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 Khat chewing in pregnant women associated with prelabor rupture of membranes, evidence from eastern Ethiopia <p><strong>Introduction:&nbsp;</strong>prelabor rupture of membranes (PROM) is a major factor that affects pregnancy outcome. Results from previous studies have suggested that there is an association between pregnant women, khat chewing and preterm birth, but evidence of association with PROM is sparse. This study therefore aims at identifying association between khat chewing in pregnancy and premature rupture of membranes in eastern Ethiopia.</p> <p><strong>Methods:&nbsp;</strong>A health facility-based cross-sectional study was conducted among 1688 pregnant women who came for delivery service in Harar town, Eastern Ethiopia between June to October in 2016. Data were collected using a pre-tested structured questionnaire and checklist to extract data from the medical record. The association between khat and PROM was examined using logistic regression analysis. A statistical significance was declared at p-value &lt; 0.05.</p> <p><strong>Results:&nbsp;</strong>Of the 1688 pregnant women who participated in the study, 397 had prelabor rupture of the membranes, representing a proportion of 23.5% [(95% CI: (21.5, 25.6%)]. Of these 397 prelabor rupture of the membranes 198 (31.53%) were from Khat chewing mothers and, 199(18.77%) were from non-khat chewing mothers. After controlling for potential confounders, the multivariable logistic regression analysis revealed the odds of PROM was 1.51 times higher among khat chewed pregnant women [AOR = 1.51; 95% CI; (1.11, 2.07)] were had no khat chewing.</p> <p><strong>Conclusion:&nbsp;</strong>this study found a significant association between khat chewing in pregnancy and PROM. Efforts to reduce PROM need to consider prevention of khat chewing in pregnancy. A specific strategy need to protect pregnant women from khat chewing.</p> Tesfaye Assebe Yadeta Gudina Egata Berhanu Seyoum Dadi Marami Copyright (c) 2020-05-01 2020-05-01 36 1 Ligamentoplastie du ligament croisé antérieur du genou chez le sportif: étude rétrospective à propos de 80 cas dans le Département d’Orthopédie de Tataouine, Tunisie <p>La ligamentoplastie du ligament croisé antérieur a pour but de corriger la laxité antérieure du genou afin de retrouver une stabilité et une indolence. Le but de notre travail est d'évaluer les résultats fonctionnels à court et à moyen terme de notre série. C'est une étude rétrospective réalisée au service de Traumato-Orthopédie de l'hôpital de Tataouine au Sud tunisien, étalée sur une période de 5 ans, allant du mois de janvier 2013 au mois d'avril 2018, concernant 80 sportifs tous présentant une laxité chronique du genou secondaire à une rupture du LCA suite à un accident sportif. Tous les patients ont été opérés par le même chirurgien sous arthroscopie, le transplant a été prélevé soit du tendon rotulien soit des tendons de la patte d'oie. L'évaluation fonctionnelle a été faite selon le score fonctionnel de Lyshlom-Tegner. Dans notre étude, la reconstruction du LCA par le tendon rotulien a été pratiquée chez 20 patients, et par les tendons de la patte d'oie pour 60 patients. Le délai moyen de la reprise du sport dans notre série était de 9 mois. L'échelle de l'activité de Tegner a montré que 65 patients ont repris le sport au même niveau, avec un délai moyen de 9 mois, avec une reprise du sport à un niveau inférieur pour le reste. La ligamentoplastie du ligament croisé antérieur sous arthroscopie avec une maitrise de la technique et une rééducation post opératoire donnent des résultats fonctionnels satisfaisants avec reprise de l'activité sportive.</p> Mourad Hammami Nizar Sahnoun Copyright (c) 2020-05-04 2020-05-04 36 1 A coronary artery aneurysm revealing a Behçet´s disease: a case report <p>Behçet´s disease (BD) is a multisystemic chronic vasculitis characterized by its clinical polymorphism. It concerns mainly young men and generally appears between the third and the fourth decades. Cardiac involvement in Behçet´s disease is rare but represents a major prognostic factor. We report the case of a young man admitted in our department for the management of an acute coronary syndrome revealing a Behçet´s disease. Coronary angiography had shown a giant thrombosed aneurysm of the left coronary artery. Surgical treatment was successfully performed and the patient had a left anterior descending coronary artery bypass using the left internal mammary artery graft.</p> Sameh Ben Farhat Mehdi Slim Copyright (c) 2020-05-04 2020-05-04 36 1 Self-reported hypertension as a predictor of chronic health conditions among older adults in Ghana: analysis of the WHO Study on global Ageing and adult health (SAGE) Wave 2 <p><strong>Introduction:&nbsp;</strong>hypertension has been identified as a significant predictor of many chronic health conditions. Body Mass Index (BMI) and Quality of Life (QoL) are key determinants of hypertension especially among elderly populations. In this study, we examined the effect of self-reported hypertension (SRH) on chronic health conditions and quality of life among older adults in Ghana.</p> <p><strong>Methods:&nbsp;</strong>the WHO Study on Global Ageing and Adult Health Wave 2 data for Ghana, collected from 2014 to 2015 was applied in this study. Data for older adults aged 50 years and above were analyzed. Weighted descriptive and inferential analyses were performed using Stata 14. We predicted any potential associations between SRH and chronic health conditions using a corrected chi-square and Coarsened Exact Matching with adjusted odds ratios.</p> <p><strong>Results:&nbsp;</strong>the prevalence of SRH among older adults in Ghana was 15.8%. This was significantly associated with sex, marital status, religion, place of residence, working status, location/region, health status BMI, and quality of life (QoL). In all, older adults with poor health status, obese state and high QoL had 3.15, 2.17 and 2.76 odds of SRH respectively [AOR(95%CI)p-value=3.15(1.65-6.02)0.001, 2.17(1.31-3.59)0.003 and 2.76(1.04-7.31)0.041)]. In addition, older adults with SRH were at increased risk of reporting chronic conditions such as stroke, angina, diabetes and cataract.</p> <p><strong>Conclusion:&nbsp;</strong>overall, a key observation from this analysis is that SRH (and not only clinically diagnosed hypertension) is significantly associated with co-morbidities. In Ghana, older adults with SRH have increased risk of co-morbidities including diabetes, stroke, angina, and cataract. Interventions to improve the awareness and early detection of hypertension at the population level is key. Controlling hypertension at the population level will reduce prevalence of chronic conditions and increased protection.</p> John Tetteh Kow Entsua-Mensah Alfred Doku Sheriff Mohammed Swithin Mustapha Swaray Martin Amogre Ayanore Alfred Edwin Yawson Copyright (c) 2020-05-04 2020-05-04 36 1 Traitement chirurgical des fractures complexes de l´extrémité supérieure de l´humérus: étude rétrospective à propos de 25 cas <p>Les fractures de l´extrémité supérieure de l´humérus posent un problème thérapeutique particulièrement pour les fractures complexe à 3 et 4 fragments. Le but de notre travail est de déterminer l´aspect épidémio-clinique des fractures complexes de l´extrémité supérieur de l´humérus chez l´adulte et d´apprécier les résultats fonctionnels et radiologiques de notre série. Il s´agit d´une série de 25 cas colligés au service d´orthopédie CHU Habib Bourguiba entre 2012 et 2017. Nous avons recensé les données épidémiologiques des patients et les circonstances du traumatisme. Le traitement était de principe chirurgical sois ostéosynthèse par plaque ou clou soit un remplacement prothétique. La réduction a été évaluée sur les radiographies post opératoire. Au recul les résultats fonctionnels ont été évalués par le score de Constant. Notre série comporte 12 hommes et 13 femmes, La moyenne d´âge de nos patients était 55 ans, les accidents de la voie publique étaient notés dans 48%, Les fractures à 4 fragments ont été retrouvées dans 76% des cas. L´ostéosynthèse par plaque vissée a été utilisée dans 40% des cas et l´enclouage antérograde a été réalisé dans 40% des cas. La prothèse a été posée pour 5 patients. Le score de constant moyen était de 65,24 avec des extrêmes allant de 35 à 88. Nous avons noté une consolidation des fractures sans cal vicieux dans 68%. Dans les fractures complexes de l´extrémité supérieure de l´humérus, une ostéosynthèse bien indiquée selon le patient et la fracture et une rééducation post opératoire précoce permettent d´avoir des résultats fonctionnels acceptables.</p> Nizar Sahnoun Sami Chtourou Mohamed Ali Rebai Achraf Lajmi Mourad Hammami Hichem Chhaydar Yosr Hentati Hassib Keskes Copyright (c) 2020-05-06 2020-05-06 36 1 Failed primary percutaneous coronary intervention in a middle-aged man without cardiovascular risk factors: left atrium myxoma <p>Embolic events are rare presentation of myxoma, which is one of the most prevalent benign cardiac tumors. Here we report the case of a 53-year-old man with presentation of acute anterior infarction and occlusion of the left anterior descending artery in association with left atrial myxoma. Intracoronary aspiration thrombectomy along with frequent balloon inflation was failed to recover distal coronary blood flow.</p> Nahid Azdaki Seyedali Moezi Mahmood Hosseinzadehmaleki Marjan Farzad Copyright (c) 2020-05-06 2020-05-06 36 1 Giant enchondroma recurrence of the proximal phalanx of the fifth finger: a case report <p>Enchondroma (EC) is a benign and cartilage-forming tumor that causes intramedullary lesions. Moreover, EC is the most common bone tumor in the phalanges and metacarpal bones of the hand, deforming the structure and causing pain and functional limitation. The management of this neoplasia is the surgical treatment and the approach that is well-accepted consists in the curettage followed by the void augmentation with biological or synthetic fillers. The results from surgery are usually good and the recurrence rate is low (2-15%). In this article we report a case of EC recurrence of the proximal phalanx of the fifth finger of the hand after curettage and grafting. The patient was treated with the amputation of the fifth ray according to the Tsuge technique, obtaining a satisfying clinical result.</p> Dario Pilla Alessandro Geraci Lawrence Camarda Alberto Ricciardi Copyright (c) 2020-05-06 2020-05-06 36 1 Macroprolactinemia in patients with hyperprolactinemia: an experience from a single tertiary center <p>Macroprolactinemia frequently causes misdiagnosis, unnecessary investigation and inappropriate treatment in hyperprolactinemic patients. Aim of this study is to investigate the prevalence and clinical characteristics of Thai patients with macroprolactinemia. We performed a cross-sectional study in 56 hyperprolactinemic patients (51 women and 5 men) whose sera were subsequently tested for the presence of macroprolactin. Recovery of less than 40% of serum prolactin after polyethylene glycol (PEG) precipitation was indicative of macroprolactinemia. Our study revealed 19.64% (11/56) of patients with hyperprolactinemia were found to have a preponderance of macroprolactin. All patients with macroprolactinemia were women, of which eight of them were initially diagnosed as idiopathic hyperprolactinemia and mistreated with dopamine agonist medications. Interestingly, neuroradiological abnormalities were reported in three patients with macroprolactinemia, 2 cases with prolactinoma and one case with stalk effect hyperprolactinemia. In conclusion, nearly one-fifth of our patients with hyperprolactinemia have macroprolactinemia. This finding suggests that the diagnostic algorithm of all patients with hyperprolactinemia should include the PEG precipitation test as the initial step.</p> Phronpan Chutpiboonwat Kanchana Yenpinyosuk Vitaya Sridama Supaksorn Kunjan Karuna Klaimukh Thiti Snabboon Copyright (c) 2020-05-06 2020-05-06 36 1 Epidemiological, clinical and diagnostic profile of breast cancer patients treated at Potchefstroom regional hospital, South Africa, 2012-2018: an open-cohort study <p><strong>Introduction</strong>: breast cancer is the second most diagnosed cancer worldwide. We aimed to depict the diagnostic approach as well as the epidemiologic and clinical profile of patients with breast cancer at Potchefstroom regional hospital, South Africa.</p> <p><strong>Methods</strong>: this descriptive open-cohort study included patients with primary invasive breast cancer, confirmed by histology results and treated at the hospital from 01 January 2012 to 31 December 2018. Data such as demographics, patient history, histology, breast clinical findings, physical mass description and diagnostic investigations were captured from hospital registries and patient files.</p> <p><strong>Results</strong>: one-hundred-thirty-eight patients (mean age 56.2 (SD: 14.4) (95% CI 54.6-59.7) years) met inclusion criteria. Most patients were female (98.6%), from African (67.4%) or Caucasian (23.9%) descent. Findings included mostly left-side breast involvement (51.8%), lesions in the upper-outer quadrant (43.1%), extensions to the skin (25.6%, N = 39), and tumour size of 2 ≤ 5 cm (49.3%), or &gt; 5 cm (39.1%). Most patients (57.9%, N = 135) were categorised as BIRADS-5, with a ductal pattern (89.6%) (p &lt; 0.01). Patients mostly presented in stages II to IV of disease (89.1%; p &lt; 0.05). Late-stage (stages III-IV) at time of diagnosis (n = 84) was significantly associated with mass location (p = 0.006; Cramér's V = 0.280), tumour size (p &lt; 0.001, Cramér's V = 0.239), and skin changes (p = 0.027, Cramér's V = 0.492).</p> <p><strong>Conclusion</strong>: most patients consulted at late-stage of the disease, indicating a need for the promotion of breast awareness campaigns, early detection, and timeous referral.</p> Baudouin Kongolo Kakudji Prince Kasongo Mwila Johanita Riétte Burger Jesslee Melinda Du Plessis Copyright (c) 2020-05-08 2020-05-08 36 1 Partners in crime: two prisoners with foreign body insertion <p>Two prisoners, a 35-year-old and a 42-year-old man, were admitted to the Emergency Department (ED), following court order. Upon clinical evaluation, their vital signs were normal, while digital rectal examination was suspicious for foreign bodies. Abdominal radiographs were performed and revealed that the first beared rectally two smartphone chargers with their cables (A) and the second a smartphone (B) for communication purposes. Penis pearling is also incidentaly noted (B) not unusual among prisoners to increase intercourse stimulation. Following mild sedation, all rectal foreign bodies were manually extracted and both were discharged in good health after 2-hour monitoring. It is common for prisoners to present with foreign body ingestion or insertion which may be associated with escape or self-destruction attempts, drug-dealing, acts of physical stimulation/assault. Admission may be involuntary and essential history information may be concealed. The emergency physician needs to be vigilant and familiar with the radiographic appearances of commonly encountered foreign bodies.</p> Androniki Kozana Gerardina Cavallo Copyright (c) 2020-05-08 2020-05-08 36 1 Typical presentation of pulmonary lepidic adenocarcinoma: a rare case report <p>Bronchioloalveolar carcinoma (BAC) is a rare subtype of adenocarcinoma of lung with distinct features and distinctive characteristics. It accounts approximately for 4% of lung cancers. In the following study we report a rare observation of a 50 years old female with a clinical, radiological and histological presentation, which is typical of an invasive mucinous lepidic adenocarcinoma formerly named BAC.</p> Rajae Azzeddine Ismail Abderahmani Rhorfi Adil Zegmout Hicham Souhi Hanane Elouazzani Ahmed Abid Hafsa Chahdi Mohamed Tbouda Copyright (c) 2020-05-11 2020-05-11 36 1 Atypical clinical presentation of systemic juvenile idiopathic arthritis or Still´s disease: a report of two cases <p>Juvenile idiopathic arthritis (JIA) constitutes a group of arthritis of unknown origin that begins before the age of 16 years. Still´s disease is the systemic form of this condition. Its clinical presentation is marked by fever, rash and sometimes joint pain, in the absence of evidence of another aetiology of the fever. We present the cases of two boys aged 4 and 10 years admitted for fever, with a cerebral origin for the first and no infectious site for the second. Fever persisted after antimalarial treatment and adequate antibiotics. Ferritinaemia, elevated sedimentation rate, lactate dehydrogenase (LDH), triglycerides, and increased serum transaminases, all in the absence of evidence of other inflammatory or malignant diseases were suggestive of Still's disease. Both children received a corticosteroid therapy with progressive dose reduction associated to methotrexate during treatment. Fever disappeared within a few hours after initiation of corticosteroid therapy, with considerable improvement in clinical state. To the best of our knowledge, these cases are among the rare cases of childhood Still disease reported in sub-Saharan Africa. These cases highlight the importance of investigating non-infectious causes of persistent fever in children, in a context of infectious disease endemicity.</p> Emeline Tiogouo Paul Eloundou Hermine Moukodi Leo Fozeu Guy Sadeu Wafeu Copyright (c) 2020-05-12 2020-05-12 36 1 Domestic donkey bite of genitalia: an unusual etiology of penile glans amputation in Burkina Faso (case report and literature review) <p>A 15-years-old boy was admitted in our hospital emergency unit with complaints of injured and hemorrhagic penile glans after donkey bites. The accident occurred during domestic activity with the animal when the boy attempted to guide the donkey. After thorough physical examination, the patient presented a penile glans amputation. Tetanic prophylaxis was started. The patient benefited from hemostatic suturing, stump regularization and penile glans reconstructive surgery and there was no complication. Functional and cosmetic results were satisfactory with good quality of micturition after six months' follow-up.</p> Adama Ouattara Clotaire Yaméogo Abdoul Karim Paré Aristide Fasnéwindé Kaboré Désiré Ky Boukary Kabré Amidou Bako Delphine Yé Timothée Kambou Copyright (c) 2020-05-12 2020-05-12 36 1 Isolated left pulmonary artery hypoplasia <p>Pulmonary artery hypoplasia is a rare malformation of childhood that is usually associated with cardiac abnormalities. In the absence of these cardiac malformations it is discovered later when respiratory signs appear. It was a 56-year-old patient who had been referred for dyspnea with cough. The physical examination was normal. Chest X-ray, thoracic computed tomography (CT) scan and echocardiography suggested the diagnosis of hypoplasia of the left pulmonary artery without associated cardiac malformations. The early diagnosis of hypoplasia of the pulmonary artery allows the close follow-up of these patient and the planning of an adequate management.</p> Imen Touil Nadia Keskes Boudawara Soumaya Bouchareb Jalel Knani Leila Boussoffara Copyright (c) 2020-05-12 2020-05-12 36 1 Successful treatment with bortezomib-containing regimen of primary plasma cell leukemia: a case report <p>Plasma cell leukemia represents the most aggressive form of plasma cell dyscrasia. We report a 67-year old male with no previous medical illnesses presented with anemic symptoms. Blood film revealed 35% circulating plasma cells, bone marrow biopsy showed plasma cells constituting 85%. Diagnosis of primary plasma cell leukemia was completed. Induction chemotherapy with bortezomib, doxorubicin, and dexamethasone was started. After the first cycle, plasma cells in peripheral blood disappeared. The patient had complete remission at evaluation after the third cycle. Re-evaluation after the sixth cycle showed that he maintained remission. As he was non-transplant eligible, he was we kept on maintenance bortezomib. Twenty-four months after the diagnosis, the patient remains in remission.</p> Mohammad Bader Obeidat Ali Mohammad Al-Swailmeen Abdulmajeed Mohammad Arabeat Ayman Sulaiman Abukamar Copyright (c) 2020-05-12 2020-05-12 36 1 Tuberculous cold abscess of sternoclavicular joint: a case report <p>Bone and joint tuberculosis is a serious medical problem; tuberculosis of sternoclavicular joint is rare. We present a case of a healthy 37-year old man with sternoclavicular joint tuberculosis. The subject presented with a three weeks history of left sternoclavicular joint painless swelling without fever or weight loss. He had no previous history of pulmonary tuberculosis. Laboratory testing revealed erythrocyte sedimentation rate of 70 mm/hour, C-reactive protein of 30 mg/liter and a normal leucocyte count. Biopsy of the lesion showed caseous necrosis and pus culture revealed&nbsp;<em>Mycobacterium tuberculosis</em>. He was treated with joint debridement and anti-tuberculous medications. Tuberculosis resolved completely but post-infection patients had residual joint arthritis. Tuberculosis may infect unusual joints such as the sternoclavicular joint.</p> Ismail Burud Mohammad Arshad Ikram Mahadevan Deva Tata Junalina Jaafar Copyright (c) 2020-05-12 2020-05-12 36 1 La crosse aortique droite avec aorte descendante gauche: une cause rare de dysphagie <p>Les anomalies aortiques constituent une étiologie rare des dysphagies chez les grands enfants, les adolescents, les adultes jeunes et les personnes âgées. Dans ces cas, l´anomalie vasculaire en cause est, très souvent une artère sous-clavière droite aberrante, une artère sous-clavière gauche naissant d´une crosse aortique droiteet plus rarementune crosse aortique à droite avec une aorte thoracique descendante à gauche. Cette dysphagie, appelée “dysphagia lusoria”, due à la compression de l´œsophage par une ou plusieurs anomalies vasculaires congénitales, peut apparaitre dans l´enfance ou plus tard à l´âge adulte. Le transit œsogastroduodénal révèle une compression extrinsèque de l´œsophage et l´angiographie (scanner ou imagerie par résonnance magnétique (IRM)) thoracique confirme le diagnostic. Dans quelques cas, un traitement chirurgical est souvent requis. Nous rapportons le cas d´une patiente de 30 ans, sans antécédent médical ou chirurgical contributif, venue consulter pour une dysphagie aux solides, d´installation récente, sans autre symptôme associé. Elle avait un bon état général, et son examen physique était normal. Dans le cadre de l´exploration de cette dysphagie, la patiente réalisera d´abord un transit œsogastroduodénal qui révèlera une compression œsophagienne extrinsèque, puis secondairement une radiographie du thoraxet une imagerie par résonnance magnétique thoracique qui mettront en évidence une crosse aortique droite avec une aorte descendante gauche, sans situs inversus. L´échographie doppler cardiaque qui sera réalisée en dernier éliminera une cardiopathie congénitale associée. L´évolution a été marquée par la régression de façon spontanée de la dysphagie.</p> David Douglas Banga Nkomo Louis Joss Bitang A Mafok Copyright (c) 2020-05-13 2020-05-13 36 1 Enhancing capacity for clinical practice guidelines in South Africa <p><strong>Introduction:&nbsp;</strong>use of good quality, evidence-informed and up-to-date clinical practice guidelines (CPGs) has the potential to impact health outcomes. This paper describes the development, implementation and evaluation of a dedicated CPG training course to address the training needs of CPG stakeholders in South Africa.</p> <p><strong>Methods:&nbsp;</strong>we first reviewed the content and teaching strategies of existing CPG courses. This review consisted of a systematic review of teaching and learning strategies for guideline teams and a document review of existing courses offered by international guideline groups, universities and professional groups. We then strengthened an existing CPG course and evaluated it.</p> <p><strong>Results:&nbsp;</strong>we found no studies on teaching and learning strategies for guideline teams. We identified six CPG courses being offered as full courses (part of a postgraduate degree program) by universities or as independent training for continuing professional education by professional groups. Contents focused on new guideline development. One course included alternative methods of guideline approaches such as contextualization and adaptation. The format varied from face-to-face sessions, to online sessions, group exercises and discussions, seminar format and project based activities. The revised CPG four-month long course that we implemented was designed to be pragmatic, reflective and contextually relevant. It used local guideline examples, authentic tasks, and an online forum for discussions and resources. It covered de novo CPG development, alternative methods of development (adopting, contextualising, adapting), and implementing CPGs. Course evaluation identified strengths and areas for improvement.</p> <p><strong>Conclusion:&nbsp;</strong>dedicated capacity development has potential to positively influence CPG development and implementation.</p> Taryn Young Janine Dizon Tamara Kredo Michael McCaul Eleanor Ochodo Karen Grimmer Quinette Louw Copyright (c) 2020-05-13 2020-05-13 36 1 Prevalence and associated factors of birth defects among newborns in sub-Saharan African countries: a systematic review and meta-analysis <p><strong>Introduction:&nbsp;</strong>birth defects are the most serious causes of infant mortality and disability in sub-Saharan African countries with variable magnitude. Hence, this study was aimed to determine the pooled prevalence of birth defects and its associated risk factors among newborn infants in sub-Saharan African countries.</p> <p><strong>Methods:&nbsp;</strong>a total of 43 eligible studies were identified through literature search from Medline (PubMed), EMBASE, HINARI, Google scholar, Science Direct, Cochrane Library and other sources. Extracted data were analyzed using STATA 15.0 statistical software. A random effect meta-analysis model was used.</p> <p><strong>Results:&nbsp;</strong>twenty-five studies in 9 countries showed that the pooled prevalence of birth defects was 20.40 per 1,000 births (95% CI: 17.04, 23.77). In the sub-group analysis, the highest prevalence was observed in southern Africa region with a prevalence of 43 per 1000 (95% CI: 14.89, 71.10). The most prevalent types of birth defects were musculo-skeletal system defects with a pooled prevalence of 3.90 per 1000 (95% CI: 3.11, 4.70) while the least was Down syndrome 0.62 per 1000 (95% CI: 0.40, 0.84). Lack of folic acid supplementation (95% CI: 1.95, 7.88), presence of chronic disease (95% CI: 2.00, 6.07) and intake of drugs (95% CI: 3.88, 14.66) during pregnancy were significantly associated with the birth defects.</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of birth defects is relatively high with high degree of regional variabilities. The most common types of birth defects were musculoskeletal defects. Lack of folic acid supplementation, presence of chronic disease and intake of drugs during pregnancy were significantly associated with birth defects.</p> Fentahun Adane Mekbeb Afework Girma Seyoum Alemu Gebrie Copyright (c) 2020-05-14 2020-05-14 36 1 Measles outbreak investigation in Ginnir district of Bale zone, Oromia region, Southeast Ethiopia, May 2019 <p><strong>Introduction:&nbsp;</strong>measles is a vaccine-preventable viral infection of humans, primarily affecting children &lt;5 years. During early 2019, outbreak of measles occurred in Ginnir district of Bale zone, Southeast Ethiopia. We investigated to describe the outbreak and identify risk factors.</p> <p><strong>Methods:&nbsp;</strong>we conducted a descriptive and 1:2 unmatched case-control study in Ginnir district from March 18 to April 29, 2019. Fifty-six cases and 112 controls were recruited. For descriptive study, we identified 1043 cases recorded on the line-list and for case-control study, cases were identified using national standard case-definition. Mothers of case-patients and controls were interviewed using structured questionnaire. We estimated vaccine efficacy (VE) from case-control study. We conducted bivariate and multivariable logistic regression.</p> <p><strong>Results:&nbsp;</strong>in four-months period, a total of 1,043 suspected measles cases epidemiologically linked to five laboratory confirmed cases reported. Of which, 555 (53.2%) were males and 714 (68.5%) were &lt;5 years. The median age of cases was 36 months (IQR=12-60 months). The overall attack rate (AR) was 63/10,000 population with case fatality ratio of 0.5% (5 deaths/1043). Infant &lt;9 months were the most affected age groups (AR=31/1000). Majority (79%) of measles cases were not vaccinated against measles. Last-year (2017/18) administrative measle vaccine coverage of the district was 76.7%. Being unvaccinated against measles (AOR=5.4, 95%CI=2.2-13.4), travel history (AOR=4.02, 95%CI=1.2-13.6), contact with measles case-patient (AOR=5.6, 95%CI=2.12-14.4) and mothers knowledge of measles transmission (AOR=0.36, 95%CI=0.15-0.87) were associated with measles infection. VE in children aged 9-59 months was 90% (95%CI=69-97%).</p> <p><strong>Conclusion:&nbsp;</strong>this confirmed measles outbreak was caused by failure to vaccinate, as indicated by the high VE, low administrative coverage, and 79% unvaccinated cases. Strengthening routine and supplementary immunization are required.</p> Falaho Sani Kalil Desta Hiko Gemeda Mohammed Hasen Bedaso Shukri Kabeta Wario Copyright (c) 2020-05-14 2020-05-14 36 1 Pattern of coronary arterial lesions amongst Saudi Arabians: a cross-sectional coronary fluoroscopic angiography study <p><strong>Introduction:&nbsp;</strong>coronary artery disease (CAD) is a major cardiovascular disease (CVD) that affects a large population globally. This study aimed at determining coronary arterial lesions (CAL), particularly in terms of age, gender, coronary artery/arteries involved, number of lesions, and dominant coronary artery in the Kingdom of Saudi Arabia (KSA).</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted at the King Khalid Hospital and Prince Sultan Centre for Health Care in Al-Kharj between January 2017 and March 2018. The patients with CAD lesion/s, fulfilling the inclusion criteria, were recruited from the cardiovascular medicine unit. Demographic information and the location and extent of their CAD lesions were extracted and documented in electronic case report form (eCRF). SPSS 22.0 was used for statistical analysis, and p value ≤ 0.05 was considered as significant.</p> <p><strong>Results:&nbsp;</strong>of the 262 patients, male and female preponderance was 74.8% and 25.2% respectively. The majority of the patients were adults above the age of 50 (72%). About half of all patients were active smokers (53%). Diabetes, hypertension, and hyperlipidaemia were recorded in 63%, 53.7% and 25% respectively. The incidence of cardiovascular lesions was documented after coronary angiography; left circumflex artery lesions had the highest incidence (85.3%), followed by left anterior descending artery lesions (82.4%) and right circumflex artery lesions (74.3%). Left main coronary artery lesions had the lowest incidence (10.3%). Most patients (59.6%) had three concomitant lesions, whereas a minority of patients had two (22.8%) and one lesion (17.7%).</p> <p><strong>Conclusion:&nbsp;</strong>the pattern of CALs is different among the Saudi population as compared to other countries.</p> Khalid Hadi Aldosari Khalid Mansour Alkhathlan Sameer Al-Ghamdi Fayez Elsayed Abdelhamid Elshaer Mohammed Hamid Karrar Abdulrahman Mohammed Aldawsari Copyright (c) 2020-05-18 2020-05-18 36 1 Nigeria, a high burden state of obstetric fistula: a contextual analysis of key drivers <p>Obstetric fistula (OF) remain a source of public health concern and one of the most devastating maternal morbidities afflicting about two million women, mostly in developing countries. It is still prevalent in Nigeria due to the existence of socio-cultural beliefs/practices, socio-economic state and poor health facilities. The country's estimated annual 40,000 pregnancy-related deaths account for about 14% of the global maternal mortality, placing it among the top 10 most dangerous countries in the world for a woman to give birth. However, maternal morbidities including OF account for 20 to 30 times the number of maternal mortalities. This review substantiates why OF is yet to be eliminated in Nigeria as one of the countries with the largest burden of obstetric fistula. There is need for coordinated response to prevent and eliminate this morbidity via political commitment, implementation of evidence-based policy and execution of prevention programs.</p> Oluwasomidoyin Olukemi Bello Imran Oludare Morhason-Bello Oladosu Akanbi Ojengbede Copyright (c) 2020-05-18 2020-05-18 36 1 The prevalence, risk factors and antifungal sensitivity pattern of oral candidiasis in HIV/AIDS patients in Kumba District Hospital, South West Region, Cameroon <p><strong>Introduction:</strong>&nbsp;oral candidiasis is one of the most common opportunistic infection in HIV/AIDS patient and it is caused by&nbsp;<em>Candida</em>&nbsp;species. The low absolute CD4+T-lymphocyte count has traditionally been cited as the greatest risk factor for the development of Oral Candidiasis. The aim of this study was to identify&nbsp;<em>Candida</em>&nbsp;species isolated from the oral cavity of HIV/AIDS patients, to determine their in vitro antifungal susceptibility and to investigate the possible risk factors associated with oral candidiasis.</p> <p><strong>Methods:</strong>&nbsp;this was a hospital based cross sectional study that was carried out for a period of 3 months amongst HIV/AIDS patients in Kumba District Hospital, whether on HAART or not. Mouth swabs were collected from 378 participants using sterile cotton wool swabs and 5ml venous blood were collected for determination of CD4 cell.&nbsp;<em>Candida</em>&nbsp;species were isolated and identified. Antifungal sensitivity testing was performed using modified kirby-bauer susceptibility testing technique.</p> <p><strong>Results:</strong>&nbsp;<em>Candida</em>&nbsp;species were present in 42.86% of the samples and&nbsp;<em>Candida albicans</em>&nbsp;was the most prevalent (60.2%) amongst the six&nbsp;<em>Candida</em>&nbsp;isolates identified, followed by&nbsp;<em>Candida glabrata</em>&nbsp;(16.9%),&nbsp;<em>Candida krusei</em>&nbsp;(12.3%),&nbsp;<em>Candida tropicalis</em>&nbsp;(6.4%),&nbsp;<em>Candida parapsilosis</em>&nbsp;(2.3%) and&nbsp;<em>Candida pseudotropicalis</em>(1.8%) .Pregnancy, oral hygiene and antibiotic usage were significantly associated with oral candidiasis in HIV/AIDS patients (P&lt;0.05). Oral candidiasis was mostly frequent in HIV/AIDS patients between 21-40 years. A CD4 cell count less than 200 cells/μl was a significant risk factor for acquiring oral candidiasis in HIV/AIDS patients (P&lt;0.001). Nystatin was the most sensitive drug (83.6%) meanwhile ketonazole was the most resistant drug (29.2%), followed by fluconazole (24.6%) to all oral&nbsp;<em>Candida</em>&nbsp;isolates.</p> <p><strong>Conclusion:</strong>&nbsp;oral&nbsp;<em>Candida</em>&nbsp;colonization occurs more frequently in HIV/AIDS patients and the is a need for the government to implement regular checks for opportunistic infections in HIV/AIDS patients, including oral candidiasis in HIV/AIDS patients to monitor disease progression and prevent subsequent complications such as candidemia and diarrhea.</p> Ngwa Fabrice Ambe Njunda Anna Longdoh Patience Tebid Tanyi Pride Bobga Claude Ngwayu Nkfusai Sangwe Bertrand Ngwa Frankline Sanyuy Nsai Samuel Nambile Cumber Copyright (c) 2020-05-19 2020-05-19 36 1 A retrospective study on the epidemiology and trends of road traffic accidents, fatalities and injuries in three Municipalities of Dar es Salaam region, Tanzania between 2014-2018 <p><strong>Introduction:&nbsp;</strong>over 90% of injuries and deaths still occur in low and middle-income countries like Tanzania due to Road traffic accidents. Available literature indicates that Tanzania suffers massive human and economic losses every year from RTAs despite several interventions that have been made to curb this scourge. To gain an insight into the current state of RTAs we examined the pre- historical case fatality rates from RTAs in Ilala and two other municipalities (Kinondoni and Temeke) in Dar es Salaam Region, Tanzania.</p> <p><strong>Methods:&nbsp;</strong>we conducted a retrospective study using the secondary data on road accidents from Road Accident Information System (RAIS) for the period 2014 to 2018.</p> <p><strong>Results:&nbsp;</strong>a total of 6,772 road traffic injuries were reported between 2014 and 2018 and the study recorded the highest RTAs in the year 2014 as compared to the other years within the study period. The death rate from RTAs in Ilala Municipality alone was 36.4 per 100,000 population. About 28% of the total fatalities were recorded among the pedestrians, and there was a significant difference (P &lt; 0.05) in the RTAs among the other road users.</p> <p><strong>Conclusion:&nbsp;</strong>the study recommends the improvement of road transport infrastructure to ensure safety for all the road users by implementing the existing policies, strengthening the enforcement of existing legislation and introducing express penalties on a real-time basis. We encourage the use of this data to develop strategies in Tanzania that protect pedestrians and other vulnerable road users from RTAs.</p> Francis Walugembe Francis Levira Balasubramanian Ganesh Dickson Wilson Lwetoijera Copyright (c) 2020-05-20 2020-05-20 36 1 The neuroimaging magnitude of pediatric brain atrophy in northern Tanzania <p><strong>Introduction:&nbsp;</strong>the loss of parenchymal brain volume per normative age comparison is a distinctive feature of brain atrophy. While the condition is the most prevalent to elderly, it has also been observed in pediatric ages. Various causes such as trauma, infection, and malnutrition have been reported to trigger the loss of brain tissues volume. Despite this literature based knowledge of risk factors, the magnitude of brain atrophy in pediatric age group is scantly addressed in most developing countries including Tanzania. The current study aims to understand the magnitude of brain atrophy in children residing in Northern Zone, Tanzania.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional hospital survey was performed in which 455 children who were presented with various brain pathologies from the year 2013 to 2019 and whose brains examined by Computerized tomography (CT)-Scanners were recruited in the study. The brain statuses were examined using three linear radiological methods including the measure of sulcal-width, Evans index, and lateral ventricular body width.</p> <p><strong>Results:&nbsp;</strong>results showed a significant number of atrophied brains among children in Northern Tanzania and that the condition was observed to have a 1:1 male to female ratio. The prevalence of pediatric brain atrophy was found to be 16.04%.</p> <p><strong>Conclusion:&nbsp;</strong>the cortical subtype of brain atrophy presented as the most prevalent type of brain volume loss. The findings of this study suggest existence of considerable trends of brain atrophy in children which need special attention and mitigation plans.</p> Richard Erasto Sungura John Martin Spitsbergen Emmanuel Abraham Mpolya Elingarami Sauli John-Mary Vianney Copyright (c) 2020-05-21 2020-05-21 36 1 Tolérance de l’évérolimus en pratique clinique: étude retrospective <p>L´évérolimus est un inhibiteur mTOR ayant démontré une activité clinique dans plusieurs tumeurs solides notamment dans le cancer du rein après une première ligne à base d´un TKI anti VEGF et dans le cancer du sein en association avec l´exemesthane après échec d´un antiaroamatase. L´objectif de ce travail est d´analyser le profil de tolérance de l´évérolimus dans le cancer du sein et le cancer du rein en pratique clinique. Il s´agit d´une étude rétrospective portant sur les patients suivis pour cancer du sein et cancer du rein durant la période s´étendant de janvier 2008 à janvier 2015. Tous les patients ont reçu l´évérolimus à la dose quotidienne de 10 mg seul ou en association avec l´exemesthane pour le cancer du sein. Les effets indésirables ont été gradés selon la classification du&nbsp;<em>National Cancer Institute Common Terminology Criteria for Adverses version 4.0 (NCI-CTCAE)</em>. Au total 100 patients ont été inclus: 76 patientes avec cancer du sein et 24 patients avec cancer rénal. La durée médiane de traitement était estimée à 5,7 mois. Le traitement a été arrêté dans plus de 70% des cas pour intolérance. Les principaux effets indésirables avec une incidence de plus de 30% pour tous les grades étaient la mucite, le rash, la fatigue, l´anémie, la lymphopénie, l´hyperglycémie,l´hyperlipidémie et les infections. Les toxicités grade 3-4 avec incidence élevée étaient la mucite, la pneumopathie non infectieuse et les infections. Le taux d´arrêt du traitement pour intolérance reste élevé en comparaison avec les données de la literature. Une attention particulière doit être accordée à la mucite, l´effet immunosuppresseur de traitement et la pneumopathie non infectieuse et ce dès le début du traitement.</p> Leila Afani Rhizlane Belbaraka Ahmad Awada Copyright (c) 2020-05-21 2020-05-21 36 1 Landscape analysis of healthcare policy: the instrumental role of governance in HIV/AIDS services integration framework <p><strong>Introduction:&nbsp;</strong>low and middle-income countries HIV/AIDS interventions are yet to achieve the desired levels of health outcome due to lack of effectiveness and efficiency in programming, a challenge associated with resource limitations, fragmentated services, complexities in population and disease characteristics including political landscape. The objective of this study was to establish the instrumental role of governance in the implementation of HIV/AIDS services integration policy framework, with focus on organization structure, participation in decision making, collaboration, stakeholder engagement, political commitment as study variables.</p> <p><strong>Methods:&nbsp;</strong>using a mixed method design, a total number of 30 health workers, 5 county AIDS services coordinators (CASCOs), 8 sub-CASCOs and 3 representatives of inter coordinating committee were interviewed in compliance with ethical protocols. Multi-stage sampling techniques was used to select counties in Kenya, health institutions and respondents. Quantitative and qualitative data was generated by administering semi structured questionnaire and key informant interview guide.</p> <p><strong>Results:&nbsp;</strong>generated from excel sheet and NVivo software indicate that organization structures existed and clarity and ease of work varied across the different levels of care. Collaboration efforts, however varied, created synergy in policy framework implementation and political commitment complemented the various leadership actions for successful implementation of integration policy framework.</p> <p><strong>Conclusion:&nbsp;</strong>governance role is indispensable in the implementation of health policy framework. Policy makers need accurate epidemiological and demographic information to implement contextualized policy framework necessary for sustained improvement in health outcomes.</p> Maureen Atieno Adoyo Copyright (c) 2020-05-21 2020-05-21 36 1 Autoimmune hypophysitis and viral infection in a pregnant woman: a challengeable case <p>The aim of this study is to report a challengeable and rare case of autoimmune hypophysitis possibly induced by viral infections. A young pregnant female developed optic neuropathy due to enlarged sellar mass responsible for hypopituitarism. Investigations exclude neoplasia and systemic diseases. High level of sedimentation rate and magnetic resonance imaging (MRI) findings supported the diagnosis of autoimmune hypophysitis. The patient reported a history of bronchitis treated with antibiotics and corticosteroids and positive serologies for hepatitis B antigen (Hbs antigen), herpes simplex 1 and rubella. Final examination showed complete recovery of visual function and sellar archnoidocele after antiviral treatment and mild dose of corticosteroids.</p> Kais Benabderrahim Copyright (c) 2020-05-21 2020-05-21 36 1 Angiosarcome mammaire radio-induit: à propos d'un cas <p>L´angiosarcome mammaire est une tumeur conjonctive rare d´origine endothéliale vasculaire, primitive chez les patientes jeunes, radio-induite chez les plus âgées, caractérisée par sa malignité et par sa présentation clinique et radiologique polymorphe, elle est de très mauvais pronostic, par la survenue fréquente de métastases viscérales et de récidive rapide. Nous rapportons un cas d´angiosarcome mammaire, chez une patiente âgée de 43 ans, ayant un antécédent de cancer de sein, traité par chirurgie conservatrice et radiothérapie adjuvante. Nous discuterons à travers cette observation, les aspects épidémiologiques, diagnostiques et thérapeutiques de ce type de rares tumeurs agressives.</p> Amine Majdoubi Badr Serji Tijani El Harroudi Copyright (c) 2020-05-21 2020-05-21 36 1 Spectrum of heart failure in sub-Saharan Africa: data from a tertiary hospital-based registry in the eastern center of Burkina Faso <p><strong>Introduction:&nbsp;</strong>heart failure (HF) is a strong contributor to non-communicable diseases burden in sub-Saharan Africa (SSA). Few studies have addressed the pattern of HF in Burkina Faso.</p> <p><strong>Methods:&nbsp;</strong>we conducted a prospective cohort study in patients with acute HF in the Regional Hospital Center of Tenkodogo, eastern region of Burkina Faso. Patients were consecutively enrolled from 1<sup>st</sup>January 2015 to 31<sup>st</sup>&nbsp;December 2016 and followed up until June 2017. Primary outcome of interest was mortality.</p> <p><strong>Results:&nbsp;</strong>overall 318 of 1805 cardiac cases presented with acute HF (17.62 %). Of the 298 patients included in the analysis process, 239 had de novo HF and 150 were male. The mean age was 58.56 ± 18.54 years. Eighty-eight patients presented with atrial fibrillation. The mean left ventricular ejection fraction (LVEF) was 38.20 ± 12.85 % with reduced ejection fraction (LVEF &lt; 40%) accounting for 59.73% of the cases. Most of the study patients lived in rural areas. Hypertensive heart disease (50.34%) and idiopathic dilated cardiomyopathy (19.80%) were the leading causes of HF. Most patients received renin-angiotensin system blockers contrasting with a lower prescription rate of beta-blockers (99% versus 18.79% respectively). The incidence of all-cause mortality was 31 percent patients-years.</p> <p><strong>Conclusion:&nbsp;</strong>heart failure is frequent in SSA, affecting patients at younger age. Predominantly of non-ischemic cause, commonly hypertensive, the disease is associated with high mortality.</p> Dakaboué Germain Mandi Joel Bamouni Rélwendé Aristide Yaméogo Dangwé Temoua Naïbé Elisé Kaboré Yibar Kambiré Koudougou Jonas Kologo Georges Rosario Christian Millogo Patrice Zabsonré Copyright (c) 2020-05-21 2020-05-21 36 1 Can we use the ankle non-invasive blood pressure during otolaryngologic surgery: an observational study <p><strong>Introduction:&nbsp;</strong>in otolaryngologic surgery, ankle is frequently used for monitoring anesthesia in place of brachial when the patient doesn´t need invasive arterial cannulation. If there is a clinically useful and Predictable link between the two readings in hemodynamic normal patient, this difference during otolaryngologic surgery, was not evaluated. We aimed to investigate the reliability and the acceptability of non invasive blood pressure measurements at the ankle compared to those obtained concurrently at the arm during otolaryngologic surgery.</p> <p><strong>Methods:&nbsp;</strong>eighty ASA grade I and II patients who had to be operated under general anesthesia were taken as subjects for our study. Blood pressures were measured simultaneously in the 2 limbs before induction and then every 10 minutes until the end of the surgical procedure. Readings were initiated concurrently. Statistical analysis was performed with PASW Statistics 13.</p> <p><strong>Results:&nbsp;</strong>there were 41 males (51.2 %) and 39 females (48.8 %). Bland-Altman analysis of mean difference between the ankle and arm (95 % limits of agreement) was -11.47 (- 23.77 to 0.82)mmHg for systolic blood pressure (SBP), -7.89 (-19.16 to 3.36)mmHg for diastolic blood pressure (DBP) and - 9.09 (18.19 to 0.00)mmHg for mean arterial pressure (MAP). Non-parametric analysis showed that 67.5 % of SBP, 46.2 % of DBP and 56.2 % of MAP measurements differed by &gt; 10mmHg.</p> <p><strong>Conclusion:&nbsp;</strong>ankle BP cannot be used routinely in otolaryngological surgery. Although, the ankle can be used as an alternative where the arm cannot be used taking into account a difference.</p> Sidi Driss El Jaouhari Mohamed Meziane Jalal Kessouati Rachid Razine Abdelhamid Jaafari Mustapha Bensghir Copyright (c) 2020-05-21 2020-05-21 36 1 An audit of licenced Zambian diagnostic imaging equipment and personnel <p><strong>Introduction:&nbsp;</strong>estimates indicate that two-thirds of the world's population lack adequate access to basic medical imaging services integral to universal health coverage (UHC). Furthermore, sparse country-level radiological resource statistics exist and there is scant appreciation of how such data reflect healthcare access. The World Health Organisation posits that one X-ray and ultrasound unit for every 50,000 people will meet 90% of global imaging demands. This study aimed to conduct a comprehensive review of licensed Zambian radiological equipment and human resources.</p> <p><strong>Methods:&nbsp;</strong>an audit of licensed imaging resources, using the national updated Radiation Protection Authority and Health Professions Council of Zambia databases. Resources were quantified as units or personnel per million people, stratified by imaging modality, profession, province and healthcare sector, then compared with published Southern African data.</p> <p><strong>Results:&nbsp;</strong>over half of all equipment (153/283 units, 54%) and almost two thirds of all radiation workers (556/913, 61%) are in two of ten provinces, serving one third of the population (5.49/16.4, 33.5%). Three-quarters of the national equipment inventory (212/283 units, 75%) and nearly ninety percent of registered radiation workers (800/913, 88%) are in the public sector, serving 96% of the population. Southern African country-level public-sector imaging resources principally reflect national per capita healthcare spending.</p> <p><strong>Conclusion:&nbsp;</strong>to achieve equitable imaging access pivotal for UHC, Zambia will need a more homogeneous distribution of specialised radiological resources tailored to remedy disparities between healthcare sectors and provincial regions. Analyses of licenced radiology resources at country level can serve as a benchmark for medium-term radiological planning.</p> Chitani Mbewe Pascalina Chanda-Kapata Veronica Sunkutu-Sichizya Nason Lambwe Nataliya Yakovlyeva Masauso Chirwa Birhanu Ayele Richard Denys Pitcher Copyright (c) 2020-05-22 2020-05-22 36 1 Nécrose gastrique secondaire à un volvulus gastrique compliquant une hernie hiatale <p>Le volvulus gastrique aigu est une situation rare compliquant 4% des hernies hiatales. C'est la rotation plus ou moins complète de l'estomac autour d'un axe transversal ou longitudinal. Il peut conduire à des perforations par nécrose ischémique pariétale de l'estomac, au pronostic très sévère (30% de mortalité). Une patiente âgée de 89 ans, bronchopathe chronique, consultait pour des épigastralgies associées à des vomissements évoluant depuis 03 jours. A l’examen, elle était fébrile à 38.5, dyspnéique (spO2 à 88% à l´air ambiant), ayant un faciès infecté, l’abdomen était souple, sensible au niveau de l’épigastre. A la biologie, SIB (GB= 22000, CRP= 80). Une TDM abdominale a été réalisée montrant une hernie hiatale associée à une importante distension gastrique avec défect pariétal de la face antérieure de l’estomac associé à une pneumatose pariétale<br>gastrique. La patiente a été opérée par voie médiane, l’exploration a trouvé une volumineuse hernie hiatale contenant la grande courbure gastrique. L’estomac distendu a été réintégré en position intraabdominale. La face antérieure de la grosse tubérosité était siège de plusieurs zones de nécrose Une gastrectomie totale avec anastomose Oeso-jéjunale manuelle sur une anse montée en Y a été réalisée. Les suites opératoires se sont compliquées de SDRA. La malade décédait au 8ème jour en réanimation. Le volvulus gastrique est une affection rare, dont l’évolution peut être gravissime. La tomodensitométrie permet de dresser le bilan lésionnel thoracique et d’étudier la vitalité de l’estomac. Le traitement de choix reste chirurgical.</p> Imen Ben Ismail Hakim Zenaidi Copyright (c) 2020-05-25 2020-05-25 36 1 Sutural cataract <p>Sutural cataract is uncommon crystalline opacities that affect Y-sutures of the fetal lens nucleus, which is usually congenital and hereditary with X-linked transmission. We report the clinical observation of a 26-year-old patient with no significant pathological history, who consults for a decrease in bilateral progressive visual acuity. The ophthalmologic examination of both eyes found visual acuity at 8/10, the examen of the anterior segment found a clear cornea with Y-shaped crystalline opacities, the examen of the post segment is without abnormality (Figure 1). Therapeutically, the sutural cataract is not very progressive, and rarely require intervention because the effects on the vision are minimal. An optical correction by telescope was prescribed to this patient, with an improvement of the visual acuity at the level of both eyes at 10/10.</p> Hassan Moutei Meriem Abdellaoui Copyright (c) 2020-05-26 2020-05-26 36 1 The economic burden of deliberate self-poisoning: insight from a tertiary hospital in the Free State Province, South Africa <p>Suicide rate in South Africa is contentiously rated among the top ten highest in the world. Deliberate self-poisoning (DSP) remains one of the common methods for suicide. The management of DSP often impose a significant economic burden on health services with a growing loss of resources. However, studies on the financial implications associated with the management of DSP cases in South Africa are scarce and no known study has investigated the financial implication of managing DSP in a resource strained health system as obtained in the Free State Department of Health (FSDoH). This present study investigated the financial implication of managing DSP in a state regional hospital in the Free State province and proffer efficient ways of utilizing limited available resources in DSP management. This was a descriptive, retrospective cross-sectional study in which clinical records of 212 DSP cases which presented during an 18-month period at the emergency department of a state regional hospital were reviewed. The incidence of DSP was higher among individuals who are females (66% females vs 34% males), unemployed (65.6%) in the age group 20-29 years (44.8%). DSP management cost an average of R50, 000 per month. Wasteful expenditures such as blanket requests for laboratory investigation accounted for 19% of the cost. These findings agree with prior studies that have reported that managing DSP could pose a huge direct financial burden on hospital expenditure and health service delivery. If future cost containment and quality of care are to be achieved in the Free State province, efforts must be made by healthcare personnel to combat wasteful and unnecessary expenditure during patient management. We hope that recommendations proffered by this current study will alleviate the financial burden of DSP management in the province.</p> Matthew Abiodun Benedict Nathaniel Mofolo Anthonio Oladele Adefuye Copyright (c) 2020-05-26 2020-05-26 36 1 Cutaneous disorders of adolescence among Nigerian secondary school students <p><strong>Introduction:&nbsp;</strong>a community-based, age-specific survey of skin disorders is usually necessary to characterize the true burden of skin disease among a given population and help to tailor health care personnel training and delivery towards the prevalent disorders in resource poor settings.</p> <p><strong>Methods:&nbsp;</strong>this was a descriptive cross-sectional study among adolescents attending secondary schools in Ilorin, Kwara State, Nigeria. A thousand and three hundred students were recruited from public and private secondary schools through a multi-staged stratified random sampling method. Information was obtained via a semi-structured questionnaire and all students underwent a physical examination. Data was analysed using SPSS version 20. Information generated was presented with tables and figures.</p> <p><strong>Results:&nbsp;</strong>the prevalence of skin disease in the study was 66.5%. More females, mid-adolescents, students in senior class and those attending public schools had skin disorders. The most prevalent skin disease were: acne vulgaris, pityriasis versicolor, tinea capitis, pityriasis capitis and traction alopecia.</p> <p><strong>Conclusion:&nbsp;</strong>skin conditions are highly prevalent among the adolescent population. Infective and inflammatory skin conditions appear to be more prevalent than other classes. Most times, only a few skin disorders account for the bulk of dermatoses affecting this age group. Adolescent skin healthcare should be subsidized because of the high prevalence of skin disorders in this age group.</p> Jadesola Tryphena Oyedepo Oludolapo Sherifat Katibi Olanrewaju Timothy Adedoyin Copyright (c) 2020-05-27 2020-05-27 36 1 Challenges and barriers to HIV service uptake and delivery along the HIV care cascade in Cameroon <p><strong>Introduction</strong>: the year 2017 marked a transition period with the end of the implementation of Cameroon´s 2014-2017 HIV/AIDS National Strategic Plan (NSP) and the development of the 2018-2022 NSP. We assessed barriers and challenges to service delivery and uptake along the HIV care cascade in Cameroon to inform decision making within the framework of the new NSP, to achieve the UNAIDS 90-90-90 target.</p> <p><strong>Methods</strong>: we conducted a cross sectional descriptive study nationwide, enrolling HIV infected patients and staff. Data were collected on sociodemographic characteristics, HIV testing, antiretroviral therapy and viral load testing delivery and uptake and factors that limit their access.</p> <p><strong>Results</strong>: a total of 137 staff and 642 people living with HIV (PLHIV) were interviewed. Of 642 PLHIV with known status, 339 (53%) repeated their HIV test at least once, with range: 1-10 and median: 2 (IQR: 1-3). Having attained secondary level of education (OR: 2.07, 95% CI: 1.04-4.14; P=0.04) or more (OR: 2.91, 95% CI: 1.16-7.28; P=0.02) were significantly associated with repeat testing. Psychological (refusal of service uptake and existence of HIV), community-level (stigmatization and fear of confidentiality breach) and commodity stock-outs "HIV test kits (21%), antiretrovirals (ARVs) (71.4%), viral load testing reagents (100%)" are the major barriers to service delivery and uptake along the cascade.</p> <p><strong>Conclusion</strong>: we identified individual, community-level, socio-economic and health care system related barriers which constitute persistent bottlenecks in HIV service delivery and uptake and a high rate of repeat testing by PLHIV with known status. Addressing all these accordingly can help the country achieve the UNAIDS 90-90-90 target.</p> Albert Frank Zeh Meka Serge Clotaire Billong Ismael Diallo Ousseni Wendlassida Tiemtore Brian Bongwong Georges Nguefack-Tsague Copyright (c) 2020-05-27 2020-05-27 36 1 Can inhaled foreign body mimic asthma in an adolescent? <p>A 14 year old male was diagnosed with asthma but didn't improve with appropriate inhalation therapy. Rigid bronchoscopy revealed a food fragment, almost completely occluding the lower-left bronchus lumen. Based on the reported history, it had been likely there for several years.</p> Alessandro Bodini Luca Pecoraro Filippo Catalano Melodie Olivia Aricò Laura Tenero Michele Piazza Giorgio Piacentini Copyright (c) 2020-05-27 2020-05-27 36 1 Intercostal lung herniation secondary to thoracotomy: a case report <p>Intercostal lung herniation is defined as a protrusion of the lung parenchyma through a defect in the intercostal muscles between adjacent ribs. The authors report a case of intercostal pulmonary hernia in a 45-year-old male patient, with smoking habit (30 packs-year), presented to the emergency department with dyspnea. He had the history of pulmonary emphysema complicated with a total right pneumothorax in 2015 treated by mini-thoracotomy with bullectomy and pleural abrasion. In 2019, he was admitted to hospital for left chest pain. The computed tomography (CT) scan of the chest revealed a bilateral emphysema with intercostal lung hernia through the fourth intercostal space the patient underwent, a left thoracotomy with repair of the intercostal muscle defect. He was discharged from hospital free of complications.</p> Samira Mhamdi Ines Aouini Salsabil Daboussi Houaida Mahfoudhi Mehdi Ben Lassoued Manel Kallel Zied Moetamri Chiraz Aichaouia Islem Mejri Mohsen Khadhraoui Rzaieg Cheikh Copyright (c) 2020-05-27 2020-05-27 36 1 Angiosarcome de l´épaule révélé par un ancien traumatisme: à propos d´un cas et revue de la littérature <p>L´angiosarcome est une tumeur rare à multiples localisations mais celle cutanée est la plus fréquente faisant de sa symptomatologie un polymorphisme clinique. C´est une tumeur de mauvais pronostic à cause de sa grande propension à la récidive locale et aux métastases à distances précoce. Nous rapportons un cas de découverte fortuite d´un angiosarcome de l´épaule sur un ancien foyer de traumatisme direct datant d´une année chez un patient de 72 ans, venu consulter pour douleur persistante en regard d´une tuméfaction à la face postérieure de l´épaule contemporaine au traumatisme. L´examen clinique conclu en un hématome ancien partiellement calcifié soutenu par la ponction de la masse ayant ramené 5 cc de sang d´aspect noirâtre et renforcé par une échographie. La radiographie de l´épaule n´étant pas pathologique, une exploration de la tuméfaction a été entreprise. Celle-ci a permis de mettre en évidence et reséquer des tissus friables, d´aspect rougeâtre, avec un saignement important difficilement maitrisé pendant deux jours compliqué d´une anémie non tolérée corrigée par deux transfusions sanguines. L´anatomie pathologique des tissus réséqués a conclu en un angiosarcome moyennement différentié avec malheureusement des berges non saines. Un bilan d´extension a été réalisé à la recherche des métastases. Pas de récidive locale sur trois mois et le patient a été transféré dans un centre spécialisé à Lusaka pour la radiothérapie complémentaire. L´objectif du présent travail est de présenter un cas rare d´angiosarcome de découverte fortuite sur un antécédent de traumatisme de l´épaule gauche et de ressortir les aspects thérapeutiques en passant en faisant une revue de la littérature.</p> Manix Ilunga Banza Israël Badypwyla Tshiamala Augustin Kibonge Mukakala Christelle Ngoie Ngoie Néron Tapenge Shutsha Stéphane Ilunga Mukangala Vincent De Paul Kaoma Cabala Mireille Meuke Tchankui Trésor Kibangula Kasanga Nathalie Dinganga Kapessa Copyright (c) 2020-05-27 2020-05-27 36 1 Addressing the workforce capacity for public health surveillance through field epidemiology and laboratory training program: the need for balanced enhanced skill mix and distribution, a case study from Tanzania <p><strong>Introduction:&nbsp;</strong>skill mix refers to the range of professional development and competencies, skills and experiences of staff within a particular working environment that link with specific outcome while responding to client needs. A balanced skill-mix and distribution of core human resources is important to strengthen decision-making process and rapid responses. We analysed graduates´ information of the Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) between 2008-2016, distribution of skill-mix and the surveillance workforce-gaps within regions.</p> <p><strong>Methods:&nbsp;</strong>trainees´ data of nine cohorts enrolled between 2008 and 2016 were extracted from the program database. Distribution by sex, region and cadres/profession was carried out. An indicator to determine enhanced-skill mix was established based on the presence of a clinician, nurse, laboratory scientist and environmental health officer. A complete enhanced skill-mix was considered when all four were available and have received FELTP training.</p> <p><strong>Results:&nbsp;</strong>the TFELTP has trained 113 trainees (male=71.7%), originated from 17 regions of Tanzania Mainland (65.4% of all) and Zanzibar. Clinicians (34.5%) and laboratory scientists (38.1%) accounted for the most recruits, however, the former were widely spread in regions (83% vs. 56%). Environmental health officers (17.7%) were available in 39% of regions. The nursing profession, predominantly lacking (6.2%) was available in 22% of regions. Only two regions (11.7%) among 17 covered by TFELTP presented complete skill-mix, representing 7.7% of Tanzanian regions. Seven regions (41%) had an average of one trainee.</p> <p><strong>Conclusion:&nbsp;</strong>the TFELTP is yet to reach the required skill-mix in many regions within the country. The slow fill-rate for competent and key workforce cadres might impede effective response. Strategies to increase program awareness at subnational levels is needed to improve performance of surveillance and response system in Tanzania.</p> Susan Fred Rumisha Rogath Saika Kishimba Ahmed Abade Mohamed Loveness John Urio Neema Rusibayamila Muhammad Bakari Janneth Mghamba Copyright (c) 2020-05-27 2020-05-27 36 1 Photokératoconjonctivite par coup d′arc <p>La photokératite est une kératite douloureuse causée par l'exposition non-protégée des yeux aux rayons ultraviolets (UV). On parle de «coup d'arc» quand la photokératite est induite par le rayonnement UV émis par l′arc électrique pendant le soudage à l′arc électrique. Nous rapportons le cas d′un patient de 35 ans, sans antécédents notables, cavalier de profession qui se dit avoir regardé pendant quelques minutes, un arc électrique durant le soudage des portes du stable suite à laquelle, il a présenté une douleur oculaire bilatérale à type de brûlure associé à des larmoiements photophobie et blépharospasme. Son examen clinique a montré une acuité visuelle avec correction à 8/10 et 9/10, une hyperhémie conjonctivale avec une kératite érosive ponctuée limité à la fente palpébrale après instillation de la fluorescéine. Vu le contexte, le diagnostic d'une kératoconjonctivite par coup d'arc a été retenu. Le patient a été mis sous antibiotique topique, agents mouillants et cicatrisants. L′évolution a été marquée, par la disparition totale des signes avec une acuité visuelle qui est remonté à 10/10 en bilatérale. A travers ce cas, on illustre l′intérêt d′une prévention par un port d′équipements de protection adaptés.</p> Brahim Salem Joumany Abdelbarre Oubaaz Sidi Dahi Mahdi Khamaily Iman Tarib Nisrine Laaribi Karim Reda Abdelbarre Oubaaz Copyright (c) 2020-05-27 2020-05-27 36 1 Hepatocellular carcinoma in Ghana: a retrospective analysis of a tertiary hospital data <p><strong>Introduction:&nbsp;</strong>Hepatocellular carcinoma (HCC) is a cancer of global public health concern because of its high incidence and mortality. The impact is greatest in areas with high prevalence of its major risk factors including chronic hepatitis B virus (HBV). HBV is endemic in Ghana but a comprehensive data on HCC is lacking. The aim of this study was to describe the clinical, laboratory and radiological features of HCC at the Korle Bu Teaching Hospital in Ghana.</p> <p><strong>Methods:&nbsp;</strong>the medical records of 194 HCC cases attended to at the Gastrointestinal Clinic of the Korle Bu Teaching Hospital between January 2015 and December 2018 were retrospectively analyzed for demographic, clinical, laboratory and radiological data.</p> <p><strong>Results:&nbsp;</strong>the male: female ratio was 2:1 and mean age was 45.2 years. Weight loss and abdominal pain were the major presenting symptoms. No patients were identified through surveillance. HBsAg was positive in 109/145 (75.2%) of cases tested. Sixty-five (59.6%) of 109 HBsAg positives were aware of their HBsAg status but only 3 were receiving medical follow ups prior to the diagnosis of HCC. Raised alpha-fetoprotein level &gt;165.2 IU/ML was found in 53.9%. One hundred and forty-four patients were eligible for only analgesia.</p> <p><strong>Conclusion:&nbsp;</strong>HBV infection is the leading aetiologial risk factor associated with HCC. Majority of HBV carriers are aware of their status but do not receive care prior to HCC diagnosis. Majority present late and are eligible for only palliative treatment. Improvement in the health seeking behavior of HBV carriers can aid early detection of HCC.</p> Kenneth Tachi Adwoa Agyei-Nkansah Timothy Archampong Copyright (c) 2020-05-28 2020-05-28 36 1 Rupture utérine spontanée en livre ouvert sur grossesse de 15 semaines chez une paucipare avec utérus cicatriciel: à propos d′un cas <p><strong>Introduction:&nbsp;</strong>sickle cell disease (SCD) has significant pediatric morbidity and mortality in sub-Saharan Africa, where access to therapies such as hydroxyurea and opioids is often limited. Poor disease control and pain management adversely affects the well-being and mental health of affected children. Questionnaires have been utilized in other regions to report the quality of life (QOL) in children with SCD, but assessments from Africa are lacking.</p> <p><strong>Methods:&nbsp;</strong>children age 2-14 years with SCD presenting for routine outpatient consultations at Hospital Central de Maputo from June-August 2017 were offered participation. After informed consent, the Pediatric QOL Inventory (PedsQL) SCD Module was administered to all caregivers and children &gt; 5 years. Responses were scored from 0-100, with higher scores representing better QOL.</p> <p><strong>Results:&nbsp;</strong>a total of 14 children were included, with six (43%), four (29%), two (14%), and two (14%) from the age groups of 2-4, 5-7, 8-12, and 13-14 years, respectively. Mean overall patient QOL was 65.3 and 56.0 in child and caregiver respondents. In patients &gt; 5 years, the difference in mean overall QOL for those on/not on hydroxyurea was 0.6 (66.5-64.9) in child respondents and 15.8 (68.4-52.6) in caregiver respondents. Domains related to worry/emotions and communication scored lower in QOL than pain-related domains for both patient and caregiver respondents.</p> <p><strong>Conclusion:&nbsp;</strong>SCD has a negative impact on QOL as reported by this cohort of Mozambican pediatric patients and caregivers, with pain being less of a concern than emotional and interpersonal issues. A comprehensive, child-focused care approach with robust psychosocial support is needed.</p> Eloge Ilunga-Mbay Olivier Nyakio Raha Maroyi Patrick Bigabwa Moise Kiminyi Silas Hamisi Dénis Mukwege Dieudonné Sengeyi Mushengezi Amani Copyright (c) 2020-05-28 2020-05-28 36 1 Correlation of ultrasonography and surgical outcome in patients with testicular torsion <p><strong>Introduction:&nbsp;</strong>testicular torsion is a surgical emergency that is caused by twisting of the spermatic cord and its content. This condition causes irreversible changes after 6 hours. Early recognition and management of testicular torsion is important for testicular salvage and preservation of fertility.</p> <p><strong>Methods:&nbsp;</strong>this is a retrospective study done on all patients who presented with acute scrotal pain from January 2013 to December 2017. The data collected included the patient's age, symptoms, the time duration between the onset, ultrasound, and surgery, ultrasound findings with Doppler and the surgical intervention. Statistical analysis was performed using SPSS 25.0. Data are presented as mean (SD) values. Differences between groups and predictive values were calculated using Chi-square, t-test and Mann-Whitney U-test and are expressed by value with 95% CI.</p> <p><strong>Results:&nbsp;</strong>the total number of patients who presented with acute scrotal pain were 88. Testicular torsion was diagnosed in 55 (62.50%) of the patients, 17 (19.32%) had epididymis-orchitis, 5 (5.68%) had torsion of appendage/cyst, and 11 (12.50%) had normal testis. Ultrasound has a sensitivity and specificity of 88.24% and 68.40% respectively. It is a good tool to detect testicular torsion but it is operator dependent. Positive predictive value was 83.33% and negative predictive value was 76.47%. When ultrasound is combined with clinical findings the rate of negative exploration is reduced by 10%.</p> <p><strong>Conclusion:&nbsp;</strong>good medical history, appropriate clinical evaluation and performing an ultrasound of the scrotum are important in testicular torsion. US evaluation in cases presented after 24 hours does not change the outcome.