:&nbsp;</strong>a health facility-based cross-sectional descriptive study was conducted on 270 people between the ages of 16-70years who are affected by epilepsy in an outpatient clinic. Standardized questionnaires were used to interview the patients with assistance gotten from their relative where necessary. The data is analyzed using SPSS version 20. The study was conducted in the outpatient clinic of The National Center for Neurological Sciences (NCNS), Ibrahim-Malik Teaching Hospital Sudan.</p> <p><strong>Results:&nbsp;</strong>the study realized that 16.6% of the patient had a positive self-stigma score, half of them having coaching stigma and 25% courtesy stigma. One third of people with epilepsy had poor coping score that was strongly determined by self- stigma and courtesy stigma score.</p> <p><strong>Conclusion:&nbsp;</strong>parents and relatives related sigma is a major problem facing people of epilepsy in Sudan; thus, raising such group awareness and education about the disease can markedly improve the quality of life of people with epilepsy in Sudan.</p> Muwada Bashir Awad Bashir Shahd Mohammed Abdalla Ngwayu Claude Nkfusai Frankline Sanyuy Nsai Rosaline Yumumkah Cumber Joyce Mahlako Tsoka-Gwegweni Samuel Nambile Cumber Copyright (c) 2019-02-27 2019-02-27 32 1 Gestational diabetes mellitus and obstetric outcomes in a Ghanaian community https://www.ajol.info/index.php/pamj/article/view/208947 <p><strong>Introduction:&nbsp;</strong>this study was aimed at evaluating effect of Gestational diabetes mellitus (GDM) and maternal characteristics on pregnancy outcome. GDM has several risk factors including; advanced maternal age, ethnic background, obesity and family history of diabetes mellitus. These pregnancy complications are associated with fetal morbidity and mortality and may lead to macrosomia and shoulder dystocia. Others are stillbirth, miscarriages, preterm and small for gestational age babies.</p> <p><strong>Methods:&nbsp;</strong>this was a retrospective case-case control study which compared maternal characteristics and pregnancy outcome among pregnant women with and without GDM. Diagnosis of GDM was done in accordance with the American Diabetes Association (ADA) criteria. Weight and height were determined and Body mass index (BMI) calculated. Pregnancy outcome was determined at the end of pregnancy and information on maternal characteristics obtained using questionnaire and patient folders.</p> <p><strong>Results:&nbsp;</strong>those who developed GDM were significantly older (OR= 1.772; 95% CI =1.432-2.192; P&lt;0.0001) and had higher BMI (OR=1.637; 95% CI=1.004-1.289; P=0.044) than those who did not. A significant number of those who developed GDM also had stillbirths OR= 5.188; 95% CI=1.093-24.613; p=0.038) and cesarean deliveries (OR=14.362; 95% CI=3.661-56.335; p= 0.001).</p> <p><strong>Conclusion:&nbsp;</strong>women who develop GDM are more likely to deliver stillborn or macrosmic babies and may require surgical intervention in order to have normal deliveries.</p> Ahmed Tijani Bawah Robert Amadu Ngala Huseini Alidu Mohammed Mustapha Seini Joshua Dokurugu Kwame Wumbee Francis Agyemang Yeboah Copyright (c) 2019-02-27 2019-02-27 32 1 Apport de l'IRM dans la maladie de Creutzfeldt-Jakob: à propos d'un cas https://www.ajol.info/index.php/pamj/article/view/208951 <p>La maladie de Creutzfeld-Jacob (MCJ) est une affection très rare et fatale qui atteint le système nerveux central. Elle est caractérisée par une détérioration mentale aboutissant à une démence progressive, une symptomatologie pyramidale et extra-pyramidale ainsi que des myolclonies. Un diagnostic précoce est essentiel pour prévenir la transmission interhumaine. Nous rapportons le cas d'un patient âgé de 62 ans chez qui le diagnostic de MCJ sporadique a été retenu, en se basant sur le tableau clinique fait de syndrome démentiel avec myoclonies précédées de troubles du comportement, des hallucinations et de dépression, et sur les données de l'IRM encéphalique qui a montré des hyper signaux au niveau du striatum et au niveau cortical en séquences pondérées Flair et diffusion.</p> Amina Alaoui Badraddine Alami Hajar Habibi Meriem Haloua Youssef Alaoui Lamrani Meryem Boubbou Mustapha Maaroufi Copyright (c) 2019-02-28 2019-02-28 32 1 Programmatic implications of some vitamin A supplementation and deworming determinants among children aged 6-59 months in resource-poor rural Kenya https://www.ajol.info/index.php/pamj/article/view/208953 <p><strong>Introduction:&nbsp;</strong>controlling vitamin A deficiency and soil-transmitted helminth infections are public health imperatives. We aimed at revealing some caregiver and child-related determinants of uptake of vitamin A supplementation and deworming, and examine their programmatic implications in Kenyan context.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study of randomly selected 1,177 households with infants and young children aged 6-59 months in three of the 47 counties of Kenya. The number of times a child was given vitamin A supplements and dewormed 6 months and one year preceding the study was extracted from mother-child health books.</p> <p><strong>Results:&nbsp;</strong>coverage for age-specific deworming was considerably depressed compared to corresponding vitamin A supplementation and for both services, twice-yearly provisions were disproportionately lower than half-yearly. Univariate and multivariate analyses showed relatively younger children, of Islam-affiliated caregivers (vis a vis Christians) and those who took less time to nearest health facilities as more likely to be supplemented with vitamin A. Similar observations were made for deworming where additionally, maternal and child ages were also determinants in favour of older groups. Other studied factors were not significant determinants. Programmatic allusions of the determining factors were discussed.</p> <p><strong>Conclusion:&nbsp;</strong>key to improving uptake of vitamin A supplementation and deworming among Kenyan 6-59 months olds are: increasing access to functional health facilities, expanding outreaches and campaigns, dispelling faith-related misconceptions and probably modulating caregiver and child age effects by complementing nutrition literacy with robust and innovative caregiver reminders. Given analogous service points and scheduling, relative lower uptake of deworming warrants further investigations.</p> Shadrack Oiye Ngowa Safari Joseph Anyango Carolyne Arimi Benzadze Nyawa Mbesa Kimeu Joseph Odinde Oscar Kambona Rachel Kahindi Richard Mutisya Copyright (c) 2019-02-28 2019-02-28 32 1 Une réponse complète d'un dermatofibrosarcome de Darrier et Ferrand localement avancé: à propos d'un cas et revue de la littérature https://www.ajol.info/index.php/pamj/article/view/208959 <p>Le dermatofibrosarcome de Darier et Ferrand (DFS) est une tumeur cutanée rare, caractérisé par son agressivité locale et son important potentiel aux récidives, dont le pronostic dépend essentiellement de la qualité de sa prise en charge. Une réponse complète avec des marges saines d'un DFS qui a été jugé initialement inopérable, après 1 an d'imatinib en situation néoadjuvante est rarement décrite dans littérature. Nous rapportons dans notre article, le cas d'une jeune patiente prise en charge au service d'oncologie médicale de Fès pour une DFS localement avancé présentant une réponse complète, afin d'évaluer la place de l'imatinib et des thérapies ciblées dans le traitement de DFS.</p> Hajar Ouahbi Lamiae Amadour Fatimazahra Elmernissi Layla Tahiri Taoufik Harmouch Zineb Benbrahim Fatimazahra Elmrabet Samia Arifi Ayat Allah Oufkigh Nawfal Mellas Copyright (c) 2019-02-28 2019-02-28 32 1 Assessing the knowledge of emergency medical care personnel in the Free State, South Africa, on aspects of paediatric pre-hospital emergency care https://www.ajol.info/index.php/pamj/article/view/208964 <p><strong>Introduction:&nbsp;</strong>in South Africa in 2016, injuries accounted for 4 483 deaths of children aged 0-4 years. Prior studies have reported that, in some parts of the country, poor pre-hospital clinical care is a key contributor to the morbidity and mortality of critically ill and injured children. A key component of a coordinated emergency health care system are emergency medical care (EMC) personnel. Here, we assess the knowledge of EMC personnel employed by the Free State Department of Health on aspects of paediatric pre-hospital emergency care.</p> <p><strong>Methods:&nbsp;</strong>this descriptive study used a questionnaire survey to obtain data on the knowledge of Free State EMC personnel on aspects of paediatric pre-hospital emergency care.</p> <p><strong>Results:&nbsp;</strong>only 197 of the initial 250 questionnaires distributed were returned, giving a response rate of 78.8%. More than half (51.2%) of the participants across the five districts had inadequate knowledge of paediatric pre-hospital emergency care. The majority of EMC personnel could not calculate the paediatric blood pressure for age and did not know the paediatric Glasgow Coma Scale (74.0% and 53.4% respectively; P &lt; 0.0001 in both cases). Participants attributed inadequate knowledge to limited exposure to paediatrics cases, insufficient training, limited scope of practice, and lack of equipment.</p> <p><strong>Conclusion:&nbsp;</strong>enhancing the knowledge and skills of EMC personnel in paediatrics pre-hospital care through a short learning programme or continuous professional development programme, and providing adequate paediatric emergency equipment, will ensure that comprehensive pre-hospital emergency care is given to paediatric patients in the province.</p> Markes Wayne Butler Anthonio Oladele Adefuye Copyright (c) 2019-03-01 2019-03-01 32 1 Acute respiratory infection related to air pollution in Bamenda, North West Region of Cameroon https://www.ajol.info/index.php/pamj/article/view/208966 <p><strong>Introduction:&nbsp;</strong>air pollution is a global health problem. It's responsible for over 4 million deaths each year and constitutes a risk factor for acute respiratory infections (ARI). The aims of this study was to assess knowledge about air pollution, and to determine environmental risk factors associated with ARIs occurence in the city of Bamenda, Cameroon.</p> <p><strong>Methods:&nbsp;</strong>we conducted a cross sectional study and performed a rectrospective analysis of ARI consultation within the period March 2016 to July 2016 in the Bamenda Health District. We interviewd 201 patients and recorded 1849 cases from hospital registers of patients diagnosed ARI from January 2013 to April 2016. Epi-info 7.2 was used for data entry and analysis. Logistic regression analysis was conducted to determine the importance of the different environmental risk factors.</p> <p><strong>Results:&nbsp;</strong>over 70% of the participants used at least a form of solid fuel for cooking. The Odds of developing an ARI was 3.62 greater among those exposed to indoor cooking compared to the unexposed (OR 3.62, CI 1.45-4.90). Participants exposed to open fire burning were 1.91 times more like to develop ARI compared to unexposed (OR: 1.91, CI 1.03-3.55: p : 0.03). Particulate Matter (PM 2.5) levels was 13.2 times higher than the World Health Organization (WHO) recommended levels. Dry and dusty weathers increased the risk of ARIs (OR 3.24; CI 1.47-7.13). The prevalence of ARIs in the Bamenda Health District was 6% of all consultations.</p> <p><strong>Conclusion:&nbsp;</strong>using solid fuels in poorly ventilated homes increase the total air particle suspension indoor. Inhalling this poor air irritates the repiratory tract, eyes while longterm exposure increases the odds of cancers. Ventilating homes with indoor cooking space reduces exposure while using clean fuels like electricity reduces the odds of ARI associated with pollution.</p> Marius Nsoh Bassong Olga Yvonne Mankollo Mbondji Ebongue Kengne Nde Cyprien Julienne Louise Ngo Likeng Sheikh Mohammed Shariful Islam Andrew Collier Joyce Mahlako Tsoka-Gwegweni Samuel Nambile Cumber Copyright (c) 2019-03-04 2019-03-04 32 1 Métastase pariétale d’un adénocarcinome bronchique https://www.ajol.info/index.php/pamj/article/view/208969 <p>Les métastases cutanées du carcinome bronchogénique sont rares, elles témoignent d'un stade tardif de la maladie. Nous rapportons le cas d'une métastase cutanée d'un adénocarcinome bronchique traitée chirurgicalement en vue d'améliorer le confort du malade.</p> Yasser El Brahmi Mbarek Yakka Abdelkader Ehirchiou Mountassir Moujahid Aziz Zentar Copyright (c) 2019-03-04 2019-03-04 32 1 Evolution spectaculaire d’un pemphigus végétant réfractaire aux thérapies conventionnelles sous Rituximab: à propos d’un cas https://www.ajol.info/index.php/pamj/article/view/209103 <p>Le pemphigus végétant est une variété rare de pemphigus. Il n'y représente que 2%. Plusieurs traitements sont de mise pour traiter cette entité, on retrouve les corticostéroïdes topiques et/ou oraux en 1<sup>ère</sup>&nbsp;intension, les immunosuppresseurs tels que l'Azathioprine, la Cyclosporine, le Méthotrexate, le Cyclophosphamide et le Mycophénolate mofétil pour remédier au effet secondaires des stéroides. Certains cas restent réfractaires à tous ces traitements, l'utilisation du Rituximab a fait révolutionner la prise en charge du pemphigus, en particulier sa forme végétante. Nous rapportons le cas d'une patiente de 42ans, admise pour prise en charge d'un pemphigus végétant confirmé histologiquement et mise initialement sous corticothérapie en association avec immunosuppresseur sans amélioration, puis fut mise sous Rituximab avec une évolution spectaculaire.</p> Younes Barbach Hanane Baybay Samia Mrabat Mohammed Chaouche Sara Elloudi Fatima Zahra Mernissi Copyright (c) 2019-03-04 2019-03-04 32 1 An unexpected cause of abdominal pain or maybe more https://www.ajol.info/index.php/pamj/article/view/209104 <p>A 61-year old Caucasian woman, presented to the Emergency Department due to a four-week history of vomiting, diarrhea and abdominal pain. Physical examination revealed tenderness in the upper abdomen and normal bowel sounds. A CT was performed and the patient was admitted. A CT scan of the chest and the abdomen revealed a chronically dissected Stanford B thoracoabdominal aneurysm with mural thrombus, thrombosis of the celiac, hepatic, splenic and superior mesenteric arteries with collateral circulation, thrombosis of the portal and superior mesenteric veins and a splenic infarct. Dissection of an aneurysm is a catastrophic complication with high mortality and morbidity, thus an invasive treatment is often warranted with either surgery or endovascular repair. On the other hand, portal thrombosis is associated with inherited or acquired procoagulant states (like Factor V Leiden), hematologic diseases (like myeloproliferative diseases), cirrhosis, abdominal surgery or trauma and intra-abdominal inflammatory conditions. Its treatment involves anticoagulation or rarely, thrombolysis or thrombectomy. Both chronic dissection of the abdominal aneurysm and the portal vein thrombosis can cause abdominal pain, nausea, and other gastrointestinal symptoms secondary to bowel hypoperfusion. Diagnosis: chronically dissected Stanford B thoracoabdominal aneurysm and thrombosis of the celiac, hepatic, splenic and superior mesenteric arteries with collateral circulation, thrombosis of the portal and superior mesenteric veins and a splenic infarct.</p> Petros Ioannou Copyright (c) 2019-03-04 2019-03-04 32 1 Antibiotic susceptibility patterns of Staphylococcus aureus strains isolated at the Yaounde Central Hospital, Cameroon: a retro prospective study https://www.ajol.info/index.php/pamj/article/view/209105 <p><strong>Introduction:&nbsp;</strong><em>Staphylococcus aureus</em>&nbsp;is an important pathogen responsible for hospital and community acquired infection(s). Emerging resistance to methicillin in this organism has left physicians with few therapeutic alternatives to treat infections caused by it. This study was aimed at determining the antibiotic susceptibility patterns of&nbsp;<em>Staphylococcus aureus</em>&nbsp;strains isolated at the Yaounde Central Hospital, Cameroon.</p> <p><strong>Methods:&nbsp;</strong>from January 2014 to November 2016, a total of 250 non repeated strains were isolated from various clinical specimens. Isolates and antibiotic susceptibility profiles were identified through standard microbiological techniques.</p> <p><strong>Results:&nbsp;</strong>methicillin-resistant&nbsp;<em>Staphylococcus aureus</em>&nbsp;(MRSA) and methicillin-sensitive&nbsp;<em>Staphylococcus aureus</em>&nbsp;(MSSA) accounted respectively for 80% (201/205) and 20% (49/205) of the total strains isolated. MRSA strains displayed high resistance to cefoxitin (100%), cotrimoxazole (89%), vancomycin (79.7%), lincomycin (70.3%), tobramycin (72.5%), doxycycline (68.0%), kanamycin (69.7%) and erythromycin (55.7%). In contrast, a high susceptibility was observed with rifampicin (82.6%). KTG (42.3%) and constitutive MLSB (17.4%) were the most frequent phenotypes recorded.</p> <p><strong>Conclusion:&nbsp;</strong>our results show that the carriage of acquired MRSA infections predominates in this population. Despite the noticeable multiresistance of MRSA strains to antibiotics, rifampicin remains the drugs of choice for the therapy of acquired MRSA infections in this setting. In order to slow down antimicrobial resistance, surveillance studies for antimicrobial susceptibility remains essential to identify resistance and inform policy on resistance.</p> Michel Kengne Olivier Fotsing Thérèse Ndomgue Thérèse Ndomgue Julius Mbekem Nwobegahay Copyright (c) 2019-03-05 2019-03-05 32 1 Lésions coronaires chez le noir africain dans les syndromes coronariens aigus https://www.ajol.info/index.php/pamj/article/view/209110 <p><strong>Introduction:&nbsp;</strong>les syndromes coronariens aigus (SCA) sont en progression en Afrique sub-saharienne. Les données angio-coronarographiques sont rares. L'objectif de cette étude était d'analyser les lésions coronaires observées dans les syndromes coronariens aigus (SCA) à Abidjan.</p> <p><strong>Méthodes:&nbsp;</strong>étude transversale, du 1<sup>er</sup>&nbsp;janvier 2010 au 31<sup>er</sup>&nbsp;décembre 2014. Tous les patients admis pour SCA et ayant bénéficié d'une coronarographie à l'Institut de cardiologie d'Abidjan pendant la période d'étude ont été inclus. Deux cent cinquante-six patients ont été sélectionnés. Nous avons analysé et comparé les lésions coronaires chez les patients ayant présenté un SCA avec sus décalage persistant du segment ST (SCA ST+) et ceux ayant présenté SCA sans sus décalage du segment ST (SCA ST-).</p> <p><strong>Résultats:&nbsp;</strong>l'âge moyen des patients était de 53,2 ± 10,8 ans. Il existait une prédominance masculine avec un sex-ratio de 6,1. Le taux de coronarographies anormales était significativement plus élevé dans les SCA ST+ (95,4% et 64,2% respectivement, p &lt; 0,001). Trois cent quatre lésions coronaires ont été observées dans les SCA ST+ contre 43 dans les SCA ST-. Les lésions sténosantes étaient majoritairement monotronculaires (45,3%) dans les SCA ST+ et bi ou tri tronculaires dans les SCA ST- (68,0%). Les lésions de type B1 étaient plus fréquentes dans les SCA ST- (62,8% versus 36,5%, p = 0,002). Les lésions les plus complexes de type C étaient plus fréquentes dans les SCA ST+ (17,8%), sans différence significative. La majorité des patients avait un score SYNTAX inférieur à 22 quel que soit le type de SCA (87,4% dans les SCA ST+ et 90,1% dans les SCA ST-).</p> <p><strong>Conclusion:&nbsp;</strong>les lésions coronaires dans les SCA sont majoritairement monotronculaires dans les SCA ST+ et plus diffuses dans les SCA ST- mais avec une proportion plus importante de coronaires angiographiquement normales. La prise en charge de ces lésions relève dans la majorité des cas de l'angioplastie coronaire.</p> Hermann Yao Arnaud Ekou Thierry Joseph Niamkey Esaïe Kossa Soya Emilienne Aboley Roland N'Guetta Copyright (c) 2019-03-05 2019-03-05 32 1 Haemophagocytic lymphohistiocytosis in patients with human immunodeficiency virus infection: to treat or not to treat https://www.ajol.info/index.php/pamj/article/view/209112 <p>Haemophagocytic lymphohistiocytosis (HLH) in Human Immunodeficiency Virus (HIV) infected individuals can either be due to the disease itself or due to associated infections/malignancies. The treatment for HLH requires immunosuppressive therapy but administering immunosuppressive therapy to an already immunosuppressed patient (HIV infection) is complex. We present two such cases of HLH in patients infected with HIV. In the first case, no alternate cause for HLH was found even after extensive investigations and it was attributed to the uncontrolled HIV replication. Patient was started on dexamethasone for the same but succumbed to hospital acquired pneumonia. The second patient was diagnosed with Hodgkin's lymphoma but he succumbed to his illness before initiating immunosuppressive therapy for HLH. We report these cases to highlight the dilemma and a need for further research in this direction.</p> Farhan Fazal Nitin Gupta Shivabalan Kathavarayan Ramu Aditya Nayan Naval Kishore Vikram Animesh Ray Copyright (c) 2019-03-06 2019-03-06 32 1 Un cas de nœud iléo-sigmoïdien chez une femme en post-partum https://www.ajol.info/index.php/pamj/article/view/209114 <p>Le nœud iléo-sigmoïdien est une cause rare d'occlusion intestinale. Nous rapportons un cas de nœud iléo-sigmoïdien survenu chez une femme en post-partum. Le diagnostic a été évoqué sur les données du scanner et confirmé en peropératoire.</p> Hind Boukhalit Ouijdane Zamani Laila Jroundi Copyright (c) 2019-03-07 2019-03-07 32 1 Prévalence et facteurs associés à la lombalgie chez les conducteurs de taxi moto à Porto-Novo (Bénin) https://www.ajol.info/index.php/pamj/article/view/209116 <p><strong>Introduction:&nbsp;</strong>la lombalgie constitue un problème majeur de santé au travail. Certaines populations de travailleurs semblent beaucoup plus exposées que d’autres. L’objectif de cette étude était de déterminer la prévalence et les facteurs associés à la survenue de la lombalgie chez les conducteurs de taxi moto à Porto-Novo.</p> <p><strong>Méthodes:&nbsp;</strong>étude transversale à visée descriptive et analytique qui avait concerné 270 conducteurs de taxi-moto ayant au moins un an d’ancienneté et consentants. Ces derniers étaient soumis au questionnaire type nordique adapté à notre contexte et un examen physique du rachis. Les données collectées ont été analysées à l’aide du logiciel Epidata 3.1. et STATA/IC 11.0. Le seuil de significativité était de 5% et les intervalles de confiance calculés à 95%.</p> <p><strong>Résultats:&nbsp;</strong>la prévalence de la lombalgie était de 68,89%. L’âge moyen des conducteurs de taxi-moto était de 42,43 ±11,25 [25-64] ans. La majorité conduisait depuis plus de 5 ans (93,33%). La durée moyenne de conduite par jour était de plus de 8 heures (93,34%) et 68,52% parcouraient plus de 160km par jour. La lombalgie était d’horaire mécanique dans 91,39%. Le mode d’installation était brutal dans 81,73%. La douleur était modérée chez 55,91% des conducteurs, d’évolution aigue (46,24%) et sans irradiation dans 62,36% des cas. L’âge, le niveau d’instruction, le stress, la posture, l’état des amortisseurs de moto étaient associés à la lombalgie chez ces conducteurs de taxi-moto (p &lt; 0,001). Par contre la distance parcourue, la durée de travail, l’ancienneté et l’état des routes n’étaient pas associés à la survenue de la lombalgie.</p> <p><strong>Conclusion:&nbsp;</strong>la lombalgie demeure un sérieux problème de santé publique notamment chez les conducteurs de taxi-moto dans notre pays où la conduite de moto devient de plus en plus un métier de secours pour la population confrontée au chômage grandissant d’où la nécessité d’agir sur les différents facteurs pour une prévention efficace.</p> Zavier Zomalhèto Rose Christelle Nayeton Mikponhoué Armand Wanvoègbe Ivanovich Adikpéto Paul Ayélo Copyright (c) 2019-03-07 2019-03-07 32 1 Les troubles neurologiques secondaires à une carence en vitamine B12: analyse de 29 cas https://www.ajol.info/index.php/pamj/article/view/209117 <p>Les troubles neurologiques secondaires à une carence en vitamine B12 sont polymorphes et variés. Peu de travaux se sont intéressés à leur analyse aussi bien dans la population marocaine qu'africaine. L'objectif de notre étude est donc de décrire les aspects cliniques, paracliniques et évolutifs des manifestations neurologiques des patients atteints d'une carence en vitamine B12, au sein du Service de Neurologie de l'Hôpital Militaire Moulay Ismail de Meknès sur une durée de 18 ans (1999-2017). Il s'agissait de 06 femmes et 23 hommes âgés en moyenne de 57 ans. Le délai du diagnostic était de 3 mois. L'atteinte neurologique était révélatrice de la carence en vitamine B12 dans 100% des cas. Le taux moyen de l'hémoglobine était de 10g/dl, le volume globulaire moyen de 115 fl. Une mégaloblastose médullaire et une gastrite atrophique étaient présentes dans respectivement 95% et 90% des cas. La réalisation systématique d'électroencéphalographie (EEG), électromyogramme (EMG) et potentiel evoqué visuel (PEV), a retrouvé chez nos patients des neuropathies périphériques et optiques infracliniques. Sur le plan étiologique, il s'agissait d'une anémie de Biermer dans 20 cas. Sous vitamine B12 parentérale, l'évolution était favorable chez tous nos patients. A la lumière de ces résultats, nous insistons sur l'intérêt du diagnostic précoce en raison de la gravité potentielle de certains tableaux neuropsychiatriques et le traitement substitutif qui doit être rapide car il est le seul garant d'une évolution favorable de ces atteintes.