Pan African Medical Journal <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 Vaccine hesitancy and other obstacles to COVID-19 control: lessons from smallpox <p>The world confronts today a disease which was unknown as recently as early 2019. Now that there is a safe and effective vaccine against COVID-19, lessons can usefully be drawn from previous well documented vaccination efforts. Of these, the best documented and most successful is the Smallpox Eradication Program (SEP). A review was made of publications by major players in smallpox eradication, respecting the important differences between the disease, this review revealed several points of connection. Cultural factors loomed large both in the eradication of smallpox and progress, to date, in the control of COVID-19. Other points of similarity included political commitment, the set-up of strong surveillance mechanisms, and assurance of uniformly high quality vaccines tested and approved by the World Health Organization. The future of COVID-19 control depends, in part, on lessons learned from previous vaccination efforts. A review of those efforts will avoid repetition of past errors and permit adoption of best practices from the past. Such analyses must, of course, respect the important differences between COVID-19 and smallpox.</p> Robert Davis Copyright (c) 2021-09-01 2021-09-01 40 1 Validation of GeneXpert testing for SARS-CoV-2 RNA in eight hospital laboratories in Oman <p>In response to the current COVID-19 pandemic, numerous commercial assays have been developed for the detection of SARS-CoV-2 for use in the clinical diagnostic laboratories. To date, there is limited comparison of testing methods performed in different hospital laboratory sites. The aims of the study were to evaluate the analytical performance of Cepheid Xpert Xpress SARS-CoV-2 when compared to RT-PCR. This is a cross-sectional study. A total of 155 nasopharyngeal swabs were taken in duplicate from patients presenting with suspected COVID-19 to 8 hospitals in Oman. One swab was tested by the hospital laboratory and the duplicate swab was sent to the national Central Public Health Laboratory (CPHL) for testing. We compared the analytical performance of the commercially available point of care Cepheid Xpert Xpress SARS-CoV-2 assay which was used in the 8 different hospitals with assays including Liferiver, Sansure, TIB MOL BIOL, Kingfisher and COBAS 6800 by Roche which were performed at the CPHL. Testing of the duplicate swabs revealed excellent agreement of results with the viral loads of Ct values ranging from 16-43 for the E gene, 18-44 for the N gene and 17-44 for the ORF gene using the Liferiver assay. The overall sample sensitivity and specificity of the Cepheid Xpert Xpress SARS-CoV-2 assay were both 100% and there was 100% agreement across specimens. We conclude that the rapid GeneXpert and RT-PCR kits assessed in this study may be used for routine diagnostic testing of COVID-19 patients by experienced clinical microbiology diagnostic laboratories. Our results highlight the importance of rapid molecular testing at different sites within a country in a public health emergency.</p> Nawal Al-Kindi Intisar Al-Shukri Azza Al-Rashdi Nada Al-Siyabi Samira Al Mahruqi Hanan Al-Kindi Amina Al-Jardani Copyright (c) 2021-09-01 2021-09-01 40 1 Reticulocyte count: a simple test but tricky interpretation! <p>N/A</p> Malvika Gaur Tushar Sehgal Copyright (c) 2021-09-02 2021-09-02 40 1 Access barriers to maternal healthcare services in selected hard-to-reach areas of Zambia: a mixed methods design <p><strong>Introduction:&nbsp;</strong>poor access to maternal health services is a one of the major contributing factors to maternal deaths in low-resource settings, and understanding access barriers to maternal services is an important step for targeting interventions aimed at promoting institutional delivery and improving maternal health. This study explored access barriers to maternal and antenatal services in Kaputa and Ngabwe; two of Zambia´s rural and hard-to-reach districts.</p> <p><strong>Methods:&nbsp;</strong>a concurrent mixed methods approach was therefore, undertaken to exploring three access dimensions, namely availability, affordability and acceptability, in the two districts. Structured interviews were conducted among 190 eligible women in both districts, while key informant interviews, in-depth interviews and focus group discussions were conducted for the qualitative component.</p> <p><strong>Results:&nbsp;</strong>the study found that respondents were happy with facilities´ opening and closing times in both districts. By comparison, however, women in Ngabwe spent significantly more time traveling to facilities than those in Kaputa, with bad roads and transport challenges cited as factors affecting service use. The requirement to have a traditional birth attendant (TBA) accompany a woman when going to deliver from the facility, and paying these TBAs, was a notable access barrier. Generally, services seemed to be more acceptable in Kaputa than in Ngabwe, though both districts complained about long queues, being delivered by male health workers and having delivery rooms next to male wards.</p> <p><strong>Conclusion:&nbsp;</strong>based on the indicators of access used in this study, maternal health services seemed to be more accessible in Kaputa compared to Ngabwe.</p> Chris Mweemba Miriam Mapulanga Choolwe Jacobs Patricia Katowa-Mukwato Margaret Maimbolwa Copyright (c) 2021-09-02 2021-09-02 40 1 Factors impacting on diabetes knowledge, medication adherence and glycemic control among adult diabetics visiting a county teaching and referral hospital in Kenya: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>optimal management of diabetes involves interplay between patients’ understanding of their disease and medication adherence, which would eventually influence glycemic control. However, there is scant published literature on the interconnection of patient related factors that impact on optimal management of diabetes in resource-limited settings such as Kenya.</p> <p><strong>Methods:&nbsp;</strong>a hospital based cross-sectional survey involving 270 freely consenting adult diabetics investigated the interconnection between diabetes knowledge, medication adherence and glycemic control. Data on the patient´s knowledge and medication adherence was collected using validated tools whilst glycemic control was evaluated using the patients’ glycated haemoglobin values. Data analysis was carried out using STATA version 13 statistical software, employing the chi square test for association and simple linear regression for prediction, with p ≤0.05 considered significant.</p> <p><strong>Results:&nbsp;</strong>participants´ level of knowledge on diabetes was significantly associated with the academic achievement (p=0.001), while their medication adherence was significantly associated with family support (p=0.001) and duration of disease since diagnosis (p=0.019). On linear regression, family support occasioned by the nature of participants’ household setup, had a strong positive correlation [r=0.99 (CI 0.60-1.00)] with optimal glycemic control.</p> <p><strong>Conclusion:&nbsp;</strong>family support is an important determinant of medication adherence and optimal glycemic control among diabetic patients. Clinicians should team up with family members of diabetic patients for optimal glycemic control.</p> Faith Machocho Mwangasha David Gitonga Nyamu Lucy Jemutai Tirop Copyright (c) 2021-09-02 2021-09-02 40 1 Basic physical exam skills versus technology: a case of undiagnosed scleroderma <p>A 50-year-old female with no previous known medical history was transferred to our tertiary hospital for undiagnosed chronic abdominal pain, bloating, nausea, recurrent vomiting, and extreme unintentional weight loss ongoing for the past three years. During that time, she had many emergency department visits and evaluated by multiple specialists. Previous workups include numerous CT scans, MRIs, EGDs and colonoscopies without a clear clinical diagnosis. She had been prescribed multiple courses of PPIs and antibiotics. Also, she had undergone two abdominal surgeries for suspected bowel obstruction and pseudo-obstruction. Upon encounter, the patient was noted to be severely cachectic after being on TPN for the last three months due to severe esophageal reflux, heartburn, and food intolerance. A more careful history revealed symptoms of Raynaud´s for the last 10 years. Also, when specifically asked and examined, the patient stated that her skin is hard and shiny, as if it was waxed. Based on the clinical presentation, diagnosis of CREST syndrome was suspected. That was further supported by a positive anti-centromere antibody test. Treatment options were limited due to the extent of disease progression by the time of diagnosis. Systemic sclerosis diagnosis can be challenging and requires a high level of suspicion. This case accents the gravity and value of a thorough history and physical examination as the prime foundation to reaching a diagnosis and it reminds us that sophisticated investigations are not a substitution for the essential skills of history taking and physical exam, especially in the setting of a long-standing undiagnosed illness.</p> Elias Shamieh Husam Bader Copyright (c) 2021-09-02 2021-09-02 40 1 Luxation antéro-supérieure de l´épaule: à propos d´un cas et revue de la littérature <p>Les luxations traumatiques de l'articulation de l'épaule sont généralement décrites comme des luxations antéro-inférieures. Les luxations antéro-supérieures sont extrêmement rares. Nous rapportons un cas rare de luxation traumatique de l´épaule antéro-supérieure chez un patient âgé de 45 ans où l´examen physique trouve une saillie antéro-superieure de la tête humérale en sous-cutanée avec comblement de l´espace sous acromiale, le diagnostic était confirmé radiologiquement avec la découverte d´une rupture totale des tendons supra-épineux et sous scapulaire à l´imagerie par résonance magnétique. L´épaule était jugée instable après réduction de la luxation. Une arthrorise gléno-humérale provisoire était réalisée par la suite avec des bons résultats fonctionnels.</p> Fahd Idarrha Yassine Fath El Khir Ahmed idoukitar Mehdi Maskouf Abdesslam Achkoun Mohammed Amine Benhima Imad Abkari Halim Saidi Copyright (c) 2021-09-02 2021-09-02 40 1 Cardiovascular risk and stroke mortality in persons living with HIV: a longitudinal study in a hospital in Yaounde <p><strong>Introduction:</strong>&nbsp;HIV infection is a well-known risk factor for stroke, especially in young adults. In Cameroon, there is a death of data on the outcome of stroke among persons living with HIV (PLWH). This study aimed to assess the cardiovascular risk profile and mortality in PLWH who had a stroke.</p> <p><strong>Methods:&nbsp;</strong>this was a retrospective cohort study of all PLWH aged ≥18 years admitted for stroke between January 2010 and December 2019 to the Cardiology Unit of the Yaoundé Central Hospital, Cameroon. Cardiovascular risk was estimated using the modified Framingham score, with subsequent dichotomization into low and intermediate/high risk. Mortality was assessed on day 7 during hospitalization (medical records), at one month, and one year by telephone call to a relative.</p> <p><strong>Results:&nbsp;</strong>a total of 43 PLWH who had a stroke were enrolled. Their mean age was 52.1 (standard deviation 12.9) years, most of them were female (69.8%, n = 30). There were 25 (58.1%) patients on concomitant antiretroviral therapy. The Framingham cardiovascular risk score at admission was low in 29 patients (67.4%) and intermediate to high in 14 patients (32.6%). Ischemic stroke was the most common type of stroke in 36 persons (83.7%). The length of hospital stay was 11.4 (interquartile range 9.2-13.7) days. Mortality at 1 year was 46.5% (n = 20).</p> <p><strong>Conclusion:&nbsp;</strong>stroke mortality was high in this population of PLWH. Most patients had a low Framingham score, suggesting that this risk estimation tool underestimates cardiovascular risk in PLWH.</p> Liliane Mfeukeu Kuate Larissa Ange Kwangoua Tchuisseu Ahmadou Musa Jingi Charles Kouanfack Francky Teddy Endomba Christian Ngongang Ouankou Leonard Ngarka Jean Jacques Noubiap Samuel Kingue Alain Menanga Pierre Ongolo Zogo Copyright (c) 2021-09-02 2021-09-02 40 1 Assessment of thyroid function of newly diagnosed SARS-CoV-2 infected patients in Nigeria <p><strong>Introduction:&nbsp;</strong>the outbreak and rapid spread of the novel SARS-CoV-2, the causative agent of the coronavirus disease 2019 (COVID-19), has evolved into an unprecedented global pandemic. The infection impairs several human organs and systems, however, it is not clear how it affects thyroid function. The study therefore aimed at measuring plasma levels of thyroid hormones and Hs-CRP in COVID-19 patients and apparently healthy uninfected controls to assess the possible effect of SAR-CoV-2 infection on thyroid function.</p> <p><strong>Methods:&nbsp;</strong>in this cross-sectional study carried out between May-August 2020, 90 consenting participants comprising 45 COVID-19 patients and 45 apparently healthy uninfected controls were recruited. Plasma FT3, FT4, TSH and Hs-CRP were measured using Enzyme Linked Immunosorbent Assay (ELISA) method. Data was analysed using SPSS version 20 and statistical significance set at p &lt; 0.05.</p> <p><strong>Results:&nbsp;</strong>the mean plasma FT3 and TSH concentrations were significantly higher in COVID-19 patients compared to controls (p &lt; 0.001, p &lt; 0.001 respectively). Euthyroidism was observed in all uninfected controls, whereas 35 (77.8%) COVID-19 patients were euthyroid. Sick euthyroid and subclinical hypothyroidism was observed in 7 (15.6%) and 3 (6.7%) COVID-19 patients, respectively.</p> <p><strong>Conclusion:&nbsp;</strong>though there was a preponderance of euthyroidism among COVID-19 patients, significantly higher mean plasma levels of TSH and FT3, sick euthyroid syndrome and subclinical hypothyroidism observed among some COVID-19 patients may be indicative of disease-related thyroid function changes. Hence, there is need to pay attention to thyroid function during and after treatment of COVID-19.</p> Chika Juliet Okwor Ijeoma Angela Meka Kazeem Sanjo Akinwande Victory Fabian Edem Vitalis Chukwuemeka Okwor Copyright (c) 2021-09-02 2021-09-02 40 1 COVID-19 vaccine hesitancy among healthcare workers and its socio-demographic determinants in Abia State, Southeastern Nigeria: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>healthcare workers are at higher risk of COVID-19 infection with ease of infection transmissibility to coworkers and patients. Vaccine hesitancy rates of 56% and up to 25% have been reported among healthcare workers in US and China respectively. Vaccination is known as the most effective strategy to combat infectious diseases. Acceptance of the COVID-19 vaccine plays a major role in combating the pandemic. This study assessed the sociodemographic factors associated with COVID-19 vaccine hesitancy among healthcare workers in Abia State.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study among 422 healthcare workers was conducted in Abia State with an online-based questionnaire. The questionnaire extracted information on socio-demographics and willingness to take vaccine uptake. Descriptive statistics was used to calculate frequencies and proportions. Bivariate analysis was used to test the association between the socio-demographic factors and the outcome variable (vaccine hesitancy). Logistic regression was conducted to identify the predictors of COVID-19 vaccine hesitancy. The level of significance was 5%.</p> <p><strong>Results:&nbsp;</strong>mean age of the respondents was 40.6 ± 9.5 years and 67.1% were females. The COVID-19 vaccine hesitancy rate was 50.5% (95%CI: 45.6-55.3). Socio-demographic factors included age, marital status, location of practice, profession, and income. Vaccine hesitancy was predicted significantly by younger age, (aOR=9.34, 95%CI:2.01-43.39), marital status (single), (aOR=4.97, 95%CI:1.46-16.97) lower income,(aOR=2.84, 95%CI:1.32-6.08) and profession–doctor (aOR=0.28, 95%CI:0.11-0.70), nurse (aOR=0.31, 95%CI:0.15-0.64) and other allied health professionals (aOR=0.22, 95%CI:0.10-0.44).</p> <p><strong>Conclusion:&nbsp;</strong>COVID-19 vaccine hesitancy was high among healthcare workers. Significant sociodemographic predictors influence the uptake of the COVID-19 vaccine. We recommend that the Federal and State Ministries of Health conduct awareness campaigns targeting the younger age group, singles, lower income class, and non-clinical staff.</p> Chidinma Ihuoma Amuzie Franklin Odini Kalu Ulu Kalu Michael Izuka Uche Nwamoh Uloaku Emma-Ukaegbu Grace Onyike Copyright (c) 2021-09-03 2021-09-03 40 1 Determining the level of condom use and associated factors among married people in Tshwane District of South Africa <p><strong>Introduction:&nbsp;</strong>despite the wide availability of free male condoms in South Africa, high rates of new HIV transmissions are reported to occur among married couples. The aim of this study was to determine the level of condom use among the married people and to assess the factors associated with condom use in the Tshwane district of the Gauteng province.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted among 325 clients accessing health care services at the Steve Biko Academic Hospital. A self- administered questionnaire was used to collect data, which were entered onto an Excel spreadsheet and imported into Epi info version 7 for analysis. A logistic regression model was used to investigate the association between condom use and the explanatory variables. The odds ratio was used to measure the strength of the associations. The 95% CI and a cut-off point of 0.05 for the p-value were used to indicate statistical significance.</p> <p><strong>Results:&nbsp;</strong>the mean age of the participants was 41.6 years (SD=7.7). Two hundred and seventy-six (276; 85%) of the 325 participants reported not using condoms. Trust, doing regular HIV testing, and refusal by the husband were among the reasons given for not using condoms. In this study it was found that, the level of education, age and employment status were the determinants of condom use.</p> <p><strong>Conclusion:&nbsp;</strong>the level of condom use was low and sero-discordance was found to be the primary motivator for condom use. This study recommends the strengthening of and the widespread implementation of the CVCT service.</p> Lindiwe Priscilla Cele Setati Vuyani Mmampedi Huma Copyright (c) 2021-09-03 2021-09-03 40 1 Gaps in the implementation of COVID-19 mitigation measures could lead to development of new strains of antimicrobial resistant pathogens: Nigerian perspective <p>The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is a new virus that is responsible for COVID-19, a disease that complicate health conditions and results in death. The total diversion of attention of government and health care workers (HCW's) to prevent the escalation of the pandemic disease has placed a great barrier to diagnosis and treatment of other illnesses that share common symptoms with COVID-19, and that has consequently enabled the endemic practice of self-antimicrobial medication to increase in the country. Development of secondary infections in COVID-19 and in other conditions, caused by antibiotic resistant pathogens are what could make them more deadly now or in the future. The mitigation strategies adopted in Nigeria and its States, which include enforcing social distancing, partial or total lockdown, and restricting access to health care facilities for non COVID-19 patients, have further increased the demand of antimicrobial agents from unauthorized outlets in communities for inappropriate use. A cross-sectional survey of 162 randomly selected individuals that visited medical stores and 170 medical store owners to evaluates the level of self-medication with five oral broad spectrum antibiotics and antimalaria during the lockdown revealed an increase (68.5%) in practice of self-medication with at least one of the antimicrobial and emergence of new misususers. Blind treatment of symptoms of malaria and common cold without diagnosis and health care consultation was nearly 100%. Irrational use of sanitizers, disinfectants and other cidal agents that can fuel antimicrobial resistance has drastically increased in Nigeria. Exposure of microorganisms in the environment without caution to large volume of fumigants is increasing on daily basis. We strongly recommend that while mitigating SARS-CoV-2 virus spread, efficacious and feasible technological, social, economic and behavioral interventions that will also control the evolution and spread antimicrobial resistant microorganisms should be applied.</p> Ibrahim Yusuf Faruk Sarkinfada Copyright (c) 2021-09-03 2021-09-03 40 1 Epidemiological, clinical, and therapeutic characteristics of Behçet's disease: a monocentric study in Tunisia <p><strong>Introduction:&nbsp;</strong>to describe the epidemiological, clinical, therapeutic and evolving characteristics of Behçet´s disease and identify prognostic factors.</p> <p><strong>Methods:&nbsp;</strong>we have realized a retrospective, single-center study, conducted over a period of 26 years and including 130 patients presenting Behçet´s disease and hospitalized in an Internal Medicine Department.</p> <p><strong>Results:&nbsp;</strong>the mean age of the Behçet´s disease at onset was 30.3 ±8.8 years and that at diagnosis was 34.6 ±9.4 years. The sex ratio (male/female) was 2.5. The mean delay of diagnosis was 53.5 months. Oral aphthosis was constant. The frequency of the manifestations was: genital aphtosis 71.5%, pseudofolliculitis 84.6%, erythema nodosum 11.5%, positive pathergy test 50%, ocular disease 36.9%, venous thrombosis 30%, arterial disease 4.6%, joint damage 30.8%, neurological disease 19.2% and digestive disease 0.8%. The male gender was significantly associated with ocular involvement (p =0.02), venous disease (p =0.01) and occurrence of relapses (p =0.01). The mean follow up was 68.5 ± 77.3 months. The poor survival prognostic factors were male gender, ocular involvement, venous disease, cardiovascular disease, a duration of follow up ≤12 months and a diagnostic delay ≤ 24 months.</p> <p><strong>Conclusion:&nbsp;</strong>improving the prognosis of Behçet´s disease requires a shortening of the time to diagnosis, multidisciplinary collaboration, intensive treatment of functional threats, regular monitoring, and patient adherence.</p> Fatma Daoud Imène Rachdi Mehdi Somai Anissa Zaouak Houda Hammami Meriem Ouederni Rym Maamouri Hana Zoubeidi Molka Tougorti Jihène Ksouri Besma Ben Dhaou Zohra Aydi Samy Fenniche Monia Cheour Fatma Boussema Copyright (c) 2021-09-03 2021-09-03 40 1 Complementary feeding practice and its determinants among mothers with children 6 to 23 months of age in Finote Selam, Ethiopia <p><strong>Introduction:&nbsp;</strong>the development of a child's full human potential requires adequate nourishment during infancy and early childhood. Under-nutrition is mostly caused by a lack of proper breastfeeding and supplemental feeding practices. After six months of age, when the incidence of growth faltering, micronutrient deficiencies and viral diseases is at its peak, children become stunted. This study aimed to assess complementary feeding practices and their determinants among mothers with children aged 6 to 23 months in Northwest Ethiopia.</p> <p><strong>Methods:&nbsp;</strong>a community-based cross-sectional study on 414 caregivers was conducted using a systematic random sampling technique. Pre-tested interviewer-administered structured questionnaire was used to collect data. The data were entered into Epi-Info version 3.5.1 and analyzed with SPSS version 21. Logistic regressions and frequency distribution were used. The strength of the association was measured using odds ratios with a 95% confidence interval.</p> <p><strong>Results:&nbsp;</strong>out of 414 study participants, 201 (48.6%) practiced timely initiation of complementary feeding. Married women [AOR=2.87; 95% CI: (1.31-6.30)], radio owners [AOR=4.58; 95% CI:(2.48-8.46)], four or more ANC follow up times [AOR=1.99; 95% CI: (1.12-3.55)] and health institution delivery [AOR=2.56(1.21-5.42)] were all associated with timely initiation of complementary feeding.</p> <p><strong>Conclusion:&nbsp;</strong>complementary feeding is not widely practiced in the study area. Complementary feeding should be promoted through institutional delivery, prenatal care follow-up, and mass media coverage. Through health information and communication, it is critical to improve the timing of the start of supplemental feeding.</p> Dejene Hailu Ayele Tilahun Yichilal Dagnew Copyright (c) 2021-09-03 2021-09-03 40 1 Spondylarthrite ankylosante au Sénégal: aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs au Centre Hospitalier Universitaire Aristide LeDantec de Dakar <p><strong>Introduction:&nbsp;</strong>la spondylarthrite ankylosante (SA) est une maladie évolutive, pouvant s'aggraver par une invalidité. Le but de notre étude est de décrire les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs de la SA dans le service de rhumatologie du Centre Hospitalier Universitaire Aristide LeDantec à Dakar.</p> <p><strong>Méthodes:&nbsp;</strong>il s´agissait d´une étude transversale descriptive et analytique, avec un recueil de données à la fois prospectif et rétrospectif sur une période de 8 ans, entre janvier 2012 et décembre 2020, sur des patients atteints de SA de diagnostic établi en accord avec les critères diagnostiques d´Amor, de l´ESSG (European Seronegative Spondylarthropathy Group), d´ASAS (Assessment of Spondyloarthritis International Society) et les critères de New York modifié pour la SA. Les données ont été recueillies par le biais d'un questionnaire structuré et analysées à l´aide du logiciel SPSS25 (Statistical Package for the Social Sciences).</p> <p><strong>Résultats:&nbsp;</strong>six cent quarante-sept (647) patients ont répondu aux critères d´inclusions; 414 femmes et 233 hommes soit un sex ratio de 1,77F/1H. Différentes formes symptomatiques étaient obtenues: les formes axiales (55,65%), les formes mixtes (44,35%) et les formes systémiques avec manifestation extra-articulaires: uvéites (12,21%), insuffisance aortique (5,71%) et maladie fibrobulleuse des poumons (3,86%). Soixante pourcent (60%) des patients étaient sous antiinflammatoires non stéroïdiens (AINS), 47% sous méthotrexate et 0,92% sous biothérapie. Les indices d´activité de la maladie, les indices fonctionnels et les indices de la qualité de vie ont permis le suivi de la maladie.</p> <p><strong>Conclusion:&nbsp;</strong>nos résultats ont montré une prédominance féminine. Les formes axiales étaient les plus représentées. Plus de la moitié de nos patients étaient sous antiinflammatoires, 47% sous méthotrexate et 0,92% sous biothérapie. Cette étude a permis de comprendre le poids de la SA dans les spondyloarthrites et son évolution dans le temps.</p> Abbasse Abba Moustapha Niasse Ladji Mohamed Diaby Hassan Ali Copyright (c) 2021-09-06 2021-09-06 40 1 Nasal oral fistula revealing Langerhans´ cell histiocytosis in adult patient: case report <p>Langerhans cell histiocytosis (LCH) is a rare systemic disease caused by proliferation of mature histiocytes; its association to histiocyto fibroma is rarely reported. It rarely affects adults. We report a case of systemic LCH, in an adult patient with osteolytic lesion causing a fistula between the left nasal cavity and hard palate, involving the bone, lung, lymph node and associated to multiple histiocyto fibroma. The patient was operating for a fistula, and he was treated by chemotherapy and corticosteroids. Langerhans´ cell histiocytosis is a rare case, especially in adult patient. The diagnosis was based on histological and immunohistochemical analyses. This patient was treated by steroids and chemotherapy.</p> Anis Mzabi Maissa Thabet Taghrid Tlili Hend Zorgati Jihed Anoun Imen Ben Hassine Monia Karmeni Fatma Ben Fredj Moncef Mokni Chadia Laouani Copyright (c) 2021-09-06 2021-09-06 40 1 Short inter-pregnancy interval: why is it still high among women in Dar es Salaam? <p><strong>Introduction:&nbsp;</strong>in Tanzania, for the past decade, there has been a rising trend of women with short inter-pregnancy interval (IPI) (16% to 19%). Short IPI is associated with poor maternal and neonatal outcomes. We aimed to determine the factors associated with short IPI among women attending antenatal clinic (ANC) at Mnazi Mmoja Hospital, Dar es Salaam, Tanzania.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted in September 2018 at Mnazi Mmoja hospital among women receiving ante-natal care. A total of 530 women were included in the analysis. Analysis was conducted through SPSS version 24 computer program using descriptive analyses to determine the IPI and characteristics thereof, and logistic regression analysis to examine factors associated with IPI among pregnant women. Associations with a p-value &lt; 0.05 were considered statistically significant.</p> <p><strong>Results:&nbsp;</strong>twenty-two percent of the women attending ANC in Mnazi Mmoja hospital had short IPI. Short IPI was associated with young(&lt;25years) age (AOR=2.67, 95% CI=1.23-5.79); non-use of a contraceptive method (AOR=2.05, 95%CI=1.22-3.45); breastfeeding for less than 6 months (AOR=3.45,95% CI=1.17-10.13) and having an antecedent dead child at the time of index conception (AOR=3.38,95% CI=1.15-9.93).</p> <p><strong>Conclusion:&nbsp;</strong>about 1 in every 5 women attending ANC in Dar es Salaam had a short IPI. Addressing short IPI will complement the government´s efforts to improve maternal indicators in Tanzania and areas with similar contexts. Such efforts should emphasize in adherence to recommended infant feeding practices, women at a younger reproductive age group, those with a history of pregnancy loss, and strengthening contraception use among women of reproductive age.</p> Amani Idris Kikula Andrea Barnabas Pembe Bruno Sunguya Copyright (c) 2021-09-06 2021-09-06 40 1 Use of medicinal plants by cancer patients at the National Institute of Oncology, Rabat: a cross-sectional survey <p><strong>Introduction:&nbsp;</strong>the use of medicinal plants has increased significantly in recent years. According to the World Health Organization, 80% of the world's population uses medicinal plants to treat themselves. Our study aims to estimate the prevalence of medicinal plant use by cancer patients, list the different plants and identify their adverse effects cited by users and their reported efficacy.</p> <p><strong>Methods:&nbsp;</strong>this study was realised among 100 patients via a questionnaire with 14-items. Socio-economic and clinical characteristics have been analysed. The bivariate and multivariate analyses have been used to demonstrate the association between the socio-demographic characteristics of the participants, the duration of the disease and the use of medicinal plants.</p> <p><strong>Results:&nbsp;</strong>45% of participants used medicinal plants. The most commonly reported reason for using medicinal plants was cancer cure (22%). During this study, 32 plants were identified. The Honey was the most commonly used (25%), thyme was also consumed at 15%, fenugreek at 13% and garlic at 7%. According to the multivariate analysis, the residence is predictor of medicinal plant use, urban residents used medicinal plants more than rural patients with an OR: 3,098, IC, 95%: [1,183-8,113] and P = 0,021. Fifty patients reported the moderate efficacy of the use of medicinal plants, and 20% described some side effects such as abdominal pain in 34%.</p> <p><strong>Conclusion:&nbsp;</strong>in order to avoid any interaction with oncological drugs and to improve their effectiveness, a great importance must be given to information, education and awareness sessions.</p> Nadia El Orfi Saber Boutayeb Bouchra Haddou Rahou Ahlam Aitouma Amine Souadka Copyright (c) 2021-09-06 2021-09-06 40 1 Comprehensive knowledge and HIV prevalence in two migrant mine workers’ communities of origin in Gaza Province in Southern Mozambique: evidence from a cross-sectional survey <p><strong>Introduction:&nbsp;</strong>migrant mineworkers are susceptible to engage in risky sexual behaviour due to their high mobility, putting at risk their families and home communities. Because comprehensive knowledge about HIV/AIDS is a key factor in reducing HIV infections, this study aims to understand the current state of knowledge about HIV in these communities, estimate HIV prevalence and evaluate the risk behaviour associated with comprehensive knowledge.</p> <p><strong>Methods:&nbsp;</strong>secondary data analysis of a cross-sectional survey conducted in two communities of origin of mineworkers in Gaza Province, targeting current and former mineworkers of the South African mines and their relatives. Households were selected using simple random sampling methodology. Chi-squared tests and logistic regression analysis were used to assess statistical differences between comprehensive knowledge and categorical variables.</p> <p><strong>Results:&nbsp;</strong>from a total of 1,012 participants, only 22.0% of the respondents had comprehensive knowledge about HIV. The overall HIV prevalence in these communities was 24.2% and the HIV prevalence in individuals with comprehensive knowledge was 18.6%. Among the respondents with comprehensive knowledge, 33.1% were male, 22.0% have worked in a South African mine and the median age was 34 years old. Individuals from Muzingane were almost twice as likely (AOR 1.7; 95% IC 1.21-7.44, p=0.014) to have less comprehensive knowledge about HIV than their counterparts in Patrice Lumumba.</p> <p><strong>Conclusion:&nbsp;</strong>the results demonstrate a low level of comprehensive knowledge about HIV amongst this population and reveal an association between comprehensive knowledge about HIV and prevalence. Therefore, it is important to improve knowledge about HIV, its transmission and prevention amongst this population.</p> Naira Jacira Luiz Alda Ester Chongo Paulino da Costa Cynthia Semá Baltazar Copyright (c) 2021-09-07 2021-09-07 40 1 Tethering of the spinal cord in cervical region in adult male patient <p>We report a case of a 31-year-old male, came to the medicine department with complains of pain and numbness in upper limb and cervical region. On clinical examination fatty lump was seen in cervical region and muscles had decreased tone. Investigations were done. Magnetic resonance imaging (MRI) showed abnormal mass at C5-C6-C7 level in spinal cord region (A). Initially MRI was taken for cervical region from lateral as well as posterior aspect considering the findings, MRI was repeated to see any involvement in lumbar region (B). No significant abnormality was seen in lumbar region, vertebral bodies showed wedging in the cervical region and fatty mass was seen. The patient was then admitted for this purpose and surgery was planned. Detethering of the spinal cord in cervical region was planned. Myelomeningocele correction was done. Complications of the surgery include cerebrospinal leakage and bladder dysfunction. This patient showed no complications post operatively and was referred to physiotherapy department. The primary goal of the physiotherapist was to prevent secondary complications and to increase the strength of muscles. Special care was taken for cervical region as the patient was post-operative, cervical collar was given and the patient was ambulated on post-operative day 5.</p> Neha Vinay Chitale Mitushi Kishorrao Deshmukh Copyright (c) 2021-09-08 2021-09-08 40 1 A qualitative evaluation of an operational research course for acute care trainees in Kigali, Rwanda <p><strong>Introduction:&nbsp;</strong>the blended SORT-IT model uses a combination of online modules and teleconferences with local and international mentors to teach operational research. We modified SORT-IT to create the Acute Care Operational Research (ACOR) course directed to anesthesiology residents in Kigali, Rwanda. This course takes students from an initial research idea through submitting a paper for publication. Our viewpoint on entering this study was that ACOR participants would have adequate resources to complete the course, but be hampered by cultural unfamiliarity with the blended teaching approach.</p> <p><strong>Methods:&nbsp;</strong>we conducted a qualitative analysis of the experiences of all those who participated in the ACOR course to understand obstacles and improve future course iterations. Six anesthesiology residents participated in the first iteration of the course, with 4 local mentors and 2 secondary mentors, one of whom was based at the University of Virginia, with a total of 12 participants. Semi-structured interviews were conducted with all participants and mentors, which were independently coded for topics by two reviewers.</p> <p><strong>Results:&nbsp;</strong>there was a 50% publication rate for those enrolled in the course and an expected 100% acceptance rate for those who completed the course. Some reported benefits to the course included improved research knowledge, societal improvements, and knowledge exchange. Some reported obstacles to successful course completion included time limitations, background knowledge, and communication. Of note, only 4 out of 12 participants recognized cultural barriers.</p> <p><strong>Conclusion:&nbsp;</strong>although successful in the sense that all participants completed their research project, ACOR did not fully solve the main issues hindering research training. Our results show that research training in low-resource settings needs a continuing and formal focus on the factors that hinder participants´ success: mentorship and time.</p> Tiffany Wang Shannon Barter Marcel Durieux Tabor Flickinger Theogene Twagirumugabe Paulin Banguti Copyright (c) 2021-09-08 2021-09-08 40 1 Giant cardiac intracavitary mass and suspect rhabdomyomatosis in newborn, in developing country <p>After a pretanal diagnosis of left ventricle apex giant mass, a late preterm (38 weeks) baby with a birth weight of 2980 grams, developed refractory bradycardia immediately after birth. After birth a 12 lead electrocardiogram (ECG) revealed sinus bradycardia. Peaked P waves. The duration of particle quantification (PQ) interval was 110 m/sec. The following Q wave, R wave and S wave (QRS) complex was normal, with ST-elevation in inferior leads. During continuous monitoring ECG a symptomatic bradycardia has been documented with phases of respiratory sinus arrhythmia with heart rate about 60-70 bpm. Echocardiography showed a large, non-capsulated 16x21 mm mass, with a large and thin base of implant and ovoid morphology occupying most of the left ventricle cavity. Clinical presentation resembled that of critical aortic stenosis. For persistent and symptomatic bradycardia, not responsive to medical treatment, and for initian signs of heart failure, the baby underwent urgent complete surgical resection of the intracardiac mass, during the second day of life. The ascending aorta was transected. Through the aortic valve, the left ventricular outflow tract was explored. A large homogeneous white mass was found just below the leaflets of the aortic valve. The large tumor infiltrated the ventricular septum and protruded into the left ventricular outflow tract, occluding 90% of its diameter. The cardiac mass was detached from the ventricular septum and the protruding portion was completely resected. Histological examination of the mass confirmed the diagnosis of rhabdomyoma.</p> Federica Iezzi James Munene Copyright (c) 2021-09-08 2021-09-08 40 1 Cutaneous metastasis of occult breast cancer: a case report <p>Occult breast cancer (OBC) is characterized by metastatic presentation of undetectable breast tumor on imaging exams. OBC is a rare disease (accounting for 0.3% to 1.0% of all breast cancers) that represents a major diagnostic challenge. The aim of this study was to report a case of OBC with primary presentation of multiple cutaneous metastases with subsequent emergence of bone metastasis. A 70-year female patient had multiple cutaneous metastatic lesions in the left cervical region, left breast, left axillary region, left subscapular region, in three chirodactylus of the right hand and three chirodactylus of the left hand. Imaging tests (mammogram, ultrasonography and magnetic resonance imaging of the breast) did not show alterations. Biopsy, histology sections and immunohistochemistry of the left cervical cutaneous lesion were compatible with OBC. After two years of anastrozole treatment (1mg/day), there was regression of all cutaneous lesions and stabilization of bone metastasis. OBC has a better prognosis. It may exhibit spontaneous regression or respond to less aggressive treatment strategies, as described in this case.</p> Rafael Everton Assunção Ribeiro da Costa Cristiane Amaral dos Reis Rafael de Deus Moura Ana Lúcia Nascimento Araújo Fergus Tomás Rocha de Oliveira Sabas Carlos Vieira Copyright (c) 2021-09-08 2021-09-08 40 1 Mélanome hépatique primitif: à propos d´un cas <p>Le mélanome malin est une maladie à fort potentiel métastatique qui se développe aux dépens des mélanocytes. Le foie est l´organe le plus souvent concerné par les métastases. Néanmoins le mélanome hépatique primitif est très rare. Peu de cas de mélanomes hépatiques primitifs ont été décrits. Nous rapportons le cas d'une patiente atteinte de mélanome hépatique primitif qui a été diagnostiquée par ponction biopsie hépatique, confirmé histologiquement et immuno-histochimiquement, avec une évaluation complète qui a permis d´exclure les autres mélanomes primitifs.</p> Mariama Jarti Sara Boulajaad Martial Ulrich Gouton Adil Ait Errami Zouhour Samlani Sofia Oubaha Khadija Krati Copyright (c) 2021-09-09 2021-09-09 40 1 Prevalence, density and predictors of malaria parasitaemia among ill young Nigerian infants <p><strong>Introduction:&nbsp;</strong>infants in the first six months of life are relatively protected from malaria. Emerging reports from endemic regions however are showing increasing malaria susceptibility in this age group. This study set out to determine the prevalence, parasite density and predictive factors for malaria parasitaemia in ill young infants at the Wesley Guild Hospital (WGH), Ilesa, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>ill infants aged one to six months were consecutively recruited over an 11-month period in a hospital based cross-sectional study. History of illness, sociodemographic and perinatal history were obtained; clinical examination and results of venous blood for thick and thin film malaria parasite examinations were recorded and analyzed.</p> <p><strong>Results:&nbsp;</strong>the mean (SD) age of the 350 infants was 3.4 (1.6) months with male:female (M:F) of 1.2:1. The prevalence of malaria parasitaemia (all plasmodium falciparum) was 19.1% while parasite density ranged from 24.0 to 400,000 parasites/µl, median (IQR) 900 (250-4,588)/µl. Sixteen (4.6%) had heavy malaria parasitaemia (&gt;5000/µl). Low social class (OR=2.457; 95%CI 1.404-4.300; p=0.002), suboptimal antenatal care (OR=2.226; 95%CI 1.096-4.522; p=0.027), low birth weight infants (OR=4.818; 95%CI 2.317-10.018; p=&lt;0.001) and injudicious use of haematinics (OR=3.192; 95%CI1.731-5.886; p=&lt;0.001) were predictors of malaria parasitaemia among the infants.</p> <p><strong>Conclusion:&nbsp;</strong>one-in-five ill young infants had malaria parasitaemia with heavy parasitaemia in 23.8% of infected infants. Malaria parasitaemia was associated with modifiable factors, high index of suspicion in endemic region and optimal maternal and child care services may assist to reduce the burden of malaria in this age group.</p> Oluwatobi Faith Folarin Bankole Peter Kuti Akibu Oyeku Oyelami Copyright (c) 2021-09-09 2021-09-09 40 1 Perceived impact of coronavirus pandemic on uptake of healthcare services in South West Nigeria <p><strong>Introduction:&nbsp;</strong>the COVID-19 pandemic since its emergence has posed a great danger to the health of the general populace while impacting the Nigerian healthcare delivery significantly. Since its emergence, the health system has been stretched with overwhelming responsibilities. The study assessed health providers´ perceived impact of coronavirus pandemic on the uptake of health care services in South West Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a descriptive cross-sectional design using an online structured survey was used to elicit responses from 385 Nigerian health workers selected by convenience sampling technique. Data analysis was done with the Statistical Package for Social Sciences (SPSS) version 26. Comparison of the uptake of healthcare before and during the COVID-19 pandemic was performed using the Chi-square test.</p> <p><strong>Results:&nbsp;</strong>findings revealed a significant difference between the uptake of health care prior and during the COVID-19 pandemic (χ<sup>2</sup>= 92.77, p=0.000) as 253 respondents (65.7%) reported that the hospital recorded a low turn-out of patients during the pandemic and 184 (47.8%) indicated that some of the facility units/departments were temporarily closed due to COVID-19 pandemic. Similarly, there was a significant difference between health-related conditions requiring hospital admission before and during COVID-19 pandemic (χ<sup>2</sup>=3.334 p=0.046). Factors influencing uptake of health services during the COVID-19 pandemic are: fear of nosocomial infection, fear of stigmatization, and misconception/misinformation on COVID-19 diseases and care.</p> <p><strong>Conclusion:&nbsp;</strong>the Nigerian health system in the past months has been remarkably impacted by the pandemic. This calls for immediate restructuring to maintain an equitable distribution of care, while minimizing risk to patients and health providers.</p> Olamide Olajumoke Afolalu Oluwabusolami Esther Atekoja Zaccheus Opeyemi Oyewumi Semiu Opeyemi Adeyeye Karimat Itunu Jolayemi Oluwadamilare Akingbade Copyright (c) 2021-09-09 2021-09-09 40 1 Syndrome de la personne raide associé à une dermatite herpétiforme: à propos d´un cas <p>Le syndrome de la personne raide (SPR) est une maladie rare affectant le système nerveux central et qui peut être d´origine auto-immune, paranéoplasique ou idiopathique. Sa présentation classique typique est caractérisée par une rigidité progressive du tronc et des membres, associée à des spasmes. Le diagnostic est soutenu par l'existence d'une activité musculaire continue et spontanée en détection à l'électroneuromyogramme, la présence d'anticorps anti-acide glutamique décarboxylase (anti-GAD) sériques, et une réponse aux benzodiazépines. Nous rapportons le cas d'un patient de 46 ans ayant une forme classique de syndrome de la personne raide auto-immune associée à une dermatite herpétiforme.</p> Loubna Tayebi Ansumana Mohammed Keita Nisrine Louhab Mouna Zahlane Laila Benjilali Lamiaa Essaadouni Copyright (c) 2021-09-09 2021-09-09 40 1 Residency training on the frontlines of the COVID-19 pandemic - a qualitative study from Tanzania <p><strong>Introduction:&nbsp;</strong>the Coronavirus Disease 2019 pandemic has affected residency training globally. The aim of this study was to understand how the pandemic affected teaching and learning in residency programs in low resource settings where residents and faculty were working on the front line treating patients with the disease.</p> <p><strong>Methods:&nbsp;</strong>this qualitative study enrolled residents and faculty from the Aga Khan University in Tanzania who were providing front line care during the pandemic. Purposeful sampling was used and data was collected using focus group discussions and in-depth interviews between August and September 2020. Analysis was done using qualitative content analysis.</p> <p><strong>Results:&nbsp;</strong>twelve residents and six faculty members participated in this study. Two main themes emerged. The first was: “New and unfamiliar teaching and learning experiences.” Residents and faculty had to adapt to changes in the learning environment and the academic program. Residents had increased responsibilities, including providing front line care and working with reduced supervision. The second theme was: “Learning opportunities amidst crisis.” There were opportunities to improve critical care and procedural skills. They also had opportunities to improve non-technical skills like teamwork and communication.</p> <p><strong>Conclusion:&nbsp;</strong>residents and faculty had to adapt to changes in teaching and learning. Residents also had to take up additional responsibilities. Support systems are required to help them adapt to the changes and settle in their new roles. There were opportunities to learn new skills, and training should be restructured to maximize the use of these opportunities.</p> Mariam Noorani Hussein Manji Elizabeth Mmari Samina Somji Nahida Walli Sherin Kassamali Shabbir Adamjee Nancy Matillya Hanifa Mbithe Aliasger Nagri Neelam Ismail Copyright (c) 2021-09-09 2021-09-09 40 1 Carcinome micropapillaire invasif: une tumeur mammaire rare et agressive <p>Le carcinome micropapillaire invasif du sein est une variante histologique rare et distincte des cancers du sein représentant moins de 3% de l´ensemble des carcinomes mammaires. Il se caractérise par un pronostic péjoratif en raison d´un envahissement ganglionnaire massif et de la présence de nombreux emboles vasculaires et lymphatiques. Il s´agit d´une femme âgée de 63 ans ayant consulté pour mastodynie gauche évoluant depuis deux mois. L´examen physique a révélé une asymétrie mammaire avec rétraction cutanée et de multiples adénopathies axillaires gauches suspectes. La mammographie a objectivé une masse spiculée du sein gauche classée ACR5. La microbiopsie mammaire a conclu à un carcinome micropapillaire invasif. La patiente a bénéficié d´une mastectomie gauche de type PATEY avec curage axillaire homolatéral. Macroscopiquement la tumeur était blanc-grisâtre à contours spiculés située à l´union des deux quadrants externes et mesurait 13 x 8 cm (A). L´examen histologique de la pièce opératoire a révélé une prolifération carcinomateuse infiltrante agencée en amas, nids, micro-papilles, morules et glandes à polarité inversée au sein d´un stroma fibro-inflammatoire rétracté au pourtour des structures carcinomateuses (B, C). Le grade histopronostique SBR modifié selon ELSTON et ELLIS était de 3. De nombreux emboles vasculaires péri-tumoraux ont été retrouvés ainsi que des métastases ganglionnaires 20N+/20N. L´étude immunohistochimique moyennant l´EMA a objectivé une inversion de la polarité (D). La classification moléculaire de la tumeur était luminal B. Les suites opératoires étaient simples. La patiente a reçu une radio-chimiothérapie adjuvante. Elle est actuellement régulièrement suivie en consultation externe.</p> Faten Limaïem Saâdia Bouraoui Copyright (c) 2021-09-09 2021-09-09 40 1 Séroprévalence des anticorps anti-virus de l´hépatite C et facteurs associés, d´après un dépistage volontaire en population générale en 2016 au Bénin <p><strong>Introduction:&nbsp;</strong>l´hépatite C est un problème de santé publique dans le monde, et plus particulièrement en Afrique subsaharienne. L´objectif de ce travail était de déterminer la séroprévalence des anticorps anti-virus de l´hépatite C ainsi que les facteurs associés, à l´occasion d´un dépistage volontaire en population générale au Bénin.</p> <p><strong>Méthodes:&nbsp;</strong>il s´agissait d´une étude transversale descriptive et analytique qui s´était déroulée en juillet 2016 dans 4 grandes villes de 4 différents départements du Bénin. Etaient inclus tous les volontaires résidents dans ces villes ciblées, de tous âges, ayant donné leur consentement éclairé. Pour cette recherche, le test de diagnostic rapide HCV ImuMed (Healgen Scientific LLC, USA) avait été utilisé. Une analyse par régression logistique avait été utilisée afin d´identifier les facteurs associés à l´infection par le virus de l´hépatite C.</p> <p><strong>Résultats:&nbsp;</strong>au total, 2809 volontaires étaient inclus avec une moyenne d´âge de 25,9± 16,5 ans (les extrêmes: 0 et 86 ans), constitués de 53,9% (1514/2809) d´hommes et de 46,1% (1295/2809) de femmes. Plus de la moitié de la population d´étude était constituée de célibataires 59,1% (1612/2726). Il s´agissait principalement de 41,3% (1074/2809) d´élèves ou étudiants. La séroprévalence du VHC était de 1,5% (42/2809). En analyse multivariée, les variables significativement associées au portage des anti-VHC étaient: l´âge de 60 ans et plus (aOR: 46,9, IC 95% 10,2-216,0; p &lt; 0,0001) et l´antécédent d´alcoolisme (aOR: 6,3, IC 95% 3,3-12,1; p &lt; 0,0001).</p> <p><strong>Conclusion:&nbsp;</strong>la séroprévalence des anticorps anti-VHC était de 1,5% dans la population étudiée. L´infection par le VHC touchait volontiers les sujets âgés (de 60 ans et plus) et ceux ayant un antécédent d´alcoolisme.</p> Aboudou Raïmi Kpossou Benoît Kouwakanou Comlan N´déhougbèa Martin Sokpon Khadidjatou Saké Alassane Marc Moboladji Bankolé Carin Ahouada Rodolph Koffi Vignon Vincent Zoundjiekpon Fadel Sourokou Jean Séhonou Nicolas Kodjoh Copyright (c) 2021-09-10 2021-09-10 40 1 Clinical characteristics and treatment outcomes in acromegaly, a retrospective single-center case series from Thailand <p><strong>Introduction:&nbsp;</strong>acromegaly, an overproduction of growth hormone (GH), is associated with high rate of morbidity and mortality particularly in case of delayed in diagnosis and treatment. A wide variation of clinical presentations, treatment outcomes and morbidities have been reported.</p> <p><strong>Methods:&nbsp;</strong>a retrospective study was conducted to review clinical characteristics and treatment outcomes of patients with acromegaly treated in King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between 2006 and 2018.</p> <p><strong>Results:&nbsp;</strong>eighty-four patients (31 males and 53 females) were reviewed, mean age at diagnosis was 45.7 ± 12.6 years (±SD), mean time of disease onset was 7.6 ± 6.4 years and mean follow-up period was 7.8 ± 5.3 years. The most common presenting symptoms were maxillofacial change (96.8%) and acral enlargement (94.7%). Hypertension (39.3%), diabetes mellitus (28.6%) and dyslipidemia (23.8%) were prevalent co-existing conditions. Four patients were identified having cancer at presentation; however, no additional malignancy was reported during the follow up. Most patients harbored macroadenomas, only 10 were found to have microadenomas. The outcomes of treatment were controlled disease in 70% of microadenoma and 64.9% of macroadenoma. Permanent loss of pituitary function was found in about 21.3% and there was one case reported of mortality. The logistic regression analysis for controlled disease outcome showed the IGF-I index after surgery was associated with controlled disease outcome with statistically significant result (P-value=0.006).==Replace this with the results section of the abstract==</p> <p><strong>Conclusion:&nbsp;</strong>our study offers descriptive clinical data of case series of acromegalic patients, which had favorable outcomes comparable with previous reports. In addition, IGF-I index after surgery is a predictive parameter for outcome of treatment.</p> Poranee Ganokroj Sarat Sunthornyothin Rungsak Siwanuwatn Kraisri Chantra Patinut Buranasupkajorn Sompongse Suwanwalaikorn Thiti Snabboon Copyright (c) 2021-09-10 2021-09-10 40 1 Post COVID-19 lung fibrosis and pleural effusion in geriatric patient <p>An 81-year-old male who has hypertension in the last 15 years coming to our hospital with a chief complaint of severe breathlessness, chest pain with a history of fever spike in the last 20 days. When he underwent real-time reverse transcription-polymerase chain reaction (RT-PCR) test, the test comes positive with SARS COVID-19. Routine test high-resolution computed tomography (HRCT) showed approximately 75% of the left side and 50% of right lung involvement with CO-RAD 6 and HRCT severity score 20. HRCT showed multiple ill-defined patchy ground-glass opacity with consolidation and septal thickening in the bilateral lung field. There is a finding of fibrotic changes with tractional bronchiectasis in bilateral lung field with minimal pleural effusion.</p> Rashmi Ramesh Walke Deepak Kumar Jain Copyright (c) 2021-09-10 2021-09-10 40 1 A rare case of pediatric primary central nervous system differentiating neuroblastoma: an unusual and rare intracranial primitive neuroectodermal tumor (a case report) <p>Neuroblastoma represents the most common solid extracranial tumor in children under 5, accounting for 8% to 10% of all childhood cancers. Primary central nervous system (CNS) neuroblastomas are a very rare location and only few cases are available in the literature. It was first described in 1973 by Hart and Earl as supratentorial primitive neuroectodermal tumors. Clinical presentation is highly variable and depends on the initial location of the tumor. Regarding imaging, primary brain neuroblastoma shows no pathognomonic appearance on brain computed tomography (CT) whether or not enhanced or magnetic resonance imaging (MRI). There were no standard guidelines available for the adjuvant treatment in case of primary CNS neuroblastoma. Surgery remains the main and the first tool toward these lesions. Radiotherapy associated or not to chemotherapy is offered based on patient´s age. Here, the authors report a new pediatric case of primitive central nervous system neuroblastoma revealed by an intracranial hypertension syndrome and confirmed by both histopathological and immunohistochemistry study after a gross total surgical excision. The postoperative course was uneventful and the child had good recovery.</p> Mehdi Borni Mohamed Znazen Najiba Mdhaffar Mohamed Zaher Boudawara Copyright (c) 2021-09-13 2021-09-13 40 1 Understanding the meaning of autonomy in adolescent pregnancy decision-making: lessons from Ghana <p><strong>Introduction:&nbsp;</strong>adolescent pregnancy in Ghana, like in most low and middle income countries, is an issue of immense public health importance. Pregnant adolescents are faced with the stronger dilemma of either terminating the unwanted pregnancy or keeping it. This discourse which is based on findings from empirical research in Accra Ghana aims at contributing to the usefulness of understanding the meaning and scope of autonomy when it comes to providing ethically grounded, and adolescent friendly, reproductive health care services to pregnant adolescents. The aim of this work was to document the meaning and determinants of autonomous decision making among pregnant adolescents in the James Town area of Accra, Ghana.</p> <p><strong>Methods:&nbsp;</strong>thirty (30) semi-structured in depth interviews were conducted among adolescents who had been pregnant at least once, 23 in depth interviews among purposively selected stakeholders (parents, teachers, NGO staff working in reproductive health, community volunteers), and 8 focus group discussions among parents, teachers, adolescent students who had not been pregnant before, and adolescents who had at least one pregnancy in the past. Data were transcribed verbatim and analyzed thematically.</p> <p><strong>Results:&nbsp;</strong>most adolescents reported that the final decision to continue a pregnancy to term or go in for an abortion was taken by them. The partner´s willingness to take responsibility of the pregnant adolescent and baby, as well as financial considerations, were main players in deciding upon the pregnancy outcomes. Cultural desirability for children and health care provider/father paternalism (power dynamics) in the decision-making process were central considerations in the decision-making process. Unaffordable and unfriendly safe abortion services pushed adolescents to either continue pregnancies to term against their will, or opt to visit unsafe abortion care providers.