Pan African Medical Journal

Sight threatening Vitreous Haemorrhage and retinal detachment in a patient with sickle cell disease

Jemal Zeberga Shifa — 2023-09-08

We report a case of sight threatening vitreous haemorrhage and retinal detachment as complication of sickle cell disease (SCD). A 35 years old female Nigerian patient had presented to ophthalmology clinic of Princess Marina Hospital, Botswana, with two weeks history of poor vision in the left eye. The loss of vision was due to vitreous haemorrhage and retinal detachment which was confirmed by direct and indirect ophthalmoscopy and B-Scan ultrasound. Prior to presentation, patient didn't have any follow up by an ophthalmologist as part of regular medical care for patients with SCD. We emphasize the importance of regular follow up for early detection, treatment and prevention of complication associated with sickle cell disease.

Clinical profile and early therapeutic response to cabergoline of patients with hyperprolactinemia in a Cameroonian population

Martine Claude Etoa Etoga — 2020-01-02

Hyperprolactinemia is responsible for 20 to 25% of consultations of secondary amenorrhea and 17% for female infertility. Dopamine agonists are the gold standard treatment of hyperprolactinemia. Although they are associated with various adverse effects, cabergoline is generally preferred due to better compliance, limited side effects and good therapeutic response. However, bromocriptine is widely and satisfactorily used in a context of limited availability of cabergoline. We sought to describe clinical manifestations of hyperprolactinemia and response to cabergoline in a sub Saharan Africa (SSA) setting. We describe the profile of all patients with a diagnosis of hyperprolactinaemia from 1^st July 2012 to 15^th May 2014 at the Endocrinology Department of Yaoundé Central Hospital. Patients with physiological hyperprolactinemia were not considered. All patients were routinely started on cabergoline at 0.5mg/week or at 1mg/week in case of macroprolactinoma or desire to become pregnant. The duration of follow up was 8-16 months. After three months of treatment, 8 of 10 patients with amenorrhea had menses and serum prolactin levels decreased significantly at month 2-3 (p = 0.025). In conclusion, our study suggests that cabergoline yields an excellent therapeutic response in a short period of time and may thus be cost saving in sub Saharan context despite its unit price.

Comparison between flutter valve drainage bag and underwater seal device for the management of non-massive malignant and paramalignant pleural effusions

Olugbenga Olalekan Ojo — 2020-01-07

Introduction: the aim of this study is to compare the use of flutter valve drainage bag system as an alternative to conventional underwater seal drainage bottle in the management of non-massive malignant/paramalignant pleural effusion.

Methods: forty-one patients with non-massive malignant and paramalignant pleural effusions were randomized into two groups. Group A (21patients) had their chest tubes connected to an underwater seal drainage bottle, while group B (20 patients) had their chest tubes connected to a flutter bag drainage device. Data obtained was analyzed with SPSS statistical package (version 16.0).

Results: breast cancer was the malignancy present at diagnosis in 24(58%) patients. Complication rates were similar, 9.5% in the underwater seal group and 10 % in the flutter bag drainage group. The mean duration to full mobilization was 35.0±20.0 hours in the flutter bag group and 52.7±18.5 hours in the underwater seal group, p-value 0.007. The mean length of hospital was 7.9±2.2 days in the flutter bag group and 9.8±2.7 days in the underwater seal group. This was statistically significant, p-value of 0.019. There was no difference in the effectiveness of drainage between both groups, complete lung re-expansion was observed in 16(80%) of the flutter bag group and 18(85.7%) of the underwater seal drainage group, p-value 0.70.

Conclusion: the flutter valve drainage bag is an effective and safe alternative to the standard underwater seal drainage bottle in the management of non-massive malignant and paramalignant pleural effusion.

Aspects électrocardiographiques de jeunes basketteurs sénégalais

Désiré Alain Affangla — 2020-01-09

La pratique intensive et prolongée de sport peut induire des modifications cardiovasculaires et électrocardiographiques. L’objectif de ce travail était de décrire les modifications électrocardiographiques attribuables à la pratique de basket de compétition chez de jeunes noirs sénégalais. Les auteurs ont réalisé une étude prospective descriptive de l’électrocardiogramme (ECG) de surface de jeunes noirs sénégalais pratiquant le basket de compétition. Il s’agissait de 40 jeunes basketteurs, 20 filles et 20 garçons, dont la moyenne d’âge était respectivement de 17 ans ± 0,86 (extrêmes: 17 et 19 ans) et 15 ans ± 1,56 (extrêmes: 13 et 18 ans). La fréquence cardiaque était plus basse chez les garçons, 59 battements ± 9 battements (extrêmes: 42 et 85) que chez les filles 73 battements / min ± 11 battements (extrêmes: 50-95) (p = 0,0004). Les particularités suivantes ont été observées: des troubles de la repolarisation à type d’onde T négative de V1 à V4 dans 3 cas (7, 5%), une hypertrophie ventriculaire droite dans 1 cas (2,5%), une déviation axiale droite de QRS dans 1 cas (2,5%). La pratique intense et prolongée de basket entraîne des modifications électrocardiographiques chez le jeune noir sénégalais.

Pycnodysostosis presented with tibial shaft fracture

Abdelhalim Mahmoudi — 2020-01-09

Pycnodysostosis is rare autosomal recessive lysosomal storage disorder of bone in which the enzyme Cathepsin K is mutated which maps on chromosome 1q21 causing osteoclast dysfunction. It is characterized by short stature, craniofacial dysmorphias, osteosclerosis, and brittle bones. Recognition of these signs is important in order to make the diagnosis and prevent possible complications. A 13-year old male patient of 130 cm height presented to the emergency with pathological fracture in shaft of left tibia. On the basis of clinical and radiological findings, he was diagnosed as a case of pycnodysostosis. The patient had history of pathological fracture in shaft of right tibia. With normal bone healing, open fontanelles, short stature, short finger tips, flat and grooved nails, micrognathia, and irregular teeth with hypodontia. Radiological evaluation of patient revealed generalized osteopetrosis, short distal phalanges, obtuse angle of mandible and open fontanelles. He was managed conservatively and showed normal bone healing pattern. No specific treatment options exist, so treatment is supportive, with fracture prevention and management constituting the most important aspects of clinical care. Dental hygiene and regular checkups are also helpful in preventing complications.

Pregnancy in non-palliated functionally single ventricle: challenges of management in resource-poor settings

Desrie Delsol-Gyan — 2020-01-09

Women with complex functionally univentricular hearts rarely survive into adulthood without corrective or palliative surgery. Reports of pregnancy outcome in this group of patients in resource-poor settings are sparse. We report a case of unrepaired pulmonary atresia ventricular septal defect (VSD) with major aorto-pulmonary collateral arteries (MAPCA) who survived into adulthood and was able to complete a successful pregnancy in a resource-poor country.

Perianal herpes ulceration in a HIV positive person

Wafaa Bennane — 2020-01-09

Mr ZA, aged 56, from the Ivory Coast, followed for HIV revealed by cutaneous kaposi with uro-genital location in 2016, under treatment, consulted for perianal ulceration evolving since 1 year. On examination, the patient was febrile, cachectic, in poor general condition, with maculopapular lesions angiomatous in the lower limbs, external genital organs without involvement of the oral mucosa. The clinical examination found a perianal ulcer wide of 12 cm long axis, painful, itchy with sharp edges with extension to the external genitalia. The rectal examination is painful, the fingerstall returns stained with blood, with extension of the lesion in endo-anal. Histopathological and cytological examination was in favor of a herpes infection, the culture confirmed the herpes infection. The patient had a CD4 count of 159 elements/mm³, and a viral load of 71 copies/ml, negative syphilitic serology, negative CMV PCR and normal fundus. In addition, the patient had a normochromic normocytic anemia at 5.9 g/dl, thrombocytopenia at 19000 elements/mm3 and white blood cells at 630 elements/mm³, non-conclusive myelogram, CRP increased to 234 mg/l, LDH at 1672 IU/l, Ferritinemia at 9000 μg/dl and TG at 2.5 μg/l, a hypofibrinogenemia at 1 μl. The patient received a bolus of corticosteroid therapy with suspicion of macrophage activation syndrome, and the ulceration was treated with acyclovir 10 mg/kg/h with a good clinical course.

Diagnostic à terme de jumeaux conjoints

Imane Benchiba — 2020-01-10

Les jumeaux conjoints sont une malformation rare des grossesses gémellaires monozygotes et mono-amniotiques. Nous rapportant la découverte anténatale de jumeaux conjoints dicéphale à 37 SA. Le pronostic fœtal de cette malformation reste très sombre, nécessitant un recours à une interruption de la grossesse si le diagnostic été posé précocement. A partir de cette observation et une brève discussion, nous faisons un rappel sur cette pathologie rarissime, sur son diagnostic échographique essentiel pour établir une stratégie de prise en charge post natale et sur son pronostic qui reste le plus souvent très réservé.

Un danger de la chirurgie thyroidienne: le nerf larynge inferieur non recurrent: cas clinique

Moustapha Ndiaye — 2019-01-10

Les lésions du nerf laryngé inférieur représentent les complications les plus dévastatrices de la chirurgie thyroïdienne. L'identification du nerf laryngé inférieur est d'autant plus difficile que son trajet est atypique. Nous rapportons un cas de nerf laryngé inférieur droit non récurrent découvert à l'occasion d'une thyroïdectomie.

Analyse biochimique multi-paramétrique révélant une augmentation de l'homocystéinémie et du NT-ProBNP chez les patients hypertendus à Bamako (Mali)

Yaya Goïta — 2023-09-08

Introduction: l'hypertension artérielle est un problème majeur de santé publique en Afrique subsaharienne par sa fréquence élevée et le risque cardiovasculaire qu'elle entraine. L'objectif de cette étude était d'évaluer la prévalence des facteurs de risques cliniques et biologiques de l'hypertension artérielle à Bamako (Mali).

Méthodes: il s'agit d'une étude cas-témoin, stratifiée en fonction du sexe, portant sur 72 participants dont 36 hypertendus et 36 contrôles. Vingt-deux paramètres biochimiques plasmatiques ont été mesurés et analysés par des tests univariés et multivariés.

Résultats: une hyperhomocystéinémie a été retrouvée chez 55,6% des femmes (p = 0,03) et 100% des hommes (p = 0,007) hypertendus. Le N-terminal pro B-type natriuretic peptide (NT-ProBNP) était également augmenté chez 16,7% des femmes (VIP > 1 dans le modèle multivarié) et des hommes hypertendus (p = 0,00006). Un bon modèle multivarié prédictif (OPLS-DA) a uniquement été obtenu chez les femmes hypertendues, avec un Q²cum = 0,73, attestant ainsi d'un important dimorphisme sexuel associé à l'hypertension artérielle. Ce modèle impliquait huit paramètres dont la concentration plasmatique était modifiée (homocystéine, NT-ProBNP, potassium, urée, glycémie, sodium, chlore et protéines totales).

Conclusion: nous avons noté une association significative entre l'hyperhomocystéinémie et l'hypertension artérielle. Par conséquent, le dosage de l'homocystéine associé à une bonne prise en charge diminuerait le risque cardiovasculaire tout en améliorant la qualité de vie des patients hypertendus.

Mosquitoes are not the major culprits for the high burden of malaria in Nigeria: a commentary

Celina Onyawoibi Aju-Ameh — 2020-01-14

Globally, Nigeria contributes the greatest proportion of the malaria disease burden. She currently bears the heaviest malaria burden (25% cases) and (19% deaths). Malaria is caused by Plasmodium parasites transmitted by female Anopheles mosquitoes however, a higher parasite biomass (99%) is found in man while only one (1%) is found in mosquitoes. Lending credence to this is the outcome of investigations carried out in Gboko and Otukpo Local Government Areas (LGAs); in which more humans (36.8%) had the malaria parasites than the anthropophagic female Anopheles (0.5%). Control efforts focused on mosquitoes are undermined by the actions or inactions of humans. Nigeria needs to self-audit her role in sustaining the heaviest burden of a preventable, curable disease that can also be eliminated. She can only ignore this imperative at her own peril.

A cross-sectional study on antibiotic prescription in a teaching hospital in Ghana

Pilar Garcia-Vello — 2020-01-15

Introduction: antibiotic misuse is the paramount factor for antibiotic resistance. Tamale Teaching Hospital (TTH), located in Ghana's northern Region, is the biggest tertiary hospital in the northern half of the country and consequently one of the biggest prescribers of antibiotics. Understanding the use of antibiotics in the TTH and providing information that could be inferred to develop strategies for antibiotic prescription is of extreme importance in this era of multiple and pan-resistant strains of pathogenic microorganisms.

Methods: a cross-sectional study on the use of antibiotics at TTH in the northern region of Ghana was performed. Data were collected by reviewing 10% of patients' files from January to June 2015 and then assessed for its appropriateness against the criteria based on the British National Formulary (BNF) 2015 and BNF children 2013-2014. Results were expressed in frequencies and percentages.

Results: a total of 617 patients' records were included in this study. Up to 385 cases of different antibiotic misuse were found, comprising of 335 errors in prescriptions and 50 non-completed treatments. The most common prescription error was made on treatment duration (29.6%). The potential interactions were 16.7%.

Conclusion: the study revealed a high burden of antibiotics misuse in TTH. This suggests a need for the development of an antibiotic stewardship programme for the hospital.

Fréquence et titrage des hémolysines anti-A et anti-B chez les mères d'enfants ictériques à Yaoundé, Cameroun

David Sock Sock — 2020-01-15

Introduction: l'allo-immunisation du système ABO est impliquée dans les ictères néonataux avec une prévalence globale considérable. Le rôle de l'incompatibilité dans le système ABO est relativement peu connu. L'objectif de cette étude était d'investiguer les ictères néonataux attribuable aux incompatibilités fœto-maternelles dans le système ABO et de déterminer le lien entre le titre d'hémolysines retrouvé chez la mère et le degré d'ictère observé chez l'enfant.

Méthodes: nous avons mené une étude transversale de juin à novembre 2015 et la population d'étude était exclusivement constituée des mamans de groupe sanguin « O » ayant des enfants de groupe sanguin différents reçus en service de néonatalogie des centres hospitalier de référence dans la ville de Yaoundé. Les analyses statistiques ont été réalisées à l'aide du logiciel GraphPadPrism 6 à un intervalle de confiance de 95%.

Résultats: la fréquence d'hémolysines retrouvées dans cette étude était de 20,58% (7/34) et l'hémolysine anti-A était le plus fréquent avec 85,7% (6/7). Les nouveau-nés de groupe sanguin B ont présenté une plus grande concentration en bilirubine comparer à ceux du groupe AB (p = 0,01). La multiparité n'était pas associée à la présence d'hémolysine (p = 0,8) tout comme le groupe sanguin de l'enfant n'a été associé à la survenue des hémolysines chez la mère (p = 0,5).

Conclusion: les ictères néonataux précoces ou prolongés sont également causés par des hémolysines anti-A et anti-B dérivées de l'allo-immunisation ABO. Une étude sur un échantillonnage plus grand est recommandée pour une meilleure évaluation.

Thrombophlébite cérébrale: complication d´une cellulite fronto-temporo pariétale chez un enfant victime d´une morsure humaine

Soufiane Badsi — 2020-01-16

La thrombophlébite cérébrale est considérée comme une pathologie rare mais grave dont la fréquence sous-estimée est de plus en plus reconnu chez les enfants et contrairement aux adultes la prise en charge reste controversée. Nous rapportons le cas d'un enfant de 12 ans ayant été victime d'une morsure par un ami au niveau du cuir chevelu de la région fronto-temporale de la tête, évoluant par l'apparition d'une tuméfaction évoquant une cellulite fronto-temporo pariétale compliquée d'une thrombophlébite cérébrale, diagnostiquée sur la présentation clinique et l'imagerie. Notre patient était admis dans notre structure dans un tableau de trouble de conscience, ainsi le recours aux anticoagulants et au traitement étiologique a permis une bonne évolution clinique.

Dietary habits and nutritional status of medical school students: the case of three state universities in Cameroon

Fala Bede — 2020-01-23

Introduction: malnutrition is a major risk factor of cardiovascular and metabolic diseases and therefore the importance of good dietary practices and balanced diet cannot be overemphasized. University students tend to have poor eating practices which is related to nutritional status. The objective of our study was to assess the dietary practices of medical students, determine the prevalence of malnutrition among medical students and factors associated with malnutrition.

Methods: we carried out a cross-sectional study from December 2013 to March 2014 involving 203 consenting students in the Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Faculties of Health Sciences of the Universities of Bamenda and Buea. A three-part questionnaire (socio-demographic profile, eating practices, and anthropometric parameters). Data was analysed using SPSS 18.0. Frequencies and percentages were determined for categorical variables. Means and standard deviations (mean ± SD) were calculated for continuous variables. Fischer's exact test was used to compare the categorical variables. Statistical significance was set at p ≤ 0.05.

Results: males constituted 44.3% of respondents. The mean age was 20.8 ± 1.6yrs. Most students had a monthly allowance of less than 20 000frs (34 USD) and 59.1% lived alone. Most students (49.8%) reported taking two meals a day with breakfast being the most skipped meal while supper was the meal most consumed by students. Snacking was common among these students as 40.8% admitted consuming snacks daily. Daily intake of milk, fruits, vegetable and meat were low (6.2%, 4.3%, 20.0% and 21.3% respectively). The BMI status of students was associated with gender (p=0.026).

Conclusion: our findings showed a high prevalence of malnutrition of 29.4% based on BMI (underweight 4.9%, overweight 21.6% and obesity 3.0%) among second year medical students of these three state universities. Irregular meals, meal skipping, low fruit, vegetable and milk consumption, high candy, fried foods and alcohol intakes were found to be poor eating practices frequent among these students. Our findings therefore suggest the need for coordinated efforts to promote healthy eating habits among medical students in general and female medical students in particular (and by extension youths in general) as a means of curbing malnutrition among youths.

Aspects épidémiologiques, cliniques et thérapeutiques des algies pelviennes aiguës de la femme à l´Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé (HGOPY)

Pierre-Marie Tebeu — 2020-01-23

Introduction: les algies pelviennes aiguës sont responsables d'une morbi-mortalité importante. L'objectif de ce travail était de décrire leurs aspects épidémiologiques, cliniques et thérapeutiques à Yaoundé.

Méthodes: nous avons mené une étude transversale descriptive avec collecte prospective des données au Service de Gynécologie-Obstétrique de l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé du 1^er avril au 31 juillet 2015. Nous avons inclus toutes les femmes admises pour douleur pelvienne dont l'évolution était inférieure à un mois et ayant accepté de participer à l'étude. Nous avons exclu les femmes qui étaient au troisième trimestre de grossesse ou en post-partum. Le logiciel Epi info version 3.5.4 a servi à l'analyse des données. Ces données ont été présentées sous forme de fréquence et de pourcentage.

Résultats: au total 5915 femmes ont consulté pendant la période de l'étude dont 125(2,11%) étaient des algies pelviennes aiguës. La moyenne d'âge était de 29,5 ± 6,9 ans. Les étiologies des douleurs étaient les infections génitales hautes (36,8%) et la grossesse extra-utérine (18,4%). Le traitement surtout médical (92,8%), associait antibiotiques (65,5%), anti-inflammatoires (56,9%) et antalgiques (39,7%). La chirurgie a été réalisée chez 25(20%) patientes par laparotomie (80%) et cœlioscopie (20%). L'indication chirurgicale était la grossesse extra-utérine dans 76% des cas. La régression de la douleur était obtenue chez 99% des cas.

Conclusion: les d'algies pelviennes aigues survenaient chez les femmes jeunes, dues aux infections génitales hautes et à la grossesse extra-utérine étaient principalement. En cas de grossesse extra-utérine le traitement chirurgical était surtout la laparotomie.

Rupture de l´aorte thoracique descendante suite à une décélération brutale post traumatique

Soufiane Badsi — 2023-09-08

Empirical research showcases that pre-abortion counseling scarcely reverses the woman’s decision either to terminate a pregnancy or not. Growing evidence regarding the high levels of decisional certainty among women seeking abortions renders a careful rethink of the place of mandatory pre abortion counseling packages. Mandatory counseling packages, when inscribed in the laws, at times contain false information that can deter women from going in for safe abortions. Mandatory waiting times indirectly label opting for an abortion as being not the right thing to do. In areas where abortion stigma from health care providers and communities remains highly prevalent, women are forced to incur extra expenses by travelling to other countries I argue that pre abortion counseling on opting-in grounds is ethically sound (enhances the woman’s reproductive autonomy), since most clients in need of abortions are certain on their decisions before the abortion care provider and do not regret these decisions after the process. Regrets are prone to be more prevalent in areas with high unsafe abortion practices, generally due to complications from excessive bleeding, pain, and post abortion infections. Allowing systematic mandatory pre abortion counseling practice as the rule in a competent adult is unjustified ethically and empirically, is time consuming and presents the legality of abortions in most settings an oxymoron.

Preventing the recurrence of acute anorectal abscesses utilizing a loose seton: a pilot study

Timucin Erol — 2019-01-23

Introduction: this pilot study aimed to document our results of treating anorectal abscesses with drainage plus loose seton for possible coexisting high fistulas or drainage plus fistulotomy for low tracts at the same operation.

Methods: drainage plus fistulotomy were performed only in cases with subcutaneous mucosa, intersphincteric, or apparently low transsphincteric fistula tracts. For all other cases with high transsphincteric fistula or those with questionable sphincter involvement, a loose seton was placed through the tract. Drainage only was carried out in 17 patients.

Results: twenty-three patients underwent drainage plus loose seton. Drainage plus fistulotomy were performed in four cases. None of the patients developed recurrent abscess during a follow-up of 12 months. Not surprisingly, the incontinence scores were similar pre and post-operatively (p=0.564). Only minor complications occurred in 4 cases (14.8 percent). Secondary interventions following loose seton were carried out in 13 patients (48.1 percent). At 12 months, drainage only was followed by 10 recurrences (58.8 percent; p<0.0001, compared with concomitant surgery).

Conclusion: concomitant loose seton treatment of high fistula tracts associated with anorectal abscess prevents abscess recurrence without significant complications or disturbance of continence. Concomitant fistulotomy for associated low fistulas also aids in the same clinical outcome. Concomitant fistula treatment with the loose seton may suffice in treating the whole disease process in selected cases. Even in patients with high fistula tracts, the loose seton makes fistula surgery simpler with a mature tract. Abscess recurrence is high after drainage only.

Survie et facteurs pronostiques du cancer bronchique non à petites cellules chez le sujet jeune au centre tunisien

Samah Joobeur — 2019-01-23

Résumé

Introduction: le carcinome bronchique non à petites cellules (CBNPC) constitue un problème de santé publique qui touche classiquement le sujet âgé. Actuellement et depuis quelques années, cette pathologie s'étend de plus en plus vers la population jeune. L'objectif de ce travail est d'étudier les caractéristiques du CBNPC chez le sujet jeune et d'évaluer sa survie ainsi que les différents facteurs pronostiques.

Méthodes: il s'agit d'une étude rétrospective ayant inclus tous les patients âgés de moins de 50 ans, pris en charge au service de pneumologie du Centre Hospitalo-Universitaire (CHU) Fattouma Bourguiba de Monastir pour CBNPC. La survie et les facteurs pronostiques ont été analysés selon la méthode de Kaplan Meier.

Résultats: l'âge moyen de nos patients était de 43,8 ± 5,29 ans. Le type histologique le plus fréquent était l'adénocarcinome bronchique (66,1%). Le CBNPC a été découvert à un stade localement avancé ou métastatique dans 79,7% des cas. La médiane de survie était de 8 ± 0,72 mois. En analyse univariée, l'état général des patients évalué par l'indice "Performance Status" (PS) de l'Organisation Mondiale de la Santé à l'admission, le stade de la tumeur et la protéine C-réactive (CRP) ont influencé de façon significative la survie. L'analyse multivariée a permis de retenir un indice PS ≥ 2 et une CRP élevée comme facteurs de mauvais pronostic.

