Pan African Medical Journal

Syringomatous tumor of the nipple: a case report

Ana Vitória de Jesus Félix — 2025-04-08

Syringomatous tumor of the nipple is a benign, locally infiltrative tumor. There are reports in the literature of tumor recurrence in cases of incomplete excision. Clinical and mammographic findings in syringomatous tumors are like those of breast carcinoma and the pathologist has a fundamental role in final tumor diagnosis. Therefore, the aim of this study was to report a case of syringoma located in the areolar region. A 33-year-old woman reported that she had noticed a nodule in her left areolar region 4 years previously (February 2019). A breast ultrasound was performed, detecting intraparenchymatous breast cysts. Surgical resection of the nodule was indicated although it was not performed. Two years later, in August 2021, the patient underwent a mastopexy with prosthesis inclusion. Histopathology study of the surgical specimen revealed a syringomatous tumor with positive margins. Thirteen (13) months after diagnosis (September 3, 2021 - October 16, 2022), the patient is doing well and receives clinical follow-up.

Tuberculose disséminée révélée par une localisation épididymaire chez un patient immunocompétent: à propos d´un cas

Rebeh Bougossa — 2025-04-08

La tuberculose épididymaire est rare et pose souvent de problème diagnostique. Elle peut être révélatrice d'une forme disséminée de l'infection, qui est le cas de notre observation. Un jeune homme de 19 ans, sans antécédents notables, était hospitalisé pour une grosse bourse gauche douloureuse évoluant depuis 8 mois. Il avait bénéficié d'une orchidectomie dont l'examen anatomopathologique était en faveur d'une tuberculose épididymaire. Un bilan radiologique avait montré d'autres localisations de l'infection: ganglionnaire, pulmonaire, pariétale et ostéo-articulaire. Un traitement antituberculeux lui était instauré. Cependant, au 4^e mois du traitement, le patient avait présenté des crises convulsives. Une IRM cérébrale lui était pratiquée concluant à des tuberculomes cérébraux. Le traitement antituberculeux était poursuivi associé à un anticonvulsivant avec une bonne évolution clinico-radiologique. L'originalité de notre observation réside sur le mode de révélation d'une tuberculose disséminée paucisymptomatique, par une localisation épididymaire, chez un sujet immunocompétent.

Pleuropulmonary blastoma: a rare clinical image

Ashwin Karnan — 2025-04-08

A 13-year-old boy presented to the outpatient department with complaints of breathing difficulty for the past 2 months. Magnetic resonance imaging of the thorax showed a solid cystic mass lesion in the right hemithorax of size 8.9 x 10.7 cm with mild pleural effusion with mass effect shifting the major vessels to the left side. Computed tomography-guided biopsy was done which showed variable thickened nodule-like areas with both single cells and cohesive aggregates with positive stains for vimentin and cytokeratin. A diagnosis of pleuropulmonary blastoma was made. The patient underwent surgical resection and is currently on follow-up. Pleuropulmonary blastomas are rare and aggressive childhood intrathoracic tumors common in children less than 6 years of age. It may be of three types- type I (cystic), type II (mixed), or type III (solid). Clinical presentation includes shortness of breath, chest pain, cough, and hemoptysis. Tumor size >5 cm with pleural or mediastinal invasion has a poor prognosis. Surgical resection, postoperative radiotherapy, and chemotherapy are available.

Invasive ductal carcinoma of the breast presenting as a cauliflower-like growth

Keval Dhone — 2025-04-08

A female patient aged 50 years presented to the general surgery outpatient department (OPD) with a history of progressively increasing growth involving the right breast. The patient had first noticed this growth 8 months back, and was progressively increasing in size as per history given by the patient. On breast examination, a cauliflower-like growth was visible on the surface of the right breast, involving the chest wall and nipple as well. For establishing tissue diagnosis, an excisional biopsy was taken from the lesion and sent for histopathological examination, which established the diagnosis of invasive ductal carcinoma (IDC) of the breast. The tumor-node-metastasis (TNM) staging of the breast cancer was found to be stage 3B and an oncologist's opinion was sought promptly, and the patient was advised neo-adjuvant chemotherapy with regular follow-up. Surgical excision could not be attempted as the tumor was found to be fixed to the chest wall, and in a locally advanced stage. Invasive ductal carcinoma has been found to be one of the commonest variants of carcinoma of the breast. This patient had a rare presentation with a cauliflower-like growth involving the right breast and the chest wall.

Investigation of potentially pathogenic Vibrionaceae in Saint-Louis city, Senegal

Seynabou Lo — 2025-04-08

Introduction: as cholera, due to toxigenic bacteria Vibrio cholera (serogroups O1 and O139), is a major public health threat in Africa, the aim of this work was to investigate potentially pathogenic Vibrionaceae bacteria firstly from human stool samples, and secondly from various environmental water points of Saint-Louis city in Senegal.

Methods: a hospital-based study was conducted between 2013 and 2015. Stool samples were taken and cultured from daily incoming patients or hospitalized for acute diarrhea at Saint-Louis´ regional hospital. For environment, a monthly longitudinal sampling from January to October 2016 was carried out at 10 sites in the city. We used total DNA extracted from APW (alkaline peptone water) broth solutions and on suspect bacterial colonies to run PCR Multiplex targeting specific DNA fragments to detect Vibrio genus and specific species. In case of positivity, a simplex PCR was performed to test for cholera toxins Ctx, and V. parahaemolyticus TRH and TDH.

Results: for 43 patients screened, bacterial culture was positive in 6% of cases but no strain of V. cholerae or other Vibrio sp. was isolated. PCR on 90 APW solutions were positive for Vibrio sp. (n = 43), V. cholera (n = 27), V. mimicus (n = 16), V. parahaemolyticus (8), V. alginolyticus (n = 4), and V. vulnificus (n = 2). Unlike for those on suspected colonies which were positive for a majority of V. parahaemolyticus (n = 40) and V. cholerae non-O1 / O139 (n = 35). Six strains of V. parahaemolyticus carried TRH gene, 3 of which expressed simultaneously virulence TRH and TDH genes. For physicochemical parameters, all temperatures varied similarly according to a unimodal seasonality, as well as salinity.

Conclusion: despite the presence of natural populations of Vibrionaceae, even toxigenic ones, was noted in water environment, along with favorable habitat conditions that could play a role in transmission of Vibriosis in the Saint Louis population, we did not isolate any of them from patients screened at the hospital.

Striking rise of cesarean section rates in Türkiye: there is a need for a whole new perspective

Mert Küçük — 2025-04-08

Since 2003, the Turkish Ministry of Health (TMOH) has activated a reformed system called Health Transformation Program (HTP) which has assertive goals. Health transformation program has brought about important improvements in many health topics. However, at the beginning of HTP, cesarean section (C-section) rate was approximately 30%, having exceeded 50% in 2013 which reflected the highest rate in Organization for Economic Cooperation and Development (OECD). Currently, most of the deliveries are carried out via C-section in Türkiye which started disputes about whether the high rate of C-section is Achilles’ heel of HTP. To overcome high C-section rate, TMOH has been making intensive efforts and taking serious measures in recent years including passing a law to ban elective C-sections. Despite the strict measures taken C-section rate didn’t decrease instead increased gradually. The current situation shows that the problem is more complicated than the authorities figure out, and a whole new perspective on the issue is needed.

Aspiration pneumonia with broncho-œsophageal fistula: a rare clinical image

Mansi Deshmukh — 2025-04-08

Broncho-œsophageal fistulas (BEF) are rarer than tracheœsophageal fistulas and can occur at birth or later in life. They may develop in adults due to various causes like malignancy, trauma, or infection. Diagnosis involves bronchoscopy, gastrointestinal endoscopy, or radiologic imaging. Management depends on symptom severity, fistula location, and patient health. Palliative options include metallic stents or surgical œsophageal bypass. Metallic stents have shown superiority. A 25-year-old female presented with fever, cough, vomiting, and weight loss. Imaging revealed consolidation with cavitation in the lower lobe communicating with the œsophagus, diagnosed as aspiration pneumonia. Endoscopy confirmed a suspected bronchœsophageal fistula, treated with stenting (A). Revealed fistulous opening 30 cm from incisor teeth (B). Revealed guidewire passes across the fistulous and position confirmed fluoroscopically and endoscopically (C). Revealed œsophageal stent (fully covered metal stent 12cm x 25cmm) placement done by passing it over guidewire. Proximal end of stent was kept at 21cm from incisor teeth and lower end kept above G-E junction.

Ventricular restoration in adults with huge congenital left ventricular aneurysm: report of two cases

Charles Mve Mvondo — 2025-04-08

Congenital ventricular aneurysms (CVA) are rare cardiac anomalies that have been predominantly described in the Black population. They are characterized by an akinetic ventricular protrusion that is commonly located at the basal and apical segments. Although the diagnosis is often incidental and the majority of patients are asymptomatic, life-threatening events such as persistent ventricular arrhythmias, CVA rupture, and heart failure are not uncommon. However, no standardized therapy is currently available and good outcomes have been reported with both conservative and surgical management. We report the cases of two young Black African patients with huge symptomatic CVA lesions who underwent successful surgical repair with a ventricular restoration technique. Both cases were consulted for chest pain and dyspnea. Chest X-ray and transthoracic Doppler echocardiography suggested the diagnosis. Thoracic angioscanner and thoracic magnetic resonance imaging confirmed the diagnosis. Both patients underwent successful surgery. This case report aims to revisit the diagnostic and therapeutic approach to this rare pathology, in our professional environment.

Predictors of household direct cost of burn injury in adult patients at a tertiary healthcare facility in Ghana: an analytical cross-sectional study in Korle-Bu Teaching Hospital

George Aryee — 2025-04-08

Introduction: treatment of severe burn injury generally requires enormous human and material resources including specialized intensive care, staged surgery, and continued restoration. This contributes to the enormous burden on patients and their families. The cost of burn treatment is influenced by many factors including the demographic and clinical characteristics of the patient. This study aimed to determine the costs of burn care and its associated predictive factors in Korle-Bu Teaching Hospital, Ghana.

Methods: an analytical cross-sectional study was conducted among 65 consenting adult patients on admission at the Burns Centre of the Korle-Bu Teaching Hospital. Demographic and clinical characteristics of patients as well as the direct cost of burns treatment were obtained. Multiple regression analysis was done to determine the predictors of the direct cost of burn care.

Results: a total of sixty-five (65) participants were enrolled in the study with a male-to-female ratio of 1.4: 1 and a mean age of 35.9 ± 14.6 years. Nearly 85% sustained between 10-30% total body surface area burns whilst only 6.2% (4) had burns more than 30% of total body surface area. The mean total cost of burns treatment was GHS 22,333.15 (USD 3,897.58). Surgical treatment, wound dressing and medication charges accounted for 45.6%, 27.5% and 9.8% of the total cost of burn respectively.

Conclusion: the direct costs of burn treatment were substantially high and were predicted by the percentage of total body surface area burn and length of hospital stay.