</p> <p><strong>Conclusion:&nbsp;</strong>adolescents stand to make truly autonomous decisions if they are provided with the right information, at the right time, at the right place, by the right persons, and in the right way. Health system, economic, and cultural factors play significant roles in rendering pregnant adolescent autonomy meaningful when deciding upon their pregnancy outcomes. Continuing pregnancies to term against one´s will or being forced to go in for an abortion are ethically unjustified. Further research is required to examine the long-term consequences of forced pregnancy terminations or births.</p> Luchuo Engelbert Bain Copyright (c) 2021-09-13 2021-09-13 40 1 Audit of the appropriateness of the indication for obstetric sonography in a tertiary facility in Ghana <p><strong>Introduction:&nbsp;</strong>the use of ultrasound is one of the most vital tools in the management of pregnancies and contributes significantly in improving maternal and child health. Certain indications in pregnancy, guide the obstetrician as to which obstetric scan deems appropriate. The full realization of the benefits of ultrasound depends on whether it is being used appropriately or not, and hence this study aimed at auditing for the appropriate indications for obstetric ultrasound.</p> <p><strong>Methods:&nbsp;</strong>a review of all request forms for obstetric scan between June 2019 and July 2020 was performed to assess the appropriateness of requests for obstetric ultrasound at the Cape Coast Teaching Hospital. The data obtained was analyzed using SPSS (SPSS Inc. Chicago, IL version 20.0). A Chi-squared test of independence was used to check for statistically significant differences between variables at p ≤ 0.05.</p> <p><strong>Results:&nbsp;</strong>three hundred and fourteen (314) out of the 527 request forms had clinical indications stated. 174 (81.7%) of requests from Cape Coast Teaching Hospital and 39 (18.3%) from other health centers did not indicate patients clinical history/indication on the request forms. Majority 76 (68.5%) of scans in the first trimester were done without indications/history. Only 29 of requests with clinical history were inappropriate.</p> <p><strong>Conclusion:&nbsp;</strong>practitioners should be mindful of adequately completing request forms for obstetric investigations since e a large number of practitioners do not state the history/indications for the scans. There should be continuous medical education on the importance of appropriate indication for obstetric ultrasound.</p> Emmanuel Kobina Mesi Edzie Klenam Dzefi-Tettey Philip Narteh Gorleku Edmund Kwakye Brakohiapa Benard Ohene Botwe Adu Tutu Amankwa Ewurama Andam Idun Henry Kusodzi Abdul Raman Asemah Copyright (c) 2021-09-14 2021-09-14 40 1 Consistency and timeliness of intrapartum care interventions as predictors of intrapartum stillbirth in public health facilities of Addis Ababa, Ethiopia: a case-control study <p><strong>Introduction:&nbsp;</strong>approximately one-third of the global stillbirth burden occurs during intrapartum period. Intrapartum stillbirths occurring in the health facilities imply that a foetus was alive on admission to labour and had greater chances of survival with optimum obstetric care. Active monitoring and follow-up by skilled birth attendants becomes critical to determine the progress of labour and to decide any emergency obstetrical care actions. Timely monitoring of labour progress indicators including fetal heart rate (FHR), uterine contraction maternal vital signs, vaginal examination (VE) are vital in reducing intrapartum stillbirth.</p> <p><strong>Methods:&nbsp;</strong>a case-control study was conducted using primary data from chart review of medical records of women who experienced intrapartum stillbirth in 20 public health centres and 3 public hospitals of Addis Ababa between July 1<sup>st</sup>, 2010 to June 30<sup>th</sup>, 2015. Data were collected from charts of all cases of intrapartum stillbirths meeting the inclusion criteria and randomly selected charts of controls from each public health facility in 2:1 control to case ratio.</p> <p><strong>Results:&nbsp;</strong>over 90% of both cases and controls received FHR monitoring care albeit the timing was substandard. More women in the live birth group than intrapartum stillbirth group received timely care related to uterine contraction (OR 2.42, 95% CI 1.77 - 3.30) and blood pressure monitoring (aOR 1.41, 95% CI 1.09 - 1.81). 1.2% and 0.3% of women in the intrapartum stillbirth and livebirth groups developed eclampsia respectively.</p> <p><strong>Conclusion:&nbsp;</strong>substandard timing and application of labour monitoring interventions including FHR, uterine contraction can predict intrapartum stillbirth in public health facilities.</p> Alemayehu Gebremariam Agena Lebitsi Maud Modiba Copyright (c) 2021-09-14 2021-09-14 40 1 Frequency and factors associated with proteinuria in COVID-19 patients: a cross-sectional study <p>Proteinuria is a marker of severity and poor outcome of patients in intensive care unit (ICU). The objective of this study was to determine the frequency of proteinuria and the risk factors associated with proteinuria in Congolese COVID-19 patients. The present cross sectional study of proteinuria status is a post hoc analysis of data from 80 COVID-19 patients admitted at Kinshasa Medical Center (KMC) from March 10<sup>th</sup>&nbsp;to July 10<sup>th</sup>, 2020. The population under study came from all adult inpatients (≥18 years old) with a laboratory diagnosis by polymerase chain reaction (PCR) of COVID-19 were selected and divided into two groups (positive proteinuria and negative proteinuria group). Logistic regression models helped to identify the factors associated with proteinuria. The P value significance level was 0.05. Among 80 patients who tested positive for SARS-CoV-2 RT-PCR, 55% had proteinuria. The mean age was 55.2 ± 12.8 years. Fourty-seven patients (58.8%) had history of hypertension and 26 patients (32.5%) diabetes. Multivariable analysis showed age ≥65 years (aOR 5,04; 95% CI: 1.51-16.78), diabetes (aOR 3,15 ;95% CI :1.14-8.72), ASAT &gt;40 UI/L (aOR 7,08;95% CI:2.40-20.87), ferritin &gt;300 (aOR 13,47 ;95% CI :1.56-26.25) as factors independently associated with proteinuria in COVID-19 patients. Proteinuria is common in Congolese COVID-19 patients and is associated with age, diabetes, ferritin and aspartate aminotransferase (ASAT).</p> Yannick Mayamba Nlandu Theodore-Junior Manyka Sakaji Yannick Mompango Engole Pitchouna Marie-France Ingole Mboliasa Dauphin Mulumba Bena Jessy Mukamamvula Abatha Jean-Robert Mpoke Nkumu Aliocha Natuhoyila Nkodila Karel Van Eckout Golan Kalifa Rodolphe Ahmed Justine Busanga Bukabau Copyright (c) 2021-09-14 2021-09-14 40 1 Evaluation de la sexualité chez des femmes atteintes d´un cancer du sein après traitement: à propos de 100 cas <p>Le cancer du sein est le cancer féminin le plus fréquent. Plusieurs stratégies de traitement sont utilisées : la chimiothérapie, la radiothérapie, la chirurgie et enfin l´hormonothérapie. Chacun de ces traitements est susceptible d´altérer la sexualité des patientes à court ou à long terme. L´objectif de notre étude est d´évaluer la sexualité des femmes atteintes d'un cancer du sein après traitement. Un devis descriptif quantitatif a été réalisé auprès de 100 patientes suivies pour un cancer mammaire non métastasique en activité sexuelle, rencontrées à la consultation de gynécologie de l´hôpital Farhat Hached de Sousse. La collecte des données a été réalisé par une fiche de renseignement et à l´aide de deux échelles validées :RSS (Relation Ship and Sexuality) et BESAA (Body EsteemScale For Adolescents and Adults) afin d´évaluer la sexualité et l´image du corps. La moyenne d´âge était 53,8 ans. Environ la moitié des patientes (48%), avaient une vie sexuelle altérée par la maladie. La fréquence des rapports, le désir sexuel et la capacité d´atteindre l´orgasme a été diminué respectivement chez 65, 45 et 54 patientes. Le score global des 3 dimensions de l´image du corps était de 49,4. Les femmes âgées entre 35 et 39 ans développaient significativement plus de peur du rapport sexuel (p=0,002) et moindre de fréquence sexuelle (p=0,004). Une formation adéquate et accentuée sur la prise en charge des femmes ayant un cancer ainsi que leurs problèmes sexuels et un travail multidisciplinaire permettent d´améliorer l´état psychologique des femmes.</p> Safa Smida Rim Bouchahda Ameni Guezguez Meriem Regaya Rim Frigui Ons Kaabia Hedi Khairi Copyright (c) 2021-09-15 2021-09-15 40 1 Knowledge of the coronavirus disease 2019 (COVID-19) and sleep problems among a selected sample of psychiatric hospital staff in Nigeria: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>as the coronavirus disease 2019 (COVID-19) spreads, sleep problems are expected to increase among healthcare workers. Therefore, we aimed to assess the knowledge of COVID-19, sleep problem and identify sociodemographic factors associated with sleep problems among healthcare workers in a Nigerian neuropsychiatric hospital.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted among 200 healthcare workers in a neuropsychiatric hospital using self-administered questionnaires to assess knowledge of COVID-19, sleep problem, social support, and sociodemographic factors that affect sleep. Chi-square test and Spearman's correlation were applied to assess the association between sociodemographic factors and sleep problems.</p> <p><strong>Results:&nbsp;</strong>about 23.9% of the healthcare workers reported having a sleep problem. However, there was no association of sleep problems with any sociodemographic factors except age (r=0.26) and social support (r=-0.18).</p> <p><strong>Conclusion:&nbsp;</strong>the study offered insight into the occurrence of sleep problems among healthcare workers and suggested a guide for planning interventions targeted at improving the psychological well-being of healthcare workers in the face of current global pandemics.</p> Kehinde Oyeyemi Oderinde Oluyemi Oluwatosin Akanni Anthony Olashore Copyright (c) 2021-09-15 2021-09-15 40 1 Undergraduate medical education in Nigeria: current standard and the need for advancement <p>The post-independence era in Nigeria ushered in an array of fundamental structuring and development in all sectors of the Nigerian economy including medical education and training. This era saw the establishment of medical schools across the country which mirrored the medical curriculum of British universities. This paper dives into the general structure of undergraduate medical education in Nigeria, its historical background and how it compares with neighboring and distant countries. Since the undergraduate medical education curriculum has not seen significant modifications since conception, this paper presents the challenges of the existent structure to include biased admission process, emphasis on irrelevant pre-medical courses, paucity of of technologically-advanced teaching and learning aids, increased workloads of lecturers amongst others. Importantly, solutions and recommendations are prescribed in this paper, which if considered, may improve undergraduate medical training in Nigeria, and ultimately improve the standard of healthcare service provision in the country.</p> Moyosoore Osoba Shamsudeen Usman Oluwafemi Oyadiran Joseph Odeyemi Michelle Abode Olamide Usman Olufemi Olulaja Olusina Ajidahun Don Eliseo Lucero-Prisno III Copyright (c) 2021-09-16 2021-09-16 40 1 COVID 19: are South African junior doctors prepared for critical care management outside the intensive care unit? <p><strong>Introduction:&nbsp;</strong>the coronavirus disease 2019 (COVID-19) pandemic has negatively impacted countries across the globe. Infected individuals will seek aid at various health care facilities. Many patients will recover without requiring specialised treatment. A significant percentage of infected individuals will need critical care management, which will begin in the emergency department, generally staffed by junior doctors. Junior doctors will need to stabilize, triage and manage these patients prior to referral to specialized units. Above and beyond the usual occupational demands that accompany junior doctors in state facilities, this pandemic will thrust further responsibility on them. The objectives were to describe crisis preparedness of junior doctors in the areas of triage decision-making and critical care management, outside the intensive care unit.</p> <p><strong>Methods:&nbsp;</strong>this is a descriptive, cross-sectional study, utilizing a web-based survey. Junior doctors in South Africa, being doctors in year one or year two of internship and community service, were invited to participate anonymously via various social media platforms.</p> <p><strong>Results:&nbsp;</strong>a total of 210 junior doctors across South Africa answered the survey. Junior doctors expressed confidence with knowledge of intubation drugs, to perform intubation and cardiopulmonary arrest resuscitation without supervision. Only 13.3% of respondents expressed comfort with setting and adjusting ventilator settings independently. 57% of participants expressed discomfort with making critical care triage decisions. Ninety-three percent (93%) of participants expressed benefit from a telemedicine intervention.</p> <p><strong>Conclusion:&nbsp;</strong>junior doctors in South Africa indicate that they are prepared to initiate management of the critically ill patient outside the intensive care unit but remain uncertain in their ability to provide ongoing critical care management. The COVID-19 pandemic has highlighted the need to prepare junior doctors with the ability to manage critical care triage and management in emergency rooms. Leveraging of the workforce in South Africa may be potentiated by telemedicine interventions.</p> Nadiya Ahmed Ryan Davids Copyright (c) 2021-09-16 2021-09-16 40 1 The COVID-19 pandemic: the benefits and challenges it presents for medical education in Africa <p>The coronavirus disease (COVID-19) has impacted many facets of everyday daily life, resulting in far-reaching consequences on social interaction, regional and global economies, and healthcare delivery systems. Numerous reports have commented on the impact of the COVID-19 pandemic on medical education in various world regions. However, we know little about the influence of the pandemic on medical education in Africa. Here, we discuss the potential impact of COVID-19 on teaching and learning in undergraduate medical education in sub-Saharan Africa, illustrating some of the unexpected benefits and challenges the pandemic presents for medical education in sub-Saharan Africa.</p> Anthonio Oladele Adefuye Henry Ademola Adeola Jamiu Busari Copyright (c) 2021-09-16 2021-09-16 40 1 Sodium picosulfate/magnesium citrate versus 4L split-dose polyethylene glycol for bowel cleansing prior to colonoscopy in high fibre diet African patients <p><strong>Introduction:&nbsp;</strong>an adequate bowel preparation is essential for good mucosal inspection during colonoscopy. This study aims to compare the efficacy of two validated oral lavage solutions for colonoscopy preparation in African patients.</p> <p><strong>Methods:&nbsp;</strong>a prospective observational study of patients undergoing colonoscopy in a referral endoscopy facility in Port Harcourt, Nigeria, using sodium picosulfate magnesium citrate (SPMC) and 4L split-dose polyethylene glycol (PEG). Variables collated were sociodemographic, primary indication, comorbidities, Aronchick bowel preparation scale, polyp/adenoma detection, caecal intubation and outcome. Statistical analysis was performed using IBM SPSS version 20.</p> <p><strong>Results:&nbsp;</strong>one hundred and twenty-four patients received PEG prior to colonoscopy and SPMC in 175 patients. The age range was from 22 to 92 years; mean age of 53.8 ± 14.2 years for PEG group and 55.3 ± 13.2 years for SPMC group (p=0.361). There were 215 males and 84 females. An excellent/good bowel preparation scale was recorded in 77 (62%) PEG group and 130 (74.3%) for SPMC group (p=0.592). PEG was predominantly used in the early years of endoscopists practice with the odds ratio (OR) of no polyp detection in the PEG vs SPMC groups as 1.64 (confidence interval CI 1.06-2.55) versus 0.76 (CI 0.62-0.92), respectively (p=0.016). For no adenoma detection, OR was 4.18 (CI 1.12-15.60) versus OR 0.63 (CI 0.52-0.75), respectively (p=0.012).</p> <p><strong>Conclusion:&nbsp;</strong>there is similar efficacy profile using either split volume PEG or SPMC prior to colonoscopy in these African patients. Polyp and adenoma detection rates are highly dependent on the expertise of the endoscopist.</p> Emeka Ray-Offor Kalanne Ada Opusunju Copyright (c) 2021-09-17 2021-09-17 40 1 Factors associated with the appropriate use of asthma medications among adult asthmatic patients attending asthma clinic in a teaching hospital <p><strong>Introduction:&nbsp;</strong>asthma tends to be more severe with worse symptoms in Africa due to late diagnosis and delayed initiation of treatment. To identify patient and treatment-related factors which influence the appropriate use of asthma medications.</p> <p><strong>Methods:&nbsp;</strong>the study was institution based cross-sectional design. Patients were invited to provide information regarding the use of their asthma medications and factors potentially associated with appropriate use of these medications. A stepwise multivariate logistic regression analysis was used to evaluate the most important factor at a 0.05 level of significance.</p> <p><strong>Results:&nbsp;</strong>respondents with better knowledge of their asthma medications were more likely to use them appropriately (OR 5.82 [CI 95% 2.25-15.04]) as were those with positive attitudes and beliefs towards asthma and asthma medications (OR 3.88 [CI 95% 1.44-10.44]).</p> <p><strong>Conclusion:&nbsp;</strong>patients need to understand the importance of adhering to the prescribed regimen for their asthma medications even in the absence of overt symptoms in order to optimize clinical outcome.</p> Victoria Sakyibea Aboagye Kofi Adesi Kyei Priscilla Awo Nortey Doris Kitson-Mills Joseph Daniels Clement Korsah Copyright (c) 2021-09-17 2021-09-17 40 1 Chemical characteristics and cancer risk assessment of smokeless tobacco used in Tunisia (neffa) <p><strong>Introduction:&nbsp;</strong>neffa, a form of air-dried smokeless tobacco used in North Africa, is spuriously perceived as a lower risk alternative to smoking. The objective of this study was to provide information on some harmful constituents of neffa and to use them for cancer risk assessment.</p> <p><strong>Methods:&nbsp;</strong>a high-performance liquid chromatography method coupled with fluorescence detector was used to determine polycyclic aromatic hydrocarbons (PAHs) in one sample of neffa. An atomic absorption spectrometry was performed to determine the concentrations of lead and cadmium in three samples of neffa. The levels of toxicants found in neffa were used to assess for lifetime cancer risk as advocated by the US Environment Protection Agency.</p> <p><strong>Results:&nbsp;</strong>the determination of PAHs in neffa allowed the identification of phenanthrene and anthracene. However, the higher molecular weight PAHs such as Benzo(a)Pyrene (B(a)P) were not detected. The concentrations of cadmium and lead varied between 1.3 to 2.8μg/g and 1.7 to 4.6μg/g respectively. Cancer risk for cadmium and lead varied between 4.2E-03 to 9.3E-03 and 2.5E-06 to 6.4E-06 respectively. Cancer risk for Cd exceeded the range of 10E-04 to 10E-06 of an acceptable risk.</p> <p><strong>Conclusion:&nbsp;</strong>neffa is not a healthy alternative for overcoming smoking addiction. It contains mineral and organic pulmonary toxicants. This study could serve as a scientific basis to inform consumers about the products´ toxicity and help them to quit smokeless tobacco (SLT) use.</p> Fatma Guezguez Mohamed Abdelwaheb Ichraf Anane Saleheddine Rekik Saad Saguem Bassem Charfeddine Sonia Rouatbi Copyright (c) 2021-09-17 2021-09-17 40 1 Drivers of the third wave of COVID-19 in Zimbabwe and challenges for control: perspectives and recommendations <p>Since the beginning of June 2021, Zimbabwe entered into a harsh third wave of the COVID-19 pandemic, which saw an increase in the cumulative number of cases from approximately 38,000 to 120,000 in just two months. This exponential case rise was accompanied by an increase in the absolute number of case fatalities, with a corresponding strain on the public health sector. To effectively inform public health responses, policy and strategy to deal with the current wave and prepare for further waves, we discuss the drivers and challenges of control for this current wave and future waves, and offer practical recommendations. Vaccination will be the most important public health intervention to deal with the spread, morbidity and mortality of COVID-19, therefore, efforts to fight vaccine hesitancy and build vaccine confidence and availability will be critical. Similarly, it will be important to build public health sector capacity and resilience to adequately deal with large-scale outbreaks and absorb the shock waves associated with such. Resuscitating and building the economy is an indispensable component of protecting public health. Therefore, collaborative efforts from relevant public health stakeholders, economists, politicians and other players are required to effectively coordinate the necessary responses and formulate the right policies and strategies.</p> Grant Murewanhema Faith Mutsigiri-Murewanhema Copyright (c) 2021-09-17 2021-09-17 40 1 Comparison of knowledge of occupational hazards of lead exposure and blood lead estimation among roadside and organized panel beaters in Enugu metropolis, Nigeria <p><strong>Introduction:&nbsp;</strong>occupational practices continuously exposes workers to hazards of lead. This study aimed to compare the knowledge of occupational hazards associated with lead exposure, and blood lead estimation among roadside and organized panel beaters in Enugu metropolis, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional study. Multistage sampling method was used to select 428 panel beaters in Enugu metropolis. Samples were analyzed using Atomic Absorption Spectrometer at 283.3 wavelengths. Data were entered and analyzed using Statistical Package for Social Science 20. Comparative analysis were done using chi - square, T-test, Mann-Whitney U-test, Kruskal-Wallis test, logistic regression and level of significance was set at 5%.</p> <p><strong>Results:&nbsp;</strong>the majority of respondents on both roadside (59.8%) and organized (73.4%) sectors had poor knowledge of hazards of lead exposure. The difference was significant using χ² (P&lt;0.05). The median blood lead levels were 3.0µg|dl and 16.0µg|dl for roadside and organized panel beaters respectively. The difference was significant with Mann-Whitney U test (P&lt;0.001). The prevalence of elevated blood lead at 10µg|dl were 36.9% (roadside sector) and 64.5% (organized sector). The duration of working hours (OR = 4.34, CI = 1.729 – 10.338) was found to be the predictor of elevated blood lead levels.</p> <p><strong>Conclusion:&nbsp;</strong>there were general poor knowledge of hazards of lead exposure and high prevalence of elevated lead levels which were more among organized panel beaters. Advocacy on standard organizational structures that support improved occupational health practices is needed and routine outreach by research institutions for health education and safety training.</p> Chukwukasi Wilson Kassy Ndubuisi Casmir Ochie Ifeoma Juliet Ogugua Chidozie Reginald Aniemenam Chikee Elias Aniwada Emmanuel Nwabueze Aguwa Copyright (c) 2021-09-17 2021-09-17 40 1 Human papillomavirus-based cervical precancer screening with visual inspection with acetic acid triage to achieve same-day treatments among women living with human immunodeficiency virus infection: testof-concept study in Ibadan, Nigeria <p><strong>Introduction:&nbsp;</strong>cervical precancer screening with same day treatment facilitates maximization of benefits of secondary prevention of cervical cancer. This is particularly important for women living with human immunodeficiency virus (WLHIV) infection because of their exceptional risk for cervical cancer. The availability of HIV programmes in low- and middle-income countries (LMICs) provide unique opportunity for possible introduction “human papillomavirus (HPV) screening followed by visual inspection after application of acetic acid (VIA) with same day treatment of eligible patients”. This study piloted this concept.</p> <p><strong>Methods:&nbsp;</strong>in this prospective, cohort study, 98 WLHIV had HPV and VIA screening for cervical precancer lesions in a HIV clinic in Nigeria. Participants positive to HPV and/or VIA had biopsies from the visible lesions or quadrant of transformation zone. Participants positive to VIA and/or HPV16 or HPV18/45 had same-day thermal ablation treatment and the number of cases documented. The HPV, VIA and scenario of HPV followed by VIA results were compared with histologically confirmed cervical lesion grade 2 or worse statistically.</p> <p><strong>Results:&nbsp;</strong>same day treatment was achieved in 95.0% of eligible cases. Statistically, sensitivity and specificity of VIA was 25.0% and 50.0% and HPV had 95.5% and 75.0%, respectively. In the HPV screening with VIA triage, sensitivity dropped to 45.5% but specificity improved to 100.0%.</p> <p><strong>Conclusion:&nbsp;</strong>triaging HPV positive test with VIA for same-day treatment in cervical precancer screening among PLWHIV looks feasible. The improved specificity will reduce the overtreatment rate, loss to follow-up associated with repeat clinic visits and improve completion of continuum of care.</p> Olutosin Alaba Awolude Sunday Oladimeji Oyerinde Ayokunle Olumuyiwa Ayeni Isaac Folorunso Adewole Copyright (c) 2021-09-20 2021-09-20 40 1 The integration of mental health care act in primary care: an audit of the use of mental health care act forms for patients´ admission and the effect of continuing medical education on health professionals´ performance of usage, based on Letsholathebe II <p><strong>Introduction:&nbsp;</strong>despite the adoption of mental disorders act in 1972, the use of required mental health care act (MHCA) forms during admission of patients with mental illnesses remained below the legal expectation in the Maun District Hospital. This study audited Letsholathebe II Memorial Hospital (LIIMH) professionals´ usage of MHCA forms.</p> <p><strong>Methods:&nbsp;</strong>this was a quasi-experimental study that audited files of patients admitted with mental illnesses, before, three and six months after a continuing medical education (CME). Cochran Q, McNemar symmetry Chi-square were used for comparison of performance.</p> <p><strong>Results:&nbsp;</strong>of the 239 eligible files, we accessed 235 (98.3%). About two in ten (n=36/235, 15.3%) MHCA forms were not used in combination with required forms. The quasi-majority of MHCA forms set used, aligned with involuntary admission (n=134/137, 97.8%). Required admission MHCA forms significantly increased from nil before continuing medical education (CME-0), to 64.6% (n=51/79) at CME-3 and 77% (n=59/77) at CME-6 (p&lt;0.001). However, there was no statistical difference between the last two periods (64.6% vs 77%, p=0.164). Voluntary admission remained below 13% (n=10/79). Only six types of MHCA forms were used during this study.</p> <p><strong>Conclusion:&nbsp;</strong>there was no adequate use of required MHCA forms at LIIMH before CME. Thereafter, the proportion of adequate use increased from period CME-0 to the periods CME-3 and CME-6. However, there was no difference in proportion between the last two periods. We recommend an effective and regular CME twice a year for health professionals on selected MHCA forms.</p> Deogratias Ongona Mbuka Stephane Tshitenge Adekunle John Ogunjumo Copyright (c) 2021-09-20 2021-09-20 40 1 Facteurs de stress en entreprise: cas de 223 salariés des Entreprises Privées Formelles (EPF) de la ville de Ouagadougou <p><strong>Introduction:&nbsp;</strong>au Burkina Faso, le stress professionnel constitue un problème de santé publique. L´objectif de cette étude était d´identifier les facteurs de stress chez les salariés des entreprises privées formelles de la ville de Ouagadougou.</p> <p><strong>Méthodes:&nbsp;</strong>l´enquête a été réalisée au moyen des questionnaires de Karasek à 26 items et de Siegrist à 23 items. Les analyses ont été réalisées sur la base des modèles d´analyse validés de Karasek et de Siegrist et sur le logiciel SPSS.</p> <p><strong>Résultats:&nbsp;</strong>nous avons enquêté 223 salariés (186 hommes et 37 femmes) âgés en moyenne de 36,70 ans ± δ = 33,25. En plus, 70,40% des salariés sont en job strain; 50,22% en iso strain et 52,02% en déséquilibre effort/récompense. Des analyses post hoc ont permis de mettre en évidence les facteurs de stress suivants: gros efforts fournis et faible pouvoir de décision.</p> <p><strong>Conclusion:&nbsp;</strong>la présente étude a révélé l´existence du stress chez les salariés des entreprises et a permis de mettre en évidence l´importante nécessité de combiner les questionnaires de Karasek et de Siegrist dans l´étude des facteurs de stress.</p> Brigitte Nana Amidou Sawadogo Ahmed Kaboré Libérat Tanimomo Copyright (c) 2021-09-21 2021-09-21 40 1 Health systems strengthening, dissemination, and implementation science in Africa: quo vadis? <p>Implementing health-system strengthening policies remains a challenge in Africa. Past successes, predictable but unanticipated flaws, underutilization of health services, traditional medicine, global inequity and poor practice by local stakeholders are some of the reasons many African countries have made little progress towards attaining global health goals. As a result, Africa has the highest disease burden despite multiple efforts from the global health community. These raise the question: what has to change so that health systems strengthening efforts in Africa are successful?</p> Berjo Dongmo Takoutsing Chibuikem Ikwuegbuenyi Alice Umutoni Oloruntoba Ogunfolaji Nourou Dine Adeniran Bankole Racheal Mpokota Gideon Adegboyega Ulrick Sidney Kanmounye Yao Christian Hugues Dokponou Copyright (c) 2021-09-21 2021-09-21 40 1 Recurrent haemorrhagic ovarian cyst and anticoagulant therapy: a case report with review of treatment modalities <p>The common gynaecological causes of acute pelvic pain include ruptured ectopic pregnancy, haemorrhagic corpus luteal cyst or torsion of an ovarian cyst. Ovarian vascular accidents are reported in women on oral anticoagulation presenting as an acute pelvic pain. Although such vascular accidents with anticoagulation therapy are an unusual entity, a meticulous history, clinical examination, and laboratory workup to confirm the diagnosis and timely intervention is needed to reduce attending morbidity and mortality. However, a standard algorithm for management is not described in the literature. We hereby report successful management of recurrent hemorrhagic ovarian cyst due to coagulopathy in a woman with mechanical heart valves with timely surgical intervention. This case report discusses operative versus non operative management approach and may provide value addition to readers encountering such cases in their clinical practice.</p> Kavitha Nagandla Mohamed Faiz Bin Mohamed Jamli Faridah Hanim Joanne Lim Xu Mei Siti Fathima Syazliana Din Copyright (c) 2021-09-21 2021-09-21 40 1 Spectrum of acute hepatitis and its clinical outcome in a central region in Tunisia <p><strong>Introduction:&nbsp;</strong>given the lack of studies on acute hepatitis (AH) in Tunisia, we carried out this study to find the etiological spectrum and clinical profile of AH and to investigate the impact of viral etiology on the outcomes of AH.</p> <p><strong>Methods:&nbsp;</strong>retrospective descriptive study collecting all patients with AH from 2010 to 2017. The data were compared between two groups (viral AH and non-viral AH).</p> <p><strong>Results:&nbsp;</strong>one hundred and three patient´s files were included. The average age of our patients was 30.15 years. An etiology was found in 92 patients (89.3%). The viral etiology was found in 70 patients (76.1%). Hepatitis A virus (HAV), Hepatitis A virus (HBV), Hepatitis A virus (HCV) and cytomegalovirus (CMV) were in the cause in 52, 16, 1 and 1 patient respectively. Elsewhere, it was toxic hepatitis in 10 patients (10.9%) including 7 of drug-related AH. Budd-Chiari syndrome and autoimmune hepatitis with acute onset were reported in 3 (3.3%) and 7 (7.6%) patients, respectively. Patients with viral AH were younger than those with non-viral AH (p = 10-³). There was more recourse to hospitalization for non-viral AH. Patients with viral AH had a higher mean ALT level than those with non-viral AH. The liver damage was more severe in the non-viral AH group with lower PT. There was more severe form, more transition to chronicity and more deaths in the non-viral AH group.</p> <p><strong>Conclusion:&nbsp;</strong>the results found in our study concerning the distribution of the etiologies of AH as well as their evolutionary aspects are consistent with the data in the literature.</p> Nour Elleuch Manel Moalla Sana Mahmoud Aya Hammami Hanen Jaziri Wafa Ben Ameur Wafa Dahmani Aida Ben Slama Ahlem Brahem Salem Ajmi Mehdi Ksiaa Ali Jmaa Copyright (c) 2021-09-21 2021-09-21 40 1 A qualitative exploration on accounts of condom-use negotiation with clients: challenges and predicaments related to sex work among street-based female sex workers in Ekurhuleni District, South Africa <p><strong>Introduction:&nbsp;</strong>female sex workers (FSWs) are the key vulnerable populations since they carry the high burden of HIV and sexually transmitted infections (STIs). However, the vulnerability of street-based FSWs to HIV/STIs is much higher than that of the establishment-based FSWs. The study aimed to explore street-based FSWs’ condom negotiation skills, barriers to condom use as well as the challenges and predicaments they face on a daily basis.</p> <p><strong>Methods:&nbsp;</strong>an exploratory qualitative approach using focus group discussions was conducted among FSWs working in a major provincial road in a district of Gauteng Province. Thematic content analysis using NVivo version 10 software was conducted.</p> <p><strong>Results:&nbsp;</strong>the age range of the FSWs was 19 to 44 years. The themes that emerged from the data on challenges to negotiation and condom use among FSWs revealed the ways condoms are used in early sex work and over time, ways of enforcing condom used, preferred types of condoms and the predicaments to working in the sex trade. FSWs gained experience of negotiating condom use over time in their work. Both female and male condoms were available and accurate insertion of condoms was reported. Male condom was preferred. Condom use strategies included direct request; using health-information messages; charging more for condomless sex; and refusing condomless sex. The FSW reported the risks of violent attacks of unregulated street-based environment.</p> <p><strong>Conclusion:&nbsp;</strong>condom negotiation strategies illustrated that peer-education and sharing experiences among themselves were beneficial for protective sexual behaviours. Peer-education benefits and peer-interactions yielded assertive attitudes and behaviours of demanding and/or enforcing condom use.</p> Nokuthula Sikhosana Mathildah Mpata Mokgatle Copyright (c) 2021-09-22 2021-09-22 40 1 Utility of p16INK4a expression for the interpretation of uterine cervical biopsies in Kenya <p><strong>Introduction:&nbsp;</strong>histologic interpretation of hematoxylin and eosin-stained cervical biopsies is subject to substantial discordance among pathologists. Immunohistochemical staining for p16INK4a can reduce inter-observer disagreement. We did a cross-sectional study to evaluate the utility of p16INK4a staining in the assessment of cervical biopsies in Nairobi, Kenya.</p> <p><strong>Methods:&nbsp;</strong>hematoxylin and eosin-stained sections from 91 colposcopic biopsies diagnosed as negative for dysplasia or as cervical intraepithelial neoplasia (CIN) grade 1-3 from 2011-2013 in Nairobi, Kenya, were reviewed and immunostained for p16INK4a. Agreement in interpretation of cervical biopsies was compared between primary and consensus review results.</p> <p><strong>Results:&nbsp;</strong>on primary evaluation, 16 cases were negative for squamous dysplasia; 23 were CIN 1; 37 CIN 2; and 15 CIN 3. On consensus review, 32 cases were negative for dysplasia; 19 were CIN 1; 16 CIN 2 and 24 CIN 3. Agreement was moderate between primary and consensus histology review results for the diagnosis of low-grade versus high-grade squamous intraepithelial lesions (Kappa = 0.568). None of the cases negative for dysplasia were positive for p16INK4a expression, but in primary and consensus review results, 17% and 5% cases of CIN 1; 49% and 69% of CIN 2, and 80% and 96% of CIN 3 were p16INK4a positive, respectively.</p> <p><strong>Conclusion:&nbsp;</strong>there was significant variability in the interpretation of cervical biopsies on hematoxylin and eosin between primary and consensus review assessments. 75% of CIN 1 cases that were upgraded to CIN 2 during consensus review expressed p16INK4a. These findings demonstrate the role of p16INK4a in increasing diagnostic accuracy and as a marker of high-grade CIN 2/3.</p> Thierry Zawadi Muvunyi Eliane Rohner Siobhan O'Connor Ahmed Yakub Kalebi Wairimu Waweru John Kairu Willis Ochuk Jennifer Susan Smith Lucy Wangari Muchiri Copyright (c) 2021-09-22 2021-09-22 40 1 Adherence to medication administration guidelines among nurses in a health facility in South-West Nigeria <p><strong>Introduction:&nbsp;</strong>medication error has become a global problem. Medication administration that is error free is important in achieving positive outcomes in patient’s care. This study assessed adherence to medication administration guidelines among nurses in a health facility in South-West Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional descriptive study was carried out on 75 nurses involved in oral medication administration. Data was collected using direct observation method with an observational checklist developed from literature. Data analysis was done using frequency, percentage, Mean and Standard Deviation. Test of relationship was carried out using Kruskal-Wallis Test and Mann Whitney Test at 0.05 (p&lt;0.05) level of significance.</p> <p><strong>Results:&nbsp;</strong>almost an average (49.3%) of participants did not provide information about the medication. More than 1/3<sup>rd</sup>&nbsp;(38.7%) did not perform right assessment where necessary. The majority (76.0%) did not serve correct medication. Overall level of non-adherence was 48%. Adherence to medication administration guidelines was significantly related to age (χ² = 9.673, p&lt;0.05), marital status (χ² = 9.426, p&lt;0.05), years of experience (U=404.000 Z=2.7622, p&lt;0.05), type of shift (χ² = 6.314, p&lt;0.05), nurses-patient ratio (χ² = 11.598, p&lt;0.05).</p> <p><strong>Conclusion:&nbsp;</strong>some nurses did not adhere strictly to the guidelines of medication administration. Adherence to medication administration guidelines was related to age, marital status, years of experience, type of shift and nurse-patient ratio. Poor adherence to medication administration guidelines may jeopardize patient safety. There is need for development of a universal medication procedure/protocol and continuous education of nurses on medication administration practices.</p> Cecilia Bukola Bello Copyright (c) 2021-09-22 2021-09-22 40 1 Rapid HIV-1 drug resistance testing in a resource limited setting: the Pan Degenerate Amplification and Adaptation assay (PANDAA) <p><strong>Introduction:&nbsp;</strong>pre-treatment drug resistance (PDR) can compromise the 3rd 95-95-95 global target for viral load suppression. The high complexity and cost of genotyping assays limits routine testing in many resource limited settings (RLS). We assessed the performance of a rapid HIV-1 drug resistance assay, the Pan Degenerate Amplification and Adaptation (PANDAA) assay when screening for significant HIV-1 drug resistance mutations (DRMs) such as K65R, K103NS, M184VI, Y181C and G190A.</p> <p><strong>Methods:&nbsp;</strong>we used previously generated amplicons from a cross-sectional study conducted between October 2018 and February 2020 of HIV-1 infected antiretroviral therapy (ART)-naïve or those reinitiating 1<sup>st</sup>&nbsp;line ART (18 years or older). The performance of the PANDAA assay in screening K65R, K103NS, M184VI, Y181C, and G190A mutations compared to the reference assay, Sanger sequencing was evaluated by Cohen´s kappa coefficient on Stata version 14 (StataCorp LP, College Station, TX, USA).</p> <p><strong>Results:&nbsp;</strong>one hundred and twenty samples previously characterized by Sanger sequencing were assessed using PANDAA. PDR was found in 14% (17/120). PDR to non-nucleoside reverse transcriptase inhibitors (NNRTIs) was higher at 13% (16/120) than PDR to nucleotide reverse transcriptase inhibitors (NRTIs), 3% (3/120). The PANDAA assay showed a strong agreement with the reference assay, i.e. Sanger sequencing for all five target DRMs (kappa (95%CI); 0.93(0.78-0.98)) and NNRTI DRMs (kappa (95%CI); 0.93(0.77-0.980), and a perfect agreement for NRTI DRMs (kappa (95%CI); 1.00(0.54-1.00)).</p> <p><strong>Conclusion:&nbsp;</strong>the PANDAA assay is a simple and rapid method to identify significant HIV DRMs in plasma samples as an alternative to Sanger sequencing in many RLS.</p> Vinie Kouamou Chiratidzo Ellen Ndhlovu David Katzenstein Justen Manasa Copyright (c) 2021-09-22 2021-09-22 40 1 An in vitro investigation of the phytochemical contents of Marsdenia macrantha root and its antibacterial activity against selected foodborne pathogens <p><strong>Introduction:&nbsp;</strong><em>Marsdenia macrantha</em>&nbsp;is a crucial source of traditional medicine in Northern Namibia. Its roots are used to treat various health conditions ranging from mouth infections to urinary retention. Despite its medicinal application, there is no known knowledge of its therapeutic properties. Thus, we investigated the phytochemical content and antibacterial activity of&nbsp;<em>M. macrantha</em>.</p> <p><strong>Methods:&nbsp;</strong><em>M. macrantha</em>&nbsp;root extracts were obtained using three different solvents (distilled water, methanol and acetone) - in the soxhlet and maceration extraction methods. Total phytochemical (terpenoid, alkaloid and/or flavonoid) content was determined by spectrophotometry. Antibacterial activity against common foodborne pathogens (<em>Staphylococcus aureus</em>,&nbsp;<em>Escherichia coli</em>&nbsp;and&nbsp;<em>Salmonella typhi</em>) was determined by both well and disc diffusion method.</p> <p><strong>Results:&nbsp;</strong>we detected the presence of all the tested phytochemicals. Methanol gave the highest percentage yield of extraction (mean: 13.95 ± standard deviation: 0.41%) followed by water (10.92 ± 0.11%) and acetone (6.85 ± 0.23%), F-ratio=326.71 and p&lt;0.0003. The total content determined showed that&nbsp;<em>M. macrantha</em>&nbsp;root extract contained more flavonoids than alkaloids (mg of standard per grams of the dry material). Antibacterial analyses showed inhibitory activity against all the selected pathogens, with the highest inhibition zone against&nbsp;<em>S. typhi</em>&nbsp;(19.7 ± 0.3 mm) - for the acetone-prepared root extract. There were variations in minimum inhibitory concentrations of the extracts prepared by the different solvents.</p> <p><strong>Conclusion:&nbsp;</strong>this is the first study demonstrating the presence of phytochemicals and antibacterial properties of&nbsp;<em>M. macrantha</em>&nbsp;roots. Further studies are needed to isolate and characterize the phytochemicals for antibacterial application.</p> Nduuvako Christophine Shikwambi Harris Onywera Lamech Malagho Mwapagha Copyright (c) 2021-09-24 2021-09-24 40 1 Multiple meningiomatosis <p>Multiple meningiomas or meningiomatosis are defined by the presence of at least 2 lesions that appear simultaneously or not, at different intracranial locations. Early classification of Cushing and Eisenhardt claimed that a diagnosis of multiple meningioma can only be made if the patient does not suffer neurofibromatosis type I (NF1 is associated with neurofibromin, ras pathway). Majority of multiple meningiomas associate with neurofibromatosis type-II, multiple meningiomatosis refers to the association of at least 2 tumors in two different sites, in a patient who has no evidence of neurofibromatosis. The incidence of this condition varies between series between 1 and 3%, reaching a frequency of 8% with the onset of magnetic resonance imaging (MRI). This entity combines benign tumors of a different histological nature in 30% of cases. A 39-year-old woman patient, with no significant pathological history, who consulted for heaviness in both lower limbs having progressed for 6 months with paresthesias without genitosphincteric disorders, the examination found a spastic paraparesis rated at 3/5. The patient underwent a medullary MRI which revealed 4 lesions, the radiological semiology of which was suggestive of spinal meningiomas, the most compressive projecting in relation to T2. A cerebral computed tomography (CT) was systematically performed and objectified two intra cranial meningiomas, which until then were asymptomatic. Although its incidence is only 1 to 3%, the discovery of multiple meningiomatosis justifies morphological exploration (MRI) of the entire neurax, in which case any symptomatic location should suggest surgical management.</p> Inas El Kacemi Gazzaz Miloudi Copyright (c) 2021-09-24 2021-09-24 40 1 Thyroid heterotopia revealed by a cervical subcutaneous nodule: a clinical case report <p>Thyroid heterotopia is an abnormal localization of normal thyroid tissue coexisting with a normal organ on a normal localization. It is a rare condition with a frequency that is not well known in the literature. We report a case of thyroid heterotopia in a 30 month-old girl referred for a painless lower antero-cervical nodule that has been developing for one year with past history no contributory. The clinical examination found a subcutaneous formation mobile in relation to the different deep and superficial planes with bilateral angulomandibular micro-lymphadenopathy. Ultrasounds of the soft parts of the neck showed hypoechogenic tissue reminiscent of thyroid tissue, the thyroid was in place. The thyroid hormone profile was normal. In the absence of a functional scintigraphy device, the diagnosis was confirmed with a pathology exam after surgery. We discuss the diagnostic relevance of thyroid heterotopia in front of any anterior nodular formation of the neck.</p> Yannick Mossus David Mindja Eko Leonel Atanga Roger Christian Meva'a Biouele Adèle-Rose Ngo Nyeki François Djomou Alexis Ndjolo Copyright (c) 2021-09-27 2021-09-27 40 1 Endometrial osseous metaplasia complicated by secondary infertility: a case report <p>Endometrial osseous metaplasia is a rare condition in which there is abnormal presence of bone in the endometrium. There is paucity of reported cases of this pathological condition in Africa and it is usually overlooked as a cause of infertility. Pathogenesis is not well understood but mostly occurs following pregnancy. Pathology may be suspected on ultrasound scan where a linear echogenic substance is seen in the endometrium but diagnosis is confirmed by and treated with hysteroscopy. We present a case of a 43-year-old woman with 2 previous miscarriages who presented with secondary infertility. She had an ultrasound scan done which revealed features suggestive of an intra-uterine copper device. She subsequently had hysteroscopy and a bone-like foreign body was found in the endometrium which was removed with the aid of a grasper and later sent for histopathological evaluation for which a subsequent diagnosis of endometrial osseous metaplasia was made. Indeed, endometrial intraosseous metaplasia should be considered an important differential cause of secondary infertility especially in patients with history of previous miscarriage. Confirmatory diagnosis can be made through hysteroscopy and/or histopathologically although the former is now used.</p> Olalekan Abisola Ajayi Olufemi Oladipupo Adebawojo Victor Chimezie Okebalama Copyright (c) 2021-09-28 2021-09-28 40 1 Burden of non-communicable diseases in Tunisia, 1990-2017: results from the global burden of disease study <p><strong>Introduction:&nbsp;</strong>non-communicable diseases (NCDs) are the leading cause of mortality and disability worldwide especially in developing countries such as Tunisia. We aimed to describe the national burden of non-communicable diseases in 2017 and to analyze disability-adjusted life year trends from 1990 to 2017 in Tunisia by cause and gender.</p> <p><strong>Methods:&nbsp;</strong>we used Joinpoint regression analysis to assess trends of the age standardized disability-adjusted life year rate from 1990 to 2017 and to determine average annual percentage change.</p> <p><strong>Results:&nbsp;</strong>non-communicable diseases accounted for 87.7% of total disability-adjusted life year in Tunisia in 2017. The five leading causes of this rate in Tunisia in 2017 were cardiovascular diseases, musculoskeletal disorders, neoplasms, mental disorders and neurological disorders. The trend of disability-adjusted life year rate of non-communicable diseases decreased significantly from 23403.2 per 100.000 (95% CI: 20830.2-26285.8) in 1990 to 18454.6 (95% CI: 15611.3-21555.4) in 2017, with a change of -0.9%; p=0.00. The decrease of the age standardized disability-adjusted life year rate concerned mainly cardiovascular diseases and neoplasms secondly. This decrease was more important in female (change=-1.1, p=0.00) in comparison to males (change=-0.7, p=0.00). On the other hand, the increase of the standardized disability-adjusted life year rate was related to musculoskeletal disorders, diabetes, kidney disorders and substance use disorders with a significant annual percentage change of 0.1%, 0.2% and 1.3% (p=0.00) respectively.</p> <p><strong>Conclusion:&nbsp;</strong>the implementation of the national strategy is the key solution to mitigate the impact of non-communicable diseases in Tunisia.</p> Houyem Khiari Rym Mallekh Ines Cherif Mohamed Hsairi Copyright (c) 2021-09-28 2021-09-28 40 1 Web-based COVID-19 risk communication by religious authorities in Uganda: a critical review <p>The objectives of this study were to explore the content of web-based communication on COVID-19 by religious authorities (RAs) in Uganda and to assess the level of integration of the Uganda Ministry of Health (MoH) and World Health Organisation (WHO) COVID-19 risk communication guidelines into the statements released by these RAs. A grey literature review was conducted by searching the websites of intra- and inter-religious bodies for the terms “COVID-19” and “coronavirus”. Thematic analysis was used to assess the content of RA statements which were also mapped to the items of the MoH and WHO statements. Results indicate that RA communications were centred on COVID-19 description and management; the need to adhere to established guidelines; and the adoption of health-protective behaviours, notably, social distancing and avoidance of misinformation. RAs also discussed the effects of COVID-19 and its control measures on the population and spoke against pandemic-aggravated injustices (gender-based violence and embezzlement). The RA messages incorporated the WHO statement to a greater extent than the MoH statement. In conclusion, RAs played a critical role in delivering public health messages in Uganda during the COVID-19 pandemic, a position we believe should be maximized by public health authorities for effective communication during emergencies.</p> Etheldreda Leinyuy Mbivnjo Ephraim Kisangala Andrew Marvin Kanyike Denis Kimbugwe Tian Okucu Dennis Justine Nabukeera Copyright (c) 2021-09-28 2021-09-28 40 1 Knowledge on mother-to-child transmission of HIV, and sexuality and fertility desires among people living with HIV in North-Central, Nigeria <p><strong>Introduction:&nbsp;</strong>mother-to-child transmission (MTCT) is the transmission of HIV from a mother to the child during pregnancy, labour and breastfeeding. People living with HIV (PLHIV) are sexually active and also HIV can be transmitted while trying to achieve pregnancy involving unprotected hetero-sexual intercourse. Fertility desire among PLHIV is increasing due to improved quality of life and survival following commencement of anti-retroviral treatment and available reproductive health services. The objective of the study was to determine the association between knowledge on MTCT of HIV and sexuality and fertility desire.</p> <p><strong>Methods:&nbsp;</strong>this study was descriptive cross-sectional applying systematic sampling technique among PLHIV using semi-structured interviewer administered questionnaires. Data was analysed using SPSS version 23.0. Chi square test was used for statistical analysis. At 95% confidence interval a P-value of &lt;0.05 was considered to be statistically significant.</p> <p><strong>Results:&nbsp;</strong>a total of 168 PLHIV were studied, 63.3% females and 36.7% males. Majority (81.5%) of the respondents were sexually active and 64.1% had fertility desire. On awareness of MTCT 62.5% had heard of MTCT but only 28.2% had good knowledge. No association was found between knowledge of MTCT and sexuality and fertility desire respectively.</p> <p><strong>Conclusion:&nbsp;</strong>PLHIV had high awareness but poor knowledge on MTCT of HIV, hence the need for healthcare workers to provide sexual and reproductive health counselling including information on MTCT to both male and female PLHIV during routine clinic visits.</p> Chikwendu Amaike Tolulope Olumide Afolaranmi Blessing Adaku Amaike Hadiza Agbo Olumide Abiodun Copyright (c) 2021-09-28 2021-09-28 40 1 Socio-demographic characteristics and pre-hospital care of children with circulatory failure in a children's emergency room in southern Nigeria <p><strong>Introduction:&nbsp;</strong>circulatory failure is a major childhood emergency. Several disease-related and patient-related factors can predispose children to shock. Early detection of such factors will improve its prevention, management and outcome. This study aimed to evaluate the incidence, socio-demographic characteristics and pre-hospital care of children presenting with circulatory failure (shock) in children´s emergency room (CHER).</p> <p><strong>Methods:&nbsp;</strong>this study adopted cross-sectional design in CHER of the University of Benin Teaching Hospital, Nigeria, from October 2018 to March 2019. Data were collected using a semi-structured questionnaire eliciting demography, socio-economic status, pre-hospital care and presence of shock. In a sub-analysis, multiple logistic regression identified variables that are independently associated with circulatory failure in the participants, using adjusted odds ratio (OR) and 95% confidence intervals (CI).</p> <p><strong>Results:&nbsp;</strong>a total of 554 acutely-ill children participated in the study. Their median age was 60 (IQR: 24-132) months. Shock was present in 79 (14.3%) of the children on arrival at CHER. Children referred from private clinics were more likely to arrive CHER in shock compared to those coming directly from home (OR = 2.67, 95%CI: 1.07-6.69; p = 0.036) while children from lower socio-economic class families presented more frequently with shock than those from higher class (OR = 14.39, 95% CI: 2.61-79.44; p = 0.002). Also, children that received oral rehydration solution as pre-hospital care seemed more likely to present with shock in CHER (OR = 6.63, 95% CI: 2.15-20.46; p =0.001).</p> <p><strong>Conclusion:&nbsp;</strong>quality of pre-hospital care and parental socio-economic status influence the presence of shock in children seen at the emergency unit. Focused health education and prevention of finance-related delays in emergency care are needed.</p> Moses Temidayo Abiodun Wilson Ehidiamen Sadoh Copyright (c) 2021-09-28 2021-09-28 40 1 Serious adverse events following immunization after ChAdOx1 nCov-19 vaccination in India: a single center experience <p>Letter to Editors</p> Miteshkumar Rajaram Maurya Renju Ravi Libby Pushparajan Copyright (c) 2021-09-29 2021-09-29 40 1 Long QT interval and syncope after a single dose of COVID-19 vaccination: a case report <p>Adverse consequences of the coronavirus disease 2019 (COVID-19) vaccination which have been reported in scientific papers are varied. One possible but rare consequence is myocarditis, which may have a diversity of clinical manifestations. We report a case of a 70-year-old man who presented to the hospital for some syncope, 3 days after his first COVID-19 AstraZeneca Vaccination. Initial electrocardiogram (ECG) showed a long QT interval (QTc = 600 milliseconds). Laboratory tests revealed elevated troponin and lack of evidence of viral infection. Further investigations revealed the vaccine-induced myocarditis and arrhythmias linked to it. Within one week of magnesium treatment, the QT interval was completely corrected, and the patient discharged with no typical syncope attacks. This case like the previous reported one confirms that myocarditis is a complication of COVID-19 vaccine, but implies its clinical manifestations may be varied and even may happen after the single dose of vaccination.</p> Nahid Azdaki Marjan Farzad Copyright (c) 2021-09-30 2021-09-30 40 1 Minimally invasive and full sternotomy in aortic valve replacement: a comparative early operative outcomes <p><strong>Introduction:&nbsp;</strong>aortic valve replacement is usually performed through a median full sternotomy (MFS) in our department. Minimally invasive aortic valve replacement (MIAVR) has been recently adopted as a new approach. According to the literature, the superiority of MIAVR is controversial. In this study we report early post-operative outcomes in MIAVR compared with MFS access with reference to blood Loss, wound infections, post-operative recovery, morbidity and mortality.</p> <p><strong>Methods:&nbsp;</strong>this study was a prospective data collection from 36 consecutive patients undergoing isolated valve replacement. Two population study was identified, MIAVR group (group I n=18) and MFS group (group II n=18). Patients´ data were collected and analyzed using IBM SPSS statistics 21 software and Khi2 test has been used to compare the variables. The study variables are presented as numbers, percentage, median with interquartile range. Pre-operative planning was performed so that to obtain similar characteristics.