</p> Ismail Abdul Sattar Burud Syed Mahmud Irfan Alsagof Roshinipriya Ganesin Sumitta Thamil Selvam Nor Aniza Binti Zakaria Mahadevan Deva Tata Copyright (c) 2020-05-29 2020-05-29 36 1 Congenital Factor V deficiency: perioperative management (case report) <p>Factor V congenital deficiency is a rare hereditary disease, it exposes patients to hemorrhagic risk, with high morbi-mortality. Its management is a real challenge for practitioners. Perioperative management of patients with Factor V congenital deficiency needs anesthetists, hematologists and surgeons to work in close collaboration.</p> Mohamed Anass Fehdi Mohamed Lazraq Sabah Benhamza Abdelhak Bensaid Youssef Miloudi Najib El Harrar Copyright (c) 2020-05-29 2020-05-29 36 1 The effects of economic stress and urbanization on driving behaviours of Boda-boda drivers and accidents in Gulu, Northern Uganda: a qualitative view of drivers <p><strong>Introduction:&nbsp;</strong>understanding motorcyclists´ on-the-road behaviour is critical for developing and evaluating interventions specifically targeting them. Risky on-the-road behaviours have historically been subdivided into errors and violations of the rules of road use. Police records could be used to record cyclists´ behaviours, however these documents do not necessarily capture all errors and violations. None use of protective wears have been documented in many studies conducted on Boda-boda drivers in Uganda. The relationship between drivers´ economic stress, and road safety have been studied for many years but the effects of global and economic stress; its joint effects on behaviours of drivers in relations to accidents have received very little attention. This study aimed at assessing the relationship between injuries and the Boda-boda drivers´ behaviours in Northern Uganda.</p> <p><strong>Methods:&nbsp;</strong>two hundred Boda-boda drivers from Gulu Municipality had face-to-face interviews to assess views and underlying factors on the issue of high prevalence of motorcycle road traffic accidents and injuries. Descriptive statistics were used to describe factors on-road accidents including personal information, knowledge, skills and attitudes towards road use and safety. The study was approved by a local Institutional Review Board (IRB).</p> <p><strong>Results:&nbsp;</strong>collectively, the results showed that economic stress is an important factor that affects drivers´ behaviour and increases their risks to motorcycle accidents.</p> <p><strong>Conclusion:&nbsp;</strong>these authors suggest that more studies should be conducted to determine the relationship between economic stress, anger and dangerous behaviours among Boda-boda drivers and accidents in Gulu Municipality using a Motorcycle Rider Behaviour Questionnaire (MRBQ).</p> David Lagoro Kitara Omar Karlsson Copyright (c) 2020-06-01 2020-06-01 36 1 Association caryotype 47XYY et déficit en 5 alpha réductase révélée par un micropénis: à propos d’un cas et revue de la littérature <p>Les sujets 47XYY ont souvent un fonctionnement gonadotrope normal, l´association à un déficit en 5alpha réductase chez ces sujets est rare ; la présentation clinique classique des déficits en 5 alpha réductase est un pseudohermaphrodisme masculin, rarement un micropénis comme mode de révélation. Le traitement par énanthate de testostérone du micropénis ne donne pas de bons résultats dans les déficits en 5alpha réductase, la dihydrotestostérone(DHT) à une efficacité prouvée dans ce cas. Nous rapportons l´observation d´un patient de 17 ans, référé dans notre formation pour la prise en charge d´un micropénis ne répondant pas aux 2 cures à base d´énanthate de testostérone. Le bilan notait une testostérone normale, des gonadotrophines à la limite supérieure de la normale, une DHT basse, avec augmentation du rapport testostérone/DHT &gt; 20.caryotype 47XYY. Le déficit en 5 alpha réductase chez ces sujets pose la problématique d´une simple coïncidence, ou d´un lien effectif.</p> Nestor Ghislain Andzouana Mbamognoua Fatima Aziouaz Suzanne Matali Hanane El Ouahabi Farida Ajdi Copyright (c) 2020-06-01 2020-06-01 36 1 Asthme et obésité: relation et implications thérapeutiques auprès des patients asthmatiques du Service de Pneumologie de Monastir, Tunisie <p><strong>Introduction:&nbsp;</strong>l´obésité et l´asthme sont deux maladies chroniques touchant des millions d´individus à travers le monde. La présence d´un lien de causalité est suggérée. L'objectif de notre travail est d'étudier le profil de l´asthmatique obèse et de déterminer la relation entre les différents paramètres de sévérité de l´asthme avec les grades de l´obésité.</p> <p><strong>Méthodes:&nbsp;</strong>il s'agit d'une étude rétrospective, monocentrique, analytique menée au Service de Pneumologie et d´Allergologie au CHU Fattouma Bourguiba de Monastir portant sur 450 asthmatiques, ayant un indice de masse corporelle (IMC) ≥ 30 kg/m<sup>2</sup>&nbsp;avec un recul d´au moins 6 mois.</p> <p><strong>Résultats:&nbsp;</strong>l´âge moyen au moment du diagnostic était de 45±12.8 ans. L´IMC moyen était de 34,8±4,2 kg/m<sup>2</sup>. L´asthme était bien contrôlé chez 55,3% des patients. Des critères de sévérité étaient notés dans 37.4% des cas. Selon GINA 2016, 24,2% sont traités par le palier 4. Deux phénotypes de l´asthme associé à l´obésité étaient notés. Le premier phénotype (52,4%) était caractérisé par un asthme à début précoce, associé à une fréquence plus élevée d´allergie, et des manifestations d'atopie. Le deuxième (47,6 %) était caractérisé par un asthme à début tardif, fréquemment associé au sexe féminin et un taux plus élevé de comorbidités et d´hospitalisations. Les obèses de grade II et III avaient un déficit ventilatoire important (CVF: p = 0,002 et VEMS: p = 0,007).</p> <p><strong>Conclusion:&nbsp;</strong>l´obésité est l´un des facteurs clefs impliqués dans le mauvais contrôle de l´asthme. Sa prise en charge, qui n'est pas encore codifiée, doit être multidisciplinaire.</p> Saousen Cheikh Mhamed Ahmed Ben Saad Asma Migaou Nesrine Fahem Naceur Rouatbi Samah Joobeur Copyright (c) 2020-06-01 2020-06-01 36 1 Corrigendum: Carcinome urothélial sur un calice rénal exclu révélé par une métastase cérébrale <p>Ce Corrigendum vise à rectifier l´oubli d´un nom d´auteur dans la liste d'auteurs de l´article original « Carcinome urothélial sur un calice rénal exclu révélé par une métastase cérébrale ». Pan Afr Med J. 2019;34:184.</p> The Pan African Medical Journal Copyright (c) 2020-06-01 2020-06-01 36 1 Habitudes toxiques et comportements alimentaires de 305 cas du cancer du sein colligés au centre Mohammed VI pour les traitements des cancers de Casablanca <p><strong>Introduction:&nbsp;</strong>le cancer du sein représente un enjeu majeur de santé publique. L´objectif de ce travail est de décrire le profil sociodémographique, les habitudes toxiques et le profil alimentaire des patientes atteintes du cancerdu sein traitées au centre Mohammed VI pour le traitement des cancers de Casablanca.</p> <p><strong>Méthodes:&nbsp;</strong>il s´agit d´une étude transversale portant sur 305 patientes atteintes de cancer du sein nouvellement diagnostiquées.</p> <p><strong>Résultats:&nbsp;</strong>l´âge moyen des patientes est 50 ans. Cinquante-six pourcent (plus précisément 55,7%) de nos patientes sont mariées et 12,8% sont veuves. Parmi les femmes interrogées, 83% sont des femmes au foyer, 63,3% résident dans un milieu urbain et 47,9% sont analphabètes. Concernant les habitudes toxiques de nos patientes, seules 5,9% des femmes enquêtées ont déclaré avoir consommé de l´alcool et une minorité a déclaré être ex-fumeuse ou fumeuse, avec respectivement 4,3% et 2,3%. Quant au régime alimentaire, nos patientes consommaient le pain et la viande rouge avec une fréquence moyenne respectivement de 8,26 et 5,84 fois/semaine, et enfin les produits laitiers avec une fréquence moyenne de consommation allant de 3,55 à 4,57 fois/semaine. Par ailleurs, nos patientes consommaient plus de pomme de terre et des fruits frais, avec respectivement des moyennes de fréquence de 5,74 et 5,38 fois/semaine. Le thé reste également la boisson la plus consommée avec une moyenne de fréquence très élevée de 8,12 fois/semaine.</p> <p><strong>Conclusion:&nbsp;</strong>à la lumière de nos résultats, la plupart des femmes interrogées, sont des femmes au foyer, analphabètes et résident dans un milieu urbain. Plusieurs aliments sont fréquemment consommés par nos patientes. En revanche, la consommation de substances psychoactives telles l´alcool et le tabac est faible. Des études analytiques type cas-témoins sont nécessaires afin d´établir d´éventuelles associations entre ces facteurs de risque et le cancer mammaire.</p> Drissi Houda Imad Fatima Ezzahra Bendahhou Karima benider Abdelatif Radallah Driss Copyright (c) 2020-06-01 2020-06-01 36 1 Abdominoplasty for male truncal obesity: case report <p>Truncal obesity and its associated health risk is an enormous burden. The traditional surgical treatment modality is liposuction or lipoabdominoplasty. An uncommon mode of the treatment is the use of abdominoplasty alone or as a surgical component. The aim of this report is to show a satisfactory outcome of abdominoplasty as the only surgical component in the management of severe truncal obesity in elderly male patient. We report a 75 year old Nigerian trader who had truncal obesity with gross abdominal asymmetry and cardiovascular and diabetes mellitus co-morbidities as well as bilateral knee osteoarthritis and social isolation due to truncal disfigurement. He was offered abdominoplasty as a sole surgical option for correction of anterior abdominal wall asymmetry. Apart from post operative wound complications and blood transfusion reactions, the patient had a good recovery and improved quality of life. Abdominoplasty is a rewarding treatment when used as a sole surgical option in centrally obese patients with anterior abdominal wall asymmetry and significant subcutaneous fat thickness.</p> Ugochukwu Uzodimma Nnadozie Gabriel Maduwuike Okorie Charles Chidiebele Maduba Njoku Isaac Omoke Amaechi Ugbala Emmanuel Uchendu Collins Nwachi Ugwu Copyright (c) 2020-06-01 2020-06-01 36 1 Seroprevalence of brucellosis and associated factors among livestock slaughtered in Oko-Oba abattoir, Lagos State, southwestern Nigeria <p><strong>Introduction:&nbsp;</strong><em>Brucella</em>&nbsp;infection, a neglected tropical zoonosis, poses public health threat to abattoir workers in developing countries including Nigeria. Oko-Oba abattoir is one of the largest abattoirs in the country that collects livestock from different parts of the country. This study determined the prevalence and factors associated with seropositivity of brucellosis among livestock slaughtered at Oko-Oba abattoir.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted from January to May 2018. A total of 473 serum samples were collected from livestock at the abattoir and tested for antibodies to&nbsp;<em>Brucella</em>&nbsp;species using the Rose Bengal Plate Test (RBPT) and indirect Enzyme Linked Immunosorbent Assay (iELISA). Data were analyzed using descriptive statistics and chi square test (p &lt; 0.05).</p> <p><strong>Results:&nbsp;</strong>overall seroprevalence values were 15.3% (RBPT) and 16.3% (iELISA) among the livestock slaughtered at the Oko-Oba abattoir. Seroprevalence of 17.2% (RBPT) and 15.8% (iELISA) in cattle; 15.1% (RBPT) and 14.5% (iELISA) in goat; and 8.3% (RBPT) and 23.3% (iELISA) in sheep were obtained. Higher seroprevalence were recorded among females in cattle (18.8% iELISA) and sheep (23.1% iELISA) while male goats had average value higher (14.7% iELISA) than the female (p &gt; 0.05).</p> <p><strong>Conclusion:&nbsp;</strong>presence of&nbsp;<em>Brucella</em>&nbsp;infection among slaughtered livestock was confirmed at Oko-Oba abattoir, Lagos State, Nigeria and poses a threat to abattoir workers and public health. Control of the disease in livestock and use of personal protective gear is recommended.</p> Kenneth Onyebuchi Ukwueze Olayinka Olabisi Ishola Magbagbeola David Dairo Emmanuel Jolaoluwa Awosanya Simeon Idowu Cadmus Copyright (c) 2020-06-02 2020-06-02 36 1 Lymphangiome kystique du cou chez un adulte jeune: à propos d'un cas et revue de la littérature <p>Les lymphangiomes kystiques sont des malformations congénitales portant sur le système lymphatique. Ce sont des lésions bénignes dysembryoplasiques rares prédominant nettement au niveau de la région de la tête et du cou plus particulièrement dans le triangle cervical postérieur. Ils surviennent généralement durant l'enfance et sont exceptionnels chez l’adulte. Nous rapportons une observation clinique d’un lymphangiome kystique du cou chez un sujet de 22 ans.</p> Augustin Kibonge Mukakala Manix Ilunga Banza Eric Mbuya Musapudi Nasser Amisi Lubosha Trésor Kibangula Kasanga Dimitri Kanyanda Nafatalewa Serge Ngoie Yumba Papy Mukimba Ngabunda Rodrigue Mupenda Mwenibamba Copyright (c) 2020-06-02 2020-06-02 36 1 Maladie de Still de l´adulte et lymphome: une association rare <p>La maladie de Still de l´adulte (MSA) et les lymphomes sont des pathologies dont la présentation clinique et même histopathologique est très proche. L′association des deux pathologies est rarement rapportée dans la littérature. Nous rapportons une observation de maladie de Still de l′adulte diagnostiquée chez une patiente de 26 ans antérieurement traitée pour lymphome malin non hodgkinien (LMNH) à grandes cellules B par chimiothérapie et auto-greffe de cellules souches hématopoïétiques avec rémission complète. Les cas de MSA associés aux lymphomes sont rares et dans tous les cas le diagnostic de MSA avait précédé celui de lymphome. Notre observation est particulière par la succession LMNH puis MSA et soulève plusieurs hypothèses sur les liens entre ces deux pathologies. Les liens entre maladies dysimmunitaires et hémopathies lymphoïdes ont largement été prouvés, qu′il s′agisse de l′évolution de maladies auto-immunes vers un lymphome ou de manifestations dysimmunitaires survenant au cours de ce dernier. Notre cas illustre la difficulté de distinction entre ces entités.</p> Jihane Smaali Abdessadak El Khattabi Mohamed El Qatni Fadoua Mekouar Youssef Sekkach Ali Abouzahir Taoufik Ameziane Driss Ghafir Copyright (c) 2020-06-02 2020-06-02 36 1 A curious case of cough: Mounier-Kuhn syndrome in a Namibian female patient <p>We report a case of a 43-year-old female who presented with a history of recurrent productive cough, since her teenage years. Her associated<br>symptoms included dyspnoea, occasional pleuritic chest pain and rarely, constitutional symptoms. Treated numerous times for lower respiratory tract infections, her symptoms would improve after antimicrobial therapy, but always recurred. She had a background of HIV infection and was virologically suppressed on antiretroviral therapy for nine years. Investigations revealed an active pseudomonas infection and high-resolution computed tomography scan (HRCT) and bronchoscopy confirmed features of Mounier-Kuhn syndrome. The patient was treated accordingly with positive airway pressure, mucolytic agents and chest physiotherapy aimed at aiding mucus clearance and received pneumococcal and influenza vaccines. MounierKuhn syndrome, though rare, should be considered in the differential diagnosis of patients with recurrent lower respiratory tract infections. In Africa, more cases may be identified and treated appropriately with timely investigation and treatment.</p> Mercy Juliette Mkandawire Nobert Makombe Muramira Ngalawi Mraba Copyright (c) 2020-06-02 2020-06-02 36 1 Erratum: Panniculite au cours d’un traitement d’une dermatomyosite par du méthotrexate <p>Cet erratum corrige l´article original: “ Panniculite au cours d´un traitement d´une dermatomyosite par du méthotrexate ”. The Pan African Medical Journal. 2016;23:149. doi:10.11604/pamj.2016.23.149.8950.</p> The Pan African Medical Journal Copyright (c) 2020-06-02 2020-06-02 36 1 La couverture en urgence des pertes de substances cutanées d′origine traumatique de la face antérieure du genou par lambeau fascio-cutané sural à pédicule proximal: à propos de 4 cas de plaies articulaires <p>Notre expérience porte sur une série de 4 patients, tous de sexe masculin, qui avaient des plaies à la face antérieure du genou avec perte de substance cutanée dans les suites d′un accident de moto, chez lesquels nous avons réalisé au même temps opératoire que le parage, depuis 2012, quatre lambeaux de couverture type fascio-cutané sural à pédicule proximal. L′âge des patients variaient entre 28 et 42 ans. La perte de substance cutanée la plus importante était de 14 x 10 cm. La longueur moyenne du pédicule était de 14 cm. Les suites post opératoires étaient sans complications avec une cicatrisation satisfaisante. Sur le plan fonctionnel le genou et la cheville étaient complètement mobile. Cette étude montre l′efficacité et la fiabilité du lambeau fascio-cutané sural à pédicule proximale dans la couverture des pertes de substances cutanée traumatiques de la face antérieure du genou et permet de limiter les indications des lambeaux musculaires des chefs gastrocnémiens.</p> Hatim Abid Ahmed Bouziane Mohamed El Idrissi Mohamed Shimi Abdelhalim El Ibrahimi Abdelmajid El Mrini Copyright (c) 2020-06-02 2020-06-02 36 1 Clinical and histological patterns and treatment of pyoderma gangrenosum <p>Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis for which accurate epidemiological data are limited and therapy remains a challenge. The primary study´s aim was to examine all cases of PG observed in our department over a 6-year period in order to describe the relevant characteristics and outcome under therapy. Fourteen patients were included (5 women, 9 men). The average age of our patients was 40,15 years. The classical, ulcerative form was found in 10 cases (71.42%), the pustular form in 4 cases (27.57%) and PG was multifocal in 4 cases. The PG was located preferentially to the lower limbs. Histological examination was realized in all patients and objectified inflammatory infiltrate composed of polymorphonuclear neutrophils in all cases with vasculitis in 4 cases. Six patients (42.85%) had associated disease at diagnosis of PG, including inflammatory bowel disease in two cases (14.28%), a blood disease in 2 cases (14.28%), lymph node tuberculosis and inflammatory arthritis in 1 case (7%). The most frequent first-line treatments were oral corticosteroids (7 cases) and other treatments used were colchicine in 2 cases, topical corticosteroids in 3 cases with good clinical evolution. Our study confirms that PG is a rare disease, associated in almost half of cases with systemic disease already present at diagnosis; in our Moroccan background, it is most often inflammatory bowel disease, hematological or solid cancer and tuberculosis.</p> Radia Chakiri Hanane Baybay Asmae El Hatimi Salim Gallouj Taoufiq Harmouch Fatima Zohra Mernissi Copyright (c) 2020-06-02 2020-06-02 36 1 Fluoroquinolone resistant bacterial isolates from the urinary tract among patients attending hospitals in Bushenyi District, Uganda <p><strong>Introduction:&nbsp;</strong>bacterial resistance to fluoroquinolones is on the rise globally, bacteria causing urinary tract infections (UTIs) are no exception to this fact. Judicious use of the current antibiotics by clinicians is therefore deemed necessary to combat development of resistance. This study determined fluoroquinolone resistant profiles, multiple antibiotic resistance indices (MARI), factors associated with fluoroquinolone resistance and their strength among patients attending hospitals in Bushenyi District, Uganda.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional study in which a total of 86 bacterial uropathogens isolated previously by standard microbiological methods were subjected to antibiotic susceptibility testing using Kirby Bauer disk diffusion method. Data for factors suspected to be associated with fluoroquinolone resistant UTI were obtained by use of questionnaires.</p> <p><strong>Results:&nbsp;</strong>the most resisted fluoroquinolone was ofloxacin with 29/83 (34.9%), followed by moxifloxacin 27/83 (32.5%), levofloxacin 24/86 (27.9%) and ciprofloxacin 23/86 (26.7%). The bacterial uropathogens that exhibited the highest frequency of fluoroquinolone resistant strains were&nbsp;<em>P. mirabilis</em>&nbsp;with 2/3 (66.7%) and&nbsp;<em>E. faecalis</em>&nbsp;with 2/3 (66.7%), followed by&nbsp;<em>E. coli</em>&nbsp;19/36 (52.8%),&nbsp;<em>S. aureus</em>&nbsp;13/27 (48.1%),&nbsp;<em>K. oxytoca</em>&nbsp;2/6 (33.3%),&nbsp;<em>K. pneumoniae</em>&nbsp;2/10 (20.0%) and&nbsp;<em>P. vulgaris</em>&nbsp;0/1 (0.0%). All the bacterial uropathogens tested showed MARI of ≥ 0.2. Hospitalization, history of fluoroquinolones use in the last 12 months and wrong prescription of antibiotics were found to bear statistically significant relationships (p &lt; 0.05) with fluoroquinolone resistant UTI.</p> <p><strong>Conclusion:&nbsp;</strong>antibiotic susceptibility testing of the first generation quinolones such as nalidixic acid in hospitalized patients, patients with history of fluoroquinolones' use in the last 12 months and wrong prescription of antibiotics should be adopted to avoid fluoroquinolone abuse. For empiric treatment of UTIs in Bushenyi District, ciprofloxacin still remains the first line of choice among the fluoroquinolone class of antibiotics.</p> Martin Odoki Adamu Almustapha Aliero Julius Tibyangye Josephat Nyabayo Maniga Emmanuel Eilu Ibrahim Ntulume Eddie Wampande Charles Drago Kato Ezera Agwu Joel Bazira Copyright (c) 2020-06-02 2020-06-02 36 1 Adénocarcinome primitif de la vessie: à propos de 6 cas <p>L´adénocarcinome primitif de la vessie est une variété rare de tumeurs vésicales qui représente moins de 2% des cancers de la vessie. Il semble atteindre préférentiellement le sexe masculin avec un sexe ratio de 3/1 et un âge moyen de survenu entre 60 ans et 70 ans. Sa présentation clinique est non spécifique et dominée par l´hématurie. La résection endoscopique de la vessie avec un examen anathomopathologique permet de poser le diagnostic. Le traitement de l´adénocarcinome primitif de la vessie reste sujet à de nombreuses controverses du fait de la rareté des cas rapportés dans la littérature. Cependant, le traitement de choix semble être une cystectomie totale avec curage ganglionnaire étendu. Nous rapportons une série de 6 cas d´adénocarcinome qui ont été traités et suivis au sein de notre formation. Notre analyse est basée sur l´évaluation des caractéristiques épidémiologiques, cliniques, anatomo-pathologiques, et thérapeutiques de l´adénocarcinome de la vessie, ainsi que sur l´étude des aspects évolutifs et des facteurs pronostiques.</p> Youssef Kadouri Farouk Hachem Jihad Lakssir Hachem Sayegh Lounis Benslimane Yassine Nouini Copyright (c) 2020-06-03 2020-06-03 36 1 Prehabilitation program for African sub-Saharan surgical patients is an unmet need <p>Approximately 4.2 million people worldwide die within 30 days of surgery each year. Half of these deaths occur in low- and middle-income countries. Postoperative deaths account for 7.7% of all deaths globally, making it the third-highest contributor to deaths, after heart disease and stroke. In sub-Saharan Africa, there is a higher rate of mortality following postoperative complications compared to high-income countries. The WHO has tools to help countries provide safer surgery. However, implementation remains poor in most African countries. Interventions focused on intraoperative or postoperative measures to improve perioperative prognosis may be too late for high-risk patients. Poor preoperative cardiorespiratory functional capacity, poor management of pre-existing comorbidities and risk factors and no assessment of the patient´s surgical risk is associated with adverse postoperative outcomes, including mortality, complications, slower recovery, longer intensive care stay, extended hospital length of stay and reduced postoperative quality of life. To significantly decrease morbidity and mortality following surgery in Africa, we propose the implementation of a comprehensive preoperative intervention, that must include: i) risk assessment of surgical patients to identify those at greater risk of postoperative complications for elective surgery; ii) increase the preoperative functional reserve of these high-risk patients, to enhance their tolerance to surgical stress and improve postoperative recovery; iii) anticipate postoperative care needs and organize tools, resources and establish simple workflows to manage postoperative complications. We believe this approach is simple, feasible and will significantly reduce postoperative burden for both patients, hospitals and society.</p> Antero do Vale Fernandes Daniel Moreira-Gonçalves Jotamo Come Nilton Caetano Rosa Victor Costa Lygia Vieira Lopes Paulo Matos da Costa Lúcio Lara Santos Copyright (c) 2020-06-03 2020-06-03 36 1 Toxic shock syndrome and pyomyositis: about an unusual case <p>Pyomyositis is a pyogenic infection of skeletal muscle with abscess formation. It is a rare disease with nonspecific symptoms which requires a rapid diagnosis and treatment. Magnetic resonance imaging is considered the gold standard for early diagnosis and to rule out other etiologies. This article reports an atypical presentation of pyomyositis revealed by a toxic staphylococcal shock syndrome in an 8-year-old boy.</p> Mouad EL Mouhtadi Karima EL Fakiri Noureddine Rada Ghizlane Draiss Youssef Mouaffak Said Younous Mohammed Bouskraoui Copyright (c) 2020-06-03 2020-06-03 36 1 Presentation and anatomical distribution of diverticular disease in four hospitals in Sudan <p><strong>Introduction:&nbsp;</strong>diverticular disease (DD) was thought to be more prevalent in the western countries, especially the white populations, but the recent increase in incidence among African and Asian population, was reported. Up to our knowledge, there is no previous study of DD in Sudan.</p> <p><strong>Methods:&nbsp;</strong>this is a descriptive cross-sectional study conducted at the department of endoscopy in four Sudanese hospitals in the period from October 2017 to February 2019. We included all patients who underwent colonoscopy during the study period. The main objective is to study the presentation and the anatomical pattern of diverticular disease among the Sudanese population.</p> <p><strong>Results:&nbsp;</strong>prevalence of DD in the included population was 7.5% (104/1393). The mean age was 66.4 ± 12.5 years with the percentage of males in our study is 77.1% and females were 22.9%. Presenting complains were: abdominal pain in all patients, constipation in 78.8% and rectal bleeding in 57.7%. Regarding anatomical distribution: 63.5% have left colonic DD, 19.2% in the right colon and 17.3% involving the entire colon. There was a significant correlation between the left side DD and following clinical presentations: mucus per-rectum (p = 0.015) and weight loss (p = 0.048). Other endoscopic findings of significance were internal pile in 21.2% and colo-rectal polyp in 15.4%.</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of DD in the included population, is 7.5% which is consistent with recent literature from the Middle East, Africa and Asia but still less than the prevalence in the western countries and left side colon is predominantly affected.</p> Alsmwal Alnour Alnzaer Ali Yasen Yasen Mohamedahmed Yousif Abdalla Adam Elmoiz Eltyiep Suliman Hussen Suliman Copyright (c) 2020-06-03 2020-06-03 36 1 Challenges faced in the management of complicated Boerhaave syndrome: a tertiary care center experience <p>Spontaneous esophageal perforation is rare and is associated with high morbidity and mortality. A spectrum of various surgical modalities ranging from primary surgical repair to esophagectomy is available for its management. The optimal management of patients presenting late in a hemodynamically stable condition is not clearly defined in the literature. A retrospective review of all patients with Boerhaave syndrome managed by a single surgical team in a tertiary care center between 2008 and 2019 was performed (n = 16). Eleven patients were initially managed in the medical intensive care unit (MICU) as non-esophageal cause and 5 patients were referred after failed management (conservative/endoscopic). Demographics, clinical presentation, characteristics of perforation, initial diagnosis, and treatment were analyzed. All patients were males with a mean age of 42.2 years. A history of ethanol use was present in 6 patients. The median delay in diagnosis and referral was 16 days (range: 11-40 days). The common presenting symptoms were chest pain (n=11), dyspnoea (n=10), vomiting (n=4) and cough (n=2). The perforation was directed into right, left, and bilateral pleural cavities in 6, 8, and 2 patients respectively. The location of perforation was distal esophagus except for one patient. One patient was successfully treated with conservative management. The remaining patients underwent esophagectomy as a definitive surgical procedure. There was no significant postoperative morbidity and mortality. Esophagectomy can be done as a one-stage definitive procedure for patients with Boerhaave syndrome who present late in a hemodynamically stable condition with acceptable morbidity and good long term outcome.</p> Sakthivel Harikrishnan Chandramohan Servarayan Murugesan Raveena Karthikeyan Kanagavel Manickavasagam Balaji Singh Copyright (c) 2020-06-03 2020-06-03 36 1 A narrative review on pressure ulcer (PU) studies relevant to medical imaging <p>Pressure ulcers (PUs) are defined as localised injuries to the skin and/or underlying tissue as a result of pressure or press ure together with shear. PUs present significant health implications to patients; costing billions to manage and/or treat. The burden of PU prevention in hospitals must be the concern of all healthcare professionals, including radiographers. The purpose of this narrative review article was to identify and critically evaluate relevant literature and research conducted into pressure ulcers (PUs) relevant to medical imaging. It is expected that this review article will increase the level of awareness about PUs amongst radiographers and help to develop appropriate interventions to minimise the risk of PUs. A literature<br>search was conducted in PubMed/Medline, Scopus, CINAHL, and Google Scholar to retrieve relevant articles. Also, books, professional body guidelines, magazines, grey and unpublished literatures were also searched. The search was limited to English Language articles. Only five articles were retrieved and reviewed. There are limited studies on PUs relevant to medical imaging. Available studies provide some evidence that radiographic procedures and settings subject patients attending for radiographic procedures to the risk of PUs. Further studies are needed into PU ri sk assessment, minimisation and management in medical imaging to help raise awareness and address the problem of the potential for PU development.</p> Seth Kwadjo Angmorterh Andrew England Judith Anaman-Torgbor Nii Korley Kortei Huseini Alidu Cosmos Yarfi Jo Webb Eric Kwasi Ofori Peter Hogg Copyright (c) 2020-06-04 2020-06-04 36 1 Prévalence du syndrome métabolique et des facteurs de risque cardiovasculaire chez les diabétiques de type 2 vu au service d’endocrinologie, Antananarivo <p>Le syndrome métabolique (SM), étant considéré comme un facteur de risque cardiovasculaire, constitue un problème majeur de santé publique. Il aggrave les risques déjà élevés chez les diabétiques. Notre étude vise à déterminer les prévalences du syndrome métabolique et des autres facteurs de risque cardiovasculaire (FDR CV) associés chez les diabétiques de type 2. Il s’agit d’une étude transversale descriptive et analytique, menée au sein du Service d’Endocrinologie du Centre Hospitalier Universitaire Befelatanana, Antananarivo, sur une période de 7 mois. Le diagnostic du SM était posé selon les critères du consensus d'harmonisation de l’International Diabetes Federation (2009). Nous avons retenu au total 219 patients diabétiques de type 2 dont 189 avaient présenté un SM donnant une prévalence de 86,30%. Leur âge moyen était de 58,58 ans avec une prédominance féminine (55,88%). Leur diabète évoluait, en moyenne, depuis 4,36 ans. A part l’hyperglycémie, l’hypertension artérielle était la composante du SM la plus observée, suivi de l’hypoHDLémie, de l’obésité abdominale et l’hypertriglycéridémie chez les deux genres. Les autres FDR CV associés au diabète le plus observé étaient la dyslipidémie, suivie de la surcharge pondérale ou l’obésité, de l’albuminurie et du tabagisme. Seul le surpoids ou l’obésité était le FDR CV corrélé significativement avec le SM. La prévalence du SM était très élevée chez nos diabétiques de type 2<br>qui cumulaient plusieurs autres FDR CV. Une prise en charge adéquate de ces différents FDR sera donc nécessaire pour réduire le SM et ses conséquences afin d’améliorer leur survie.</p> Sitraka Angelo Raharinavalona Thierry Razanamparany Rija Eric Raherison Andrinirina Dave Patrick Rakotomalala Copyright (c) 2020-06-04 2020-06-04 36 1 Preparedness of primary health care workers and audit of primary health centres for newborn resuscitation in Port Harcourt, Rivers State, Southern Nigeria <p><strong>Introduction:&nbsp;</strong>Nigeria still has high newborn deaths and birth asphyxia remains a major cause. Birth attendants´ readiness to perform newborn resuscitation depends largely on their competence in basic resuscitation and availability of newborn resuscitation equipment to enable the various steps outlined in resuscitation guidelines to be applied quickly and appropriately. This study aimed to assess primary health care workers´ experience of neonatal resuscitation and audit primary health centres for availability of neonatal resuscitation equipment.</p> <p><strong>Methods:&nbsp;</strong>this descriptive cross-sectional study surveyed 106 primary health care workers (22 doctors, 84 nurses) randomly selected from 28 Primary Health Centres to document their experiences in newborn resuscitation and appraise the centres for availability of newborn resuscitation equipment. Experience in newborn resuscitation was obtained using a semi-structured questionnaire and audit was with a Proforma following on-site facility visits. Data was analysed using SPSS v20 and displayed in tables and graphs.</p> <p><strong>Results:&nbsp;</strong>all health care workers had resuscitated newborns but only 58(57.4%) had ever used a bag and mask, 53(50%) used stethoscopes and 19(17.9%) had resuscitation protocol in their facilities. Fifteen (53.6%) health centres had functional newborn-specific bag and masks, 11(39.3%) had suction machines and 5(25%) had empty oxygen cylinders.</p> <p><strong>Conclusion:&nbsp;</strong>primary health care workers´ experience of newborn resuscitation is very limited and some primary health centres were grossly unequipped. Neonatal resuscitation training interventions and supplies of neonatal resuscitation equipment are urgently needed.</p> Datonye Christopher Briggs Augusta Unoma Eneh Copyright (c) 2020-06-04 2020-06-04 36 1 Délégation des tâches dans le domaine de la planification familiale au Burkina Faso: qualité des services offerts par le délégataire <p><strong>Introduction:&nbsp;</strong>pour améliorer l´accessibilité des méthodes contraceptives au Burkina Faso, il a été initié un projet pilote de transfert des compétences de l´offre du DIU et de l´implant aux agents de santé première ligne (APL) ainsi que l´offre des méthodes contraceptives injectables aux agents de santé communautaire (ASC) dans 20 centres de santé du district sanitaire de Tougan. La présente étude visait à apprécier la qualité des services de planification familiale (PF) offerts par ces délégataires (APL et ASC).</p> <p><strong>Méthodes:&nbsp;</strong>il s´est agi d´une étude transversale à visée descriptive et analytique. La collecte des données a combiné les méthodes quantitatives et qualitatives. Elle a porté sur l´ensemble des 20 centres de santé de la zone d´intervention du projet et sur tous les prestataires (54) impliqués dans l´offre des produits contraceptifs (délégants et délégataires). Dix-neuf (19) bénéficiaires dont 10 nouvelles utilisatrices d´une méthode contraceptive ont été interviewées. Les techniques de collecte étaient constituées de l´observation des prestations de services de PF et de l´environnement de travail, de la revue documentaire et des entretiens individuels. Les données ont été analysées à l´aide du logiciel Epi info 7 et Open Epi version 3.01. Le test du Chi carré et le test t de Student ont été utilisés pour déterminer s´il y existait une différence significative entre la qualité des services de PF offerts par les délégants et celle des délégataires.</p> <p><strong>Résultats:&nbsp;</strong>le score de qualité générale du service de PF de la zone d´intervention était de 73% chez les délégataires contre 69% chez les délégants. Il n´y avait pas de différence statistiquement significative entre ces scores. Par contre, Il existait une différence statistiquement significative entre le score de qualité des agents de santé communautaire (75,8 %) et celui des délégants (87,5 %) en matière counseling (P &lt;0.05). Il en était de même pour le score de qualité en matière de détermination des critères d´éligibilité des implants où la qualité chez les APL semble supérieure à celle des délégants: 79% pour les délégataires, 64% pour les délégants.</p> <p><strong>Conclusion:&nbsp;</strong>cette expérience a eu l´avantage d´améliorer la couverture géographique de l´offre des méthodes contraceptives de longue durée d´action. Sous certaines conditions (renforcement des compétences, suivi, coaching), il est bien possible d´étendre l´offre des méthodes contraceptives de longues durées aux APL ainsi que celle des injectables aux ASC tout en conservant un niveau de qualité des services PF satisfaisant.</p> Souleymane Kaboré Roland Sanou Boureima Baillou Isabelle Zongo Alidou Zongo Elizabeth Kondé André Yolland Ky Ida Salou Kagoné George Coulibaly Djénéba Sanon Ouédraogo Robert Karama Copyright (c) 2020-06-05 2020-06-05 36 1 Atypical presentation of placental abruption <p>A 25-year-old primigravida with no significant medical history was referred to our department, at 30 weeks´ gestation, for threatened preterm labor. On general examination, the patient was afebrile with normal vital signs. Obstetrical examination revealed fundal height corresponding to gestational age and regular uterine contractions without uterine rigidity. Fetal heart rate was normal. On speculum, the cervix was macroscopically normal without bleeding, amniotic fluid or vaginal discharge. Vaginal examination objectified an open cervix (2cm). Ultrasound scan showed a single live intrauterine fetus in cephalic presentation of 29 - 30 weeks with oligoamnios. Placenta was anterior and thick with a hyper echoic basal area measuring 8cm x 3cm suggestive of placental abruption. Her blood investigations were normal. Under spinal anesthesia, an emergent caesarean section was performed giving birth to a male newborn, weighing 1200g with normal Apgar scores.&nbsp; acroscopic examination of the placenta confirmed the retro placental clot in maternal surface. The postoperative period was uneventful for patient and the newborn was transferred to neonatal intensive care unit. The highly variable presentation of placental abruption makes the clinical diagnosis difficult. As was in the present case, it should be suspected in any case of unexplained threatened preterm labor. Ultrasound evaluation can play a role in the diagnosis of acute placental abruption especially in those with atypical clinical presentation.</p> Mounir Moukit Jaouad Kouach Copyright (c) 2020-06-08 2020-06-08 36 1 Assessment of acute flaccid paralysis surveillance performance in East and Southern African countries 2012 - 2019 <p><strong>Introduction:&nbsp;</strong>polio eradication initiatives started in 1988, this is almost the past 32 years following the WHA resolution 41.8 of eradicating polio by the year 2000. As of 2019, only 3 countries remained to be polio endemic globally, Afghanistan, Pakistan and Nigeria. The east and southern sub-region countries had shown progressive achievement towards polio eradication and to start with the African regional certification. The availability of sensitive AFP surveillance performance is among important strategies in the achievement of polio eradication. We, therefore, decided to conduct this assessment of AFP performance from 2012 to 2019 in the ESA sub-region have evidence documentation and support the certification process of the WHO AFRO region.</p> <p><strong>Methods:&nbsp;</strong>we reviewed all reported acute flaccid paralysis (AFP) cases from 19 countries in the ESA sub region with the date of onset of paralysis from 1 January 2012 to 31 December 2019. The data were run to descriptive analysis based on the personal characteristics and AFP surveillance performance indicators parameters.</p> <p><strong>Results:&nbsp;</strong>a total of 46,014 AFP cases were reported from 19 countries in the ESA countries who were paralyzed from 1 January 2012 to 31 December 2019. The most affected age group was children aged 0 to 3 years old where 19,740 children with acute paralysis were reported representing 42.9% of the total reported AFP for the period. The overall assessment of the non-polio AFP rate, there is an increase from a rate of 2.7 in 2012 to 3.5 in 2019 per 100,000 population aged less than 15 years, reflects a significant change with a p-value of 0.040 (95% C.I. ranges from 0.035 to 1.564). Furthermore, the percentage of stool adequacy raised from 86.4% in 2012 to 88.5% in 2019, with an observed 2.1% difference and no significant change over the 8 years.</p> <p><strong>Conclusion:&nbsp;</strong>we observed an overall increase in the sensitivity of the AFP surveillance performance for the ESA sub-region countries from 2012 to 2019 using the national performance indicators. The COVID-19 pandemic paused an operational challenge for AFP surveillance performances from 2020. A further subnational surveillance performance analysis is suggested.</p> Daudi Manyanga Charles Byabamazima Brine Masvikeni Fussum Daniel Copyright (c) 2020-06-08 2020-06-08 36 1 Pitfall of I-131 whole body scan: a mucinous adenocarcinoma of the ovary <p>False positive radioiodine uptake following thyroidectomy for differentiated thyroid cancer has been reported in some cases. A 57-year-old female patient was referred for ablative radioiodine treatment four weeks after undergoing total thyroidectomy for papillary thyroid carcinoma. Posttherapeutic I-131 scintigraphy showed uptake in the neck and large focus in the lower abdomen and pelvis. Pathology revealed a mucinous adenocarcinoma of the right ovary.</p> Ali Sellem Issam Msakni Wassim Elajmi Hatem Hammami Copyright (c) 2020-06-08 2020-06-08 36 1 Schwannoma of the descending loop of the hypoglossal nerve: case report <p>Schwannomas of the descending loop of the hypoglossal nerve are very rare. Existing literature of the schwannoma of the descending loop of the hypoglossal nerve is limited to two previously reported case. They are slow-growing tumors that may masquerade a carotid body tumor. We herein described a rare case of schwannoma of the descending loop of the hypoglossal nerve in the s right latero-cervical region with diagnostic imaging and histopathological findings. A 37-years-old woman has had a palpable firm, mobile mass in the right latero-cervical region, of imaging, MR images showed homogeneous hypointensity on T1-weighted imaging (T1-WI), heterogeneous hyperintensity on T2-WI, and heterogeneous enhancement on contrast-enhanced T1-WI. Diagnostic imaging using computed tomography (CT) and magnetic resonance imaging (MRI) was suspected of Chemodectoma or neurogenic tumor. At operation, a 4 cm mass arising from the descending loop of the hypoglossal nerve of was resected en bloc with the loop itself; Final diagnosis was confirmed on the basis of histopathological finding and intraoperative findings. Postoperative course was uneventful and the patient is free from disease recurrence at tree-year follow-up. En bloc resection remains the real curative treatment of Schwannomas, ensuring unlimited freedom from disease, although causing functional impairment which may be significant. Nonetheless recurrence should be prevented as, besides requiring reintervention, it may harbor a malignant evolution towards sarcoma. Schwannomas of the descending loop of the hypoglossal nerve may masquerade a chemodectoma of the carotid bifurcation and can be curatively resected without any functional impairment. This case confirmed the differential diagnosis on the basis of the intraoperative finding that the tumor was continuous with the hypoglossal nerve.</p> Nadia M´jahad Mohamed Ridal Houda Chafai Amal Douida Hammas Naoual Aamal Akamar Mustapha Maaroufi Mohamed Nourredine EL Alami Copyright (c) 2020-06-08 2020-06-08 36 1 Cricoarytenoid joint arthritis: a possible complication of dermatomyositis <p>Cricoarytenoid joint arthritis is most frequently reported in Rheumatoid Arthritis and in other systemic diseases such as Sjogren’s syndrome, Systemic Lupus Erythematosus, Ankylosing Arthritis, Juvenile Chronic Arthritis, and autoimmune hepatitis but it has not been reported in dermatomyositis. In this paper, we report the case of a 43 years-old woman treated for dermatomyositis who presented with hoarseness and severe odynophagia. The laryngoscopy revealed the presence of an extensive white swelling of the left cricoarytenoid joint with reduced mobility of the left vocal cord, consistent with left cricoarytenoid joint arthritis, which has not previously been described in dermatomyositis to our knowledge. Treatment with high<br>doses of prednisone produced a complete resolution of the laryngeal symptoms.</p> Chadi Farah Ouidade Aitisha Tabesh Jad Okais Arlette Hajjar Amine Haddad Copyright (c) 2020-06-09 2020-06-09 36 1 Congenital radioulnar synostosis presenting in adulthood - a case report <p>Congenital radioulnar synostosis is a rare developmental skeletal malformation of the upper limb, characterized by the fusion of the proximal ends of the radius and ulna from birth. The failure of prenatal longitudinal segmentation of the adjacent radius and ulna results in a fibrous bony bridge between the radius and ulna. We present a 23-year-old female who presented with pain and restricted mobility of the left elbow joint for 7 years. A plain X-ray was performed for the patient, revealing a diagnosis of congenital radio-ulnar synostosis. Careful evaluation of the anatomical relations and spatial orientation of bony structures is required for the diagnosis and treatment of such cases.</p> Mohammed Hamid Karrar Alsharif Juman Mahmoud Almasaad Khalid Mohammed Taha Abubaker Yousif Elamin Nagi Mahmoud Bakhit Mohammed Ahammed Noureddin Abair Awadalla Ahmed Mahdi Copyright (c) 2020-06-09 2020-06-09 36 1 Influence des comorbidités sur l’évolution et le pronostic des patients porteurs de broncho-pneumopathie chronique obstructive dans un centre tunisien <p><strong>Introduction:&nbsp;</strong>la broncho-pneumopathie chronique obstructive (BPCO) s´associe fréquemment avec des comorbidités. L´objectif de notre travail est d'étudier l'impact des comorbidités sur l´évolution et le pronostic de la BPCO.</p> <p><strong>Méthodes:&nbsp;</strong>il s´agit d´une étude rétrospective incluant des patients porteurs de BPCO hospitalisés et/ou suivis à la consultation de Pneumologie au Centre Hospitalo-Universitaire Fattouma Bourguiba de Monastir entre Janvier 2000 jusqu´à Décembre 2017. Les patients ont été répartis initialement en deux groupes, le groupe G0: BPCO isolée et le groupe G1: au moins une comorbidité. Nous avons divisé les patients du groupe G1 en deux sous-groupes: Groupe A: patients ayant 1-2 comorbidités et Groupe B: ≥ 3 comorbidités associées. Nous avons comparé les différents paramètres de sévérité de la BPCO entre les différents groupes.</p> <p><strong>Résultats:&nbsp;</strong>en tout 1152 patients BPCO ont été inclus. Soixante-dix-neuf pourcent des patients avaient au moins une pathologie chronique associée à leur BPCO. La présence d´au moins une comorbidité était associée à l'augmentation du nombre des exacerbations sévères (p = 0,004), avec plus de recours à l´oxygène longue durée (p = 0,006) et à une survie réduite (p = 0,001). De même, un nombre de comorbidités plus important (≥ 3 comorbidités) était associé à une inflammation systémique plus importante, à un recours plus fréquent à la ventilation mécanique ou la ventilation non invasive (p = 0,04) et à une survie réduite (p = 0,05).</p> <p><strong>Conclusion:&nbsp;</strong>la présence de comorbidités au cours de la BPCO s´associe à une sévérité plus importante et un pronostic plus sombre de la maladie.</p> Ahmed Ben Saad Lobna Loued Samah Joobeur Asma Migaou Saousen Cheikh Mhamed Naceur Rouatbi Nesrine Fahem Copyright (c) 2020-06-09 2020-06-09 36 1 Nigeria′s street children, epitome of oral health disparity and inequality <p><strong>Introduction:&nbsp;</strong>it has been close to four years since the authors highlighted the total neglect of the oral health of street children in the Journal of Public Health Policy. Since then, the authorities appear to have simply turned the blind eye making this follow-up imperative. This follow-up report specifically examines the resultant oral health disparity between Nigeria's street children and Private, fee-paying secondary school students in Northern Nigeria.</p> <p><strong>Methods:&nbsp;</strong>we conducted a cross-sectional comparative survey of randomly selected 12-14 years old street children (children of Quranic informal educational institutions) in Northern Nigeria while fee paying, private secondary school children served as controls. A simple close-ended questionnaire translated into Hausa language was used to assess oral health knowledge and the Simplified Oral Hygiene Index used to categorize oral hygiene status of the participants.</p> <p><strong>Results:&nbsp;</strong>the mean age (SD) of the participating street children was 12.7 (0.86) while that of the private secondary school students (PSSS) was 13.05 (0.96). The majority (89%) of parents of street children compared with that (7%) of parents of students of private secondary schools had no western education. Only 6% of street children compared with 90% of PSSS cleaned their teeth for the right reasons. Only 5% of street children compared with 90% of private secondary school students used a fluoride-containing toothpaste. Though both groups of children have poor knowledge (street children 3%, private secondary school students 16%) on the use of dental floss, the mean oral hygiene score (SD) for street children was 4.42 (0.85) compared with 1.90 (0.09) for private secondary school students. There were striking differences in knowledge and practice with only 4% of street children compared with 69% of PSSS with knowledge about fluoride and its use (p &lt; 0.0005). Also, 2% of street children compared with 40% of PSSS were aware of the benefits of regular dental visits. Sixty five (65%) of street children used finger and water only for tooth cleaning, none of the secondary school students practiced this (p = 0.0005).</p> <p><strong>Conclusion:&nbsp;</strong>there is disparity in oral health practice between Nigeria's street children and private secondary school children. This disparity may be attributed to lack of western education and socio-economic status.</p> Enoch Abiodun Idowu Solomon Olusegun Nwhator Adedapo Olanrewaju Afolabi Copyright (c) 2020-06-09 2020-06-09 36 1 A case of massive hepatic infarction in severe preeclampsia as part of the HELLP syndrome <p>Hepatic infarction is a rare and fatal complication associated with hemolysis, elevated liver enzymes and low platelets syndrome. It can develop into fulminant liver failure and lead to death in 16% of cases. A 25-year-old woman, with unremarkable prenatal history, was sent to gynecological emergency unit for management of severe preeclampsia at 30 weeks and 4 days of pregnancy. Initial laboratory studies revealed aspartate aminotransferase at 290 U/L, alanine aminotransferase at 193 U/L and a normal value of hemoglobin, platelets and the prothrombin time. Behind the persistence of high blood pressure despite dual therapy, an emergent cesarean section was performed. However, two days after surgery, the patient accused an epigastric pain and was subsequently noted to have developed HELLP syndrome: thrombocytopenia (77000 /ul), anemia (hemoglobin 9.1 g/dL) and worsened liver injury (aspartate aminotransferase 2809 U/L; alanine aminotransferase 2502 U/L). A thoraco-abdominopelvic computed tomography (CT) was performed, which revealed massive hepatic infarction more marked on the right lobe, by showing the existence of diffuse hypodense plaques, poorly limited, not enhanced after injection, interesting all hepatic segments. The vascular permeability of the portal and subhepatic was preserved. During the surveillance, the laboratory tests worsened (hemoglobin = 4,6 g/dl; platelets count = 20000 /ul; WBC = 26000 /ul; CRP = 340 mg/l; albumin = 16 g/l, prothrombin time (PT) = 50%). The patient received antibiotics, she was transfused by red blood cells and platelets concentrates, she also received albumin with the pleural effusion drainage. The damaged hepatic areas stayed stable in control CT and the patient gradually improved here biological test, to become normal at 11 days after delivery. Hepatic infarction is an extraordinarily rare complication of preeclampsia. The diagnosis should be suspected by noting elevated liver enzymes, thrombocytopenia and typical images of hepatic infarction on abdominal CT. Early recognition and multidisciplinary management is necessary to prevent hepatic failure and death.</p> Linda El Allani Said Benlamkaddem Mohamed Adnane Berdai Mustapha Harandou Copyright (c) 2020-06-09 2020-06-09 36 1 Quality assessment in undergraduate medical training: how to bridge the gap between what we do and what we should do <p><strong>Introduction:&nbsp;</strong>the outcome of the undergraduate medical training programme in South Africa is to produce competent medical doctors who can integrate knowledge, skills and attitudes relevant to the South African context. Training facilities have a responsibility to ensure that they perform this assessment of competence effectively and defend the results of high-stakes assessments. This study aimed to obtain qualitative data to suggest practical recommendations on best assessment practices to address the gaps between theoretical principles that inform assessment and current assessment practices.</p> <p><strong>Methods:&nbsp;</strong>a focus group interview was used to gather this data. The teaching and learning coordinators for five of the six modules that are offered in the clinical phase of the undergraduate medical programme participated in the focus group interview. The focus group interview proceeded as planned and took 95 minutes to complete. The responses were transcribed and recorded on a matrix.</p> <p><strong>Results:&nbsp;</strong>the lack of formal feedback to students was identified as an area of concern; feedback plays an important role to promote student learning and improve patient care. The role of teaching and learning coordinators as drivers of quality assessment were recognized and supported. All participants agreed on the outcome of the programme and the central role of the outcome in all assessments.</p> <p><strong>Conclusion:&nbsp;</strong>the training of assessors and the implementation of workplace-based assessment and assessment portfolios were recommended and can also address feasibility challenges. Participants recommended decreasing summative assessments and only performing these for borderline students.</p> Hanneke Brits Johan Bezuidenhout Lynette Jean Van der Merwe Copyright (c) 2020-06-09 2020-06-09 36 1 Genome sequencing and the diagnosis of novel coronavirus (SARS-COV-2) in Africa: how far are we? <p>The coronavirus disease (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) has become a pandemic. There is currently no vaccine or effective treatment for COVID-19. Early diagnosis and management is key to favourable outcomes. In order to prevent more widespread transmission of the virus, rapid detection and isolation of confirmed cases is of utmost importance. Real time reverse transcriptase polymerase chain reaction (RT-PCR) is currently the "gold standard" for the detection of SARS-COV-2. There are several challenges associated with this test from sample collection to processing and the longer turnaround time for the results to be available. More rapid and faster diagnostic tests that may produce results within minutes to a few hours will be instrumental in controlling the disease. Serological tests that detect specific antibodies to the virus may be such options. In this review, we extensively searched for studies that compared RT-PCR with serological tests for the diagnosis of COVID-19. We extracted the data from the various selected studies that compared the different tests and summarised the available evidence to determine which test is more appropriate especially in Africa. We also reviewed the current evidence and the challenges for the genome sequencing of SARS-COV-2 in Africa. Finally, we discuss the relevance of the different diagnostic tests and the importance of genome sequencing in identifying potential therapeutic options for the control of COVID-19 in Africa.</p> Muki Shey Joseph Chukwudi Okeibunor Ali Ahmed Yahaya Belinda Louise Herring Oyewale Tomori Sheick Omar Coulibaly Hieronyma Nelisiwe Gumede-Moeletsi Jason Mathiu Mwenda Zabulon Yoti Charles Shey Wiysonge Ambrose Otau Talisuna Copyright (c) 2020-06-09 2020-06-09 36 1 Implications of COVID-19 infections in sickle cell disease <p>Sickle cell disease is a major concern of public health significance in Africa. Nearly 2/3<sup>rd</sup>&nbsp;of the global burden of sickle cell disease (SCD) is found to be in sub-Saharan Africa. There is increased mortality risk in sickle cell disease patients in Africa due to associated complications such as acute chest syndrome, asthma, pulmonary emboli and sepsis. Sickle cell disease management is the major contributor of financial burden on the government. Moreover, there is a shortage of medical specialists in Africa. COVID-19 pandemic has further led to devastating impact on economy and health globally. The chances of SCD patient contracting COVID-19 infections are higher as these patients are immunocompromised and may be at a higher risk of mortality. Practicing preventive measures including isolation and social distancing by these patients will prevent mortality rates as well as economic burden on government in the present unprecedented COVID-19 pandemic.</p> Nitin Ashok John Jyoti Elgiva John Copyright (c) 2020-06-09 2020-06-09 36 1 Nasopharyngeal carcinoma in Ibadan, Nigeria: a clinicopathologic study <p><strong>Introduction:&nbsp;</strong>nasopharyngeal carcinoma is relatively common in our environment. It is one of the most difficult malignancies to diagnose at an early stage. The aim of the study was to determine the clinical features, clinical disease stage of nasopharyngeal carcinoma at presentation and at diagnosis as well as the histologic types at the University College Hospital, Ibadan, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>this was a ten year retrospective study of all histologically confirmed nasopharyngeal carcinoma between January 2007 to December 2016 using clinical and pathology records and files.</p> <p><strong>Results:&nbsp;</strong>there were 73 cases. The male: female ratio was 1.7. The age of patients ranged from 12 to 80 years with a mean age of 39 ± 16 years. The median age at diagnosis was 40 years. The peak age group of occurrence was 40-49 years. The most common symptoms were namely epistaxis in 67.1% of patients at presentation, neck mass/swelling (64.4%) and nasal mass/obstruction (63.0%). Majority (54.8%) of the patients presented late with stage 3 or 4 disease. Most (94.5%) of the tumours were of the non-keratinizing squamous cell carcinoma subtype. The keratinizing and basaloid variants accounted for 4.1% and 1.4% of the tumours respectively.</p> <p><strong>Conclusion:&nbsp;</strong>vague, non-specific symptoms make patients present at late stages of the disease, making it almost impossible to attempt cure. The dominant histopathological type is non-keratinizing squamous cell carcinoma and resembles that seen in most parts of Nigeria and endemic areas of the world.</p> Gabriel Olabiyi Ogun Aralola Adepeju Olusanya Victor Ifeolu Akinmoladun Adebolajo Adewunmi Adeyemo Segun Ayodeji Ogunkeyede Adekunle Daniel Babatope Lanre Awosusi Ebenezer Oluwaseun Fatunla Ayotunde James Fasunla Paul Adekunle Onakoya Aderemi Adeleke Adeosun Onyekwere George Nwaorgu Copyright (c) 2020-06-09 2020-06-09 36 1 Primary hydatid cyst of the small intestine masquerading as intestinal duplication in a child <p>Hydatid disease or hydatidosis is a worldwide zoonosis disease caused by the tapeworm of&nbsp;<em>Echinococcus granulosus</em>&nbsp;and still widely endemic in Tunisia especially in rural areas where the sheep-dog cycle is dominant. It is an important public health problem in the pediatric age group causing significant morbidity and mortality. We report a case of primary hydatid cyst of the small intestine in a child and we want to highlight the difficulty that we meet in the diagnosis despite the contribution of imaging.</p> Sameh Tlili Youssef Hellal Rabia Ben Abdallah Aida Daib Malek Boughdir Fatma Trabelsi Shanaz Abid Khaoula Ben Hassine Wafa Koubaa Youssef Gharbi Nejib Kaabar Copyright (c) 2020-06-12 2020-06-12 36 1 Gestion de la rechute d'une tuberculose naso-sinusienne primaire <p>La tuberculose naso-sinusienne primaire est une affection relativement rare voir exceptionnelle. La présentation clinique est polymorphe et non spécifique. Le diagnostic définitif repose sur l’examen anatomopathologique et l’examen mycobactériologique d’une pièce biopsique de la lésion. Son pronostic est favorable sous une antibiothérapie antituberculeuse classique et précoce. Cependant, notre observation rapporte une rechute de cette localisation rare chez une patiente immunocompétente malgré un traitement antituberculeux bien adaptée initialement et avec une bonne observance. La rechute a été attribuée à un sous dosage en rifampicine. Les auteurs insistent sur la démarche diagnostique, étiologique et sur la gestion thérapeutique de cette rechute. Notre expérience pourrait aider les cliniciens à mieux gérer cette situation inhabituelle.</p> Adil Zegmout Ahmed Rouihi Abdelhalim Boucaid Younes Amchich Hicham Souhi Hanane El Ouazzani Ismail Abderrahmane Rhorfi Ahmed Abid Copyright (c) 2020-06-12 2020-06-12 36 1 Sarcome de kaposi et myélome multiple: s´agit-il d´une association causée par le HHV-8? <p>Le sarcome de kaposi est une affection tumorale, caractérisé par des lésions violacées ou brunâtres sur la peau. Il s´agit d´un cancer le plus souvent lié à l´infection par l´herpès virus humain type 8 et peut être secondaire à une hémopathie maligne notamment les lymphomes. Nous rapportons à travers notre observation un autre nouveau cas qui illustre l´association très rare kaposi-myélome multiple. Mr âgé de 67 ans, suivi en dermatologie pour la maladie de kaposi avec une sérologie de l´herpès virus humain type 8 positive associée à un myélome multiple (MM) à IgG lambda stade I de pronostic défavorable. Nous rapportons à notre connaissance le 21<sup>e</sup>&nbsp;cas kaposi-kahler. Ceci nous laisse penser à l´existence d´un variant kaposi herpès virus humain type 8 impliqué dans la physiopathologie du myélome multiple. D´où la nécessité d´élargir les études dans ce sens afin de trancher dans cette liaison exceptionnelle.</p> Sophia Kahouli Hafid Zahid Majid Benkirane Nezha Messaoudi Copyright (c) 2020-06-12 2020-06-12 36 1 Amniotic band syndrome <p>A 30-year-old primiparous woman underwent routine nuchal translucency scan at 12+1 weeks of gestation. A possible amniotic band with entrapment of the upper limbs and the umbilical cord was noted. Amniotic bands or constriction rings may obstruct vascular and lymph supply and cause deformity, amputation or even intrauterine death. The exact etiology is unknown but they may be the result of rupture of the amnion without rupture of the chorion. In some cases, a fetoscopic intrauterine procedure may release the entangled limb, thus avoiding amputation. In this case, a follow up scan was scheduled at 14 gestational weeks to reassess and plan possible treatment, however, at that time a missed miscarriage was diagnosed, probably due to constriction of the umbilical cord. Following medical management, the abortus showed an amniotic band that caused amputation of both hands and constriction of the umbilical cord, as sonographically suspected.</p> Tsakiridis Ioannis Dagklis Themistoklis Copyright (c) 2020-06-12 2020-06-12 36 1 Atypical resorption of an unknown post-traumatic hyphema <p>We report the case of an 80-year-old patient with Alzheimer's disease who was referred to ophthalmic emergencies for a whitish pupillary reflection. The interrogation does not allow to have information on the circumstances of occurrence of this lesion. The biomicroscopic examination showed a whitish plaque contiguous to the corneal endothelium, with a large horizontal axis measuring 6mm, and a small vertical axis measuring 3.5mm. Its edges are spiculated, with a reddish blood around the entire lesion. The anterior chamber was seat of a hyphema measuring 1mm in height. Given the atypical aspect of the lesion, the patient benefited from a large assessment comprising a blood-smear blood count, a sedimentation rate, HSV1, HSV2, EBV serologies, CMV, syphilis, toxoplasmosis. All these exams returned without anomalies. We also performed anterior chamber puncture which also returned without abnormalities. Therapeutically, the patient was placed on topical corticosteroid hourly and progressive degression, with a beginning of resorption of plaque after 48 hours of treatment. This resorption continued at 7 days, with lightening of the cornea after 20 days of treatment. Given the patient's dementia, we assumed that the patient had to be the victim of an ocular trauma, having caused a post traumatic hyphema, probably total, having regressed leaving a fibrin plate attached to the corneal endothelium. The evolution was favorable, with a decline of 8 months. The occurrence of trauma in the elderly, with comorbidities can lead to atypical lesions.</p> Kawtar Belkhadir Ouafaa Cherkaoui Copyright (c) 2020-06-15 2020-06-15 36 1 A case of an AIDS patient with Cryptococcus neoformans infection <p>Cryptococcosis is the most common fungal disease in HIV-infected persons. It is known as the AIDS-defining illness for 60-70% of HIV-infected patients. Before antiretroviral therapy (ARV) was discovered, fungal and other opportunistic infections were a major problem for people with advanced HIV/AIDS. Presented here is a case of a 43-year-old man who was newly diagnosed HIV, in which he was admitted due to shortness of breath and decreased consciousness. His clinical symptoms, physical examination, laboratory and radiologic findings indicated a&nbsp;<em>Cryptococcus neoformans</em>&nbsp;infection. The patient had received treatment using anti-fungal and ARV that showed a clinical improvement during observation.</p> Bramantono Bramantono Ahmad Danial Usman Hadi Copyright (c) 2020-06-15 2020-06-15 36 1 <i>Aggregatibacter actinomycetemcomitans</i> pneumonia mimicking lung cancer in a previously healthy 12-year-old child from Saudi Arabia: a case report <p><em>Aggregatibacter actinomycetemcomitans</em> formely known as <em>Actinobacillus actinomycetemcomitans</em> is a known part of the normal oral flora. It can sometimes cause oral or rarely extra-oral infections secondary to hematogenous extension or aspiration. It is a rare cause of invasive pneumonia. It can resemble tuberculosis or lung cancer in its presentation. Making the diagnosis in such case is crucial for better management that usually require tissue biopsy. We report a case of <em>Aggregatibacter actinomycetemcomitans</em> invasive pneumonia in a 12-year-old previously healthy boy from Saudi Arabia. After a prolonged course of antibiotics, clinical and radiological follow up showed complete resolution of the infection.</p> Abdullah Al-Nafeesah Copyright (c) 2020-06-15 2020-06-15 36 1 Grossesse molaire partielle avec fœtus diploïde vivant: à propos d’un cas et revue de la littérature <p>La môle hydatiforme partielle (MHP) fait partie des maladies trophoblastiques gestationnelles. Appelée également môle embryonnée, il s’agit d’un œuf humain pathologique comportant des villosités en transformation vésiculaire, mais conservant une forme placentaire reconnaissable et une cavité amniotique avec un fœtus. La circonstance diagnostique la plus commune étant le tableau d’avortement spontané au premier trimestre. Rarement les môles partielles persistent au-delà du premier trimestre et sont alors source de complications maternelles et fœtales et de confusion diagnostique. L’origine génétique des MHP correspond à une conception triploïde avec un lot chromosomique supplémentaire d’origine paternelle. La coexistence d’un fœtus de caryotype normal avec une MHP est une situation exceptionnelle. Nous rapportons un cas rare de grossesse molaire partielle avec fœtus vivant diploïde à 27 semaines d’aménorrhée (SA) chez une femme âgée de 36 ans dont le diagnostic est porté à l’occasion d’une menace d’accouchement prématurée associée à un placenta prævia.</p> Dhekra Toumi Ahmed Hajji Wael Mbarki Soumaya Kraiem Haifa Bouchahda Copyright (c) 2020-06-15 2020-06-15 36 1 Urothelial bladder carcinoma in childhood: a case report <p>We report an exceptional case of transitional cell carcinoma of the bladder in a 14-years old boy without personal nor family history who consulted for a total hematuria. Work-up showed a bladder lesion sized 5cm with histology of urothelial cancer. Treatment consisted of a transurethral surgery with carcinologic complete resection. Patient is alive, free of disease with a follow-up of 36 months.</p> Aref Zribi Sonia Ben Nasr Issam Msakni Sarra Karrit Faten Gargouri Sana Fendri Mehdi Balti Abderrazek Haddaoui Copyright (c) 2020-06-15 2020-06-15 36 1 Intracardiac thrombus in Behçet´s disease: a rare case in Morrocco <p>Behçet´s syndrome is a systemic inflammatory disease generally presented with the triad of uveitis, oral and genital ulcers. However, it may present with gastrointestinal, central nervous system, skin and vascular disease manifestations. Intracardiac thrombus is a rare but serious complication of Behçet´s disease. A 16-year-old man with Behçet's syndrome was hospitalized into our department with a history of cough, fever, chest pain, hemoptysis, and weight loss. Transthoracic echocardiography and Chest scan revealed a right ventricular thrombus. After one month of treatment with cyclophosphamide, and corticosteroid the intracardiac thrombus has been resolved.</p> Younes Amchich Nezha Reguig Abdelhalim Boucaid Reda Belghoule Adil Zegmout Jamal Eddine Bourkadi Copyright (c) 2020-06-15 2020-06-15 36 1 The STOPBANG score is effective for obstructive sleep apnea syndrome screening and correlates with its features, in a sub-Saharan African population <p><strong>Introduction:&nbsp;</strong>the STOPBANG score is an easy-to-use screening tool for obstructive sleep apnea (OSA), which has not been validated in sub-Saharan Africa (SSA). We sought to evaluate its diagnostic performance in Cameroun.</p> <p><strong>Methods:&nbsp;</strong>this community-based study took place in a sub-urban area, from November 2015 to April 2016. Adults aged ≥19 years underwent a clinical assessment, including the STOPBANG and the Epworth sleepiness scale (ESS) questionnaires. A respiratory polygraph (RP) was performed on a randomly selected sample. Diagnosis performance included sensitivity (Se), specificity (Sp), and positive and negative predictive values (PPV and NPV). An association was sought between STOPBANG and OSA features.</p> <p><strong>Results:&nbsp;</strong>a total of 3033 were interviewed, of whom 102 had a RP. Their mean age was 49.1±17.9 years, the sex ratio was 1 and the mean body mass index 29.1±6.1 kg/m². For OSA screening (apnea-hypopnea index (AHI) ≥5), the STOPBANG score at threshold 3 obtained: Se=82.9%, Sp=34.4%, PPV=45.9% and NPV=75.0%. For moderate-to-severe OSA (IAH ≥15), these values were 93.3%, 31.1%, 18.9% and 96.4% respectively. Furthermore, STOPBANG-based high risk of OSA correlated with AHI (9.1±10.7/hr vs 3.8±3.5/hr, p=0.0003) and oxygen desaturation index (6.4±7.9/hr vs 2.6±2.1/hr, p=0.0004). There was a non-significant association with ESS (6.3±5.3 vs 4.5±3.5, p=0.06)</p> <p><strong>Conclusion:&nbsp;</strong>in this Cameroonian population, the STOPBANG diagnostic performance did not differ from the original Caucasian one. It could therefore be proposed on a larger scale, since obesity and other OSA risk factors are increasing in SSA.</p> Massongo Massongo Adamou Dodo Balkissou Corine Kenne Kenyo Brice Nouga Sawa Nadine Kanko Eric Walter Pefura Copyright (c) 2020-06-15 2020-06-15 36 1 Simultaneous bilateral anterior shoulder dislocation as a result of minimal trauma <p>Simultaneous bilateral anterior shoulder dislocation is rare, it often occurs after high energy trauma, we report a case of a 43-years-old male presented with bilateral anterior shoulder dislocation when he tries to stand up from the floor, shoulders in extension, abduction and external rotation. A closed reduction was performed without complications, and one month later the right shoulder was stabilized by open Laterjet technique. The evolution was favorable for both shoulders with no pain, recuperation of the range motion and no recurrence of dislocation. Through this case we underline the value of early diagnosis and appropriate treatment of bilateral anterior shoulder dislocation, to avoid complications and obtain good result.