Conclusion: malgré les progrès thérapeutiques, le CBNPC du sujet jeune demeure de mauvais pronostic. Un diagnostic et une prise en charge précoces permettent d'améliorer la survie de ces patients.

Huge omental lymphangioma with haemorrhage in children: case report

Abdelhalim Mahmoudi — 2019-01-24

Omental cystic lymphangioma is a rare benign intraabdominal anomaly with uncertain etiology, predominantly occurring in children. Most cases of abdominal lymphangioma are asymptomatic. However, patients may occasionally present with acute abdomen because of an intestinal obstruction or peritonitis caused by infected cysts, hemorrhaging, and/or torsion. This report describes a case of omental cystic lymphangioma with acute intracystic haemorrhage. Ultrasonography and computed tomography (CT) scan confirmed the diagnosis. Complete excision of the cyst along without omentectomy done with no clinical or radiological evidence of recurrence till 17 months.

Falciform ligament abscess secondary to a ruptured liver abscess in a child: a case report

Abdelhalim Mahmoudi — 2020-01-21

Abscess of the liver ligaments is extremely rare, and abscess of the falciform ligament has been sporadically reported. We report the case of a 3 years old male who presented with a three days history of right upper quadrant abdominal pain, fever and nausea. The ultrasound and computed tomography (CT) scan showed an abdominal wall abscess located anterior to the liver. The patient underwent surgery. Abscess of the falciform ligament secondary to a ruptured liver abscess was found. Excision of the falciform ligament including the abscess was performed. Although pathology of the falciform ligament is rare, it should be included in the differential diagnosis of acute abdomen.

Laboratoires médicaux et qualité des soins: la partie la plus négligée au niveau des hôpitaux ruraux de la République Démocratique du Congo

Sylvie Linsuke — 2019-01-24

Introduction: la qualité des soins est essentielle pour sauver des vies humaines de différentes maladies. Cependant, un diagnostic inapproprié ne peut en aucun cas aboutir à une prise en charge correcte des patients ainsi qu'à des soins de qualité. Nous avons effectué une analyse descriptive transversale dans trois laboratoires des hôpitaux généraux en République Démocratique du Congo.

Méthodes: une équipe d'experts nationaux dans le domaine des laboratoires avait conduit l'enquête au niveau de trois laboratoires cliniques des hôpitaux généraux de la République Démocratique du Congo. Des observations, visites et entretiens structurés à l´aide d'un questionnaire ont été utilisées pour évaluer la performance de ces laboratoires cliniques. Nous avons également utilisé un guide d'évaluation développé au niveau national pour l'évaluation des laboratoires.

Résultats: les laboratoires cliniques des hôpitaux généraux visités ont présenté de nombreux déficits notamment en ce qui concerne les infrastructures, la formation de base et continue des personnels, les équipements, la supervision et le contrôle de qualité. Le plateau technique de ces laboratoires n'était pas adapté pour répondre aux besoins de la population en ce qui concerne les maladies fréquemment rencontrées dans ces zones. Nous avons également noté que, ces laboratoires sont peu ou presque pas accompagnés et qu'il n'y avait aucune équipe de coordination dédiée à la supervision et évaluation des laboratoires au niveau de l'hôpital, voire même au niveau de la zone de santé. En plus, les techniciens de ses différents laboratoires n'ont pas été supervisés pendant de nombreuses années.

Conclusion: les laboratoires cliniques doivent être améliorés pour permettre un diagnostic adéquat de différentes maladies. Cette amélioration doit s'appuyer sur les maladies locales. Au sein du système, il est important de consacrer plus d'attention aux laboratoires cliniques. Un plaidoyer pour cette composante négligée du système de santé est nécessaire, car cette situation pourrait être la même dans de nombreux pays en voie de développement.

Facteurs associés aux circulaires du cordon: étude cas-témoin dans trois hôpitaux de Yaoundé

Florent Ymele Fouelifack — 2020-01-27

Introduction: la circulaire du cordon ombilical correspond à l´enroulement du cordon ombilical en un ou plusieurs tours sur une partie du fœtus. Anomalie la plus fréquente du cordon, sa prévalence varie selon les auteurs de 5,7% à 35,1%. En 2011, le taux de mortalité périnatale liée à la circulaire du cordon au Cameroun était de 6,1%. Cependant ses facteurs associés restent peu connus dans notre contexte. Notre objectif était de déterminer les facteurs associés aux circulaires du cordon dans trois hôpitaux de Yaoundé.

Méthodes: il s´agissait d´une étude analytique de type cas-témoin, réalisée pendant 4 mois dans les maternités de l´Hôpital Central de Yaoundé, du Centre Hospitalier et Universitaire de Yaoundé et du Centre d´Animation Sociale et Sanitaire de Nkoldongo. Pour un cas (nouveau-nés avec circulaire du cordon), on recrutait 2 témoins (nouveau-nés sans circulaire) tous en présentation céphalique, issus de grossesses monofoetales à terme. Les données recueillies étaient compilées sur des fiches techniques préétablies, saisies et analysées grâce aux logiciels Microsoft Excel 2017 et SPSS version 23. Les outils utilisés pour l´analyse étaient la moyenne d´âge, l´écart type et la fréquence, le rapport de cote cru (OR) et/ou ajusté (aOR) avec leur intervalle de confiance à 95%. P était considéré significatif pour toute valeur inférieure à 5%.

Résultats: sur un total de 3300 accouchements, 500 nouveau-nés soit 15,15% avaient une circulaire du cordon. Toutes les circulaires étaient autour du cou. Nous avons retenu et analysé 136 nouveau-nés avec circulaire du cordon (cas) pour 272 nouveau-nés sans circulaire (témoins). Les facteurs indépendamment associés aux circulaires étaient non modifiables: longueur du cordon =70cm (ORa = 32 IC = 17,5- 35 P=0,02), sexe masculin (ORa = 67,09 IC = 22,31 - 97,46 P=0,001), APGAR 5ème minute <7 (ORa =76,98 IC =2,19-27,05 P=0,017), et modifiables: l´âge gestationnel = 42SA (ORa =15,15 IC = 6,14-18,2 P=0,001).

Conclusion: la circulaire du cordon est une anomalie fréquente du cordon. Nous suggérons aux décideurs de sensibiliser davantage le personnel de santé et la population sur l´importance de l´échographie du troisième trimestre afin de rechercher et prévoir la prise en charge des nouveau-nés avec circulaire du cordon. Les cliniciens devraient éviter autant que possible le post terme.

Pneumothorax spontané de l´enfant

Abdelhalim Mahmoudi — 2020-02-03

Spontaneous pneumothorax is a rare pathology in children, which can lead to life-threatening complications. We here report a rare cause of spontaneous pneumothorax such as bullous disorders. The study included a 13-year old girl with a year-history of recurrent bronchopneumopathies. Symptoms were aggravated by the occurrence of stage III dyspnoea (according to the New York Heart Association (NYHA)). Clinical examination performed at the time of admission showed conscious patient, polypneic at 35 breaths/min, 90% ambient air saturation and 99% ambient air saturation under 2 liters of O2. Pleuropulmonary examination showed syndrome of right aerial effusion. Chest x-ray was performed which showed right pneumothorax . The patient underwent chest drainage and, given the persistence of pneumothorax, chest CT scan was performed which showed the presence of a bleb at the level of the upper lobe of the right lung. Then the patient underwent thoracoscopy with resection of the blebs and talcage. Patient's outcome had a median 3-year follow-up with no recurrences.

Suprasellar region: view during an endoscopy fenestration of a suprasellar arachnoid cyst

Sidi Salem-Memou — 2020-02-03

Arachnoid cysts are intra-arachnoid fluid formations containing cerebrospinal fluid. About 66% of arachnoid cysts are located in the temporal fossa. The suprasellar location is relatively rare, representing 5%-12% of intracranial arachnoid cysts in the general population and 16% in the pediatric population (1-8). They are most often congenital and progressively growing due to an abnormality of the Liliequist membrane or the interpeduncular cistern. The management of suprasellar arachnoid cysts requires a perfect understanding of their anatomy and physiopathogeny. Endoscopic ventriculo-cysto-cisternostomy is an interesting alternative in the management of this pathology. A 7-year-old girl with no significant pathological history, who had visual problems associated with headache for 13 months. At admission, the examination noted a patient conscious with a very ataxic walking without sensitivomotor deficit. Visual acuity was 3/10 on both sides. Brain magnetic resonance imaging (A, B) showed an important suprasellar expansive process, well limited, in hyposignal in sequences T1 (A) and hypersignal in sequence T2 (B) identical to CSF signal, without enhancement after gadolinium injection . This process pushes up the optic chiasma and blocks Monro's foramens, achieving obstructive hydrocephalus. The patient was operated by transventricular approach with endoscopic ventriculocystocisternostomy (VCC) (C). During the endoscopic procedure, the anatomical view of the skull base was demonstrative. From the interior of the cyst (C), we have identified the following anatomical structures: optic nerve, pituitary stalk, internal carotid arteries, pituitary gland, posterior communicating arteries, posterior cerebral arteries, basilar artery, dorsum sellae. The evolution was marked by a good clinical improvement, with a regression of signs of intracranial hypertension and improvement of walking during the first postoperative week. Visual recovery wasn't observed until the 4<sup>th</sup> week.

Gliosarcoma case report and review of the literature

Awadia Salman Awadalla — 2020-02-03

Gliosarcoma is an unusual subtype of glioblastoma multiforme. Its characteristic features are biphasic configuration, constituting a definite, separate glial and sarcomatous differentiation, on histological evaluation. Herein, we present a rare case of Gliosarcoma that had presented only once in our center in last 13 year. A 60 years old, diabetic, hypertensive male patient came to e emergency department with disturbed level of consciousness and right sided hemiplegia which was progressive over four days. On examination he was, conscious, unoriented in time, person or place, his mouth deviated to left and vitally stable. After initial evaluation, CT scan and MRI were advised. These showed a complex left parieto-occipital heterogeneous mass lesion with cystic and solid components, measuring approximately 5.2x4 cm. The mass lesion was seen displacing the occipital horn anteriorly and inferiorly with probable extension into the lateral ventricular cavity. There was no associated midline shift or definite herniation. The lesion was diagnosed as highly suggestive of brain tumor with a differential diagnosis of glioblastoma multiforme or ependymoma. Blood picture revealed a rapidly increasing level of anemia. Surgical intervention comprising left parieto-occipital craniotomy and near total resection of the tumor was carried out. On histopathological and immunohistochemical evaluation the diagnosis of GS was established. A plan of a combination of adjuvant chemotherapy and radiation was formulated that was however, declined by the family. On regular follow up, the patients clinical state rapidly deteriorated with persistence of seizures and requirement of repeated blood transfusions. The patient finally passed away after eighth months.

Quadrigeminal cistern arachnoid cyst causing hydrocephalus

Sidi Salem-Memou — 2020-02-04

The quadrigeminal cistern is an unusual location for these cysts. Quadrigeminal arachnoid cysts account for 5% to 10% of all intracranial arachnoid cysts. They are frequently diagnosed coincidentally on computed tomography (CT) or magnetic resonance imaging (MRI). They cause symptoms when they become sufficiently large to compress the adjacent brain structures. Endoscopic fenestration of the cyst with cystocisternostomy or cysto ventriculostomy, when combined with third ventriculostomy, is the procedure of choice for such patients. A 14-month-old boywas referred to neurosurgery clinic due to increased head circumference. His had been in good health until age 8 months, between age 9 and 13 months his acquisition of developmental skills was slow. Magnetic resonance image (MRI) demonstrated enlargement of the supratentorial ventricular system secondary to a large quadrigeminal cistern arachnoid cyst compressing the brainstem, cerebellum, aqueduct of Sylvius and fourth ventricle. The cystic mass appeared hyperintense on T2 weighted-images (A, B), hypointense on T1-WI (C, D), similar to cerebrospinal fluid (CSF) signal, without enhancement after Gadolinium administration. The patient was operated by transventricular approach with endoscopic third ventriculocystostomy and endoscopic third ventriculostomy (ETV). The postoperative course was uneventful.

Poor prenatal service utilization and pregnancy outcome in a tertiary health facility in Southwest Nigeria

Jacob Olumuyiwa Awoleke — 2020-02-06

Introduction: poor prenatal service utilization is common in developing countries. However, the predictors and pregnancy outcomes of poor utilizers have not been fully examined in our setting.

Methods: poor and good prenatal service utilizers were compared with respect to demographic characteristics and pregnancy outcomes in Ado-Ekiti, Nigeria.

Results: poor utilizers were significantly more likely to be single mothers, with unemployed husbands/partners, but less likely to have labour induction compared with good utilizers. Also, the women with fewer than four antenatal visits had significantly more babies with low birth weight (18% versus 9.8%, p = 0.003), and 5-minute Apgar scores less than 7 (17.9% versus 10.1%, p = 0.023). Multivariate regression analysis revealed that having an unemployed husband/partner (adjusted odds ratio (AOR): 2.33; 95% Confidence Interval (C.I.): 1.24 - 4.38; p = 0.009), with low birth weight babies (AOR: 1.66; 95% C.I.: 1.01 - 2.73; p = 0.045), and delivering without induction of labour (AOR: 4.27; 95% C.I.: 2.38 - 7.64; p < 0.001) were independently associated with poor prenatal service utilization.

Conclusion: efforts devoted to identifying women who are likely to be non- and poor-utilizers of prenatal care are recommended. Scaling up awareness campaigns on maximizing the benefits of prenatal care, increasing the content quality of antenatal visits to give women a positive pregnancy experience and implementing a National Health Insurance package that strategically targets the most socially underprivileged classes are advocated to promote safe motherhood and the objectives of antenatal care.

Infrequent small bowel intestinal bacterial overgrowth in malnourished Zambian children

Namwiinga Ndulo — 2020-02-07

There is evidence that children with malnutrition have an increased frequency of small intestinal bacterial overgrowth (SIBO) due to impaired gastric acidity, impaired intestinal motility, and dysbiosis. Children with malnutrition respond to antibiotic therapy but it is not clear if this effect is mediated by treatment of SIBO. We set out to determine the frequency of SIBO in children of varying nutritional status in a poor community in Lusaka, Zambia. Hydrogen breath testing, following a dose of 1g/kg oral glucose, was used to determine the presence of SIBO amongst the study participants. Forty nine children, 45 of whom had varying degrees of malnutrition, completed a full series of observations at 15, 30 and 60 minutes. Four children (8%) had a rise of 10ppm from baseline, consistent with SIBO. No correlation with nutritional status was observed. In this small study of Zambian children, SIBO was infrequent and unrelated to nutritional status.

Erysipelas on surgical scar: a case report

Asma Korbi — 2020-02-07

Erysipelas is a non-necrotizing acute dermal hypodermatitis most often of streptococcal origin. It most often affects the lower limbs. Erysipelas on surgical scar has been rarely reported in the literature. Few cases have been published since the first descriptions of this pathological entity by Baddour et al in 1982. We report the case of a 47-year-old patient. Operated for right breast mucinous carcinoma, she had neo-adjuvant chemotherapy followed by a surgical treatment (Patey) which occured without incident. The evolution was marked by the appearance after 11 months of the intervention of an Erysipelas on Patey scar. The patient was put on cefazol for 7 days intravenously injectable. The evolution was marked by the complete disappearance of the rash and the edema.

Lady with seizure and skin lesions

Avik Panigrahi — 2020-02-07

A 35-year-old Indian lady, born out of non-consanguineous parentage, presented with multiple asymptomatic bumps over face and fingers. The facial lesions had started appearing since 2 years of age and finger lesions were first noticed during her adolescence. She had been on anti-epileptic medication for recurrent episodes of seizures since last 15 years. Her family history was insignificant. Examination revealed multiple non-tender, discrete, yellowish-brown to skin-coloured, soft-to-firm papules (1 to 3 mm) distributed symmetrically over centrofacial region. Multiple firm, non-tender, skin-coloured nodules over proximal nail fold along with longitudinal nail grooving were noted (Panel A, red arrow). A small firm skin-coloured plaque (Panel B, red arrow) and a leaf-shaped hypopigmented macule (Panel B, black arrow) were observed over thigh. Oral examination revealed a non-tender soft-to-firm papule over upper gingival (Panel A, black arrow). Systemic examination was insignificant. Routine blood investigations, echocardiography, ultrasonography of abdomen and fundoscopy of eyes failed to reveal any abnormality. Magnetic resonance imaging of the brain revealed cortical tubers and calcified subependymal nodules.

Characterisation of Vibrio cholerae isolates from the 2009, 2010 and 2016 cholera outbreaks in Lusaka province, Zambia

Kapambwe Mwape — 2020-02-07

Introduction: in 2009 and 2010, more than 6,000 cholera cases were recorded during these outbreaks with more than 80% of cases recorded in Lusaka province. After a five-year break, in 2016 an outbreak occurred in Lusaka, causing more than 1,000 cases of cholera. This study will strengthen the epidemiological information on the changing characteristics of the cholera outbreaks, for treatment, prevention and control of the disease.

Methods: this was a laboratory-based descriptive cross-sectional study conducted at the University Teaching Hospital in Lusaka, Zambia. A total of 83 V. cholerae O1 isolates were characterised by biochemical testing, serotyping, antimicrobial susceptibility testing, and macrorestriction analysis using Pulsed-Field Gel Electrophoresis.

Results: macrorestriction analysis of the isolates demonstrated high genetic diversity among the isolates with 16 different patterns. The largest pattern comprised 9 isolates, while the smallest one had 1 isolate. 2009 and 2010 isolates were highly resistant to nalidixic acid and cotrimoxazole, but highly sensitive to azithromycin and ampicillin. Of the fifty-two isolates from the 2016 cholera outbreak, 90% (47) were sensitive to cotrimoxazole, 94% (49) to tetracycline, and 98% (51) to azithromycin, while 98% (51) were resistant to nalidixic acid and 31(60%) to ampicillin.

Conclusion: macrorestriction analysis demonstrated high genetic diversity among the V. cholerae O1 strains, suggesting that these isolates were probably not from a similar source. This study also revealed the emergence of multidrug resistance among the 2016 V. cholerae outbreak isolates but were susceptible to cotrimoxazole, tetracycline, and azithromycin, which can be used for treatment of the cholera cases.

Seroprevalence of brucellosis and associated risk factors among abattoir workers in Bauchi State, Nigeria

Philip Bobu Igawe — 2020-02-07

Introduction: brucellosis is a reemerging and neglected zoonotic disease. It is an occupational bio-hazard and a public health problem. The objective of the study was to determine the seroprevalence of brucellosis and its risk factors among abattoir workers in Bauchi state.

Methods: a cross-sectional study was conducted in the three senatorial district abattoirs of Bauchi State. Abattoir workers (n=284) were selected by stratified random sampling. Data were collected using an adapted questionnaire. Serum samples collected, were screened for brucellosis with Rose Bengal Plate Test (RBPT), tested with Enzyme Linked Immunosorbent Assay (ELISA). Seropositive participants were positive for both RBPT and ELISA. Data were described in proportions and analyzed using bivariate and multivariate analysis.

Results: participants were all male, age range: 18-70 years (mean 35 ±13 years). Ninety-five participants were seropositive (seroprevalence 33.5%) after laboratory testing. Following bivariate analysis, using personal protective equipment (PPE) [OR: 0.5 CI95%=0.3>OR: 0.5 CI95%=0.3-0.9] was significantly protective against brucellosis. Slaughtering of animals (OR: 2.19 CI95%= 1.2-3.7), assisting in animal parturition (OR: 2.25 CI95%= 1.3-3.7), working with an open cut/wound (OR:2.1 CI95%= 1.1-3.9) and eating while working in the abattoir [OR:2.4 CI95%= 1.1>OR:2.4 CI95%= 1.1-4.9] were risks of brucellosis. Multivariate analysis showed that slaughtering of animals: Adjusted Odds-Ratio (AOR) = 1.92; CI95% = 1.03 - 3.59) and assisting in animal parturition (AOR = 2.43; CI95% = 1.40 - 4.23) remained significantly associated with brucellosis.

Conclusion: seroprevalence of brucellosis among abattoir workers in Bauchi state is high. Workers should use PPEs and animal parturitions should be handled by trained personnel alone.

Corneal perforation: the most feared complication of corneal abscess

Ihsane Sabrane — 2020-02-07

We report the case of a 60-year-old patient who consults for eye pain after 3-months of trauma to the right eye. The examination finds a visual acuity with light perception, a perforated cornea in the center with hernia of the iris and a corneal halos abscessed all around (A, B). Corneal abscesses are a serious pathology and potentially blinding, their risk factors are multiple: contact lens wear, corneal trauma, dry eye with blepharitis, corneal anesthesia and keratoplasties. The severity factors requiring hospitalization with corneal harvesting and treatment with fortified antibiotic eye drops adapted to the antibiogram are: an abscess 3mm or more long axis, a central location or less than 2mm from the center, an inflammatory reaction of the anterior chamber. Corneal abscesses appearing at a distance from trauma, as the case we describe are often of fungal origin and are generally of very poor prognosis.

Facteurs associés à la qualité de la stérilisation du linge opératoire au Centre National Hospitalier Universitaire Hubert Koutoukou MAGA de Cotonou

Comlan Cyriaque Dégbey — 2020-02-10

Introduction: la stérilisation des linges opératoires joue un rôle important dans la prévention des infections associées aux soins. Au Centre National Hospitalier Universitaire Hubert Koutoukou MAGA (CNHU-HKM), le processus de stérilisation des linges rencontre des problèmes. La présente étude avait pour objectif d'étudier les facteurs associés à la qualité de stérilisation du linge opératoire au CNHU-HKM.

Méthodes: il s'agissait d'une étude transversale, descriptive et analytique qui avait porté sur 20 linges opératoires stérilisés, 41 agents impliqués dans la gestion des linges et 55 membres de l'équipe chirurgicale. La méthode avait été probabiliste pour les linges opératoires stérilisés et non probabiliste pour les autres. Le test de Khi carré de Pearson et la régression logistique ont été utilisés pour rechercher l'association avec un seuil significatif et un p <0,05.

Résultats: quatre-vingt-six virgule quarante-six pourcent des sujets étaient de sexe masculin avec un âge médian de 42 ans. La qualité du processus de stérilisation du linge opératoire n'était pas bonne dans les deux services en charge de traiter les linges. Le contrôle bactériologique avait montré que sur les 20 linges opératoires stérilisés, 9 portaient Acinetobacter spp. un germe d'infection nosocomiale multi résistant. L'analyse multivariée avait montré que l'expérience professionnelle (p=0,015) et le contrôle de qualité dans le processus de traitement (p=0,034) sont statistiquement associés à la qualité de la stérilisation.

Conclusion: Acinetobacter spp. trouvé sur des linges stérilisés montre que la stérilisation des linges au CNHU-HKM n'est pas de qualité. Un renforcement des compétences des prestataires est nécessaire pour l'amélioration de la qualité du processus de stérilisation.

Male involvement and associated factors in birth preparedness and complication readiness in Debre Berhan Town, North East Ethioipia

Melkamu Worku — 2019-02-10

Introduction: men play indispensable role in health and wellbeing of mothers and children. Their level of involvement in regard to birth preparedness and complication readiness is understudied. This study was therefore carried out to assess male involvement and associated factors in birth preparedness and complication readiness in Debre Berhan town, North East Ethiopia.

Methods: community based cross-sectional study was conducted from July 1^st- 30^th, 2014 in Debre Berhan town among 806 study participants. Cluster sampling technique was employed to select study participants. Data were collected using a structured and pre-tested questionnaire by face-to-face interview technique. Bivariate and multivariate analyses were performed to check associations and control confounding.

Results: the study showed that male involvement in birth preparedness and complication readiness found to be 51.4%. Educational status of tertiary level (AOR = 4.37 95% (CI: 2.10, 9.13), having 1 or 2 children (AOR = 2.52, 95% CI:1.30,4.87) and 3 or 4 (AOR = 5.19, 95% CI:2.44,11.03), knowledge of danger signs (AOR = 7.71, 95% (CI:5.15, 11.54), knowledge of birth preparedness and complication readiness (AOR = 11.98, 95% CI:7.73,18.56) and attitude (AOR = 2.23, 95% CI: 1.41,3.51) were significantly associated with male involvement in birth preparedness and complication readiness.