</p> <p><strong>Results:&nbsp;</strong>in group I, upper mini-sternotomy was used in 12 patients and right mini-thoracotomy in 6 patients. There was no difference in term of mortality and morbidity. MIAVR was associated with longer CPB time (93.25 (58-161) vs 131 (75-215) mins, P=0.047) with no significant difference in term of ACC time (81 (33-162) vs 58.8 (59-102) mins P=0.158). MIAVR´ Patients had likely lower incidence of red blood cells transfusion (16.7 vs 52.3%) without significant difference about post-operative haemoglobin (P = 0,330). Patients in group I had shorter ventilation time (2.35 (1-12) vs 9.3 (1-48) hours P &lt; 0.01), shorter ICU stay (2.44 (1-8) vs 4.25 (1-9) days, P = 0,024). The length of hospital stay was shorter, 6.5 (5-9) days in group I vs 7.4 (6-11), P=0.0274. Length of chest tube stay was shorter in group I (mean 1.53 vs 2.4 days, P=0,033). Wound infections were not found in both groups.</p> <p><strong>Conclusion:&nbsp;</strong>minimally invasive aortic valve replacement is associated with less blood loss, faster post-operative recovery faster post-operative recovery but increase operation time.</p> Issaka Zallé Moussa Son Mohamed El-Alaoui Macédoine Nijimbéré Drissi Boumzebra Copyright (c) 2021-09-30 2021-09-30 40 1 Endovascular management of an isolated common iliac artery aneurysm: a case report <p>Isolated iliac artery aneurysms are rare, and treatment by conventional surgery gives good results. Endovascular repair of such aneurysms has recently become the preferred form of treatment, provided the appropriate anatomy for endovascular repair exists. We report the case of a 60-year-old man admitted in our department for an aneurysm of the left primitive iliac artery revealed by intermittent claudication and treated by a covered stent after embolization of the hypogastric artery by an Amplatzer Vascular Plug with a good result. This case highlights the importance of preservation of the collaterals of the hypogastric artery when you treat such entity; in order to avoid transient gluteal claudication and sexual dysfunction.</p> Imtinene Ben Mrad Melek Ben Mrad Sobhi Mleyhi Rim Miri Ihsen Zairi Yassine Khaddar Mohamed Ben Hammamia Raouf Denguir Copyright (c) 2021-09-30 2021-09-30 40 1 Patterns of allergic rhinitis among adults in Qassim region, Saudi Arabia: a cross sectional study <p><strong>Introduction:</strong>&nbsp;developing and developed countries have a high prevalence of allergic rhinitis (AR). Severe AR has negative impacts on sleep, quality of life, and work performance. The study aimed to identify the patterns of AR among patients attending the ears nose and throat Unit (ENT) clinic at King Saud Hospital, Qassim, Saudi Arabia.</p> <p><strong>Methods:</strong>&nbsp;this study was a cross-sectional study conducted at the ENT clinic of King Saudi Hospital, Unaizah City, Qassim region, Saudi Arabia. We examined outpatients diagnosed with AR using an interview questionnaire and clinical examination.</p> <p><strong>Results:</strong>&nbsp;the sample included 455 patients. Of these, 23.7% were 21-30 years old, 65.7% had a family history of AR, 57.8% had no general symptoms, 75.6% reported runny nose as the most common nasal symptom, and 35.4% reported no complications. Dust was the most common trigger of AR (82.4%), 49.2% reported allergic symptoms in all seasons, 96% of patients have inferior turbinate hypertrophy, and oral histamine was the most commonly used treatment (33.2%).</p> <p><strong>Conclusion:</strong>&nbsp;perineal AR and inferior turbinate hypertrophy were very common findings comparing to previous studies, further studies to assess the risk factors are highly recommended.</p> Sultan Alanazy Mazyad Alenezi Ibrahim Al-Quniabut Ibrahim Al-juraifani Malek Alburayh Abdullah Altuaysi Yahya Alyahya Hajaj Al-Homaidan Osama Al-Wutayd Copyright (c) 2021-09-30 2021-09-30 40 1 How large is the burden of depression in a medical school? A cross-sectional study among medical students in Nigeria <p><strong>Introduction:&nbsp;</strong>mental health of students deteriorate when they begin studies in a medical school. The study aimed to determine the prevalence of depression and associated factors among medical students in a university in Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study design was used. All matriculated medical students of Ebonyi State University Abakaliki, Nigeria were included in the study. Information was obtained using a self-administered structured questionnaire. Beck´s depression inventory was used to determine the prevalence of depression. Chi square test was used to ascertain association between variables. Level of statistical significance was determined by p value of &lt;0.05.</p> <p><strong>Results:&nbsp;</strong>the mean age of the students was 23.2 ± 3.3 years and majority, 60.2% were males. Prevalence of depression was 17.4%. Third-year class (major examination class) had the highest proportion of students who were depressed, 24.2% while final year class had the least, 8.8%. Coping mechanisms for low moods included sleeping, 50.4% and having interactions with colleagues, 46.9%. Factors associated with depression included being &lt;25 years, (p=0.008), being in the pre-clinical school, (p=0.023) and being afraid some students may not graduate from medical school (p=0.030).</p> <p><strong>Conclusion:&nbsp;</strong>burden of depression was high among the students and most pronounced among third year students. There is need for proper orientation of newly admitted medical students on the medical curriculum by authorities of the university. Efforts should be made to decrease undue anxiety among students especially during examination. Adequate measures should be put in place for early detection and prompt management of cases of depression among the students.</p> Edmund Ndudi Ossai Irene Ifeyinwa Eze Rejoice Chinecherem Onyenakazi Elias Ugebe Basil Eze Obinna Obasi Copyright (c) 2021-10-01 2021-10-01 40 1 Psoriasis with onychomycosis in a diabetic patient <p>Global prevalence of psoriasis ranges between 0.09% to 11.43%. Psoriasis is basically a defective inflammatory response. Dry flakes of silvery white skin scales in psoriasis results from the excessive proliferation of skin. Incessant irritation brought about by psoriasis is the most significant and huge contributing component for the expanded diabetes hazard and different other metabolic disorders. A 45-year-old man presented with complaints of yellowish discoloration of nails on both hands with difficulty to perform day to day activities. Patient a known case of psoriasis for the past 7 years and was on topical medication for the same. Examinations revealed yellowish discoloration of fingernails, thickening of nails, with separation of nail from nail bed. A deep ulceration of size 1 x 2 cm over the distal phalanx is noticed. Lab investigations revealed poor glycemic control and on direct microscopy with 20% potassium hydroxide (KOH) and culture revealed onychomycosis. Patient was started on systemic anti-fungals medication and simultaneous treatment for achieving glycemic control.</p> Surya Besant Natarajan Krishna Prasanth Baalann Copyright (c) 2021-10-01 2021-10-01 40 1 Erosive oral lichen planus <p>Plethora of clinical forms exists in oral lichen planus (OLP), a common autoimmune disease involving mucous membrane. The commonest forms described in the literature are reticular, atropic, papular, bullous, plaque and erosive. The erosive type being the second most common, is a premalignant condition owing to its aggressiveness. A 54-year-old male presented to private clinic with one year history of intermittent burning sensation on inner aspect of cheeks. He was on antihypertensives since two years and using tobacco for the past ten years. On oral examination, the lesion was extending from commissure of lip to retromolar region bilaterally, with elevated white lacy streaks/striae (Wickam´s striae) throughout the lesion, typical of lichen planus (LP). On palpation, tenderness (+) and lesion was unscrapable. The case was provisionally diagnosed as erosive LP. Incisional biopsy was taken and histopathological examination confirmed the provisional diagnosis. Patient was treated with antioxidants, topical and systemic steroids. After one week, patient had a note-worthy reduction in burning sensation. Patient was encouraged to quit tobacco, educated about oral cleanliness and was encouraged to seek regular follow-up to monitor the disease. The odds of oral lichen planus developing into squamous cell carcinoma go upto 10, among which erosive type has a noteworthy frequency. Hence, it is prudent for all clinicians to do oral examination for each and every patient for it provides a clue to diagnose a wide gamut of diseases. Early identification of oral lesions will help in effective treatment as well as to avert grievous complications like malignant transformation.</p> Pragadeesh Palaniappan Krishna Prasanth Baalann Copyright (c) 2021-10-04 2021-10-04 40 1 Psychological responses of Tunisian general population during COVID-19 pandemic <p><strong>Introduction:&nbsp;</strong>this is the first study assessing the psychological impact on Tunisian general population during the first peak of the COVID-19 pandemic. We aimed to assess the prevalence of anxiety, depressive symptoms and insomnia, as well as associated factors.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted through an online survey of 1615 people during March 23<sup>rd</sup>&nbsp;to May 5<sup>th</sup>, 2020. We used the hospital anxiety and depression scale for anxiety and depression screening, and the insomnia severity index to assess sleep disturbances.</p> <p><strong>Results:&nbsp;</strong>our study revealed a high prevalence of anxiety and depressive symptoms, and insomnia (70.9%, 71.1% and 60.6% respectively). Multivariable statistics showed that anxiety symptoms were correlated to female gender (adjusted odds ratio [aOR] 1.784, 95% confidence interval (CI 1.252-2.542; p=10ˉ<sup>3</sup>), history of mental illness (aOR: 1.680, 95% CI: 1.329-2.125; p&lt;10ˉ<sup>3</sup>), frequently social media exposure (aOR: 1.578, 95%CI: 1.250-1.992; p&lt;10ˉ<sup>3</sup>), times to focus on COVID-19 ≥ 3hours (aOR: 1.840, 95% CI: 1.433-2.362; p&lt;10ˉ<sup>3</sup>), consultation with doctor in the clinic in the past 14 days (aOR: 1.821, 95%CI :1.220-2.718; p=0.003) and recent traumatic event in the past 14 days (aOR: 1.641,95% CI: 1.331-2.024; p&lt;10ˉ<sup>3</sup>). Principal factors associated with depressive symptoms included female gender (aOR: 1.637, 95% CI: 1.150-2.331; p=0.006), history of mental illness (aOR: 1.498, 95% CI: 1.189-1.888; p=10ˉ<sup>3</sup>), times to focus on COVID-19 ≥ 3hours (aOR: 1.956, 95% CI: 1.555-2.461; p&lt;10ˉ<sup>3</sup>), and recent traumatic event in the past 14 days (aOR: 1.558, 95% CI: 1.265-1.919; p&lt;10ˉ<sup>3</sup>). The main factors correlated to insomnia were younger (age &lt;35years) (aOR: 1.592, 95% CI: 1.17 -2.152; p=0.003), female gender (aOR: 1.864, 95% CI: 1.252-2.775; p=0.002), having organic diseases (aOR: 1.527, 95% CI: 1.131-2.061; p=0.006), history of mental illness (aOR: 1.777, 95% CI: 1.396-2.263; p&lt;10ˉ<sup>3</sup>), students (aOR: 1.931, 95% CI: 1.495-2.495; p&lt;10ˉ<sup>3</sup>), times to focus on COVID-19 ≥3hours (aOR: 1.877, 95% CI: 1.467-2.400; p&lt;10ˉ<sup>3</sup>) and recent traumatic event (aOR: 1.431, 95% CI: 1.144-1.789; p=0.002).</p> <p><strong>Conclusion:&nbsp;</strong>our study revealed a major mental health burden in Tunisia during COVID-19 pandemic. Many factors were correlated to anxiety, depressive symptoms and insomnia, suggesting the need for greater psychological support in general and in certain vulnerable groups.</p> Wiem Bouattour Mariem Turki Sahar Ellouze Neila Messedi Fadwa Charfeddine Najla Halouani Lobna Aribi Jihen Aloulou Copyright (c) 2021-10-04 2021-10-04 40 1 Prevalence of metabolic abnormalities in patients with urolithiasis in Kinshasa, Democratic Republic of Congo <p><strong>Introduction:</strong>&nbsp;metabolic abnormalities are key factors in urolithiasis patients because they can be modified to prevent the risk of urinary stones. The objectives of this study were to estimate the frequency of metabolic abnormalities in the urine of patients with urolithiasis and to determine their possible link with the chemical composition of stones.</p> <p><strong>Methods:</strong>&nbsp;we conducted a cross-sectional study evaluating 73 patients referred for urolithiasis in 8 clinics in Kinshasa, between January 2017 and September 2019. Twenty four-hour or early morning urine were collected and analyzed in the Tenon Hospital in Paris. Parameters analyzed included pH, specific gravity, creatinine, uric acid, calcium, phosphate, oxalate, citrate and magnesium. Chi square test or chi-square likelihood-ratio and student's t test were used as statistical tests.</p> <p><strong>Results:</strong>&nbsp;overall, 89% (n=65) of patients with lithiasis had metabolic abnormalities. Mean (SD) age of patients was 47.0 (14.2) years with male to female ratio of 1.6:1. The mean (SD) 24-hour diuresis was 1836.4 (1216.9)ml; the mean (SD) urine density was 1.018 (0.007); and the mean (SD) pH was 6.1(0.8). Hypocitraturia was the most frequently observed metabolic abnormality and was found in 76.7% patients. Other significant metabolic abnormalities were low magnesuria (35.6%), hyperoxaluria (11%), and low sulphaturia (74%). Whewellite (73.5%) was the main chemical component. The mean pH was higher in patients with carbapatite and struvite stones (p=0.031).</p> <p><strong>Conclusion:</strong>&nbsp;this study suggests that inadequate diuresis and hypocitraturia were important lithogenic factors. The population should be encouraged to increase water intake to limit the frequency of urine super saturation with crystals.</p> Pablo Kuntima Diasiama Diangienda Dieudonné Molamba Moningo Ernest Kiswaya Sumaili Alain Ngoma Mayindu Augustin Monga Lembe Punga-Maole Jean-Philippe Haymann Michel Daudon Copyright (c) 2021-10-05 2021-10-05 40 1 Psychological impact of COVID-19 on diabetes mellitus patients in Cape Coast, Ghana: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>COVID-19 pandemic has had a greater psychological impact on patients with chronic ailments such as diabetes mellitus, tuberculosis, and HIV/AIDS compared to those without chronic conditions. We explored the psychological impacts of COVID-19 among people living with diabetes mellitus in Ghana.</p> <p><strong>Methods:&nbsp;</strong>this study employed a hospital-based cross-sectional design involving 157 diabetes mellitus patients aged 20 years and above. We assessed diabetes distress by the seventeen-item diabetes stress (DDS17) scale and COVID-19 worries by 3 specific benchmarks: “worry about overly affected due to diabetes if infected with COVID-19”, “worry about people with diabetes characterized as a risk group” and “worry about not able to manage diabetes if infected with COVID-19”. A close-ended questionnaire was used in data collection.</p> <p><strong>Results:&nbsp;</strong>of 157 diabetic patients interviewed, the majority had type 2 diabetes mellitus with known complications and only 42.7% were managing COVID-19 symptoms. The participants showed moderate to high level of COVID-19 specific worry, moderate fear of isolation, and low level of diabetes-associated distress. About 33.8% of the study population expressed a sense of worry towards the pandemic. The logistic regression showed that age, employment status, and presence of other chronic diseases were significantly associated with worries about being overly affected if infected with COVID-19 due to their diabetes status. Age and sex were associated with worries about people with diabetes being characterized as a risk group and age, sex and employment status were associated with participants who were worried about not being able to manage diabetes if infected with COVID-19.</p> <p><strong>Conclusion:&nbsp;</strong>the general trend indicates a sense of worry among diabetes patients during the COVID-19 pandemic which is associated with poorer psychological health. Clients' education and counseling on COVID-19 are necessary to address some of their concerns to minimize the level of anxiety and emotional stress in these individuals.</p> Richard Kobina Dadzie Ephraim Evans Duah Charles Nkansah Samuel Amoah Emmanuel Fosu Justice Afrifa Felix Botchway Perditer Okyere Samuel Essien-Baidoo Kofi Mensah Dorcas Serwaa Samuel Asamoah Sakyi Prince Adoba Linda Ahenkorah Fondjo Jerry Paul Ninnoni Yaa Boahemaa Gyasi Aderoju Copyright (c) 2021-10-05 2021-10-05 40 1 Collodion baby <p>Lamellar ichthyosis or non-bullous congenital ichthyosis is an inherited autosomal recessive genodermatosis with a prevalence of 1 in 300,000 live births. The affected child is born with a tight, clear sheath covering their skin called a collodion membrane, that usually dries and peels off during the first few weeks of life, and then it becomes obvious that affected babies have scaly skin, and eyelids and lips that are turned outward. Infants with lamellar ichthyosis may develop infections, an excessive loss of fluids (dehydration), respiratory problems and even death within the first few days to weeks of life. Although the cause of this disorder is unknown, in some cases mutations in the Transglutaminase-1 (TGM1) gene are held accountable. We present to you a case of a term male baby born to a 31-year-old primigravid mother, with yellowish brown hard scales covering the whole body, but mostly the head, trunk, palm and soles with abnormally formed fingernails and toenails (nail dystrophy). The baby was examined for any other abnormalities. Skin biopsy showed epidermal hyperkeratosis and preservation of granular layer, confirming the diagnosis. The baby was treated in humidified environment with intravenous fluids and prophylactic antibiotics. Emollient was applied to the whole body. Rarity of such a case requires early and prompt diagnosis by clinicians, paying attention to skin care and hydration status of the baby, also mindful of any respiratory complications that may occur to prevent morbidity and mortality occurring from this condition.</p> Vinoth Kumar Perumal Krishna Prasanth Baalann Copyright (c) 2021-10-06 2021-10-06 40 1 A community survey on maternal perception about the initiation of dental home for infants in Lagos, Nigeria <p><strong>Introduction:&nbsp;</strong>because efforts directed toward oral health promotion and disease prevention are fundamentally superior to dental rehabilitation after disease development, early preventive dental visits are widely encouraged by dental professional and academic stakeholders. Aim: this study aimed to determine the perceptions and practices of mothers with regards to the establishment of dental home at four local government areas (LGAs) in Lagos, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>was a community-based descriptive household survey conducted amongst mothers in Alimosho, Ikorodu, Surulere and Epe LGAs of Lagos State. Socio-demographic data, information about the importance of primary teeth, knowledge about dental home as well as their child´s age at first dental visit and reasons for attending was obtained with a validated, structured interviewer administered questionnaire. Descriptive statistics, Chi-square and multivariable regression analysis were conducted, and the level of significance was set at P&lt;0.05.</p> <p><strong>Results:&nbsp;</strong>the highest proportion of the mothers were aged between 26-30 years (27.4%; mean age: 34.58±7.8 years) and had a tertiary level of education (n=206, 59.9%); most respondents (n=80, 51.4%) did not know the age a child should be taken to the dental clinic for the first time and had not taken their child for any dental visit (n=229, 65.4%). Out of those who had previously taken their child for dental visits, the greater proportion (n=115, 95.0%) took the child when he/she was older than one year of age. Overall, only 126 (36.0%) respondents had a good perception about oral health and the need for a dental home while 224 (64.0%) respondents had poor knowledge. Logistic regression analysis of predictor variables that showed mothers with a tertiary level of education (OR=0.108; CI=0.0023-0.495) and those with 2-3 children (OR=0.482; CI=0.253-0.920) had significant lower odds of poor perception about the importance of a dental home.</p> <p><strong>Conclusion:&nbsp;</strong>maternal knowledge and practices with regards to dental home were poor and inadequate. It is necessary to create more awareness among parents/caregivers, especially through antenatal and immunization clinics to establish the concept of dental home.</p> Olubukola Olamide Olatosi Afolabi Oyapero Gbemisola Ojombo Boyede Copyright (c) 2021-10-06 2021-10-06 40 1 Acute decompensated left heart failure in a young patient revealing a large obstructive left ventricular mass <p>We report the case of a 21-year-old female patient with no prior cardiovascular history, at only 3 months postpartum, who was presented to the emergency room for rapidly worsening dyspnea, the physical examination showed low O<sub>2</sub>&nbsp;stats and crackling lung sounds with signs of respiratory struggle, electrocardiograms (EKG) showed a regular sinus tachycardia at 145bpm with negative T waves in apicolateral leads. The patient was intubated and benefited from an emergency thoracic computed tomography (CT) angiography which showed a bilateral hilar alveolar-interstitial syndrome without signs of pulmonary embolism, the transthoracic echocardiography showed a huge obstructive mass of the left ventricle with segmental kinetic disorders .To better understand the nature of this mass a transoesophageal echocardiography was performed which was in favour of a thrombus, unfortunately, the patient died the same day before any procedure could have been done.</p> Houda Mokhlis Achraf Zaimi Copyright (c) 2021-10-06 2021-10-06 40 1 Ectrodactyly-lobster claw deformity <p>Lobster-claw deformity, also called as ectrodactyly is an uncommon congenital presentation occurring in the hand due to longitudinal failure of development of second, third or fourth ray. It occurs in 1 to 4 newborns in 100,000 live births. It occurs mostly due to consanguineous marriage but can also occur in the non - consanguineous marriage. This deformity is usually associated with ectodermal defects, mental retardation, deafness, orofacial clefting and tibial aplasia. A 6-year-old boy was brought to the Department of Orthopedics in a Private Medical Hospital, Chennai, with deformity of left hand since birth. The affected hand had a wide median cleft and, there was deformity of flexion of the ring and index finger with absence of middle finger. The other hand and both feet were normal. On radio-imaging, left hand showed transversely oriented bone between third and fourth metacarpal and phalanges of middle finger were absent except for rudimentary proximal phalanx. No other congenital defects were present other than this. The child was born to non-consanguineous parents with no significant family history. The treatment for this anomaly is complete surgical excision of transverse bone with partial excision of the third metacarpal and apposition of the second and fourth metacarpal by absorbable sutures which leads to a smaller cleft. If required, flexion contracture of ring and index finger will be corrected.</p> Sarath Kumar Udaya Kumar Krishna Prasanth Baalan Copyright (c) 2021-10-06 2021-10-06 40 1 Adverse events following immunization reporting and impact on immunization services in informal settlements in Nairobi, Kenya: a prospective mixed-methods study <p><strong>Introduction:&nbsp;</strong>adverse events following immunization (AEFIs) are thought to contribute to cases of vaccine hesitancy, yet little data exists describing the state of reporting and management of AEFIs. This study investigated the occurrence and influence of AEFIs on vaccine hesitancy in an informal settlement of Nairobi.</p> <p><strong>Methods:&nbsp;</strong>this was a prospective mixed-methods study involving 7 focus group discussions, 8 key informant interviews and 457 face-to-face interviews with caregivers. Caregivers were recruited at/or before the 6-week clinic visit and assessed for occurrence of AEFIs in their children at the subsequent 10- and 14-week visits and a follow-up two weeks following the 14 weeks visit via phone calls.</p> <p><strong>Results:&nbsp;</strong>in this study, 12.3% (56/457) of the infants experienced an AEFI. Of these, 19 did not report for the next scheduled vaccine. Fever was the most common AEFI, for which most caregivers (66.7%) used paracetamol as antipyretic, while 20.8% sought help from a nearby health facility. Three of the 56 AEFIs (convulsions) that occurred in study participants could be classified as severe reactions. Diphtheria, pertussis and tetanus (DPT) 3 completion rate was 75.3%. Most (96.4%) caregivers considered immunization an important strategy for child survival. Vaccine hesitancy occurred among 3.6% of participants, 30% of whom attributed their hesitancy to occurrence of AEFIs. The review of health records revealed that no AEFI had been reported from any of the study facilities.</p> <p><strong>Conclusion:&nbsp;</strong>cases of adverse events following immunization are not reported in Mathare Valley and they do have implications for vaccine hesitancy by some caregivers.</p> Oliver Ombeva Malande Deogratias Munube Rachel Nakatugga Afaayo Carolyne Chemweno Mutunga Nzoka James Kipsang Andrew Munyalo Musyoki Johanna Catharina Meyer Leonidah Nyamusi Omayo Lawrence Owino-Okongo Copyright (c) 2021-10-07 2021-10-07 40 1 Magnitude and predictors of female domestic abuse in pregnancy in a patriarchal African society: a cross-sectional study of pregnant women in Enugu, South East Nigeria <p><strong>Introduction:&nbsp;</strong>domestic abuse against women is very common globally and has far-reaching consequences on the society. Therefore, it is essential to deeply study the seriousness of this public health issue among our pregnant women. The objectives were to determine the prevalence, pattern, and predictors of domestic abuse among pregnant women in Enugu, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study of 400 consenting pregnant women at the antenatal clinics of the University of Nigeria Teaching Hospital Ituku-Ozalla, Nigeria. Each woman completed a modified abuse assessment screen structured questionnaire. Data analysis was descriptive and inferential with Chi-square and multivariate binary logistic regression using SPSS version 21. A p-value of &lt;0.05 was considered statistically significant.</p> <p><strong>Results:&nbsp;</strong>a total of 172 out of 400 respondents (43.0%) had ever experienced domestic abuse in their pregnancies. One hundred and ten (37.2%; 110/296) of the multigravid women were abused in previous pregnancies while 137 (34.3%; 137/400) of all respondents were being abused in the current pregnancy. For all pregnancies, the most common type of abuse experienced by the respondents was verbal abuse (85.5%; 147/172), while the commonest perpetrators of abuse were the respondents´ spouses for both the index pregnancy (82.5%; 113/137) and previous pregnancies (84.5%; 93/110). The most common women perceived cause of abuse was financial constraints (68.6%; 118/172). Age less than 25 years (AOR=1.9, 95% CI=1.01-3.76, p=0.048), not having tertiary education (AOR=2.0, 95% CI=1.17 - 3.25, p=0.01), having at least a male child (AOR=3.3, 95% CI=1.71 - 6.40, p=&lt;0.001), and maternal unemployed status (AOR=2.0, 95% CI=1.27 - 3.19, p=0.003) were the identified predictors among women abused in pregnancy.</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of domestic abuse was high among pregnant women in the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu, Nigeria. The predominant women perceived cause of domestic abuse was financial constraints while age less than 25 years, not having tertiary education, having at least a male child, and maternal unemployed status were the predictors in abused women. Domestic abuse poses a great threat to women´s reproductive health, and so, its screening should be incorporated into antenatal care in our environment.</p> Ifeoma Veralyn Njoku Joseph Tochukwu Enebe Cyril Chukwudi Dim Copyright (c) 2021-10-07 2021-10-07 40 1 Prevalence and awareness of mode of transmission of typhoid fever in patients diagnosed with Salmonella typhi and paratyphi infections at the Saint Elisabeth General Hospital Shisong, Bui division, Cameroon <p><strong>Introduction:&nbsp;</strong>typhoid fever is a systemic infectious disease caused by the bacteria&nbsp;<em>Salmonella enterica</em>&nbsp;subspecies (<em>typhi</em>). It is a major cause of morbidity and mortality worldwide. This cross-sectional descriptive study aimed at determining the prevalence and awareness of the mode of transmission of&nbsp;<em>Salmonella typhi</em>&nbsp;among patients at the Saint Elisabeth General Hospital Shisong of Cameroon.</p> <p><strong>Methods:&nbsp;</strong>the study carried out from March 1<sup>st</sup>, 2017 to May 31<sup>st</sup>, 2017 recruited patients who presented at the hospital with clinical signs and symptoms of typhoid fever and who had lab requests for stool culture requested by the resident physician. The prevalence of&nbsp;<em>Salmonella typhi</em>&nbsp;infections among the patients and the proportion of patients with adequate knowledge on the mode of transmission of&nbsp;<em>Salmonella typhi</em>&nbsp;were estimated at a 95% CI. Data were analyzed using Epi info7.1.3.3.</p> <p><strong>Results:&nbsp;</strong>out of the 172 patients recruited for the studies, 52 (30.1%) were diagnosed with&nbsp;<em>Salmonella typhi</em>, 59.6% of which were male. Also, 3 (5.8%) were diagnosed with&nbsp;<em>Salmonella paratyphoid</em>&nbsp;A. A positive correlation between knowledge on the mode of transmission of&nbsp;<em>Salmonella typhi</em>&nbsp;and the level of education was established, showing that 92% of participants with a higher level of education indicating that typhoid fever can be contracted through consumption of contaminated water.</p> <p><strong>Conclusion:&nbsp;</strong>high prevalence of typhoid fever was observed in our study. The unawareness of the patients on typhoid fever and its contraction through contaminated water and food was positively correlated to the level of educations of the patients. These findings, therefore, suggest a public health challenge faced by inhabitants in this region where typhoid fever remains endemic. Scarcity of potable water, improper drainage systems, and problems of unsanitary toilets in Cameroon require urgent intervention.</p> Heasla Fibuonu Njoya Mbunka Muhamed Awolu Tume Bonglavnyuy Christopher Jutcha Florent Duclerc Jerome Ateudjieu Frankline Sevidzem Wirsiy Catherine Atuhaire Samuel Nambile Cumber Copyright (c) 2021-10-07 2021-10-07 40 1 Malaria amongst febrile children: call for a pediatric malaria assessment tool <p>In 2017, malaria accounted for 435 000 deaths worldwide. Eleven percent (11%) of these deaths occurred in the Democratic Republic of Congo (DRC), where malaria continues to be a leading cause of morbidity and mortality. Children are amongst the most vulnerable to malaria, which causes 40% of childhood deaths in the country. Although many risk factors for developing malaria have been identified, there is a paucity of data available on the sociodemographic risk factors for pediatric malaria. A cross-sectional study including 131 febrile children aged 2 months to 14 years presenting to Heal Africa Hospital due to febrile illness. Guardians of participants answered a questionnaire about household and maternal characteristics, as well as child symptomatology. Malaria status was confirmed via blood smear. Results were analyzed using the chi-square test, likelihood ratios and a logistic regression. The absence of father as head of household (p=0.011) and gestational malaria (p=0.044) were significantly associated with pediatric malaria. This study provides insight into sociodemographic risk factors associated with pediatric malaria in the DRC. While further investigation is required, this study highlights the benefit of considering these factors when approaching the febrile child. A pediatric malaria assessment tool incorporating socio-demographics, symptoms and physical exam findings may guide investigations to reduce unnecessary testing and provide better patient-centred care.</p> Mumbere Hangi Stan Megan Andrea Singh Sejal Paresh Doshi Susan Andrea Bartels Copyright (c) 2021-10-07 2021-10-07 40 1 Rubinstein-Taybi syndrome: a rare case report of a female child emphasizing physiotherapy on gross motor function <p>Rubinstein-Taybi syndrome (RSTS) is a chromosomal segment 16p13.3 microdeletion syndrome and is characterized by CREBBP gene mutations, delay in the development of height and weight, distinctive facial features, broad and sometimes angulated thumbs and halluces, short stature, and intellectual impairment that is mild to extreme. Current literature emphasizes mainly medical, dental, and psychiatric issues in RSTS and there is no retrievable literature on physiotherapy and its role in improving motor function in RSTS. The present case report is of a baby girl of 17 months suspected case of RSTS, presented with all the features of RSTS. Delay in the acquisition of skills and development were the chief complaints. We designed a 12-week treatment regimen that concentrated mainly on transitions using principles of neurodevelopmental therapy. Gross motor function measure (GMFM 88) was taken pre- and post-treatment which showed tremendous improvement. This is the first study on the role of physiotherapy in RSTS.</p> Rakesh Krishna Kovela Mohammad Irshad Qureshi Ansar Manakandathil Mukesh Kumar Sinha Neethu Dinesh Pallavi Harjpal Copyright (c) 2021-10-08 2021-10-08 40 1 Juvenile recurrent parotitis in a 4-year-old patient: a case report <p>Juvenile recurrent parotitis (JRP) is a rare disease. It is most commonly occurring between the ages of 3 and 5 years, that classically resolves at adolescence. It is characterized by recurrent non-suppurative parotitis, with several acute inflammatory episodes per year. The parotid´s swelling tends to be unilateral, but it can occur bilaterally, with a more predominant side. The aim of this work was to present a case report that highlights signs and symptoms of this unusual condition and to stress on the value of ultrasonography as an aid to diagnosis.</p> Nouha Dammak Latifa Berrezouga Imen Raadani Wissal Selmi Mohamed Ben Khelifa Copyright (c) 2021-10-11 2021-10-11 40 1 Measles outbreak investigation in Aweil East county, South Sudan <p>During January 2018-June 2020, Aweil East confirmed five measles outbreaks. In March 2020, Aweil East reported twenty measles IgM+ cases. Before this outbreak, Aweil East had confirmed an outbreak in late November 2019. Even after conducting outbreak reactive vaccinations (ORV) in December 2019 and February 2020, measles spread was not interrupted. The nationally supported measles follow-up campaign (MFUC) conducted in late February 2020 was deferred in Aweil East because of the February ORV. We reviewed the measles data collected through passive and active surveillance. A matched case-control study was conducted to evaluate potential exposures. Face-to-face interviews with cases and controls using a semi-structured questionnaire were used to collect demographics, disease, and exposures related data. A total of 687 cases with eight deaths; attack and case fatality rate of 123/100,000 population and 1.16%, respectively. Among the cases, 51.8% were male, the median age was four years, and 59% of cases ≥9 months were unvaccinated. Eighty point six percent (80.6%) of cases reported after the February ORV were unvaccinated. The outbreak peaked in late March 2020. Unvaccinated persons had higher odds of getting measles (adjusted odds ratio (AOR)=8.569; 95% CI [1.41 – 53.4], p=0.02). Non exposed persons had a lower odd of getting measles (AOR=0.114; 95% CI [0.02 – 0.61], p=0.011). During 2018-2019, the accumulated number of unvaccinated children (18,587) is more than a birth cohort of the county. Persistent low routine vaccination is the most critical driver of the measles outbreaks. Low-quality ORV and the intermediate population density are secondary drivers of the outbreaks.</p> Evans Nyasimi Mokaya Zingbondo Isaac Nathan Atem Anyuon Copyright (c) 2021-10-11 2021-10-11 40 1 Community-based surveillance contribution to the response of COVID-19 in Niger <p><strong>Introduction:&nbsp;</strong>the COVID-19 pandemic has spread across all countries in Africa, with much of the model forecasting disastrous results owing to weak health services and political uncertainty. In Niger, an adaptive solution to the COVID-19 pandemic has been implemented by community-based surveillance system (CBS) to complement passive case-finding in health systems.</p> <p><strong>Methods:&nbsp;</strong>the CBS program was designed to use the current CBS polio network spanning 37 health districts in six regions. Between April and November 2020, 150 community health workers (CHWs) were equipped to improve integrated disease surveillance and response (IDSR) preparedness and response to the COVID-19 pandemic. We retrospectively analysed the health data of the National Health Information System to describe the effect of CBS in COVID-19 surveillance.</p> <p><strong>Results:&nbsp;</strong>overall, trained CHWs were able to raise awareness among 2,681,642 persons regarding COVID-19 preventions and controls strategies. They reported 143 (84%) valid alerts resulting in two positive COVID-19 cases missing in the community. In addition, CHWs added to the contact tracing of 37 individuals and informed about the deaths in the community.</p> <p><strong>Conclusion:&nbsp;</strong>community-based surveillance improved COVID-19 response in Niger. Logistic assistance and ongoing training are the foundations for increasing and sustaining the sensitivity of CBS systems in response to the COVID-19 pandemic to deter hotspots across countries.</p> Ahmed Abani Maazou Batouré Oumarou Baruani Bienvenu Blanche-Philomene Melanga Anya Tambwe Didier El Khalef Ishagh Biey Joseph Nsiari-muzeyi Patrick Katoto Charles Shey Wiysonge Copyright (c) 2021-10-11 2021-10-11 40 1 Retraction: a case of meningitis due to Achromobacter xylosoxidans in a child with a polymalformative syndrome: a case report <p>This article retracts the publication&nbsp;<em>“Achromobacter xylosoxidans in a child with a polymalformative syndrome: a case report”</em>&nbsp;by Mehdi Borni&nbsp;<em>et al.</em>&nbsp;for instances of image manipulation and plagiarism.</p> The Pan African Medical Journal Copyright (c) 2021-10-12 2021-10-12 40 1 Effect of the antenatal HIV testing scale up community intervention in South West, Nigeria: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>HIV/AIDS is a major killer of under five children, with about 25-30% of children born to infected mothers becoming infected with HIV in the absence of Prevention of Mother to Child Transmission of HIV (PMTCT) intervention. This study was carried out to assess the effectiveness of the antenatal HIV testing scale up community intervention to increase the uptake of antenatal HIV Testing. The intervention was implemented to increase the low coverages of antenatal HIV testing and PMTCT services in Osun State, South West, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>the cross-sectional design was utilized for the study. Data was collected using data collection instruments administered to 600 respondents from the 30 Local Government Areas (LGAs) of the State. Data was also extracted from Medical Records generated from the Health Facilities where pregnant women received HIV Testing.</p> <p><strong>Results:&nbsp;</strong>the study revealed that 72% of adult respondent had adequate knowledge of the importance of antenatal HIV testing while 98% of female respondent had accepting attitude to getting tested for HIV during their next pregnancy. The number of pregnant women who received HIV Testing increased from 6,254, pre-intervention (April to August 2019) to 8,240, post-intervention (September 2019-January 2021).</p> <p><strong>Conclusion:&nbsp;</strong>the antenatal HIV testing scale up community intervention is effective in increasing the utilization of antenatal HIV testing by increasing awareness and attitude to HIV testing in the community. Thus, efforts to scale it up in Nigeria should be accelerated to improve PMTCT services and reduce Mother to Child Transmission of HIV.</p> Akin Olufemi Oyebade Monsur Akanmu Bello Isola Oladimeji Familusi Copyright (c) 2021-10-12 2021-10-12 40 1 Fistule réno-colique compliquant une tuberculose rénale: à propos d´un cas <p>La tuberculose urogénitale reste peu évoquée et peu connue par les cliniciens. Les fistules réno-coliques sont parmi les formes compliquées de la tuberculose rénale survenant à un stade avancé de la maladie, mais qui sont rares. Elles intéressent en général le colon ascendant et descendant. Nous rapportons le cas clinique d´une patiente âgée de 58 ans qui s'est présentée aux urgences pour une pyélonéphrite aiguë gauche grave. La tomodensitométrie abdominale a objectivé une pyonéphrose gauche avec une fistule réno-colique gauche. Vu l´évolution clinico-biologique défavorable de la patiente malgré les mesures de réanimation et les traitements antibiotiques, une néphrectomie gauche a été pratiquée en urgence avec une déconnexion et un drainage dirigé de la fistule réno-colique. L'histologie a conclu à une tuberculose rénale. La patiente a été mise sous traitement anti-bacillaire selon le protocole 2ERHZ/4RH. Le traitement de cette forme de tuberculose doit être adéquat pour éviter toute possibilité de récidive dont la prise en charge serait alors plus compliquée.</p> Ramzi Mejri Kays Chaker Mokhtar Bibi Sami Ben Rhouma Yassine Nouira Copyright (c) 2021-10-12 2021-10-12 40 1 Transplantation rénale entre époux et immunisation anti-HLA en prégreffe: à propos de deux observations <p>La transplantation rénale est la meilleure thérapeutique pour l'insuffisance rénale terminale. Cette transplantation est possible grâce au don de rein à partir d'un donneur vivant ou d'un donneur en état de mort encéphalique (EME). L'immunisation des receveurs est une vraie problématique de la greffe car elle est responsable de difficultés particulières de choix d'un donneur et surtout expose au risque de rejet de greffon. Nous allons présenter deux observations de greffe rénale entre époux, ou les deux receveurs avaient des taux faibles d'anticorps dirigés contre des antigènes HLA du donneur mais dont l'issue en post-greffe immédiat était différente selon le sexe du receveur. En effet l'immunisation anti-HLA des femmes suite aux grossesses est un vrai obstacle à leur greffe par le rein de leur époux. Malgré la faible compatibilité HLA qui caractérise la transplantation rénale entre les époux, car le donneur est ici non apparenté, cette transplantation offre une bonne alternative aux greffes de reins à partir de donneurs en EME, qui font cruellement défaut au Maroc.</p> Asmaa Drissi Bourhanbour Sanae Ouadghiri Sara Bougar Ouafae Atouf Chahrazade Brick Imane Yakhlef Kaoutar Atiifis Kaoutar El Morabit Malika Essakalli Copyright (c) 2021-10-12 2021-10-12 40 1 Fracture nonunion <p>A fracture that lasts for a minimum of nine months without signs of healing for three months is the standard description of nonunion. Plethora of literatures highlights the determinants that increase the risk of nonunion as infections, older age, diabetes, anti-inflammatory drugs, use of tobacco/nicotine, open/compound fracture, low vitamin-D, hypothyroidism, poor nutrition, severe anaemia, etc. Apart from these, there are hidden factors influencing the occurrence of nonunion. This article emphasises on such hidden factors. This case is a 70 year old man who came with complaints of cold and cough. Incidentally, the abnormal appearance and mobility in the forearm was noticed (A). Further history revealed that, the patient had a past history of road traffic accident 10 years back, followed by which he took native treatment from traditional bone setters. He´s a known case of diabetes, hypertension. On examination, patient had painless abnormal movement in the upper 1/3rd of the forearm. The distal part of forearm was moving horizontally, vertically and rotationally. Radiological image shows complete fracture of both bones in forearm (B). In fracture treatment, patient compliance is very crucial. In this case, the patient was initially treated by a local traditional bone setter. The patient is unaware of the treatment options available in modern medicine for such fractures. The patient´s poor socioeconomic status, nutritional status, smoking habit (30 years) also played a vital role in poor bone healing. In developing countries like India, this case scenario throws light on the huge lacunae in health education and perception regarding fracture management among people in the rural areas.</p> Pragadeesh Palaniappan Krishna Prasanth Baalann Copyright (c) 2021-10-13 2021-10-13 40 1 Smegma in diabetes mellitus <p>A 37-year-old male patient presented with 1-month history of pain over the bulb of penis during retraction of foreskin. Patient suffered from type 1 diabetes mellitus on poor glycemic control. On examination multiple white patches of 1 mm x 3 mm dimension were observed with pain during retraction of prepuce. Smegma deposition over the glans penis and erythematous areas were revealed while scraping the lesions. The patient, screened for urinary tract infection (UTI) and sexually transmitted disease (STD) including hepatitis B, syphilis and HIV which were negative and complete blood count was normal. Since smegma can be a precursor for genital infections, physicians must scrupulously examine diabetic patients presenting as timely diagnosis and treatment would improve patient´s quality of life. The patient, put on long acting insulin and advised personal hygiene and showed significant improvement during his follow-up visit, 1 month later.</p> Thamarai Kannan Sampath Krishna Prasanth Baalan Copyright (c) 2021-10-13 2021-10-13 40 1 Frontal sinus infection leading to sino-orbital aspergillosis: a case report <p>Sino-orbital aspergillosis is an uncommon but aggressive infection. It rarely originates from the frontal sinus due to the complex anatomy of the frontal recess and anteromedial position of its ostium. An 87-year-old man of Nigerian heritage with a history of multiple myeloma, chronic kidney disease and type 2 diabetes, presented to the eye clinic with a right tense swollen eyelid and proptosis. Computed tomography (CT) and magnetic resonance imaging (MRI) scan revealed a right superomedial mass communicating with the frontal sinus and biopsy confirmed an orbital aspergilloma. The patient was successfully treated with debulking surgery and anti-fungal treatment despite developing side effects to the drugs. To improve prognosis, ophthalmologists should be aware of this distinct entity and use a multi-disciplinary approach.</p> Camille Yvon Didar Abdulla Sarah Watson Izhar Bagwan Christopher Mclean Copyright (c) 2021-10-13 2021-10-13 40 1 Assessment of urogenital schistosomiasis among basic school children in selected communities along major rivers in the central region of Ghana <p><strong>Introduction:&nbsp;</strong>urogenital schistosomiasis affects school-aged children with impacts on health, growth, and cognitive development. Basic schools along active water bodies have a possibility of a high infection among the children.</p> <p><strong>Methods:&nbsp;</strong>we performed a school-based cross-sectional assessment of urogenital schistosomiasis among children in four selected rural communities along major rivers in the central region of Ghana. Three hundred and nine (309) basic school children class 1 to junior high school (JHS) 3 were recruited. Sociodemographic data and information on behavioral influences were collected with a structured written questionnaire. Laboratory examinations were conducted on fresh urine samples. Descriptive statistics and cross-tabulations with measures of association between variables, adjusted and unadjusted logistic regression analysis were performed on measured variables.</p> <p><strong>Results:&nbsp;</strong>we recorded a 10.4% prevalence of urogenital schistosomiasis. Schools in communities along the Kakum river recorded the highest disease burden (65.6%). The odds of infection among pupils who engage in irrigation activities were 4 folds more than those who do not engage in irrigation activities (adjusted odds ratio (aOR) (95%CI): 4.3 (1.6-12.1), P-value=0.005). Pupils of caregivers who resort to self-medication using local herbal concoctions had 14-fold more odds of infection compared to those who visit the health facility (aOR (95%CI): 14.4 (1.4-143.1), P-value=0.006).</p> <p><strong>Conclusion:&nbsp;</strong>poor health-seeking behaviors and lack of access to health facilities influenced the disease proportion among the children in these endemic communities.</p> Evans Duah Ernest Kenu Edward Morkporkpor Adela Hilda Adjoa Halm Clement Agoni Ransford Oduro Kumi Copyright (c) 2021-10-13 2021-10-13 40 1 Forced migration as a risk factor for COVID-19 infection in Africa: insight from Agadez, Niger <p>Letter to the editors</p> Aboubacar Abdou Batoure Oumarou Batoure Blanche-Philomene Melanga Anya Didier Tambwe Bienvenu Baruani Ishag El Khalef Joseph Nsiari-Muzeyi Biey Patrick Katoto Charles Shey Wiysonge Copyright (c) 2021-10-13 2021-10-13 40 1 Osteogenesis imperfecta <p>Osteogenesis imperfecta is a rare hereditary connective tissue disorder that affects the bones fragility. It causes the bones to break easily. The defective gene affects the body mechanism to form collagen, which strengthens the bone. A 20-year-old male patient came with complaints of pain in the left leg since morning. He was a known case of osteogenesis imperfecta and already had a history of fracture 6 months back in the right upper limb. On local examination of left leg swelling present, tenderness present, sensations intact and restricted range of motion. X-ray showed fracture of shaft of left tibial bone. The patient was on plaster of Paris for 6 weeks. The patient was advised for regular physiotherapy and to follow-up with the orthopedic surgeon.</p> Surya Besant Natarajan Krishna Prasanth Baalann Copyright (c) 2021-10-13 2021-10-13 40 1 Implantation dermoid <p>True epidermoid inclusion cysts result from the implantation of epidermal elements in the dermis, and can result from any trauma or surgical procedure. Theoretically, any skin puncture, laceration or incision has the potential to implant epidermal elements into the dermis and subcutaneous tissue, where continued production of keratin and other epidermal products produces a thick-walled cyst containing white cheesy material. They are frequently seen in who are subject to repeated minor traumas to the hand. Human papillomavirus (HPV) infection, ultraviolet exposure and ecrine duct obstruction are also suggested to be the additional factors in the development of palmoplantar epidermoid cysts. A 57-year-old male patient, who is a farmer by occupation, presented with a swelling in the left palm for last 4 years. He had a history of thorn prick in his palm 5 years back. He noticed a swelling in his palm four and a half years back, which was about 0.5 cm in size at the onset. The swelling is increasing slowly in size to attain the present size of about 4 cm. No heterotopic ossification (H/O) pain, fever, discharge. On examination a swelling in the middle of the left palm, globular 4 cm in diameter, smooth surface, no redness over the swelling. The surgical treatment is needed for symptomatic cysts causing interference with function. The treatment requires careful complete excision, removal of the entire cyst wall is necessary to avoid the recurrence.</p> Surya Besant Natarajan Krishna Prasanth Baalann Copyright (c) 2021-10-13 2021-10-13 40 1 Flexible insulin therapy improves metabolic control and decreases the risk of hypoglycemia in type 1 diabetic patients <p><strong>Introduction:&nbsp;</strong>flexible insulin therapy (FIT) is considered as a crucial turning point in the management of type 1 diabetes. The purpose of this study was to evaluate the impact of this optimum therapeutic approach on improving metabolic control and decreasing hypoglycemic events in patients with type 1 diabetes.</p> <p><strong>Methods:&nbsp;</strong>thirty-seven type 1 diabetic patients were included in a five days training programme of FIT. They had an HbA1c between 7.5 and 10%. Those patients were enrolled in a flexible insulin program and we evaluate clinical and metabolic parameters (glycated haemoglobin (HbA1c), hypoglycemic events, body mass index (BMI) and the rate of blood glucose measurements) before the course of FIT and 3, 6 and 9 months after the course.</p> <p><strong>Results:&nbsp;</strong>over a 9 months period of the study, the frequency of mild hypoglycemia decreased from 11.7 to 1.7 episodes/3 months (p = 0.005). The baseline HbA1c value improved by 1% at 3 months with an increase of 0.2% at 6 months, which remained unchanged at 9 months (p = &lt;0.0001). Patients who were poorly controlled (HbA1c ≥ 8%) improved their baseline HbA1c value from 9.2% to 8.0% (p = &lt;0.0001).</p> <p><strong>Conclusion:&nbsp;</strong>the present study confirms that a structured training programme for FIT improves glycemic control and decreases hypoglycemic events in patients with type 1 diabetes and it can be adopted in countries with weak or intermediate income (e.g. Morocco), which allows those patients to take advantages of this therapeutic approach.</p> Siham Rouf Amine Ezzerrouqi Salma Benyakhlef Naima Abda Hanane Latrech Copyright (c) 2021-10-14 2021-10-14 40 1 Vaccination coverage against COVID-19 in a Tunisian general hospital <p>Lettor to the editors</p> Hamdi El Kefi Khira Kefi Nejla Stambouli Ridha Belaej Mohamed Jalel Hmida Abdelaziz Oumaya Copyright (c) 2021-10-14 2021-10-14 40 1 Concordance of vaccination status and associated factors with incomplete vaccination: a household survey in the health district of Segou, Mali, 2019 <p><strong>Introduction:&nbsp;</strong>the region of Segou recorded 36.8% of children were incompletely vaccinated in 2018. In 2019, the district of Segou was one of the districts with the lowest vaccination coverage in the region, with 85.1% coverage for the three doses of the pentavalent vaccine and 85.4% for the measles vaccine. This study was initiated to better understand this low vaccination coverage, in the absence of specific studies on vaccination coverage in the district of Segou.</p> <p><strong>Methods:&nbsp;</strong>a prospective cross-sectional study was conducted from May to August 2020 with 30 clusters. We performed Kappa coefficient, bivariate, and multiple logistic regression analysis.</p> <p><strong>Results:&nbsp;</strong>findings showed that 18.46% (101/547) [15.44-21.93] of children were incompletely vaccinated. Mothers correctly reported the vaccination status of their children in 67.30% of cases (Kappa coefficient). Uneducated (OR[IC95%]=2.13[1.30-3.50]), living in rural area (OR[IC95%]=2.07[1.23-3.47]), lack of knowledge of Expanded Program on Immunization (EPI) target diseases (OR[IC95%]=2.37[1.52-3.68]), lack of knowledge of vaccination schedule (OR[IC95%]=3.33[1.90-5.81]) and lack of knowledge of the importance of vaccination (OR[IC95%]=3.6[2.35-6.32]) were associated with incomplete vaccination. In multivariate analysis, uneducated (ORa[IC95%&gt;]=1.68[1.004-2.810]) and lack of knowledge of the importance of vaccination were associated with incomplete vaccination (ORa[IC95%]=3.40[2.049-5.649]).</p> <p><strong>Conclusion:&nbsp;</strong>findings showed a good concordance of the vaccination status. Living in a rural area, no education, lack of the knowledge of EPI target diseases, lack of the knowledge of vaccination schedule and lack of knowledge of the importance of vaccination were associated with incomplete vaccination.</p> Sidiki Sangaré Oumar Sangho Lancina Doumbia Hannah Marker Yeya dit Sadio Sarro Housseini Dolo Nouhoum Telly Issa Ben Zakour Hadji Mamadou Ndiaye Moussa Sanogo Fanta Sangho Niélé Hawa Diarra Aboubacar Sangho Fatoumata Bintou Traoré Baba Diallo Cheick Abou Coulibaly Sadou Ongoiba Lamine Diakité Seydou Doumbia Copyright (c) 2021-10-14 2021-10-14 40 1 Place de la laparoscopie dans le diagnostic de la tuberculose péritonéale dans une région endémique de la Tunisie <p>La tuberculose reste un problème de santé publique en Tunisie. Le gouvernorat de Tataouine est une zone endémique. Le péritoine est atteint dans 1 à 2% des cas. Nous rapportons une étude épidémiologique rétrospective descriptive de 32 cas de patients opérés au Service de Chirurgie de Tataouine entre 2010 et 2020, la plupart par voie laparoscopique (28 patients), pour biopsie chirurgicale et confirmation histologique de tuberculose péritonéale. Nos patients étaient répartis en 24 femmes et 8 hommes soit un sexe ratio H/F de 0,33. L´âge médian était de 43 ans avec des extrêmes de 14 à 78 ans. La laparoscopie à visée diagnostic a été pratiquée dans 28 cas (87,5%). Devant l'aspect macroscopique per opératoire, le diagnostic de tuberculose péritonéale était fortement suspecté chez 16 patients (50%). L´étude anatomopathologique des biopsies réalisées a permis de confirmer le diagnostic chez tous les patients. Le but de ce travail est de rappeler les aspects épidémiologiques, cliniques de la tuberculose péritonéale dans une région endémique de la Tunisie et de présenter la place actuelle de la laparoscopie comme moyen diagnostique rapide et efficace.</p> Issam Loukil Yassin Maalej Amine Zouari Haythem Rjab Copyright (c) 2021-10-14 2021-10-14 40 1 Cancer pain control in a Nigerian oncology clinic: treating the disease and not the patient <p><strong>Introduction:&nbsp;</strong>inadequate pain control negatively impacts the quality of life of patients with cancer while potentially affecting the outcome. Proper pain evaluation and management are therefore considered an important treatment goal. This study assessed the prevalence of pain, the prescribing patterns, and the efficacy of pain control measures in cancer patients at the Radiation Oncology Unit of the Lagos University Teaching Hospital, Lagos.</p> <p><strong>Methods:&nbsp;</strong>this was a longitudinal study design recruiting adults attending outpatient clinics. Participants were assessed at initial contact and again following six weeks using the Universal Pain Assessment Tool developed by the UCLA Department of Anaesthesiology.</p> <p><strong>Results:&nbsp;</strong>among the patients reviewed, 34.0% (118 of 347) were at the clinic, referred for initial assessment following primary diagnosis. All respondents had solid tumours; the most common was breast cancer. The prevalence of pain at initial assessment was 85.9% (298 of 347), with over half of respondents, 74.5% (222 of 347) characterising their pain as moderate to severe. Over a quarter, 28.9% (100 of 347) of patients were not asked about their pain by attending physicians, and none of the patients had a pain assessment tool used during evaluation. In 14.4% (43 of 298) of patients, no intervention was received despite the presence of pain. At six weeks review, 31.5% (94 of 298) of patients had obtained no pain relief despite instituted measures.</p> <p><strong>Conclusion:&nbsp;</strong>under-treatment of cancer pain remains a significant weak link in cancer care in LMICs like Nigeria, with a significant contributor being physician under-evaluation and under-treatment of pain. To ensure pain eradication, the treatment process must begin with a thorough evaluation of the patient's pain, an explicit pain control goal and regular reevaluation.