</p> Ismail El Antri Youssef Benyass Ali Zine Copyright (c) 2020-06-15 2020-06-15 36 1 Lost to follow-up: reasons and characteristics of patients undergoing corneal transplantation at Tenwek Hospital in Kenya, East Africa <p><strong>Introduction:&nbsp;</strong>corneal transplantation is a surgical procedure requiring consistent long-term follow-up to maximize the chance of graft survival. The purpose of this study was to explore patient characteristics and reasons for being lost to follow-up (LTFU).</p> <p><strong>Methods:&nbsp;</strong>a retrospective review of clinical records from January 2012 to October 2014 was conducted of patients who received corneal transplantation at Tenwek Hospital. At the time of chart review, all patients who provided a mobile phone number were contacted to answer a phone questionnaire. Logistic regression was used to assess the association of each patient characteristic, separately, with the outcome of LTFU.</p> <p><strong>Results:&nbsp;</strong>of the 118 patients that met inclusion criteria, 40 (33.9%) were considered LTFU by failing to follow up at Tenwek Hospital to at least one year postoperatively. The odds of LTFU for patients age 60 and older were 3.78 times that of those who were 18-59 (95% CI: 1.21-11.80]; p-value=0.02). The odds of LTFU for patients with a preoperative diagnosis of pseudophakic bullous keratopathy were 3.83 times that of those with a preoperative diagnosis of keratoconus (95% CI: [1.13-12.94]; p-value=0.03). Education level, employment status, distance from the hospital, and possession of a mobile contact number appeared marginally associated with follow-up status, though not statistically significant at the 0.05 significance level. Financial barriers were the most commonly cited reason for LTFU (42.4%, n=14).</p> <p><strong>Conclusion:&nbsp;</strong>certain reasons and patient characteristics may be associated with follow-up adherence. Identifying these factors may help providers identify patients who are at a higher risk of LTFU and influence providers in medical decision-making and system-based interventions when offering corneal transplantation.</p> Belinda Ijeoma Ikpoh Allen Kunselman Christy Stetter Michael Chen Copyright (c) 2020-06-15 2020-06-15 36 1 Giant metastasis of the thenar eminence revealing ovarian rhabdomyosarcoma <p>Ovarian rhabdomyosarcoma is extremly rare and the diagnosis might be a real dilemma clinically and histologically. We report here the case of a 19-year-old patient, who presented a progressive increase of the abdominal volume associated with dyspnea and general conditions deterioration. The pelvic MRI showed bilateral ovarian masses associated with peritoneal carcinomatosis. CA125 was elevated (273u/ml) while other markers including bHCG, inhibine, AFP were normal. Simultaneously, the patient developed a cutaneous lesion in the thenar's lodge of the right hand rapidly increasing volume, painful and necrotic. The MRI of the right hand showed a large necrotic tissue mass of the right thenarian lodge without bone involvement which may correspond to a secondary localization. Cutaneous biopsy was performed and revealed a skin localization of undifferentiated malignant tumour and IHC analysis were compatible with alveolar rhabdomyosarcoma. After these findings, an exploratory laparotomy was performed and revealed the presence of two bilateral ovarian masses with ascites of great abundance and large dissemination of carcinomatosis nodules. Several biopsies were performed and the histological analysis with IHC have confirmed the diagnosis of ovarian rhabdomyosarcoma (desmin, myogenin, myoD1 were positive). The patient received chemotherapy based on: vincristine, adriamycin and cyclophosphamide with peritoneal and thenar progression after 6 cycles. Patient refused hand amputation and was proposed for radiotherapy. A second line chemotherapy with etoposide and ifosfamide was established.</p> Karima Oualla Nawfel Mellas Copyright (c) 2020-06-15 2020-06-15 36 1 Cervical cancer screening behaviours and challenges: a sub-Saharan Africa perspective <p>Cervical cancer may be fatal to women if not identified and treated early. The importance of organised cervical screening has been felt in many developed countries. However, the majority of women in developing countries may be under-screened or may have never been screened because many developing countries have not developed a national cervical cancer prevention program accessible to all women due to reasons such as competing funding priorities, low prioritization of cervical cancer and cultural practices across Africa. It is important that these factors are adequately addressed to improve access to regular cervical screening services and ultimately help curb the incidence and impact of cervical cancer on women in sub-Saharan Africa.</p> Judith Anaman-Torgbor Seth Kwadjo Angmorterh Dzifa Dordunoo Eric Kwasi Ofori Copyright (c) 2020-06-16 2020-06-16 36 1 An unusual diagnosis of hemorrhage during third trimester <p>A 33-year-old multiparous woman, presented for the first time in our department, at 39 weeks gestation, with the chief complaint of spontaneous vaginal bleeding appeared 6 hours before. There was no abdominal pain, uterine contractions and the bleeding was moderate in amount. She had only a third-trimester ultrasound with normal placental insertion site. On general examination, she was afebrile with normal vital signs. Obstetrical examination revealed fundal height corresponding to gestational age without uterine tenderness or rigidity. Fetal heart rate was normal. Vaginal examination revealed a well-circumscribed vascular mass arising from the posterior vaginal wall. A differential diagnosis of benign vaginal tumours (leiomyoma, angiomyofibroblastoma and cellular angiofibroma) or aggressive vaginal tumours was made. Under spinal anesthesia, caesarean section was performed followed (using lithotomy position) by a circular incision around the lesion with clear margins forcing enucleation of the mass; the wound was repaired with No. 0 monocryl sutures. The histopathologic report was vaginal angiofibroma. The postoperative course was uneventful and no recurrence was noted during a follow-up period of 3 years. Despite its rarity, vaginal angiofibroma should be considered in the differential diagnosis of antepartum haemorrhage.</p> Mounir Moukit Jaouad Kouach Copyright (c) 2020-06-16 2020-06-16 36 1 Surgical management of groove pancreatitis: a case report <p>Groove pancreatitis (GP) is a rare form of chronic pancreatitis involving the groove area bound by the pancreatic head, the duodenum, and the common bile duct. The diagnosis of this entity is challenging since it can mimic pancreatic carcinoma. We herein report the case of groove pancreatitis diagnosed in a 37 year old men, with a past history of chronic alcohol consumption. The patient was admitted for several times over the past three years because of recurrent alcohol-induced pancreatitis. The diagnosis of groove pancreatitis was made on the basis of CT, MRI and EUS findings. A medical treatment was initially attempted. In the absence of improvement in clinical symptoms, a pancreatico-duodenectomy was performed with satisfying results at 24 months follow up. Pancreatico-duodenectomy is the treatment of choice in groove pancreatitis since it leads to total resolution of clinical symptoms.</p> Imen Ben Ismail Hakim Zenaidi Abdelwahed Yahmadi Saber Rebii Ayoub Zoghlami Copyright (c) 2020-06-16 2020-06-16 36 1 Caesarean delivery of first prediagnosed COVID-19 pregnancy in Nigeria <p>The COVID-19 pandemic is currently causing widespread infection and deaths around the world. Since the identification of the first case in Nigeria in February 2020, the number of confirmed cases has risen to over 9,800. Although pregnant women are not necessarily more susceptible to infection by the virus, changes to their immune system in pregnancy may be associated with more severe symptoms. Adverse maternal and perinatal outcomes have been reported among pregnant women with COVID-19 infection. However, literature is scarce on the peripartum management and pregnancy outcome of a pregnant woman with COVID-19 in sub-Saharan Africa. We report the first successful and uncomplicated caesarean delivery of a pregnant woman with COVID-19 infection in Nigeria.</p> Christian Chigozie Makwe Kehinde Sharafadeen Okunade Muyiwa Kayode Rotimi Oluwayemisi Esther Ekor Olalekan Gabriel Oyeleke Qazeem Oladele Bello Ayodeji Ayotunde Oluwole Iorhen Ephraim Akase Beatrice Nkoli Ezenwa Iretiola Bamikeolu Fajolu Rotimi Williams Dada Yewande Oshodi John Olutola Olatosi Olabisi Oluranti Opanuga Sunday Omilabu Veronica Chinyere Ezeaka Bosede Bukola Afolabi Copyright (c) 2020-06-16 2020-06-16 36 1 An atypical case of febrile infection-related epilepsy syndrome following acute encephalitis: impact of physiotherapy in regaining locomotor abilities in a patient with neuroregression <p>Encephalitis refers to inflammation of the brain parenchyma. It is potentially life-threatening with the highest incidence and severity in younger children. Febrile infection-related epilepsy syndrome (FIRES) is a condition, in which a child develops a nonspecific febrile illness that may not persist when the initial seizure activity begins. However, an electroencephalogram (EEG) shows that the child is in status epilepticus. We report the case of a five-year-old male who presented with difficulty to maintain sitting posture, and inability to stand and walk without support, following viral encephalitis at the age of one year. He had motor, visual, speech and cognitive impairment along with a seizure disorder. The physiotherapy interventions including neurodevelopmental treatment (NDT) and sensory integration (SI) helped in regaining locomotion ability in the child. The study aims to assess the impact of physiotherapy interventions on regaining locomotor ability in a child with FIRES following infective encephalitis.</p> Chanan Goyal Waqar M. Naqvi Arti Sahu Copyright (c) 2020-06-17 2020-06-17 36 1 Prune-Belly syndrome, a rare case presentation in neonatology: about one case in Yaounde, Cameroon <p>The Prune-Belly syndrome (PBS) is a rare pathology predominating in male infants, classically manifesting with the triad including aplasia of the abdominal wall muscles, dilatation of the urinary tract, and testicular abnormalities. We report and discuss the case of a full-term male newborn, in whom clinical examination at birth revealed abdominal wall muscle hypoplasia, cryptorchidism, urinary tract dilatation and renal failure. The diagnosis was made based on physical assessment, abdominal ultra-sonographic imaging, and blood sampling of urea and creatinine. For such cases, the recommended surgical management usually consists in a sequential surgical intervention including urinary tract reconstruction, abdominoplasty, and orchidopexy. However, these could not be practiced in due time in our patient, who died on the seventh day of life because of kidney failure. The prognosis of infants with Prune-Belly syndrome may be improved by quality antenatal follow-up, to enable the early diagnosis and preparation for prompt surgical intervention.</p> Dany Hermann Ngwanou Emmanuel Ngantchet Georges Pius Kamsu Moyo Copyright (c) 2020-06-17 2020-06-17 36 1 Une cardiomyopathie révélant un déficit en carnitine palmitoyltransférase I: à propos d'un cas inhabituel <p>Les déficits en carnitine palmitoyltransférase (CPT) sont des atteintes rares due à un défaut d'oxydation des acides gras. Patient de 10 ans sans antécédant présente une dyspnée aigue associée à une toux productive dans un contexte fébrile et d´altération de l´état général. Le patient était polypnéique, tachycarde avec un souffle systolique mitral sans signes d´insuffisance cardiaque. La radiographie thoracique a identifié une cardiomégalie et l'échocardiographie montrait une cardiomyopathie dilatée hypokinétique. Il s´agissait d´un déficit en CPT I. La prise en charge consistait en un traitement de sa cardiopathie et un régime strict hypolipidique et hyperglucidique. Trois mois plutard, le patient se présente une décompensation en insuffisance cardiaque congestive par une infection à&nbsp;<em>Aeromonas caviae</em>&nbsp;résistant identifié à l´hémoculture. Une cardiomyopathie dilatée devrait faire penser au déficit en CPT pour une prise en charge précoce qui peut compromettre le pronostic.</p> Imane Fetoui Karima El Fakiri Noureddine Rada Ghizlane Draiss Mohammed Bouskraoui Copyright (c) 2020-06-17 2020-06-17 36 1 COVID-19 suspicion revealed to be fat embolism syndrome <p>The novel coronavirus, named SARS-CoV-2, responsible of the COVID-19 is now causing a pandemic. Detecting all possible cases and eliminating differential diagnoses in front of any acute respiratory distress has become a daily challenge for doctors around the world. We believe that non-COVID patients are the hidden victims of the actual health problematic. We report from this manuscript the case of a patient with fat embolism syndrome that has been suspected as COVID-19.</p> Salim Mazouz Ouissal Aissaoui Mohamed Anass Fehdi Afak Nsiri Rachid AlHarrar Copyright (c) 2020-06-17 2020-06-17 36 1 Comparing hospital stay and patient satisfaction in a resource poor setting using conventional and locally adapted negative pressure wound dressing methods in management of leg ulcers with split skin grafts: a comparative prospective study <p><strong>Introduction:&nbsp;</strong>chronic leg ulcers cause a prolonged hospital stay with devastating effects on the patients. Several modifiable factors are taken care of to reduce the duration of stay. A further measure to hasten wound bed preparation pre-grafting and to hasten graft healing post-grafting is with negative pressure dressing.</p> <p><strong>Methods:&nbsp;</strong>sixty-two patients were placed in two groups of 31 cases each. The wound beds were prepared with negative pressure apparatus locally adapted with suction machine for group A and with conventional gauze dressing using 5% povidone iodine soaks for group B. Grafted wound was also dressed similarly for the respective groups. Grafts were inspected on the 5<sup>th</sup>&nbsp;post-operative day and were determined with planimeter grid. Grafts were monitored until completely healed and patients were discharged. Satisfaction and length of stay were determined at discharge.</p> <p><strong>Results:&nbsp;</strong>the mean hospital stay pre-grafting and post-grafting were 12.2 (±8.64) days and 13.6 (±2.03) days respectively for the negative pressure dressing and 28.8 (±30.9) days and 21.8 (±21.97) days respectively for the traditional dressing group. These differences with p values of 0.038 for the pre-grafting stay and 0.006 for the post-grafting stay were statistically significant. The patients managed with negative pressure dressing also recorded greater satisfaction with the process and the outcome.</p> <p><strong>Conclusion:&nbsp;</strong>negative pressure dressing contributes significantly to reducing the length of hospital stay in chronic leg ulcers both in wound bed preparation and in graft healing resulting to better patient satisfaction than in patients treated with conventional gauze dressing and 5% povidone iodine soaks.</p> Charles Chidiebele Maduba Ugochukwu Uzodimma Nnadozie Victor Ifeanyichukwu Modekwe Ezekiel Uchechukwu Nwankwo Copyright (c) 2020-06-18 2020-06-18 36 1 Congenital cytomegalovirus infection as an important cause of infantile cholestatic jaundice: a case report <p>Infantile cholestasis has numerous causes and diagnosis can be difficult, especially in low-income countries where essential laboratory facilities are not readily available. This is a report of a baby who had severe conjugated neonatal hyperbilirubinaemia and deranged liver function tests, which posed a diagnostic dilemma before a diagnosis of congenital cytomegalovirus (CMV) infection was made. He was treated with Ganciclovir and responded well to treatment. He had no obvious associated neurologic manifestation of the disease and is presently been followed-up. This report highlights the challenges encountered in the diagnosis and management of the baby, as well as the favourable outcome with Ganciclovir therapy. The aim of the report is to increase the awareness of paediatricians and other stakeholders on congenital CMV infection in order to ensure early diagnosis and appropriate treatment of affected babies, with the ultimate aim of improving their prognoses and preventing the associated audiologic and cognitive sequelae.</p> Olufunmilola Olubisi Abolurin Idowu Odunayo Senbanjo Adesola Olubunmi Adekoya Emmanuel Damilare Ajibola Copyright (c) 2020-06-19 2020-06-19 36 1 Score de prédiction de récidive après un premier épisode de pneumothorax spontané primitif <p><strong>Introduction:&nbsp;</strong>la relation entre les constatations scanographiques et le risque de récidive d´un pneumothorax spontané primitif (PSP) reste conflictuelle. L´objectif de cette étude est de déterminer la relation entre le score scanographique DSS (Dystrophy Severity Score) et la survenue de récidive du PSP après un premier épisode.</p> <p><strong>Méthodes:&nbsp;</strong>il s´agit d´une étude rétrospective incluant les patients hospitalisés pour un premier épisode de PSP entre 2005-2017. Nous avons reparti notre population en 2 groupes, G1: récidive du PSP, G2: absence de récidive. Nous avons procédé à une analyse uni varié incluant différentes variables dont le score DSS suivie d´une analyse multi variée.</p> <p><strong>Résultats:&nbsp;</strong>quatre-vingt-six patients ont été inclus dans cette étude. Quarante-huit pourcent des cas ont eu une récidive du PSP. Bien que le score DSS soit significativement associé à la survenue de récidive du PSP (p=0.008), l'analyse multi variée montre que la présence de bulles à la tomodensitométrie thoracique est le facteur de risque indépendant associé à la récidive du PSP après un premier épisode (rapport des risques: 3.26, p&lt; 0.008).</p> <p><strong>Conclusion:&nbsp;</strong>le risque de récidive d´un PSP est significativement associé à la présence de bulles au scanner thoracique. D´autres études sont nécessaires pour une meilleure appréciation du score DSS.</p> Ahmed Ben Saad Asma Migaou Maroua Ammar Saousen Cheikh Mhamed Nesrine Fahem Naceur Rouatbi Samah Joobeur Copyright (c) 2020-06-19 2020-06-19 36 1 Preparedness among dental professionals towards COVID-19 in India <p><strong>Introduction:&nbsp;</strong>novel corona virus infection has become a public health crisis leading the world to a standstill including dentistry. However, since the dental services cannot be stopped for a long period it is important that dentist be fully prepared before resuming their services. Therefore, the current study was carried out for evaluating knowledge, attitude and practices (KAP) along with perceived barriers to practice dentistry during pandemic.</p> <p><strong>Methods:&nbsp;</strong>this cross-sectional study was conducted through an online survey questionnaire on dentists of India. Dentists were enquired for demographics, KAP and perceived barriers regarding practicing dentistry during pandemic. The knowledge was assessed based on 16 items in true or false or multiple choice questions format getting score of 1 or 0. The attitude and practices by 8 items each, on 5-point Likert scale and 4 items perceived barriers were enquired. The differences between the median scores among demographic variables were determined by applying student's t-test and keeping level of significance at below 0.05.</p> <p><strong>Results:&nbsp;</strong>out of 500 dentists who were approached through email, a total of 296 dentists returned the questionnaire (response rate, 59.2%) among which 22 questionnaires were incomplete and thus excluded making 274 as final study participants. Overall poor median scores of knowledge and practices were obtained whereas for attitude total median score was good. Median practice scores were significantly higher among female respondents (20(6)). Median knowledge and practice scores were significantly better in study participants with age &lt;40 years (6(4) and 19(5), respectively).</p> <p><strong>Conclusion:&nbsp;</strong>with the recent claims of authorities that virus is going to stay in world for quite some time it is essential that dentists must be fully prepared before resuming their services and must attain proper awareness to limit the disease spread.</p> Kumar Tathagat Singh Gaurav Mishra Alok Kumar Shukla Subasish Behera Arun Kumar Tiwari Subhasish Panigrahi Kumar Gaurav Chhabra Copyright (c) 2020-06-19 2020-06-19 36 1 Unusual sites of hydatid disease: report of two cases of dumbbell formations <p>Hydatidosis is a zoonosis caused by&nbsp;<em>Echinococcus granulosus</em>. Humans are accidentally contaminated by ingesting the parasite´s eggs mainly released through the faeces from infected dogs. Hydatidosis affects the bone in 0.5 to 2% of cases, with 44% of these cases involving in the spine. Vertebral hydatidosis is rare and it represents the most frequent and most dangerous form of bone involvement. This manifestation is extremely delicate, difficult to correctly identify and manage. The authors report two cases of vertebral hydatidosis revealed by medullar compression and increasing lumbar-radicular pain and functional impotence of lower limbs. Imaging showed multicystic bony lesions in lumbar spine. The extension into the spinal canal and to the perivertebral soft tissue were involved in both cases. We present those two cases to highlight the role of radiological exploration for diagnosis especially with magnetic resonance imaging (MRI) and the importance of monitoring this dangerous pathology.</p> Younes Dkhissi Badreeddine Alami Meryem Haloua Moulay Youssef Alaoui Lamrani Meryem Boubbou Mustapha Mâaroufi Copyright (c) 2020-06-19 2020-06-19 36 1 Exposition au mercure et état de santé des médecins dentistes de deux régions du centre du Maroc: enquête transversale descriptive <p><strong>Introduction</strong>: l´exposition au mercure est un problème de santé publique mondialement reconnu. Si les intoxications aiguës ou subaiguës par ce métal font l´objet d´un consensus diagnostique, l´impact d´une exposition chronique à de faibles doses est encore sujet à débat. En dentisterie, le mercure est utilisé pour la réalisation des amalgames dentaires. De ce fait, les professionnels de la médecine dentaire et spécialement des médecins dentistes représentent une population exposée à ce facteur de risque. Dans ce contexte, une enquête épidémiologique descriptive, transversale et exhaustive a été réalisée afin d´évaluer cette exposition chez les médecins dentistes dans deux régions du centre du Maroc. Parallèlement, leur état de santé globale a été relevé afin de juger de la pertinence d´une enquête étiologique ultérieure pour étudier l´impact probable de l´exposition à ce facteur de risque.</p> <p><strong>Méthodes</strong>: la présente étude a été réalisée par le biais d´un questionnaire auto-renseigné par les participants. L´exposition professionnelle des médecins dentistes a été évaluée en déterminant la fréquence d´utilisation de l´amalgame dentaire. Les différentes sources de mercure qui modulent la pollution de fond ou qui provoquent des pics d´exposition et qui sont en rapport avec l´environnement ou les habitudes du travail ont aussi été étudiés. Les sources d´exposition non professionnelle prises en compte sont le tabagisme, la vaccination, la consommation de poisson et la présence des amalgames dentaire en bouche. Enfin, l´état de santé des praticiens recrutés dans l´étude a été sondé globalement en se basant sur leurs déclarations.</p> <p><strong>Résultats</strong>: Cent quatre vingt douze (192) médecins dentistes ont été recrutés dans cette étude. Parmi lesquels, 76,04% déclarent utiliser l´amalgame dans leur pratique avec une fréquence variable. De plus, plusieurs sources de surexposition en rapport avec les conditions ou les habitudes du travail ont été mises en évidence. La principale source d´exposition non professionnelle dans notre population est en rapport avec la présence des amalgames dentaires en bouche (63,45%). Les plaintes sanitaires exprimées par les participants concernaient en chef de file les problèmes neuropsychologiques et ce chez 46,35% de la population. En prenant en compte la neurotoxicité reconnue du mercure, une étude étiologique s´avère parfaitement justifiable dans notre contexte.</p> <p><strong>Conclusion</strong>: l´exposition au mercure chez les médecins dentistes des régions étudiées est réelle. Des mesures de prévention sont à promouvoir. La réalisation d´une recherche étiologique pour juger l´impact de cette exposition est parfaitement indiquée.</p> Nourdine Attiya Rkia Fattahi Ahmed El-Haidani Nadia Lahrach Mohamed-Yassine Amarouch Younes Filali-Zegzouti Copyright (c) 2020-06-19 2020-06-19 36 1 Paediatric jaw tumours: experiences and findings from a resource limited tertiary health care center <p><strong>Introduction:&nbsp;</strong>primary maxillofacial tumors are uncommon in pediatric patients. When they do occur, the tissue damage caused directly alters facial growth, development as well as psycho-social evolution. This study was carried out to determine the pattern, sociodemographic characteristics and histologic peculiarities of paediatric jaw tumors in our environment.</p> <p><strong>Methods:&nbsp;</strong>a retrospective hospital-based study where the case notes of children below the age of 14 years who presented with jaw tumors and tumor-like lesions from January 2014 to December 2018 were studied.</p> <p><strong>Results:&nbsp;</strong>eighty-two patients were studied; patients aged 10-14 years had the highest representation. Mean time of presentation was 8 months with jaw swelling being the commonest presentation (84.1%). Majority of the fathers were in their 4<sup>th</sup>&nbsp;decade of life while most of the mothers were in their third decade of life and both parents possessed primary school certificate as their highest level of educational attainment. Fathers were mostly traders, while mothers were mostly full-time housewives. The maxilla and mandible were most commonly affected with the left side showing higher preponderance. Burkitt lymphoma (19 (23.2%)) and adenomatoid odontogenic tumor (14 (17.1%)) were the commonest lesions. When the tumor involved both the maxilla and the mandible, the tumor was most likely malignant.</p> <p><strong>Conclusion:&nbsp;</strong>in our center, paediatric jaw tumors are commonest in male children with the 10-14 years´ age group most commonly affected. Burkitt lymphoma and adenomatoid odontogenic tumors were the commonest tumors. Early presentation must be encouraged since these tumors if presented early can be successfully treated.</p> Benjamin Idemudia Akhiwu Daniel Otasowie Osunde Helen Oluwadamilola Akhiwu Ibrahim Aliyu Kelvin Uchenna Omeje Basil Ojukwu Priscilla Okhiabigie Ameh Rafael Adetokunbo Adebola Akinola Ladipo Ladeinde Copyright (c) 2020-06-19 2020-06-19 36 1 Parental willingness to vaccinate adolescent daughters against human papilloma virus for cervical cancer prevention in Western Nigeria <p><strong>Introduction:&nbsp;</strong>cervical cancer, which is vaccine preventable, is the commonest gynaecological cancer worldwide. This study aimed to assess parental willingness to vaccinate adolescent girls against Human Papilloma Virus for cervical cancer prevention.</p> <p><strong>Methods:&nbsp;</strong>this was a descriptive cross-sectional study among 301 parents of adolescent girls who reside in Surulere Local Government Area in Lagos, Nigeria. A pretested, semi-structured interviewer-administered questionnaire was used to collect data and analysis was done using Epi-info™ version 7. The chi-square (or Fisher’s exact) test and the t-test were used to test for associations between categorical and continuous variables respectively. The level of significance was set at 0.05.</p> <p><strong>Results:&nbsp;</strong>over half (53.5%) of the respondents had heard of cervical cancer. Of these, two thirds (62.1%) were aware that it could be prevented, 19.0% had good knowledge of cervical cancer prevention, only 4% had their daughters vaccinated though 79.2% were willing to vaccinate. The poor vaccine uptake was mostly due to lack of awareness of vaccination centres and the high cost of the vaccine. Willingness was significantly associated with level of education (p = 0.047) and knowledge of HPV vaccination (p =&lt; 0.001), however once aware, most parents were willing to get their daughters vaccinated.</p> <p><strong>Conclusion:&nbsp;</strong>awareness about cervical cancer prevention was high though uptake was low. A high level of education and good knowledge of cervical cancer prevention were facilitators of willingness to vaccinate, though once aware parents were willing. Creating awareness and educating parents about cervical cancer prevention is essential in improving the uptake of the vaccine.</p> Haleemat Wuraola Akinleye Oluchi Joan Kanma-Okafor Ifeoma Peace Okafor Kofoworola Abimbola Odeyemi Copyright (c) 2020-06-19 2020-06-19 36 1 Pancreatic cancer revealed by a Sister Mary Joseph’s nodule <p>Sister Mary Joseph<span class="ArticleTitleParagraph">´</span>s nodule is a metastatic of a primary cancer, usually adenocarcinoma and associated with poor prognosis. Here we report the case of a 48-year-old man, admitted to the hospital with six months history of epigastric pain without vomiting or externalized hemorrhage and without transit disorders in a context of alteration of the general state with weight loss. Clinical examination showed epigastric sensitivity with a painful umbilical nodule, firm and irregular (A). Laboratory tests revealed a cholestasis. His computed tomography (CT) of the abdomen showed a mass lesion at the tail of the pancreas measuring 45 mm enclosing the splenic artery with secondary ganglionic, hepatic, bone and peritoneal localization (B, C). The umbilical lesion biopsies revealed metastasis of the pancreatic adenocarcinoma (D). The patient received palliative chemotherapy.</p> Naoual El Omri Fadwa Mekouar Copyright (c) 2020-06-22 2020-06-22 36 1 A solitary hemangioblastoma of the posterior brain fossa: the role of radiotherapy <p>We report here the case of a patient admitted for management of posterior fossa cerebral hemangioblastoma. A 16-year-old male patient with a history of intracranial hypertension syndrome consisting of progressively worsening headache, vomiting, especially morning and jet vomiting, and decreased visual acuity. The patient's symptomatology worsened a few days later with the appearance of a disturbance of balance with enlargement of the sustentation polygon. The patient initially benefited from a brain computed tomography (CT) scan that objectified a solidocystic process of the posterior brain fossa. The patient then underwent a surgical excision that was considered partial and the diagnosis of hemangioblastoma was made on the surgical specimen. Since the surgical removal was partial the patient was referred to our training where he received external radiotherapy on his hemangioblastoma of the posterior brain fossa. The patient was examined one month after the end of irradiation; he presented a spectacular improvement in his neurological symptomatology with a clear regression of balance disorders. The standard treatment for cerebellar hemangioblastoma is complete microsurgical removal, but our results show a high level of efficacy for fractional photon radiotherapy after partial surgery of this benign tumour.</p> Fatima Zahra Abboud Moulay Ali Youssoufi Touria Bouhafa Khalid Hassouni Copyright (c) 2020-06-22 2020-06-22 36 1 Predictors of diarrhea episodes and treatment-seeking behavior in under-five children: a longitudinal study from rural communities in Zambia <p><strong>Introduction:&nbsp;</strong>globally, diarrhea is the second leading cause of mortality in children aged below five years, and is responsible for killing about 760 000 children every year. Poor treatment-seeking behavior among caretakers remains a major challenge in low-income countries. The current study aimed to determine the predictors of diarrhea episodes and treatment-seeking behavior among under-five children of Chivuna and Magoye in Zambia.</p> <p><strong>Methods:&nbsp;</strong>we conducted a community-based longitudinal study among 1216 children aged 12-59 months between July 2006 and June 2007. A structured interviewer-administered questionnaire was used to collect data on demographic factors, diarrhea episodes and treatment-seeking behavior from caretakers. Chi-square, one-sample test of proportions and logistic regression were the statistical methods used in this study.</p> <p><strong>Results:&nbsp;</strong>of the 1216 children who participated in the study, 698 (57%) were from Chivuna and 518 (43%) from Magoye. Factors associated with diarrhea episodes were location (children in Chivuna had increased episodes of diarrhea; aOR 1.32; 95%CI 1.15, 1.52) and age distribution (children aged 37-59 months vs. 12-36 months had reduced episodes of diarrheal aOR 0.81; 95%CI 0.72, 0.91). Fifty two percent (52%) of the diarrhea cases had their treatment sought within 24 hours of onset (early treatment). Thirty one percent (31%) of the diarrhea cases had their early treatment at a health facility. Female children (52%) had the majority of their diarrhea episodes treated within 24 hours of onset. The higher proportion of diarrhea episodes had their treatment at home (52%). Children who did not have home treatment had a significantly reduced chance of having early treatment (aOR 0.62; 95%CI 0.47, 0.82).</p> <p><strong>Conclusion:&nbsp;</strong>this study revealed that diarrhea episodes and treatment seeking behavior in under-5 children is of public health concern. There is need to re-enforce the preventative and control measures aimed at reducing diarrhea in under-5 children, and interventions should take into account the different predictors of diarrhea and treatment seeking behavior in different settings, like the ones highlighted in this study.</p> Benson Malambo Hamooya Sepiso Kenias Masenga Hikabasa Halwiindi Copyright (c) 2020-06-22 2020-06-22 36 1 Rapidly progressive necrotizing pneumonia: remember the Streptococcus anginosus group! <p>Acute necrotizing pneumonia in an immunocompetent host is uncommon and usually caused by&nbsp;<em>Staphylococcus aureus</em>&nbsp;infection.&nbsp;<em>Streptococcus anginosus</em>&nbsp;group (SAG) is a less recognized cause of rapidly destructive lung infection resulting in significant patient morbidity and mortality. Unlike many other bacterial infections, SAG can cross fascial planes and cause fulminant infections. Necrotizing pneumonia and lung abscesses due to SAG often fails conservative therapy with antimicrobials and requires definitive surgical intervention. Consideration of SAG as a potential etiology might help to institute definitive therapy earlier and prevent complications.</p> Biplab Kumar Saha Copyright (c) 2020-06-23 2020-06-23 36 1 Giant intraparietal inguinal hernia misdiagnosed as spigelian hernia in an old woman <p>Intraparietal inguinal hernias are a rare variant of inguinal hernia in which the hernia sac lies between the layers of the abdominal muscles. Intraparietal inguinal hernias mimic Spigelian hernias clinically; the diagnosis presents superior difficulties than its treatment. We report a case of a giant intraparietal hernia misdiagnosed as a Spigelian hernia clinically. The patient was 83 years old woman presented with complain of a large swelling over right abdomen for around 25 years. The patient had a huge mass of 25 x 30 cm occupying right flank, right lumbar region extending up to the umbilicus and inguinal region, partially reducible with gurgling sounds. Surgery started with transversal incision over the mass, it was found to be an interstitial variety of intraparietal inguinal hernia with a long viable segment of the small bowel with their mesentery as content of the sac. Hernioplasty with a polypropylene mesh was achieved satisfactorily. The patient was discharged on third postoperative day without complications. It is challenging to diagnose intraparietal hernias preoperatively; intraoperative findings defined its definitive diagnosis and its surgical technique.</p> Barbara Yordanis Hernandez Cervantes Radisnay Guzmán Lambert Duniesky Martínez Lopez Mariuska Rodríguez Gonzalez Frank Edwin Copyright (c) 2020-06-23 2020-06-23 36 1 Postoperative morbidity and mortality from aortic valve replacements in 25 cases in Senegal <p>The purpose is to study the short- and medium-term morbidity and mortality linked to the implantation of an aortic prosthesis during cardiac surgery. This is a longitudinal, retrospective and descriptive study which takes place over a period from January 2017 to March 2020 (38 months) at the level of the thoracic and cardiovascular surgery clinic of the University Hospital Center of Fann in Dakar. All patients who underwent aortic valve replacement during this period were included in the study. A number of the series was 25 patients with a sex ratio of 2.66. The average age of the patients was 29.5 years (8-51 years). In the patients’ history, 19 patients (76%) had a notion of recurrent angina. Exercise dyspnea was the most common functional symptomatology present in 24 patients (96%). In the series, there were 22 cases (88%) of aortic insufficiency of various grades (2 to 4) with 7 cases (28%) associated with mitral insufficiency. We had 3 cases (12%) of aortic stenosis. All patients received surgical management under cardiopulmonary bypass. The average duration of cardiopulmonary bypass was 132 minutes ± 41.21 (53-226 minutes). The average duration of aortic clamping was 101 minutes ± 31.87 (53-164 minutes). The surgical procedures consisted in replacing the aortic valve with a biological prosthesis in one patient (4%) and a mechanical prosthesis in 24 patients (96%). The average length of hospital stay in intensive care was 5 days ± 4.03 (2-20 days). The average length of hospital stay was 20.76 days ± 13.19 (9 to 64 days). The average duration of follow-up was 8.2 months ± 4.57 (1 week - 32 months). During the follow-up, only one patient (4%) had developed infectious endocarditis on prosthesis and only one patient (4%) had a complication related to anticoagulant therapy (antivitamin K) such as gingivorrhagia and melena. We had recorded a single case of death at 6 months, a late mortality of 4%. Aortic valve replacement surgery, by median sternotomy gives satisfactory short- and medium-term results with negligible morbidity and negligible operative mortality.</p> Momar Sokhna Diop Papa Salmane Ba Abdoulaye Boubou Aw Papa Amath Diagne Ndeye Fatou Sow Papa Ousmane Ba Amadou Gabriel Ciss Copyright (c) 2020-06-23 2020-06-23 36 1 Intraocular pressure variation after conventional extracapsular cataract extraction, manual small incision cataract surgery and phacoemulsification in an indigenous black population <p><strong>Introduction:&nbsp;</strong>intraocular pressure changes have been reported following the various cataract surgical technique. This study aims to compare the intra-ocular pressure (IOP) variation following conventional extra-capsular cataract extraction (ECCE), manual small incision cataract surgery (MSICS) and phacoemulsification in an indigenous black population.</p> <p><strong>Methods:&nbsp;</strong>a comparative cross-sectional study of adult patients aged 40 years and above who had pressure was measured with Goldman´s applanation tonometer pre-operatively and 1<sup>st</sup>&nbsp;day, 1<sup>st</sup>&nbsp;week, 1<sup>st</sup>&nbsp;month as well as 3<sup>rd</sup>&nbsp;month post-operative periods and recorded. Data was analyzed using SPSS version 21. Mean IOP changes between study groups were compared using ANOVA. P-value of &lt; 0.05 was taken as statistically significant.</p> <p><strong>Results:&nbsp;</strong>total of 82 patients consisting of 20(24.4%) ECCE, 32(39%) MSICS and 30(36.6%) phacoemulsification with mean preoperative 13.4mmHg, 13.5mmHg and 14.1 mmHg (p = 0.657) respectively was studied. Mean IOP increased from baseline at 1st day post-operative period in the ECCE and MSICS groups (13.4 ± 3.0mmHg to 13.7 ± 4.5mmHg (p = 0.84) and 13.5 ± 3.1mmHg to 15.3 ± 5.1mmHg (P = 0.48) respectively), and decrease in the phacoemulsification group (14.1 ± 2.6mmHg to 13.9 ± 3.5mmHg (p = 0.378). There was a decline in IOP in all the 3 study groups by one week post-operative period; the difference was significant only in the ECCE group (p = 0.032). By 3<sup>rd</sup>&nbsp;month postoperatively, there was a reduction in mean IOP when compared with pre-operative IOP the difference being greatest in the ECCE group.</p> <p><strong>Conclusion:&nbsp;</strong>ECCE, MSICS, and Phacoemulsification cause a decline in IOP below preoperative levels at 3<sup>rd</sup>&nbsp;month postoperatively in the MSICS group.</p> Oluwatoyin Helen Onakpoya Adenike Odunmorayo Adeoye Bernice Oluwakemi Adegbehingbe Sarat Abolore Badmus Bolajoko Abidemi Adewara Oluwaseun Olaniyi Awe Patrick Agadaigho Udonwa Copyright (c) 2020-06-23 2020-06-23 36 1 Temporal choroidal fissure cyst: a rare cause of temporal lobe epilepsy <p>Only a few cases of temporal choroidal fissure cyst are reported. We describe a new case of an 8 years old girl who manifested complex partial seizure. The diagnosis was made by magnetic resonance imagining (MRI). The signal intensity of the cyst was identical to the cerebrospinal fluid (CSF), and the underlying hippocampus was compressed by the cyst. The seizures were medically controlled. The value of MRI in the diagnosis and medical treatment will be discussed.</p> Asma Achour Walid Mnari Ahmed Miladi Badii Hmida Mezri Maatouk Mondher Golli Ahmed Zrig Copyright (c) 2020-06-23 2020-06-23 36 1 Leveraging best practices: protecting sub-Saharan African prison detainees amid COVID-19 <p>The risk of infection and death from COVID-19 is higher among older prisoners with pre-existing health conditions especially in sub-Saharan African. Hawks L&nbsp;<em>et al</em>. raise four concerns that need to be considered when developing public health and clinical responses to COVID-19 to protect prisoners. This paper applies these concerns to the sub-Saharan African context. These focus areas include 1) challenges of social distancing; 2) higher risk of severe infection and death; 3) difficulties health care systems may face in the case of COVID-19 surge; and 4) recommended solutions to prevent harm and preventing a public health catastrophe. Prisoners are more vulnerable and the time to take immediate actions to minimize an imminent COVID-19 outbreak and its impacts is now.</p> Batholomew Chireh Samuel Kwaku Essien Copyright (c) 2020-06-24 2020-06-24 36 1 Large intra-abdominal mucinous cystic adenoma: is it of ovarian or mesenteric origin <p>A 54-year-old female presented with a six year history of increasing abdominal swelling and discomfort and two months of intermittent constipation and difficulty with micturition. She was referred from the gynecological service having been investigated for a pelvic pathology without any positive findings. Her medical history was otherwise unremarkable. Physical examination revealed a non-tender intra-abdominal mass extending from epigastrium to the pelvis with a smooth surface. A large intra-abdominal multi-loculated cyst, separate from the ovaries, was seen on imaging. At laparotomy, the cystic tumour was discovered to arise from the mesentery of the terminal ileum and was resected en bloc. Histopathology revealed the tumour to be a benign mucinous cystadenoma, possibly of ovarian origin. This report aims to raise awareness of the difficulty of distinguishing ovarian from extra-ovarian mucinous cystadenomas on histopathological examination alone.</p> Radisnay Guzmán Lambert Barbara Yordanis Hernandez Cervantes Mariuska Rodríguez Gonzalez Duniesky Martínez Lopez Frank Edwin Copyright (c) 2020-06-25 2020-06-25 36 1 Laparoscopic removal of an ingested fish bone from the head of the pancreas: case report and review of literature <p>Most ingested foreign bodies pass spontaneously through the gastrointestinal tract and only 1% of them can perforate or penetrate the wall of stomach and duodenum and migrate into organs, such as the liver and pancreas. We report herein the case of a 59-year-old woman who presented to the emergency department with epigastric pain and fever. Computed tomography of the abdomen revealed a linear foreign body that perforate the posterior wall of the prepyloric region of the stomach. The foreign body was removed laparoscopically in one piece and was identified as a 3-cm-long fish bone. The patient recovered without complications and was discharged on the 4th postoperative day. Pancreatic foreign body is a rare entity and laparoscopic removal is warranted in majority of cases.</p> Francesk Mulita George Papadopoulos Stelios Tsochatzis Ioannis Kehagias Copyright (c) 2020-06-25 2020-06-25 36 1 Mélanome malin vulvaire: à propos d’un cas observé à l’Hôpital du Cinquantenaire de Lubumbashi <p>Le mélanome malin primitif de l'appareil génital féminin est une tumeur extrêmement rare. Il est néanmoins plus observé à la vulve qu´au col utérin et au vagin. La localisation vulvaire représente environ 1% (toutes localisations confondues) des mélanomes, puis par ordre de fréquence la localisation vaginale, utérine puis ovarienne; et moins de 200 cas de cancers de la vulve ont été décrits à travers le monde. Nous présentons ici un cas clinique de mélanome malin vulvaire chez une femme ménopausée de 72 ans. Une hemivulvectomie partielle et une lymphadénomectomie superficielle inguinale bilatérale ont été réalisées. Les suites postopératoires étaient globalement favorables et la patiente a quitté le service au 15<sup>e</sup>&nbsp;jour post opératoire.</p> Gabriel Kapya Mukeya Ivan Mwandwe Kakoka Joseph Chola Mwansa Willy Arung Kalau Copyright (c) 2020-06-25 2020-06-25 36 1 permatic vein thrombosis with lupus anticoagulant, a cause of acute inguinal pain: a case report <p>Patients with lupus anticoagulants are at high risk of systemic arterial and venous thrombosis and arterial stroke. We present an unusual case of a young man presenting inguinal pain. Doppler ultrasound revealed spermatic vein thrombosis on the left side. Hematologic workup revealed positive lupus anticoagulant. The patient was treated with therapeutic heparin.</p> Mohammed Aynaou Tarik Mhanna Amine Elhoumaidi Paapa Dua Boateng Ali Barki Copyright (c) 2020-06-25 2020-06-25 36 1 Parasitic contamination and public health risk of commonly consumed vegetables in Ibadan-Nigeria <p><strong>Introduction:&nbsp;</strong>vegetables form a major component of the human diet. However, poor agronomic practices may put consumers at risk of parasitic infections. This study evaluated the parasitic contamination of vegetables grown in selected farms in Ibadan, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>Two hundred and eigthy vegetable species: African eggplant (<em>Solanum macrocarpon</em>), lettuce (<em>Lactuca sativa</em>), cucumber (<em>Brassica oleracea</em>), spinach (<em>Amaranthus cruentus</em>), white jute (<em>Corchorus olitorius</em>), pumpkin (<em>Telfaria occidentalis</em>), green pepper (<em>Capsicum sp.</em>), okro (<em>Abelmoschus esculentus</em>), quill grass (<em>Celosia argenta L</em>), tomato (<em>Lycopersicum sativus</em>) were collected from farms within Ibadan. Samples were washed in water, and the resulting washing solution was filtered and centrifuged to concentrate the parasitic stages. Sediments were examined by iodine and modified Ziehl-Neelsen stained smears technique.</p> <p><strong>Results:&nbsp;</strong>parasites were detected in 14 (5.0%, 95% CI 32.6%-67.3%) of samples. The highest contaminated vegetable was white jute 32.1 (95% CI 17.9%-50.6%), followed by pumpkin 7.1(95% CI 1.9-22.6), quill grass 7.1 (95% CI 1.9-22.6) and lettuce 3.5 (95% CI 0.6-17.7). The commonest parasites were&nbsp;<em>Strongyloides stercoralis</em>&nbsp;larvae 42.9 (95% CI 21.3-67.4),&nbsp;<em>Entamoeba histolytica/E.dipaar</em>&nbsp;21.4 (95% CI 7.5-47.5),&nbsp;<em>Trichostrongylus spp</em>&nbsp;21.4 (95% CI 21.3-67.4), and&nbsp;<em>Ascaris sp.</em>&nbsp;14.3 (95% CI 4.0-39.9).</p> <p><strong>Conclusion:&nbsp;</strong>these findings provide evidence of contamination of vegetables from farms in Ibadan with parasites of public health importance. Information on best practices should be designed, packaged and disseminated through appropriate channels to enhance positive behavior change among farmers.</p> Oluwasola Olaiya Obebe Olufemi Oludare Aluko Olufarati Oludunsin Falohun Kayode Blessing Akinlabi ThankGod Emmanuel Onyiche Copyright (c) 2020-06-25 2020-06-25 36 1 A protracted cholera outbreak among residents in an urban setting, Nairobi county, Kenya, 2015 <p><strong>Introduction:&nbsp;</strong>in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures.</p> <p><strong>Methods:&nbsp;</strong>we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged &gt;2 years with acute watery diarrhea (&gt;4 stools/≤12 hours) and illness onset 1-14 May 2015. Confirmed cases had&nbsp;<em>Vibrio cholerae</em>&nbsp;isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and&nbsp;<em>Escherichia coli</em>.</p> <p><strong>Results:&nbsp;</strong>during December 2014-June 2015, 4,218 cholera cases including 282 (6.7%) confirmed cases and 79 deaths (case-fatality rate [CFR] 1.9%) were reported from 14 of 47 Kenyan counties. Nairobi county reported 781 (19.0 %) cases (attack rate, 18/100,000 persons), including 607 (78%) hospitalisations, 20 deaths (CFR 2.6%) and 55 laboratory-confirmed cases (7.0%). Seven (70%) of 10 water samples from communal water points had coliforms; one had&nbsp;<em>Escherichia coli</em>. Factors associated with cholera in Nairobi were drinking untreated water (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 2.3-18.8), lacking health education (aOR 2.4, CI 1.1-7.9) and eating food outside home (aOR 2.4, 95% CI 1.2-5.7).</p> <p><strong>Conclusion:&nbsp;</strong>we recommend safe water, health education, avoiding eating foods prepared outside home and improved sanitation in Nairobi county. Adherence to these practices could have prevented this protacted cholera outbreak.</p> Hudson Taabukk Kigen Waqo Boru Zeinab Gura George Githuka Robert Mulembani Jacob Rotich Isack Abdi Tura Galgalo Jane Githuku Mark Obonyo Raphael Muli Ian Njeru Daniel Langat Peter Nsubuga Jackson Kioko Sara Lowther Copyright (c) 2020-06-25 2020-06-25 36 1 Recurrent pterygo-palatal angiofibroma with intracranial extension: case report <p>We report the case of a patient with recurrent pterygo-palatal angiofibroma and its treatment. A 21-year-old male patient had a long history of recurrent epistaxis with progressive nasal obstruction. He was diagnosed with an angiofibroma centered in the right pterygo-palatine fossa. Initially, he underwent surgical excision with removal of the entire tumor. The evolution was clinically good with no signs of recurrence on the cervico-facial scan of control (CT). Nine months after, he presented a reappearance of epistaxis. A cervico-facial MRI was performed and showed a recurrence of the tumor process, which this time was considered inextirpable, hence the decision to opt for radiotherapy with intensity modulated radiation therapy (IMRT). He has improved clinically with a clear reduction in tumor mass on CT scan. This technique represents an interesting alternative to overcome anatomical complexity of the region, cover the tumor and preserve the organs at risk.</p> Fatima Zahra Abboud Moulay Ali Youssoufi Sofia Zoukal Touria Bouhafa Khalid Hassouni Copyright (c) 2020-06-25 2020-06-25 36 1 Academic performance and intelligence quotient of primary school children in Enugu <p><strong>Introduction:&nbsp;</strong>intellectual capacity measured as intelligence quotient (IQ) is one of the determinants of school performance of children. It influences academic achievement, future personal health, social well-being and therefore, is of public health significance. The objectives of the study was to determine the intelligence quotient (IQ) and academic performance of primary school children in Enugu-East LGA.</p> <p><strong>Methods:&nbsp;</strong>children who met the inclusion criteria were recruited from both public and private primary schools in the Local Government Area (LGA) using a proportionate multistage sampling technique. Academic performance was classified into high, average and low academic using past records of class assessment. Intelligence Quotient was assessed using the Raven´s Standard Progressive Matrices (RSPM) and was grouped into optimal and suboptimal. A semi-structured questionnaire was used to obtain data such as-age, gender, socio-economic indices and family size of the study participants. Analysis was done with Statistical Package for Social Sciences (IBM-SPSS).</p> <p><strong>Results:&nbsp;</strong>a total of 1,122 pupils aged 6 to 12 years were recruited. Optimal IQ and high academic performance was found in 54.0% and 58.8% of the study participants. Being from upper social class, in private school, and family size less than 4 were the significant determinants of high IQ and good academic performance (p&lt;0.001).</p> <p><strong>Conclusion:&nbsp;</strong>low socio-economic status, large family size and public school attendance impact negatively on IQ and academic performance. Hence, measures to curb large family sizes (i.e.&gt;4 children) and improve the socio-economic status of families are needed environmental measures to improve intelligence and academic performance.</p> Uzoamaka Chinenye Akubuilo Kenechukwu Kosisochukwu Iloh Justus Uchenna Onu Adaeze Chikaodinaka Ayuk Agozie Chukwunedum Ubesie Anthony Nnaemeka Ikefuna Copyright (c) 2020-06-25 2020-06-25 36 1 Students’ voices: assessment in undergraduate clinical medicine <p><strong>Introduction:&nbsp;</strong>the perception exists among students that not all clinical assessments in undergraduate medical programmes are of high quality. ‘Student voice’ is a term used to describe how students feel about and experience their education in a safe and controlled environment. This study aimed to investigate the opinions and experiences of medical students at the University of the Free State on the quality of assessment in the clinical phase of medicine.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study design was used. Quantitative data were collected with space to clarify opinions and make recommendations. The study population consisted of the clinical medical students in 2019 who had completed at least one module and one end-of-year assessment. Self-administered, anonymous questionnaires were distributed to obtain opinions and experiences regarding assessment. Questions in the questionnaire derived from an assessment framework for clinical medicine to ensure construct and content validity.</p> <p><strong>Results:&nbsp;</strong>one hundred and ninety-two (192) students completed questionnaires (84.6% response rate). Less than half of the students were of the opinion that the assessments were fair, with lack of blueprinting and incorrect level of assessment major contributors to this opinion. Two thirds believed that the assessment was aligned with outcomes, however training was not aligned with the assessment. More than 90% of students reported on the lack of feedback after assessment. Valuable suggestions from the students included ways of assessing professionalism, timing of assessments and training of assessors.</p> <p><strong>Conclusion:&nbsp;</strong>majority of students were of the opinion that there is room for improvement in the quality of assessment.</p> Hanneke Brits Johan Bezuidenhout Lynette Jean van der Merwe Gina Joubert Copyright (c) 2020-06-25 2020-06-25 36 1 Sclerosing epithelioid fibrosarcoma: rare and serious <p>Sclerosing Epithelioid Fibrosarcoma (SEF) is a rare form of soft tissue sarcoma. It is characterized by a slow evolution, with local recurrences and late metastases that are mainly pulmonary and pleural in about 50% of cases. The treatment is based on the surgery which must be as wide as possible. The efficacy of adjuvant therapy in the control of SEF is not yet demonstrated. Chemotherapy is used in recurrences, some have also proposed radiotherapy. Long-term follow-up of patients with SEF is therefore essential.</p> Mounir Yahyaoui Mohammed Benhammou Soufiane Aharram Jawad Amghar Mohammed Sadougui Omar Agoumi Abdelkrim Daoudi Copyright (c) 2020-06-25 2020-06-25 36 1 Prothèse totale du genou sans resurfaçage de la rotule: à propos de 60 cas <p>Lors de la mise en place d´une prothèse totale du genou (PTG), une des principales problématiques de la technique chirurgicale est le choix à faire entre la conservation de la patella ou son resurfaçage avec remplacement du cartilage patellaire par une prothèse. Cette problématique continue à faire l´objet d´une controverse au sein de la communauté orthopédique. Il n'y a pas de consensus clair sur la gestion optimale de la rotule pendant arthroplastie totale du genou (PTG). Ce travail est une étude rétrospective concernant 60 arthroplasties totales du genou sans resurfaçage de la rotule, implantées au Service de Chirurgie Traumatologique et Orthopédique (B) du CHU Hassan II de Fès, depuis janvier 2009 à décembre 2015. L´âge moyen de nos patients était de 58 ans avec des extrêmes allant de 20 ans à 80 ans. La prédominance féminine est nette avec 41 femmes soit (72%) et 16 hommes soit (28%). Cliniquement, nos malades se plaignaient de douleurs de type mécanique dans la majorité des cas et tous nos patients ont bénéficié d´un examen clinique et radiologique. Le score IKS a été utilisé pour évaluer l´état du genou avant et après l´intervention. L´acte opératoire a consisté en une arthroplastie totale du genou par prothèse totale du genou sans resurfaçage de la rotule. Les complications post-opératoires étaient marquées par 7 cas de douleur antérieur de genou, 2 cas d´infections cutanées superficielles traitées par une antibiothérapie adéquate et 3 cas de raideur. Aucun cas d´hématome ou de phlébite ou de sepsis n´a été signalé. Les résultats cliniques après un recul de 18 mois ont été satisfaisants. À la lumière de ces résultats, la conservation de la patella a permis d´obtenir des résultats très satisfaisants à moyen terme concernant la douleur et la fonction. De plus, les complications potentielles des prothèses patellaires ont été évitées. Une seule contrainte demeure concernant l´avenir de ces prothèses implantées sans resurfaçage est l´apparition ou parfois la persistance de la douleur antérieur du genou d´où la nécessité d´un resurfaçage secondaire.</p> Seddik Benchekroun Mohammed Lahsika Hatim Abid Mohammed El Idrissi Abdelhalim El Ibrahimi Abdelmajid El Mrini Copyright (c) 2020-06-25 2020-06-25 36 1 Epidemiological profile and clinical characteristics of metabolic syndrome in Marrakesh, Morocco <p><strong>Introduction:&nbsp;</strong>the purpose of this study was to bring out some epidemiological and clinical characteristics of metabolic syndrome.</p> <p><strong>Methods:&nbsp;</strong>a total of 300 subjects willingly participated in the present study which was conducted at Ibn Zohr regional hospital in Marrakesh. We were interested in socio-demographic variables, body mass index (BMI) which assesses the degree of obesity of each subject. The blood parameters were determined by an adequate biochemistry automaton. All statistical analyses were performed using SPSS software.</p> <p><strong>Results:&nbsp;</strong>among the 300 subjects who participated in the study, 57.3% were females and 42.7% were males with a sex-ratio of 0.74. The average age was 51.6 ± 13.42 years old. Seventy nine of the participants (26.3%) had a metabolic syndrome, with a predominance of women: 60 women (34.9%) and 19 men (14,8%). Illiterates (33.8%) and married subjects (25.6%) were the most affected by the metabolic syndrome. The high waist circumference found in 97.5% was the predominant criteria in our study. Finally, the statistical analysis showed a significant association between high waist circumference, BMI and the presence of metabolic syndrome (P = 0,001&gt;) and (P &lt; 0,001) respectively.</p> <p><strong>Conclusion:&nbsp;</strong>the metabolic syndrome is slowly but surely setting. Implementing prevention strategies and encouraging healthy lifestyles will surely minimize serious public health problems in the city.</p> Zineb Hannoun Khouloud Harraqui Rachmat Attoumane Ben Ali Kamar Tahiri Omar Ben Smail Ilyas Samara Fatine El Arabi Abdellatif Bour Copyright (c) 2020-06-26 2020-06-26 36 1 Rapid detection of Mycobacterium tuberculosis complex by real-time polymerase chain reaction (PCR) in pulmonary and extra-pulmonary samples in Casablanca, Morocco <p><strong>Introduction:&nbsp;</strong>the laboratory diagnosis of tuberculosis (TB) relies mainly on conventional techniques. However, it either lacks sensitivity or it is time-consuming. This study aims to evaluate the use of real-time polymerase chain reaction (PCR) targeting IS6110 for&nbsp;<em>Mycobacterium tuberculosis (TB)</em>&nbsp;Complex (MTBC) in the routine diagnosis of TB in our laboratory.</p> <p><strong>Methods:&nbsp;</strong>clinical samples were collected from the laboratory of bacteriology at Ibn Rochd University Hospital in Casablanca Morocco. Real-time polymerase chain reaction (PCR) results were compared to AFB smear and culture on Löwenstein-Jensen (LJ) solid media. Sensitivity, specificity, positive and negative predictive value (PPV and NPV) with 95% confidence intervals were calculated using GraphPad Prism.</p> <p><strong>Results:&nbsp;</strong>on 171 clinical samples, the study showed positivity of microscopy, culture and real-time PCR for&nbsp;<em>M. TB complex</em>&nbsp;as 19%, 31%, and 32% respectively. Sensitivity, specificity, PPV and NPV for real-time PCR in pulmonary samples were 95.2%, 95.4%, 90.91% and 97.65% respectively. For extra-pulmonary samples, they were: 72.7%, 90.32%, 72.7%, and 90.3%.</p> <p><strong>Conclusion:&nbsp;</strong>our study shows the effectiveness of using real-time PCR IS6110 in pulmonary and extra pulmonary samples. Future multicentric studies could seek to evaluate the place of this technique on routine diagnosis for better management of TB in Morocco.</p> Maaloum Fakhreddine Katfy Khalid Diraa Othman Diawara Idrissa Belabbes Houria Zerouali Khalid Copyright (c) 2020-06-26 2020-06-26 36 1 About an observation of coccydynia treated by surgery <p>Coccygodynia is pain located in coccyx. Factors that increase are stay position and stand up. Trauma seems to be his first cause, it can be falled in a sitting position, post-delivery or repeated micro-trauma. Therapeutic management depends on the mechanism involved and relies on manual treatments, infiltrations, even surgery, with good results and a success rate of about 90%. We report the case of a 23-year-old patient with disabling coccygeal pain, progressively worsening, following a fall of a floor 4 meters high, the patient sitting with reception on the buttocks. The pains have a repercussion on the sphincter function with the installation of a rather severe constipation. The examination finds an exquisite pain with regard to the sacrum on palpation without any sign of disco-radicular conflict and the skin facing is normal. The patient has tried everything in terms of conservative treatment including manipulations. The sacro-coccygeal CT shows in sagittal section (A) a dislocation of the entire coccyx compared to the 5<sup>th</sup>&nbsp;sacred piece. The incision arcuate (B) was preferred over the median vertical incision in the intergluteal fold closer to the anus with a non-nefiable infectious risk, ranging from 6.15 to 16.6% depending on the data from the terature. Excision of the coccyx (C) was performed under general anesthesia, the patient installed in ventral decubitus. The clinical evolution was significantly favorable.</p> Noukhoum Koné Copyright (c) 2020-06-26 2020-06-26 36 1 Prevalence and lifestyle-associated risk factors of metabolic syndrome among commercial motor vehicle drivers in a metropolitan city in Ghana <p><strong>Introduction:&nbsp;</strong>commercial motor vehicle drivers are at risk of metabolic syndrome (MetS) due to the nature of their work as they tend to go to work early, work for more hours, have irregular dietary habits and patterns, have little sleep and live sedentary lifestyle. The study sought to determine the prevalence and lifestyle-related risk factors of MetS among commercial taxi drivers around Kwame Nkrumah University of Science and Technology (KNUST) campus, in the Kumasi metropolis, Ghana.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional survey was conducted among 100 commercial taxi drivers in 3 selected taxi ranks around KNUST campus. Fasting blood lipid and fasting blood glucose levels, blood pressure and anthropometric characteristics were determined using WHO and NCEP-ATP III criteria. Lifestyle-related risk factors of MetS were assessed using a semi-structured questionnaire and dietary pattern was assessed using food frequency questionnaire. Bivariate analysis and linear correlation were used to determine the relationship between lifestyle practices and MetS.</p> <p><strong>Results:&nbsp;</strong>the prevalence of diabetes, high blood pressure, dyslipidemia, overweight and obesity were 12%, 63%, 40%, 32% and 13% respectively. The prevalence of MetS was 5% according to NCEP-ATP III (2005) criteria. The lifestyle behaviours of the drivers were, alcohol intake, irregular dietary pattern, long working hours, lack of exercise and tiredness due to driving. Tobacco use (R = 0.405, p = 0.041) and time of supper (R = 0.931, p = 0.047) were related with MetS among the participants.</p> <p><strong>Conclusion:&nbsp;</strong>though prevalence of MetS (5%) was low among the drivers, the need for intervention to promote positive lifestyle change and curb the high prevalence of overweight/obesity, diabetes, high blood pressure and dyslipidemia is necessary to improve the health of the drivers and the safety of passengers.</p> Collins Afriyie Appiah Edward Opoku Afriyie Frank Ekow Atta Hayford Emmanuel Frimpong Copyright (c) 2020-06-29 2020-06-29 36 1 Promote a new paradigm to prevent neurodegenerative disease in sub-Saharan Africa <p>Prevention is the corner stone when dealing with disability as it must be considered as a nearly irreversible condition in elderly people. There is a growing demand for the identification of effective solutions against the detrimental consequences that age-related conditions (in particular, disabilities) exert on our healthcare systems. Therefore, preventive interventions able to modify the natural history of age-related conditions are urgently needed. Nutritional interventions appear to be a potentially effective way to prevent dementia in high income countries. The promotion of a healthy lifestyle and the adoption of preventive countermeasures for a specific condition are quite challenging. The approach based on the use of local natural resources such as diversified and rich food must be explored in SSA.</p> Callixte Kuate-Tegueu Pierre Waffo-Teguo Nadine Simo Maturin Tabue-Teguo Copyright (c) 2020-06-29 2020-06-29 36 1 Promote a new paradigm to prevent neurodegenerative disease in sub-Saharan Africa <p>Prevention is the corner stone when dealing with disability as it must be considered as a nearly irreversible condition in elderly people. There is a growing demand for the identification of effective solutions against the detrimental consequences that age-related conditions (in particular, disabilities) exert on our healthcare systems. Therefore, preventive interventions able to modify the natural history of age-related conditions are urgently needed. Nutritional interventions appear to be a potentially effective way to prevent dementia in high income countries. The promotion of a healthy lifestyle and the adoption of preventive countermeasures for a specific condition are quite challenging. The approach based on the use of local natural resources such as diversified and rich food must be explored in SSA.</p> Callixte Kuate-Tegueu Pierre Waffo-Teguo Nadine Simo Maturin Tabue-Teguo Copyright (c) 2020-06-29 2020-06-29 36 1 Intramuscular cavernous haemangioma of the triceps <p>A 16-year-old teenager presented himself with a swollen left elbow, with no associated vascular-nerve complications. The standard radiography was without abnormalities. The echography showed the presence of an oblong vascularized formation occupying the posterior part of the elbow. The magnetic resonance imaging (MRI) showed a hyper vascularized lesion developing at the expense of the brachial triceps muscle with an intermediate signal intensity on the sequences weighted in T1 and a hyper signal in T2. The anatomopathological study of the initial biopsy and of the tumor part concluded with a cavernous hemangioma. Although their origin is vascular, hemangiomas never metastasize and do not undergo malignant transformation. The treatment of symptomatic hemangioma consists of surgical excision.</p> Nabil Dammak Hassen Cheikh Rouhou Issam Khalifa Ines Haddad Yadh Zitoun Faouzi Abid Copyright (c) 2020-06-30 2020-06-30 36 1 Migrated fish bone induced liver abscess: medical management <p>Liver abscess secondary to a migrated ingested foreign body is an uncommon condition where early diagnosis helps management and improves prognosis. Abscess drainage with removal of the foreign body is the recommended management. We report the successful management of a patient with a liver abscess from a migrated fishbone that was treated medically with the foreign body left in situ.</p> Moustafa Allam Stephanos Pericleous Copyright (c) 2020-06-30 2020-06-30 36 1 Post-operative rehabilitation in a traumatic rare radial nerve palsy managed with tendon transfers: a case report <p>Radial nerve is a frequently injured nerve. Radial nerve palsy result from direct trauma, neuropathies, and fracture over the humerus, malignant tumor and neuritis. A case of 26-year male is presented in this report who had a road traffic accident resulting in injury over the right shoulder, wrist joint and diagnosed of radial nerve palsy, consequently was operated with soft tissue reconstruction with tendon transfers which resulted into pain over wrist joint and loss of extensors muscle function of the wrist joint, which led to difficulty in performing activities of daily living. Surgical history and rehabilitation is mentioned in the case report. We report that there were significant improvements in muscle strength, range of motion, relief from pain, and exceptional improvements in the patient´s functional independence with physiotherapy interventions post-operative tendon transfers.</p> Pratik Phansopkar Vrushali Athawale Aachal Birelliwar Waqar Naqvi Swapna Kamble Copyright (c) 2020-06-30 2020-06-30 36 1 Isolated blast crisis relapse in the central nervous system of a patient treating for a chronic myelogenous leukemia <p>Chronic myeloid leukemia (CML) is a myeloproliferative disorder associated with the Philadelphia chromosome t (9;22) and the BCR-ABL fusion gene. The condition is relatively rare, accounting for 2.0% to 3.0% of childhood leukemia cases. CML has historically been a triphasic disease. Most patients are diagnosed in chronic phase. Without treatment, it inevitably progresses into a more aggressive accelerated phase and blast crisis. Some proportion of CML cases of blastic transformation develop an extramedullary disease that involves rarely central nervous system. This report describe an extremely rare case of 13-year-old girl with CML and extramedullary blast crisis in the central nervous system. Treatment options and monitoring of disease response are discussed.</p> Houda Boudiaf Khedaoudj Ezziane Nassiba Ould Rouis Meriem Himrane Saliha Hakem Hanifa Benchabane Houria Boukhelal Radja Arous Lynda Chikhi Copyright (c) 2020-06-30 2020-06-30 36 1 Avortements clandestins compliques et médicaments de la rue à Brazzaville <p><strong>Introduction:&nbsp;</strong>les avortements clandestins augmentent la morbi-mortalité maternelle en Afrique sub-Saharienne et sont favorisés par les législations restrictives et la faiblesse prévalence contraceptive. A Brazzaville l´automédication par les « médicaments de la rue » semble être un procédé abortif fréquent. L´étude visait à déterminer la proportion des « médicaments de la rue » et le profil sociodémographique des patientes impliquées.</p> <p><strong>Méthodes:&nbsp;</strong>nous avons réalisé une étude longitudinale de Juillet à Décembre 2018, 67 patientes admises pour complications d´avortement provoqués ont été recrutées à l´hôpital de Talangaï. Leurs (i) caractéristiques socio démographiques, (ii) obstétricales et (iii) les caractéristiques de l´avortement (procédé, implication du manganguiste, rang et coût de l´avortement) ont été collecltées et analysées avec le logiciel Epi info 7. Nous avons comparé les moyennes avec le test de student, les proportions avec le CHI-2, p était fixé à &lt;0,05.