Conclusion: male involvement in birth preparedness and complication readiness found to be low in study area. Education, number of children, knowledge on danger signs, knowledge on birth preparedness and complication readiness and attitude were factors associated with male involvement. Creating awareness on danger signs of pregnancy, birth preparedness and complication readiness both at community and institutional level were recommended in order to increase male involvement in birth preparedness and complication readiness.

Antibiotic resistance patterns in human, animal, food and environmental isolates in Ghana: a review

Pilar García-Vello — 2020-02-12

Many articles have been published on resistant microorganisms isolated from humans, animals, foods and the environment in Ghana. However, there are no reviews that summarize the information on the isolates and antibiotics tested so far in the country. This literature review was completed through "PubMed" and "Google Scholar" searches. We included publications from the period 1975-2015 with a laboratory-based methodology to determine antibiotic resistance of strains isolated in Ghana. In total, 60 articles were included in the analysis with 10% of the articles carrying out nationwide research on antibiotic resistance. The regions of Ghana with the highest published articles were Greater Accra (40%), Ashanti (21.7%) and Northern Region (10%). Most of the studies (86.7%) were related to isolate collected from human samples followed by environmental (5%), animal (3%) and food samples (2%). Ten different bacteria genera were observed in the studies. The most common was Escherichia coli, followed by Staphylococcus spp., Mycobacterium spp. and Streptococcus spp. The highest mean resistance rate was encountered in Escherichia coli (62.2%) followed by Klebsiella spp. (60.4%) and Pseudomonas spp. (52.1%). High resistance rates have been found in Ghana, however, the data are skewed and some regions of the country have been neglected. There is a need for higher quality research to establish and monitor resistance patterns in Upper West, Brong-Ahafo, Volta and Eastern Regions of Ghana.

The barriers to initiating lung cancer care in low-and middle-income countries

Buhle Lubuzo — 2012-04-09

Lung cancer in low-and middle-income countries is the leading and the second leading cause of cancer deaths in males and females, respectively. This, in part, is due to late presentation of patients in health facilities and late diagnosis, thereby compromising the effectiveness of treatment and resulting in poor treatment outcomes. Investigating patients' late presentation to health facilities and late diagnosis, as barriers to achieving good treatment outcomes, is an important step towards improving the existing pathways of care. Therefore, the aim of this paper is to critically review the published and unpublished literature, including government reports on lung cancer care, with regards to the barriers to patient access, referral, diagnosis and treatment in low-and middle-income countries. The emphasis is on access point and the primary care continuum. This review has been packaged into themes in order to efficiently inform researchers and cancer health professionals, on the existing gaps necessary for developing appropriate intervention strategies and policy guidelines. This review has revealed that the timeous and correct diagnosis of lung cancer enables lung specialists to engage on options for improved patient care. Currently, there are variations in lung cancer management in low-and middle-income countries. Many of the factors impacting on health care outcomes are a function of patient circumstances and/or understanding, leading to delays in presentation to health facilities. Factors pertaining to individual patient circumstances are further compounded by inefficiencies within the health care system. Therefore, limited health system capacities and competing health priorities in these settings require action.

Analysis of distribution, capacity and utilization of public health facilities in Borno, North-Eastern Nigeria

Usman Alhaji Aliyu — 2020-02-12

Introduction: this study aimed to analyze the spatial distribution and capacities of public health facilities and assess utilization of the facilities in Biu area of Borno State, Nigeria.

Methods: a descriptive survey of health facilities and households were conducted by stratifying the area into 11 electoral wards. Data collection instruments include a hand-held GPS (Garmin 76CSx) and 2 sets of structured questionnaires (facility and household). The hand-held GPS was used in taking the coordinates of each health facility in the area. Twenty-five facility-based and 400 household-based questionnaires were administered.

Results: it was identified that 138 public health personnel serve the area's population of 240,838. Medical professionals (doctors/nurses/midwives) to patient ratio is 1:2973, about 7 times less than the minimum WHO recommendation of 2.5 medical personnel per 1000 population. Uneven distribution of facilities exists, which impact on utilisation. For instance, a ward (Mandaragrau) with a population of 18,732 have 5 facilities (4 dispensaries and 1 primary health care) in comparison to a ward (Miringa) with a population of 21,343 with only one Dispensary. Income level and distance were significant socio-economic factors affecting service utilisation (p < 0.001). The area's households Gini index was 26.7, most of which (49.7%) survive on less than USD2/day and majority (33.6%) spend an average cost of treatment of

Prévalence de l'obésité et du surpoids en milieu scolaire, oasis de Tafilalet, sud-est du Maroc

Karima Azekour — 2020-02-12

Introduction: l'obésité représente un sérieux problème de santé publique qui a un impact direct sur la santé physique et mentale des individus. L'objectif du présent travail est de déterminer la prévalence de l'obésité et du surpoids en milieu scolaire urbain et rural, chez une population infantile oasienne.

Méthodes: nous avons entrepris une étude transversale descriptive au sein des établissements scolaires publics urbains et ruraux de l'oasis de Tafilalet. Nous avons recruté un échantillon représentatif de 3684 enfants scolarisés appartenant à 39 écoles publiques primaires.

Résultats: la moyenne d'âge était de 9,81 ± 2,13 ans. L'échantillon total s'est réparti en 1794 garçons (48,70%) et 1890 filles (51,30%). Deux mille trois cent neuf appartenant à l'urbain (62,70%) et 1375 au rural (37,30%). Selon les références de l'organisation mondiale de la santé, notre étude a révélé un taux d'obésité de 1,9% et 10,8% pour le surpoids. L'obésité et le surpoids n'étaient pas significativement associés avec le sexe des enfants.

Conclusion: la prévalence de l'obésité dans l'oasis de Tafilalet est inférieure aux données nationales et internationales, le mode de vie et les habitudes alimentaires de cette population semblent être un facteur protecteur contre l'obésité et le surpoids.

Unusual cause of filling defect in pulmonary artery: pulmonary artery sarcoma

Cisel Yazgan — 2020-02-12

Pulmonary artery (PA) sarcoma is an extremely rare malignant tumor of pulmonary artery. It is often misdiagnosed as pulmonary thromboembolism (PTE) because of its clinical and imaging features which are quite similar to PTE. Multimodality diagnostic imaging and recognition of specific imaging characteristics with appropriate clinical suspicion are required to make correct diagnosis. In this report, we present a case of PA sarcoma with imaging and clinical features as well as emphasize the significance of using multimodality imaging.

Factors associated with the uptake of intermittent preventive treatment of malaria in pregnancy in the Bamenda health districts, Cameroon

Ngwene Hycentha Diengou — 2020-02-12

Introduction: the World Health Organization (WHO) recommends that in malaria endemic areas with moderate to high transmission rates, pregnant women presenting for antenatal clinic (ANC) should receive at least three doses of intermittent preventive treatment in pregnancy (IPTp) for malaria between the 16^th and 36^th weeks of pregnancy at intervals of 4 weeks between doses. Several challenges remain in effective implementation of IPTp policymaking the targeted coverage (80%) of the third doses of IPTp far from being achieved. The main objective of this study was to assess factors associated with the uptake of IPTp among pregnant women attending ANCs in the Bamenda Health District.

Methods: to reach our objectives, we carried out a cross-sectional study following informed consent with thirty-nine (39) healthcare workers (HCW) and four hundred (400) pregnant women who were either in the third trimester of pregnancy or had recently given birth in any of thirty-six (36) health facilities (HF) within the Bamenda Health District (BHD) from May to August 2014. All sites within the BHD were included. The participants were selected by simple random sampling. The principal research instrument was a structured and pre-tested questionnaire that was designed to capture socio-demographic data and data related to stage of pregnancy and knowledge about IPTp. Data was entered using Ms Excel and analysed using SPSS v20.0. Descriptive statistics (frequencies and percentages) was used to report findings. We used Chi-Square test to compare the categorical variables (Fischer’s exact test was used in cases were conditions for Chi-Square test were not met).

Results: uptake for at least one dose of IPTp was 95.3% (381/400) and 54.9% (209/400) had received all three doses, 15.5% (59/400) received only one dose and 4.8% (19/400) did not receive any of the doses of IPTp. Knowledge about IPTp was associated with an increase uptake of IPTp (P<0.001). All health care providers were knowledgeable about the importance and use of IPTp. However, 35.9% reported not receiving any training on IPTp. Among the health providers, 28.2% did not know when to start IPTp and 43.59% did not know when to stop IPTp. Out of all the health care providers, 30.77% complained of medication (sulfadoxine-Pyrimethamine) stock out and 84.62% practiced the policy of direct observed therapy.

Conclusion: the uptake of the third dose of IPTp is poor in the Bamenda Health District and this may be attributed to medication stock out and inadequacy of routine trainings for the health providers. The good practice observed was that of direct observed therapy by HCWs. Patient knowledge about IPTp in our study was associated with better uptake of IPTp. Encouraging education of pregnant women on the importance of IPTp, providing routine training to HCWs and promoting direct observation of therapy may improve on IPTp uptake during pregnancy.

Risk factors associated with hepatitis B and C in rural population of Burera district, Rwanda

Patrick Gad Iradukunda — 2020-02-12

Introduction: several studies have shown that older people have a higher risk of exposure to viral hepatitis B and C than younger people. This study aimed to determine the seroprevalence of hepatitis B and C and their associated factors in people aged 45+ years old in Burera, a rural district of Rwanda.

Methods: a cross-sectional study was conducted from July to December 2017 during a mass campaign of hepatitis B (HBV) and hepatitis C (HCV) screening and vaccination of eligible populations against HBV in Burera District. Blood samples were collected and hepatitis B surface antigen (HBsAg) and an antibody against hepatitis C (Anti-HCV) were detected using an Enzyme-Linked Immuno-Sorbent Assay (ELISA). The associated factors were identified using a structured questionnaire and the data was analyzed using SPSS software.

Results: of the 374 people included in this study, 53.2% were females. The median age was 56 years old with an interquartile range (IQR) of 50 - 63 years old. The prevalence of HBV and HCV infection was 6.4% and 9.4%, respectively, with 0.3% co-infection rate. Age, social economic level, history of blood transfusion, history of never using a condom, as well as a history of injury with a used sharp material were significantly associated with HCV infection.

Conclusion: the study showed a high seroprevalence of both HBV and HCV in Burera's elderly population aged 45+ years. Several factors associated with HBV and HCV in this study could be prevented through education and improved hygiene.

Legal perspectives on liability for medical negligence and malpractices in Nigeria

Oludamilola Adebola Adejumo — 2020-02-17

Medical practice usually involves different activities which if not professionally handled, may give rise to liabilities on the part of the medical practitioner. These liabilities may arise in tortious claims and in some other cases, may go beyond the realm of civil liabilities to criminal liabilities. This review focuses on liabilities that amount to negligence both under the civil and criminal laws in Nigeria, other instances of malpractices which may not amount to negligence but may suffice to give rise to a successful cause of action in other branches of substantive law including claims for breach of fundamental human rights; contract; and fiduciary relationship. The review concludes by emphasizing the need for caution and the need to ensure that justice is seen to be done not only to the victims but also to the medical practitioners who deserve all legal protection in the exercise of their professional duties.

Predictors of incident heart failure in a cohort of patients with ischemic heart disease

Senbeta Guteta Abdissa — 2020-02-17

Introduction: heart failure (HF) is a major complication following ischemic heart disease (IHD) and it adversely affects the outcome. The objective of this study was to identify predictors of HF in patients with IHD.

Methods: this is a 24-month longitudinal retrospective study of all consecutive patients diagnosed with IHD. Endpoints were incident HF and time to incident HF. Patients with a previous history of HF were excluded.

Results: a total of 306 patients with IHD were included in the analysis. The 6-month, 12-month and 18-month cumulative risk of developing incident HF were 18.8%, 28.4%, and 53.5% respectively. Increasing age, female gender, diabetes mellitus (DM), lower hemoglobin, and dilated left atrium were strong predictors of incident HF. Predictors of shorter time to incident HF were coexisting DM and hypertension, and the presence of dilated left atrium in patients with left ventricular ejection fraction < 40%. The strongest predictor of incident HF in patients with DM was a higher level of LDL cholesterol.

Conclusion: patients with IHD have a higher risk of incident HF. Strong predictors of incident HF in these patients were increasing age, female gender, DM, lower hemoglobin and dilated left atrium. Such patients need close follow-up and more intensive treatment.

Exposure to secondhand smoke in health institutions and sources of knowledge: a cross-sectional study from the city of Bulawayo, Zimbabwe

Nkanyiso Ndlovu — 2020-02-18

Introduction: annually, many people die due to being exposed to secondhand smoke (SHS) which they experience at a number of premises that include health institutions. Scientists agree that there is no safe exposure level to SHS, however, in the City of Bulawayo many people are exposed to SHS. There are great expectations from communities for health professionals to reduce SHS exposure-related morbidity and mortality. This study sought to establish exposure to SHS in health institutions and sources of knowledge on SHS.

Methods: a cross-sectional study, with participants randomly selected from residents visiting the 13 municipal revenue halls in the City of Bulawayo, was conducted. Data were collected through a structured questionnaire and were analyzed by performing descriptive and multivariate logistic regression.

Results: 26.3% (N = 419) of respondents who had been to health institutions in the previous 30 days had been exposed to SHS within those institutions. Almost all the respondents (85.4%) had never received a lesson on SHS from a health professional or had last received one three months before the survey. Furthermore, 74% of respondents had not seen posters on SHS or had last seen one more than three months before the survey.

Conclusion: health professional should collaborate with other professionals in the fight against exposure to SHS as evidenced by the high prevalence of exposure in the health institutions and low health education given on SHS exposure in the City of Bulawayo.

A four-year-old Nigerian boy with battered child syndrome: implications for public health

Olayinka Rasheed Ibrahim — 2023-09-08

Battered child syndrome (BCS) is a form of physical abuse that is characterised by multiple injuries and potentially fatal outcome. Despite the high prevalence of physical abuse in developing countries, BCS is rarely reported. Hence, this report highlighted a four-year-old Nigerian boy who suffered multiple injuries (scalp haematoma, bruises, right clavicular fracture, and burns) from the paternal uncle’s wife. This case report is discussed along the line of public health approach for curbing the social menace.

L´association entre les gènes HLA II et la susceptibilité à l´asthme chez une population Constantinoise sélectionnée

Dahbia Ines Dahmani — 2020-02-18

Introduction: l'asthme est une maladie complexe causé par l'interaction de plusieurs gènes dont certains ont un effet protecteur et d'autres contribuent à l'apparition de la maladie. Cet article s'intéresse à une partie du bras court du chromosome 6 où siègent les gènes codant pour le complexe majeur d'histocompatibilité dénommé HLA qui joue un rôle important dans la pathogénèse de l'asthme.

Méthodes: notre étude inclut 61 personnes dont 30 personnes non asthmatiques non allergiques et 31 patients atteints d'asthme allergique depuis plus de 2 ans. Le statut atopique de l'asthme a été confirmé par les tests cutanés et le typage HLA classe II a été réalisé suivant le principe de la technique sérologique de séparation par Fluorobeads B.

Résultats: l'analyse statistique révèle que les gènes HLA-DR11 et DQ2 sont significativement plus fréquent chez les asthmatiques par rapport aux témoins, les résultats sont comme suit: le HLA-DR11 avec une p=0,05 et le HLA-DQ2 avec une p=0.002, cela nous a conduit à dire qu'il s'agit peut-être de marqueurs HLA en association avec l'asthme. En revanche le marqueur HLA-DQ6 était nettement plus important chez la population témoin que chez les sujets asthmatiques avec p=0.003.

Conclusion: cela nous a conduit à dire que les marqueurs HLA-DR11 et DQ2 pourraient être des gènes potentiels de susceptibilité à l'asthme, alors que HLA-DQ6 pourrait avoir un effet protecteur.

Adherence to antiretroviral therapy among HIV infected pregnant women in public health sectors: a pilot of Chilenje level one Hospital Lusaka, Zambia

Moses Mukosha — 2020-02-19

Introduction: regular use of Antiretroviral Therapy (ART) in pregnancy and breastfeeding reduces the odds of Mother-to-Child HIV Transmission (MTCT). However, adherence to ART is critical for MTCT to be successful. The present study investigated factors that influence adherence to ART among HIV infected pregnant women in Zambia.

Methods: a cross-sectional study design was conducted involving 71 HIV infected pregnant women who were advised to join the Prevention of Mother-to-Child HIV Transmission (PMTCT) program during their routine Antenatal clinic (ANC) visit and were on ART for more than six months. We used the Medication Possession Ratio (MPR) to quantify adherence levels. We used logistic regression to establish factors that influence adherence to ART.

Results: a total of 71 HIV infected pregnant women with a median age of 27years (IQR, 25-30) were enrolled in the study. There was evidence of a difference in adherence levels between pregnant women above 30 years and ones between 15 years and 30 years (P<0.001). Median adherence levels in this group were found to be at 96%(IQR 89-97). The main predictor of adherence in this population was marital status (being on separation) and age. The women who were on separation were 0.14 times less likely to adhere to option B+ compared to married women.

Conclusion: adherence to option B+ among pregnant women is low. Adherence was significantly influenced by marital status (being on separation) and age. Efforts to improve adherence should be directed towards women on separation and young adults (< 30 years of age).

Facteurs pronostiques de mortalité par accident vasculaire cérébral artériel à la phase aiguë dans une population nord-africaine

Khadija Sonda Moalla — 2020-02-20

Introduction: l'accident vasculaire cérébral (AVC) constitue un problème majeur de santé publique, tant par le nombre de personnes atteintes, que par ses conséquences médicales, sociales et économiques. L'objectif était de dégager les facteurs de mauvais pronostic vital à la phase aiguë de l'AVC artériel.

Méthodes: il s'agit d'une étude prospective durant quatre mois portant sur les patients présentant une symptomatologie évocatrice d'AVC aux deux CHU de Sfax, Tunisie. Le suivi a été de un mois.

Résultats: nous avons colligé 200 patients. Après un mois de suivi, la mortalité était de 19,9%. Les facteurs de mauvais pronostic vital étaient: le sexe masculin, la consommation de tabac, l'antécédent d'AVC, le score de Glasgow bas, le NIHSS élevé, les céphalées, les crises épileptiques symptomatiques aiguês, le signe de Babinski, la mydriase, l'aphasie, la déviation conjuguée de la tête et des yeux, les chiffres élevés de pression artérielle systolique (PAS), pression artérielle diastolique (PAD) et pression artérielle pulmonaire (PAP), l'hyperthermie, l'hyperglycémie, l'hyperleucocytose, l'augmentation des CRP, créatinine, urée et la troponine Tc, la nature hémorragique de l'AVC, l'œdème péri lésionnel, l'effet de masse, l'engagement, la topographie sylvienne totale de l'ischémie, la présence de signes précoces d'ischémie, l'hémorragie méningée, l'inondation ventriculaire, l'hydrocéphalie, le recours à une assistance respiratoire, au traitement anti-œdémateux et antihypertenseur, la transformation hémorragique, l'épilepsie vasculaire, les complications infectieuses, métaboliques et de décubitus.

Conclusion: l'identification des facteurs prédictifs du devenir vital permet d'optimiser les procédures thérapeutiques et mieux organiser les filières de prise en charge. Une étude comparative sera envisagée afin de mesurer l'impact des mesures correctives.

Syndrome de Perthes: à propos de deux cas pédiatriques

Soufiane El Youssfi — 2020-02-21

Le syndrome de Perthes est défini par l'association d'hémorragies sous conjonctivales, de cyanose cervico-faciale et des pétéchies à des manifestations neurologiques. La compression brutale du thorax ou thoraco-abdominal bloqué en inspiration forcée avec effort à glotte fermée est le mécanisme responsable du syndrome. Le pronostic est en général bon si la durée de la compression est brève et la réanimation cardiorespiratoire commencée précocement. L'objectif de cet article est de décrire les caractéristiques du syndrome de Perthes chez les enfants.

Intrastromal injection of voriconazole as a therapeutic of fungal hypopyon: a case report

Nabil Albab — 2020-02-21

We describe the case of a 7-year-old child, victim of ocular trauma causing a corneal wound that was sutured urgently. The child has been regularly monitored in our department. A few months later, he consults for a painful red eye evolving within two weeks. The use of voriconazole as an intracameral injection has shown its superiority in treating fungal endophtalmitis. Further studies should be underwent to learn more about better injection strategies and so as to consider better its benefits and side effects.

Congenital hyperinsulinsim: case report and review of literature

Brahim El Hasbaoui — 2020-02-24

Neonatal hypoglycemia (NH) is one of the most common abnormalities encountered in the newborn. Hypoglycemia continues to be an important cause of morbidity in neonates and children. Prompt diagnosis and management of the underlying hypoglycemia disorder is critical for preventing brain damage and improving outcomes. Congenital hyperinsulinism (CHI) is the most common and severe cause of persistent hypoglycemia in neonates and children, it represents a group of clinically, genetically and morphologically heterogeneous disorders characterised by dysregulation of insulin secretion from pancreatic β-cells. It is extremely important to recognize this condition early and institute appropriate management to prevent significant brain injury leading to complications like epilepsy, cerebral palsy and neurological impairment. Histologically, CHI is divided mainly into two types focal and diffuse disease. The diffuse form is inherited in an autosomal recessive (or dominant) manner whereas the focal form is sporadic in inheritance and is localized to a small region of the pancreas. Recent discoveries of the genetic causes of CHI have improved our understanding of the pathophysiology, but its management is complex and requires the integration of clinical, biochemical, molecular, and imaging findings to establish the appropriate treatment according to the subtype. Here we present a case of sever congenital hyperinsulinism in a girl admitted for lethargy, irritability and general seizures accompanied with profound hypoglycemia, in spite of aggressive medical treatment, she died because of sever congenital hyperinsulinism diazoxide unresponsive.

Evaluation of the national tuberculosis surveillance and response systems, 2018 to 2019: National Tuberculosis, Leprosy Buruli Ulcer Control Programme, Abuja, Nigeria

Ayi Vandi Kwaghe — 2020-02-24

Introduction: Nigeria is among the countries with high Tuberculosis (TB) burden by global rating signifying the relevance of TB surveillance system evaluation in improving performance and capacity of the existing system. Hence, this evaluation was conducted in order to determine the gaps and proffer solution to enhance the TB surveillance system performance.

Methods: questionnaires were administered to eight key informants using face-to-face interview method; data obtained was analyzed. Total number of TB cases and estimated number of cases for year 2018 was obtained. Percentage of positive cases using the GeneXpert test for 6 months (January to June 2019) was obtained. Available documents and publications on the National Tuberculosis, Leprosy and Buruli Ulcer Control Programme (NTBLCP) were also sought for information.

Results: the NTBLCP has over 5,300 TB service points and 1,602 microscopy Centre's distributed across the country. Acceptance for the standard TB case definition was 100%, forms used are easy to fill and diagnosis is laboratory-based requiring specialized trainings for laboratory personnel. The system had 25% sensitivity, high data quality with 100% timeliness. The TB surveillance system is representative of all ages. The system was first designed as TB and leprosy control programme but later buruli ulcer was incorporated into the programme. First quarter supervisory visits are skipped due to late funding and delayed budget approval. Major share of the funding comes from donor partners.

Conclusion: the system is useful, representative, acceptable, has good data quality, timely, and sensitive. The system is stable but needs to be funded more by the government. There is need for early funding and budget approval to avoid skipping of the first quarter supervisory visits due to funding challenges. The system is not simple due the various test that need to be conducted before, during and after treatment to detect and verify that the patient is cured. We recommend continuous training of health workers, routine monitoring and evaluation, integration of TB care and prevention into other health services programmes like HIV/AIDS and active case search at all levels to increase the sensitivity of the system. Speed up the process of integration of NTBLCP surveillance system with IDSR for data harmonization in the country.