</p> Adedayo Olufemi Joseph Omolola Salako Adewunmi Alabi Muhammadu Habeebu Onyinye Balogun Olubukola Ayodele Opeyemi Mercy Awofeso Adeniyi Adenipekun Copyright (c) 2021-10-15 2021-10-15 40 1 Challenges in diagnosis and management of neonatal hyperparathyroidism in a resource-limited country: a case series from a Sudanese family <p>Neonatal hyperparathyroidism is a rare disease caused by a homozygous inactivating mutation in the calcium sensing receptor gene. It presents early in life with life threatening manifestations of hypercalcemia, if left untreated the condition may be lethal. This is the first case series reported from Sudan. Three Sudanese siblings presented with severe symptoms of hypercalcemia in the form of polyuria, failure to thrive and multiple bone fractures. Serum calcium and parathyroid hormone levels were very high with low phosphate and normal alkaline phosphatase levels. Ultrasonography and sestamibi scan were normal and did not assist in diagnosing their condition. Medical management was a great challenge due to unavailability of medications such as parentral bisphosphonates and calcimimetics. Parathyroidectomy was inevitable. Tissue biopsies revealed parathyroid hyperplasia and no adenoma. Gene sequencing revealed a homozygous missense mutation: c 2038 C T p (Arg680Cys) in two siblings, both parents were heterozygous for the same missense mutation. Our report reflects the challenges in diagnosis and management of neonatal hyperparathyroidism in resource limited countries. We also high light the importance of genetic testing in the diagnosis and management of such cases in countries with high rates of consanguineous marriage.</p> Samar Sabir Hassan Marlies Kempers Dorien Lugtenberg Asmahan Tajelsir Abdallah Salwa Abdelbagi Musa Areej Ahmed Ibrahim Mohamed Ahmed Abdullah Copyright (c) 2021-10-15 2021-10-15 40 1 Repousse spectaculaire d´une pelade décalvante traitée par triamcinolone en intramusculaire et stimulateur folliculaire topique <p><em>We here report the case of a 42-year-old female patient presenting with alopecia areata that had progressed over the past month. The anamnesis revealed no psychoaffective irritative stimulus or atopy. Clinical examination was normal. The patient weighed 65kg with a BMI of 22kg/m<sup>2</sup>. Haemoglobin level was 12.5g/dL. Fasting blood glucose was 1.01g/L, TSHus and T4L were normal; 0.23 pmol/L and 13.32 pmol/L, respectively. Anti-nuclear and Anti-electroconvulsive Therapy (ECT) antibodies were negative. The diagnosis of isolated alopecia areata was retained. The patient was treated with intramuscular injections of 80mg of triamcinolone every ten days for 4 sessions (total dose of 320mg). Hair loss treatment topical spray was applied (12 sprays a day). Patients's outcome was marked by a spectacular regrowth of hair assessed at day 30 and day 60.</em></p> Saer Diadie Suzanne Oumou Niang Copyright (c) 2021-10-15 2021-10-15 40 1 Nevus pigmentosus et pilosus <p>Congenital melanocytic nevus (CMN) is a proliferation of melanocytes that presents at birth or shortly after birth as light brown to black patches or plaques, covering any part of the body occasionally exhibiting hypertrichosis. The estimated prevalence of such large forms is 0.002% of the births, resulting from mutations of genes coding for NRAS and KRAS proteins, usually during the first twelve weeks of pregnancy. Giant CMN also known as "bathing trunk nevus," "giant hairy nevus", and "nevus pigmentosus et pilosus" has highest potential to turn into malignant melanoma. We present a case of a 7 year old boy who came to our clinic with complaints of itching over his left shoulder and back for 4 months duration. He gave history of black patches on those areas since birth that gradually grew in size and attained the current presentation. On examination, well demarcated black patches were noted over his left shoulder, arm, trunk (A) and extending from nape of the neck and the entire back with excessive hair growth (B). A diagnosis of congenital melanocytic nevus was established and since it could potentially evolve into a melanoma, prophylactic surgery with skin grafting was suggested but the patient's parents refused. Hence dermabrasion was done to lighten the dark pigmentation and reduce hair growth within nevi. Parents were counselled about complications of CMN and advised to follow up with a dermatologist regularly. Clinicians should scrupulously examine the child to facilitate timely surgical intervention thereby reducing morbidity and mortality associated with this condition.</p> Supraja Nagarathinam Krishna Prasanth Baalann Copyright (c) 2021-10-18 2021-10-18 40 1 Frequency of recurrent stroke in Burkina Faso: an observational hospital based study of 6 months <p><strong>Introduction:&nbsp;</strong>studies on stroke recurrence are rare in sub Sahara Africa. The aim to this study is to determine the prevalence and risk factors for recurrent stroke in two University Teaching Hospital in Burkina Faso.</p> <p><strong>Methods:&nbsp;</strong>this prospective cross-sectional study was carried on 266 stroke patients admitted in two hospitals in the city of Ouagadougou from September 1, 2017 to February 28, 2018. Patients with stroke recurrence (ischemic or hemorrhagic) were included.</p> <p><strong>Results:&nbsp;</strong>of 266 acute stroke patients included, 44(16.4%) had recurrent stroke. The mean age of patients was 66.5 ± 11.49 years with male predominance. Hypertension was the most vascular risk factors (81.8%). Previous stroke was ischemic in 61.4%, hemorrhagic in 22.7% and unknown in 15.9% of cases. Poor compliance (&lt; 60%) was determined in patients taking antiagregant agents (43.6%) and statins (50%). At admission, the most neurological disorders was motor deficit (100%), aphasia (84.1%), and deglutition disorders (15.9%). CT scan showed ischemic in 82% and hemorrhagic stroke in 18% of cases. With the analysis of second stroke, recurrent stroke after intracerebral hemorrhage was hemorrhagic in 77.8% and ischemic in 22.2%. Recurrent stroke after ischemic stroke was ischemic in 100%.</p> <p><strong>Conclusion:&nbsp;</strong>stroke recurrence is common in our context. Hypertension was the most common vascular risk factor in recurrent stroke. Poor compliance was determined in patients taking antiagregant agents and statins in previous stroke.</p> Alfred Anselme Dabilgou Alassane Dravé Julie Marie Adeline Kyelem Robert Zoungrana Christian Napon Athanase Millogo Jean Kaboré Copyright (c) 2021-10-19 2021-10-19 40 1 Knowledge of health effects and determinants of psychoactive substance use among secondary school students in Sokoto Metropolis, Nigeria <p><strong>Introduction:&nbsp;</strong>psychoactive substance use (PSU) is a patterned use of a drug in which the user consumes the substance in amounts or methods which are harmful to themselves or others. Psychoactive substance use takes a considerable toll on financial status, academic achievement and health status of addicts. In Nigeria, PSU is on the increase, one of the most disturbing health-related problems and a leading cause of premature death among school aged population worldwide. We therefore, determined the knowledge of health effects and determinants of psychoactive substance use among secondary school students in Sokoto Metropolis, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>we conducted a cross-sectional study among 430 secondary school students that were selected using multistage sampling in Sokoto, Northwestern, Nigeria from April to May 2019. We collected data using a semi-structured, interviewer-administered questionnaire. We calculated proportions and adjusted odds ratios (OR) with 95% confidence intervals (CI) in a binary logistic regression model.</p> <p><strong>Results:&nbsp;</strong>knowledge of health effects of PSU was good in 38.1% of the respondents with a mean score of 19.6 ± 10.0. The overall prevalence of PSU was high among current users (16.3%), male participants (78.6%) and those aged 17-years or more (68.6%). Independent predictors of current use of psychoactive substances were poor knowledge of health effects (aOR: 4.1, 95% CI: 1.7-10.0) and father´s use of psychoactive substances (aOR: 10.3, 95% CI= 1.9-57.1).</p> <p><strong>Conclusion:&nbsp;</strong>knowledge of health effects of psychoactive substances was generally poor among the participants with an associated high prevalence among current users. Poor knowledge of its health effects determines the use of psychoactive substances. We conducted awareness campaigns and health talk on health effects of PSU to secondary school students in the state. The Federal Ministry of Education should ensure that PSU-related topics are incorporated in the secondary school curriculum.</p> Auwal Usman Abubakar Aisha Ahmad Abubakar Mu'awiyya Babale Sufiyan Muhammad Shakir Balogun Kehinde Joseph Awosan Ismail Abdullateef Raji Aishat Bukola Usman Abdulkarim Mohammad Abdullahi Ahmad Muhammad Njidda Hashim Abdulmumin Bala Aminu Umar Kaoje Patrik Mboya Nguku Adamu Usman Shehu Copyright (c) 2021-10-19 2021-10-19 40 1 Solid pseudopapillary tumor of the pancreas: Ecadherin, β-catenin, CD99 new useful markers with characteristic expression (about two case reports) <p>Solid pseudopapillary neoplasm of the pancreas is a rare tumor that has favorable prognosis. It poses frequently diagnostic challenges. We describe two cases of solid pseudopapillary tumor of the pancreas managed in our department between 2007 and 2011. Two females have mean age of 36.5 years. Clinical presentation include: abdominal pain, bloating and palpable abdominal mass. Tumor is localized in the head of the pancreas in one case and in the tail in the other case. The mean size of the mass was 6 cm (range: 5 to 7 cm). Surgical treatment was performed in two cases. Histological examination confirms the diagnosis of solid pseudopapillary tumor of the pancreas. Immunohistochemical analysis was concordant to the literature data especially concerning CD99 which positivity was in dot, loss of positivity of E-cadherin and nuclear staining of β-catenin. CD10 and α-1-antitrypsin were also positive. One patient was dead 3 days postoperative and neither cancer recurrence nor distant metastases were detected on the follow up of the other. However, solid pseudo-papillary tumor of the pancreas has a distinctive histological appearance; some cases are problematic requiring the use of immunohistochemistry to distinguish it from other pancreatic neoplasm which prognosis is different.</p> Nechi Salwa Dhouib Rym Doghri Raoudha Charfi Lamia Abbes Imen Driss Maha Mrad Karima Copyright (c) 2021-10-19 2021-10-19 40 1 Active tuberculosis case findings in Ghanaian health facilities: effectiveness and sensitivity of the symptoms-based screening tool <p><strong>Introduction:&nbsp;</strong>the National Tuberculosis Programme (NTP), Ghana, introduced Symptoms-Based Screening (SBS) Tool for TB case finding. This study aimed to determine the challenges and limitations associated with the use of the SBS Tool for active tuberculosis case finding in Ghanaian health facility settings.</p> <p><strong>Methods:&nbsp;</strong>this study targeted suspected TB patients attending two health facilities in the Ho Municipality, Ghana. Initially, suspected TB patients were screened with the SBS tool and presumptive patients subsequently tested for&nbsp;<em>M. tuberculosis</em>&nbsp;using microscopy and geneXpert assay. Additionally, health personnel were interviewed to assess the user-friendliness, challenges, and limitations associated with the tool.</p> <p><strong>Results:&nbsp;</strong>of 636 presumptive TB patients identified, 1.73% had tuberculosis. Coughing for &gt; 2 weeks (χ²=24.8; p&lt;0.05); chest pain (χ²=28.3; p&lt;0.01) and night sweat (χ²=34.8; p&lt;0.05) associated significantly with&nbsp;<em>M. tuberculosis</em>&nbsp;infection status. The health personnel found the tool to be not user-friendly and it also lacked indicators to identify other vulnerable individuals such as diabetics, cigarette smokers, alcoholics, immunocompromised, and malnourished individuals. Therefore, the SBS tool was found not to be sensitive enough to identify probable cases.</p> <p><strong>Conclusion:&nbsp;</strong>the SBS tool is useful for detecting active TB cases, however, it must be improved to identify vulnerable individuals such as diabetics, immunosuppressed, and malnourished.</p> Kwabena Obeng Duedu Enoch Aninagyei Diana Ayinpokbila Akila Margaret Kweku Copyright (c) 2021-10-20 2021-10-20 40 1 Community acceptance and willingness to pay for hypothetical COVID-19 vaccines in a developing country: a web-based nationwide study in Nigeria <p><strong>Introduction:</strong>&nbsp;some promising COVID-19 vaccines are soon to be available but getting the African community to accept them may be challenging. This study assessed the acceptability and willingness to pay (WTP) for hypothetical COVID-19 vaccines among Nigerians.</p> <p><strong>Methods:</strong>&nbsp;a cross-sectional, web-based study was conducted among the Nigerian populace. A 20-item questionnaire was used to collect responses through Google form which was shared to consenting participants through two social media platforms. Multivariate logistic regression was used to determine the sociodemographic factors that were predictive of respondents´ willingness to accept the COVID-19 vaccines. Statistical significance was set at p&lt;0.05.</p> <p><strong>Results:</strong>&nbsp;six hundred and eighty-nine respondents completed the survey, with 50.5% being females. Exactly 43.3% of respondents reported that they would accept a hypothetical vaccine if it is currently available, 62.1% said they would accept it in the future while 71.1% agreed to accept it if recommended by healthcare providers. A third (31.9%) of respondents accepted the vaccine for their self-protection and half of those not accepting it (51.3%) said they did not want to “be used as an experiment”. Respondents who were of oldest ages (aOR=0.330, 95% CI:0.141-0.767, p=0.010), of Christian religion (aOR=3.251, 95% CI:1.301-8.093, p=0.011), and aware of a possible vaccine being made available (aOR=0.636, 95% CI:0.440-0.920) were significantly more unwilling to accept the vaccine. The median range of WTP was US$1.2-2.5.</p> <p><strong>Conclusion:</strong>&nbsp;there is a low acceptance in Nigeria for a COVID-19 vaccine if it was available now, but much higher if it is recommended by a healthcare provider. A high proportion of willing respondents indicated a positive WTP for the vaccine.</p> Ukamaka Gladys Okafor Abdulmuminu Isah Jude Chidiebere Onuh Chiagozie Bonita Mgbemena Chukwuemeka Michael Ubaka Copyright (c) 2021-10-21 2021-10-21 40 1 Enhancing capacity of Zimbabwe’s health system to respond to climate change induced drought: a rapid nutritional assessment <p><strong>Introduction:</strong>&nbsp;Zimbabwe experienced the negative effects of the devastating cyclone Idai which affected several districts in the country, and the drought due to low rainfall that has affected the whole country. As a result of these catastrophes, the food and nutrition security situation in the country has deteriorated. For this reason, we carried out a rapid assessment of the health facilities in 19 sampled high global acute malnutrition and high food insecurity districts from the ten provinces of Zimbabwe to ascertain the preparedness of the facilities to respond to drought effects.</p> <p><strong>Methods:</strong>&nbsp;we conducted a rapid nutritional assessment in 19 purposely selected districts with highest rates of global acute malnutrition from the 10 provinces of Zimbabwe. From these districts, we selected a district hospital and a rural health facility with high number of acute malnutrition cases. We adapted and administered the WHO recommended checklist (Multi-Cluster/Sector Initial Rapid Assessment (MIRA) as the assessment tool. We used STATA to generate frequencies, and proportions.</p> <p><strong>Results:</strong>&nbsp;about 94% (16/19) of the districts had less than 50% health workers trained to manage acute malnutrition. A total of 26% (5/19) of the district hospitals and 32% (6/19) of the primary health care facilities were not admitting according to integrated management of acute malnutrition (IMAM) protocol. Twelve districts (63%) had none of their staff trained in infant and young child feeding (IYCF), 58% (11/19) had no staff trained in growth monitoring and 63% (12/19) of the districts had no trained staff in baby friendly hospital initiative (BFHI). A total of 60% of the provinces did not have combined mineral vitamin mix stocks, 80% had no resomal stocks, 20% did not have micronutrient powder stocks and 30% had no ready to use supplementary food stocks in all their assessed facilities. Fifty percent (50%) of the health facilities were not adequately stocked with growth monitoring cards. Manicaland had the least (20%) number of health facility with a registration system to notify cases of malnutrition.</p> <p><strong>Conclusion:</strong>&nbsp;we concluded that the Zimbabwe health delivery system is not adequately prepared to respond to the effects of the current drought as most health workers had inadequate capacity to manage acute malnutrition, the nutrition surveillance was weak and inadequate stocks of commodities and anthropometric equipment was noted. Following this, health workers from six of ten provinces were trained on management of acute malnutrition, procurement of some life -saving therapeutic and supplementary foods was done. We further recommend food fortification as a long-term plan, active screening for early identification of malnutrition cases and continuous training of health workers.</p> Zvanaka Sithole Tasiana Nyadzayo Trevor Kanyowa Joyeux Mathieu Tinashe Kambarami Mildred Nemaramba Ruth Machaka Hana Bekele Handrea Njovo Alex Gasasira Copyright (c) 2021-10-21 2021-10-21 40 1 Assessment of vaccine wastage in South Sudan <p><strong>Introduction:&nbsp;</strong>vaccine utilization monitoring provides valuable information for practical forecasting and formulation of strategies to reduce avoidable wastage. This monitoring is weak at county and health facility levels in South Sudan. Lack of national wastage rates could result in inaccurate forecasting, leading to vaccine shortages or overstocking and expiration of vaccines at the subnational and service delivery points. As the country gears to introduce relatively expensive vaccines such as rotavirus and pneumococcal vaccines, a robust vaccine utilization monitoring system must be rolled out. This study provides the best possible estimates of vaccine wastage rates and the possible causes of the wastage.</p> <p><strong>Methods:&nbsp;</strong>we conducted the study in 45 conveniently sampled health facilities across 9 of the ten states in South Sudan. Vaccine consumption data were prospectively collected to estimate vaccine wastage and the reason for the wastage of each vaccine type.</p> <p><strong>Results:&nbsp;</strong>wastage of lyophilized vaccines, measles, and Bacillus Calmette–Guérin (BCG) ranged between 39.0-66.7% and 52.1-74.3%, respectively, mainly due to doses that were discarded 6 hours after the opening of the vial or at the end of the immunization session. Wastage of liquid vaccines Oral poliovirus vaccines (OPV), Penta, Inactivated polio vaccine (IPV), and Tetanus- diphtheria (Td) ranged between 24.4-49%, 15.5-43.4%, 25.3-57.9%, and 3.8-57.2%, respectively, mainly due to unusable VVM, expiry, unused doses at the end of outreach sessions, and vials without labels.</p> <p><strong>Conclusion:&nbsp;</strong>wasted rates for all vaccines were higher than the indicative WHO wastage rates used in South Sudan to forecast national vaccine needs. Unopened vial wastage was high and needs immediate attention.</p> James Bol Nathan Atem Anyuon Evans Nyasimi Mokaya Copyright (c) 2021-10-22 2021-10-22 40 1 Laurin-Sandrow syndrome <p>Polydactyly is a typical abnormality, happening both as a segregated deformity or as component of a syndrome. The presence of mirror polydactyly, however, is rare. One such feature is seen in Laurin-Sandrow syndrome (LSS). Laurin-Sandrow syndrome (LSS) is characterized by complete polysyndactyly of hands, mirror feet and nose anomalies (hypoplasia of the nasal alae and short columella), often associated with ulnar or fibular duplication (and sometimes tibial agenesis). This image describes a case of 2-year-old boy, who came to the clinic with complaints of cough and cold for 1 week duration. The Child was alert, active and feeding well. The child was born at term by normal delivery to a healthy parent. Antenatal period was normal. No systematic illness occurred in the neonatal period. On Examination, there was cup shaped hands with syndactyly on the fingers extending upto the tip. Polysyndactyly was present in the feet, with nine digits on the right foot and ten on the left. Conspicuous nose with short columella, depressed nasal bridge, underdeveloped nasal alae. There are not many cases of LSS revealed in the literature. Hence there are no clear insights regarding the etiopathogenesis. Laurin-Sandrow syndrome is supposed to be an autosomal dominant disorder and the gene associated is said to be limb development membrane Protein 1 (LMBR1). The child was treated for cold and referred to an orthopedician and pediatrician for further management with respect to LSS.</p> Pragadeesh Palaniappan Krishna Prasanth Baalann Copyright (c) 2021-10-22 2021-10-22 40 1 Cross-sectional survey of knowledge and attitudes of healthcare workers and community members toward the Ebola virus disease and antimicrobial resistance pathogens outbreaks in Nigeria <p><strong>Introduction:&nbsp;</strong>the 2014 Ebola virus disease (EVD) outbreak in Nigeria has further raised the awareness of health-care workers (HCWs) and community members (MCs) on the threat posed by infectious diseases and the need for improvement on infection control practices. However, awareness of dangers of increasing incidences of antimicrobial resistance (AMR) in hospitals and communities remained low.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional survey of awareness of 195 HCWs and 265 MCs toward EVD and AMR was conducted through a structured questionnaire.</p> <p><strong>Results:&nbsp;</strong>majority of HCWs (95.4%) and MCs (82.8%) still have knowledge of EVD´s danger and give reasons like its unique way of killing and unavailability of drugs for their awareness. Only 17.2% of MCs are aware of AMR as a problem, and only 3.4% of MCs and 10.3% of HCWs agreed that AMR is more dangerous than EVD. On the contrary, 76.4% of doctors, 95.1% nurses, 67.9% laboratory scientists, 66.7% pharmacists, 77.4% students and 100% of civil servants, drivers and religious leaders believed that EVD is more horrific and spread faster. They both attributed the rapid awareness of EVD in Nigeria, despite being new at the time of the outbreak, to the seriousness with which stakeholders and the media fought EVD, the gesture AMR is yet to receive. Though both HCWs and MCs agreed that prevention, not treatment is the best option to tackle Ebola like-diseases, but surprisingly, about 37% and 65% of HCWs and MCs respectively, still believe that traditional medicines can be used to treat Ebola related illnesses.</p> <p><strong>Conclusion:&nbsp;</strong>AMR awareness remains low among MCs and some HCWs when compared with EVD. It is recommended that efforts put in place during EVD outbreak by all stakeholders and the media need to be doubled to increase the knowledge of both HCWs and MCs toward AMR.</p> Ibrahim Yusuf Auwalu Halliru Arzai Muhammad Yusha´u Lawal Garba Musa Haruna Muhammad Ibrahim Getso Copyright (c) 2021-10-22 2021-10-22 40 1 Large hemorrhagic pericardial effusion with cardiac tamponade in a 16-year-old adolescent in an endemic area of tuberculosis: a case report <p>Pericardial effusion complicated by cardiac tamponade is a medical emergency. Large pericardial effusion and tamponade are rare in childhood. Tuberculosis remains a major cause of pericardial effusion in endemic areas. A 16-year-old adolescent with no significant past history was admitted to the medical unit of the Buea Regional hospital in the South West region of Cameroon for heart failure after presenting with abdominal distension, shortness of breath and fever of two weeks duration. Echocardiographic study during admission revealed a large pericardial effusion (27mm in thickness) with echocardiographic signs of tamponade. Echocardiographic guided pericardiocentesis was performed through a sub-xiphoid route and about 500 cc of heavily stained blood fluid that was not coagulating was drained. Pericardial fluid analysis for acid fast bacilli was negative. There was no evidence of malignancy. A strong suspicion of tuberculosis was made and he was started on anti-tuberculosis medications for presumptive hemorrhagic tuberculous pericarditis. Patient was asymptomatic during follow up and repeat echocardiographic examinations showed no re-accumulation of pericardial fluid. Tuberculosis should be considered as the etiology of pericardial effusion in endemic areas although the identification of mycobacterium is challenging in these settings.</p> Clovis Nkoke Christelle Makoge Denis Tewafeu Cyrille Nkouonlack Charifa Njoya Ines Nepetsoun Engelbert Bain Luchuo Ahmadou Musa Jingi Copyright (c) 2021-10-22 2021-10-22 40 1 The effect of a mass distribution of insecticide-treated nets on insecticide resistance and entomological inoculation rates of Anopheles gambiae s.l. in Bandundu City, Democratic Republic of Congo <p><strong>Introduction:&nbsp;</strong>insecticide-treated nets (ITNs) remain the mainstay of malaria vector control in the Democratic Republic of Congo. However, insecticide resistance of malaria vectors threatens their effectiveness. Entomological inoculation rates and insecticide susceptibility in&nbsp;<em>Anopheles gambiae s.l.</em>&nbsp;were evaluated before and after mass distribution of ITNs in Bandundu City for possible occurrence of resistance.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted from 15<sup>th</sup>&nbsp;July 2015 to 15<sup>th</sup>&nbsp;June 2016. Adult mosquitoes were collected using pyrethrum spray catches and human landing catches and identified to species level and tested for the presence of sporozoites. Bioassays were carried out before and after distribution of ITNs to assess the susceptibility of adult mosquitoes to insecticides. Synergist bioassays were also conducted and target site mutations assessed using Polymerase chain reaction (PCR).</p> <p><strong>Results:&nbsp;</strong>a total of 1754 female&nbsp;<em>An. gambiae s.l.</em>&nbsp;were collected before and after deployment of ITNs. Fewer mosquitoes were collected after the distribution of ITNs. However, there was no significant difference in sporozoite rates or the overall entomological inoculation rate before and after the distribution of ITNs. Test-mosquitoes were resistant to deltamethrin, permethrin, and Dichlorodiphenyltrichloroethane but susceptible to bendiocarb. Pre-exposure of mosquitoes to Piperonyl butoxide increased their mortality after exposure to permethrin and deltamethrin. The frequency of the Kinase insert domain receptor (kdr)-West gene increased from 92 to 99% before and after the distribution of nets, respectively.</p> <p><strong>Conclusion:&nbsp;</strong>seasonal impacts could be a limiting factor in the analysis of these data; however, the lack of decrease in transmission after the distribution of new nets could be explained by the high-level of resistance to pyrethroid.</p> Emery Metelo-Matubi Josué Zanga Guillaume Binene Nono Mvuama Solange Ngamukie Jadis Nkey Pauline Schopp Maxwell Bamba Seth Irish Jean Nguya-Kalemba-Maniania Sylvie Fasine Jonas Nagahuedi Jean-Jacques Muyembe Paul Mansiangi Copyright (c) 2021-10-25 2021-10-25 40 1 Peripartum cardiomyopathy: alluring challenge - case series and review of literature <p>Peripartum cardiomyopathy (PPCM) is a rare disease responsible for heart failure that usually occurs in the last month of pregnancy or within five months postpartum, without any other known cause. A case series of five PPCM patients admitted at the Department of Cardiology of the University Hospital Mohammed VI of Oujda, Morocco, between 2017 and 2019. All cases were represented by young (case 1: 35-year-old; case 2: 28-year-old; case 3: 30-year-old; case 4: 36-year-old; case 5: 34-year-old). All patients were multiparous who were admitted to our department with a severely reduced left ventricular ejection fraction. Case 1 and 4 were admitted 3 days after delivery for heart failure. Case 2 was admitted for cardiogenic shock after 3 months of delivery. Case 3 was admitted twelve days after delivery for acute heart failure with pulmonary embolism and multiple venous thrombosis. Case 5 had a history of PPCM was admitted for cardiogenic shock with a course marked by recurrent thromboembolic events. Case 1 and 2 responded to treatment at an early stage, case 4 has evolved to chronicity, the third patient died from an unclear cause, and the fifth patient died from a contraindicated pregnancy leading to the recurrence of fatal thromboembolic events. Above reported cases confirming the great heterogeneity in clinical presentation and course of peripartum cardiomyopathy and seems to confirm that a delayed diagnosis, as well thromboembolic complications are bad prognosis factors of these patients. Early diagnosis, multidisciplinary collaboration, prompt treatment of heart failure and continued monitoring are the keys to improve maternal survival.</p> Youssra Bouhaddoune Anas Hbali Hanane Aissaoui Asmae Mrabet Nabila Ismaili Noha El Ouafi Copyright (c) 2021-10-25 2021-10-25 40 1 Overview of surgical and anesthesia practice in sub-Saharan Africa during the 19th century: the example of the people of Bunyoro <p>In 1879, during a missionary expedition in the actual Uganda, the British medical student Robert Felkin witnessed a cesarean delivery surgery under general anaesthesia performed by Bunyoro´s doctors. On this occasion he saw how Bunyoro´s medicine was well elaborate in comparison with other sub-Saharan African cultures but also with occidental medicine. Through his report, Felkin brought to light the high scientific medical level of the Bunyoro´s doctors far away from the prejudice of a traditional African medicine surrounded by superstition and witchcraft.</p> Sylvain Diop Copyright (c) 2021-10-27 2021-10-27 40 1 Mycetoma trichophyton <p>A 2-year-old female child admitted to the hospital due to a palpable mass at her scalp referred by her parents. Her past medical history was clear. The clinical examination revealed edema, redness/erythema, blisters, tenderness and itching. No neurological changes were referred, no hair loss occurred and no other areas of the body were affected. The initial evaluation included X-rays, an ultrasonography and a magnetic resonance imaging (MRI) scan. The imaging findings were not pathognomonic but in combination with the clinical features, the differential diagnosis shrinked between mycetoma and pilomatrixoma (or calcifying epithelioma of Malherbe). For further evaluation, a small specimen of the scalp was obtained by scraping the skin with a scalpel. Cytological investigation revealed fungi infection caused by trichophyton species. So the final accurate diagnosis was mycetoma trichophyton. Patient was treated with miconazole nitrate (daktarin cream 2%), 1x3 for 15 days. First follow-up (day 15) showed improvement to complete cure. At the second follow up (day 30) there was no evidence of relapse. Mycetoma trichophyton must be differentiated from pilomatrixoma (which may appear with similar clinical and sonographic features), cutaneous tuberculosis, folliculitis, actinomycosis, chromomycosis, sporotrichosis, coccidioidomycosis, blastomycosis of the skin, botryomycosis etc. Dermatophyte infections usually occur in immuno compromised patients. In our case, the young patient was healthy and no medication administration had previously happened. A trichophyton infection mainly causes superficial lesions to the skin, nails and hair, deeper dermis and subcutaneous tissue anywhere on the body but most frequently at the lower extremities.</p> Evangelia Christodoulou Savas Deftereos Copyright (c) 2021-10-27 2021-10-27 40 1 COVID-19 restrictive control measures and maternal, sexual and reproductive health issues: risk of a double tragedy for women in sub-Saharan Africa <p>Governments in sub-Saharan Africa implemented restrictive measures, including lockdowns, to curb the spread of COVID-19, without measures to protect women and girls. Evidence from previous humanitarian crises in resource-limited settings in sub-Saharan Africa indicates that these populations may suffer disproportionately from the effects of the restrictive control measures, owing to differential access to services, including maternal, sexual and reproductive health services. These services are time-sensitive, and delays and disruptions introduced by the restrictive measures may result in adverse consequences, including increased maternal and perinatal morbidity and mortality. Therefore, governments must find ways of ensuring continuity of these essential services during pandemic times, in a conducive environment, protective to both care providers and care seekers. Surveillance of the impact of the pandemic must be ongoing to inform practice and refine public health interventions, as the indirect effects of the COVID-19 pandemic might be worse than the direct effects.</p> Grant Murewanhema Mugove Gerald Madziyire Copyright (c) 2021-10-28 2021-10-28 40 1 Assessment of knowledge and foot self-care practices among diabetes mellitus patients in a tertiary care centre in Makkah, Saudi Arabia: a cross-sectional analytical study <p><strong>Introduction:&nbsp;</strong>diabetic foot is a common long-term complication of uncontrolled diabetes mellitus. Knowledge about foot self-care practices among diabetic patients in Saudi Arabia is limited. Thus, the aim of this study was to assess the level of patients´ knowledge and practices regarding self-care of diabetic foot among diabetic patients.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional analytical study was conducted using a sample of diabetic patients attending outpatient clinics at Heraa Diabetic Center, Ministry of Health, Makkah City, Saudi Arabia from June 2020 to July 2020. The participants were interviewed through a self-administered questionnaire inquiring sociodemographic factors, patients´ knowledge and practices regarding foot self-care.</p> <p><strong>Results:&nbsp;</strong>a total of 409 patients were included in this study. Respondents' ages ranged between 6 and 75 years with a mean of 42.5 years and standard deviation of 13.9 years. Females represented 51.1% of the participants. Type 2 diabetes represented 85.6% of the responses. Overall, most of the participants (72.4%) had a poor level of knowledge whereas only 4.2% expressed a good level of knowledge. Being employed (P = 0.046), type II diabetes patients (P = 0.047) and those whose main source of information was health staff (P = 0.026) were more knowledgeable compared to their peers. Almost two-thirds (63.3%) of patients showed a poor level of practice related to diabetic foot self-care.</p> <p><strong>Conclusion:&nbsp;</strong>low level of knowledge and practice of foot care are prevalent among diabetic patients attending outpatient clinics at Heraa Diabetic Center. Designed interventions should be implemented to enhance diabetic foot self-care.</p> Abrar Ali Wazqar Meaad Mohammed Baatya Fahad Saqib Lodhi Adeel Ahmed Khan Copyright (c) 2021-10-29 2021-10-29 40 1 Research priorities for accelerating the achievement of three 95 HIV goals in Cameroon: a consensus statement from the Cameroon HIV Research Forum (CAM-HERO) <p><strong>Introduction:&nbsp;</strong>the Treat-All remains the globally endorsed approach to attain the 95-95-95 targets and end the AIDS pandemic by 2030, but requires some country-level contextualization. In Cameroon, the specific research agenda to inform strategies for improving HIV policy was yet to be defined.</p> <p><strong>Methods:&nbsp;</strong>under the patronage of the Cameroon Ministry of health, researchers, policy makers, implementing partners, and clinicians from 13 institutions, used the Delphi method to arrive at a consensus of HIV research priorities. The process had five steps: 1) independent literature scan by 5 working groups; 2) review of the initial priority list; 3) appraisal of priorities list in a larger group; 4) refinement and consolidation by a consensus group; 5) rating of top research priorities.</p> <p><strong>Results:&nbsp;</strong>five research priorities and corresponding research approaches, resulted from the process. These include: 1) effectiveness, safety and active toxicity monitoring of new and old antiretrovirals; 2) outcomes of Antiretroviral Therapy (ART) with focus in children and adolescents; 3) impact of HIV and ART on aging and major chronic diseases; 4) ART dispensation models and impact on adherence and retention; 5) evaluations of HIV treatment and prevention programs.</p> <p><strong>Conclusion:&nbsp;</strong>the research priorities resulted from a consensus amongst a multidisciplinary team and were based on current data about the pandemic and science to prevent, treat, and ultimately cure HIV. These priorities highlighted critical areas of investigation with potential relevance for the country, funders, and regulatory bodies.</p> Anastase Dzudie Boris Tchounga Rogers Ajeh Charles Kouanfack Peter Vanes Ebasone Tatiana Djikeussi Léonard Bonono Nyoto Joseph Fokam Jérôme Ateudjieu Patrice Tchendjou Ezechiel Ngoufack Jagni Semengue Fabrice Youbi Jean Anoubessi Marie Varloteaux Boris Youngui Felicite Naah Tabala Benjamin Atanga Leonie Simo Armel Zemsi Emile Shu Nforbih Gilles Ndayisaba Annereke Nyenti Apungwa Cornelius Ntabe Therese Abong Bwemba Eugene Sobngwi Serge Billong John Ditekemena Anne Cecile Zoung-Kanyi Bisseck Louis Richard Njock Copyright (c) 2021-10-29 2021-10-29 40 1 A rare association between a dermoid cyst and arachnoid cyst of the cerebellopontine angle: a case report <p>Supratentorial arachnoid cysts are usually asymptomatic and may be discovered by chance at autopsy; however, infratentorial arachnoid cysts, which correspond to liquid forms enclosed by an arachnoid sheet but whose pathogenesis is unknown, might cause symptoms. They don't need to be treated if they're asymptomatic and were discovered by chance. A variety of neurological symptoms can be present depending on their localization. Intracranial dermoid cysts are uncommon tumours that develop from ectopic epithelial cells in the brain. They are benign, slow-growing, and rarely rupture. The association between the two diseases is extremely rare and when it is present may suggest the existence of a common factor. We present a unique case of a young girl who developed headache and ataxia as a result of an intracranial infratentorial dermoid cyst and an arachnoid cyst of the cerebellopontine angle. Complete removal of the dermoid cyst and drainage of the cyst leads to a full recovery. Dermoid and arachnoid cyst are two pathologies with a possible common embryogenic factor, early surgery can give a better outcome in the long term.</p> Zoubeyr Abbou Rania Djennati Zeyad Khalil Copyright (c) 2021-11-01 2021-11-01 40 1 Outcomes of treatment of severe COVID-19 pneumonia with tocilizumab: a report of two cases from Tunisia <p>The SARS CoV-2 pandemic is a global health threat with high morbidity and mortality (1 to 4%) rates. COVID-19 is correlated with important immune disorders, including a “cytokine storm”. A new therapeutic approach using the immunomodulatory drug, Anti-IL6 (tocilizimub), has been proposed to regulate it. We report here the first Tunisian experience using tocilizimub in two severe cases of COVID-19 pneumonia. The diagnosis was confirmed by chest scan tomography. Biological parameters showed a high level of Interleukin-6 (IL-6) that increased significantly during hospitalization. The patients developed hypoxia, so they received intravenously 8 mg/kg body weight tocilizumab. There was a resultant decrease in the level of IL6, with clinically good evolution. Blocking the cytokine IL-6 axis is a promising therapy for patients developing COVID-19 pathology.</p> Mouna Ben Azaiz Bassem Chatbri Walid Sellami Chihebeddine Romdhani Khaled Lamine Ezzedine Ghazouani Ridha Oueslati Hedi Gharsallah Mustapha Ferjani Copyright (c) 2021-11-02 2021-11-02 40 1 Health care payment practice, perception and awareness of national health insurance scheme by market women in Enugu Metropolis South-East Nigeria <p><strong>Introduction:&nbsp;</strong>health insurance is in the fore front of health financing and achievement of universal health coverage for all. It provides a means of coping with some of the risks faced by individuals in achieving optimal healthcare. Women are vital in the family especially when it comes to the health of their children. We therefore set out in this study to assess the healthcare payment method of women in the informal sector and their awareness of the National health insurance scheme (NHIS) in Nigeria.</p> <p><strong>Methods:&nbsp;</strong>the study was a cross sectional descriptive survey involving women traders who were aged 18 years and above. Three hundred and fifty-three (353) womens were recruited using semi-structured interviewer questionnaire and data was analyzed using SPSS version 22.</p> <p><strong>Results:&nbsp;</strong>the prevalence of awareness of NHIS among the women was 57.5% and educational status was contributor to awareness of the scheme. Also, only 9.9% of the women were registered under the NHIS and out of pocket payment for healthcare was practiced by as much as 88.7% of the respondents. Most respondents had poor perception about the scheme with 60% believing that the government cannot be trusted to keep its end of the bargain with regards to the NHIS.</p> <p><strong>Conclusion:&nbsp;</strong>the need for awareness of the NHIS especially in the informal sector for women is brought to fore. The policy -makers should take into account how women in informal sectors should be captured to enrol in the NHIS in order to expand its coverage and this enrolment should be compulsory.</p> Ebelechukwu Lawretta Okiche Chikosolu Yvonne Okiche Chima Theresa Isife Clara Chinasa Obi-Ochiabutor Chukwunweike Anukeyi Ogbuabor Copyright (c) 2021-11-02 2021-11-02 40 1 Food handling practices and associated factors among food handlers working in public food and drink service establishments in Woldia town, Northeast Ethiopia <p><strong>Introduction:&nbsp;</strong>foodborne disease (FBD) is a major public health problem globally. Inadequate food workers' knowledge, attitude, and low level of food handling practices (FHPs) may all contribute to the possibility of FBD outbreaks in public food service establishments. This study aimed to assess FHPs and associated factors among food handlers working in public food and drink service establishments in Woldia town, Northeast Ethiopia.</p> <p><strong>Methods:&nbsp;</strong>an institutional-based cross-sectional study was conducted from 01<sup>st</sup>&nbsp;to 29<sup>th</sup>, January 2017. A total of 288 food handlers were recruited through a simple random selection method. A structured interviewer-administered questionnaire and observation checklists were used to collect the respondents' socio-demographic characteristics, knowledge status on FHPs, and food handling working practices data. Descriptive statistics, bivariate and multivariate logistic regression analysis were employed using SPSS version 20 software. Those variables with a p&lt; 0.05 were considered statistically significant.</p> <p><strong>Results:&nbsp;</strong>out of 288 participants, 91.7% were female, and 82.3% were single, while 69.8% were literate. One hundred eighty-four (63.9%) of them were under 15-25 years of age, with a median age of 23.3 years. The proportion of good FHP was (n=134, 46.5%) (95% CI:41.00-52.4%). Advanced age (adjusted odds ratio (AOR) =12.01, 95% CI:1.96-73.52), education (participants who attend grades 7-12 (AOR=2.33, 95% CI:1.14-4.79), and above secondary education (AOR=2.29, 95% CI:1.05-4.61), work experience above six years (AOR=2.43, 95% CI:2.08-3.17), received formal training (AOR=1.79, 95% CI:1.68-4.71), and inspection visits by a concerned body (AOR=2.24, 95% CI:1.05-3.09) were factors positively associated with handling practices.</p> <p><strong>Conclusion:&nbsp;</strong>the study revealed that FHP in the study area was low. Age, education, service year, training received and sanitary inspection visits by the regulatory personnel were factors significantly associated with FHPs. This finding highlights the importance of employing regular sanitary inspection visits to public food service establishments by the concerned authority to ensure that all food handlers have the knowledge and the skill to provide safe food.</p> Melese Abate Reta Mekonnin Tesfa Lemma Ashete Adere Gemeda Getasew Assefa Lemlem Copyright (c) 2021-11-02 2021-11-02 40 1 Determinants of retention in HIV antiretroviral treatment (ART) in the Cameroon International epidemiology Database to Evaluate AIDS (IeDEA) study clinics: the context of the HIV treat all strategy in Cameroon <p><strong>Introduction:</strong>&nbsp;retaining patients in antiretroviral treatment (ART) is essential for successful outcomes. Unfortunately, Cameroon continues to report suboptimal ART retention. This study focused on identifying determinants of ART retention in three HIV clinics in Cameroon within the HIV treat all context.</p> <p><strong>Methods:</strong>&nbsp;a medical chart review of 423 subjects who initiated ART between July and September 2016 in the Limbe, Bamenda and Jamot Hospitals. Patients' sociodemographic and clinical characteristics and ART retention data were abstracted using structured paper forms. Chi square test was used to assess bivariate associations. Logistic regression was used to adjust for confounders. P-value was set at &lt;0.05 at 95% confidence interval.</p> <p><strong>Results:</strong>&nbsp;the mean age was 40±11 years, and 65.1% were females. Antiretroviral treatment retention after 24 months was 309/392(78.83%) and 30/423(7.1%) were transferred-out, 11/423(2.6%) reported dead and 73/423(17.3%) lost to follow-up. HIV status disclosure (AOR 0.16 95% CI: 0.05-0.51, p&lt;0.01) and age group 31-50 years (AOR 3.63, 95% CI:1.04-12.59, P= 0.04) were associated with lower and higher ART retention respectively.</p> <p><strong>Conclusion:</strong>&nbsp;about a quarter of the participants were not retained in ART after 24 months. Patient-level factors determined ART retention. These factors should be considered in designing strategies to improve ART retention. More research is needed to identify other determinants of ART retention under the HIV treat all strategy.</p> Rogers Awoh Ajeh Halle Ekane Gregory Egbe Obinchemti Thomas Nsah Awachwi Noela Anastase Dzudie Assob Nguedia Jules Adebola Adedimeji Copyright (c) 2021-11-02 2021-11-02 40 1 Chronic tophaceous gout <p>Fifty-eight (58) year-old male with gouty arthritis for over 12 years, other medical history pertinent for hypertension, CKD stage 3 and heavy alcohol use. Patient described irregular usage of colchicine and urate-lowering drug for the last 10 years due to noncompliance with therapy. On physical examination, the patient was confined to a wheelchair because of his severe arthritis, he had deforming tophi and active synovitis of bilateral small joints of the hands (A), flexor tendon contractures (B), massive right big toe tophus (C) and concomitant septic arthritis and tophaceous gout of the left foot and ankle (D). Laboratory data were as follows: uric acid, 8.9 mg/dl; C-reactive protein (CRP): 33.5 mg/dl; creatinine, 2.8 mg/dl; blood and left ankle fluid cultures grew MRSA. Patient was treated emergently with IV antibiotics and subsequent below knee amputation as the foot was deemed clinically and radiographically unsalvageable. Patient was later started on febuxostat. After 4 months of therapy with febuxostat, he had no active synovitis. He was able to get out of the wheelchair and his CRP (0.4 mg/dl) and uric acid (4.2 mg/dl, the target is &lt; 5 mg/dl) levels normalized. In addition, not only the tophaceous burden lessened but also the joint mobility improved, probably owing to control of the inflammation.</p> Husam Bader Rama Maghnam Copyright (c) 2021-11-02 2021-11-02 40 1 Analysis of snakebite data in Volta and Oti Regions, Ghana, 2019 <p><strong>Introduction:&nbsp;</strong>globally about 5.4 million people are affected by snakebite annually leading to 2.7 million cases of snakebite envenoming and 81,000-138,000 deaths. In sub-Saharan Africa, the burden of disease caused by snakebite is often underestimated despite its status as a category A neglected tropical disease. We reviewed snakebite data to determine the magnitude of snakebite by person, place, and time in the Volta and Oti Regions of Ghana.</p> <p><strong>Methods:&nbsp;</strong>we conducted a descriptive secondary data analysis using snakebite data from 2014-2018 extracted from the District Health Information and Management Systems (DHIMS 2) database. Data were analyzed descriptively by person, place, and time using summary statistics and results were presented in proportions and graphs. Missed outbreaks were determined through calculation of cumulative sum (CUSUM 2).</p> <p><strong>Results:&nbsp;</strong>a total of 2,973 cases of snakebites were reported over the 5 years of which 1675 (56.3%) were males. Majority 867 (29.2%) of snakebite victims were between 20-34 years of age with recorded 5-year average incidence of 24 snakebite cases per 100,000. Nkwanta North District recorded the highest cases 499 (16.8%) with most of the snakebite cases 2,411 (81%) recorded in the rainy season. Overall, there was a decreasing trend of snakebites and four missed snakebite outbreaks occurred during the period. No snakebite death was recorded.</p> <p><strong>Conclusion:&nbsp;</strong>a 5-year average snakebite incidence of 24 cases per 100,000 persons was recorded and Nkwanta North District recorded the highest cases with peaks occurring in rainy and harvesting seasons. Four outbreaks were missed. There is a need to conduct periodic data analysis for effective intervention programs.</p> Baba Ceesay Abdoulie Taal Momodou Kalisa Magdalene Akos Odikro David Agbope Ernest Kenu Copyright (c) 2021-11-03 2021-11-03 40 1 Malignant hypertension secondary to iliac artery stenosis after kidney transplantation: a case report <p>Iliac artery stenosis is a rare complication after renal transplantation. This complication affects elderly patients and related to atheromatous disease. It mimics the same clinical presentation as a transplant renal artery stenosis or renal artery stenosis. This entity is can be responsible for serious complications such as renal dysfunction, malignant hypertension and acute pulmonary oedema. We present in this paper the case of a 51-year-old patient, who benefited 7 years early of renal transplantation, with a good initial result, and who was admitted actually for malignant hypertension and renal function impairment due to an iliac artery stenosis proximal to the renal transplant and who was treated with a stenting angioplasty of the external iliac artery with a mixed outcome. Our case highlights the importance of the early diagnosis and treatment of such complications to avoid definitive renal failure and permanent hypertension.</p> Imtinen Ben Mrad Lilia Ben Fatma Melek Ben Mrad Ikram Mami Boutheina Ben Abdellatif Rim Miri Sobhy MleyhiKarim Zouaghi Raouf Denguir Copyright (c) 2021-11-03 2021-11-03 40 1 High flow nasal cannula therapy versus continuous positive airway pressure and nasal positive pressure ventilation in infants with severe bronchiolitis: a randomized controlled trial <p><strong>Introduction:</strong>&nbsp;non-invasive ventilation is widely used in the respiratory management of severe bronchiolitis.</p> <p><strong>Methods:</strong>&nbsp;a randomized controlled trial was carried out in a tertiary pediatric university hospital´s PICU over 3 years to compare between continuous positive airway pressure/nasal positive pressure ventilation (CPAP/NPPV) and high flow nasal cannula (HFNC) devices for severe bronchiolitis. The trial was recorded in the national library of medicine registry (NCT04650230). Patients aged from 7 days to 6 months, admitted for severe bronchiolitis were enrolled. Eligible patients were randomly chosen to receive either HFNC or CPAP/NPPV. If HFNC failed, the switch to CPAP/NPPV was allowed. Mechanical ventilation was the last resort in case of CPAP/NPPV device failure. The primary outcome was the success of the treatment defined by no need of care escalation. The secondary outcomes were failure predictors, intubation rate, stay length, serious adverse events, and mortality.</p> <p><strong>Results:</strong>&nbsp;a total of 268 patients were enrolled. The data of 255 participants were analyzed. The mean age was 51.13 ± 34.43 days. Participants were randomized into two groups; HFNC group (n=130) and CPAP/NPPV group (n=125). The success of the treatment was significantly higher in the CPAP/NPPV group (70.4% [61.6%- 78.2%) comparing to HFNC group (50.7% [41.9%- 59.6%])- (p=0.001). For secondary outcomes, lower baseline pH was the only significant failure predictor in the CPAP/NPPV group (p=0.035). There were no differences in intubation rate or serious adverse events between the groups.</p> <p><strong>Conclusion:</strong>&nbsp;high flow nasal cannula was safe and efficient, but CPAP/ NPPV was better in preventing treatment failure. The switch to CPAP/NPPV if HFNC failed, avoided intubation in 54% of the cases.</p> Aida Borgi Assaad Louati Narjess Ghali Ahmed Hajji Ahmed Ayari Asma Bouziri Mohamed Hssairi Khaled Menif Nejla Benjaballah Copyright (c) 2021-11-03 2021-11-03 40 1 Nasal sarcoidosis <p>A 19-year-old woman with a two years history of dragging oto-rhino-laryngeal infections, purulent rhinorrhea and sinusitis, polyarthralgia, and an episode of granulomatous uveitis. Clinical examination showed destruction of nasal wing, hepatomegaly and splenomegaly. A rounded lesion with atrophic center in the forearm. Laboratory tests revealed upper limit calcemia, the angiotensin-converting enzyme was high 323 UI/L. Nasal biopsy revealed non-caseating epithelioid-cell granulomas. Differential diagnosis includes granulomatous disease of the nose such as leprosy, tuberculosis and Wegener´s granulomatosis. Special staining for typical mycobacterium and lepra bacilli were negative. The polymerase chain reaction for mycobacterium tuberculosis was negative. There was no renal involvement and the cytoplasmic antineutrophil cytoplasmic antibody (cANCA/PR3/ANCA) was negative. The diagnosis of nasal sarcoidosis was retained. The patient was treated with prednisone and azathioprine with favorable outcome.</p> Fadwa Mekouar Mohamed Elqatni Copyright (c) 2021-11-03 2021-11-03 40 1 Left paraduodenal hernia: a rare cause of recurrent abdominal pain: case report <p>Internal hernias are quite rare, accounting for fewer than 1% of all abdominal hernias. Moreover, the most frequent cause of internal herniation is paraduodenal hernia (PDH). Diagnosing paraduodenal hernias can be difficult due to the wide range of symptoms that can occur. It is a case report of paraduodenal hernia that was diagnosed and managed in a tertiary center. We describe the case of a 55-year-old male patient who had been experiencing nonspecific abdominal discomfort for the last 5 years and had several comorbidities and positive serology. An abdominal computed tomography (CT) revealed that he had a left PDH, which was effectively treated with laparoscopic surgical repair. The study's strength is that it was correctly identified by CT and subsequently laparoscopically corrected. A gastrografin swallow study was also performed postoperatively to ensure there was no leak. The study's flaw is that the patient was misdiagnosed for five years in other medical facilities. Because paraduodenal hernia is an uncommon diagnosis, it's important to keep it in mind as one of the differential diagnoses for persistent discomfort. It also needs accurate imaging in order to identify and successfully manage it. To demonstrate the relevance of this uncommon condition, future research is needed to report on any misdiagnosis or treatment. To conclude, nowadays the best option for paraduodenal hernia repair is laparoscopic surgery. However, because it can present with a wide variety of symptoms and diagnosis might be challenging, it demands a high index of suspicion. The gold standard for identifying paraduodenal hernia is still a CT scan of the abdomen. Patients who are stable and have no signs of intestinal obstruction might decide to have their hernia repaired to avoid future problems. To demonstrate the relevance of this uncommon condition, future research is needed to report on any misdiagnosis or treatment.</p> Leena Hatem Moshref Shumukh Hassan Alqahtani Zaid Abdulrahim Majeed Jameel Miro Copyright (c) 2021-11-03 2021-11-03 40 1 Pfeiffer syndrome type 3 with FGR2 c.1052C>G (p.Ser351Cys) variant in West Africa: a case report <p>Pfeiffer syndrome is a rare genetic condition that includes anomalies of the head, hands, and feet. It was originally described by Rudolf Pfeiffer in 1964. As a result of varied clinical presentations, there is a low threshold for missing the diagnosis. Three (3) cases were found by the authors in the medical literature from the African continent, all of which lacked molecular studies. The main dysmorphic features we observed in our patient were; macrocephaly with widely gaped sagittal sutures, proptosis with ocular hypertelorism, ankylosed elbows, wide sandal gap and medially deviated broad great toes. In this case, sequence analysis using Illumina technology and deletion/duplication testing of 65 genes for variants associated with craniosynostosis syndromes was performed at Invitae Medical Genetic laboratory. A diagnosis of Pfeiffer syndrome type 3 with FGFR2 c.1052C&gt;G (p.Ser351Cys) variant was made. In conclusion, this case will aid health care providers especially in areas of low accessibility to molecular studies to promptly identify, appropriately manage the condition as well as counselling the parents to offset the risk of abandonment of neonates with dysmorphic features.</p> Kwadwo Apeadu Danso Rosemary Sefakor Akuaku Florence Naa Adoley Young Samuel Agyei Wiafe Copyright (c) 2021-11-04 2021-11-04 40 1 Les complications thromboemboliques chez les enfants au cours de COVID-19 <p>Letter to the editors.</p> Amal El Ouarradi Ilham Bensahi Insaf Alaammari Amal Haoudar Nezha Dini Mohamed Sabry Copyright (c) 2021-11-04 2021-11-04 40 1 Diagnostic accuracy of the syndromic management of four STIs among individuals seeking treatment at a health centre in Nairobi, Kenya: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>the syndromic approach to the management of sexually transmitted diseases (STIs) is recommended in areas without adequate laboratory support. We assessed the diagnostic accuracy of this approach in diagnosing&nbsp;<em>Neisseria gonorrhoeae</em>&nbsp;(NG),&nbsp;<em>Chlamydia trachomatis</em>&nbsp;(CT),&nbsp;<em>Trichomonas vaginalis</em>&nbsp;(TV) and&nbsp;<em>Mycoplasma genitalium</em>&nbsp;(MG) among 18 to 49 year-old individuals seeking treatment for STIs in a health centre in Nairobi, Kenya.</p> <p><strong>Methods:&nbsp;</strong>participants were recruited between April and June 2019. After providing written informed consent, an interviewer-administered questionnaire was completed. Endocervical swabs from women and urethral swabs from men were collected for STI testing using polymerase chain reaction (PCR). Diagnostic accuracy of reported symptoms was calculated using PCR as the gold standard.