</p> <p><strong>Résultats:&nbsp;</strong>l´âge moyen était de 25 ans ±6,6; 59,7% étaient au collège, 53,8% sans activité génératrice de revenu dans et 38,8% des cas vivaient seules dans; 15% avaient une paternité refusée. Les « médicaments de la rue » étaient retrouvés dans 74,5%, où le coût moyen de l´avortement était 3500 CFA (7$US) et 29500CFA (59$US) chez les professionnels de santé. Les enquêtées du lycée étaient plus nombreuses (73,69%) à connaitre au moins méthode contraceptive (p&lt;0,05). Les célibataires (p=0,000) et celles qui connaissaient une méthode contraceptive (p=0,003) exprimaient plus l´intention d´adopter une contraception.</p> <p><strong>Conclusion:&nbsp;</strong>lutter contre les « médicaments de la rue » ainsi que sécuriser l´avortement volontaire sont nécessaires pour limiter les avortements clandestins compliqués.</p> Darius Eryx Mbou Essie Hermann Ndinga Ange Niama Guy Oyere Grace Kifoueni Jean-Rosaire Ibara Copyright (c) 2020-06-30 2020-06-30 36 1 Radial neck fracture in children: anatomic and functional results of Metaizeau technique <p>Fractures of the radial neck accounts for 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique. The purpose of this study was to identify the main clinical features of radial neck fracture in children and to evaluate the anatomical and functional results of the Metaizeau technique. In this retrospective study, we evaluated 22 patients under the age of 16 who were treated for radial neck fracture at the orthopedic and trauma surgery department of Sahloul University Hospital in Sousse over a period of 16 years from January 2001 to April 2017. Authors used Metaizeau classification. Functional results were evaluated by Mayo elbow performance score (MEPS) and the radiological evaluation was based on standard images with measurement of the residual rocker. The average age was 8.6 years (5-13 years). Seven fracture were grade III injuries and three grade IV. In the immediate postoperative period, radiological measurements showed a residual rocker less than 20° in 86.3% and more than 20° in 13.7% of cases. At an average follow-up of 13 months and a half, the MEPS score was excellent and good for 17 patients. Four types of complications were found: necrosis of the radial head in 1 case, pseudarthrosis in 1 case, periarticular calcification in 2 cases and stiff-ness of the elbow in 3 cases. Despite the small number of patients in our series, we believe that the elastic stable intramedullary pinning according to the Metaizeau technique is the treatment of choice for displaced radial neck fractures in children.</p> Ahmed Trabelsi Mohamed Ali Khalifa Rim Brahem Mehdi Jedidi Karim Bouattour Walid Osman Mohamed Laziz Ben Ayeche Copyright (c) 2020-06-30 2020-06-30 36 1 Task shifting of emergency caesarean section in south Ethiopia: are we repeating the brain drain? <p><strong>Introduction:&nbsp;</strong>preventable mortality from complications which arise during pregnancy and childbirth continue to claim more than a quarter of million women's lives every year, almost all in low- and middle-income countries. However, life-saving emergency obstetric services, including caesarean section (CS), significantly contribute to the prevention of maternal and newborn mortality and morbidity. Between 2009 and 2013, a task shifting intervention to train caesarean section (CS) teams involving 41 CS surgeons, 35 anesthetic nurses and 36 scrub nurses was implemented in 13 hospitals in southern Ethiopia. We report on the attrition rate of those upskilled to provide CS with a focus on the medium-term outcomes and the challenges encountered.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study involving surveys of focal persons and a facility staff audit supplemented with a review of secondary data was conducted in thirteen hospitals. Mean differences were computed to appreciate the difference between numbers of CSs conducted for the six months before and after task shifting commenced.</p> <p><strong>Results:&nbsp;</strong>from the trained 112 professionals, only 52 (46.4%) were available for carrying out CS in the hospitals. CS surgeons (65.9%) and nurse anesthetists (71.4%) are more likely to have left as compared to scrub nurses (22.2%). Despite the loss of trained staff, there was an increase in the number of CSs performed after the task shifting (mean difference=43.8; 95% CI:18.3-69.4; p=0.003).</p> <p><strong>Conclusion:&nbsp;</strong>our study, one of the first to assess the medium-term effects of task shifting highlights the risk of ongoing attrition of well-trained staff and the need to reassess strategies for staff retention.</p> Anteneh Asefa Alison Morgan Tadesse Hailemariam Mekonnen Shiferaw Emebet Mekonnen Yifru Birhan Copyright (c) 2020-07-01 2020-07-01 36 1 Prevention of mother-to-child transmission activities after one-off clinical mentorship training in selected health facilities, Zimbabwe: 2014-2018 <p>This was a cross-sectional study describing HIV testing uptake and ART initiation for pregnant women and HIV-exposed infants after one-off clinical mentorship training in 2013 for nurses in 56 peripheral health-facilities, Zimbabwe. Between 2014-2018, 92% of 106411 pregnant women were HIV tested and 98% of HIV-positive women initiated antiretroviral therapy (ART). There were 15846 HIVexposed infants, of whom 96% had dried blood spots collected for virologic diagnosis and 51% of those diagnosed HIV-positive initiated ART. In conclusion, this one-off clinical mentorship training in 2013 was associated with consistently high HIV testing and ART initiation in pregnant women and their children.</p> Winnie Mandewo Cephas Muchuchuti Obey Shoko Collins Timire Kudakwashe Collin Takarinda Anthony David Harries Hannock Tweya Talent Tapera Saziso Nyathi Addmore Chadambuka Anesu Chimwaza Agnes Mahomva Copyright (c) 2020-07-01 2020-07-01 36 1 Forme pseudotumorale de tuberculose oculaire: à propos de 2 cas <p>Les manifestations oculaires de la tuberculose sont non spécifiques et polymorphes pouvant toucher toutes les tuniques de l´œil et entrainer une perte visuelle sévère en l´absence d´un traitement précoce et adapté. Nous rapportons 2 cas de forme pseudo tumorale de tuberculose oculaire ayant bien évolué sous traitement anti bacillaire; le premier présentant un éclatement spontané récent du globe avec issue d´une masse bourgeonnante charnue et suppurée de 10cm/6cm, le second patient présente un granulome du corps ciliaire mimant un mélanome; puis nous discutons les particularités cliniques et thérapeutiques de cette affection.</p> Incaf Elboukhani Asmaa Siati Issam Errachiq Adil Mchachi Leila Benhmidoune Rayad Rachid Mohamed Elbelhadji Copyright (c) 2020-07-02 2020-07-02 36 1 Determinants of improved data consistency across routine immunization data tools for health facilities in Kano State, Nigeria <p><strong>Introduction:&nbsp;</strong>in this study, determinants of improved data consistency for routine immunization information at health facilities was measured to identify associated factors.</p> <p><strong>Methods:&nbsp;</strong>between June and August 2015, 1055 HFs were visited across 44 Local Government Areas in Kano state. We assessed data consistency, frequency of supportive supervision visits, availability of trained staff and attendance to monthly LGA RI review meetings. We compared RI monthly summary forms (MSF) versus national health management information system summary form (NHMIS) and vaccine management form 1a (VM1a) versus HF vaccine utilization summary monthly summary (HFVUM) for consistency. Data consistency at HF was determined at &lt;+10% between number of children reportedly immunized, and doses of vaccine opened using 3 antigens (BCG, Penta and Measles). Levels of discrepancy &lt;10% were considered as good data consistency. Bivariate and multivariate analysis used to determine association.</p> <p><strong>Results:&nbsp;</strong>data Consistency was observed in 195 (18.5%) HFs between (MSF vs NHMIS) and 90 (8.5%) HFs between (VM1a vs HFVUM). Consistency between MSF vs NHMIS was associated with receiving one or more SS visits in the previous month (p=0.001), data collection tools availability (p=0.001), recent attendance to monthly LGA RI review meeting and availability of trained staff. Data consistency between VM1a form and the HF VU summary was associated with a recent documented SS visit (p=0.05) and availability of trained staff (p=0.05).</p> <p><strong>Conclusion:&nbsp;</strong>low level of data consistency was observed in Kano. Enhanced SS visits and availability of trained staff are associated with improved data quality.</p> Adekunle Akerele Ramatu Obansa Oluwasegun Joel Adegoke Suleiman Haladu Olorunsogo Bidemi Adeoye Nnamdi Usifoh Sulaiman Etamesor Belinda Uba Ndadilnasiya Endie Waziri Copyright (c) 2020-07-02 2020-07-02 36 1 Appendagite épiploïque: cause rare d´abdomen aigu <p>L´appendagite épiploique primitive est une cause rare d´abdomen aigu. Elle peut simuler le tableau clinique d´autres processus inflammatoires tels que la diverticulite ou l´appendicite. Le diagnostic repose sur le scanner. Le traitement est médical en dehors des complications.</p> Saad Slaiki Mohamed Afdil Hicham El Bouhaddouti El Bachir Benjelloun Abdelmalek Ousadden Khalid Ait Taleb Ouadii Mouaqit Copyright (c) 2020-07-03 2020-07-03 36 1 The visceral larva migrans caused by Toxocara canis: a case report <p>Hepatic toxocarosis is caused by the dog´s roundworm,&nbsp;<em>Toxocara canis</em>. Responsible for an eosinophilic inflammatory syndrome causing liver damage that can be detected on ultrasound, computed tomography and sometimes magnetic resonance imaging. We report the case of a nine-year-old child, living in countryside, with a notion of cohabitation with canids. He presented a digestive symptomatology revealed by abdominal pain, with a hemeosinophilia in the hemogram. The etiological assessment of hyper eosinophilia objectified a positive&nbsp;<em>Toxocara canis</em>&nbsp;serology. The imaging assessment in search of digestive visceral lesions, found multiple heterogeneous hypoechogenic areas, poorly defined, scattered in the liver. On the abdominal CT scan, its areas appear of unenhanced density and low density and better visible after injection of contrast product. This observation reveals that imagery, although not very specific, helps in the assessment of liver damage from digestive toxocarosis.</p> Labretesche Gracia Christ Gakosso Fatima Baadi Fatima Zahra Abakka Dounia Basraoui Hicham Jalal Copyright (c) 2020-07-03 2020-07-03 36 1 Management of a post-coital recto vaginal fistula at the Douala Gyneco-Obstetric and Pediatric Hospital: a case report <p>Recto vaginal fistula can be secondary to various and multiple causes. However, intercourse is an exceptional cause. The objective of this work is to expose its clinical, therapeutic and prognostic particularities. We report the case of rectovaginal fistula in a 29-year-old patient, following consensual sex. She underwent posterior colpoperineorraphy under spinal anesthesia, with a favorable outcome. Post-coital recto vaginal fistula is a stigmatizing pathology responsible for polymorphic complications. Prompt care can improve quality of life and the obstetrical prognosis of the patient.</p> Alphonse Nyong Ngalame Armand Talom Kamga Rakya Inna Darolles Wekam Mwadjie Emile Telesphore Mboudou Copyright (c) 2020-07-03 2020-07-03 36 1 The severity of fall injuries in Saudi Arabia: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>fall injuries constitute a major public health concern worldwide, contributing to over 646,000 deaths every year. The aim of this study was to determine the nature and severity of fall injuries at a tertiary hospital in the Kingdom of Saudi Arabia (KSA).</p> <p><strong>Methods:&nbsp;</strong>we conducted a cross-sectional study at the King Khalid Hospital and Prince Sultan Centre for Health Care in Al Kharj. We recruited the patients and followed them through the triage, admission and discharge processes. We analyzed the participant´s clinical notes on the electronic health record (EHR) to obtain information relevant to the study, including the nature, cause, mechanism of injury, demographic characteristics and prognostic factors captured through the injury severity score (ISS), the Glasgow coma scale (GCS) and the presence or absence of shock.</p> <p><strong>Results:&nbsp;</strong>of 264 patients, most of the patients were children under the age of ten (25.7%), followed by young adults between the ages of twenty-one and thirty (18.2%). The ISS was associated with severe head, chest, skull, brain, scalp, rib, abdominal, pelvic and lower limb injuries. The GCS was associated with severe the head, chest, skull, brain and rib injuries (p&lt;0.005). The degree of shock was also significantly associated with pelvic, head, chest, skull, brain, scalp, abdominal and upper limb injuries (p&lt;0.05).</p> <p><strong>Conclusion:&nbsp;</strong>fall injuries in our setting are severe. Training of staff should prioritize head, chest, skull, brain, abdominal and rib injury management. As a reference hospital, minor injuries are more likely to be managed at lower levels of care.</p> Mohamed Abdel Razik Faisl Abdulmohsin Alslimah Khalid Saeed Alghamdi Mohammed Abdulaziz Altamimi Adel Ahmed Alzhrani Naif Mutrik Alqahtani Sami Munahi Alshalawi Copyright (c) 2020-07-05 2020-07-05 36 1 Oncology practice in the COVID-19 pandemic: a report of a Nigerian expert panel discussion (oncology care in Nigeria during the COVID-19 pandemic) <p>Since the first case of COVID-19 and its progression to a pandemic, healthcare systems the world over have experienced severe difficulties coping with patient care for both COVID-19 and other diseases most especially non communicable diseases like cancer. These difficulties in Low- and middle-income countries (LMICs), especially in Sub-Saharan Africa including Nigeria, are myriad. These LMICs are already bedeviled by weak health systems, ill equipped cancer treatment centers, with outdated machines and grossly inadequate numbers of oncologists required to treat patients with cancer. As a result of these challenges coupled with unclear guidelines on how to manage cancer patients in the wake of the COVID-19 pandemic, 11 key Nigerian opinion leaders had a consensus meeting to identify challenges and possible workable solutions on continuing cancer care during the COVID-19 pandemic. The discussion highlighted ethical issues, barriers to continuing cancer care (such as lockdown, fear of contracting disease, downscaled health services) and resource constraints such unavailable personal protective equipment. Yet, practical solutions were proffered such as necessary protective measures, case by case prioritization or de-prioritization, telemedicine and other achievable means in the Nigerian setting.</p> Adeniyi Adedayo Olabumuyi Musa Ali-Gombe Olusegun Abayomi Biyi-Olutunde Olumide Gbolahan Chinenye Iwuji Adedayo Olufemi Joseph Nwamaka Ngozika Lasebikan Babatunde Olutoye Ogunnorin Adebowale Emmanuel Omikunle Omolola Salako Abdulazeez Salawu Copyright (c) 2020-07-06 2020-07-06 36 1 La coagulation intravasculaire disséminée: intérêt du score de la société internationale sur la thrombose et l´hémostase <p>La coagulation intravasculaire disséminée (CIVD) est une cause de mortalité redoutable en milieu de réanimation. L´utilisation du système de score de la société internationale sur la thrombose et l´hémostase (ISTH) permet de faciliter le diagnostic précoce de la CIVD. Nous présentons trois observations cliniques de CIVD d´étiologies différentes: un adénocarcinome prostatique, un choc septique et un hématome rétro-placentaire. Les tests d´hémostase nécessaires au calcul du score&nbsp;<span class="ArticleParagraph">de la Société Internationale sur la Thrombose et l´Hémostase (</span>ISTH) (numération plaquettaire, taux de prothrombine, fibrinogène et D-dimères) ont été régulièrement réalisés. D´autres tests complémentaires (recherche de complexes solubles, test de lyse des euglobulines, dosage des taux d´antithrombine, de protéine C activée et du facteur V) ont été également réalisés. L´utilisation du score ISTH permet de faciliter le diagnostic précoce de la CIVD.</p> Sawsen Bouzidi Mayssa Daiki Amen Allah Nasr Kaouther Nsiri Samy Layouni Zied Hajjej Najiba Fekih-Mrissa Mustapha Ferjani Brahim Nsiri Copyright (c) 2020-07-06 2020-07-06 36 1 Acute hemiplegia: aetiology and outcome in Nigerian children <p><strong>Introduction:&nbsp;</strong>acute hemiplegia of childhood is a postnatally acquired nonspecific clinical response of the brain to various aetiological insults in a child who was neurologically normal at birth. This study aims at evaluating the aetiology and outcome of acute hemiplegia in children admitted into the University of Calabar Teaching Hospital (UCTH), Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a 5-year retrospective review of all children admitted to the Neurology Unit of the Department of Paediatrics of UCTH with a diagnosis of acute hemiplegia. The demographic characteristics of the children and the clinical features were noted. Investigations including neuroimaging of the brain and haemoglobin genotype were documented. The outcomes of the patients were recorded as either dead, recovered with deficit or loss to follow up. Data obtained was analysed using the SPSS version 24. Simple tables were used to display the results in number and percentages.</p> <p><strong>Results:&nbsp;</strong>twenty-five children with diagnosis of hemiplegia were admitted. Associated clinical features were prolonged seizures (68%), speech defect (32%), cranial nerve deficit (36%) and loss of consciousness (12%). Viral encephalitis was the common aetiology in 11(44%) of the patients, followed by meningitis and sickle cell anaemia in 6(24%) patients each. Four(16%) of the patients recovered completely within the follow up period of three month, 19(76%) had varying degrees of weakness; 2(8%) died. Twelve (48%) were lost to follow-up.</p> <p><strong>Conclusion:&nbsp;</strong>central nervous system infections and sickle cell disease as dominant aetiological factors of acute hemiplegia in Nigerian children. This calls for effective infection control and genetic counselling.</p> Komomo Eyong Chimaeze Torty Asindi Asindi Emmanuel Ekanem Copyright (c) 2020-07-06 2020-07-06 36 1 “It is what I tell her that she will do”: a mixed methods study of married men´s knowledge and attitude towards supporting their wives´ cervical cancer screening in rural South-East Nigeria <p><strong>Introduction:&nbsp;</strong>cervical cancer is a leading cause of death among Nigerian women. Women often require spousal support before attending cervical cancer screening services. This study assessed married men´s knowledge and attitude towards male involvement in cervical cancer screening of their wives.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study using a mixed methods approach was conducted among 245 married men in Izzi, Local Government Area of Ebonyi State, South-East Nigeria. Quantitative data collected using structured, interviewer-administered questionnaires and qualitative data from focus group discussions were triangulated. Data analysis was done using IBM SPSS version 20. Qualitative findings were analysed using thematic analysis.</p> <p><strong>Results:&nbsp;</strong>the mean knowledge of cervical cancer was 2.06±0.55. Only 2.9% of the respondents had adequate knowledge of risk factors for cervical cancer. Up to 89.8% were willing to approve screening for their spouses. Majority (76.3%) considered screening important in cervical cancer prevention, while 91.4% were willing to pay for the screening test. Most of them exhibited patriarchal tendencies and insisted that their wives must obtain their consent before screening as depicted by the statement “It is what I tell her that she will do<span class="ArticleParagraph">”</span>. Previous spousal screening was a predictor of good knowledge (OR = 10.94, 95% CI = 2.44-48.93; P=0.002).</p> <p><strong>Conclusion:&nbsp;</strong>married men in this study had poor knowledge of cervical cancer. However, they were willing to support cervical cancer screening conditional on their pre-information and consent. Awareness creation activities on cervical cancer screening should incorporate active engagement of husbands in order to promote screening uptake by their wives.</p> Ijeoma Nkem Okedo-Alex Chigozie Jesse Uneke Henry Chukwuemeka Uro-Chukwu Ifeyinwa Chizoba Akamike Onyedikachi Echefu Chukwu Copyright (c) 2020-07-06 2020-07-06 36 1 Prevalence of extended-spectrum beta-lactamase-producing enterobacterial urinary infections and associated risk factors in small children of Garoua, Northern Cameroon <p><strong>Introduction:&nbsp;</strong>the emergence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (E-ESBLs) is currently a major public health problem in the world and, in particular, in developing countries. In Cameroon, data on E-ESBLs are rare, especially in Garoua and in the northern region of the country. The objective of this study is to document the epidemiology of E-ESBL infections in small children and to explore their associations with possible risk factors.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional, descriptive study conducted from June 14 to September 30, 2018, including small children with suspected urinary tract infections (UTI) attending the outpatient pediatric departments of two health facilities in the city of Garoua. Urine samples were analyzed at the Bacteriology Laboratory of the Pasteur Center of Cameroon, Annex Garoua. Bacterial culture was carried out on Bio-Rad UriSelect® chromogenic agar and the identification was confirmed by bioMérieux API 20E. The antibiotic susceptibility was determined using the bioMérieux ATB UR gallery and the ESBL phenotype was detected by the double disk synergy method according to the CA-SFM 2013 recommendations. The data was analyzed with the R Statistical Software version 2.15.2.</p> <p><strong>Results:&nbsp;</strong>a total of 57 urine samples were collected from children aged from one month to two years, 37 boys and 20 girls. Bacteria were detected by culture in 20 samples:&nbsp;<em>Escherichia coli&nbsp;</em>was the most frequently (75 %) isolated species followed by&nbsp;<em>Klebsiella pneumoniae</em>&nbsp;(25%). More than half of the infected samples (55%) contained E-ESBL. The presence of an ESBL was significantly associated with previous antibiotic intake up to 3 months prior current UTI (p=0.01664). The E-ESBL strains showed co-resistance to different antibiotics.</p> <p><strong>Conclusion:&nbsp;</strong>this study reveals the important dissemination of E-ESBLs among small children in the community and a high rate of co-resistance to the different antibiotic families commonly used.</p> Karyom Djim-Adjim-Ngana Leila Aïcha Oumar Brunel Wanda Mbiakop Hermann Landry Munshili Njifon Tania Crucitti Elias Nukenine Nchiwan Nicolas Njintang Yanou Louis Deweerdt Copyright (c) 2020-07-06 2020-07-06 36 1 Imminent risk of COVID-19 in Diabetes Mellitus and Undiagnosed Diabetes Mellitus patients <p>Diabetes mellitus is a non-infectious disease and has affected about 425 million adults globally and nearly 15.9 million of them reside in Africa. Moreover, the prevalence of Undiagnosed Diabetes Mellitus is very high in Africa and approximates to around 62%. Nearly 75% of the total deaths due to diabetes are in individuals lesser than 60 years of age. The multifaceted disease of Diabetes Mellitus produces chronic complications such as, neuropathy, nephropathy, retinopathy, microangiopathy etc. These patients of Diabetes Mellitus are more susceptible to infections due to compromised immune system. Hence these patients of Diabetes Mellitus and Undiagnosed Diabetes Mellitus are at greater risk of contracting COVID-19 infections. The dual impact of pathophysiology of COVID-19 infections in Diabetes Mellitus may increase morbidity and mortality in these patients. Hence there is need of health awareness in diabetics as well in the high-risk group for diabetes such as persons with hypertension and obesity. The scarcity of health resources, shortage of trained medical personnel and disease burden of infectious and non-infectious diseases has laid a heavy impact on the economy in Africa and this has been further strained due to the COVID-19 pandemic. The practice of preventive measures by the risk group of Undiagnosed Diabetes Mellitus patients will prevent them from getting infected by COVID-19 and at the same time decrease mortality rates and hence the undiscovered group that is the patients of Undiagnosed Diabetes Mellitus needs to be vigilant regarding safe preventive practices.</p> Jyoti Elgiva John Nitin Ashok John Copyright (c) 2020-07-06 2020-07-06 36 1 Influenza epidemiology and risk factors for severe acute respiratory infection in Morocco during the 2016/2017 and 2017/2018 seasons <p><strong>Introduction:&nbsp;</strong>in order to implement an influenza vaccination program for high-risk-groups in Morocco, as recommended by the World Health Organization, an epidemiological study indicating the influenza virus effect in the development of complicated influenza for subjects with co-morbidity was required. The present study aims to evaluate the risk factors for severe acute respiratory infections caused by influenza in risk groups.</p> <p><strong>Methods:&nbsp;</strong>this research is based on the epidemiological and virological surveillance data of severe acute respiratory infections and influenza-like illness during the 2016/2017 and 2017/2018 seasons. It was realized using a retrospective series study with a descriptive and analytical purpose.</p> <p><strong>Results:&nbsp;</strong>the over-recruitment of pediatric cases with a severe acute respiratory infection has been significantly rectified because cases of severe acute respiratory infections under 15 years old in the 2017/2018 season represent only 57.9%, whereas they represented 75.9% of the total cases of severe acute respiratory infections during the 2016/2017 season. The influenza positivity rate has increased globally and specifically by age group, clinical service and co-morbidity. The risk factors considered were significantly associated with hospitalization for influenza-associated severe acute respiratory infections. The multivariate logistic regression analysis considers male sex (OR=2.1), age ≥65 years (OR=5.4), presence of influenza cases in the surroundings (OR=0.1), diabetes (OR=7.5) and chronic respiratory disease (OR=10.9) as risk factors influenza-associated severe acute respiratory infections.</p> <p><strong>Conclusion:&nbsp;</strong>the risk assessment of influenza-associated severe acute respiratory infections in high-risk groups revealed national epidemiological findings, particularly for diabetics and the elderly. An influenza vaccination program for these high-risk-groups becomes much recommended in Morocco.</p> Hind Ezzine Imad Cherkaoui Ahmed Rguig Hicham Oumzil Mouad Mrabet Abderrahman Bimouhen Fatima El Falaki Zakia Regragui Zineb Tarhda Mohammed Youbi Mariam Naciri Copyright (c) 2020-07-07 2020-07-07 36 1 Ostéoblastome de l´os pariétal de la voÛte du crâne: à propos d´un cas <p>L´ostéoblastome est une tumeur osseuse primitive peu fréquente, sa localisation au niveau de la voûte du crâne est extrêmement rare. Nous rapportons un cas d´ostéoblastome de l´os pariétal droit chez une femme âgée de 46 ans ayant des antécédents de traumatisme crânien bénin. Elle a présenté de façon progressive une tuméfaction pariétale droite douloureuse non inflammatoire. Le scanner crânio-cérébral a montré une lésion osseuse hyperdense respectant la table interne de l´os pariétal droit. La patiente a bénéficié d´abord d´une biopsie puis d´une résection totale de la lésion osseuse avec une cranioplastie au ciment méthyl-méthacrylique. Les suites post-opératoires étaient simples. L´examen anatomo-pathologique a montré qu´il s´agissait d´un ostéoblastome sans signes de malignité. Nous discuterons, à travers notre premier cas d´ostéoblastome de la voûte du crâne et une revue de la littérature, sa présentation clinique, l´examen anatomo-pathologique, les aspects radiologiques, ainsi que la prise en charge de cette rare pathologie.</p> Zoubida Bargach Abderrazak Bertal Idriss El Fathi Khadija Ibahioin Abdelhakim Lakhdar Copyright (c) 2020-07-07 2020-07-07 36 1 Microalbuminuria in type 1 diabetes mellitus children in University of Port Harcourt Teaching Hospital, Nigeria <p><strong>Introduction:&nbsp;</strong>glycaemic control is usually best achieved using the basal bolus regimen, however, this is not always available in resource-limited settings. Long-term complications like renal parenchymal disease are consequences of poor glycaemic control. Screening type 1 diabetes patients irrespective of their disease duration was used to buttress the need for ethical principles of justice to be incorporated in the care of type 1 diabetes children.</p> <p><strong>Methods:&nbsp;</strong>urine albumin creatinine ratio (UAC) was calculated for 20 type 1 diabetes mellitus children in the endocrinology clinic after submitting early morning urine over a 4-month period. The calculated ratio was compared between duration of disease (&lt; 5 years and &gt; 5 years) and between insulin regimen types (mixtard and basal bolus). Repeat tests were done for children who had elevated UAC ratio levels after 2 months.</p> <p><strong>Results:&nbsp;</strong>there were 5 males and 15 females and the mean UAC ratio of the cohort was 123mg/g with a range of 5.30 − 906 mg/g. Twelve children (8 diagnosed less than 5 years) had UAC ratio ≥ 30mg/g with a mean of 193.15. The repeat mean UAC ratio for these was 144.35 mg/g. Children who had diabetes for more than 5 years and were on mixtard had higher UAC ratio than those with diabetes &lt; 5 years and on basal bolus.</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of microalbuminuria is high in our cohort of type 1 diabetes children and these were children on mixtard and had diabetes greater than 5 years.</p> Iroro Enameguolo Yarhere Tamunopriye Jaja Mirabelle Anolue Copyright (c) 2020-07-07 2020-07-07 36 1 Impact de la pandémie à COVID-19 sur les activités du Service de Pédiatrie du Centre Hospitalier National d´Enfants Albert Royer: étude préliminaire comparant les premiers trimestres des années 2019 et 2020 <p><strong>Introduction:&nbsp;</strong>l´objectif de cette étude est d´évaluer l´impact du COVID-19 sur les activités de soins et les recettes au Centre Hospitalier National d´Enfant Albert Royer de Dakar au Sénégal.</p> <p><strong>Méthodes:&nbsp;</strong>il s´agissait d´une étude rétrospective, descriptive et analytique comparant les activités de consultations externes, d´hospitalisation et les recettes du premier trimestre des années 2019 et 2020.</p> <p><strong>Résultats:&nbsp;</strong>une baisse moyenne de 33% des consultations externes a été notée au premier trimestre de l´année 2020 correspondant à la période de la pandémie comparée au premier trimestre de 2019. Une augmentation des hospitalisations était observée surtout pour les mois de janvier et février. Cependant, au mois de mars, une baisse de 11% était notée. Il en est de même pour les recettes où une baisse n´est observée qu´au mois de mars; elle était de 10%.</p> <p><strong>Conclusion:&nbsp;</strong>l´épidémie actuelle au COVID-19 impacte fortement sur les activités de consultations externes, de soins et les recettes du centre hospitalier national d´Enfants Albert Royer. Des mesures efficaces doivent être prises pour éviter les conséquences sur la mortalité et le fonctionnement de la structure.</p> Ousmane Ndiaye Fatime Tall Fall Papa Moctar Faye Aliou Thiongane Amadou Lamine Fall Copyright (c) 2020-07-08 2020-07-08 36 1 Impact du COVID-19 sur la consultation en ophtalmologie en Maroc: enquête auprès de 35 ophtalmologistes <p>D´une épidémie en Décembre à une pandémie mondiale en début de Mars, le COVID-19 est arrivée au Maroc le 02 Mars et le nombre des patients consultants en ophtalmologie a connu, depuis, une baisse considérable. Par ailleurs, les ophtalmologistes en majorité se sont portés au-devant de la scène pour assurer la continuité de soins et les urgences en respectant les consignes sanitaires. Nous avons élaboré un questionnaire afin de collecter les informations sur les orientations générales de 35 ophtalmologistes concernant l´impact du COVID-19 sur l´activité de la consultation. Les résultats de cette enquête ont objectivé que 88,57% des ophtalmologistes sondés ont maintenu leurs activités de consultation dont les ¾ faisaient que les cas urgents ou dont l´état nécessite une prise en charge sans différée. La majorité des ophtalmologistes déclare une activité en baisse d´au moins 90% par rapport à leur activité habituelle. Les ophtalmologues en activité estiment que le risque d´être contaminer ou de contaminer ses patients et ses proches demeures moyennes à élever dans la majorité des cas malgré les gestes barrières de protection.</p> Shamil Louaya Omar Moustaine Mohammed Badaoui Youssef Hnach Ahmed Alaayoud Said Chatoui Copyright (c) 2020-07-08 2020-07-08 36 1 Development of a community-based, one-stop service centre for children with developmental disorders: changing the narrative of developmental disorders in sub-Saharan Africa <p>Sub-Saharan Africa is home to about 15 million children with varying developmental disorders. Services for children with developmental disorders are scarce in Africa. The few available services are limited to the capital cities and are in the private sector, with the cost beyond the reach of most families. In 2016, the Centre for Early Development, Learning and Care was established in Ibadan, South-west, Nigeria. The centre provide services for children with developmental disorders is a one-stop, multidisciplinary team approach. Children are assessed on both structured and unstructured interviews. A total of 584 children were assessed between December 2016 and December 2019. One third (32.4%) of the children assessed within this period met diagnostic criteria for ASD, 29.1% had intellectual disability and 27.6% had cerebral palsy. The remaining clients (10.9%) had other disorders including ADHD, Down´s syndrome, hearing impairment and visual impairment. Parents tend to downplay the severity of their children´s disability. There are many challenges that are associated with the establishment of a service centre in a low resource setting. This and other experiences are discussed.</p> Yetunde Celia Adeniyi Ade Fatai Adeniyi Copyright (c) 2020-07-08 2020-07-08 36 1 Pre-extensively drug-resistant tuberculosis spondylodiscitis in an immunocompetent patient: a case report <p>Pre-extensively drug resistant tuberculosis (pre-XDR-TB) has been an area of growing concern, and posing a threat to global efforts of TB control. We report a case of PreXDR-TB spondylodiscitis with resistance to a Fluoroquinolone, in an immunocompetent patient under antibacillary treatment for pleural tuberculosis, managed with drug sensitivity-based second-line antituberculous drug regimen. Our case shows the challenges of the diagnostic and management of Drug-resistant TB spondylodiscitis.</p> Safaa Fellous Hanan Rkain Latifa Tahiri Amina Bouraqadi Ittimad Nassar Fadoua Allali Copyright (c) 2020-07-08 2020-07-08 36 1 Scabies complicated by necrotizing lymphocytic vasculitis in an infant <p>Scabies is very common among children. It is often a harmless infectious disease, responding well to antiparasitic medication. Nevertheless, severe forms can occur in immunocompromised populations like newborns and infants. We report a unique case of scabies in a three-months-old infant, complicated by generalized cutaneous lymphocytic vasculitis and unilateral acral necroses.</p> Houda Nassih Fatimzehra El Hanafi Safa Elalaoui Rabiy El Qadiry Aicha Bourahouat Imane Ait Sab Copyright (c) 2020-07-09 2020-07-09 36 1 A misleading CMV myocarditis during the COVID-19 pandemic: case report <p>Coronavirus disease 2019 (COVID-19) has been reported as the possible cause of acute myocarditis. Myocarditis is an inflammatory heart disease mostly caused by viral infections. Cytomegalovirus (CMV) primary infection is often not suspected as a cause of myocarditis in immune-competent adults. We report the case of A 37-year-old male admitted with fever, cough and dyspnea. Chest CT showed typical ground-glass changes indicative of viral pneumonia. He was tested negative for COVID-19 but had biological markers that made us still suspect it. He had elevated troponin I level (up to 111,5 ng/mL) and diffuse myocardial dyskinesia along with a decreased left ventricular ejection fraction (LVEF). He was diagnosed with CMV myocarditis with cardiac insufficiency and totally recovered without antiviral therapy. During the COVID-19 pandemic patients may develop myocarditis, still every myocarditis is not a COVID infection. Myocarditis linked to CMV infection may be rare, but life-threatening.</p> Sara Oualim Amal Elouarradi Sara Hafid Abdelhamid Naitelhou Mohamed Sabry Copyright (c) 2020-07-09 2020-07-09 36 1 Rehabilitation of post-COVID-19 patients <p>N/A</p> Mouna Asly Asmaa Hazim Copyright (c) 2020-07-09 2020-07-09 36 1 Acute urinary tract infection in patients with underlying benign prostatic hyperplasia and prostate cancer <p><strong>Introduction:&nbsp;</strong>the occurrence of urinary tract infection in patients with obstructing prostate causes reduction in their health-related quality of life and overall well-being. The objective of this study was to determine the prevalence, risk factors and antimicrobial sensitivity pattern of pathogens causing urinary tract infection in patients with benign prostatic hyperplasia and prostate cancer.</p> <p><strong>Methods:&nbsp;</strong>all patients who presented to our urology division with bladder outlet obstruction secondary to benign prostatic hyperplasia or prostate cancer between January 2016 and January 2019 were included. Information on age, co-morbid conditions, presence of an indwelling catheter, bacteriologic analysis, imaging findings and histological diagnosis were obtained and analyzed using SPSS version 20.</p> <p><strong>Results:&nbsp;</strong>de-novo urinary tract infection occurred in 35.6% of patients while recurrent infection occurred in 5.9% of them. The most commonly isolated organisms were gram-negative bacteria with&nbsp;<em>Escherichia coli, Klebsiella spp, Citrobacter spp and Aerobacter spp</em>&nbsp;accounting for 62.2%, 27.0%, 8.1% and 2.7% respectively. Nitrofurantoin (64.3%), Ceftriaxone (46.3%) and Genticin (42.9%) were the three most sensitive antimicrobials to the organisms isolated. Only the presence of an indwelling catheter in the bladder was an independent predictor of urinary tract infection in the study population.</p> <p><strong>Conclusion:&nbsp;</strong>about one-third of patients with benign prostatic hyperplasia and prostate cancer develop urinary tract infection. The predominant bacterial cause was&nbsp;<em>Escherichia coli,</em>&nbsp;which had a high degree of sensitivity to Nitrofurantoin. The presence of an indwelling catheter was the only independent predictor of this infection. Appropriate measures should be re-enforced to prevent the occurrence of catheter-associated infections.</p> Musliu Adetola Tolani Aisha Suleiman Mudi Awaisu Muhammad Mukhtar Abdulaziz Ahmad Tijjani Lawal Ahmad Bello Copyright (c) 2020-07-09 2020-07-09 36 1 Case report: postoperative myocardial injury in a patient with left ureteric stone and asymptomatic COVID-19 disease <p>Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8<sup>th</sup>&nbsp;December 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes or by a rise in serum troponin level. Patients with myocardial involvement are generally at risk of developing severe illness and tend to have a poor outcome. We hereby present a case of a hypertensive male patient with undiagnosed, asymptomatic COVID-19, who underwent an emergency urologic procedure for ureteric calculi. He eventually sustained a postoperative myocardial injury resulting in his demise. This case highlights the importance of detailed preoperative assessment and anticipation of complications during this global pandemic.</p> Nadeem Kassam Omar Aziz Ally Zain Ismail Rodgers Swai Samina Somji Robert Mvungi Mustaafa Bapumia Aliakber Zehri Salim Surani Copyright (c) 2020-07-10 2020-07-10 36 1 Revisiting the sub-mandibular approach with a modified incision <p>Angle of mandible has been long plagued throughout the history for being one of the most common places of facial bone fracture and also related complications if not treated properly. Hereby, two cases of fracture of angle of mandible those were surgically treated with an aim to modify existing extra-oral approaches specifically for treating the mandibular angle fractures for the purpose of open reduction and internal fixation so as to have a good access combined with an aesthetic and inconspicuous scar postoperatively are described. Also, an attempt is made to add one more type of incision to many existing ones so that future surgeons can choose over which best suits their procedure and as an addition to the ever-increasing literature. There is no doubt that meticulous surgical procedure and experience is needed to identify the structures, to stay in the plane of desire and work in comparatively bloodless field. Hence this approach can be bit challenging for newer surgeons. Nonetheless, the result after the closure of the field is quite rewarding.</p> Namdeo Prabhu Zafar Ali Khan Rakhi Issrani Copyright (c) 2020-07-10 2020-07-10 36 1 An unusual presentation of ischemic stroke <p>A 67-year-old man with history of diabetes mellitus and arterial hypertension, presented with sudden diplopia and gait disturbance. Physical examination showed truncal instability and dysmetria of left limbs, associated with signs of left unilateral internuclear ophtalmoplegia (INO), without impairment of convergence (A, B). Two days later, Brain MRI showed a small ischemic stroke involving the paramedian tegmentum of the left ponto-mesencephalic junction (C, D). The stroke was secondary to the atherosclerosis process. The patient was treated with 160mg/j of aspirin. The follow up at 10 days was marked with little attenuation of neurological signs.</p> Aziz Ahizoune Ahmed Bourazza Copyright (c) 2020-07-10 2020-07-10 36 1 Post-surgical complications of median nerve release at the wrist level <p>Carpal tunnel syndrome is a set of signs and symptoms caused by compression of the median nerve as it travels through the wrist at the carpal tunnel. The diagnosis is clinical and based on the presence of characteristic signs and symptoms. Proper nonsurgical treatment can stop the progression of this disorder and prevent the development of permanent disability. Surgical treatment may be indicated to patients with complications rated as moderate to severe. Although the surgery is relatively simple, basic antisepsis care before, during, and after the procedure, and guidance of patients for the management of wound hygiene upon discharge, make recovery more secure and prevent disabling sequelae. We report a case of a patient that had infection, edema, and temporary loss of flexibility of the fingers after a surgical procedure to release the median nerve.</p> Julia Brasileiro de Faria Cavalcante Pedro Nogarotto Cembraneli Renata Brasileiro de Faria Cavalcante Volmer Fernandes Valente Junior José Edison da Silva Cavalcante Copyright (c) 2020-07-10 2020-07-10 36 1 Cancer du sein traité par chimiothérapie première: facteurs prédictifs du traitement radical (étude rétrospective à propos de 72 cas) <p>La chimiothérapie néoadjuvante est devenue le traitement de première intention des cancers du sein localement avancés. Elle permet d´une part, une augmentation des chances de conservation mammaire sans pour autant une majoration du risque de récidive, et d´autre part un contrôle locorégional des formes inopérables d´emblée. Cependant, certains facteurs cliniques, radiologiques et histologiques sont associés à une augmentation du risque de mastectomie, tels que la présence de microcalcifications, la multifocalité, le grade SBR1 et 2, les stades cT3 et cT4 et la surexpression d´HER2. A partir de ce travail, nous avons cherché à déterminer les facteurs prédictifs de mastectomie après chimiothérapie néoadjuvante (CNA), si la mastectomie était justifiée ou non histologiquement et quels étaient les facteurs prédictifs de mastectomie non justifiée. Nous avons réalisé une étude rétrospective colligeant 72 patientes atteintes de cancer du sein et traitée par CNA aux départements de gynécologie et d´oncologie médicale au CHU Fattouma Bourguiba de Monastir-Tunisie. Le taux du traitement conservateur était de 18,1%, il passe à 63,15% pour les tumeurs stade T2. La mastectomie n´était pas justifiée par l´histologie définitive dans 26,3% des cas. Les facteurs prédictifs de mastectomie non justifiée retrouvées dans notre étude étaient le statut RH négatif et le stade cT2. La réalisation de ce travail a conduit à une réflexion sur nos pratiques et leurs modifications. Le traitement chirurgical conservateur devra être considéré comme un standard thérapeutique et être systématiquement proposé à toutes les patientes traitées par CNA pour un cancer du sein y compris en cas de multifocalité, une taille clinique importante, des microcalcifications étendues, dans le but de diminuer de façon conséquente le nombre de mastectomies non justifiées.</p> Ahmed Hajji Dhekra Toumi Amira Daldoul Manel Njima Houda El Mhabrech Raja Faleh Copyright (c) 2020-07-10 2020-07-10 36 1 Pronostic maternel et périnatal de l'éclampsie à l'hôpital de Tombouctou au Mali <p>L´éclampsie représente l´une des principales causes de décès maternels dans le monde. Notre objectif était de déterminer le pronostic maternel et périnatal de l´éclampsie à l´hôpital de Tombouctou, Mali. L´étude a été descriptive, rétrospective du 1<sup>er</sup>&nbsp;janvier 2013 au 31 décembre 2017, incluant les cas d´éclampsies survenues au cours de la grossesse ou l´accouchement à l´hôpital de Tombouctou. Nous avons retrouvé 116 cas sur 4951 accouchements soit un taux d´incidence de 2,3%. Il s´agissait essentiellement de femmes de moins de 26 ans (85,3%), primipare (81%), admise en moyenne 8 heures après la première crise. La césarienne était pratiquée dans 77,6% des cas. Le Sulfate de magnésium a été utilisé dans 75% des cas. Les létalités maternelle et périnatale étaient respectivement à 4,3% et 21,5%. Le facteur de mauvais pronostic maternel était un score Glasgow ≤ 8 à l´admission (p: 0,004). Les facteurs de mauvais pronostic périnatal étaient la résidence hors de la ville de Tombouctou (p: 0,000), l´absence de consultation prénatale (p: 0,020) et l´accouchement par voie basse (p: 0,012). Ainsi, l´amélioration du pronostic maternel et périnatal nécessite un suivi correct des grossesses, la réduction des retards dans l´accès à des soins adéquats.</p> Mamadou Ibrahima Kampo Seydou Sogoba Djibril Kassogué Idrissa Konaté Oumar Ongoiba Djibril Sissoko Fatoumata Sow Youssouf Traoré Karim Dembélé Copyright (c) 2020-07-13 2020-07-13 36 1 Anosmie sans agueusie chez des patients COVID-19: à propos de 2 cas <p>Dans la pandémie actuelle, l'anosmie associée ou non à une agueusie semble être un symptôme fréquent en cas d'infection par le SRAS-CoV-2 responsable de COVID-19. Nous rapportons deux cas d´anosmies sans agueusies chez des patients COVID-19 adultes. L´installation a été brutale et a persisté quelques semaines après leur guérison. Ils consultèrent dans notre service ORL où ils bénéficièrent d´une abstention thérapeutique et d´une surveillance en ambulatoire. Au bout de 5 semaines, ils ont déclaré avoir récupéré leur odorat. Nous avons constaté que l´anosmie peut exister sans agueusie et persister après la guérison au COVID-19. La récupération de l´odorat est possible au bout de quelques semaines sans traitement médical. C´est pourquoi, nous recommandons un suivi des malades guéris du COVID-19 pour mieux appréhender les symptômes persistants.</p> Abdoulaye Keita Hamza Abdou Bacharou Ibrahima Diallo Alseny Camara Copyright (c) 2020-07-13 2020-07-13 36 1 Early experience with permanent pacemaker implantation at a tertiary hospital in Nigeria <p><strong>Introduction:&nbsp;</strong>artificial pacemakers generate electrical impulses and regulate the heart´s conduction system. They are often used to treat individuals with bradycardia. Permanent pacemaker implantation is a lifesaving procedure especially in patients with symptomatic bradyarrhythmias. The objectives was to evaluate the clinical attributes and outcomes of permanent pacemaker implantation in Ile-ife, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>we retrospectively reviewed medical records of 22 patients who had pacemaker implantation from January 2015 to December 2019. Patient´s demographics, clinical presentation, diagnosis, comorbidities, type of device, complications and long-term follow up were studied.</p> <p><strong>Results:&nbsp;</strong>sixteen males (72.7%) and 6 females (27.3%) were recruited into the study with ages ranging between 54 and 84 years and a mean of 70.3 +8.7 years. The commonest symptom was easy fatigability (45.5%) followed by syncope (31.8%). The main indication for permanent pacemaker implantation was complete heart block (86.4%). Seventeen (77.3%) patients had hypertension as the comorbidity present at diagnosis. Single chamber (VVIR) pacemaker was implanted in 13(59.1%) patients while dual chamber (DDDR) was implanted in 9(40.9%) patients. Hematoma, pneumothorax and acute lead dislodgement were the complications observed in 3 patients. There was no statistical significance between the type of device implanted and the occurrence of complications, p-value 0. 186. There was no mortality and 15 patients (68.2%) are currently attending regular 6 monthly follow-up.</p> <p><strong>Conclusion:&nbsp;</strong>complete heart block is the most common indication for permanent pacemaker implantation and the procedure is safe with minimal complications and satisfactory outcomes.</p> Uvie Ufuoma Onakpoya Olugbenga Olalekan Ojo Oghenevware Joel Eyekpegha Abayomi Emmanuel Oguns Anthony Olubunmi Akintomide Copyright (c) 2020-07-13 2020-07-13 36 1 Aspects cliniques, thérapeutiques et pronostiques des tumeurs germinales malignes de l´ovaire: expérience tunisienne de 21 ans <p><strong>Introduction:&nbsp;</strong>les tumeurs germinales malignes de l´ovaire (TGMO) sont des tumeurs ovariennes rares. Chaque type histologique peut avoir des particularités cliniques et thérapeutiques qu´il est important de connaître. L´objectif était de rapporter et analyser les particularités des données épidémiologiques, diagnostiques, anatomopathologiques, thérapeutiques et pronostiques des TGMO dans notre contexte tunisien.</p> <p><strong>Méthodes:&nbsp;</strong>notre étude est une enquête rétrospective descriptive et analytique réalisée aux services de Gynécologie-obstétrique du CHU FARHAT HACHED de Sousse sur une période de 21 ans colligeant tous les cas des patientes ayant été traitées pour TGMO.</p> <p><strong>Résultats:&nbsp;</strong>un nombre total de 30 dossiers a été éligible pour notre étude. L´âge moyen de nos patientes était de 22ans. La majorité des patientes étaient en période d´activité génitale. Le motif de consultation était représenté essentiellement par les douleurs abdomino-pelviennes suivie d´une augmentation du volume abdominal. L´échographie abdominopelvienne a été pratiquée chez 80% de nos patientes montrant un aspect suspect de malignité chez 100% d´entre elles. Pour nos patientes, 70% ont été abordées par laparotomie médiane vu le volume tumoral et 30% seulement par cœlioscopie. 76,7% ont eu un traitement conservateur. On a noté la prédominance de stade I alors qu´on n´a pas eu de cas en stade IV. La survie globale tout stade confondu était de 96,7% à 2ans et de 85,7% à 5ans et 75,8% à 10ans. Les facteurs pronostiques des TGMO isolés de notre série étaient le délai de consultation supérieur à 6mois, l´âge supérieur à 30ans, la taille tumorale supérieure à 20cm et le stade tumoral.</p> <p><strong>Conclusion:&nbsp;</strong>il serait plus intéressant de rassembler les autres cas de TGMO diagnostiqués au niveau des autres registres du cancer du pays afin d´établir un registre national des tumeurs rares de l´ovaire.</p> Imen Ghaddab Raja Briki Sassi Bouguizene Hedi Khairi Copyright (c) 2020-07-13 2020-07-13 36 1 Proposed strategies for easing COVID-19 lockdown measures in Africa <p>As SARS-CoV-2 rapidly spread across the globe, short-term modeling forecasts provided time-critical information for containment and mitigation strategies. Global projections had so far incorrectly predicted large numbers of COVID-19 cases in Africa and that its health systems would be overwhelmed. Significantly higher COVID-19-related mortality were expected in Africa mainly because of its poor socio-economic determinants that make it vulnerable to public health threats, including diseases of epidemic potential. Surprisingly as SARS-CoV-2 swept across the globe, causing tens of thousands of deaths and massive economic disruptions, Africa has so far been largely spared the impact that threw China, USA, and Europe into chaos. To date, 42 African countries imposed lockdowns on movements and activities. Experience from around the world suggests that such interventions effectively suppressed the spread of COVID-19. However, lockdown measures posed considerable economic costs that, in turn, threatened lives, put livelihoods at risk, exacerbated poverty and the deleterious effects on cultures, health and behaviours. Consequently, there has been great interest in lockdown exit strategies that preserve lives while protecting livelihoods. Nonetheless in the last few weeks, African countries have started easing restrictions imposed to curb the spread of SARS-CoV-2. WHO recommends lifting of lockdowns should depend on the ability to contain SARS-CoV-2 and protect the public once restrictions are lifted. Yet, the greatest challenge is the critical decision which must be made in this time of uncertainties. We propose simple strategies on how to ease lockdowns in Africa based on evidence, disease dynamics, situational analysis and ability of national governments to handle upsurges.</p> David Lagoro Kitara Eric Nzirakaindi Ikoona Copyright (c) 2020-07-13 2020-07-13 36 1 Prevalence of onchocerciasis after seven years of continuous community-directed treatment with ivermectin in the Ntui health district, Centre region, Cameroon <p><strong>Introduction:&nbsp;</strong>onchocerciasis is one of the major infectious diseases caused by&nbsp;<em>Onchocerca volvulus</em>. This parasite is responsible for chronic cutaneous and ocular diseases affecting more than 37 million people of whom 99% are in Africa. The study was conducted in the health district of Ntui from June to September 2016 to determine the prevalence of&nbsp;<em>O. volvulus</em>&nbsp;infection after seven years of massive administration of ivermectin.</p> <p><strong>Methods:&nbsp;</strong>two cutaneous snips were made at the iliac crests level in volunteers. These tissues were incubated in physiological saline water and were examined for parasitological investigations in the laboratory.</p> <p><strong>Results:&nbsp;</strong>a total of 310 participants were randomly selected, of whom 170 (54.8%) were women and 140 (45.1%) were men aged 6 to 83 years, thus giving a sex ratio of 1.2 in favour of women. After parasitological analysis, 26 participants had microfilaraemia, of whom 15 (10.7%) were men and 11 (6.4%) were women. The most infected age group was 16 to 26 years (12.5%). The highest infection rates were found among farmers (11%) and participants living in the village of Essougly (26.6%). No significant differences in prevalence values between the different groups were noted, whatever the parameter considered.</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of onchocerciasis in the health district of Ntui has declined from a hyperendemic to a hypoendemic state after seven years of massive administration of ivermectin. However, careful monitoring of onchocerciasis should be continued to prevent the area from returning to its original hyperendemicity.</p> Estelle Makou Tsapi Françoise Guemgne Todjom Guy-Armand Gamago Josué Wabo Pone Félicité Flore Djuikwo Teukeng Copyright (c) 2020-07-14 2020-07-14 36 1 Carcinome épidermoïde de la vulve chez une patiente infectée par le VIH-1 en échec de traitement antirétroviral de première ligne <p>Le cancer de la vulve est une affection rarement rapportée dans la littérature. Chez la femme jeune, il est le plus souvent lié à une infection par le papillomavirus humain (HPV) alors que chez les femmes ménopausées, chez qui ce cancer est plus fréquent, il serait lié à la carence œstrogénique. En outre, l´infection à VIH augmente le risque de survenue chez les femmes séropositives de néoplasies vulvaires du fait de la prévalence élevée de l´infection à HPV chez elles. Ainsi devant toute lésion suspecte de la vulve, une biopsie suivie d´un examen anatomo-pathologique devra être réalisée afin de poser le diagnostic. Nous rapportons le cas d´un carcinome épidermoïde de la vulve chez une patiente séropositive au VIH-1 en échec de traitement antirétroviral (ARV) de première ligne.</p> Alassane Dièye Bruce Wembulua Shinga Jacques Noel Tendeng Moustapha Diedhiou Birame Seck Abdourahmane Ndong Ndèye Méry Dia-Badiane Copyright (c) 2020-07-14 2020-07-14 36 1 Prévalence et facteurs associés au portage des anticorps anti-VHC chez des femmes enceintes à Cotonou <p><strong>Introduction:&nbsp;</strong>l´hépatite C est une infection dont la transmission mère-enfant est possible. L´objectif de ce travail était d´étudier la prévalence du portage des anticorps anti-VHC chez des femmes enceintes à Cotonou et d´identifier les facteurs qui y sont associés.</p> <p><strong>Méthodes:&nbsp;</strong>il s´est agi d´une étude transversale menée du 01/06/2018 au 01/09/2018 auprès de 253 gestantes reçues pour des soins prénatals dans quatre grandes maternités de Cotonou (Bénin). Les anticorps anti-VHC avaient été détectés par des tests rapides d´orientation diagnostique. Un échantillon de sang veineux avait été prélevé chez les gestantes avec anti-VHC positifs en vue de tests sérologiques de confirmation et d´un dépistage du diabète gestationnel.</p> <p><strong>Résultats:&nbsp;</strong>la prévalence des anticorps anti-VHC était de 1,2% (3/253 gestantes). Les facteurs associés au portage du VHC n´avaient pu être identifiés compte tenu du faible nombre de cas positifs. Cependant, les gestantes porteuses des anticorps anti-VHC avaient une moyenne d´âge élevée (32 ± 3) comparativement au reste de la population (29,58 ± 5,5). Les facteurs de risque potentiels d´infection par le VHC retrouvés étaient les scarifications, le piercing, le tatouage, le partage du matériel de manucure, un antécédent d´intervention chirurgicale et de transfusion sanguine. La prévalence du diabète gestationnel dans notre étude était de 7,9% (20/253). Aucune association n´était trouvée entre le diabète gestationnel et l´hépatite C.</p> <p><strong>Conclusion:&nbsp;</strong>la prévalence des anticorps anti-VHC chez les gestantes à Cotonou était faible. Une étude d´envergure nationale s´avère nécessaire afin d´identifier les facteurs associés à cette infection.</p> Moufalilou Aboubakar Aboudou Raïmi Kpossou Bignon Rosalie Gloria Hermione Glago Amel Gildas Aguiah Zafy Hairou Mboreha Jean Sehonou Copyright (c) 2020-07-14 2020-07-14 36 1 Breast cancer in men: a serie of 45 cases and literature review <p>Immunohistochemical profiling studies carried out on female breast cancer has been extrapolated to breast cancer in males. Although, we do not know if it really reflects the reality of this pathology in males patients since the studies are often retrospective and studying a limited number of patients. The objectives was to describe particualrities of breast cancer in males and analyze the evolutionary characteristics and study the molecular profile of this rare disease in Tunisian men. It is a retrospective, descriptive and analytic study carried out over a period of 15 years in the departments of gynecology-obstetrics, general surgery, medical carcinology and anatomopathology of the Farhat Hached Teaching Hospital in Sousse, Tunisia. Fourty five patients were included.The most common histological type was invasive ductal carcinoma (95% of our patients).Our series was divided into 3 immunohistochemical groups with a majority group: luminal A (68.2%), followed by luminal B (27.3%) and only one patient had a triple negative type tumor (4.5%).The Overall survival rate (OSR) at 5 and 10 years was 83.2% and 76.8% respectively. Recurrence-free survival (RFS) at 5 and 10 years was 64.5% and 58.6%, respectively. The OSR was influenced significantly by age, clinical and histological size of the tumor, the presence of distant metastases and the occurrence of recurrence. Recurrence-free survival (RFS) was influenced by age, clinical and histological size of the tumor, and infiltration of the dermis. Breast cancer in males has similarities with women's breast cancer. However, it remains diagnosed at a later stage.</p> Marwa Methamem Imen Ghadhab Samir Hidar Raja Briki Copyright (c) 2020-07-14 2020-07-14 36 1 Hydrocéphalie du nouveau-né et du nourrisson au Centre Hospitalier National de Nouakchott <p>L´hydrocéphalie du nouveau-né et du nourrisson constitue un facteur important de mortalité et de morbidité dans les pays en voie de développement avec des moyens diagnostiques et thérapeutiques limités. Cette étude avait pour objectif de rapporter notre expérience dans la prise en charge de cette pathologie en Mauritanie. Il s´agissait d´une étude rétrospective portant sur 126 dossiers d´enfants d´âge compris entre 0 et 24 mois, pris en charge pour hydrocéphalie dans le service de neurochirurgie du CHN de Nouakchott, de juin 2014 au juin 2018. Le délai moyen de suivi était de 15 mois (9-27 mois). L´âge moyen au diagnostic était de 5 mois (2 jours à 20 mois). On notait une prédominance féminine (sex-ratio de 0,77). La série était composée de 45 nouveau-nés (35,7%) et de 81 nourrissons (64,3%). Un antécédent infectieux de la grossesse avait été retrouvé dans 19,8% et une infection néonatale dans 23,8%. Sur le plan clinique, 87,3% avaient une macrocéphalie, 35,7% un retard du développement psychomoteur et 15,8% un refus de téter. La principale étiologie était représentée par les myéloméningoceles (23,8%), suivie de la méningite (15,8%). La dérivation ventriculo-péritonéale (DVP) était le principal traitement chez le nouveau-né (68,8%), tandis que la ventriculocisternostomie endoscopique (VCE) était préférée chez le nourrisson (74,1%). Le taux global de complications était de 26,1% (57,6% pour les DVP et 4,1% pour la VCE). L´hydrocéphalie est la principale pathologie de la neurochirurgie pédiatrique en Afrique. Sa prise en charge reste tardive, d´où l´importance de la prévention surtout des anomalies du tube neural et des infections.</p> Sidi Salem-Memou Sidiya Chavey Hamdy Elmoustapha Abdallahi Mamoune Ahmedou Moctar Sidimohamed Salihy Najat Boukhrissi Copyright (c) 2020-07-14 2020-07-14 36 1 Dengue virus serological markers among potential blood donors: an evidence of asymptomatic dengue virus transmission in Cameroon <p><strong>Introduction:&nbsp;</strong>the risk of dengue virus or its antibodies which can be transmitted through blood transfusion by asymptomatic individuals infected, has been a major concern all over the world. Dengue is an endemic disease in sub-Saharan Africa, particularly in Cameroon. The purpose of this study is to determine the frequency of dengue virus (DENV) infection among potential blood donors at Yaounde Jamot Hospital.</p> <p><strong>Methods:&nbsp;</strong>serum samples were collected from 310 potential adult blood donors aged 18-57 years, who signed a written informed consent and completed the questionnaire between March 2019 and August 2019. This serum is used to screen for the presence of serological markers of DENV infection (NS1, IgM and IgG) using immunochromatographic tests (Zhuhai Encode Medical Engineering Co., Ltd, China). IgM/IgG positive samples were confirmed by enzyme-linked immunosorbent assays (ELISA).</p> <p><strong>Results:&nbsp;</strong>the overall prevalence was 24.8% among potential blood donors were subdivided as follows: 4.5% (14/310), 12.3% (38/310) and 6.1% (19/310) showed mono-positivity to DENV-NS1 antigen, anti-DENV IgM and anti-DENV IgG antibodies respectively. 1.9% (6/310) of potential blood donors showed dual positivity to anti-DENV IgM antibodies and anti-DENV IgG antibodies. The presence of DENV-NS1 antigen show asymptomatic viremia of dengue at the time of donation, while the presence of IgG antibodies reflects the high endemicity of dengue disease in the city of Yaoundé.</p> <p><strong>Conclusion:&nbsp;</strong>these findings demonstrate the high level of risk of the DENV transmission among potential blood donors to needy recipients, underscoring the importance of establishing dengue fever blood screening in different services and blood collection units in Cameroon to improve safety transfusion and control the dissemination of the DENV.</p> Salomon Bonsi Tchuandom Abel Lissom Ghislaine Haverie Mimfoumou Ateba Thibau Flaurant Tchouangueu Constantin Tchakounte Agbor Rolland Ayuk Etienne Philemon Atabonkeng Ankiambom Innocent Ngong Godwin Nchinda Jules-Roger Kuiate Copyright (c) 2020-07-14 2020-07-14 36 1 Randomized controlled trial comparing 400μg sublingual misoprostol versus placebo for prevention of primary postpartum hemorrhage <p><strong>Introduction:&nbsp;</strong>obstetric hemorrhage is estimated to cause 25% of all maternal deaths and is the leading direct cause of maternal mortality worldwide. The World Health Organization recommended the use of uterotonics that should be offered for all women who will give birth but in some countries or in special situations oxytocin is not available. The goal of this study is to determine whether the 400μg dose of Misoprostol decreases the incidence of postpartum hemorrhage (PPH) of women who did not show signs of hemorrhage.</p> <p><strong>Methods:&nbsp;</strong>a prospective randomized double blind controlled trial was conducted between February 2012 and June 2012, among women in the active stage of labor attending the Obstetric Gynecology Department, University Hospital Farhat Hached of Sousse, Tunisia. Women with term singleton pregnancies greater than 32 weeks of amenorrhea with anticipated vaginal delivery were eligible for the study. Participants were randomly assigned to receive 400 μg sublingual Misoprostol or 2 ets of placebo immediately after cord clamping. The primary outcome measures were an estimation of blood loss including the subjective finding of vaginal hemorrhage &gt; 500 ml, the decrease of hemoglobin and hematocrit, a change in hemodynamic parameters, and the need for additional dose of oxytocin. Secondary outcomes were occurrence of possible side effects such as: headache, nausea, vomiting, pyrexia, diarrhea and abdominal pain.</p> <p><strong>Results:&nbsp;</strong>a total of 211 patients were randomized: 111 in the Misoprostol group (Cytotec*) and 100 patients in the placebo group. The two groups were similar in terms of sociodemographic characteristics. Significant difference between the 400-μg of Misoprostol and placebo group were recorded in mean postpartum blood and PPH occurrence. The difference in pre- and postpartum hemoglobin loss (expressed in grams per 100 ml) was 1.21 ± 1.05 for the Misoprostol group and 1.51 ± 0.74 for the placebo group with significant difference (p = 0.02). No differences were observed in the occurrence of headache, dizziness, vomiting, diarrhea and metallic taste but the incidence of shivering was more than twice as great among women receiving Misoprostol than among those treated with placebo with a significant difference (p = 0.01). Similarly, women who received Misoprostol had a significantly higher mean temperature after delivery in comparison with those receiving placebo.</p> <p><strong>Conclusion:&nbsp;</strong>misoprostol, administered as 400 μg after delivery, appears to be effective for the prevention of post-partum hemorrhage, but its side effects appears to be significant.</p> Rym Zgaya Imen Ghadhab Mohamed Amine Triki Raja Briki Copyright (c) 2020-07-15 2020-07-15 36 1 Prevalence and factors associated with uncontrolled hypertension among adult hypertensive patients on follow-up at Northern Ethiopia, 2019: cross-sectional study <p><strong>Introduction:&nbsp;</strong>uncontrolled hypertension is a major risk factor for cardiovascular, renal, and cerebrovascular morbidities and mortalities. This study aims to assess the prevalence and factors associated with uncontrolled hypertension among adult hypertensive patients.</p> <p><strong>Methods:&nbsp;</strong>hospital-based cross-sectional study was conducted. Systematic random sampling technique was used to select 396 hypertensive patients. Respondents were interviewed and their medical charts were reviewed using pretested structured questionnaire. Bivariable logistic regression was employed to examine the crude associations between the outcome variable and determinant variables. This was followed by multivariable logistic regression analysis using those variables with P-value ≤ 0.25 in the bivariable analysis.</p> <p><strong>Results:&nbsp;</strong>of the total 396 hypertensive patients the prevalence of uncontrolled hypertension was found to be 48.6%. One fourth (26.1%), 231(59.1%), 289(73.9%), and 151(38.6%) hypertensive respondents were non adherent to anti-hypertensive medication, physical exercise, low salt diet, and weight management respectively. Age ≥50 years old (AOR = 2.33, 95%CI: 1.25, 4.35), non-adherence to anti-hypertensive medication, (AOR = 1.82 95%CI: 1.08, 3.04), non-adherence to physical exercise (AOR = 1.79 95%CI: 1.13, 2.83), non-adherence to low-salt diet (AOR = 1.98 95%CI: 1.18,3.31), and non-adherence to weight management (AOR = 2.06, 95%CI: 1.31, 3.23) were significantly associated with uncontrolled hypertension.</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of uncontrolled hypertension was high. Older hypertensive patients, non-adherent to their medications, physical inactivity, non-adherent to low salt diet and non-adherent to weight management were more likely to have uncontrolled hypertension. Therefore, more effort should be dedicated to those identified modifiable risk factors to maximize blood pressure control.</p> Woldu Aberhe Teklewoini Mariye Degena Bahrey Kidane Zereabruk Abrha Hailay Guesh Mebrahtom Kibrom Gemechu Brhanu Medhin Copyright (c) 2020-07-15 2020-07-15 36 1 The pandemic COVID-19: a tale of viremia, cellular oxidation and immune dysfunction <p>COVID-19, caused by SARS-CoV-2 is a tester of the immune system. While it spares the healthy, it brings severe morbidity and in a few cases, mortality to its victims. This article aims at critically reviewing the key virulence factors of COVID-19 which are the viremia, cellular oxidation and immune dysfunction. The averse economic effect of certain disease control measures such as national lock-downs and social distancing, though beneficial, makes them unsustainable. Worse still is the fact that wild animals and domestic pets are carriers of SARS-CoV-2 suggesting that the disease would take longer than expected to be eradicated globally. A better understanding of the pathological dynamics of COVID-19 would help the general populace to prepare for possible infection by the invisible enemy. While the world prospects for vaccines and therapeutic agents against the SARS-CoV-2, clinicians should also seek to modulate the immune system for optimum performance. Immunoprophylactic and immunomodulatory strategies are recommended for the different strata of stakeholders combating the pandemic with the hope that morbidities and mortalities associated with COVID-19 would be drastically reduced.</p> Adekunle Babajide Rowaiye Olukemi Adejoke Onuh Angus Nnamdi Oli Okiemute Ajiroghene Okpalefe Solomon Oni Ezinne Janefrances Nwankwo Copyright (c) 2020-07-15 2020-07-15 36 1 A large apical pseudoaneurysm of the left ventricle ruptured into the pericardium <p>This is the case of a 78 years old patient with a history of acute coronary syndrome complicated by rupture of the left ventricle. The ventricular wall defect was closed by tachosyl heamostatic patchs and gluing. Two months after the occurrence of the acute coronary syndrom, computed tomography detected a huge apical pseudoaneurysm of the left ventricle ruptured into the pericardium (A). The patient underwent median sternotomy and cardiopulmonary bypass associated with a moderate hypothermia at 28°C, then, we performed the DOR technique for the cure of the pseudoaneurysm (B), using a Gore Tex patch and Teflon felt support (C,D).</p> Ayoub Abetti Marouane Ouazzani Ibrahimi Copyright (c) 2020-07-16 2020-07-16 36 1 Serum uric acid and left ventricular hypertrophy in hypertensive patients in Ado-Ekiti <p><strong>Introduction:&nbsp;</strong>systemic hypertension is a foremost risk factor for cardiovascular morbidity and mortality. Its actions are manifested on organs like the brain, heart and kidneys. High serum uric acid (SUA) escalates cardiovascular vulnerability in patients with systemic hypertension.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was performed in 271 (178 females, 93 males) patients with systemic hypertension. Two hundred and seventy one healthy age and sex matched non-hypertensive persons obliged as controls. Left ventricular hypertrophy (LVH) was estimated by echocardiography. Blood samples were collected for measuring uric acid levels.