</p> Maha Ait Berri Abdellah Taous Tarik Boulahri Imane Traibi Abdelhadi Rouimi Copyright (c) 2019-03-08 2019-03-08 32 1 Evaluation des protocoles analgésiques pour la prise en charge de la douleur au cours de la lithotripsie extra corporelle https://www.ajol.info/index.php/pamj/article/view/209119 <p>La douleur ressentie au cours d'une séance de lithotritie extracorporelle (LEC) est le facteur limitant le plus important de cette technique. Le but de notre travail était de comparer l'efficacité des différents types d'analgésiques utilisés pour le contrôle de la douleur pendant les séances de LEC. Nous avons mené une étude prospective colligeant 300 patients présentant une lithiase urinaire justifiant un traitement par LEC. Les patients ont été répartis de façon randomisée en trois groupes: le groupe I, incluant 100 patients ayant reçu 2cc de sérum physiologique en IM ( inta musculaire) (placebo), le groupe II regroupant 100 patients ayant reçu 100mg de kétoprofène en IM tandis que le groupe III colligeant 100 patients ayant eu une application locale d'une crème contenant la lidocaïne et la prilocaïne. L'échelle visuelle analogique (EVA) a servi à évaluer la douleur à 10 minutes et à la fin de la séance. L'EVA moyenne à 10 minutes et à la fin de la LEC étaient respectivement de 3,7 et 4,91. Aucune différence significative n'a été trouvée entre les trois groupes concernant: les données épidémiologiques (âge, sexe, IMC, antécédents pathologies) et les caractéristiques du calcul (côté, taille, localisation, présence ou non de sonde double J). L'interruption précoce de la séance de LEC a été notée chez 11 patients du groupe I, avec une différence significative par rapport aux autres groupes (p=0,003). L'EVA à 10 minutes et à la fin de séance de LEC, était statistiquement plus élevée dans le groupe I par rapport aux groupes II et III (p &lt; 0,001). Aussi, la LEC était nettement plus efficace dans les groupes (II et III) comparativement au groupe I (p&lt;0,001). L'utilisation d'un traitement antalgique est nécessaire lors de la séance de lithotritie extracorporelle. Les deux molécules antalgiques évaluées ont montré un bon contrôle de la douleur ainsi qu'une augmentation de l'efficacité du traitement par lithotritie.</p> Kheireddine Mrad Daly Kays Chaker Sami Ben Rhouma Mohamed Ali Ben Chehida Yassine Ouanes Ahmed Sellami Yassine Nouira Copyright (c) 2019-03-08 2019-03-08 32 1 Place de la néphrolithotomie à ciel ouvert dans le traitement du calcul coralliforme: à propos d'une série de 53 patients https://www.ajol.info/index.php/pamj/article/view/209122 <p>Le but de notre étude est de discuter la place de la chirurgie ouverte dans le traitement de la lithiase rénale, et notamment le coralliforme complexe, devant l'avènement de nouvelles techniques moins invasives. Nous rapportons une série de 53 calculs coralliformes colligés au sein de notre formation durant une période de 7 ans, de janvier 2011 au janvier 2018, traités par néphrolithotomie ouverte par lombotomie. La moyenne d'hospitalisation postopératoire était de 10 jours. Les suites postopératoires immédiates et précoces étaient simples chez 36 patients, 6 patients ont nécessités une transfusion sanguin, 2 ont représenté un sepsis sévère en postopératoire, 5 cas une infection de la paroi et 4 cas une fistule urinaire jugulée secondairement par un drainage endoscopique. Les calculs résiduels sont retrouvés dans 9 cas (16,9%). Ces calculs sont traités essentiellement par la lithotripsie extra corporelle. Les suites tardives étaient marquées par une atrophie rénale chez 2 patients, une récidive lithiasique chez 9 patients. Une amélioration de la clairance de créatinine chez 9 patients, et une légère aggravation chez 5 patients. La chirurgie à ciel ouvert de la lithiase rénale a de nombreuses complications, elle n'est pas recommandée en première ligne, mais il est important de reconnaître les patients chez lesquels une néphrolithotomie par voie ouverte pourrait représenter un choix valide de traitement.</p> Abdelilah El Alaoui Hicham El Boté Oussama Ziouani Hachem El Sayegh Ali Iken Lounis Benslimane Yassine Nouini Copyright (c) 2019-03-08 2019-03-08 32 1 A cross-sectional survey on the prevalence of anaemia and malnutrition in primary school children in the Tiko Health District, Cameroon https://www.ajol.info/index.php/pamj/article/view/209137 <p><strong>Introduction:&nbsp;</strong>anaemia and malnutrition are common health problems in developing countries with children being the most vulnerable. They have negative impacts on human performance, growth and development, in children, both as cause and consequences of disease. Although annual mass deworming and nutrition supplement strategies have been implemented in the Tiko Health District (THD), no study has been carried out to determine the prevalence of anaemia and malnutrition. The aim of this study was therefore designed to determine the prevalence of anaemia and malnutrition among primary school children aged 5-15 years in the Tiko Health District.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was carried out in 10 randomly selected schools in the THD and a total of 400 school children were enrolled in the study. Body weight and height were measured using an electronic weighing scale and stadiometer respectively. Anthropometric indices: Height-for-Age Z scores (HAZ), Weight-for-Age Z scores (WAZ) and Body Mass Index-for-Age Z scores (BMIAZ) were analyzed and compared with WHO Growth Reference Standards using WHO Anthroplus software. Hemoglobin levels were determined using Urit-12 Haemoglobinometer and anaemia defined as Hemoglobin (Hb) &lt; 11g/dl. Data analysis was done using the SPSS software.</p> <p><strong>Results:&nbsp;</strong>the overall prevalence of malnutrition was 9.25%, prevalence of stunting 7.5% with 0.8% being severely stunted. The prevalence of wasting was 1% and underweight 0.7%. The overall prevalence of anaemia was 5%. Parents occupation and the absence of toilet were statistically associated with anaemia (P = 0.04 and P = 0.003). Age, floor type, absence of toilet and BMI were significantly associated with malnutrition (P = 0.00, P = 0.01, P = 0.02 and P = 0.003).</p> <p><strong>Conclusion:&nbsp;</strong>this study revealed a low prevalence of malnutrition and anaemia which could be attributed to the deworming and nutrition supplement strategies which have been implemented.</p> Egbe Sarah Balle Tabi Samuel Nambile Cumber Kenneth Okoth Juma Elvis Akwo Ngoh Eric Achidi Akum Esum Mathias Eyong Copyright (c) 2019-03-11 2019-03-11 32 1 Metformin-associated lactic acidosis treated successfully by peritoneal dialysis in a resource limited setting: case report https://www.ajol.info/index.php/pamj/article/view/209143 <p>Metformin is a commonly used treatment modality in type 2 diabetes mellitus with lactic acidosis as a rare but life-threatening side effect. In this case report we highlight the importance of recognizing this uncommon side effect and the treatment options in a resource limited situation. We present a 14-year-old African girl who ingested an unknown amount of metformin intentionally after an argument with her mother. She was referred late to our institution in severe lactic acidosis. Lactic acidosis resolved with appropriate treatment including peritoneal dialysis. We conclude that in resource constrained settings, peritoneal dialysis may be used for metformin associated lactic acidosis with favourable outcome.</p> Khaled Elmezughi Chukwuma Ekpebegh Copyright (c) 2019-03-11 2019-03-11 32 1 Desmoplastic infantile ganglioglioma https://www.ajol.info/index.php/pamj/article/view/209148 <p>The term desmoplastic infantile ganglioglioma was coined by VandenBerg&nbsp;<em>et al</em>. in 1987. In their first report these authors referred to a rare, distinct brain tumor. About 60 cases of desmoplastic infantile ganglioglioma have been described in the literature since its first description. We report a case of a 6-year-old girl who was admitted for seizure without family history. Magnetic resonance imaging scan showed a hypodense area in the right temporal region. A right temporal craniotomy was performed and the tumor was excised. The pathologic examination revealed the diagnosis of desmoplastic infantile ganglioglioma.</p> Salma Kamoun Heifa Azouz Marwa Zemmali Slim Haouet Nidhameddine Kchir Copyright (c) 2019-03-11 2019-03-11 32 1 Un hémangiome intraosseux localement agressif de siège inhabituel https://www.ajol.info/index.php/pamj/article/view/209153 <p>L'hémangiome osseux est une lésion primitive bénigne de l'os, caractérisée par la néoformation et l'agglomération de vaisseaux sanguins anormaux. L'atteinte des vertèbres et du squelette cranio-facial est la plus fréquente mais, tous les os peuvent être lésés. Sa localisation au niveau de l'astragale est rare. Il s'agit d'une patiente âgée de 71 ans sans antécédents pathologiques notables, qui avait consulté pour des douleurs de la cheville évoluant depuis deux ans. La tomodensitométrie du pied a objectivé une image lytique et une fracture de l'astragale ainsi qu'une perte de substance interne osseuse. Une biopsie chirurgicale de cette lésion a été pratiquée. Macroscopiquement, nous avons reçu un matériel hémorragique, friable. Histologiquement, il s'agissait d'une prolifération vasculaire bénigne, constituée de cavités vasculaires plus ou moins gorgées d'hématies et revêtues d'une assise de cellules endothéliales aplaties. Il n'y avait pas d'atypies cytonucléaires ni d'activité mitotique anormale au niveau des cellules endothéliales. Sur le plan immunohistochimique ces cellules exprimaient le CD34. Le diagnostic retenu était celui d'un hémangiome osseux. Les hémangiomes localement agressifs peuvent être confondus, cliniquement et à l'imagerie, avec un processus malin, vasculaire ou non. L'histologie apporte la confirmation diagnostique. Cette tumeur est généralement stable, parfois spontanément résolutive en quelques années. Elle peut cependant aussi avoir une évolution agressive localement.</p> Faten Limaïem Copyright (c) 2019-03-11 2019-03-11 32 1 Abcès de la face révélant une sinusite maxillaire d'origine dentaire https://www.ajol.info/index.php/pamj/article/view/209158 <p>La sinusite maxillaire s'extériorise exceptionnellement. Nous rapportons une voie inhabituelle d'extériorisation à travers le méat moyen en suivant la cloison intersinuso-nasale vers l'angle antérieur de l'os maxillaire et le sillon naso-génien. Il s'agissait d'un patient âgé de 17 ans, sans antécédents particuliers, qui a consulté pour l'apparition depuis deux jours d'une tuméfaction de la face avec une obstruction nasale droite. A l'examen, il était fébrile avec présence d'une tuméfaction inflammatoire collectée du sillon naso-génien droit (A) avec comblement total de la fosse nasale droite par un bombement sous muqueux rénitent. Un scanner injecté du massif facial a montré une sinusite maxillaire droite élargissant le méat moyen (B) avec des collections au niveau de la cloison intersinuso-nasale et du sillon nasogénien. Par ailleurs, on visualise une migration de la 17<sup>ème</sup>&nbsp;racine dentaire en intra-sinusien (C). D'où le diagnostic d'une sinusite maxillaire d'origine dentaire extériorisée à la face a été déduit. Sous anesthésie générale, le patient a eu un drainage des différentes collections purulentes à travers une incision du vestibule nasal, une méatotomie moyenne pour drainage du sinus maxillaire et une extraction de la 17<sup>ème</sup>&nbsp;dent. L'évolution était favorable avec régression de la fièvre et des signes inflammatoires.</p> Souha Kallel Abdel Mounem Ghorbel Copyright (c) 2019-03-12 2019-03-12 32 1 Maladie des brides amniotiques: diagnostic anténatal et difficultés de prise en charge (à propos de 02 cas de malformations létales) https://www.ajol.info/index.php/pamj/article/view/209161 <p>La maladie des brides amniotiques (MBA) est un ensemble de malformations congénitales complexes, intéressant principalement les membres, mais aussi la région cranio-faciale et l'axe thoraco-abdominal. Deux théories principales physiopathologiques s'opposent: la rupture précoce de l'amnios (théorie exogène) conduirait à la formation de brides fibreuses, qui seraient elles-mêmes responsables par strangulation des malformations observées; la théorie endogène privilégie une origine vasculaire, les brides n'ayant alors aucun rôle causal. Le pronostic de la maladie dépend de la gravité des malformations. Afin de discuter des difficultés diagnostiques et thérapeutiques de la maladie des brides amniotiques (MBA), nous rapportons deux cas témoignant de malformations létales de cette maladie. L'objectif principal de ce travail est d'aborder l'intérêt du diagnostic anténatal concernant son influence sur la prise en charge thérapeutique de cette embryo-foetopathie.</p> Hind Adadi Hekmat Chaara Imane Attar Sofia Jayi Fatim-Zahra Fdili Alaoui Moulay Abdelilah Melhouf Copyright (c) 2019-03-13 2019-03-13 32 1 Occlusion intestinale sur diverticule de Meckel: à propos d'un cas https://www.ajol.info/index.php/pamj/article/view/209164 <p>Le diverticule de Meckel est un reliquat du canal omphalomésenterique. Ce diverticule peut se perforer, s'enflammer aussi créer une occlusion. Les auteurs rapportent le cas d'un homme âgé de 30 ans, hospitalisé et pris en charge dans les cliniques universitaires de Lubumbashi pour occlusion intestinale et dont le constat per opératoire était un volvulus du grêle sur diverticule de Meckel avec nécrose intestinale. Son évolution était bonne après l'intervention chirurgicale.</p> Pius Wonga Omole Didier Tshibangu Mujinga Nasser Amisi Lubosha Igor Mujinga Wa Mujinga Daniel Ilunga Ntanga Copyright (c) 2019-03-13 2019-03-13 32 1 Accuracy and precision of four main glucometers used in a Sub-Saharan African Country: a cross-sectional study https://www.ajol.info/index.php/pamj/article/view/209169 <p><strong>Introduction:&nbsp;</strong>capillary glucose measurement using point-of-care glucometers is an essential part of diabetes care. We determined the technical accuracy, clinical accuracy and precision of commonly available glucometers against standard spectrophotometry in Cameroon.</p> <p><strong>Methods:&nbsp;</strong>a sample of four glucometers was selected. In the 108 diabetic and non-diabetic participants, blood glucose values obtained by glucometers were compared to the reference laboratory method to determine their technical and clinical accuracies. Precision was determined by repeated measurements using standard solutions of different concentrations.</p> <p><strong>Results:&nbsp;</strong>accu-Chek® Active, CodeFree™, Mylife™ Pura™ and OneTouch® Ultra® 2 values had correlation coefficients of 0.96, 0.87, 0.97 and 0.94 respectively with reference values, and biases of 18.7%, 29.1%, 16.1% and 13.8% respectively. All glucometers had ≥ 95% of values located within the confidence limits except OneTouch® Ultra®2. Accu-Chek® Active, CodeFree™, Mylife™ Pura™ and OneTouch® Ultra® 2 had 99%, 93.1%, 100% and 98.0% of values in Parke's zones A and B. The coefficients of variation of the glucometers were all below 5% at all standard concentrations, except for Accu-Chek<sup>®</sup>&nbsp;Active for glucose concentrations at100 and 200mg/dL.</p> <p><strong>Conclusion:&nbsp;</strong>no glucometer met all the international recommendations for technical accuracy. Accu-Chek™ Active and Mylife™, Pura™ met the International Organization for Standardization 2013 recommendations for clinical accuracy based on Parke's consensus error grid analysis. All glucometers assessed except Accu-Chek® Active showed a satisfactory level of precision at all concentrations of standard solutions used.</p> Simeon-Pierre Choukem Colette Sih Daniel Nebongo Philomene Tientcheu André-Pascal Kengne Copyright (c) 2019-03-14 2019-03-14 32 1 The bane of publishing a research article in international journals by African researchers, the peer-review process and the contentious issue of predatory journals: a commentary https://www.ajol.info/index.php/pamj/article/view/209172 <p>Scholarly publication in a peer-reviewed journal is the highest form of disseminating research findings. However, the process of publishing in peer-reviewed journals remains a daunting task for researchers and academics in Africa. This commentary will assist authors in Africa to understand the peer-review process, to appreciate the length of time it takes a manuscript to be published and to encourage them to publish in local peer-review journals. The authors argue that the peer-review process is essential because it acts as a quality control mechanism to ensure that valid and reliable research is published. Although peer review does not guarantee exclusive publication of reliable and valid research, it remains central in the scientific activity. Authors need to take seriously the comments from reviewers and editors, even in cases of rejection seriously and in the positive sense, in order to improve upon the quality of their work. Rejections by some journals happen not to be scientifically grounded. It happens that African authors suffer more from this flaw. This could justify why some naïve authors easily turn to publish in predatory journals. Authors argue that publishing in local journals is imperative for Africans scholars. Initiatives to encourage publication in these journals are highly needed.</p> Elvis Enowbeyang Tarkang Luchuo Engelbert Bain Copyright (c) 2019-03-14 2019-03-14 32 1 Hyporegenerative anemia and other complications of rhesus hemolytic disease: to treat or not to treat is the question https://www.ajol.info/index.php/pamj/article/view/209175 <p>Rhesus hemolytic disease of the newborn is rarely found after the implementation of anti-D immunoglobulin prophylaxis. However, it may lead to cholestasis, elevated liver transaminases, iron overload and late hyporegenerative anemia when it occurs. Etiology of this type of anemia is not defined yet and treatment is controversial. It is typically recognized after two weeks of life which is characterized by low hemoglobin and reticulocyte count. We have reported a case of a neonate with Rh hemolytic disease with late hyporegenerative anemia that was noted at day 18 of life. We treated this anemia by erythropoietin (EPO) 250 U/kg three times per week. Two weeks after initiation of erythropoietin treatment, a stable hemoglobin was noted along with an increased reticulocyte count. The patient required one further blood transfusion in the third week of therapy. Other associated findings were self-limited. A year of follow-up showed an appropriate development for age.</p> Aqeel Abdullah Alaqeel Copyright (c) 2019-03-14 2019-03-14 32 1 Primary papillary carcinoma of the thyroglossal duct in a 14-year-old female: case report and review of the literature https://www.ajol.info/index.php/pamj/article/view/209242 <p>Thyroglossal duct carcinoma is a rare pathologic entity. The surgeon's main concern is whether to perform thyroidectomy or not. In this paper, we report another case of thyroglossal papillary duct carcinoma in a 14-old girl suspected preoperatively and confirmed postoperatively on the histological analysis of resected specimen by a Sistrunk procedure. Therapeutic strategy was completed by a total thyroidectomy with radioactive iodine therapy and suppressive levothyroxine therapy. In the absence of clear guidelines, the management of thyroglossal duct carcinoma is depending on the clinical situation and the experience of the team of surgeons.</p> Amel El Korbi Jihène Houas Rachida Bouatay Khaled Harrathi Jamel Koubaa Copyright (c) 2019-03-14 2019-03-14 32 1 The prevalence of HBsAg, knowledge and practice of hepatitis B prevention among pregnant women in the Limbe and Muyuka health districts of the South West region of Cameroon: a three-year retrospective study https://www.ajol.info/index.php/pamj/article/view/209250 <p><strong>Introduction:&nbsp;</strong>hepatitis B infection is caused by the hepatitis B virus (HBV). HBV is transmitted through sexual intercourse, by exchange of saliva during kissing and also to newborns of infected mothers. In the Global Burden of Diseases 2010, 786,000 deaths were attributed to HBV. Studies in Cameroon, reported the prevalence of HBV as high as 10.1% and 12% among blood donors in hospital blood banks. This study therefore, aims at determining the prevalence of HBsAg, knowledge and practices of pregnant women on HBV prevention and transmission in the Limbe health district (LHD) and Muyuka health district (MHD).</p> <p><strong>Methods:&nbsp;</strong>ANC registers were exploited from the health centers for a period of three years (2014-2016) in order to determine the prevalence of HBV infection. 270 women attending ANC were selected by exhaustive sampling. Knowledge and practices of participants on HBV prevention and transmission was assessed using a structured questionnaire.</p> <p><strong>Results:&nbsp;</strong>the prevalence of HBV in the LHD and MHD were 5.7% and 7.5% respectively. Pregnant women in the LHD demonstrated good knowledge but adopted poor practices whereas in the MHD, pregnant women demonstrated poor knowledge and adopted poor practices regarding the mode of transmission and prevention of HBV infection. There was a significant association between the prevalence of HBsAg and marital status (p = 0.000) in the LHD and age (p = 0.022) in the MHD.</p> <p><strong>Conclusion:&nbsp;</strong>this study indicated a high prevalence of HBV among pregnant women in the LHD and MHD, knowledge and practices were identified as potential risk factors.</p> Esum Mathias Eyong Brenda Mbouamba Yankam Esemu Seraphine Che Henry Ngwa Ngwayu Claude Nkfusai Cho Sabastine Anye Gilbert Karngong Nfor Samuel Nambile Cumber Copyright (c) 2019-03-15 2019-03-15 32 1 Comparing static and outreach immunization strategies and associated factors in Uganda, Nov-Dec 2016 https://www.ajol.info/index.php/pamj/article/view/209253 <p><strong>Introduction:&nbsp;</strong>the government of Uganda aims at reducing childhood morbidity through provision of immunization services. We compared the proportion of children 12-33 months reached using either static or outreach immunization strategies and factors affecting utilization of routine vaccination services in order to inform policy updates.</p> <p><strong>Methods:&nbsp;</strong>we adopted the 2015 vaccination coverage cluster survey technique. The sample selection was based on a stratified three-stage sample design. Using the Fleiss formula, a sample of 50 enumeration areas was sufficient to generate immunization coverages at each region. A total of 200 enumeration areas were selected for the survey. Thirty households were selected per enumeration area. Epi-Info software was used to calculate weighted coverage estimates.</p> <p><strong>Results:&nbsp;</strong>among the 2231 vaccinated children aged 12-23 months who participated in the survey, 68.1% received immunization services from a health unit and 10.6% from outreaches. The factors that affected utilization of routine vaccination services were; accessibility, where 78.2% resided within 5km from a health facility. 29.7% missed vaccination due to lack of vaccines at the health facility. Other reasons were lack of supplies at 39.2% and because the caretaker had other things to do, 26.4%. The survey showed 1.8% (40/2271) respondents had not vaccinated their children. Among these, 70% said they had not vaccinated their child because they were busy doing other things and 27.5% had not done so because of lack of motivation.</p> <p><strong>Conclusion:&nbsp;</strong>almost 7 in 10 children aged 12-23 months access vaccination at health facilities. There is evidence of parental apathy as well as misconceptions about vaccination.</p> Fred Nsubuga Steven Ndugwa Kabwama Immaculate Ampeire Henry Luzze Pande Gerald Lilian Bulage Opar Bernard Toliva Copyright (c) 2019-03-15 2019-03-15 32 1 Diagnostic predictive values of the hain genotype MTBDRsl assay in mycobacterial strains isolated from Sudan https://www.ajol.info/index.php/pamj/article/view/209259 <p><strong>Introduction:&nbsp;</strong>hain GenoType MTBDRsl is nucleic acid amplification assay based on reverse hybridization with specific oligonucleotide probes on nitrocellulose strips. MTBDRsl identifies&nbsp;<em>M. tuberculosis</em>&nbsp;complex and detects resistance to fluoroquinolone, second line injectable drugs and ethambutol evident as mutations of&nbsp;<em>gyrA, rrs and embB</em>&nbsp;genes respectively. This study aimed to evaluate the diagnostic performance of the Hain GenoType MTBDRsl Assay using 1% proportion method on LJ medium as gold standard.</p> <p><strong>Methods:&nbsp;</strong>a total of 52 rifampicin resistant (RR) isolates were tested for second line drug sensitivity by 1% proportion method and by MTBDRsl assay.</p> <p><strong>Results:&nbsp;</strong>two strains were identified as mycobacteria other than tuberculosis MOTT and the rest were&nbsp;<em>Mycobacterium tuberculosis</em>&nbsp;complex MTBC. Five of the MTBC isolates (5/50; 10%) showed resistance to at least one second line drug and one isolate (1/50; 2%) was XDR. XDR strain was concordantly detected by the two methods. One of two Kanamycin-resistant isolates showed discordant result. Ofloxacin showed one false positive and one false negative result. Most discrepancies were detected with Ethambutol. The sensitivity, specificity, positive and negative predictive values were respectively as follows: Ethambutol (63.3.4%, 85.7%, 94.4% and 62%): for Kanamycin (67%, 100%, 100% and 97.9%): for Amikacin and Capreomycin (100%, 100%, 100% and 100%): for Ofloxacin (75%, 97.5%, 75% and 97.8%). For XDR isolate the values were (100%, 100%, 100% and 100%) respectively.</p> <p><strong>Conclusion:&nbsp;</strong>MTBDRsl showed high specificity and negative predictive values making it acceptable and time-saving for early presumptive detection of resistance to second-line drugs in Sudan.