</p> <p><strong>Results:&nbsp;</strong>a total of 297 individuals (148 men and 149 women) were recruited. Majority of the participants had at least one reported symptom (130/148; 87.8% men and 145/148; 97.3% women). The most commonly diagnosed STI was NG (85/297; 28.6% 95%CI 23.5%-34.1%). Vaginal discharge syndrome had moderate (44.4%) to high (92.9%) sensitivity, low specificity, low positive predictive value (PPV) (2.4 % to 31.5%) and high negative predictive value (NPV) (68.2% to 95.2%). The lower abdominal pain syndrome had moderate to high sensitivity (40% to 71.4%), low specificity (30.9% to 35.6%), low PPV (9.9% to 15.8%) and high NPV (79.2% to 93.8%). The urethral discharge syndrome had high sensitivity (71.4% to 84.8%); moderate specificity (37.6% to 51.7%); low to moderate PPV (5.4% to 53.8%) and high NPV (83.6% to 96.4%). The kappa scores for the three syndromes were generally poor.</p> <p><strong>Conclusion:&nbsp;</strong>these findings support the need for the review of the syndromic management of STIs.</p> Anne Njeri Maina Marianne Wanjiru Mureithi John Kiiru Ndemi Gunturu Revathi Copyright (c) 2021-11-04 2021-11-04 40 1 Perception of mental health and professional quality of life in Tunisian doctors during the COVID-19 pandemic: a descriptive cross-sectional study <p><strong>Introduction:&nbsp;</strong>few research studies about mental health problems in medical staff during the first wave of the COVID-19 pandemic have been reported. The Aim of the study is to assess the prevalence of anxiety and insomnia, affecting the professional quality of life of physicians during COVID-19 pandemic.</p> <p><strong>Methods:&nbsp;</strong>doctors answered an online questionnaire regarding their perception of insomnia, anxiety and professional quality of life during COVID-19 pandemic with psychological parameters including the Generalized Anxiety Disorder (GAD-7), Insomnia Severity Index (ISI) and Professional quality of life version 5 (ProQOL5).</p> <p><strong>Results:&nbsp;</strong>anxiety was found in 64.8% of the participants. This disorder was respectively moderate and severe in 12.4% and 6.7% of cases. Insomnia was found in 51.4% of respondents, 29.5% of whom worked in the COVID circuit (p=0.17). Insomnia was assessed as mild, moderate and severe in respectively 38.1%, 11.4% and 1.9% of cases. Compassion satisfaction was moderate in 72.4 of cases and high in 24.8% of cases. The entire population with low CS belonged to the 20-29 age group (p=0.019). Compassion satisfaction was statistically higher in married people (32.7%) (p=0.004). This entity varied significantly with occupational grade (p=0.003), seniority in grade (p=0.011) and working in the private health sector (p=0.046). Burnout was moderate in 73.3% and low in 26.7% of cases. Burnout was significantly higher among single people (p=0.03) and statistically altered in the staff working in the COVID unit (p=0.028). Secondary traumatic disorder was above moderate in 69.6%.</p> <p><strong>Conclusion:&nbsp;</strong>a high prevalence of psychological symptoms was found among doctors during COVID-19. Medical health workers are in need of health protection and adequate working conditions.</p> Imen Youssfi Najla Mechergui Irtyah Merchaoui Faten Bouden Hanene Ben Said Imen Youssef Nizar Ladhari Copyright (c) 2021-11-05 2021-11-05 40 1 The prevalence and pattern of antibiotic prescription among insured patients in Dar es Salaam Tanzania <p><strong>Introduction:&nbsp;</strong>high prevalence of antibiotic prescriptions may contribute to the problem of antibiotic resistance. Understanding the pattern of antibiotic prescriptions in a country may inform monitoring and stewardship activities, which are crucial in the fight against antibiotic resistance. We aimed to determine the prevalence and describe the pattern of antibiotic prescriptions among National Health Insurance Fund (NHIF) insured patients receiving treatment at health facilities in Ilala Municipality, Dar es Salaam, Tanzania.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional analysis of claim forms of NHIF insured patients. A data extraction form was used to capture data for September, 2019 submitted to the Ilala NHIF offices.</p> <p><strong>Results:&nbsp;</strong>among 993 insured patients (mean [±SD] age 36.3 [±23.2] years; 581 [58.5%] females; 535 [53.9%] adults) a total of 357 (46.4%, 95% CI, 42.8-50.0) received an antibiotic prescription. Of the 357 patients who received an antibiotic prescription, 71(19.9%) received more than one antibiotic prescription. The most common antibiotic prescribed was amoxicillin/clavulanate (17.1%) followed by amoxicillin (16.5%) whereas the most commonly prescribed antibiotic class was the penicillins (51.3%) followed by the nitroimidazoles (14.0%). Among patients who received more than one antibiotic, the most commonly co-prescribed antibiotics were Ampicillin/Cloxacillin plus Metronidazole (11.4%) followed by Amoxicillin plus Metronidazole (7.1%). According to 2019 WHO Access, Watch, Reserve (AWaRe) Classification of antibiotics, 60.8% of patients received the access antibiotics, 33.3% received the watch antibiotics whereas 17.4% of patients received antibiotics that were not recommended. No patient received an antibiotic from the reserve group.</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of antibiotic prescriptions in Tanzania is high and some antibiotics not recommended by the WHO are still prescribed. We recommend revision of the current Tanzania treatment guideline on antibiotics to reflect WHO recommendations, and further research to address local factors influencing antibiotic prescriptions is warranted.</p> Mohamed Ally Khalfan Philip Galula Sasi Sabina Ferdinand Mugusi Copyright (c) 2021-11-05 2021-11-05 40 1 Clinical and aetiologic profile of patients with chronic urticaria at the outpatient clinic of a tertiary hospital in Lagos, Nigeria: a cross-sectional observational study <p>Chronic urticaria is a condition characterized by recurrent wheals associated with itching lasting longer than six weeks. The condition tends to run a chronic course with significant morbidity. Several factors have been explored in the cause, yet the aetiology is still uncertain. We documented the clinical profile and assessed the possible aetiologic factors in patients with chronic urticaria. Clinical profile of sixty consecutive patients with chronic spontaneous urticaria was assessed with possible precipitants identified using a structured questionnaire. The complete blood count with erythrocyte sedimentation rate, antithyroid peroxidase (antiTPO), hepatitis B surface antigen (HBsAg), antihepatitis C virus screening (AntiHCV), stool for ova and parasites and helicobacter pylori were carried out. Controls without a history of urticaria were recruited in a 1:1 ratio for stool for parasites and H. pylori because of the high prevalence rates reported in this environment. Data analysis was carried out with Statistical Packages for Social Sciences (SPSS) version 22. Sixty patients with chronic urticaria and sixty age and sex matched controls were enrolled in the study. Females presented more often with urticaria with a M:F ratio of 1:2.5. The mean age of onset of urticaria was in the third decade of life. Precipitants were identified in close to a third of patients. The investigated antigenic aetiology was not found to play a role. The presentation and clinical profile of patients in this environment is similar to previously documented studies. History still remains the cornerstone of management as precipitants and triggers may be identified. Management of patients should therefore be individualized.</p> Shakirat Gold-Olufadi Olusola Ayanlowo Ayesha Omolara Akinkugbe Erere Otrofanowei Copyright (c) 2021-11-05 2021-11-05 40 1 Correlates of intimate partner violence among adolescents in East Africa: a multi-country analysis <p><strong>Introduction:&nbsp;</strong>intimate partner violence (IPV) is a global concern not only among adults but also adolescents. It has been reported that 35% of adolescent women have ever experienced IPV - occuring more so in non-industrialized countries. This study sought to understand the correlates associated with experiencing IPV among adolescent women between the ages 15 and 24 in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda.</p> <p><strong>Methods:&nbsp;</strong>this was a secondary analysis of Demographic and Health Survey (DHS) data on adolescent women aged 15-24 years in five East African countries. IPV was measured as a composite variable of emotional, physical, and sexual violence. Other sociodemographic, income, maternal, sexual, knowledge, behavioral, and partner-related variables were included in the analysis.</p> <p><strong>Results:&nbsp;</strong>the prevalence of ever experiencing IPV was 45.1% (n=2380). A higher proportion of women who reported experiencing IPV had their first sexual encounter when they were less than 18 years of age (p&lt;0.001). The adjusted odds ratio (aOR) of experiencing IPV increased almost two times for women who were aged 18-24 years (aOR: 1.7; CI: 1.3-2.3), almost four times (aOR 3.8; CI: 1.7-8.3) for those who had two or more children, and two-fold for women who had ever terminated a pregnancy compared to those who had not (aOR 2.2; CI: 1.0-4.9). Additionally, there was a higher odds (aOR: 1.5 (1.0-2.3)) of experiencing IPV if the respondent believed their husband/spouse´s abuse was justified.</p> <p><strong>Conclusion:&nbsp;</strong>raising early awareness and educating both the young males and females appropriately to mitigate contributing factors to IPV could ensure stable, healthy relationships free of domestic violence in the future.</p> Peter Memiah Courtney Cook Caroline Kingori Leso Munala Kathryn Howard Sandra Ayivor Tristi Bond Copyright (c) 2021-11-05 2021-11-05 40 1 Marburg virus disease outbreak in Guinea: a SPIN framework of its transmission and control measures for an exemplary response pattern in West Africa <p>Responding to highly infectious diseases relies on a thorough understanding of transmission epidemiology. With the recent outbreak of Marburg Virus Disease (MVD) in Guinea, we saw the need to shed some technical light based on published literature and our field experiences. We reviewed 14 previous MVD outbreaks globally. Coupled with core one - health approaches, we propose a Socio-environmental context, Possible transmission routes, Informing and guiding public health action, Needs in terms of control measures (SPIN) framework as a guiding tool for response teams to appropriately approach future infectious disease outbreaks.</p> Frankline Sevidzem Wirsiy Denis Ebot Ako-Arrey Claude Ngwayu Nkfusai Eugene Vernyuy Yeika Luchuo Engelbert Bain Copyright (c) 2021-11-08 2021-11-08 40 1 Management of extrusive luxation of upper incisors in young permanent teeth: a case report <p>This case report documents the clinical approach adopted for two permanent maxillary incisors with extrusive luxation in a 16-year-old boy. The proposed procedures involved reposition of both teeth, by digital pressure and stabilized by using semi-rigid splint for 2 weeks. Endodontic therapy was performed. Clinical and radiographic follow-up examinations were conducted at 6-month intervals for two years. Assessment revealed the absence of pulpal and periapical disease and the restoration of the maxillary incisors to a state of health and normal function. A long-term clinical and radiological follow-up is needed to prevent and precociously detect possible complications that may occur following a extrusive luxation.</p> Emna Hidoussi Sakly Copyright (c) 2021-11-08 2021-11-08 40 1 Basal cell carcinoma- a rare clinical image <p>We are presenting a case of a 50-year-old female, a farmer by profession and often exposed to sunlight. She came with complaints of lesions on her face along with pain over the lesions for the past year, which was left unmanaged since then. No one in their family has similar complaints as per her knowledge. On thorough inspection of lesions, there was neither sensory loss nor oozing of any fluid. On evaluation, there were lesions over the nose and medial aspects of eyes looked like a hemorrhagic crusted plaque with hyperpigmented border initially started as hyperpigmented papules which progressed to present size gradually in one year. Skin biopsy was sent for histopathological examination which confirmed it as basal cell carcinoma, on the confirmation the patient was referred to the oncology department for further management.</p> Saritha Aadhi Rakesh Krishna Kovela Copyright (c) 2021-11-09 2021-11-09 40 1 Effect of food hygiene training on food handlers´ knowledge in Sokoto Metropolis: a quasi-experimental study <p><strong>Introduction:&nbsp;</strong>training intervention for food handlers is necessary to increase their knowledge and awareness about food hygiene. Research in this area has been given low attention in Nigeria, especially in the Northern part of the country. Therefore, we assessed the effect of food hygiene training on the knowledge of food hygiene among food handlers in Sokoto metropolis.</p> <p><strong>Methods:&nbsp;</strong>we conducted a quasi-experimental study between January and July 2019. We used a multistage sampling technique to select 360 food handlers randomized into intervention and control groups. We conducted a training intervention after the baseline data collection. Post-intervention data collection was conducted six months after the intervention. We estimated the proportion of respondents with good knowledge at baseline and post-intervention. We assessed the difference in pre-and post-intervention proportions using McNemars Marginal Homogeneity test at 5% level of significance.</p> <p><strong>Results:&nbsp;</strong>in the intervention and control groups, 19 (10.6%) and 18 (10.0%) had primary education respectively, p = 0.231. At baseline, 23 (12.8%) and 22 (12.2%) in intervention and control groups respectively had good knowledge, p= 0.515. At post-intervention, the proportion of those with good knowledge in the intervention group increased to 56.7%, p &lt; 0.001; while in the control group, there was no significant difference in the proportion of those with good knowledge, p = 0.248.</p> <p><strong>Conclusion:&nbsp;</strong>the training intervention has significantly improved the knowledge of the food handlers. We recommend that the National Food and Drug Agency, in collaboration with restaurant owners, ensure regular on-the-job training of food handlers.</p> Ismail Abdullateef Raji Oche Mansur Oche Aminu Umar Kaoje Kehinde Joseph Awosan Mansur Olayinka Raji Godwin Jiya Gana Jessica Timane Ango Auwal Usman Abubakar Copyright (c) 2021-11-09 2021-11-09 40 1 Congenital cataract and congenital glaucoma in Marshall-Smith syndrome <p>Marshall-Smith syndrome (MSS) is an ultra rare congenital condition (prevalence &lt;1/1.000.000) caused by de novo mutations involving the gene nuclear factor I/X. It is characterized by increased bone age, respiratory disorders, facial abnormalities and failure to thrive. We present a 22-day-old infant referred to our care centre for large bulging eyes and dysmorphism including prominent eyes, bilateral proptosis, depressed nasal bridge, anteverted nares, micrognathism, prominent forehead and hypertrichosis. Fiberoptic bronchoscopy concluded to severe laryngomalacia. On ophthalmic examination, the corneal diameter was 13.5 mm in the right eye (RE) and 14 mm in the left eye (LE). The intra-ocular pressure was 29 mmHg in the RE and 36 mmHg in the LE. Biomicroscopy showed severe corneal edema in both eyes. Corneal scarring secondary to hydrops has been noted in the LE. Bilateral total cataract precluded fundus examination. Ultrasound B-mode was unremarkable in both eyes. The patient passed away from respiratory compromise at the age of 29 days. Genetic testing has not been performed. However, facial features, the course of respiratory difficulty and ocular involvement were highly suggestive of the diagnosis of MSS.</p> Jihene Sayadi Ines Malek Copyright (c) 2021-11-10 2021-11-10 40 1 Measuring adherence to ARVs among HIV-positive adolescents in Cameroon: a comparative assessment of self-report and medication possession ratio methods <p><strong>Introduction:&nbsp;</strong>adherence to ARV medications has been shown to improve treatment outcomes in HIV positive patients. Given that ARV treatment is lifelong, adherence has become a critical issue as it may reduce over time. Measuring adherence is therefore imperative in programming. There are different methods of measuring adherence each with its advantages and disadvantages, depending on the context and the time. This study therefore compares two widely used adherence measurement scales in Cameroon, namely, the self-report and the medication possession ration (MPR) methods.</p> <p><strong>Methods:&nbsp;</strong>the study was done in some selected health facilities of the North West and South West regions of Cameroon among adolescents on ARV. The study was designed as an analytical cross-sectional study with a record review component and systematic random sampling was used to select the participants. Adherence was measured through self-report and the medication possession ratio. Adolescents with adherence levels of at least 95% were considered adherent. Viral load suppression was considered as having the most recent viral load suppression results of less than 1000 copies per ml. The kappa statistics of inter-rate agreement was used to ascertain the difference between adherence as measured by self-report and MPR. The difference in adherence between the two scales was also compared using Fischer´s exact test and p-values were reported.</p> <p><strong>Results:&nbsp;</strong>the study shows that adherence level using the self-report technique is 82.9% while that of MPR was 73.4%. When compared using the using Kappa statistics, there was substantial agreement between the two scales of 66% (p=0.54). The results of both self-report adherence and MPR were also compared with viral load suppression and the difference between viral load suppression and MPR was significant (p&lt;0.01). The difference in adherence between viral load suppression and the self-report measure also showed to be significant (p&lt;0.01).</p> <p><strong>Conclusion:&nbsp;</strong>adherence from the self-report measure was higher than from MPR, but there was substantial agreement between the scales. Although there is no gold standard for adherence measurement, self-report or medication possession ratio could be used and complemented with laboratory markers like viral load counts.</p> Mbuwir Charlotte Bongfen Kwasi Torpey John Ganle Ankomah Augustine Copyright (c) 2021-11-10 2021-11-10 40 1 Dentigerous cyst: enucleation or marsupialization? (a case report) <p>Dentigerous cysts, also called follicular cysts, are slow-growing benign odontogenic cysts that are thought to be developmental in origin. On imaging, they usually present as a well-defined and unilocular radiolucency surrounding the crown of an unerupted or impacted tooth. This article presents a case of unilateral mandibular dentigerous cysts associated with unerupted mandibular canine in a healthy patient treated by enucleation, along with a review of the literature and an examination of the treatment modality. The aim of this paper is to highlight how to choose the adequate treatment for dentigerous cyst cases.</p> El Gaouzi Rajae El Harti Karima Copyright (c) 2021-11-10 2021-11-10 40 1 Health extension service utilization barriers in East Gojjam Zone, Northwest Ethiopia: qualitative study <p><strong>Introduction:&nbsp;</strong>the health extension service is a package that aims to improve primary healthcare services, mainly in rural areas through an innovative community-based approach that focuses on prevention, healthy living, and basic curative care which is implemented by the health extension workers using the health post as a center of care. Thus, this study aimed to explore the barriers of health extension service utilization in East Gojjam Zone, North West, Ethiopia.</p> <p><strong>Methods:&nbsp;</strong>qualitative study was conducted from Feb 16 to May 30, 2021, on the barriers to health extension service utilization among households in East Gojjam Zone. The data was collected with focus group discussion and in-depth interviews to address our objective. Study participants were selected purposively until the required data was saturated. The data was analyzed under selected themes based on the guide and summarized manually.</p> <p><strong>Results:&nbsp;</strong>respondents reported that there were lots of reasons that preclude proper utilization of the health extension packages both in urban and rural households in East Gojjam Zone-like negligence, previous experience, misinterpretation of the health extension packages, the religion they believe, unavailability of water continuously, wrongly utilization of the packages rather than their purpose and the environment they live.</p> <p><strong>Conclusion:&nbsp;</strong>there are still lots of barriers regarding health extension package utilization in the East Gojjam Zone. Working on households on purpose and utilization of health extension packages in a religiously and culturally acceptable manner is advisable. Further research on reported barriers is needed.</p> Bewket Yeserah Aynalem Misganaw Fikrie Melesse Copyright (c) 2021-11-11 2021-11-11 40 1 Assessment of service readiness for maternity care in primary health centres in rural Nigeria: implications for service improvement <p><strong>Introduction:&nbsp;</strong>several scientific reports from studies across Nigeria revealed a higher incidence of maternal mortality in rural parts of the country as compared to the urban areas. Part of the reasons is the paucity of health care infrastructure and personnel. This study was designed as part of an intervention program with the goal to improve the access of pregnant women to skilled pregnancy care in rural Nigeria. The specific objective of the study was to determine the nature and readiness of Primary Health Centres (PHCs) in two Local Government Areas (LGAs) in rural parts of Edo State, Southern Nigeria to deliver effective maternal and child health services.</p> <p><strong>Methods:&nbsp;</strong>the study was conducted in 12 randomly selected PHCs in the two LGAs. Data were obtained with a semi-structured questionnaire administered on health workers and through direct observation and verification of the facilities in the PHCs. The results obtained were compared with the national standards established for PHCs in Nigeria by the National Primary Health Care Development Agency (NPHCDA). Descriptive statistics were used to analyze the data.</p> <p><strong>Results:&nbsp;</strong>the results showed severe deficits in buildings and premises, rooms, medical equipment, essential drugs, and personnel. Only 40% of items recommended by the NPHCDA were available for buildings; 41% of the PHCs had facilities available in the labour ward; while less than 30% had the recommended facilities in the antenatal care rooms. Only one PHC had a laboratory space, with only one item (a dipstick for urine analysis) identified in the laboratory. None of the PHCs had ambulances, mobile phones, internet or computers. There was no nurse/midwife in 4 PHCs; only one nurse/midwife each were available in 8 PHCs; while there was no Environmental/Medical Records Officer in any PHC. About 26% of the essential drugs were not available in the PHCs.</p> <p><strong>Conclusion:&nbsp;</strong>we conclude that PHCs in Edo State, Nigeria have severe deficits in infrastructural facilities, equipment, essential drugs and personnel for the delivery of maternal and child health care. Efforts to improve these facilities will help increase the quality of delivery of maternal and child health, and therefore reduce maternal and child mortality in the country.</p> Lorretta Favour Chizomam Ntoimo Julius Ogungbangbe Wilson Imongan Sanni Yaya Friday Ebhodaghe Okonofua Copyright (c) 2021-11-11 2021-11-11 40 1 Infective endocarditis following COVID-19 pneumonia: about two cases <p>Coronavirus disease 2019 (COVID-19) has emerged as a pandemic and public health crisis across the world. The severity of this situation is escalating in certain populations, particularly when the COVID-19 diagnosis may delay the recognition of more dramatic illnesses such as infective endocarditis, which is a dreaded complication in patients with cardiac disease. We report the case of two patients who presented with infective endocarditis initially mistaken for COVID-19 pneumonia, which was responsible for a delay in diagnosis. We discuss the diagnostic difficulties as well as the management of this complication in the COVID-19 era. As a physician, one must remain alert to this dreaded complication, especially in patients with a cardiac history, in order to prevent it, detect it early, and manage it in time.</p> Amal El Ouarradi Aziza Kantri Khalid Agrad Ilham Bensahi Fatimazzahra Merzouk Zineb Guennoun Said Makani Yousra Jebbari Chafik Elkettani Mohamed Sabry Copyright (c) 2021-11-12 2021-11-12 40 1 Congenital tracheobronchomegaly (Mounier-Kuhn syndrome) in a 28-year-old Zambian male: a case report <p>Congenital tracheobronchomegaly, also known as Mounier Kuhn Syndrome (MKS) is a rare respiratory disorder characterized by dilatation of the trachea and bronchi. We report a case of a 28-year-old male of African descent in Zambia, who presented with a history of chronic productive cough and repeated chest infections since childhood. He had been treated numerous times for lower respiratory tract infections, and had received empiric tuberculosis (TB) treatment based on chest radiograph findings, despite negative sputum microscopy and molecular tests for TB. Investigations revealed normal baseline blood results and sputum results. He however had markedly increased levels of serum immunoglobulin E. and spirometry showed an obstructive pattern with significant post bronchodilator improvement. High-resolution computed tomography scan revealed tracheal dilatation, extensive bilateral bronchiectasis and tracheal and bronchial diverticula. The latter were also seen on bronchoscopy, confirming the diagnosis of Mounier-Kuhn syndrome. The patient was treated with combined inhaled corticosteroids and bronchodilators, as well as chest physiotherapy for mucus clearance, which led to improvement in his symptoms. Our case highlights how in low-resource settings, chronic lung diseases, particularly bronchiectasis, are often clinically and radiologically mistaken for and presumptively treated as TB (or its sequelae). Mounier-Kuhn syndrome, albeit rare, should be considered in the differential diagnosis of patients with recurrent lower respiratory tract infections or bronchiectasis. Multidisciplinary team meetings can help in the diagnosis of rare lung diseases.</p> Saifurrahman Shahin Thijs Hoffman Wouter van Es Jan Grutters Kondwelani Mateyo Copyright (c) 2021-11-12 2021-11-12 40 1 Kearns Sayre syndrome: a rare etiology of complete atrioventricular block in children (case report) <p>Kearns Sayre syndrome is a rare mitochondrial abnormality first described in 1958, characterized by a triad associating progressive external ophthalmoplegia, ptosis, and pigmentary retinopathy with progressive alteration of cardiac conduction, which determines the vital prognosis of this entity. Here we report the case of a 13-year-old child of consanguineous parents who consults for recurrent syncope. The clinical exam found bilateral ptosis with complete atrioventricular block on electrocardiogram. The ophthalmological exam found pigmentary retinopathy. The patient underwent successful implantation of a double chamber pacemaker within 24 hours of admission, with an uneventful postoperative course. This case report highlights the interest of systematically assessing cardiac complications in children with mitochondrial disease such as Kearns Sayre syndrome, especially since cardiac involvement is the major prognostic factor in this disease.</p> Hanane Kharbouch Badr Boussaadani Ibtissam Fellat Latifa Oukerraj Nawal Doghmi Mohamed Cherti Copyright (c) 2021-11-15 2021-11-15 40 1 Esophageal achalasia in an adolescent in Central Africa: a case report <p>Esophageal Achalasia has rarely been reported in sub-Saharan Africa. We report a case of a 12 years old boy who has been diagnosed after experiencing dysphagia for a year and progressive wasting. Esophagogram was the only exploration available in our settings and showed classical features. He underwent a Heller esophago-cardiomyotomy with Toupet fundoplication. Postoperative period was unremarkable and BMI normalized for age and sex on the sixth postoperative month. In low settings, history is a key step which lead to clinical suspicion as esophagogram is often the only available exploration to confirm the diagnosis.</p> Trésor Kibangula Kasanga Manix Ilunga Banza Florent Tshibwid A Zeng Augustin Kibonge Mukakala Jonas Tshilolo-Yona Williams Kalala Mpumbwa Anatole Nyembwe Mbuyi Olivier Tshiteya Kabeya Sébastien Mbuyi-Musanzayi Copyright (c) 2021-11-16 2021-11-16 40 1 Awareness, knowledge, attitudes, and behaviors related to COVID-19 in Libya: a nation-wide online survey <p><strong>Introduction:&nbsp;</strong>the World Health Organization declared the COVID-19 outbreak to be a global pandemic in March 2020. However, the pandemic cannot be ended overnight and more social distancing and other self-care measures are needed to protect our communities. Therefore, people´s awareness, knowledge, attitudes, and appropriate behaviors are instrumental to containing the pandemic. The aim of this study was to determine COVID-19 awareness, knowledge, attitudes, and related behaviors in Libya.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional online survey was conducted from October 10&nbsp;<sup>th</sup>&nbsp;to November 10<sup>th</sup>, 2020 in 24 cities in Libya. The participants were non-medical professionals who were living in Libya for at least 2 years and were at least 18 years old.</p> <p><strong>Results:&nbsp;</strong>a total of 1018 participants completed the questionnaire, with ages ranging from 18-74 years (Mean ± SD = 33.49±13.24); nearly two-thirds were &lt; 40, and 68.2% were females. Almost half of the participants considered the potential threat of COVID-19 to be low, and one in five reported that they were “Not worried at all” about getting COVID-19. In multivariate analyses, participants who were 40-49 years old, had master´s degrees or higher, and worked in the private sector reflected high mean scores for both knowledge and attitudes, while those who lived in the Eastern or Southern regions had lower mean attitude scores.</p> <p><strong>Conclusion:&nbsp;</strong>the low levels of awareness as well as the attitudes and behaviors among the public in Libya are worrisome. This study highlighted profound gaps that may put Libyan communities at high risk of a COVID-19 explosion. Therefore, immediate action is needed to address public awareness and attitudes and to improve COVID-19 related behaviors among the Libyan public.</p> Alhadi Jahan Marwa Mohamed Eman Alabani Aymaan Almaziq Huda Elarriesh Fatma Alagelli Farag Alhadar Khadejah Ben Tahir Hazar Berrah Mohammed Abudabbous Wedad Hamouda Najla Albahloul Joma Elzoubia Amal Dier Copyright (c) 2021-11-16 2021-11-16 40 1 Possible future trajectory of COVID-19: emphasis on Africa <p>Coronavirus disease 2019 (COVID-19) has caused morbidity and mortality in many countries. COVID-19 has also negatively affected the economy of several nations. The dynamics of interaction between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and host, and possible evolution of the virus into more virulent strains pose a threat to global eradication. With the advent of vaccination in most countries, vaccine hesitancy, especially in Africa, is expected to reduce. We also believe that the COVID-19 vaccine would have substantial impact on reducing incidence, hospitalizations, and deaths. A predictor model for COVID-19 infection pattern through to 2025 suggests that recurrent outbreaks are likely to occur. There is a prediction that Africa would not fully recover from the economic crises posed by the pandemic; nonetheless, we expect that economic activities on the continent will improve as countries undertake mass vaccinations and populace attain herd immunity. The growth of e-commerce has been remarkable during the pandemic and we don´t expect trend to decline anytime soon. The pandemic has led to technology and digital platform utilization and/or improvement, which invariably has the tendency to improve quality of lives in the future. These include effective big data monitoring, online shopping, among others. Our future trajectory for recurrent waves of COVID-19 is that these may occur in winter months in temperate climates. We believe that COVID-19 has strengthened Africa´s resilience to future pandemics.</p> Seth Kwabena Amponsah Benjamin Tagoe Daniel Kwame Afriyie Copyright (c) 2021-11-16 2021-11-16 40 1 Low seroprevalence of hepatitis C among children at the Princess Marie Louis Children´s Hospital in Accra, Ghana <p>Hepatitis C is a leading cause of chronic hepatitis and causes severe health problems in areas where prevalence is high. Ghana is noted for a relatively high sero-prevalence of hepatitis C virus infection. However, there is very little data on prevalence of hepatitis C virus (HCV) among children in Ghana, and what data is available indicates very low prevalence rate. We conducted a cross-sectional study to determine the sero-prevalence and associated pre-disposing risk factor for HCV infection among children attending the Princes Marie Louis Children´s Hospital in Accra. Two hundred archived blood samples from a previous study were retrieved and tested for the presence of HCV antibodies using a dipstick test kit. Out of the 200 samples tested, one (1) tested positive for HCV antibodies giving a prevalence of 0.5% among the study group. The results show that there is potentially a very low prevalence of hepatitis C among Ghanaian children. Hence, the higher prevalence among adults usually seen is often due to infection later in life. Obtaining an appropriate vaccine early in life could thus help prevent people from getting infected in later life.</p> Kwabena Obeng Duedu Donzala Asomah Seraphine Kugbemanya Theophilus Korku Adiku Copyright (c) 2021-11-16 2021-11-16 40 1 Prevalence and correlates of diastolic dysfunction in patients with hypertension: a cross-sectional study from in The Kingdom of Saudi Arabia <p><strong>Introduction:&nbsp;</strong>diastolic dysfunction refers to impaired ventricular relaxation or filling regardless of ejection fraction and symptoms. It accounts for 8% and 25% in the hospitalized and general population, respectively. The present study was conducted to determine the prevalence and correlates of diastolic dysfunction in hypertensive patients living in Saudi Arabia.</p> <p><strong>Methods:&nbsp;</strong>a multicentric, cross-sectional study was conducted from February 2019 to February 2020 at King Khalid Hospital and Prince Sultan Center for Health Services, Prince Sattam Bin Abdulaziz University hospital in Al Kharj, and Al Kharj Military Industries Corporation hospital, KSA. All patients with hypertension who underwent an echocardiography were included in the study. Logistic regression analysis was performed to determine factors associated with left ventricular diastolic dysfunction (LVDD).</p> <p><strong>Results:&nbsp;</strong>the study included a total of 104 participants, where 51.9% were females andthe mean age of the patients was 48.01±12.81 years.Most patients had an abnormal echocardiography finding (64.4%, n = 67). The most common abnormalities were left ventricular (LV) hypertrophy (44.2%, n = 46), and diastolic dysfunction, (35.6%, n = 37). The study revealed that age (aOR: 6.1, 95% CI 1.17-31.3; p = 0.032) and dyslipidemia (aOR: 3.45, 95% CI 1.16-10.24; p = 0.026) have significant association with LVDD in the patients with hypertension.</p> <p><strong>Conclusion:&nbsp;</strong>in conclusion, diastolic dysfunction is prevalent among older hypertensive patients and those with dyslipidaemia. Age and dyslipidaemia were non-modifiable and modifiable factors associated with LVDD in hypertensive patients, respectively.</p> Sameer Al-Ghamdi Faisal Khalid Alzubaidi Sultan Abdulrahman Alharthai Meshal Saleh Alzahim Fahad Mohammed Al Bahily Mohammed Ibrahim Alsifaee Hiaallah Ali Alshehri Muath Salman Anazi Copyright (c) 2021-11-16 2021-11-16 40 1 The role of humanitarian missions in surgical training for maxillofacial surgery residents: SOS Face Marrakesh experience <p>Resident´s participation in humanitarian work has been controversial, while it´s recognized by some authors to bring significant value to the resident´s education. Herein, we aim to provide an evidence of the role of humanitarian missions in the surgical training as part of residency program, through report of a 10 years experience of SOS FACE Marrakesh, a non-benefit association within maxillofacial surgery department of Marrakesh. Its operating mode is to organize humanitarian missions coupled to targeted surgical training program, which is framed by educational objectives using a pedagogic portfolio. As a result, 60.6% of the residents felt an improvement in surgical skills, and the evaluation of residents before and after the targeted training showed an increase of 57% in average clinical knowledge, especially the diagnosis part. In conclusion, humanitarian work helps to improve surgical skills in addition to enhancement of human values and we suggest incorporating volunteerism in residency programs.</p> Zakaria Aziz Salma Aboulouidad Abdelghafour Jaifi Mohamed El Bouihi Nadia Mansouri Hattab Hanane Rais Copyright (c) 2021-11-16 2021-11-16 40 1 Radical treatment of Sister Mary-Joseph nodule: case report and literature review <p>Sister Mary-Joseph nodule (NSMJ) is a cutaneous metastasis of the umbilicus, rare and accounts for 2-3% of the patients with advanced stages of colorectal adenocarcinoma. Here we report the observation of a 48-year-old Moroccan man, referred to our hospital to manage a painful ulcero-budding nodule of the umbilicus; computed tomography revealed that the processes infiltrated the urachus and the bladder. Laboratory parameters were normal and radical surgery was performed to remove the tumor and embryological remnant of the umbilicus. The histological assessment confirmed the sigmoidal origin of the umbilical nodule. This kind of disease always poses a problem of treatment. It was considered for a long time as an outdated stage of tumor disease that deserves just palliative treatment. Several cases published in the international literature with radical treatment had good survival and evolution, which gives hope to patients with this disease.</p> Amine Majdoubi Tarek Bouhout Marouan Harhar Achraf Mirry Serji Badr Tijani El Harroudi Copyright (c) 2021-11-16 2021-11-16 40 1 Trends and factors associated with repeated adolescent pregnancies in Tanzania from 2004-2016: evidence from Tanzania demographic and health surveys <p><strong>Introduction:&nbsp;</strong>a repeated pregnancy represents a failure of health and social systems to educate and provide the necessary services and skills to ensure adolescent girls do not experience any further unwanted pregnancies during this young age. We aimed to determine trends and factors associated with repeated adolescent pregnancies in Tanzania 2004-2016.</p> <p><strong>Methods:&nbsp;</strong>an analytical cross-sectional study was conducted using secondary data from Tanzania demographic and health surveys of the years 2004-2005, 2010 and 2015-2016 among adolescent mothers aged 15 to 19 years. Data analysis was performed using STATA version 15 and considered the complex survey design. The Poisson regression model was used to estimate prevalence ratios (PR) and 95% confidence intervals for factors associated with repeated adolescent pregnancy.</p> <p><strong>Results:&nbsp;</strong>the proportion of repeated adolescent pregnancies increased from 15.8% in 2004/2005 to 18.6% in 2010, then to 18.8% in 2015/2016. Adolescents who delivered their first pregnancy at home (APR: 1.36, 95% CI: 1.03, 1.78) and who started sexual activity before 15 years of age (APR: 1.80, 95% CI: 1.40, 2.31) were likely repeated adolescent pregnancy. In contrast, adolescents who used contraception (APR: 0.52, 95% CI: 0.34, 0.81) had a lower prevalence of repeated adolescent pregnancies.</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of repeated adolescent pregnancies has increased and remains unacceptably high. Adolescents who had low education delivered their first pregnancy at home and were non-contraceptive users need to be targeted in policies and programs for the prevention of repeated adolescent pregnancies.</p> Octavian Aron Ngoda Innocent Baltazar Mboya Michael Johnson Mahande Sia Emmanuel Msuya Jenny Renju Copyright (c) 2021-11-17 2021-11-17 40 1 Impact of pre-exposure and post-exposure prophylaxes prevention programme on HIV burden and services in a low-resource setting: a simulation modelling approach <p><strong>Introduction:&nbsp;</strong>sub-Saharan African countries contribute substantially to the global HIV disease burden. Despite this burden, and the promises that prevention could deliver, the implementation and uptake of HIV prevention programmes are still low. The study used the decision support system model to explore the potential impacts of prevention implementation on HIV burden (incidence) and service delivery.</p> <p><strong>Methods:&nbsp;</strong>an operational research technique known as discrete event simulation model was used to capture an individual patient´s pathways through the HIV care process from diagnosis to treatment and monitoring. The regular monitoring, over a 5-year period, including all the activities and resources utilized at each stage of the pathway were analysed, and the impact of increasing prevention measures for an HIV treatment service in a treatment centre in Nigeria was tested using the simulation model.</p> <p><strong>Results:&nbsp;</strong>forty-three patients currently access the Pre-Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP) annually, with a 20% and 80% split in the number of patients offered PrEP and PEP, respectively. Scenarios-based on increasing the number of people offered PrEP and PEP from 43 to 250 with a 50/50 split were tested. The outputs revealed improved preventive care by averting new HIV cases, reduction in service demand and utilization, but an increase in the required human resource as well as financial burden. In the next 5 years, the cumulative averted HIV cases are expected to increase from 2 and 5 people (baseline) to 24 and 20 people for PrEP and PEP, respectively. The potentially averted 2 cases per infected persons based on the basic reproductive number of HIV.</p> <p><strong>Conclusion:&nbsp;</strong>the effective implementation of PrEP/PEP programme offers an additional safety measure to prevent HIV transmission in at-risk individuals and possibility of ending HIV epidemic.</p> Adekunle Olatayo Adeoti Eren Demir Shola Adeyemi Usame Yakutcan Andre Pascal Kengne Gbenga Kayode Ahmad Aliyu Nneoma Idika Christian Isichei Copyright (c) 2021-11-17 2021-11-17 40 1 Le chordome sacrococcygien: à propos d´un cas <p>Le chordome sacrococcygien est une entité pathologique rare, rapporté dans seulement moins de 3% des cas. Nous allons rapporter l´observation d´une patiente prise en charge au Centre Régional d'Oncologie d'Oujda au Maroc ayant présenté un chordome sacrococcygien localement avancé. Le traitement a consisté en une radiothérapie exclusive sur la tumeur, la chirurgie d´exérèse n´était pas possible. Actuellement la patiente est à 2 ans de recul, la tumeur est d´aspect stable cliniquement et radiologiquement avec un bon état général.</p> Mohamed Moukhlissi Ahmed Ben Sgheir Mohammed Bensaid Loubna Mezouar Copyright (c) 2021-11-17 2021-11-17 40 1 Adverse drug reactions reporting practice and associated factors among community health extension workers in public health facilities, Southwest, Nigeria <p><strong>Introduction:&nbsp;</strong>timely adverse drug reactions (ADRs) reporting has contributed immensely towards public health safety. Community health extension workers (CHEWs) provides basic medical care in rural areas. This study assessed the knowledge, attitude, practice, and determinants of ADRs reporting among CHEWs in public health institutions, Southwest, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional survey of 333 CHEWs randomly selected from public health facilities using self-administered questionnaires. The questionnaire sought information on the knowledge, attitude and practice of CHEWs towards ADRs reporting. The knowledge and attitude questions were scored and categorized. The association between dependent and independent variables assessed with bivariate and multivariate logistic regressions, and p &lt; 0.05 considered statistically significant.</p> <p><strong>Results:&nbsp;</strong>among 333 respondents, 205 (61.6%) had encountered patients with ADRs but only 26 (12.6%) had reported it with yellow forms. About half, 169 (50.8%), and 191 (57.4%) respondents had a positive attitude and inadequate knowledge of ADRs reporting respectively. Sex (aOR: 2.84, 95% CI: 2.10-7.10; p &lt; 0.0001), working in Ogbomoso area (aOR:3.3, 95% CI: 1.34-8.21; p=0.01), and training (aOR:2.01, 95% CI: 1.20-3.42; p = 0.01) were factors associated with adequate knowledge. The determinant of ADRs reporting was training (aOR: 3.63, 95% CI: 1.13-11.63; p = 0.03).</p> <p><strong>Conclusion:&nbsp;</strong>though CHEWs had a slightly positive attitude, they had inadequate knowledge and poor ADRs reporting. The determinant of inadequate ADRs reporting knowledge and under reporting was lack of training. There is an urgent need for educational intervention programmes towards improving knowledge and practices of ADRs reporting among CHEWs.</p> Waheed Adeola Adedeji AbdulKabir Babajide Adegoke Fatai Adewale Fehintola Copyright (c) 2021-11-17 2021-11-17 40 1 Outcomes of the first meeting of the CAMEROON HIV RESEARCH FORUM (CAM-HERO) <p>Research is a vital component for the development of any country. In Cameroon, HIV Operational research is rapidly growing, however, it faces some intractable problems which can only be solved through an urgent, strategic, efficient, and collaborative approach involving key stakeholders. The Kribi meeting (09 and 10<sup>th</sup>&nbsp;December 2020) brought together under the auspices of the Ministry of Public Health leading HIV research organisations and connected HIV researchers and actors from different sectors. These actors disseminated and discussed recent research findings and worked out mechanisms to advance HIV research development, developed new ideas and identified priority research areas, with emphasis on translational research. The official launching and consolidation of Cam-HERO was a critical step and it is hoped that these synergistic efforts will catalyse attainment of the 95-95-95 goals in Cameroon.</p> Boris Tchounga Rogers Ajeh Tatiana Djikeussi Peter Vanes Ebasone Patrice Tchendjou Jean Anoubissi Ezechiel Ngoufack Jagni Semengue Charles Kouanfack Fabrice Youbi Kamgang Marie Varloteaux Boris Youngui Tchakounte Felicite Naah Tabala Benjamin Atanga Leonie Simo Jérôme Ateudjieu Armel Zemsi Lainsi Judith Nasah Njie George Ngeke Nicoline Ndiforkwah Mireille Teno Bouseko Falone Tientchou Sandjong Emile Nforbih Shu Madeleine Bakari Yves Tiojio Gilles Ndayisaba Nyenti Annereke Apungwa Cornelius Ntabe Therese Abong Bwemba Serge Clotaire Billong Anne Cecile Zoung-Kanyi Bisseck John Ditekemena Anastase Dzudie Copyright (c) 2021-11-17 2021-11-17 40 1 Burden of chronic disease comorbidities among cancer patients at Queen Elizabeth and Kamuzu Central Hospitals in Malawi: an exploratory cross-sectional study <p><strong>Introduction:&nbsp;</strong>chronic disease comorbidities are common among cancer patients in most parts of the world, however; there are limited data on the same for Malawi. Comorbidities worsen clinical outcomes and are associated with lower quality of life among cancer patients. We aimed at estimating chronic disease comorbidities and associated factors among cancer patients attending oncology services at the Queen Elizabeth Hospital (QECH) and Kamuzu Central Hospital (KCH) in Blantyre and Lilongwe respectively.</p> <p><strong>Methods:&nbsp;</strong>we conducted a cross-sectional study at QECH and KCH in Malawi from January to March 2021. Participants were recruited using simple random sampling technique at the oncology clinics and were interviewed using structured questionnaires. The College of Medicine Research and Ethics Committee (COMREC) approved the study and informed consent was obtained with each participant. Data were analyzed in Stata version 14 and summary statistics were presented as frequencies and proportions.</p> <p><strong>Results:&nbsp;</strong>we interviewed 398 cancer patients and the mean age was 45.4years (SD± 12.77). The common cancers were cervical (30%), Kaposi´s sarcoma (24%), breast (11%), esophageal (4%) and leukemia (4%). The prevalence of chronic disease comorbidities was 61.56% (n=398) and common conditions included: HIV and AIDS (43%), depression (9%) hypertension (8%) and anemia (9%). Chronic disease comorbidities were significantly associated with formal employment (p&lt;0.01) and obesity (p&lt;0.02).</p> <p><strong>Conclusion:&nbsp;</strong>chronic disease comorbidities were prevalent among cancer patients in the study settings in Malawi. There is a need to develop a multidisciplinary approach when managing cancer patients with emphasis on active screening for the common conditions as reported by this study.</p> Jonathan Chiwanda Banda Adamson Sinjani Muula Copyright (c) 2021-11-17 2021-11-17 40 1 Effectiveness of life review on depression among elderly: a systematic review and meta-analysis <p><strong>Introduction:</strong>&nbsp;depression is considered one of the most common obstacles to daily life activities and quality of life in the elderly. Evidence is accumulating regarding the effectiveness of reminiscence and life review interventions in reducing depression and raising well-being in the elderly. The aim of this review was to determine the effects of life review interventions on depression outcomes among the elderly.</p> <p><strong>Methods:</strong>&nbsp;a search of the literature was performed through 11 electronic databases to identify all randomized controlled trials studies that examine life review effects on depression among the elderly. For each study, the effect size (Cohen's d) between groups (life review vs. control) differences in depression scores for post-intervention and follow-up intervention were computed.</p> <p><strong>Results:</strong>&nbsp;in total, 15 studies were met the inclusion criteria and was evaluated by meta-analysis. Results showed that the life review group has a large effect on reducing depression level than the control group on post-intervention and follow-up. After conducted sensitivity analysis, a moderate effect (effect size=-0.54; 95% CI=-0.71 to -0.36; p&lt;0.05) and small effect (effect size=-0.20; 95% CI=-0.41 to -0.01; p&lt;0.05) were found on post-intervention and follow-up, respectively.</p> <p><strong>Conclusion:</strong>&nbsp;through this systematic review and meta-analysis, the overall results showed a moderate effect to reducing depression levels among the elderly in the life review group after carrying out post-intervention measurements, while in the follow-up the effect was small. This review indicates that life review intervention is one of the options likely to be of benefit for elderly in primary care settings, but further research can be focused on intervention and follow-up durations to obtain long-term effects.</p> Bushra Rashid Al-Ghafri Abdulaziz Al-Mahrezi Moon Fai Chan Copyright (c) 2021-11-18 2021-11-18 40 1 Increasing incidence of lung transplantation in patients with post-COVID-19 pulmonary fibrosis <p>Twenty months into the COVID-19 pandemic, we are still learning about the various long-term consequences of COVID-19 infection. While many patients do recover with minimal long-term consequences, some patients develop irreversible parenchymal and interstitial lung damage leading to diffuse pulmonary fibrosis. Unfortunately, these are some of the consequences of post-SARS-CoV-2 infection which thousands more people around the world will experience and which will outlast the pandemic for a long time to come. It is now being observed at various leading medical centres around the world that lung transplantation may be the only meaningful treatment available to a select group of patients experiencing serious lung damage and non-resolving COVID-19-associated respiratory failure, resulting from the triad of coronavirus infection, a hyper-inflammatory immune response to it and the inability of the human body to repair that injury.</p> Rumi Khajotia Copyright (c) 2021-11-18 2021-11-18 40 1 Cigarette smoking prevalence and associated factors among college students, Amhara, Ethiopia <p><strong>Introduction:&nbsp;</strong>tobacco is the only legal drug that kills many of its users when used exactly as intended by the manufacturers. It is estimated that of the 1.1 billion smokers worldwide, nearly 80% of them live in low and middle-income countries. This trend increases in college and university students with most smokers starting to smoke during adolescent. The aim of this study is to assess cigarette smoking prevalence and associated factors among a select group of college of teachers´ education students.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted. Multistage sampling was used to select 605 study participants from across the eight departments of the Injibara College of Teachers´ Education. Each subject was selected by simple random sampling technique after proportional allocation to each class. EpiData version 4.2 was used for data entry and Stata version 14 was used for data cleaning and analysis. Variables with p-value &lt; 0.2 in bi-variable analysis were selected for multi-variable analysis. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported to show the strength of association.</p> <p><strong>Results:&nbsp;</strong>the current prevalence of cigarette smoking is 6.8% amongst the Injibara College of Teachers´ Education students. Males [AOR: 2.84 (95% CI: 1.13, 7.14)], divorced marital status [AOR: 7.27 (95% CI: 1.23, 42.85)], food source in hostel [AOR: 11.62 (95% CI 3.23, 41.71)] and exposure to family/other smokers [AOR: 6.17 (95% CI: 2.17, 16.06)] were statistically significant factors for cigarette smoking.</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of cigarette smoking was relatively low. Male, marital status, source of food, and exposure to family/other smokers were identified associated factors. Policy makers and health regulatory body are strongly encouraged to consider this evidence and the associated factors for smoking in their efforts to develop and implement tobacco control laws.</p> Animut Takele Telayneh Mihretie Gedefaw Dessalegn Haile Samuel Derbie Habtegiorgis Daniel Shitu Getahun Yilkal Tafere Moges Agazhe Assemie Wubetu Woyraw Habtamu Temesgen Nakachew Mekonnen Copyright (c) 2021-11-19 2021-11-19 40 1 Benign multicystic peritoneal mesothelioma in a postmenopausal woman complicated with an ovarian cyst: a case report <p>Benign multicystic peritoneal mesothelioma is a rare cystic neoplasm, characterized by subtle symptoms, that occurs predominantly in reproductive-aged women. The pathogenesis and etiology of the disease are yet to be determined. We herein present a 71-year-old woman presented to our clinic with persistent low back pain. The clinical examination showed a palpable mass in the abdominal area. The magnetic resonance imaging revealed multiple cystic lesions that occupy the largest part of the pelvis, posterior to the uterus. The patient underwent cyst excision, total hysterectomy with bilateral salpingo-oophorectomy, omentectomy and lymph node dissection. Postoperative course was uneventful and histopathology of the specimen revealed a benign multicystic peritoneal mesothelioma. Complete tumor resection is considered the optimal therapeutic approach of peritoneal mesothelioma. Histopathological analysis is required to confirm the diagnosis of multicystic peritoneal mesothelioma.</p> Eirini-Aikaterini Evangelopoulou Konstantinos Zacharis Georgia Skoufi Nikolaos Vlassis Papamichali Roidoula Georgios Lialios Copyright (c) 2021-11-19 2021-11-19 40 1 Cerebellar stroke complicating coronary catheterization: a case report <p>Cerebrovascular events are rare but devastating events that can complicate any coronary intervention. In the vast majority of cases, they involve major cerebral arteries. We report the case of a 56-year-old woman admitted for unstable angina associated with severe left systolic dysfunction. She developed moderate cerebellar stroke while undergoing percutaneous coronary intervention, with a national institutes of health stroke scale score of 5. Immediate systemic thrombolysis was performed, but her neurological status deteriorated. A large hemorrhagic transformation was then diagnosed, and she died despite surgical intervention. Periprocedural strokes are marred with high morbidity and mortality, therefore preventionis key, as many risk factors can be controlled or mitigated. Our patient presented many of these factors; they can be procedure-related (transfemoral approach, anticoagulation) or patient-related (age, diabetes mellitus, uncontrolled hypertension, diffuse atherosclerosis).</p> Hamza Chraibi Zakia El Yousfi Najat Mouine Zouhair Lakhal Aatif Benyass Copyright (c) 2021-11-19 2021-11-19 40 1 Exposed implants five years after spine surgery: poor outcomes due to poor follow-up <p>An eighteen-year-old female presented with the complaint of dull aching lower back pain for past 3 months. The pain was localized and was mildly aggravated by movement. She had a history of resolved spinal tuberculosis and vertebral fracture managed with pedicle screw fixation and L1-L3 vertebral fusion before five years. She had not followed up since then. On examination, there were exposed and protruding metallic implants surrounded by dried and foul smelling tissue in the lumbar area of the back (A). The skin surrounding it was normal. Lateral X-ray suggested that the screws were retracted from their original site (B). There were no signs of infection of the deeper tissues. Her vitals were normal. Hematological parameters were suggestive of mild iron deficiency anemia. Her condition was managed by surgical extraction of the implants and debridement of the damaged tissue. She was discharged after one week and her follow-up after two weeks was normal. The most important factor to be considered here is the lack of follow-up appointments. The probable reasons behind the lack of follow-up in our patient are suspected to be lack of patient education and poor socio-economic status. These factors play a major role in patient care, especially in the developing countries.