</p> <p><strong>Results:&nbsp;</strong>mean SUA was significantly higher among the hypertensive patients (371±125μmol/L) than in the controls (269 ± 101.4μmol/L; p &lt; 0.001), and the prevalence of hyperuricemia was 46.9% among the hypertensives and 11.1% among the controls (P &lt; 0.001). Independent predictors of SUA were class of systemic hypertension, left ventricular mass index (LVMI), body mass index (BMI) and age. However, class of hypertension was the best independent predictor of SUA levels in the multivariate regression model (β = 0.597). Linear regression revealed SUA levels ≥ 430μmols/l as a predictor of stage 2 hypertension (F = 26.620, p = &lt; 0.001). Among the hypertensive patients, LVH was present in 39.3% of those with hyperuricemia and in 28.0% of those with normal SUA levels (p = 0.003).</p> <p><strong>Conclusion:&nbsp;</strong>results indicate serum uric acid is positively correlated with hypertension and a reliable indicator of LVH in study population.</p> Oladapo Adedamola Adewuya Ebenezer Adekunle Ajayi Rasaaq Ayodele Adebayo Opeyemi Ezekiel Ojo Olatunji Bukola Olaoye Copyright (c) 2020-07-16 2020-07-16 36 1 Invasive liver abscess syndrome caused by Klebsiella pneumoniae: first Tanzanian experience <p>Over the past 20 years there has been growing awareness of community-acquired primary liver abscess caused by strains of&nbsp;<em>Klebsiella pneumoniae</em>&nbsp;(<em>K. pneumoniae</em>) especially in patients of Asian descent, a minority of which are characterized by metastatic spread. A common and frequent destructive complication is endophthalmitis as well as the involvement of the central nervous system (CNS), causing suppurative meningitis or brain abscess. Here we report a case of invasive liver abscess caused by&nbsp;<em>K. pneumoniae</em>&nbsp;in an Asian patient who presented to our hospital in Tanzania with bilateral lower limb swelling for 6 weeks with acute onset of difficulty in breathing.</p> Nadeem Mehboob Kassam Omar Mohamed Aziz Samina Sadrudin Somji Zainab Yusuf Fidaali Salim Ramzan Surani Copyright (c) 2020-07-16 2020-07-16 36 1 Congenital liver hemangioma revealed by cholestasis syndrome: report of a rare case <p>Our paper reports a case of hepatic angioma revealed by neonatal cholestasis, thing that has never been reported in the literature to our knowledge. A newborn boy of 25 days of life had cholestatic jaundice since his fifth day of life. During its health assessment, the angioscan detected the presence of multiple hepatic agiomas. The rest of the etiological report returned without any anomaly. Beta-blockers were started with a very good clinical and ultrasonographic evolution after 12 months of treatment.</p> Chaimae Khairoun Amina Barkat Copyright (c) 2020-07-17 2020-07-17 36 1 Prevalence of dental caries and associated risk factors in children living with disabilities in Rwanda: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>several studies have been done on children with disabilities, and the results have shown that these particular individuals are more prone to developing various abnormal oral conditions. However, little is known about the oral health conditions among children with disabilities in Rwanda. This study aims to determine the prevalence of dental caries and associated risk factors among children with disabilities.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study conducted among 226 randomly selected children living with physical disabilities; learning, intellectual and developmental disabilities; deafness, blindness and hearing impairment disabilities aged between 7 and 20 years old, who live and/or are under the care of Nyanza Home de la Vierge des Pauvres (HVP) Gatagara. Bivariate and logistic regression analyses were done using SPPS version 20 at 95% confidence interval. The significance level was set at p&lt;0.05.</p> <p><strong>Results:&nbsp;</strong>the prevalence of dental caries found in children with disabilities is 42.4%. In bivariate analysis age (p=0.003), frequency of sugary food consumption (p=0.001) and oral hygiene status (p=0.000) are respectively significantly associated with dental caries. In logistic regression model, children who take once or more times per day sugary food like biscuits, cake, chocolates and sweets are almost 6 times higher at risk of developing dental caries [OR: 5.945, CI: 1.187; 29.774, P=0.03) while a good oral hygiene status was protective against dental caries [OR: 0.296, CI: 0.159; 0.550, P=0.000].</p> <p><strong>Conclusion:&nbsp;</strong>dental caries is a reality among children living with disabilities. Appropriate measures should be taken to protect these children and these measures should mainly focus on identified factors.</p> Donat Uwayezu Agnes Gatarayiha Manassé Nzayirambaho Copyright (c) 2020-07-17 2020-07-17 36 1 Mucocutaneous presentation of Kaposi sarcoma of rapid growth in a young male with HIV infection <p>A 26-year-old male with a medical history of risk sexual behavior, is brought to the Emergency Room (ER) with complaints of dyspnea associated with an oral cavity mass. At the interrogation, he referred that the symptomatology started 2 months ago with a lesion of approximately 1cm, originated from the upper gum. Patient also reported dysphonia, and dysphagia due to the expansion of the mass, and a weight loss of 10 kilograms. At physical examination a purple-black colored mass was identified coming from the oral cavity (A), including the upper gums with extension into the palate, reaching the uvula (B), the mass had exophytic margins, no tenderness at palpation with a fetid smell, multiple maculopapular violaceous lesions of approximated 1cm located in the neck, thorax and upper extremities. At palpation, bilateral cervical and inguinal adenopathies were detected, blood pressure within range, tachycardic, tachypneic but with oxygen saturation of 94% at room-air and a body temperature of 36.8°C. The laboratory tests reported anemia and thrombocytopenia, hyponatremia and an antigen-antibody test positive to HIV. A skin biopsy from skin violaceous lesions in forehead reported a positive result for Human Herpes Virus 8, within the next 48 hours the patient started with fever and hypoxemia (So<sub>2</sub>&nbsp;84%), antibiotic therapy was started with levofloxacin under suspicion of bacterial pneumonia, within the next day the patient presented hemoptysis; thus, a bronchoscopy was ordered. During the bronchoscopy the patient exhibited hypotension, despite intravascular fluid resuscitation; the patient entered cardiac arrest with no response to cardiopulmonary resuscitation.</p> Luis Alberto Pérez-Arredondo Jorge Rafael Violante-Cumpa Copyright (c) 2020-07-20 2020-07-20 36 1 La grossesse en hémodialyse chronique: à propos de 25 cas survenus dans le Sud Tunisien <p><strong>Introduction:&nbsp;</strong>la survenue de grossesse au cours de l´hémodialyse chronique est rare. Néanmoins, avec l´évolution des techniques de dialyse, une amélioration de la fertilité est possible. Le but de notre travail est de rapporter notre expérience concernant la survenue d'une grossesse chez les patientes dialysées et de dégager les facteurs impliqués dans sa réussite.</p> <p><strong>Méthodes:&nbsp;</strong>notre étude rétrospective a porté sur 25 grossesses spontanées survenues chez 19 patientes traitées par hémodialyse périodique dans différents centres d´hémodialyse du sud tunisien sur une période de 34 ans.</p> <p><strong>Résultats:&nbsp;</strong>l´âge maternel de survenue de grossesse était en moyenne égal à 35,6 ans [23-44ans] avec une ancienneté moyenne en hémodialyse de 4,22 ans [1-17 ans]. Sept patientes (37%) avaient une diurèse résiduelle (&gt;500 ml/24h). Le volume horaire hebdomadaire de dialyse était ≥16 heures par semaine dans 7 cas et ≥20 heures dans 4 cas. Le succès de la grossesse (nouveau-né survivant au moins 28 jours) était estimé à 56%. L´âge gestationnel médian était de 34 semaines d´aménorrhée [28-38 SA]. Le poids néonatal moyen est égal à 1970g [1500g-2300g]. L´étude analytique a montré une corrélation significative entre l´augmentation des heures de dialyse par semaine et la réussite de la grossesse (R= 0,59; p= 0,002).</p> <p><strong>Conclusion:&nbsp;</strong>on souligne qu´avec une prise en charge adéquate et notamment la majoration du nombre de séances de dialyse, les complications materno-fœtales peuvent être minimisées et la balance risque-bénéfice vire vers donner la chance à une femme dialysée de devenir maman.</p> Hanen Chaker Slim Masmoudi Salma Toumi Najla Dammak Jamil Hachicha Khawla Kammoun Soumaya Yaich Mohamed Ben Hmida Copyright (c) 2020-07-20 2020-07-20 36 1 Comment on “Dermatitis herpetiformis in an African woman”, the importance of direct immunofluorescence assay <p>This a reply letter to Machona MS et al.'s work. Authors describe a case of dermatitis herpetiformis (DH) solved after a gluten-free diet, associated to dapsone treatment. According to guidelines, in patients with clinical and/or histopathological findings suggestive for DH, a direct immunofluorescence (DIF) assay on perilesional skin, together with anti-tissue transglutaminase antibody dosage, are mandatory for a correct diagnosis. DIF remains the gold standard for DH diagnosis. This examination was not performed by authors, as well as serological parameters. Since autoimmune blistering skin diseases comprise different entities, a correct diagnosis is needed for accurate treatment and follow-up. In our opinion, the diagnosis in this case could be consistent with linear IgA bullous dermatosis more than DH, and the clinical and histopathological examinations could not be considered criteria sufficient enough to establish a diagnosis of DH.</p> Alice Verdelli Marzia Caproni Copyright (c) 2020-07-20 2020-07-20 36 1 Trends and factors associated with acute respiratory infection among under five children in Zambia: evidence from Zambia´s demographic and health surveys (1996-2014) <p><strong>Introduction:&nbsp;</strong>acute respiratory infection (ARI) is one of the leading causes of morbidity and mortality among children under the age of five years globally accounting for 16% of deaths. In Zambia, ARI accounts for 30-40% of children's outpatient attendance and 20-30% of hospital admissions. We assessed trends and factors associated with ARI among under-five children in Zambia from 1996 to 2014.</p> <p><strong>Methods:&nbsp;</strong>we analysed the Zambia demographic and health survey data for 1996, 2002, 2007 and 2014 of under five children and their mothers. We extracted data using a data extraction tool from the women's file. We analysed trends using chi square for trends. We conducted a complex survey multivariable logistic regression analysis, reported adjusted odds ratios (AOR) 95% confidence intervals (CI) and p-values.</p> <p><strong>Results:&nbsp;</strong>we included a total of 6,854 and 2,389 (8%) had symptoms consistent with ARI. A 2% upward trend was noted between the 1996 and 2002 surveys but a sharp decline of 10% occurred in 2007. The chi2 trend test was significant p &lt; 0.001. Children whose mothers had secondary or higher education were less likely to have ARI (AOR 0.30 95% CI 0.15-0.58) compared to those with no education. Underweight children had 1.50 times increased odds of having ARI (AOR 1.50 95% CI 1.25 - 1.68) compared with children who were not. Use of biomass fuels such as charcoal (AOR 2.67 95% CI 2.09 - 3.42) and wood (2.79 95% CI 2.45 -3.19) were associated with high odds for ARI compared to electricity.</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of ARI has declined in Zambia from 1996 to 2014. Factors associated with occurrence of ARI included being a child under one year, underweight, use of biomass fuel such as charcoal and wood. Interventions to reduce the burden of ARI should be targeted at scaling up nutrition programs, as well as promoting use of cleaner fuels.</p> Nelia Langa Mulambya Francis Hamaimbo Nanzaluka Ntazana Nana Sinyangwe Mpundu Makasa Copyright (c) 2020-07-20 2020-07-20 36 1 Diabetes knowledge among non-diabetic hypertensive patients in Calabar, Nigeria <p><strong>Introduction:&nbsp;</strong>among hypertensive patients, the comorbidity of diabetes is not uncommon. Yet, little is known about diabetes prevention among non-diabetic hypertensive patients. This study sought to assess such patients' knowledge about diabetes and its risk factors.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional descriptive study design and random sampling were used to recruit non-diabetic hypertensive patients from University of Calabar Teaching Hospital. A pretested 33-item questionnaire was used to assess various aspects of diabetes knowledge. Participants' alcohol consumption, smoking habits, physical activity, and fresh fruit consumption were also assessed. The p-value was set to 0.05.</p> <p><strong>Results:&nbsp;</strong>of 212 respondents with a mean age of 45.5 ± 10.8 years, approximately half (49.1%) had inadequate knowledge of diabetes. Most participants demonstrated poor knowledge of diabetes' clinical features (81.1%) and complications (59.4%), while fewer participants showed poor knowledge of causes and risk factors (24.5%) and diabetes management (40.6%). Older subjects, those in the wards, non-drinkers, physically active people, and those who frequently consumed fresh fruit had a significantly greater understanding of diabetes symptoms and complications (p&lt;0.05).</p> <p><strong>Conclusion:&nbsp;</strong>hypertensive patients' diabetes knowledge is generally suboptimal, with greater knowledge deficiencies being apparent in specific areas. More strategic health education initiatives are required, about minimizing the risk of developing diabetes comorbidities.</p> Ofem Egbe Enang Ogban Ezukwa Omoronyia Agam Ebaji Ayuk Kenneth Nnachetam Nwafor Anette Oshioagiemhe Legogie Copyright (c) 2020-07-20 2020-07-20 36 1 Myocarditis associated with campylobacter jejuni colitis: a case report <p>Myocarditis is a rare complication of acute diarrhea due to Campylobacter Jejuni infection. We present the case of 25-year-old male who presented with campylobacter jejuni colitis who subsequently had chest pain and elevated cardiac biomarkers. The patient developed acute myocarditis confirmed on cardiac magnetic resonance imaging.</p> Oussama Daboussi Salamata Diallo Boundia Djiba Mamadou Ngoné Gueye Copyright (c) 2020-07-21 2020-07-21 36 1 Large pedunculated colonic lipoma: a rare cause of colorectal intussusception in adults <p>Colo-rectal intussusception is rare in adults and is often secondary to malignant lesions, rarely benign lesions such as colonic lipomas can also be the cause. We present the case a 60-year-old man who presented to the emergency department with acute abdominal pain. On physical examination, the abdomen was distended with diffuse tenderness. CT scan of the abdomen revealed a colo-rectal intussusception secondary to a rectal lipoma with parietal pneumatosis of the invaginated loop. An emergency laparotomy was performed. Intraoperatively the radiological findings were confirmed. A rectosigmoid resection (Hartmann's procedure) taking off the lipoma and the invaginated segment of the colon was performed and the patient had an unevent full recovery. Histopathology confirmed a 6cm sub-mucosal lipoma without evidence of malignancy. As the diagnosis of a benign disease in patients presenting with colonic intussusception can only be made on pathological examination, this entity should be managed as a malignant lesion due to the high incidence of malignancy.</p> Hakim Zenaidi Imen Ben Ismail Fatma Rekik Mouelhi Aziz Saber Rebii Ayoub Zoghlami Copyright (c) 2020-07-21 2020-07-21 36 1 Unrecognized Ebola virus infection in Guinea: complexity of surveillance in a health crisis situation: case report <p>The ebola epidemic that raged in West Africa between 2013 and 2016 was the largest since the discovery of the virus in 1976. During this epidemic, more than 11,000 cases were notified with a lethality of over 67%. Several means of transmission have been described. The great difficulty noted during the epidemic was the estimation of the number of asymptomatic and paucisymptomatic cases, however there is evidence that this population has been in contact with the virus for some time. Thus, they could be a source for the spread of the epidemic. In this paper, we report in Guinea-Conakry three stories of probable pauci-symptomatic form of ebola disease that would have been the cause of massive infection in a population sorely tried by the epidemic between 2014 and 2015 in Guinea.</p> Ibrahima Camara Mamadou Saliou Sow Abdoulaye Touré Bakary Oularé Elhadj Ibrahima Bah Salifou Talassone Bangoura Alioune Camara Alpha Kabinet Keita Copyright (c) 2020-07-21 2020-07-21 36 1 Un cas marocain d’érythrophagocytose blastique et LAL T de novo sans anomalie cytogénétique <p>L´érythrophagocytose blastique correspond à une hyperactivation des blastes. L´érythrophagocytose est retrouvée dans les hémopathies myéloïdes surtout avec la t (8;16). Dans ce travail nous présentons un cas exceptionnel d´érythrophagocytose blastique au cours d´une leucémie aigue lymphoblastique T sans anomalies cytogénétiques. A.Z âgée de 19 ans, l´examen à l´admission a trouvé un syndrome fébrile avec des vertiges et phosphènes, un syndrome tumoral avec une hypertrophie amygdalienne et gingivale. L´hémogramme a objectivé une hyperleucocytose (399,5 G/L), avec une anémie arégénérative (Hb: 9,3 g/dl) et thrombopénie (plaquettes: 40 G/L). Le myélogramme a montré 90% des blastes (MPO négative) avec des images d´érythrophagocytose blastique. L´immunophénotypage a confirmé une LAL T. L´analyse cytogénétique était normale. L´érythrophagocytose blastique dans une LAL T semblerait être une entité distincte nécessitant la précision de l´impact de ces images sur le diagnostic, le pronostic voir même le traitement des LAL T.</p> Sophia Kahouli Hafid Zahid Mohamed El khorassani Saâd El kabbaj Majid Benkirane Nezha Messaoudi Copyright (c) 2020-07-22 2020-07-22 36 1 Affects de la mère pendant la grossesse, relation mère-bébé, santé et développement du nourrisson à Kinshasa <p><strong>Introduction:&nbsp;</strong>le rôle de l´affectivité maternelle prénatale dans le développement du nourrisson est peu documenté dans notre milieu. L´objectif de cette étude était de déterminer les liens entre les sentiments de la mère à la connaissance de la grossesse, la peur de l´accouchement, la relation mère-bébé et le développement du nourrisson.</p> <p><strong>Méthodes:&nbsp;</strong>en consultations préscolaires à Kinshasa, 120 mères âgées de 28,4 ans (± 12,18 ans), portant des bébés de 1 à 10 mois, ont participé à une étude transversale, par entretien et questionnaire, sur la relation mère-bébé, le comportement, la santé et le développement du bébé et l´affectivité maternelle. Les échelles de dépression maternelle postnatale d´Edimbourg (l´EPDS), de dépression et anxiété de Goldberg et les critères DSM-IV de dépression ont été utilisées. Il y a eu recours aux tests de Khi-carré et Mann-Whitney dans l´analyse statistique.</p> <p><strong>Résultats:&nbsp;</strong>l´absence de joie relative à la grossesse était associée à la grossesse non désirée (p&lt;0,001) , l´absence du soutien du père de l´enfant (p=0,011), l´ennui au portage du bébé frustré (p=0,046), la conso labilité difficile du bébé (p&lt;0,001), le comportement non affiliatif du bébé né d´une grossesse désirée (p=0 ,034), la santé infantile moins bonne (p=0 ,010) et la dépression maternelle (EPDS) (p=0,043). La peur de l´accouchement était associée au déficit de réponses aux signaux du bébé (p=0 ,002) et la tension au portage du bébé frustré (p=0,02).</p> <p><strong>Conclusion:&nbsp;</strong>les affects négatifs pendant la grossesse prédiraient des troubles de la relation mère-bébé, de la santé et du développement du nourrisson.</p> Daniel Okitundu Luwa E-Andjafono Brigitte Imbula Essam Adelin N´situ Mankubu Ally Ndjukendi Omba Timothée Kamanga Mbuyi Copyright (c) 2020-07-22 2020-07-22 36 1 Perceptions of Nigerian healthcare workers towards hand hygiene: a qualitative study <p><strong>Introduction:&nbsp;</strong>hand hygiene (HH) is an effective measure to reduce healthcare-associated infections and the growing burden of antimicrobial resistance. There is a need to understand the perceptions of healthcare workers towards its practice and the use of alcohol-based hand rubs (ABHR) to make recommendations to promote HH. Our study aimed to explore the perceptions of Nigerian healthcare workers towards HH and the use and availability of ABHR to suggest potential interventions to improve its practice as qualitative evidence in this field is limited in Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a qualitative study design was utilized to understand the perceptions of healthcare workers towards HH and the use of ABHR at Adeoyo Maternity Hospital, Ibadan, Nigeria. Purposive sampling was used to recruit nineteen healthcare workers who were interviewed. Thematic content analysis was used to analyze the data generated.</p> <p><strong>Results:&nbsp;</strong>five themes emerged including discrepancies in what constitutes HH practice as participants, motivation for HH practice, a good knowledge of timing as regards practice, barriers to good practice and evidence of poor practice.</p> <p><strong>Conclusion:&nbsp;</strong>while many healthcare workers know about HH and self-reported compliance towards it seems to be high, knowledge gaps, lack of resources, absence of regulations and poor working conditions were impediments to the successful implementation of HH practices. We recommend that hospitals institute well-articulated HH regulations, continuous education and training of healthcare workers. Hospitals should also ensure adequate provision of resources for hand hygiene and institute a continuous monitoring and feedback program to evaluate compliance with regulations.</p> Jude Nwaokenye Sulaiman Lakoh Julia Morgan Copyright (c) 2020-07-22 2020-07-22 36 1 Unexpected delivery: a case report of cryptic pregnancy in Nigeria <p>The etiology of cryptic pregnancy has not been fully elucidated and there exist misconceptions about this phenomenon in our contemporary Nigerian society. This case presents the first case report of cryptic pregnancy in sub-Saharan Africa. A case of a 19 year old overweight female student who presented to the sick bay at 01:30 hours with a 3-day history of lower back pain, abdominal discomfort and constipation. At the sick bay the general practitioner on call asked if she was pregnant and she vehemently said no, recounting that she sees her menstruation regularly. Abdominal examination however, revealed a gravid uterus of about 36 weeks and vaginal examination showed a fully dilated cervix. She was surprised, terrified and confused and only remembered having unprotected sexual intercourse many months earlier. Barely two hours later, she gave birth via spontaneous vaginal delivery, to a live female infant at 03:14 hours. This case emphasizes the need for general practitioners and specialists in sub-Saharan Africa to be aware of the phenomenon of cryptic pregnancy, which involves women not being conscious of their gravid state until final weeks of gestation or at delivery, to reduce neonatal and maternal complications.</p> Uloaku Akubueze Nto-Ezimah Nto Johnson Nto Emmanuel Anayochukwu Esom Chika Juliet Okwor Charles Adiri Copyright (c) 2020-07-22 2020-07-22 36 1 Expedited COVID-19 vaccine trials: a rat-race with challenges and ethical issues <p>The intense global efforts are directed towards development of vaccines to halt the COVID-19 virus pandemic. There are 160 candidate vaccines under clinical trials across the world using different molecular targets and techniques. This race for the vaccine has several challenges and ethical issues like compressed timelines, generation and proper management of resources and finances, risks to the participating volunteers due to curtailed research trial processes, geopolitical contentions, misinformation through social media and parallel race with drugs. We feel that the fundamental principles of ethics: autonomy, beneficence, non-maleficence and justice should not be violated in this hastened vaccine development process. We recommend constitute a Consortium on a global platform to formulate, provide and monitor a comprehensive ethical umbrella to the process of vaccine development.</p> Prathamesh Haridas Kamble Siddharth Pramod Dubhashi Copyright (c) 2020-07-22 2020-07-22 36 1 Knowledge, attitudes and perceptions regarding malaria: a cross-sectional study in pregnant women attending antenatal care in the New-Bell district hospital, Douala, Cameroon <p><strong>Introduction:&nbsp;</strong>malaria remains a major public health problem in Cameroon. For a successful malaria control, there is a need to evaluate the level of awareness, attitude and perception of people living in malaria endemic areas such as the swampy littoral region of Cameroon.</p> <p><strong>Methods:&nbsp;</strong>this was a descriptive cross-sectional study targeting pregnant women attending ANC in the New-Bell District Hospital. Data was collected with a semi-structured questionnaire on demographic characteristics as well as knowledge, attitudes and practices regarding malaria.</p> <p><strong>Results:&nbsp;</strong>two hundred and six pregnant women were enrolled in the study, all of them had heard on malaria in the past, with hospitals and television been the most known information dissemination channels. Only 60.2% of them own and used a LLINs with only 51.6% of owners treating the net.</p> <p><strong>Conclusion:&nbsp;</strong>respondents with no education had poor knowledge on malaria. There is a need to improve education on malaria with active participation of women and improve malaria surveillance that will lead to malaria eradication.</p> Corine Blondo Kangmo Sielinou Damian Anong Samuel Nambile Cumber Rosaline Yumumkah Cumber Theresa Nkuo-Akenji Copyright (c) 2020-07-22 2020-07-22 36 1 Implementing the 2013 WHO diagnostic criteria for gestational diabetes mellitus in a Rural Nigerian Population <p><strong>Introduction:&nbsp;</strong>the World Health Organization (WHO) reviewed the threshold values required for the diagnosis of Gestational Diabetes Mellitus (GDM) in 2013 and the implementation of the new diagnostic criteria have been associated with increase in the prevalence of GDM in some populations. The new cohort of pregnant women that will be labeled to have GDM by the 2013 WHO diagnostic criteria but not by the 1999 WHO diagnostic criteria will pose additional burden to specialized antenatal care, though their pregnancy outcome may not warrant such care. It is thus important to first determine the effect of the implementation of these new consensus diagnostic criteria on the prevalence of GDM in our environment.</p> <p><strong>Methods:&nbsp;</strong>this is a prospective hospital-based study that compared the implementation of both 1999 and 2013 WHO GDM diagnostic criteria among 117 pregnant women who were initially screened with 50-gram Glucose Challenge Test (50-g GCT). Women with a positive Glucose Challenge Test (GCT) result underwent a 75-gram Oral Glucose Tolerance Test (75-g OGTT), which was used as the actual diagnostic test for GDM using both 2013 WHO and 1999 WHO diagnostic criteria. Associations between variables were tested using Chi-square, Fisher's exact and t-test as appropriate. Significance level was set at P value &lt; 0.05.</p> <p><strong>Results:&nbsp;</strong>the prevalence rates of GDM in the study were 2.6% and 7.7% for 1999 WHO and 2013 WHO criteria respectively. Clinical characteristics were similar in women with GDM and women without GDM. The fasting component of the OGTT identified all the women with GDM.</p> <p><strong>Conclusion:&nbsp;</strong>the implementation of the 2013 WHO diagnostic criteria is associated with a 2.5 to 3-fold rise in the prevalence of GDM. Selective risk-factor based screening may be clinically irrelevant with the adoption of the 2013 WHO diagnostic criteria. A minimum of fasting plasma glucose in resource poor settings can be considered to identify women with GDM since it appeared to have 100% sensitivity in our study.</p> Ayokunle Moses Olumodeji Raymond Akujuobi Okere Idowu Oluwaseyi Adebara Gbadebo Oladimeji Ajani Olumide Emmanuel Adewara Segun Murtala Ghazali Ufuoma Oluwaseyi Olumodeji Copyright (c) 2020-07-22 2020-07-22 36 1 An unusual evolution of a partitioned post tubercular meningitic hydrocephalus <p>Post meningitic hydrocephalus occurs in 20 to 70% of bacterial or BK meningitis in infants and are responsible for a severe neuropsychic sequelae, the compartmentalized forms are seen in less than 2% of cases, and can pose therapeutic difficulties for drainage of large or multiple partitions. Calcification, rather a mode of involution of the fleshy lesions, is an unusual evolutionary mode of partitioned hydrocephalus. We report the case of a 26 years old man, treated at the age of six months for compartmentalized hydrocephalus on tuberculous meningitis with a good outcome under VPS. Recent cerebral magnetic resonance imaging (MRI) and computed tomography (CT) scan (A,B,C and D) after an epileptic episode found a sequellar ventriculomegaly in addition to an intracerebral, right occipital, cystic formation with complete calcification of the wall, revealing an exceptional evolutionary mode of compartmentalized hydrocephalus. Given the good control of epilepsy under medical treatment, the surgical indication was not retained.</p> Hilal Abboud Abdessamad Elouahabi Copyright (c) 2020-07-23 2020-07-23 36 1 Impact of neoadjuvant chemotherapy in improving operative intervention in the management of cervical cancer in low resource setting: a preliminary report <p>There is paucity of data on interventions to improve cancer outcome in the low-resource setting. This study aims to determine the effect of Neoadjuvant Chemotherapy (NACT) in improving operative outcomes of cervical cancer. This was a longitudinal intervention study of patients diagnosed with FIGO stage IIB - IIIA cervical cancer that had NACT. Patients were re-evaluated after treatment with 4 cycles of chemotherapy for operability. McNemar test was used to determine changes in operability of the tumour. There was a significant difference in the number of patients that converted from inoperable to operable tumor post-chemotherapy. This study shows some promise for NACT for FIGO stage IIB - IIIA cancer of the cervix, especially in low-resource settings, where radiotherapy is scarce.</p> Theophilus Ogochukwu Nwankwo Uchenna Anthony Umeh Uzochukwu Uzoma Aniebue Justus Uchenna Onu Chioma Roseline Umeh Copyright (c) 2020-07-23 2020-07-23 36 1 Complete cervical agenesis: successful surgical treatment: one case report <p>Cervical agenesis is a rare congenital pathology linked to an abnormality in the development of the Mullerian system, the mechanism of this anomaly is unknown. We reported a case of complete cervical agenesis in a 17-year-old girl who underwent a successfully utero-vaginal anastomosis.</p> Soumaya Kraiem Olfa Zoukar Asma Hnayin Ahmed Zouari Raja Faleh Anis Haddad Copyright (c) 2020-07-23 2020-07-23 36 1 Journal response types and times: the outcomes of manuscripts finalised for submission by the University of the Free State School of Medicine medical editor, South Africa <p><strong>Introduction:&nbsp;</strong>health professionals are involved in research as researchers themselves and as supervisors to undergraduate and postgraduate students. Authors may have unrealistic expectations regarding journal submission and review processes. The study aimed to describe journal response types and times for manuscripts finalised for submission by the University of the Free State School of Medicine medical editor.</p> <p><strong>Methods:&nbsp;</strong>this descriptive cohort study with an analytical component included all manuscripts finalised for submission to accredited journals by the medical editor, 2014-2017. Excel spreadsheets capturing all stages of the manuscript process were used to confidentially note information regarding submission and subsequent journal responses.</p> <p><strong>Results:&nbsp;</strong>ninety-five manuscripts were submitted to 72 peer-reviewed accredited journals. The total number of submissions was 163. Only 46 (48.4%) manuscripts were accepted by the first journals submitted to. Rejected submissions (n=82) had a median journal response time of 15.5 days (range 0-381 days), with a third being sent for review. Nine manuscripts were accepted with no revisions needed. Accepted submissions (n=72) had a median of one round of revision (range 0-4 rounds), and a median time of 119.5 days (range 0-674 days) from submission to final acceptance.</p> <p><strong>Conclusion:&nbsp;</strong>within our setting, half of first submissions were unsuccessful, but rejection usually occurred rapidly. Acceptance for publication occurred at a median time of 4 months after one round of revision. If health professionals were made aware of expected outcomes and response times, it may prevent authors from falling victim to the publication practices of predatory journals.</p> Gina Joubert Theanette Mulder Wilhelm Johannes Steinberg Johan Botes Copyright (c) 2020-07-24 2020-07-24 36 1 The organizational challenges in the management of the revised national tuberculosis control program of India: an overview <p>The developing world is facing a serious problem of tuberculosis (TB) since ages. The condition is really profound in resource-constrained countries. The situation in some of the high TB burden countries is so grave that there are huge numbers of TB patients and deaths due to TB. TB control in most of the countries is done by the national TB control programs. In India, this is popularly known as the Revised National Tuberculosis Control Program (RNTCP). The RNTCP comes under the umbrella of the national health mission. The main components of RNTCP are directly observed treatment, short-course (DOTS) and DOTS-Plus. The effective and adequate implementation of the RNTCP is the most effective solution to control the ever growing cases of TB. The present situation, as detailed in the WHO global annual TB report, with ever-rising cases of various categories of TB is really scary and demands prompt attention. In this paper, the authors highlight the important issues related to the RNTCP in India. The main motto of writing this paper was to address the challenges associated with the organizational structure of the national TB control program of India and to suggest solutions for the same. The authors believe that these challenges could pose a serious threat to the efforts aimed at TB elimination from India. Besides, this paper will serve as a tool to modify and/or to formulate new guidelines for the betterment of the program. Also, the challenges detailed here are usually common in the other high TB burden countries of the world and this will help the program managers worldwide.</p> Sankalp Yadav Gautam Rawal Copyright (c) 2020-07-24 2020-07-24 36 1 A rare case of a giant placental chorioangioma with favorable outcome <p>Chorioangioma is the most common type of placental tumor. A primigravida woman was noted on routine scan at 21 weeks of gestation to have a placental mass measuring 1.8 x 2.2cm. A detailed ultrasound scan revealed a well circumscribed, hypoechoic lesion protruding into the amniotic cavity; hence a preliminary diagnosis of placental chorioangioma was made and close prenatal surveillance was scheduled. At 34 weeks of gestation, the mass was measuring 6.27 x 5.38cm. The patient experienced reduced fetal movements at 37 weeks gestation. A small-for-gestational age but normal female neonate was delivered by caesarean section. Histopathological analysis of the placenta confirmed the diagnosis. According to our case, a giant placental chorioangioma may have a favorable outcome without any medical intervention.</p> Konstantinos Zacharis Stavros Kravvaritis Theodoros Charitos Eleni Chrysafopoulou Anastasia Fouka Copyright (c) 2020-07-24 2020-07-24 36 1 Giant squamous cell carcinomas of the shoulder <p>Giant squamous cell carcinomas (SCC) larger than 5 cm in diameter are uncommon; there is no guideline on the size of an SCC that is considered giant. Treatment may be difficult with the need for large tissue resections and complex surgical reconstruction. We report a rare case of giant squamous cell carcinoma of the shoulder attached to deep anatomic planes. The entire mass was removed, resulting in a large defect that was repaired with myocutaneous flap rotation of the&nbsp;<em>latissimus dorsi</em>. Three courses of radiotherapy were performed after surgery. Fifteen months after the operation, the patient is well and working without any local recurrence and metastasis.</p> Mounir Yahyaoui Najib Abbassi Abdelhafid Derfoufi Abdelkarim Daoudi Omar Agoumi Hicham Yacoubi Abdeljaouad Najib Badr Serji Tijjani Elharroudi Nabil Mouzouri Siham Dikhaye Nada Zizi Hanane Hadjkacem Copyright (c) 2020-07-27 2020-07-27 36 1 Pre-eclampsia with severe features: management of antihypertensive therapy in the postpartum period <p><strong>Introduction:&nbsp;</strong>there is variance in both the types and combinations of antihypertensive drugs used for managing pre-eclampsia in the postpartum period. Knowledge of the most common and suitable single or combination antihypertensive drug therapies in the postpartum period will minimize harmful effects, promote adherence to medications, overcome any fears that lactating mothers may have about these drugs and will assist in healthcare planning. Objective: to determine the types of antihypertensive drug therapies used in managing pre-eclampsia with severe features (sPE) in the postpartum period in a regional hospital in South Africa.</p> <p><strong>Methods:&nbsp;</strong>fifty consecutively presenting pregnant women with sPE were followed up prospectively from the pre-delivery period (within 48 hours before delivery) until day 3 postpartum. The antihypertensive drug therapies administered to the participants were observed. Their blood pressures were measured daily at 04:00, 08:00, 14:00 and 22:00 hours.</p> <p><strong>Results:&nbsp;</strong>nifedipine was the commonest rapid-acting agent used for severe hypertension. Prepartum, 9 different combinations of antihypertensive drugs were prescribed; alpha-methyldopa was the commonest single long-acting agent used. Postpartum, the number of different drug combinations administered were 15, 18, 22 and 16 on days 0, 1, 2 and 3 respectively. Alpha-methyldopa was the commonest single agent used on postpartum days 0 - 2 while hydrochlorothiazide was the most frequently used single agent on postpartum day 3. Postpartum, the commonest combination therapy was alpha-methyldopa and amlodipine on day 0; alpha-methyldopa and amlodipine as a regimen as well as alpha-methyldopa, amlodipine and hydrochlorothiazide as another regimen on day 1; alpha-methyldopa and amlodipine on day 2; and many amlodipine-based regimens on day 3.</p> <p><strong>Conclusion:&nbsp;</strong>a variety of antihypertensive drug combinations were used in the postpartum period indicating the need for standardised guidelines; however, detailed studies are required to evaluate their efficacies completely.</p> Nnabuike Chibuoke Ngene Jagidesa Moodley Copyright (c) 2020-07-27 2020-07-27 36 1 C1-C2 instability in psoriatic arthritis <p>Cervical spine damage is common in psoriatic arthritis especially in older forms and it is rarely initiated by symptomatic atloid-axoid instability. Spinal involvement is frequently associated with sacroiliac dysfunction, the cervical spine involvement is observed in 35%-75% of cases with two types of radiological lesion. Upper cervical spine localization often manifests as C1-C2 arthritis, lower cervical spine involvement is manifested by syndesmophytes, ossification of the anterior longitudinal ligament and posterior inter apophyseal osteoarthritis. Our case is about a late onset upper cervical spine instability in a 45-year-old patient who has been treated for 20 years for rheumatism and has checked for paraesthesia's of the four limbs and gait difficulty that have been evolving over the last 3 months and the outcome of this case is that a C1-C2 instability must be systematically checked for in view of the appearance of deficient signs.</p> Teka Maher Zaier Akram Yassine Ben Hnia Majdi Naouar Nader Copyright (c) 2020-07-27 2020-07-27 36 1 Extensive drug resistant (XDR) Acinetobacter baumannii parappendicular-related infection in a hydrocephalus patient with ventriculoperitoneal shunt: a case report <p>Ventricular infection due to XDR-<em>Acinetobacter baumanii</em>&nbsp;(<em>A. baumanii</em>) is the most severe complication after neurosurgery which associated with high morbidity and mortality. Managing&nbsp;<em>A. baumanii</em>&nbsp;ventriculitis/shunt infection and multiple brain abscesses is challenging since its nature that tends to be pandrug resistant to all antibiotics used. Thus, we present the first such case with problems in administration based on the available data.</p> Cucunawangsih Cucunawangsih Akhil Deepak Vatvani Kalis Waren Copyright (c) 2020-07-27 2020-07-27 36 1 Classical pellagra, the disease of 4 Ds, the forgotten entity <p>Pellagra is a nutritional disorder due to deficiency of vitamin niacin (vitamin-B3) or its precursor tryptophan, which was first described by a Spanish physician, Gaspar Casal (1735AD). Classically, it manifests with triad of diarrhea, dermatitis and dementia and if not treated in time leading to death. Thus, it´s a disorder affecting the skin, nervous system, and gastrointestinal. It is commonly associated with malnutrition and alcoholism. It´s mostly found in some areas of India, China, and Africa where corn is used as a staple food and poverty supervenes. We present a case of a middle-aged male clinically diagnosed to 3Ds of pellagra and successfully treated with vitamin B3 supplementation to prevent the fourth D i.e. death. A forty-two-year farmer from hilly area of central Nepal, presented with pruritic and eczematous skin lesions over dorsum of hands and forearms, face, neck (A) and lower leg with mild confusion state and diarrhea of 2 months duration. There was no history of fever, seizures or jerky movements or weakness of limbs. His family was on stable diet of maize and was also an occasional alcohol consumer. Laboratory investigation revealed mild anemia and serum niacin level was found to be low. The diagnosis of a classical pellagra was established. We supplemented with combination of vitamin B complex with higher dose of niacin with abstaining him from alcohol and providing niacin rich diet. The condition improved within a period of two weeks and two months of follow up, most of his signs and symptoms were subsided (B).</p> Vikash Paudel Deepa Chudal Copyright (c) 2020-07-27 2020-07-27 36 1 Blastomycose pulmonaire <p>La blastomycose est une maladie fongique rare en Afrique, due souvent à l´inhalation de «&nbsp;<em>Blastomyces dermatitidis</em>&nbsp;». La forme pulmonaire est la manifestation clinique la plus fréquente, pouvant aller de la forme asymptomatique jusqu´à la forme rapidement mortelle. Nous rapportons l´observation d´un patient tunisien âgé de 35 ans sans antécédents médicaux, hospitalisé pour une toux chronique, des douleurs basithoraciques bilatérales, fièvre et un amaigrissement. L´examen clinique a objectivé la fièvre ainsi qu´une tuméfaction sous cutanée para-vertébrale gauche en regard de la dixième vertèbre thoracique (T10). L´imagerie thoracique a objectivé des opacités alvéolaires et nodulaires bilatérales excavées par endroit. La recherche de bacille de Koch (BK) dans les expectorations était négative à l´examen direct et à la culture. La fibroscopie bronchique était normale. L´étude anatomopathologique de la biopsie de la masse dorsale a conclu à une blastomycose et le diagnostic a été confirmé par le résultat des cultures des fragments biopsiques de la masse sus décrite. Un traitement antifongique à base d´itraconazole a été instauré avec une amélioration clinique et radiologique. Ce cas illustre la difficulté diagnostique que peut poser la blastomycose, notamment, avec la tuberculose dans notre pays, d´où le retard thérapeutique.</p> Fatma Chermiti Ben Abdallah Imène Bachouch Nidhal Belloumi Marwa Kacem Mouna Mlika Faouzi El Mezni Soraya Fenniche Copyright (c) 2020-07-28 2020-07-28 36 1 Dual right coronary artery: an unconventional presentation from Pakistan <p>There is a significant variation in the mapping of epicardial coronary arteries. This variation may present as different anomalies. These anomalies are usually asymptomatic and can be present at birth. Some might become symptomatic during adulthood and subsequently, result in sudden death. The anomalies, in turn, present a challenge to clinicians during therapeutic intervention. Therefore, there is a growing need to have knowledge about the various forms of the coronary artery anomalies. In our case report, we present the case of a patient who had one such anomaly and provide a hint at one strategy that was used to tackle the challenge.</p> Jahanzeb Malik Nismat Javed Copyright (c) 2020-07-28 2020-07-28 36 1 Painful testicular swelling: an unusual localization of sarcoidosis <p>Sarcoidosis is a systemic inflammatory disease characterized by non-caseating epitheloid granulomas; whereas it usually involves the lungs and lymph nodes. Testicular sarcoidosis is extremely rare, having been reported to occur in 0.2% of all sarcoidosis patients. We describe a very unusual form of sarcoidosis of the testis, mimicking malignancy at initial presentation.</p> Karima Bouytse Hanane Haddaoui Jouda Benamour Jamal-Eddine Bourkadi Copyright (c) 2020-07-28 2020-07-28 36 1 An unusual cause of large bowel obstruction: are we aware of this? <p>Primary lymphomas of the colon account for 0.5% of all primary colon malignancies. Burkitt´s lymphoma is a B-cell lymphoma with aggressive clinical behavior. Herein, we describe a case of a male patient who presented with signs of large bowel obstruction, underwent surgery and found to suffer from Burkitt´s lymphoma of the ileocecal region. The histopathological examination was indicative for Burkitt´s lymphoma. To the best of our insight this is one of the few reported cases of such type of lymphoma in an adult patient presenting with bowel obstruction. Burkitt´s lymphoma is a rare malignancy in adults affecting gastrointestinal tract. It has a high proliferation potential and can rapidly progress to advanced disease. Early diagnosis is necessary to prevent complications and improve overall prognosis.</p> Maria Sotiropoulou Nikolina Stavrinou Michail Vailas Paraskevi Alexakou Michail Psarologos Panagiotis Metaxas Michael Economou Christine Vourlakou Stylianos Kapiris Copyright (c) 2020-07-28 2020-07-28 36 1 Polymorphic erythema associated with mycoplasma pneumoniae <p>Male child, 6 and a half years old, followed for psychomotor delay from the age of 2 years with diagnosis of epilepsy put on sodium valproate for 3 years and in the absence of seizure control carbamazepine was added 2 months before admission. The patient had presented 5 days before his consultation a generalized erythematous rash with edemas of two lower limbs, a dry cough and a fever. He was initially treated as a meningococcemia. On skin examination: generalized erythematous lesions with a rosette appearance, vesicular lesions in the lips. On admission to the service, the patient was put on acilovir, josamycin with discontinuation of carbamazepine. HSV 1 and 2 serology returned negative. Mycoplasma serology was positive for IgM and negative for IgG. The chest X-ray was normal. The skin biopsy was in favor of superficial dermatitis. The evolution was favorable with progressive disappearance of the lesions. Aciclovir was discontinued due to the rapid improvement and negativity of serology and josamycin was discontinued after 14 days of treatment. The general condition improved in 48 hours and the skin lesions disappeared in 15 days.</p> Leila Debono Naima El Hafidi Copyright (c) 2020-07-28 2020-07-28 36 1 Syndrome de la queue de cheval révélant une hydatidose vertébro-médullaire <p>L´hydatidose est une anthropozoonose due au développement chez l´homme de la forme larvaire de l´Echinococcus granulosus. Elle sévit surtout dans les régions rurales et d´élevages au niveau du bassin méditerranéen, l´Amérique du sud, proche et moyen orient. La localisation vertébrale est rare mais représente la forme la plus grave des localisations osseuses de l´hydatidose. Elle touche préférentiellement le rachis dorsal. Cette atteinte est grave vu le risque de compression médullaire. Nous illustrons le cas d´une patiente de 60 ans, admise pour lombo-radiculalgies paralysantes bilatérales mal systématisées, d´évolution progressive, associées à une impériosité mictionnelle. L´IRM a retrouvé une hydatidose vertébrale lombaire infiltrant les structures endo et extra-canalaires et comprimant les racines de la queue de cheval. La patiente a été opérée par voie postérieure et l´évolution a été favorable.</p> Imane Benabdallah Staouni Zineb Marzouki Meryem Haloua Youssef Alaoui Lamrani Meryem Boubbou Mustapha Maâroufi Badr-eddine Alami Copyright (c) 2020-07-28 2020-07-28 36 1 Congenital adrenal hyperplasia due to 11-Beta-hydroxylase deficiency in a Tunisian family <p>Congenital adrenal hyperplasia refers to a group of rare genetic disorders affecting the adrenal glands. 21-hydroxylase deficiency is the most prevalent and the most studied cause while the remaining enzymatic defects are less common, accounting for less than 10% of cases. We herein described the clinical, biological and molecular characteristics and outcome of patients of the same family diagnosed with 11-Beta-hydroxylase deficiency. The disorder was revealed by peripheral precocious puberty between the age of 2-3 years in males and by the virilization of the external genitalia in females. Genetics finding a homozygous p.Gly379Val mutation in the CYP11B1 gene. All patients received hydrocortisone supplementation therapy and mineralocorticoid-receptor antagonist. The females underwent a surgical correction of the ambiguous genitalia at the neonatal age. Long term follow-up revealed metabolic syndrome, obesity and hypertension in the first two patients, an impaired final height in the two females and hypokalemia in three patients.</p> Hamza Elfekih Asma Ben Abdelkrim Hajer Marzouk Ghada Saad Moez Gribaa Yosra Hasni Amel Maaroufi Copyright (c) 2020-07-28 2020-07-28 36 1 Health insurance and the financial implications of sickle cell disease among parents of affected children attending a tertiary facility in Lagos, south-west Nigeria <p><strong>Introduction:&nbsp;</strong>there is a paucity of data on the financial implications of sickle cell disease on households of affected children and their use of health insurance in Nigeria. This study assessed the awareness of health insurance, patterns of health service utilization and financial implications of sickle cell disease among children seeking care at a tertiary facility in Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a structured questionnaire was administered to parents of 314 children with sickle cell disease attending the pediatric hematology unit of the Lagos University Teaching Hospital between May and December 2019.</p> <p><strong>Results:&nbsp;</strong>mean age of the children was 91.5 ± 43.1 months. M:F was 1.17:1. 45.5% of households earned above NGN 150,000 (USD 417) monthly. 71.3% of the parents had heard of health insurance but only 20.7% were enrolled in a health insurance scheme. Awareness of health insurance was significantly associated with social class (p=0.000) and monthly household income (p=0.000). 60.8% of the parents preferred pre-facility treatment. Social class (p=0.01) and monthly household income (p=0.001) were significantly associated with home treatment. Time on admission ranged from 2-18 days with an average of 4.31 days. Average cost of hospitalization was USD 148 ± USD 14.2 and total cost of care incurred was USD 20,787. Neither age of child (p=0.857), estimated household income (p=0.863) nor social class (p=0.397) was associated with cost of care.</p> <p><strong>Conclusion:&nbsp;</strong>a high cost of care was observed in our study population underscoring the need for increased awareness and access to health insurance for households of children with sickle cell disease.</p> Chibuzor Franklin Ogamba Adeseye Michael Akinsete Henry Somtochukwu Mbaso Oluwagbemiga Ayomiposi Adesina Copyright (c) 2020-07-29 2020-07-29 36 1 Verrucous sarcoidosis: a diagnosis to keep in mind <p>Skin manifestations of sarcoidosis occur in up to 30% of cases, and may be the sentinel sign of the disease, with the skin being sometimes exclusively affected. While this may facilitate an early dermatologic diagnosis, heterogeneity in the cutaneous morphologies of sarcoidosis complicates recognition and affirms its reputation as a “great imitator”. Here, we present a case of a verrucous version of sarcoidosis that may be misdiagnosed because it can mimic other inflammatory and neoplastic skin disorders. Although it is a rare variant, its presence should alert clinicians to the likelihood of systemic involvement of cutaneous sarcoidosis.</p> Nadia Nabli Rima Gammoudi Amina Aounallah Badreddine Sriha Colandane Belajouza Mohamed Denguezli Copyright (c) 2020-07-29 2020-07-29 36 1 Autosomal dominant mutation of MSX1 gene causing tooth and nail syndrome <p>Tooth and Nail Syndrome or Nail Dysplasias with Hypodontiaor Witkop´s Syndrome is an autosomal dominant condition present at birth and improves by age. An early diagnosis is essential to avoid future functional, aesthetic, and psychological problems. Here we report two classic cases with brief clinical, radiological and genetic investigation along with a brief review of literature.</p> Mohammed Najmuddin Safeena Abdul Khader Saheb Abdulrahman Nahi Alharbi Fahad Mohammed Alsobil Chitra Jhugroo Aftab Ahmed Khan Darshan Devang Divakar Sachin Naik Sanjeev Balappa Khanagar Copyright (c) 2020-07-29 2020-07-29 36 1 Knowledge, attitude, practice and prevalence of traditional cauterization among patients in Massawa Hospital, Eritrea: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>use of traditional cautery for the treatment of varied ailments is one of the most ancient and harmful traditional medical practices that is still in use. This study was conducted to assess the knowledge, attitude, practice and to estimate the prevalence of traditional cautery among patients visiting Massawa hospital.</p> <p><strong>Methods:&nbsp;</strong>a hospital-based cross-sectional study was conducted in Massawa hospital from February 20 to April 20, 2019. The study enrolled all patients aged &gt;18 years, non-critical and willing to participate.</p> <p><strong>Results:&nbsp;</strong>a total of 900 participants were enrolled in the study. The study was dominated by Muslims (81.4%) with a median age of 42 years (IQR: 20). Self-reported prevalence of traditional cauterization was found to be 43.6% and 63% of them did their latest cautery between 2011 and 2019. Metal rods were used as cauterant in 92.3% and 47.9% reported that traditional practitioners used the same cauterant for different people. One-third of the respondents reported that it is a safe practice and 47% had the understanding that it cannot transmit communicable diseases. Moreover, 90.4% of the study participants reported that they knew someone who did cautery. Respondents with poor knowledge (AOR=6.45, 95% CI: 4.69-8.87) and attitude (AOR=8.68, 95% CI: 6.31-11.95) were more likely to practice cauterization compared to those with good knowledge and attitude.</p> <p><strong>Conclusion:&nbsp;</strong>the practice of cauterization in visitors of Massawa hospital was rampant which is mainly associated with poor knowledge and attitude of the respondents, limited access to health facilities and religious/cultural conviction.</p> Berhe Tesfai Adhanom Debesai Saliem Mekonnen Fnan Girmay Fitsum Kibreab Lemlem Hussien Mulugeta Russom Copyright (c) 2020-07-29 2020-07-29 36 1 Ovarian adenocarcinoma metastasis mimicking psoas abscess on imaging: a case report <p>Malignant psoas syndrome (MPS) is very rare with poor prognosis, and usually occurs in patients with advanced and recurrent cancer. Authors report herein the case of a 48-year-old female with history of neoadjuvant chemotherapy has been performed before hysterectomy with bilateral adnexectomy and ovariectomy for ovarian adenocarcinoma. She presented 18 months posttreatment with MPS due to a psoas abscess mimicking metastasis confirmed on computed tomography guided fine needle aspiration cytology.</p> Youssef Kharbach Siham Rachidi Alaoui Abdelhak Khallouk Copyright (c) 2020-07-29 2020-07-29 36 1 A novel variant of genotype 7b hepatitis C virus emphasizing viral hepatitis elimination challenges for sub-Saharan Africa <p>Sub-Saharan Africa has approximately 10.15 million people viraemic with chronic hepatitis C virus infection, extensive genotype and sub-genotype diversity is present, in addition to novel hepatitis C genotypes. Many of the unusual genotypes have extensive baseline resistance associated substitutions with direct acting antiviral therapy treatment outcome data, limited. We report a patient found to have a novel genotype 7b variant with extensive baseline resistance associated substitutions. There is a clear need for a better understanding of the virological characteristics of hepatitis C populations in sub-Saharan Africa to guide best optimal treatment decisions in national hepatitis C elimination programmes.</p> Mark Wayne Sonderup Heidi Smuts Catherine Wendy Spearman Copyright (c) 2020-07-30 2020-07-30 36 1 Antimicrobial resistance pattern, genetic distribution of ESBL genes, biofilm-forming potential, and virulence potential of Pseudomonas aeruginosa isolated from the burn patients in Tehran Hospitals, Iran <p><strong>Introduction:&nbsp;</strong>according to the studies performed, researchers considered&nbsp;<em>Pseudomonas aeruginosa (P. aeruginosa)</em>&nbsp;as the major cause of infectious diseases like burn and wound infection that makes it one of the most threatening opportunistic pathogens. The present research aimed at investigating antimicrobial resistance, biofilm-forming abilities, and frequency of the genes contributed to&nbsp;<em>bla<sub>VEB-1</sub>, bla<sub>PER-1</sub>,</em>&nbsp;and&nbsp;<em>bla<sub>PSE-1</sub></em>&nbsp;genes and virulence of&nbsp;<em>P. aeruginosa</em>&nbsp;separated from the burn infections in Tehran, Iran.</p> <p><strong>Methods:&nbsp;</strong>we evaluated the resistance of 156&nbsp;<em>P. aeruginosa</em>&nbsp;isolates to fifteen antimicrobial agents and generation of the ESBL and MBL enzymes phenotypically based on the CLSI instructions. Moreover, the biofilm forming potential has been assayed in a microtitre plate. In addition, PCR has been used to examine the frequency of virulence-and biofilm-related genes. Furthermore, the PCR of&nbsp;<em>bla<sub>VEB-1</sub>, bla<sub>PSE-1</sub></em>, and&nbsp;<em>bla<sub>PER-1</sub></em>&nbsp;genes has been amplified.</p> <p><strong>Results:&nbsp;</strong>according to the results, 72.2% of&nbsp;<em>P. aeruginosa</em>&nbsp;isolates have been MDR and 35.6% and 55.5% have been positive for producing MBL and ESBL, respectively. Moreover, 67.8% have been positive for forming biofilms. It has been found that 15.3% isolates are ESBL-positive; from among them 60% belong to the females and 40% belong to the males. In addition, one and two isolates respectively harbored the&nbsp;<em>bla<sub>VEB-1</sub></em>&nbsp;and&nbsp;<em>bla<sub>PER-1</sub></em>&nbsp;genes.</p> <p><strong>Conclusion:&nbsp;</strong>the present research outputs indicated the higher frequency of the multi drug resistance and higher percent of the virulence-related genes in the clinical&nbsp;<em>P. aeruginosa</em>&nbsp;isolates in Iran.</p> Mohammad Shahbazzadeh Elham Moazamian Alireza Rafati Masoud Fardin Copyright (c) 2020-07-30 2020-07-30 36 1 Fungal nasal septum abscess caused by Aspergillus flavus complicating sinonasal surgery <p>The fungal nasal septum abscess is a rare localized invasive form of fungal rhinosinusitis. Rare cases have been described in the literature. In this article, we intend to describe a new case of fungal nasal septum abscess caused by&nbsp;<em>Aspergillus flavus</em>&nbsp;in diabetic patient after sinonasal surgery. A 53-year-old woman with a history of uncontrolled type 2 diabetes and asthma developed a nasal septum abscess after a sinonasal endoscopic surgery which was performed for nasal polyposis. Needle aspiration of the abscess was performed and the pus cultures were positive for&nbsp;<em>Aspergillus flavus</em>. The patient was treated with antifungal drugs and surgical drainage of the abscess. A clinical and biological improvement was observed. Her case has been followed up for 18 months, and there hasn't been any recurrence of the infection. The fungal nasal septum abscess should be suspected in patients who do not respond adequately to standard treatment of nasal septum abscess, especially patients with risk factors of fungal rhinosinusitis.</p> Youssef Rochdi Youness Labani Omar Oulghoul Mohamed Mehdi El Fakiri Hassan Nouri Abdelaziz Raji Copyright (c) 2020-07-30 2020-07-30 36 1 Mucosal coronally positioned flap technique for management of excessive gingival display <p>Improvement of smile esthetics is a major goal of modern dentistry. Various treatment modalities have been proposed to correct excessive gingival display, depending on intraoral or extraoral etiologies. This report aimed to document the use of mucosal coronally positioned flap called surgical lip repositioning technique for the management of a gummy smile associated with vertical maxillary excess. The procedure restricts the muscle pull of the elevator lip muscles by shortening the vestibule, thus reducing the gingival display when smiling. Rapid surgical healing with minimal postoperative sequelae was observed. The follow up examinations showed esthetic satisfaction up to 6 months postoperatively, at the end of one year a partial relapse was observed. Although the short-term stable results of lip repositioning surgery appear satisfying postoperatively, its utility as a long-term treatment option remains questionable. More studies with larger sample size and long-term follow-up are necessary to establish the level of scientific evidence of this procedure.</p> Adel Bouguezzi Ouiam Hiba Boudour Sameh Sioud Hajer Hentati Jamil Selmi Copyright (c) 2020-07-30 2020-07-30 36 1 Informing health professions education through modern educational theories: a necessary process with potential pitfalls <p>This article presents an overview of educational theories focusing on undergraduate health professions education. It represents yet another attempt at untangling the complex issues of what learning theories are about, and how they can inform health professions education. The roles of "self-directed learning" and social interaction in undergraduate medical education are critically discussed; two relevant educational principles are proposed.</p> Mohammed Alhassan Copyright (c) 2020-07-30 2020-07-30 36 1 L'accouchement des grossesses gémellaires et pronostic materno-fœtal dans un Centre Universitaire Tunisien de niveau 3: étude rétrospective à propos de 399 cas <p>En dépit des progrès obstétricaux et pédiatriques, les grossesses gémellaires représentent une situation à haut risque aussi bien pour le déroulement de la grossesse que pour l´accouchement et reste encore une situation angoissante pour l´équipe obstétricale. Le but de cette étude était de décrire la pratique des accouchements des grossesses gémellaires au service de gynécologie obstétrique de Sousse, de décrire le pronostic maternel et fœtal et d´analyser les facteurs pouvant l´influencer. Nous avons réalisé une étude descriptive, rétrospective portant sur les accouchements des grossesses gémellaires sur une période de deux ans. Ont été incluses dans l´étude les grossesses gémellaires ayant atteint au moins 28 semaines d´aménorrhée (SA) et les femmes ayants une grossesse gémellaire compliquée d'une mort fœtale in utéro. Ont été exclues les femmes ayant une grossesse gémellaire et accouchés avant 28 SA. Les grossesses bi-choriales bi-amniotiques représentaient 67% des cas, contre seulement 11,5% de grossesses mono-choriales bi-amniotiques et 3% de grossesses mono-choriale mono-amniotique. Nous avons recensés 52 césariennes programmées. Le travail a été spontané dans 304 cas. Il a été déclenché dans 43 cas. Au total 178 parturientes ont accouché par voie basse (44,6%), contre 215 par voie haute (53,9%). Le taux de césarienne pour le deuxième jumeau était de 1,5%. Quand l'accouchement était par voie basse, 19 cas de complications ont été observés (10,7%). Nous avons analysé le score d'Apgar du premier jumeau et du deuxième jumeau en fonction du mode d'accouchement. Il n'y a pas eu de différence statistiquement significative du score d'Apgar entre les deux voies d'accouchement. La morbi-mortalité périnatale est plus importante pour le deuxième jumeau que pour le premier jumeau. La morbidité maternelle en cas d´accouchement par voie basse était supérieur à la morbidité en cas d´accouchement par césarienne. Il n´y a pas de différences significatives dans le score d´Apgar selon que les enfants sont nés par voie basse ou par césarienne.</p> Chekib Zedini Rania Bannour Imen Bannour Badra Bannour Majdi Jlassi Leila Goul Hedi Khairi Copyright (c) 2020-08-03 2020-08-03 36 1 A forgotten parasitic infestation in an immunocompromised patient-a case report of crusted scabies <p>Crusted scabies is a rare and highly contagious form of Sarcoptes scabiei var hominis infestation whose incidence may increase in the near future due to increasing use of immunosuppressive therapies and a general lack of awareness about the condition. It is misdiagnosed as psoriasis, irritant dermatitis or eczema. Delays in diagnosis lead to widespread transmission amongst contacts leading to potential community outbreak. Crusted scabies is extremely difficult to treat and there are growing concerns of possible resistance to current treatment. This case report describes a 44-year-old Ghanaian woman with human immunodeficiency virus (HIV) infection and diagnosed with skin scrapings. Treatment was initiated but the patient died from HIV related complications. Crusted scabies, though rare, should be an issue of global concern due to the potential for widespread dissemination. Adequate resources need to be channeled into scabies eradication as well as education of health personnel to promptly identify and treat cases.</p> Martin Agyei Afua Ofori Elliot Koranteng Tannor John Jude Annan Betty Roberta Norman Copyright (c) 2020-08-04 2020-08-04 36 1 Antenatal depression and its correlates on northwestern Ethiopian women: community-based cross-sectional study <p><strong>Introduction:&nbsp;</strong>mental health during pregnancy is a very important but neglected problem in most African countries including Ethiopia. In general, there was a scarce of studies on antenatal depression at the community level in Ethiopia. Therefore, this study was aimed at assessing the prevalence and correlates of antenatal depression among postpartum women in Gondar city, Northwest Ethiopia.</p> <p><strong>Methods:&nbsp;</strong>a community-based cross-sectional study was conducted in Gondar city among 526 women from July 01<sup>st</sup>&nbsp;to 30<sup>th</sup>/2018. A cluster sampling technique was employed and an interviewer-administered semi-structured questionnaire was utilized to collect the data. The data were entered into Epi-info version 7.0 and exported to SPSS version 20. Both bivariate and multivariable logistic regression analyses were performed. The level of statistical significance was declared based on the AOR with 95% CI and P-value ≤0.05.</p> <p><strong>Results:&nbsp;</strong>the prevalence of ante partum depression was 24.1% (95% CI: 20.5-27.5) and it was independently predicted by relatives´ mental illness (AOR = 2.30; 95% CI: 1.17-4.53), sex preference (AOR = 1.80; 95% CI: 1.07-3.02), lack of relatives´ support (AOR = 2.07; 95% CI: 1.12-3.87), unhappy marriage (AOR = 2.94; 95% CI: 1.81-4.76), history of depression (AOR = 5.23; 95% CI: 2.87-9.50) and no or one alive child (AOR = 1.78; 95% CI: 1.13-2.79).</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of ante partum depression was high and connected to poor psycho-social experiences. Therefore, building-up of family's network, fortifying relatives' support, resolving unhappy spousal relationships, and assuming early screening and intervention would degrade its burden.</p> Eyerusalem Desta Zelalem Mengstu Melkamu Asaye Muhabaw Shumye Mihret Copyright (c) 2020-08-04 2020-08-04 36 1 Diurnal rhythm of blood pressure among Nigerians with hypertension using 24-hour ambulatory blood pressure monitoring <p><strong>Introduction:&nbsp;</strong>hypertension is the most common cardiac disease in Nigeria. There are very limited studies in Nigeria on the use of 24-hour ambulatory blood pressure monitoring (24-h ABPM) for evaluation of hypertensive patients. Twenty four-hour ABPM, unlike office blood pressure (OBP), can assess diurnal variation using parameters like awake blood pressure (BP), asleep (nocturnal) BP, mean 24-hour BP and dipping pattern. This can help in assessment of increased cardiovascular risk and management of hypertensive patients. We purposed to assess the diurnal rhythm of BP among Nigerians with hypertension.</p> <p><strong>Methods:&nbsp;</strong>this was a prospective cross-sectional study. Consecutive 77 hypertensive subjects were studied using Schiller MT-300 for 24-h ABPM.</p> <p><strong>Results:&nbsp;</strong>out of the 77 patients reviewed, 39 (50.6%) were females. The mean age was 50.9 years (SD 13.5). The mean awake systolic and diastolic BP were 135.6mmHg (SD 15.0) and 83.2mmHg (SD 10.0) respectively; mean asleep systolic and diastolic BP were 127.6mmHg (SD 17.9) and 76.2mmHg (SD 12.2) respectively; and mean 24-h systolic and diastolic BP were 133.6mmHg (SD 15.3) and 81.4mmHg (SD 10.2) respectively. Awake BP was elevated in 59.7% of study subjects. Elevated awake systolic BP and awake diastolic BP were present in 50.6% and 41.6% of the study population. Nocturnal (asleep) BP was elevated in 79.2%. Non-dipping pattern was the most prevalent pattern at 55.8%, followed by dipping (24.7%), reverse dipping (15.6%) and extreme dipping (3.9%).</p> <p><strong>Conclusion:&nbsp;</strong>a high proportion had nocturnal hypertension (79.2%) and non-dipping pattern was the most prevalent pattern (55.8%). Mean awake systolic BP, mean asleep systolic and diastolic BP and mean 24-h systolic and diastolic BP were elevated. The use of 24-h ABPM will enhance assessment of increased cardiovascular risk and management of Nigerians with hypertension.</p> Ifeoluwa Amjo Rasaaq Ayodele Adebayo Olumide Akinniyi Akinyele Oladiipo Ayoola Olanipekun Obafemi Sunday Adesanya Oyeronke Titilope Williams Suraj Adefabi Ogunyemi Anthony Olubunmi Akintomide Olufemi Eyitayo Ajayi Michael Olabode Balogun Busayo Onafowoke Oguntola Ikponmwosa Godfrey Akhionbare Lukman Obasanjo Adebiyi Copyright (c) 2020-08-04 2020-08-04 36 1 Evaluation of the treatment guidelines, practices and outcomes of complicated severe acute malnutrition in children aged 0-59 months in sub-Saharan Africa: a study protocol for the SAMAC study <p><strong>Introduction:&nbsp;</strong>in hospitals across Africa, the case fatality rates of severe acute malnutrition (SAM) have remained consistently high (over 20%), despite the existence of the WHO treatment guideline. This has been attributed to inconsistencies in the implementation of the WHO treatment guidelines in sub-Saharan African countries. In spite of this awareness, the SAM treatment guidelines adopted by various sub-Saharan African countries and hospitals are unknown. Knowledge of the exact treatment practices employed in the management of SAM in different hospitals in sub-Saharan Africa is not known. This study aims to investigate the admission criteria, in-patient treatment guidelines and practices and outcomes of complicated SAM in sub-Saharan African children aged 0-59 months.</p> <p><strong>Methods:&nbsp;</strong>this is an observational study which involves the extraction of admission, treatment and discharge data from the medical records of infants and children aged 0-59 months diagnosed and treated for complicated SAM in sub-Saharan Africa. This information is being used to develop a comprehensive database on the treatment of complicated SAM across sub-Saharan Africa. Information on the national and hospital guidelines for the treatment of complicated SAM is also collected.</p> <p><strong>Results:&nbsp;</strong>results of this study will serve as a useful resource on the true reflection of the treatment of complicated SAM across sub-Saharan Africa and will provide valuable information for optimising SAM treatment.</p> <p><strong>Conclusion:&nbsp;</strong>in order to advocate best practice and reduce SAM-related mortality in sub-Saharan Africa, the identification of the different diagnostic and treatment methods and respective outcomes across different hospitals and countries is imperative.