Efficacy of botulinum toxin A for the treatment of hemiparesis in adults with chronic upper limb spasticity

Sameh Ghroubi — 2020-02-25

Introduction: this study aimed to evaluate the effectiveness of botulinum toxin A (BoNT-A) injection in hemiparetic patients with chronic spasticity in the upper limb resulting from stroke or traumatic brain injury.

Methods: we conducted a retrospective study including 45 patients seen, in our department of Physical Medicine and Rehabilitation, between January 2014 and December 2016. All patients received an injection of BoNT-A (Dysport, 100 U/ml). Affected upper-extremity muscles could be injected as per the investigator's discretion to a maximum total dose of 1000 U. We evaluated muscle tone using Modified Ashworth Scale (MAS). Functional disability was assessed using Modified Frenchay Scale (MFS), Nine Hole Peg Test (NHPT) and Barthel Index (BI). Quality of life (QoL) was assessed using the 36-Item Short Form Health Survey (SF-36). The achievement of treatment goal was assessed by the Goal Attainment Scaling (GAS).

Results: patients decreased their MAS score over the first and the third months (p<0.05). MFS showed improvement at 1 month after injection with a median change from baseline of 8 (range: 1-16; p<0.001). The change from baseline ranged from 0 to 5 points for NHPT at 1 month after injection (p< 0.001).This functional improvement was maintained to 3 months. Improvements in Barthel Index was observed at 3 months with a median change from baseline of 5 points (range 0-15; p<0.001). The mean change from baseline of SF-36 score was 4.77 ± 3.39 (p<0.001). The mean GAS T-score was 47.04 ±7.78 (median 50, IQR 7.7), giving a mean (SD) change from baseline of 25.36 ± 8.46 (95% CI 22.82 to 27.90; p <0.001). Binary logistic regression was used to identify the independent factors predicting a favorable functional outcome of Bon-T treatment. It showed that neglect was independent predictive factor treatment failure (p=0.009, OR=3.2) while previous injection of BoNT-A was an independent predictive factors of treatment success (p=0.009, OR=0.3).

Conclusion: our study showed a good response to BoNT-A injection delivered in the management of chronic upper limb spasticity resulting from stroke or traumatic brain injury. It demonstrated its outcome in improving muscle tone, function and QoL. It also showed that the majority of patients achieved their goal as defined at the start of the treatment, mainly for patients who received previous injection of BoNT-A.

Testicular schistosomiasis mimicking hydrocele in a child: a case report

Olubanji Ajibola Oguntunde — 2020-02-26

Schistosomiasis is a disease of profound public health importance worldwide. Testicular schistosomiasis (TS) is however still considered as a rare entity despite the burden of the disease. We report a case of a 9 year old male who presented with features suggestive of testicular hydrocele. The spermatic cord and testis were seen as thickened lesion on examination and a biopsy taken revealed calcified ova of Schistosoma haematobium. This is being reported to enhance increased suspicion amongst surgeons in cases of testicular masses within endemic settings like Nigeria.

Observance de l´hygiène de main dans les Hôpitaux Généraux de Référence de la ville de Kisangani en République Démocratique du Congo

Eugène Basandja Longembe — 2020-02-26

Introduction: la présente étude avait pour objectif d'évaluer le niveau de l'observance de l'hygiène des mains par les professionnels de santé des Hôpitaux Généraux de Référence (HGR) de la ville de Kisangani et d'identifier les facteurs déterminants.

Méthodes: une étude transversale est menée dans les services de maternité, chirurgie, pédiatrie et urgences des quatre HGR de la ville de Kisangani pendant la période du 13 au 20 juin 2018. Un questionnaire auto-administré a été remis à 120 professionnels de santé recrutés parmi les médecins, infirmiers, techniciens de laboratoire et garçons et filles de salle pour évaluer leur niveau de connaissance et une grille dobservation de l'hygiène des mains utilisée sur 44 prestataires pour 1920 opportunités.

Résultats: le taux d'observance global de l'hygiène des mains est de 39% [IC95 0,37; 0,41]; la friction avec la solution hydro alcoolique est beaucoup moins fréquente (5%); les techniciens de surface et les médecins ont présenté des taux d'observance plus élevés respectivement 49% et 44% que les infirmiers (33%). Environ un tiers de professionnels connaissent les indications de l'hygiène des mains selon l'OMS; 37% de prestataires ont déclaré avoir suivi une formation en cours d'emploi sur l'hygiène des mains et 36% connaissent l'importance de l'hygiène des mains en milieu de soin. La différence de connaissance n'est pas significative entre les catégories professionnelles étudiées (p > 0,05).

Conclusion: cette étude nous a permis à travers les résultats obtenus de conclure que le niveau d'observance des précautions standards en hygiène des mains par les professionnels de santé reste insuffisant. Il s'avère donc nécessaire de renforcer l'observance de l'hygiène des mains par les programmes de formation et de sensibilisation des professionnels de santé, l'approvisionnement en produits d'hygiène et la prise de conscience des prestataires de soins.

Sarcoma undifferentiated (unclassified) fusiform cell type of mesentery: a case report and literature review

Korbi Ibtissem — 2020-02-26

Sarcomas are a heterogeneous group of malignant tumors that come from mesenchymal tissues. Undifferentiated sarcoma represents approximately 20% of soft tissue sarcomas. This entity represents approximately 20% of soft tissue sarcomas. These tumors are subdivided according to their appearance. Morphological in 4 subtypes: pleomorphic cells, fusiform cells, round cells, epithelioids. We report the case of a 72-year-old woman operated for a complicated adnexal tumor, but it turned out that it was sarcoma undifferentiated (unclassified) fusiform cell type of mesentery. It is a rare and a latent tumor. Its diagnosis is histological. Its treatment consists on surgical wide excision if possible. This type of sarcoma has a poor prognosis considering the limited benefits of radio-chemotherapy. Undifferentiated sarcoma type fusiform cells of the mesentery is an exceptional entity. Its diagnosis is difficult. Its treatment is to discuss case by case, surgery is the best option if it is possible. The prognosis is bad. This entity remains to be studied.

Facteurs de risque alimentaires du cancer colorectal au Maroc: étude cas-témoin

Fatima Ezzahra Imad — 2020-02-27

Introduction: le cancer colorectal par sa fréquence et par sa gravité, est un problème majeur de santé publique. L'alimentation occupe une place primordiale dans la prévention de ce type de cancer. Le but de notre étude est de déterminer, dans notre contexte marocain, les facteurs de risque nutritionnels du cancer colorectal.

Méthodes: il s'agit d'une étude cas-témoin incluant les cas du cancer colorectal comparés à des témoins. L'analyse statistique des résultats a été réalisée par le logiciel R.

Résultats: notre étude a inclus 225 patients pris en charge au centre Mohammed VI pour le traitement des cancers et 225 témoins. L'âge moyen de notre population au moment du diagnostic était de 55,49±14,06 ans, dont 119 hommes (52,9%) et 106 femmes (47,1%) avec un sex-ratio de 1,12. Des associations ont été trouvées entre les apports les plus élevés de viandes rouges, de charcuteries, de saucisses et le risque de cancer colorectal avec respectivement ((p = 0,0001); F4 (4-7 fois/semaine) versus F1 (jamais): OR = 4,4 (1,6-11,9); (p = 0,001), OR = 1,7 (0,5-5,7); (p = 0,003), OR = 5,7 (1,2-27,4)). En revanche, la consommation du poisson est associé à une diminution du risque de cancer colorectal (p = 0,0001; OR = 0,3 (0,11-0,7)), alors que la consommation de volailles et des œufs grillés n'est pas associés au cancer colorectal. Nous avons constaté également que l'apport en légumes frais et légumes cuits est faible chez les cas par rapport aux témoins (p = 0,0001). Par ailleurs, l'apport élevé en café noir est associé à une diminution du risque de cancer colorectal (p = 0,0001; F4 versus F1: OR = 0,2 (0,1-0,4)).

Conclusion: notre étude conforte l'idée qu'un changement du régime alimentaire peut prévenir ou empêcher la croissance d'un cancer colorectal. Il est important de promouvoir une alimentation équilibrée, riche en poissons, légumes, fruits et fibres sans excès de viandes rouges et d'éviter les charcuteries et les saucisses.

Embolisation d´un faux anévrisme artériel sur rein unique: à propos d´une complication rare de la néphrolithotomie percutanée

Traore Abdoulaye Ababacar — 2020-02-28

La néphrolithotomie percutanée s'accompagne d'un risque de complications en particulier hémorragiques, qui en fait une technique potentiellement invasive. Nous rapportons le cas d'une patiente de 70 ans, traitée auparavant pour néphrolithotomie percutanée d'une lithiase sur un rein unique gauche. Une hématurie persistante de moyenne abondance est apparue il y a 2 mois et demi, et qui a motivé à la réalisation d'une tomodensitométrie découvrant un faux anévrisme intra rénal polaire inférieur, d'origine iatrogène. Il a nécessité une embolisation sélective efficace à la colle biologique.

Mining laboratory data to describe prostate specific antigen testing and prostate cancer in Johannesburg, South Africa

Mpho Reginah Maphayi — 2020-02-28

Introduction: guidelines issued by different organizations worldwide differ on the use of prostate specific antigen (PSA) in prostate cancer. However, no local data is available describing how PSA testing is offered by our healthcare facilities in the country. The objectives of this study were to describe PSA testing and subsequent prostate biopsy uptake in a South African urban population.

Methods: this was a descriptive retrospective study. Data of all PSA tests and prostate biopsies performed at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) laboratory for 2013 calendar year was extracted from the laboratory information system.

Results: a total of 20 365 PSA tests were performed on 17 481 men during the study period. The majority of men were Black African (79%). The mean age for Black Africans (55.5 years, SD 13.3) was significantly lower than other racial groups (62.9 years, SD 12.6, p < 0.0005). PSA level was lower in Black Africans compared to others. Prostate biopsy uptake across all age groups was lower in Black African men compared to others (2% versus 4%, p = 0.01). Of the 423 men who had a prostate biopsy, 50% had prostate cancer. More Black African men were diagnosed with prostate cancer on biopsy compared to men of other racial groups (54% versus 43%, p = 0.03).

Conclusion: our study confirms that PSA testing is prevalent in healthcare facilities in South Africa. Black African men are tested for PSA levels but have low biopsy uptake and are more likely to be diagnosed with prostate cancer.

Transient lower cranial nerve palsies following spinal anesthesia with bupivacaine-fentanyl combination for transurethral resection of the prostate

Ali Akhaddar — 2020-03-03

Spinal anesthesia is a widely used regional anesthesia for many infra-umbilical surgical procedures with proven efficacy and safety. However, although rare, some neurologic complications can occur with potentially life threatening consequences. Among them, lower cranial nerve palsies have been rarely reported in the literature. We report such a case in a 75-year-old man with transient dysphagia, dysphonia and spinal accessory nerve palsy occurring four days after spinal anesthesia for transurethral resection of the prostate. His symptoms completely resolved spontaneously within 2 weeks. The possibility of lower cranial nerve palsies should be added to the potential complications during or following spinal anesthesia with bupivacaine-fentanyl combination. Although transitional, this complication may occur few days after the procedure and need to be promptly recognized, carefully evaluated and treated by conservative measures.

Saccharomyces cerevisiae, une levure de plus en plus impliquée dans les infections urinaires: à propos de 3 cas

Mohamed Zaïd Saoud — 2020-03-03

Saccharomyces cerevisiae est un champignon ascomycète ubiquitaire. C'est une levure qui est retrouvée chez l'homme sous forme commensale [1]. Elle est largement utilisée dans l'industrie agroalimentaire pour son rôle dans la fabrication de plusieurs aliments, notamment le pain et les boissons fermentées. Elle est aussi utilisée en tant que supplément nutritionnel et en tant que probiotique, notamment les souches de S. cerevisiae var. boulardii pour le traitement de divers troubles intestinaux [2]. Longtemps considérée comme inoffensive, cette levure est de plus en plus impliquée dans des cas d'infections parfois invasives, principalement des sepsis fongiques, pouvant être fatales, notamment chez des patients prédisposés [2, 3]. Nous rapportons 3 cas d'infection urinaire à S. cerevisiae diagnostiqués au niveau du laboratoire central de parasitologie et de mycologie du centre hospitalier Ibn Sina à Rabat, au Maroc. Les méthodes utilisées pour le diagnostic mycologique sont l'examen microscopique direct du culot de centrifugation des urines, la mise en culture des urines à 37°C sur les différents milieux Sabouraud (simple, additionné au chloramphénicol et additionné au chloramphénicol et à la cycloheximide) et la réalisation d'un auxanogramme (kit AuxaColorTM 2) pour l'identification biochimique des levures isolées. Un cas d'infection urinaire à S. cerevisiae a été diagnostiqué en 2015 et 2 cas en 2016. Les trois patientes étaient de sexe féminin. L'âge était compris entre 5 et 40 ans (moyenne d'âge de 26,33 ans). Deux patientes étaient suivies pour diabète sucré, une de type 2 et une de type 1. Une patiente était suivie pour un neuroblastome surrénalien opéré et sous chimiothérapie. Deux patientes, dont l'une était fébrile, ont présenté des signes urinaires à type de brûlures mictionnelles associées à une pollakiurie.

Views of students on qualities expected of their lecturers: a case study of the University of Medical Sciences, Ondo city, Nigeria

Wilfred Aghahekokhian Iguodala — 2020-03-03

Although the assessment of teachers by students has been introduced into tertiary educational development in Nigeria, very limited information exists on students' expectations of their teachers. We investigated this component among a cohort of newly admitted students at the University of Medical Sciences in Ondo State, South-West Nigeria. This was a descriptive quantitative study consisting of a community-interactive session with students at the 100 and 200 levels of the University. Three hundred (300) students participated in the session. We first explained the purpose of the study. Thereafter, the students individually completed a semi-structured questionnaire that elicited information on their views on the qualities they expected of their lecturers. The results were analyzed quantitatively with SPSS version 21. Of the 300 students, 204 (64.0%) completed the questionnaire. Friendliness and congeniality (46.1%), good classroom management (38.7%), good sense of humor (36.3%), good communication skills (33.3%) and expertise (32.8%) were the five most desirable qualities of good lecturers listed by the students. By contrast, the five qualities which rated lowest in the assessment were equity (4.4%), mentoring capacity (4.9%), enthusiasm (6.9%), encouraging students to succeed (7.8%) and approachability (8.3%). We conclude that students at the University of Medical Sciences look out for personal social relationships with their teachers during curricular delivery. We recommend that approaches to address these concerns should be incorporated into the design of training programs for teachers and in protocols for students' evaluation of teachers in this university and others in similar circumstances.

Description d´un nouveau foyer épidémique de leishmaniose cutanée à Leishmania major à l´Ouest du Burkina Faso

Issouf Konate — 2020-03-06

Introduction: au Burkina Faso, le seul foyer de leishmaniose cutanée (LC) avec confirmation biologique dans la littérature à notre connaissance est celui de Ouagadougou au centre. Nous rapportons les résultats épidémiologiques, cliniques et biologiques de l’investigation d’un nouveau foyer épidémique à Larama, à l’ouest du Burkina.

Méthodes: la méthode du camp a été utilisée pour recevoir les cas. Les données sociodémographiques et cliniques ont été recueillies à l'aide d'un questionnaire. La confirmation a été faite par la microscopie puis par réaction en chaîne par polymérase (PCR).

Résultats: au total, 108 cas suspects ont été recensés à Larama, soit un taux d’attaque de 5,8%. Le sex ratio était de 1,08. Les patients concernés étaient le plus souvent des cultivateurs (35,2%) et des commerçants (33,3%). La population active (15 à 49 ans) représentait 51,9%. Le nombre de lésion variait entre 1 et 5 dans 91,7% des cas. Les lésions qui se présentaient sous formes ulcéro-crouteuses surélevées et infiltrées, étaient localisées sur les membres (87%) avec une durée d’évolution entre un et cinq mois dans 96,3% des cas. Sur les deux cas prélevés, la microscopie a montré des leishmanies et la PCR a confirmé l’espèce Leishmania major.

Conclusion: nos résultats confirment l'existence d'une épidémie de leishmaniose cutanée à L. major dans l'ouest du pays. Des enquêtes complémentaires sont nécessaires pour préciser la charge de morbidité des leishmanioses au Burkina Faso.

Une épine végétale méconnue simulant une tumeur osseuse de la main chez l´enfant

Mohammed Tazi Charki — 2019-02-06

Les corps étrangers (CE) au sein des tissus mous sont fréquents chez les enfants, en particulier au niveau des mains. Elles sont souvent méconnues ou difficile à diagnostiquer, d'autant plus qu'il s'agit d'un CE d'origine organique, induisant des granulomes avec des lésions ostéolytiques et/ou des réactions périostées qui peuvent simuler des lésions d'origine infectieuse ou tumorale. Nous illustrons cette éventualité diagnostique par le cas d'un enfant admis pour une tumeur de main avec une réaction périostée chez qui l'exploration chirurgicale a trouvé une épine végétale. Il s'agit d'un nourrisson de 18 mois, sans antécédents pathologiques notables, admis aux urgences pour une tuméfaction du dos de la main évoluant depuis trois semaines avant son admission, sans notion de traumatisme. L'examen clinique avait mis en évidence une tuméfaction du dos de la main droite en regard du deuxième métacarpien faisant 1,5 cm de diamètre, dure, indolore, sans signes inflammatoires en regard (Panel A). La radiographie standard de la main a montré une réaction périostée type éperon de Codmann en regard du bord externe de la diaphyse du deuxième métacarpien, avec une deuxième opacité linéaire en regard de la métaphyse (Panel B). Le bilan biologique était normal. Le diagnostic d'une tumeur osseuse a été suspecté. Une incision limitée pour biopsie a été réalisée. L'exploration a objectivé une épine végétale juxta-osseuse (Panel C) avec périoste décollé et une collection sous-périostée faite d'un liquide louche. Une biopsie osseuse a été réalisée. L'étude cytobactériologique du liquide était négative. L'examen anatomopathologique avait trouvé un tissu fibreux lâche comportant des fibroblastes, avec des travées osseuses sans signes de malignité. L'enfant a été mis sous antibiothérapie par voie orale, avec bonne évolution clinique et radiologique.

Human papillomavirus genotype profiles and cytological grades interlinkages in coinfection with HIV

Lucy Wanja Karani — 2020-03-10

Introduction: the study aimed to examine and characterize human papilloma virus (HPV) cytological grade trends and genotypes among HPV/HIV co-infected/cases and HPV monoinfected/control women attending Kisii teaching and referral hospital, Kenya.

Methods: HIV positive co-infected with HPV (HPV/HIV) and HIV negative women monoinfected with HPV profiled as co-infected/cases and monoinfected/control arms respectively were enrolled. HPV subtypes were assayed by Xpert^® HPV system (GXHPV-CE-10) alongside pathological cytology analysis of cervical tissue samples.

Results: low grade intraepithelial lesion (LSIL) was the most predominant cytological grade across cases and controls with a prevalence of 32 (38.1%) while high grade squamous intraepithelial lesion (HSIL) was highest among HPV/HIV co-infected with a prevalence of 23 (27.38%). Among the monoinfected (controls) the predominant lesion was low grade intraepithelial lesions (LSIL) with a prevalence of 23 (27.38%). HPV type 16 had the highest prevalence 26 (30.8%) among the VIA positive women in the overall study participants followed by combinations of HPV types (16, 18/45) at 19 (22.6%).

Conclusion: high risk HPV types 16 and 18/45 were the most predominant in the established cytological grades and among the co-infected women. Routine screening using both cytological and HPV testing should be embraced and/or reinforced as early screening and preventive strategies in the covered geographical region population. Provision of the currently available vaccines to these women at an early age would provide effective protection since the HPV type profiles in this population are covered by such vaccines.

Efficacy of artemether-lumefantrine and artesunate-amodiaquine as first line therapy of uncomplicated malaria in Burkina Faso, 11 years after policy change

Issaka Zongo — 2020-03-10

Introduction: artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) are the first line therapy of uncomplicated malaria in Burkina Faso. We assessed the treatment efficacy, tolerability of these drugs 11 years following its adoption as first line treatment.

Methods: in this opened randomized controlled trial carried out in 2016, participants with age over 6 months who consented to participate were randomly assigned treatment with artemether-lumefantrine or artesunate-amodiaquine and followed up for 28 days. Primary endpoint was the treatment efficacy over 28 days of follow up unadjusted by Polymerase chain reaction (PCR).

Results: two hundred and eighty-one (281) participants were enrolled and the completion rate was 92.9%. No early treatment failure was found. Adequate clinical and parasitological responses were significantly higher in artesunate-amodiaquine group (97% versus 85.2%, p = 0.0008). On day 28, the risk of failure was 4 times higher in AL group 20.14%, 95% CI (13-30.47) against 5.16%, 95% CI (1.91-13.54) in ASAQ group. All treatments had a similar and good tolerability profile.

Conclusion: eleven years following artemether-lumefantrine and artesunate-amodiaquine adoption as first line therapy for uncomplicated malaria in Burkina Faso, artemether-lumefantrine retained fairly good efficacy even though its efficacy fell below WHO threshold of 90% considering uncorrected outcome.

The human parvovirus B19/human immunodeficiency virus co-infection in healthy eligible voluntary blood donors at the blood transfusion national center in Kinshasa

Chabo Byaene Alain — 2020-03-10

Introduction: parvovirus B19 (PVB19) is one of several viruses transmissible by blood transfusion. Levels of exposure to PVB19 among HIV-infected voluntary blood donors are comparable to those among HIV-negative controls because, in blood donors, the PVB19 infection is transmitted mainly via the respiratory route. Thus, we hypothesize that the seroprevalence of PVB19 in HIV-positive blood donors is equal to the seroprevalence of PVB19 in HIV-negative blood donors. The objective of this study was to compare the seroprevalence of PVB19 between asymptomatic HIV-positive and HIV-negative blood donors.

Methods: a random sample of 360 eligible blood donors were firstly examined for HIV antibodies by using ELISA automaton and so were categorized as HIV-positive donors and HIV-negative donors. Then the two categories of donors were examined for PVB19 IgG and IgM by using ELISA kits. The seroprevalence of PVB19 in HIV-positive donors was compared to that of HIV-negative donors by using chi-square test or Fisher's exact test. All statistical analyzes were performed with SPSS 21.

Results: the prevalences of PVB19 IgG and IgM in HIV-positive blood donors were 92.1% (35 of 38) and 44.7% (17 of 38), respectively and those in control group were 89.1% (287 of 322) and 46.3% (149 of 322), respectively. But for both IgG and IgM the difference was not statistically significant (p > 0.05).

Conclusion: this research confirms our hypothesis: the seroprevalence of PVB19 in HIV-positive blood donors is equal to the seroprevalence of PVB19 in HIV-negative blood donors.

Assessment of quality and readability of internet-based health information related to commonly prescribed angiotensin receptor blockers

Anuoluwapo Oloidi — 2020-03-11

Introduction: hypertension is a global public health burden. Angiotensin receptor blockers (ARBs) have proven efficacy in the management of hypertension and related complications. The Internet has become a major source of health information for patients and healthcare professionals. The study aimed to assess the quality and readability of internet-based information related to selected Angiotensin Receptor Blockers (ARBs).

Methods: the three most widely used ARBs were identified from published literature, after which internet-based patient information was identified from the first five pages of three search engines (Google, Yahoo and Bing). Quality of identified websites were assessed using the DISCERN instrument, while readability was evaluated using the SMOG instrument and the Flesch Kincaid readability algorithm. Final ratings were then calculated as described by the instruments developers. Further, inter-class correlation coefficients (ICC) were calculated using the Statistical Package for Social Sciences.