</p> Tapan Patel Shivani Patel Copyright (c) 2021-11-21 2021-11-21 40 1 Clinical and intraoperative findings for dangerous chronic suppurative otitis media in paediatric cases <p>The number of complications in dangerous Chronic Suppurative Otitis Media (CSOM) remain high, especially in late presentation. Extensive disease with intratemporal and intracranial complications, especially in children, was commonly found in Cipto Mangunkusumo General Hospital (CMGH), a tertiary referral hospital. This was a retrospective study that used secondary data from 2017 to 2019 in CMGH. All paediatric patients with diagnoses of dangerous CSOM and who underwent surgery from January 2017 to June 2019 were included. Clinical and intraoperative findings were described in this study. Twenty paediatric patients underwent surgery in CMGH from 2017 to 2019; of that number, 17 had unilateral dangerous CSOM, and three had bilateral dangerous CSOM. All patients aged 2 to 18 years old underwent canal wall down technique surgery. Profound hearing loss was found in nine ears; severe loss, in four ears; moderately severe loss, in four ears; and moderate loss, in seven ears. The most common intraoperative finding were total ossicular destruction in 17/23 ears. Erosion of sigmoid sinus plate was found in 5/23 ears, with perisinus abscess occurring in one case. Tegmen erosion was found in 4/23 ears. Facial nerve dehiscence was found in seven ears (5 vertical segments, 2 horizontal segments) and two patients had facial nerve paralysis before surgery. Lateral semicircular canal (SCC) fistula was found in 6/23 ears. Late presentation in dangerous CSOM can lead to extensive disease and complication, especially in paediatric patients.</p> Ratna Dwi Restuti Harim Priyono Rangga Rayendra Saleh Ayu Astria Sriyana Copyright (c) 2021-11-21 2021-11-21 40 1 Primary squamous cell carcinoma of the kidney in southern Senegal (Ziguinchor): case report and review of the literature <p>The kidney's primary squamous cell carcinoma is a rare tumor, representing 0.5-0.8% of malignant renal tumors and 4% of upper urinary tract tumors. This pathology often occurs after a long past history of renal lithiasis and repeated untreated or poorly treated urinary tract infections. The delay in diagnosis resulting from an insidious symptomatology, without specific signs, often leads to a pejorative development, especially in poor countries. A seventy-nine-year-old Senegalese woman, with no past history of lithiasis nor recurrent urinary tract infection and urinary schistosomiasis, was received for a recurrent total hematuria associated with left lumbar pain. Clinical examination revealed a mobile tender left lumbar mass, with lumbar contact and renal sloshing. The left renal tumor´s diagnosis was retained on clinical and scannographic arguments, justifying an enlarged left total nephrectomy, by laparotomy. The anatomopathological examination of the surgical sample made it possible to make the diagnosis of primary invasive squamous cell carcinoma of the left kidney and to find foci of carcinoma in-situ on squamous metaplasia in the calyxes. Unlike the typical case of primary squamous cell carcinoma of the kidney, our patient did not have a long past history of renal lithiasis nor untreated or poorly treated recurrent urinary tract infections and urinary schistosomiasis. Primary squamous cell carcinoma of the kidney may not be related to a past history of recurrent urinary tract infections and lithiasis, but to any other cause of squamous metaplasia of the urothelium. Surgery remains the best option for this entity.</p> Fabrice Senghor Ibou Thiam Omar Sow Aboubacar Traore Boubacar Fall Chérif Mohamed Moustapha Dial Copyright (c) 2021-11-21 2021-11-21 40 1 Onychomycosis: experience of the laboratory of parasitology-mycology of CHU-Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar <p><strong>Introduction:&nbsp;</strong>onychomycosis is defined as a fungal infection of the nails. They represent the main cause of onychopathy. They constitute a public health problem because of their increased prevalence in the world ranging between 20 to 30%. However, they remain under documented in Madagascar. This study was conducted in order to determine the mycological profile of onychomycosis diagnosed in the Parasitology Mycology laboratory of CHU-JRA.</p> <p><strong>Methods:&nbsp;</strong>a descriptive retrospective study was taken over a 13-year period from June 2005 to December 2018. The data presenting onychomycosis on the mycological outcome register were included in the study. Results showing the presence of fungi on direct examination and / or culture were considered positive.</p> <p><strong>Results:&nbsp;</strong>during the study period, a prevalence of 17.75% (180/1014) was observed. The age of our patients ranged from 3 to 76 years. Women were the most affected in 68.34% (n = 123) with a sex ratio of 0.46. Onychomycosis was localized in 64.65% of the fingers (n = 128). Simultaneous involvement of the hands and feet was found in 10% of the cases (n = 18).&nbsp;<em>Candida albicans (C. albicans)</em>&nbsp;was the most isolated in 33.03% (n = 71) of cases, followed by other species of Candida (24.65%, n = 53) and&nbsp;<em>Trichophyton spp</em>&nbsp;(9.3%, n=17). Mixed infections associating dermatophytes, Yeasts and molds were found in 23.33% (n = 42) of the cases.</p> <p><strong>Conclusion:&nbsp;</strong>this is the first investigation dealing with onychomycosis in Madagascar. These data may be useful for future research and in the development of preventive and educational strategies.</p> Norosoa Julie Zafindraibe Fenosoa Anita Mireille Tsatoromila Zolalaina Huberthine Rakotoarivelo Njariharinjakamampionona Rakotozandrindrainy Christian Rafalimanana Olivat Aimée Rakoto-Alson Lala Rasoamialy-Soa Razanakolona Copyright (c) 2021-11-22 2021-11-22 40 1 Association between hyperuricemia and glycated hemoglobin in type 2 diabetes at the District Hospital of Dschang <p><strong>Introduction:&nbsp;</strong>given the difficulty to obtain glycemic control in type 2 diabetes, the exploration of others pathophysiological hypotheses could improve the understanding of this phenomenon. We conducted this study to search for an association between uric acid and uncontrolled diabetes.</p> <p><strong>Methods:&nbsp;</strong>it was a cross-sectional study in a population of type 2 diabetes with normal postprandial and fast blood sugar for the last three months at the District Hospital of Dschang. Chi square test were used to analyzed categorical variables and Pearson correlation coefficient to evaluate the relationship between uric acid level and HbA1c. Means were compared using Kruskal-Wallis´s or Student´s test.</p> <p><strong>Results:&nbsp;</strong>our study of 80 patients found that, female sex and central obesity were risk factors for hyperuricemia. Prevalence of hyperuricemia and uncontrolled diabetes was respectively 27.5% and 33.8%. The proportion of women with hyperuricemia was significantly higher than that of men (59.1% versus 40.9%, p=0.021) and this inequality of proportion was more marked particularly after 45 years (40% versus 18.8%, p=0.022). Hyperuricemia was not significantly associated to uncontrolled diabetes (OR=2.01 IC (0.73-5.52), p=0.095). Serum uric acid was positively and significantly correlated to glycated hemoglobin (r=0.318, p=0.002) and hyperuricemia was significantly correlated to uncontrolled diabetes (r=0.712, p=0.035). The mean of glycated hemoglobin is abnormal (7.14%) when uric acid level is around 5.75 mg/dl without sex distinction.</p> <p><strong>Conclusion:&nbsp;</strong>these results suggest that the rate of glycated hemoglobin is associated to serum uric acid variations during type 2 diabetes.</p> Martial Donkeng Dieudonné Kuaté Patrice Nzogang Koudjou Jean Jacques Noubiap Jules Roger Kuiate Copyright (c) 2021-11-22 2021-11-22 40 1 Assessment of diabetes self-management amongst Nigerians using the diabetes self-management questionnaire: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>self-management is probably the most important factor contributing to achieving euglycaemia. The Diabetes Self-Management Questionnaire (DSMQ) is an instrument that shows favourable prospects compared to older measures. This study aimed to investigate the association between self-management and glycaemic control using the DSMQ, and determine factors that affect glycaemic control in patients living with diabetes mellitus.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional analytic study of 103 patients, carried out in a public tertiary health institution located in a Southern Nigerian City. An interviewer administered DSMQ was used to assess self-management among the patients. Data analysis was performed using SPSS 22.0.0, and AMOS 22.0.0 (IBM SPSS Statistics, New York, USA).</p> <p><strong>Results:&nbsp;</strong>females had significantly lower DSMQ scores compared to males (40 vs. 36, P=0.015) while median DSMQ score was highest in participants with tertiary level of education (P=0.017), and those who earned the highest annual income (P=0.007). The DSMQ´s behaviour scales showed a notable negative correlation with HbA1c (-0.565, P &lt; 0.001). More females (80.3%) than males (56.3%) had high HbA1C (Χ²=6.44, P=0.016).</p> <p><strong>Conclusion:&nbsp;</strong>diabetes self-management using DSMQ showed significant correlation with glycaemic control. Male sex, higher income, and higher level of education are associated with better self-management and glycaemic control.</p> Ogochukwu Chinedum Okoye Oluwatoyin Abisoye Ohenhen Copyright (c) 2021-11-24 2021-11-24 40 1 Paternal characteristics associated with low birth weight among singleton births: a hospital-based birth cohort study in northern Tanzania <p><strong>Introduction:</strong>&nbsp;low birth weight (LBW) remains a devastating adverse pregnancy outcome in low and middle income countries (LMICs). There is evidence showing that maternal demographic and pregnancy-related characteristics are associated with LBW. Little attention is given to paternal characteristics, which may be associated with a higher risk of LBW. This study aimed to assess the effect of paternal characteristics on LBW among singleton deliveries at Kilimanjaro Christian Medical Centre (KCMC) zonal referral hospital in Kilimanjaro region, northern Tanzania.</p> <p><strong>Methods:</strong>&nbsp;this was a secondary analysis of a hospital-based cohort study from maternally-linked medical birth registry data at KCMC between 2000 and 2018. A total of 47,035 singleton deliveries were included in this study. Data analysis was performed using statistical package for social sciences (SPSS), version 20 (IBM Corp., Armonk, NY). Relative risk and corresponding 95% confidence intervals (CI) were used to determine association between LBW and paternal characteristics using log-binomial regression models, with robust standard errors to account for clustering of deliveries within mothers.</p> <p><strong>Results:</strong>&nbsp;the proportion of LBW during the study period was 9.6%. After adjusting for maternal characteristics, higher risk of LBW was among fathers with low education level (RR=1.72, 95% CI: 1.22, 2.41, p=0.002), aged ≤24 years old (RR=1.37, 95% CI: 1.21, 1.55), and those unemployed (RR= 1.11, 95% CI: 1.01, 1.21). Lower risk of LBW was among fathers aged ≥40 years (RR=0.97, 95% CI: 0.88, 1.08), but this association was not statistically significant.</p> <p><strong>Conclusion:</strong>&nbsp;the study confirmed paternal young age (≤24 years old), paternal low education level and unemployment as predictors for LBW . Current evidence on the effect of paternal characteristics on LBW might suggest that programs and policies should target their engagement as a key strategy for improving birth outcomes during the perinatal period. Future studies should assess how paternal factors are associated with the risk of adverse birth outcomes.</p> Romani Roman Sabas Noreen Nickson Nyange Andrea Malimi Mayala Michael Johnson Mahande Caroline Amour Innocent Baltazar Mboya Copyright (c) 2021-11-24 2021-11-24 40 1 Implementing national COVID-19 vaccination programmes in sub-Saharan Africa- early lessons from Zimbabwe: a descriptive cross-sectional study <p><strong>Introduction:&nbsp;</strong>Zimbabwe was one of the first countries to run a national COVID-19 vaccination programme in Africa. Lessons learnt could inform the rollout of similar programmes in sub-Saharan Africa. To describe the trends of uptake of the COVID-19 vaccines in the first three months (February - May 2021) of the Zimbabwe vaccination programme and the lessons learnt.</p> <p><strong>Methods:</strong>&nbsp;a secondary descriptive analysis of routinely available COVID-19 vaccination data extracted from the daily situation reports published by the Ministry of Health and Child Care.</p> <p><strong>Results:</strong>&nbsp;in the first three months of the programme, 1 020 078 doses were administered, with 675 678 being first doses and 344 400 were second doses. Using population estimates, at three months, 5.2% of the population had received at least one dose and 2.6% had received the full two doses. Uptake was initially slow, followed by a gradual, and subsequently an exponential increase.</p> <p><strong>Conclusion:</strong>&nbsp;by the end of May 2021, Zimbabwe had rolled out one of the largest COVID-19 vaccination programme in sub-Saharan Africa. The uptake followed a pattern and trend that is consistent with vaccine hesitancy reported in the literature, driven by a combination of confidence, complacency and convenience factors. The gradual increase in uptake followed a series of national and local community engagement programmes. The roll-out of similar programmes must recognise likely patterns of uptake across the population and ensure plans are in place to address vaccine hesitancy. The available data did not allow granular analysis to understand the demographics of people who participated in the programme, which is important for surveillance, targeted action, preventing inequalities and ensuring adequate and proportionate protection of residents prioritising the most vulnerable. Further analysis of the process, outcomes and impact of the programme will be helpful in informing the rollout of similar programmes across Africa.</p> Grant Murewanhema Trouble Victor Burukai Brighton Chireka Edward Kunonga Copyright (c) 2021-11-24 2021-11-24 40 1 Ectopic adrenal gland tissue in the left ovary of an elderly woman: a case report <p>Ectopic adrenal gland in the ovary is very rare case, and even more rarer in older women. We reported a case of ectopic adrenal tissue as an incidental finding in left ovary from a 68-year-old woman. She presented with bearing down sensation due to uterine prolapse for 5 years. Upon physical examination, uterine prolapse grade III, cystocele, and rectocele were observed. Ultrasonography findings showed 0.69 cm intramural myoma, and no specific findings were found in the bilateral adnexae. She underwent a total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and anterior-posterior repair. The final pathologic diagnosis of the case was ectopic adrenal gland tissue in the left ovary and uterine leiomyoma. No eventful reactions were observed during hospitalization and after discharge. Although ectopic adrenal gland rarely occurs in elderly women and in the pelvic ovaries, it has a risk of neoplastic transformation and accompanying germ cell tumor and sex cord tumor. Hence, if the ectopic adrenal gland tissue is suspected during surgery, the tissue should be removed. Additionally, by closely examining the contralateral ovary, determining whether other lesions are suspected is necessary. If the other lesions including germ cell tumor or sex cord tumor are suspected, a biopsy of the contralateral ovarian tissue should be performed. Thus, gynecologists must have knowledge about ectopic adrenal gland tissues.</p> Seon Mi Lee Jong Chul Baek Ji Eun Park Hyen Chul Jo Hyun Min Koh Copyright (c) 2021-11-24 2021-11-24 40 1 Undiagnosed apical hypertrophic cardiomyopathy in an old amateur soccer player: a case report <p>Hypertrophic cardiomyopathy is a primary muscle disorder characterized by an abnormal thickness of the left ventricular wall. It is often going undiagnosed because many patients have few symptoms and can lead normal lives. This is a case report about an apical cardiomyopathy diagnosed at a very late stage in an old amateur soccer player. He was hospitalized due to acute chest pain; neurologic disorder related to a hypertensive emergency, he underwent successful percutaneous coronary intervention, echocardiography and CMR revealed Apical hypertrophic cardiomyopathy. The development of sports cardiology has major importance in the detection of cardiac disease which may have poor prognosis. Our patient had the chance to achieve his entire career without rhythmic complications.</p> Mahassine El Harras Ilham Bensahi Salma Abdeladim Fatimazahra Merzouk Amal Elouarradi Sara Oualim Mohamed Sabry Copyright (c) 2021-11-25 2021-11-25 40 1 An analysis of the COVID-19 laboratory dataset at AiBST Laboratory in Harare, Zimbabwe, 2020 <p><strong>Introduction:&nbsp;</strong>coronavirus disease 2019 (COVID-19) has become a major public health problem and has spread rapidly around the globe since its first identification in Wuhan, China, in December 2019. Zimbabwe reported its first case on the 20<sup>th</sup>&nbsp;March 2020, and since then the disease has spread to almost every part of the country. Laboratory testing is important in controlling this pandemic. However, few studies have focused on assessing trends of SARS-CoV-2 laboratory data. We described SARS-CoV-2 data from African Institute of Biomedical Science and Technology (AiBST) Laboratory in Harare, Zimbabwe.</p> <p><strong>Methods:&nbsp;</strong>a retrospective record review of secondary SARS-CoV-2 data from AiBST Laboratory in Harare between May to September 2020 was done. Epi Info TM was used to generate frequencies, proportions and conduct bivariate analysis.</p> <p><strong>Results:&nbsp;</strong>a total of 6,535 SARS-CoV-2 laboratory records were analysed. The median age of the patients was 36 years and 55% (3594/6535) were males. There was an increase in average analytical turn-around time (TAT) of SARS-CoV-2 results from May to August 2020. Analytical and preanalytical TAT remained above 2 days from August to September. Males were 1.18 times at risk of being SARS-CoV-2 infected than females (p&lt;0.05). The risk of being SARS-CoV-2 infected increased with age from 1.06 in the 11-20 age group to 1.45 in the 41-50 age group.</p> <p><strong>Conclusion:&nbsp;</strong>COVID-19 poses a greater threat to the older age groups and to men. The delayed TAT of SARS-CoV-2 results limits the efforts to control the pandemic. Decentralization of testing to provincial and district level would help improve result TAT.</p> Tendai Chipendo Takudzwa Marembo Humphrey Chituri Clayton Munemo Portia Manangazira Donewell Bangure Justen Manasa Copyright (c) 2021-11-25 2021-11-25 40 1 Role of psychomotricity in the management of body image disorders in schizophrenia: a case report <p>Schizophrenia is one of the most debilitating psychiatric disorders affecting around 1% of people worldwide. Its causes and management are quite poorly controlled. Patients with schizophrenia often experience an alteration in their body image. Its corollaries such as depersonalization are felt like real torture. In the biopsychosocial model of the management of mental health disorders, very few tools are effective in the management of depersonalization syndrome which is often overlooked by psychiatrists who mainly focus on erasing hallucinations and other positive symptoms. Psychomotricity, a poorly known branch of the biopsychosocial model, is still trying to find a place between psychological and body therapies. For a period of 6 months, we conducted a prospective case-study on two patients living with schizophrenia and treated in the Psychiatry Department of Laquintinie Hospital in Douala in Cameroon. In those patients, the association of psychomotor therapies provided a satisfactory response to a problem of depersonalization, also known as fragmentation anxiety.</p> Christian Eyoum Nathalie Kingue Mbenda Rodrigue Tchokona Kontchou Simon Noé Elessa Belle Erero Njiengwe Copyright (c) 2021-11-26 2021-11-26 40 1 Perceptions and opinions of Nigerians to the management and response to COVID-19 in Nigeria <p><strong>Introduction:&nbsp;</strong>we present a qualitative analysis of opinions of the Nigerian public as to how successful healthcare strategies have been, in containing the COVID-19 outbreak.</p> <p><strong>Methods:&nbsp;</strong>an online qualitative survey was conducted, consisting of 30 semi-structured questions.</p> <p><strong>Results:&nbsp;</strong>four hundred and ninety-five (495) respondents participated, ranging in age from 18 to 59 years. Over 40% of all respondents were critical of public health information. Participants saw provision of social support measures (n = 83), lack of economic, financial and social support (n = 65), enforcement of restrictions on movement outside the home, availability of face-masks and social distancing (n = 53) and provision of COVID-19 testing (n = 48) as the major things that were handled poorly by the government and health authorities.</p> <p><strong>Conclusion:&nbsp;</strong>we advocate coordinated forward planning for public safety until vaccines are widely available; while social distancing should continue. Policymakers need to be adaptable to changing conditions, given fluctuating case numbers and fatality rates.</p> Obinna Ositadimma Oleribe Ifeoma Eugenia Idigbe Princess Osita-Oleribe Olatayo Olawepo Zaidat Adesola Musa Samuel Aikhuomogbe Oliver Chukwujekwu Ezechi Michael Fertleman Babatunde Salako Simon David Taylor-Robinson Copyright (c) 2021-11-26 2021-11-26 40 1 COVID-19 pandemic and unmet need for family planning in Nigeria <p><strong>Introduction:&nbsp;</strong>the unmet need for family planning is a global health burden. The lockdown occasioned by the COVID-19 pandemic has reduced access to contraceptives, especially in the developing countries. This study examined the predictors of the unmet need for family planning during the COVID-19 pandemic lockdown in Nigeria.</p> <p><strong>Methods:&nbsp;</strong>the study adopted a cross-sectional analytical survey design. A self-designed questionnaire was administered to 1,404 adult respondents aged 18 years and above. The data was generated through the use of online Google survey and analyzed with SPSS version 25. The results were presented using descriptive and logistic regression at p≤0.05.</p> <p><strong>Results:&nbsp;</strong>fourty-seven percent of the respondents were females and 58.8% were married. The four major reasons for non-access to contraceptive methods during the lockdown were: fear of visiting health facility (77.9%), locked drug/chemist stores (51.2%), the restriction of movement (47.6%) and a lack of access to health care providers (42.9%). Predictors of unmet need for family planning were: aged 26-33 (OR = 1.912, 95% CI: 1.02-3.55), married/cohabiters (OR = 3.693, 95% CI: 2.44-5.58), tertiary education (OR = 0.272, 95% CI: 0.13-0.54), Yoruba ethnicity (OR=1.642, 95% CI: 1.02-2.62), rural residence (OR = 0.554, 95% CI: 0.36-0.85) and 2-4 children born (OR = 3.873, 95% CI: 2.32-6.45).</p> <p><strong>Conclusion:&nbsp;</strong>a significant proportion of Nigerians experienced an unmet need for family planning during the COVID-19 lockdown. Prioritizing the access to contraceptives during the pandemic would not only allow women and men to correctly plan childbirth, it also reduces maternal risks, poverty and undesirable fertility rates.</p> Turnwait Otu Michael Richard Dele Agbana Tolulope Funmilola Ojo Olasumbo Bilikisu Kukoyi Alfred Stephen Ekpenyong Damian Ukwandu Copyright (c) 2021-11-26 2021-11-26 40 1 An unusual occurrence of synovial sarcoma in forearm: a case report <p>Soft tissue sarcomas are group of malignant tumours arising from extra skeletal mesenchymal tissue. Presenting a patient with swelling over the posterior aspect of left arm for 6 months, gradually increasing in size for four months and rapidly increasing in size for last 2 months and not associated with pain. Peripheral pulses felt. Ultrasound showed large solid cystic intramuscular lesion arising from triceps muscle and Trucut biopsy showed poorly differentiated malignancy. Magnetic resonance imaging (MRI) left arm impression was large lobulated solid cystic space occupying lesion in triceps muscle, possibility of neoplastic lesion. Here the patient underwent wide local excision and reconstruction procedure followed by Radiotherapy, chemotherapy and regular follow up.</p> Karthikeyan Selvaraj Bharathiraja Kuppusami Manimaran Ramachandran Rajiv Kannan Ravishankar Kalambur Sundaram Copyright (c) 2021-11-26 2021-11-26 40 1 Colon perforation by foreign body insertion for sexual gratification: a case report <p>Occurrence of retained rectal foreign bodies with bowel perforation resulting from auto-eroticism is rare among males in Africa. Embarrassment attached to this condition may delay or derail acquisition of information and management. A 30-year-old male presented with abdominal pain and constipation for 3 days. Abdominal X-rays revealed free air-stripes under both hemidiaphragms and in the peripherals, a 25cm x 5.9cm lucent foreign body on the left side with proximal tapering. There was no evidence of intestinal obstruction. This was consistent with bowel perforation secondary to foreign body introduction. Exploratory laparotomy was performed, a plastic bottle of 250mls was removed from the colon. Transverse repair of a 10cm laceration extending from the rectum to the sigmoid was done and a colostomy placed. A high index of suspicion, a systematic approach and a lower threshold for imaging studies were key to successful management and favorable outcomes of this patient.</p> Alphonce Nsabi Simbila Ahmed Suphian Novath Julius Ngowi Ramadhani Juma Mfinanga Said Kilindimo Hendry Robert Sawe Copyright (c) 2021-11-29 2021-11-29 40 1 An entomological survey in the Sudanese Guinean environmental transition zone after indoor residual spraying, Chad <p><strong>Introduction:&nbsp;</strong>malaria is a major public health issue in Africa. In Chad in 2019, with 955,243 confirmed cases and 2,955 deaths, malaria is the main cause of consultations. A longitudinal entomological study was conducted in Moïssala Health District. Its objective was to assess the impact of indoor residual spraying with 80% bendiocarb wettable powder on malaria transmission.</p> <p><strong>Methods:&nbsp;</strong>two areas were defined for the study: Dembo, located in the sprayed area, Moïssala, in the untreated area. Two sampling methods were used: pyrethrum spray catches and human landing catches.</p> <p><strong>Results:&nbsp;</strong>sixteen sessions of human landing catches totalling 32 man-nights were conducted and 160 rooms/site were sprayed. Two anopheles were captured in Dembo and 547 in Moïssala. In Moïssala,&nbsp;<em>An coluzzii</em>,&nbsp;<em>An funestus</em>&nbsp;and&nbsp;<em>An rufipes</em>&nbsp;were captured in the rooms and on human bait.&nbsp;<em>An colluzzii</em>&nbsp;and&nbsp;<em>An funestus</em>&nbsp;were captured in pyrethrum spray catches in Dembo. The anophelian human landing catches density was zero in Dembo while it was 8.38 bites/man/night in outdoor and 10.06 bits/man/night in indoor in Moïssala. Only&nbsp;<em>An coluzzii</em>&nbsp;was found infected in human landing catches and sporozoite index of was 7.46% (10/134) in outdoor and 7.45% (12/161) in indoor in Moïssala. Malaria transmission was estimated at 0.63 infected bites/man/night in outdoor and 0.75 infected bites/man/night in indoor i.e. 229.95 infected bites/man/year in outdoor and 273.75 infected bites/man/year. In pyrethrum spray catches,&nbsp;<em>An coluzzii</em>&nbsp;and&nbsp;<em>An rufipes</em>&nbsp;were the two species found infected in Moïssala with sporozoite indices of 6.70% (23/343) and 20% (2/10) respectively. However, in Dembo, neither of the two captured mosquitoes was found infected.</p> <p><strong>Conclusion:&nbsp;</strong>the indoor residual spraying campaign in the eastern zone of Moïssala has led to the collapse of vectors´ density and aggressiveness. However, its evaluation over a short period of time is not sufficient to assess the impact of malaria transmission in this constant and endemic malaria zone.</p> Israël Demba Kodindo Elise Yangalbé Kalnoné Adoum Mahamat Oumar Moundai Tchonfinet Amen Nakebang Fadel Brahim Adef Abba Djédion Belemel Péka Mallaye Clément Kerah Hinzoumbe Copyright (c) 2021-11-29 2021-11-29 40 1 Carbon monoxide suicide by charcoal-burning: a case report and review of the literature <p>Charcoal burning (CB) suicide is an old method that revived and has clearly become prevalent across several countries, as considered "soft" and "painless". This alarming spread is induced by the contagious effect of suicidal behaviors. Internet and suicide web forums may play, unfortunately, a crucial role in promoting this suicide's method. In this paper, we present the first documented case of CB suicide in Tunisia and probably in all African countries. Thereupon, we report a case of a young man suicide and we detail the forensic investigation findings. In order to prevent a potential epidemic spread, this form of suicide should require further attention not only in regions where it is already recognized but also in countries where it is not yet prevalent.</p> Youssef Nouma Copyright (c) 2021-11-30 2021-11-30 40 1 Investigations and treatment offered to women presenting for infertility care in Harare, Zimbabwe: a cross sectional study <p><strong>Introduction:</strong>&nbsp;clinical infertility is failure to conceive within a year of regular sexual intercourse by a non contracepting couple. Infertility care is costly and result in investigations being incomplete and inconclusive. It is therefore important to streamline investigations offered to infertile couples such that only the most cost effective tests are done. This paper explores the adequacy of investigations and treatments offered to women presenting for infertility care.</p> <p><strong>Methods:</strong>&nbsp;the data used in this analysis was obtained from a cross sectional sample of 216 women who presented with infertility in public and private gynaecological clinics in Harare, Zimbabwe. Information on investigations and treatment offered to women presenting for care was extracted from hospital cards, case notes, laboratory and radiological reports. Data was analysed using STATA SE/15.</p> <p><strong>Results:</strong>&nbsp;of the 178 (82.4%) who had ultrasound scan evaluation (USS) 50 (28.1%) had fibroids and 22 (12.4%) had polycystic ovaries. Tubal patency tests were done in 118 participants using (hystero-salpingogram) HSG alone in 62.7%, laparoscope and dye alone in 21.2% and both in 16.1% of them. Of the 97 (44.9%) men who had semen analysis 61 (62.9%) had abnormal parameters.</p> <p><strong>Conclusion:</strong>&nbsp;this study reveals that evaluation for tubal patency and USS to rule out reproductive organ pathology are not being offered to all women with a diagnosis of infertility. Likewise, male partner semen evaluation is not being done in all male partners. There is a high prevalence of abnormal semen parameters. Studies should be done to understand why some male partners are not forthcoming in providing semen for analysis. It is important for protocols to be produced by professional bodies which prescribe the minimum basic investigations in couples with infertility.</p> Mugove Gerald Madziyire Thulani Lesley Magwali Vasco Chikwasha Tinovimba Mhlanga Copyright (c) 2021-11-30 2021-11-30 40 1 Prévalence et facteurs de risque des pseudarthroses traumatiques des os longs des membres à l´Hôpital Matanda en ville de Butembo à l´Est de la République Démocratique du Congo <p>La pseudarthrose est très redoutée et très difficile à traiter, même par le chirurgien orthopédiste. Le mieux à faire est toujours de la prévenir. L´objectif de notre étude était de déterminer la prévalence et les facteurs de risque des pseudarthroses traumatiques des os longs des membres en ville de Butembo. L´étude a été rétrospective sur un échantillon de 36 patients avec pseudarthrose traumatique, tirés d´une population de 968 patients avec fracture d´un os long de membre à l´hôpital Matanda, en ville de Butembo, à l´Est de la République Démocratique du Congo, du 01/06/2016 au 31/05/2019. Les données ont été tirées des dossiers d´hospitalisation. Nous avons calculé la fréquence et utilisé un modèle de régression logistique unifactorielle et multifactorielle pour explorer les facteurs associés à la pseudarthrose. La fréquence des pseudarthroses était de 3,72%. Le type de pseudarthrose le plus fréquent était le type flottant (69,44%). Les facteurs de risque retenus étaient: les professions pousse-pousseur (ORa: 4,60; IC à 95% 1,04-15,21; p = 0,023) et cultivateur (ORa: 2,31; IC à 95% 1,17-4,68; p = 0,008), la malnutrition (ORa: 5,83; IC à 95% 1,87-15,62; p = 0,004), l´intoxication au tabac (ORa: 6,70; C à 95% 1,84-20,11; p = 0,003) et à alcool + tabac (ORa: 4,74; IC à 95% 2,17-9,89; p &lt; 0,001), le traumatisme par balle (ORa: 6,70; IC à 95% 1,84-20,11; p = 0,003), la fracture ouverte (ORa: 4,35; IC à 95% 2,17-9,12; p &lt; 0,001), l´infection au foyer de fracture (ORa: 3,10; IC à 95% 1,03-7,95; p = 0,023); le soignant tradipraticien (ORa: 12,18; IC à 95% 5,74-25,37; p &lt; 0,001), le médecin généraliste (ORa: 8,33; IC à 95% 1,77-30,31; p = 0,006) et l´absence de radiographie initiale (ORa: 12,21; IC à 95% 5,92-24,96; p &lt; 0,001). Les pseudarthroses des os longs des membres sont fréquentes à Butembo. La connaissance et l´éviction de leurs facteurs de risque pourraient être une voie de solution efficace.</p> Ernest Badako Mogonza Aimé Lukwamirwe Vahamwiti Amos Sivulyamwenge Kaghoma Franck Katembo Sikakulya Emmanuel Kabuyahia Kamenge Sévérin Uwonda Akinja Copyright (c) 2021-11-30 2021-11-30 40 1 Quality of life of patients with allergic rhinitis at a South African referral hospital: a prospective cross-sectional study <p>Allergic rhinitis causes nasal as well as extranasal symptoms, and may adversely affect quality of life. The aims of this study were to determine the impact of allergic rhinitis on the health-related quality of life of adult patients attending the Ear Nose and Throat clinic at Universitas Academic Hospital, a public referral hospital in Bloemfontein, South Africa, and to determine the change in the health-related quality of life of patients with allergic rhinitis after one month of treatment. This was a prospective cross-sectional study of adult patients who were newly diagnosed with allergic rhinitis. Patients completed the Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ) at initial presentation and at follow-up after one month of appropriate treatment. Eighty-five (85) patients were included. At the initial visit, patients were most troubled by activity limitations and nasal symptoms, with a blocked nose being the most troublesome nasal symptom. There was a statistically significant improvement in scores of all domains after one month of treatment, with the mean total symptom score improving from 2.05±0.73 to 0.94±0.49. Allergic rhinitis had a negative impact on quality of life of patients. Appropriate treatment resulted in an improvement in quality of life.</p> Devesh Ramdhani Tamaryn Daniller Riaz Yakoob Seedat Copyright (c) 2021-12-01 2021-12-01 40 1 Frequency of sexual interactions and associated factors among long-distance truck drivers operating along the Northern Corridor Highway, Kenya <p><strong>Introduction:&nbsp;</strong>harsh working conditions among long-distance truck drivers (LDTDs) expose them to risky sexual interactions while on transit. As a result, the risky sexual interactions among the LDTDs place them at a high risk of contracting human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). This study sought to assess the sexual interactions and associated factors among the LDTDs in Kenya.</p> <p><strong>Methods:&nbsp;</strong>two hundred ninety-six (296) LDTDs were interviewed using interviewer-administered questionnaires. A systematic sampling technique was adopted. The number of sexual acts reported by the respondents was used to generate an ordered outcome variable (frequency of sexual interactions), in the order of; no sexual acts (zero), one to three sexual acts (1), and four to six sexual acts (2). Association between the predictor variables and the outcome variable was analysed using ordered logistic regression analysis in R statistical software.</p> <p><strong>Results:&nbsp;</strong>the mean age of the study participants was 38.4 years, with the youngest being 24 years and the oldest 57 years. Slightly above half of the participants (52.4%) reported no sexual interactions, while the rest (47.6%) had sexual interactions with either casual or regular sexual partners on the week preceding the survey. Age, the number of weeks spent on a transit journey, and drug use were independently associated with the frequency of sexual interactions among LDTDs involved in the study.</p> <p><strong>Conclusion:&nbsp;</strong>the frequencies of sexual interactions are likely to be higher among the younger LDTDs, those who spent more than one week on transit, and those who use alcohol and khat, hence a high exposure risk to HIV/STIs among them.</p> Cyrus Mutie Salome Kairu-Wanyoike Susan Mambo Reagan Ngoge John Gachohi Copyright (c) 2021-12-01 2021-12-01 40 1 Hand hygiene and face mask wearing practices for COVID-19 prevention: a non-intrusive observation of patrons of community convenience shops in Accra, Ghana <p><strong>Introduction:&nbsp;</strong>in the absence of a vaccine and definitive treatment, non-pharmacological measures of physical distancing, regular hand hygiene and wearing of face covering remain the mainstays of mitigating coronavirus disease 2019 (COVID-19). In Ghana, these measures are mandatory in public places and underpin COVID-19 infection prevention and control (IPC). We assessed adherence and appropriate performance of these measures among patrons of community convenience shops in selected hotspots.</p> <p><strong>Methods:&nbsp;</strong>we conducted a non-intrusive observation of patrons of convenience shops in COVID-19 burden hotspots. We observed patrons as they entered and exited the shops and collected data on their gender, adherence and appropriate use of face covering and hand hygiene facilities. Data were analyzed descriptively and inferentially to determine factors associated with adherence to IPC guidelines.</p> <p><strong>Results:&nbsp;</strong>of 800 patrons observed from eight community shops, 481 (60.1%) were males. Of these, 653 (81.6%) wore face covering and 98 (12.3%) performed hand hygiene; with 92 (11.5%) adhering to both measures. Patrons who wore face mask appropriately were 578; comprising 299 (92.3%) of patrons who wore face mask before entering the shops. Of 89 patrons who washed their hands, appropriate handwashing was recorded among nine (10.1%). Compared to inappropriate handwashing, appropriate handwashing was negatively associated with adherence to IPC guidelines [aOR=0.1 (95% CI=0.01-0.59)].</p> <p><strong>Conclusion:&nbsp;</strong>adherence to and appropriate performance of IPC measures of handwashing and use of face covering in the selected shops was low. There is the need to complement availability of IPC measures with intensification of risk communication messaging targeted at ensuring their appropriate use.</p> Donne Kofi Ameme Magdalene Akos Odikro Abraham Baidoo Paul Dsane-Aidoo Francis Sena Nuvey Dikena Garmonyou Jackson Abdul Gafaru Mohammed Felicia Alemna Emmanuel Kwame Tender Georgia Naa Korkoi Ghartey Oxygen Gershion Wullar Leroy Maximore Yaw Karikari Asamoah Ernest Kenu Copyright (c) 2021-12-01 2021-12-01 40 1 Adherence to iron folate supplementation and associated factors among pregnant women attending antenatal care at public hospitals in Jigjiga Town, Somali Region, Ethiopia 2020 <p><strong>Introduction:&nbsp;</strong>pregnant women are at particular risk of folate and iron deficiency due to their increased requirements, which can be difficult to meet through diet alone. Poor adherence to the supplement makes the prevalence of anemia among pregnant women high, which is associated with increased maternal and perinatal morbidity and mortality. The objective of study was to assess magnitude of adherence to iron-folic supplements and their associated factors among pregnant women attending antenatal care (ANC) at public hospitals in the Jigjiga Town, Somali Region.</p> <p><strong>Methods:&nbsp;</strong>an institutional based cross-sectional study was conducted on 290 pregnant during antenatal care service in two public hospitals. Mothers were randomly selected and interviewed using questionnaires. Multiple logistic regressions used to show the effect of independent variables.</p> <p><strong>Results:&nbsp;</strong>in this study, 290 women interviewed and the response rate was 91%. Nearly 54.9% were adherent to iron folic supplementation. The odds of adherence for secondary and above educated woman was almost three times (adjusted odds ratio [AOR]: 2.843; 95% CI: 1.177-6.865; P=0.020) that of illiterate. The odds of adherence for more than four visit women is almost twice of less than four visits (AOR: 1.991; 95% CI: 1.098-3.610; p=0.023). Similarly, odds of adherence for knowledgeable woman about iron folate supplement were twice of ill-informed women (AOR: 2.090; 95% CI: 1.134-3.852; P=0.018).</p> <p><strong>Conclusion:&nbsp;</strong>adherence to iron folic supplementation was very poor. Number of ANC visits, education of women, knowledge about iron folic supplement, history of still birth, and age were significant determinants to adherence.</p> Neima Ridwan Abdulfeta Shafi Copyright (c) 2021-12-01 2021-12-01 40 1 Mental health status of adults under institutional quarantine: a cross-sectional survey in Tunisia <p><strong>Introduction:</strong>&nbsp;restrictive measures imposed during the COVID-19 pandemic, such as quarantine, may induce psychiatric outcomes among concerned individuals. The present study aimed to describe the mental health status of Tunisian adults under mandatory institutional quarantine imposed during the COVID-19 pandemic, and to determine factors influencing the occurrence of psychiatric symptoms.</p> <p><strong>Methods:</strong>&nbsp;a cross-sectional phone survey was conducted from April to November 2020 using convenience sampling of persons who had experienced mandatory institutional quarantine. A standardized questionnaire was administered to participants including questions about socio-demographic characteristics and quarantine related information. Generalized anxiety disorder, depression symptoms, and sleep quality during quarantine were assessed using, respectively, the generalized anxiety disorder-7 (GAD-7), the centre for epidemiological studies depression (CES-D-10) and the insomnia severity index (ISI) scales. Bivariate and multivariate analyses were performed to determine factors associated with anxiety and/or depression and with clinical insomnia.</p> <p><strong>Results:</strong>&nbsp;among 506 participants, 38.3% experienced anxiety and/or depression symptoms (anxiety:15.4%; depression:37.4%) and 19.2% had clinical insomnia. The prevalence of anxiety and/or depression symptoms and insomnia were higher among women those who spent three hours or above on COVID-19 news, those who had economic difficulties due to COVID-19 pandemic, those who were not satisfied by the accommodation conditions of quarantine facilities, and those who had experienced stigma.</p> <p><strong>Conclusion:</strong>&nbsp;high prevalence of psychiatric symptoms among quarantined individuals was found in this study. Psychological interventions should thus be an integral part of the COVID-19 control strategy in order to provide adequate psychological support to persons quarantined due to COVID-19.</p> Ghassen Kharroubi Ines Cherif Sina Haj Amor Mariem Zribi Wejdene Ben Atigue Uta Ouali Jihene Bettaieb Copyright (c) 2021-12-03 2021-12-03 40 1 Personnel knowledge of intravenous admixtures: a survey in a government hospital <p><strong>Introduction:&nbsp;</strong>in Indonesia, intravenous admixtures are a common problem in hospitals. The incidence of microbial contamination in hospitals is still increasing every year. As such, knowledge of compounding personnel about intravenous admixtures is crucial in determining product quality. This study aims to assess the compounding personnel´s knowledge regarding intravenous admixtures and determine the relationship between socio-demographic characteristics with knowledge of compounding personnel in a government hospital, Indonesia.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted on 119 compounding personnel selected using purposive sampling from five different hospital units from September to November 2020. Data were collected using a self-administered questionnaire on socio-demographic factors and knowledge of intravenous admixtures.</p> <p><strong>Results:&nbsp;</strong>of the 119 compounding personnel who was respondent in this study, only 28 compounding personnel had good knowledge (23.5%). Most of the respondents were female at 52.9%, early adulthood at 63.9%, profession as a nurse of 100%, working period less than five years at 37.0%, civil servants at 53.8%, and employees who have never attended training at 84.9%. Spearman rank correlation test results showed that no significant correlation between sex, profession, working period, and employment status with knowledge. However, age and intravenous admixtures training history have a significant correlation with knowledge.</p> <p><strong>Conclusion:&nbsp;</strong>we found that most compounding personnel in a government hospital, Indonesia, were sufficiently understood with intravenous admixtures so that they should be aware of the importance of performing intravenous admixtures adequately.</p> Erza Genatrika Ika Puspitasari Susi Ari Kristina Teuku Nanda Saifullah Sulaiman Copyright (c) 2021-12-03 2021-12-03 40 1 A human rights assessment of a large mental hospital in Kenya <p><strong>Introduction:&nbsp;</strong>globally, human rights violations of persons with mental health conditions are rampant, and the quality of mental health services below that for general health services. The aim of this paper is to document the findings of an assessment of the quality of mental health services at the largest mental hospital in Kenya, and offer recommendations useful for service transformation.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional study. Assessment was conducted guided by the World Health Organization (WHO) QualityRights Tool Kit, which assesses for compliance with five human rights themes drawn from the Convention on the Rights of People with Disabilities. Trained assessors collected data through document review, observation, and interviews with hospital staff and service users at Mathari National Teaching and Referral Hospital. The sample was composed of 64 interviewees.</p> <p><strong>Results:&nbsp;</strong>overall, the facility was scored as “achievement initiated” indicating that there was evidence that steps had been taken to fulfil the five human rights themes but significant improvements were necessary. Five key gaps emerged: 1) the buildings and infrastructure were in a state of disrepair; 2) staffing was inadequate; 3) patients had no right to legal capacity; 4) there was gross neglect of patients as well as physical and verbal abuse; 5) there were no strategies in place to support community reintegration and independent living.</p> <p><strong>Conclusion:&nbsp;</strong>significant improvements to infrastructure, staffing, and the quality of services are needed before the Mathari National Teaching and Referral Hospital meets the requirements of the Convention on the Rights of People with Disabilities.</p> Joy Muhia Florence Jaguga Victoria Wamukhoma Jacqueline Aloo Simon Njuguna Copyright (c) 2021-12-03 2021-12-03 40 1 Real-time monitoring of a circulating vaccine-derived poliovirus outbreak immunization campaign using digital health technologies in South Sudan <p><strong>Introduction:&nbsp;</strong>the use of digital health technologies and geographical information systems (GIS) in the conduct of immunization campaigns had proven to be a success story, and is gaining acceptance towards improving supervision, accountability, and real-time access to quality information. The demand for real-time information by policymakers and stakeholders in the polio eradication programme is increasing towards ensuring a world free from all polioviruses. This study aims to develop a tool that monitor and evaluate the circulating vaccine-derived poliovirus (cVDPV) campaign processes in real-time using open data kits (ODK) to collect data, analyze and visualize using an interactive dashboard in Power BI, towards improving timeliness and completeness of data reporting and providing real-time quality information to stakeholders.</p> <p><strong>Methods:&nbsp;</strong>electronic checklists were developed using open data kits (ODK) and uploaded onto android-based smartphones for data collection during a round of cVDPV outbreak response immunization. Supervisors were deployed to the field and the checklists were utilized at both stages of the campaign activities. A Power BI data visualization tool was used for reporting, analysis, and monitoring the activities of the campaign.</p> <p><strong>Results:&nbsp;</strong>an interactive dashboard was developed, providing real-time information that supports stakeholders during the campaign processes with improved timeliness and completeness of data reporting. The usage of the tool during the campaign enhanced close supervision, and increased transparency in data availability and accessibility by all partners.</p> <p><strong>Conclusion:&nbsp;</strong>the study had shown that real-time information has significantly improved the smooth conduct of the immunization campaign processes through identifying gaps, and challenges in the field and can be utilized in similar resource settings including complex and humanitarian. It has demonstrated the capability of mobile phones using ODK for data collection and linked to a Power BI dashboard for enhanced supervision and transparency, and we encourage further studies to assess the effects of the tools on the campaign results.</p> Isah Mohammed Bello Maleghemi Sylvester Melesachew Ferede Godwin Ubong Akpan Ademe Tegegne Ayesheshem Michael Nzioki Mwanza Samuel Okiror Atem Anyuon Olu Olushayo Oluseun Copyright (c) 2021-12-04 2021-12-04 40 1 The rationale of ethanol inhalation for disinfection of the respiratory tract in SARS-CoV-2-positive asymptomatic subjects <p>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is a major health concern and is affecting the socio-economic lives. As other highly contagious diseases, it is of outmost importance to early identify and treat the healthy carriers or positive asymptomatic subjects (PAS). SARS-CoV-2 entry points are mainly in the respiratory tract. No specific virucidal treatments against SARS-CoV-2 are currently available. Monoclonal antibodies are under evaluation, but high cost and possible ineffectiveness against virus variants could limit its use. Resorting nonspecific drugs is an alternative approach. Among them, ethanol (EtOH) is known to be a powerful, cost-effective and abundant virucidal agent, now advised for surgical hand and surfaces disinfection. The paper aims to determine the potential role of inhaled ethanol to disinfect SARS-CoV-2 PAS, taking into account the dimension of the problem, ethanol efficiency and other beneficial effects on the respiratory tract, ethanol local and general toxicity and ethanol therapeutic window; consequently, to propose a study in order to verify this hypothesis. Together with the consolidated knowledge, an extensive review of the medical literature has been carried out looking for sound data able to support (or discard) the rationale on which a study could be built up. Evident data supporting the inhaled ethanol potential role on SARS-CoV-2 PAS disinfection have been found and discussed. A clinical trial to test the hypothesis that inhaled ethanol could be rapidly efficient in lowering or eradicating SARS-CoV-2 from the respiratory tract in PAS is advisable. Individual and public health benefits are stressed, together with socio-economic positive fallouts.</p> Pietro Salvatori Copyright (c) 2021-12-04 2021-12-04 40 1 Aggressive behavior and recurrent spinal hydatid cyst <p>Hydatid cyst disease is caused by the parasite&nbsp;<em>Echinococcus granulosus</em>. Hydatidosis affecting the spine constitutes only 1% of cases. In 90% of the spinal cases, the disease is confined to the bone and the epidural space. Here we report a 25-year-old female patient, followed since the age of 3 for hepatic, renal and peritoneal hydatidosis, undergoing medical treatment (Albendazole). Operated 15 years ago (dorsal laminectomy) for spinal cord compression in consequence to the extension of the disease to the spinal cord at D12-L1 level. The course was marked by the progressive worsening of gait disorders with spinal deformity. The current examination shows a steppage gait and paraparesis, without sensitive disorders. The osteotendinous reflexes are abolished in the 2 lower limbs. We also noted the presence of a significant thoracolumbar kyphoscoliosis. A spinal MRI demonstrated a recurrence of hydatidosis centered on the vertebral body of D11 which is practically destroyed with right and left para-vertebral extensions at D10, D11, D12 and epiduritis in D11 (A, B, C, D). Spinal CT confirms the almost complete lysis of the D11 vertebral body (E). Albendazole (400 mg p.o.) is administered twice daily. A Spondylectomy D11, curettage of the lesion and aspiration of necrotic tissue with spinal stabilization were proposed. Her situation remained unchanged after 4 months of follow-up. Although the hydatid cyst is characterized as benign pathology, in consequence of its local growing pattern, it can be classified in the malign group because of its high potential for dissemination, which can result in high incidence of recurrences.</p> Amine Trifa Kais Maamri Copyright (c) 2021-12-06 2021-12-06 40 1 Human papillomavirus type 16 (HPV-16) IgG antibody among women of reproductive age presenting at a healthcare facility in Central Nigeria: a pilot study <p>Approximately, 70% of cervical cancer cases worldwide are attributable to HPV-16 and HPV-18, with HPV-associated cancers being the second most common infection-related cancers globally. However, there´s paucity of data about this infective agent in Central Nigeria. In a cross-sectional study, we evaluated the seroprevalence of HPV-16 immunoglobulin G (IgG) and risk determinants among women in Central Nigeria as a first step towards evaluating anti-HPV IgM antibody for active cases and determining incidence. Blood samples were collected between August 2016 and January 2018, from 400 consenting women of childbearing age (15-49 years) who completed structured questionnaires. Samples were analyzed using HPV-16 specific IgG ELISA kits (Cusabio Co. Ltd, Germany). Statistical analysis was performed to determine predictors. Overall, we found that 128 (32.0%) had IgG antibody against HPV-16. Seroprevalence by age was 50.0% (15-19 years), 55.0% (20-24 years), 12.9% (25-29 years), 50.0% (30-34 years), 32.1% (35-39 years), 18.2% (40-44 years) and 19.4% (45-49 years) respectively. Factors associated with infection were age (P=0.0002; 95% CI 5.06-31.51), occupation (P&lt;0.0001; 95% CI 1.4-12.6), number of sex partners (P=0.0037; 95% CI 1.27-49.93), history of genital warts (P=0.0203; 95% CI 1.34-9.55) and education level (P&lt;0.0001; 95% CI 3.89-60.11). In addition, forty six (11.5%) reported having the history of genital warts with 268 (67.0%) and 132 (33.0%) subjects being married and single respectively. Individuals who were either artisans or civil servants were 260 (65.0%), whereas 140 (35.0%) were students. Majority, 324 (81.0%), had either primary, secondary or tertiary education with 76 (19.0%) of the subjects having no formal education. In respect of sexual behaviour, 196 (49.0%) reported having at least two sexual partners, out of which 64 (16.0%) had three or more. These findings provide high serological evidence of exposure to HPV-16 in Central Nigeria with implications for national and regional intervention initiatives.</p> Moses Peter Adoga Rine Christopher Reuben Khadijah Abubakar Victor Baba Oti Abigail William Zakka Copyright (c) 2021-12-06 2021-12-06 40 1 Improving sepsis care in Africa: an opportunity for change? <p>Sepsis is common and represents a major public health burden with significant associated morbidity and mortality. However, despite substantial advances in sepsis recognition and management in well-resourced health systems, there remains a distinct lack of research into sepsis in Africa. The lack of evidence affects all levels of healthcare delivery from individual patient management to strategic planning at health-system level. This is particular pertinent as African countries experience some of the highest global burden of sepsis. The 2017 World Health Assembly resolution on sepsis and the creation of the Africa Sepsis Alliance provided an opportunity for change. However, progress so far has been frustratingly slow. The recurrent Ebola virus disease outbreaks and the COVID-19 pandemic on the African continent further reinforce the need for urgent healthcare system strengthening. We recommend that African countries develop national action plan for sepsis which should address the needs of all critically ill patients.</p> Alexander James Keeley Emmanuel Nsutebu Copyright (c) 2021-12-06 2021-12-06 40 1 Analysis of registered radiological equipment in Kenya <p><strong>Introduction:</strong>&nbsp;diagnostic radiology plays a key role in healthcare. Proper planning of healthcare requires accurate and robust data. There´s, however, paucity of comprehensive figures on radiological equipment in the African setting. The goal of this study was to carry out an in-depth analysis of the registered radiological equipment in Kenya, a lower middle-income African country, and compare the findings to published international data.</p> <p><strong>Methods:</strong>&nbsp;data on radiological equipment were obtained from the Kenya Nuclear Regulatory Authority and analyzed as units/million of the population by imaging modality, health service sector and administrative units. The findings were then compared to published international data.</p> <p><strong>Results:</strong>&nbsp;there has been an overall increase in the number of radiological equipment in comparison to data published in 2013, with a relatively uniform distribution of resources across all eight regions. General radiography is the most available modality at 24.5 units/million with the majority of the equipment owned privately, while the public sector (9.6 units/million) has less than a half of the WHO recommendation of 20 units/million. Accessibility to computerized tomography (CT) scan, fluoroscopy and mammography in the public sector closely mirrors that of South Africa. On the contrary, positron emission tomography-computerized tomography (PET-CT) is the least-resourced modality and is currently only available in the private sector.</p> <p><strong>Conclusion:</strong>&nbsp;the increased number and homogenous distribution of radiological resources can largely be attributed to the Managed Equipment Services project launched by the national government in 2016. More needs to be done with regards to availability of PET/CT scanners and general radiography equipment in the public sector.