</p> Muatsim Ahmed Mohammed Adam Hamdan Mustafa Hamdan Ali Eltahir Awad Gasim Khalil Copyright (c) 2019-03-15 2019-03-15 32 1 When do you not listen to your doctor https://www.ajol.info/index.php/pamj/article/view/209260 <p>Gout is a disease caused by an inflammatory response to crystals of sodium monourate, which occurs in people with elevated uric acid levels. There are acute and chronic forms. Acute forms arise as sudden, self-limiting bouts of arthritis (swelling, flushing, pain and heat of a joint), while chronic forms result in the deposition of crystal aggregates in and around the joints, with progressive joint destruction. In addition to joint manifestations, uric gout has renal manifestations (kidney stones and renal insufficiency) and metabolic manifestations (hypertension, elevated triglycerides). Patients are often obese, have high alcohol consumption and insulin resistance. It is a very painful and disabling illness. Gout is more common in men and usually begins in the 40's and 60's. Analytically the patient had uric acid values of 10.2 mg/dL (2.0-7.0 mg/dL) despite being daily medicated with alopurinol 300mg for more than 5 years. It has an abnormality of fasting glycemia and triglycerides of 305 mg/dl. However it maintains consumptions of alcohol and a diet rich in meat, seafood and fats. He did not diet to lose weight and sometimes he does not take the medication (alopurinol). He already shows involvement and destruction of the joints and deformation on the feet and the hand that currently prevent him from fulfilling the necessary safety norms in his profession.</p> Catia Aguiar Cabral António Grilo Novais Copyright (c) 2019-03-15 2019-03-15 32 1 TB or not TB! That’s the question https://www.ajol.info/index.php/pamj/article/view/209262 <p>Twenty seven years old lady presented to the emergency department accompanied by family members with complaint of fluctuating consciousness and fever for the past three days. Upon further questioning the patient has been complaining from headache for two months, decreased appetite for the past month and had a travel history to Ethiopia five months ago. Family members were not sure about any history of weight loss, the patient took a one week course of antibiotics for tooth infection two weeks ago. Physical examination showed an ill looking, vitally stable lady on chest auscultation diffuse crackles heard bilaterally. Septic work up including CSF sample was ordered to rule-out meningitis chest X-ray was also ordered. Chest X ray result showed a clinical image specious of milliary TB (A) and results were confirmed by a positive acid fast stain of the CSF. Patient was taken to isolation and proper management was started with a final diagnosis of TB meningitis. A follow-up MRI showed few hyper-intense foci in deep white matter of left frontal lobe (B).</p> Ahmed Nugud Assmaa Nugud Copyright (c) 2019-03-15 2019-03-15 32 1 La maladie de Weber-Christian: s'agit-il d'un état pré-leucémique? https://www.ajol.info/index.php/pamj/article/view/209267 <p>La maladie de Weber-Christian ou panniculite idiopathique est une affection rare, caractérisée par une inflammation du tissu adipeux sous-cutané; il s'agit d'une entité pathologique non spécifique qui reste toujours un sujet de débat et dont l'évolution est imprévisible. Nous rapportons dans cet article le cas d'un nourrisson de sexe féminin de 9 mois, admise dans un tableau de sepsis précédé d'une symptomatologie respiratoire et suivi de l'apparition de nodosités sous cutanées érythémateuses, de petite taille, dures, sensibles, asymétriques et situées au niveau des bras et des membres inférieurs, la biopsie cutanée a montré une hypodermite lobulaire avec infiltration des polynucléaires neutrophiles. La maladie de Weber-Christian a été retenue après avoir éliminé les autres diagnostics différentiels. Notre patiente a été traitée par la prednisone avec une bonne évolution initiale. Durant le suivi et au cours de la dégression, le diagnostic d'une leucémie aigue lymphoblastique type B a été posé. Cette évolution atypique à notre connaissance n'a jamais été décrite dans la littérature. Nous allons discuter à travers ce cas les différentes situations similaires où un autre diagnostic a été fait après avoir pris en charge les malades comme ayant une panniculite lobulaire idiopathique, en concluant de la nécessité d'une enquête étiologique exhaustive et d'une surveillance prolongée afin de rechercher une éventuelle pathologie associée.</p> Salahiddine Saghir Toufik Meskini Said Ettair Naima Erreimi Nezha Mouane Copyright (c) 2019-03-18 2019-03-18 32 1 La patella cubiti découverte à la suite d’un traumatisme: à propos d’un cas et revue de la littérature https://www.ajol.info/index.php/pamj/article/view/209274 <p>La patella cubiti est une anomalie très rare qui se caractérise par la non union de l'olécrane au cubitus proximal. Nous rapportons un patient de 27 ans admis pour traumatisme du coude dont le diagnostic révélait une patella cubiti faisant confondre avec une fracture de l'olécrane. Le patient a bénéficié d'une résection du fragment osseux. A 3 mois de l'intervention, le patient s'est senti satisfait car le corps étranger qu'il ressentait au niveau du coude a disparu.</p> Amour Espoir Mokoko-Louckou Kevin Parfait Bienvenu Bouhelo-Pam Badarou Chaibou Ismail Abdouli Mohammed Shimi Abdelhalim El Ibrahim Abdelmajid El Mrini Copyright (c) 2019-03-18 2019-03-18 32 1 Paratubal borderline serous tumor in a postmenopausal woman: a case report https://www.ajol.info/index.php/pamj/article/view/209277 <p>Unlike borderline ovarian tumors, paratubal borderline tumors are extremely rare gynecologic tumors. They occur in reproductive-aged females at an earlier stage of disease and have a good prognosis. A 61-year-old woman, gravida 3 para 3, presented with progression of ovarian cyst. Computed tomography revealed a 6-cm simple cystic lesion without enhancing papillary projections. The patient underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Frozen specimens showed that the tumor was benign, thereby confirming a final diagnosis of paratubal borderline serous tumor. The patient refused comprehensive surgical staging and opted for close follow-up. The patient remains asymptomatic with no evidence of recurrence at the 24-month follow-up. To the best of our knowledge, this is the first reported case of paratubal borderline serous tumor in a postmenopausal patient. The findings of this study and those of other case reports can contribute to the understanding, diagnosis, treatment and prognosis of these rare tumors.</p> JongChul Baek Copyright (c) 2019-03-18 2019-03-18 32 1 Knowledge, attitude and practice of cervical cancer prevention, among women residing in an urban slum in Lagos, South West, Nigeria https://www.ajol.info/index.php/pamj/article/view/209279 <p><strong>Introduction:&nbsp;</strong>cervical cancer is the most common genital tract malignancy among women in Nigeria. Cancer of the cervix is preceded by a curable premalignant stage which can be detected by screening. The disease can also be prevented by Human papillomavirus (HPV) immunization. Women living in slums usually have poor reproductive health knowledge and poor health behaviours. Mostly of low socioeconomic status, these women are at higher risk of cervical cancer. This study assessed the knowledge, attitude and preventive practices towards cervical cancer among women living in an urban slum in Lagos, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>this descriptive cross-sectional study was carried out among 305 women of reproductive age in Idi-Araba, Lagos, Nigeria. Multistage sampling method was used to select respondents. Data was collected using interviewer administered questionnaires. Analysis was done with SPSS 20 software.</p> <p><strong>Results:&nbsp;</strong>only 39 (12.8%) had heard about cervical cancer. Knowledge of cervical cancer, screening and Human papilloma virus (HPV) immunization was poor. Most respondents (64.3%) did not consider themselves at risk for cervical cancer. However, majority (88.9%) were willing to undergo screening and 93.8% were willing to take HPV immunization or recommend the vaccine to a friend/relative. Only 2(0.7%) had done a cervical cancer screening test and none had taken HPV vaccine or immunized their eligible daughters.</p> <p><strong>Conclusion:&nbsp;</strong>there is thus the need for increased awareness creation and health education programs on cervical cancer prevention among such population of women.</p> Tope Olubodun Oluwakemi Ololade Odukoya Mobolanle Rasheedat Balogun Copyright (c) 2019-03-18 2019-03-18 32 1 Magnetic resonance imaging changes in a 69-year old man with hypoglycemia induced brain injury: case report and literature review https://www.ajol.info/index.php/pamj/article/view/209287 <p>We present the case of a 69-year old man who was brought to the hospital after being found unconscious; last seen at baseline 9 hours prior. On admission he was found to be severely hypoglycemic and received prompt glucose administration, with no immediate neurological improvement. Stroke was suspected. A brain MRI revealed abnormal hyperintense signal involving the head and tail of the left hippocampus. After close neurological monitoring and supportive care in the ICU, his condition improved over time, leaving no residual focal deficits. This case highlights the presence of MRI changes in patients with severe hypoglycemia as it happens in hypoglycemic coma.</p> Pranitha Reddy Arrabyru Ihtesham Aatif Qureshi Lauren Skalomenos Gustavo Jose Rodriguez Copyright (c) 2019-03-20 2019-03-20 32 1 Œdème papillaire isolé révélant une sarcoïdose oculaire https://www.ajol.info/index.php/pamj/article/view/209289 <p>La sarcoïdose est une granulomatose multisystémique d'étiologie inconnue, défini par la présence de granulomes épithélioïdes et gigantocellulaires, sans nécrose caséeuse. La sarcoïdose oculaire se manifeste essentiellement par une uvéite antérieure granulomateuse et bilatérale. L'atteinte postérieure au cours de la sarcoïdose oculaire est rare et se manifeste par des périphlébites ou une atteinte choroïdienne. L'œdème papillaire isolé au cours est un tableau atypique d'où la particularité de notre observation. L'atteinte postérieure est un élément de mauvais pronostic menaçant le pronostic visuel, une prise en charge rapide en collaboration avec les pneumologues par corticothérapie systémique permet d'améliorer le pronostic visuel et limiter les complications.</p> Yasmine Chaoui Roqai Yousra Ajhoun Nisrine Laaribi Soukaina Belfaiza Yassine Mouzari Fouad El Asri Karim Reda Abdelbarre Oubaaz Copyright (c) 2019-03-20 2019-03-20 32 1 Rectal stromal tumor with an exceptional liver and bone metastatic locations https://www.ajol.info/index.php/pamj/article/view/209370 <p>Gastrointestinal stromal tumours (GIST) are rare mesenchymal tumours which represent 1% to 3% of gastrointestinal neoplasm. Rectal location of GIST is extremely rare reaching 5% of GIST and only 0.1% of rectal tumours. They usually metastases to the liver (65%) and exceptionally to the bone (3%). We reported a case of rectal stromal tumour with an exceptional metastasis located in the rib. A 40-year-old man who presented with pelvic pain, associated with rectal syndrome, rectal bleeding and subocclusive episodes. Physical examination objectified a tough, budding rectal mass, with a smooth wall, localized 3cm above of anal margin. A Thoraco-abdominal computed tomography showed a large heterogeneous tissue mass, taking the whole pelvis, coming from the right-side wall of the rectum of 17.3 x 14cm. It was associated with liver and bone secondary locations. Biopsies confirmed the secondary locations of an intermediate risk GIST. Immunohistochemical study showed an overexpression of c-kit protein (CD117) and Dog1. Imatinib was prescribed to reduce the tumour size. Stromal metastatic rectal tumours in bone level are extremely rare conditions. The diagnosis is confirmed by histological examination with immune histochemical analysis. The prognosis remains poor in metastatic forms but it has been improved since the introduction of Imatinib.</p> Dougaz Mohamed Wejih Gouta Esma Leila Chaouch Mohamed Ali Nouira Ramzi Bouasker Ibtissem Dziri Chadli Copyright (c) 2019-03-20 2019-03-20 32 1 Erythème marginé de Besnier: manifestation rare au cours du rhumatisme articulaire aigu https://www.ajol.info/index.php/pamj/article/view/209383 <p>Il s'agissait d'une fillette âgée de 3 ans accusant depuis un an, une éruption cutanée se manifestant par des plaques discoïdes faites de macules rosées, non prurigineuses arrondies et ovalaires, de 1 à 3 cm de diamètre, polycycliques, confluentes et à centre clair évoluant par poussée, avec régression et réapparition. L'enfant a été admise aux urgences dans un tableau de détresse respiratoire et de fièvre avec aggravation des lésions cutanées préexistantes devenant diffuses. L'auscultation cardiaque trouvait un souffle holo-systolique mitral d'une intensité de 4/6. L'échographie cardiaque objectivait une insuffisance mitrale aigue massive avec des végétations valvulaires. Sur le plan biologique, on notait la présence d'un syndrome inflammatoire biologique avec une CRP à 300mg/l et une vitesse de sédimentation à 60 mm à la première heure et les ASLO étaient très élevés (1600 UI/ml). Le diagnostic d'endocardite infectieuse sur valvulopathie rhumatismale était retenu. Après mise en condition, instauration d'une antibiothérapie et d'une cure chirurgicale urgente pour plastie mitrale, il a été noté une régression des lésions dermatologiques en quelques jours mais l'état hémodynamique de l'enfant s'était dégradé rapidement avec un décès brutal. L'érythème de Besnier est une manifestation cutanée rare du rhumatisme articulaire aigu. Les médecins devraient faire attention à ne pas négliger ce signe clinique rare mais utile, en particulier chez les patients présentant une atteinte valvulaire subclinique pour éviter les complications cardiaques tardives potentielles. Les trois diagnostics différentiels étaient l'herpès circiné, l'urticaire et l'érythème de l'angioedème héréditaire.</p> Bousayna Iraqi Badr Sououd Benjelloun Dakhamaa Copyright (c) 2019-03-20 2019-03-20 32 1 Cyto-histologic discordancy in patients undergoing thyroidectomy at Aga Khan University Hospital https://www.ajol.info/index.php/pamj/article/view/209389 <p>Fine needle aspiration cytology (FNAC) findings are the basis upon which decision and type surgery is made. Therefore the diagnostic accuracy and utility of FNAC being such an integral tool in management of thyroid lesions must be evaluated for cyto-histologic discrepancy from time to time as a quality assurance measure. The objective was to compare thyroid fine-needle aspiration cytology (FNAC) with final histopathological findings at in patients undergoing thyroidectomy. This was a cross-sectional retrospective study at Aga Khan university hospital, Nairobi. Cyto-histologic discrepancy was found in 19(25%) of cases with false positive and negative rates at 9% and 16%. False positive results constituted 7(9%) while 12(16%) were false negative findings. The higher cyto-histological discordancy than seen previous studies could be due to sampling error and cytological mis-interpretation. Our study found higher than expected cyto-histologic discrepancy.</p> Moses Barasa Abdulkarim Abdallah Copyright (c) 2019-03-21 2019-03-21 32 1 Massive splenic calcification in amyloidosis with normal labs and physical exam https://www.ajol.info/index.php/pamj/article/view/209392 <p>A 64-year-old male with medical history of hypertension, type II diabetes, coronary artery disease, and AL amyloidosis involving the heart, kidney and liver was admitted for decompensated heart failure, requiring Intra-Aortic Balloon Pump (IABP) and inotropic support. The patient was listed for heart transplant, but later developed cardiac arrest and required Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) treatment. Abdominal X-ray was obtained to confirm the position of feeding tube which showed massive intra-peritoneal calcification (A). CT abdomen was obtained, and he was found to have extensive splenic calcification measures 8.9 x 7.1cm in cross-section and it spans 8.9 cm in craniocaudal direction (B). Spleen was impalpable on physical exam. Before the cardiac arrest, patient's renal function was at baseline, with the remaining of the basic metabolic panel normal. Hepatic function panel was significant for mild elevation in alkaline phosphatase and alanine aminotransaminases. All other laboratory work including coagulation and iron studies were normal. Nonetheless, patient's condition deteriorated over the course and he expired. Amyloid fibrils have an affinity to calcium and can result in calcific deposition in organs. Literature review showed that in amyloidosis, splenic calcification occurs in conjunction with other organs calcification especially liver. Thus this patient's case highlights the unique presentation of massive splenic calcification without any other organ calcification with relatively normal laboratory and physical examination except findings consistent with his heart failure diagnosis.</p> Gaurav Dhansukhlal Gheewala Ifeoma Oriaku Copyright (c) 2019-03-22 2019-03-22 32 1 Kaposi of the penis: about a case https://www.ajol.info/index.php/pamj/article/view/209396 <p>Kaposi sarcoma (KS) is a multicentric angioproliferative disorder of endothelial origin. It predominantly affects mucocutaneous sites but may also affect visceral organs. We are reporting a case of KS with unusual presentation. A 45-year-old male presented violaceous macules on the glans which appeared 3 weeks ago. Otherwise he reported fever and loss weight. Histological examination detected the presence of spindle cells and the positivity for Kaposi-associated Herpes virus-8 confirmed the lesions as Kaposi's sarcoma. Visceral sarcoma lesions were also present in the oesophagus and gastric fundus. HIV viral serology was positive. Treatment with antiretroviral therapy and bleomycine was initiated. Sarcomas of the penis are very uncommon, representing less than 5% of malignant tumors in this area. KS is the most common sarcoma of the penis and the second most common is leiomyosarcoma. Primary presentation of KS on the penis is not common but more often observed in patients with AIDs, whose lesions are the aggressive form, and only approximately 2-3% cases have shown penile KS lesions as first manifestation of disease as our patient. This case is important as it illustrates that disseminated KS was not to be predicted by the number or the external lesions.</p> Sqalli Houssaini Asmaa Badreddine Hassam Copyright (c) 2019-03-22 2019-03-22 32 1 Acute coronary syndrome with non ST segment elevation myocardial infarction revealing anomalous connection of the left anterior descending artery https://www.ajol.info/index.php/pamj/article/view/209402 <p>The occurrence of an acute coronary syndrome (ACS) with an anomalous connection of coronary artery (ANOCOR) identified as a culprit artery is very rare. This association may lead in some anatomical forms to a delay in coronary reperfusion. We report the clinical case of a patient admitted for high-risk Non ST elevation myocardial infarction (NSTEMI) in whom coronary angiography accidentally discovers an anomalous connection of the left coronary network from the right anterior. In light of this case and a review of literature, we discuss the peculiarities of these anomalous connections.</p> Abdelmajid Bouzerda Zouhair Lakhal Laila Bendriss Ali Khatouri Copyright (c) 2019-03-25 2019-03-25 32 1 Perforation gastrique spontanée compliquant une bronchiolite aiguë chez un nourrisson https://www.ajol.info/index.php/pamj/article/view/209405 <p>La perforation gastrique spontanée est une affection rare chez le nourrisson et les mécanismes de survenue demeurent mal compris. Nous rapportons le premier cas congolais. Il s'est agi d'un nourrisson de sexe féminin, âgée de 5 mois qui au 4<sup>ème</sup>&nbsp;jour d'hospitalisation pour une bronchiolite aiguë sévère associée à une diarrhée compliquée de déshydratation aiguë modérée, a présenté de façon brutale une distension importante et douloureuse de l'abdomen associée à des signes de choc. La radiographie de l'abdomen sans préparation montrait un pneumopéritoine massif. La laparotomie avait permis de mettre en évidence une perforation arrondie sur la paroi postérieure de l'estomac qui a été suturée. Les suites opératoires étaient marquées par la survenue d'un choc septique et le décès du nourrisson.</p> Aymar Pierre Gildas Oko Patricia Irène Ondima Marlène Kibangou Lenvo Letitia Lombet Judicaël Kambourou Nelly Pandzou Guembo Mamadou Ildevert Cyriaque Ndjobo Aurore Mbika Cardorelle Copyright (c) 2019-03-25 2019-03-25 32 1 Hepatitis B virus (HBV) infection amongst children in Senegal: current prevalence and seroprotection level https://www.ajol.info/index.php/pamj/article/view/209411 <p><strong>Introduction:&nbsp;</strong>hepatitis B virus (HBV) infection is highly endemic in Senegal. HBV vaccine of all children has been introduced in 1999 and included in the Expanded Programme on Immunization in 2004. The aim of this study was to assess the HBV prevalence and immunity status against HBV amongst children in Senegal.</p> <p><strong>Methods:&nbsp;</strong>between March and August 2016, consecutive children aged from 6 months to 16 years old were recruited in outpatient department of three main children hospitals in Senegal. Serum samples were analyzed for HBV serology (HBsAg, HBcAb, HBsAb) using ARCHITECT analyzer. Children with HBsAb levels ≥ 10 IU/l) were considered as seroprotected against HBV.</p> <p><strong>Results:&nbsp;</strong>during the study period, 295 children fulfilled the criteria for the study and were further analyzed. Three children were HBsAg positive giving a seroprevalence at 1.1% (95% CI: 0.2-3.3), 12/267 (4.5%, 95% CI=2.3-7.7) had positive HBcAb and 226/295 (76.6%, 71.4-81.3) had positive HBsAb including 191 (77.3%, 71.6-82.4) with isolated HBsAb related to previous active immunization. However only 165 children (56%, CI 50-62) had seroprotective HBsAb levels (HBsAb ≥ 10 UI/L) and 63 (21.4, 16.8-26) had a strong seroprotectiondefined by HBsAb ≥ 100 IU/L.</p> <p><strong>Conclusion:&nbsp;</strong>our results suggest that although HBV prevalence has significantly decreased in children in Senegal following a better HBV vaccine coverage, the number of children correctly seroprotected is insufficient (56%). Assessing the levels of&nbsp;</p> Gora Lô Amina Sow-Sall Halimatou Diop-Ndiaye Ndiaye Babacar Niokhar Ndane Diouf Sokhna Moumi Daffé Babacar Ndao Moussa Thiam Moustapha Mbow Mamadou Bayo Soumboundou Maud Lemoine Maguette Sylla-Niang Ousseynou Ndiaye Cheikh Saad Boye Souleymane Mboup Ndeye Coumba Touré-Kane Copyright (c) 2019-03-25 2019-03-25 32 1 On artherogenic index of plasma in sickle cell anaemia patients https://www.ajol.info/index.php/pamj/article/view/209419 <p><strong>Introduction:&nbsp;</strong>Sickle cell anaemia (SCA) is an inherited abnormality of haemoglobin associated with reduced life expectancy. Patients' complications include dyslipideamia. This study was aimed at determining the artherogenic index of plasma (AIP) in sickle cell anaemia patients and compares the value to HbAA controls value. A high AIP is strongly predictive of elevated cardiovascular risk.</p> <p><strong>Methods:&nbsp;</strong>a comparative study was conducted among SCA patients attending the haematology clinic, Lagos State University Teaching Hospital (LASUTH) and HbAA Phenotype controls. A total of 304 participants were recruited consisting of equal numbers of SCA and HbAA controls. Single lipid profiles were done; logarithms of triglycerides/high density lipoprotein were calculated to obtain AIP and lipid profile ratios established for all participants.</p> <p><strong>Results:&nbsp;</strong>there were lower mean values of Total Cholesterol (TC), High Density Lipoprotein(HDL) and Low Density Lipoprotein (LDL) amongst SCD participants than controls and higher mean values of triglycerides (TG) and Very Low Density Lipoprotein (VLDL) in SCD p &lt; 0.05. The AIP in SCD ranges from -0.62 to 1.32 while that of controls ranges from -0.56 to 0.61.The mean AIP were 0.14 ± 0.29 and -0.009 ± 0.26 in SCD and controls respectively. P value = 0.002.</p> <p><strong>Conclusion:&nbsp;</strong>AIP value is higher in sickle cell anaemia than controls, the former have lower mean values of TC, HDL and LDL and higher mean values of TG and VLDL.</p> Akinsegun Abduljaleel Akinbami Ebele Ifeyinwa Uche Aishatu Maude Suleiman Ann Abiola Ogbena Festus Olusola Olowoselu Benjamin Augustine Mulikat Adesola Badiru Rafat Abiodun Bamiro Omolara Risqat Kamson Copyright (c) 2019-03-25 2019-03-25 32 1 Prevalence and spatial distribution of trematode cercariae in vector snails within different agro-ecological zones in Western Kenya, 2016 https://www.ajol.info/index.php/pamj/article/view/209426 <p><strong>Introduction:&nbsp;</strong>freshwater vector snails' distribution, infection with cercariae, preferred habitat and possible trematodiases transmission foci is not well known in Western Kenya. We sought to determine the distribution and prevalence of infection of snails per agro-ecological zone and environmental factors in vector snail habitats.</p> <p><strong>Methods:&nbsp;</strong>we conducted a cross-sectional survey from March, 2016 - May, 2016, harvested and identified snails using shell morphology, determined their infection with trematode cercariae using microscopy, used descriptive statistics to estimate the prevalence of infection and relationship between snail abundance and environmental factors.</p> <p><strong>Results:&nbsp;</strong>we sampled a total of 1,678 vector snails from 47 sampling sites of which 42% were Lymnaeid, 23% Biomphalaria, 10% Bulinus, 22% Oncomelaniae and 2% Melanoides. Lower Midland I Ago-Ecological Zones had 44% of the snails and streams from springs had 41% of the snails. Overall, 26.5% (445/1678) (95% CI: 24.4 - 28.6) of the snails shed cercariae. Cercariae were found in 11 (23%) of the sites and in all zones.&nbsp;<em>F. gigantica</em>&nbsp;cercariae were shed by&nbsp;<em>L. natalensis, B. pfeifferi, B. sudanica</em>. Lakeshore had both&nbsp;<em>F. gigantica</em>&nbsp;and S. mansoni cercariae shed by&nbsp;<em>B. sudanica</em>. About 72% (1,202/1,678) of snails were found in water with a pH 6.5 - 7.5. Grass habitat had 54% (912/1,678) of the snails.</p> <p><strong>Conclusion:&nbsp;</strong>lymnaeid snails were present in all the zones, while streams from springs and near neutral habitats had most of the snails. Infection with trematode cercariae was noted in all the zones. Trematodiases control should be focused on all zones especially in freshwater streams and lakeshores.