Results: the average overall DISCERN score in this study was 2.99 (SD±1.05). No website received an excellent rating, 15% were rated good, 66% as moderate and 19% as poor. The inter-class reliability for losartan was 0.804 and 0.695 for valsartan. The mean Flesch Reading Ease score for the websites was 48.87 (SD±16.12), mean Flesch Kincaid Reading Grade Level was 9.29 (SD±1.98) while mean SMOG value was 11.29 (SD±1.70).

Conclusion: overall, patient information on the reviewed ARBs websites was found to be of moderate quality and suboptimal readability. Content providers on websites should ensure that health information is of favorable quality and easy to read by patients with varying degree of health literacy.

Awareness of pregnancy induced hypertension among pregnant women in Tigray Regional State, Ethiopia

Abadi Kidanemariam Berhe — 2020-03-11

Introduction: pregnancy-induced hypertension is among the leading cause of maternal mortality in Tigray regional state, Ethiopia. However, there was no study in this study area about awareness of pregnancy induced hypertension among pregnant women. Therefore the aim of this study was to assess awareness of pregnancy induced hypertension among pregnant women.

Methods: a cross-sectional study design was conducted on a total of 798 pregnant women attending antenatal care in general hospitals of Tigray Regional State. Data were collected from February to November 30, 2018. Binary logistic regression analysis was used to determine factors associated with poor awareness and p-values < 0.05 was considered as statistically significant.

Results: a total of 792 pregnant women were included in this study with a response rate of 99.2%. In this study, 41.8% of pregnant women were having poor awareness of pregnancy-induced hypertension. Primigravida, women with no formal education, women with the lowest wealth status and occupation of a housewife were significantly associated with poor awareness. Additionally, there was a significant difference in the mean score of awareness of pregnancy-induced hypertension between normotensive women and women with pregnancy-induced hypertension (Mean score difference (95% CI) = 1.90(1.35, 2.45), t = 6.75, df = 790, p < 0.001)).

Conclusion: a high proportion of pregnant women had poor awareness on pregnancy-induced hypertension. Health care providers should improve awareness of pregnant women about pregnancy-induced hypertension in antenatal care clinics and at a community level with a special focus of awareness on primigravida women, women with no formal education, women with lowest wealth status and housewives.

Métastase cutanée d´un carcinome indifférencié du cavum: à propos d´un cas

Fadila Kouhen — 2020-03-13

Les métastases cutanées du carcinome indifférencié du cavum représentent une entité clinique rare, de pronostic défavorable. Nous rapportons à travers cette observation le cas d'un jeune patient de 16 ans qui présente 6 mois après la fin de sa radiochimiothérapie concomitante, pour un carcinome indifférencié du cavum, une métastase cutanée unique au niveau du scalp avec une évolution rapide et le patient est décédé un mois après le diagnostic de la métastase. Vu son pronostic sombre, le diagnostic de métastases cutanées doit toujours être évoqué devant des lésions cutanées chez les patients ayant un antécédent de cancer.

Mobilisation communautaire pour l´amélioration de la surveillance de la grossesse en milieu rural au Maroc

Majda Sebbani — 2020-02-16

Introduction: l'amélioration de la santé maternelle est une priorité de santé pour de nombreux pays en développement. L'objectif était de décrire l'apport d'un projet à base communautaire dans l'amélioration du suivi de la grossesse d'une commune rurale vulnérable du Haut Atlas marocain.

Méthodes: il s'agissait d'une recherche action intégrant une démarche de mobilisation communautaire menée en 2014. Le projet impliquant plusieurs intervenants dont les acteurs sociaux, les autorités locales, les professionnels de santé et des étudiants en médecine a permis d'assurer le suivi d'une cohorte de 283 femmes enceintes. Au cours des consultations prénatales les femmes étaient interviewées, examinées et participaient à des séances d'information et d'éducation. Les enquêtrices parlant berbères étaient formées pour la collecte des données. Les analyses statistiques étaient descriptives et bivariées avec un seuil de signification de 5%.

Résultats: la moyenne de l'âge des participantes était de 27,1±6,7 ans. La majorité était analphabète, sans couverture sanitaire et sans profession. Près de 73,4% n'avaient aucun contact antérieur avec le système de soins (N = 252). Parmi 500 grossesses attendues estimées, 56,6% des femmes étaient suivies, 30,4% ont consulté deux fois et 6,7% ont effectué trois visites sur un total de 407 consultations prénatales effectuées. L'adhésion au suivi de la grossesse par la réalisation d'au moins deux consultations a été de 60,3%. La notion d'anomalie du déroulement de la grossesse était significativement liée au suivi (p = 0,04).

Conclusion: les résultats témoignent de l'intérêt de la participation communautaire dans l'approche des problèmes de santé complexes comme la santé maternelle.

Evaluation du statut vaccinal et des rappels vaccinaux chez les adolescents scolarisés à Libreville, au Gabon

Ulrick Bisvigou — 2020-03-16

Introduction: la vaccination chez l'adolescent est particulière et le statut vaccinal de ce dernier est peu connu. L'objectif de cette étude était d'apprécier ce statut vaccinal et d'identifier les facteurs associés à la compliance vaccinale chez les adolescents scolarisés à Libreville.

Méthodes: une enquête observationnelle transversale descriptive a été réalisée chez les élèves des classes de 6^edu lycée National Léon MBA de Libreville.

Résultats: au total, 304 élèves ont été inclus dans l'étude. L'âge moyen des élèves était de 11,60±1,20 ans et le sexe ratio était de 0,6. Deux cent soixante-six enfants (87,5%) vivaient avec leur géniteur direct (père et/ou mère). Le nombre moyen d'enfants par famille était de 4. Le taux de couverture vaccinale était de 78,3%. Le nombre d'enfants par famille n'était pas associée à la couverture vaccinale des vaccins du PEV (p=0,088), par contre les enfants vivant avec au moins l'un des parents avaient une meilleure couverture vaccinale respectivement par les vaccins du PEV (p=0,025) et les vaccins hors PEV (p=0,035). Les facteurs évoqués par les parents pour expliquer la non-vaccination étaient le manque d'information (30,59%), l'oubli (24,67%) et le manque de moyens financiers (12,82%).

Conclusion: la couverture vaccinale des adolescents scolarisés à Libreville semble relativement proche des objectifs du PEV, mais elle reste associée à la situation familiale. D'autres campagnes de sensibilisation seraient utiles pour améliorer cette couverture vaccinale au Gabon.

Association rare d´une tumeur ovarienne maternelle et d´une tumeur cérébrale néonatale: à propos d´un cas

Houda Rhalem — 2020-03-16

Les tumeurs cérébrales fœtales sont rares. Le tératome est le type histologique le plus fréquent. Leur évolution est souvent fatale. L'utilisation de l'échographie et de l'imagerie par résonance magnétique permet un diagnostic précoce anténatal. Cependant, le diagnostic définitif repose sur l'histologie. Les métastases placentaires sont rares et semblent compliquées plus souvent les mélanomes malins, les hémopathies, les cancers mammaires et bronchiques. Chez toute femme enceinte ayant présenté récemment un cancer, un examen anatomopathologique du placenta devrait être demandé à la recherche d'un envahissement tumoral. De même, une évaluation néonatale et un suivi pédiatrique prolongé s'imposent. La création de registres des cancers de la femme enceinte est indispensable pour mieux connaître l'épidémiologie de ces cancers ainsi que les facteurs pronostiques maternels et pédiatriques. Nous rapportons un cas de tumeur cérébrale fœtale chez une mère qui a un cancer de l'ovaire récidivant.

Pneumopéritoine spontané idiopathique: à propos d’une observation

Kpatékana Simlawo — 2020-03-16

Le pneumopéritoine résulte, dans la majorité des cas, d'une perforation du tractus gastro-intestinal dont le traitement est habituellement chirurgical.
Son caractère spontané est rare, avec dans ce cas, une présentation inhabituelle qui met le chirurgien devant un dilemme diagnostic et thérapeutique.
Nous rapportons un cas de pneumopéritoine spontané chez un sujet de 77 ans ayant bien évolué sous traitement non opératoire. Nous discutons
des modalités de prise en charge de cette entité peu commune.

Plaie isolée du cholédoque post traumatique, lésion inhabituelle: à propos d´un cas

Yacoub Mohamed Sghair — 2020-03-17

La section traumatique du cholédoque est un phénomène extrêmement rare surtout lorsqu'elle est isolée. Habituellement, elle survient suite à une chirurgie des voies biliaires notamment laparoscopique. Cette lésion est souvent associée à une ou plusieurs lésions des organes de voisinage. Nous rapportons un cas de section isolée du cholédoque suite à un traumatisme abdominal chez un enfant âgé de 5 ans pris en charge dans notre service au Centre Hospitalier Mère et Enfant de Nouakchott. L'exploration radiologique n'était concluante. Une laparotomie exploratrice faite devant un tableau chirurgical a révélé une péritonite généralisée d'origine biliaire secondaire à une plaie du bas cholédoque. Le traitement d'urgence était une toilette avec une dérivation biliaire externe suivie à un mois après par une dérivation bilio-digestive. La complication la plus redoutable de section de cholédoque est la péritonite biliaire. La morbidité postopératoire précoce est de l'ordre de 20 à 30% dans la littérature alors que la mortalité est de 0 à 2%. La section traumatique isolée du cholédoque chez l'enfant est une lésion dont le tableau clinique et la conduite thérapeutique doivent être connus afin de diminuer la morbi-mortalité. La prise charge doit être multidisciplinaire impliquant le chirurgien pédiatre, le radiologue et le réanimateur anesthésiste.

Association entre le niveau d'activité physique, l'indice de masse corporelle et la masse grasse chez des jeunes scolarisés dans la Wilaya de Marrakech (Maroc)

Abdelmoujoud El Haboussi — 2020-03-19

Introduction: l'activité physique est un bon indicateur de l'état de santé et du bien-être. Le présent travail se propose d'évaluer le niveau d'activité physique et d'étudier son association avec l'indice de masse corporelle (IMC) et la masse grasse chez des jeunes scolarisés dans la Wilaya de Marrakech.

Méthodes: un échantillon de 1173 jeunes scolarisés âgés de 15 à 20 ans a été constitué dans la ville de Marrakech (zone urbaine) et dans la province d'Al Haouz (zone rurale). Le niveau d'activité physique a été déterminé en mesurant la dépense énergétique par rapport à la dose d'activité physique recommandée. La régression logistique a été utilisée dans l'étude statistique des associations.

Résultats: quarante et un virgule un pourcent (41,1%) des enquêtés sont actifs pendant trois heures et plus par semaine, 31,1% pratiquant moins de trois heures par semaine, tandis que 27,3% (41,1% des filles contre 14,2% des garçons; p < 0,001) ne pratiquent aucune activité sportive de loisir en dehors de l'école. Les garçons sont plus actifs par rapport aux filles (OR = 3,16; p < 0,001). Les élèves ruraux sont plus actifs par rapport aux citadins (OR = 1,9; p < 0,001). Chez les filles, en passant du niveau «Sédentaire» au niveau «Très Actif», les moyennes de l'IMC et de la masse grasse ont diminué, respectivement, de 1,9 kg/m² (F = 8,03; p < 0,001) et de 6,28% (F = 15,80; p < 0,001). Chez les garçons, la diminution était de 0,85 kg/m² (F = 1,17; p = 0,17) pour l'IMC, et de 2,77% (F = 5,15; p = 0,006) pour la masse grasse.

Conclusion: l'activité physique est significativement associée à la masse grasse et à l'IMC. Promouvoir l'activité physique des jeunes, dans leurs activités quotidiennes ainsi que pendant leurs loisirs, reste une première nécessité pour faire face aux effets néfastes d'un mode de vie sédentaire sur leur santé.

Proximal subungual onychomycosis of digitus minimus due to Aspergillus brasiliensis

Manjula Mehta — 2020-03-19

Onychomycosis is a common nail infection caused by dermatophytes, non-dermatophytic molds (NDMs) and yeast. Aspergillus spp. are emerging etiological agents of non-dermatophyte mold onychomycosis (NDMO). Though this is usually of cosmetic concern, it may also cause pain and discomfort to the patient. The toenail is more commonly involved as compared to fingernail. The nails are discoloured and disfigured. Onychomycosis may expose the patient to cellulitis of lower extremities. The clinical presentation of dermatophytic and NDM onychomycosis is more or less similar, which creates problem in the diagnosis. Fingernail infection may cause social and psychological problem to the patient if fingernail is involved. Incidence of onychomycosis has been seen more in immunosuppressed individuals, where it is of more serious medical concern. In the present study we are reporting a case of proximal subungual onychomycosis (PSO) due to Aspergillus brasiliensis.

Mandatory pre-abortion counseling is a barrier to accessing safe abortion services

Luchuo Engelbert Bain — 2020-03-19

Empirical research showcases that pre-abortion counseling scarcely reverses the woman’s decision either to terminate a pregnancy or not. Growing evidence regarding the high levels of decisional certainty among women seeking abortions renders a careful rethink of the place of mandatory pre-abortion counseling packages. Mandatory counseling packages, when inscribed in the laws, at times contain false information that can deter women from going in for safe abortions. Mandatory waiting times indirectly label opting for an abortion as not being the right thing to do. In areas where abortion stigma from health care providers and communities remains highly prevalent, women are forced to incur extra expenses by travelling to other countries. I argue that pre-abortion counseling on opting-in grounds is ethically sound (enhances the woman’s reproductive autonomy), since most clients in need of abortions are certain on their decisions before the abortion care provider and do not regret these decisions after the process. Regrets are prone to be more prevalent in areas with high unsafe abortion practices, generally due to complications from excessive bleeding, pain, and post abortion infections. Allowing systematic mandatory pre-abortion counseling practice as the rule in a competent adult is unjustified ethically and empirically, is time consuming and presents the legality of abortions in most settings an oxymoron.

Clinical predictors of significant intracranial computed tomography scan findings in adults experiencing headache disorder

Ulrich Igor Mbessoh Kengne — 2020-03-19

Introduction: radiological assessments for adult headache disorder show significant intracranial findings in 2.5% to 10% of performed computed tomography scans (CT-scans), leading to an overuse consideration for CT-scan requests by physicians in headache-experiencing patients. Therefore, we undertook this study in order to determine predictors of significant intracranial CT-scan findings in adults experiencing headache disorder; in order to help physicians better select patients who need imaging, which would subsequently decrease the costs of headache disorder management and the useless irradiation rates.

Methods: we carried out a cross-sectional study in the medical imaging departments of Yaounde Central Hospital and Douala Laquintinie Hospital, which are two teaching hospitals in Cameroon, over a period of five months. We consecutively and non-exhaustively included all consenting patients aged eighteen years and above, referred to the radiology department to perform a head CT-scan as aetiological workup of headache disorder, from either a traumatic or non-traumatic mechanism. Patients having a known brain lesion and those with a Glasgow coma scale less than thirteen were excluded. The clinical history of patients was taken and a complete physical examination was performed. Demographic data, clinical characteristics of the headache, results of neurological and physical examinations were collected and correlated to the results of head CT-scan.

Results: we enrolled 169 patients in the study, 56.2% were males, with a sex ratio of 1.3; sudden onset of headache increased by two the risk of discovering significant intracranial pathology (p = 0.032). Occipital and cervical location of headache, headache evolving by crisis, and recurrent paroxysmal headache were rather significantly correlated to no structural brain finding. An abnormal neurological examination with specifically abnormal stretch reflexes, aphasia, loss of consciousness, raised intracranial signs, weakness, and meningeal signs were predictive of structural intracranial pathology. Otorrhagia, epistaxis, and periorbital ecchymosis in addition were predictive in post-traumatic headaches.

Conclusion: abnormal results from neurological examination are the best clinical parameters to predict structural intracranial pathology on CT-scan in adult patients experiencing headache disorder. In case of post-traumatic headaches, in addition, otorrhagia, epistaxis, and periorbital ecchymosis are too highly predictive.

Endométriose cervicale: à propos d´un cas

Saad Benali — 2020-03-19

This study reports the case of a 46-year old multiparous patient with no particular past medical history, who had given birth vaginally twice, presenting with abnormal isolated inter-menstrual bleeding with well-defined bluish cyst at the level of the anterior labia of the cervix, measuring 4mm in diameter on speculum examination. Pelvic ultrasound showed adenomyosis. A biopsy of the lesion was performed, which showed dark brown chocolate colour liquid. Histological study objectified endometrium embedded under the epithelium, suggesting endometriosis of the uterine cervix. Endometriosis of the uterine cervix can involve the endocervix and the ectocervix. Primary endometriosis of the uterine cervix can develop in the cervix while secondary endometriosis can result from neighboring endometriosis. Trauma is the main cause of these lesions. The de-epithelialization caused by trauma would allow for endometrial transplantation during menstruation. Endometriosis of the uterine cervix is usually asymptomatic. It is usually discovered during a careful systematic examination of the uterine cervix. Rarely, it manifests as minimal, spontaneous metrorrhagias in the premenstrual period. Sometimes, metrorrhagias occur during menstruations and are persistent or are caused by sexual intercourses. Isolated endometriosis of the uterine cervix never causes pain. The treatment of this benign condition is based on the destruction or removal of the endometriosis foci. Diathermocoagulation is the most used procedure.

Oxaliplatin-induced peripheral neuropathy risk factors and management in Tunisian population

Aref Zribi — 2020-03-19

The most important limits of oxaliplatin treatment is its peripheral neurotoxicity. The aim of our study was to evaluate the oxaliplatin-induced peripheral neuropathy, its impact on treatment and its management. One hundred chemo-naive patients treated with oxaliplatin-based regimen in the medical oncology department of the military hospital of Tunis between 2012 and 2017 were recruited retrospectively. Evaluation of neuropathy was done according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE V4). Fifty-six patients were aged more than 60 years. The sex-ratio was 1.56. Twenty-seven patients were overweight, 17 were obese and 56 had a BMI inferior to 25 kg/m². Two patients were consuming alcohol. Twenty-three patients had diabetes. Sixty-four patients developed chronic peripheral neuropathy because of oxaliplatin (grade 1-2 in 58 cases and grade 3 in 6 cases). Sex, BMI, diabetes and alcohol consumption were not associated with the development of peripheral neuropathy. No association was found between grades of neuropathy and sex, alcohol consumption and diabetes. The median cumulative dose of oxaliplatin that induced neuropathy was 432.4 mg/m². The most prescribed treatment was gabapentin (81%) and carbamazepine (16.8%). The treatment was not sufficient to stop neuropathy in 82.6% of cases. Dose reduction was done in 64.2% of cases, treatment delay in 10.7% of cases and treatment interruption in 10.7% of cases. We didn't find any association between known risk factors and peripheral neuropathy. The cumulative dose is interesting to define or to predict the timing of neurotoxicity.

Measles outbreak in 2018-2019, Madagascar: epidemiology and public health implications

Marcellin Mengouo Nimpa — 2020-03-19

Introduction: in October 4^th, 2018, a measles outbreak was declared in Madagascar. This study describes the epidemiology of the outbreak and determines public health implications for measles elimination in Madagascar.

Methods: data have been collected using line list developed for the outbreak. Serum samples were collected within 30 days of rash onset for laboratory testing; confirmation was made by detection of measles immunoglobulin M (IgM) antibody.

Results: a total of 2,930 samples were analysed in the laboratory among which 1,086 (37%) were laboratory confirmed. Measles cases age ranged from a minimum of 1 month to a maximum of 88 years. The median and the mean were 7 years and 9 years respectively. Children between 1 to 9 years accounted for 50.6% of measles cases. Attack rate (39,014 per 1,000,000 inhabitants) and case fatality rate (1.2%) were highest among children aged 9-11 months. A total of 67.2% cases were unvaccinated. As of March 14^th, 2019, all the 22 regions and 105 (92%) health districts out of 114 were affected by the measles outbreak in Madagascar.

Conclusion: measles outbreak in Madagascar showed that the country is not on the track to achieve the goal of measles elimination by 2020.

Nijmegen breakage syndrome: case report and review of literature

Brahim El Hasbaoui — 2020-03-20

Nijmegen Breakage Syndrome (NBS) is a rare autosomalrecessive DNA repair disorder characterized by genomic instability andincreased risk of haematopoietic malignancies observed in morethan 40% of the patients by the time they are 20 years old. The underlying gene, NBS1, is located on human chromosome 8q21 and codes for a protein product termed nibrin, Nbs1 or p95. Over 90% of patients are homozygous for a founder mutation: a deletion of five base pairs which leads to a frame shift and protein truncation. Nibrin (NBN) plays an important role in the DNA damage response (DDR) and DNA repair. DDR is a crucial signalling pathway in apoptosis and senescence. Cardinal symptoms of Nijmegen breakage syndrome are characteristic: microcephaly, present at birth and progressive with age, dysmorphic facial features, mild growth retardation, mild-to-moderate intellectual disability, and, in females, hypergonadotropic hypogonadism. Combined cellular and humoral immunodeficiency with recurrent sino-pulmonary infections, a strong predisposition to develop malignancies (predominantly of lymphoid origin) and radiosensitivity are other integral manifestations of the syndrome. The diagnosis of NBS is initially based on clinical manifestations and is confirmed by genetic analysis. Prenatal molecular genetic diagnosis is possible if disease-causing mutations in both alleles of the NBN gene are known. No specific therapy is available for NBS; however, hematopoietic stem cell transplantation may be one option for some patients. Prognosis is generally poor due to the extremely high rate of malignancies. We present here a case of Nijmegen breakage syndrome associated with Hodgkin lymphomas and Combined variable immunodeficiency.

Giant anal condyloma

George Kirkilessis — 2020-03-24

A 61 years old male patient presented to the Accident and Emergency (AE) Department reporting bleeding during defecation, difficulty and low pain while walking and sitting. On physical examination we saw an exophytic cauliflower like, ulcerated tumor mass measuring 20 x 14 cm that covered the whole perineum and a similar satellite lesion 3 x 4 cm, with malodorousness. The mass was there for at least three years, progressively growing.

Assessment of minor psychiatric morbidity, stressors, and barriers of seeking help among medical students at the University of Khartoum, Khartoum, Sudan

Muwada Bashir Awad Bashir — 2020-03-24

Introduction: medical education can be stressful and a source of psychiatric morbidity for medical students with the potential of causing serious professional and personal negative consequences. With the limited studies investigating this issue in Sudan, this study aimed at assessing psychiatric morbidity, determine stressors, evaluate mental health care seeking behavior and barriers to seeking help among medical students in Khartoum, Sudan.

Methods: this was a cross-sectional study with data collection for a period of one month, during the survey. Following ethical clearance and administrative approval, 644 students who gave consent were selected randomly from the university of Khartoum’s faculty of medicine. The “12-General Health Questionnaire (GHQ12)” was used as a tool to assess prevalence of psychiatric morbidity, determine stressors and evaluate barriers to seeking mental health care among students for a period of a month.

Results: the overall prevalence of psychiatric morbidity was 56% (n = 356). The mean score of the GHQ12 was 6.7. There was a statistically significant association between GHQ12-score and level of study (in medical school), age, student’s income (student financial allowance). Stressors mostly experienced by students were fear of academic failure, dissatisfaction with academic performance and examination stress. The most frequent barriers to seeking mental health care elicited by participants were fear of stigmatization 63% (n = 401), preference for dealing with the problem alone 60% (n = 379), fear of the unknown 59% (n = 365) and failure to recognize symptoms 58% (n = 366).

Conclusion: psychiatric morbidity is commonly experienced by students in medical school as can be seen from the high prevalence (56%). The reported high figures of psychiatric morbidity among medical school students points to the urgency for interventions to address this problem with potential for negative sequelae (personal and professional). Our findings suggest that interventions to improve the social and economic conditions of students in medical school as well as addressing stigma related to mental health and educating students to recognize signs and symptoms of psychiatric morbidity while making help accessible might go a long way to address this challenge.