</p> Lynne Muthoni Gathuru Gabriel Daniel Onditi Elias Richard Denys Pitcher Copyright (c) 2021-12-06 2021-12-06 40 1 An evaluation of COVID-19 surveillance system in New Juaben South Municipality of Ghana: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>among others, the objectives of Ghana’s COVID-19 surveillance system are to rapidly detect, test, isolate and manage cases, to monitor trends in COVID-19 deaths and to guide the implementation and adjustment of targeted control measures. We therefore aimed to examine the operations of the COVID-19 surveillance system in New Juaben South Municipality, describe its attributes and explore whether its objectives were being met.</p> <p><strong>Methods:&nbsp;</strong>we utilized a mixed method descriptive study design to evaluate the COVID-19 surveillance system in the New Juaben South Municipality of the Eastern Region of Ghana. Desk review and key informant interviews were carried out from 1<sup>st</sup>&nbsp;February to 31<sup>st</sup>&nbsp;March 2021 to measure nine surveillance system attributes as an approximation of its performance using the CDC’s 2013 updated surveillance system guidelines.</p> <p><strong>Results:&nbsp;</strong>while the COVID-19 surveillance system in New Juaben South (NJS) was highly representative of its population, it was rated ‘moderate’ for its stability, flexibility, sensitivity and acceptability. The system was however characterized by a low performance on data quality, simplicity, timeliness and predictive value positive. The sensitivity and predictive value positive (PVP) of the system were 55.6% and 31.3% respectfully.</p> <p><strong>Conclusion:&nbsp;</strong>while the surveillance system is only partially meeting its objectives, it is useful in the COVID-19 response in New Juaben South Municipality. System performance could improve with stigma reduction especially among health care workers, timely testing and simplification of surveillance forms and software.</p> Hectoria Awekeya Stephen Dajaan Dubik Kingsley Amegah Anthony Ashinyo Francis Wuobar Ekow Kaitoo Winfred Ofosu Mary Eyram Ashinyo Copyright (c) 2021-12-06 2021-12-06 40 1 Blood donor eligibility after COVID-19 vaccination: the current state of recommendations <p>The medical screening practices for blood donor eligibility after vaccination against several conventional infectious agents are well known to blood transfusion centres worldwide. Classically, blood donations are contraindicated for four weeks after vaccination with a live attenuated virus vaccine. For other types of vaccines, no postponement is necessary as there is no proven infectious risk. But for the COVID-19 vaccine, besides the classic platforms for the vaccine, two new types of vaccine platforms have been developed and based on viral vectors vaccines and vaccines from viral genetic material. Thus, blood establishments could be worried that these COVID-19 vaccine production platforms can pose any particular safety concerns for recipients of blood or blood products from vaccinated subjects. Our work aims to provide professionals in blood transfusion centres with all the available information to clarify any confusion relating to the need or not to defer donors who have received a COVID-19 vaccination. So in this paper, we provide an international review of the data available to date about the recommendations of international scientific societies about blood donation after COVID-19 vaccination, all types of COVID-19 vaccines included. We also present some experiences of blood transfusion establishments worldwide concerning this topic and among them our institution, the Moroccan National Centre for Blood Transfusion and Haematology.</p> Sabah Bouhou Khadija Lahjouji Azlarab Masrar Copyright (c) 2021-12-06 2021-12-06 40 1 La grossesse ovarienne à propos d’un cas et revue de la littérature <p>La grossesse ovarienne représente une entité rare parmi les grossesses ectopiques. Son diagnostic et sa prise en charge ne sont pas toujours aisés. C´est une pathologie particulière, le clinicien est confronté à une sémiologie clinique pauvre et à un diagnostic échographique difficile. Les critères chirurgicaux restent difficiles à prouver. Nous avons colligé un cas de grossesse ovarienne. La patiente a consulté nos urgences pour des douleurs pelviennes, métrorragies et une aménorrhée de 9 semaines d’aménorrhée (SA). Le diagnostic préopératoire a été évoqué à l´échographie qui a montré une image latéro utérine droite de 7*8cm au dépend de l'ovaire droit. Une laparotomie a été réalisée en urgence. Le traitement chirurgical a été radical après l´échec du traitement conservateur. La grossesse ovarienne est une entité rare de la grossesse extra-utérine qui présente certaines particularités sémiologiques. Son diagnostic est difficile et se base sur des constatations per-opératoires. Sa prise en charge thérapeutique reste pour le traitement des grossesses extra-utérines, malgré le progrès de traitement médical, chirurgicale.</p> Olfa Zoukar Ines Zouari Yosra Jemaa Rahma Aissa Amina Mnejja Amel Bayar Dalel Naguez Dhekra Toumi Mossaab Ghannouchi Anis Haddad Copyright (c) 2021-12-07 2021-12-07 40 1 Management of chyle leak in right side neck dissection: a rare case and review of literature (a case report) <p>Chyle leak is a well-recognized iatrogenic thoracic duct injury but a rare and serious complication of head and neck surgery affecting 1-2.5% of head and neck surgery dissections. It is potentially a life-threatening condition and management may be problematic and prolonged. Here we presented a rare case report of right sided chyle leak with its surgical management and review of literature. A 56-year-old patient with a complain of non-healing ulcer in the right buccal vestibule in the last 1-2 months reported to the outpatient department (OPD). After complete preoperative profile and counseling patient's consent was taken and wide local excision of lesion was done with bite composite resection with right hemimandibulectomy and maxillary alveolectomy till pterygoid plates, with right side selective neck dissection, level I-III followed by reconstruction with right side pectoralis major myofascial flap. Then the patient was on 5 days octreotide therapy. Regular post-operative follow-up was taken and no leak was noted further. In case of a chyle leak early diagnosis and aggressive treatment is essential to avoid local and systemic complications that prolong hospitalization.</p> Rahul Deshmukh Purva Kulkarni Umesh Bhutekar Atul Kala Shivam Richhariya Hitesh Tawari Copyright (c) 2021-12-07 2021-12-07 40 1 Detection of metallo-beta lactamases and oxacillinase genes in carbapenem-resistant Acinetobacter baumannii strains isolated in Morocco <p><strong>Introduction:&nbsp;</strong>resistance to carbapenem is widespread among&nbsp;<em>Acinetobacter baumannii</em>&nbsp;(<em>A. baumannii</em>) strains. Metallo-beta lactamases enzymes (MBL) are responsible for carbapenem resistance, as are oxacillinases (OXA). In recent years, MBL producing carbapenem-resistant strains have been reported in the world and Morocco at increasing rates. Our study aimed to investigate the presence of carbapenemases in acinetobacter strains isolated from hospitalized patients in CHU Fez.</p> <p><strong>Methods:&nbsp;</strong>a total of 58 imipenem-resistant&nbsp;<em>A. baumannii</em>&nbsp;strains isolated from clinical samples were investigated. The presence of MBL was described phenotypically by the double-disk synergy test (DDST), MBL E-test, and modified Hodge test. The bla<sub>IMP</sub>, bla<sub>VIM</sub>, genes, and bla<sub>OXA-23</sub>, bla<sub>OXA-51</sub>&nbsp;genes were investigated by multiplex polymerase chain reaction (PCR). The blaNDM-1 gene was determined by simplex PCR.</p> <p><strong>Results:&nbsp;</strong>fifty-eight strains were resistant to imipenem (98%), the modified Hodge test (MHT) was positive for 58 strains (100%), 47 strains (82%) were found to be positive for MBL by the test of double-disk synergy (DDST), 58 strains (100%) were positive by E-test MBL. The OXA 51 gene was detected in all strains, and the OXA 23 gene was detected in 53 strains (91%). In addition, the MBL genes were not detected by genotypic methods.</p> <p><strong>Conclusion:&nbsp;</strong>the OXA-23 and OXA-51 carbapenemases type are responsible for the resistance to carbapenems in&nbsp;<em>A. baumannii</em>&nbsp;resistant to carbapenems in our establishment. Resistance to carbapenems by MBL enzymes has been found by phenotypic tests, which must be confirmed by genotypic methods; and solicit other MBL genes.</p> Abdelhamid Massik Lahbib Hibaoui Btissam Arhoune Ghita Yahyaoui Bouchra Oumokhtar Mustapha Mahmoud Copyright (c) 2021-12-07 2021-12-07 40 1 Séries temporelles: déterminants pathologiques des examens cytobiochimiques d´urines et infection urinaire entre 2011-2014 aux cliniques universitaires de Kinshasa <p><strong>Introduction:&nbsp;</strong>l´examen cytobiochimique urinaire est un outil complémentaire le plus demandé au laboratoire à côté de l´hémogramme. Il a une grande valeur prédictive dans les infections urinaires quand il est correctement fait et scrupuleusement interprété. L´objectif de cette étude était d´évaluer l´ampleur, l´évolution, les déterminants, et les comorbidités cytobiochimiques de l´infection urinaire.</p> <p><strong>Méthodes:&nbsp;</strong>il s´est agi d´une étude documentaire, avec des approches, descriptive, analytique et comparative portant sur des patients référés pour examens cytobiochimiques des urines aux laboratoires de Cliniques Universitaires de Kinshasa (CUK) entre 2011 et 2014.</p> <p><strong>Résultats:&nbsp;</strong>au total, 8926 analyses cytobiochimiques ont été demandées avec moins de 2% d´analyses biochimiques. Les femmes étaient plus représentées (6426 femmes vs 2500 hommes) avec un sex ratio 3F:1H. Il y avait plus de demandes dans la tranche d´âge de 30-39 ans (17%; n=1517). Les analyses ont plus été demandées pendant les saisons de pluies 72% (n=3511) avec le pic pendant les mois de mai. Les infections urinaires estimées à 54,8% [n=4892 ajusté dont&nbsp;<em>E. coli</em>&nbsp;(n=1937), Klebsiella (n= 993)] étaient plus diagnostiqués pendant la période de 2012 à 2014. Il existait une association indépendante et significative entre le sexe féminin (OR aj = 3,5; IC = 95%; 3,1-3,8; P&lt;0,0001, l´admission pendant les saisons de pluies (OR aj = 1,3, IC = 95%; 1,2-1,4; P&lt;0,0001 et l´infection urinaire.</p> <p><strong>Conclusion:&nbsp;</strong>l´infection urinaire émerge comme une préoccupation majeure pour les patients de sexe féminin et admises pendant les saisons de pluies et les années 2012-2014 de la série de 2011 à 2014 aux CUK. La rareté de l´infection urinaire était observée au cours de l´année La Nina 2011 post-l´année trop chaude EL Nino alors que l´ampleur de l´infection urinaire était coexistante pendant les années 2012-2014 normales relativement chaudes pré-l´année très chaude El Nino 2015. Il existe donc une interaction entre le climat tropical chaud et humide de la ville de Kinshasa et le climat global (mondial) froid dans le cadre de la variabilité climatique/réchauffement climatique, pouvant expliquer la flambée des infections urinaire à Kinshasa.</p> Jacques Bikaula Ngwidiwo Mireille Solange Nganga Nkanga Vandersal Salaboni Munzengi Eugène Epombo Yvon Wangi Ngoy Héritier Mawalala Malengele Etienne Mokondjimobe Benjamin Longo Mbenza Copyright (c) 2021-12-08 2021-12-08 40 1 Translation, psychometric evaluation and validation of the “diabetes health profile-18” questionnaire in Arabic <p><strong>Introduction:&nbsp;</strong>measuring quality of life requires an instrument validated in the population language. The purpose of our study was to translate and analyze the psychometric properties of the literary Arabic version of the “diabetes health profile (DHP)-18”.</p> <p><strong>Methods:&nbsp;</strong>we conducted a methodological study for psychometric evaluation and validation of the DHP-18, following the steps of the cross-cultural validation described by Vallerand. A convenience sample of people with diabetes was collected for this purpose. The developed questionnaire included participants‘ demographic characteristics, diabetes data and the experimental version of the DHP-18 questionnaire. Validity, reliability and questionnaire standards establishment were carried out.</p> <p><strong>Results:&nbsp;</strong>a sample of 333 diabetics was recruited. Test-retest correlation coefficient (r = 0.985; p&lt;0.01) and Cronbach's alpha coefficient (alpha = 0.840) showed that the experimental version was accurate in terms of temporal stability and internal consistency. The content validity index was 0.84 and showed that the questionnaire statements accurately measured the concepts under study. The exploratory principal axis factoring, using the orthogonal varimax rotation, allowed the extraction of a factorial solution with four independent factors, grouping the 18 items of the questionnaire. Correlation coefficients between the three corresponding dimensions of the theoretical model of the questionnaire were low and positive, between 0.431 and 0.535, confirming that each dimension measured a unique content.</p> <p><strong>Conclusion:&nbsp;</strong>the literary Arabic version of the DHP-18 has proven to be valid, reliable and ready for use in clinical practice in Tunisian people with diabetes.</p> Maali Haoues Chekib Zedini Molka Chadli-Chaieb Copyright (c) 2021-12-08 2021-12-08 40 1 Exploring reasons for COVID-19 vaccine hesitancy among healthcare providers in Ethiopia <p><strong>Introduction:&nbsp;</strong>the World Health Organization has identified vaccine hesitancy as one of the top ten threats to global health. The purpose of this study was to explore factors contributing to COVID-19 vaccine hesitancy among healthcare providers, their perspectives regarding vaccine uptake by the public and their recommendations to improve vaccine uptake in Ethiopia.</p> <p><strong>Methods:&nbsp;</strong>a phenomenological qualitative study was conducted among purposively selected healthcare providers working in the Ministry of Health (MoH), regulatory authority, public and private hospitals and health centres who hesitated to take the COVID-19 vaccine in Addis Ababa, Ethiopia in June 2021. A total of twenty in-depth interviews were conducted using a semi-structured open-ended interview guide. Participants included nurses, physicians, pharmacists, health officers, Medical Laboratory technologists and midwives. A qualitative content analysis approach was chosen to analyse the data.</p> <p><strong>Results:&nbsp;</strong>all the participants agreed (n=20) that lack of consistent information and inadequate evidence about COVID-19 vaccine safety, efficacy and quality were the main reasons for COVID-19 vaccine hesitancy. History of perceived and confirmed COVID-19 infection history, misinformation, religious views, unknown short and long-term effects of the vaccine and undefined length of time of vaccine´s protection were also other reasons mentioned by the participants.</p> <p><strong>Conclusion:&nbsp;</strong>healthcare providers were hesitant toward COVID-19 vaccine mainly due to lack of clear evidence regarding the vaccine´s short and long-term safety, efficacy and quality profiles. Hence, the long-term safety and efficacy of the vaccine should be extensively studied and evidence dissemination and communication should be clear and transparent.</p> Fisseha Shiferie Oumer Sada Theodros Fenta Mirgissa Kaba Atalay Mulu Fentie Copyright (c) 2021-12-08 2021-12-08 40 1 An outcome of educational intervention on the menstrual hygiene practices among school girls in Ogun State, Nigeria: a quasi-experimental study <p><strong>Introduction:</strong>&nbsp;adolescence is a special period of physical and psychological preparation for safe motherhood that requires specific attention as it marks the onset of menarche. Hygiene-related practices are significant during menstruation to prevent being predisposed to reproductive tract infections and other complications. The main objective of the study was to determine the outcome of educational intervention on the menstrual hygiene practices among school girls in Ogun State, Nigeria using the health belief model. One hypothesis guided the study.</p> <p><strong>Methods:</strong>&nbsp;the study utilized a quasi-experimental design comprising of three experimental groups and one control group. The population of the study was one hundred and twenty (120) in-school adolescent girls. The multistage sampling technique was used in selecting participants from four secondary schools within Ogun State. A validated semi-structured questionnaire was used for data collection with a Cronbach alpha with a score of 0.87. Data collected were analysed using Statistical Package for Social Sciences (SPSS) version 23.</p> <p><strong>Results:</strong>&nbsp;a paired T-test analysis was conducted in determining the results. The observed difference in the mean in the parent-led (Δ = 3.80; t = 20.886; p=0.000), peer-led group (∆ = 4.23; t = 19.901; p=0.000), and combination of parent and peer-led group intervention group (Δ = 3.53; t = 18.015; p=0.000) were statistically significant.</p> <p><strong>Conclusion:</strong>&nbsp;peer-led experimental group had the greatest effective change in the level of adolescent girls´ menstrual hygiene practices. Peer educators could be recruited for future interventions and scaled up in other aspects of young girls´ reproductive health and well-being.</p> Catherine Olukemi Agbede Ugochinyere Chinasa Ekeanyanwu Copyright (c) 2021-12-08 2021-12-08 40 1 Prevalence and etiologies of pulmonary hypertension at Somalia-Turkey Training and Research Hospital in Mogadishu <p><strong>Introduction:</strong>&nbsp;pulmonary hypertension (PH) is one of the leading causes of mortality in the world. This study aimed to determine the ratio distribution and etiological characteristics of PH in Somalia-Turkey Training and Research Hospital.</p> <p><strong>Methods:</strong>&nbsp;the study was designed as a hospital-based retrospective observational study and included 260 patients who were diagnosed with PH by transthoracic echocardiography (TTE) in the cardiology outpatient clinic in Somalia-Turkey Training and Research Hospital in Mogadishu. Sociodemographic and clinical characteristics and data on morbidity were retrieved from clinical records.</p> <p><strong>Results:</strong>&nbsp;the echocardiographic prevalence of PH was found to be 18% (n=260). PH due to left heart disease was the most common form of PH (n=151, 58%), followed by PH due to lung disease (n=61, 23%), group 1 PH (n=38, 16%), group 5 PH (n=7, 2%), and chronic thromboembolic PH (CTEPH) (n=3, 1%).</p> <p><strong>Conclusion:</strong>&nbsp;the present study showed that the prevalence of PH in Somalia is relatively higher than the rest of the world's average. The distribution characteristics of the disease could be related to the region-specific differences of the causative diseases. Further studies are needed to better capture the epidemiology of PH in Somalia.</p> Gökhan Alıcı Ömer Genç Copyright (c) 2021-12-09 2021-12-09 40 1 Vaccination against Hepatitis B among health care workers in the Bamenda Health District: influence of knowledge and attitudes, Cameroon <p><strong>Introduction:&nbsp;</strong>Hepatitis B virus (HBV) infection is one of the most serious occupational hazards faced by healthcare workers (HCW). This study aimed at assessing the influence of knowledge and attitudes of HCWs in the Bamenda Health District (BHD) on their vaccination status.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional analytic study carried out in Bamenda health district, Cameroon. Random sampling method was used to select 10 private, 10 public, and 4 confessional health facilities, from which 280 HCW were included in the study by convenience sampling. Data were analysed using Epi Info 7 and presented using tables, figures, and percentages.</p> <p><strong>Results:&nbsp;</strong>the vaccination coverage among HCW in the BHD was found to be 13.9%. Healthcare workers who had no knowledge of the minimum number of doses for complete primary HBV vaccination were less likely to be vaccinated than those who had knowledge (p = 0.00). Healthcare workers who had been tested for HBsAg were more likely to be vaccinated than those who had not done the test (p = 0.00). Among HCW (90.7%) who knew they were more at risk of contracting HBV, 98.6% knew it can be prevented out of which 72.6% reported that vaccination is the most effective means of prevention; only 13.9% of HCW were vaccinated. Other factors could have influenced the vaccination status of HCW; high cost of the vaccine, lack of time for vaccination, negligence, and the non-availability of the vaccine.</p> <p><strong>Conclusion:&nbsp;</strong>awareness should be created among HCW and they should be encouraged to go for HBsAg screening and those who are negative should receive a full dose of HBV vaccine. Also, the vaccine should be subsidized and made available to all HCW in the BHD.</p> Anye Muriel Ngum Sobngwi Joëlle Laure Xavier Tchetnya Tabe Armstrong Tambe Claude Nkfusai Ngwayu Frankline Sevidzem Wirsiy Catherine Atuhaire Samuel Nambile Cumber Copyright (c) 2021-12-09 2021-12-09 40 1 Gender differences in HIV testing service visits and its related factors among adults: a cross-sectional study in Homa Bay, Kenya <p><strong>Introduction:&nbsp;</strong>at least 90% of people living with human immunodeficiency virus (HIV) were expected to know their HIV status by 2020. However, only 84% are aware of their status. This study determined the frequency of HIV testing services visits (HTS) and its related factors to HTS visits among adults in Homa Bay County, Kenya.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional study. Quantitative and qualitative data were collected. A backward stepwise logistic regression analysis was conducted for quantitative data by gender. Qualitative data were thematically categorised into factors of HTS visits by gender.</p> <p><strong>Results:&nbsp;</strong>a total of 645 adults participated in quantitative survey and 17 in qualitative survey. There were no gender differences in the frequency of HTS visits (males=56.3%; females= 58.7%, P=0.785). The frequency of visits was however significantly different between the rural-based (Rachuonyo North=87.5%; Ndhiwa=58.7%) and urban-based (Homa Bay Town=36.8%) facilities at P&lt;0.001. In males, HTS visits were positively associated with ´being in Protestant church´, ´partner´s attitude´, and ´being accompanied by a friend to HTS´. ´Distance to HTS´ was negatively associated with HTS visits in males. For females, 'sexual intercourse in the past 2-5 months´ was positively associated with HTS visits. ´Being in a polygamous marriage´, ´not married´, ´community HIV testing´, and ´affordability of transport cost to HTS centre´ were negatively associated with HTS visits.</p> <p><strong>Conclusion:&nbsp;</strong>there were no gender differences in the frequency of HTS visits. Social position for males and position in the family for females are suggested as the factors influencing HTS visits in Homa Bay County.</p> Kana Suzuki Ryota Ochiai Rose Okoyo Opiyo Yuri Tokunaga Yoko Imazu Setsuko Watabe Copyright (c) 2021-12-09 2021-12-09 40 1 An innovative fixation technique by osteosuture in a young athletic female patient with coracoid process fracture: a case report <p>Coracoid process fractures are uncommon lesions but are frequently associated with an acromioclavicular dislocation. The aim of this article is to report our experience of an innovative fixation technique by osteosuture in a young athletic female patient presenting a displaced fracture of the coracoid process on the insertion footprint of coracoclavicular ligaments, with no breach of continuity of the lower coracoid cortex. She also had a roockwood type 3 acromioclavicular dislocation. After a deltopectoral approach, the fracture was reduced to the anatomical position and stabilized by a first lacing, using a non-absorbable large caliber thread passing under the mid part of the coracoid process between the 2 coracoclavicular ligaments. A second lacing passing under the coracoid process and through the trapezoid ligament, and a third one through the conoïd ligament. At 6 months, the fracture was consolidated and the constant score was 100/100. This innovative fixation provides good clinical and radiological results in the short and medium term.</p> Juliette Fradet Alexandre Losson Christopher Koneazny Tanguy Vendeuvre Copyright (c) 2021-12-11 2021-12-11 40 1 Spontaneous vertebral artery dissection in an elder patient: a case report <p>Vertebrobasilar artery dissection (VBD) is a rare cause of posterior ischemic strokes. It is more likely to occur in young patients with a history of traumatism or hereditary connective tissue disorders. Spontaneous VBD is rare, especially in elder patients. This paper aims to report the case of an old patient that presented with a posterior ischemic stroke due to a spontaneous vertebral artery dissection (SVAD), linked to atherosclerosis. The diagnosis of SVAD was made by Magnetic resonance imaging (MRI) which is the gold standard technique to diagnose this pathology in a short time so the patient could receive adequate treatment.</p> Fatima-Ezzahrae Badi Mouna Sabiri Samia El Manjra Samira Lezar Fatiha Essodegui Copyright (c) 2021-12-11 2021-12-11 40 1 Therapeutic plasma exchange in acute fatty liver of pregnancy: a case report and literature review <p>Acute fatty liver of pregnancy(AFLP) is characterised by acute liver failure that occurs most commonly in the third trimester of pregnancy. Emergent delivery of the foetus reverses liver failure in most cases. Rarely, termination of pregnancy may not reverse liver failure, and adjunct interventions may be required. Therapeutic plasma exchange (TPE) has been described in AFLP in very few reports. We describe a patient in whom liver failure and extrahepatic organ failure persisted four days after delivery. She underwent TPE for persistent liver failure which resulted in prompt clinical improvement. We propose that TPE be considered as a measure to salvage AFLP patients with liver failure that does not reverse after termination of pregnancy.</p> Ajay Kumar Anand Sharma Yatendra Mohan Itish Patnaik Ashok Kumar Kavita Khoiwal Gita Negi Rohit Gupta Copyright (c) 2021-12-13 2021-12-13 40 1 Sexual and reproductive health of adolescents and young people in the Gambia: a systematic review <p><strong>Introduction:&nbsp;</strong>in Gambia, adolescents and young people make up 32% of the national population. Observations indicate that this population group lacks access to quality information and services on sexual and reproductive health. This systematic review explored sexual and reproductive health indicators for adolescents and young people in Gambia.</p> <p><strong>Methods:&nbsp;</strong>published studies on sexual and reproductive health indicators were searched in PubMed, Google Scholar and African Journals Online. Moreover, national reference documents containing relevant in-country data on adolescents and young people's sexual and reproductive health were also collected and reviewed. Search terms for published studies focused on modern contraceptive and sexually transmitted infections (STIs) prevalence rates, availability and accessibility to sexual and reproductive health (SRH) services and satisfaction levels with SRH services among adolescents and young people (aged 10-24 years).</p> <p><strong>Results:&nbsp;</strong>the review showed that contraceptive prevalence rates among adolescents and young people in Gambia ranged from 7% to 9%. Reasons for low contraceptive prevalence among adolescents and young people included limited knowledge and access to sexual and reproductive health information and services, provider attitudes, stigma, shame, lack of money and cultural and religious misconceptions associated with contraception. Overall, the review found limited information on STI prevalence among adolescents and young people, with only a single published study reporting a prevalence rate of 8.4%. In addition, inadequate counseling and complaints related to physical environmentprocess of providing sexual and reproductive health services and information were significant factors associated with satisfaction with SRH services among adolescents and young people.</p> <p><strong>Conclusion:&nbsp;</strong>this review provides important baseline data that may be useful for policymakers and program managers to improve adolescents and young people's sexual and reproductive health in Gambia.</p> Mat Lowe Phebian Ina Grant Sagnia Olusegun Awolaran Yves Armand Médessi Mongbo Copyright (c) 2021-12-13 2021-12-13 40 1 The determinants of early childbearing by disability status in Uganda: an analysis of demographic and health survey data <p><strong>Introduction:&nbsp;</strong>females with disabilities experience multiple sexual and reproductive challenges that can result in teenage pregnancy and motherhood. This study assessed the determinants of early childbearing among women by disability status.</p> <p><strong>Methods:&nbsp;</strong>the study used the 2016 Uganda demographic and health survey data, analyzing a weighted sample of 18,506 women of reproductive age. We used frequency distributions to describe respondents´ characteristics, chi-squared tests and multivariable logistic regressions to establish the determinants of early childbearing.</p> <p><strong>Results:&nbsp;</strong>early childbearing is higher among women with disabilities. The determinants of early childbearing among women with disabilities were marital status, religion, education, and occupation. The odds of early childbearing were higher among ever married compared with never married women (aOR=5.35; 95% CI: 2.42-11.84, p=0.000); women who engaged in sales and services compared with those that did not work (aOR=2.73; 95% CI: 1.36-5.50, p=0.005); and smaller religious faiths compared with protestants (aOR=2.70; 95% CI: 1.04-1.34, p=0.047). The odds reduced with advancement in education. Region, attitude towards violence and knowledge of the ovulatory cycle, though associated with early childbearing for nondisabled women were not significant for women with disabilities.</p> <p><strong>Conclusion:&nbsp;</strong>the lack of formal education and early marriages increased the odds of early childbearing for all women. Efforts to address early childbearing especially for women with disabilities should consider advancing women´s education; and preventive measures targeting women of smaller religious faiths, stressing the dangers of early sex and marriages. The measures should target women with disabilities irrespective of attitudes towards violence, knowledge concerning fertility, and region.</p> Betty Kwagala Stephen Ojiambo Wandera Copyright (c) 2021-12-14 2021-12-14 40 1 Hysterosalpingography findings of female partners of infertile couple attending fertility clinic at Lagos University Teaching Hospital <p><strong>Introduction:&nbsp;</strong>Hysterosalpingography (HSG) is an outpatient fluoroscopic method for the evaluation of the uterine cavity, fallopian tubes, and the surrounding peritoneal cavity. Female fertility depends greatly on normal female reproductive organs; hence tubal abnormalities may contribute significantly to female infertility. HSG is an invaluable screening tool in the evaluation of women with suspected tubal factor infertility. This study aims to review the HSG findings of women who sought fertility treatment at the Lagos University Teaching Hospital, Lagos (LUTH).</p> <p><strong>Methods:&nbsp;</strong>this was a retrospective study of the pattern of HSG findings among female partners of infertile couples seeking fertility treatment at the LUTH, over a 2-year period, from January 2018 to December 2019.</p> <p><strong>Results:&nbsp;</strong>a total of 266 medical records and HSG results were reviewed and included in the data analysis. The mean age (± standard deviation) was 38.4 (± 0.3) years with a range of 24 to 50 years. Most (80.5%) of the participants have secondary infertility and majority (65.4%) were nulliparous. Tubal pathology was the commonest abnormality detected on HSG in 54.9% of women. About one-third (30.8%) of women had bilateral tubal occlusion on HSG. With regards to the right fallopian tube, 43.2% of the participants had tubal occlusion, which differs from 41.7% on the left fallopian tube. Similarly, 10.2% of the women had hydrosalpinx on the left tube when compared with 9% on the right tube. Age (OR 1.055; 95% CI: 1.006, 1.106, p-value 0.028), and previous salpingectomy [OR 6.151; 95% CI: 1.335, 28.349] and myomectomy [OR 4.6; 95% CI: 1.814, 11.67] were identified as risk factors for tubal pathologies on HSG.</p> <p><strong>Conclusion:&nbsp;</strong>tubal abnormalities are common findings on HSG and the identifiable risk factors for tubal pathologies include age, salpingectomy, and myomectomy. HSG remains a vital screening tool in the evaluation of tubal-factor infertility in Nigeria.</p> Christian Chigozie Makwe Aloy Okechukwu Ugwu Oyebola Halimah Sunmonu Salimat Abisoye Yusuf-Awesu Nneoma Kwemtochukwu Ani-Ugwu Olayemi Emmanuel Olumakinwa Copyright (c) 2021-12-14 2021-12-14 40 1 Diagnostic challenges and management of choledochal cyst in an 11-year-old child: a delayed diagnosis (a case report) <p>Choledochal cyst are rare congenital disease of the biliary tree. It presenting as cystic dilatations of the biliary tree can involve the extrahepatic biliary radicles, the intrahepatic biliary radicles or both. They are typically a surgical problem of infancy and childhood, but less than a quarter of the patients the diagnosis is delayed until adulthood as it presenting with vague and nonspecific signs and symptoms. In a case with biliary symptoms, abdominal ultrasound scan is the initial imaging modality of choice. Precise and accurate delineation of the biliary system mandates cholangiography with the advantage of non-invasive magnetic resonance cholangiopancreatography (MRCP) over endoscopic retrograde cholangiopancreatography. A case report of 11-year-old Tanzania girl with abdominal swelling and jaundice presented to a health facility for evaluation. She complained of abdominal swelling that her mother noticed when she was 3 years old, located above the umbilicus and since then it was not changed its size until 8 years later when it rapidly increased in size associated with non-specific dull pain. Abdominal computed tomography (CT) scan was done showed A well-defined hypo-attenuated non-enhancing retro-gastric cyst. Percutaneous transhepatic cholangiopancreatography (PTC) was performed due to inconclusive findings from CT-scan showed extrahepatic huge cystic dilatation, dilated central right hepatic ducts, left intrahepatic ducts failed to be visualize. Diagnosis of choledochal cyst type isovaleric acidaemia (IVA) was made. Explorative laparotomy was done, huge cystic mass occupying common bile duct was seen below the liver with distended gallbladder covered with visceral peritoneum. Second part of duodenum, pancreases and transverse colon was adhered to the inferior surface of the mass that further make difficult for cyst excision and reconstruction. Cyst was decongested and cholangioenterostomy with Roue-en-Y reconstruction was made. Cholecystectomy was done, hemostasis archived abdomen closed and patient sent to Intensive care units (ICU). Despite of advanced diagnostic modalities, delayed diagnosis of choledochal cyst can be a challenge due to its vague and nonspecific signs and symptoms. Excision of the cyst and reconstruction by hepatojejunostomy as the standard therapy could be difficult due to its biliary complications such as adhesion and infection and hence cyst-enterostomy drainage procedure can be done as option for relief of patient discomfort and prevent further complications.</p> Novath Julius Ngowi Kaitila Murusuri Ally Mwanga Yona Ringo Copyright (c) 2021-12-15 2021-12-15 40 1 Economic Impact of COVID-19 Lockdown on households <p><strong>Introduction:&nbsp;</strong>this study evaluated the economic impact of the COVID-19 lockdown on individuals and households.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional online survey was used to collect data. Nigerian citizens who were domiciled or restricted from travelling abroad for no less than one month since the COVID-19 restrictions and lockdown were recruited into the study through focal persons purposively selected across the different states in Nigeria. Using WhatsApp® platform, the respondents completed the survey on household income and expenditure before and during the lockdown. Economic burden of COVID-19 lockdown on individuals and families was estimated using a prevalence-based cost of illness approach.</p> <p><strong>Results:&nbsp;</strong>four hundred and four (male = 242; female = 162) individuals have participated in the study. The mean (SD) age of the respondents was 30.98 (10.92) years. Monthly income showed no statistically significant difference (p = 0.73) before and during lockdown. The overall household expenditure before and during the lockdown periods were USD 320 and USD 290. The total mean monthly costs for COVID-19 and non-COVID-19 health related problems were ₦11746.25 (USD30.79) and ₦11784.9 (USD 30.89), respectively. Household expenditure for hand sanitizers, facemasks, hand gloves, and disinfectants increased significantly during the COVID-19 restriction lockdown (p &lt; 0.05). However, expenditure on education, water, electricity, fuel, internet data, clothing and wears, toiletries decreased significantly during the lockdown period (p &lt; 0.05).</p> <p><strong>Conclusion:&nbsp;</strong>this study suggests that the costs of continuing COVID-19 restrictions could have huge economic consequences on households and health system.</p> Francis Fatoye Tadesse Gebrye Olujide Arije Clara Toyin Fatoye Omotola Onigbinde Chidozie Emmanuel Mbada Copyright (c) 2021-12-15 2021-12-15 40 1 Computed tomography features of spontaneous acute intracranial hemorrhages in a tertiary hospital in Southern Ghana <p><strong>Introduction:</strong>&nbsp;spontaneous acute intracranial hemorrhage (SICH) accounts for approximately 10-15% of all stroke cases. Early detection by computed tomography (CT) and early treatment are key. Hence this study to examine the CT features of SICH.</p> <p><strong>Methods:</strong>&nbsp;this retrospective cohort study reviewed all 435 patients diagnosed with SICH from 1<sup>st</sup>&nbsp;March, 2017 to 1<sup>st</sup>&nbsp;January, 2021 in a tertiary facility in Southern Ghana. Data collected (age, sex, SICH type and the CT scan features) were organized and analyzed using GNU PSPP and Libre Office Calc. Statistical significance level was pegged at p≤0.05.</p> <p><strong>Results:</strong>&nbsp;the SICH types were acute intracerebral hemorrhage (97.93%), acute subarachnoid/intraventricular hemorrhage (1.15%), acute epidural hemorrhage (0.46%) and acute subdural hemorrhage (0.46%). Acute intracerebral hemorrhage was more common in those &gt;60 years (57.75%, p&lt;0.001). The commonest CT feature for acute intracerebral hemorrhage was hyperdense lesion with perilesional edema (40.98%), with smoking (OR=2.24, 95% CI: 1.14-4.41, p=0.019) and anticoagulants intake (OR=2.56, 95% CI: 1.15-5.72, p=0.022) as the predictive factors; followed by hyperdense lesion extending to the edge of the brain (25.03%), also predictable by smoking (OR=0.23, 95% CI: 0.11-0.47, p&lt;0.001); and hyperdense lesion with mass effects (22.70%) was not predictive with any risk factor. Type 2 diabetes mellitus (60.00%, p&lt;0.001) and smoking (97.83%, p&lt;0.001) were more common in males.</p> <p><strong>Conclusion:</strong>&nbsp;hyperdense lesion with perilesional edema was the most frequent CT feature for acute intracerebral hemorrhage and was predictable by smoking and anticoagulants intake. Smoking was a predictive factor to the development of most of the features of acute intracerebral hemorrhage.</p> Emmanuel Kobina Mesi Edzie Klenam Dzefi-Tettey Edmund Kwakye Brakohiapa Philip Narteh Gorleku Eric Aidoo Kwasi Agyen-Mensah Peter Appiah-Thompson Adu Tutu Amankwa Ewurama Andam Idun Frank Quarshie Richard Ato Edzie Benard Osei Prosper Dziwornu Abdul Raman Asemah Copyright (c) 2021-12-16 2021-12-16 40 1 Perceived quality of life and life style modification of cancer patients undergoing varied treatments in a tertiary health institution, Ekiti State, Nigeria <p><strong>Introduction:&nbsp;</strong>cancer is viewed in the African context as a death sentence. Its effect can be overwhelming to both the patient and their support system. The objective of the study was to assess the perceived quality of life of cancer patients undergoing varied cancer treatments in a tertiary health institution in Ekiti State and to determine the life style modification of cancer patients undergoing varied treatments in the same health facility.</p> <p><strong>Methods:&nbsp;</strong>the study employed a descriptive cross-sectional design. A consecutive sampling approach was utilized to select 80 respondents among the cancer patients who attended the cancer registry within the study time frame. Data was collected from these cancer patients by using structured and validated questionnaire. Data was analyzed using descriptive statistics and inferential statistics with level of significance set at p &lt; 0.05.</p> <p><strong>Results:&nbsp;</strong>respondent´s ages ranged from 20 - 61 years with a mean age of 50 ± 18.3 years. Only 7.8% are not dependent on medications to function in their daily life. Most of the participants reported that their sex life has been affected (61.1%) and 77% of the respondents reported fatigue. About 76% of respondents need varying measure of medical treatment to function in their daily life. Overall, 44.8% have poor quality of life, while 55.1% had good quality of life in this current study. Moreover, a significant relationship was found between quality of life and self-assessment of patient´s health (p &lt; 0.001). Multivariate analysis predicting factors affecting quality of life of respondents revealed that self-assessment of respondents (AOR: 3.389; 95% CI: 1.897-6.054) remained a significant and more likely predictor of quality of life while respondent´s age (AOR: 0.244; 95% CI: 0.068-0.876) and level of education (AOR: 0.054; 95% CI: 0.005-0.546) were less likely predictors.</p> <p><strong>Conclusion:&nbsp;</strong>one quarter of the participants have poor quality of life and majority of the participants need varying measure of medical treatment to function in their day to day life. Management of cancer patients should be geared towards improving/ameliorating symptoms and improving quality of life of cancer patients.</p> Deborah Tolulope Esan Khadijat Toyin Musah Fayokemi Mary Olaiya Opeyemi Adeniyi Adedeji Emmanuel Omoniyi Olowolafe Copyright (c) 2021-12-16 2021-12-16 40 1 Impact of the recent Ebola epidemic with pandemic potential on the economies of Guinea, Liberia and Sierra Leone and other West African countries <p>West Africa experienced its first Ebola epidemic in 2014. Its magnitude in terms of morbidity and mortality was greater than any other epidemic. It has particularly affected Guinea, Liberia and Sierra Leone. Its impact, beyond the high mortality, is also economic. The Ebola virus disease spread to several other African countries with limited resources, causing a significant financial burden to their health systems but also impacting the entire economy of the countries. The objective of this essay is to reflect on the consequences of the Ebola virus epidemics on West African economies in the short term. Estimates of the economic burden of the epidemic range from $2.8 billion to $32.6 billion in lost gross domestic product. The sectors affected by the economic crisis are the most important of the contaminated countries, namely agriculture, mining and trade. There has been a halt in socio-economic activities in the most affected regions. The decrease in the number of workers affected by the virus, the exodus to the least affected areas, and the repatriation of government employees have contributed to the decrease in the income of individuals and states. The fear of contamination by foreign countries has reduced imports, but also all tourist activities, which in turn have had an impact on the restaurant and hotel sectors. All these financial and food disruptions have exposed the population of these countries to food insecurity. The analysis of the impact of the Ebola virus on West African economies in the short term was as devastating as the health impact. This impact has directly contributed to a decrease in economic growth not only for the affected countries but also for all West African countries that depend on these same resources. A loss of about US$32.6 billion over two years in the West African region has been estimated, which is equivalent to 3.3% of the regional gross domestic product (GDP) in the absence of Ebola in 2014.</p> Mohamed Lamine Dramé Paulo Ferrinho Maria Rosário Oliveira Martins Copyright (c) 2021-12-16 2021-12-16 40 1 Invalid measles vaccine dose administration and vaccine effectiveness in Ethiopia <p><strong>Introduction:&nbsp;</strong>Ethiopia endorsed the African regional measles elimination goal in 2012 and has been implementing measles elimination strategies. Administration of measles vaccine before the age of nine months decreases seroconversion. Ensuring administration of valid doses and monitoring vaccine effectiveness is crucial for achieving measles elimination. The objective of the study was to describe the magnitude of invalid measles dose administration and vaccine effectiveness in Ethiopia.</p> <p><strong>Methods:&nbsp;</strong>we analysed the 2016 Ethiopian Demographic and Health Survey (EDHS) immunization coverage data for Ethiopia to determine the age at measles vaccine administration and proportion of measles age invalid doses administered. The national measles surveillance data for children with birthdates that match 12-23 months old children surveyed in the EDHS 2016, were analysed to determine the Proportion of Cases Vaccinated (PCV) with one dose of measles vaccine. We estimated the effectiveness of measles vaccine by using the proportion of measles cases vaccinated (PCV) from measles surveillance data and the measles vaccination coverage among children aged 12-23 months reported in the demographic health survey (DHS) done in 2016 (Percent of Population Vaccinated for measles, PPV). The screening method was used to estimate measles vaccine effectiveness at national level and for regions which reported more than 30 measles cases among children 9-23 months of age in the 2013-2015 period. The correlation between the median age of invalid doses administered, proportion of invalid doses and measles vaccine effectiveness was analysed.</p> <p><strong>Results:&nbsp;</strong>at national level, the proportion of invalid measles dose administration was 27.6% for children aged 12-35 months surveyed in the 2016 DHS survey in Ethiopia. Among children reported in the measles case-based surveillance database with birthdates that match the children surveyed in the Ethiopian DHS 2016, the proportion of measles cases vaccinated with a single dose of measles vaccine in the 2013-2015 period was 22.7%. The vaccine effectiveness for single dose measles vaccination was estimated at 75.3%. The measles vaccine effectiveness was low for regions with high proportion of invalid dose administration and lower median age of invalid dose administration. The median age of measles dose administered before the age of nine months was significantly correlated with measles vaccine effectiveness (r=0.971, p=0.001) in the respective regions.</p> <p><strong>Conclusion:&nbsp;</strong>the proportion of invalid measles dose administration is very high in Ethiopia and is associated with lower vaccine effectiveness. Further assessment should be carried out to understand the underlying root causes for invalid dose administration, focusing on areas with high proportion of invalid measles doses. The national program should devise strategies to promote timely vaccination as per the national schedule, and to revaccinate those vaccinated before 9 months of age. The ministry of health should also strengthen the platform for immunization in the 2<sup>nd</sup>&nbsp;year life, to ensure high routine immunization coverage with two doses of measles vaccine to achieve the measles elimination goal in Ethiopia.</p> Teklay Desta Ephrem Lemango Daddi Wayessa Liya Wondowossen Mirkuzie Kerie Balcha Masresha Copyright (c) 2021-12-16 2021-12-16 40 1 Splénomégalie multi-nodulaire révélatrice d’une tuberculose multifocale à localisation splénique et vertébrale: à propos d’un cas <p>La tuberculose splénique et le mal de Pott sont deux entités rares, notamment chez un sujet immunocompétent. Nous rapportons le cas d'une femme immunocompétente de 57 ans qui a présenté un tableau de douleur de l´hypocondre gauche atypique évoluant depuis 3 mois, associée à une paraparésie des 2 membres inférieurs d´installation progressive. Les données de laboratoire n'ont fourni aucune information spécifique pour le diagnostic, à part les résultats du QuantiFERON qui était positive. La tomodensitométrie abdominopelvienne a révélé une splénomégalie avec de multiples lésions nodulaire hypodenses dans la rate. L´imagerie par résonance magnétique (IRM) médullaire a montré un aspect de spondyldiscite de l´étage D10-D11 avec des collections épidurales et paravertébrales responsable d´une compression médullaire, le GenExpert dans le prélèvement osseux était positif avec la présence d´un granulome centré par une nécrose caséeuse à l´étude histologique, le diagnostic de la tuberculose multifocale a été retenu.</p> Asmaa N´khaili Mariama Jarti Marj Zouhour Haida Meryem Aouroud Adil Ait Errami Sofia Oubaha Zouhour Samlani Khadija Krati Copyright (c) 2021-12-16 2021-12-16 40 1 Treatment outcomes and characteristics of hiv-2 patients compared to hiv-1 patients on an NNRTI-based first line art at the adult infectious diseases centre of the university Teaching Hospital (UTH) in Lusaka <p><strong>Introduction:&nbsp;</strong>the focus of antiretroviral therapy (ART) in Zambia has been on HIV-1. However, some patients are infected with HIV-2 or both. HIV-2 is resistant to non-nucleoside reverse transcriptase inhibitors (NNRTIs), drugs used for HIV-1. Therefore, this study sought to determine the seroprevalence of HIV-2 or dual infection in HIV infected individuals and compare the treatment outcomes associated with HIV subtype in patients taking NNRTI-based first line cART at the University Teaching Hospitals (UTH).</p> <p><strong>Methods:&nbsp;</strong>this was a cross- sectional study, we collected data from the Virological Impact of Switching from Efavirenz and Nevirapine based first-line cART regimens to Dolutegravir (VISEND) study being conducted at UTH. Ninety six individuals were included in the study. Descriptive and inferential statistics were performed. Logistic regression was used to assess the relationship between treatment outcomes and HIV type.</p> <p><strong>Results:&nbsp;</strong>the proportion of HIV 1 and 2 co-infected patients was 5.2% (95% CI 2%-12%). The mean age was 46 years ± 2 years with 60 (62.5%) being females. The median viral load was 1.3 log 10 copies/ml, IQR 0-1.7 log 10 copies/ml and the median absolute CD4+ T cell count increased from 231 to 463 cells/mm³ (p &lt; 0.001) after being on cART for one year or more. The study did not report any associations between treatment outcomes and HIV type (p &gt; 0.05).</p> <p><strong>Conclusion:&nbsp;</strong>there is a small proportion of patients that are HIV 1 and 2 co-infected but are on an NNRTI-based cART regimen, drugs that are not active against HIV-2. This, however, does not seem to significantly affect the patient´s virological or immunological treatment outcome.</p> Anita Thandiwe Bhebhe Gershom Chongwe Given Moonga Copyright (c) 2021-12-16 2021-12-16 40 1 Leprechaunism <p>Donohue syndrome is a chromosome recessive inherited disorder. It’s additionally called leprechaunism. Donohue syndrome is because of compound heterozygous or homozygous mutation within the insulin receptor (INSR) gene. It results in either complete or virtually complete absence of hypoglycemic agent receptors. Donohue syndrome is most severe type of hypoglycemic agent disorder. A 21-year-old male, born to blood- related birth-givers, could be a noted case of Donohue syndrome. He was diagnosed with this syndrome at three years of age. He was a known Type 1 diabetic with overstated hyperglycemia with hyperinsulinism and dysmorphic characteristics and cranio-facial abnormalities. Physical examination showed genitomegaly, lipoatrophy (A), abdominal distension, dermal disorders and huge depressed ears with elfin facies (B). Laboratory tests were conducted and the findings disclosed: plasma aldohexose random-339 mg/dl, blood urea nitrogen- 42 mg/dl, creatinine-3.50 mg/dl, Insulin- &gt;1000 micro-IU/ml and very low testosterone-19.82ng/dl. Clinical examinations for complete body systems were additionally performed. Chest X-ray and echo was traditional. Retinopathy screening showed macular-star in the right eye. Ultrasound abdomen showed accrued cortical echoes in each kidney with reduced corticomedullary differentiation, therefore the patient was also on weekly chemical dialysis. Neurological examinations were intact. Deoxy ribonucleic acid analysis using period-time polymerase chain reaction (PCR) are frequently used for distinguishing this syndrome. Other diagnosis are Type-A syndrome and Rabson Mendenhall syndrome. Treatment needs efforts from endocrinologists, dermatologists and numerous different medical professionals. Treatment with insulin-like protein one can also be contemplated.</p> Supraja Nagarathinam Krishna Prasanth Baalann Copyright (c) 2021-12-16 2021-12-16 40 1 Drug therapy problems identified among patients receiving antiretroviral treatment in a HIV clinic: a prospective study in North Central, Nigeria <p><strong>Introduction:&nbsp;</strong>despite improved life expectancy for people living with HIV (PLWH), aging, comorbidities, and associated drug treatment increase the risk for drug therapy problems (DTPs). We assessed pharmacists´ identification and resolution of DTPs among PLWH.</p> <p><strong>Methods:&nbsp;</strong>a prospective study was conducted among PLWH aged ≥10 years (N=100) in a Nigerian HIV clinic. Trained pharmacists delivered a six-step intervention that included the establishment of patient-provider relationship, gathering and validation of patient´s data, identification of DTPs, intervention, outcome identification, and documentation. Descriptive statistics were used to examine data collected via a pharmaceutical care assessment tool.</p> <p><strong>Results:&nbsp;</strong>in all, 215 DTPs were identified and classified as unnecessary drug therapy [27.4% (n=59)], non-adherence [21.9% (n=47)], needs additional drug therapy [16.7% (n=36)], adverse drug reaction [(14.0% (n=30)], wrong drug [(10.7% (n=23)], and dosage variation [n=20 (9.3%)]. Within each DTP class, the most common cause was addiction/recreational drug use [39.0% (n=23)], drug product not available [63.8% (n=30)], untreated condition(s) [61.1% (n=22)], undesirable effects [66.7% (n=20)], condition refractory to drug [34.8% (n=8)], and drug interaction [45.0% (n=9)], respectively. The most common interventions were medication information/recommendation to patients/prescribers (30.4%) and initiation of drug therapy (22.2%). Six-month resolution rate was 90% (n=194) with the most common outcomes being improvement in patient adherence [23.6% (n=50)], addition of a drug [18.9% (n=40)], and reduction in drug overuse [15.6% (n=33)].</p> <p><strong>Conclusion:&nbsp;</strong>pharmacists´ intervention resulted in 90% resolution of detected DTPs, implying that pharmacists are crucial in improving antiretroviral treatment outcomes.</p> Roseline Iberi Aderemi-Williams Sabina Onyinye Nduaguba Eric Monday Akoji Patricia Uche Ogbo Isaac Okoh Abah Copyright (c) 2021-12-16 2021-12-16 40 1 Factors associated with genital prolapse to Saint Joseph Hospital of Kinshasa <p><strong>Introduction:&nbsp;</strong>the aim of this study was to identify factors associated with genital prolapse in the gynecology and obstetrics service of Saint Joseph hospital of Kinshasa.</p> <p><strong>Methods:&nbsp;</strong>this was a retrospective case-control study conducted from 148 medical files of patients admitted in the gynecology and obstetrics service of Saint Joseph hospital from January 1, 2008 to December 31, 2017. It was based on the non-probabilistic sampling of suitability for cases selection. The T-student test, Chi-test and logistic regression were used in statistical analyses.</p> <p><strong>Results:&nbsp;</strong>five factors independently associated with genital prolapse were identifying: obesity with BMI≥30Kg/m<sup>2</sup>&nbsp;(OR: 3.770, 95% CI: 1.040-9.250; p=0.001), menopause (OR: 1.910, 95% CI: 1.090-10.930; p=0.001), fœtal macrosomia (OR: 4.290, 95% CI: 3.320-5.550; p=0.000), vaginal delivery (OR: 2.070, 95% CI: 1.010-5.210; p=0.006) and perineal tears (OR: 1.510, 95% CI: 1.250-1.910; p=0.000).</p> <p><strong>Conclusion:&nbsp;</strong>these factors independently associated with genital prolapse can be used for screening of high-risk women in gynecological and obstetrical consultations in order to improve the treatment of genital prolapse in our milieu.</p> Antoine Tshimbundu Kayembe Charles Didier Kitenge Kia Kayembe Jean-Patrick Kamba Bebele Rahma Rachid Tozin Copyright (c) 2021-12-16 2021-12-16 40 1 Cervical cancer and precancerous cervical lesions detected using visual inspection with acetic acid at Livingstone Teaching Hospital <p><strong>Introduction:</strong>&nbsp;cervical cancer (CaCx) is the second most common malignancy in women world-wide. Precancer screening aided by visual inspection with acetic acid (VIA) is an early diagnosis method used to detect the lesions that are high indicators of cancer in women. cervical cancer is more prevalent in the developing world affecting mainly women in the reproductive age group and is the commonest cancer among Zambian women. Therefore, the study aimed to determine the prevalence and factors associated with a positive VIA at Livingstone Teaching Hospital (LTH).</p> <p><strong>Methods:</strong>&nbsp;this was a cross-sectional study conducted at LTH among 329 women from Livingstone district aged 18 and above, who were coming for routine cervical cancer screening using VIA between 2019 and 2020. Demographic and clinical data were collected from the CaCx clinic. A positive VIA (precancerous cervical lesions) and cervical cancer were the primary and secondary outcome variables. A positive VIA was defined by presence of a dense ulcerative acetowhite area in the transformation zone of the cervix. Cervical cancer diagnosis was defined by presence of cancerous cells on histological examination by a qualified pathologist. Data were analyzed using Statistical package for social sciences (SPSS) version 22.0. Chi-square test, Mann-Whitney and logistic regression were the statistical methods used.</p> <p><strong>Results:</strong>&nbsp;the participants had a median (interquartile range) age of 37 (29, 44) years. Prevalence of CaCx and positive VIA were 6% (95% confidence interval (CI) 4, 9) and 19% (95% CI: 15, 24) respectively. At multivariable analysis, the factors associated with a positive VIA were alcohol consumption [odds ratio (OR) 0.30 (95% CI: 0.12, 0.74)] and HIV infection [OR 0.37 (95% CI: 0.19, 0.70)].</p> <p><strong>Conclusion:</strong>&nbsp;the study showed that precancerous cervical lesions are common among our study participants and it was influenced by alcohol consumption and HIV status. There is therefore need to enhance the screening programs using VIA in order to identify cancerous lesions at an early stage for early intervention in resource limited settings.