Impact of haemoglobin variants on the diagnostic sensitivity of glycated haemoglobin (HbA1c) assay methodologies in sub-Saharan Africa: a laboratory-based method validation study

Priscilla Agatha Balungi — 2025-04-08

Introduction: the utility of glycated haemoglobin (HbA1c) for the diagnosis and monitoring of diabetes in sub-Saharan Africa is uncertain due to limited data on the performance of the available HbA1c assay methods in this population, which has a high prevalence of haemoglobin variants. We aimed to compare the diagnostic accuracy of the major HbA1c methodologies (Boronate Affinity, Capillary Electrophoresis, High Performance Liquid Chromatography, Immunoassay) in an African population, and assess the impact of the common haemoglobin variant HbAS (sickle cell trait).

Methods: whole blood samples were obtained from 182 individuals living with type 2 diabetes in Uganda. HbA1c values for each method were compared to average glucose measured over 14 days by continuous glucose monitoring (CGM). To determine concordance, the three HbA1c assay methods were compared to the capillary electrophoresis method.

Results: there was a strong correlation between CGM average glucose levels and all four HbA1c methodologies (r=0.81-0.89) which did not differ in those with and without HbAS (present in 37/182 participants). The presence of HbAS did not alter the relationship between HbA1c and CGM glucose for any assay (p for interaction >0.2 for all methods). Diagnostic accuracy for CGM average glucose thresholds of 7 and 10mmol/L was similar across methods (area under the receiver operating characteristic curve 0.80-0.84 and 0.76-0.84 respectively). The maximum bias between the HbA1c assay methodologies was 2 mmol/mol (2.07%).

Conclusion: all major HbA1c technologies offer accurate and comparable HbA1c measurement even in this population with high prevalence of haemoglobin variants.

Knowledge, practices, and self-reported health outcomes related to chemical use and safety among beauty salons and parlor workers in Polokwane, Limpopo Province

Konyana Edgar Nkoana — 2025-04-08

Introduction: daily, workers in beauty salons and parlors use different cosmetic products made of various chemicals. This study aimed to determine the knowledge, practices, and self-reported health outcomes related to chemical use and safety among workers in beauty salons and parlors.

Methods: a quantitative, cross-sectional descriptive study was conducted among 145 participants, randomly selected using a simple random sampling design. A self-administered questionnaire was used to assess the Knowledge, practices, and self-reported health outcomes related to chemical safety. Pearson´s correlation was used to assess the correlation between perception, awareness, and other study determinants.

Results: fifty-seven percent of participants had been working with chemicals for more than two years, and only 5% were smokers. There was a positive relationship between age and years of experience in the beauty and salon industry (r= 0.385; p < 0.001), while significant positive correlations between knowledge score with educational levels (r=0.444; p= <0.001) and formal training as a salon and beauty parlor worker (r=0.504; p= <0.001) were also found. Participants also reported symptoms such as headache (43%), nausea (23%), skin irritation (48%), eye irritation (39%), and respiratory illness-related symptoms (62%).

Conclusion: there is a need for health and safety training in beauty salons and parlors, with emphasis on the correct use of personal protective equipment (PPE). The findings of this study may serve as the baseline for the development of safety policies for all beauty salons and parlors in South Africa.

Biochemical characterization of actinomycete from Namibia rocky crest mountainous soil and analyzing their bioactive metabolites for antagonistic effect against human respiratory pathogens

Albertina Mariina Ndinelao Shatri — 2025-04-08

Introduction: the present study aimed at isolating and characterizing actinomycete from unexplored Windhoek rocky crest mountainous soil and extracting bioactive metabolites as possible therapeutics against common life-threatening Streptococcus pneumonia (S. pneumonia) and Stachybotrys chartarum (S. chartarum).

Methods: chemotaxonomy and biochemical methods were used to identify the isolates. The solvent extraction method was used to extract bioactive compounds. Agar overlay and disc diffusion methods were used to determine the antimicrobial activity of isolates and extracted bioactive metabolites against S. pneumonia and S. chartarum. The antioxidant activity of the extracted bioactive metabolites was determined using 2.2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging method with ascorbic acid as a positive control. Comparison between groups was done using a Two-way ANOVA, followed by Bonferroni post-test.

Results: three distinct isolates from 3 soil samples were identified on starch casein agar and distinguished using biochemical tests. All three isolates showed strong inhibitory activity against S. pneumonia with average growth inhibition zones between 18.0±1.00 and 27±0.00 mm p< 0.005. All isolates showed potent inhibitory activity against S. chartarum with the average inhibition zones ranging between 42.0±1.00 and 48±0.00 mm, p< 0.005. The chloroform extracts showed potent DPPH activity of up to 73± 1.41%.

Conclusion: growth conditions and extraction solvents can influence the antimicrobial and antioxidant properties of bioactive metabolites.

A rare presentation of rhino-orbital-cutaneous mucormycosis in an immunocompetent patient: a case report

Ni Putu Ayu Reza Dhiyantari — 2025-04-08

Mucormycosis is a rare opportunistic infection caused by Mucorales fungi. Cutaneous mucormycosis typically present as chronic indolent infection, whereas rhino-orbital mucormycosis is rapidly progressive disease often invade the adjacent cerebral tissue associated with high mortality. This case represents the atypical clinical history of rhino-orbital-cutaneous mucormycosis. The patient was presented with a right orbital cellulitis associated with an extensive multiple suppurative deep cutaneous infection and worsening headache. The skin lesion was initiated from a localized abscess at the right periorbital area nine months before admission. Suspicion of fungal infection was raised after weeks of non-responsive antibiotics treatment. Aggressive treatment with exoneration of the right eye and surgical debridement was undertaken. Periodic acid Schiff staining from healthy periorbital tissue revealed ribbon-like hyphae with pauciseptate and 90° branching identified as Mucoraceae family. The resolution was seen after four weeks of antifungal treatment with Amphotericin B.

Effect of post-discharge postnatal educational intervention on postnatal practices among low-income primiparas in Nairobi informal settlements, Kenya: a post-test quasi-experiment

Immaculate Wambui Kamau — 2025-04-08

Introduction: informal settlements exhibit disproportionately worse maternal and newborn outcomes. Postnatal care (PNC) is a high-impact intervention for populations contributing to higher mortalities. Postnatal education is crucial to adopting evidence-based postnatal practices (PNPs) thus its post-discharge reinforcement is vital for low-income primiparas. This study aimed to determine the effect of post-discharge follow-up postnatal education intervention (PNE) on the adoption of recommended PNPs among low-income primiparas.

Methods: quasi-experimental study in Nairobi informal settlements with 118 primiparas discharged early after normal delivery on each arm. Facility and demographic data collected using an interviewer-administered questionnaire. Study arm received the intervention for 6 weeks in addition to routine PNC while control received routine PNC only. An interviewer-administered exit questionnaire was applied after 6 weeks. Focus group discussions were conducted for qualitative data then analyzed thematically. SPSS used to analyze quantitative data then descriptive statistics, t-tests, Chi-square, Mann-Whitney, and multiple linear or logistic regressions derived. PNPs composed of health-seeking for maternal and newborn danger signs, self and baby care practices, and utilization of PNC contacts.

Results: the intervention was a positive predictor of adoption of composite PNPs (β=0.26, p=0.00), self-care practices (β=0.39, p=0.00) and mothers' two weeks PNC contact (OR=4.64, p=0.00, 95% CI=1.9-11.2). Neither a significant predictor of health-seeking for maternal (β=-0.11, p=0.31) nor newborns danger signs (β=-0.04, p=0.73) though inversely related. No influence on baby care practices, two weeks newborn contact and six weeks contact for the dyad. Multi-pronged approaches are appreciated.

Conclusion: follow-up post-discharge PNE intervention enhances adoption of PNPs among low-income primiparas thus a worthwhile supplement to routine PNC.

Prevalence and determinant factors of depression and anxiety in people with chronic kidney disease: a Moroccan cross-sectional study

Amina Chrifi Alaoui — 2025-04-08

Introduction: the chronic kidney disease (CKD), is associated with various psychiatric conditions and poorer quality of life. The main objective of this study is to estimate the prevalence of depression and anxiety among CKD patients and to assess their determinant factors.

Methods: this is a cross-sectional study in a Moroccan university hospital. Patients aged ≥18 years and followed for more than one year for a stage 3 to 5 CKD, not under renal replacement therapy (RRT) were included. The data were collected using a questionnaire and the hospital anxiety and depression scale (HADS). The association between depression and anxiety sub-scores and the estimated glomerular filtration rate (eGFR) was assessed using simple and multiple linear regression.

Results: eighty-three patients (mean age 61.7 ± 14.1 years, and 61.4% were women), were included. Regarding the stages of CKD, 10.7% were in stage 3, 52.2% in stage 4, and 25% in stage 5 of CKD. The median of the depression sub-score was 5.00 (IQR (2.00; 10.0)). The median of the depression sub-score was 5.00 (IQR (2.00; 10.09)), and the median of the anxiety sub-score was 6.00 (IQR (4.00; 9.00)). It also shows that 22.0% of patients had depression (stage 4 = 23.8%, stage 5 = 36.8%) and 22.2% had anxiety (stage 4 = 26.2%, stage 5 = 33.3%). Both depression and anxiety scores were significantly associated with the eGFR before (p<0.001, p= 0.001 respectively) and after adjustment (p=0.001, p=0.002 respectively).

Conclusion: according to this study depression and anxiety are strongly related to eGFR.

Effect of stage-matched educational intervention on use of institutional delivery in Northwest Ethiopia: using community readiness model

Adane Nigusie — 2025-04-08

Introduction: even though there are many initiatives to improve institutional delivery, there are low service utilization and community readiness for institutional delivery in Ethiopia. This study assessed the role of community readiness on delivery service use.

Methods: a pre-and post-test design with a control group was used for the evaluation of the stage-matched educational intervention following the protocol of the community readiness assessment model. Based on the baseline assessment of community readiness among 15 kebeles where the study was conducted, the overall score of nine kebeles was below stage-5 out of the nine stages, which were targeted for the intervention. The intervention group (n= three kebeles) participated in the stage-matched intervention for 15 months, while the control group (n= three kebeles) were not given the intervention. The data were analyzed using the difference in difference (DiD) method.

Results: there were significant improvements in a stage of change for the promotion of institutional delivery (p-value <0.001) and institutional delivery use (p-value <0.001) in the intervention group as compared to the control group. The study revealed that the intervention influenced community resource allocation (at marginally significant levels), improved leader-ship quality of prevention, and community climate to supportive prevention efforts. There was evidence that the intervention (health promotion) also increased service use at a significant level.

Conclusion: the community readiness-based intervention (health promotion) can be useful to measure the combined attitude and behavior towards institutional delivery services. The village-based mobilizer approach had a positive effect on institutional delivery use and the level of community readiness on the promotion of institutional delivery.