Field notes from the Nigeria Centre for Disease Control 2019 pilot internship program for resident doctors

Oluwatomi Funbi Iken — 2020-03-25

The 10-week internship for the pilot cohort of resident doctors from various teaching hospitals in Nigeria was a very rewarding experience. The internship was a beautiful immersion into field epidemiology, rumor surveillance, risk communication, digital tools for surveillance, developing strategic documents, line lists interpretation, weekly presentations and outbreak response coordination alongside working briefly as an incident manager for the Yellow Fever technical working group. Some of the learning points included: meeting coordination, contributions to ongoing research, review of training documents for surveillance officers and the mechanisms of escalating and de-escalating technical working groups in the face of outbreaks and working as an incident manager. There is the need to continue this internship to strengthen the capacity of our emerging health workforce in residency training to address our public health priorities in Nigeria.

Transition nutritionnelle, prévalence de la double charge de la malnutrition et facteurs de risque cardiovasculaires chez les adultes de l'île comorienne d'Anjouan

Rachmat Attoumane Ben Ali — 2020-03-25

Introduction: le surpoids et de l'obésité progressent de manière effrayante, notamment dans les pays en développement. Cette étude vise à déterminer la prévalence de l'insuffisance et de la surcharge pondérale et à évaluer la relation entre l'indice de masse corporelle et les facteurs de risque cardiovasculaires associés chez les adultes de l'île d'Anjouan.

Méthodes: l'enquête est une étude transversale, où un échantillon de 902 individus âgés de 25 à 64 ans est sélectionné en utilisant la méthode de sondage empirique « des quotas ». Le statut nutritionnel est déterminé en calculant l'indice de masse corporelle (IMC), le périmètre abdominal et le rapport tour de taille/tour de hanche (RTH). La pression artérielle, le périmètre abdominal et le tour de hanche ont été mesurés pendant l'interview tandis que la glycémie capillaire à jeun a été mesurée le lendemain.

Résultats: les résultats ressortis font état d'une moyenne d'âge de 39,5 ± 11,67 ans. La prévalence globale de l'insuffisance pondérale, du surpoids et de l'obésité est respectivement de 4,1%, 28,6% et 22,2%. Les facteurs de risque associés au surpoids/obésité sont l'âge avancé (P= 0,004), le genre (P=0,000), le poids (P=0,000), le diabète (P= 0,006), l'hypertension (P= 0,01), l'obésité abdominale (P= 0,000), le tour de hanche (P=0,000), le RTH (P=0,000), la durée inactive/jour (P=0,001) et le tabagisme (P< 0,05), contrairement à l'inactivité physique (P= 0,10).

Conclusion: les résultats confirment la présence du double fardeau nutritionnel. D'où l'urgence de mettre en place des stratégies de prévention des maladies non transmissibles.

Cancer ecosystem assessment in West Africa: health systems gaps to prevent and control cancers in three countries: Ghana, Nigeria and Senegal

Omobolaji Ayandipo — 2020-03-25

Introduction: sub-Saharan Africa is experiencing a rapid epidemiological transition with the increasing incidence of Non-Communicable Diseases (NCD). Among these, cancer is one of the main causes of death in adults. This is a public health problem whose burden is unknown due to lack of statistical data. In addition, the already overburdened health systems are experiencing enormous constraints to address the problem with the double challenge of communicable and NCDs.

Methods: the purpose of this evaluation was to assess the capacity and needs of health systems to prevent and control cancer. A cross-sectional study, using both quantitative and qualitative methods, was conducted between April 2017 and February 2018 in target countries, through in-depth interviews with key actors, direct observations and documents review. The WHO framework for health system strengthening with the 6 pillars was used for the gaps analysis.

Results: little priority is given to the fight against cancer because of low political commitment. Programs´ resources are very limited and there is a poor coordination of the actions. Human resources are insufficient, and most of them are concentrated in the capital city. This limits access to care with a late consultation of patients. Diagnosis and treatment services are expensive and generally paid by households. Finally, the unavailability of reliable data at national level hinders the decision-based evidence.

Conclusion: there is an urgent need to create strong partnerships at national and regional levels to (i) Advocate for a strong political commitment; (ii) Strengthen the coordination of actions and create more synergy among stakeholders; (iii) Improve the quality and quantity of human resources; (iv) Extend universal health coverage to cancer and improve program funding; and (v) Set up cancer registries at national level.

Asthma co-morbidities in Nigerian children: prevalence, risk factors and association with disease severity and symptoms control

Bankole Peter Kuti — 2020-03-26

Introduction: prompt recognition and management of co-morbidities is an important step in ensuring optimal childhood asthma symptoms control. This study sets out to determine the prevalence, predictive factors and association of co-morbidities with asthma severity, lung functions and symptoms control in Nigerian children.

Methods: children (aged 2 to 15 years) with physician-diagnosed asthma at the Wesley Guild Hospital, Nigeria were consecutively recruited. Asthma co-morbidities, severity and levels of symptoms control were assessed using standard definitions. Lung functions of children ≥ 6 years were also measured. Factors predictive of asthma co-morbidities and association of co-morbid conditions with asthma severity, lung functions and symptoms control were determined using univariate and multivariate analyses.

Results: a total of 186 children (male: female 1.4:1) were recruited and the majority (81.0%) had mild intermittent asthma. Forty (21.5%) had suboptimal symptoms control and 112 (60.2%) had associated co-morbidities. Allergic rhinitis and/or conjunctivitis (41.4%) were the most common co-morbidities. Predictors of concomitant presence of allergic rhinitis among the children were older age group ≥ 6 years (OR = 2.488; 95%CI 1.250-4.954; p = 0.036) and lack of exclusive breastfeeding (OR = 2.688; 95%CI 1.199 -5.872; p = 0.020) while obesity/overweight (OR = 6.300; 95%CI 2.040-8.520; p = 0.003) and Allergic rhinitis (OR = 2.414; 95%CI 1.188-6.996; p = 0.049) were determinants of persistent asthma. Suboptimal symptoms control was associated with having concomitant allergic rhinitis (p = 0.018), however no comorbid condition predicted lung function impairment.

Conclusion: about two-thirds of children with asthma had co-morbidities and allergic rhino-conjunctivitis was the most common. School age group and early introduction to breast milk substitutes predict the presence of these co-morbidities which also affect asthma severity and control.

Malignant transformation of hepatocellular adenoma: report of a case

Mohamed Mouhoub — 2020-03-26

Hepatocellular adenomas are benign liver tumours that occur mainly but not exclusively in young women taking contraceptives. Their malignant transformation into hepatocellular carcinoma is a rare complication that has been rarely reported in women taking contraceptives. The purpose of our work is to remind the epidemiological and diagnostic features of malignant transformation of hepatic adenomas by reporting the case of a hepatocellular carcinoma developed from a hepatocellular adenoma diagnosed within the pathologydepartment of the Mohammed VI university hospital of Oujda.

L´impact du vieillissement démographique sur la consommation médicale: assurance maladie obligatoire au Maroc

Imane Sninate — 2020-03-27

Introduction: les régimes d'assurance maladie obligatoire des salariés des secteurs public et privé connaissent, d'une part, une croissance continue des dépenses médicales, et d'autre part, une augmentation de la part de la population couverte ayant plus de 60 ans. L'objectif de cet article est d'analyser l'impact du vieillissement sur la dépense moyenne par personne bénéficiant de la couverture médicale.

Méthodes: nous avons effectué le test de Kruskal-Wallis afin de tester si il y a une différence significative entre les populations - de différents groupes d'âge - en matière de consommation médicale selon que la personne est touchée ou non par une affection de longue durée. Ont été effectuées également des analyses d'autres indicateurs à savoir la part de la population souffrant d'une affection de longue durée et recourant aux soins, la dépense moyenne par personne touchée par une affection de longue durée et la dépense moyenne par personne couverte non touchée par une affection de longue durée aussi bien pour les personnes ayant moins de 60 ans que celles ayant plus de 60 ans.

Résultats: le test de Kruskal-Wallis a montré que l'âge est une variable explicative de la dépense moyenne par personne couverte. L'examen de l'évolution des principales composantes de la dépense moyenne a permis de mettre en évidence d'autres facteurs.

Conclusion: le vieillissement démographique contribuerait à la hausse de la consommation médicale et il existe d'autres facteurs dont l'impact sur l'augmentation des dépenses n'est pas moins important.

Road map for capacity building and development for biomedical sciences in Kenya

Bartholomew Nyangahu Ondigo — 2020-03-30

There is an effort to develop a critical mass of biomedical researchers in low middle-income countries by funding organizations and academic institutions in high-income countries. This involves providing short- and/or long-term training. Short-term training encompasses acquiring competencies in any or a combination of fieldwork, proposal/grant writing, laboratory techniques, data management, statistical approaches for data analyses and dissemination of research findings. Long-term training involves acquisition of an array of competencies that results into an award of a Master’s or PhD degree or acceptance into post-doctoral training programs. The author is motivated to write this article to create awareness on this capacity building effort and more importantly provide much needed guidance to potential graduate students considering pursuing long-term training careers in biomedical sciences and global health from Kenya.

Profile of people seeking health services during Pope Francis´ visit to Mozambique, 2019

Hélio Inácio Elias — 2020-04-01

Pope Francis visited Mozambique from September 4-6, 2019. During the visit, a real-time surveillance system for mass gathering events was implemented in all places where people gathered in Maputo City for early detection of possible outbreaks and other health-related events. The system was implemented at four sites were mass gathering events occurred over the three-day visit. Data were collected by administering a simple questionnaire on a tablet, which collected information about sociodemographics, syndromic diagnoses, and outcomes of the patients that sought medical care. Additionally, a descriptive epidemiological assessment was performed during the event. A total of 150 individuals were attended at the designated places during the event. Of these, 56.7% were female and 90.7% aged > 15 years. The majority of the patients (74.7%) sought care on the third day of the event, which was held at the Zimpeto National Stadium. The most common diagnoses were hypertension (20.7%), hypothermia (15.3%), and headache (11.3%). Almost all cases (95.0%) were discharged, (4.0%) cases were transferred and (1.0%) case resulted in death on the way to the health facility. The surveillance system strategy developed to detect real-time public health events during the Pope?s visit was successfully implemented. No outbreak was identified during the event.

Foreign bodies ingestion

Danilo Coco — 2020-04-01

Foreign body ingestion (FB) obstruction or impaction depend on the physical properties of the object, including size, shape and composition. Foreign body ingestion and food bolus impaction occur commonly. The majority of ingested foreign bodies will pass spontaneously. Pre-endoscopic series have shown that 80% or more of foreign objects will likely pass without the need for intervention. A 40-year-old Caucasian man was admitted to Emergency Room of our institution for acute abdominal pain. His past medical history was negative for previous gastrointestinal disease or surgery. He was on medical therapy for schizophrenia. He not referred any acute abdominal pain saying he has eaten a number of foreign object 6 hours before to admission. His abdominal physical examination was unremarkable. White blood tests were in normal range. Body temperature was 36.2^oC. Chest X-ray was normal. Abdominal X-ray not showed free subdiaphragmatic air but but showed five thin foreign bodies like a pins and a key in right iliac fossa. The patient was referred to gastrointestinal unit only to be observed. At the 6-day follow-up, the patient was in good clinical condition, blood tests were normal, and bowel function was recovered.

Surgical wound infection caused by a multi drug resistant Streptococcus pneumoniae serotype 19A after a total coloproctectomy with ileostomy

Nzoyikorera Néhémie — 2020-04-06

Streptococcus pneumoniae (S. pneumoniae) colonizes asymptomatically the human nasopharynx. This pathogen is responsible for sinusitis, otitis media, pneumonia, bacteremia and meningitis. We report the case of a 35-year-old female patient who developed a surgical wound infection by a multi drug resistant S. pneumoniae serotype 19A after a total coloprotectomy. This first found in Morocco shows the implication of multidrug resistant S. pneumoniae in surgical wound infections.

Safe abortion services for adolescents in Ghana

Luchuo Engelbert Bain — 2020-04-06

Ghana has one of the most liberal abortion laws in sub-Saharan Africa. The Ghanaian abortion law of 1985 permits abortion in cases of rape, incest or the defilement of a female idiot if the life or health of the woman is in danger; or if there is risk of fetal abnormality. A woman is also legally allowed to obtain an abortion for mental reasons [1]. However, a diagnosis from a psychiatrist is not a mandatory requirement. The challenges in accessing safe abortion services by adolescents are different from those faced by adults. The law, as well as the Ghana Health Service Reproductive Health Strategy, does not provide specific guidance regarding access to safe abortion care for adolescents. Five main areas need special attention as far as improving adolescent access to safe abortion services in Ghana is concerned: (1) Rendering safe abortion fees uniform and affordable in facilities that offer safe abortion care; (2) Establishment of explicit context specific guidelines to fight against stigma among abortion seekers and providers; (3) Training of health care providers in respectful and non-judgmental counseling policies when caring for pregnant adolescents; (4) Expanding the availability and affordability of Long Acting Reversible Contraceptives (LARCs) in health care facilities; (5) Inclusion of clear policies on how to deal with conscientious objection in health facilities.

The Pan African Medical Journal in 2019 - a year in review

Raoul Kamadjeu — 2020-04-06

Since its inception in 2008, the Pan African Medical Journal (PAMJ) enjoyed an exponential growth, not only in the number and geographical diversity of submissions received, but also in the range of services offered to researchers and professionals across the broad spectrum of biomedical and public health sciences. PAMJ in 2019 is: 2705 manuscripts submitted, a cumulative number of 13874 authors from 85 countries, 994 manuscripts accepted for publication and 774 articles published. The PAMJ in 2019 is also an editorial board of 15 and 46 dedicated reviewers to whom we extend our sincere appreciation.

Mutuelles de santé à Bukavu en République Démocratique du Congo: facteurs favorables à l’utilisation des services de santé par des adhérents

Justine Bashi — 2020-04-07

Introduction: la présente étude s'intéresse aux déterminants de l'utilisation des services de santé par des adhérents aux trois mutuelles de santé dans la ville de Bukavu en République Démocratique du Congo.

Méthodes: l'étude, de type descriptif transversal, est une enquête de perception menée auprès des utilisateurs des services de santé affiliés aux mutuelles de santé dans les zones de santé de Bukavu. L'encodage et l'analyse statistique ont été réalisés avec le logiciel Epi Info version 2010.

Résultats: les principaux déterminants de l'utilisation des services de santé par des adhérents aux mutuelles de santé sont: le lieu de résidence de l'adhérent, le niveau d'instruction du responsable du ménage, l'expérience antérieure des soins dans la structure sanitaire partenaire de la mutuelle de santé, la réputation de la structure partenaire des mutuelles de santé et la capacité des ménages à payer le ticket modérateur.

Conclusion: la présente étude révèle, qu'au-delà de la barrière financière, le développement d'une mutuelle de santé devrait permettre de promouvoir une meilleure régulation du ticket modérateur et une bonne qualité des soins pour satisfaire les besoins en soins de ses adhérents. Les facteurs qui ressortent de l'étude en tant que principaux déterminants de l'utilisation des services de santé des adhérents à une mutuelle de santé ne sont pas souvent pris en compte lors de l'implantation des mutuelles de santé dans des contextes similaires à ceux de Bukavu.

Lipome du corps calleux révélé par une crise convulsive: à propos d’un cas

Francois Kouda — 2020-04-07

Le lipome du corps calleux est une lésion congénitale bénigne très rare, qui peut être isolée ou associée à des degrés divers de dysgénésie du corps calleux. Il peut être asymptomatique ou se révélé par des signes non spécifiques tels que des crises épileptiques, des céphalées, de déficit neurologique ou de démences. L'imagerie en coupe fait le diagnostic aisément. Nous rapportons le cas d'un adolescent de 18 ans qui a présenté une crise convulsive chez qui l'imagerie a révélé un lipome du corps calleux.

Posterior short segment pedicle screw fixation for the treatment of thoracolumbar fracture

Mourad Aoui — 2020-04-07

The choice of the type of stabilization device in the osteosynthesis of dorso-lumbar spine fractures remains a subject of controversy. The present study aims to evaluate the efficiency of short segment in patients suffering post-traumatic thoracolumbar fractures. This study was conducted in the Department of Orthopedic Surgery and Traumatology of the Habib Bourguiba University Hospital, Sfax, Tunisia. All our patients had a spinal osteosynthesis via the posterior approach with a short segment pedicle screw fixation. We established a record of the pre and post-operative data, the functional results in the post-operative stage during the follow-up period and in retrospect according to the Denis Pain Scale, as well as the Oswestry score. The correction was evaluated by determining the relative gain and loss at the last period of retrospect: vertebral kyphosis, regional kyphosis, Gardner Segment Kyphotic Deformity (GSKD), and computed tomography (CT) scan in retrospect to check the quality of the arthrodesis. The average Oswestry score was 14%. Twenty-nine patients had an Oswestry score ≤40%. The relative gain obtained postoperatively was 57.3% for vertebral kyphosis, 67.2% for regional kyphosis and 71.3% for Gardner kyphosis deformity; while the loss of correction at the last follow-up was 0.6° for vertebral kyphosis, 1.5° for regional kyphosis and 0.9° for GSKD. No cases of non-union were reported. The short segment fixation makes it possible to limit operating time, the abundance of bleeding and the aggression of the soft tissues.

Étude rétrospective concernant la prise en charge chirurgicale des lombosciatiques communes dans le Département d´Orthopédie de Tataouine, Tunisie: à propos de 44 cas

Mourad Hammami — 2020-04-07

La lombosciatique commune représente un problème de santé publique par son retentissement socioprofessionnelle. Le but de notre travail est d'étudier l'indication du traitement chirurgical et la place de chaque technique utilisé. Il s'agit d'une étude rétrospective réalisée au Service d'Orthopédie de Tataouine, concernant 44 patients présentant une lombosciatique commune et ayant eu un traitement chirurgical durant la période allant de 2013 à 2018. La fiche de renseignement a inclus les données épidémiologiques et les données cliniques. Les patients ont eu un bilan radiologique comportant une radiographie du rachis lombaire face et profil et une tomodensitométrie (TDM) lombaire qui a précisé l'étiologie de la sciatalgie commune. Le traitement chirurgical a été indiqué après échec d'un traitement médical, en cas de sciatique hyperalgique et en cas de complication neurologique. Dans notre étude, la hernie discale était la principale étiologie de lombosciatique (50% des cas) suivie par le canal lombaire étroit (25%), le spondylolisthésis (22,7%) et la méga apophyse transverse de L5 (2,3%). La dissectomie classique était la technique utilisée pour la cure chirurgicale des hernies discales. Huit patients présentant un spondylolisthésis ont bénéficié d'une laminectomie associée à une arthrodèse postérieure. Pour la cure chirurgicale de canal lombaire rétréci, on a pratiqué une laminectomie seule dans 54,54% des cas. L'évolution au recul a été favorable dans 90% des cas l'échelle visuelle analogique (3±1 au recul). Le choix des techniques chirurgicaux dépend de l'étiologie et des données de l'imagerie qui imposent le choix des étages de l'arthrodèse.

Quality of age data in the Sierra Leone Ebola database

Lindsay Shively Womack — 2020-04-07

Introduction: while it is suspected that some ages were misreported during the 2014-2016 West African Ebola outbreak, an analysis examining age data quality has not been conducted. The study objective was to examine age heaping and terminal digit preference as indicators for quality of age data collected in the Sierra Leone Ebola Database (SLED).

Methods: age data quality for adult patients was analyzed within SLED for the Viral Hemorrhagic Fever (VHF) database and the laboratory testing dataset by calculating Whipple's index and Myers's blended index, stratified by sex and region.

Results: age data quality was low in both the VHF database (Whipple's index for the 5-year range, 229.2) and the laboratory testing dataset (Whipple's index for the 5-year range, 236.4). Age was reported more accurately in the Western Area and least accurately in the Eastern Province. Age data for females were less accurate than for males.

Conclusion: age data quality was low in adult patients during the 2014-2016 Ebola outbreak in Sierra Leone, which may reduce its use as an identifying or stratifying variable. These findings inform future analyses using this database and describe a phenomenon that has relevance in data collection methods and analyses for future outbreaks in developing countries.

Continuous external compression for the treatment of humeral pseudarthrosis: a single center experience

Sami Sallemi — 2020-04-08

Humeral pseudarthrosis are common with a non-union rate after fracture between 8% and 13%. Several operative methods have been described for the treatment of humeral pseudarthrosis. The aim of this study was to assess a new approach based on compression using a monoplane external fixator without graft. This study was conducted in the Department of Orthopedic Surgery, and Traumatology of Habib Bourguiba University Hospital in Sfax-Tunisia between April 2009 and September 2018. Fifty-eight patients were operated on using a dynamic monoplane axial fixation device with continuous compression by manipulating the compression system of the fixator. All the cases were evaluated according to the modified Stewart and Hundley classification. The fracture was located in the middle third in 53.4% of the cases. The pseudarthrosis was hypertrophic in 34.5% of the cases. Fifty-four patients were treated with this method as a first cure of non-union and four patients had previously a first cure for their pseudarthrosis. We noted 11 septic pseudarthrosis. The average follow-up was 47.2 months. We obtained consolidation in 98% of the cases. The average consolidation time was 5.1 months. Based on the modified Stewart and Hundley criteria, 75.8% had very good results. This study highlights that a continuous external compression is effective in the treatment of non-unions, as it allows consolidation without opening the pseudarthrosis site and without bone grafting while having satisfactory anatomical and functional results.

Relationship between serum insulin and point-of-admission blood glucose of ill neonates at a tertiary health facility in Nigeria

Emmanuel Oluwatosin Adeniji — 2020-04-08

Introduction: optimal glucose metabolism is important in neonatal survival especially in the first days of life. Insulin plays a significant role in maintaining blood glucose homeostasis. This study set out to determine the serum insulin levels of ill neonates as related to their point-of-admission blood glucose estimation at the Wesley Guild Hospital, Ilesa, Nigeria.

Methods: three hundred babies took part in the study. Blood glucose and serum insulin levels were assayed at admission using Accu-Chek Active glucometer^(R) and Accu-Ɔ-Bind ELISA Microwells^(R) respectively. Hyperglycaemia was defined as blood glucose ≥7mmol/L and hypoglycaemia as blood glucose <2.2mmol/L.

Results: The median (IQR) age of the babies was 10.0 (0.5 - 70.0) hours with male to female ratio of 1.5:1. Seventy-four (24.7%) were preterms and 35 (11.7%) were small-for-gestational age. The mean (SD) blood glucose level of the babies was 4.1(2.1) mmol/L with a range of 0.6-13.4mmol/L. Hyperglycaemia and hypoglycaemia were observed in 18(6.0%) and 40(13.3%) babies, respectively. The median (IQR) serum insulin level was 9.8(3.0-35.3) µIU/ml. There was weak positive correlation between serum insulin and blood glucose levels of the babies (r = 0.197, p = 0.001). Birth asphyxia was associated with lower serum insulin, while probable sepsis with relatively higher levels.

Conclusion: serum insulin level increases with increasing blood glucose in ill Nigerian babies at presentation to the hospital. Babies with asphyxia and sepsis particularly tend to have abnormal serum insulin at admission. Hyperinsulinaemia in ill babies may connote a compensatory mechanism to normalise abnormal blood glucose, rather than playing a significant role in its aetio-pathogenesis.

Prevalence of onchocerciasis, attitudes and practices and the treatment coverage after 15 years of mass drug administration with ivermectin in the Tombel Health District, Cameroon

Sharon Mumah Nyagang — 2020-04-08

Introduction: onchocerciasis is an infection caused by Onchocerca volvulus. It affects 37 million people, of which 99% are in Africa. This study assessed the prevalence of onchocerciasis after 15 years of mass drug administration with ivermectin.

Methods: this was a population based cross-sectional study. Questionnaires covering participants' identity and attitudes and practices of community respondents towards ivermectin were administered. The treatment coverage was obtained by review of records of mass drug administration from 1999 to 2015. The epidemiological evaluation of infection status was done by parasitological examination of skin snips and nodule palpation in individuals in five health areas of the district.