</p> Janet Adede Carboo Martani Lombard Cornelia Conradie Robin Claire Dolman Cristian Ricci Copyright (c) 2020-08-04 2020-08-04 36 1 Lordoscoliosis and hyperlordosis in quadriplegic cerebral palsy <p>A 7-year-old female, born out of a non-consanguineous marriage, presented with an extreme posturing of the spine. As per her father, she had a history of delayed birth cry and recurrent episodes of seizures. She was diagnosed with quadriplegic cerebral palsy with epilepsy. She was referred by an orthopedic surgeon to the department of physiotherapy for evaluating if the spinal deformity was fixed or flexible, so that the further line of management could be determined. On observation of her posture in supine lying (A) and in prone lying (B), marked lordoscolios was noted along with hyperlordosis. Examination revealed spasticity of grade 3 on the modified Ashworth scale (MAS) in spinal extensor muscle group. She was neither able to roll over nor was she able to sit even with extensive support. The posturing of the spine posed difficulties for caregivers during feeding, dressing and during activities to maintain hygiene. In an attempt to examine flexibility of the spine, child was placed prone on the lap by the physiotherapist. Slow vestibular stimulus in the form of rocking movements was given by the movement of the physiotherapist´s thighs. As the child displayed some relaxation of trunk muscles, the physiotherapist clasped her hands below her knees providing a firm pressure to the child´s back through her arms. This further inhibited the resistance offered by the child´s muscles and the spine could be aligned to near neutral in the sagittal as well as in the coronal plane revealing the flexible nature of the deformity (C).</p> Chanan Vivek Goyal Waqar Mohsin Naqvi Copyright (c) 2020-08-04 2020-08-04 36 1 Endoscopic meatotomy in the treatment of ureterocele: results in adult patients <p>To evaluate the efficacy of endoscopic meatotomy in the treatment of ureterocele in adults. A retrospective study of adult patients with ureterocele, treated between January 1987 and December 2014. In 47 patients, 55 intravesical ureteroceles were diagnosed and classified as 18 right, 21 left and eight bilateral (38%, 44% and 17% respectively). According to the Bruézière classification, 41 (75%) ureteroceles were type A and 14 (25%) others were type C. These ureteroceles were complicated by calculus formation in 22 cases, moderately dilated excretory pathways in 16 cases and both complications in a total of 9 cases. Four patients had a complicated ureterocele with pyelonephritis, one of which was emphysematous. The endoscopic treatment was performed in cases of complicated and/or symptomatic ureteroceles. Fifty one cases were treated by a "smiling mouth" meatotomy consisting in a transverse horizontal incision, with the treatment of any associated complication. The mean operative time was 35 minutes (10-90). The operative follow-up was uneventful in 42 patients and complications occurred in 5 patients (2 urinary retentions, 2 infectious complications and one hematuria). The mean duration of postoperative stay was 1-2 days. The mean follow-up was 15 months. Four patients developed vesicoureteral reflux and no stenosis was noted. The endoscopic incision of the ureteroceles seems today, after reviewing the results, to be a good treatment of adult ureterocele. It is a simple, minimally invasive and has a low morbidity rate.</p> Amine Oueslati Ahmed Saadi Marouene Chakroun Selim Zaghbib Abderrazak Bouzouita Amine Derouiche Mohamed Riadh Ben Slama Haroun Ayed Mohamed Chebil Copyright (c) 2020-08-04 2020-08-04 36 1 Prevalence and attitude towards hepatitis B vaccination among healthcare workers in a tertiary hospital in Ghana <p><strong>Introduction:&nbsp;</strong>adequate knowledge on hepatitis B virus (HBV) infection is important among healthcare workers (HCWs) as this impacts the vaccination seeking behaviour. This study sought to assess the knowledge, vaccination status and related factors amongst HCWs in a tertiary facility in Ghana.</p> <p><strong>Methods:&nbsp;</strong>an analytical cross-sectional study was conducted amongst full-time HCWs of different categories at the Cape Coast Teaching Hospital, Ghana. Stratified sampling was used to arrive at the number needed for each category of HCW and then simple random sampling to recruit participants. A structured self-administered questionnaire was used. Descriptive statistics and logistics regression were carried out on the data.</p> <p><strong>Results:&nbsp;</strong>a total of 303 HCWs participated with 78.07% (n=235) being between 20-30 years, and majority being females (62.38%, n=189). A total of 186 (61.39%) participants had adequate knowledge, mean knowledge score was 4.73/7 (±0.97). About 80% (n=218) had received the 3 doses of HBV vaccine. Among the unvaccinated, cost was the major barrier (62.07%, n=18). Participants who did not know that HBV was more infectious than HIV (aOR=5.31, 95%CI: 1.91-14.77), p&lt;0.001) and those who did not have knowledge that HBV vaccine was effective were more likely to be unvaccinated (aOR=8.63, 95%CI: 2.99–24.94), p&lt;0.0001). The gender and cadre of staff did not show statistical evidence of an association with vaccination status.</p> <p><strong>Conclusion:&nbsp;</strong>knowledge on HBV is paramount for all HCWs as well as the importance of receiving the full doses of the hepatitis B vaccines. Barriers to vaccination must be removed to ensure protection of HCWs.</p> Elizabeth Tabitha Botchway Elizabeth Agyare Letsa Seyram Kwadwo Koduah Owusu Mohamed Mutocheluh Dorcas Obiri-Yeboah Copyright (c) 2020-08-05 2020-08-05 36 1 Profile of geriatric presentations at the emergency department of a rural district hospital in South Africa <p><strong>Introduction:&nbsp;</strong>the geriatric population is increasing in South Africa and globally. According to Statistics South Africa (STATSSA), people aged 60 years or older constitute approximately 8.4%-9.3% of the population in the Free State province, South Africa, the majority of which are rural dwellers. Elderly patients constitute a high percentage of patients presenting at the emergency department (ED) and it has been suggested that understanding the pattern of geriatric morbidities presenting at the ED can help prepare the healthcare workers and the healthcare system to confront the challenges of delivering acute geriatric care. In this present study, we compiled the profile of geriatric patients that presented at the ED of Botshabelo district hospital (BDH), Free State province, South Africa, with the aim of formulating evidence-based strategies to improving quality of service and patient outcome.</p> <p><strong>Methods:&nbsp;</strong>this was a descriptive, retrospective cross-sectional clinical audit of all geriatric cases (≥ 65 years), that presented at the ED of BDH from January 1<sup>st</sup>&nbsp;2017, to March 31<sup>st</sup>&nbsp;2017.</p> <p><strong>Results:&nbsp;</strong>geriatric cases accounted for 25% of the total adult ED presentation at BDH. The majority (66.6%, n=197) of the patients were female and the mean age at presentation was 75 years. The majority (63.5%) of cases were self-referred and trauma (fracture) was the most frequently diagnosed morbidity. More than half (53.7%) of the cases were classified as priority 2 (P2) and the average waiting time was 86 ± 93 minutes. Less than half of the patients (48.3%; n=143) were admitted for further management, while 36.1% (n=107) of them were discharged from the ED. The remaining 46 cases (15.5%) were referred to a tertiary hospital for further management.</p> <p><strong>Conclusion:&nbsp;</strong>it is crucial that healthcare facilities in South Africa recognise the special needs of elderly patients due to the growing aging population. Compiling the profile of geriatric cases presenting at ED can help identify crucial area of need and help prepare the healthcare workers and the healthcare system to confront challenges of delivering acute geriatric care. Findings presented herein will assist in formulating evidence-based strategies to improve geriatric patient outcome at the ED in BDH.</p> Matthew Olukayode Abiodun Benedict Anthonio Oladele Adefuye Copyright (c) 2020-08-05 2020-08-05 36 1 Profil des décès survenus chez les enfants âgés de 3 à 59 mois dans l’unité des soins intensifs d’un centre pédiatrique à Yaoundé-Cameroun <p><strong>Introduction:&nbsp;</strong>le risque de décès serait élevé dans les unités des soins intensifs (USI) des pays en développement. Nous décrivons les décès survenus à l´Unité des Soins Intensifs du Centre Mère et Enfant de Yaoundé au Cameroun.</p> <p><strong>Méthodes:&nbsp;</strong>étude rétrospective portant sur les caractéristiques cliniques, sociodémographiques, l´itinéraire thérapeutique ainsi que certains facteurs associés aux décès survenus entre 2010 et 2014 chez 200 patients âgés de 3-59 mois.</p> <p><strong>Résultats:&nbsp;</strong>sur 2675 patients admis, 1807 étaient âgés de 3 à 59 mois et 303 sont décédés. Les taux de mortalité global et spécifique à cette tranche d´âge étaient de 11,3% et de 16,7% respectivement. La plupart (152/200 soit 76,0%) décédait à moins de 24 mois et le délai médian de leur admission était de 7 jours. Plus de la moitié (57,0%) avait recouru à un centre de santé et seuls 66 (33,0%) avaient bénéficié d´une référence. Le paludisme grave (41,5%), la pneumonie (22,7%) et la gastroentérite (27,8%) étaient les pathologies les plus incriminées. La malnutrition et le VIH/Sida constituaient les causes sous-jacentes de décès chez 23,0% et 20,5% de sujets respectivement. La présence de la gastroentérite multipliait le risque de décès d´environ 6 fois (OR = 5,76; P = 0,000) lorsque la malnutrition et l´infection à VIH étaient présentes. Les décès survenaient majoritairement (90,0%) dans les 72 heures d´admission.</p> <p><strong>Conclusion:&nbsp;</strong>certaines pathologies auraient pu être traitées avec des moyens simples afin d´éviter les complications nécessitant une réanimation dans un contexte à ressources limitées. Il est crucial d´intensifier la lutte contre le paludisme, l´infection à VIH et la malnutrition.</p> Félicitée Nguefack Evelyn Mah Mina Ntoto Kinkela Thierry Tagne David Chelo Roger Dongmo Paul Koki Ndombo Copyright (c) 2020-08-05 2020-08-05 36 1 An uncommon acute type A aortic dissection mimicking an inferior STEMI <p>Aortic dissection in the most common fatal disease affecting the aorta. Ascending aortic dissection can lead to coronary malperfusion causing myocardial infarction with ST elevation. The distinction between aortic dissection and a primary myocardial infarction can be difficult because both conditions can have similar presentations. Making the right diagnosis is essential because the therapies used to treat myocardial infarction can be fatal for patients with aortic dissection. Emergency transthoracic echography presents a rapid imaging procedure that provides strong hints of the coexistence of these two diseases, leading to further imaging examination and prevent inappropriate administration of treatments that could cause catastrophic outcome. We report a case of a 62-year-old man admitted to our hospital with chest pain, who was diagnosed as inferior wall myocardial infarction based on electrocardiographic findings. The diagnosis was reassessed due to a significant aortic regurgitation and an intimal tear in the ascending aorta on transthoracic echocardiography. Computed tomography angiogram of the chest and transesophageal echography fully confirmed the presence of ascending aortic dissection. Emergency surgery was successfully performed and the patient recovered well.</p> Karima Benbouchta Mehdi Berrajaa Mohamed Ofkire Noha El Ouafi Zakaria Bazid Copyright (c) 2020-08-05 2020-08-05 36 1 Pregnancy management in laparoscopic promontofixation patients: a challenging situation with no clear recommendations <p>Uterine-sparing prolapse surgery offers fertility preservation; however, available data on the safety of pregnancy after surgery and the effects of pregnancy on surgical outcome are limited. Authors report herein reflections on the case of a 39-year-old woman with pelvic organ prolapse who underwent laparoscopic promontofixation. Pregnancy was diagnosed 2 weeks post-surgery. The main target of this research is to focus on pregnancy management before and after promontofixation due to the lack of data on the safety of pregnancy following surgery and the effect of pregnancy on surgical outcome. It seems preferable to us to operate patients in the first part of the cycle, if not after a dosage of beta-HCG and to provide effective contraception for at least 12 months.</p> Youssef Kharbach Abdelhak Khallouk Copyright (c) 2020-08-05 2020-08-05 36 1 Acute miliary tuberculosis of the pharynx (Isambert disease): case report <p>Miliary pharyngeal tuberculosis or Isambert disease is a rare form of tuberculosis. It can be isolated or more often associated with lung damage. We report the case of a 25-year-old patient referred for deep asthenia with fever, sweating and weight loss, all associated with dysphagia and hearing loss. The pharyngeal examination found an oropharyngeal miliary and an involvement of the cavum. Chest computed tomography (CT) showed excavated lesions suggestive of tuberculosis. The clinical situation clearly improved with anti-tuberculous treatment. Isambert disease is a rare pharyngeal disorder occurring especially at extreme ages or in immunocompromised patients. The contamination is either direct or hematogenous. The pharyngeal examination finds grayish tubers on an often congestive mucosa. The diagnosis is bacteriological and/or histological. Treatment is mainly medical, more rarely surgical. The general assessment aims to find other locations. The miliary pharyngeal tuberculosis is rare and must make seek other locations. The diagnosis is easy and treatment mainly medical. The consequences can be significant.</p> Younes Chebraoui Abdelfattah Aljalil Mohamed Amine Hanine Amine Ennouali Haddou Ammar Youssef Darouassi Amine Benjelloun Copyright (c) 2020-08-06 2020-08-06 36 1 Pancréas ectopique de localisation hépatique <p>Le pancréas ectopique (ou aberrant ou hétérotopie pancréatique) se définit par la présence de tissu pancréatique en situation anormale, sans rapport anatomique avec la glande principale. Son incidence est estimée entre 0,5% et 14% sur les séries autopsiques, mais est probablement sous-estimée du fait de son caractère le plus souvent asymptomatique. Les localisations habituelles sont représentées par le duodénum (30-35%), l´estomac (30%) et le jéjunum (15%). Sa localisation hépatique est exceptionnelle. Nous en rapportons un nouveau cas de découverte fortuite. Il s´agit d´une patiente âgée de 54 ans, hypertendue, opérée deux ans auparavant pour un adénocarcinome du sigmoïde classé pT3N1b (A). L´évolution était marquée par l´installation de multiples nodules d´allure secondaire prédominant au niveau du lobe hépatique droit (B), d´où l´instauration d´une chimiothérapie néo-adjuvante (4 cures FOLFOX-ERBITUX). La patiente a bénéficié d´une lobectomie droite. L´examen histologique des différents prélèvements effectués a confirmé la présence d´une localisation secondaire hépatique d´un adénocarcinome moyennement différencié d´origine colorectale avec des limites d´exérèses saines. Le foie alentour était le siège d´une stéatose macrovacuolaire non systématisée estimée à 20%. Il s´y associait un foyer d´hétérotopie pancréatique englobant des acini et des canaux excréteurs organisés en lobule (C, D). Les suites opératoires immédiates étaient simples, cependant, l´évolution a été marquée par la récidive tumorale au niveau du foie gauche.</p> Faten Limaïem Copyright (c) 2020-08-06 2020-08-06 36 1 Treatment of localized prostate cancer and use of nomograms among urologists in the West Africa sub-region <p><strong>Introduction:&nbsp;</strong>there is a high incidence of prostate cancer among men of African descent. The disease tends to occur at an early age with a tendency to be aggressive. The objective was to determine the practice of urologists in the West African sub-region regarding treatment of localized prostate cancer, the use of nomograms and their perception of the usefulness of nomograms.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional study that involved urologists practicing in the West African sub-region attending urology and surgery conferences of the “Société internationale d´Urologie”, West African college of surgeons and the Ghana association of urological surgeons. A structured questionnaire was used that sort to ascertain the treatment modalities used for localized prostate cancer and the use of nomograms in the sub-region. The study period spanned the years 2018 and 2019.</p> <p><strong>Results:&nbsp;</strong>fifty-six urologists practicing in eleven West African countries responded. Fifty percent had been in practice for less than 5 years. Sixty eight percent (38/56) had been involved in the treatment of localized prostate cancer. Radical prostatectomy was widely available and the treatment modality most used 94.7% (36/38). Nomograms was used by 57.9% of them (22/38) with the Partin tables being the most commonly used nomogram (34.2%). No Locally developed nomogram for treatment of localized prostate cancer was identified.</p> <p><strong>Conclusion:&nbsp;</strong>radical prostatectomy is the commonest treatment modality used for the management of localized prostate cancer in the West Africa sub-region. Majority of the urologists used nomograms with the Partin tables being the most used.</p> Mathew Yamoah Kyei Ben Adusei George Oko Klufio James Edward Mensah Samuel Gepi-Attee Emmanuel Asante Copyright (c) 2020-08-06 2020-08-06 36 1 Unilateral lateral rectus palsy: an unusual presentation of pineal epidermoid cyst <p>An 11-year-old boy presenting with sudden onset double vision, headache and neck pain was found to have left lateral rectus palsy, papilledema and neck rigidity. An initial diagnosis of benign intracranial hypertension was considered. However, magnetic resonance imaging (MRI) of the brain surprisingly discovered the pineal gland cyst. He underwent Krause´s procedure for the excision biopsy of the cyst. Histopathological examination confirmed epidermoid cyst. Postoperatively, he had transient ataxia and upgaze palsy but recovered well. He was asymptomatic during the first and third-month follow-ups. The case highlights the unusual presentation of a rare intracranial tumor, pineal epidermoid cyst. Neuroimaging and timely surgery lead to a good outcome.</p> Koushik Handattu Ramesh Bhat Yellanthoor Sandesh Kini Copyright (c) 2020-08-06 2020-08-06 36 1 Monitoring of Lassa virus infection in suspected and confirmed cases in Ondo State, Nigeria <p><strong>Introduction:&nbsp;</strong>Lassa virus (LASV), the causative agent of Lassa fever (LF), an endemic acute viral haemorrhagic illness in Nigeria, is transmitted by direct contact with the rodent, contaminated food or household items. Person-to-person transmission also occurs and sexual transmission has been reported. Thus, this study investigated the presence of LASV in body fluids of suspected and confirmed cases.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional study between March 2018 and April 2019 involving 112 consenting suspected and post ribavirin confirmed cases attending the Lassa fever treatment center in Ondo State. Whole blood was collected from 57 suspected and 29 confirmed cases. Other samples from confirmed cases were 5 each of High Vaginal Swab (HVS) and seminal fluid; 12 breast milk and 4 urine. All samples were analyzed using reverse transcription-PCR (RT-PCR) targeting the S-gene of LASV.</p> <p><strong>Results:&nbsp;</strong>analysis of whole blood by RT-PCR showed that 1/57 (1.8%) suspected and 1/29 (3.4%) confirmed post ribavirin treated cases were positive. While LASV was detected in 2/5 (40%) post ribavirin treated seminal fluids and 1/11 (8.3%) breast milk. However, LASV was not detected in any of the HVS and urine samples.</p> <p><strong>Conclusion:&nbsp;</strong>the detection of LASV in seminal fluid and breast milk of discharged post ribavirin treated cases suggests its persistence in these fluids of recovering Nigerians. The role of postnatal and sexual transmissions in the perennial outbreak of LF needs to be further evaluated.</p> Olumuyiwa Babalola Salu Olufemi Samuel Amoo Joseph Ojonugwa Shaibu Chukwuyem Abejegah Oluwafemi Ayodeji Adesola Zaidat Musa Ifeoma Idigbe Oliver Chukwujekwu Ezechi Rosemary Ajuma Audu Babatunde Lawal Salako Sunday Aremu Omilabu Copyright (c) 2020-08-06 2020-08-06 36 1 Self-rated health and general procrastination in nurses: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>nurses are responsible for taking care of the health of the general public. Nurses´ own health is among the important factors affecting the quality of patient care. Self-rated Health (SRH) is one of the indicators used extensively in health research for the assessment of the health status of individuals. The present study was conducted to evaluate Self-rated Health and its relationship with general procrastination in nurses.</p> <p><strong>Methods:&nbsp;</strong>the present cross-sectional study was conducted in 2019 on 305 Iranian nurses selected by stratified random sampling. The relationship of Self-rated Health with procrastination was determined using an ordinal logistic regression analysis after adjustments for personal and occupational factors.</p> <p><strong>Results:&nbsp;</strong>self-rated Health was poor/bad in 11.3% of the nurses, fair in 23.7%, good in 34.3% and excellent in 30.7%. After adjustments for personal and occupational factors, a significant relationship was observed between procrastination and Self-rated Health (OR=0.95; 95%CI 0.92, 0.98).</p> <p><strong>Conclusion:&nbsp;</strong>the results showed an unfavorable health status in nurses. Given the significant relationship between procrastination and poor Self-rated Health in nurses, it is essential to consider this relationship for improving nurses´ health.</p> Mahdi Basirimoghadam Forough Rafii Abbas Ebadi Copyright (c) 2020-08-06 2020-08-06 36 1 Professional accountability in a sternal bone marrow aspiration: a forensic case report <p>An aortic injury with concomitant pericardial tamponade caused by sternal bone marrow aspiration is rare. We report a case of fatal sternal bone marrow aspiration performed to a 73 year old man for the purpose of confirming the diagnosis of multiple myeloma. This puncture was followed by an injury in the aorta causing a pericardial tamponade and the death of the patient immediately after the aspiration. This paper stresses the precautions to be taken, by the operator, in certain particular situations that make the sternal bone marrow aspiration difficult and risky, and discusses the different types of operator´s liability that can be involved and their foundations.</p> Sami Bardaa Narjes Karray Zouhir Hammami Samir Maatoug Copyright (c) 2020-08-06 2020-08-06 36 1 Idiopathic focal organizing pneumonia mimicking malignancy <p>Idiopathic FOP is a rare type of COP. What we know on this subject is made up of a few clinical cases published in recent years. Our patient was admitted to the hospital with an intermittent coughing complaint that worsens over time. Due to a suspicion of malignancy, a radiological evaluation was requested including a PET-CT and a transbronchial biopsy was performed. Until the last part of our algorithm, the patient profile was clinically and radiologically in favor of the diagnosis of malignancy but, in the end, the diagnosis of FOP was fixed with a follow-up decision. In conclusion, FOP is a relatively new entity that should be kept in mind in the differential diagnosis of malignancy.</p> Emrah Dogan Utku Tapan Ozge Oral Tapan Turhan Togan Özgür Ilhan Çelik Copyright (c) 2020-08-07 2020-08-07 36 1 Chest CT-scan finding of asymptomatic COVID-19 pneumonia: a prospective 542 patients’ single center study <p>Since asymptomatic infections as “covert transmitter”, and some patients can progress rapidly in the short term, it is essential to pay attention to the diagnosis and surveillance of asymptomatic patients with SARS-COV2 infection. CT scan has great value in screening and detecting patients with COVID-19 pneumonia, especially in the highly suspected or probable asymptomatic cases with negative RT-PCR for SARS-COV2. This study aimed to detect incidentally COVID-19 pneumonia on medical imaging for patients consulting for other reasons.</p> Asma Achour Oussema Dkhil Jamel Saad Mabrouk Abdelali Ahmed Zrig Badii Hmida Mondher Golli Mezri Maatouk Walid Mnari Copyright (c) 2020-08-07 2020-08-07 36 1 Odontogenic cervico-facial cellulitis during pregnancy: about 3 cases <p>Pregnancy is considered as a risk factor for development, severity, and complications of odontogenic infections. Without adequate treatment, the infection can spread and threaten both the mother’s and the foetus lives. We aim to analyze the predisposing factors, diagnostic and therapeutic aspects of cervico-facial cellulitis during pregnancy, through a descriptive retrospective study conducted at oral and maxillofacial surgery department of Mohamed VI university hospital center at Marrakesh, between June 2017 and June 2019. A total of three patients; all patients were at their last trimester were recruited. Every patient was immediately given intravenous antibiotics, drainage was carried out under local anesthesia, and the causing tooth was removed. During hospitalization, one patient was referred to the gynaecology department for preterm labor, while the remaining two patients were discharged after the pus drainage has stopped. The possible compromise of oral health during pregnancy is well known, however severe odontogenic infections are rarely considered in the literature. It is essential to aggressively treat the gravid patient to minimize the risk of infection spreading to the facial spaces. Moreover, poor oral health in pregnancy has been implicated in adverse birth outcomes, specifically prematurity. We recommend upgrading communication between obstetrician and dentists so that regular routine dental visits are planned for pregnant patients during early stages of pregnancy in order to identify and manage the problem as early as possible.</p> Zakaria Aziz Salma Aboulouidad Mohammed El Bouihi Saad Fawzi Mohammed Lakouichmi Nadia Mansouri Hattab Copyright (c) 2020-08-10 2020-08-10 36 1 L’encéphalopathie de Gayet Wernicke: aspects cliniques et anomalies radiologiques <p>L´encéphalopathie de Gayet Wernicke (EGW) est<br>une urgence neurologique secondaire à une carence<br>en thiamine (vitamine B1) le plus souvent<br>secondaire à l´alcoolisme chronique. L´objectif de ce<br>travail est de rappeler certaines situations cliniques<br>évocatrices d´EGW autre que l´éthylisme et les<br>différentes anomalies en IRM autour de 4<br>observations. L´âge moyen des patients était de 40<br>ans (2 femmes et 2 hommes). Le tableau<br>neurologique comportait des troubles de la<br>vigilance chez tous les patients, des troubles<br>oculomoteurs dans 2 cas, et une ataxie cérébelleuse<br>chez un seul patient. La notion de vomissements<br>chroniques était notée dans 2 cas, un jeûne<br>prolongé dans un cas et l´alcoolisme pour le dernier. <br>Article<br>Siham Bouchal et al. PAMJ - 36(259). 10 Aug 2020. - Page numbers not for citation purposes. 2<br>L´IRM cérébrale avait révélé des anomalies<br>évocatrices d´EGW chez tous les patients avec une<br>prise de contraste pour un cas. Le déficit en<br>thiamine était confirmé chez 2 patients. Dans notre<br>contexte l´EGW semble être plus fréquente dans<br>d´autres circonstances pathologiques autres que<br>l´alcoolisme chronique (vomissements chroniques,<br>dénutrition sévère, un jeûne pathologique, et<br>chimiothérapie...). Le contexte clinique peut faire<br>suspecter d´autres pathologies comme la<br>thrombose veineuse cérébrale, l´accident vasculaire<br>cérébral, ou un autre trouble métabolique mais<br>l´IRM a permis de les écarter et de poser le<br>diagnostic d´EGW. L´IRM cérébrale présente un<br>intérêt primordial dans le diagnostic de l´EGW.<br>L´absence ou le retard de la mise en route du<br>traitement influence le pronostic.</p> Siham Bouchal Naoual Bougtoub Badr Alami Naima Chtaou Mustafa Maaroufi Faouzi Belahsen Copyright (c) 2020-08-10 2020-08-10 36 1 Endoscopic treatment of obstructive ureterohydronephrosis in children <p>Obstructive ureterohydronephrosis in childhood population is a matter of debate between paediatric surgeons and paediatricians, as far as the therapeutic protocol that should be applied. Close observation, chemoprophylaxis, endoscopic and surgical approaches are the universally used techniques that provide quality of life in the paediatric patients. Undoubtedly, "the less is more" even when we have to encounter obstructive ureterohydronephrosis in children. Herein, we present a short case series where the endoscopic management of obstructive uropathies proved to be therapeutic without any need of surgical intervention.</p> Charikleia Demiri Vassilis Lambropoulos Vasileios Mouravas Chrysostomos Kepertis Dimitrios Godosis Maria Tsopozidi Ioannis Spyridakis Copyright (c) 2020-08-10 2020-08-10 36 1 Knowledge and adherence to isoniazid preventive therapy among people living with HIV in multilevel health facilities in South-East, Nigeria: baseline findings from a quasi-experimental study <p><strong>Introduction:&nbsp;</strong>isoniazid preventive therapy is a crucial component of TB/HIV collaborative program and patient good knowledge and adherence to this preventive treatment are essential in improving implementation. The aim of this study was to determine the knowledge and adherence to isoniazid preventive therapy among patients receiving HIV care.</p> <p><strong>Methods:&nbsp;</strong>this is a baseline result of a quasi-experimental study which was carried out among 200 patients receiving HIV care in six high patient load health facilities providing comprehensive HIV care in Ebonyi State. This included a tertiary health facility and five secondary level health facilities. We used structured interviewer-administered questionnaire to collect information from the participants. Adherence was assessed by self-reports. Descriptive, bivariate and multivariate logistic regression analyses were conducted using SPSS version 20 at 5% level of significance.</p> <p><strong>Results:&nbsp;</strong>majority (65%) of the respondents were between 30 and 49 years and most (73.5%) were females. Majority (85%) had been on antiretroviral therapy (ART) for more than one year. More than half of the respondents had ever received and had been counselled on IPT (55%, 62% respectively) while only 17.5% were on IPT during the study. More than half (60.5%) of the respondents had low level of knowledge. Marital status was the only predictor of knowledge. Unmarried respondents were 2 times more likely to have knowledge of IPT compared with the married (AOR = 2.11, CI = 1.10-4.06). Among the 35 patients who were on IPT, 32 (91%) reported good adherence in the 30 days preceding the survey.</p> <p><strong>Conclusion:&nbsp;</strong>there was poor knowledge of IPT among the respondents however self-reported adherence was high. We recommend intensification of general and personalized education of PLHIV on IPT by health workers.</p> Ifeyinwa Chizoba Akamike Ijeoma Nkem Okedo-Alex Adaoha Pearl Agu Chihurumnanya Alo Lawrence Ulu Ogbonnaya Copyright (c) 2020-08-10 2020-08-10 36 1 Pseudoaneurysm of the subclavian artery following clavicle fracture due to blunt traumatism: a case report <p>The clavicle fractures are frequent, vascular<br>injuries associated with closed fractures of clavicle<br>are rare. The pseudoaneurysms of the subclavian<br>artery constitute an exceptional complication. We<br>report a case of a 40-year-old who presented an<br>expanding hematoma of the right side of the neck<br>after a road traffic accident. Radiography of the<br>right shoulder showed a midclavicular fracture. An<br>arterial doppler of vessels showed a circulating<br>hematoma in the contact of the right subclavian<br>artery with a correct distality flow. Computed<br>tomographic angiogram of the chest confirmed the<br>diagnosis of a false aneurysm in the postvertebral<br>portion of the right subclavian artery. The<br>treatment was surgical and consisted of excision of<br>the false aneurysm and a repair of the arterial<br>injury by an arterial patch, the clavicle was fixed<br>with a reconstruction plate and screws. Early<br>intervention appears to be indicated due to the risk<br>of thrombo-embolic complications. Endovascular<br>repair appears to be the preferred treatment<br>modalities, due to a lower rate of cardiopulmonary<br>complications, but it is reserved for much selected<br>cases.</p> Hicham Belmir Anis Chagou Youssef Tijani Amine Azghari Copyright (c) 2020-08-11 2020-08-11 36 1 Hydrostatic reduction of intussusception in children: a single centre experience <p><strong>Introduction:&nbsp;</strong>intussusception is a common surgical emergency in children especially in infants. Treatment of intussusception could be non-operative or operative. Non-operative treatment (hydrostatic reduction) of intussusception is increasingly being practiced in developing countries.</p> <p><strong>Methods:&nbsp;</strong>this was a review of our experience in the hydrostatic reduction of intussusception in children at a teaching hospital in Enugu, Nigeria. This study covered an 18-months period, October 2017 to March 2019. Patients on presentation were resuscitated, appropriate investigations done and prepared for surgery before the hydrostatic reduction (using normal saline) was carried out. Patients with features of peritonitis and marked abdominal distension were excluded from hydrostatic reduction.</p> <p><strong>Results:&nbsp;</strong>twenty patients who had 21 episodes of intussusception were analyzed. One patient had a recurrence that necessitated repeat hydrostatic reduction. Eighty percent of the patients were male. The mean and peak age of the patients was 8 months and 6 months respectively. Significant number of the patients presented after 48 hours of onset of their symptoms. Abdominal pain was the predominant presenting symptom. Twenty percent and fifteen percent of the patients had a history of preceding gastrointestinal and respiratory infections preceding the intussusception respectively. Ileocolic intussusception was the most common type and the most distal end of the intussusception was at the transverse colon. Hydrostatic reduction was successful in 13 patients (65%).</p> <p><strong>Conclusion:&nbsp;</strong>hydrostatic reduction is a simple and effective method of treatment of intussusception. However, early presentation and proper patient selection is necessary for optimal outcome.</p> Kevin Emeka Chukwubuike Obinna Chukwuebuka Nduagubam Copyright (c) 2020-08-11 2020-08-11 36 1 Mozambique Field Epidemiology and Laboratory Training Program as responders workforce during Idai and Kenneth cyclones: a commentary <p>The ability to rapidly and effectively respond to public health emergencies, including outbreak investigations and natural disasters, is critical in a strengthened health system. In March and April 2019, the impact of tropical cyclones Idai and Kenneth in Southern Africa and subsequent flooding resulted in devastating consequences to the Mozambique health care system. In this article, we highlight the role of Mozambique’s Field Epidemiology and Laboratory Training Program (FELTP) graduates as first responders during one of the most significant natural disasters on the African continent. The FELTP graduates played a key role in conducting risk assessments, active epidemiological surveillance for priority communicable diseases, and outbreak investigations and supporting the laboratory diagnosis system. The cyclone emergencies in Mozambique revealed the vulnerability of the health system. It is vital to continue the investment in increasing epidemiological capacity of health human resources, staff to adequately prepare for and respond to public health emergencies to mitigate the negative health impacts associated with those events.</p> Cynthia Semá Baltazar Erika Valeska Rossetto Copyright (c) 2020-08-11 2020-08-11 36 1 Profil épidémiologique des épicondylites latérales en milieu de rééducation <p><strong>Introduction:&nbsp;</strong>l´épicondylite latérale, mieux connue sous le nom de « Tennis elbow », fait partie des troubles musculo-squelettiques du membre supérieur et constitue un problème majeur de santé publique. Le but de notre étude est d'évaluer le profil épidémio-clinique et les modalités thérapeutiques des patients suivis au service de médecine physique et réadaptation, pour épicondylite latérale.</p> <p><strong>Méthodes:&nbsp;</strong>il s'agit d'une étude rétrospective sur 6 ans (2012-2017) portant sur des patients adressés au Service de Médecine Physique et de Réadaptation Fonctionnelle au CHU Tahar Sfar Mahdia pour une épicondylite latérale. Les caractéristiques sociodémographiques et cliniques ainsi que les modalités thérapeutiques ont été évalués pour chaque patient.</p> <p><strong>Résultats:&nbsp;</strong>cinquante patients ont été inclus. L´âge moyen était de 44,82 ans, avec une prédominance féminine (72%). La moitié de nos patients étaient actifs et la majorité (60%) effectuait un travail type bureautique. Le membre supérieur droit était le plus touché dans 78% des cas. La durée moyenne des symptômes était de 14,66 mois. L´examen clinique a révélé une triade tendineuse positive, au niveau des épicondyliens latéraux dans 96% des cas. L´examen radiologique a été réalisé pour 8 patients, et l´échographie pour 6 patients. Tous les patients ont reçu un traitement antalgique, 84% des patients ont reçu des anti-inflammatoires non stéroïdiens et seulement 8 patients ont bénéficié d´une infiltration de corticoïdes. Un seul patient a bénéficié d´un traitement chirurgical après échec de la prise en charge médicale. Des séances de rééducation ont été prescrites chez 92% des patients. Une amélioration totale a été notée chez 42% des patients, 46% ont rapporté une amélioration transitoire et 12% ont évolué vers la chronicité.</p> <p><strong>Conclusion:&nbsp;</strong>l´épicondylite latérale est une source fréquente de douleur du coude. Sa prise en charge en Médecine Physique repose sur un traitement médical et une rééducation fonctionnelle adaptée. Mais aucune option thérapeutique ne semble être clairement supérieure à l´autre.</p> Mouna Sghir Takieddine Elhersi Anouer Abdallah Aymen Haj Salah Nadia El Khemiri Nabil Dammak Wassia Kessomtini Copyright (c) 2020-08-11 2020-08-11 36 1 Injury-related deaths in Enugu, Nigeria from 2010 to 2016: a descriptive review <p><strong>Introduction:&nbsp;</strong>death from injuries is a global public health problem. Ninety percent occur in low- and middle-income countries like Nigeria. This study aimed to determine the burden and demographic characteristics of injury-related death in Enugu, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>this is a retrospective study of injury-related deaths in Enugu over a 7-year period. Standardized forms were used to collect data from autopsy reports archived in the Forensic Unit of Enugu State University Teaching Hospital, Enugu and a descriptive analysis of collected data performed.</p> <p><strong>Results:&nbsp;</strong>of the Coroner deaths examined in the period reviewed, 1,067 (86.9%) were injury-related. The male-to-female ratio was 5.2:1. Mean age of victims was 34.2 ± 14.3years and range was 8 months to 86 years. Most victims (56.7%) aged 21-40 years. Accidents accounted for most deaths (53.2%) followed by homicide (44.3%). Road traffic deaths (51.4%), cult/gang violence (20.8%) and robbery (14.7%) were the commonest. Suicide (0.5%) and domestic violence (0.7%) were the least. More females died in domestic incidents while more males died in all other circumstances. Firearm (56.7%) was the most common weapon followed by knife (19%). Knife and wood (28.7% each) were the commonest weapons in domestic violence. Generally, fatal incidents occurred more in the day-time (65.5%). Most robberies (80.4%) occurred at night. Most cult/gang killings (75.2%) and robberies (81.7%) occurred in public places and at homes respectively.</p> <p><strong>Conclusion:&nbsp;</strong>injury is the highest source of Coroner's death in Enugu. Efforts to curb it are insufficient. A definitive policy on the prevention and management of injury-related deaths is needed.</p> Samuel Robsam Ohayi Nnaemeka Thaddeus Onyishi Mark Sunday Ezeme Copyright (c) 2020-08-11 2020-08-11 36 1 Encéphalopathie de Wernicke: complication rare de l’hyperemesis gravidarum <p>L’encéphalopathie de Wernicke est une pathologie<br>carentielle causée par un déficit profond en<br>thiamine (vitamine B1). Elle survient le plus<br>souvent sur un terrain alcoolique, mais parfois elle<br>est de diagnostic difficile et dont l’évolution en<br>l’absence de traitement conduit à des séquelles<br>cognitives sévères. L’imagerie par résonance<br>magnétique est l’examen de référence permettant<br>de confirmer le diagnostic par la présence d’hyper<br>signaux T2 au niveau périaqueducal, des thalami,<br>et des corps mamillaires. Nous rapportons<br>l’observation d’une femme de 30 ans ayant des<br>vomissements abondants lors du premier trimestre<br>de la grossesse (hyperemesis gravidarum), à<br>l’origine d’une encéphalopathie de Wernicke<br>symptomatique.</p> Soumaya Nasri Narjisse Aichouni Mounia Ettayeb Yassine Mebrouk Imane Kamaoui Copyright (c) 2020-08-11 2020-08-11 36 1 Use of tunica vaginalis graft for repair of traumatic bilateral testicular rupture after gunshot: a case report <p>Bilateral testicular injuries are rare. However, the incidence of these injuries has been increasing in wartime. We describe the case of gunshot wound of the both testicle caused by high velocity bullets. The patient was managed by surgical exploration, debridement and repaired of both testis using tunica vaginalis. During the follow up, the left testis was not viable and there was a need for orchiectomy; in a follow-up of 4 months, ultrasonography showed a viable right testis with minimal atrophic change and the patient reported to have normal erection with borderline hormonal function. We describe this case of bilateral testicular rupture, which was repaired using tunica vaginalis as graft, with attention to the management and outcome of this injury process.</p> Faisal Ahmed Mohammed Naji Ahmed Al-Hitari Qais Amer Mohammed Al-sagheer Umayir Chowdhury Copyright (c) 2020-08-12 2020-08-12 36 1 Differential diagnosis of COVID-19 in symptomatic patients at the University Hospital Center Mohammed VI, Marrakesh <p><strong>Introduction:&nbsp;</strong>coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 was first reported in Wuhan, China. Clinical spectrum of this disease has nonspecific symptoms shared by many other frequent infectious diseases of the respiratory tract and other respiratory tract diseases. This study explains the importance of differential diagnosis between COVID-19 and other lung diseases.</p> <p><strong>Methods:&nbsp;</strong>we analyzed in this study, the demographic features, clinical presentations, laboratory data and radiologic findings of the COVID-19 patients in comparison to those with other respiratory infections or diseases.</p> <p><strong>Results:&nbsp;</strong>the mean age of all patients was 38.04 years; 35 patients were later confirmed to be positive for SARS-CoV-2 infection. The most common symptoms reported by both groups included nonproductive cough and myalgia. Two of the non-COVID-19 patients were having below 92% oxygen saturation and low systolic blood pressure. The patients shared relatively similar laboratory findings except 3% of the non-COVID-19 patients who had lympho-neutropenia and 22.6% had high levels of C-reactive protein. Pulmonary tuberculosis and autoimmune disease respiratory disorder were suspected in 2 of the non-COVID-19 patients respectively.</p> <p><strong>Conclusion:&nbsp;</strong>we emphasize the importance of good screening protocols, rapid detection of SARS-CoV-2 and other most common respiratory pathogens, which may help for a better control of COVID-19 spread and avoid delayed care of other lung diseases.</p> Khadija Krati Jihane Rizkou Adil Ait Errami Lamiaa Essaadouni Copyright (c) 2020-08-12 2020-08-12 36 1 A new tool for early diagnosis of rheumatoid arthritis using combined biomarkers; synovial MAGE-1 mRNA and serum anti-CCP and RF <p><strong>Introduction:&nbsp;</strong>rheumatoid arthritis (RA) is a common autoimmune disease with unknown etiology and pathogenesis. Biomarkers have the potential to aid in the clinical diagnosis of the disease, or to provide means of detecting early signs of the disease. Evaluating Melanoma associated antigen genes (MAGE-1) mRNA expression rate in synovial fluid cells and serum levels of anti-cyclic citrullinated peptides (anti-CCP) and rheumatoid factor (RF) for RA early diagnosis.</p> <p><strong>Methods:&nbsp;</strong>a total of 213 subjects were enrolled in the study, 135 RA patients and 78 normal subjects with traumatic knee joints (control group). Serum RF and anti-CCP were estimated quantitatively using ELISA. MAGE-1 mRNA expression rate was analyzed by RT-PCR.</p> <p><strong>Results:&nbsp;</strong>a significant increase in serum levels of RF IgM and anti-CCP in RA patients compared to the controls. A positively significant correlation was found between serum anti-CCP and RF IgM. The expression rate of MAGE-1 mRNA was 100% in RA patients versus the controls (0%). The specificity and the sensitivity of the three biomarkers was 100%.</p> <p><strong>Conclusion:&nbsp;</strong>the high expression rate of MAGE-1 in synovial fluid cells of RA patients is encouraging its utilization as a diagnostic biomarker for RA. The combined use of MAGE-1 transcript in synovial fluid cells, serum RF and anti-CCP is recommended for improving early diagnostic ability of RA.</p> Al-Qtaitat Aiman Mwafi Nesrin Albtoosh Amal Al-Dalaien Nassar Copyright (c) 2020-08-12 2020-08-12 36 1 Tackling an emerging epidemic: the burden of non-communicable diseases among people living with HIV/AIDS in sub-Saharan Africa <p>Sub-Saharan Africa (SSA) is at a crossroad. Over the last decade, successes in the scale up of HIV care and treatment programs has led to a burgeoning number of people living with HIV (PLHIV) in care. At the same time, an epidemiologic shift has been witnessed with a concomitant rise in non-communicable diseases (NCD) related morbidity and mortality. Against low levels of domestic financing and strained healthcare delivery platforms, the NCD-HIV syndemic threatens to reverse gains made in care of people living with HIV (PLHIV). NCDs are the global health disruptor of the future. In this review, we draw three proposals for low and middle-income countries (LMICs) based on existing literature, that if contextually adopted would mitigate against impending poor NCD-HIV care outcomes. First, we call for an adoption of universal health coverage by countries in SSA. Secondly, we recommend leveraging on comparably formidable HIV healthcare delivery platforms through integration. Lastly, we advocate for institutional-response building through a multi-stakeholder governance and coordination mechanism. Based on our synthesis of existing literature, adoption of these three strategies would be pivotal to sustain gains made so far for NCD-HIV care in SSA.</p> Dunstan Achwoka Regina Mutave Julius Otieno Oyugi Thomas Achia Copyright (c) 2020-08-12 2020-08-12 36 1 Risk predictors of early recurrence in women with epithelial ovarian cancer in Lagos, Nigeria <p><strong>Introduction:&nbsp;</strong>epithelial ovarian cancer (EOC) is the most lethal gynaecological cancer with a recurrence rate as high as 85% after an initial treatment. However, there are currently no reliable means of predicting the risk of recurrence after first-line treatment. This study investigated the risk factors that predict early recurrence of EOC after primary treatment among women in Lagos, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>this was a retrospective cohort study involving the review of all histologically confirmed EOC patients managed at the Lagos University Teaching Hospital, Lagos, Nigeria over a 7-year period from January 2010 to December 2016. A study proforma was used to retrieve relevant information and descriptive statistics were computed for all data. The associations between variables were tested and multivariate analysis was done to adjust for all the possible characteristics that predict early EOC recurrence.</p> <p><strong>Results:&nbsp;</strong>the rate of recurrence of EOC was 76.4%. Suboptimal debulking surgery is the only independent predictor of early tumour recurrence.</p> <p><strong>Conclusion:&nbsp;</strong>women should be adequately counselled and encouraged to report their symptoms early to ensure optimal primary treatment. Strategic efforts should also be made to further improve subspecialty training programs and skills development in gynaecological oncology in Nigeria and sub-Saharan Africa.</p> Kehinde Sharafadeen Okunade Imoleayo Elijah Adetuyi Muisi Adenekan Ephraim Ohazurike Rose Ihuoma Anorlu Copyright (c) 2020-08-12 2020-08-12 36 1 Le syndrome Sturge-Weber: à propos d’un cas <p>Le syndrome de Sturge-Weber (SWS) ou angiomatose encéphalo-faciale, est un syndrome neuro-cutané et oculaire congénital rare. Il comporte deux types de malformations: capillaire faciale congénitale à type d´angiome plan et capillaro-veineux lepto-méningé de localisation le plus souvent pariéto-occipitale homolatérale. La Neuroimagerie, essentiellement l´imagerie par résonnance magnétique (IRM), joue un rôle important dans l'établissement du diagnostic, idéalement avant l'apparition de complications neuro-oculaires. Nous rapportons le cas d´un enfant chez qui le SWS est suspecté devant la présence d´un angiome facial et d´une épilepsie pharmaco-résistante.</p> Meriem Doumiri Mohamed Labied Siham Salam Dalal Laoudiyi Kamilia Chbani Lahcen Ouzidane Copyright (c) 2020-08-12 2020-08-12 36 1 Stump appendicitis: a myth that can become reality <p>Stump appendicitis is a rare etiology of acute lower right quadrant abdominal pain often forgotten in the emergency room (ER). The Mac Burney scar or a previous laparoscopic appendectomy always rule out the eventuality of appendicitis and mislead management. Advanced imaging tools are more than compulsory to help correct the diagnosis. Computed tomography (CT) scan is the option of choice that may be replaced if unavailable by simple ultrasound examination. The treatment is mainly surgical. We report the case of a stump appendicitis occurring 12 years after laparoscopic appendectomy in an 18-year-old girl. The diagnosis was based on consistent clinical signs and conclusive radiological data. A successful completion appendectomy was performed with good outcome.</p> Atef Mejri Khaoula Arfaoui Badreddine Aloui Copyright (c) 2020-08-12 2020-08-12 36 1 Chronic posterior fracture-dislocation of the shoulder: case report and a literature review <p>Posterior shoulder fracture-dislocation is a rare<br>injury accounting for approximately 0.9% of<br>shoulder fracture-dislocations and often<br>misdiagnosed during the initial presentation to a<br>physician. Though the reverse Hill-Sachs lesion is a<br>common injury associated with posterior shoulder<br>dislocation, the associated scapula fracture<br>represents only 6% of the lesions associated with a<br>posterior dislocation of the shoulder. We report<br>the case of a neglected posterior shoulder<br>dislocation with a reverse Hill-Sachs lesion treated<br>by filling with an autologous graft associated with<br>an extra articular fracture of the scapula fixed by a <br>Article<br>Ahmed Daoudi et al. PAMJ - 36(275). 13 Aug 2020. - Page numbers not for citation purposes. 2<br>plate and a posterior bone end-stop because of the<br>posterior instability. After two years of follow-up,<br>the patient has no episode of dislocation and is<br>satisfied with the functional result with a constant<br>score of 68/100 points.</p> Ahmed Daoudi Najib Abdeljaouad Hicham Yacoubi Copyright (c) 2020-08-13 2020-08-13 36 1 Undifferentiated nasopharyngeal cancer extending to maxillary sinus: a case report <p>Undifferentiated nasopharyngeal cancer of the<br>cavum (UCNT) is the most frequent neoplasm of<br>the nasopharynx, having a close relationship with<br>exposure to Epstein-Barr virus. It has a high<br>potential for locoregional or distant invasion which<br>are the cause of some treatment failures. The<br>extension to the maxillary sinus is rarely described.<br>We report here the case of a 38-year-old patient<br>with headaches associated with epistaxis, left<br>otalgia and facial pain. Examination by anterior<br>rhinoscopy objectively revealed a polylobed<br>ulcerating mass. Otoscopic examination revealed a<br>left seromucous otitis media. Computed<br>tomography showed a voluminous tumour process <br>Article<br>Mohamed Beghdad et al. PAMJ - 36(276). 13 Aug 2020. - Page numbers not for citation purposes. 2<br>in the infra temporal fossa and nasopharynx with<br>significant locoregional extension particularly in<br>the maxillary sinus. Pathological examination<br>revealed an UCNT of the cavum and the patient<br>was classified as T4N2M0. The patient received<br>chemoradiotherapy, with wide irradiation of the<br>cervical lymph node areas. The deep localization of<br>the cancer of the cavum, which is difficult to<br>examine, requires a diagnostic and extension<br>work-up, both endoscopic and radiological, which<br>is an important step in the diagnostic and<br>therapeutic management.</p> Mohamed Beghdad Amine Mkhatri Yassine Harmoumi Meriem Doumiri Sami Rouadi Reda Abada Mohamed Roubal El Benna Naima Mohamed Mahtar Copyright (c) 2020-08-13 2020-08-13 36 1 Torticollis as a sign of spinal tuberculosis <p>Bone localization of tuberculosis mainly affects the thoracolumbar spine. The cervical spine is rare. Its diagnosis is often late which exposes to great instability and potentially serious complications. We report the case of a 12-year old girl with no medical history, showing torticollis and high temperature without neurological complication. In the physical examination, he had torticollis and pain in the third, fourth and fifth cervical vertebra. When the biopsy was performed, we find an inter apophysis (between C7 and D1) collection. The histological examination confirmed the diagnosis of apophysis tuberculosis. The management based on tuberculosis chemotherapy and immobilization started as soon as possible.</p> Rim Boussetta Mohamed Zairi Sami Bouchoucha Sami Rafik Lafrem Ahmed Msakeni Walid Saied Nebil Nessib Copyright (c) 2020-08-14 2020-08-14 36 1 Knowledge, attitudes and preventive practices for human papilloma virus infection among female sex workers in Lagos metropolis <p><strong>Introduction:&nbsp;</strong>risky and hard-to-reach populations like female sex workers (FSW) face a huge burden with sexually transmitted infections (STIs) among which is human papilloma virus (HPV) infection. This study was conducted to evaluate the knowledge, attitudes and preventive practices for HPV infection among FSW in Lagos, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a descriptive cross-sectional study was carried out among 403 respondents. The sampling units were FSW in brothels in two urban communities of Lagos. A multistage sampling technique was used for selection of respondents. Pre-tested, validated questionnaire was used for data collection. Responses to knowledge, attitude and practice questions were scored graded as poor (&lt;50%) and good (≥50%). Bivariate analysis were carried out using Chi-square, Fisher exact test and student t-test. Logistic regression model was used for multivariate analysis. P-value &lt; 0.05 was considered statistically significant.</p> <p><strong>Results:&nbsp;</strong>the mean age of the respondents was 32.97 ± 8.43. Majority of the respondents were within the age range of 18-34 years (51.61%), christians (51.12%), single (42.93%) and had secondary education (52.61%). Among the respondents 51.61% had good knowledge, 97.27% had good attitude and 62.28% had good preventive practice. FSW belonging to the age group 35-51 or 52-68 years, were more likely to have a good knowledge compared to those between 18-34 years. FSW with no formal education or living with a relative are less likely to have a good knowledge, compared to those having primary education or living alone. FSW with traditional or other religious beliefs are less likely to have good preventive practices against HPV compared to christian religious belief. Having tertiary education or married makes a FSW less likely, while being widowed makes her more likely to have good preventive practice. FSW living with friends are more likely to be exposed to good preventive practices compared to those living alone.</p> <p><strong>Conclusion:&nbsp;</strong>there is a need for regular health education program on HPV for FSW in order to increase their awareness and encourage best preventive practices against HPV.</p> Nforbih Emile Shu Abdul-Hakeem Olatunji Abiola Babatunde Abdulmajeed Akodu Benjamin Afahakan Bassey Nadine Misago Copyright (c) 2020-08-14 2020-08-14 36 1 Bioequivalence studies in Morocco <p>Letter to the editors</p> Sanaa Zaoui Wafaa Fadili Copyright (c) 2020-08-14 2020-08-14 36 1 Prevalence and characteristics of HIV infection among female sex workers in Lubumbashi, Democratic Republic of Congo <p><strong>Introduction:&nbsp;</strong>female sex workers (FSWs) are considered a high-risk group for acquiring HIV infection due to their HIV prevalence estimated to be 10-20 times higher than in woman in the general population. This study aimed to determine the prevalence and risk factors of HIV among female sex workers (FSWs) in Lubumbashi.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted among FSWs presenting for the first time at the sexually transmitted infections (STIs) clinic of Katuba, Lubumbashi, between April 2016 and December 2017. Information on the participants´ socio-demographic characteristics, sexual behaviors, and HIV serology results were collated and analyzed using a multiple logistic regression to identify factors associated to HIV infection among FSWs.</p> <p><strong>Results:&nbsp;</strong>information on 1555 sex workers was analysed in this study, the prevalence of HIV was 8.2%. The median age of the participants was 26 years (IQR: 21-34). Of the 127 HIV positive sex workers, 74% have been in the business for two years or less, 97% sell sex as their main income, 74% have more than 5 sexual intercourses per week, 95% reported using condom, 73% reported having history of STIs, 70% reported using alcohol before sex and 97% reported having three or more sexual partners per week. After adjusting for potentials cofounders, Age, Sex work as main income, years of selling sex, condom use, and alcohol use before sex were found to have a significant effect on HIV infection among sex workers.</p> <p><strong>Conclusion:&nbsp;</strong>these findings highlight the vulnerability of FSWs to HIV infection and the necessity of immediate interventions to strengthen HIV prevention through behavioral change strategies and making available Pre-exposure Prophylaxis (PrEP) for FSWs in Lubumbashi.</p> Christian Kakisingi Michel Muteba Olivier Mukuku Véronique Kyabu Kevin Ngwej Patricia Kajimb Michel Manika Hippolyte Situakibanza Claude Mwamba Dieudonné Ngwej Copyright (c) 2020-08-14 2020-08-14 36 1 Factors associated with culture proven neonatal sepsis in the Ho municipality 2016 <p><strong>Introduction:&nbsp;</strong>Neonatal Sepsis (NNS) is a public health problem which causes death or disability unless appropriate antibiotic treatment is given promptly. Globally, sepsis is an important cause of morbidity and mortality in neonates despite recent progress in health care delivery. We assessed the factors associated with culture proven sepsis among neonates in the Ho Municipality, Ghana.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted in two public hospitals in the Ho Municipality between January and May, 2016. All neonates who were clinically suspected with sepsis in the Neonatal Intensive Care Unit (NICU) and their mothers were recruited. A 2ml blood sample was taken aseptically and dispensed into a mixture of thioglycollate and tryptone soy broth in a 1:10 dilution and microbiological procedures performed. Case notes of both neonates and their mothers were reviewed and interviews conducted to collect both clinical and socio-demographic data. We determined the factors associated with culture proven neonatal sepsis using logistic regression model and statistical significance was determined at 95% confidence intervals.</p> <p><strong>Results:&nbsp;</strong>out of 150 neonates, 26 (17%) had laboratory confirmed sepsis. The most common pathogen isolated was Staphylococcus epidermidis 14, (54%). Neonates whose mothers were primigravida (OR=2.74; 95% CI:1.12-6.68), and those who attended antenatal clinics (ANC) fewer than three schedules (OR=2.90; 95% CI:1.06-7.96) had higher odds of developing culture proven sepsis.</p> <p><strong>Conclusion:&nbsp;</strong>neonates who were the first babies of their mothers were more likely to develop laboratory confirmed sepsis. Also, neonates of mothers who attended ANC less than 3 times were more likely to develop laboratory confirmed sepsis. High index of suspicion is required to diagnose neonatal sepsis among neonates of primigravida mothers and mothers who attend fewer than three ANC schedules.</p> Fortress Yayra Aku Patricia Akweongo Kofi Mensah Nyarko Lord Graceful Mensah Kokou Amegan-Aho Lawrence Kumi Edwin Andrew Afari Donne Kofi Ameme Ernest Kenu Copyright (c) 2020-08-14 2020-08-14 36 1 Bilateral supernumerary axillary breasts: a case report <p>Accessory breast tissue is an uncommon condition which occurs in 0.4-6% of women. It is mostly located in the axilla and has a high incidence of being misdiagnosed. Usually it is bilateral and presents as an asymptomatic mass during pregnancy or lactation. The diagnosis of ectopic breast tissue is important as it can undergo the same pathological changes that occur in a normal breast, such as mastitis, fibrocystic disease and carcinoma. We present a case of a bilateral axillary localization of accessory breast in a 45-year-old woman. The principal symptom was pain and the clinical diagnosis was bilateral lipoma. However, subsequent imaging and histopathological examination proved it to be an accessory breast tissue.</p> Khalid Mazine Abdesslam Bouassria Hicham Elbouhaddouti Copyright (c) 2020-08-14 2020-08-14 36 1 Roseomonas gilardii in patient with leukemia and acute appendicitis: case report and review <p>Appendicitis is one of the most common abdominal<br>conditions requiring emergency surgery. However,<br>acute appendicitis in patients with leukemia is a<br>rare condition. We report herein the case of an 18-<br>year-old female with acute lymphoblastic leukemia<br>(ALL), who was hospitalized in hematology<br>department because of abdominal pain and fever.<br>Ultrasound (US) of the abdomen revealed<br>appendicitis and the patients underwent open<br>appendectomy. The patient recovered without<br>complications and was discharged in a good<br>condition. The day of the operation blood and<br>peritoneal fluid cultures were taken and<br>Roseomonas gilardii was detected and healed<br>empirically. The correct diagnosis of appendicitis in <br>Article<br>Francesk Mulita et al. PAMJ - 36(283). 14 Aug 2020. - Page numbers not for citation purposes. 2<br>patients with leukemia and their management is<br>challenging for physicians. Very rare<br>microorganisms can be detected in these patients.</p> Francesk Mulita Nikoleta Oikonomou Athanasios Provatidis Agelos Alexopoulos Ioannis Maroulis Copyright (c) 2020-08-14 2020-08-14 36 1 Paralysie faciale périphérique de l´enfant: une manifestation inhabituelle d´un corps étranger de l´oreille <p>Les corps étrangers de l´oreille, fréquents chez l´enfant, se compliquent rarement. Nous rapportons un cas rare de paralysie faciale de l´enfant compliquant un corps étranger toxique de graine d<em>´Abrus precatorius.</em>&nbsp;Il s´agissait d´une enfant de 4 ans qui avait introduit ce type de corps étranger dans l´oreille, ayant entrainé, 15 jours plus tard une paralysie faciale homolatérale. Des signes de nécroses locaux associés à une otite externe étaient retrouvés sans atteinte systémique. L´extraction du corps étranger était effectuée au micro crochet. Des traitements locaux et généraux ainsi qu´une corticothérapie et une kinésithérapie faciale avaient permis une bonne évolution de la paralysie faciale au bout de trois semaines. Le séjour prolongé du corps étranger dans l´oreille et l´infection locale qui en résulte favorisent la survenue des complications fonctionnelles. L´extraction précoce et les soins locaux constituent les bases de leur traitement.</p> Patrick Maholisoa Randrianandraina Hery Henintsoa Randrianirina Avisoa Theodora Fare Ando Mathieu Andriamahenina Ravaka Hariniaina Andriambelo Diavolana Koecher Andrianarimanana Fanomezantsoa Andriamparany Rakoto Copyright (c) 2020-08-17 2020-08-17 36 1 Prevalence and predictors of problematic smart phone use among pre-varsity young people in Ibadan, Nigeria <p><strong>Introduction:</strong>&nbsp;smart phone possession and use among young people is on the increase in Africa and phone addiction has been shown to be similar to substance use dependence. However, there is barely any literature focused on the effect of smart phone use on young people in Nigeria. This study looked at the prevalence of problematic smart phone use and associated factors among pre-varsity young people in Ibadan.</p> <p><strong>Methods:</strong>&nbsp;problematic smart phone use was assessed using the 27-item mobile phone problem use scale and scored on a 5-point Likert scale. Scores 27-76 indicated low-moderate degree and scores ≥ 77 indicated moderate-severe degree of problematic smart phone use. Chi square test was used to compare problematic phone use with some selected respondents' characteristics and p was 0.05.</p> <p><strong>Results:</strong>&nbsp;five hundred and seventy five participants were recruited, age range 14-24 years and 46.0% were males. Almost all (96.7%) of the respondents had smart phone access and 46.5% had moderate-severe problematic phone use. Young people who were males, had their parents paying for the data they use, had high extroversion, low conscientiousness and low intellect scores were likely to have problematic phone use. The identified predictors for problematic phone use were male gender (OR=1.77, 95% CI: 1.26-2.50), high extroversion (OR=1.68, 95% CI: 1.16-2.43) and low conscientiousness (OR=2.09, 95% CI: 1.41-3.09).</p> <p><strong>Conclusion:</strong>&nbsp;there was a high rate of problematic phone use among these young people. Interventions to promote responsible smart phone use is required to counter this problem.</p> Folusho Mubowale Balogun Oluwatoyin Esther Olatunde Copyright (c) 2020-08-17 2020-08-17 36 1 COVID-19 and fortuitous discovery of chronic lymphocytic leukemia: biological findings and therapeutic challenges <p>With the major spread of SARS-COV-2 around the world, its association with various pathologies has been reported. However, hemopathy has rarely been revealed during a coronavirus infection. The authors of this article aim to emphasize the diagnostic and therapeutic challenges faced while treating COVID/hemopathy patients.</p> Boubaker Charra Ayman Ellouadghiri Abdellah Magramane Touda Kebbou Kenza Damaan Abdeljabbar Maghfour Kamal Seddiki Hanane Ezzouine Copyright (c) 2020-08-17 2020-08-17 36 1 Emergency response to a cluster of suspected foodborne botulism in Abuja, Nigeria: challenges with diagnosis and treatment in a resource-poor setting <p>Food-borne botulism is a rare, acute and potentially<br>fatal neurologic disorder that results from ingestion<br>of food contaminated by botulinum toxin released<br>from the anaerobic, spore-forming, gram-positive<br>bacterium Clostridium botulinum. We reported an<br>unusual cluster of botulism outbreak with high case<br>fatality affecting a family following ingestion of<br>home-made fish. A suspected outbreak of botulism<br>affecting three patients in a family of six was<br>reported to the Nigeria Centre for Disease Control.<br>A rapid response team investigated by line-listing all<br>the family members, interviewed extended family<br>members, caregivers, clinicians, and nurses to<br>collect socio-demographic and clinico<br>epidemiological information using a semistructured questionnaires. We collected blood from<br>patients and food samples and locally made drink<br>from the family home for laboratory testing. All<br>family members ingested the same home-made<br>food within the 48hrs before onset of symptoms in<br>the index case. The clinical presentation of the three<br>affected cases (AR=50.0%) was consistent with<br>botulinum poisoning. Two of the affected cases died<br>(CFR=66.7%) within 48hrs of admission, before<br>antitoxin was made available. The third case had a<br>milder presentation and survived, after<br>administration of appropriate antitoxin. The<br>remaining three children developed no symptoms.<br>None of the samples cultured Clostridium<br>botulinum. The blood samples were negative for<br>mouse lethality test. Our report describes the<br>challenges of diagnosis and management of rare<br>emerging infectious disease outbreaks in resourceconstrained settings.</p> Oyeladun Okunromade Mahmood Muazu Dalhat Aminatu Makarfi Umar Augustine Olajide Dada Jamilu Nikau Lamin Maneh Okokon Ita Ita Muhammad Shakir Balogun Patrick Nguku Olubunmi Ojo Chikwe Ihekweazu Copyright (c) 2020-08-17 2020-08-17 36 1 Gender and educational attainment influence willingness to donate organs among older Nigerians: a questionnaire survey <p><strong>Introduction:&nbsp;</strong>disparity between the demand for and the supply of organs for transplantation remains a major public health issue of global concern. This study evaluated the knowledge and determinants of willingness to donate organs among outpatient clinic attendees in a Nigerian teaching hospital.</p> <p><strong>Methods:&nbsp;</strong>a 43-item semi-structured interviewer-administered questionnaire was designed to assess awareness and willingness of individuals attending Neurology, Psychiatry and Geriatrics Outpatient clinics to donate bodily organs for transplantation. Association between participants´ characteristics and willingness towards organ donation was investigated using logistic regression models.</p> <p><strong>Results:&nbsp;</strong>a total of 412 participants were interviewed and mean age was 46.3 (16.1) years. There were 229 (55.6%) females and 92.5% had at least 6 years of formal education. Overall, 330 (80.1%) were aware of donation of at least one organ for transplantation purposes but only 139 (33.7%) were willing to donate organ. In analyses adjusting for sex, marital status, family setting and educational status, male gender AOR [2.066(1.331-3.2016)] secondary education [AOR 5.57 (1.205-25.729) p= 0.028] and post-secondary education [AOR-6.98 (1.537-31.702) p= 0.012 were independently associated with willingness towards organ donation.</p> <p><strong>Conclusion:&nbsp;</strong>the survey revealed high level of awareness but poor willingness towards organ donation among older Nigerians attending outpatient clinics of a premier tertiary hospital. Male gender and educational attainment were significantly associated with willingness to donate. Educational programs that particularly target women and less educated older Nigerians are needed to promote organ donation in Nigeria.</p> Rufus Olusola Akinyemi Joshua Odunayo Akinyemi Olorunyomi Felix Olorunsogbon Ezinne Uvere Ayodele Samuel Jegede Oyedunni Sola Arulogun Copyright (c) 2020-08-17 2020-08-17 36 1 Lived experiences of stressors and problems of higher education students on teacher education course in the Eastern Highlands of Zimbabwe, 2019 <p><strong>Introduction:&nbsp;</strong>there is increasing levels of stressors and hardship among higher education students especially in low and middle income countries. Higher education institutions have an important role to play in the provision of robust and comprehensive support for students who experience stressors and hardship. Research and action in this area has however not been prioritized by the institutions in Zimbabwe. This study examined students´ expression of their experience with stressors and problems of studying in higher education in the Eastern Highlands of Zimbabwe.</p> <p><strong>Methods:&nbsp;</strong>the study employed a qualitative approach using the phenomenology approach. Three institutions of higher education in the eastern border highlands of Zimbabwe were considered. Four focus group discussions were conducted with eight participants in each group. A one-to-one semi-structured interview with eight individual participants was also conducted to further examine the issues raised in the focus groups. Data were analyzed thematically using the Silences Framework theoretical model.</p> <p><strong>Results:&nbsp;</strong>five overarching themes emerged from the analysis: (i) the stress of completing assessments without adequate learning materials. (ii) Unfair placement workload results into poor assessment outcomes. (iii) College-life is more difficult due to financial constraints. (iv) Marital problems interfering with college work: there is no mental health service available. (v) Enduring pains of bereavement with no emotional support or helpline.