Urétéro-hydronéphrose avec rupture du fornix sur syndrome de jonction pyélo-urétérale

Idriss Ziani — 2025-04-08

La rupture des cavités pyélo-calicielles encore
dénommée rupture du fornix rénal (RFR) avec
extravasation rétropéritonéale d'urine est une
complication urologique rare le plus fréquemment
en lien avec une obstruction aiguë des voies
urinaires par un calcul. Nous décrivons par notre
observation une étiologie exceptionnelle d'une
rupture du fornix à savoir la jonction pyélourétérale. À notre connaissance, c'est la première
observation rapportant une telle complication
dans la littérature. Les étiologies habituelles
responsables de RFR sont les valves de l'urètre
postérieur en période néonatale, les hyperplasies
prostatiques ou les causes traumatiques et
principalement la pathologie lithiasique. Nous
rapportons le cas d'un jeune patient de 19 ans
consulté pour lombalgie fébrile. L'uro-scanner
objective une rupture des voies excrétrices avec
extravasation du produit de contraste et un
urinome de grande abondance (A). Le patient a
bénéficié en urgence d'un drainage par sonde
double J avec une antibiothérapie probabiliste par
ceftriaxon et gentamycine. Une bonne évolution
clinico-biologique avec une régression complète
de l'urinome sur le scanner de contrôle (B). Suite
au retrait de la sonde double J dans le cadre du
bilan étiologique, une scintigraphie au DTPA a
objectivé un syndrome de la jonction pléyourétérale. Le patient a bénéficié par la suite d'une
cure du syndrome de jonction par voie
laparoscopique avec évolution favorable (C, D).

Intravenous versus intracuff alkalinized lidocaine to prevent postoperative sore throat: a prospective randomized controlled trial

Salma Ketata — 2025-04-08

Introduction: postoperative sore throat (POST) is a common complication after general anesthesia with endotracheal intubation caused by tracheal mucosal injury. Multiple techniques prevent postoperative sore throat (POST). Our study aimed to compare two techniques: intravenous and intracuff lidocaine versus placebo to prevent postoperative sore throat after general anesthesia with orotracheal intubation.

Methods: we conducted a prospective double-blind, randomized controlled clinical trial involving patients, proposed for a scheduled surgery less than 240 minutes under general anesthesia with orotracheal intubation. Patients were divided into three groups: L group: infused with saline, cuff filled with alkalinized lidocaine. S group: Infused with 1.5 mg/kg of lidocaine, cuff filled with saline. T group: placebo: infused with saline, cuff filled with saline. Our primary outcome was the incidence of sore throat and their (visual analog scale) VAS score in the first 24 postoperative hours. Our secondary outcomes were the incidence of cough, dysphonia, dysphagia, and postoperative nausea and vomiting.

Results: ninety patients were analyzed and divided into 3 groups of 30. The incidence of POST at the sixth postoperative hour, for placebo, the "L" group, and the "S" group, respectively, was 67%, 30%, and 47%. And at the 24^th postoperative hours 67%, 13%, and 37%. Intravenous lidocaine reduced significantly the VAS of POST at the 24^th hour (S: 6.80 ± 20.70; T: 20.67 ± 18.182; p= 0.02). Alkalinized lidocaine decreased significantly the VAS of POST in the sixth (L: 8.17 ± 22.761; T: 23 ± 21.838; p = 0.048) and the 24^th postoperative hour (L: 6.33 ± 20.592; T: 20.67 ± 18.182; p= 0.019) with the lowest pain score. There was no statistically significant difference between the L and S groups at the 6 and 24 postoperative hours. Both lidocaine techniques reduced cough at emergence, with the superiority of alkalinized lidocaine (p=0.02). They decreased the incidence of cough, dysphonia, dysphagia, nausea, and vomiting compared to a placebo.

Conclusion: intravenous and intracuff lidocaine allowed better control of postoperative sore throat.

Multisectoral approach for the control of cholera outbreak - lessons and challenges from Lusaka district - Zambia, October 2023 - February 2024

Ernest Kateule — 2025-04-08

Introduction: on October 18, 2023, the Ministry of Health declared an outbreak of cholera in the Lusaka district. Public health interventions were implemented using a multisectoral approach in the Lusaka district and other hotspots in the country. We documented the multisectoral response efforts and their impacts on the cholera epidemic in the Lusaka district of Zambia. We highlighted the major challenges and their associated impacts on the epidemiologic patterns of disease in hotspot areas.

Methods: we conducted a descriptive observational study of cholera response activities in the Lusaka district. We used quantitative and qualitative non-participant techniques using the Centers for Disease Prevention and Control's direct in-person observation tool in healthcare settings. We reviewed surveillance records to estimate the magnitude of the outbreak, and characterized cases by person, place, and time. We documented the response interventions and challenges using situation reports.

Results: during the 2023 - 2024 cholera outbreak, Lusaka district was the most affected district with 13,122 cases and 498 deaths as of 12^th February 2024. Despite having a well-established system for coordinating technical support and resource mobilization, inadequate sanitation and limited access to clean water remained potential risks for cholera outbreaks in Lusaka district.

Conclusion: Lusaka district may have experienced one of the most severe cholera epidemics in the nation's history, as indicated by its rapid spread and increased mortality reported from both the community and treatment centers. A multisectoral coordination for improved sanitary systems, access to clean water, health education strategies, and vaccination campaigns contributed to the decline in cholera cases.

A maxillary location of extra-nodal Rosai Dorfman disease: a case report

Yassine Bennaoui — 2025-04-08

Rosai-Dorfman disease (RDD) is a rare benign histiocytic proliferation, characterized by a group of clinical symptoms. This report presents a case of extranodal RDD manifesting as a progressively enlarging left maxillary mass in a 42-year-old woman. Surgical exploration and biopsy confirmed the diagnosis of RDD, with characteristic histopathological features including emperipolesis. Treatment involved corticotherapy, resulting in controlled maxillary pain and improvement of the disease after one year. This case underscores the potential for extra-nodal RDD presentations, posing diagnostic challenges and emphasizing the importance of considering RDD in the differential diagnosis of maxillary masses.

Epidemiological profile of patients attending the maxillofacial prosthodontics unit at Ibn Sina University Hospital in Rabat, Morocco: a cross-sectional study

Mohamed Azhari — 2025-04-08

Introduction: the present study aimed to establish an epidemiological profile of patients consulting the unit of maxillofacial prosthodontics in Rabat. Results deriving from this study will help enhance the quality of patient care in our center and can also serve as a comparison tool with other maxillofacial teams around the world.

Methods: during 11 months all patients consulting the unit of maxillofacial prosthodontics in our center were included. We opted for a questionnaire with 3 variables: socio-demographics, clinical examination data, and the type of prosthetic treatment adopted. The study was conducted in the Department of Removable Prosthodontics in the Center of Consultation and Dental Treatment of Rabat Morocco (CCDTR) from September 2020 to July 2021.

Results: the study population consisted of 91 patients, with a majority of male patients at 53% (n=48). During our study period, the proportion of patients under one-year-old was predominant, accounting for 38.4% (n=35) of the total sample. Among the patients in the sample, 72.5% (n=66) had no profession, while 66% (n=60) had a low income. Regarding medical insurance, the majority of our patients, 85.5% (n=78), were covered by Public Health Insurance for the Low-income Population (PHILP). Among the total sample, 57.1% (n=52) consulted for a combination of pain function and aesthetics. Additionally, 61.5% (n=56) were referred by teaching hospitals. For the type of oro-facial defect, 52.7% (n=48) of the sample consisted of newborns with congenital facial cleft. Out of the 91 patients, 36 had maxillofacial tumors, with 47.6% (n=17) of them presenting squamous cell carcinoma. Furthermore, 63.7% (n=58) of the prosthetic treatments adopted involved presurgical orthopedic treatments for newborns with facial cleft.

Conclusion: the study on the epidemiological profile of patients attending the maxillofacial prosthodontics unit at Ibn Sina University Hospital in Rabat, Morocco provides important insights. The findings highlight the predominance of male patients and the prevalence of oro-facial defects in newborns. Socioeconomic factors, such as low income and lack of profession, are significant considerations. The majority of patients are covered by the PHILP, indicating the importance of medical insurance. These findings contribute to improving healthcare planning and specialized care for this patient population.

Knowledge, attitude and practices on intermittent preventive treatment in pregnant women with malaria: a mixed method facility-based study in Western Kenya

Joseph Mukala — 2025-04-08

Introduction: intermittent preventive treatment remains a core strategy for malaria prevention in pregnancy. Sulfadoxine-pyrimethamine is recommended for all pregnant women in malaria-prone zones. It is scheduled monthly at each antenatal care visit for up to 36 weeks. Here, we sought to assess the knowledge, attitude, and practices of intermittent preventive treatment among pregnant women with malaria in Webuye Hospital.

Methods: a total of 140 participants aged between 18 and 49 years and at approximately 16 weeks of gestation were enrolled in this study, which utilized a mixed qualitative-quantitative method. Before enrollment, malaria testing was conducted using microscopy, and participants were divided into two cohorts: malaria-positive and malaria-negative. Close-ended and open-ended questionnaires were used. Qualitative-quantitative data analyses were performed.

Results: our analysis revealed a significant difference between the proportion of mothers in the negative and positive groups in terms of their knowledge about side effects (p ≤ 0.001) and different doses (p ≤ 0.012) of intermittent preventive treatment. The proportion of mothers who knew side effects and different doses was higher among the malaria-positive group as compared to malaria-negative group with 37(52.9%, n=70) versus 18(25.7%, n=70) and 14(20.0%, n=70) versus 4(5.7%, n=70) respectively. Additionally, there was also a significant difference in knowledge about intermittent preventive treatment before administration (p ≤ 0.003) between the two groups.

Conclusion: good knowledge, attitude and practices on intermittent preventive treatment (IPT) benefits, side effects, safety, doses and other prior information should be leveraged to empower pregnant women in malaria-endemic zones.

Seroprevalence of brucellosis in sheep and goats from Al Jufrah district in Libya

Khawla Aldweni Alshekh — 2025-04-08

Introduction: brucellosis is a global neglected zoonotic disease affecting mainly livestock, causing communicable and zoonotic infections. This study aimed to investigate the seroprevalence and determine epidemiological risk factors associated with Brucella infection in sheep and goats in Al Jufrah central district of Libya.

Methods: sera samples from 555 animals (goats (n=320) and sheep (n=235)) sheep) were obtained and subjected to the Rose Bengal Plate Test (RBPT) then further confirmed by a validated Enzyme Linked Immunosorbent assay (ELISA). Collected data was analyzed using Statistical Package for the Social Sciences (SPSS).

Results: in total, 2.7% were ELISA seropositive for brucellosis with the highest seropositivity rate among the studied animals from Sokna with 5.8% (n=13/225) followed by 0.7% (n=2/285) in Waddan and 0% (n=0/45) in Houn. Only location was identified as a significant risk and no significant differences were identified between seropositivity and the age studied groups, species of animals, gender, and size of farms (p-value>0.05).

Conclusion: the present study provides important information on the epidemiological status of Brucella infection in an important region in North Africa. Prevention control systems adopting “One Health” concept, and regional and international collaboration are important to control brucellosis and other zoonotic and transboundary diseases.

Effect of short-term exposure to Raag Bilawal of North Indian classical music on young Indian adults: a high-density electroencephalogram microstate study

Abhisek Sahoo — 2025-04-08

Introduction: the objective of the study was to find out the microstate map topographies and their parameters generated during the resting state and during listening to North Indian classical Music Raag 'the Raag Bilawal'. It was hypothesized that in the resting state and during listening to music conditions, there would be a difference in microstate parameters i.e. mean duration, global explained variance (GEV), and time coverage.