Results: a total of 400 participants were randomly selected. Of these, 56.0% were males, 62.0% single, 59.5% farmers and 98.0% Christians. Participants with good attitudes towards community directed treatment with ivermectin made up 80.5%, while 47.8% of the participants had good practice. The highest treatment coverage achieved was 88.0% in 2010 while the lowest was 57.0% in 2002. Less than 2% had microfilaria and 6.0% had nodules. There was no statistically significant difference in the prevalence of microfilaria with respect to age. There was a statistically significant difference in the distribution of nodules (χ²=73.6, p=0.001) among the different age groups. The greatest rate of infection (2.1%) was among farmers.

Conclusion: this study showed that the prevalence reduced compared to other prevalence studies in Cameroon. The study area was hypo-endemic for onchocerciasis.

Isolated schwannoma of the urinary bladder: a case report and review of the literature

Hamid Nasrollahi — 2020-04-08

The urinary bladder schwannoma is an extremely rare primary urologic tumor. Schwannoma arises from the Schwann's cells in the nerve sheaths and is almost associated with von Recklinghausen's disease. We report a case of schwannoma in a 35-year old female who presented with urinary frequency for 2 months with absence of evidence of von Recklinghausen disease and successfully treated with transurethral resection of bladder lesion (TUR_B). To the best of our knowledge, this represents only the 10^th case of benign schwannoma of the urinary bladder in a patient without von Recklinghausen disease. We report a case of an isolated schwannoma of the urinary bladder, and also searched the English literature as we had access to bladder schwannoma.

Factors associated with non-utilization of long acting and permanent contraceptive methods among married women of reproductive age in Chencha district, Southern Ethiopia: a case-control study

Andamlak Gizaw Alamdo — 2020-04-08

Introduction: in many developing countries like Ethiopia, access and the utilization of long acting and permanent contraceptive methods (LAPCMs) is very low, and it is also difficult to find them from many reproductive health programs. The aim of this study was to assess factors associated with non-utilization of long-acting and permanent contraceptive methods among married women in the reproductive age (15-49 years).

Methods: a community based unmatched case-control study was conducted in Chencha district, Southern Ethiopia from November 2015 to December 2015. Cases were those women who used contraceptive methods other than LAPCMs and women who were not using contraceptive methods. Controls were women who used LAPCMs in their lifetime. Study participants were selected by simple random sampling technique and records were reviewed and then by tracing their address, the selected samples were interviewed. We analyzed data using SPSS version 20.0 and logistic regression models to identify associated factors.

Results: we enrolled 328 women: factors such as partner's lower level of education (p = 0.003), less number of live children (p = 0.04), preference to have children in the future (p = 0.042), husband's approval to LAPCMs (p = 0.002), not informed to use contraception (p = 0.006), started using contraceptives during campaign (p = 0.021) and discussion with health professionals (p = 0.039) were predictors of non-utilization of LAPCMs.

Conclusion: non-utilization of LAPCMs in the district is associated with knowledge about LAPCMs and quality of health service. Interventions should focus on couple's knowledge, training of service providers in quality care, and the rights of clients, informed choice to contraceptive methods.

Nurses practice towards palliative care in Shire Endasilasie health facilities, Northern Ethiopia: a cross-sectional study

Teklay Zeru — 2020-04-08

Introduction: the public health strategy of the World Health Organization for palliative care is to increase access to palliative care services by integrating it with the healthcare systems. Therefore, the value of palliative care service provision by nurses who deliver the majority of care to chronical patients is an important issue. The objective of the study is assessing nurses' practice of palliative care.

Methods: a facility based cross-sectional study was carried out among 278 nurses working in governmental health facilities of Shire Endasilasie town, Tigray region, Ethiopia from February to June 2018. The questionnaire was revised based on the findings of the pre-test. The collected data was checked for its completeness, consistency, and accuracy before analysis. Data were entered and analyzed using SPSS version 22. The final result was reported using text and tables.

Results: a total of 278 nurses were included in the study and the response rate was 100%. The majority of the participants (71.9%) were females and the mean age of the respondents was 32.08 years (range from 20 to 60). Approximately two-thirds (74.8%) of the respondents had poor knowledge of palliative care practice. Half of the study participants reported emotional support gained as primary psychological support. Commonly used drugs for severe pain were paracetamol or ibuprofen 202 (72.2%) and 47.8% nurses focus on quality patient pain assess.

Conclusion: the majority of the nurses had a poor practice of palliative care.

Pronostic de la grossesse qui saigne au premier trimestre: à propos de 239 cas colligés au Centre Hospitalo-Universitaire de Kamenge, Bujumbura

Etienne Kajibwami Birindwa — 2020-04-09

L'objectif de cette étude était d'évaluer le pronostic de la grossesse qui saigne au premier trimestre à l'issue d'un épisode d'hospitalisation d'une femme en urgence à la maternité du Centre Hospitalo-Universitaire de Kamenge (CHUK) en fonction de l'âge de la patiente, de la quantité des saignements ainsi qu'en fonction des constats échographiques. Il s'agit d'une étude rétrospective descriptive et analytique menée sur 239 dossiers des patientes ayant été hospitalisées sur une période de six ans; de janvier 2012 à décembre 2017. Dans cette étude, le pronostic des grossesses avec métrorragies du premier trimestre au CHUK est mauvais; la majorité a abouti à une fausse couche précoce avec un taux de 65,7%. L'abondance des saignements, l'âge maternel inférieur à 20 ans ou bien supérieur ou égal à 35 ans, sont des facteurs de risque importants mais bien plus la découverte échographique d'un décollement trophoblastique. Il est intéressant de réaliser une étude prospective afin de déceler les étiologies de ces métrorragies et déterminer les complications tardives sur les grossesses qui se poursuivent.

Determinants to late antenatal clinic start among pregnant women: the case of Saint Elizabeth General Hospital, Shisong, Cameroon

Mbinkar Adeline Venyuy — 2020-04-10

Introduction: to improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system. The World Health Organisation (WHO) cites distance to health facility and inadequate health institutions as factors that prevent women from receiving or seeking care during pregnancy and childbirth. Specifically, we intended to determine factors associated with late start of late Antenatal Care (ANC) among pregnant women in the Saint Elizabeth General Hospital Shisong (SEGHS), Cameroon.

Methods: this was a cross sectional study carried out from the 24^th October to 24^th November 2016. A total of 602 pregnant women were recruited from ANC units of SEGHS and its satellite institutions. The outcome variable was gestational age at start of ANC (estimated by counting from last menstrual period to day of first ANC consultation) while the independent variables were individual, community and institutional factors. Data was analyzed using Epi info version 7. Chi square test was used to appreciate the influence of different variables on risk of late ANC initiation (> 14 weeks of pregnancy). The level of significance was set out at (p: < 0.05).

Results: out of the 602 pregnant women included in our study, 75% initiated ANC late (after 14 weeks of pregnancy). Factors associated with late ANC start were; age (p = 0.001), level of education (p = 0.002), marital status (p = 0.016), religion (p = 0.034), parity (p = 0.001), having a source of income (p=0.001), cost of services (p = 0.010), distance to health facility (p = 0.021) and dissatisfaction with previous ANC services (p = 0.014).

Conclusion: Cameroon is one of the countries with a high maternal mortality ratio. WHO estimated it to be 529 per 100000 live births in 2017. Prompt and adequate ANC services can improve on maternal and child outcomes of pregnancy. The results of this study suggest tackling issues related to cost of ANC services and improving geographical (distance) barrier to accessing ANC services (in addition to addressing other identified measures) may lead to an increase in pregnant women starting ANC early and thus potentially improve pregnancy outcomes.

Rapports sexuels chez les élèves de la commune de Matoto à Conakry en Guinée

Abdourahamane Diallo — 2020-04-13

Introduction: l'objectif de ce travail était d'étudier les facteurs associés à la pratique des rapports sexuels chez les élèves adolescents de la commune de Matoto à Conakry.

Méthodes: il s'agissait d'une étude transversale, descriptive et analytique étendue sur 3 mois (1^er mars - 31 mai 2018) ayant concerné les élèves âgés de 10 à 19 ans fréquentant les collèges et lycées de la commune de Matoto à Conakry.

Résultats: parmi les 500 élèves interrogés, 226 (162 filles et 64 garçons) déclarent avoir eu des rapports sexuels soit une fréquence de 45,2%. Le préservatif n'était utilisé que par 16,4% des élèves et les contraceptifs par 35,4%. La fréquence des infections sexuellement transmissibles était de 23,5%. Parmi les filles ayant eu des rapports sexuels, 32,1% ont eu au moins une grossesse et celle-ci s'est soldée par un avortement clandestin dans 30,8% des cas. Le facteur associé à la réalisation des rapports sexuels chez les adolescents était les sorties nocturnes (p = 0,000).

Conclusion: les rapports sexuels sont fréquents chez les élèves adolescents de la commune de Matoto. Le préservatif et les contraceptifs sont peu utilisés. Il ressort aussi de notre étude que les sorties nocturnes étaient le facteur le plus associé à la pratique.

Compliance with disease surveillance and notification by private health providers in South-West Nigeria

Olusesan Ayodeji Makinde — 2020-04-13

Introduction: private health facilities are important contributors to health service delivery across several low and middle income countries. In Nigeria, they make up 33% of the health facilities, account for more than 70% of healthcare spending and over 60% of healthcare contacts are estimated to take place within them However, their level of participation in the disease surveillance system has been questioned.

Methods: we conducted a cross-sectional survey of 507 private health facilities in South-West Nigeria to investigate the level of compliance with disease surveillance reporting and the factors that affect their participation.

Results: we found only 40% of the private health facilities to be complying with routine disease surveillance reporting which ranged from 17% to 60% across the six states in the region. Thirty-four percent of the private health facilities had the requisite data collection tools, 49% had designated professionals assigned to health records management and only 7% of the clinicians could properly identify the three data collection tools for disease surveillance. Some important factors such as awareness of a law on disease surveillance (OR=1.55 95% CI=1.08-2.24), availability of reporting tools (OR=13.69, 95% CI=8.85-21.62), availability of a designated health records officer (OR=3.9, 95% CI=2.68-5.73), and health records officers (OR=10.51, 95%CI=2.86-67.70) and clinicians (OR=2.49, 95% CI=1.22-5.25) with knowledge of disease surveillance system were important predictive factors to compliance with disease surveillance participation.

Conclusion: private health facilities are poorly compliant with disease surveillance in Nigeria resulting in missed opportunities for prompt identification and response to threats of infectious disease outbreaks.

Assessment of the medical expenditure of the basic health insurance in Morocco

Amal Yassine — 2020-04-14

Introduction: the health care consumption for the population insured by the Basic Health Insurance in Morocco are paid directly to the care providers for the health care or health products from the health insurance funds. The level of expenditure recorded is changing at an accelerated rate than the financial resources. The objective of this study is to evaluate the health care consumption care by the insured population under the Basic Health Insurance.

Methods: this is a cross-sectional study analysis of the economic data collected by the National Moroccan Health Insurance Agency Related to the expenditures from the health insurance fund for both public and private sectors to identify the behavior of the consumption of health care by the insured population under the Basic Health Insurance.

Results: the medical expenditure of the covered population by the basic Health Insurance in Morocco has almost doubled from 354800 to 652500 US Dollars between 2009 and 2014 with significant increase in the public sector than the private sector. The share of expenditures in the public ambulatory care sector under Basic Health Insurance is higher relative to the hospital care. Although in the private sector the share of expenditures for both types of care varies. In 2014, the drug item expenditure accounted for 33% of Health Insurance expenses for both sectors. The level of health care consumption among the population in Long-Term Illness (LTI) represents 49,29% of the total expenditure by the Health Insurance whereas its insured covered population does not exceed 2,78%.

Conclusion: controlling the medical expenditure of the health insurance requires strengthening and the development of regulatory measures that contribute to the health reforms. For chronic diseases, it is necessary to put in place prevention actions.

What about the treatment of asymptomatic forms of congenital malaria: case report and review of the literature

Salahiddine Saghir — 2020-04-14

We report in this manuscript a case of newborn baby with asymptomatic form of congenital malaria; the screening of the peripheral blood smear of the baby after a positive result in the mother allowed the diagnosis. The authors were permitted through this case to discuss the therapeutic possibility in these cases.

Une électrophorèse des protéines sériques insolite dans un contexte de cholangiocarcinome

Aboubacar Dit Tietie Bissan — 2020-04-14

L'électrophorèse des protéines sériques revêt un intérêt diagnostic certain. Nous rapportons un cas associant une électrophorèse insolite à une cholestase ictérique compliquant un cholangiocarcinome. Il s'agit d'un patient âgé de 55 ans hospitalisé pour l'exploration d'un ictère cholestatique. L'électrophorèse capillaire a montré une bis-albuminémie objectivée par l'épaississement du bas du pic de l'albumine, et un pic surnuméraire X. Une seconde électrophorèse sur Hydragel a montré la disparition des deux anomalies précitées qui est la preuve de l'origine acquise de cette bis-albuminémie et de la nature lipidique du pic X. L'étiologie la plus probable dans notre cas est la présence de substances interférentes telles que la bilirubine libre (hyperbilirubinémie), les lipides (hyperlipémie) et les acides biliaires. Un tableau de bis-albuminémie dans un tracé électrophorétique similaire à notre cas, devrait suscitée la recherche de pathologies sous-jacentes.

Laparoscopic assessment and transvaginal reparation of post-coital vaginal cuff dehiscence with bowel evisceration: a case report

Feras Sendy — 2020-04-14

Vaginal cuff dehiscence (VCD) is a rare postoperative complication of total hysterectomy. Presenting symptom is acute pelvic or abdominal pain accompanied by nausea and vomiting. Immediate recognition and surgical repair are crucial for successful management. A 40-year-old para 1+0 presented with complaints of pelvic pain associated with sexual activity, three months after a total laparoscopic hysterectomy. Speculum examination revealed the presence of bowel into the vagina. Diagnostic laparoscopic assessment combined with VCD repair through the transvaginal route. The occurrence of VCD after laparoscopic hysterectomy has been linked to overuse of electrocautery, prolonged inflammatory response and suturing methods. Laparoscopic, abdominal and vaginal approaches are the routes for repairing VCD. However, it depends on the clinical presentation and surgeon expertise. Careful history, and physical examination are vital factors in guiding clinicians to diagnose and treat VCD. Nevertheless, an ideal modality remains variable to each case.

An extremely rare case of indirect hernia type co-existing with testicular ectopia

Christos Plataras — 2020-04-14

We present an extremely rare case of inguinal hernia coexisting with testicular ectopia in a child. Male infant 9.5 month old presented with an empty scrotum and the ipsilateral intravaginal testis lying in a high iliac crest position. When crying a moving right inguinal bulge appeared on clinical examination. This grew bigger in moments of increased abdominal pressure and seemed to move upwards towards the right ileac crest. No abdominal wall defect could be palpated. At operation a large hernia sac fixed in the area of the right iliac crest was identified. Adjacent was the fixation point of the gubernaculum and the testis was found in an ectopic location. We removed the large sac after separating the vas and vessels and the testis and we strengthened the dorsal inguinal wall and fixed the testis in a subdartos scrotal pouch. No postoperative complications happened. An undescended testis may present as an iliac crest ectopy, coexisting with moving inguinal hernia. In our case we propose that the higher position of the aponeurosis of the external oblique in combination with ectopia of gubernacular fixation in the ipsilateral scrotum may have caused the ectopic fixation of the sac in the ipsilateral inguinal crest.

The epidemiological characterization and geographic distribution of Hepatitis D virus infection in Libya

Mohamed Ali Daw — 2020-04-14

Introduction: north Africa is known to be endemic for hepatitis D virus. However, data one the prevalence of this virus in Libya are scanty. This study aimed to determine the prevalence of hepatitis D virus infection in Libya and analyze the demographic factors associated with the infection, and also to assess the variations across the regions and districts.

Methods: a total of 1873 samples collected from all over the country were tested for antibodies against hepatitis B surface antigen and the results were correlated with demographic and geographic variables.

Results: the overall prevalence of hepatitis D virus infection was 1.7%. The prevalence rate was significantly high among those aged over 40 years (P < 0.001) and it was associated with intravenous drug use and coinfection with human immunodeficiency virus and/or hepatitis C virus infection (P < 0.001). The prevalence rates varied with geographic location and differed markedly within the regions the country. The highest rate reported was in the central region of Libya, followed by the western and eastern regions.

Conclusion: hepatitis D virus infection rate in Libya is considered to be low but is of some concern in some districts. This has been propagated by population displacement and African immigrants, indicating that a continuous epidemiological surveillance program should be implemented.

Assessment of knowledge and attitude towards palliative care and associated factors among nurses working in selected Tigray hospitals, northern Ethiopia: a cross-sectional study

Teklay Zeru — 2020-04-15

Introduction: palliative care is a multidisciplinary approach which is focused on both the patient and their family. Therefore, the objectives of the study is to assess the knowledge and attitude towards palliative care and its associated factors among nurses in Tigray, Northern Ethiopia, 2018.

Methods: an institutional based cross-sectional quantitative study design was carried out using 355 nurses working in selected hospitals in Tigray region from February to March 2018. Systematic random sampling was used to select six governmental hospitals. We used triangulation in the study method, making use of both Frommelt's Attitude Toward Care of the Dying (FATCOD) scale, and Palliative Care Quiz for Nursing (PCQN) knowledge. SPSS were applied for data entry and analysis. Statistical significance was declared at P<0.05. The goodness of fit of the final logistic model was tested by using the Hosmer and Lemeshow test at a value of > 0.05.

Results: all the participants were able to respond. Out of the total study participants, 223 (62.8%) had good knowledge and 200 (56.3%) had a favorable attitude towards Palliative care. A medical ward had (AOR = 3.413, CI = 1.388-8.392, P = 0.019), trained Nurses [AOR = 3.488; CI = 1.735-7.015; P = 0.00) significant associated with nurses knowledge towards palliative care. Nurses working in the lemlem Karl (AOR=2.541; 95% CI; 0.013(1.106-5.835), nurses who had a 20-30 years ago had unfavorable attitude (AOR = 2.660; 95% CI; 0.002(1.386-5.106) were significant.

Conclusion: the nurses had poor knowledge. However, their attitude towards palliative care (PC) was favorable.

Le psoriasis du gland chez le sujet circoncis

Soufiane Ennaciri — 2020-04-15

L'atteinte génitale exclusive du psoriasis ne concerne que 2 à 5% des
psoriasiques. Cette affection constitue un motif fréquent dans les
consultations spécialisées dédiées aux muqueuses génitales
masculines, puisqu'elle représente jusqu'à 24% des motifs de
consultation. Sur le gland, l'atteinte est habituellement finement
squameuse chez le sujet circoncis et non squameuse chez le non
circoncis, du fait de l'humidité favorisée par le prépuce. L'atteinte du
gland peut être diffuse et s'associer à une atteinte de la face interne
du prépuce. Nous présentons le cas d'un jeune patient de 30 ans, qui
a comme antécédent un grand parent atteint de psoriasis. Notre
patient a vu apparaitre depuis 2 mois des lésions érythémateuses
squameuses circonférentielles au niveau du gland sans prurit ni
signes urinaires associées et sans manifestations cutanées. Une
biopsie de la muqueuse du gland a été réalisée ayant confirmé le
diagnostic de psoriasis.

Palate herpes simplex virus infection

Giovanna Mosaico — 2020-04-15

A 50-year-old man came to our private practice, for palate pain and difficulty swallowing. The medical history reported gastro esophageal reflux, otherwise the patient was in good health. He reported having recently suffered from a flu syndrome treated with antibiotics (amoxicillin and clavulanic acid) cortisone and anti-inflammatory drugs. At the second day of drug therapy, the patient started to have severe oropharyngeal pain with inability to eat, reflex sialorrhea and dysphagia. From an objective examination of the oral cavity, we could see vesicular lesions along the right arch of the hard palate with partial extension to the left. A diagnosis of herpetic infection was made. The erythematous and oedematous mucosa was in the ulcerative phase. Paracetamol and systemic acyclovir have been recommended to alleviate general symptoms, fever and pain. The patient was advised to not touch the palate with his hands to avoid the expansion of the virus in other facial areas. The prescribed therapy was not performed due to the increase in esophageal gastrointestinal reflux, so after 3 weeks the lesion was still present if reduced. The differential diagnosis could be thermal burn, chemical trauma, herpes zoster lesion (VZV).

Quality of life of adolescents living with sickle cell anaemia in Ondo State, Nigeria

Funmilola Adenike Faremi — 2020-04-15

Introduction: this study assessed the level of knowledge and quality of life of adolescents living with sickle cell disease (SCD) and their quality of life.

Methods: this study utilized descriptive research design. The study was conducted in two secondary level hospitals with functional SCD clinic in Ondo State. One hundred and four (104) adolescents participated in the study. Their consents were sought and gained.

Results: results showed that more males (63.5%) participated in the study. The mean age of the participants was 15.26±3.09 years. More than half (62.5%) of the participants that participated in the study had SCD crisis within six months. The mean SCD knowledge of participants in the study was 22.12±2.76, while 15.4% of the participants had good knowledge of SCD and only 13(12.5%) have high quality of life. Also, the mean score of the participants on the quality of life scale was 39.50±6.47.

Conclusion: knowledge of adolescents with SCD that participated in the study was relatively low and their quality of life moderate. Effort should therefore, geared towards improving their knowledge about SCD and providing supportive care that will improve their quality of life.

Quality of life among cervical cancer patients undergoing radiotherapy

Kofi Adesi Kyei — 2020-04-17

Introduction: there has been an increasing rate of the incidence and mortality of cervical cancer in Ghana. Cancer and the treatment's side effects have adverse effects on the patients and this affects patient's well-being and lifestyle during and after radiotherapy. The study sought to assess the impact of demographic and clinical characteristics on Quality of Life (QoL) among cervical cancer patients undergoing radiotherapy in Ghana.

Methods: a cross sectional quantitative study design was carried out on 120 cervical cancer patients who were conveniently sampled from the study site. The data was collected between the months of December, 2017 and February, 2018. QoL was measured using the FACT-G questionnaire. The mean scores of QoL were determined, whiles the chi-square test was used to determine the impact of socio-demographic and clinical characteristics on the QoL of the patients.

Results: the mean age of the patients was 56.8 years. Majority of the patients reported stable QoL. The social well-being of the older patients was more affected than other patients. The unmarried, widows and patients who underwent surgery with radiotherapy were emotionally affected. Majority (56%) of the participants had stable QoL whiles 22% each had poor and good QoL. Significant association was found among 35-39 age group with physical well-being and overall QoL (p=0.017 and 0.029) respectively.

Conclusion: there is a need to embrace a QoL assessment instrument in the study site so as to help the oncology team in the identification and addressing of specific indicators that affect the QoL of cervical cancer patients.

The magnitude of opportunistic infections and associated factors in HIV-infected adults on antiretroviral therapy in southern zone Tigray, Ethiopia: a cross-sectional study

Teklay Zeru Weldearegawi — 2020-04-17

Introduction: greater than twenty known opportunistic infections have been associated with HIV infection and usually patients experience co-infections during the stage of illness, HIV-related opportunistic infections are associated with significant morbidity and mortality.

Methods: a hospital-based retrospective study was conducted in HIV-infected adult patients on antiretroviral (ART) from April to June 2017; secondary data were collected from review of clinical records. A total of 400 study participants selected through a systematic sampling technique and a pre-tested checklist was used to collect data from records of study subjects. The data was entered and analyzed using SPSS version 22.

Results: a total of 400 patients included in the study, in which more than half (51.0%) were females. The mean age of patients was 34 (standard deviation [SD] ±1.96) years. The overall of opportunistic infections (OIs) among HIV/AIDS patients on ART was 55.3%. The highest rates of OIs observed were oral candidacies 11.0%, followed by herpes zoster (10.8%) and tuberculosis (TB) (9.5%). The odds of having college and above educational levels were less likely to developed OIs compared to illiterate (AOR=0.007; 95% CI=0.053, 0.634). The odds of having OIs in WHO clinical stage I were less likely to have OIs compared to WHO clinical stage III and V (AOR=0.001; 95% CI=0.000, 0.015 and AOR=0.00; 95%CI=0.00 respectively).