</p> <p><strong>Conclusion:&nbsp;</strong>the study recommends the need to develop an inter-ministerial mental health strategy for institutions of higher learning with the view of implementing policies that address students suffering in Zimbabwean HE institutions.</p> Mathew Nyashanu Rebecca Nuwematsiko Wendy Nyashanu Dung Ezekiel Jidong Copyright (c) 2020-08-17 2020-08-17 36 1 The factors that affect the mortality of emergency operated ASA 3 colon cancer patients <p><strong>Introduction:&nbsp;</strong>colorectal cancers take third place among cancer-related deaths and 10-28% of these patients are admitted with the necessity of emergency surgical intervention. The main propose of this study was to investigate the factors affecting mortality in ASA 3 colorectal cancer patients who undergo emergency surgery.</p> <p><strong>Methods:&nbsp;</strong>between 2010 and 2017 ASA 3 patients who underwent emergency colon cancer surgery were included in the study. All of the study group was evaluated within the first 30-day time-frame. The results were obtained by a statistical comparison of the data of patients with and without mortality.</p> <p><strong>Results:&nbsp;</strong>one hundred and twenty eight patients included in the study. There was no statistical difference in the demographic data of the groups and the indications of the operation. The differences and durations of surgery also did not make any statistical difference. The complication rate was the same according to the Clavien-Dindo classification.</p> <p><strong>Conclusion:&nbsp;</strong>despite the screening programs applied in colorectal cancers, applications to emergency services and procedures performed under emergency conditions are still at high levels. Surgical operations, which have to be performed in patients with impaired metabolic status, carry major risks for patients, but their outcomes are also satisfactory for them.</p> Yeliz Yilmaz Fevzi Cengiz Erdinç Kamer Turan Acar Emine Özlem Gür Halis Bag Yasin Peker Kemal Atahan Copyright (c) 2020-08-17 2020-08-17 36 1 Aplasia cutis congenita: a report of two cases from National Hospital Abuja, Nigeria and review of the literature <p>Aplasia cutis congenita is a rare congenital abnormality first described in 1767 by cordon. It mostly appears as a solitary lesion involving various layers of the skin and sometimes the bone on the scalp, limbs or abdomen. Genetics, environmental and exogenous causes have been implicated as potential causes. Only about 500 cases have been reported globally as of 2013. Two cases of Aplasia Cutis Congenita (ACC) who presented with scalp and bone defects at birth are reported, one in a syndromic child delivered to a consanguineous family, with associated cardiac, skin and nail anomalies (likely Adams Oliver syndrome) and the other as an isolated scalp lesion. Both were large defects managed conservatively by a multidisciplinary team. The challenges of investigating and managing such complex scalp anomalies in sub-Saharan Africa are highlighted.</p> Mariya Mukhtar-Yola Lauretta Mshelia Amsa Baba Mairami Adekunle Tolutope Otuneye Edith Terna Yawe Patricia Igoche Lamidi Isah Audu Copyright (c) 2020-08-17 2020-08-17 36 1 Mucocutaneous leishmaniasis: case report and literature review of a rare endonasal infection <p>Leishmaniasis is a protozoal infection transmitted<br>by a sandfly vector. In Germany, leishmaniasis of<br>the mucous membranes is a rare condition and<br>usually due to extension of local skin disease into<br>the mucosal tissue via direct extension,<br>bloodstream or lymphatics. We report a case of<br>endonasal leishmaniasis in a female German<br>resident who presented in a university hospital<br>with nasal obstruction. Histology of the left nasal<br>septum biopsy was suggestive of leishmaniasis.<br>The molecular detection of DNA was positive for<br>leishmania infantum. The patient was successfully<br>treated as a case of mucocutaneous leishmaniasis<br>receiving liposomal amphotericin follow up visits<br>showed significant improvement with no<br>recurrence.</p> Abrar Adnan Suqati Annett Pudszuhn Veit Maria Hofmann Copyright (c) 2020-08-17 2020-08-17 36 1 Perceptions and usage of selected fermented foods for feeding children aged 13-60 months in Tshwane, Gauteng Province <p><strong>Introduction:&nbsp;</strong>fermented indigenous foods are known to confer health and nutritional benefits to young children. However, perception and usage of these foods is not well understood. This study aimed to determine the perceptions and usage of fermented foods, by child caregivers, for children feeding in Gauteng Province, South Africa.</p> <p><strong>Methods:&nbsp;</strong>a standard questionnaire was used to obtain data from child caregivers on the perceptions and usage of fermented foods to feed young children in Tshwane metro.</p> <p><strong>Results:&nbsp;</strong>a total of 1248 child caregivers completed the questionnaires. Their age ranged from 15-65 years, 71.7% being single, with majority (74%) having attained secondary school education and unemployed (65%). Over 60% of children were fed sour milk (maas), sour porridge and yoghurt at a frequency of 1-3 times a week, with the feeding starting at the age of 6-12 months. Majority (59-74%) had positive perceptions on benefits of feeding children with fermented foods.</p> <p><strong>Conclusion:&nbsp;</strong>there is a high acceptability of fermented foods for feeding children in this community. Further promotion of these foods may improve the frequency of their usage.</p> Paul Kiprono Chelule Sphiwe Madiba Mathildah Mokgatle Copyright (c) 2020-08-17 2020-08-17 36 1 Clinical characteristics and treatment outcomes of angioid streak associated choroidal neovascular membrane (AS-CNV): a Zambian case series <p>This case series illustrates clinical features and<br>treatment outcomes of angioid streak associated<br>CNV (AS-CNV) in 3 consecutive patients. Mean age<br>of patients was 43.2 years with one female<br>patient. Bilateral CNV was present in one patient.<br>Comet-tail lesions were present in all cases. No<br>underlying systemic association was found in any<br>of the patients. All patients were treated with 3<br>loading doses of anti-VEGF injections (ranibizumab<br>in two and aflibercept was used in one case).<br>Subretinal fluid resolved in all cases with no<br>recurrence of CNV activity at mean follow-up of<br>10.75 months. AS-CNV in Zambian eyes responds<br>favourably to anti-VEGF injections.</p> Kshitiz Kumar Santosh Balasubramaniam Amar Agarwal Copyright (c) 2020-08-17 2020-08-17 36 1 ENT manifestations of tuberculosis: an important aspect of ENT practice <p>Tuberculosis involving organs other than the lungs<br>is termed as 'extra pulmonary tuberculosis'.<br>Tuberculosis (TB) remains a worldwide public<br>health problem despite the fact that the causative<br>organism was discovered more than 100 years<br>ago. The present study was conducted to assess<br>different manifestations of tuberculosis affecting<br>the ear, nose and throat (ENT) in patients<br>attending the outpatient department in a total of<br>520 cases of tuberculosis. One hundred and eight<br>cases were of extra pulmonary tuberculosis. Sixty<br>nine cases had the manifestations of TB in the ENT<br>region. These included patients with tuberculous cervical lymphadenopathy (91.35), laryngeal TB<br>(4.3%), tuberculous otitis media (1.4%), nasal TB<br>(1.4%) and oral tuberculosis (1.4%). Extra<br>pulmonary tuberculosis constitutes about 15-20%<br>of all tuberculosis cases as per WHO survey and it<br>is 20.6% in the present study.</p> Shilpam Sharma Amit Kumar Rana Copyright (c) 2020-08-18 2020-08-18 36 1 Low retention rate of voluntary blood donors: contribution of an original method based on a composite classification (results of a monocentric study in the Democratic Republic of Congo) <p><strong>Introduction:&nbsp;</strong>in order to improve the safety of blood transfusion, the retention of voluntary donors remains a major concern in the Democratic Republic of Congo. Nevertheless, retention is still difficult to assess because of the lack of local studies. The present study establishes the donors' profile and regularity, as well as regularity-associated factors, at the Provincial Blood Transfusion Centre in Bukavu.</p> <p><strong>Methods:&nbsp;</strong>this descriptive and analytical cross-sectional study included the records of 387 out of 773 blood donors during the period from 2015 to 2017. Donor retention and its associated factors were measured. The composite approach used here considered the number of blood donations, their frequency, the previous regularity of donors and the inter-donation interval.</p> <p><strong>Results:&nbsp;</strong>we bring to light an important loss of regular voluntary donors in the centre. Only 23.8% of them were still regular donors in 2017. The majority of donors registered in the centre are young males and have no income. On the contrary, factors associated with the profile of a regular donor in 2017 were: age at least 46 years old, being a woman and working in the formal sector. The composite classification highlighted that an important proportion of former regular donors, namely 72.8% (N=161/221), had not given blood in 2017.</p> <p><strong>Conclusion:&nbsp;</strong>the use of a composite classification to assess the regularity of voluntary blood donors provides more accurate information that will enable the improvement of donors' awareness and retention as well as the possible reinstatement of former donors.</p> Susanne Mbaka Ngunza Cyprien Munyashongore Gisèle Nshokano Nshobole Dominique Latine Isabelle Aujoulat Copyright (c) 2020-08-18 2020-08-18 36 1 Evaluation of knowledge and awareness of invasive fungal infections amongst resident doctors in Nigeria <p><strong>Introduction:&nbsp;</strong>it has been estimated that about 11.8% of the Nigerians suffer serious fungal infections annually. A high index of suspicion with early diagnosis and institution of appropriate therapy significantly impacts on the morbidity and mortality of invasive fungal infections (IFIs).</p> <p><strong>Methods:&nbsp;</strong>we conducted a cross-sectional multicentre survey across 7 tertiary hospitals in 5 geopolitical zones of Nigeria between June 2013 and March 2015. Knowledge, awareness and practice of Nigerian resident doctors about the diagnosis and management of invasive fungal infections were evaluated using a semi-structured, self-administered questionnaire. Assessment was categorized as poor, fair and good.</p> <p><strong>Results:&nbsp;</strong>834(79.7%) of the 1046 participants had some knowledge of IFIs, 338(32.3%) from undergraduate medical training and 191(18.3%) during post-graduate (specialty) residency training. Number of years spent in clinical practice was positively related to knowledge of management of IFIs, which was statistically significant (p &lt; 0.001). Only 2 (0.002%) out of the 1046 respondents had a good level of awareness of IFIs. Only 4(0.4%) of respondents had seen &gt; 10 cases of IFIs; while 10(1%) had seen between 5-10 cases, 180(17.2%) less than 5 cases and the rest had never seen or managed any cases of IFIs. There were statistically significant differences in knowledge about IFIs among the various cadres of doctors (p &lt; 0.001) as level of knowledge increased with rank/seniority.</p> <p><strong>Conclusion:&nbsp;</strong>knowledge gaps exist that could militate against optimal management of IFIs in Nigeria. Targeted continuing medical education (CME) programmes and a revision of the postgraduate medical education curriculum is recommended.</p> Rita Oladele Akaninyene Asuquo Otu Olubunmi Olubamwo Olufunmilola Bamidele Makanjuola Ernest Afu Ochang Joan Ejembi Nicholas Irurhe Iember Ajanaku Halimat Ayodele Ekundayo Adebola Olayinka Oluwole Atoyebi David Denning Copyright (c) 2020-08-18 2020-08-18 36 1 Hepatitis B-related hepatocellular carcinoma in a 36-year-old pregnant woman: prognosis and management dilemma <p>Management of chronic hepatitis B infection<br>complicated by hepatocellular carcinoma (HCC) in<br>pregnancy poses a treatment dilemma as the<br>pregnancy accelerates disease progression and<br>narrows the diagnostic tools and therapeutic<br>choices. Studies have reported higher maternal<br>and fetal losses. We share our experience with a<br>36-year-old pregnant woman who presented at 35<br>weeks' gestation with a large painful nodular liver<br>and significant weight loss. She tested HBsAgpositive and had both clinical and laboratory<br>features of severe liver decompensation. The<br>abdominal ultrasound rightly described HCC on a<br>cirrhotic background. The fetus was delivered by<br>cesarean section but the mother died soon after.</p> Bruce Shinga Wembulua Kalilou Diallo Mame Aïsse Thioubou Jean Didier Bosenge Nguma Noel Magloire Manga Copyright (c) 2020-08-18 2020-08-18 36 1 Is it time to use nucleic acid amplification tests for identification of persons with sexually transmitted infections?: evidence from seroprevalence and behavioral epidemiology risk surveys in men with chlamydia and gonorrhea <p>Chlamydia and gonorrhea are common sexually transmitted infections (STIs) that can cause multiple problems, and can be easily treated, but frequently present without symptoms. Because of this, commonly used syndromic diagnosis misses a majority of infected persons. Previously, diagnostic tests were expensive and invasive, but newer nucleic-acid amplification tests (NAATs) are available that use urine to non-invasively test for these infections. These analyses used data from seroprevalence studies conducted in five militaries. Data included self-reported current symptoms of STIs as well as chlamydia and gonorrhea NAAT results. A total of 4923 men were screened for chlamydia and gonorrhea from these 5 militaries during April 2016 to October 2017. The combined prevalence of chlamydia and gonorrhea in these five militaries ranged from 2.3% in Burundi to 11.9% in Belize. These infections were not successfully identified by symptomology; for example, only 2% of cases in Belize reported symptoms. In three of the five countries there was no statistical association between symptoms and positive NAAT results. The majority of individuals with these infections (81% to 98%) would be undiagnosed and untreated using only symptomology. Therefore, using symptoms alone to diagnose cases of chlamydia and gonorrhea is not an effective way to control these infections. We propose that automated, cartridge-based NAATs, be considered for routine use in diagnosing those at risk for STIs.</p> Laura Tobin Lydia Guerra Léonce Ahouanvoeke Jose González Carpio Donatien Irambona Edward Owusu Nyarko Caroline Macera Steven Wiersma Copyright (c) 2020-08-18 2020-08-18 36 1 Oral hygiene practices and utilization of oral healthcare services among in-school adolescents in Calabar, Cross River State, Nigeria <p><strong>Introduction:&nbsp;</strong>oral health mirrors an individual´s general health, hence, proper care should be taken to prevent oral diseases and conditions. An estimated 3.9 billion people worldwide are affected by oral conditions, and adolescents are at increased risk due to diet choices and hormonal changes. This study aimed at determining the oral hygiene practices, awareness and utilization of oral healthcare services among in-school adolescents in Calabar Municipality.</p> <p><strong>Methods:&nbsp;</strong>a descriptive cross-sectional study design was employed in studying these variables among in-school adolescents (10-19 years) in secondary schools (JSS1-SSS2) using a self-administered, semi-structured questionnaire. Data were entered and analyzed with EPI-Info. Cross tabulations of variables were conducted using Chi-square test with significance level of 5%.</p> <p><strong>Results:&nbsp;</strong>a total of 335 students participated in the study with 228 (68.1%) and 136 (40.6%) reporting that they are aware of and have utilized oral healthcare services (OHS), respectively. There was no statistically significant association between age (p=0.923), gender (p=0.351) and type of school (p=0.497) respectively with awareness and utilization of OHS. Toothache/pain and presumed good dental health respectively were the main reasons for the usage and non-utilization of these services. Time-to-use of oral health services after the onset of toothache/pain was within five days (75.7%).</p> <p><strong>Conclusion:&nbsp;</strong>the utilization rate of OHS did not match up to the level of awareness of these services with pain being the main driver for utilization. Increased awareness of oral healthcare through health education and oral healthcare demonstrations among adolescents is highly recommended as part of school health programs.</p> Divine-Favour Chichenim Ofili Ekpereonne Babatunde Esu Regina Idu Ejemot-Nwadiaro Copyright (c) 2020-08-18 2020-08-18 36 1 The completion of partograms: knowledge, attitudes and practices of midwives in a public health obstetric unit in Bloemfontein, South Africa <p><strong>Introduction:</strong>&nbsp;most maternal and 24.3% of infant deaths occur during childbirth. Interventions during childbirth may reduce maternal and neonatal deaths. The&nbsp;<em>Guidelines for maternity care in South Africa</em>&nbsp;(2015) stipulates that all observations during labour should be recorded on a partogram. The objective of this study was to assess the knowledge and attitudes of nursing personnel and to evaluate their practices of completing partograms at National District Hospital, South Africa.</p> <p><strong>Methods:</strong>&nbsp;a two-phase, quantitative, cross-sectional, descriptive study design was used. In phase 1, the knowledge and attitudes of midwives and nurses were evaluated. Midwives and nurses completed anonymous, self-administered questionnaires that assessed their knowledge and attitudes. In Phase 2, partogram practices were measured by assessing completed partograms using a data collection tick sheet.</p> <p><strong>Results:</strong>&nbsp;twelve of the 17 nursing personnel completed the questionnaires. More than 90% of participants answered basic partogram knowledge questions correctly, but only two thirds knew the criteria for obstructive labour and just more than half that for foetal distress. Participants displayed a positive attitude toward the use of partograms. Of the 171 randomly selected vaginal deliveries during the study period, only 57.1% delivered with a completed partogram. Most elements of foetal monitoring and progress of labour scored above 80%, however, for maternal monitoring scored poorly in 26.4% of cases.</p> <p><strong>Conclusion:</strong> although 71.4% of partograms scored more than 75% for completion, the critical components that influence maternal and foetal death, like the identification of foetal distress, maternal wellbeing and progress of labour, were lacking.</p> Hanneke Brits Gina Joubert Fulufhelo Mudzwari Monica Ramashamole Moipone Nthimo Ntšebo Thamae Mamello Pilenyane Maphuti Mamabolo Copyright (c) 2020-08-18 2020-08-18 36 1 Une loase oculaire: à propos d'un cas <p>Notre objectif est de rapporter le cas d´une loase dans une zone sahélienne habituellement non endémique dans sa manifestation ophtalmologique. Il s´agissait d´un homme de 25 ans admis en consultation ophtalmologique pour sensation des corps étranger dans l´œil droit. Après examen ophtalmologique un ver translucide tortueux et mobile d´environ 4cm sous la conjonctive bulbaire à l´œil droit est observé. Après une extraction non traumatique chirurgicale, l´examen parasitologique confirme la loase. Il s´agit d´une parasitose des régions forestières essentiellement africaines. Suites aux mouvements des populations, elle peut être présente partout dans le monde. Il faut savoir la reconnaitre lors de nos consultations.</p> Nouhou Diori Adam Yacoubou Soumana Ali Saley Idrissa Saley Copyright (c) 2020-08-18 2020-08-18 36 1 Une polyradiculonévrite inflammatoire démyélinisante chronique paranéoplasique secondaire à un lymphome natural killer nasal <p>Nous rapportons un cas unique d´une polyradiculonévrite inflammatoire démyélinisante chronique paranéoplasique secondaire à un lymphome non hodgkinien T de type&nbsp;<em>natural killer</em>&nbsp;nasal.</p> Selim Jennane Nawal Hasnaoui Mahtat El Mehdi Hicham El Maaroufi Nezha Messaoudi Mohamed Mikdame Kamal Doghmi Copyright (c) 2020-08-18 2020-08-18 36 1 Challenges related to resources mobilization for measles outbreak response: Madagascar experience during the 2018-2019 measles outbreak <p><strong>Introduction:&nbsp;</strong>on October 4<sup>th</sup>, 2018, a measles outbreak was declared in Madagascar. This study describes challenges related to resources mobilization for the outbreak response.</p> <p><strong>Methods:&nbsp;</strong>data were collected using minutes of coordination committee meetings, activities reports, operational action plans and situation reports.</p> <p><strong>Results:&nbsp;</strong>the total cost of the outbreak response was estimated to US$ 11,281,381. Operational cost was the leading cost driver (42.45%) followed by vaccine cost (33.74%). Cases management, epidemiological surveillance, communication and social mobilization and routine immunization strengthening represented 23.81% of the total cost. The main funder of the outbreak response was the measles and rubella initiative.</p> <p><strong>Conclusion:&nbsp;</strong>good coordination, open dialogue, good use of financial resources and accountability of government and partners have enabled to gain the confidence of national and international donors.</p> Vincent Dossou Sodjinou Marcellin Mengouo Nimpa Alfred Douba Yolande Vuo Masembe Mireille Randria Charlotte Faty Ndiaye Copyright (c) 2020-08-19 2020-08-19 36 1 Dorsal onlay buccal mucosa graft urethroplasty for bulbar urethral stricture: a single centre experience <p><strong>Introduction:&nbsp;</strong>the successful treatment for urethral strictures demands not just attention to surgical details but careful selection of the reconstructive technique. For long segment urethral strictures substitution urethroplasty is required. This study sought to determine the success rate and complications of dorsal onlay buccal mucosal graft (BMG) urethroplasty for long segment urethral strictures in our hospital.</p> <p><strong>Methods:&nbsp;</strong>this was a retrospective study carried out at Jos University Teaching Hospital from March 2015 to March 2018. The case notes of male patients who had dorsal onlay buccal mucosal graft urethroplasty for long segment bulbar urethral stricture within the study period were retrieved. Patients´ demographics, cause and nature of urethral strictures, duration of follow up, the success rate and complications were collected and subjected to statistical analysis using SPSS® version 22.</p> <p><strong>Results:&nbsp;</strong>twenty-four men with mean age of 45 years (range 14-67 years) had dorsal onlay buccal mucosal graft urethroplasty during the study period. The mean stricture length was 4.5cm (range, 2-7cm). After a mean follow up duration of 2 years (range, 1 - 4 years), 21(87.5%) patients had a successful urethroplasty as they were able to pass urine at one year post urethroplasty without lower urinary tract symptoms, while 3(12.5%) had recurrence of the urethral stricture. At the recipient site, 2(8.3%) patients had primary bleeding that did not require blood transfusion. Also, 2(8.3%) patients had superficial wound infection which was treated with antibiotics. At the donor site, 4(16.7%), 2(8.3%), 4(16.7%) had donor site swelling, transient bleeding and soreness respectively.</p> <p><strong>Conclusion:&nbsp;</strong>dorsal onlay BMG urethroplasty has a good success rate and minor complications and therefore suitable for long segment bulbar urethral strictures.</p> Idorenyin Cletus Akpayak Samaila Ibrahim Shuaibu Chima Gideon Ofoha Ayodele Olufikayo Oshagbemi Nuhu Kutan Dakum Venyir Mamzhi Ramyil Copyright (c) 2020-08-19 2020-08-19 36 1 Behaviour change communication for control of tuberculosis by healthcare workers in DOTS facilities in Nigeria <p><strong>Introduction:</strong>&nbsp;prevention and control of tuberculosis (TB) should be behaviour-centred to facilitate change of unhealthy behaviours that encourage the spread of the infective agent. This study aimed to ascertain the knowledge, beliefs and practices of Behavior Change Communication (BCC) in the control of TB by healthcare workers in DOTS in Nigeria.</p> <p><strong>Methods:&nbsp;</strong>using the qualitative research approach, we interviewed 38 healthcare workers from two states in Nigeria. The interview questions consisted of 13 open-ended questions framed to elicit information about the health workers' knowledge, beliefs and practices of BCC in the control of TB. Analysis was done using the conventional content analysis.</p> <p><strong>Results:&nbsp;</strong>the following themes emerged: lack of knowledge and understanding about BCC; BCC believed to be important in the control of TB; lack of adequate skills for BCC; some aspects of BCC practiced; BCC was mainly done in health facilities; and lack of adequate system for maintaining long term change.</p> <p><strong>Conclusion:&nbsp;</strong>the BCC training needs of healthcare workers in the area of study have been revealed. These should form the basis for effective BCC capacity building programme for healthcare workers in the prevention and control of TB. We recommended that BCC should go beyond interpersonal communication to community-wide campaign through mass media to produce a massive change in behaviour that will enable the elimination of TB.</p> Evelyn Nwanebe Nwagu Lawreta Ijeoma Abugu Wamanyi Yohanna Dorothy Nwakaego Eze Amaka Harry Ononuju Agatha Nneka Obayi Copyright (c) 2020-08-19 2020-08-19 36 1 Magnitude and factors associated with upper respiratory tract infection among under-five children in public health institutions of Aksum town, Tigray, Northern Ethiopia: an institutional based cross-sectional study <p><strong>Introduction:&nbsp;</strong>upper respiratory tract infection is a leading cause of morbidity among under-five, particularly in the developing countries. Delays in the identification and treatment of under-fives are among the main contributors to the complication. The aim of this study was to assess the magnitude and to identify factors associated with upper respiratory tract infection among under-five children, in public health institutions of Aksum City, Tigray Region, North Ethiopia, 2016.</p> <p><strong>Methods:&nbsp;</strong>institutional based cross-sectional study was done. Cases were under-five children who had get service. The study participants were selected using Systematic random sampling technique. Data were entered, using Epi-info version 7 and analyzed using SPSS version 22.0. Clinical data from the chart were used to diagnose upper respiratory tract infection types. The binary logistic regression model was used to test the association between dependent and independent variables and multivariable logistic regression was used to identify the associated factors to upper respiratory tract infections.</p> <p><strong>Results:&nbsp;</strong>out of 213 study participants 52.6% identified as having at least one type of upper respiratory tract infection, i.e. sinusitis 22 (10.3%), 37 (17.4%) otitis media, 39 (18.3%) tonsillitis and common cold 83 (39.0%). Multivariable logistic regression analysis shows that rural residence 7.6 [AOR (95%CI) (2.49, 23.58)], civil servant father's children 4.49 [AOR (95%CI) (1.57, 12.83)], non-immunization 6.0 [AOR(95%CI) (1.38, 26.8)], mud house wall 4.58 [AOR (95%CI) (1.74, 12.0)], rental house 5.1 [AOC (95% CI) (1.82, 14.6] and large family size 5.3 [AOC (95%CI) (2.3, 12.1 )], were found to be statistically associated.</p> <p><strong>Conclusion:&nbsp;</strong>socioeconomic, maternal and environmental factors had contributed to the upper respiratory tract infection. Strengthening of the existing disease prevention policy as well as improvement of institutional health service behavior is crucial.</p> Teklay Zeru Hagos Berihu Gerezgiher Buruh Haftom Gebrehiwot Copyright (c) 2020-08-19 2020-08-19 36 1 Sturge Weber syndrome, when brain CT is enough for diagnosis: about a case <p>One of the main manifestations of Sturge Weber syndrome is seizures. We report the case of a child received in the context of generalized seizures and in whom a cerebral contrast CT was sufficient to make the diagnosis of Sturge Weber syndrome.</p> Ibrahima Niang Khadim Mbacké Ndiaye Alassane Mamadou Diop Ibrahima Faye Mbaye Thiam Coumba Laobé Ndao Sokhna Ba Copyright (c) 2020-08-20 2020-08-20 36 1 Clinicopathological associations and prognostic values of IDH1 gene mutation, MGMT gene promoter methylation, and PD-L1 expressions in high-grade glioma treated with standard treatment <p><strong>Introduction:&nbsp;</strong>the objective was to evaluate the impact of IDH1 R132H mutation, MGMT methylation and PD-L1 expression in high grade glioma that received standard therapy (surgery, radiation and chemotherapy) to overall survival (OS).</p> <p><strong>Methods:&nbsp;</strong>this is a retrospective study of 35 high grade glioma cases. Genotyping of IDH1 gene alteration on the mutation hotspot R132 (Sanger sequencing method with Applied Biosystems 3500 Genetic Analyzer), EZ DNA Methylation-Gold kit (Zymo Research) is used to study the methylation, Cell line BT549 (ATCC HTB-122) and HCT-116 (ATCC CCL-247) were used as unmethylated control and partially methylated control respectively. Anti-human PD-L1 antibody clone E1L3N<sup>®</sup>&nbsp;from Cell Signalling Technology (USA) and Rabbit XP<sup>®</sup>&nbsp;were used to see PDL-1 expression.</p> <p><strong>Results:&nbsp;</strong>anaplastic astrocytoma cases had more MGMT promoter methylation (50%) than glioblastoma multiforme (GBM) (20%), more IDH1 R132H mutation (42%) than GBM (4.3%). Immunohistochemistry tumor proportion score method (TPS) identified 17% and 8.7% were PD-L1 positive in AA and GBM groups, respectively. Cases with IDH1 R132H mutation and MGMT methylation still showed better OS although with high PD-L1 expression.</p> <p><strong>Conclusion:&nbsp;</strong>IDH1 R132H mutation and MGMT methylation were good prognostic markers. High expression of PD-L1 apparently might not indicate poor overall survival in the presence of IDH1 R132 mutation and MGMT methylation.</p> Julius July Diana Patricia Pricilla Yani Gunawan Handrianto Setiajaya Teridah Ernala Ginting Teguh Pribadi Putra Zerlina Wuisan Dini Budhiarko Najmiatul Masykura Gintang Prayogi Ahmad Rusdan Utomo Steven Tandean Michael Lumintang Loe Copyright (c) 2020-08-20 2020-08-20 36 1 A critical appraisal of COVID-19 as a nosocomial infection: an African perspective <p>The pandemic of Coronavirus disease 19 is not abating since the outbreak began in December 2019. Africa is currently experiencing a surge after an initial low incidence and nosocomial infections could be contributing to this. A dominant factor responsible for this is a weak healthcare system because of many years of neglect due to abysmal budgetary allocation to the sector. The testing capacity for COVID-19 diagnosis in Africa is grossly inadequate coupled with a severe shortage of personal protective equipment and inadequate infectious diseases expert. These factors exposed the frontline health workers and patients to the hazard of nosocomial infection with the attendants´ morbidity and mortality. Deliberate efforts need to be made toward reducing nosocomial COVID-19 infection.</p> Elijah Kolawole Oladipo Olumuyiwa Elijah Ariyo Francis Ifedayo Ibukun Oluwadamilola Gideon Osasona Ayodeji Akinwumi Akinbodewa Chukwuyem Abejegah Julius Kola Oloke Copyright (c) 2020-08-20 2020-08-20 36 1 Knowledge, attitudes and practices among Brazzaville midwives on cervical cancer screening <p><strong>Introduction:&nbsp;</strong>cervical cancer is an illness that causes 250,000 deaths worldwide. Data on Health professional's skills is highly important for the elaboration of prevention strategies. Objective: assess the knowledge, attitudes and practices (KAP) among Brazzaville midwives on cervical cancer screening.</p> <p><strong>Methods:&nbsp;</strong>analytical KAP Study, from May 2<sup>nd</sup>&nbsp;to August 10<sup>th</sup>&nbsp;2018. Participants are midwives working in the Gynaecology-Obstetrics departments of six hospitals in Brazzaville (Republic of Congo). Variables were related to their socio-demographic and occupational characteristics, as well as to their knowledge, attitudes and practices. Analyses were done using the Epi Info software. Frequencies, central trend parameters, as well as rib ratios were calculated. Pearson, Fisher and Wald statistical tests with a significance level of 5% where used.</p> <p><strong>Results:&nbsp;</strong>the study included 114 midwives aged 43.07 (± 7.40) years. They had an unsatisfactory level of knowledge (59.64%), favourable attitudes (92.98%) and poor practices (71.05%). The factors linked with best (satisfactory) knowledge were, seniority at workplace (10-27 years) [29.31%] vs. 51, 79%; OR; 2.59 (1.19-5.60)] and age (42-60 years) [31.81% vs. 52.08%; OR 2.32 (1.08-5.01)]. The best knowledge were related to the best practices (good) [16.18% vs. 47.83%; OR a = 2.95 (1.87-4.67)]; Midwives attitudes seem to not impact on their practices (p = 0.53).</p> <p><strong>Conclusion:&nbsp;</strong>Brazzaville midwives have little knowledge and practices on cervical cancer screening. Therefore, the need of training them and equipping cervical cancer screening.</p> Pierre Marie Tebeu Jesse saint Saba Antaon Derguedbé Nerbardoum Pierre Vassilakos Pierre de Beaudrap Patrick Petignat Copyright (c) 2020-08-20 2020-08-20 36 1 Natal teeth: report of two cases <p>Presence of teeth at birth or within a month postdelivery is a rare condition. We report here 2 cases<br>to highlight their clinical features and discuss their<br>possible treatment. A 7- days old female newborn<br>with two mandibular central incisors, noticed by the<br>parents at birth, with complaint of continuous<br>crying, inability to suck milk and causing discomfort<br>to the mother. The left incisor was highly mobile<br>justifying its extraction. The second case was a<br>female newborn referred 2 hours after delivery, for<br>a brownish highly mobile mandibular incisor<br>noticed by the pediatrician. Extraction was<br>immediately made to avoid the danger of<br>aspiration. This phenomenon can lead to<br>complications either local such as pain on suckling or general such as undernutrition or asphyxia by<br>aspiration. The decision to maintain or remove<br>these teeth should be assessed in each case<br>independently, based on degree of mobility and<br>interference with breastfeeding.</p> Salma Aboulouidad Zakaria Aziz Mohammed El Bouihi Saad Fawzi Abdeljalil Abouchadi Nadia Mansouri Hattab Copyright (c) 2020-08-20 2020-08-20 36 1 Determinants of anthropometric characteristics of under-five children in internally displaced persons´ camps in Abuja municipal area council, Abuja, Nigeria <div class="BoxAbstract"> <p><strong>Introduction:&nbsp;</strong>displacement predisposes to deprivation and hunger and consequently malnutrition. In Nigeria, information on anthropometric characteristics and associated factors among displaced under-five children is important to strengthen strategies to ameliorate malnutrition and promote child health. This study was conducted to identify the determinants of anthropometric indices among under-five children in internally displaced persons’ camps in Abuja, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>this cross-sectional study involved 317 mother-child (0-59 months) pairs selected using two-stage simple random sampling technique. Information on socio-demographic, care practices (infant feeding, immunization, deworming) and anthropometric characteristics of index children was obtained using semi-structured, interviewer-administered questionnaire. Weight and length/height were assessed using standard procedure and analysed using World Health Organization (WHO) Anthro software. Data were analysed using descriptive statistics and logistic regression at p&lt;0.05.</p> <p><strong>Results:&nbsp;</strong>median age was 24 months, 50.8% were male and 42.3% were delivered at health facility. Only 45.4% were exclusively breastfed, 28.8% were fed complementary foods too early, 45.4% were dewormed in the preceding six months and 43.9% had complete/up-to-date immunisation. Prevalence of underweight, stunting and wasting was 42%, 41% and 29.3%, respectively. Poor anthropometric indices were higher among male than female children, except wasting. Having good anthropometric index was 2.5 times higher among children &lt;12 months than children ≥37 months (CI:1.08-5.8), 2.4 times higher among 1<sup>st</sup>&nbsp;birth order than 5<sup>th</sup>&nbsp;order (CI:0.19-0.93), 1.7 times higher among female than male children (CI:1.08-2.82).</p> <p><strong>Conclusion:&nbsp;</strong>malnutrition is a major health problem among under-five children in internally displaced camps and major determinants include age, birth order, gender and deworming status.</p> </div> Samson Olufunminiyi Idowu Abimbola Ellen Akindolire Bosede Ehelamioke Adebayo Ayodeji Matthew Adebayo Oluwaseun Ariyo Copyright (c) 2020-08-20 2020-08-20 36 1 The interventions and outcomes associated with fall-related injuries at tertiary hospitals in the Kingdom of Saudi Arabia: a cross sectional study <p><strong>Introduction:&nbsp;</strong>fall-related injuries are an important health concern around the globe, imposing an immense economic burden. The aim of this study is to evaluate the interventions and outcomes associated with fall-related injuries in a tertiary hospital in the Kingdom of Saudi Arabia (KSA).</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study including 264 patients with fall-related injuries was conducted at the King Khalid Hospital and Prince Sultan Centre for Health Care and other hospitals in Al Kharj from March 01, 2019 to November 30, 2019. The patients were recruited, identified at the point of presentation to the emergency department and followed through the triage, admission and discharge processes. The researchers analysed the participant´s clinical notes on the electronic health record (EHR) to obtain information relevant to the study, including demographic information, the injury patterns and their management.</p> <p><strong>Results:&nbsp;</strong>most patients studied were children under the age of 10 (25.7%). The vast majority (96.9%) of patients fell from a height, while the rest fell from a height onto a sharp object. Most of them (90.9%) had experienced no shock symptoms. Upper limb injuries had the highest prevalence (37.8%), followed by lower limb injuries (22.7%), head injuries (19.7%) and skull fractures (13.6%). Invasive surgery, blood transfusions, admission to intensive care (ICU) and thoracostomy (chest tube) were required by 74%, 3%, 3% and 2% of patients, respectively.</p> <p><strong>Conclusion:&nbsp;</strong>fall-related injuries may result in invasive surgery, chest drain insertion, or ICU admission, increasing the burden on the healthcare system.</p> Sameer Al-Ghamdi Ahmed Mohammed Alosaimi Abdullah Omar Bin Shihah Abdulrahman Ibrahim Alhadlaq Musaad Abdullah Alotaibi Ahmed Zaid Alnefaie Faisal Musaad Alsaleh Saad Fahad Alotaibi Saud Fahad Alotaibi Copyright (c) 2020-08-20 2020-08-20 36 1 Cushing´s syndrome: high aggressiveness of low-grade tumors <p>Cushing´s syndrome is caused by prolonged exposition supraphysiological to endogenous or exogenous cortisol. Ectopic production of adrenocorticotropic hormone by lung carcinoid tumors is relatively rare. Most documented cases have been reported individually. This rare neoplasm low grade that may secrete adrenocorticotropin (ACTH) leading to rapid development of hypercortisolism which is the main mode of discovery, can be a real aggressive form. This report shows a high aggressiveness of this endocrine neoplasia, wich was marked on the general, morphological, bone and psychiatric level. The trivialization of clinical signs had caused the delay in diagnosis with irreparable bone consequences.</p> Faycal El Guendouz Sara Derrou Fouad Atoini Hassan Ouleghzal Somaya Safi Copyright (c) 2020-08-21 2020-08-21 36 1 Prise en charge des patients diabétiques au cours du jeûne du Ramadan: application des recommandations internationales en pratique clinique <p>Le jeûne n´est pas sans risques chez les patients diabétiques. L´objectif de notre étude est d´évaluer l´impact du jeûne chez une cohorte de patients diabétiques ayant bénéficié d´une préparation au jeûne avec ajustement des traitements selon les recommandations de l´association américaine du diabète (ADA) en 2010. Il s´agit d´une étude prospective de cohorte menée en 2014, incluant des patients diabétiques désirants jeûner au cours du mois de Ramadan consentant pour participer à l´étude. Nous avons exclu les patients considérés comme à très haut risque selon la classification de l´ADA. Les patients ont bénéficié d´une consultation avant le mois du Ramadan (J0) comprenant éducation et ajustement du traitement, suivi d´une consultation au cours du Ramadan (J7) puis à J30 et à J60. Notre étude a inclus 34 patients, dont 60% sont des femmes, d´âge moyen de 50,4 ans avec une ancienneté moyenne du diabète de 6,2 ans et un index de masse corporelle (IMC) moyen de 27,83 kg/m<sup>2</sup>. Les ajustements thérapeutiques réalisés (J0) étaient une diminution de la dose de sulfamides hypoglycémiants (SH) et la mise sous gliptine chez les patients à risque hypoglycémique, ainsi qu´une répartition de la dose de metformine. Au cours de la première semaine (J7), deux patients ont présenté une glycémie inférieure à 0,7g/l avant la rupture du jeûne, 38% de l´échantillon ont présenté une glycémie &gt;2g/l après la rupture du jeûne. Nous avons noté des erreurs diététiques chez 15% des patients. L´ajustement à (J7) a consisté à adapter la dose du SH ou à ajouter une gliptine. Aucun patient n´a présenté d´hyperglycémie majeure, de cétose ou d´hypoglycémie grave. Une patiente a présenté une arythmie complète par fibrillation atriale (ACFA) sur cardiopathie ischémique méconnu avec arrêt du jeûne. Trois patients ont arrêté le jeûne entre J15 et J20 devant une asthénie intense sans déséquilibre glycémique. La moyenne d´HBA1C chez les patients après le jeûne était de 7,10 versus 6,8% avant le jeûne (p=0.42). Les facteurs significativement associés au déséquilibre glycémique après le jeûne avec des HBA1C &gt; à 8% étaient principalement les taux d´HBA1C de départ (p=0.002), l´absence d´autosurveillance (p=0.01), et l´ancienneté du diabète (p=0.06). Une bonne évaluation du niveau de risque du patient, une éducation thérapeutique, une autosurveillance glycémique et un ajustement du traitement selon les recommandations internationales, permettent aux patients diabétiques musulmans de diminuer le risque lié au jeûne. Néanmoins une consultation au cours du Ramadan (J7) permet une correction des erreurs diététiques et un ajustement thérapeutique si cela est nécessaire.</p> Saloua Elamari Siham Elaziz Asmaa Chadli Ahmed Farouqi Copyright (c) 2020-08-21 2020-08-21 36 1 There is no ideal place, but it is best to deliver in a hospital: expectations and experiences of health facility-based childbirth in Imo State, Nigeria <p><strong>Introduction:&nbsp;</strong>annually, about 67,000 of the 196,000 maternal deaths in sub-Saharan Africa occur in Nigeria, second only to India. Though health facility childbirths have been linked with improved health outcomes, evidence suggests that experiences of care influence future use. This study explored the expectations and experiences of health facility childbirths for mothers in Imo State, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>this qualitative study utilised in-depth interviews with 22 purposively sampled mothers who delivered in different types (private and public) and levels (primary, secondary, tertiary) of health facilities in Imo State. Interviews were digitally recorded, transcribed verbatim and analysed following Braun and Clarke´s six-stage thematic analysis.</p> <p><strong>Results:&nbsp;</strong>four key themes emerged from the analysis. Generally, women saw value in facility-based delivery. However, they had varying expectations for seeking care with different care providers. For those who sought care from public hospitals, the availability of “experts” was a key driver. While those who used private facilities went there because of their perceived empathy and dignity. However, while experiences of disrespect, abuse and health worker expectation for them to cooperate were reported in both public and private facilities, long waiting times, unconducive environments, and lack of privacy were experienced in public facilities.</p> <p><strong>Conclusion:&nbsp;</strong>every woman deserves a positive experience of childbirth. To achieve this, mothers´ perceptions of different providers need to be heard. Going forward, strategies ensuring that both public and private sector providers can guarantee holistic care for every woman will be key to realising the maternal mortality target of the Sustainable Development Goal 3.</p> Uchenna Chinenye Gwacham-Anisiobi Aduragbemi Banke-Thomas Copyright (c) 2020-08-21 2020-08-21 36 1 Awareness about stroke among high and low risk individuals in Khartoum, Sudan: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>stroke causes 10.17% of all deaths in Sudan. Levels of stroke awareness amongst patients in Sudan are unknown. The aim of this study is to assess the level of awareness of stroke risk factors, symptoms and immediate management amongst high and low risk patients.</p> <p><strong>Methods:&nbsp;</strong>using descriptive cross-sectional study, participants of high and low risk groups were recruited from the referral clinics of three tertiary hospitals in Khartoum. Data was collected through interviews using structured questionnaire. Knowledge score was devised to assess the awareness about stroke symptoms, risk factors, and management.</p> <p><strong>Results:&nbsp;</strong>of the 286 participants, 150 were females. The mean age was 44.66 years. About 79.4% reported that stroke is preventable. Hypertension was the most identified risk factor (71.6%) while genetics (0.2%) and alcohol (0.2%) were the least identified risk factors. Twenty-seven percent (27.6%) did not know any stroke risk factors, while 32.9% did not know any warning symptoms. Paralysis of one side of the body was the most identified warning symptom (30.7%). The mean awareness score was 21.9 ± 3.4 among the high risk group vs. 22.1 ± 3.6 among the low risk group with no statistically significant difference between the two groups (p = .717). The mean awareness score was statistically associated with the level of education (p &lt; 0.001).</p> <p><strong>Conclusion:&nbsp;</strong>the awareness level was relatively low and not statistically different between high and low risk groups. We recommend the development of an effective educational program for the whole community.</p> Ola Ahmed Abdulmjeed Mohammed Fatima Abd Alraheem Osman Ahmed Abubaker Emadeldin Adlan Koko Sufian Elshafee Osman Khalifa Hind Abdelaziz Mohamed Abdelaziz Mohamed Elmojtaba Adil Mohamed Francis Harrington Sulaf Ibrahim Abdelaziz Ihab Babiker Abdalrahman Copyright (c) 2020-08-21 2020-08-21 36 1 Electrocardiographie du sportif de haut niveau d´entrainement à Bobo-Dioulasso, Burkina Faso <p>Le sport de haut niveau d´entrainement entraine des modifications électrocardiographiques. Certaines sont bénignes, d´autres sont péjoratifs à l´origine de mort subite. Les auteurs se proposent de décrire les caractéristiques électrocardiographiques de repos chez les sportifs de haut niveau d´entraînement de la ville de Bobo-Dioulasso. Il s´est agi d´une étude transversale descriptive allant d´août 2015 à février 2016 dans le service de cardiologie du CHU Sanou Sourô de Bobo-Dioulasso. Elle a inclus des sportifs de haut niveau d´entrainement âgés de 17 à 35 ans ayant au moins huit heures d´entrainement par semaine depuis plus de six mois quel que soit le type de sport. Deux cents sportifs de haut niveau d´entrainement de 4 disciplines sportives ont été inclus. L´âge médian des athlètes était de 24 ans (IIQ: 21-27). L´ancienneté médiane de la pratique du sport à haut niveau d´entrainement était de 6 ans (IIQ: 4-8) et la durée médiane des séances d´entraînement hebdomadaire de 10 heures (IIQ: 10-10). Seulement 4% des athlètes avaient déjà réalisé un électrocardiogramme (ECG). L´ECG présentait des anomalies dans 90,5% et la bradycardie sinusale était l´anomalie la plus fréquente rapportée dans 72,5% des cas. L´hypertrophie ventriculaire gauche et celle atriale gauche étaient rapportées respectivement dans 44% et 34,5%. Le syndrome de repolarisation précoce était retrouvé dans 47% des cas. La pratique du sport de haut niveau d´entraînement peut occasionner des modifications électriques chez l´athlète. Celles-ci nécessitent d´être connus par les praticiens afin de les différencier de la pathologie cardiaque.</p> Somnoma Jean-Baptiste Tougouma Yibar Kambiré Aimé Arsène Yaméogo Samba Sidibé Jonas Koudougou Kologo Widouh Benjamin Adolphe Zingue Ouattara Georges Millogo Nobila Valentin Yaméogo Patrice Zabsonré Copyright (c) 2020-08-21 2020-08-21 36 1 Geospatial distribution of severe paediatric intussusception in KwaZulu-Natal province, South Africa <p><strong>Introduction:&nbsp;</strong>intussusception in South African (SA) children is often severe. A proportion of cases require management at quaternary hospitals which are a scare resource in SA. A geospatial investigation of severe paediatric intussusception (SPI) in the KwaZulu-Natal (KZN) province of SA would assist with identifying regions which should be targeted for preventative interventions. This could reduce resource utilisation for this condition at quaternary hospitals. The objective of this study was to determine the geospatial distribution of SPI in KZN.</p> <p><strong>Methods:&nbsp;</strong>this was a retrospective analysis of data for patients with SPI who were admitted to a quaternary hospital in KZN over an 11-year period. Data related to patient demographics, duration of hospitalization, surgical intervention, inpatient mortality and residential postal code were extracted from the electronic hospital admissions system. Each residential postal code was linked to a corresponding KZN district municipality. Descriptive statistical methods were used to determine the distribution of various characteristics in the study sample. Semi-quantitative geospatial analysis was used to determine the distribution of patients with SPI in each KZN district municipality.</p> <p><strong>Results:&nbsp;</strong>the study sample consisted of 182 patients with SPI. Most patients were &lt;1 year old (83.5%), male (51.1%) and black African (87.9%). All patients underwent surgical intervention. Inpatient mortality was 2.7%. The majority of patients in the study sample resided in the eThekwini and King Cetshwayo district municipalities (51.1% and 14.8%, respectively).</p> <p><strong>Conclusion:&nbsp;</strong>preventative interventions for SPI should be considered for rollout in the eThekwini and King Cetshwayo district municipalities of KZN, SA.</p> Yoshan Moodley Vineshree Mischka Moodley Sitheni Samson Mashele Ravi Pokala Kiran Thandinkosi Enos Madiba Copyright (c) 2020-08-21 2020-08-21 36 1 Alcohol use disorders in multidrug resistant tuberculosis (MDR-TB) patients and their non-tuberculosis family contacts in Nigeria <p><strong>Introduction:&nbsp;</strong>the main aim of this study was to determine the prevalence and associated factors of alcohol use disorder (AUD) in patients with Multi-Drug Treatment-Resistant Tuberculosis (MDR-TB) compared with their non-tuberculosis control, and its association with disease pattern and associated medical comorbidities.</p> <p><strong>Methods:&nbsp;</strong>MDR-TB patients (128) and their respective caregivers were interviewed in a treatment unit in Nigeria. Diagnosis of AUD was made using the Structured Clinical Interview for DSM-IV Axis I Disorder, information was obtained on the severity of the TB and associated health problems.</p> <p><strong>Results:&nbsp;</strong>prevalence of AUD was (21.9%) and was significantly higher among cases than in controls (2.3%), p = 0.006. Severe TB, OR = 3.33 (1.56-6.83), hematological diseases, OR = 2.34 (1.06-4.33) and HIV/AIDS, OR = 3.01 (1.67-7.01) were the strongest predictors of AUD at 95% CI.</p> <p><strong>Conclusion:&nbsp;</strong>AUD was highly prevalent in MDR-TB and was associated with certain medical comorbidities and increased severity of the illness.</p> Victor Olufolahan Lasebikan Olusoji Mayowa Ige Copyright (c) 2020-08-21 2020-08-21 36 1 The prevalence of positive rapid diagnostic test of hepatitis C virus infection in Ghana <p><strong>Introduction:&nbsp;</strong>hepatitis C virus (HCV) infection is one of the most common viral hepatitis in Africa. Rapid diagnostic test (RDT) is a useful tool to identify antibody anti-HCV in point of care. In this study, we decided to determine prevalence of cases with positive rapid diagnostic test of HCV infection.</p> <p><strong>Methods:&nbsp;</strong>this cross-sectional study was conducted in a polyclinic, Accra, Ghana. Using convenience sampling, 728 participants were screened with blood-based RDT and interviewed about personal risk behaviors for transmission of HCV. Data was entered in SPSS version 18 and analyzed.</p> <p><strong>Results:&nbsp;</strong>there was 1.6% positive RDT in our participants. The mean age of them was 29.58 ± 12.31 years old that were younger than the participants with negative RDT (p: 0.027). The rate of positive test was 66.67% in women and 33.33% in men. There was a negative association between age and RDT positive (aOR: 0.91, 95%CI 0.85-0.96). The odds of positive RDT in married participants was 6.32 fold others after adjusting model (p: 0.014). There were no important risk behavior for HCV, except one person with history of contacting blood or needles.</p> <p><strong>Conclusion:&nbsp;</strong>the risk of positive RDT has a reverse relationship with aging and also it has an increase in married individuals. Therefore preventive education and screening for HCV should be a priority in young and middle-aged adults because of more sexual activity.</p> Masood Maleki Birjandi Mahbobeh Oroei Copyright (c) 2020-08-21 2020-08-21 36 1 Zambia field epidemiology training program: strengthening health security through workforce development <p>The Zambia Field Epidemiology Training Program (ZFETP) was established by the Ministry of Health (MoH) during 2014, in order to increase the number of trained field epidemiologists who can investigate outbreaks, strengthen disease surveillance, and support data-driven decision making. We describe the ZFETP´s approach to public health workforce development and health security strengthening, key milestones five years after program launch, and recommendations to ensure program sustainability.&nbsp;<strong>Program description:</strong>&nbsp;ZFETP was established as a tripartite arrangement between the Zambia MoH, the University of Zambia School of Public Health, and the U.S. Centers for Disease Control and Prevention. The program runs two tiers: Advanced and Frontline. To date, ZFETP has enrolled three FETP-Advanced cohorts (training 24 residents) and four Frontline cohorts (training 71 trainees). In 2016, ZFETP moved organizationally to the newly established Zambia National Public Health Institute (ZNPHI). This re-positioning raised the program´s profile by providing residents with increased opportunities to lead high-profile outbreak investigations and analyze national surveillance data-achievements that were recognized on a national stage. These successes attracted investment from the Government of Republic of Zambia (GRZ) and donors, thus accelerating field epidemiology workforce capacity development in Zambia. In its first five years, ZFETP achieved early success due in part to commitment from GRZ, and organizational positioning within the newly formed ZNPHI, which have catalyzed ZFETP´s institutionalization. During the next five years, ZFETP seeks to sustain this momentum by expanding training of both tiers, in order to accelerate the professional development of field epidemiologists at all levels of the public health system.</p> Ramya Kumar Ernest Kateule Nyambe Sinyange Warren Malambo Shadrick Kayeye Elizabeth Chizema Gershom Chongwe Patrick Minor Muzala Kapina Henry C Baggett Ellen Yard Victor Mukonka Copyright (c) 2020-08-21 2020-08-21 36 1 Neuro-meningeal cryptococcal infection revealing a multiple myeloma <p>Rare cases of Cryptococcus have been documented in patients living with multiple myeloma. To date there has been no documented evidence of cryptococcosis revealing multiple myeloma. We reported a 63-year-old man who had a 2-months history continuous holocranial headaches, morning vomiting, complaining of blurred vision and fever. The biologic and the imaging showed a Cryptococcus meningoencephalitis. The search for a cause of immunodeficiency revealed a multiple myeloma. The diagnosis for Cryptococcus was confirmed according to an India ink stain, blood and cerebrospinal fluid culture. The patient's treatment for multiple myeloma was initiated with a chemotherapy regimen. The evolution was good without complication. Cryptococcosis, especially in the neuro-meningeal form, is a serious, deadly opportunistic infection. The search of an underlining immunodeficiency must be systematic. In this case, it was associated with early stage multiple myeloma.</p> Sameh Sayhi Sawsen Bouzidi Imen Beji Aman Allah Nasr Souha Hannachi Ines Bedoui Samy Layouni Najiba Fekih-Mrissa Bassem Louzir Brahim Nsiri Rym Abid Riadh Battikh Copyright (c) 2020-08-21 2020-08-21 36 1 Furrowed tongue, fatten lip and facial droop <p>Melkersson-Rosenthal syndrome (MRS) is a rare, neuro-mucocutaneous syndrome characterized by recurrent facial nerve palsy, swelling of the upper lip, and fissured tongue. Young adults in the second and third decades are more predisposed. We report a case of a 23-years old female Chinese who presented with 5 days history of right facial weakness; her second event in one year (first weakness was on the left). On examination, she had right peripheral facial nerve palsy (House-Brackmann stage IV) and, mild swelling of the upper lip (Image-Arrow A). Her tongue revealed two central furrows. The anterior central furrow (Image-Arrow B) measured about 2cm and the posterior one measured about 1.5cm with lateral grooves and few posterior perpendicular furrows measuring about 1-2 mm in depth. Her complete blood count, blood sugar, urine routine, C-reactive protein, serum angiotensin-converting enzyme level was all normal. Her brain magnetic resonance imaging revealed no abnormal signals. She was commenced on oral prednisolone 60mg daily for 5 days, acyclovir 800mg 4 times daily for 5 days, vitamin B capsules and methylcellulose drops to prevent scleritis. She was commenced on physiotherapy with steady clinical improvement. Although fissured tongue is a common clinical condition with a long list of differential diagnosis, the presence of recurrent facia nerve palsy and swollen lip should raise the suspicion of MRS. Other causes of recurrent facial nerve palsy and buccal mucosa involvement like sarcoidosis, system lupus erythematosus, Bechet disease and Crohn disease should be considered.</p> Philip Babatunde Adebayo Hanifa Mbithe Copyright (c) 2020-08-24 2020-08-24 36 1 Hernie para duodénale gauche: une cause rare d´occlusion intestinale aiguë <p>La hernie para duodénale gauche est une hernie interne congénitale qui se complique rarement par une occlusion intestinale aiguë et qui peut mettre en jeux le pronostic vital par ischémie des anses. Nous rapportons un cas d´un jeune homme de 28 ans pris en charge pour un syndrome occlusif. Le scanner abdominal a objectivé une occlusion intestinale aiguë haute, l´exploration peropératoire a trouvé des anses jéjunales incarcérées dans une hernie para duodénale gauche. Le collet a été fermé et les suites opératoires étaient simples. En conclusion, la hernie para duodénale gauche, est souvent diagnostiquée lors d´une complication, son traitement est chirurgical et préférentiellement par laparoscopie.</p> Abdelkader Mizouni Fathia Harrabi Waad Farhat Linda Ghabri Mohamed Ben Mabrouk Ali Ben Ali Copyright (c) 2020-08-24 2020-08-24 36 1 Insulin injection technique in the western region of Algeria, Tlemcen <p><strong>Introduction:&nbsp;</strong>Algeria has more than 1.7 million diabetic patients on to whom a descriptive assessment particularly on the insulin usage behaviors has not yet been initiated, although is needed. This study aims to provide a descriptive analysis of how Algerian diabetic patients perceive and apply insulin injection techniques.</p> <p><strong>Methods:&nbsp;</strong>using the “patient” questionnaire within the Injection Technique Questionnaire (ITQ) 2016 survey, this study assessed the insulin injection practices of 100 patients recruited over a seven-month period in western Algeria at the Tlemcen University Hospital Center. The results of this study are compared to those of the ITQ 2016 survey.</p> <p><strong>Results:&nbsp;</strong>pens are the instruments of injection for 98% of Algerians who continue to use mostly long needles of 6- and 8-mm, although 4mm needles are the recommended safer option. Insulin analogues (fast and basal) are plebiscite. Arms and thighs are the preferred injection sites; the abdomen (the preferred site elsewhere) is neglected for reasons to be investigated. The correct re-suspension technique for cloudy insulin is unknown. Extensive pen needle re-use (10+ times) for over half of the patients exposes them to both higher intramuscular (IM) injection risk and lipohypertrophy (LH). Injection training is performed in Algeria by the diabetologist.</p> <p><strong>Conclusion:&nbsp;</strong>this study describes for the first time Algerian patients´ insulin injection technique. It highlights their skills and identifies many deficiencies which patients and professionals must correct given the issues in this area.</p> Mohammed Nassim Boukli Hacene Meriem Saker Amina Youcef Soumia Koudri Souad Cheriet Hafida Merzouk Ali Lounici Nimer Alkhatib Copyright (c) 2020-08-24 2020-08-24 36 1 The association of leadership styles and nurses well-being: a cross-sectional study in healthcare settings <p><strong>Introduction:</strong>&nbsp;the nurses´ perception of their supervisors´ leadership styles has a substantial impact on their well-being. Effective leadership in health care is crucial in improving and enhancing the effectiveness of health care systems. This study aims to assess the leadership styles of nurse leaders as perceived by employees, and to explore the relationship between perceived leadership styles and the quality of life of nurses in Lebanese hospital settings.</p> <p><strong>Methods:</strong>&nbsp;it was a cross-sectional study conducted in 2017 and involved a sample of 250 nurses chosen randomly in eight hospitals. The survey included questions on socio-demographic and health-related characteristics, Multifactor Leadership Questionnaire 5X Short Form, and the Short Form Health Survey-12 V2 (SF-12v2).</p> <p><strong>Results:</strong>&nbsp;the managers used enough transformational leadership style, whereas they used fairly often transactional leadership. The Laissez-faire style was adopted from time to time by the managers. Male nurses perceive their managers as transformational significantly more than female nurses (2.94 vs. 2.73; p = 0.05). Transformational leadership style was statistically related to all scales scores of the SF-12v2 (p &lt; 0.001) except the Social Functioning domain (p = 0.42). The transactional leadership style was associated with the Vitality scale scores (p &lt; 0.001). The physical (p &lt; 0.05) and Emotional Role (p &lt; 0.001) and the mental health summary measure (p &lt; 0.05) were lower in persons who perceived the leadership style of their manager as Laissez-faire.</p> <p><strong>Conclusion:</strong>&nbsp;this study highlights the existence of a positive effect of leadership styles in the wellbeing of nurses, and confirms that nursing management has been identified as a challenge in the Lebanese hospitals.</p> Ibtissam Mohamad Sabbah Tahanie Tarek Ibrahim Rania Hani Khamis Hajar Ahmad-Majed Bakhour Sanaa Mohamad Sabbah Nabil Sami Droubi Hala Mohamad Sabbah Copyright (c) 2020-08-24 2020-08-24 36 1 Prévalence du trait drépanocytaire chez les donneurs de sang au centre régional de transfusion sanguine de la région Haute Matsiatra, Madagascar <p><strong>Introduction:&nbsp;</strong>le trait drépanocytaire correspond à la forme hétérozygote de la drépanocytose. Les porteurs du trait drépanocytaire sont capables de synthétiser de l´hémoglobine A normale et de l´hémoglobine S. Cette affection est cliniquement inapparente de telle sorte que des porteurs du trait drépanocytaire, ignorant leurs statuts génétiques, peuvent se retrouver parmi les donneurs de sang. Cette situation peut avoir des conséquences sévères sur leurs propres états de santé ainsi qu´aux receveurs, particulièrement si ces derniers sont drépanocytaires. L´objectif de notre étude est de déterminer la prévalence du trait drépanocytaire chez les donneurs de sang.</p> <p><strong>Méthodes:&nbsp;</strong>nous avons réalisé une étude prospective descriptive sur 4 mois (de janvier à mai 2017) au Centre Régional de Transfusion Sanguine (CRTS) Haute Matsiatra. Tous les donneurs ont été dépistés par test d´Emmel et confirmation des cas positifs par électrophorèse de l´hémoglobine.</p> <p><strong>Résultats:&nbsp;</strong>nous avons recruté 427 donneurs dont 332 hommes et 95 femmes avec un sex-ratio de 3,4. L´âge moyen des donneurs était de 32,72 ans allant de 18 à 64 ans. Le test d´Emmel s´est révélé positif chez 5 donneurs (1,17%), tous confirmés de génotype AS à l´électrophorèse de l´hémoglobine.</p> <p><strong>Conclusion:&nbsp;</strong>les résultats de cette étude révèlent l´existence de porteurs de trait drépanocytaire parmi les donneurs de sang du CRTS dont la plupart ignore leur statut drépanocytaire avant le don de sang. Afin d´assurer la sécurité transfusionnelle et la qualité des produits sanguins, le dépistage de la drépanocytose chez les donneurs de sang est désormais une question pertinente et d´actualité.</p> Jocia Fenomanana Irène Rakotoniaina Stéphania Niry Manantsoa Harinirina Randriamahenina Zely Arivelo Randriamanantany Copyright (c) 2020-08-24 2020-08-24 36 1 First cases of Burkholderia cenocepacia IIIA neonatal sepsis in Central African Republic <p>Bacteria of the&nbsp;<em>Burkholderia cepacia</em>&nbsp;complex cause frequent infections in immunocompromised and hospitalized patients, with a significant mortality rate. Phenotypic identification of those bacteria is difficult and therefore rarely reported from developing countries. This study presents the first ever reported case series of&nbsp;<em>Burkholderia cenocepacia</em>&nbsp;neonatal sepsis in Central African Republic. It demonstrates the superiority of molecular methods to accurately identify&nbsp;<em>B. cenocepacia</em>&nbsp;IIIA species compared to the phenotypic methods.</p> Thierry Frank Julita Gil-Cuesta Jean Robert Mbecko Hugues Sanke Chantal Lakis Anne Le Flèche-Matéos Alain Berlioz-Arthaud Copyright (c) 2020-08-24 2020-08-24 36 1 Tracheobronchial calcifications in a child <p>Three months old child was admitted in the department of pediatrics I for respiratory distress, fever and laryngeal stridor. He was born to consanguineous parents. The prenatal history was unremarkable. However, he was hospitalized at birth for respiratory distress which improved quickly with oxygen nasal cannula. Since one month old, he was presenting a laryngeal stridor, persistent cough and chest congestion. Clinical examination found a dyspnea, stridor occuring in both phases of respiration, signs of retractions, a dysmorphic face with mid-facial hypoplasia and brachytelephalengia. The chest x-ray showed calcifications involving the entire tracheobronchial tree. A chest computed tomography revealed bilateral and symmetrical calcifications involving the anterior cartilaginous part of the trachea and the stem bronchi. The transthoracic ultrasound was normal. Routine physicochemical examinations found a low prothrombin time with decrease in the levels of vitamin-k dependent coagulation factors. The clinical course was favorable with oxygen nasal cannula and respiratory physiotherapy. The diagnosis of Keutel syndrome was made on calcifications of the tracheal cartilage associated to brachytelephalengia, and also facial dysmorphism.</p> Houda Rahmoun Chafiq Mahraoui Copyright (c) 2020-08-24 2020-08-24 36 1 Un cas de spondylodiscite d'Anderson <p>Nous rapportons le cas d´un patient de 48 ans sans antécédent particulier suivi pour une spondylarthrite ankylosante depuis 2012 en accord avec les critères d´ASAS (Assessment of SpondyloArthritis International Society). Il présente une lombalgie d´horaire inflammatoire sans facteurs déclenchants. Il n´était retrouvé ni notion de fièvre, ni de toux, ni d´amaigrissement. L´examen physique montrait une raideur lombaire avec l´indice de Schöber 10+1, la distance doigts-sol = 30 cm. La radiographie n´était pas contributive. L´imagerie par résonance magnétique (IRM) lombaire révèle une spondylite d´Anderson au niveau L4-L5, ces données sont confirmées par le scanner lombaire qui met en évidence une spondylolyse avec érosions L4-L5. Une cause infectieuse et néoplasique a été éliminée. L´évolution était favorable sous traitement antalgique, anti-inflammatoires et port de ceinture lombaire.</p> Kaba Condé Garba Mahaman Salissou Copyright (c) 2020-08-24 2020-08-24 36 1 Oral contraceptive use and premenstrual syndrome among sexually active female university students in Cameroon <p><strong>Introduction:&nbsp;</strong>premenstrual syndrome (PMS) is a prevalent health problem affecting women of reproductive age and some young women use oral contraceptive pills (OCPs) to prevent unwanted pregnancy. However, the association between OCP use and the experience of symptoms of PMS has not been studied in Cameroon. We examined the association between the use of OCPs and PMS among female university students in Cameroon.</p> <p><strong>Methods:&nbsp;</strong>we used data extracted from a larger study on sexual and reproductive health that was conducted between July and August 2018 among female university students at the University of Yaoundé 1, Cameroon. A pre-tested, validated and paper-based self-administered questionnaire was used to collect data. We extracted data (demographic and health characteristics, contraceptive use and experience of PMS) for the 424 sexually active students who participated in the larger study. We used Poisson regression analysis to examine the association between OCP use and PMS and conducted stratified analysis to determine effect modification. The level of statistical significance was set at p≤0.05.</p> <p><strong>Results:&nbsp;</strong>the median age of the 424 sexually active female university students was 23 years (IQR=21-25). About 77.8% of participants self-reported to have experienced symptoms of PMS prior to their last menstrual period. The most commonly reported symptoms of PMS were breast tenderness (55.7%), acne/pimples (39.2%) and abdominal pain (31.1%). After adjusting for confounders in multivariate analysis, we found a statistically significant relationship between the use of OCPs and experience of symptoms of PMS. Current OCP users had a slightly increased risk (PR=1.21; 95% CI, 1.09-1.32, p&lt;0.001) of developing symptoms of PMS compared to non-pill users. We found that age modified the effect of this association. Among older students (≥25 years), the direction of the effect was strongly positive and statistically significant (APR=1.32; 95% CI, 1.12-1.56, p=0.001).</p> <p><strong>Conclusion:&nbsp;</strong>the proportion of female university students who reported to have experienced symptoms of PMS prior to their last menstrual period was high. The use of OCPs was positively associated with the risk of developing symptoms of PMS and this relationship was modified by age. Further studies in Cameroon and other sub-Saharan African countries are required to understand this relationship.</p> Derick Akompab Akoku Thomas Achombwom Vukugah Mbah Abena Tihnje Idris Bigweh Nzubepie Copyright (c) 2020-08-24 2020-08-24 36 1 Conservative management of spontaneous coronary artery dissection: a case report <p>Spontaneous coronary artery dissection (SCAD) is a<br>rare cause of acute coronary syndromes (ACS) that<br>mainly occurs in young women with no risk factors<br>and no coronary atherosclerosis. Diagnosis is made<br>by invasive coronary angiography (CA), computed<br>tomography coronary angiography (CTCA),<br>intravascular ultrasound (IVUS) and optical<br>coherence tomography (OCT). The rarity of this<br>entity as well as the complications of invasive<br>treatment make it difficult to choose therapy<br>between conservative management, percutaneous<br>coronary intervention (PCI) or coronary artery<br>bypass grafting (CABG). We report a case of a 36-<br>year-old woman presented with non ST elevation<br>myocardial infarction (NSTEMI) related to<br>spontaneous dissection of coronary arteries (left<br>main trunk, left anterior descending artery and left<br>circumflex artery) treated medically with<br>spectacular results at 2 months, controlled by CTCA.