Methods: a 128-channel electroencephalogram (EEG) was recorded for 12 Indian subjects (average age 26.1+1.4 years) while resting and listening to music using the EEG microstate investigation. Investigation and comparison of the microstate parameters were the mean duration, global explained variance (GEV), and time coverage between both conditions were performed.

Results: seven microstate maps were found to represent the resting state and listening to music condition, four canonical and three novel maps. No statistically significant difference was found between the two conditions for time coverage and mean duration. The statistical significance levels of the map-1, map-2, map-3, map-4, map-5, map-6, and map-7 for the mean duration were 0.4, 0.6, 0.97, 0.34, 0.32, 0.69, and 0.29 respectively; and for time coverage were 0.92, 0.92, 0.96, 0.64, 0.78, 0.38, and 0.76 respectively. Map-1, map-4, and map-7 were the three novel maps we found in our study.

Conclusion: similarities regarding stability and predominance of maps with small vulnerability exist in both conditions indicating that phonological, visual, and dorsal attention networks may be activated in both resting state and listening to music condition.

Tarlov cyst: a rare image

Angan Ghosh — 2025-04-08

A 67-year-old male came to the casualty with complaints of severe backache, inability to hold urine, and weakness in all four limbs. On neurological examination, sensory was intact and power was 3/5 in bilateral lower limbs. The patient was referred to orthopaedic department after routine examination and investigations which were normal. Magnetic resonance imaging (MRI) of the cervical spine with contrast and screening of dorsolumbar spine was done which showed subcentrimetric tarlov cyst at the neural foramina aspect of the C7/D1 disc level. A diagnosis of cervical disc disease with quadriplegia and bladder incontinence was made and the patient was posted for posterior decompression and spinal fusion.

Bilateral claw hand deformity: a rare image

Angan Ghosh — 2025-04-08

A 58-year-old male came to the hospital with the complaint of difficulty in opening both hands and inability to perform routine activities. On inspection, fingers were bent with atrophy of the intrinsic muscles of both hands. On routine evaluation, it was noted that the patient had a past history of Hansen´s disease for which he took multidrug therapy (MDT) consisting of rifampicin, dapsone, and clofazimine for 6 months. The patient was then examined thoroughly to check the strength and flexibility of the fingers and an electromyography test was done. A diagnosis of bilateral claw hand was made due to ulnar nerve damage. The patient was advised physical therapy along with strengthening exercises to gain more flexibility in fingers and braces to prevent further nerve injury. The patient was posted for a Zancolli lasso procedure in the following hospital visit. Routine investigations and radiological imaging were normal and the surgery was done under a brachial plexus block with tourniquet control using local anaesthetics. Intraoperatively the patient was vitally and hemodynamically stable. The surgery was uneventful and postoperative rehabilitation was done.

Association of bullous pemphigoid with acquired hemophilia A: a case report

Ouadii Abakarim — 2025-04-08

Acquired hemophilia A, a rare condition resulting in spontaneous bleeding without prior bleeding disorders, arises due to autoantibody-mediated inhibition of coagulation factor VIII and is typically associated with autoimmune, neoplastic, drug, or obstetric factors. We present the case of a 31-year-old woman with bullous pemphigoid, managed with corticosteroids since 2013, who presented spontaneous hemorrhagic manifestations. Upon admission, laboratory tests revealed hypochromic microcytic anemia, prolonged activated partial thromboplastin time, and a factor VIII level < 1%, indicative of acquired hemophilia A. Further assessments showed elevated Ristocetin cofactor activity, von Willebrand factor antigen, and a factor VIII inhibitor level of 665 BU. This underscores the importance of considering acquired hemophilia A in autoimmune dermatological conditions like bullous pemphigoid, highlighting the association between autoimmune disorders and coagulation abnormalities, particularly in cases of spontaneous hemorrhagic events.

Diabetic mastopathy: about two cases

Karam Harou — 2025-04-08

Diabetic mastopathy is a rare and benign pathology affecting young individuals with type 1 diabetes or autoimmune diseases. It clinically resembles breast cancer, necessitating a histological examination for a definitive diagnosis. These cases underscore the diagnostic challenges and the importance of histological examination. This report details two cases of diabetic mastopathy at Mohammed VI Hospital in Marrakech. The first case involved a 35-year-old with type 1 diabetes and mastodynia, revealing a 4 x 3 cm nodule in the left breast. Biopsies confirmed fibrous breast tissue with lymphocytic infiltrates, characteristic of diabetic mastopathy, with no recurrence during follow-up. The second case featured a 38-year-old with trisomy 21 and type 1 diabetes presenting with a right breast abscess. Drainage revealed lymphocytic infiltrates, confirming diabetic mastopathy. Though diagnostically challenging, diabetic mastopathy lacks a direct link to breast cancer. Long-term cancer risks in affected patients mirror the general population.

Systems issues limiting acute fracture care delivery at a tertiary care hospital in Northern Tanzania

Papa Kwadwo Morgan-Asiedu — 2025-04-08

Introduction: sub-Saharan Africa experiences a significant musculoskeletal trauma burden. Among patients who receive surgical treatment, there have been no reports as to how often surgical care is determined to be “adequate” or, if “inadequate”, then what hospital and orthopaedic specialty-specific systems limitations might be prohibitive.

Methods: data from patients presenting to the orthopaedic trauma service at a tertiary care center in sub-Saharan Africa were prospectively collected over a 6-week period and then retrospectively reviewed to determine whether the surgical treatment was “adequate” (or otherwise, “inadequate”) according to the principle of restoring length, alignment, and rotation. Exclusion criteria included insufficient clinical information; isolated spinal injury; infection; cases involving only removal of hardware; soft-tissue procedures; tumor cases; and medical (non-surgical) conditions.

Results: 112 cases were included for analysis. Surgery was indicated in 106 of 112 cases (94.6%), and of those, surgery was performed in 62 cases (58.4%). Among patients who underwent surgery with available post-operative imaging (n=56), surgical treatment was “inadequate” in 24 cases (42.9%). The most common reasons treatment was deemed “inadequate” included unavailability of appropriate implants (n=16), unavailability of intraoperative fluoroscopy (n=10) and incomplete intraoperative evaluation of injury (n=5).

Conclusion: several systems limitations prevent the delivery of adequate surgical treatment in patients with acute orthopaedic traumatic injuries, including lack of intraoperative fluoroscopy and lack of implant availability. This study will serve as a useful baseline for ongoing efforts seeking to improve orthopaedic specialty resource availability and facilitate more effective fracture care in this region.

Evaluation of Gallium-68 prostate-specific membrane antigen, positron emission tomography/computed tomography (GA-68 PSMA PET/CT) in recurrent prostate cancer: a retrospective review of initial clinical experience at Tygerberg Hospital

Bright Awadh Sangiwa — 2025-04-08

Introduction: prostate cancer recurrence after definitive therapy for organ-confined disease often manifests as rising prostate-specific antigen (PSA) levels without clinically overt disease. ⁶⁸Gallium prostate-specific membrane antigen, positron emission tomography/computed tomography (⁶⁸GaPSMA PET/CT) imaging plays a major role in the management of recurrent prostate cancer. The purpose of this study was to assess the positivity rate of ⁶⁸Ga PSMA PET/CT scans in cases of prostate cancer recurrence, and to compare the results with existing international literature.

Methods: a retrospective analysis of 177 ⁶⁸Ga PSMA PET/CT scans of patients with biochemically proven disease recurrence was performed. The possible association of a positive PSMA PET/CT with the PSA level and Gleason score were analyzed.

Results: a total of 177 ⁶⁸Ga PSMA PET/CT scans were performed in 163 patients (median age 66 years). Of these, 117 (66%) scans detected the site of disease recurrence. Among patients with PSA 0.2-0.99 ng/ml, 23/49 (47%, p<0.0001) were positive, and 20/35 (57%, p<0.0005) were positive in the group of patients with PSA 1.00-1.99. When PSA values were further categorized into PSA <2 ng/ml and PSA ≥2 ng/ml, detection rates were 49% and 86% respectively (p <0.0001). The scans were positive in 65% of patients with Gleason score of <7, 62% with Gleason score of =7 and 68% with Gleason score >7 (p=0.745).

Conclusion: there was an increase in the detection rate with an increase in the PSA. Gleason score was not a predictor of a positive ⁶⁸Ga PSMA PET/CT scan. ⁶⁸Ga-PSMA PET/CT should be prioritized in patients with biochemical recurrence with PSA levels >0.2 ng/ml.

Laparoscopic transabdominal preperitoneal repair of inguinal bladder hernia: a case report

Ghassane El Omri — 2025-04-08

Inguinal bladder hernia is a rare clinical condition, and only a small number of reported cases have been treated by laparoscopic surgery. We report a case of a patient aged 65-year-old who presented to our outpatient care unit for a right inguinal swelling. Computer tomography (CT) imaging showed a direct inguinal hernia with bladder and epiploic content. We performed a laparoscopic transabdominal preperitoneal repair, which involved carefully reducing the bladder's protrusion from the hernial orifice. Subsequently, a mesh prosthesis was employed to treat the right inguinal hernia. This case represents an unusual instance of a successful laparoscopic repair for a right direct inguinal bladder hernia.

Tuberculose hépatique primaire chez un immunocompétent: à propos d'un cas

Yannick Bangda Ekanga — 2025-04-08

La tuberculose est une maladie infectieuse courante qui affecte principalement les poumons, peut affecter tout autre organe avec un vaste éventail de manifestations cliniques. Dans l'atteinte hépatique, trois formes peuvent se présenter: tuberculose hépatique diffuse avec tuberculose pulmonaire; tuberculose hépatique diffuse sans atteinte pulmonaire et la tuberculose hépatique nodulaire dite focale/locale qui est une forme très rare et présente un défi diagnostique. Ce cas clinique rapporté chez un jeune marocain, se présentant dans un tableau de colique hépatique évoluant depuis un mois associé à des signes frustres d'imprégnation tuberculeuse. Des lésions nodulaires hépatiques non spécifiques ont été révélées au scanner et à l'imagerie par résonance magnétique (IRM) hépatique. Le diagnostic de tuberculose hépatique focale a été confirmé après analyse anatomopathologique sur biopsies des nodules hépatiques obtenues au décours d'une cœlioscopie. Après début du traitement anti bacillaire bien conduit, une bonne amélioration clinico-biologique a été obtenue.

Caractérisation des blessures sur une saison sportive chez des footballeurs d'élite au Burkina Faso: cas de la saison 2019-2020

Adama Tiama — 2025-04-08

Introduction: les blessures représentent un évènement indésirable majeur dans la carrière du sportif et la prévention est tributaire de leurs caractéristiques. Le but de cette étude était de déterminer les caractéristiques des blessures subies par des footballeurs d'élite au Burkina Faso au cours de la saison sportive 2019-2020.

Méthodes: il s'agissait d'une étude transversale, réalisée avec 160 joueurs, soumis à un questionnaire. Les tests de proportion et de χ² ont été utilisés respectivement pour calculer les fréquences et déterminer les facteurs associés.