</p> Maurice Omondi Owiny Mark Odhiambo Obonyo Peter Maina Gatongi Eric Maurice Fèvre Copyright (c) 2019-03-26 2019-03-26 32 1 Chondrosarcome né sur un ostéochondrome solitaire: à propos d’un cas https://www.ajol.info/index.php/pamj/article/view/209517 <p>Le chondrosarcome est une tumeur osseuse maligne rare. Elle peut être primitive ou secondaire à une transformation maligne d'une tumeur cartilagineuse bénigne sous-jacente. Le chondrosarcome secondaire découlant d'un ostéochondrome solitaire bénin est extrêmement rare et les données montrent que l'incidence rapportée de l'ostéochondrome du bassin est très faible. Nous rapportons le cas d'un patient âgé de 20 ans présentant un chondrosarcome secondaire à la transformation maligne d'un ostéochondrome de l'aile sacro-iliaque droite.</p> Hafsa Chahdi Amal Damiri Mohamed Reda El Ochi Mohamed Allaoui Abderrahmane Al Bouzidi Mohamed Oukabli Copyright (c) 2019-03-26 2019-03-26 32 1 Strangulated obturator hernia: a case report with literature review https://www.ajol.info/index.php/pamj/article/view/209520 <p>Obturator hernia is rare. It occurs when part of the pelvic contents protrude through the obturator foramen. It is a diagnostic challenge in the emergency department since the signs and symptoms are non-specific. It often occurs in elderly, emaciated and chronically ill women. The clinical picture include intestinal obstruction with abdominal pain, nausea and vomiting. The treatment is only surgical. Delayed diagnosis of this condition usually leads to a high mortality rate. We report the case of an 83-year-old woman with a strangulated obturator hernia. The hernia was discovered early by computed tomography and was treated by emergency laparotomy. We emphasize on the rule of CT scan to establishing a prompt preoperative diagnosis of an obturator hernia, appropriate planning of surgical intervention and thus optimizing the outcome.</p> Walid Mnari Badii Hmida Mezri Maatouk Ahmed Zrig Mondher Golli Copyright (c) 2019-03-26 2019-03-26 32 1 Porcine cysticercosis in slaughtered pigs and factors related to Taenia solium transmission amongst abattoir workers in Ibadan, Nigeria https://www.ajol.info/index.php/pamj/article/view/209525 <p><strong>Introduction:&nbsp;</strong>porcine cysticercosis is under-reported particularly in Nigeria, despite the reportedly high prevalence of epilepsy and associated life-threatening health implications. This study aimed at determining the prevalence of porcine cysticercosis and factors related to&nbsp;<em>Taenia solium</em>&nbsp;transmission to humans.</p> <p><strong>Methods:&nbsp;</strong>slaughtered pigs at a major abattoir, south-western Nigeria were randomly inspected and questionnaire was administered to pig workers/consumers while the data were analysed using Stata 12.0.</p> <p><strong>Results:&nbsp;</strong>a 4.4% (11/250) prevalence of porcine cysticercosis was obtained; the age, breed, sex and body conditions of pigs were not significant for infection (p &lt; 0.05). Further, none (0.0%) of the respondents knew that&nbsp;<em>T. solium</em>&nbsp;could cause epilepsy in man and 39.5% often defaecated on neighbouring open fields and farmlands. Respondents purchasing pork from home slaughter were about four and 10 times less likely to demonstrate good knowledge (OR = 0.24; 95% CI: 0.08-0.74) and practice (OR = 0.10; 95% CI: 0.05-0.22) than those purchasing from abattoir. Moreover, those lacking toilet facility were about four and five times less likely to demonstrate good knowledge (OR = 0.24; 95% CI: 0.07-0.86) and practice (OR = 0.19; 95% CI: 0.08-0.45) than those who had it. Other factors associated with practices related to&nbsp;<em>T. solium</em>&nbsp;transmission included age (p = 0.000), sex (p = 0.000) and duration (p = 0.003).</p> <p><strong>Conclusion:&nbsp;</strong>the increased odds of poor knowledge and practices related to&nbsp;<em>Taenia solium</em>&nbsp;transmission especially among respondents purchasing home slaughter pork and lacking toilet facility provides insights into the parasite epidemiology. Above findings are important in lowering the infection prevalence in pigs and humans in this endemic area.</p> Hezekiah Kehinde Adesokan Fiyinfoluwa Adedolapo Adeoye Copyright (c) 2019-03-26 2019-03-26 32 1 Abortion practices among women in Buéa: a socio-legal investigation https://www.ajol.info/index.php/pamj/article/view/209527 <p><strong>Introduction:&nbsp;</strong>there are controversies surrounding the practice of abortion especially in developing countries of Africa. Cameroon is not an exception to this and hence this study aims at assessing knowledge on the awareness of abortion laws, the factors that determine abortion and people’s perceptions on the legality of abortion in Cameroon.</p> <p><strong>Methods:&nbsp;</strong>the study is cross-sectional in its design. A total of 224 women were randomly sampled. Data for the study were collected through the use of questionnaires from the sampled women of child bearing age. These were used to assess knowledge on the awareness of abortion laws and the determinants of abortion. The data were analysed using STATA 15.</p> <p><strong>Results:&nbsp;</strong>the prevalence of induced abortion was 21%. The major determinants of abortion among these women were; desire to stay in school (28%), fear of parents (24%) and shame of being pregnant out of wedlock (26%). Furthermore, many women are not aware of the situations where abortion is allowed and hence some still undertake illegal abortions even when they find themselves in situations deserving a legal abortion.</p> <p><strong>Conclusion:&nbsp;</strong>induced abortion is still common in Buea, Cameroon despite the fact that it is illegal. Cameroon’s legal and health system needs to work in harmony in order to lessen the legal processes of having a legal abortion.</p> Mbuwir Charlotte Bongfen Essimien Elizabeth Bessem Abanem Copyright (c) 2019-03-26 2019-03-26 32 1 Orbital varix: rare cause of blepharospasm https://www.ajol.info/index.php/pamj/article/view/209529 <p>Orbital varix (or varicose) is an exceptional pathology with poor clinical sign. The blepharospasm can be a revealing cause. The long-term risk is optic atrophy and blindness. Magnetic resonance imaging is the best diagnostic tools. The rise of lesion dimensions by Valsalva maneuvers and prone position is characteristic. We report the observation of a 42-year-old young man, consulting for a blepharospasm of the left eye evolving for two years. Imaging investigations made the diagnosis of orbital varicose.</p> Badii Hmida Walid Mnari Mezri Maatouk Ahmed Zrig Mondher Golli Copyright (c) 2019-03-26 2019-03-26 32 1 Evaluation of interleukin 8 and interleukin 10 cytokines in liquid based cervical cytology samples https://www.ajol.info/index.php/pamj/article/view/209531 <p><strong>Introduction:&nbsp;</strong>inflammatory cytokines have been associated with various cancers, including cervical cancers. Interpreting cytokine expression in liquid based cervical samples is quite challenging. This study is aimed at evaluating the levels of interleukin 8 and 10 in liquid based cervical samples.</p> <p><strong>Methods:&nbsp;</strong>this is a descriptive analytical study carried out on eighty five (85) subjects aged between 23 and 68 years. Cervical samples were collected in liquid based medium and smears later examined after staining with Papanicolaou technique. These were categorized into low grade intra-epithelial lesion/malignancy, high grade intraepithelial lesion/malignancy according to the degree of dyskaryosis. Concentrations of interleukin 8 and interleukin 10 in the samples were determined by enzyme linked immunosorbent assay.</p> <p><strong>Results:&nbsp;</strong>the mean age, standard deviation (SD) of the study subjects were 40.6 (7.8) years. A total number of 79 females (92.9%) were negative for intra-epithelial lesion/malignancy (NILM), while 4 (4.71%) and 2 (2.35%) were positive for low grade intra-epithelial lesion/malignancy (LILM) and high grade intra-epithelial lesion (HILM) respectively. While mean levels of interleukin 8 increased with the degree of malignancy, (107.27 ± 11.88pg/ml) in LILM, (114.80 ± 2.12pg/ml) in HILM when compared with NILM (88.39 ± 18.06pg/ml), (f = 0.700, p = 0.018); the mean levels of interleukin 10 was comparable between these groups (p ≥ 0.05). Pearson correlation coefficient analysis showed a negative association between interleukin 8 and interleukin 10 (r = -1.999, p = 0.000) in LILM.</p> <p><strong>Conclusion:&nbsp;</strong>interleukin 8 cytokines in cervical cancer is associated with the degree of malignancy. Possible anti-inflammatory effect of interleukin 10 was not observed.</p> Daniel David Osiagwu Alfred Ederialo Azenabor Abimbola Akinduro Osijirin Philomina Ikuoyah Awopetu Folasade Ruth Oyegbami Copyright (c) 2019-03-26 2019-03-26 32 1 Rupture du tendon rotulien avec fracture fermée distale du fémur homolatéral https://www.ajol.info/index.php/pamj/article/view/209532 <p>Un patient de 45 ans a subi un traumatisme du genou droit à la suite d'un accident de la voie publique occasionnant chez lui une fracture distale supra condylienne comminutive du fémur droit et une rupture du tendon rotulien ipsilatérale. Cette association est exceptionnelle et aucun cas n'a été retrouvé dans la littérature. Un diagnostic précis clinique et radiologique suivi d'une prise en charge précoce et adaptée par une ostéosynthèse interne et une rééducation fonctionnelle précoce et adaptée ont permis d'obtenir de bons résultats à long terme.</p> Soufiane Aharram Yahyaoui Mounir Abdelhafid Derfoufi Abdessamad Kharraji Jawad Amghar Jawad Amghar Mohammed Benhamou Lamhaoui Abdessamad Bouziane Walid Sadougui Mohammed Omar Agoumi Abdelkarim Daoudi Copyright (c) 2019-03-26 2019-03-26 32 1 Measles outbreak investigation in an urban slum of Kaduna Metropolis, Kaduna State, Nigeria, March 2015 https://www.ajol.info/index.php/pamj/article/view/209538 <p><strong>Introduction:&nbsp;</strong>despite availability of an effective vaccine, the measles epidemic continue to occur in Nigeria. In February 2015, we investigated a suspected measles outbreak in an urban slum in Rigasa, Kaduna State, Nigeria. The study was to confirm the outbreak, determine the risk factors and implement appropriate control measures.</p> <p><strong>Methods:&nbsp;</strong>we identified cases through active search and health record review. We conducted an unmatched case-control (1:1) study involving 75 under-5 cases who were randomly sampled, and 75 neighborhood controls. We interviewed caregivers of these children using structured questionnaire to collect information on sociodemographic characteristics and vaccination status of children. We collected 15 blood samples for measles IgM using Enzyme Linked Immunosorbent Assay. Descriptive, bivariate and logistic regression analyses were performed using Epi-info software. Confidence interval was set at 95%.</p> <p><strong>Results:&nbsp;</strong>we recorded 159 cases with two deaths {case fatality rate = 1.3%}. 50.3% (80) of the cases were male. Of the 15 serum samples, 11(73.3%) were confirmed IgM positive for measles. Compared to the controls, the cases were more likely to have had no or incomplete routine immunization (RI) [adjusted odds ratio (AOR) (95% confidence interval (CI)]: 28.3 (2.1, 392.0), contact with measles cases [AOR (95% CI)]: 7.5 (2.9, 19.7), and having a caregiver younger than 20 years [AOR (95% CI)]: 5.2 (1.2, 22.5). Measles serum IgM was positive in 11 samples.</p> <p><strong>Conclusion:&nbsp;</strong>we identified low RI uptake and contact with measles cases as predictors of measles outbreak in Rigasa, Kaduna State. We recommended strengthening of RI and education of care-givers' on completing RI schedule.</p> Obafemi Joseph Babalola Ismaila Nda Ibrahim Ibrahim Usman Kusfa Saheed Gidado Patrick Nguku Adebola Olayinka Aisha Abubakar Copyright (c) 2019-03-28 2019-03-28 32 1 Ankylose de l'articulation temporo-mandibulaire post-arthrosique https://www.ajol.info/index.php/pamj/article/view/209543 <p>L'ankylose de l'articulation temporo-mandibulaire (ATM) est définie comme une constriction permanente des mâchoires avec ouverture buccale inférieure à 30 mm mesurée entre les incisives, survenant en raison d'une fusion osseuse, fibreuse ou fibro-osseuse. L'arthrose est une cause rare de l'ankylose de L'ATM. Nous rapportons un cas d'ankylose de l'ATM d'origine arthrosique, afin de préciser les particularités diagnostiques et thérapeutiques de cette entité pathologique assez rare.</p> Abdelouahid Taleuan Dounia Kamal Lotfi Aouinti Moahamed Nourdine Elalami Copyright (c) 2019-03-28 2019-03-28 32 1 Barriers and facilitators to implementing a regional anesthesia service in a low-income country: a qualitative study https://www.ajol.info/index.php/pamj/article/view/209550 <p><strong>Introduction:&nbsp;</strong>regional anesthesia is a safe alternative to general anesthesia. Despite benefits for perioperative morbidity and mortality, this technique is underutilized in low-resource settings. In response to an identified need, a regional anesthesia service was established at the University Teaching Hospital of Kigali (CHUK), Rwanda. This qualitative study investigates the factors influencing implementation of this service in a low-resource tertiary-level teaching hospital.</p> <p><strong>Methods:&nbsp;</strong>following service establishment, we recruited 18 local staff at CHUK for in-depth interviews informed by the “Consolidated Framework for Implementation Research” (CFIR). Data were coded using an inductive approach to discover emergent themes.</p> <p><strong>Results:&nbsp;</strong>four themes emerged during data analysis.&nbsp;<em>Patient experience and outcomes:</em>&nbsp;where equipment failure is frequent and medications unavailable, regional anesthesia offered clear advantages including avoidance of airway intervention, improved analgesia and recovery and cost-effective care. Professional&nbsp;<em>satisfaction:</em>&nbsp;morale among healthcare providers suffers when outcomes are poor. Participants were motivated to learn techniques that they believe improve patient care.&nbsp;<em>Human and material shortages:</em>&nbsp;clinical services are challenged by high workload and human resource shortages. Advocacy is required to solve procurement issues for regional anesthesia equipment.&nbsp;<em>Local engagement for sustainability:</em>&nbsp;participants emphasized the need for a locally run, sustainable service. This requires broad engagement through education of staff and long-term strategic planning to expand regional anesthesia in Rwanda.</p> <p><strong>Conclusion:&nbsp;</strong>while the establishment of regional anesthesia in Rwanda is challenged by human and resource shortages, collaboration with local stakeholders in an academic institution is pivotal to sustainability.</p> Matthew Ho Patricia Livingston M Dylan Bould Jean Damascène Nyandwi Françoise Nizeyimana Jean Bonaventure Uwineza Robin Urquart Copyright (c) 2019-04-01 2019-04-01 32 1 Traumatic spinal injuries in the Kingdom of Saudi Arabia: a study of associated injuries, management and mortality https://www.ajol.info/index.php/pamj/article/view/209553 <p><strong>Introduction:&nbsp;</strong>traumatic spinal fracture is a painful and disabling injury associated with poor long-term functional outcome. The objective of the present study was to assess the frequency of spinal fractures in road traffic accident (RTA) victims, their management, mortality rate and associated injuries. This study reveals and adds useful insights to the literature from Kingdom of Saudi Arabia (KSA) in terms of incidence of RTA-related spinal fractures, including their management and mortality rate.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted at King Khalid Hospital and Prince Sultan Center for Health Services (KKH &amp; PSCHS) in AlKharj, KSA from September 2016 to June 2017. A total of 120 patients suffering from spinal/vertebral fractures due to RTAs were included in this study. The data was collected from patients' charts, including age, gender, region or distribution of the spinal fracture, associated fractures, number of fractures, degrees of shock, admission to intensive care unit (ICU), treatment modalities, along with the management of spinal fractures, days of hospital stay, referral and discharges or deaths.</p> <p><strong>Results:&nbsp;</strong>the mean age of patients was 29.21. The most common anatomic region of the fracture was the cervical region (35%). Injuries associated with traumatic spinal fracture were predominated by clavicular fractures. More than half of the victims (58.30%) had a cervical brace applied before leaving the hospital. 29.20% patients required posterior stabilization with pedicle screws. Anterior corpectomy, grafting and plating was done to 4.30% patients.</p> <p><strong>Conclusion:&nbsp;</strong>traumatic spinal fractures require prompt diagnosis and timely management in order to improve the outcome.</p> Khalid Mansour Alkhathlan Mohammad Ghormallah Alzahrani Khalid Hadi Aldosari Mohammed Ibrahim Alsheddi Abdullah Abdulrahman Alqeair Copyright (c) 2019-04-01 2019-04-01 32 1 Evaluation of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in recurrent epistaxis in childhood: case controlled study https://www.ajol.info/index.php/pamj/article/view/209558 <p><strong>Introduction:&nbsp;</strong>the aim of this study was to investigate the possible relationship of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) and routine hematological parameters with recurrent epistaxis in children.</p> <p><strong>Methods:&nbsp;</strong>in this retrospective case-controlled study, 294 patients aged between 2 and 18 years who applied to the Tokat State Hospital Ear Nose Throat Clinic due to recurrent epistaxis between January 1<sup>st</sup>&nbsp;2013 and December 31<sup>st</sup>&nbsp;December 2017 and 329 sex-and age-matched controls were investigated.</p> <p><strong>Results:&nbsp;</strong>NLR was 1.45±0.75 in the study group and the 1.35±0.7 in the control group. There was no significant difference between the groups (p&gt;0.05). PLR values were found significantly (p&lt;0.05) higher in the study group than in the control group (103,21±29.57 vs. 97,3±30.38). Red Blood Cell Distribution Width (RDW) values were found significantly (p&lt;0.05) lower in the study group than in the control group (39,56±2,87 and 38,92±2,46).</p> <p><strong>Conclusion:&nbsp;</strong>the increase of PLR, an inflammatory marker, in epistaxis supports the effect of inflammatory factors in the etiology of epistaxis. However, more study in future is needed to support this.</p> Ceyhun Aksakal Mehmet Şahin Copyright (c) 2019-04-02 2019-04-02 32 1 Individualized dosing of oral propranolol for treatment of infantile hemangioma: a prospective study https://www.ajol.info/index.php/pamj/article/view/209563 <p><strong>Introduction:&nbsp;</strong>infantile hemangioma is the most common benign tumor in infancy. Currently, oral propranolol is the treatment of choice for infantile hemangioma, but there is no consensus when it comes to its recommended dosage for this condition. Hence this study was conducted to find out the appropriate dosage of oral propranolol for treatment of infantile hemangioma.</p> <p><strong>Methods:&nbsp;</strong>a prospective study was conducted on 25 patients with infantile hemangioma, who were treated with gradually increasing dose of propranolol starting from a lower dose of 1mg/kg/day.</p> <p><strong>Results:&nbsp;</strong>17/22(76%) patients showed regression of the tumor at the dose of 1- 1.5 mg/kg/d. 5/22(24%) patients were unresponsive to the treatment with the lower dose and they did not respond even with the gradually escalated dose of 3-4 mg/kg/day.</p> <p><strong>Conclusion:&nbsp;</strong>propranolol in a lower dose of 1-1.5 mg/kg/day is safe and efficacious in the treatment of infantile hemangioma and the lesions which do not show initial response to the lower dose are unlikely to respond to the higher dose of 3-4 mg/kg/day.</p> Arun Prasad Amit Kumar Sinha Bindey Kumar Abhiranjan Prasad Manju Kumari Copyright (c) 2019-04-08 2019-04-08 32 1 Prevalence of smoking among male secondary school students in Arar City, Saudi Arabia https://www.ajol.info/index.php/pamj/article/view/209566 <p><strong>Introduction:&nbsp;</strong>tobacco is one of the leading preventable cause of death worldwide. Tobacco consumption among teenagers is a major public health problem, especially in developing countries. Younger smokers are more liable to smoking complications. The objectives were to evaluate the prevalence of smoking among male secondary school students in the Northern Borders region, KSA.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted in Arar city. Four schools were chosen randomly from 21 secondary schools. A total of 240 students responded to the pre-designed questionnaire. The questionnaire included questions on demographic factors, smoking behavior and knowledge about smoking hazards.</p> <p><strong>Results:&nbsp;</strong>prevalence of current smoking among male secondary school students is 40.8%. Cigarette smoking was the most common type (67.3%) followed by Shish smoking(22.4%). Few students (2.1%) reported other forms of smoking, example (Hashish). Of the studied group, 39.8% smoke on a daily basis with 29.6% of them smoke more than five cigarettes per day.</p> <p><strong>Conclusion:&nbsp;</strong>smoking is a prevalent habit among teenagers. Special concern should be directed to smoking cessation campaigns with behavioral, legal and economic interventions.</p> Fahed Hlilan Albangy Amal Elwan Mohamed Sabry Mohamed Hammad Sabry Mohamed Hammad Copyright (c) 2019-04-08 2019-04-08 32 1 Endocardite infectieuse mitro-aortique compliquée de perforation valvulaire, d’anévrisme mycotique et d’infarctus spleno-rénal https://www.ajol.info/index.php/pamj/article/view/209569 <p>L'endocardite infectieuse est considérée comme une pathologie potentiellement grave malgré tous les progrès en diagnostic et traitement. Les valves du cœur gauche sont plus touchées et les évènements emboliques, les anévrismes mycotiques, les abcès ainsi que les perforations des valves en sont des complications redoutables. Nous rapportons le cas d'une endocardite ayant atteint les valves aortique et mitrale et qui s'est compliquée d'infarctus splénique et rénale, d'anévrisme mycotique cérébral et d'une perforation de la grande valve mitrale. L'intérêt du cas est souligné suite à la bonne évolution au décours d'un traitement médico-chirurgical en dépit de la multitude des complications.</p> Mohammed Bachrif Houssam Laachach Ilham Benahmed Mehdi Berrajaa Alaa Fliti Mustapha Aziouaz Nabila Ismaili Noha Elouafi Copyright (c) 2019-04-08 2019-04-08 32 1 Service de Cardiologie, Faculté de Médecine, Université Mohammed Premier, Oujda, Maroc https://www.ajol.info/index.php/pamj/article/view/209574 <p>L’amylose rénale est une complication rare au cours de la maladie de Still de l’adulte. Nous rapportons 3 observations d’amylose rénale parmi une série de 33 cas de maladie de Still de l’adulte. Il s’agit de 3 patientes d’âge moyen de 43 ans (extrême: 33 et 58 ans). Le diagnostic de maladie de Still a été retenu devant une polyarthrite fébrile (3 cas) associée à une éruption cutanée fugace (1 cas), un syndrome inflammatoire biologique en l’absence de toute cause infectieuse, inflammatoire ou néoplasique. Toutes ont été traitées par une corticothérapie associée secondairement au méthotrexate devant une polyarthrite destructrice (2 cas) et devant une récidive (1 cas). Une amylose rénale était survenue 4,9 ans après la maladie de Still (extrême: 33 mois et 7ans). L’amylose était révélée par un syndrome néphrotique (3 cas), associé à une insuffisance rénale (1 cas). Le diagnostic a été posé par une ponction biopsie rénale (3 cas) concluant à une amylose AA (2 cas) et non typée (1 cas). Tous les malades ont reçu la colchicine. L’évolution était favorable chez une patiente alors que les deux autres ont évolué vers l’insuffisance rénale chronique. L’amylose rénale est une atteinte inhabituelle de la maladie de Still de l’adulte. Une fois installée, elle peut engager le pronostic vital.</p> Marzouk Sameh Ben Salah Raida Cherif Yosra Jallouli Moez Garbaa Saida Kammoun Khawla Hachicha Jamil Bahloul Zouhir Copyright (c) 2019-04-08 2019-04-08 32 1 Factors associated with unfavourable tuberculosis treatment outcomes in Lusaka, Zambia, 2015: a secondary analysis of routine surveillance data https://www.ajol.info/index.php/pamj/article/view/209578 <p><strong>Introduction:&nbsp;</strong>focus has been put on strengthening surveillance systems in high tuberculosis (TB) burden countries, like Zambia, however inadequate information on factors associated with unfavourable TB treatment outcomes is generated from the system. We determined the proportion of tuberculosis treatment outcomes and their associated factors.</p> <p><strong>Methods:&nbsp;</strong>we defined unfavourable outcome as death, lost-to-follow-up, treatment-failure, or not-evaluated and favourable outcome as a patient cured or completed-treatment. We purposively selected a 1<sup>st</sup>&nbsp;level hospital, an urban-clinic and a peri-urban clinic. We abstracted data from TB treatment registers at these three health facilities, for all TB cases on treatment from 1<sup>st</sup>&nbsp;January to 31<sup>st</sup>&nbsp;December, 2015. We calculated proportions of treatment outcomes and analysed associations between unfavourable outcome and factors such as age, HIV status, health facility, and patient type, using univariate logistics regression. We used multivariable stepwise logistic regression to control for confounding and reported the adjusted odds ratios (AOR) and 95% confidence intervals (CI).</p> <p><strong>Results:&nbsp;</strong>we included a total of 1,724 registered TB patients, from one urban clinic 694 (40%), a 1<sup>st</sup>&nbsp;Level Hospital 654 (38%), and one peri-urban-clinic 276 (22%). Of the total patients, 43% had unfavourable outcomes. Of the total unfavourable outcomes, were recorded as treatment-failure (0.3%), lost-to-follow-up (5%), death (9%) and not evaluated (29%). The odds of unfavourable outcome were higher among patients &gt; 59 years (AOR=2.9, 95%CI: 1.44-5.79), relapses (AOR=1.65, 95%CI: 1.15-2.38), patients who sought treatment at the urban clinic (AOR=1.76, 95%CI:1.27-2.42) and TB/HIV co-infected patients (AOR=1.56, 95%CI:1.11-2.19).