Conclusion: there was a high prevalence of OIs observed in this study. Illiterate educational level and advanced WHO clinical stages were found to be predictors of OIs. Interventions were aimed at promoting early HIV testing and ART enrollment of HIV-infected.

Comorbidity of sickle cell trait and albinism: a cross-sectional survey in the Democratic Republic of the Congo

Paul Kambale-Kombi — 2020-04-17

Introduction: Sickle Cell Disease (SCD) and albinism are both recessive hereditary diseases in humankind with a high prevalence in sub-Saharan Africa. This study aimed to determinate the prevalence of sickle cell trait in people living with albinism (PLA).

Methods: a cross-sectional descriptive survey was conducted in PLA attending the "Hôpital du Cinquantenaire de Kisangani". In total, by non-probabilistic convenience sampling, 82 albinos and 139 non-albinos and without any antecedents of albinism in their family were included, selected from students in the Faculty of Medicine and Pharmacy at the University of Kisangani. Blood samples were collected on "dried blood spot" and analyzed by mass spectrometry at CHU of Liège. Data were entered into an Excel file and analyzed on SPSS 20.0 (Chicago, IL).

Results: forty-six of the 82 albinos (56.1%) were female and 43.9% male with a sex ratio of 1.28. Among albinos, 18.3% had hemoglobin AS (HbAS) and 81.7% hemoglobin AA (HbAA) compared to 18% of subjects with hemoglobin AS and 82% hemoglobin AA in the control group. The difference was not statistically significant (Chi-square=0.003, ddl=1, p=0.9544).

Conclusion: this study highlighted that the prevalence of the sickle cell trait is high among people living with albinism, but does not differ from that observed in non-albinos in the Democratic Republic of the Congo. It is therefore important to raise awareness among this category of people about sickle cell disease and the importance of its premarital screening.

Hepatitis B virus infection and associated factors among pregnant women attending antenatal clinics in West Hararghe public hospitals, Oromia region, Ethiopia

Belay Mamuye — 2020-04-18

Introduction: globally, approximately 350-400 million persons are chronically infected with hepatitis B virus (HBV), over 65 million of whom are in Africa. One in four people with chronic hepatitis B develop serious health problems. Mother-to-child transmission (MTCT) is responsible for more than half of chronic infections. If infected at birth, a child has a 90% chance of becoming a chronic carrier. We evaluated hepatitis B virus prevalence and risk factors for infection among pregnant women attending antenatal clinics in West Hararghe public hospitals, Oromia region, Ethiopia.

Methods: we conducted a cross-sectional study among 363 pregnant women at routine antenatal clinic visits in West Hararghe public hospitals from April-May, 2017. We used systematic random sampling method to enroll participants. We used a structured questionnaire to collect information on risk factors, and collected blood samples to test for hepatitis B virus surface antigen (HBsAg) by enzyme-linked immunosorbent assay (ELISA). Data were entered using EpiData Version.3.1 and exported to SPSS Version 23.0 for descriptive analyses and binary logistic regression

Results: the overall seroprevalence of HBsAg among participants was 6.1% (95% CI 3.9-8.5). History of abortion (aOR=4.3, 95% CI 1.3-15.0), traditional tonsillectomy (tonsillectomy conducted by an untrained practitioner) (aOR=4.4, 95% CI 1.1-17.8), admission to a health facility (aOR=4.4, 95% CI 1.2-16.9), multiple sexual partners (aOR=6.3, 95% CI 1.7-23.4) and familial liver disease (aOR=8.2, 95% CI 2.1-32.8) were associated with hepatitis B virus infection among pregnant women.

Conclusion: the prevalence of hepatitis B virus in study area indicates a high-intermediate level epidemic. Multiple types of healthcare, as well classic risk factors such as multiple sex partners and a family history of liver disease increased the odds of infection. Hygiene promotion and infection prevention methods in healthcare settings are recommended to avoid nosocomial infections. To reduce MTCT, we recommended screening all pregnant women for hepatitis B virus as part of routine antenatal care and supportive treatment and making available methods of preventing infection at birth, including prophylaxis and birth dose vaccine.

Twice weekly hemodialysis is safe at the beginning of kidney replacement therapy: the experience of the Nephrology Department at Hedi Chaker University Hospital, Sfax, south of Tunisia

Hanen Chaker — 2020-04-20

We re-examine the infrequent paradigm of a biweekly dialysis at the start of renal replacement therapy. The current method is to launch hemodialysis among patients using a ‘full-dose’ posology three times a week. As a matter of fact, recent data has suggested that frequent hemodialysis leads to high mortality at the onset of dialysis. The aim of our study is to show the factors affecting early mortality, especially the hemodialysis frequency. We undertook an observational study in the hemodialysis unit of Sfax University Hospital (south Tunisia). We enrolled the incident patients during one year. Baseline demographic and clinical characteristics of patients were noted. The survival status of each patient is observed at 6 months after the onset of hemodialysis. We analyzed the factors associated with mortality, especially the hemodialysis frequency (twice or thrice weekly hemodialysis regimen). We enrolled 88 patients with mean age of 56 ± 18 years old. Thirty patients underwent twice weekly dialysis (Group 1) and 58 patients underwent thrice weekly dialysis (Group 2). The mortality at 6 months was similar in the 2 groups (the rate of death = 30% in group 1 vs 13.8% in group 2, p = 0.07). However, the mortality was lower in the group with preserved residual diuresis (35.3% vs 64.7% in the group without residual diuresis, p = 0.02). The mortality was higher in diabetes patients (64.7% vs 35.5%, p = 0.02). It was concluded that twice or threefold weekly treatment have some considerable similar outcomes on the patients' survival (at 6 months).

Lifestyle modification and hypertension: prescription patterns of Nigerian general practitioners

Olagoke Korede Ale — 2020-04-20

Introduction: implementation of lifestyle modification (LM), a cornerstone of hypertension control has been reported to be more challenging than pharmacotherapy. We studied the LM prescription patterns of general medical practitioners (GPs) in Lagos, Nigeria for blood pressure control.

Methods: GPs were assessed using anonymous self-administered questionnaire on the prescription of salt restriction, weight management, cessation of tobacco use, physical exercise, and consumption of DASH-like diet for blood pressure control. Chi-square, Fisher's exact and Student t-test were used to test for differences as appropriate. Logistic regression model was constructed to identify the determinants of adequate LM prescription.

Results: a total of 213 GPs (38% females) participated in the survey. LM prescription was over 90% for the following: salt restriction (96.7%), tobacco cessation (94.8%), weight management (94.4%). The remaining were 81.2% and 75.1% for healthy diet and physical activity respectively. The median LM prescription score (of the GPs) was 18.0 [15.0-50.0]. The single significant predictor of adequate LM prescription was total patient load of the GPs (AOR:0.98, 95% CI: 0.97-0.99, p=0.006). Eleven (5.2%), 190 (89.2%), and 12 (5.6%) GPs initiated LM prescription at blood pressure values >140/90mmHg, =140/90mmHg and <140/90mmHg respectively. LM initiation at BP <140/90mmHg was associated with female gender, shorter work experience, working in tertiary care facility and ignorance about hypertension prevention (p<0.05).

Conclusion: LM is widely prescribed for the treatment of hypertension, but rarely prescribed for its prevention in Nigeria. Interventions to reduce physician's patient load may engender improved LM prescription.

Soil transmitted helminth infections in Ghana: a ten year review

Monica Ahiadorme — 2020-04-20

For more than a decade, intervention programs have been instituted in Ghana to combat soil transmitted helminth (STHs) infections. Knowledge of the trend of the infection in the country is needed for evaluation and modification of existing control programs to achieve national targets. The objective of this review is to examine the pattern of soil transmitted infections in Ghana between 2009-2018. We searched and reviewed published literature on soil transmitted helminths in Ghana in PubMed, Medline, Google Scholar and Institutional Repositories of Kwame Nkrumah University of Science and Technology, University of Ghana, University of Cape Coast, and University for Development Studies-Tamale. We observed paucity of research work on STHs in Ghana over the period of this review. Twenty-nine studies consisting of 24 published works in peer reviewed journals and five graduate theses were included in the study. Hookworm was the most prevalent of STHs recorded followed by roundworm, threadworm, and whipworm. Pinworm was very rarely reported. These infections were reported from different regions and ecological zones of the country and among children, pregnant women, farmers, food vendors, children in orphanage home and psychiatric institution. Although there is some downward trend over the period, soil transmitted helminths are still prevalent in Ghana. This is an indication of some hope of eventual control and elimination of these diseases in the country if control measures are optimised. Further research particularly population studies into soil transmitted helminths in Ghana is needed.

Hand games, naughty games

Kawtar Belkhadir — 2020-04-20

We report the case of a 13-year-old child who presented to the ophthalmic emergencies for left eye trauma because of a sore eyelid, while fighting with one of his classmates using pairs of scissors. The clinical examination found a wound on the upper left eyelid with loss of substance of the skin without involvement of the orbicularis muscle (A). Examination of the left eye found a visual acuity preserved at 12/10 without optical correction, a calm anterior segment and a flat retina. Faced with the loss of cutaneous substance, it was decided to perform a total skin graft from the abdominal skin (B). The sample was taken using a scalpel and the graft was defatted. The total skin graft was immediately performed, and sutured with fluted edges to prevent healing in the staircase (C). The patient was seen again 10 days after the graft, with good budding of the graft, and removal of the stitches (D). Fat bandage care has been recommended to allow good healing of the graft. Eyelid sores in children represent a multitude of clinical forms. These wounds require early and appropriate management, with a complete initial clinical examination, to look for lesions of the free edge or lachrymal passages, but also a careful examination of the globe in order to rule out a wound of the globe that would be associated. Their management should be early and specialized, in order to avoid the occurrence of skin retraction, or harmful aesthetic sequelae.

L´anxiété et la dépression chez les patients suivis pour microcarcinome différencié de la thyroïde

Nassim Essabah Haraj — 2020-04-20

Introduction: le microcarcinome de la thyroïde est un cancer de bon pronostic mais qui peut avoir un retentissement sur la qualité de vie des patients. L'objectif de l'étude est d'évaluer la dépression et l'anxiété chez les patients suivis pour microcarcinome différencié de la thyroïde et de les comparer aux autres stades du cancer.

Méthodes: étude transversale observationnelle menée entre octobre 2013 et février 2015. L'étude a inclus les patients adultes suivis pour carcinome différencié de la thyroïde. La dépression et l'anxiété ont été évaluées en utilisant deux échelles de qualité de vie, dont la traduction a été validée en arabe: le Hamilton anxiété et Hamilton dépression. Les patients ont été répartis en deux groupes, un groupe microcarcinome de la thyroïde et un groupe non microcarcinome. L'analyse des données faite par le logiciel SPSS. 16.

Résultats: l'étude a concerné 37 patients suivis pour un microcarcinome différencié de la thyroïde, et un groupe de comparaison de 87 patients suivis pour autres stades de cancer différencié de la thyroïde. La qualité de vie des patients dans le groupe avec microcarcinome de la thyroïde était meilleure par rapport aux autres stades de carcinome différencié de la thyroïde. La présence de microcarcinome de la thyroïde était associée significativement à une absence d'anxiété (p = 0,042), une tendance positive a été notée sur le Hamilton dépression (mais p non significatif).

Conclusion: la qualité de vie des patients dans le groupe avec microcarcinome de la thyroïde était meilleure par rapport aux autres stades de carcinome différencié de la thyroïde. Ceci pouvant être expliqué par la non agressivité du traitement (absence de traitement par l'iode, et objectif de TSH plus souple).

A post traumatic capsulorhexis

Kawtar Belkhadir — 2020-04-20

We report the case of a patient aged 50 years, with no pathological history, who consulted for a decrease in visual acuity secondary to an ocular trauma of the left eye occurred 6 months ago. The clinical examination found a visual acuity reduced to luminous perception, a clear cornea, an anterior chamber of good depth. Examination after pupillary dilation revealed an anterior capsule broken, in the manner of an incomplete circular anterior capsulorhexis, with retraction of the anterior capsule in superior temporal area, and yellowish pupillary reflection. The examination was completed by a B-mode ultrasonography which revealed a vitreous dislocated lens nucleus with vitreous organization in favor of intravitreal hemorrhage secondary to the trauma associated with an old retinal detachment. In view of the severity and the age of the post-traumatic lesions, therapeutic abstention was advocated. Ocular contusion trauma is a common cause of ophthalmic emergency consultation. An early and complete examination is necessary in order to carry out an exhaustive lesion assessment and to allow an early and adequate management in order to avoid the potentially blinding sequelae of these affections.

Etude rétrospective des fractures de Galeazzi chez l´adulte dans le Département d´Orthopédie du Centre Hospitalier Universitaire Habib Bourguiba Sfax, Tunisie: à propos de 45 cas

Nizar Sahnoun — 2020-04-21

La fracture de Galeazzi est définie par l'association d'une fracture du radius et une luxation radio-ulnaire inférieure. Son diagnostic est souvent méconnu initialement. Le but de notre travail est de déterminer l'aspect épidémio-clinique des fractures luxation de Galeazzi chez l'adulte et d'apprécier les résultats fonctionnels et radiologiques de notre série. Il s'agit d'une étude rétrospective descriptive, sur une période allant de 2009 à 2018 colligée au Service d'Orthopédie du CHU Habib Bourguiba Sfax, portant sur 45 cas de fractures de Galeazzi traitées chirurgicalement. Nous avons utilisé le score de Mestdagh pour l'évaluation clinique de nos résultats. Le délai moyen de prise en charge était 5,35 jours. La synthèse du radius a été pratiquée par plaque vissée dans 39 cas et la radio-ulnaire a été embroché dans 13 cas. La consolidation a été obtenue dans un délai moyen de 10,5 semaines. Les résultats étaient excellents chez 35 patients, bon chez 3 patients, moyen chez 6 patients et mauvais chez un patient. Nous avons déploré 3 cas de sepsis sur broche et deux cas de cal vicieux. La fracture luxation de Galeazzi reste une entité sous diagnostiquée dans certains cas. Un examen dynamique peropératoire après synthèse solide du radius a permis d'avoir de bons résultats fonctionnels.

Traitement de la fracture vertébrale ostéoporotique par kyphoplastie percutanée avec un extenseur de type SpineJack®

Moussa Diallo — 2020-04-22

Introduction: l´objectif était d´évaluer le résultat de notre prise en charge chirurgicale des fractures ostéoporotiques vertébrales avec un extenseur vertébral percutané de type SpineJack®.

Méthodes: il s´agit d´une étude rétrospective analytique et mono centrique de 33 mois (avril 2015 - décembre 2017). Elle avait porté sur les patients ayant été traités par kyphoplastie avec le pour une fracture vertébrale ostéoporotique. Le kit comprenant un extenseur vertébral en titane à type de SpineJack® de Vexim et le ciment acrylique avait été utilisé. Les patients présentant une rachialgie d´intensité croissante malgré le traitement lié à une fracture vertébrale ostéoporotique ont été inclus dans l´étude ainsi que ceux ayant acceptés le principe de la chirurgie et donner leur consentement éclairé. La fracture vertébrale était diagnostiquée à la tomodensitométrie (TDM) et son caractère récent confirmé par l´imagerie par résonnance magnétique (IRM).

Résultats: entre avril 2015 et décembre 2017, trente-sept patients porteurs de fractures ostéoporotiques vertébrales ont été traités par kyphoplastie avec un extenseur vertébral en titane. L´âge moyen était de 73,4 ans avec un sexe ratio à 0,6. L´échelle visuelle analogique moyenne était de 7,3. Le score d´Osvestry était en moyenne de 81,6. Les fractures étaient prédominantes au niveau de la charnière thoraco-lombaire. L´angle de cyphose vertébrale mesurait en moyenne 18,45°. La kyphoplastie avait concerné 44 vertèbres. Quatre cas de complications opératoires avaient été enregistrés. La durée moyenne d´hospitalisation était de 5,4 jours. A 6 mois de suivi, 9 patients étaient encore sous traitement antalgique. A un an, aucun cas de fracture de vertèbre adjacente n´avait été trouvé.

Conclusion: la kyphoplastie percutanée avec un extenseur en titane est un moyen thérapeutique sûr et efficace des fractures vertébrales ostéoporotiques. Avec son effet quasi immédiat, il permet au patient, un retour rapide à la vie active.

Solid pseudopapillary tumor of the pancreas: a rare entity in children

Ghita Berrada — 2020-04-27

Solid pseudopapillary tumors (SPTs) constitute 0.2 to 2.7% of non-endocrine primary tumors of the pancreas and comprise the majority (70%) of pediatric pancreatic neoplasms. These tumors are of unclear pathogenesis, low malignancy and favorable prognosis. Surgical resection offers an excellent chance for longterm survival, even in the presence of distant metastasis. The objective of this study is to review our experience in the management of SPT in a 12 years old girl at the pediatric hospital of the University hospital of Casablanca, in Morocco and provide an update on current management in pediatric population.

Challenges and possible solutions to peritoneal dialysis use in Nigeria

Samuel Ajayi — 2020-04-28

Introduction: peritoneal dialysis is a form of renal replacement therapy that is both effective and relatively affordable. Peritoneal dialysis (PD) was first used in Nigeria as a treatment option for renal failure. Its use was first reported in Nigeria in 1969 and became more widespread in the 80s and 90s. Haemodialysis, which is capital intensive to set up and requires infrastructures and facilities such as electricity, intense water consumption and buildings, seems to have upstaged peritoneal dialysis both in demand and supply.

Methods: this cross-sectional study is a convenient survey of nephrologists, renal technicians and nurses in Nigeria. We used a structured, self-administered questionnaire on a cross-section of members and associate members attending a national nephrology association meeting.

Results: there were 68(54.4%) doctors, 43(27.2%) nurses, and 14(11.2%) renal technicians, all from medical institutions with renal treatment programs who participated in the study. The most common problems encountered with PD use are financial constraints (51.7%), inadequate fluid supply (50%), frequent line blockage (22.4%) and frequent infections (17.2%). Reasons attributed to the stoppage of PD in the centres included lack of PD fluids (50.8%), unavailability of PD catheters (22.8%), lack of expert personnel to train (15.8%).

Conclusion: main challenges to peritoneal dialysis use in Nigeria include limited experience and training and availability and cost of consumables. Effort to overcome the factors militating against its use should be positively pursued so that peritoneal dialysis will be re-integrated into the mainstream of renal replacement therapy once more.

Effects of counseling professional ethics principles on midwifery professional codes of ethics compliance and applicability rate among midwives in community health centers: a randomized clinical trial in Iran

Soheila Shahabnia — 2020-04-29

Introduction: compliance with ethical principles is regarded as one of the key components in providing services in midwifery profession. This study was to evaluate the effects of counseling professional ethics principles on midwifery professional codes of ethics compliance and applicability rate among midwives working in community health centers in the city of Karaj, Iran.

Methods: this randomized controlled trial (RCT) was conducted in 2018 on a total number of 84 eligible midwives in two intervention and control groups, selected through multistage sampling method. The intervention group took part in six counseling sessions but the control group only received a training manual. Both groups then completed the Self-Reporting Questionnaire of Ethical Codes of Reproductive Health Providers (including 95 items in 14 domains) at three time points (before, immediately, and four weeks after intervention). Finally, the data were analyzed using the IBM SPSS Statistics (version 22) software via descriptive and inferential statistics.

Results: the findings showed that level of compliance and applicability rate in all 14 domains of midwifery professional codes of ethics were higher in the intervention group (after intervention) than those in the control group and trend of time changes in mean level of compliance and applicability rate of codes of ethics during the three time points were significantly different between both groups (p < 0.001).

Conclusion: given the effectiveness of counseling professional ethics principles on midwifery professional codes of ethics compliance and applicability rate among the midwives working in community health centers, designing and applying this counseling approach was recommended to improve quality of reproductive health care services.

Mucocèle de la muqueuse buccale

Soukaina Essaket — 2020-04-29

Les mucocèles buccales sont des pathologies tumorales bénignes des glandes salivaires accessoires de la muqueuse buccale. La localisation la plus fréquente de ces lésions est la muqueuse labiale. Etiologiquement, elles sont de deux types: le premier est dû à une rupture de l´épithélium de la glande déversant de la salive dans l´espace extra-glandulaire, et forment un pseudo kyste (mucocèle par extravasation); le second est causé par blocage de l´évacuation salivaire par prolifération épithéliale du conduit excréteur, réalisant un vrai kyste salivaire (kyste de rétention). Il existe diverses modalités thérapeutiques, l´exérèse chirurgicale conventionnelle reste la stratégie la plus efficace où la récidive est la moins fréquente. A travers une observation clinique, une mise au point sur cette lésion est faite, illustrée par un cas clinique pris en charge dans le Service d´Odontologie Chirurgicale, Centre de Consultation et de Traitement Dentaire (CCTD), Rabat, Maroc.

Connaissances, attitudes et pratiques des étudiants en médecine en matière de sexualité

Imen Baati — 2020-04-29

La sexualité est un aspect central de la personne humaine qui, devant des problèmes sexuels, va fréquemment se tourner vers une source qu'elle considère compétente et bien informée, son médecin. Les objectifs de notre étude étaient d´évaluer les connaissances, les attitudes et les pratiques des étudiants en médecine en termes de sexualité et d´identifier les principaux déterminants du manque de connaissances basiques à ce sujet. Notre étude était descriptive et analytique, menée auprès des étudiants à la faculté de médecine de Sfax (Tunisie). Le questionnaire, rempli individuellement et de manière anonyme par chaque étudiant, recueillait les données sociodémographiques, les connaissances en matière de sexualité ainsi que leurs sources, les attitudes adoptées par les étudiants vis-à-vis de la sexualité et les pratiques sexuelles. La note totale moyenne relative aux questions de sexologie était de 11,05/20. Les facteurs corrélés à un score moyen élevé aux questions de sexologie étaient le sexe masculin (p=0,003), le statut de marié (p=0,012), le niveau socio-économique élevé (p=0,02), les livres comme source d´informations (p=0,041) et la présence de pratiques sexuelles (p<0,001). Ces pratiques étaient toutes significativement plus fréquentes chez les étudiants de sexe masculin (p<0,001). Des lacunes dans les connaissances en matière de sexualité existent chez les étudiants en médecine, du moins dans certains de ses aspects. Un programme d'enseignement complet et uniforme sur la sexualité humaine, surtout dans ses aspects physiologiques, peut sensiblement améliorer la capacité des futurs médecins à fournir des soins optimaux à leurs patients.

Parental knowledge and practice on antibiotic use for upper respiratory tract infections in children, in Aksum town health institutions, Northern Ethiopia: a cross-sectional study

Teklay Zeru — 2020-04-29

Introduction: worldwide, antibiotics are the most commonly prescribed and abused drugs for upper respiratory tract infections. Acute upper respiratory infections are common in children who attend childcare, and preventing transmission of disease in a health setting depends on actions by parents and staff. Therefore, the objective of this study is to assess the parental knowledge and practice on antibiotic use for upper respiratory tract infections in children, in Aksum town health institutions, northern Ethiopia, 2018.

Methods: a facility-based cross-sectional study design was adopted involving 384 parents of children visited governmental health facilities in Aksum town from February to March 2018. Respondents were selected based on the proportion of nurses in the health facilities. SPSS version 22 was applied for data entry and analysis.

Results: the total number of questionnaires was 384 resulting in a 100% response rate. Almost half of the parents had poor knowledge of the use of antibiotics in children for URTIs 183(47.7%), followed by 156(40.6%) moderate knowledge and 45(11.7%) good knowledge. Practices regarding antibiotic use in children with URTI varied. Only 12.8% of the parents did not always follow the doctors´ advice regarding antibiotic use. In this study has reported many areas in which parental awareness on antibiotic use for acute URTI is considered inadequate, consequently inappropriate knowledge and practices.

Conclusion: nearly half of the parents attending the physicians for their children with URTI expected to get antibiotics.