Résultats: au total, 157 blessures ont été enregistrées chez 143 joueurs (89,4%). Les lésions musculaires (45,85%) et l'entorse (30,6%) étaient courantes. La majorité des blessures (52%) étaient de gravité moyenne. La cuisse (30%), la cheville (26,5%) et le genou (18%) étaient les zones les plus touchées. La fréquence des blessures était plus élevée après un contact que sans contact physique avec un autre joueur (69,5% versus 30,5; p = 0,009), lors de matchs qu'à l'entraînement (82% versus 28%; p = 0.003) et durant la phase retour que la phase allée du championnat (58,5% versus 41,5%; p = 0.02).

Conclusion: la fréquence des blessures subies par des footballeurs au cours de la saison 2019-2020 était élevée. Ces blessures étaient en majorité de type musculaire et tendineux, puis affectaient davantage les membres inférieurs. Elles étaient associées aux contacts physiques, aux matchs et à la phase retour du championnat. Les mesures préventives doivent tenir compte de ces caractéristiques pour être efficace.

Pemphigus vulgaris: a rare clinical image of post-homeopathic necrosis

Leuri Ukey — 2025-04-08

Pemphigus vulgaris is an autoimmune disorder of the skin. It involves blistering skin and membranes that are mucous. While pemphigus may affect anyone at any age, middle age or older seems to be the most common age for it to appear. Without treatment, some forms of this condition may be fatal and have a prolonged course. It can be more painful and itchy blisters. This blisters in your mouth and then on your skin or genital mucous membranes. A 68-year-old female has been experiencing multiple red-colored lesions with discharge on bilateral left lateral and unilateral. She complained of itching around the border of the lesions and a pins and needles sensation in the middle. she reports multiple ulcers and erosions on her bilateral lower limbs and back. Oral lesions, swelling over legs and face, fluid-filled lesions, and discharge from the lesion. Additionally, she reports multiple ulcers and erosions on her bilateral lower limbs and back, which have worsened in the last 18 days. The patient has also complained of oral lesions for the past eight days. The patient's medical history indicates that she was healthy until six years ago when she started developing small lesions (0.5×0.5cm) on her bilateral legs, which caused burning, itching, and pins and needles sensation. The lesions turned blackish in color and increased in size to approximately 2×1cm after itching. A month later, similar lesions developed on her hands, back, and abdomen, along with blackish discoloration of toes on bilateral feet, which was painful and worsened in the evenings. It will be managed through regular follow-up and taking systemic corticosteroids such as Azathioprine, mycophenolate.

A case of ulnar deviation (drift) in a patient with chronic rheumatoid arthritis

Amol Madhav Deshpande — 2025-04-08

Rheumatoid arthritis is an autoimmune disease which affects articular and extra-articular structures. It develops slowly in weeks to months, with the onset of signs and symptoms. The patient frequently first experiences stiffness in one or more joints, which is frequently accompanied by discomfort with movement and joint soreness. Although the total number of joints involved varies greatly, the process always ends up being polyarticular, involving five or more joints. A palindromic presentation is another pattern where patients report swelling in one or two joints that may last a few days or weeks before going away completely, only to subsequently return in the same or other joints with an increasing pattern over time. The hands' Proximal Interphalangeal (PIP) and Metacarpophalangeal (MCP) joints, the wrists, and the tiny joints of the feet, especially the Metatarsophalangeal (MTP) joints, are the joints most usually affected. A 62-year-old female patient came to the outpatient department of Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H) with all the signs and symptoms of rheumatoid arthritis along with ulnar deviation in both hands. Clinical observation revealed an ulnar deviation.

Self-care practices and its associated factors among adult diabetes mellitus patients in public hospitals of Sidama region, Southern Ethiopia: a cross-sectional study

Gizachew Ambaw Kassie — 2025-04-08

Introduction: poor adherence to diabetes self-care practices can result in adverse health outcomes. Thus, it is important to adapt self-care behaviors to reduce and prevent complications from diabetes mellitus. Therefore, this study aimed to determine the level of diabetes self-care practices and associated factors among adults with diabetes in Ethiopia.

Methods: a health facility-based cross-sectional study was conducted from March to April 2021 in the Sidama region public hospitals. A systematic random sampling technique was used to select 437 diabetic patients. The data were entered using Epi data version 3.1 and analyzed using SPSS version 25. A binary logistic regression analysis was performed, and variables with a p-value <0.05 were considered statistically significant.

Results: in this study, a large number of diabetes patients had inadequate self-care practices. Therefore, it is important to strengthen and establish support systems, such as collaborating with healthcare providers, enlisting the support of family members, and providing health education to improve self-care practices.

Conclusion: this study found that 48.9% of participants had a good level of self-care practice. College graduates and above [AOR: 4.4, 95% CI (1.87, 10.4)], those with strong social support [AOR: 4.6, 95% CI (2.3,10.5)], attendees of health education [AOR: 2.33, 95% CI (1.38,4.6)], those who were on oral hypoglycemic drug [AOR: 0.45, 95% CI (0.24, 0.83)], those who perceived the benefits of self-care [AOR: 0.46, 95% CI (0.25,0.84)], and those who perceived the severity of complications [AOR: 0.56, 95% CI (0.29, 0.77)] were predictors of diabetes self-care practices.

Pertussis outbreak investigation in Likimsa-Bokore kebele, Meda Walebu district, Bale zone, Oromia region, Ethiopia, 2019: a descriptive cross-sectional study

Mohammed Hasen Badeso — 2025-04-08

Introduction: pertussis is a major cause of childhood morbidity and mortality. Globally, an estimated 45 millions cases and 400,000 deaths occur every year. Meda Walebu surveillance office reported a pertussis outbreak among the residents of the Liqimsa-Bokore kebele communities. We investigated to describe the magnitude of the pertussis outbreak in Likimsa-Bokore kebele of Meda-Walebu district, Bale Zone, Southeast Ethiopia.

Methods: we conducted a descriptive cross-sectional study in April 2019. We identified pertussis cases recorded on the line list. Suspected cases of pertussis were defined as any resident of Likimsa-Bokore kebele with cough illness and any of the following: paroxysms of coughing, inspiratory whooping, post-tussive vomiting, or apnea. The pentavalent vaccine coverage data were extracted from the Bale zone health management information system department database. Microsoft Excel pivot table and SPSS version 23 software cleaned and analyzed the data.

Results: in three months period, a total of 439 suspected cases of pertussis were reported from Likimsa-Bokore kebele of the Meda-Walebu district. Half of the cases 220(50.1%) have occurred in females and the majority of cases 256 (58.3%) occurred in under five years children. The median age of cases was 4 years ranging from 2 months to 30 years (interquartile range= 4 years). The overall Attack Rate (AR) was 55 per 1000 population with a case fatality rate of 0.7% (3 deaths/439). Children less than five years were the most affected age group with an AR of 198 per 1000 population. The administrative pentavalent vaccine coverage of the district was above 100% during the year 2015-2018.

Conclusion: the overall attack rate of pertussis outbreak was high. Children under five years were the most affected age group irrespective of high administrative coverage of the pentavalent vaccine. Strengthening routine immunization management and intensified surveillance system is required for early detection, investigation, and response activities.

Perforated ulcer at the gastrojejunal anastomosis: a rare complication of pancreaticoduodenectomy (case report)

Amine Majdoubi — 2025-04-08

Pancreaticoduodenectomy (PD) is recognized as one of the most intricate abdominal surgical procedures, often accompanied by high morbidity rates. The occurrence of an anastomotic ulcer at the gastrojejunal anastomosis post-pancreaticoduodenectomy surgery is a relatively uncommon complication, albeit potentially leading to severe, life-threatening consequences. The predominant symptomatology manifests as acute abdominal pain accompanied by peritonitis. Conventionally, diagnosis is achieved through computed tomography (CT) scans, facilitating subsequent management, and surgical management is recommended in the majority of instances. Herein, we present a rare case of a patient who experienced ulcer perforation at the gastrojejunal anastomosis site after undergoing pancreaticoduodenectomy with stomach preservation, and we reviewed the available literature to gain more comprehension of this rare complication of this type of surgical intervention.

To study the utility of HER2 and Ki-67 as immunohistochemical prognostic markers in comparison to histopathological parameters and tumour, node and metastasis staging in colorectal carcinoma

Suhit Naseri — 2025-04-08

Colorectal Carcinoma (CRC) ranks among the most prevalent cancers globally, with significant variability in incidence rates across different regions. A shift towards a Westernized diet has been implicated in rising cancer rates, particularly in emerging nations. By 2020, CRC is projected to represent a notable proportion of global cancer cases and deaths. In India, CRC primarily affects individuals aged 45 to 84, with a higher incidence in males, commonly occurring in the rectum and sigmoid colon. Risk factors such as obesity, dietary factors, sedentary lifestyle, smoking, and alcohol use contribute to CRC development, especially in aging populations. Diagnosis involves various imaging modalities and histological assessments using Tumour, node and metastasis (TNM) and American Joint Committee on Cancer classifications. Recent advancements in targeted therapies like monoclonal antibodies against HER2 have shown promise in treating metastatic CRC. Immunohistochemistry markers like Ki-67 and HER2 play crucial roles in prognostic assessment and treatment planning. This study aims to investigate Ki-67 and HER2 expression in CRC, correlating with histological characteristics and prognostic factors.

Facteurs prédictifs de la polysensibilisation aux allergènes de contact: étude comparative réalisée à l´Unité de Dermato-Allergologie du CHU Farhat Hached de Sousse, Tunisie

Noura Belhadj — 2025-04-08

Introduction: la polysensibilisation est souvent définie comme une sensibilisation à trois allergènes de contact ou plus. Les objectifs de notre étude étaient de déterminer la prévalence de la polysensibilisation aux allergènes des tests épicutanés et d´analyser les facteurs associés à une polysensibilisation aux allergènes de la Batterie Standard Européenne en comparaison avec les cas d´oligosensibilisation.

Méthodes: il s´agit d´une étude descriptive transversale rétrospective qui a porté sur tous les patients ayant bénéficié de tests épicutanés à l´Unité de Dermato-Allergologie du Service de Médecine de Travail et de Pathologie Professionnelle du CHU Farhat Hached de Sousse s´étalant sur une période de 10 ans allant du 1^er janvier 2009 au 31 décembre 2018.

Résultats: au total, nous avons colligé 464 cas de dermatite de contact au cours de la période d´étude. L´âge moyen des patients était de 38,93 ± 12,52 ans avec une légère prédominance féminine (soit 52,8% des cas). Parmi l´ensemble des patients ayant consulté durant la période d´étude (832 patients), 133 patients avaient de réactions positives à 3 allergènes ou plus soit 16% des patients. En effet, les associations des allergènes les plus fréquemment notées étaient celles de triplet (chrome, cobalt et nickel) chez 15 patients et de triplet (mercaptobenzothiazole, thiuram mix et N-Isopropyl-N-phenyl-4-phenylenediamine (IPPD)) dans 7 cas. Les facteurs prédictifs de polysensiblisation étaient les antécédents personnels d´ulcère de jambe; la localisation des lésions au niveau de thorax et l´aspect érythémato squameux et dysidrosique des lésions.