</p> <p><strong>Conclusion:&nbsp;</strong>unfavourable TB treatment outcomes were high in the selected facilities. We recommend special attention to TB patients who are &gt; 59 years old, TB relapses and TB / HIV co-infected. The national TB programme should strengthen close monitoring of health facilities in increasing efforts aimed at evaluating all the outcomes. Studies are required to identify and test interventions aimed at improving treatment outcomes.</p> Francis Hamaimbo Nanzaluka Sylvia Chibuye Clara Chola Kasapo Nelia Langa Sulani Nyimbili Given Moonga Nathan Kapata Ramya Kumar Gershom Chongwe Copyright (c) 2019-04-08 2019-04-08 32 1 Pronostic obstétrical des femmes atteintes de vaginisme primaire https://www.ajol.info/index.php/pamj/article/view/209581 <p><strong>Introduction:&nbsp;</strong>dysfonction importante, le vaginisme est un problème tant individuel que du couple qui peut altérer la relation sexuelle. Il peut influencer le pronostic obstétrical. Le but de cette étude était de déterminer si les caractéristiques cliniques du vaginisme ont une incidence sur le processus de l’accouchement.</p> <p><strong>Méthodes:&nbsp;</strong>étude rétrospective multicentrique incluant des patientes affectées par un vaginisme primaire, ayant donné naissance à terme à un premier enfant vivant, entre 2005 et 2015.</p> <p><strong>Résultats:&nbsp;</strong>sur les 19 patientes inclues dans l’étude, nous avons constaté 9 grossesses prolongées, 14 mises en travail spontanées (dont 8 à terme atteint), 3 césariennes en dehors du travail et 2 déclenchements artificiels. Parmi les 16 femmes ayant eu un travail, nous avons dénombré 4 césariennes, 5 accouchements par voie basse avec forceps et 7 par voie basse spontanée. Parmi les 12 accouchements par voie basse, 9 épisiotomies ont été pratiquées, 7 femmes ont présenté des déchirures périnéales spontanées seules ou associées à une épisiotomie, aucune lésion périnéale de type 3 ou 4, ni de périnées intacts n’ont été recensés. Le poids moyen des nouveau-nés était de 3380g±332 (2870g-3970g, 47<sup>e</sup>&nbsp;percentile).</p> <p><strong>Conclusion:&nbsp;</strong>la proportion d’accouchements dystociques et la morbidité périnéale étaient notablement élevées, ce qui parait comparable avec la plupart des données de la littérature. Il est possible que les composantes psychologiques et comportementales du vaginisme, (mécanisme de peur-évitement, anxiété) aient favorisé les grossesses prolongées, les césariennes, les dystocies mécaniques et les lésions périnéales. Des études complémentaires sont nécessaires afin de mieux cerner le vaginisme et ses implications obstétricales.</p> Elise Tourrilhes Marie Veluire David Hervé Erdogan Nohuz Copyright (c) 2019-04-08 2019-04-08 32 1 Electrophorèse des protéines sériques: étude de 410 profils électrophorétiques https://www.ajol.info/index.php/pamj/article/view/209584 <p>L'électrophorèse des protéines sériques (EPS) est une analyse de routine dans la pratique quotidienne d'un laboratoire de biologie médicale. Le but de notre étude est d’analyser les différents profils électrophorétiques rencontrés dans notre pratique courante. Nous avons mené une étude transversale portant sur 410 échantillons sériques qui ont été collectés dans le cadre de l’analyse de routine au sein du laboratoire de biochimie du Centre Hospitalier Universitaire (CHU) Mohammed VI d’Oujda. L’électrophorèse des protéines sériques a été réalisée sur automate Capilarys2 Flex piercing de Sebia. 241 sérums de femmes et 169 sérums d’hommes ont été collectés. Âgés de 1 à 91 ans avec une moyenne d’âge de 49 ans. 19,5% des EPS étaient normales, l’hypo-albuminémie a été noté chez 34% des cas, un syndrome inflammatoire chronique dans 19,5% des cas, un syndrome néphrotique chez 2% des cas, 5,8% de nos patients avaient un bloc béta-gamma, une hypogammaglobulinémie a été observée dans 8,5% des cas, et 29 pics monoclonaux ont été notés, une bis-albuminémie a été objectivée chez 2 patients. Sur les 410 prélèvements: 92 immunofixations ont été réalisées dont 23 étaient positives (objectivant une gammapathie monoclonale). Cette étude met en évidence la variabilité des motifs de prescription d’une électrophorèse des protéines sériques, ainsi que l’importance des données cliniques pour une interprétation meilleure.</p> Ouardia Bouayadi Mohammed Bensalah Nawal Rahmani Said Assoufi Mohammed Choukri Copyright (c) 2019-04-08 2019-04-08 32 1 Age de début de la presbytie chez le sujet noir camerounais https://www.ajol.info/index.php/pamj/article/view/209588 <p><strong>Introduction:&nbsp;</strong>la prescription d'une addition dans notre pratique n'est pas rare chez les patients de moins de 40 ans. Nous avons recherché le besoin d'une addition après étude objective de la réfraction et partant déterminer l'âge moyen de début de la presbytie.</p> <p><strong>Méthodes:&nbsp;</strong>nous avons mené une étude transversale et descriptive à l'Hôpital Central de Yaoundé durant trois mois chez les patients âgés de 35 à 45 ans. Ils ont tous bénéficié d'une étude objective de la réfraction sous cycloplégie. La correction de la vision de loin était faite sous cycloplégie, alors que l'addition en vison de près était évaluée deux jours plus tard lorsque la cycloplégie n'était plus effective. La prescription probable d'une addition à la correction de loin devait être réalisée 2 jours après la cycloplégie. L'analyse statistique a été faite avec le logiciel IBM SPSS 20.0.</p> <p><strong>Résultats:&nbsp;</strong>nous avons examiné 55 patients soit 110 yeux. L'âge moyen des patients était de 41,87±2,5 ans, avec un sex-ratio de 0,28 en faveur des femmes. L'astigmatisme hypermétropique était l'amétropie la plus fréquente avec 58,2% de cas suivi de l'hypermétropie avec 24,6%. Nous n'avons retrouvé aucun sujet myope. L'âge moyen de début de la presbytie dans cette tranche d'âge était de 43,2±1,7 ans. Après correction objective en vision de loin, aucun patient n'avait besoin d'une addition avant 40 ans. Par ailleurs, 4 patients sur 10 avec une amétropie hypermétropique n'ont pas besoin d'addition avant 45 ans. La prescription d'une addition était liée de façon significative à l'âge.</p> <p><strong>Conclusion:&nbsp;</strong>l'âge moyen de début de la presbytie est de 43,2±1,7 ans. Avant 45 ans, toute prescription d'une addition doit être précédée d'une étude objective de la réfraction.</p> Stève Robert Ebana Mvogo Viola Andin Dohvoma José Stéphanie Ngassam Fangwa Caroline Mvilongo Tsimi Marie Evodie Akono Zoua Marie Blanche Nguena Epee Emilienne Augustin Ellong Côme Ebana Mvogo Copyright (c) 2019-04-09 2019-04-09 32 1 Setting priorities for disaster management in the East African sub-region https://www.ajol.info/index.php/pamj/article/view/209626 <p>La localisation cervicale de la tuberculose est rare et peut prendre l'apparence d'un cancer du col utérin. La présentation pauci-symptomatique et l'évolution insidieuse sont à l'origine d'un retard diagnostique. Les symptômes communément rencontrés sont non spécifiques, ce qui contribue au retard thérapeutique et majore le risque d'infertilité qui reste la séquelle quasi inéluctable. Nous rapportons un cas de tuberculose du col utérin dont le diagnostic de prime abord n'a pas été évident. En effet une patiente a été adressée à notre département pour suspicion de cancer du col utérin. Le diagnostic de suspicion de cancer a été alors retenu devant un col qui saignait au contact avec une tomodensitométrie abdomino-pelvienne en faveur d'une tumeur du col utérin. Une biopsie de confirmation histologique a été indiquée. On a retrouvé à l'examen anatomopathologique, un granulome épithélio-giganto-cellulaire avec nécrose caséeuse, compatible avec une tuberculose cervicale. La recherche d'un terrain était négative. Un traitement antituberculeux instauré a conduit à la guérison. Retenue souvent sur la base d'éléments présomptifs, la décision diagnostique et thérapeutique de tuberculose du col cervicale reconnait la place de l'examen anatomopathologique.</p> Michel Assane Ndour Maimouna Sow Ibou Thiam Boundia Djiba Fabrice Senghor Nafi Diagne Awa Cheikh Ndao Abdoulaye Pouye Copyright (c) 2019-04-09 2019-04-09 32 1 Write-up and dissemination of undergraduate and postgraduate research at the University of Rwanda: a cross-sectional study https://www.ajol.info/index.php/pamj/article/view/209633 <p><strong>Introduction:&nbsp;</strong>research is essential in all areas of health development. However, medical students and residents frequently lack the time and training on performing research. This is especially prevalent in resource-limited settings. We aimed to compare the word counts of undergraduate and postgraduate dissertations with published projects in Rwanda, and to identify the proportion of postgraduate pediatric research projects that have been published since 2012.</p> <p><strong>Methods:&nbsp;</strong>retrospective, cross-sectional study of undergraduate and postgraduate research dissertations at the University of Rwanda. Dissertations were then compared to randomly selected published papers of Rwandan research. Each IMRaD (Introduction, Methodology, Results and Discussion) section word count was compared using Student's t-test.</p> <p><strong>Results:&nbsp;</strong>19/190 (10%) undergraduate dissertations and 22/41 (54%) postgraduate dissertations, were available in electronic format for word-count analysis. The mean total word count for postgraduate dissertations (5163 words) was significantly longer (p&lt;0.001) than the randomly selected peer-reviewed journal articles (2959 words). Each section of the IMRaD structure of postgraduate dissertations was significantly longer than those of the control group. Undergraduates used a similar number of words to published papers, but used significantly more tables and figures. Of the 41 postgraduate dissertations, only four (10%), were published in peer-reviewed journals.</p> <p><strong>Conclusion:&nbsp;</strong>this is the first study to assess the writing style of Rwandan medical students and pediatric postgraduate residents. A simple step to increase dissemination of research findings would be for institutions to modify academic regulations so that students write-up in manuscript form rather than dissertation format.</p> Christian Nsanzabaganwa Hubert Habineza Naphtal Nyirimanzi Christian Umuhoza Katie Cartledge Craig Conard Peter Cartledge Copyright (c) 2019-04-09 2019-04-09 32 1 The prognostic value of serum uric acid in the acute phase of hemorrhagic stroke patients in black Africans https://www.ajol.info/index.php/pamj/article/view/209644 <p><strong>Introduction:&nbsp;</strong>very few studies have been conducted to evaluate the prevalence of hyperuricemia and its impact on the prognosis amongst acute hemorrhagic stroke (AHS) patients. The objectives was to determine the prevalence of hyperuricemia in AHS patients and examined the association between hyperuricemia and stroke outcomes in the Douala General Hospital (DGH).</p> <p><strong>Methods:&nbsp;</strong>this was a hospital based prospective cohort which included AHS patients with baseline SUA levels and 3 months post stroke follow-up data. SUA values were divided into quintiles. Associations between hyperuricemia and stroke outcomes were analyzed using multiple logistic regression and survival analysis (cox regression and Kaplan Meier).</p> <p class="ParagraphSeparator">&nbsp;</p> <p><strong>Results:&nbsp;</strong>a total of 221 AHS patients were reviewed with a mean age of 55.8±11.8 years. The prevalence of hyperuricemia among AHS patients was 34.4% with mean SUA level of 376.8±131.9 µmol/l. On multivariate analysis, hyperuricemia was not independently associated with early death [(OR = 1.072 (CI: 0.370-3.056; p = 0.897)] and poor functional outcome [(OR=2.487 (CI: 0.771-8.699; p = 0.154)] after hemorrhagic stroke. No significant increase in stroke deaths was observed across higher SUA quintiles amongst hemorrhagic stroke patients (p = 0.326). No statistically significant correlation was observed between SUA level and NIHSS (r = 0.063, p = 0.353) and between SUA level and mRS (r = 0.030, p = 0.662) in hemorrhagic stroke.</p> <p><strong>Conclusion:&nbsp;</strong>about one third of patients present with hyperuricemia in the acute phase of hemorrhagic stroke. Hyperuricemia can act as risk factor for stroke because of its relationship with CVRFs but hyperuricemia has no impact on the severity and short-term outcome amongst black African hemorrhagic stroke patients.</p> Yacouba Njankouo Mapoure Chia Mark Ayeah Hamadou Ba Hugo Bertrand Mbatchou Ngahane Romuald Hentchoya Henry Namme Luma Copyright (c) 2019-04-09 2019-04-09 32 1 Superbugs-related prolonged admissions in three tertiary hospitals, Kano State, Nigeria https://www.ajol.info/index.php/pamj/article/view/209651 <p><strong>Introduction:&nbsp;</strong>superbugs are pathogenic micro-organism and especially a bacterium that has developed resistance to the medications normally used against it. As the superbug family increases, the need for appropriate diagnostic, treatment, prevention and control strategies cannot be over emphasized. Therefore, this work determined the distribution of superbug bacteria among patients on prolonged hospital admissions in three tertiary hospitals of Kano state, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a descriptive cross sectional study was undertaken among 401 patients from medical, surgery, orthopedic and burn Centre wards in a three tertiary hospitals in Kano state. A sample collected comprises wound/pus, urine, urine catheter and nasal intubation and were analysed using standard microbiological methods for&nbsp;<em>Acinetobacter spp</em>&nbsp;and other related nosocomial bacterial pathogens. Antibiotic susceptibility testing was done using Kirby-Bauer disc diffusion method.</p> <p><strong>Results:&nbsp;</strong>one hundred and thirty eight (138) isolates were recovered, from the studied participants. More than 80% of the nosocomial infections (Nis) were caused by Gram-negative bacteria, predominantly Escherichia coli,&nbsp;<em>Klebseilla spp</em>,&nbsp;<em>Proteus spp</em>,&nbsp;<em>Pseudomona spp</em>&nbsp;and&nbsp;<em>Acinetobacter</em>&nbsp;spp. In-vitro antibiotic susceptibility test revealed that&nbsp;<em>acinetobacter</em>&nbsp;were 100% resistant to amoxicillin, co-trimoxazole, perfloxacin and imipenem.</p> <p><strong>Conclusion:&nbsp;</strong>the results of this study reported higher antibiotic resistant among&nbsp;<em>Acinetobacter spp</em>&nbsp;isolated from three studied hospitals. The healthcare managers of these hospitals and ministry health need to take measures against this resistant bacteria (<em>Acinetobacter spp</em>) especially on prescribing antibiotics that showed 100% resistant from these studied hospitals.</p> Alkali Bashir Iliyasu Garba Adamu Almustapha Aliero Abdurrazak Kibiya Muhammad Hassan Abubakar Ibrahim Ntulume Faruk Sarkinfada Agwu Ezera Copyright (c) 2019-04-09 2019-04-09 32 1 Une association malformative exceptionnelle: situs inversus totalis et hernie rétro-costo-xyphoidienne https://www.ajol.info/index.php/pamj/article/view/209661 <p>La hernie rétro-costo-xyphoïdienne est une malformation congénitale rare. Elle représente 3% de l'ensemble des hernies diaphragmatiques. Elle peut être isolée ou associée à d'autres malformations. Nous rapportons une observation rarissime d'hernie de Larrey-Morgagni et de situs inversus totalis découverts à la suite d'une détresse respiratoire néonatale.</p> Badr Slioui Mohammed Abdellaoui Soufiane Belabbes Rachida Dafiri Copyright (c) 2019-04-09 2019-04-09 32 1 Insights from the fifth International One Health Congress, 2018, Saskatoon, Canada https://www.ajol.info/index.php/pamj/article/view/209854 <p>The recent outbreaks of diseases including Ebola reemergence in the Democratic Republic of Congo (DRC), Nipah virus outbreak in India, Lassa virus in Nigeria and the continued Influenza pandemic shows that we cannot predict outbreaks, however, developing response plans could help alleviate the burden of diseases. Developing response plans involves strategies such as creating a repository of microbial agents as well as the implementation of the plans. In addition, zoonotic experts and policy makers should work together in order to succeed in fighting against any disease outbreaks. We should also not forget about the importance of vaccination because of the benefits it has brought to humankind preventing disease occurrence. Furthermore, the challenges that come with vaccination including vaccine delivery and vaccine uptake needs to be overcome to make sure that this public health tool continues to be effective. Overcoming these vaccination challenges would play a significant role in decreasing the overuse of antimicrobials, hence avoiding resistance. The One Health Community (OHC) therefore has the responsibility to advocate for the use of vaccines and show that it has costs benefits; this strategy has the potential to fight against antimicrobial resistance.</p> Anelisa Jaca Copyright (c) 2019-04-09 2019-04-09 32 1 Systemic mastocytosis: a rare cause of osteoporosis https://www.ajol.info/index.php/pamj/article/view/209856 <p>A 61-year old female patient who was referred to the endocrine clinic for evaluation of an elevated alkaline phosphatase. She was originally referred to gastroenterology (GI), however no GI causes of elevated alkaline phosphatase was found. Upon fractionation, it was noted that she had elevation in bone specific alkaline phosphatase. Past history was significant for hypertension, atrial fibrillation and menopause 6 years ago. She was also noted to have multiple drug allergies manifesting as urticaria and flushing. Review of the past records revealed a persistently elevated alkaline phosphatase over the last two years. She had no history of falls or fractures. Computed tomography (CT) abdomen done to rule out biliary pathology, revealed osteosclerotic and osteolytic lesion in the pelvis concerning neoplastic disease. Bone marrow biopsy however, was negative for cancer but consistent with systemic mastocytosis (SM). Dual Energy X-ray absorbimetery (DEXA) scan revealed osteoporosis Serum tryptase levels were elevated; further genetic analysis showed a positive CKIT D816 mutation. She was started on bisphosphonates (initially alendronate and then ibandronate). Upon follow up at two years she had not experienced any fractures and her bone mineral density also had improved significantly.</p> Vishnu Vardhan Garla Kanooz Ul Qadir Chaudhary Abid Yaqub Copyright (c) 2019-04-09 2019-04-09 32 1 Forme pseudo-tumorale d’une tuberculose broncho-pulmonaire chez un immunocompétent mimant un cancer https://www.ajol.info/index.php/pamj/article/view/209859 <p>La tuberculose est une maladie due à une infection par le bacille tuberculeux, tous les organes peuvent être touchés, la tuberculose pulmonaire représente un peu plus de 50% des atteintes, elle constitue un problème de santé publique dans le monde entier et particulièrement dans les pays en voie de développement. La tuberculose broncho-pulmonaire pseudo-tumorale est une forme de présentation particulière de la tuberculose chez le sujet immunocompétent, elle peut revêtir la forme d'une lésion bronchique ou pulmonaire évocatrice d'une pathologie néoplasique, que ce soit sur une TDM thoracique ou lors d'une endoscopie bronchique. Cette similitude avec la pathologie néoplasique est source de confusion pour le clinicien et rend difficile l'établissement du diagnostic positif, elle nécessite le recours à des moyens diagnostiques souvent invasifs, puisque les moyens classiques sont généralement mis à défaut, ce qui alourdit la prise en charge et retarde la mise sous traitement. L'objectif de cet article est de sensibiliser le clinicien vis-à-vis de cette forme particulière de présentation de la tuberculose, certes peu fréquente, mais à évoquer de principe devant un aspect radiologique compatible d'autant plus que le pays de résidence est de forte endémicité. Le traitement de cette forme demeure le même que celui des présentations habituelles, que ce soit en matière de médicaments ou de durée.</p> Mouhcin Daoudi Laila Herrak Mustapha El Ftouh Leila Achachi Copyright (c) 2019-04-09 2019-04-09 32 1 Evaluation de la qualité des concentrés de globules rouges produits au Centre National de Transfusion Sanguine de Lomé https://www.ajol.info/index.php/pamj/article/view/209861 <p><strong>Introduction:&nbsp;</strong>au Centre National de Transfusion Sanguine de Lomé, le sang total est systématiquement séparé en différents produits sanguins labiles. L'objectif de cette étude était d'évaluer la qualité des concentrés de globules rouges (CGR) qui y sont produits.</p> <p><strong>Méthodes:&nbsp;</strong>il s'est agi d'une étude transversale réalisée de janvier à mars 2018 qui a porté sur 260 CGR (204 unités adultes et 56 unités pédiatriques). Les poches incluses ont été pesées afin de déterminer le volume de leur contenu. Le taux d'hémoglobine et l'hématocrite ont été déterminés en utilisant l'automate Pentra XLR de Horiba Médical. Nous avons évalué la fidélité et la justesse de l'automate afin d'assurer la fiabilité des mesures des variables analysées. Les analyses statistiques ont été réalisées à l'aide du logiciel R.</p> <p><strong>Résultats:&nbsp;</strong>concernant les unités adultes, 79,90%; 81,86% et 43,13% des poches étaient conformes respectivement pour le volume, la teneur en hémoglobine et l'hématocrite. Au niveau des unités pédiatriques, 98,21%; 69,64% et 37,50% étaient conformes respectivement pour le volume, la teneur en hémoglobine et l'hématocrite. En considérant les trois paramètres simultanément, on avait un taux de conformité de 42,16% pour les CGR adultes contre 35,71% pour les CGR pédiatriques.</p> <p><strong>Conclusion:&nbsp;</strong>nous recommandons d'élargir l'intervalle entre deux dons de sang et de mettre en œuvre le contrôle d'hémoglobine avant le don dans les critères d'aptitude au don de sang au CNTS de Lomé.</p> Hèzouwè Magnang Essohana Padaro Koffi Mawussi Tama Ouenangou Yao Layibo Messanh Délagnon Irenée Kuéviakoé Ahoefa Vovor Copyright (c) 2019-04-09 2019-04-09 32 1 Compétences des couples en matière de planification familiale en post-partum immédiat dans le District de Santé de Biyem-Assi, Cameroun https://www.ajol.info/index.php/pamj/article/view/209862 <p><strong>Introduction:&nbsp;</strong>la planification familiale en post-partum immédiat reste encore peu connue et peu pratiquée par la plupart des couples au Cameroun. Pourtant, juste après un accouchement, nombreux sont ceux qui désirent différer la naissance de leur prochain enfant. Cette étude avait pour objectif de déterminer le niveau de compétences et le besoin éducationnel des couples en matière de planification familiale en post-partum immédiat dans le District de Santé de Biyem-Assi.</p> <p><strong>Méthodes:&nbsp;</strong>il s'agissait de mener une enquête CAP (connaissances, attitudes et pratiques), dans le District de Santé de Biyem-Assi. La collecte des données s'est faite à l'aide de deux questionnaires de 40 questions chacun, rédigés en français, l'un adressé aux femmes en couple et en post-partum et l'autre aux hommes en couple et ayant au moins un enfant. Les données recueillies ont été saisies dans le logiciel CSPro version 6.2, puis analysées à l'aide du logiciel SPSS version 20.0.</p> <p><strong>Résultats:&nbsp;</strong>un total de 300 individus a été interrogé avec un sex-ratio de 1. Plus de la moitié (56,7%) avait une connaissance approximative de la planification familiale en post-partum immédiat. Pour 36% des répondants, le post-partum immédiat n'était pas un moment approprié pour l'utilisation d'une méthode contraceptive moderne, l'interaction entre contraceptifs et lait maternel (65,4%) et l'infertilité de la femme (26,3%) étaient les principales raisons évoquées. Les pratiques contraceptives en post-partum immédiat de 60,5% des couples vivant dans le District de Santé Biyem-Assi étaient inadéquates. Par conséquent, la plupart des enquêtés avaient un niveau de compétences insuffisant (32,6%) et faible (23,3%) en matière de planification familiale en post-partum immédiat.</p> <p><strong>Conclusion:&nbsp;</strong>certains préjugés et de fausses idées persistent dans la population du District de Santé Biyem-Assi en ce qui concerne les méthodes contraceptives modernes, et constituent un frein à la pratique contraceptive en général et en post-partum immédiat en particulier. Des efforts de sensibilisation et d'éducation des couples pour l'amélioration de leurs compétences en matière de contraception en post-partum immédiat s'avèrent nécessaires.</p> Nadia Maguiassué Téfouet Marius Zambou Vouking Marie-José Essi Copyright (c) 2019-04-09 2019-04-09 32 1 Tuberculose intestinale révélée par une occlusion intestinale aigüe au cours d’une réaction paradoxale au traitement anti-tuberculeux chez un patient immunocompétent: à propos d’un cas et revue de la littérature https://www.ajol.info/index.php/pamj/article/view/209963 <p>La tuberculose intestinale représente 3 à 5% de toutes les localisations viscérales. Malgré l'efficacité démontrée des anti-tuberculeux, des cas d'exacerbation du tableau clinique initial ont été décrits à l'initiation du traitement. Ces réactions dites «paradoxales» sont cependant rarement rapportées chez les immunocompétents et beaucoup moins sous forme d'occlusion intestinale. Nous rapportons un cas de tuberculose intestinale révélée par une occlusion intestinale aigüe au cours d'une réaction paradoxale aux anti-tuberculeux. Il s'agit d'un patient de 26 ans, immunocompétent qui a présenté un syndrome occlusif à un mois de traitement d'une tuberculose pleuro-pulmonaire. La tomodensitométrie (TDM) abdominale était en faveur d'une occlusion intestinale grêlique. La laparotomie objectivait une masse intra-péritonéale avec de multiples adhérences. L'examen anatomopathologique de la pièce opératoire était en faveur d'une tuberculose intestinale. L'évolution était favorable après la poursuite du traitement anti-tuberculeux initial.