</p> Hind Regragui Badre El Boussaadani Lamyae Sasbou Hanae Bouhdadi Hicham Wazaren Mohammed Cherti Copyright (c) 2020-08-25 2020-08-25 36 1 Gossypiboma: the failure of a successful intervention <p>If successful surgery is the primary quest of any surgeon, unintentionally leaving behind surgical items in the operative field remains his most feared obsession. This rare but dramatic accident can lead to potentially fatal complications and turn both lives of the surgeon and the patient upside down. We present the case of a 29-year-old female patient who presented to the ER with three days history of severe diffuse abdominal pain associated with fever, biological inflammatory syndrome and well-tolerated iron deficiency anaemia. She had no past medical history except for a lower segment cesarean section 5 months ago. Abdominal MRI allowed the diagnosis of two gossypibomas responsible for two intra-abdominal collections. An emergency laparotomy allowed the removal of these foreign bodies and the management of their serious complications of intestinal perforation by the construction of a double intestinal stoma. The patient made a post-operative uneventful recovery. This observation emphasizes the need to raise the practitioner´s awareness about this differential diagnosis in every case of any poorly localized abdominal pain occurring after surgery.</p> Atef Mejri Khaoula Arfaoui Badreddine Aloui Jasser Yaakoubi Copyright (c) 2020-08-25 2020-08-25 36 1 Knife ingestion in an eighteen months child <p>A Male child of eighteen months old was admitted in the pediatric medical emergency department for ingestion of foreign body while he was playing with his seven years old sister. He was not presenting any symptoms. The clinical examination was normal: he was conscious, calm, with no respiratory distress. The inspection of oropharynx did not find any abrasions or lacerations and the abdomen examination was normal. A thoraco abdominal X-ray showed an image of a knife measuring 12cm between the lower third of the esophagus and the stomach. A second X-ray with the undressed child confirmed the diagnosis (A). A second anamnesis made the sister confess that they were watching a television show of sword swallowers when her brother ingested the knife. The patient was admitted in the operating room to extract the sharp object. The surgical removal did not find any lesions of the gastrointestinal tract and was successful (B).</p> Leila Debono Nour Mekaoui Copyright (c) 2020-08-25 2020-08-25 36 1 Unusual manifestation of fungal malignant external otitis <p>Malignant external otitis (MEO) is a fatal disease of the external auditory canal and temporal bone. The infection begins as an external otitis that later spreads and turns into an osteomyelitis of the temporal bone. It has an extremely aggressive behavior and poor prognosis. It mainly affects immunocompromised men over 60 years old. Diabetes is the most common risk factor and&nbsp;<em>Pseudomonas Aeruginosa</em>&nbsp;is the organism responsible for 90% of all cases. These pictures represent a case of an extremely invasive fungal MEO in a 59 years old man. It was a patient with a history of MEO on the right ear, with a poorly controlled type II diabetes and a chronic renal insufficiency. He presented with one month complaint of severe left ear pain and discharge. In otoscopy (A) we observed otorrhea and granulation tissue at the osseocartilaginous junction. Swab culture from the ear canal showed the presence of&nbsp;<em>Aspergillus Flavus</em>, an uncommon organism. Technetium and gallium scans reveled an intense uptake within the left temporal bone. During the treatment with intravenous voriconazole and vancomycin the patient developed paresis of VI nerve (B). Head MRI showed significant inflammatory soft tissue in mastoids, with an extensive inflammatory process involving the skull base (C). Cranial nerves can be damage when the infection spreads along skull base. The patient remains under antifungal treatment and with a special concern about pain relieving.</p> Mafalda da Silva Ferreira Clara Silva Copyright (c) 2020-08-25 2020-08-25 36 1 The prevalence and associated factors of underweight and overweight/obesity among adults in Kenya: evidence from a national cross-sectional community survey <p><strong>Introduction:&nbsp;</strong>the study aimed to investigate the prevalence and factors associated with underweight and overweight or obesity in an adult population in Kenya.</p> <p><strong>Methods:&nbsp;</strong>data from a cross-sectional nationally representative community-based study in Kenya (N=4283, 18-69 years) conducted in 2015 was utilized. Assessments included anthropometric, interview, blood pressure and biochemistry mesures. Multinomial logistic regression was used to assess the determinants of underweight and overweight or obesity relative to normal weight.</p> <p><strong>Results:&nbsp;</strong>in all, 11.9% of the study sample was underweight (BMI &lt;18.5kg/m²), 60.1% had normal weight (BMI 18.5-24.9kg/m²), 18.9% overweight (25.0-29.9kg/m²) and 9.1% obesity (BMI ≥30.0kg/m²). In adjusted multinomial logistic regression, male sex (adjusted relative risk ratio-ARRR: 1.47, confidence interval-CI: 1.01, 2.13), lower education (ARRR: 0.63, CI: 0.46, 0.88), lower wealth status (ARRR: 0.47, CI: 0.29, 0.78), inadequate fruit and vegetable consumption (ARRR: 1.79, CI: 1.19, 2.70), adding daily sugar into beverages (ARRR: 1.49, CI: 1.01, 2.22) and having no hypertension (ARRR: 0.54, CI: 0.40, 0.74) were associated with underweight. Factors associated with overweight or obesity were middle and older age (ARRR: 2.15, CI: 1.46, 3.80), being female (ARRR: 0.30, CI: 0.22, 0.41), higher education (ARRR: 1.61, CI: 1.26, 2.24), greater wealth (ARRR: 2.38, CI: 1.41, 3.50), being a Kikuyu by ethnic group (ARRR: 1.68, CI: 1.19, 2.37), urban residence (ARRR: 1.45, CI: 1.06, 1.99), no current tobacco use (ARRR: 0.39, CI: 0.24, 0.54), low physical activity (ARRR: 1.49, CI: 1.02, 2.18) and having hypertension (ARRR: 1.96, CI: 1.54, 2.50).</p> <p><strong>Conclusion:&nbsp;</strong>more than one in ten were underweight and almost three in ten were overweight or obese among adults in Kenya. Several risk factors, including sociodemographic, lifestyle and health status risk variables, were identified for underweight and overweight or obesity, which can assist in developing intervention strategies targeting both these conditions.</p> Supa Pengpid Karl Peltzer Copyright (c) 2020-08-25 2020-08-25 36 1 Bladder paraganglioma: a case report <p>Bladder Paraganglioma is a rare type of bladder tumor (0.06%). It is typically benign and the most common symptoms are hematuria, hypertension and headache. About 14% of these tumors are malign and consequently radio and chemoresistants. Therefore, surgery is the mainstay of treatment. As they are likely to recur and to metastize lifelong follow-up is required. The authors report a rare case of a 53 years old man with hematuria and a previous history of micturition syncope who was diagnosed with bladder lesion. During the transurethral ressection of bladder he became severely hypertensive. Plasma metanephrines, and urinary vanillylmandelic acid, were still high and the exams suggested residual tumor. The patient underwent radical cistoprostatectomy. After 4 years of follow-up the patient remains disease free.</p> Gil Falcão Cabrita Carneiro Luís Campos Pinheiro Copyright (c) 2020-08-25 2020-08-25 36 1 The experiences of using polio outbreak simulation exercises to strengthen national outbreaks preparedness and response plans in sub-Saharan Africa <p><strong>Introduction:&nbsp;</strong>globally, by 2020 the paralytic poliomyelitis disease burden decreased to over 99% of the reported cases in 1988 when resolution 41.8 was endorsed by the World Health Assembly (WHA) for global polio eradication. It is clearly understood that, if there is Wild Poliovirus (WPV) and circulating Vaccines Derived Poliovirus (cVDPV) in the world, no country is safe from polio outbreaks. All countries remain at high risk of re-importation depending on the level of the containment of the types vaccine withdrawn, the laboratory poliovirus isolates, and the population immunity induced by the vaccination program. In this regard, countries to have polio outbreak preparedness and response plans, and conducting the polio outbreak simulation exercises for these plans remain important.</p> <p><strong>Methods:&nbsp;</strong>we conducted a cross-section qualitative study to review to 8 countries conducted polio outbreak simulation exercises in the East and Southern Africa from 2016 to 2018. The findings were categorized into 5 outbreak response thematic areas analyzed qualitatively and summarized them on their strengths and weaknesses.</p> <p><strong>Results:&nbsp;</strong>we found out that, most countries have the overall technical capacities and expertise to deal with outbreaks to a certain extent. Nevertheless, we noted that the national polio outbreak preparedness and response plans were not comprehensive enough to provide proper guidance in responding to outbreaks. The guidelines were inadequately aligned with the WHO POSOPs, and IHR 2005. Additionally, most participants who participated in the simulation exercises were less familiar with their preparedness and response plans, the WHO POSOPs, and therefore reported to be sensitized.</p> <p><strong>Conclusion:&nbsp;</strong>we also realized that, in all countries where the polio simulation exercise conducted, their national polio outbreak preparedness and response plan was revised to be improved in line with the WHO POSOPs and IHR 2005. we, therefore, recommend the polio outbreak simulation exercises to be done in every country with an interval of 3-5 years.</p> Daudi Manyanga Brine Masvikeni Fussum Daniel Copyright (c) 2020-08-25 2020-08-25 36 1 Irathérapie dans la maladie de Basedow: place et efficacité <p>Le traitement de la maladie de Basedow repose sur trois thérapies: le traitement médical par les antithyroïdiens de synthèse, la chirurgie et l´irathérapie. L´objectif de notre étude était d´étudier la place et l´efficacité du traitement à l´iode radioactif dans le traitement de la maladie de Basedow. Une étude rétrospective portant sur 54 patients suivis pour une maladie de Basedow et traités par iode 131. On a mené en une étude descriptive des aspects épidémiologiques, cliniques, para cliniques et thérapeutiques et du le taux de rémission à court et à moyen terme. Le sex-ratio était de 0,45. L´âge moyen est de 38,33 ± 12,7 ans. Les signes fonctionnels les plus fréquemment retrouvés étaient l´amaigrissement, les tremblements et les palpitations. La FT4 moyenne est de 54,51 ± 19,56ng/dl (extrêmes: 8,90-100). La TSHus moyenne de nos patients était égale 0,074 ± 0,29 µUI/ml. Les antithyroïdiens de synthèse ont été prescrits chez 49 patients avec une persistance d´une hyperthyroïdie dans 83,67% des cas. L´irathérapie a été prescrite en première intention dans 9,3% et en 2ème intention dans 90,7% des cas. L´activité moyenne était égale à 13,29 mCi ± 1,46 avec des extrêmes allant de 10 à 15 mCi. Le premier contrôle hormonal post-irathérapie, réalisé après un délai moyen de 1,91 mois, a montré une rémission (eu- ou hypo-thyroïdie) chez 29 patients soit 53,7%. Après 12 mois de suivi, l´évolution était marquée par une rémission dans 88,88% (euthyroïdie chez 14,8% et l´hypothyroïdie chez 74%). L´irathérapie est un traitement efficace de la maladie de Basedow. Une dose forfaitaire forte d´iode radioactif permet d´obtenir un taux de rémission élevé.</p> Ali Sellem Wassim Elajmi Rania Ben Mhamed Nesrine Oueslati Haroun Ouertani Hatem Hammami Copyright (c) 2020-08-25 2020-08-25 36 1 Giant cell tumor of the maxilla: an unusual neoplasm <p>Giant cell tumors (GCT) of the bone are uncommon primary bone neoplasms that occur mainly in the epiphyses of long bones. Their incidence in craniofacial skeleton is rare, particularly in the maxilla. We report a case of a 12-year-old patient with a GCT of the left maxilla, who underwent a surgical excision of whole mass, and showed no recurrence one year after intervention.</p> Soukayna Bahbah Karima El Harti Wafaa El Wady Copyright (c) 2020-08-25 2020-08-25 36 1 Quality of life assessments in a cohort of Mozambican children with sickle cell disease <p><strong>Introduction:&nbsp;</strong>sickle cell disease (SCD) has significant pediatric morbidity and mortality in sub-Saharan Africa, where access to therapies such as hydroxyurea and opioids is often limited. Poor disease control and Pain management adversely affects the well-being and mental health of affected children. Questionnaires have been utilized in other regions to report the quality of life (QOL) in children with SCD, but assessments from Africa are lacking.</p> <p><strong>Methods:&nbsp;</strong>children age 2-14 years with SCD presenting for routine outpatient consultations at Hospital Central de Maputo from June-August 2017 were offered participation. After informed consent, the Pediatric QOL Inventory (PedsQL) SCD Module was administered to all caregivers and children &gt; 5 years. Responses were scored from 0-100, with higher scores representing better QOL.</p> <p><strong>Results:&nbsp;</strong>a total of 14 children were included, with six (43%), four (29%), two (14%), and two (14%) from the age groups of 2-4, 5-7, 8-12, and 13-14 years, respectively. Mean overall patient QOL was 65.3 and 56.0 in child and caregiver respondents. In patients &gt; 5 years, the difference in mean overall QOL for those on/not on hydroxyurea was 0.6 (66.5-64.9) in child respondents and 15.8 (68.4-52.6) in caregiver respondents. Domains related to worry/emotions and communication scored lower in QOL than Pain-related domains for both patient and caregiver respondents.</p> <p><strong>Conclusion:&nbsp;</strong>SCD has a negative impact on QOL as reported by this cohort of Mozambican pediatric patients and caregivers, with Pain being less of a concern than emotional and interpersonal issues. A comprehensive, child-focused care approach with robust psychosocial support is needed.</p> Faiaz Issa Brian Norman Dang W Chris Buck Sérgio Chicumbe Nelsa Nicolau Chana Virate Naya Cassamo Angelina Dias Faizana Amodo Copyright (c) 2020-08-25 2020-08-25 36 1 Fasciite nécrosante monomicrobienne de la jambe due à l'Acinetobacter baumannii multirésistante chez un adulte sain: rapport d'un cas <p>La fasciite nécrosante est une infection des tissus mous qui se propage rapidement et se caractérise par une nécrose étendue du fascia profond et superficiel. Il s'agit d'une infection polymicrobienne dans environ 70% des cas. L´infection monomicrobienne est généralement due aux streptocoques β-hémolytiques du groupe A. La fasciite nécrosante monomicrobienne due à l´<em>Acinetobacter baumannii</em>&nbsp;multirésistante est rare et survient généralement chez les patients immunodéprimés, ayant des antécédents médicaux, chez ces sujets l´infection est grave et mortelle à cause de la décompensation des tares sous-jacentes et le choc septique. La survenue de cette entité clinique chez le sujet sain est rare. Nous rapportons l'observation d'un homme âgé de 54 ans en bonne santé atteint d´une fasciite nécrosante monomicrobienne de la jambe gauche due à l´<em>Acinetobacter baumannii</em>&nbsp;multirésistante dont l´évolution était favorable après un débridement chirurgical étendu.</p> Jean Baptiste Ramampisendrahova Rado Razafimahatratra Gaëtan Duval Solofomalala Copyright (c) 2020-08-25 2020-08-25 36 1 Prevalence and determinants of intimate partner violence among adult women in an urban community in Lagos, Southwest Nigeria <p><strong>Introduction:&nbsp;</strong>intimate partner violence (IPV) is a global public health problem of human rights concern. It is a global issue, regardless of social, economic, religious or cultural group. Ever experienced IPV is a risk factor for many acute and chronic diseases and or stress-related conditions among women. This study determined the prevalence and predictors of lifetime IPV among women in an urban community in Lagos, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a descriptive cross-sectional study was conducted among 400 respondents from April to September 2019. An interviewer-administered questionnaire was used to obtain information from respondents. Data analysis was done using SPSS Version 22. Descriptive analyses were performed. Associations were explored with Chi-square test; multivariate analysis was done with logistic regression at p≤5% level of significance (95% CI).</p> <p><strong>Results:&nbsp;</strong>a total of 400 adult women aged 18-73 years who have been in an intimate relationship for at least 1 year participated in this study. The mean ± SD age of the respondents was 36.72 ± 11.74 years. Lifetime prevalence of IPV was 73.3%. The significant predictors for IPV were; being employed (OR=0.461; 95% CI=0.230-0.924); witnessed parental violence (OR=1.909; 95% CI=1.023-3.563); partner consuming alcohol (OR=1.669; 95% CI=0.999-2.788) and partner having other sexual partners (OR=2.104; 95% CI=1.174-3.771).</p> <p><strong>Conclusion:&nbsp;</strong>community-based interventions by government and other stakeholders are needed to empower women, reduce exposure of children to IPV at home and provide enlightenment education on IPV in communities.</p> Esther Oluwakemi Oluwole Nneoma Claranelly Onwumelu Ifeoma Peace Okafor Copyright (c) 2020-08-25 2020-08-25 36 1 Fractures sus et inter-condyliennes de l’humérus distal chez l’adulte <p><strong>Introduction:&nbsp;</strong>les fractures articulaires complètes de l´extrémité inférieure de l´humérus de l´adulte sont des lésions rares et graves. Les options thérapeutiques sont nombreuses mais le traitement chirurgical par ostéosynthèse est ardemment défendu. L´objectif de notre travail a été de décrire les caractéristiques épidémiologiques, clinico-radiologiques et thérapeutiques de ces fractures, ainsi que d´évaluer les résultats fonctionnels obtenus chez nos patients.</p> <p><strong>Méthodes:&nbsp;</strong>nous avons mené une étude prospective sur une période de 3 ans, portant sur 38 patients admis pour fracture articulaire complète sus et inter-condylienne de l´humérus distal (classée type C selon la classification de l´AO), traités chirurgicalement par voie postérieure trans-olécranienne avec un recul moyen de 34 mois.</p> <p><strong>Résultats:&nbsp;</strong>nous avons remarqué une distribution bimodale avec une atteinte du sujet jeune de sexe masculin d´une part, et une survenue chez les femmes âgées d´autre part. Les étiologies étaient dominées par les accidents de la voie publique chez 78%. Lors du suivi, nous avons noté un seul cas d´infection superficielle du site opératoire et il n´y a eu aucun cas de démontage du matériel ni de pseudarthrose. De surcroit, aucune complication de l´ostéosynthèse de l´olécrane n´a été enregistrée. Les résultats fonctionnels ont été très satisfaisants avec un score de Mayo-Clinic Elbow Performance Score (MEPS) moyen de 86.</p> <p><strong>Conclusion:&nbsp;</strong>nous considérons que la voie postérieure trans-olécranienne semble être la meilleure voie d´abord de ces fractures puisqu´elle permet une bonne exposition articulaire, condition sine qua non pour une restitution anatomique parfaite et une ostéosynthèse stable afin d´entreprendre une rééducation précoce et adaptée.</p> Meryem Lemsanni Rachid Chafik Mohamed Madhar Hanane Elhaoury Youssef Najeb Copyright (c) 2020-08-25 2020-08-25 36 1 Episiotomy related morbidities measured using redness, edema, ecchymosis, discharge and apposition scale and numerical pain scale among primiparous women in Mulago National Referral Hospital, Kampala, Uganda <p><strong>Introduction:&nbsp;</strong>episiotomy induced inflammatory signs like redness, edema, ecchymosis and pain may remain beyond the period of hospitalization and can be objectively measured using redness, edema, ecchymosis, discharge and apposition (REEDA) scale. Pain in the postpartum period is a common problem and can be measured using the numerical pain scale (NPS). Episiotomy is normally poorly executed and poorly repaired with little attention to the subtle pain-free scar. Postpartum perineal pain has been found to affect more people with episiotomy compared to spontaneous perineal tears or contusion in the first two weeks. This study was aimed at comparing NPS and REEDA scores in the first two weeks of postpartum among primiparous parturients with or without episiotomy in Mulago National Referral Hospital.</p> <p><strong>Methods:&nbsp;</strong>a prospective cohort study conducted by recruiting primiparous women systematically on the first postnatal day and categorizing them into episiotomy and no episiotomy group. NPS and REEDA scale were taken at baseline and 2 weeks postpartum.</p> <p><strong>Results:&nbsp;</strong>the mean total REEDA score for primiparous women among the episiotomy group was significantly higher both on day 1 and day 14 with p-values &lt;0.0001 and &lt;0.0001 respectively as well as the day 14 mean NPS p-value 0.001.</p> <p><strong>Conclusion:&nbsp;</strong>episiotomy, a traumatic obstetric procedure, that heals slowly and with persistent perineal pain compare to spontaneous perineal contusion or tears.</p> Pebalo Francis Pebolo Ajeani Judith Kaye Kabonge Dan Copyright (c) 2020-08-26 2020-08-26 36 1 Spontaneous gastrocnemius muscle haematoma formation in a patient with alcoholic liver disease <p>Advanced liver disease is associated with several haemostatic alterations which can lead to either thrombosis or bleeding complications. Spontaneous muscle haematomas although a rare complication of liver cirrhosis is increasingly being described in the literature and hyperfibrinolysis is an emerging plausible pathophysiological mechanism. We describe a patient who presented with a life threatening spontaneous haematoma in his gastrocnemius muscle that required treatment with antifibrinolytic therapy to control further bleeding.</p> Ndawapeka Tulonga Nhinda Innocent Lule Segamwenge Twitileni Nampweya Chrizelda Engels Copyright (c) 2020-08-26 2020-08-26 36 1 Localisation exceptionnelle de condylomes acuminés dans les fosses nasales d´une patiente vivant à Yaoundé, Cameroun: cas clinique et revue de la littérature <p>Les condylomes acuminés sont des lésions sexuellement transmissibles causées par le&nbsp;<em>human papillomavirus</em>. Ils se localisent surtout sur la sphère ano-génitale et sont exceptionnellement rencontrés dans les fosses nasales. Nous en rapportons un nouveau cas. Une patiente séropositive au VIH et suivie en gynécologie pour récidive de condylomes acuminés vulvaires, nous est adressée pour prise en charge de masses rosées des fosses nasales empêchant la respiration nasale et évoluant depuis plusieurs semaines. L´examen clinique et le scanner suspectent des condylomes, un traitement chirurgical est effectué sous anesthésie générale sous contrôle endoscopique et l´histologie revient en faveur de condylomes acuminés. Les suites postopératoires sont simples et sans récidive à 6 mois postopératoire. La localisation nasale des condylomes acuminés est rare voire exceptionnelle, seule une poignée de cas sont décrits dans la littérature. Le profil est celui d´un adulte jeune séropositif ou non avec notion de comportement sexuel à risque. Plusieurs localisations notamment génitales peuvent être retrouvées et dans ce cas la greffe nasale des lésions pourrait être manuportée. Le traitement chirurgical est efficace et le suivi à long terme est indispensable pour prendre en charge d´éventuelles récidives.</p> Antoine Bola Siafa Yves Christian Andjock Nkouo Sandrine Owona Grâce Nganwa François Djomou Copyright (c) 2020-08-26 2020-08-26 36 1 Ibuprofen versus paracetamol for treating fever in preschool children in Nigeria: a randomized clinical trial of effectiveness and safety <p><strong>Introduction:&nbsp;</strong>fever is the primary symptom of most childhood illnesses and a cause of concern to their caregivers. The antipyretics commonly used to treat fever are ibuprofen and paracetamol. Most studies on the effectiveness of ibuprofen and paracetamol in treating fever in under-fives were conducted in Europe and North America with very few in African children. This study was aimed at assessing the effectiveness and safety of a single dose therapy of ibuprofen versus paracetamol for treating childhood fever in Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a randomized, controlled clinical trial was conducted in the University of Calabar Teaching Hospital, in Nigeria. A total of 140 eligible children aged 6-59 months with tympanic temperature of 38°C-40°C were enrolled, and 70 of them were assigned to one arm that received a single dose of ibuprofen (10mg/kg) and 70 had paracetamol (15mg/kg). After drug administration, the children were admitted and observed in the hospital for six hours during which period a half-hourly temperature measurement and monitoring for adverse events were done.</p> <p><strong>Results:&nbsp;</strong>the overall result showed that ibuprofen had a better fever reducing effect compared to paracetamol. The proportion of afebrile children in the ibuprofen versus paracetamol group at 1.5-2.5 hours of administration of the drugs was statistically significant (p = 0.04). The adverse events of both drugs were mild and quite comparable with vomiting being the commonest.</p> <p><strong>Conclusion:&nbsp;</strong>ibuprofen is more effective in the treating fever in under-fives compared to paracetamol. The adverse events of both drugs were mild and comparable.</p> Ekaete Olajide Alaje Ekong Emmanuel Udoh Patrick Aboh Akande Friday Akwagiobe Odey Martin Madu Meremikwu Copyright (c) 2020-08-26 2020-08-26 36 1 Assessment of eligibility for thrombolysis in acute ischaemic stroke patients in Morocco <p><strong>Introduction:&nbsp;</strong>intravenous thrombolysis with recombinant tissue plasminogen activator (rTPA) is an approved treatment for acute ischaemic stroke (AIS). However, its use remains low. We aimed to assess the eligibility of thrombolysis for our patients with AIS before implementing this treatment method in our teaching hospital.</p> <p><strong>Methods:&nbsp;</strong>we conducted a prospective cross-sectional study in the emergency department of Casablanca University Hospital. We included every patient admitted for a stroke-related symptom. Delays between symptom-onset and admission and delays regarding the in-hospital evaluation of patients were recorded. Patients eligible for intravenous thrombolytic therapy were identified according to American Heart Association guidelines.</p> <p><strong>Results:&nbsp;</strong>in all, 463 patients were included. Only 8.42% of patients were eligible for thrombolysis; 74% of patients were ineligible because of an onset-to-thrombolysis delay longer than 4.5 hours. Mean onset-to-thrombolysis time was 27.2 hours. Patients were admitted with a mean delay of 24.9 hours. The in-hospital evaluation, from admission to computerized tomography (CT) interpretation, averaged 2.3 hours in length.</p> <p><strong>Conclusion:&nbsp;</strong>the percentage of patients eligible for thrombolysis remains very low in our structure. The majority would not have benefitted from the therapy because of an extra hospital delay far exceeding the recommended therapeutic window. To shorten our delays and increase the number of patients benefiting from thrombolysis, we must implement strategies aiming to improve the recognition, evaluation and management of patients from the general public to the neurovascular unit.</p> Mohamed Acherqui Hajar Khattab Younes Habtany Rim Amzil Salma Bellakhdar Hicham El Otmani Bouchra El Moutawakil Mohammed Abdoh Rafai Copyright (c) 2020-08-26 2020-08-26 36 1 HIV-hepatitis co-infection in a rural community in Northern Nigeria <p><strong>Introduction:&nbsp;</strong>HIV, hepatitis B and hepatitis C pose a public health challenge in sub-Saharan Africa and there are only few studies on co-infection of these viruses done in rural areas in Northern Nigeria. This study provides a rural perspective on HIV-hepatitis co-infection in a Northern Nigerian community.</p> <p><strong>Methods:&nbsp;</strong>this cross-sectional study was carried out amongst people living with HIV/AIDS (PLWHA) in a rural community hospital over a three-month period. Socio-demographic data and other relevant information were obtained from the participants and case notes using an interviewer-administered questionnaire. Hepatitis B surface antigen and antibody to Hepatitis C virus were assayed from serum using enzyme-linked immunosorbent assay (ELISA) kits developed by LabACON®. Chi-square test was used to compare categorical variables and logistic regression modelling was used to determine correlates of co-infection in the population.</p> <p><strong>Results:&nbsp;</strong>a total of 281 individuals participated in the study. The prevalence of Hepatitis B co-infection, Hepatitis C co-infection and triple infection was 6.0%, 14.6% and 1.1% respectively. Using Chi-square test, none of the socio-demographic characteristics, WHO Clinical Stage, viral suppression had significant association with Hepatitis B co-infection, however marital status was significantly associated with Hepatitis C co-infection and level of education was significantly associated with triple infection (p &lt; 0.05). Logistic regression modelling generated no significant results.</p> <p><strong>Conclusion:&nbsp;</strong>co-infection of viral hepatitis (particularly Hepatitis C) in PLWHA is common in rural Northern Nigeria, and significant correlates include lack of formal education and being married. There is need for provider-initiated routine counselling and screening of PLWHA for viral hepatitis, with adequate follow-up and treatment of co-infected individuals and Hepatitis B vaccination for those without co-infection.</p> Oluwaseyitan Andrew Adesegun Olabiyi Hezekiah Olaniran Emmanuel Bamidele Joseph Nicholas Inyang Michael Adegbe Tolulope Oyinloluwa Binuyo Osaze Ehioghae Oluwafunmilola Adeyemi Oyekunle Oyebisi Akolade Olukorede Idowu Oluwafemi Ajose Copyright (c) 2020-08-27 2020-08-27 36 1 La hernie diaphragmatique congénitale: une pathologie pas toujours facile à diagnostiquer <p>La hernie congénitale de la coupole diaphragmatique (HCCD) est une embryopathie congénitale qui se définit par l´absence de développement de tout ou d´une partie d´une coupole diaphragmatique. La fréquence de cette pathologie est de l´ordre de 1/3500 naissances vivantes avec une prédominance masculine. Ce travail porte sur l´étude d´un cas de hernie de Bochdalek, ainsi que les données de littérature et consiste à décrire les difficultés diagnostiques et thérapeutiques rencontrées devant cette pathologie. Le diagnostic et la prise en charge anténatale sont des éléments importants pour réduire la mortalité et la morbidité des patients. Le pronostic demeure encore sévère et reste tributaire de l´existence et du degré de l´hypoplasie pulmonaire et de l´association à des malformations congénitales.</p> Soukaina Ait Hmadouch Amina Barkat Copyright (c) 2020-08-27 2020-08-27 36 1 Clinico-laboratory profile and perforin gene mutations of pediatric hemophagocytic lymphohistiocytosis cases: a five-year single center study <p><strong>Introduction:&nbsp;</strong>hemophagocytic lymphohistiocytosis (HLH) is an immunological disease characterized by hemophagocytosis of blood cells and proliferation of T-cells and histiocytes in the spleen and bone marrow then infiltration into body organs. Familial HLH (FHL) is a fatal disorder and determining gene mutations is a good guide for predicting the prognosis and choosing treatment options. This study aimed to illustrate the clinical, laboratory characteristics, including perforin gene mutation screening, treatment and survival outcome of pediatric HLH patients.</p> <p><strong>Methods:&nbsp;</strong>we conducted this cross-sectional study on pediatric patients who were diagnosed with HLH using the revised HLH-2004 criteria, from January 2014 to February 2019 at Zagazig University Children's Hospital, Egypt. We collected demographic, clinical and laboratory data and screened for the presence of mutations in perforin (PRF1) gene by polymerase chain reaction (PCR) amplification. We treated the patients according to HLH-2004 treatment protocol and documented their survival outcome.</p> <p><strong>Results:&nbsp;</strong>the total number of cases were 18; eight males and ten females, the age range was between three months and 12 years. Of the eight HLH-2004 diagnostic criteria, all patients met at least five criteria. We detected PRF1 gene mutation in 38.9% (7 patients) with nine previously unreported mutations. Sixteen patients (88.9%) received HLH-2004 treatment protocol and the remaining two patients died before initiation of treatment. The overall mortality was 72.2% (13 patients).</p> <p><strong>Conclusion:&nbsp;</strong>our results increase the awareness of clinical and laboratory characterizations of pediatric HLH patients and the prevalence of PRF1 gene mutations among those patients.</p> Mohamed Abdelkader Almalky Safaa Hamdy Ahmad Saleh Eman Gamal Baz Ahmed Elsadek Fakhr Copyright (c) 2020-08-27 2020-08-27 36 1 The need to return to the basics of predictive modelling for disease outbreak response: lessons from COVID-19 <p>The outbreak of COVID-19 has been unprecedented in speed and effect. Efforts to predict the disease transmission have mostly been done using flagship models developed by the global north. These models have not accurately depicted the true rate of transmission of SARS-CoV-2 in Africa. The models have ignored Africa´s unique socio-ecological makeup (demographic, social, environmental and biological) that has aided a slower and less severe spread of the virus. This paper opines on how the science of infectious disease modelling needs to evolve to accommodate contextual factors. Country-owned and tailored modelling needs to be urgently supported.</p> Sam Agatre Okuonzi Copyright (c) 2020-08-27 2020-08-27 36 1 The effect of anaesthesia on flank incisional pain: infiltration versus intercostal nerve block, a comparative study <p>The object of this study is to determine which local wound analgesic option is superior, local anaesthetic infiltration or intercostal nerve block, by combined local anaesthetic agents (0.5% bupivacaine + 2% lidocaine) and to detect which option can best alleviate the post-operative pain management and significantly prolong the time to the first rescue analgesic requirement and the total consumption of opioids in the first post-operative 72 hrs. The medical records of 1458 patients who underwent flank incision procedures by two different surgeons in our institute were retrospectively reviewed. Each surgeon used a different type of local incisional pain management; the first one used infiltration of flank incision routinely, the second surgeon used an intercostal block with all his patients. These elective procedures were carried out in our Urology Centre between June 2007 and June 2019. The duration of follow-up was from the recovery transfer until the end of the third post-operative day. Patients were divided into two groups: group 1 (729 patients-infiltration of flank incision) and group 2 (729 patients-intercostal nerve block). Patients were aged between 19-78 years. No significant differences were seen regarding the demographic data between both groups, P &gt; 0.05. On the other hand, there were significant differences between group 1 and group 2 according to the mean visual analogue scale score (lower in group 1, P &lt; 0.05), the total mean analgesic requirements during the first post-operative 72 hrs (lower in group 1, P &lt; 0.05) and the time to the first analgesic demand (higher in group 1, P &lt; 0.05). There were no statistically significant differences in post-operative complications between both groups, P &gt; 0.05. The infiltration of flank incision with combined local anaesthetic agents (0.5% Bupivacaine + 2% lidocaine) is more effective in alleviating post-operative pain, decreasing total analgesic consumption during the first post-operative 72 hrs and prolonging the time required for the first rescue opioid.</p> Awad Al-Kaabneh Adnan Abo Qamar Firas Al-Hammouri Ashraf Al-Majali Ali Alasmar Nizar Al-sayedeh Firas Khori Anan Qapaha Mohammad Beidas Copyright (c) 2020-08-27 2020-08-27 36 1 Prosthetic rehabilitation of multiple-digit amputations using silicone material in sub-Saharan African country Ghana <p>Digit loss might be due to traumatic injuries, congenital malformations and various diseases. Rehabilitation of finger amputations requires aesthetics and functional aspects. Due to limited resources in low income countries, some local professionals find it difficult to meet the patient´s needs. One of the methods of gaining total suspension is to don the residual finger with aesthetic silicone prosthesis. A 25-year-old female presented with multiple-digit amputations of both of her hands due to autoimmune disease. At first stage of the treatment, silicone prostheses of the loss fingers of both hands were planned. The impressions of the remaining fingers were taken to manufacture the silicone prostheses. The manufactured prostheses with total suspension improved patient´s social life. The patient´s residual fingers were fitted with the prostheses after which she was satisfied with the aesthetic aspects.</p> Akouetevi Aduayom-Ahego Copyright (c) 2020-08-27 2020-08-27 36 1 Left ventricular myxoma: case report <p>Left ventricular (LV) myxomas are rare. We present a case of a LV myxoma arising from the interventricular septum in a 70-year-old asymptomatique man. General examination of the patient did not reveal any abnormality. Transthoracic echocardiography revealed a round pedunculated mass (size, 20mm x 13mm) at the interventricular septum with a broad pedicle. The mass was successfully removed and was pathologically confirmed to be a myxoma.</p> Mohamed Rida Ajaja Amine Cheikh Noëllie Akpabie Wafa Elmire Amale Tazi Mezalek Amine El Hassani Mahdi Ait Houssa Copyright (c) 2020-08-27 2020-08-27 36 1 La tumeur de Buschke-Löwenstein <p>La tumeur de Buschke-Löwenstein (TBL) ou condylome acuminé géant(CAG) est une prolifération pseudo-épithéliomateuse appartenant au groupe des carcinomes verruqueux. Sa première description remonte à 1896. C´est en 1925 que Buschke et Löwenstein en ont fait une entité caractérisée. Elle est d´origine virale (HPV), de transmission sexuelle atteignant surtout les zones ano-génitales. Elle est caractérisée par son potentiel dégénératif et son caractère récidivant après traitement. La TBL est une affection relativement rare et toujours précédée de condylomes acuminés, son incidence annuelle semble être de 0,1% parmi la population adulte active sexuellement. Elle survient à tout âge après la puberté et prédomine entre les 4<sup>e</sup>&nbsp;et 6<sup>e</sup>&nbsp;décennies. L´infection peut atteindre les deux sexes, elle se voit fréquemment chez le sexe masculin. Le développement, la persistance et les récidives des condylomes dépendent largement du statut immunitaire de l´hôte. L´immunodépression, l´inflammation chronique, le manque d´hygiène et l´infection à VIH semblent être des facteurs de risque de cette affection. L´implication du papillomavirus et en particulier de ses sérotypes l´HPV 6 et 11 est admise dans la genèse de la TBL. Sa prévention est impérative basée sur le traitement des condylomes acuminés et la lutte contre les maladies sexuellement transmissibles. Le traitement doit être précoce, il est essentiellement chirurgical nécessitant une large exérèse. Nous rapportons le cas d´un patient âgé de 55 ans, ayant comme antécédent une notion de vagabondage sexuel et des urétrites à répétition, qui consulte pour une tumeur pénienne évoluant depuis 8 ans. L´examen clinique notait la présence plusieurs lésions tumorales infiltrées, papillomateuses en chou-fleur intéressant la racine et la face ventrale de la verge, fétides et indolores. Les aires ganglionnaires étaient libres. Les sérologies VIH, syphilitique et des hépatites B et C étaient négatives. Le traitement a consisté en une exérèse chirurgicale avec un recouvrement cutané par la peau adjacente. L´examen histologique de la pièce d´exérèse a retrouvé une importante hyperplasie papillomateuse de l´épiderme et quelques koïlocytes en faveur d´un condylome géant. Après 2 ans de recul nous n´avons pas constaté de récidive.</p> Youssef Kadouri Yassine Nouini Copyright (c) 2020-08-28 2020-08-28 36 1 Abcès rétropharyngé et la revue de la littérature: à propos de 5 observations <p>Nous rapportons 5 cas d´abcès rétropharyngés que nous avons corrélé avec la littérature. Il y avait des enfants ainsi que des adultes. Le corps étranger à type d´arête de poisson a été l´étiologie la plus dominante. La dysphagie accompagnée de douleur, la fièvre et le torticolis ont été les symptômes fréquents. L´abcès rétropharyngé siégeait beaucoup plus en région oropharyngée et hypopharyngée. L´imagerie notamment la tomodensitométrie nous a permis d´avoir des informations précises chez les 3 patients qui en ont bénéficié. L´obstruction des voies aéro-digestives a été retrouvé chez la plupart de nos patients. Seulement 4 patients ont bénéficié d´une incision drainage. Tous les patients ont bénéficié d´un traitement médical. Nous avons enregistré le décès de l´enfant de 2 ans dans un tableau de choc septique à J5 post-opératoire. Nous avons constaté la rareté de cette affection dans notre contexte mais engageant le pronostic vital si le diagnostic et le traitement retardent.</p> Abdoulaye Keïta Ibrahima Diallo Mamady Fofana Mamadou Aliou Diallo Mamadou Mouctar Ramata Diallo Oughaïlou Balde Alseny Camara Sory Sacko Copyright (c) 2020-08-28 2020-08-28 36 1 Infarctus de l´os fémoral révélant une drépanocytose composite SC chez un patient marocain <p>La double hétérozygotie SC est considérée comme un syndrome drépanocytaire majeur; en effet, son évolution peut être marquée par des complications sévegrave;res voire irréversibles, tel que l´infarctus osseux. Notre observation rapporte la découverte d´une hétérozygotie composite SC chez un patient de 17 ans à la suite de gonalgies intenses et met ainsi en exergue le retard diagnostic de cette maladie, et soulegrave;ve la nécessité de mise en place d´une politique de dépistage précoce afin d´améliorer la prise en charge et le pronostic des sujets atteints.</p> Fatima-Zahrae Bennis Asmae Biaz Aida Zkik Achraf Rachid Sanae Bouhsain Abdellah Dami Elmachtani Idrissi Samira Copyright (c) 2020-08-28 2020-08-28 36 1 Hepatitis B infection in the rural area of Dschang, Cameroon: seroprevalence and associated factors <p><strong>Introduction:&nbsp;</strong>viral hepatitis B remains a major public health problem around the world, especially in underdeveloped and developing countries. Cameroon shows a grate variability in prevalence of this infection in the country and even within different populations groups. The aim of this study was to determine the prevalence and factors associated with viral hepatitis B infection in the rural area of Dschang.</p> <p><strong>Methods:&nbsp;</strong>we conducted a cross-sectional community-based study, involving 551 participants of both genders recruited by a voluntary sampling technique. The biological diagnosis of HBsAg was done by the Immunochromatographic method (PKL<sup>®</sup>&nbsp;kit of PARAMEDICAL srl laboratories). Positive cases were confirmed by ELISA method (reagent Kit from DIALAB Laboratories).</p> <p><strong>Results:&nbsp;</strong>results show a Viral Hepatitis B prevalence of 5.08% (95% CI: 3.2-6.9). University students were the most infected (11/88) with a positivity rate of 12.50% (95%CI: 5.6-19.4). Only 29/551 participants (5.26%) had received at least one dose of vaccine against the disease and were less infected (3.44%) than the others (5.17%). Age (p=0.000), level of education (p=0.013), occupation (p=0.002), belief in the traditional healing of hepatitis B (p=0.000) and knowledge about the disease and its contamination roads (p=0.049) were associated with viral hepatitis B.</p> <p><strong>Conclusion:&nbsp;</strong>there is a need of intensifying awareness, education, routine screening and vaccination of the population, especially in schools and university milieu to better counteract the infection with hepatitis B virus in our local Communities.</p> Thomas Djifack Tadongfack François Roger Nguepy Keubo Patrice Bianke Copyright (c) 2020-08-28 2020-08-28 36 1 Socio-demographic, pattern of presentation and management outcome of breast cancer in a semi-urban tertiary health institution <p><strong>Introduction:&nbsp;</strong>breast cancer is the most common malignancy in females worldwide and a major cause of cancer-related deaths in both developing and developed countries. The objective of this study was to determine the socio-demographics, pattern of presentation and management outcome of breast cancer patients.</p> <p><strong>Methods:&nbsp;</strong>clinical records of confirmed breast cancer patients between January 2011 and December 2015 at the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria were reviewed.</p> <p><strong>Results:&nbsp;</strong>eighty two breast cancer patients were seen. Their ages ranged from 26-95 years (mean 48.9 ± 14.9 years, median 47.5 years). Eighty one (98.8%) were females and the majority (65.4%) were premenopausal. The peak age of incidence was in the 4<sup>th</sup>&nbsp;decade. All patients presented with breast lump with mean duration of 9.49±6.1 months and size ranging from 2 to 16cm (mean 7.9±3.4 cm). Ten (12.2%) patients presented early, 61 (74.4%) were locally advanced while 11 (13.4%) had distant metastases. Fifty one (62.2%) patients had mastectomy. Only 38 (46.3%) patients completed six courses of chemotherapy. None had immunohistochemistry but they all routinely took tamoxifen. Only 4 (4.9%) had radiotherapy. Nineteen (23.2%) died within a year of presentation. The follow-up period ranged between 1 and 44 months (mean, 10.3 months). Thirty one (37.8%), 19 (23.2%) and 8 (9.8%) patients were seen during the first, second and third year of follow up respectively.</p> <p><strong>Conclusion:&nbsp;</strong>breast cancer mostly affects young premenopausal women presenting in advanced stage in our setting. The generally poor outcome is not unconnected with late presentation and inadequate diagnostic and treatment facilities.</p> Julius Gbenga Olaogun John Adetunji Omotayo Joshua Taye Ige Abidemi Emmanuel Omonisi Olusoga Olusola Akute Olufunso Simisola Aduayi Copyright (c) 2020-08-28 2020-08-28 36 1 La maladie à IgG4: à propos de 3 cas <p>La maladie à IgG4 encore appelée polyexocrinopathie auto-immune à IgG4 est une nouvelle entité où s´inscrit la PAI de type 1. Elle peut toucher différents organes (système nerveux central, les glandes salivaires, la thyroïde, les poumons, le pancréas, les voies biliaires, le foie, le tube digestif, les reins, la prostate…) avec des symptômes relatifs à l´organe atteint. Elle est plus fréquente chez l´homme de plus de 50 ans. Son incidence et sa prévalence sont mal connues car c´est une maladie peu fréquente. Elle est a priori plus fréquente en Asie et ne représente que 20 à 30% des PAI en occident. Son diagnostic est histologique caractérisé par la présence, dans un contexte d´élévation sérique des IgG4 dans plus de 80% des cas, d´un infiltrat lymphoplasmocytaire dense de l´organe atteint avec positivité des IgG4 en immuno- histochimie, d´une fibrose d´organe et des veinulites oblitérantes. Elle est sensible à la corticothérapie avec un risque de rechute à l´arrêt de la corticothérapie qui n´est pas négligeable et qui conduit alors à l´utilisation d´immunomodulateurs, principalement: les thiopurines (Azathioprine ou le 6-mercaptopurine), le méthotrexate et de façon plus récente le rituximab qui peut être utilisé également comme traitement d´induction. Grâce aux avancées récentes, des critères histologiques et cliniques précis sont maintenant connus permettant de limiter les prises en charge inadaptées telle que la chirurgie. Cependant, de nombreuses lacunes persistent dans nos connaissances: sur la physiopathologie, l´identification de biomarqueurs spécifiques autres que les IgG4, l´histoire naturelle de la maladie et l´évaluation du risque de cancer à long terme, les performances des outils diagnostiques comme la biopsie pancréatique sous échoendoscopie. De même, une prise en charge consensuelle internationale reste à définir dans les phases initiales de la maladie et en cas de rechute. L´objectif de cette étude est de rapporter 3 cas de ML-IgG4 en se basant sur les critères cliniques et radiologiques, la réponse thérapeutique.</p> Hakima Abid Moulaye El Hacen Horma Babana El Alaoui Moulay Youssef Alaoui Lamrani Mouna Figuigui Beiba Cheikh Ahmed Nada Lahmidani Mounia El Yousfi Dafr-Allah Benajah Mustapha Maaroufi Mohammed El Abkari Sidi Adil Ibrahimi Nourdin Aqodad Copyright (c) 2020-08-28 2020-08-28 36 1 One novel virus, different beliefs as playmakers towards disease spread in Africa: looking at COVID-19 from a religious lens <p>Religious and spiritual observances that draw large people together are pervasive in many parts of the world, including Africa. With the recent emergence of COVID-19, these mass religious gatherings may pose significant threats to human health. Given the compromised healthcare systems in many parts of Africa, faith-based institutions have a huge responsibility towards the management of the potential spread of the virus through effective organizational strategies or interventions. This essay sheds light on what the novel virus has to do with religion, the role of religious practices in inhibiting or spreading COVID-19, and what appropriate evidence-based interventions religious or faith-based organizations could adopt to help prevent the spread of the disease in Africa through a unity of thoughts for religious action.</p> Edward Kwabena Ameyaw John Elvis Hagan Bright Opoku Ahinkorah Abdul-Aziz Seidu Thomas Schack Copyright (c) 2020-08-28 2020-08-28 36 1 Mainstream reintegration of COVID-19 survivors and its implications for mental health care in Africa <p>The novel coronavirus pandemic has undoubtedly emerged as a serious public health threat in many societies across the world. Due to the sporadic and unpredictable nature of the pandemic, it is important to admit that the virus can cause psychological distress and emotional instability that might impact on people in diverse ways at the individual, community and national levels, with serious mental health implications (e.g. depression, mood disorders, obsessive-compulsive disorder, other anxiety disorders). Due to the weak healthcare challenges inherent in Africa, these mental health challenges require urgent redress to ensure mental health well-being for all, especially COVID-19-positive patients who have recovered (i.e. survivors). This essay outlines some of these challenges and offers strategies to address them. Broader mental health training for facility and community-based health workers are urgently required and should be coordinated within countries with specific guidelines for psychosocial support during outbreaks such as the current pandemic. A framework that promotes reintegration for COVID-19 survivors could also be designed based on context-specific needs through individualized protocols such as the “RAPID-Psychological First Aid [PFA]”. This tool kit, if effectively employed, would help facilitate optimal well-being of the people devoid of any psychological challenges created by the pandemic.</p> Edward Kwabena Ameyaw John Elvis Hagan Bright Opoku Ahinkorah Abdul-Aziz Seidu Thomas Schack Copyright (c) 2020-08-28 2020-08-28 36 1 Systemic lupus erythematosus, antiphospholipid syndrome and Hashimoto thyroiditis occurring in a patient with Niemann-Pick disease: a second case <p>Lysosomial diseases and autoimmune diseases are systemic disorders. Their clinical manifestations can overlap with the broad spectrum of one another. Their association has been rarely reported. We report a new case of systemic lupus erythematous (SLE) associated to antiphospholipid syndrome (APS) and Hashimoto thyroiditis occurring in Niemann-Pick disease (NPD) type B patient. A 42-year-old woman with a familial history of NPD was diagnosed with a NPD type B at the age of ten. Twenty years later (2008), she complained of inflammatory arthralgia with acute dyspnea. She was diagnosed with SLE (according to ACR criteria) and Hashimoto disease with positive IgG anti-cardiolipin and IgA anti-beta2 glycoprotein. In 2018, she presented a left segmental pulmonary embolism. Antiphospholipid syndrome was retained. She was treated with steroids, hydroxychloroquine, anticoagulation therapy and levothyroxine. Her SLE treatment was re-enforced by cyclophosphamide because of corticosteroid dependence and recurrent hemolytic crises.</p> Wafa Baya Fatma Ben Fredj Imen Ben Hassine Jihed Anoun Anis Mzabi Monia Karmani Amel Rezgui Mohamed Adnane Laatiri Chedia Laouani Kechrid Copyright (c) 2020-08-28 2020-08-28 36 1 Cardiac tamponade: an uncommon presenting feature of systemic lupus erythematosus (a case-based review) <p>Although pericarditis is the most prevalent cardiac involvement in systemic lupus erythematosus (SLE), cardiac tamponade is extremely infrequent notably as the first manifestation of the disease. Here we report the case of a 22-year-old woman presenting with cardiac tamponade as the initial presentation of SLE.</p> Chadia Chourabi Houaida Mahfoudhi Sameh Sayhi Rim Dhahri Karima Taamallah Sarra Chenik Abdeddayem Haggui Nadhem Hajlaoui Dhaker Lahidheb Ajili Faida Nadia Ben Abdelhafidh Bassem Louzir Wafa Fehri Copyright (c) 2020-08-28 2020-08-28 36 1 Sarcomatoid carcinoma of the urinary bladder: analysis of five cases and literature review <p>Sarcomatoid carcinomas of the bladder represent a tiny part of bladder tumors and are characterized by a high potential for malignancy. Very aggressive and affecting mainly men, these tumors present both a urothelial and sarcomatoid contingent. The treatment of these tumors is not well codified given the rarity of cases reported in the literature, however, it seems that the treatment is essentially based on radical cystectomy with extensive pelvic lymph node dissection. We report the experience of our departement in the management of this type of tumor in a series of five cases collected over a period of 8 years.</p> Youssef Kadouri Salim Ouskri Hachem El Sayegh Lounis Benslimane Yassine Nouini Copyright (c) 2020-08-29 2020-08-29 36 1 Seroprevalence and associated factors of brucellosis and Q-fever in cattle from Ibarapa area, Oyo state, south-western Nigeria <p><strong>Introduction:&nbsp;</strong>a cross-sectional study was conducted to determine the seroprevalence and associated factors of brucellosis and Q-fever among cattle in a rural setting in Oyo State, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>one hundred and fourty nine serum samples (24 males; 125 female) from 16 cattle herds were collected and screened. The Rose Bengal Plate test (RBPT) and competitive Enzyme-Linked Immunosorbent Assay (cELISA) were used for brucellosis while indirect Enzyme-Linked Immunosorbent Assay (iELISA) was used for Q-fever. Further, a checklist was used to collect data on cattle sampled. Data were analyzed using STATA 12.</p> <p><strong>Results:&nbsp;</strong>serum analysis revealed that 11.4% (17/149) and 6.7% (10/149) were seropositive by RBPT and cELISA respectively for brucellosis, while 23.5% (35/149) were seropositive by iELISA for Q-fever. A significant association was detected between cattle age (OR=27.7; 95% CI: 2.34-449.86), herd size (OR=10.53; 95% CI: 1.85-60.53) and seropositivity to&nbsp;<em>Brucella</em>&nbsp;infection. Also, there was a significant association between breed (OR=6.69; 95% CI: 1.7-28.74), herd size (OR=4.25; 95% CI: 1.31-13.85) of cattle and seropositivity to&nbsp;<em>Coxiella burnetii</em>&nbsp;infection. Importantly, the only significant associated factor to cattle herd seropositivity to&nbsp;<em>Brucella</em>&nbsp;and&nbsp;<em>C. burnetii</em>&nbsp;infections was the method of handling aborted foetuses.</p> <p><strong>Conclusion:&nbsp;</strong>the study revealed that brucellosis and Q-fever are prevalent among cattle in the study area. Thus, there is a need for further studies to provide better insight into the epidemiology of both diseases and particularly Q-fever. This becomes imperative in the study area and generally in Nigeria given the dearth of information about the diseases in pastoralist communities who are at grave risk of infection at the human-animal-ecosystem interface.</p> Simeon Idowu Cadmus Kelechi Araloluwa Akporube Fiyinfoluwa Ola-Daniel Olubukola Deborah Adelakun Victor Oluwatoyin Akinseye Copyright (c) 2020-08-29 2020-08-29 36 1 Delayed onset acute cerebral venous infarct following meningioma excision: a word of caution <p>We describe an unusual case of delayed onset acute cerebral venous infarct that developed after an uneventful parasagittal meningioma excision. While the acute and chronic venous infarct are well known entities, there is dearth of literature regarding delayed onset acute form, which may prove to be fatal.</p> Gautam Dutta Divya Mahajan Daljit Singh Hukum Singh Anita Jagetia Arvind Kumar Srivastava Copyright (c) 2020-08-29 2020-08-29 36 1 Tackling heart failure in sub-Saharan Africa: the imperious need for hypertension prevention and control <p>Editorial.</p> Jean Jacques Noubiap Copyright (c) 2020-08-31 2020-08-31 36 1 Accouchement différé d'une grossesse multiple: à propos d'un cas et revue de la littérature <p>L´accouchement gémellaire différé a pour but de prolonger la vie intra-utérine du ou des fœtus restants après l´expulsion prématurée du premier jumeau au deuxième trimestre de la grossesse, en vue d´atteindre un âge gestationnel compatible avec la survie néonatale pour le ou les fœtus restants. L´objectif de ce travail est de mettre en exergue le bénéfice et les indications de cette pratique obstétricales, et ce, à travers la description d´un cas clinique d´un accouchement gémellaire différé chez une patiente porteuse d´une grossesse triple, et chez qui le délai entre l´expulsion du premier jumeau et l´accouchement du troisième jumeau était de 10 semaines.</p> Mehdi El Hassani Jihad Drissi Saad Benali Abdellah Baba Habib Jaouad Kouach Driss Moussaoui Copyright (c) 2020-08-31 2020-08-31 36 1 The case of pulmonary tuberculosis with COVID-19 in an Indian male-a first of its type case ever reported from South Asia <p>We report the first case of tuberculosis with COVID-19 from South Asia. The patient was a 43 years old Indian male. He reported to us in the outpatient department with chief complaints of cough with expectoration associated with fever, chest pain, and night sweats. The diagnosis of tuberculosis in the current pandemic of COVID-19 required a high degree of suspicion to rule out the SARS-CoV-2 infection along with the infection of Mycobacterium tuberculosis. The clinical presentations in the two diseases are quite similar and thus the present case will serve as a tool to help the clinicians handling cases of both the viral and bacterial infection across the globe.</p> Sankalp Yadav Gautam Rawal Copyright (c) 2020-08-31 2020-08-31 36 1 Primary malignant pericardial mesothelioma: a case report <p>Metastases to the heart and pericardium are much more common than primary malignant neoplasms. Primary malignant pericardial mesothelioma is a rare tumor that arises from the mesothelial cells of the pericardium. It is usually characterized by a delayed diagnosis, a low response to treatment, and a poor prognosis with an overall survival up to six months after the onset of symptoms. We report a rare case of a 32-year-old woman with primary pericardial malignant mesothelioma that was diagnosed 4 months after the onset of pericardial effusion as the first clinical manifestation.</p> Sameh Ben Farhat Maroua Salah Sami Milouchi Copyright (c) 2020-08-31 2020-08-31 36 1 Elucidating challenges and solutions in the maternal healthcare, identified by medical doctors in northern South Africa: a qualitative study <p><strong>Introduction:&nbsp;</strong>as South Africa's maternal mortality ratio increased between 1990 and 2015, the country failed to reach the United Nations millennium development goal 5a. The maternal mortality ratio of Limpopo province is higher than the national average and previous studies report shortages of manpower and medical equipment in Limpopo province. The overall study aim was to elucidate views and experiences of medical doctors regarding maternal healthcare by identifying the challenges they experience and solutions they suggest.</p> <p><strong>Methods:&nbsp;</strong>a qualitative interview-based study was performed with ten medical doctors as participants. Manifest content analysis was used to analyze the data.</p> <p><strong>Results:&nbsp;</strong>the main findings were categorized as lack of material and human resources, feelings of experienced isolation and solution-focused expressions. The challenges identified included logistical issues, staffing issues, demographic characteristics of the patient population, poor interinstitutional communication and lack of support from the administration. The solutions included revision of resource allocation and improvement of the interinstitutional cooperation. For example, participants suggested that exchange programs between hospitals could be arranged, that the emergency medical service personnel could triage patients and that private practitioners could be contracted to work at public institutions.</p> <p><strong>Conclusion:&nbsp;</strong>most identified challenges were related to a lack of resources. Based on their inside experience, the participants suggested several solutions. These firsthand accounts of the local medical doctors highlight the need for intervention and should be taken into account when it comes to improving the provincial healthcare and working toward achieving the healthcare-related sustainable development goals by 2030.</p> Carl-Johan Valentin Olseén Tebogo Mothiba Linda Skaal Stefan Rocco Hansson Vanja Berggren Copyright (c) 2020-08-31 2020-08-31 36 1 Tétanos localisé sans porte d'entrée apparente: à propos d'un cas à Bamako (Mali) <p>Le tétanos demeure un problème majeur de santé publique en Afrique Subsaharienne. La forme localisée semble rare, contrairement à la forme généralisée suffisamment décrite. Nous rapportons un cas de tétanos localisé sans porte d´entrée apparente, pris en charge dans un service des Maladies Infectieuses à Bamako. Il s´est agi d´une infirmière à la retraite de 59 ans qui n´avait pas fait de rappel de vaccination antitétanique depuis 10 ans, correspondant à la période de son dernier accouchement. Elle avait été référée dans un tableau clinique associant une dysphagie et impossibilité d´ouvrir la cavité buccale. L´histoire de la maladie avait révélé un long itinéraire thérapeutique marqué par de nombreuses consultations spécialisées sans amélioration aucune. Le diagnostic de tétanos localisé sans porte d´entrée apparente avait été retenu après avoir éliminé toute autre affection locale. L´évolution était déjà favorable dix jours après une prise en charge adéquate. Sous diagnostiqué ou méconnu du personnel de santé, le tétanos localisé peut mimer d´autres affections retardant le diagnostic et la prise en charge. La sensibilisation ciblée de la population doit être renforcée en vue du respect scrupuleux du calendrier des rappels vaccinaux.</p> Hermine Meli Mikaila Kaboré Mohamed Aly Cissé Abdoulaye Zaré Mariam Soumaré Yacouba Cissoko Jean Paul Dembélé Issa Konaté Assetou Fofana Sounkalo Dao Copyright (c) 2020-08-31 2020-08-31 36 1 Accessory spinal nerve damage during a cervical lymph node biopsy: case report <p>The lesion of the accessory spinal nerve is often of iatrogenic origin. We report the case of an injury after a right jugulocarotid lymph node biopsy. A 30-year-old patient was referred for the treatment of right cervical lymphadenopathy suspected of tuberculosis. After the intervention and confirmation of tuberculosis diagnosis, the patient presented a functional impotence of the right shoulder and swarming of the right hand. The clinical examination found an active limitation of the shoulder, and a wasting of the upper bundle of the right trapezius muscle and the sternocleidomastoid. The EMG showed axonotmesis of the accessory spinal nerve and the MRI an amyotrophy of the trapezius with denervation edema. A simple rehabilitation has been scheduled. Damage of the accessory spinal nerve most often occurs after local surgery. EMG is essential for diagnosis. Rehabilitation is the first therapeutic option. Surgery can be considered if it fails. The surgeons must consider the protection of the accessory spinal nerve in case of cervical lymph node surgery.</p> Hafid Arabi Aziz Ahizoune Rachid Benchanna Nabil Abida Salah Belasri Badr Slioui Amine Benjelloun Copyright (c) 2020-08-31 2020-08-31 36 1 Cysticercose disséminée à localisation neurologique, oculaire et cutanée chez une patiente sénégalaise <p>La cysticercose est une maladie tropicale négligée prioritaire pour l´Organisation Mondiale de la Santé. La plupart des cas rapportés sont des formes cutanées, oculaires ou neurologiques isolées. Les formes disséminées restent cependant rares. Nous rapportons un cas de cysticercose disséminée à localisation neurologique, oculaire et cutanée chez une patiente sénégalaise de 66 ans reçue pour des céphalées et des crises convulsives chroniques et chez qui l´examen clinique avait objectivé un syndrome cérébelleux associé à des lésions nodulaires sous-cutanées généralisées et indolores. Le diagnostic a été confirmé par la mise en évidence des cysticerques à l´examen histopathologique de la pièce biopsique cutanée. La patiente avait bien évolué sous Albendazole.</p> Bruce Shinga Wembulua Kalilou Diallo Moussa Diallo Marie Antoinette Daba Dione Abdoulaye Diop Noel Magloire Manga Copyright (c) 2020-08-31 2020-08-31 36 1 Twenty-Nail-Dystrophy (TND) / Trachyonychia: a case report in a five year old girl seen at the Paediatric Out-patient Department of a Tertiary Hospital in Lafia North-Central Nigeria <p>Twenty-Nail-Dystrophy (TND) also referred to as Trachyonychia is a disorder of the nails. It can affect all the nails hence the name. Trachyonychia is characterized by nail roughness, longitudinal ridging, fragility and hyper-pigmentation. It can occur in all ages and respond poorly to treatment. With this background, we report the case of a five year old girl with this disorder.</p> Bello Surajudeen Oyeleke Kure Ibrahim Shekwonyadu Copyright (c) 2020-08-31 2020-08-31 36 1 Epidemiological characteristics and some risk factors of extrapulmonary tuberculosis in Larache, Morocco <p><strong>Introduction:&nbsp;</strong>this work aims to bring out the epidemiological characteristics of extrapulmonary tuberculosis (EPTB) in the province of Larache (Morocco) and to investigate the effect of gender and age on its localization and treatment outcome.</p> <p><strong>Methods:&nbsp;</strong>it consists in a retrospective study based on 2962 cases of EPTB, reported during the period 2000 to 2012.</p> <p><strong>Results:&nbsp;</strong>the mean age was 31.74 ± 18.83 years, with a median age of 26. Males are more affected by this form of tuberculosis, with a male to female sex-ratio of 1,15. The EPTB affects particularly the young population whose age is between 15 and 34 years. The pleural and lymph node localizations are the most common with 45% and 28% respectively. The statistical analysis reveals that younger patients are preferentially affected by lymph node tuberculosis whereas oldest ones are more likely to suffer from urogenital and pericardial tuberculosis. Regarding the treatment outcome, we demonstrated that age is significantly associated with the treatment outcome and that deaths occur preferentially in the oldest patients. Finally, we found out a significant association between males and pleural ETB localization, and between females and lymph node and peritoneo-itestinal ETB localizations.</p> <p><strong>Conclusion:&nbsp;</strong>special attention must be paid to the mentioned most vulnerable categories of EPTB patients.</p> Adil Sbayi Amine Arfaoui Hasna Janah Safaa EL Koraichi Ali Quyou Copyright (c) 2020-08-31 2020-08-31 36 1 Otoendoscope combined with ablation electrodes for treatment of benign tracheal stenosis caused by granulation tissue hyperplasia after tracheotomy <p>Benign tracheal stenosis mainly appears due to tracheotomy, tuberculosis, trauma, benign tumor, or ventilation. With the increase in the number of tracheotomies and the prolongation of the life span of patients after incision, the long-term complications after tracheotomy gradually increase, among which intratracheal granulation hyperplasia is a more serious complication. The present case describes a 59-year-old male with granulation tissue hyperplasia induced by tracheotomy. He underwent tracheal resection to remove the granulation tissue and he remained well after the follow-up. Even though the endoscopic intervention and tracheal resection are readily accessible, they usually quite challenging. Here we summarize the present details on this condition.</p> Laina Ndapewa Angula Yongliang Teng Le Sun Xin Wang Jing Shang Ning Fang Copyright (c) 2020-08-31 2020-08-31 36 1 Aberrant single metastasis to the elbow from primary rectal cancer: a rare presentation <p>Rectal adenocarcinoma usually metastasizes to the liver and lungs and when it has bone spread, it more frequently involves the vertebrae and pelvis. Thus, aberrant metastasis from a rectal adenocarcinoma to upper extremities with preservation of intra-abdominal organs is very uncommon. We present the case of an 80-year-old male patient with a diagnosis of adenocarcinoma of the rectum T4N1M1 with non-axial single bone metastases and with preservation of visceral organs. Anterior resection of rectum after neoadjuvant chemotherapy and radiotherapy were made. The bone metastasis received palliative radiotherapy and was not resected. The patient died 10 months after diagnosis. This clinical situation generally has a poor prognosis. When the patient complains of unusual bone pain it is necessary to suspect a malignant disease and even if extraordinarily rare, rectal cancer must be considered as a possible cause.</p> Alessandro Bianchi Marina Jimenez-Segovia Jaume Bonnin-Pascual Marga Gamundí-Cuesta Myriam Fernandez-Isart Monica Guillot-Morales Diego Salinas-Gonzalez Xavier Francesc Gonzalez-Argenté Copyright (c) 2020-08-31 2020-08-31 36 1 The impact of nephrostomy balloon inflation volume on post percutaneous nephrolithotomy hemorrhage <p><strong>Introduction:&nbsp;</strong>the study aims to match different volumes of nephrostomy balloon inflation to point out the foremost effective volume size of post percutaneous nephrolithotomy (PCNL) bleeding control.</p> <p><strong>Methods:&nbsp;</strong>we have retrospectively reviewed “560” medical records of patients who underwent percutaneous nephrolithotomy between (the years 2017 and 2018) at Prince Hussein Urology Center. The Patients were divided into two teams, group-1 (a number of 280 patients) with nephrostomy balloon inflated concerning three ml and group-2 (a number of 280 patients) the balloon inflated concerning one ml. The preoperative and postoperative hematocrit, the operation duration, the stone size, the postoperative pain severity, the transfusion rate and the duration of hematuria between the two groups were compared during hospitalization.</p> <p><strong>Results:&nbsp;</strong>regarding patients with ages (between 18 and 68 years); the preoperative hematocrit (mean values ± SDs) was (40.35% ± 3.57) vs (39.95% ± 3.43) for groups-1 and 2, respectively; the p value=0.066. The postoperative hematocrit was (37.91% ± 3.96) vs (34.38 ± 2.78), respectively; the p value was (0.008); the blood transfusion rate was 11.2% vs 13.4% (the p value was 0.039), respectively. The Postoperative pain score was (4.93 ± 1.44) vs (3.89 ± 1.45) (the p value was 0.012), respectively.</p> <p><strong>Conclusion:&nbsp;</strong>increasing the nephrostomy balloon volume to a “3cc” competes for a task to decrease bleeding which was found to be as a secure and considerable effective procedure-related factor. However, the disadvantage of this technique resulted in increasing the postoperative pain in patients undergoing such a procedure.</p> Firas Azar Khori Mohannad Mueen Al-Naser Ashraf Suleiman Al-Majali Mohammad Abdelfattah Al-Serhan Awad Bakheet Al-Kaabneh Abdelhakim Saleh Ni’mate Ayman Ahmad Al-Qaralleh Abdullah Muhammad Alrababaah Samer Gaith Al-Jfout Nizar Jamal Al-Saidah Ali Ahmad Al-Asmer Belal Abdullah Al-Khawaldah Monther Ata Alemoush Anees Adel Al-Hjazeen Copyright (c) 2020-08-31 2020-08-31 36 1 Presentation of a case of Bruton type primary agammaglobulinemia in Guinea <p>X-linked agammaglobulinemia (XLA) is a rare genetic disease caused by a mutation in the Bruton tyrosine kinase (BTK) gene. It is characterized by a profound deficiency of B cells and a decrease in all classes of immunoglobulins (Ig). We report one case in a 3-year-old boy seen for recurrent acute otitis media, perineal abscess, oligoarthritis. The serum immunoglobulin (Ig) assay showed an IgG level of 0.6g/l. IgM and IgA are indosable. Marrow immunophenotyping showed an absence of precursor B less than 1%. Molecular biology confirmed Burton's disease (stop mutation, C37C) in exon 2 of the BTK gene. Treatment with intravenous immunoglogulin was started.</p> Kaba Condé Hugues Ghislain Atakla Mamadou Ciré Barry Mohamed Lamine Condé Malé Doré Copyright (c) 2020-08-31 2020-08-31 36 1