Conclusion: devant ce phénomène aussi fréquent de polysensibilisation, une collaboration étroite entre dermatologue et médecin du travail pour prévenir ce type d´allergie multiple en passant par une meilleure prise en charge des facteurs de risque personnels et aussi professionnels.

Assessment of the efficiency of the routine epidemiological surveillance system for malaria at the Tambacounda Health District, Senegal

Tidiane Gadiaga — 2025-04-08

Introduction: as part of the fight against malaria, epidemiological surveillance (ES) is one of the key pillars of the global technical strategy 2016-2030 to combat this disease. However, in the south-east of Senegal, where malaria poses a major public health problem, epidemiological surveillance has until recently been very neglected. To help reduce malaria-related morbidity and mortality in Senegal, an evaluation of the routine malaria ES system was conducted in the Tambacounda Health District in 2021.

Methods: we conducted a cross-sectional, descriptive survey of 27 health structures in Tambacounda district from 20^th February to 1^st March 2022.

Results: overall, the routine ES system in the district was acceptable according to its users, with satisfactory tool filling time in 96.3% of the structures in our study, a cumulative completeness of reports at 92% despite a 77% promptness. The data collected at the services delivery points (SDP) level allowed a representativeness of the ES system in 100% of health facilities. The ES system was also rated as simple by 74.1% of SDP managers even though only 55.6% of them were trained. However, the stability of the system was low because 55.6% of SDP had staff to ensure the continuity of ES service despite the availability of management tools (100%) and the telephone network (96.3%). The same was true for the usefulness of the ES because only 25.9% of SDP managers analyzed their produced data. The reported ES and malaria morbidity data were not adequate. On the other hand, the ES system was reactive with a speed of transmission of information at 96.3% and a possibility of rapid diagnosis and management of cases at 100%.

Conclusion: the routine malaria ES system at the level of health facilities in Tambacounda District was acceptable, simple, flexible, representative, and responsive. However, an increase in qualified staff at the health posts, capacity strengthening of the ES staff and regular supervision of SDP are needed essentials to make the district's malaria surveillance system more efficient.

Observational study on the characteristics of COVID-19 transmission dynamics during the first wave of the epidemic in Lusaka, Zambia

Millica Phiri — 2025-04-08

Introduction: coronavirus disease 2019 (COVID-19) transmission dynamics in the communities of low- and middle-income countries, particularly sub-Saharan African countries, are still not fully understood. This study aimed to determine the characteristics of COVID-19 secondary transmission during the first wave of the epidemic (March-October 2020) in Lusaka, Zambia.

Methods: we conducted an observational study on COVID-19 secondary transmission among residents in Lusaka City, between March 18 and October 30, 2020. We compared the secondary attack rate (SAR) among different environmental settings of contacts and characteristics of primary cases (e.g, demographics, medical conditions) by logistic regression analysis.

Results: out of 1862 confirmed cases of COVID-19, 272 primary cases generated 422 secondary cases through 216 secondary transmission events. More contacts and secondary transmissions were reported in planned residential areas than in unplanned residential areas. Households were the most common environmental settings of secondary transmission, representing 76.4% (165/216) of secondary transmission events. The SAR in households was higher than the overall events. None of the environmental settings or host factors of primary cases showed a statistically significant relationship with SAR.

Conclusion: of the settings considered, households had the highest incidence of secondary transmission during the first wave in Lusaka, Zambia. The smaller proportion of contacts and secondary transmission in unplanned residential areas might have been due to underreporting of cases, given that those areas are reported to be vulnerable to infectious disease outbreaks. Continuous efforts are warranted to establish measures to suppress COVID-19 transmission in those high-risk environments.

Prevalence and determinants of frailty among the elderly in the province of Essaouira, Morocco

Hicham Mejdouli — 2025-04-08

Introduction: Morocco is no exception to the global phenomenon of an ageing population. The number of people aged 60 and over rose from one million to 4.5 million between 1970 and 2022. In terms of health, 64.4% of Moroccan seniors are affected by at least one chronic disease, and almost a third suffer from disability. We aimed to estimate the prevalence and identify the factors associated with frailty among the elderly in the Essaouira province of Morocco.

Methods: a descriptive and analytical cross-sectional survey of 384 people aged 65 and over attending health centres in Essaouira province was conducted between March 2022 and January 2023. Data were collected using a self-administered questionnaire. The Fried phenotype was used to assess frailty in the participants.

Results: according to Fried's phenotype, 46.4% of the elderly were frail. Multivariate analyses showed that frailty was associated with family type [OR=1.9; 95% CI 1.4-2.6], professional activity [OR=2.2; 95% CI 1.2-3.9], financial difficulties [OR=1.7; 95% CI 1.1-2.8] and undernutrition [OR=2.9; 95% CI 1.7-4.8].

Conclusion: implementing a screening strategy and speeding up the process of generalising social protection are actions that will make it possible to reduce the prevalence of frailty among the elderly, prevent its complications and act on its main determinants in Morocco.

Acute hepatitis as a manifestation of secondary syphilis: a case report and literature review

Sakina El Mamouni — 2025-04-08

This is the case of a 25-year-old patient, with the notion of unprotected sexual relations with multiple partners consulted for cholestatic icterus with pruritus evolving for 2 months. The general examination found an intense mucocutaneous icterus. The examination of the lymph nodes revealed multiple lymph nodes. A thoracic-abdominal-pelvic scanner showed peri-portal edema and adenopathies above and below the diaphragm without suspicious lesions. Biologically, there was acute cytolysis with ASAT at 1612IU/L, ALAT at 1506IU/L, and icteric cholestasis, the acute viral serologies and other autoantibodies were all negative. Given the presence of adenopathy and sexual risk factors, a syphilis serology was requested and was positive: a TPHA at 2560UI/L, and a VDRL at 1/32 UI/L. A liver biopsy was performed, which showed the presence, on immunohistochemistry, of anti-treponemal-pallidum antibodies. After eliminating all etiologies of cytolytic hepatitis, we retained the diagnosis of syphilitic hepatitis. Therapeutically, we started a treatment based on ceftriaxone 2g/dl with spectacular biological improvement at H48 of the beginning of treatment.

Angiokeratoma of Fordyce: scrotum

Sabiha Quazi — 2025-04-08

Multiple, asymptomatic, firm, non-tender, skin-colored, elevated papular lesions measuring about 2-4 mm in diameter presented over the scrotal region of a 68-year-old male patient for the last 4 months. Initially, they were few, but gradually got increased in number and size over a period of time. The patient had no history of trauma, pain, itching and bleeding. On investigation, the venereal disease research laboratory (VDRL) test and human immunodeficiency virus (HIV) test were negative. A dermoscopic examination was done which showed classic well-demarcated reddish round lacunae with a whitish veil, a typical feature of angiokeratoma of Fordyce. Skin punch biopsy was also done using a 3 mm punch, which revealed hyperkeratosis and acanthosis of the epidermis with elongated rete ridges and numerous, congested and dilated thin-walled capillaries in the dermis. Based on the clinical, dermoscopic, and histopathological findings, the diagnosis of angiokeratoma of Fordyce was made. Proper counseling of the patient was done, regarding its benign nature, and the patient was treated with cryotherapy; 3 sittings were done four weeks apart.

Neonatal mesenteric cyst in a 5-day-old patient: a case report

Seth Jotham — 2025-04-08

Mesenteric cysts have been documented as a rare occurrence in children. They are mostly renowned to be benign intra-abdominal tumors with no known etiology. The symptoms are non-specific ranging from being asymptomatic to an acute abdomen. Most of the diagnoses are made below the age of 10 years with devoid of reports for the early neonatal occurrences. We report a case of an early neonatal mesenteric cyst in a 5-day-old female patient who presented with signs of intestinal obstruction markedly by abdominal distension, vomiting, and absolute constipation. Abdominal X-ray showed evidence of small bowel obstruction while abdominal ultrasound and computed tomography (CT) scan were used to reach the diagnosis of a mesenteric cyst, all laboratory baseline investigations were within a normal range. On laparotomy a 12 by 13 cm cyst that was firmly adhering to the proximal ileal wall was meticulously dissected, complete cystectomy was done with no segmental resection. Histopathologically there were no signs of malignancy and the patient successfully recovered with no signs of recurrences after being followed for a year and a half. Being a rare case in the early neonatal period with unspecific presentations; mesenteric cyst should be considered as one of the diagnoses best to be managed by surgical excision to prevent recurrences.

Giant urinary bladder stone: an uncommon cause of anuria

Hamedoun Larbi — 2025-04-08

The patient was 73-year-old, with antecedents of diabetes, arterial hypertension, atrial fibrillation on anticoagulation, and benign prostatic hypertrophy for more than 10 years on medical treatment with therapeutic malobservance. He was admitted to the intensive care unit for management of an acute subdural hematoma. On admission, the patient was comatose, had a Glasgow score of 8, intubated and ventilated, and the brain scan already indicated the beginnings of brain engagement. He underwent drainage of the hematoma after being placed in the appropriate condition. Forty-eight hours later, the patient presented with anuria, and the work-up showed an acute renal failure with creatinine at 134 mg/l, urea at 2.98 g/l, alkaline reserve at 9 mmol/l, hyperkalemia at 7 mmol/l and a GFR of 4. This prompted the intensive care doctor to order an emergency abdominal scan, which revealed significant bilateral pyelocalic dilatation with the presence of 2 huge bladder stones measuring 7 and 6 cm each. Given the anuria and fragile condition, the patient was dialyzed and then admitted to the operating room for drainage using a bilateral double J catheter, which was very difficult given the macromolecules occupying almost the entire bladder. Postoperatively, the patient resumed diuresis and began to improve his renal function, but unfortunately, his prognosis was poor following worsening cerebral involvement and he died within 72 hours. The association of a giant primary calculus with acute renal failure is very rare, which is what makes our observation so special.

Clinical and epidemiological profiles of pediatric COVID-19 in two private Kenyan hospitals

Del-rossi Sean Quadros — 2025-04-08

Introduction: COVID-19 infection has attracted global attention with limited published data on the burden in African children.

Methods: hospital-based longitudinal survey in children with COVID-19 infection, aged 0-18 years admitted between August 2020 and December 2021. The main objective of the study was to describe socio-demographic, clinical and diagnostic manifestations of COVID-19 infection in children.

Results: the study enrolled 85 children. Median age was 5·1 years (IQR = 1·3 - 12·4) with equal gender distribution. Under five years were 52·9%. Average length of hospital stay among non-severe cases was three days (IQR=2·0-5·0). No deaths were reported. Fifteen patients (18·7%) were asymptomatic. The most common presenting symptoms were fever (51·8%), vomiting (36·5%), cough (27·1%), diarrhea (20·0%), nasal congestion (14·1%) and fast breathing (12·9%). Two patients presented in shock and features consistent with Multisystemic Inflammatory Syndrome in Childhood (MIS-C). Procalcitonin and C-reactive proteins were elevated in 76·9% and 45·8% respectively. Majority (n=80) had white cell counts within normal range and none had bacterial pathogens isolated from blood (n=63). Liver and Renal function tests were within the normal range in the majority of those tested (n=24 and n=64 respectively). Three of the five patients with elevated platelet count (>500 x109/L) had clinical diagnosis of MIS-C. Eight of 20 patients subjected to imaging had radiological features of bilateral ground glass opacifications while six of nine patients who presented with cardiovascular compromise had mild to moderate ventricular dysfunction on echocardiography.