</p> Bruce Wembulua Shinga Alassane Dièye Ndèye Méry Dia Badiane Ndèye Aissatou Lakhe Viviane Marie-Pierre Cisse Diallo Khadiatou Diallo Mbaye Daye Ka Aboubakar Sidikh Badiane Assane Diouf Louise Fortes Déguénonvo Cheikh Tidiane Ndour Moussa Seydi Copyright (c) 2019-04-10 2019-04-10 32 1 Prevalence of precancerous cervical lesions in women attending Mezam Polyclinic Bamenda, Cameroon https://www.ajol.info/index.php/pamj/article/view/209966 <p><strong>Introduction:&nbsp;</strong>precancerous cervical lesion is significantly a health problem globally. Thus, screening targeting women between the ages of 17-60 is being undertaken in developing countries, including Cameroon. Over 50% (7.8 per 100,000) women die of cervical cancer every year. This study was to determine the prevalence of precancerous cervical lesion, the age demography and access the risk factor.</p> <p><strong>Methods:&nbsp;</strong>a hospital-based cross-sectional study was conducted from August 09th to October 17th 2017. A total of 60 women participated, and were screened for precancerous cervical lesion. Data were collected by using a questionnaire. Visual inspection with acetic acid and visual inspection with Lugol’s iodine was applied for the screening. SPSS version 16.0 was used for data entry and analysis. Logistic regression analysis was fitted and odds ratios with 95% confidence intervals and p-values were computed to identify factors associated with precancerous cervical cancer lesion.</p> <p><strong>Results:&nbsp;</strong>out of 60 study participants, 2(3.33%) were found to be positive for precancerous cervical cancer lesion.</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of precancerous cervical lesion in women that consulted at the Mezam polyclinic is high.</p> Ngwayu Claude Nkfusai Tchakounte Minette Mubah Brenda Mbouamba Yankam Tabe Armstrong Tambe Samuel Nambile Cumber Copyright (c) 2019-04-10 2019-04-10 32 1 Secondary severe thrombocytosis in a patient who underwent splenectomy due to hereditary spherocytosis and its treatment using hydroxyurea https://www.ajol.info/index.php/pamj/article/view/209968 <p>Thrombocytosis is a frequently seen condition during childhood. While it usually develops secondarily due to reasons such as infection or anemia, it may rarely develop due to clonal causes. Thrombocytosis becomes a life-threatening condition by causing severe complications such as hemorrhage and thrombosis development. Treatment is not recommended in patients who are asymptomatic and with a platelet count below 1,500,000/mm<sup>3</sup>, however, treatment is required in cases who are symptomatic and with a platelet count above 1,500,000/mm<sup>3</sup>&nbsp;in conditions such as primary thrombocytosis. This article present the outcomes of a patient who was treated using low-dose hydroxyurea when he developed severe thrombocytosis after splenectomy.</p> Hakan Sarbay Sinan Akbayram Copyright (c) 2019-04-10 2019-04-10 32 1 Tuberculome cérébral un challenge diagnostic: à propos d’un cas et mise au point https://www.ajol.info/index.php/pamj/article/view/209970 <p>La tuberculose du système nerveux central est le deuxième site le plus fréquent après la méningite tuberculeuse. Elle est une cause majeure de morbidité et de mortalité dans les pays en développement et représente 10 à 30% des lésions expansives intracrâniennes dans ces pays contre 0,2% dans certains pays occidentaux. Le but de cet article est de présenter un cas atypique de tuberculome cérébral dans sa présentation clinique et radiologique (l'IRM cérébrale et de la spectroscopie), de faire une mise au point à partir de cette observation sur cette pathologie infectieuse. Il s'agit d'une patiente de 44 ans, sans antécédent médico-chirurgical, qui a présenté depuis un an des céphalées, compliquées 08 mois après de crises de crises d'épilepsies partielles à généralisation secondaire et de lourdeur de l'hémicorps gauche avec des épisodes de vomissements sans trouble visuel ni fièvre ni altération de l'état général. L'examen clinique trouvait une patiente consciente GCS= 15, pupilles égales et réactives, station debout et marche possible sans anomalie, avec hémiparésie gauche 4/5 sans autres signes neurologiques. L'IRM cérébrale objectivait en séquence T1 non injectée une lésion pariétale droite sus tentoriel plurilobées iso intense mal limitée, en séquence T2 elle est hétérogène avec un liseré hyper intense et un fond hypo intense traduisant un processus charnu avec des zones de nécroses centrales et un œdème péri-lésionnel en doigt de gans avec une prise de contraste annulaire intense après injection de gadolinium. L'analyse de la spectroscopie était en faveur d'une tumeur gliale. La patiente fut mise sous anticonvulsivant et a bénéficié d'un abord direct avec exérèse macroscopiquement complète. L'analyse anatomopathologique était en faveur d'un tuberculome cérébral. Elle a été mise sous traitement antituberculeux avec arrêt des crises et récupération du déficit après 04 semaines. A travers ce cas nous entrevoyons le polymorphisme clinique et radiologique qu'est le tuberculome cérébral. Il est évoqué devant un faisceau d'argument clinique, biologique et radiologique mais le diagnostic de certitude reste essentiellement anatomopathologique. La prise en charge ne saurait tarder car les complications sont néfastes et de mauvais pronostic lorsqu'il est détecté tardivement.</p> Patrice Niamien Koffi Olivier Ouambi Nizar El Fatemi Rachid El Maaquili Copyright (c) 2019-04-10 2019-04-10 32 1 Molluscum contagiosum palpébral: à propos d’un cas https://www.ajol.info/index.php/pamj/article/view/209972 <p>Les&nbsp;<em>Molluscums contagiosum</em>&nbsp;(MC) sont des lésions cutanées bénignes causées par Molluscipoxvirus, ils affectent principalement les enfants et les adultes jeunes et intéressent surtout la peau et rarement les muqueuses. Le diagnostic clinique est facile, confirmé par l'analyse histologique de la lésion, cependant il n'existe pas de consensus concernant la prise en charge thérapeutique. La localisation palpébrale de MC est rare, elle pose un problème d'ordre diagnostic différentiel surtout lorsqu'elle est isolée et un problème thérapeutique vu la proximité du globe oculaire. Nous rapportons le cas d'une fille de 7 ans ayant présenté une lésion palpébrale isolée dont l'exérèse avec étude anatomopathologique a révélé un MC. A la lumière de cette observation nous décrivons les particularités cliniques, thérapeutiques, et évolutives de cette localisation rare du molluscum contagiosum.</p> Moulay Omar Moustaine Bouchra Allali Loubna El Maaloum Asmaa El Kettani Khalid Zaghloul Copyright (c) 2019-04-11 2019-04-11 32 1 Perforation d’anévrysme de la valve mitrale postérieure: complication rare de l’endocardite infectieuse: à propos d’un cas https://www.ajol.info/index.php/pamj/article/view/209973 <p>L'anévrysme de la valve mitrale est une anomalie rare dont la physiopathologie est mal élucidée. Il se définit par une protubérance localisée au niveau du feuillet valvulaire mitral bombant dans l'oreillette gauche. La localisation sur le feuillet postérieur est exceptionnelle. Nous rapportons le cas d'un jeune homme de 26 ans suivi depuis 4 ans pour une insuffisance aortique rhumatismale qui est hospitalisé pour un syndrome fébrile avec poussée d'insuffisance cardiaque gauche. L'échocardiographique transthoracique (ETT) et transoesophagienne (ETO) ont mis en évidence des végétations sur la valve aortique avec un large anévrysme de la petite valve mitrale associé à une fuite mitrale importante. Le patient a bénéficié d'un double remplacement valvulaire mitral et aortique avec des suites opératoires simples. Une suspicion clinique avec une imagerie adaptée préopératoire et un traitement chirurgical à temps sont nécessaires pour reconnaître et traiter cette complication rare de l'endocardite infectieuse.</p> Loubna Hara Fatima-Zahra El Hattab Fatima-Zohra Radi Jamila Zarzur Mohamed Cherti Copyright (c) 2019-04-11 2019-04-11 32 1 Prevalence of HIV infection among siblings of HIV positive children in Calabar, Nigeria https://www.ajol.info/index.php/pamj/article/view/209990 <p><strong>Introduction:&nbsp;</strong>early diagnosis and treatment of paediatric HIV is key as mortality of untreated patients is very high in the first two years of life, and reaches 80% by four years. Case finding efforts for children especially outside Prevention of mother-to-child transmission (PMTCT) is inadequate. Targeting siblings of index HIV-exposed and infected children is an important way of improving identification and enrolment into care thereby reducing paediatric mortality. The study therefore aimed to determine the prevalence of HIV infection among siblings of HIV positive children in care in Calabar.</p> <p><strong>Methods:&nbsp;</strong>this descriptive cross-sectional study was conducted among children aged six weeks to 15 years who are siblings of HIV positive children receiving care. Parental consent and child assent were obtained, the children were tested for HIV at their homes irrespective of their prior test results. Ethical clearance certificates were obtained from the health institutions.</p> <p><strong>Results:&nbsp;</strong>siblings of 401 index patients were tested for HIV, four were positive giving a prevalence rate of 1%. Three hundred and sixty-seven 367(91.5%) had been tested previously while 34(8.5%) never had HIV test. Among the siblings who were HIV positive, 1(0.3%) was a male while 3(0.7%) were females. There were more HIV positive siblings in the 11-15 years age group.</p> <p><strong>Conclusion:&nbsp;</strong>all the four HIV positive siblings were from the lower socioeconomic class (p=0.022). The routine screening of siblings of HIV positive children should be sustained with focus on adolescents from the lower socioeconomic class. This will improve early identification and enrolment into care thereby reducing paediatric mortality.</p> Sunday Oteikwu Ochigbo Chimaeze Torty Maxwell Anah Copyright (c) 2019-04-11 2019-04-11 32 1 Traumatic pulmonary pseudocyst: a rare complication of blunt thoracic injury https://www.ajol.info/index.php/pamj/article/view/209993 <p>Traumatic pulmonary pseudocyst is a rare and underreported complication of blunt chest trauma. It represents air trapped within a pulmonary laceration. It generally appears on radiographs as a thin-walled, air-filled cavity, with or without air-fluid levels. It is very important for emergency physicians and pediatricians to be familiar with this condition because it generally represents a benign, self-limited condition that only requires observation. We report a case of a young man admitted in our ICU for thoracic injury consecutive to a motor vehicle accident. The chest X-Ray showed multiple large thin-walled cystic lesions. The Chest CT identified several large cavities on the right lung confirming the diagnosis of traumatic pulmonary pseudocysts. He was treated by oxygen therapy and analgesia. His condition was relatively stable and improved after few days. He was discharged 10 days later and a follow-up chest CT showed spontaneous resolution of the pseudocyst.</p> Ouissal Aissaoui Rachid Alharrar Copyright (c) 2019-04-11 2019-04-11 32 1 Antinuclear antibody testing in a Turkish pediatrics clinic: is it always necessary? https://www.ajol.info/index.php/pamj/article/view/209994 <p><strong>Introduction:&nbsp;</strong>the term anti-nuclear antibody (ANA) is used to define a large group of autoantibodies which specifically bind to nuclear elements. Although healthy individuals may also have ANA positivity, the measurement of ANA is generally used in the diagnosis of autoimmune disorders. However, various studies have shown that ANA testing may be overused, especially in pediatrics clinics. Our aim was to investigate the reasons for antinuclear antibody (ANA) testing in the general pediatrics and pediatric rheumatology clinics of our hospital and to determine whether ANA testing was ordered appropriately by evaluating chief complaints and the ultimate diagnoses of these cases.</p> <p><strong>Methods:&nbsp;</strong>the medical records of pediatric patients in whom ANA testing was performed between January 2014 and June 2016 were retrospectively evaluated. Subjects were grouped according to the indication for ANA testing and ANA titers.</p> <p><strong>Results:&nbsp;</strong>ANA tests were ordered in a total of 409 patients during the study period, with 113 positive ANA results. The ANA test was ordered mostly due to joint pain (50% of the study population). There was an increased likelihood of autoimmune rheumatic diseases (ARDs) with higher ANA titer. The positive predictive value of an ANA test was 16% for any connective tissue disease and 13% for lupus in the pediatric setting.</p> <p><strong>Conclusion:&nbsp;</strong>in the current study, more than one-fourth of the subjects were found to have ANA positivity, while only 15% were ultimately diagnosed with ARDs. Our findings underline the importance of an increased awareness of correct indications for ANA testing.</p> Erhan Aygün Fatih Mehmet Kelesoglu Gafur Dogdu Aysenur Ersoy Dilruba Basbug Dilara Akça Özge Nur Çam Berat Akyüz Tülay Günsay Ahmet Hakki Kapici Nur Gökçe Aydin Edanur Karapinar Sirin Atay Nesibe Saglam Nazli Kübra Okumus Melike Zeynep Can Fatmatüzzehra Yazici Rukiye Eker Ömeroglu Copyright (c) 2019-04-11 2019-04-11 32 1 Contraceptive use and associated factors among sexually active female adolescents in Atwima Kwanwoma District, Ashanti region-Ghana https://www.ajol.info/index.php/pamj/article/view/210000 <p><strong>Introduction:&nbsp;</strong>unintended pregnancies and adolescent childbearing are on the increase in Sub-Saharan Africa. In Ghana, 14% of adolescents aged 15-19 are already mothers or pregnant with their first child. Most of these pregnancies are associated with poor outcomes such as miscarriages, stillbirths, unsafe abortions and other complications that might result in infant or mortality. In addition, sexually-active adolescents (16-19 years) are at higher risk of contracting STIs. Evidence suggest that contraceptive use help reduce fertility rate and adolescent reproductive health. This study therefore sought to understand the magnitude and associated factors that influence female adolescents' use of contraceptive in the Atwima Kwanwoma District, Ghana.</p> <p><strong>Methods:&nbsp;</strong>a descriptive and analytic cross-sectional study design was used for this study. Using a structured questionnaire, data were collected from randomly sampled 200 sexually active female adolescents; aged 16-19 for a three month period; June to September 2017. The questionnaire elicited data on the socio-demographic characteristics of respondents, their knowledge and perception, use of contraceptives and factors influencing their contraceptive use. Data were analyzed using STATA version 12.1 software.</p> <p><strong>Results:&nbsp;</strong>ninety-five percent of the respondents exhibited some knowledge about contraceptives, but this high knowledge did not translate into its use as the prevalence rate was 18%. Condom was the most widely used contraceptive (33%) and perceived side effects of contraceptives was found to be the main reason for not using the contraceptives (53.66%). Marital status and the participants who were staying with both parents were found to be associated with contraceptive use with their p-values of 0.023 and 0.002 respectively.</p> <p><strong>Conclusion:&nbsp;</strong>considering the fact that contraceptive knowledge does not necessarily translate into use, further studies (qualitative), are needed to understand why high knowledge levels are not associated with high usage patterns.</p> Joyce Agyemang Sam Newton Isaac Nkrumah Joyce Mahlako Tsoka-Gwegweni Samuel Nambile Cumber Copyright (c) 2019-04-12 2019-04-12 32 1 Genetic diversity of Plasmodium falciparum infection among children with uncomplicated malaria living in Pointe-Noire, Republic of Congo https://www.ajol.info/index.php/pamj/article/view/210136 <p><strong>Introduction:&nbsp;</strong>molecular characterization of malaria parasites from different localities is important to improve understanding of acquisition of natural immunity to&nbsp;<em>Plasmodium falciparum</em>, to assist in identifying the most appropriate strategies for control and to evaluate the impact of control interventions. This study aimed to determine the genetic diversity and the multiplicity of infection in&nbsp;<em>Plasmodium falciparum</em>&nbsp;isolates from Pointe-Noire, Republic of Congo.</p> <p><strong>Methods:&nbsp;</strong><em>Plasmodium falciparum</em>&nbsp;isolates were collected from 71 children with uncomplicated malaria; enrolled into the study for evaluating the therapeutic efficacy of artemether-lumefantrine combination. Both&nbsp;<em>msp-1</em>&nbsp;and&nbsp;<em>msp-2</em>&nbsp;genes were genotyped.</p> <p><strong>Results:&nbsp;</strong>from 296 distinct fragments detected, 13&nbsp;<em>msp-1</em>&nbsp;and 27&nbsp;<em>msp-2</em>&nbsp;different alleles were identified. For&nbsp;<em>msp-1</em>, RO33 family was poorly polymorphic. The K1 family has shown the trend of predominance (41%), followed by Mad20 (35%). Comparatively to&nbsp;<em>msp-2</em>, 49.6% and 48.8% fragments belonged to 3D7 and FC27 respectively. Taking together&nbsp;<em>msp-1</em>&nbsp;and&nbsp;<em>msp-2</em>&nbsp;genes, the overall multiplicity of infection has been increased to 2.64 and 86% harbored more than one parasite genotype. Parasite density was not influenced by age as well as the multiplicity of infection which was not influenced neither by age nor by parasite density.</p> <p><strong>Conclusion:&nbsp;</strong>genetic diversity of&nbsp;<em>Plasmodium falciparum</em>&nbsp;in isolates from patients with uncomplicated malaria in Pointe-Noire is high and consisted mainly of multiple clones. The overall multiplicity of infection has been largely increased when considering&nbsp;<em>msp-1</em>&nbsp;and&nbsp;<em>msp-2</em>&nbsp;genes together. With the changes in malaria epidemiology, the use of both&nbsp;<em>msp-1</em>&nbsp;and msp-2 genes in the characterization of&nbsp;<em>Plasmodium falciparum</em>&nbsp;infection is recommended.</p> Brice Pembet Singana Pembe Issamou Mayengue Roch Fabien Niama Mathieu Ndounga Copyright (c) 2019-04-12 2019-04-12 32 1 Rupture spontanée de la rate chez un enfant https://www.ajol.info/index.php/pamj/article/view/210139 <p>Les ruptures non traumatiques ou spontanées de la rate (RNTR) sont des entités rares mais potentiellement mortelles. La mortalité de cette affection est essentiellement liée au retard diagnostique et thérapeutique, ainsi qu'aux risques liés au terrain et à la gravité de la pathologie sous-jacente. Elles nécessitent dans la majorité des cas une splénectomie. Elles peuvent survenir soit sur une rate macroscopiquement saine, par exemple au cours d'une mononucléose infectieuse (MNI) ou d'un accès palustre ou sur une rate pathologique par exemple tumorale mai aussi dans certaines coagulopathies. Dans notre cas il s'agit d'un enfant de 6 ans suivi pour une coagulopathie admis pour douleurs abdominales diffuses brutales, une pâleur cutanéo-muqueuse avec un état hémodynamique stable. Le bilan biologique a révèle une anémie normochrome macrocytaire; le diagnostic de confirmation de la rupture était réalisé par l'échographie et le scanner abdominal. Vu la stabilité de l'état hémodynamique, la décision d'un traitement conservateur a été prise avec transfusions de 2 culots globulaires. L'évolution était favorable.</p> Charifa Rachidi Alaoui Mohamed Rami Khalid Khatalla Aziz Elmadi Youssef Bouabdellah Copyright (c) 2019-04-16 2019-04-16 32 1 Knowledge, risk perception, and condom utilization pattern among female sex workers in Dire Dawa, Eastern Ethiopia 2016: a cross-sectional study https://www.ajol.info/index.php/pamj/article/view/210140 <p><strong>Introduction:&nbsp;</strong>in 2015, in Dire Dawa administration city, adult HIV prevalence was 3.26 with 9,523 HIV positive population, &amp; 251 annual AIDS deaths. Female sex workers are one of the high-risk groups for contracting HIV. Therefore, this study has assessed the level of HIV/AIDS knowledge, risk perception and condom utilization pattern among female sex workers' in Diredawa city.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted from April 15-June 25, 2016, in Dire Dawa among 156 female sex workers using convenient sampling method. Respondents were interviewed face-to-face using a pretested questionnaire. Training was provided to the data collectors and supervisors. Close supervision was done and double data entry was performed. Then the data were checked for completeness, consistency and entered into Epi Info v3.1 and analyzed using SPSS v20. The descriptive statistical analysis was used to compute frequency, mean, mode and proportion of the findings of this study. The results were presented using tables, charts, graphs, and texts.</p> <p><strong>Results:&nbsp;</strong>among the 156 female sex workers (FSWs), 99 (63.5%) had been working on commercial sex for more than one year, 92 (59%) were usually street-based, and 80 (51.3%) had partners between 2-3 per night. Only, 17 (10.9%) respondents mentioned three and above ways of HIV/AIDS transmission and prevention methods. Less than two-thirds (64.1%) of FSWs used a condom with all partners. One hundred thirty-eight (88.5%) of participants were engaged in unsafe sexual practice at least once since their engagement in sex work. Majority of FSWs (85.3%)) believed that their occupation is hazardous and 145 (92.9%) reported that they were unhappy being a commercial sex worker. Regarding risk perception, 79 (50.64%) and 37 (23.7%) of respondents perceived their chances of contracting HIV/STIs to be high and moderate respectively.</p> <p><strong>Conclusion:&nbsp;</strong>Knowledge about HIV/STIs and magnitude of condom utilization were good. However, a high number of unsafe sex and unsatisfactory risk perception attitudes were observed. Thus, a collaborative effort is needed to create awareness regarding risk perception attitude and increase the level of their practice towards the prevention of unsafe sex.</p> Hailemariam Mekonnen Workie Teshager Worku Kassie Tewodros Tesfa Hailegiyorgis Copyright (c) 2019-04-16 2019-04-16 32 1 Graves’ disease following hypothyroidism due to Hashimoto’s thyroiditis in a black South African lady: a case report https://www.ajol.info/index.php/pamj/article/view/210141 <p>Graves' disease and Hashimoto's thyroiditis are autoimmune thyroid disorders with distinct pathological and histopathological features. The conversion from Hashimoto's thyroiditis to Graves' disease has been rarely reported throughout the world with no reports in the African race to our knowledge. We here report an African lady who was initially diagnosed with primary hypothyroidism following Hashimoto's disease but later became thyrotoxic due to Graves' disease.</p> Chukwuma Ekpebegh Khaled Elmezughi Lungiswa Mtingi Copyright (c) 2019-04-17 2019-04-17 32 1 Causes de décès à Dakar et politique de santé https://www.ajol.info/index.php/pamj/article/view/210142 <p>L'étude de la mortalité permet d'identifier les principaux problèmes de santé publique des pays dont ils émanent. Elle donne une idée des mesures préventives et médico-curatives et des investissements dans la recherche qui pourraient accroître l'espérance de vie de la population. L'objectif général de ce travail était d'évaluer les causes de mort dans la population générale à partir des informations figurant sur les registres de décès à Dakar. Les objectifs spécifiques étaient de déterminer les causes de mort, d'identifier les facteurs sociodémographiques influençant les décès et d'identifier les genres de mort et type de mort. Il s'agit d'une étude rétrospective portant sur les cas de décès dans la population générale de Dakar, de 2003 à 2012, ayant bénéficié d'une autopsie. Les sources des données étaient les registres des autopsies de l'Hôpital Aristide le Dantec (HALD) et de l'Hôpital Général de Grand-Yoff (HOGGY), seuls hôpitaux de Dakar où sont effectuées des autopsies. Les informations contenues dans les différentes sources de données ont été rapportées sur une fiche d'enquête analysée par Epi-info version 6.04. Durant la période d'étude, nous trouvions 985 décès parmi lesquels, 693 morts violentes (70,3%), 261 morts naturelles (26,5%) et 14 morts indéterminées (1,4%). Il y avait une prédominance des accidents de la circulation au nombre de 394 (40%). Concernant le genre de mort, plus de la moitié des cas de décès étaient accidentels donc des morts violentes. Les décès par accident de la circulation se passaient le plus souvent en zone préhospitalière ou à l'arrivée à l'hôpital. Le ministère de la santé devra continuer les efforts sur la prévention et la prise en charge des maladies transmissibles. Les deux priorités devront être les maladies cardiovasculaires et les traumatismes.</p> Mohamed Maniboliot Soumah Mariame Koumare Mor Ndiaye Mamadou Lamine Sow Copyright (c) 2019-04-17 2019-04-17 32 1 Refugee camp health services utilisation by non-camp residents as an indicator of unaddressed health needs of surrounding populations: a perspective from Mae La refugee camp in Thailand during 2006 and 2007 https://www.ajol.info/index.php/pamj/article/view/210271 <p><strong>Introduction:&nbsp;</strong>this study explored the differences on the level of medical care required by camp and non-camp resident patients during utilisation of the health services in Mae La refugee camp, Tak province, Thailand during the years 2006 and 2007.</p> <p><strong>Methods:&nbsp;</strong>data were extracted from camp registers and the Health Information System used during the years 2006 and 2007 and statistical analysis was performed.</p> <p><strong>Results:&nbsp;</strong>the analysis showed that during 2006 and 2007 non-camp resident patients, coming from Thailand as well as Myanmar, who sought care in the outpatient depart-ment (OPD) of the camp required at a significantly higher proportion admission to the inpatient department (IPD) or referral to the district hospital compared to camp resident patients. Although there was a statistically significant increased mortality of the non-camp resident patients admitted in the IPD compared to camp resident patients, there was no significant difference in mortality among these two groups when the re-ferrals to the district hospital were analysed.