</p> Valerie Hayumbu Joy Hangoma Benson Malambo Hamooya Malan Malumani Sepiso Kenias Masenga Copyright (c) 2021-12-17 2021-12-17 40 1 Towards a unified approach for multiple myeloma care in Kenya - proceedings of the Inaugural Multiple Myeloma Congress <p>The rising burden of multiple myeloma in Kenya has not been met by a commensurate effort for control. Patients and practitioners struggle with unavailability and unaffordability of diagnostics, drugs and stem cell transplant leading to presentation at advanced stages and under-treatment with increased morbidities and mortality. A concerted effort among stakeholders is urgently needed to develop strategies for myeloma control. The scarcity of providers also carries grave consequences for Kenyan patients. The Academic Model Providing Access To Healthcare (AMPATH) multiple myeloma program organized the Inaugural Virtual Multiple Myeloma Congress to achieve both interactive specialist instruction and stakeholder engagement. Expert presenters and panellists from diverse disciplines were invited to offer in-depth presentations on myeloma care and case studies from panellists´ practice were used to contextualize learning points and form a basis for generating debate on the challenges facing providers and opportunities for care improvement. An audience of health professionals offering care to myeloma patients was invited. The underlying principle of recommendations developed during the congress was collaboration among in-country and international practitioners, researchers and policy experts from private and public sector. This partnership of stakeholders bears the potential of pooling scarce resources and for collective advocacy towards better patient care.</p> Teresa Cherop Lotodo Beatrice Jepngetich Melly Kelvin Mogesa Manyega Mercy Oduor Valerie Magutu Fredrick Chite Asirwa Riyat Malkit Alfred Karagu Simon Onsongo Caroline Wafula Roselyne Yatich Pravas Chandra Mishra Austin Omondi Diana Flora Namaemba Yvette Oyollo Maureen Kugo Copyright (c) 2021-12-17 2021-12-17 40 1 Five-year trend analysis of malaria prevalence in Shewarobit, Amhara regional state, North-central Ethiopia <p><strong>Introduction:&nbsp;</strong>analysis of the prevalence of malaria infection in health facilities is crucial for sympathetic the transmission dynamics and implementing evidence-based control strategies. The study was to determine a five-year pattern of malaria infection in Shewarobit, Northcentral Ethiopia.</p> <p><strong>Methods:&nbsp;</strong>institutional based retrospective study was carried out to determine the prevalence of malaria infection from a five-year examination of malaria cases at Shewarobit Health Center, Ethiopia. The directory of all malaria cases reported between 2013-2017 was carefully examined and recorded. Data were analyzed using SPSS version 20.0 and the results were presented in tables and figures.</p> <p><strong>Results:&nbsp;</strong>the results confirmed a total of 33,932 malaria suspects were diagnosed using microscopy over the last 5 years, of which 4705 (13.9%) were confirmed positive for malaria infection. Out of 4705 positive individuals, 3074 (65.3%) were males and 1631 (34.7%) were females.&nbsp;<em>Plasmodium vivax, Plasmodium falciparum</em>, and mixed infection (both species) accounted for 44.8%, 44.1%, and 7.1% of the confirmed cases, respectively.</p> <p><strong>Conclusion:&nbsp;</strong>the study demonstrated that malaria infection is a public health concern in the study area, and&nbsp;<em>Plasmodium vivax</em>&nbsp;was the predominant species. The resulting necessity, the district health bureau and other concerned stakeholders should strengthen evidence-based intervention of malaria control strategies to eliminate malaria infection.</p> Tadegew Teshome Shiferawu Azene Tesfaye Desta Copyright (c) 2021-12-17 2021-12-17 40 1 Influence of nursing interventions in improving midwives' knowledge of misoprostol use in the management of postpartum haemorrhage at selected hospitals in Ondo State, Nigeria <p><strong>Introduction:&nbsp;</strong>despite large investments in maternal health services in the world, postpartum hemorrhage (PPH) remains a major cause of maternal mortality. Misoprostol is the most available, accessible, and affordable uterotonic agent in the management of the third stage of labor and has been found to be effective in PPH prevention in low-income countries. This study, therefore, assessed the influence of nursing interventions improving midwives´ awareness of misoprostol use in the management of PPH at selected health facilities.</p> <p><strong>Methods:&nbsp;</strong>we conducted a quasi-experimental study in two secondary health institutions in Ondo State. A total of 68 midwives, who consented to participate, were randomly distributed into experimental and control groups respectively. A questionnaire was administered for obtaining information about participants´ knowledge and use of misoprostol in the management of PPH. Midwives in the intervention group were trained using the adapted Pathfinder International Teaching Package on the use of misoprostol in the management of PPH. Data were analyzed using descriptive and inferential statistics.</p> <p><strong>Results:&nbsp;</strong>in the pre-intervention phase, the mean knowledge score of the control group was 7.55 ± 2.57 while that of the experimental group was 8.89 ± 2.57. There was a significant increase in the number of participants knowing the correct dose of misoprostol for the management of PPH after intervention (27.0% vs 81.1% p=0.01). After intervention, there was a significant increase (p=0.01) in knowledge of misoprostol use in the intervention group compared to the control group (14.73 ± 2.57 vs 8.89 ± 2.57).</p> <p><strong>Conclusion:&nbsp;</strong>misoprostol educational intervention was effective in improving knowledge and use of misoprostol. Hence, continuing educational units in hospitals should include periodic training of midwives on the use of misoprostol in PPH prevention.</p> Olufunke Mercy Iwaola Christiana Olanrewaju Sowunmi Matthew Idowu Olatubi Gbemisola Bolanle Ogbeye Copyright (c) 2021-12-17 2021-12-17 40 1 Comparing the effect of independent and combined interventions of household chlorination and handwashing on diarrhea of under-fives in rural Dire Dawa, eastern Ethiopia: a cluster randomized controlled trial <p><strong>Introduction:</strong>&nbsp;in poorly developed countries, no single intervention is adequate to interrupt diarrhea occurrence in rural households. However, the effect sizes of multiple interventions and participants combined adherence to the interventions are understudied. This study aimed at comparing combined intervention of water sanitation and hygiene (WASH) with each individual intervention in reducing diarrhea among under-five children in rural Dire Dawa.</p> <p><strong>Methods:</strong>&nbsp;a cluster randomized controlled factorial trial was conducted between October 2018 and January 2019. Householders in the first, second and third arms received waterguard, soap and both, respectively. However, householders in the control arm were followed with their customary practices. Generalized estimation equations (GEE) with log link Poisson distribution was used to compute adjusted incidence rate ratio and the corresponding 95% CIs.</p> <p><strong>Results:</strong>&nbsp;overall, 36% (aIRR =0.64, 95% CI:0.57 - 0.73), 41% (aIRR =0.588, 95% CI:0.53 - 0.65), and 41% (aIRR =0.585, 95% CI:0.53 - 0.65) reduction in incidence of diarrhea was observed in the water treatment, handwashing and combined arms respectively. This study showed no additional benefit of combining the two interventions than the individual intervention.</p> <p><strong>Conclusion:</strong>&nbsp;we recommend implementing either household water disinfection using sodium hypochlorite or household handwashing with hand hygiene promotion independently at large scale to vulnerable population to reduce diarrheal morbidity.</p> Ephrem Tefera Solomon Sirak Robele Gari Helmut Kloos Bezatu Mengistie Alemu Copyright (c) 2021-12-20 2021-12-20 40 1 Reversible Wernicke encephalopathy caused by hyperemesis gravidarum in the second trimester of pregnancy: a case report <p>Wernicke encephalopathy is a potentially life-threatening neurologic syndrome caused by acute thiamine (vitamin B1) deficiency. It is usually associated with excessive alcohol consumption. Less frequently, this syndrome can be caused by persistent vomiting. This is a case report of a 33-year-old woman diagnosed with Wernicke encephalopathy (WE) during the second trimester of pregnancy. The presence of neurological and ophthalmological symptoms in the context of hyperemesis gravidarum led us to evoke the diagnosis of WE, and it was confirmed when specific lesions were found in the brain magnetic resonance imaging (MRI). Luckily for our patient, WE was diagnosed promptly and the signs were reversible after thiamine supplementation. In conclusion, any first line care taker or midwife must know the symptoms of Wernicke encephalopathy because prompt diagnosis and treatment can lead to recovery.</p> Nadia Ben Jdidia Sawssan Ben Halima Hana Hakim Sahbi Kebaili Ines Koubaa Hedi Chelly Kais Chaabane Copyright (c) 2021-12-20 2021-12-20 40 1 Intra-radicular reinforcement using a modified fiber post customization technique: a case report <p>Trauma sustained by developing anterior teeth can lead to an arrested root development and loss of structure which can complicate the endodontic and restorative management. The preservation of the anterior tooth has a definite esthetic and biologic advantage especially during the developmental years of adolescence. However, restorative treatment of such cases is met with serious biomechanical and adhesive challenges in the form of thin dentinal walls, a high configuration factor etc. This case report describes a fiber post customization technique for the intraradicular reinforcement of a maxillary central incisor in a 14-year-old patient.</p> Usman Anwer Bhatti Muhammad Qasim Javed Mustafa Hussein Al Attas Copyright (c) 2021-12-20 2021-12-20 40 1 Delayed presentation of congenital diaphragmatic hernia: a case report <p>Congenital diaphragmatic hernia (CDH) is known as a structural defect caused by inadequate fusion of the pleuroperitoneal membrane forming the diaphragm, allowing peritoneal viscera to protrude into the pleural cavity. It affects nearly one out of 2500 live births. We here report the case of a six-month-old boy with left diaphragmatic hernia presenting with poor feeding, breathing difficulty, cough, and recurrent pneumonia in the last 2 months. Chest X-ray and computed tomography scan revealed left sided CDH. The defect was corrected through open surgical repair without complications. At 5-month follow-up a radiograph was performed which revealed full recovery. The primary goal of this report was to alert physicians to suspect this diagnosis in patients with unexpected presentation of diaphragmatic hernia.</p> Saif Ghabisha Faisal Ahmed Saleh Al-wageeh Ebrahim Al-shami Abdu Al-hajri Waleed Aljbri Fawaz Mohammed Copyright (c) 2021-12-21 2021-12-21 40 1 Mixed neuroendocrine-non-neuroendocrine neoplasms of the right colon: a case report <p>Mixed neuroendocrine-non neuroendocrine neoplasm (MiNENs) is a rare gastrointestinal neoplasm that has been redefined by the World Health Organization (WHO) in 2017 as the association of two types of components, neuroendocrine and non-neuroendocrine, each of them present in at least 30% of the tumour mass. Small case reports and case series have demonstrated the occurrence of this neoplasm in the colon. We here report the case of a 47-year-old man undergoing colonscopy for anemia. This showed impassable polypoidal tumor budding in the right colic flexure. Computerized tomography (CT) scan and magnetic resonance imaging (MRI) showed the presence of liver metastases. As the tumor was hemorrhagic, right hemicolectomy with lymph node dissection was performed. The histological examination showed MiNEN of the ascending colon. The patient received adjuvant chemotherapy.</p> Zakaria El Barkaoui Mohammed Najih Aboulfeth El Mehdi Hicham El Majdoubi Imane El Messaoudi Mohamed Amine Essaoudi Mohamed Bouzroud Sidi Mohammed Bouchentouf Hakim El Kaoui Ahmed Bounaim Copyright (c) 2021-12-21 2021-12-21 40 1 Paralysie faciale périphérique post-vaccination COVID-19: à propos d’un cas <p>Il s´agit d´une observation clinique d´un patient sans contexte pathologique particulier et sans antécédents personnels ou familiaux qui consulte pour une asymétrie faciale droite deux jours après une vaccination (vaccin recombiné) contre la COVID-19. Un examen clinique complet et un bilan biologique et une IRM étaient sans anomalies plaidant vers l´opportunité du diagnostic d´une paralysie faciale périphérique post vaccinale (COVID19). Une paralysie faciale périphérique dans un contexte de vaccination COVID-19 avec récupération complète est retenue.</p> Smail Kharoubi Copyright (c) 2021-12-21 2021-12-21 40 1 Infraclavicular arterio-arterial prosthetic loop is a safe and effective vascular access technique for haemodialysis in frail patients: a prospective observational study <p>Vascular access failure causes significant morbidity among end stage renal failure patients. With the increased life expectancy and frailty of those patients, maintaining vascular access became a great challenge. In this study, we assess the short and midterm outcomes of infraclavicular arterio-arterial prosthetic loop (IAAPL) as vascular access for haemodialysis in frail patients who have exhausted conventional vascular access methods. A prospective observational study of 43 patients undergoing IAAPL was conducted in a single centre between May 2017 and March 2020. Primary, assisted primary and secondary patency rates were recorded in addition to complications and patient compliance with access. The achieved primary, assisted primary and secondary patency rates at 6 months are 87.5%, 95%, 97.5% respectively, at one year, corresponding rates were 75%, 83.3%, 94.4% and at 18 months they were 68.6%, 77.1%, 85.7% respectively. There was no procedure related mortality and life-threatening complications during the study period. So we can assume that infraclavicular AAPL is a safe and effective method of obtaining alternative vascular access for hemodialysis in frail patients for whom the conventional vascular access for hemodialysis is not suitable or contraindicated.</p> Ahmed Mohammed Ahmed Abdel Rahim Alexander Bush Aml Ahmed Sayed Ahmed Aml Mohammed Soliman Mohammed Ahmed Mohammed Ismail Copyright (c) 2021-12-21 2021-12-21 40 1 A rare presentation of hydatid cyst in abdominal wall: case report <p>Echinococcus species cause hydatidosis, which is a verminosis. Echinococcus vogeli results in polycystic hydatid disease, and wild dogs are the definitive hosts. In fact, wild dogs and rats are the most common hosts. The transit of Echinococcus eggs through the liver and lungs is hypothesized to result in hydatid cyst formation in the subcutaneous tissue. In 1.5 percent of patients with hydatidosis, hydatid cysts of the subcutaneous tissue have been documented. They ranged from 0.6 percent to 2.6 percent. We here report a case of hydatid cyst of the abdominal wall which was surgically treated. A 30-year-old lady had been experiencing pain associated with lump in her right lower abdomen for three months. On clinical examination, an enlargement in the left side measuring 4 x 3 cm was discovered. Imaging was performed preoperatively to rule out other differential diagnoses. Ultrasound was performed, followed by computed tomography and magnetic resonance imaging, which revealed multilocular cystic mass measuring 9 x 8.5 x 4.7 cm along the right lower anterior abdominal wall muscles (with cysts inside cysts), which suggested hydatid cyst. Histopathology confirmed the diagnosis of hydatid cyst, after the mass was surgically removed. Treatment with albendazole was continued. Hydatid cyst of the subcutaneous tissue is uncommon, with only a few occurrences recorded in the literature. This study describes a case of hydatid cyst in an uncommon place. Imaging confirmed the diagnosis, and the tumour was surgically removed. It ruptured during surgery and was successfully treated with hypertonic saline and albendazole. Then it was adequately managed. Given that subcutaneous hydatid cyst is rare, it's vital to keep in mind that it can be a possible cause of abdominal wall mass. Specific imaging test is essential to correctly locate and remove it. It must be treated with anthelmintic before surgery, in order to reduce the risk of contamination due to cyst rupture during surgery. Subcutaneous hydatid cyst should be considered one of the differential diagnoses for soft tissue masses, in particular in patients living in endemic areas. To rule out alternative possibilities, proper imaging test is essential. The treatment of choice is complete excision.</p> Leena Moshref Haifaa Malaekah Copyright (c) 2021-12-21 2021-12-21 40 1 Exposure to aflatoxin B1 and associated risk factors in hepatitis C patients in cosmopolitan city of Pakistan: facility-based study <p><strong>Introduction:&nbsp;</strong>population-based follow-up study has been designed to investigate the contributing factors to high exposure to Aflatoxin B<sub>1</sub>&nbsp;(AFB<sub>1</sub>) and the subsequent associated risk factors among hepatitis C-infected patients at a referral centre, Karachi. Pakistan. Hepatitis C infection affects millions of individuals worldwide and confers high morbidity and mortality, especially in lower middle-income countries (LMICs) including Pakistan. A literature review of recent studies has revealed that a number of hepatocellular carcinomas (HCC) cases are markedly increased in Pakistan, where one of the potential causes of HCC is hepatitis C virus. The objectives of this study were to determine frequency of Aflatoxin B<sub>1</sub>&nbsp;(AFB<sub>1</sub>) exposure and other associated characteristics among hepatitis C patients at a referral centre, Karachi, Pakistan.</p> <p><strong>Methods:&nbsp;</strong>a semi-structured pre-coded pro forma designed to collect socio-demographic, Pharmacological, biochemical and clinical information from patients and hospital records. Patient´s pre and post polymerase chain reaction (PCR), serum alanine aminotransferase (ALT) levels and other blood parameters were analysed. AFB<sub>1</sub>&nbsp;exposure was determined using an ELISA kit and validated through HPLC.</p> <p><strong>Results:&nbsp;</strong>AFB<sub>1</sub>&nbsp;exposure was found in 30 (34%) patients. Post treatment responders were 49 (55.6%). More than 37% of study participants had a family history of hepatitis C. About 74% had a history of surgical procedure, and around 36% of study participants had a blood transfusion history. Up to 36% participants were fond of spicy food and around 25% study participants were eating roadside food on daily basis.</p> <p><strong>Conclusion:&nbsp;</strong>high frequency of AFB<sub>1</sub>&nbsp;exposure due to risky dietary habits, low level of formal education and awareness are contributing factors may be responsible for high exposure of AFB<sub>1</sub>. Effective and multidimensional strategies are needed to prevent advance stage progression of disease and associated complications.</p> Muhammad Ayaz Mustufa Zubia Zia Rabia Ilyas Rehan Khan Syed Naim Ul Hasan Naqvi Firdous Imran Ali Copyright (c) 2021-12-21 2021-12-21 40 1 Prevalence and patterns of birth defects among newborns in southwestern Ethiopia: a retrospective study <p><strong>Introduction:&nbsp;</strong>prenatal development could be considered normal or abnormal. Abnormal development occurs because of interference of normal development from genetic disorders, environmental factors, and multifactorial inheritances during the critical period of embryogenesis. The present study was aimed at evaluating the prevalence and patterns of birth defects among newborns in southwestern Ethiopia.</p> <p><strong>Methods:&nbsp;</strong>institutions-based cross-sectional study design was conducted in six purposively selected hospitals in southwestern Ethiopia based on their caseload. The study included data's from 2011 to 2015, during which 45,951 deliveries were recorded. All records of births in the selected hospitals were screened from medical records to identify the presence and types of birth defects.</p> <p><strong>Results:&nbsp;</strong>out of twenty-one different birth defects identified, nearly half of them belong to anencephaly and hydrocephalus. Five types of birth defects, namely: anencephaly (25.0%), hydrocephalus (24.6%), spina bifida (13.1%), meningomyelocele (7.1%), and umbilical hernia (4.8%) accounted for about three-fourths (75%) of all recorded birth defects. The prevalence rate of birth defects at birth was 55 per 10,000 births.</p> <p><strong>Conclusion:&nbsp;</strong>in the present study, the neural tube defects were identified to be the most prevalent. Nearly equal proportions of birth defects occurred among male and female newborns. The majority of the mothers who gave birth to newborns with birth defects were younger than 35 years. The high prevalence of birth defects revealed in this study call for the need to implement urgent prevention strategies including but not limited to the provision of sustained family planning, youth education and antenatal care services, and strict observation of rational medication use during pregnancy to curb the possible occurrences of the birth defect.</p> Soressa Abebe Geneti Girmai Gebru Dimsu Demisew Amenu Sori Lemessa Dube Amente Zeleke Mekonnen Kurmane Copyright (c) 2021-12-21 2021-12-21 40 1 COVID-19 pandemic waves: how prepared is West Africa for managing a high COVID-19 caseload? Urgent actions needed <p>The ECOWAS Region and the world have learnt a lot in the last year and a half concerning the pandemic. As the pandemic continues to evolve, the region needs to put together all these lessons in other to better protect its people, rebuild its economy and strengthen the regional health security for better regional prosperity. We reviewed the response mounted by the region from January 2020 to July 2021 and the existing body of knowledge. We recommend that the region quickly increase the COVID-19 immunization coverage, sustain the enhance genomic surveillance, improve testing and the strengthen point of entry surveillance.</p> Virgil Kuassi Lokossou Chukwuma David Umeokonkwo Stanley Okolo Patrick Mboya Nguku Nanlop Ogbureke Issiaka Sombie Copyright (c) 2021-12-21 2021-12-21 40 1 Impact of psychological stress on the outcomes of assisted reproduction in Tunisian infertile women <p><strong>Introduction:&nbsp;</strong>childlessness is an emotionally difficult experience for infertile couples. Undergoing assisted reproductive treatments (ART) could generate further stress in these patients. Studies investigating the impact of anxiety on ART outcomes have shown controversial results. Moreover, there are no publications focusing on anxiety symptomsin infertile Tunisian couples.</p> <p><strong>Methods:&nbsp;</strong>we conducted a prospective study including 79 infertile women undergoing in vitro fertilization at the Reproductive Medicine Unit of the Farhat Hached Hospital (Tunisia). Participants were asked to answer to the Beck anxiety inventory (BAI) on the day of oocyte retrieval. Accordingly, they were classified into the 3 groups:&nbsp;<strong>group A</strong>: very low anxiety (n= 36; BAI&lt;21),&nbsp;<strong>group B</strong>: moderate anxiety (n= 24; 22≤BAI≤35) and&nbsp;<strong>group C</strong>: severe anxiety (n=19; BAI≥36). For each patient, two blood samples were collected to assess free cortisol level on the day of oocyte retrieval and on the day of embryo transfer.</p> <p><strong>Results:&nbsp;</strong>results showed that women with primary infertility were significantly more stressed than those with secondary infertility (p= 0.011). Cortisol level was significantly higher on the day of embryo transfer than on the day of oocyte pick-up (p&lt;0.0001). A lower implantation rate was found in severely anxious patients compared with moderately anxious women (p= 0.03) and those having low levels of anxiety (p= 0.001) and was negatively correlated to BAI score (r= -0.65; p= 0.001). Both clinical pregnancy and livebirth rates were similar among the three groups.</p> <p><strong>Conclusion:&nbsp;</strong>the day of embryo transfer is the most stressful timepoint and psychological counseling is crucial to enhance implantation rate. Hence implantation took place, no effect of stress on pregnancy and live birth was found.</p> Amira Sallem Habiba Essoussi Henda Ben Mustapha Monia Zaouali Mounir Ajina Copyright (c) 2021-12-21 2021-12-21 40 1 "The angel within the devil": COVID-19 silver linings <p>Coronavirus disease (COVID-19) has impacted every aspect of human existence in a variety of ways. However, depending on how we interpret the impact of the pandemic, we may either despair or embrace challenges with hope. Several empirical findings and expert opinions have highlighted the significant negative impact of COVID-19 on economy, health and wellbeing, education, ecosystem and governance around the world. Amid all these negative effects on human existence, we claim that there are some silver linings across several domains such as health and wellbeing, education, eco-system and social connectedness, with the main benefit being adherence to public health measures which will be retained beyond the pandemic.</p> Nuworza Kugbey Anthony Amoah Sam-Quarcoo Dotse Emelia Amoako-Asiedu Cephas Delalorm Eric Nyarko-Sampson Copyright (c) 2021-12-21 2021-12-21 40 1 Perceived impact of the COVID-19 pandemic on young adults with type 1 diabetes in Rwanda <p><strong>Introduction:&nbsp;</strong>data on the impact of COVID-19 on people with type 1 diabetes (T1D) in less resourced countries are limited. Our study was undertaken in Kigali, Rwanda, and aimed to investigate and describe the problems and challenges experienced by young adults with T1D resulting from the early phase of the pandemic. The study further aimed to understand the mechanisms being used to solve problems and overcome challenges, and perceived support needs.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional study, with anonymous data (n=52) collected through use of questionnaire. Participants were registered, and attending or receiving diabetes-related healthcare through the Rwanda Diabetes Association clinic.</p> <p><strong>Results:&nbsp;</strong>mean+standard deviation age and T1D duration were 24.0±2.1 and 7.4±3.4 years respectively, with sex distribution unequal (male n=22, 42.3%). Of 43 participants, the COVID-19 pandemic did not significantly affect participants´ access to diabetes management supplies and care. Eight (18.6%) participants experienced difficulties accessing blood glucose testing strips, 13 (30.2%) insulin, and three (7.0%) syringes and pen devices. Thirty-two (74.4%) experienced difficulty in attending standard diabetes healthcare reviews at the clinic setting. Some participants experienced hardship, through a decrease in personal or family income (n=42, 80.8%) and challenges in accessing food (n=34, 65.4%), with thirty (57.7%) participants having decreased meal frequency (p&lt;0.001).</p> <p><strong>Conclusion:&nbsp;</strong>our research illustrates the indirect effects of measures undertaken to curb the spread of COVID-19 on young adults with T1D in Rwanda. Study findings may help inform actions to mitigate negative impacts on T1D care in other crises.</p> Jean Claude Habineza Steven James Laurien Sibomana Emma Klatman Etienne Uwingabire Jayanthi Maniam Graham David Ogle Copyright (c) 2021-12-21 2021-12-21 40 1 Appendicite sur appendice diverticulaire <p>La diverticulose appendiculaire se définit comme l´existence de diverticule(s) sur l´appendice cæcal, réalisant des tableaux cliniques polymorphes avec infection de l´appendice et de la région péri-appendiculaire. On présente le cas d´une jeune patiente de 28 ans sans antécédents pathologiques notables consultant en urgence pour syndrome douloureux et fébrile de la fosse iliaque droite associé à des vomissements. L´examen de l´abdomen trouve une température à 38,5°C, une nette sensibilité de la fosse iliaque droite avec un signe de Blumberg positif et un toucher rectal douloureux à droite. Les diagnostics différentiels en particulier avec une infection urinaire ont été éliminés devant la négativité de l´examen cytobactériologiques des urines. D´autres diagnostics tels que la maladie de Crohn et les tumeurs coliques étaient éliminés du fait de l´anamnèse et du contexte. Le diagnostic d´appendicite aiguë a été porté, le patient a été opéré par voie coelioscopique permettant de découvrir un appendice latérocecal interne phlegmoneux avec présence de deux diverticules au niveau de la pointe et du corps de l´appendice (A: vue peropératoire coelioscopique de l´appendice phlegmoneux siège de diverticules). Il a été réalisé une appendicectomie (B: vue macroscopique de l´appendice montrant les diverticules) sans incidents et l´examen histologique avait conclu à une appendicite aiguë avec diverticules appendiculaires non compliqués. Les suites opératoires étaient simples.</p> Mohamed Hedfi Hakim Zenaidi Copyright (c) 2021-12-21 2021-12-21 40 1 COVID-19 mitigation measures to maintain access to essential health services: new opportunities with long-term benefits <p>The coronavirus disease 2019 (COVID-19) pandemic<br>has substantially impacted health systems globally.<br>To highlight potential opportunities to improve<br>health service delivery in low- and middle-income<br>countries, we describe lessons learned from<br>published literature and experiences responding to<br>the pandemic. The benefits of healthcare service<br>measures implemented during the pandemic<br>with potential for lasting benefits for<br>strengthening health systems are highlighted:<br>1) innovative pharmaceutical dispensing methods;<br>2) appointment-based systems in health facilities;<br>3) telehealth to provide patient care; 4) task shifting<br>to redistribute healthcare workloads; and 5) homebased pulse oximetry to monitor oxygen levels.<br>These measures can reduce unnecessary contact<br>with healthcare staff while maintaining critical<br>health service delivery and may be of value to<br>continue after the pandemic subsides.</p> Jacquelyn Lickness Pamela Bachanas Rania Tohme Anna Russell Allen Craig Avi Hakim Copyright (c) 2021-12-21 2021-12-21 40 1 Evaluation médico-légale des certificats médicaux initiaux au sein des structures sanitaires du Nord de la Tunisie <p>Le certificat médical initial est un document médico-légal descriptif dont finalité est de prouver l´existence du dommage et de permettre à la victime d´obtenir ce que de droit. L´objectif de notre étude était d'étudier le contenu et d'évaluer la qualité de rédaction des certificats médicaux initiaux. Il s´agissait d´une étude rétrospective et descriptive sur une période de 18 mois allant de janvier 2015 à juin 2016. Nous avons colligé 450 certificats médicaux initiaux parvenus au service de médecine légale du centre hospitalier universitaire de Charles Nicolle à Tunis. La qualité des certificats médicaux initiaux a été évaluée grâce à un canevas qui a permis de leur attribuer une note sur 30. Les certificats médicaux initiaux évalués étaient majoritairement moyens. Les scores obtenus à partir du canevas que nous avons élaboré oscillaient entre 9,5 et 27,5/30 avec une moyenne de 18,59/30. Les médecins généralistes, les médecins ayant une spécialité d´organe comme les ophtalmologistes ou encore les neurochirurgiens et les médecins qui ont utilisé le support du ministère de la santé ont rédigé de meilleurs certificats. De même nous avons noté une qualité de rédaction meilleure lorsqu´il s´agit de coups et blessures volontaires. Notre étude a montré que la majorité des certificats médicaux initiaux ne sont pas conformes aux recommandations de rédaction. Ces insuffisances sont probablement liées au fait que les médecins n´ont jamais bénéficié d´une formation médico-légale adéquate.</p> Chahnez Makni Myriam Gorgi Meriem Gharbaoui Sarra Ben Abderrahim Mohamed Amine Zaara Azza Belhaj Moncef Hamdoun Mohamed Allouche Copyright (c) 2021-12-22 2021-12-22 40 1 Physiotherapists’ perceptions and experiences of home-based rehabilitation in Libya: a qualitative study <p><strong>Introduction:</strong>&nbsp;home-based rehabilitation (HBR) is a rehabilitation model that aims to help people with disabilities to integrate into the community and be independent as much as possible. HBR is a promising alternative to institution-based rehabilitation, in which rehabilitation services are provided at patients' homes. However, challenges and barriers to HBR practice in Libya have never been researched before. This study explores physiotherapists' perceptions of home-based rehabilitation (HBR) in Libya and examines their views and the concerns they face.</p> <p><strong>Methods:</strong>&nbsp;eight physiotherapists (2 females, 6 males) with at least two years of work experience in the Libyan physiotherapy community participated in in-depth semi-structured interviews. The interviews were audio-recorded and transcribed verbatim, and the data were analyzed using framework method.</p> <p><strong>Results:</strong>&nbsp;three themes emerged from the data, namely: i) access problems, including lack of infrastructure; ii) lack of governmental policies, such as the absence of governmental support (e.g., lack of programs and resources); iii) poor awareness and misconception issues, including that of patients and families.</p> <p><strong>Conclusion:</strong>&nbsp;although all the interviewed physiotherapists described HBR as an essential practice in Libya, they expressed concerns about several factors that hinder its development and may influence the quality of interventions provided in the community. Given the fact that this is the first qualitative study in this field in Libya, there is a need for future research to explore HBR from other perspectives, such as those of policymakers, healthcare planners, or patients and their families and/or caregivers.</p> Alhadi Mohamed Jahan Ali Emhemed Rwaiha Copyright (c) 2021-12-22 2021-12-22 40 1 Infected omental cyst complicated with subacute intestinal obstruction and ileal erosion in a 2-year-old boy: a case report <p>An omental cyst is a rare intraabdominal pathology that can cause acute abdomen and intestinal obstruction among children. A 2-year-old boy presented with fever, bilious vomiting, abdomen distension and loose stool of acute onset. The chest and abdominal radiographs showed right pleural effusion and prominent small bowels with thickening walls respectively. Ultrasonography revealed a gastrointestinal duplication cyst. An exploratory laparotomy was done and found a 5x5 cm infected omental cyst, severely adhered to and eroded into the ileum causing a small perforation. Omental cyst excision and ileal primary repair were done. The final diagnosis was a benign omental cyst. Omental cyst is usually asymptomatic; however, symptomatic omental cyst should be cautious for bleeding, intestinal obstruction, infection, torsion and rupture.</p> Hock Chin Chong Hazlina Mohd Khalid Nur Atiqah Mohd Hanifah Vebster Jaffrey Naveena Thiyagaraja Firdaus Hayati Copyright (c) 2021-12-22 2021-12-22 40 1 Dystrophic calcinosis cutis associated with systemic lupus erythematosus: a case report <p>Calcinosis cutis is a rare and potentially disabling condition characterized by calcium deposition in soft tissues. When associated with autoimmune connective tissue diseases, calcinosis cutis is classified as Dystrophic Calcinosis Cutis (DCC), being its occurrence in systemic lupus erythematosus (SLE) patients fairly uncommon. We report a case of DCC in a 49 years old woman with eleven years evolution SLE that presented with a two years history of multiple painful skin lesions, some of them ulcerated and exhibiting a chalky white-yellow floor, in both hands, forearms, thighs, buttocks, abdomen and left breast. The pelvic X-ray showed soft tissue calcifications and the skin biopsy confirmed the diagnosis of DCC. The patient was treated with diltiazem 240mg/day and a significant regression of the lesions and associated pain was observed. Dystrophic calcinosis cutis is often a painful and disrupting condition in which timely diagnosis and treatment may be quite challenging.</p> Filipa Costa Sousa Mariana Figueiras Ana Rita Parente Sónia Santos Mafalda Miranda Mónica Teixeira Teresa Mendonça Copyright (c) 2021-12-22 2021-12-22 40 1 Réparation chirurgicale de l´insuffisance tricuspide associée à une valvulopathie du cœur gauche: à propos de 162 cas <p>L´insuffisance tricuspide (IT) constitue un facteur pronostic dans l´évolution des patients opérés d´une valvulopathie du cœur gauche. L´objectif de cette étude est d´évaluer les résultats postopératoires de l´insuffisance tricuspide associée à une valvulopathie du cœur gauche et de déterminer les facteurs liés à l´échec de la réparation chirurgicale. Une étude rétrospective incluant 162 patients a été menée durant une période allant du mois de janvier 2009 au mois juillet 2019 incluant tous les patients opérés pour une IT associée à une chirurgie valvulaire gauche. L´âge moyen de nos patients était de 39,70 ans ± 10,8 avec une prédominance féminine. Sur les 162 plasties tricuspidiennes, nous avons effectué 47 (29%) annuloplasties prothétiques, 103 (63,5%) annuloplasties de DeVega, et 12 (7,5%) réductions ou effacement de l´anneau postérieur. Sur le plan échocardiographique, l´évolution a été marquée par une nette amélioration des moyennes des différents paramètres morphologiques et fonctionnels, pourtant l´échec de la plastie tricuspide était présent chez 24 (14,8%) patients de tous les opérés. Nous avons colligé 4 décès dans les 30 jours postopératoires soit un taux de mortalité hospitalière de 2,46%. Les causes du décès sont réparties en dysfonction ventriculaire droite réfractaire pour 2 cas, et en dysfonction ventriculaire gauche sévère pour 2 cas. Les facteurs liés à l´échec de la plastie tricuspide dans notre travail sont: l´insuffisance tricuspide préopératoire sévère, des pressions pulmonaires postopératoires supérieures à 60mmHg, le rapport VD/VG télé diastolique préopératoire supérieur à 0,6. Les résultats de la présente étude permettent de mieux comprendre l´évolution des patients subissant une chirurgie de l´insuffisance tricuspide et apportent des informations permettant d´évaluer de façon plus fiable les indications des plasties tricuspides.</p> Amine Majdoub Salaheddine Boulmakoul Anas Elhafidi Mohammed Messouak Copyright (c) 2021-12-23 2021-12-23 40 1 Le syndrome de Mayer-Rokitansky-Küster-Hauser comme cause d'aménorrhée primaire: à propos d'un cas <p>Le syndrome de Mayer-Rokitansky-Küster-Hauser (MRKH) est une cause rare d´aménorrhée primaire. Il est défini par une aplasie congénitale de l´utérus et des deux tiers supérieurs du vagin chez des femmes présentant un développement normal des caractères sexuels secondaires. Le diagnostic est basé essentiellement sur imagerie par résonance magnétique (l´IRM). Nous rapportons le cas d'une fille de 17 ans qui a consulté pour une aménorrhée primaire, avec des caractères sexuels secondaires présents et bien développés. Le bilan biologique a révélé une fonction ovarienne normale ainsi que l´axe gonadotrope. L´échographie pelvienne et l´imagerie par résonance magnétique ont mis en évidence une agénésie complète de l´utérus, des deux tiers supérieurs du vagin et du rein gauche permettant de confirmer le diagnostic du syndrome de Mayer-Rokitansky-Küster-Hauser (MRKH) type II. L´intérêt de ce cas clinique est d'évoquer le diagnostic de MRKH, Devant toute aménorrhée primaire chez une jeune femme présentant des caractères sexuels bien développés, et aussi de chercher les signes spécifiques sur l'imagerie notamment l'IRM.</p> Mohamed Abdellaoui Jamal El Fenni Meryem Edderai Copyright (c) 2021-12-23 2021-12-23 40 1 Liver function in dengue and its correlation with disease severity: a retrospective cross-sectional observational study in a tertiary care center in Coastal India <p><strong>Introduction:&nbsp;</strong>dengue, the most important arthropod- borne disease is transmitted to humans by mosquitos of the&nbsp;<em>Aedes</em>&nbsp;family. Liver dysfunction in dengue varies from mild injury with elevation of transaminases to severe hepatocyte injury. The aim of our study was to assess the prevalence of hepatic dysfunction in patients with dengue and to correlate between the severity of the disease with the extent of hepatic dysfunction.</p> <p><strong>Methods:&nbsp;</strong>retrospective cross-sectional observational study including 120 patients with confirmed dengue serology admitted in Medicine Department of Father Muller Medical College during November 2018-December 2019. Patient demographics, presenting symptoms, clinical signs, laboratory parameters such as complete blood count, serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), alkaline Phosphatase (ALP), total and direct bilirubin; serum albumin and globulin levels were collected. Patients were categorized based on the modified WHO classification of 2009 into dengue with or without the warning signs and severe dengue. Comparison of multiple means across disease severity was performed using One Way-ANOVA with post hoc analysis using least significant difference. Pearson's correlation coefficient test was used to calculate the correlation between transaminases and platelet count. P-value &lt;0.05 and CI 95% were considered in all analyses.</p> <p><strong>Results:&nbsp;</strong>serum glutamic-oxaloacetic transaminase was elevated in 66.7%, 78.6% and 91.7% patients of dengue without warning signs, warning signs and severe dengue respectively. Serum glutamic-pyruvic transaminase was elevated in 42.4%, 52.4% and 91.7% patients of dengue without warning signs, warning signs and severe dengue respectively. Patients with elevated SGOT (93.8%) and SGPT (81.2%) had a higher incidence of bleeding manifestations. Hypoalbuminemia (50.8%) and A:G ratio reversal (27.3%) was significantly more in severe dengue (p&lt;0.0001). Serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase levels negatively correlated with platelet count (p&lt;0.0001).</p> <p><strong>Conclusion:&nbsp;</strong>liver involvement in the form of elevated transaminases was found in 74.2% dengue patients. Serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase level increases with increase in dengue severity which is indicated by fall in platelet count as they are negatively correlated with each other. Liver damage is one of the common complications of dengue and transaminitis, hypoalbuminemia and reversal of A:G ratio should be used as biochemical markers in dengue patients to detect and monitor hepatic dysfunction.</p> Anusha Mruthyunjaya Swamy Prasanth Yelkana Mahesh Sujith Tumkur Rajashekar Copyright (c) 2021-12-23 2021-12-23 40 1 Distribution of wealth quintiles and risk factors of non-communicable diseases in Ghana: evidence from the Ghana demographic and health survey 2014 using concentration curves model <p><strong>Introduction:</strong>&nbsp;in recent times, the assertion of non-communicable diseases afflicting the rich has been demystified but cuts across the rich and the poor. Individuals in all categories of wealth quintiles are affected by the risk factors of non-communicable diseases such as alcohol consumption, tobacco use, unhealthy dietary practices and physical inactivity. However, information on the distribution of these risk factors across different socio-economic status is scanty. This study assessed the distribution of wealth quintiles and the risk factors of non-communicable diseases, using the concentration curve model.</p> <p><strong>Methods:</strong>&nbsp;it was a quantitative study with analytical design using the Ghana Demographic and Health Survey (GDHS), 2014 data. The variables of interest were income status of respondents and risk factors of non-communicable diseases. In the analysis, income levels were categorized into wealth quintiles with assigned percentages (25%, 50%, 75% and 100%) denoting poor, rich, richer and richest respectively. The risk factors of non-communicable diseases were also categorized and assigned percentages (relatively exposed 25%, exposed 50%, more exposed 75% and most exposed 100%). A concentration table was employed to assess the risk factors of non-communicable diseases labelled X-axis and wealth quintiles labelled Y-axis. The cumulative percentage of the wealth quintiles (Y-axis) were plotted against the cumulative percentage of the risk factors of non-communicable diseases on the X-axis.</p> <p><strong>Results:</strong>&nbsp;the study found moderate concentration of alcohol consumption among the middle to upper wealth quintiles (richest). Again, the study revealed that, wealth quintiles are practically indifferent to tobacco use and that both the rich and poor equally and minimally use tobacco as the concentration curve is very close to the perfect line of equality (45°). This study found near equal distribution of unhealthy dietary practices among the rich and poor in Ghana. It was found that, 40% - 80% of rich people were physically inactive with the application of a physical activity level of 100%. It was noticed that, 40% of the rich people only performed 20% of physical activities.</p> <p><strong>Conclusion:</strong>&nbsp;the study concludes that; wealth quintiles have implications for the risk factors of non-communicable diseases.</p> Brenyah Joseph Kwasi Copyright (c) 2021-12-23 2021-12-23 40 1 Infection tuberculeuse latente chez l’enfant à Bangui: à propos de 524 cas exposés à domicile aux cas index de tuberculose pulmonaire à microscopie positive <p><strong>Introduction:&nbsp;</strong>malgré la vaccination par le BCG, le risque de développer la tuberculose chez les jeunes enfants dans les régions endémiques reste plus élevé après exposition au cas de tuberculose chez l´adulte. Le but de cette étude était de réduire le risque de tuberculose active chez les enfants contacts des cas index adultes à domicile.</p> <p><strong>Méthodes:&nbsp;</strong>une étude transversale multisite (avril 2016-janvier 2019) a été réalisée sur des enfants de 0 à 59 mois, contacts des cas index à domicile, dépistés et suivis au centre pédiatrique de Bangui.</p> <p><strong>Résultats:&nbsp;</strong>cinq cent vingt- quatre (524) enfants ont été enregistrés. La moyenne d´âge était de 2 ans et 1 mois et le sex ratio garçon/fille de 1,02. Environ quatre-vingt-huit pourcent (88,5%) des contacts étaient vaccinés avec le BCG contre 11,5% non vaccinés. Dans plus de la moitié des cas (52%), les contacts et les cas index ont partagé la même chambre et le temps de contact journalier était supérieur à 12h dans 56% des ménages. Un peu plus de neuf pourcent (9,35%) des contacts avaient une IDR positive. Tous les enfants ont été mis sous chimioprophylaxie à base de Rifampicine + Isoniazide selon les directives nationales et malgré cela, 14 soit 2,67% ont développé une tuberculose active dont 13 formes pulmonaires et une forme ganglionnaire.</p> <p><strong>Conclusion:&nbsp;</strong>la chimio prophylaxie tuberculeuse a sans doute permis de réduire considérablement le risque de survenue de la tuberculose chez des enfants ayant été en contact avec les cas index à domicile.</p> Edgard Djimbélé Béradjé Alain Farra Jess Elio Kosh Komba Palet Marie Colette Nganda- Bangué Simplice Cyriaque Kango Boniface Koffi Jean Chrysostome Gody Copyright (c) 2021-12-27 2021-12-27 40 1 Risk of obstructive sleep apnea and quality of sleep among adults with type 2 diabetes mellitus in a subSaharan Africa city <p><strong>Introduction:&nbsp;</strong>diabetes mellitus (DM) and Obstructive Sleep Apnea (OSA) are two major and interconnected non-communicable diseases. Both negatively impact on sleep quality. This study aimed to determine among persons with type 2 DM, the proportions at high risk of OSA and of self-reported poor sleep quality along with their associated-factors in Parakou city, Benin.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional prospective study of 100% (n=383) outpatient adults with type 2 DM, conducted between April and August 2019 in the three top centres managing diabetic persons in Parakou city. They were interviewed, examined and investigated using capillary fasting blood glucose tests. The STOP-Bang Questionnaire (SBQ) was used to determine the risk of OSA.</p> <p><strong>Results:&nbsp;</strong>overall, their mean age was 57.37 (11.45) years. They were 61.62% (n=236) females and 38.38% (n=147) males. Sleep duration was insufficient in 26.89% (n=103). Nocturia was reported in 49.35% (n=189). The risk of OSA was high in 14.10% (n=54), intermediate in 24.80% (n=95) and low in 61.10% (n=234). Friedman Position Tongue Grade 3 (Adjusted Odds Ratio, aOR=2.48; 95%CI=1.11 - 5.55; p=0.025) and 4 (aOR=4.65; 95%CI=1.26 - 15.90; p=0.015) were independently associated with a high risk of OSA. The prevalence of reported poor sleep quality was 27.42% (n=105). Female gender (aOR=2.08; 95%CI=1.18-3.83; p=0.014), diabetic foot (aOR=5.07; 95%CI=1.15-23.63; p=0.031), nocturia (aOR=1.96; 95%CI=1.18-3.29; p=0.010), tiredness (aOR=2.77; 95%CI=1.26-6.23; p=0.012) and a high risk of OSA (aOR=3.31; 95%CI=1.28-8.93; p=0.015) were independently associated with a greater risk of reported poor sleep quality.</p> <p><strong>Conclusion:&nbsp;</strong>in Parakou, the proportions of patients with type 2 DM at increased risk of OSA and with poor quality of sleep are relatively high. There is need for better systematic screening of OSA in persons with DM.</p> Serge Ade Adebayo Cossi Alassani Prudence Ablo Wachinou Audrey Tchemoua Youzeu Abdoulaye Imorou Lionelle Fanou Marius Claude Flatin Spero Hounkpatin Gildas Agodokpessi Anthony David Harries Copyright (c) 2021-12-28 2021-12-28 40 1 Dilatation mitrale percutanée des rétrécissements mitraux en hypertention pulmonaire importante au cours de la grossesse <p>Le rétrécissement mitral (RM) rhumatismal est la valvulopathie organique la plus fréquente dans les pays en voie de développement. La grossesse constitue l´une des circonstances de décompensation de cette valvulopathie. Nous rapportons notre expérience dans la dilatation mitrale percutanée des rétrécissements mitraux en hypertension pulmonaire importante au cours de la grossesse. La commissurotomie mitrale percutanée a été réalisée chez deux cent vingt-trois parturientes entre janvier 2009 et d écembre 2015. Quarante trois soit 19% de ces patients avaient une hypertension pulmonaire importante (PAPS &gt; 70 mmHg). Toutes les parturientes de notre série sont porteuses d´un RM très serré symptomatique malgré un traitement médical bien conduit. La CMP a été un succès chez l´ensemble des patientes de l´étude, toutes les patientes se sont améliorées sur le plan clinique. L´insuffisance mitrale a progressé d´un grade chez deux patientes. Une patiente a présenté une tamponnade avec une évolution favorable après ponction péricardique. Aucun avortement n´est survenu après procédure et deux accouchements prématurés ont été rapportés. La prise en charge d´un RM serré durant la grossesse doit être multidisciplinaire et faire intervenir le gynécologue-obstétricien, l´anesthésiste et le cardiologue. La CMP constitue actuellement le traitement de référence du RM au cours de la grossesse.</p> Fatima Azzahra Benmessaoud Nessema Bendagha Aida Soufiani Lassana Konaté Nadia Fellat Rajae Benani Naima El Haitam Roukia Fellat Copyright (c) 2021-12-30 2021-12-30 40 1 Infection par Helicobacter pylori: prévalence et facteurs associés dans une population tout venant d’après une recherche par test respiratoire à l’urée marquée au carbone 14 <p><strong>Introduction:&nbsp;</strong>l´infection à Helicobacter pylori (<em>H. pylori</em>) est fréquente dans les pays en voie de développement comme le Bénin. Ce germe peut favoriser la survenue d´affections gastroduodénales, allant de la gastrite au cancer gastrique. Les différentes études réalisées au Bénin sur cette bactérie ont utilisé des méthodes telles que la sérologie, l´étude anatomo-pathologique de biopsies ou la recherche d´antigène dans les selles. La présente étude avait pour but d´évaluer la prévalence d´infection par&nbsp;<em>H. pylori</em>&nbsp;et les facteurs associés à cette infection en utilisant un test respiratoire.</p> <p><strong>Méthodes:&nbsp;</strong>il s´agissait d´une étude prospective descriptive sur 150 patients qui ont réalisé le test respiratoire à l´urée marquée au carbone 14. Seuls les patients admis pour test respiratoire et ayant donné leur consentement étaient inclus. Une fiche d´enquête a été remplie au fur et à mesure. Une analyse univariée par régression logistique simple a permis d´identifier les facteurs associés à l´infection par&nbsp;<em>H. pylori</em>&nbsp;à un seuil de 0,05. La stratégie d´analyse multivariée a consisté à inclure dans le model toutes les variables dont la valeur de p est inférieure à 0,20. La procédure manuelle descendante a été utilisée jusqu´à obtenir le modèle final qui a permis de retenir de facteurs associés avec des rapports de cotes ajustés.</p> <p><strong>Résultats:&nbsp;</strong>l´âge moyen était de 44,4±15,8 ans; avec des extrêmes de 5 ans et 84 ans. Les hommes représentaient 54% de la population d´étude. Des 150 sujets, 82 (57,8%) avaient un niveau d´instruction supérieur contre 8 (5,6%) non scolarisés, 116 (80,6 %) vivaient en couple, 24 (36%) vivaient dans une chambre de plus de 10 personnes et 84 (59,6%) étaient des chrétiens. Les principaux motifs ayant conduit à la réalisation de test respiratoire étaient: douleurs abdominales mal systématisées (53,3%; 70/150), douleurs épigastriques provoquées (35,3%; 53/150), les épigastralgies (20,7%; 31/150), un syndrome ulcéreux (16%; 24/150). La prévalence d´<em>H. pylori</em>&nbsp;par test respiratoire au sein de la population étudiée était de 34,7% (52/150). En analyse multivariée, les variables significativement associées à l´infection à l´<em>H. pylori</em>&nbsp;étaient: l´âge moyen [AOR (95%IC) = 1,02; OR (95% IC) = 1,00-1,05 et p = 0,01] et la notion d´un traitement antérieur d´éradication de l´<em>H. pylori</em>&nbsp;[AOR (95%IC) = 4,79; OR (95% IC) = 1,50-13,86 et p = 0,006]. Aucune comorbidité étudiée n´était associée à l´infection par&nbsp;<em>H. pylori</em>&nbsp;dans notre série.</p> <p><strong>Conclusion:&nbsp;</strong>la prévalence d´<em>H. pylori</em>&nbsp;trouvée par cette méthode est faible (34,7%). Elle est significativement associée à l´âge moyen et à la notion d´un traitement antérieur d´éradication de l´<em>H. pylori</em>.</p> Aboudou Raïmi Kpossou Homagnissin Benoît Kouwakanou Carin Ahouada Rodolph Koffi Vignon Comlan N´déhougbèa Martin Sokpon Vincent Zoundjiekpon Nicolas Kodjoh Jean Séhonou Copyright (c) 2021-12-30 2021-12-30 40 1 Child abuse during the COVID-19 pandemic in Bangladesh: a brutal reality <p>Violence against children, ranging from mental torture to forceful rape, is a critical public health issue that stifles growth. Convention on the Rights of the Children defined violence against children as “all forms of physical or mental violence, injury and abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse”. Along with all pre-existing forms mentioned in the above definition, online harassment added a new dimension to child abuse during the pandemic situation. Every year, globally, almost one out of every two children or one billion children experience some form of violence. But it is difficult to determine the situation of Bangladesh as there is a dearth of exact statistics related to violence against children. However, as stated by a recent Multiple Indicator Cluster Surveys (MICS) report, nearly 89% of Bangladeshi children aged 1-14 years had experienced violence against them, including physical torture, psychological hostility, etc., from their caregivers in the last one month before the MICS survey conducted. Based on reports from Ain o Salish Kendra (ASK), a Bangladeshi legal aid and human rights organization, at least 6,514 children (including 705 victims aged six years or below) experienced some form of violence within the years of 2016 to 2020 in Bangladesh, but only 3,237 victims sought for legal action.&nbsp; Presumably, the problem is worsening, as there has been a sharp increase in child rape and online harassment during the COVID-19 period. Considering the situation, the guardians should be more cautious about taking care of their children during the pandemic. Besides, there should be mass media coverage to encourage more reporting towards child violence which will eventually help us reform the social views by strengthening the system to reduce the overall burden.</p> Mosharop Hossian Md Utba Rashid Mohammad Hayatun Nabi Mohammad Delwer Hossain Hawlader Copyright (c) 2021-12-30 2021-12-30 40 1 Adverse event following vaccine surveillance in Kaduna State, Northwestern Nigeria (January 2018 - June 2019): analysis of health facility´s records <p><strong>Introduction:&nbsp;</strong>Adverse Events Following Immunization (AEFI) are one of the main reasons for inadequate immunization coverage in Kaduna State, and AEFI underreporting serves as a barrier to achieving goals of global pharmaco-vigilance for vaccine. The purpose of this study is to estimate the completeness of variables in the AEFI line-listing forms, calculate AEFI reporting rates by local government Areas &amp; vaccine type and profile the reported cases according to their reactions.</p> <p><strong>Methods:&nbsp;</strong>we conducted a descriptive, cross-sectional, retrospective study of primary surveillance records. We calculated AEFI reporting rates in the State and local government areas and AEFI Vaccine reaction rates to the various antigens. We used Binary logistic regression to determine the association between gender and vaccine reactions.</p> <p><strong>Results:&nbsp;</strong>seven thousand eight hundred and twenty-four (7,824) AEFI cases were reported. The completeness of variables on the filled AEFI line-list varied from 21% to 100%. The State had a high AEFI reporting rate of 9.09 per 10,000 administered doses. Fever (&lt;38oC) was the main AEFI reaction. Severe AEFI cases accounted for only 0.89% of the total reported cases. Pentavalent vaccine was the suspect antigen responsible for the highest number of AEFI cases, with a vaccine reaction rate of 44.77 per 10,000 doses. The Zaria Local Government area had the highest AEFI reporting rate, while the Sanga Local Government area had the lowest AEFI reporting rate in the State. The difference between genders in the number of reported AEFI cases was not statistically significant (p&gt;0.05). There were 35% higher odds of occurrence of bleeding among males than among females (aOR:1.354; P-value: p=.012; 95% CI: 1.070-1.715; Nagelkerke-R<sup>2-</sup>: 0.003). The other reactions were not significantly related to gender.</p> <p><strong>Conclusion:&nbsp;</strong>our study shows a higher occurrence of severe AEFI in subjects undergoing pentavalent vaccine. Thiscaused the highest incidence of AEFI. There was no significant association between gender and AEFI reactions.</p> Sambo Godwin Ishaku Gregory Umeh Bulus Adzu Anthony Onimisi Madubu Dauda Hadiza Aliyu Iyal Neyu Iliyasu Danjuma Jenom Sunday Jeremiah Daikwo Sannom Mildred Yates Ibrahim Idris Ibrahim Lami Hajara Samaila Basirat Abdullahi Stephen Kadarko Parom Kabir Yusuf Maiwashi Fureratu Zakari Kase Sarah Nuhu Copyright (c) 2021-12-30 2021-12-30 40 1