Conclusion: our study suggests that children in the African setting manifest a mild form of the COVID-19 infection with low mortality.

COVID-19 pandemic response and Field Epidemiology and Laboratory Training Programs in ECOWAS

Virgil Kuassi Lokossou — 2025-04-08

The COVID-19 pandemic has been persistent with a huge demand for human health resources which is a vital component of its preparedness and response. Globally, the public health workforce through field epidemiology and laboratory training programme (FELTP) has been instrumental to global health security. We determined the status of FELTP in the region and its contributions to the COVID-19 pandemic response in the ECOWAS region. We conducted a desk review, shared a questionnaire among member states and organized a two-day online regional consultative meeting on field epidemiology training on 30^th-31^st March 2022 during which there were presentations, group discussions and deliberations on the status and contribution of FETP during the COVID-19 pandemic. Data collected were analyzed in themes. All countries in the ECOWAS region had established at least one tier of FELTP, 11 (73.3%) had established two tiers of FELTP and only 3 (20.0%) had established all three tiers of the program. Despite the pandemic, the cumulative number of graduates increased from 2996 to 4271 frontline, 41 to 380 intermediate, and 409 to 802 for advanced FELTP between 2019 and 2022. However, the progress has been disproportionate across countries. The key activities supported through FELTP graduates included pandemic response coordination, surveillance, data collection/management, laboratory support, case management, risk communication, infection prevention and control, COVID-19 vaccination, and research. Despite improvements in the FELTP in the Economic Community of West African States (ECOWAS) region, there is a need for continuous stakeholder engagement for its implementation, resource mobilization for sustainability, and leveraging critical partnerships.

Preoperative quality of life of patients with cleft lip and palate in Nigeria: a multicentre cross-sectional pilot study

Afieharo Igbibia Michael — 2025-04-08

Introduction: the objective of this study was to determine the quality of life (QoL) of the patient with a cleft lip or palate scheduled for surgery.

Methods: this analytic multicenter cross-sectional study involved six participating Smile Train Partner Hospitals from five geopolitical zones of the country and three major ethnic groups. Patients with cleft lip or cleft palate aged between 8 to 29 years scheduled for repair were recruited. The main outcome measure was quality of life scores as measured by cleft Q.

Results: thirty-four (females 18, males 16) patients were scheduled for surgery of either cleft lip n=7 (20.6%) or cleft palate n=27 (79.4). Patients scheduled for primary surgeries were more than those for secondary surgeries, 23 (68.7%) vs 10 (30.3%). Of the QoL scales, the speech distress score was the least (56.0 ± 22.6) and the psychological score highest (73.9 ± 15.8). All QoL mean scores except the psychological score fell below normative cleft Q scores. The psychological scores in males (80.9 ± 16.2) were significantly higher than in females (67.7 ± 12.9, p=0.01). Patients for lip repair had lower psychological scores than those for palatal repair (median=59 vs 73, p=0.01). Patients for palate repair demonstrated significantly lower speech function and distress scores than those for lip repair (p=0.01, p<0.01 respectively).

Conclusion: most of the QoL measures in patients with cleft lip and palate in this study fell below normative values. Gender and cleft type affect the quality of life. A larger study is recommended to establish national normative data.

The severity of distal sensory polyneuropathy increasing with HIV/AIDS stage

Andi Weri Sompa — 2025-04-08

Distal sensory polyneuropathy (DSP) is the most common neurological problem in HIV/AIDS Patients. It represents a complex symptom that occurs because of peripheral nerve damage related to advanced HIV disease and in association with the use of antiretroviral therapy. DSP is a frequent symptom in which the specific pathophysiology is not well understood. Recently, mitochondrial toxicity and antiretroviral toxic neuropathies have been more identified as a possible etiology of DSP. This study's objective was to determine factors associated with DSP severity in HIV/AIDS patients. This cross-sectional study was followed by 50 HIV/AIDS outpatients at some hospitals in Makassar, Indonesia who met the inclusion criteria. DSP is diagnosed using non-invasive screening tools subjective peripheral neuropathy screen (SPNS) which can determine the severity of DSP in advance. Some factors were analyzed by using Pearson's chi-square test and Spearman's correlation test. Fourty-three participants (86%) had diagnosed DSP which is mostly moderate in severity (48%). Statistical analysis showed significant correlation between HIV/AIDS Stage and DSP severity (p=0.032) meanwhile CD4 count, antiretroviral, body mass index (BMI), and hemoglobin level have no significant correlation to DSP severity. In conclusion, HIV/AIDS stage and DSP severity correlate where the later the stage the more severe DSP.

Aplasia cutis congenita of the trunk in a newborn: a rare case report

El Mouloua Ahmed — 2025-04-08

Aplasia cutis congenita (ACC) is a rare congenital disorder defined as a congenital skin defect, characterized by the absence of all skin layers at birth. The most frequent presentation is a small erythematous ulcerated or scar-like alopecic ectodermal lesion on the scalp vertex. However, extensive cutis aplasia of the trunk is extremely uncommon. Clinical and radiological evaluation defined the appropriate treatment. We herein report a rare case of a large aplasia cutis congenita of the trunk occurring in a male newborn managed with sulfadiazine silver 1% dressing, complete healing was achieved in about a month. The report highlights that conservative treatment is a highly effective and practical option for managing non-scalp extensive ACC.

Schmidt´s syndrome found by tan: a case report

Gabriela Venade — 2025-04-08

Addison´s disease can form part of type 2 autoimmune polyglandular syndrome. The article reports the case of a 41-year-old female patient with hypothyroidism and vitiligo, who came to the emergency department complaining of asthenia that had worsened in recent months, as well as anorexia, nausea, and weight loss (6 kg in a year). Cutaneous hyperpigmentation was the main finding on physical examination, together with vitiligo lesions on the face, hands, and armpits. Further study revealed a low serum cortisol level, normal urine-free cortisol, and an elevated adrenocorticotropic hormone (ACTH). Antiperoxidase antibodies and 17-alpha-hidroxylase antibodies were both positive. Treatment was started with prednisolone and fludrocortisone, and a good clinical response was obtained. This case report aims to draw attention to the high level of clinical suspicion required to diagnose Addison´s disease and the need to screen actively for other potentially associated autoimmune diseases that may be associated.

Clinico-epidemiological characteristics of adolescents and young adults living with HIV in Ghana

Vincent Ganu — 2025-04-08

Introduction: sub-Saharan Africa is experiencing a boom in the number of adolescents and young adults living with HIV (AYALHIV). Existing HIV intervention programs are mainly for children and adults living with HIV, with little attention paid to AYALHIV. Characterizing this population is necessary for planning, and designing, AYALHIV-centered HIV intervention programs.

Methods: a retrospective single-center, hospital-based chart review was conducted at the largest HIV clinic in Ghana. We examined routinely collected data for AYALHIV (aged 10-24 years) on antiretroviral therapy (ART) for at least 1 year and in active care from 1^st January to 31^st December 2019. Data was collected using a structured data extraction form. The Chi-square and the Student´s t-test were used to compare characteristics between adolescents and young adults.

Results: of 252 AYALHIV, 68% (172/252) were adolescents with a median age of 17 years (IQR 13-19); 32% were young adults with a median age of 22 years (IQR: 20-24). Most (56.7% (143/252)) AYALHIV were female. Almost 40% were orphans. Eighty-six percent of AYALHIV had HIV type I infection. The commonest mode of HIV acquisition among adolescents was vertical transmission (70.5%) and that among young adults was via unprotected sex (31.3%). Eighty-eight percent (88%) of AYALHIV were on non-nucleoside reverse transcriptase inhibitors-based regimen. The viral suppression rate among AYALHIV was 78%.

Conclusion: the study shows there is a growing population of AYALHIV most of which are adolescents. About two-fifths were orphans. Policymakers and HIV programs should ensure AYALHIV-centred interventions are developed for this vulnerable population.

Closing gaps in the oxygen supply chain in nations with limited resources

Fabrice Humura — 2025-04-08

Oxygen is an essential medication used across all levels of healthcare for conditions such as surgery, trauma, heart failure, asthma, pneumonia, and maternal and child care. Despite its critical importance and inclusion on the World Health Organization’s list of essential medicines, many low- and middle-income countries (LMICs) face significant challenges in providing adequate oxygen supplies. These challenges are exacerbated by the COVID-19 pandemic, which has drastically increased global oxygen demand. This paper examines the current challenges and advancements in the oxygen supply chain within LMICs, focusing on availability, infrastructure, and usage. It highlights the innovative solutions being implemented to improve oxygen access and offers strategic recommendations for enhancing oxygen delivery and maintenance in resource-limited settings.

Metastatic myxoid round cell liposarcoma of the buttock: a case report

Niare Ndour — 2025-04-08

Liposarcoma is a rare primitive mesenchymal tumor, developed at the expense of adipose tissue and with a preferential location in the thigh. We report an observation of liposarcoma in the buttock. A 56-year-old man, presented with a tumor of the right buttock for 2 years. Examination revealed an inflammatory, ulcerated tumor in the upper-external quadrant of the right buttock, measuring about 8 cm. Bilateral inguinal adenopathies were associated. The diagnostic hypotheses were: a squamous cell carcinoma, a cutaneous lymphoma, and cutaneous metastases. An anatomical examination confirmed the diagnosis of myxoid round-cell liposarcoma. The extension work-up appeared compatible with secondary pleuropulmonary, hepatic, cutaneous, and lymph node neoplastic localizations. The patient was treated with chemotherapy with the Adriamycin-carboplatin protocol. The evolution was rapidly fatal after a few weeks after the first course of chemotherapy. It should be evoked in front of any ulcerated tumor of the buttock.

Extensive scrofuloderma with recurrent tubercular lymphadenitis diagnosed as drug-resistant tuberculosis

Jay Dinesh Bhanushali — 2025-04-08

A 26-year-old male presented with a history of several painless lumps on the right side of the neck that began two years ago ulcerated about two months later, formed secreting fistulas, and then spontaneously healed after four months. Similar swellings appeared on the left side of the neck six months later. On examination, a 4cm x 3cm swelling was palpated in the left cervical region along with other small, matted lymph nodes, and a needle aspiration of the lymph node was performed. Chest X-rays showed no abnormalities. A clinical diagnosis of Tubercular Lymphadenitits was made. The pus aspirated from the lymph node tested positive for mycobacteria tuberculosis and rifampicin resistance using the cartridge-based nucleic acid amplification test (CB-NAAT, GeneXpert). The patient was started on a treatment regimen for drug-resistant tuberculosis, and the pus was sent for a second-line line probe assay (LPA) for further determination of drug resistance. Scrofuloderma is a skin infection near a tuberculosis focus. Its clinical presentation includes painless, slowly growing nodules beneath the skin, which eventually turn into ulcers and fistulas that discharge serous, purulent, or caseous material. It progresses gradually and may result in persistent discharge, chronic ulcers, scarring, or recovery. The cervical group of lymph nodes is the most frequently impacted, but there is also potential involvement of axillary, inguinal, pre-auricular, submandibular, and occipital lymph nodes as well. Histopathological examination typically reveals the presence of granuloma with a central core of caseous necrosis, and acid-fast bacilli may also be seen. This image represents the extensive nature of scrofuloderma and active tubercular lymphadenitis with antigravity aspiration of the lymph node.