</p> <p><strong>Conclusion:&nbsp;</strong>non-camp resident patients tended to need a more advanced level of medical care compared to camp resident patients. Provided that this it is further vali-dated, the above observed pattern might be potentially useful as an indirect indicator of unaddressed health needs of populations surrounding a refugee camp.</p> Lykourgos Christos Alexakis Maria Athanasiou Angeliki Konstantinou Copyright (c) 2019-04-17 2019-04-17 32 1 Dysphagia revealing diffuse idiopathic skeletal hyperostosis: report of two cases and literature review https://www.ajol.info/index.php/pamj/article/view/210273 <p>Diffuse Idiopathic Skeletal Hyperostosis (DISH) also known as Forestier's disease, is a musculoskeletal disorder characterized by the calcification of ligaments essentially the vertebral longitudinal anterior ligament. Men are generally affected. It is often asymptomatic. The most common extra-spinal clinical manifestation of this disease presents as dysphagia followed by respiratory disturbances such as dyspnea and sleep apnea. In this paper we discuss two cases where the patients have experienced progressive dysphagia. Radiological findings were compatible with DISH. The management was based on diet modification and anti-inflammatory medication.</p> Monia Ghammam Jihene Houas Mouna Bellakhdher Mohamed Abdelkefi Copyright (c) 2019-04-17 2019-04-17 32 1 Predictors of urethral stricture recurrence following urethroplasty: a retrospective review at the Jos University Teaching Hospital, Nigeria https://www.ajol.info/index.php/pamj/article/view/210276 <p><strong>Introduction:&nbsp;</strong>incidence of urethral stricture recurrence ranges between 2% to 36.4% with 75% occurring within the first 6 months of surgery. Hence, they need to identify the predictors of recurrence following urethroplasty.</p> <p><strong>Methods:&nbsp;</strong>this is a retrospective study involving patients that had urethroplasty from January 2008 to December 2017. Patients' records were reviewed. Analyzed data were for patients with a minimum follow up of one year from the time of urethroplasty and included aetiology of urethral stricture, presence of suprapubic cystostomy, prior urethral dilatation, urine M/C/S, site of urethral stricture, length of urethral stricture, type of urethroplasty, level of training of the surgeon, type of urethral stent used and duration of stenting. Analysis was done using SPSS version 23. P-value of &lt; 0.05 was considered significant.</p> <p><strong>Results:&nbsp;</strong>eighty seven urethroplasties were done, from January 2008 to December 2017. However, only records of 44 patients were accessible. Twenty patients completed duration of follow up ≥ one year. Urethral stricture recurrence was defined as resurgence of Lower Urinary Tract Symptoms (LUTS) within one year. Median age of the patients was 39.5 (± 19) years. Urethral stricture recurrence rate was 25% with mean time to recurrence from urethroplasty of 5.3 (±3) months. The use of preoperative suprapubic catheter (SPC) for urinary diversion as well as urethroplasties performed by the consultants had a lower incidence of recurrence.</p> <p><strong>Conclusion:&nbsp;</strong>this study found urethral stricture recurrence of 25%. The level of training of surgeon vis-à-vis the expertise and experience seems to be an important factor, though not statistically significant in determining the outcome of urethroplasty.</p> Chimaobi Gideon Ofoha Venyir Mamhzi Ramyil Nuhu Kutan Dakum Samaila Ibrahim Shu'aibu Idorenyin Cletus Akpayak Felix Echebiri Magnus Ushaaka Swem Ayodele Oshagbemi Olutayo Osunaiye Julius Akhaine Copyright (c) 2019-04-18 2019-04-18 32 1 Résultats à moyen terme du traitement des ostéochondrites disséquantes des condyles fémoraux par greffe ostéochondrale en mosaïque https://www.ajol.info/index.php/pamj/article/view/210280 <p>Face à une perte de substance cartilagineuse des condyles fémoraux, plusieurs alternatives thérapeutiques interventionnelles sont envisageables y compris la mosaïcoplastie. Le but de notre travail était d'évaluer le résultat clinique et radiologique à moyen terme ainsi que d'évaluer les principaux éléments pronostiques. Notre étude épidémiologique rétrospective étalée sur 15 ans nous a permis de colliger 35 dossiers exploitables d'ostéochondrite disséquante des condyles fémoraux traités par la technique de mosaïcoplastie avec un recul moyen de 24 mois. Le niveau des plaintes ainsi que la fonction du genou en préopératoire ont été étudiés et comparés par rapport au genou sain selon le Score International Cartilage Repair Society (ICRS), le score International Knee Documentation Committee (IKDC) et l'échelle visuelle de la douleur (EVA) et nous avons trouvé qu'elle était inférieure à 60% chez 27 malades. L'évaluation des résultats au recul ont été analysés selon les critères fonctionnels et radiologiques de Hunghston. Après un recul moyen de 24 mois, l'algoneurodystrophie était observée dans 05 cas avec un seul cas d'hémarthrose. Une nette amélioration du score ICRS était observée avec une moyenne qui a passée du 54% à 74% au recul. Les patients satisfaits ou très satisfaits (82,9%) furent largement majoritaires. Les éléments de bon pronostic constatés dans notre étude étaient: un délai opératoire moins de 18 mois de début de la symptomatologie, les lésions profondes ayant un diamètre inférieur à 02 cm et les lésions siégeant au niveau du condyle interne. Le traitement des pertes de substances cartilagineuses passe obligatoirement par la correction des causes directes et indirectes à savoir le morphotype, la laxité et le capital méniscal. Aucun consensus décisionnel n'a pu être proposé et nul ne peut confirmer la supériorité d'une technique par rapport à l'autre mais nous pouvons dire que le défect cartilagineux de 2 à 4 cm<sup>2</sup>&nbsp;peut être la meilleure indication à la mosaïcoplastie.</p> Abdallah Elmokhtar Abderazzak Rafrafi Talel Znagui Saber Saadi Mounira khezami Mounir Hamdi Lotfi Nouisri Copyright (c) 2019-04-18 2019-04-18 32 1 Retinal involvement in an acute lymphoblastic leukemia https://www.ajol.info/index.php/pamj/article/view/210288 <p>We report a case of a patient who presents for ophthalmic complaints revealing systemic acute lymphoblastic leukemia. The eye fundus examination shows bilateral papilledema, retinal hemorrhages and diffuse white retinal infiltration. After chemotherapy, there was noticeable improvement of visual acuity and important regression of papilledema. Ocular involvement in leukemia is considered as a central nervous system lesion. It requires, therefore, a proper treatment including corticosteroids, chemotherapy and radiation treatment of the central nervous system.</p> Fouad Chraibi Idriss Andaloussi Benatiya Copyright (c) 2019-04-18 2019-04-18 32 1 What is the cost benefit ratio of sending adeno-tonsillar tissues for histology: does adenoid/tonsillar tissue in children undergo malignant transformation? https://www.ajol.info/index.php/pamj/article/view/210292 <p>Due to the enormous amount spent on histology of adenoid and tonsillar samples from children with adeno-tonsillectomy with no confirmed result of malignancy, it has become expedient to reconsider sending such tissues for histology. Objectives: this study is aimed at determining the necessity of sending tissues of adenoid and tonsils for histology by means of ascertaining the prevalence of malignancy among children with adeno-tonsillectomy. This was a retrospective study done in three private hospitals that provide care for children in Enugu. Data was obtained from the medical records of 72 patients who had undergone tonsillectomy and/or adenoidectomy from September 2011 to May 2018. All the surgical cases done had their samples sent immediately for histology. A total of 72 adeno-tonsillar tissues were taken for histology of which all showed lymphoid hyperplasia with none showing any form of malignancy. Age group ranged from 6 months-18 years with 57 males and 15 females. Histology of the adeno-tonsillar tissue specimen was done among all the children with each costing 9000 Naira (26 US dollars). There were 3 tonsillectomies, one adenectomy and 68 adeno-tonsillectomies done. Indications for surgery were mainly upper air way obstruction for 69 cases and recurrent tonsillectomy for 3 cases. Histology revealed lymphoid hyperplasia for all cases. None of the patients in our study had histologic evidence of malignancy. Routine histopathologic examination in adeno-tonsillectomy specimens among children may be dispensable as it showed a negative cost-benefit ratio.</p> Josephat Maduabuchi Chinawa Awoere Tamunosiki Chinawa James Akpe Lovelyn Kelvin-Iloafu Vivian Onukwuli Copyright (c) 2019-04-18 2019-04-18 32 1 Les syringomes https://www.ajol.info/index.php/pamj/article/view/210295 <p>Les syringomes sont des tumeurs bénignes des annexes cutanées qui tireraient leur origine des canaux exocrines ou apocrines et qui affectent environ 1% de la population. Ils s'observent le plus souvent chez les femmes et prennent généralement la forme de papules molles de couleur chair ou légèrement jaunâtres à la paupière inférieure et à la partie supérieure des joues. Plus rarement, les syringomes s'observent ailleurs qu'au pourtour des yeux, soit au cou, aux aisselles, aux seins, à la portion inférieure de l'abdomen, aux cuisses et à l'aine. Au plan clinique, les syringomes se distinguent des xanthélasmas, des verrues ou des cancers par leur caractère monomorphe et leur distribution régulière; le diagnostic est confirmé par biopsie dans les cas douteux. À l'examen histologique, les syringomes se reconnaissent facilement par la présence de canaux sudoripares ayant la forme de virgules dans le derme. Même si les syringomes sont bénins, leur apparence peut être gênante pour les patients. Les options thérapeutiques, étayées pour la plupart par de petites séries et rapports de cas, incluent l'excision chirurgicale, l'électrodessication et curetage, l'exfoliation chimique, la cryochirurgie et le traitement au laser. Toutefois, comme ces tumeurs sont profondément ancrées dans le derme, tous les traitements sont associés à un risque substantiel de récurrence et peuvent entraîner des cicatrices et des changements pigmentaires. Nous rapportons l'observation d'une patiente de 40 ans sans antécédents qui présentait des papules couleur chair péri-orbitaires dont l'étude histologique était en faveur de syringomes.</p> Fatima-Zahra Agharbi Copyright (c) 2019-04-18 2019-04-18 32 1 Les maladies rares et leurs manifestations cliniques orales dans deux formations hospitalières de Yaoundé https://www.ajol.info/index.php/pamj/article/view/210298 <p><strong>Introduction:</strong>&nbsp;les maladies rares ont pour certaines des manifestations orales. Celles-ci sont souvent sous-étudiées; ce qui contribue à limiter l'offre de soins bucco-dentaires pour cette catégorie de patients. Le but est de déterminer les aspects épidémiologiques et cliniques des manifestations bucco-dentaires dans les maladies rares dans notre milieu.</p> <p><strong>Méthodes:</strong>&nbsp;nous avons effectué une étude transversale et descriptive sur une durée de 04 mois, dans deux hôpitaux de référence de Yaoundé: les informations ont été recueillies des dossiers médicaux, de l'interrogatoire des parents ou tuteurs et de l'examen bucco-dentaire des patients. Le seuil de significativité considéré pour p &lt; 0.05.</p> <p><strong>Résultats:</strong>&nbsp;les manifestations orales sur maladies rares sont variables et fonction du groupe d'affections, de la denture, et ont souvent un retentissement fonctionnel. Elles étaient présentes dans 97,2% de nos patients. En denture temporaire (59,4%), c'était plus des anomalies de forme et de position dentaire (conicité dentaire 7 cas/22, soit 32%), et en denture permanente des lésions carieuses (7 cas/10 soit 70%) et des anomalies de structure dentaire (4 cas/10 d'usure dentaire). Un lien significatif existait entre le type de denture, l'anomalie de structure (p=0,001) et de nombre (p=0,018). Les difficultés à la mastication (p=0,023) et à la succion (p=0,033) étaient liées aux groupes de maladies rares.</p> <p><strong>Conclusion:</strong>&nbsp;les lésions orales dans les maladies rares bien que présentes dans notre milieu, sont souvent négligées. Les soins bucco-dentaires devraient être intégrés dans le paquet minimum des activités des formations sanitaires et rendus gratuits ou financièrement accessibles à ces patients handicapés ou présentant des besoins spécifiques.</p> Hubert Désiré Mbassi Awa Rose Mbédé Nga Mvondo Séraphin Nguefack Charles Bengondo Messanga Paul Olivier Koki Ndombo Copyright (c) 2019-04-22 2019-04-22 32 1 Tuberculose extrapulmonaire multi résistante: à propos de 7 cas https://www.ajol.info/index.php/pamj/article/view/210381 <p>La tuberculose multi-résistante constitue un défi majeur pour l’Organisation Mondiale de la Santé. Son incidence croissante, les difficultés diagnostiques et thérapeutiques en font un problème de santé publique surtout dans les pays en développement. Nous rapportons deux cas de tuberculose résistante extra pulmonaire exclusive (ganglionnaire et ostéo-articulaire) et cinq cas associant à l’atteinte pulmonaire d’autres localisations extra pulmonaires (pleurale, ganglionnaire, anale et neuro-méningée) chez des patients hospitalisés à l’hôpital Moulay Youssef de Rabat. Ces cas illustrent la problématique de la résistance aux antituberculeux et soulèvent le rôle des tests génotypiques dans le diagnostic de la tuberculose extra-pulmonaire.</p> Hanane Haddaoui Fatima Zahra Mrabet Mohammed Aharmim Jamal-Eddine Bourkadi Copyright (c) 2019-04-23 2019-04-23 32 1 Angiotensin-converting enzyme insertion/deletion gene polymorphisms and the risk of glioma in an Algerian population https://www.ajol.info/index.php/pamj/article/view/210384 <p><strong>Introduction:&nbsp;</strong>just recently, it has been established that the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism is linked to the pathogenesis and to the evolution of human cancers. Therefore, the present study was concerned with the investigation of an eventual association between glioma and I/D polymorphism of the ACE gene.</p> <p><strong>Methods:&nbsp;</strong>the expression of ACE gene was detected by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) analysis in 36 Algerian patients with glioma and 195 healthy controls.</p> <p><strong>Results:&nbsp;</strong>in glioma cases, allelic frequencies and genotypes distribution of the ACE I/D polymorphism were different from controls cases. ACE DD genotype were highly presented in glioma cases (63.9%) than controls (33.8%) and conferred 3.64-fold risk for predisposition in glioma cases (vs ID genotype, p&lt;0.001). Recessive model (ACE II + ID genotypes vs DD) was associated with a 72% reduced risk of glioma (OR = 0.28, 95% CI: 0.13-0.60, p &lt;0.001). Per copy D allele frequency was found higher in glioma cases (79.2%) than in controls (63.3 %), OR = 2.20, 95% CI: 1.20 - 4.03, p = 0.009.</p> <p><strong>Conclusion:&nbsp;</strong>the obtained data showed that the presence of the D allele might be a risk factor for the development of glioma. Further studies considering different ethnic groups with large samples are required to confirm this finding.</p> Hana Ikram Benenemissi Karima Sifi Lakhder Khalil Sahli Ouarda Semmam Noureddine Abadi Dalila Satta Copyright (c) 2019-04-23 2019-04-23 32 1 Une lesion cutanée persistante non cicatricielle depuis 3 ans: le pyoderma gangrenosum https://www.ajol.info/index.php/pamj/article/view/210387 <p>Le pyoderma gangrenosum (PG) est une dermatose neutrophilique non infectieuse rare souvent méconnue. Il se présente généralement par des ulcérations cutanées inflammatoires, très douloureuses et d'évolution rapide. Il est fréquemment retrouvé dans un contexte de néoplasie, de pathologies inflammatoires digestives, rhumatologiques et/ou hématologiques. Son diagnostic est très souvent tardif après de multiples échecs thérapeutiques. Nous rapportons un cas de pyoderma gangrenosum dont le diagnostic n'a pas été criant. Un patient a été admis dans notre service pour une lésion dermatologique persistante et d'évolution défavorable malgré les débridements et l'administration d'antibiotiques. Il était suivi pour un cancer de la prostate, une hypertension artérielle et un asthme. Du fait des anomalies biologiques observées telles qu'une hyperleucocytose à polynucléaires neutrophiles avec myélémie à myélocytes et métamyélocytes, sans blastose sanguine et une anémie normochrome normocytaire, une leucémie myéloïde chronique a été évoquée chez ce patient. Elle a par la suite été infirmée devant les différents examens complémentaires non concluants. C'est ainsi que le diagnostic de PG a été évoqué et confirmé à l'examen anatomopathologique montrant un aspect histopathologique d'un tissu de granulation concordant avec un pyoderma gangrenosum et une absence de signe histologique de malignité. L'institution d'un traitement à base de corticothérapie a abouti à la guérison.</p> Michel Assane Ndour Djiby Sow Demba Diedhiou Fabrice Senghor Muriel Diembou Moustapha Diouf Awa Faye Ibrahima Mané Diallo Ahmed Limane Barrage Léa Marie Kabou Maimouna Ndour Mbaye Anna Sarr Copyright (c) 2019-04-23 2019-04-23 32 1 Zona de l’enfant: à propos de deux cas https://www.ajol.info/index.php/pamj/article/view/210390 <p>Le zona de l'enfant est une situation rare mais souvent bénigne et ne nécessitant qu'un traitement symptomatique. Les antiviraux sont exceptionnellement utilisés devant les formes compliquées qui sont l'apanage surtout des immunodéprimés ou de localisation ophtalmique. Pour le nourrisson, il s'agit le plus souvent d'une contamination in utero au cours d'une varicelle maternelle. Nous rapportons deux cas de Zona chez des enfants immunocompétents. Le premier chez un nourrisson et le deuxième chez un enfant de 7 ans.</p> Fatima-Zahra Agharbi Copyright (c) 2019-04-24 2019-04-24 32 1 Frequency of HIV status disclosure, associated factors and outcomes among HIV positive pregnant women at Mbarara Regional Referral Hospital, southwestern Uganda https://www.ajol.info/index.php/pamj/article/view/210392 <p><strong>Introduction:&nbsp;</strong>positive HIV results disclosure plays a significant role in the successful prevention and care of HIV infected patients. It provides significant social and health benefits to the individual and the community. Non-disclosure is one of the contextual factors driving the HIV epidemic in Uganda. Study objectives: to determine the frequency of HIV disclosure, associated factors and disclosure outcomes among HIV positive pregnant women at Mbarara Hospital, southwestern Uganda.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study using quantitative and qualitative methods among a group of HIV positive pregnant women attending antenatal clinic was done and consecutive sampling conducted.</p> <p><strong>Results:&nbsp;</strong>the total participant recruitment was 103, of which 88 (85.4%) had disclosed their serostatus with 57% disclosure to their partners. About 80% had disclosed within less than 2 months of testing HIV positive. Reasons for disclosure included their partners having disclosed to them (27.3%), caring partners (27.3%) and encouragement by health workers (25.0%). Following disclosure, 74%) were comforted and 6.8% were verbally abused. Reasons for non-disclosure were fear of abandonment (33.3%), being beaten (33.3%) and loss of financial and emotional support (13.3%). The factors associated with disclosure were age 26-35 years (OR 3.9, 95% CI 1.03-15.16), primary education (OR 3.53, 95%CI 1.10-11.307) and urban dwelling (OR 4.22, 95% CI 1.27-14.01).</p> <p><strong>Conclusion:&nbsp;</strong>participants disclosed mainly to their partners and were comforted and many of them were encouraged by the health workers. There is need to optimize disclosure merits to enable increased participation in treatment and support programs.</p> Joseph Ngonzi Godfrey Mugyenyi Mukasa Kivunike Julius Mugisha Wasswa Salongo Sezalio Masembe Ronald Mayanja Francis Bajunirwe Copyright (c) 2019-04-24 2019-04-24 32 1 Naphthalene induced acute kidney injury in an African patient in Ghana: about a case report https://www.ajol.info/index.php/pamj/article/view/210393 <p>Naphthalene is commonly used in Ghana as an insecticide and there have been occasional ingestion unintentionally ingestion in children. Naphthalene use has been associated with intravascular haemolysis especially in patients with glucose-6-phoshate dehydrogenase (G6PD) deficiency but its unorthodox use for the treatment of urethritis in a young man and its associated acute kidney injury has not been described in Ghana. This case report bring to fore the indiscriminate use of complementary medicines and the multiple adverse effects on the kidneys after the ingestion of a combination of naphthalene, alcohol and aluminium sulphate (Alum) as a treatment for urethritis upon a friend's suggestion requiring intermittent haemodialysis but recovered completely of his renal functions. Naphthalene ingestion can cause acute tubular necrosis from haemoglobinuria and timely interventions are necessary to restore renal and maintain good renal functions.</p> Elliot Koranteng Tannor Kojo Awotwi Hutton-Mensah Copyright (c) 2019-04-24 2019-04-24 32 1 Rotavirus-associated acute diarrhea outbreak in West Shewa Zone of Oromia Regional State, Ethiopia, 2017 https://www.ajol.info/index.php/pamj/article/view/210396 <p><strong>Introduction:&nbsp;</strong>rotavirus causes severe-diarrheal diseases in infants. An estimation of 138 million rotavirus-associated diarrheal cases and 215,000 deaths occur every year globally. In December 2016, West-Shewa zone in Ethiopia reported unidentified gastrointestinal diarrhea outbreak. We investigated to identify the causative agent of the outbreak to support response operations.</p> <p><strong>Methods:&nbsp;</strong>medical records were reviewed, and the daily line list was collected from health facilities. Descriptive data analysis was done by time, person and place. Stool specimens were first tested by antigen capture enzyme immunoassay (EIA) technique and further confirmed by reverse-transcription polymerase chain reaction (RT-PCR) as a gold standard. The product of RT-PCR was genotyped for each gene using G1-G4, G8-G9 and G12 primers for VP7 gene and P(4), P(6), P(8) and P(14) primers for VP4 gene.</p> <p><strong>Results:&nbsp;</strong>a total of 1,987 diarrheal cases (5.7 per 1000) and five deaths (case-fatality rate 0.25%) were identified and epidemiologically-linked to confirmed rotavirus from December 2016 to February 2017. Among the cases, 1,946 (98%) were &lt; 5 children. Fourteen (74%) of the 19 tested stool specimens were positive for rotavirus by EIA and RT-PCR. Majority of strains detected were G12P(6) (25%) and G-negative P(8) (25%) followed by G9P(8) (19%), G1P(8) (13%) and G3/G2 P(8), G12P(8), and G-negative P(6) (6% each).</p> <p><strong>Conclusion:&nbsp;</strong>diarrheal outbreak which occurred in West-Shewa zone of Ethiopia was associated with rotavirus and relatively more affected districts with low vaccination coverage. Routine rotavirus vaccination quality and coverage should be evaluated and the surveillance system needs to be strengthened to detect, prevent and control a similar outbreak.</p> Abyot Bekele Woyessa Almaz Abebe Berhane Beyene Mesfin Tefera Esete Assefa Hiwot Ketema Birke Teshome Ayenachew Bekele Yohanis Dugasa Shambel Habebe Zewdu Assefa Diriba Sufa Dagnachew Alemu Habtamu Tilahun Mengistu Biru Gemechu Shume Copyright (c) 2019-04-26 2019-04-26 32 1 Méningite à Streptococcus pneumoniae sérotype 7A chez un nourrisson immunisé par deux doses du vaccin pneumococcique conjugué 13-valent: à propos d’un cas https://www.ajol.info/index.php/pamj/article/view/210422 <p>Cause majeure de morbidité et mortalité, les méningites à pneumocoque (PNO) représentent un fléau mondial. Au Maroc, le vaccin conjugué 13-valent contre le pneumocoque (PCV13) a été introduit dans le Programme National de Vaccination en octobre 2010 selon le calendrier 2 + 1 et remplacé par le PCV10 en juillet 2012, selon le même calendrier. Malgré le recours au PCV13, essentiel dans la lutte contre les maladies pneumococciques, l'émergence de nouveaux sérotypes non vaccinaux entrainent toujours des méningites chez l'enfant et engendrent de lourdes séquelles. Nous rapportons le cas d'une méningite causée par&nbsp;<em>Streptococcus pneumoniae&nbsp;</em>sérotype 7A chez un nourrisson immunisé avec 2 doses de PCV13. La particularité de cette observation réside dans une méningite à PNO sérotype 7A, non contenu dans le PCV13, chez un nourrisson vacciné par 2 doses du PCV13. Les auteurs insistent sur la nécessité et l'importance d'un observatoire PNO et d'une large étude épidémiologique afin de déterminer les sérotypes en circulation au Maroc depuis l'introduction du PCV13 puis PCV10.</p> Kaoutar Ouazzani Touhami Hind El Bayed Sakkali Fakhreddine Maaloum Idrissa Diawara Makine Ouazzani Touhami Mohamed Bezzari Khalid Zerouali Houria Belabbes Copyright (c) 2019-04-26 2019-04-26 32 1 Profil épidémiologique et clinique des tentatives de suicide chez l'enfant et l'adolescent en Tunisie en post révolution https://www.ajol.info/index.php/pamj/article/view/210436 <p><strong>Introduction:&nbsp;</strong>les conduites suicidaires sont en augmentation en Tunisie et touchent une population de plus en plus jeune. Le but de notre étude était de décrire le profil sociodémographique et clinique des tentatives de suicide chez l'enfant et l'adolescent.</p> <p class="ParagraphSeparator">&nbsp;</p> <p><strong>Méthodes:&nbsp;</strong>cette étude était transversale et descriptive, incluant 50 suicidants, recrutés au service de pédopsychiatrie de l'Hôpital Razi de la Manouba et dans deux services de réanimation et de pédiatrie de Tunis, entre juillet 2012 et juin 2013. Ont été relevés les facteurs sociodémographiques et cliniques, les antécédents de maltraitance, la scolarité, les caractéristiques de la TS, l'intentionnalité suicidaire évaluée par le Suicide Intent Scale, et les troubles psychopathologiques à l'aide du Mini-International Neuropsychiatric Interview.</p> <p class="ParagraphSeparator">&nbsp;</p> <p><strong>Résultats:&nbsp;</strong>le sex-ratio était de 0,56, la moyenne d'âge était de 12,4 ans avec des extrêmes de 7 à 16 ans. Un échec ou un fléchissement scolaire a concerné 86% des suicidants. Dans 38% des cas il s'agissait de récidive; des antécédents d'automutilations ont été retrouvés dans les mêmes proportions. Un contexte de maltraitance a été signalé dans 46% des cas. L'ingestion médicamenteuse était le moyen le plus fréquent, les psychotropes étant les plus représentés. Une différence significative entre le genre a été retrouvée dans le recours aux moyens suicidaires, ainsi les garçons ont eu davantage recours aux moyens physiques (p=0,04) et les filles aux intoxications (p=0,001). L'intentionnalité suicidaire était élevée dans 44%. Un épisode dépressif majeur et le trouble de l'adaptation étaient les troubles les plus fréquemment retrouvés dans respectivement 58% et 24% des cas.</p> <p><strong>Conclusion:&nbsp;</strong>les troubles dépressifs et la maltraitance se dégagent comme des facteurs de risque des TS chez les enfants et les adolescents, ces facteurs doivent être pris en considération dans les stratégies de prévention du suicide dans cette population.</p> Fatma Charfi Azza Harbaoui Afef Skhiri Zeineb Abbès Ahlem Belhadj Soumaya Halayem Asma Bouden Copyright (c) 2019-04-26 2019-04-26 32 1 Quality optimisation in colonoscopy: a function of time of colonoscopy or bowel preparation https://www.ajol.info/index.php/pamj/article/view/210443 <p>To test the hypothesis claimed in recent studies that quality of bowel preparation for colonoscopy could be influenced by the time of the day colonoscopy is performed. Do patients in morning list have better bowel preparation than those on the afternoon list? Retrospective analysis of 736 consecutive patients who had colonoscopy from 1<sup>st</sup>&nbsp;August to 31<sup>st</sup>&nbsp;December 2012. Patients with poor bowel preparation (Boston Bowel Prep Score 6 or less) were identified (n = 242). Colonoscopy reports of these patients analysed. Patients were stratified into two groups (am and pm) and results compared. Mean patient age 63.9 years (range 19-89). Male to female ratio 1:1. 92% of patients were given Moviprep. for bowel preparation. 32.9% (242/736) of patients were identified as having inadequate bowel preparation. 37.7% of morning list patients had poor bowel preparation. 26.7% of afternoon list patients had poor bowel preparation. 14.7% (108/736) had incomplete colonoscopy, of which 26.9% (29/108) were due to poor bowel preparation. The commonest reasons for incomplete examination were patient discomfort &amp; bowel looping. Our study demonstrates that morning session patients had poorer bowel preparation than the afternoon session patients in contrast to published evidence in recent literature. This implies that timing of bowel preparation is probably more important than timing of colonoscopy. Poor bowel preparation does not seem to have a significant impact on the colonoscopy failure rate in this series.</p> Haytham Abudeeb Khurram Khan Min Maung Lee Malcomson Alistair Brown Copyright (c) 2019-04-26 2019-04-26 32 1 Effect of HIV infection on TB treatment outcomes and time to mortality in two urban hospitals in Ghana-a retrospective cohort study https://www.ajol.info/index.php/pamj/article/view/210462 <p><strong>Introduction:&nbsp;</strong>Tuberculosis (TB) is currently causing more deaths than Human Immunodeficiency Virus (HIV) globally. Ghana as one of the 30 high burden TB/HIV countries has a high annual TB case-fatality rate of 10%. The study sought to assess the effect of HIV infection on TB treatment outcomes and assess the time to mortality after treatment onset.</p> <p><strong>Methods:&nbsp;</strong>we conducted a review of treatment files of TB patients who were treated from January 2013 to December 2015 in two urban hospitals in the Accra Metropolis. Modified Poisson regression analysis was used to measure the association between HIV infection and TB treatment outcomes. Kaplan-Meier survival estimates were used to plot survival curves.</p> <p><strong>Results:&nbsp;</strong>seventy-seven percent (83/107) of HIV infected individuals had successful treatment, compared to 91.2% (382/419) treatment success among HIV non-infected individuals. The proportion of HIV-positive individuals who died was 21.5% (23/107) whilst that of HIV-negative individuals was 5.5% (23/419). Being HIV-positive increased the risk of adverse outcome relative to successful outcome by a factor of 2.89(95% CI 1.76-4.74). The total number of deaths recorded within the treatment period was 46; of which 29(63%) occurred within the first two months of TB treatment. The highest mortality rate observed was among HIV infected persons (38.6/1000 person months). Of the 107 TB/HIV co-infected patients, 4(3.7%) initiated ART during TB treatment.</p> <p><strong>Conclusion:&nbsp;</strong>the uptake of ART in co-infected individuals in this study was very low. Measures should be put in place to improve ART coverage among persons with TB/HIV co-infection to help reduce mortality.</p> Lily Ogyiri Margaret Lartey Oluwayemisi Ojewale Andrew Anthony Adjei Awewura Kwara Richard Mawuena Adanu Kwasi Torpey Copyright (c) 2019-04-26 2019-04-26 32 1 Parental views on plastic surgery for Down syndrome: an African perspective https://www.ajol.info/index.php/pamj/article/view/210469 <p><strong>Introduction:&nbsp;</strong>plastic surgery for Down syndrome has not been embraced in sub-Saharan Africa. This study sought to determine the attitudes of some parents from sub-Saharan Africa to plastic surgery for their Down syndrome child.</p> <p><strong>Methods:&nbsp;</strong>consenting parents completed a questionnaire survey instrument that obtained demographic characteristics and contained a likert scale on attitudes to plastic surgery. Internal consistency of the scale was determined with Chronbach's alpha and Pearsons chi square analysis was used to analyze relationships between demographic variables and attitudes scores. Values less than 0.05 were considered statistically significant.</p> <p><strong>Results:&nbsp;</strong>most (61.9%) of the 42 consenting mothers were above 35 years of age. The most disturbing of the Down syndrome characteristics were the protruding tongue, 18(42.9%), slanting palpebral fissures, 14(33.3%) and the flattened nasal bridge 14(33.3%). Although the mothers had low awareness of plastic surgery, most of them had favourable attitudes towards it. A reliability analysis of the mother's attitudes on the likert scale showed good internal consistency. Chronbachs alpha 0.87.</p> <p><strong>Conclusion:&nbsp;</strong>the parents in this study have favourable attitudes towards plastic surgery for Down syndrome. The prominent tongue was the most disturbing feature.</p> Afieharo Igbibia Michael Olumide Olatokunbo Jarrett Copyright (c) 2019-04-29 2019-04-29 32 1 Safaa Ammouri https://www.ajol.info/index.php/pamj/article/view/210472 <p>Leiomyomas represent about 3.8% of all benign soft tissue tumors. Vulvar localization is very rare. We present a case of a vulvar leiomyoma and discuss diagnostic and therapeutic features of this disease. A 30-year-old female patient with no medical history, had a 5cm mass located in the left large lip causing a discomfort at the perineum especially in sitting and walking. She underwent a complete surgical excision of the mass. The pathological examination confirmed the diagnosis of a leiomyoma. There was no recurrence after 24-months' follow-up. The vulvar leiomyoma is a rare benign tumor. The diagnosis is made only postoperatively after resection of the mass. The treatment is essentially based on total excision of the mass with a good prognosis.</p> Safaa Ammouri Chourouk Elkarkri Najia Zeraidi Amina Lakhdar Abdelaziz Baydada Copyright (c) 2019-04-29 2019-04-29 32 1 Profil clinique et évolutif des lésions de la peau et des parties molles chez les diabétiques en 2017 à la salle de pansement du Centre Marc Sankale de Dakar https://www.ajol.info/index.php/pamj/article/view/210473 <p><strong>Introduction:&nbsp;</strong>le but de notre étude était de déterminer le profil clinique et évolutif des lésions de la peau et des parties molles des sujets diabétiques suivis à la salle de pansement.</p> <p><strong>Méthodes:&nbsp;</strong>il s'agissait d'une étude observationnelle descriptive et analytique menée du 1<sup>er</sup>&nbsp;janvier au 31 décembre 2017 à la salle de pansement du centre Marc Sankale de Dakar. Notre étude a porté sur les sujets diabétiques ayant consultés à la salle de pansement.</p> <p><strong>Résultats:&nbsp;</strong>au total, 37173 actes de soins ont été enregistrés au centre Marc Sankale. Les activés de soins à la salle de pansement représentaient 16418 cas soit une prévalence de 14,16%. L'âge moyen était de 56,6 ± 12 ans et le sex ratio (H/F) de 0,88. Le diabète de type 2 prédominait (78,97%) et la durée moyenne du diabète était de 8,06 ± 7,9 ans. La glycémie capillaire moyenne était de 2,4 ± 1 g/l. La neuropathie diabétique était présente chez 72,33% des cas. Les lésions se situait aux membres dans 93,98% (1185 cas). Les lésions les plus représentatives étaient l'ulcère (46,76%), l'abcès (13,46%), le phlegmon (13,20%), la gangrène (8,41%), l'érysipèle (3,78%), le mal perforant (3,53%), l'intertrigo (3,95%). Les lésions étaient infectieuses (61,41), non infectieuses (33,50%), vasculaires pures (1,57%) et Mixtes (3,70%). Sur les 1189 patients 7,57% avaient présentés une ostéite. Les germes retrouvés étaient des bactéries grams positifs (12,70%), grams négatifs (23,80%). L'amputation était corrélée à la topographie de la lésion (p=0.00), au type de lésion (p=0.000), à l'ancienneté du diabète (p=0,02), au type de diabète (p=0,008), à la présence d'ostéite (p=0,006). L'amputation etait mineur (43,33%), et majeur (37,43%). Nous avons enregistré 70 décès (5,89%).</p> <p><strong>Conclusion:&nbsp;</strong>les lésions de la peau et des tissus mous restent dominées par le pied diabétique. La mortalité est non négligeable et le risque d'amputation était statistiquement corrélé à la topographie, au type de lésion, à l'ancienneté et le type de diabète et à l'existence d'ostéite.</p> Diallo Ibrahima Mané Diédhiou Demba Sow Djiby Ndour Michel Assane Barrage Ahmet Limane Ka-Cissé Marie Sarr Anna Ndour Mbaye Maimouna Copyright (c) 2019-04-29 2019-04-29 32 1 Prevalence and predisposing factors of brachial plexus birth palsy in a Regional hospital in Ghana: A five year retrospective study https://www.ajol.info/index.php/pamj/article/view/210477 <p><strong>Introduction: b</strong>rachial plexus birth injury is one of the challenges associated with maternal delivery, with varying prevalence between countries. Brachial plexus birth injury poses negative health implications to children and also has socio-economic implications on families and the community as a whole. To treat BPB injury, a multi-disciplinary treatment approach is recommended. Brachial plexus birth palsy is categorised into two-upper plexus injury (Erb's palsy) and lower plexus injury (Klumpke's palsy). These categories present with various degrees of injuries, with less severe injuries responding well to treatment and in most instances may resolve on their own, but serious and complicated injuries will require a multi-disciplinary treatment approach to treat and/or manage. Effective treatment and management depends on adequate knowledge of the disease condition. These include the risk factors and prevalence of Brachial plexus birth injury within a particular population at a specific period in time. The aim of this study was to determine the risk factors and the prevalence of a hospital based BPBP within a five-year period (2013-2017).</p> <p><strong>Methods:&nbsp;</strong>a five-year retrospective study design was used. The study involved selection of all clients' diagnosed with brachial plexus birth palsy, where their gender, birth weight, complications at birth, type of brachial plexus suffered, mothers' diabetes status, mother's age, birth attendant, side of affectation, presentation at birth and mode of delivery were recorded.</p> <p><strong>Results:&nbsp;</strong>the prevalence rate of brachial plexus birth palsy was 14.7% out of a total of three hundred and twenty (320) cases reviewed over the study period in the Volta Regional Hospital. Erb's palsy was found to be the modal type of BPBP in this population (93.6%).</p> <p><strong>Conclusion:&nbsp;</strong>there is the need to provide a nationwide education on the risk factors that predispose babies to brachial plexus birth palsy. There is also the need for frequent antenatal visit by pregnant women; this will help in the provision of best antenatal history, diagnostic investigation in determining the birth weight and safe mode of delivery.</p> Cosmos Yarfi Cephas Elekusi Adjoa Nkrumah Banson Nii Korley Kortei Eric Kwasi Ofori Copyright (c) 2019-04-29 2019-04-29 32 1 Prevalence of viral and non-viral hepatitis in Menoua Division, West Region, Cameroon: a retrospective hospital-based study https://www.ajol.info/index.php/pamj/article/view/210480 <p><strong>Introduction:&nbsp;</strong>the paucity of data on hepatitis' epidemiology in Menoua Division, west region, Cameroon, prompted us to assess the prevalence of viral and non-viral hepatitis in this area.</p> <p><strong>Methods:&nbsp;</strong>a retrospective exhaustive study based on records of patients from January 2008 to June 2014 was conducted in 9 health centres in Menoua Division. Targeted subjects were patients who did not receive hepatitis vaccines for the past year and have been screened for hepatitis B virus (HBV), hepatitis C virus (HCV) and/or a blood transaminase. Associations between variables were quantified with odd ratios (OR) and 95% confidence interval (CI). Cochran-Armitage test of linear trend was used for testing proportions of ordinal variables. Fisher's exact test was used for testing the association between 2 qualitative variables when expected counts were less than 5.</p> <p><strong>Results:&nbsp;</strong>the overall prevalence were 9.6% and 6.7% for HBV and HCV respectively. HBV mostly infected people aged 21-30 (12.4%) while the prevalence of HCV increased with age up to 35.4% (p=0.03). A 0.6% co-infection was observed. Thirty percent of positive HBV or HCV had high transaminase while 13% of patients with elevated transaminase showed negative viral serology.</p> <p><strong>Conclusion:&nbsp;</strong>these results show that hospital-based prevalence of HCV and HBV in Menoua Division is under the Cameroon's national range but point out the fact that non-viral hepatitis might be a serious case of concern in this area. There is therefore, a need to identify the risk-factors of non-viral hepatitis.</p> Mathias Kenfack Tsague Agathe Lambou Fotio Cyrille Lionel Kamga Bomgning Georges Nguefack-Tsague Francois Fopa Télesphore Benoît Nguelefack Copyright (c) 2019-04-29 2019-04-29 32 1 Hanhart syndrome: hypoglossia-hypodactylia syndrome https://www.ajol.info/index.php/pamj/article/view/210484 <p>Hanhart syndrome is a congenital disorder that causes an undeveloped tongue and malformed extremities and fingers. Small mouth, short or incompletely developed tongue (hypoglossia), absent or shortened fingers and/or toes, jaw abnormalities such as micrognathia, retrognathia or partially missing mandible (lower jaw), high-arched, narrow, palate, absent or unusually formed arms and/or legs. If the tongue and/or mouth are affected, this can worsen feeding difficulties that are already present due to the craniofacial abnormalities. A diagnosis of Hanhart syndrome is typically made based on the presence of characteristic signs and symptoms. To date, no specific disease-causing genes have been identified. We present the case of a 3000 g male infant who was born at 39 weeks' gestation to a 42-year-old gravida 2 para 2 mother via cesarean section. At the physical examination he was noted to have adactyly at two hands, micrognathia, incompletely developed tongue and high-arched palate. Tongue movements were inadequate because of the small size. When we looked at the pregnancy history the mother took thyroid drugs cause of hypothyroidism after thyroid surgery and there was no family history of congenital anomalies or consanguinity. Due to feeding difficulties he stayed at neonatal intensive care unit. Cranial and abdominal ultrasonographyic examination of the infant was otherwise normal. The infant was discharged home on full oral feedings on day 6.</p> Ipek Guney Varal Pelin Dogan Copyright (c) 2019-04-29 2019-04-29 32 1 Exceptional intrarenal pseudomembranous https://www.ajol.info/index.php/pamj/article/view/210485 <p class="ArticleParagraph">We report the case of a 51-year-old patient, known as hypertensive and type 2 diabetic, admitted to emergency for acute pyelonephritis. She suffered from low back pain in a feverish context. A Uro-scanner showed the presence of a 12mm pyelic renal calculus and a calycal calculus of 6mm diameter responsible for a moderate dilation of left pyelocalictic cavities. First, we performed drainage with a double J probe. Then, in a second step, the left ureteroscopy allowed partial laser fragmentation. The presence of a suspect soft magma prompted us to stop the procedure. After performing a hydatid serology that has returned negative, a laparoscopic left pyelotomy allowed the progressive externalization of the suspect magma. It presented with a greenish, fibrinous, semi-solid shell completely molding the pyelon and the pyelocalicielles cavities. The introduction of the flexible cystoscope through a trocar at the end of the procedure allowed us to check the complete cleaning of the excretory cavities. The anatomopathological study is back in favor of a weakly eosinophilic acellular material with some polyhedral crystals and some inflammatory elements. There were no signs of malignancy. The patient did not present any postoperative complication and did not present a recurrence.</p> Souhail Regragui Gabriel Stoica Copyright (c) 2019-04-29 2019-04-29 32 1 Selected genes of Human herpesvirus-8 associated Kaposi’s sarcoma among patients with Human Immunodeficiency Virus-1 and Acquired Immunodeficiency Disease Syndrome https://www.ajol.info/index.php/pamj/article/view/210490 <p><strong>Introduction:&nbsp;</strong>Kaposi's sarcoma (KS) is a kind of cancer that causes flat or raised lesions containing Human herpes virus 8 (HHV8). The KS lesions are common among immunosuppressed HIV patients. Highly Active Antiretroviral (HHART) treats and prevents the development of KS. The objective of this study was to determine the presence of K1 and K15 (predominant alleles) genes in Kaposi's sarcoma-associated herpes virus (KSHV) among immunosuppressed patients due to HIV -1.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional descriptive study where consecutive sampling technique was adopted to pick archived tissue blocks from the Thematic Unit of Anatomic Pathology, Department of Human Pathology, College of Health Sciences, University of Nairobi and Department of Laboratory Medicine, Histology Section, Kenyatta National Hospital</p> <p><strong>Results:&nbsp;</strong>upon staining 81 tissue blocks with H &amp; E, 84% (68/81) were diagnosed as KS and 16% (13/81) as KS-like. The K1 and K15 (P) genes were both detected at 88.9% (72/81) in the tissue blocks, with 95.8% (69/72) detection from KS and4.2% (3/72) from the KS-like.</p> <p><strong>Conclusion:&nbsp;</strong>the K1 and K15 (P) genes of KSHV were present among the immunosuppressed patients with Human Immunodeficiency Virus (HIV)-1. It is important to carry out K1 and K15 (P) genes detection on tissues that are diagnosed as KS or KS-like by histology technique</p> Rodgers Norman Demba Nathan Shaviya Sylviah Mweyeli Aradi Walter Mwanda Copyright (c) 2019-04-30 2019-04-30 32 1 Syndrome d’antidiurèse inappropriée néphrogénique https://www.ajol.info/index.php/pamj/article/view/210493 <p>Les troubles de l'équilibre de l'eau représentent une pathologie fréquente dans notre pratique clinique. L'étude du récepteur V2R est importante pour la compréhension de la physiologie de l'équilibre hydrique et a servi de prototype pour la biologie des récepteurs G couplés aux protéines. Le syndrome d'antidiurèse inappropriée néphrogénique (NSIAD) est un syndrome de sécrétion inappropriée d'hormone antidiurétique (SIADH)-like avec un dosage plasmatique de vasopressine bas. La preuve du rôle du récepteur V2R et de l'aquaporine (AQP) dans le mode d'action de l'hormone antidiurétique (ADH) est venue de l'identification de mutations dans les gènes de ces protéines dans le diabète insipide néphrogénique et dans le syndrome NSIAD. Des mutations activatrices du V2R ont été retrouvées dans le NSIAD, à l'opposé des nombreuses mutations inactivatrices du V2R liées à l'X décrites dans le diabète insipide néphrogénique.</p> Benabdellah Nawal Hassan Izzedine Intissar Haddiya Yassamine Bentata Copyright (c) 2019-04-29 2019-04-29 32 1 Predictors of loss to follow-up among children attending HIV clinic in a hospital in rural Kenya https://www.ajol.info/index.php/pamj/article/view/210496 <p><strong>Introduction:&nbsp;</strong>African studies have reported high rates of loss to follow up (LTFU) among children in HIV care and treatment centres. Factors associated with LTFU may vary across populations. Few studies have been conducted among HIV infected children in care in rural areas of Kenya.</p> <p><strong>Methods:&nbsp;</strong>this involved children aged less than 15 years on follow up at Kangundo Level 4 Hospital HIV clinic from January 2010 to December 2015. We obtained sociodemographic and clinical information from patient files and electronic databases. Univariate and multivariate regression analyses were conducted to identify factors predictive of LTFU.</p> <p><strong>Results:&nbsp;</strong>a total of 261 HIV-infected children were followed up. The mean age was 10.0 years (IQR, 7-13) and median CD4 count of 582cells/ul (IQR 314-984). By December 2015, 171 children (65.5%) remained in active care, 32 (12.3%) transferred out, 13 (5%) died, while 45 (17.2%) were classified as LTFU. Out of the 45 children presumed as LTFU, we traced 44 out of the 45 children (98%) and found that their actual current status was as follows: 33 of the 44 children (75.0%) had dropped out of care (true LTFU). Factors strongly predictive of LTFU included low caregiver level of education (HR 2.3, 1.9-3.9, P = 0.001), WHO stage I and II at enrolment (HR 1.6, 1.4-2.1, P = 0.05).</p> <p><strong>Conclusion:&nbsp;</strong>LTFU of HIV infected children was common with an incidence of 32.9 per 1000 child years and occurred early in treatment and risk factors included poverty, low caregiver education, male child and early HIV disease stage.</p> Winnie Mueni Saumu Elizabeth Maleche-Obimbo Grace Irimu Rashmi Kumar Christine Gichuhi Bundi Karau Copyright (c) 2019-04-30 2019-04-30 32 1 Connaissances attitudes et pratiques du personnel des salons de coiffures sur l'infection à VIH à Lomé Togo https://www.ajol.info/index.php/pamj/article/view/210502 <p><strong>Introduction:&nbsp;</strong>le but de cette étude était de décrire les connaissances, attitudes et pratiques du personnel des salons de coiffure sur l'infection à VIH à Lomé.</p> <p><strong>Méthodes:&nbsp;</strong>il s'est agi d'une étude descriptive, dont la population d'étude était constituée par les patrons et les apprentis des salons de coiffure de la préfecture d'Agoè-nyivé à Lomé entre le 1<sup>er</sup>&nbsp;octobre 2016 et le 31 mars 2017. Les différents paramètres étudiés étaient les données sur la connaissance générale du VIH, les attitudes et pratiques sur le VIH/Sida dans les salons de coiffure.</p> <p><strong>Résultats:&nbsp;</strong>au total, 203 patrons et apprentis présents dans les 68 salons de coiffure des préfectures d'Agoè-nyivé ont été enquêtés. L'infection à VIH/ Sida était connue par tous (100%) les participants et 79,3% d'entre eux la définissaient comme étant une infection sexuellement transmissible. Le port de tablier ou de gants avant certains gestes de coiffure était fait dans respectivement 33(51,5%) et 35(48,5%) salons de coiffures. Aussi, dans 60(88,2%) salons de coiffure, une décontamination des objets tranchants était faite avant leur usage. Cependant, l'alcool était le désinfectant le plus utilisé par la majorité (89,3%) du personnel des salons de coiffure. Aussi, l'ébullition pendant en moyenne 7 minutes était réalisée par 79,8% des coiffeurs. En cas d'accident d'exposition au sang, 69,6% du personnel des salons de coiffure faisaient un nettoyage du site exposé avec de l'alcool.</p> <p><strong>Conclusion:&nbsp;</strong>cette étude a montré que les coiffeurs/coiffeuses et leurs apprentis ont de bonnes connaissances sur l'infection à VIH/Sida, sur ses modes de transmission et ses moyens de prévention dans les salons de coiffure. Cependant, certaines pratiques dont les méthodes de désinfections du matériel souillé et la conduite en cas d'accidents d'exposition au sang (AES) étaient mauvaises.</p> Julienne Noude Teclessou Bayaki Saka Abravi Emefa Sabli Abla Séfako Akakpo Abas Mouhari-Touré Koussake Kombate Palokinam Pitche Copyright (c) 2019-04-30 2019-04-30 32 1 Impasse thérapeutique pour une tumeur de la vessie métastatique métachrone à un sarcome de kaposi: à propos d’un cas rare https://www.ajol.info/index.php/pamj/article/view/210504 <p>La chimiothérapie est le traitement indiqué pour un carcinome urothélial métastatique de la vessie, la coexistence d'une tumeur de vessie métastatique avec un sarcome de Kaposi pose un sérieux problème d'aggraver le nouveau néoplasie, un cas rare où n'avons pu que confier le patient à sa famille.</p> Bienvenu Bega Shamalirwa Omana Wembonyama Richepin Tidahy Soufiane Mellas Jalal Eddine El Ammari Mohammed Fadl Tazi Moulay Hassan Farih Hakima Elmahi Ibrahim Sory Sidibe Copyright (c) 2019-04-30 2019-04-30 32 1