Constricted pathways: esophageal and laryngeal stenosis

Jay Dinesh Bhanushali — 2025-04-08

A 39-year-old female presented to the emergency department with complaints of difficulty swallowing solids and liquids, along with cough and breathlessness on exertion for the past 30 days. The patient gave a history of carcinoma of the tongue for which she was operated and had received radiotherapy 2 years back. The patient was admitted for further evaluation and fibre optic flexible bronchoscopy showed significant laryngeal stenosis and the bronchoscope could not be negotiated further through the vocal cords. Esophageal stenosis was also noted, along with multiple rounded 0.5x0.5 cm mass lesions at the proximal esophageal opening. Biopsy was taken, which was suggestive of well-differentiated squamous cell carcinoma. Post-radiotherapy laryngeal and esophageal stenosis can occur as a complication of radiation therapy aimed at treating cancers in the head and neck region. Radiation therapy, while effective in targeting cancer cells, can also affect nearby healthy tissues, leading to inflammation, fibrosis, and reduced elasticity of the tissues in the throat and esophagus. Symptoms may include hoarseness, coughing, choking, difficulty swallowing, pain during swallowing, shortness of breath, and a sensation of something stuck in the throat. Treatment options may include speech therapy, dilation procedures, surgical intervention, or a combination of these approaches, depending on the severity and specific manifestations of stenosis.

A unique finding of Henoch-Schönlein purpura in adults

Jay Dinesh Bhanushali — 2025-04-08

A 27-year-old male presented in the clinic with a two-day history of sudden onset abdominal pain, vomiting, joint pain, and a rash over his lower limbs. The patient had recently returned from his village and had a history of a recent upper respiratory tract infection. He did not have any significant history. On examination, he had per abdominal tenderness with no guarding rigidity or mass, and bowel sounds were present. The laboratory blood findings showed raised neutrophils with a white-blood-cell count of 14509 cells/mm³ and raised C-reactive protein (CRP) levels. A urine sample showed hematuria and proteinuria. A clinical diagnosis of Henoch-Schönlein Purpura (HSP) was made. The classic tetrad of symptoms in HSP includes palpable purpura (small red or purple spots on the skin), arthritis or joint pain, abdominal pain, and renal involvement. In adults, arthritis and joint pain may be more pronounced and persistent compared to children. The rash appears as small red or purple spots on the skin and is often distributed symmetrically on the lower extremities, especially around the ankles and buttocks. It may also involve the arms, thighs, and occasionally the trunk. The rash is palpable, meaning it can be felt by running a finger over the affected area. The skin may feel slightly raised or bumpy due to inflammation and the presence of small blood vessels affected by vasculitis. Diagnosis of HSP in adults is based on clinical presentation, physical examination, laboratory tests (including inflammatory markers, urinalysis, and renal function tests), and sometimes, skin biopsy. In severe cases, management typically involves supportive care, pain control, anti-inflammatory medications (such as NSAIDs), and corticosteroids. Our patient was managed intravenous fluids, diclofenac sodium for arthralgia, and a short course of 5 days of intravenous hydrocortisone. The patient improved symptomatically and the rash resolved over 3 weeks.

A randomized comparative study of serial membrane sweeping at term for vaginal birth after caesarean section in two tertiary hospitals in Delta State

Innocent Okoacha — 2025-04-08

Introduction: postdate pregnant women with one previous caesarean section that are planned for vaginal birth after ceasarean sections are faced with adverse pregnancy outcomes. This trial was conducted to determine the effect of serial membrane sweeping from 38 weeks gestation in pregnant women planned for vaginal birth after ceasarean section.

Methods: this randomized controlled trial (RCT) was conducted on 90 women at 38 weeks with one previous ceasarean section. In the study group, membranes sweeping commenced at 38 weeks and repeated weekly till labour onset. If no labour onset at 41 weeks and 3 days, elective caesarean section was done. In the control group, patients awaited labour onset till 41 weeks and 3 days, after which elective Caesarean section was done. Data collected were analyzed using the Statistical Package for Social Sciences (SPSS ver. 22). All analyses were done at p<0.05.

Results: labour onset before 41 weeks and 3 days was statistically significantly higher in the study group compared to the control group (RR= 1.5; 95% CI: 1.1 - 2.0; P=0.006). Likewise, successful vaginal birth after caesarean section was statistically significantly higher in the study group (RR=1.7; 95% CI: 1.2-2.5; P = 0.001).

Conclusion: serial membrane sweeping from 38 weeks gestation has significant beneficial effect on labour onset and successful vaginal delivery in women with one previous caesarean section.

Refus et hésitation vis-à-vis de la vaccination anti-COVID-19 à Douala, Cameroun

André Arsène Bita Fouda — 2025-04-08

Introduction: la vaccination est l'une des stratégies recommandées par l'Organisation mondiale de la Santé pour réduire le poids de la COVID-19. Cependant, de nombreux pays africains comme le Cameroun présentent de faibles couvertures vaccinales anti-COVID-19. Cette étude avait pour objectif d'étudier les raisons de refus de la population de la ville de Douala vis-à-vis de la vaccination contre la COVID-19.

Méthodes: l'étude était transversale et analytique et conduite dans la ville de Douala du 10 février au 31 mai 2022. Les participants étaient âgés d'au moins 21 ans résidant dans la ville de Douala étaient interviewés. Les mesures d'association entre les variables d'intérêt ont été effectuées à l'aide des tests de Chi-deux et de Fisher avec un intervalle de confiance à 95%.

Résultats: au total, 1555 personnes avaient été incluses dans l'étude. Seulement 168 (11%) étaient vaccinées. La proportion de refus vaccinal était importante 711 (45,7%), 640 participants soit 41,1% hésitaient alors que 204 personnes soit 13,2% étaient favorable à la vaccination anti-COVID-19. Les raisons principales de refus de vaccination anti-COVID-19 étaient la crainte des effets indésirables 406 (44,8%), le manque d'information sur les vaccins 331 (36,5%) et le manque de confiance 302 (33,3%). Les facteurs associés au refus vaccinal étaient la religion (p=0,026) et le niveau d'étude (p=0,002).

Conclusion: cette étude avait révélé la faible couverture vaccinale anti-COVID-19 à Douala avec une proportion importante de refus et hésitation vaccinale. Les stratégies de communication devraient tenir compte des raisons et facteurs associés au refus.

Hysterosalpingography findings in infertile Sudanese women: a cross-sectional study on tube blockage

Eiman Kamal — 2025-04-08

Introduction: infertility is a significant public health concern in Africa and Hysterosalpingography (HSG) is an affordable option for initial treatment. This study aimed to provide information about the incidence of abnormal pathology and tubal findings in HSG of Sudanese women who experienced infertility.

Methods: this prospective cross-sectional study included 100 infertile patients who were requested for HSG, including age, duration of infertility, body mass index (BMI), medical history, and HSG findings collected after performing the radiographic test, which was diagnosed by an experienced radiologist.

Results: one hundred infertile women (46% and 54%) experienced primary and secondary infertility, respectively. Mean age was (31.1 ± 5.2, 27.5 ± 6.0) years, and BMI was (25.1 ± 3.3, 25.7 ± 2.9 ) Kg/cm² for primary and secondary infertility respectively. Abnormal findings prevalence was (29/46, 63%) and (30/54, 56%). The incidence of fallopian tube abnormality was (52/100, 52% (25/46, 54.3%), and (27/56, 50%) for primary and secondary infertility, respectively. Forty-one percent of participants had normal hysterosalpingograms. Pelvic surgery was the highest risk factor in 24% of the participants. Age and medical history were significantly associated with the infertility type (P < 0.05).

Conclusion: infertile patients who underwent hysterosalpingography (HSG) were predominantly older, with secondary infertility being slightly more common, underscoring the importance of early diagnostic evaluation and care. Fallopian tube abnormalities were the most common cause of infertility, with tube blockage affecting nearly half of the participants. Additionally, this study revealed that prior pelvic surgery significantly increased the risk of infertility.

Safety observation of antiarrhythmic drug use in a patient with sinus bradycardia following atrial fibrillation radiofrequency ablation combined with cardiac neural ablation: a case report

Qijun Zhang — 2025-04-08

This study assessed the safety of Antiarrhythmic Drug (AAD) administration in a patient experiencing sinus bradycardia following radiofrequency ablation for Atrial Fibrillation (AF), followed by cardiac ganglion ablation. Post-AF radiofrequency ablation, the employment of AADs is a prevalent clinical practice; however, these drugs may exacerbate bradycardia, leading to increased patient discomfort and treatment complexity. The decision to employ AADs in patients with sinus bradycardia post-AF ablation poses a significant clinical challenge. This investigation aimed to ascertain the safety of AADs in such patients. The study encompassed a single case, wherein a patient with pre- and post-procedure sinus bradycardia was treated with AADs following AF radiofrequency ablation and cardiac ganglion ablation, with a subsequent safety assessment. The findings indicate that AADs can be safely administered to patients with sinus bradycardia after these procedures, offering valuable insights for clinical decision-making. This case report underscores the intricacies of post-AF ablation management in patients with sinus bradycardia and advocates for personalized therapeutic strategies. The results enhance the clinical knowledge regarding the safety of AADs in this patient subset and may guide future treatment protocols. Nonetheless, the study's conclusions are drawn from a single case, and further research with larger cohorts is essential to substantiate these findings and elucidate the long-term safety and efficacy of this therapeutic approach.

Burst abdomen: a preventable risk of severe maternal morbidity in a developing country (a case-control study at a university teaching hospital in Tanzania)

Andrew Hans Mgaya — 2025-04-08

Introduction: burst abdomen is a preventable complication of caesarean section that carries an increased risk of maternal death, especially in developing countries including Tanzania. The study aimed to identify the risk factors and high-risk patients for burst abdomen at Muhimbili National Hospital in Tanzania.

Methods: a case-control study was performed at Muhimbili National Hospital in Dar es Salaam from 2^nd April to 27^th December 2019. Characteristics of interest of one case of burst abdomen were compared to three randomly selected controls that consisted of caesarean deliveries either 24 hours before or after the time of delivery of cases. The chi-square test, Fischer´s exact test, and multivariate analysis were used. The level of significance was p < 0.05.

Results: a total of 524 women that met the inclusion criteria, comprising 131 cases and 393 controls, delivered by caesarean section in the most recent pregnancy at Muhimbili National Hospital. Cases were independently associated with perioperative illness, including cough (OR 3.8, 95%CI 1.9-7.6), chorioamnionitis (OR 4.5, 95% CI 1.3-14.7), and surgical site infection (OR 3.2, 95% CI 1.7-6.4), and a vertical midline incision wound (OR 1.9, 95% CI 1.2-3.1) compared to control group. Most cases (70%) had intact sutures and loose surgical knots.

Conclusion: burst abdomen remains a cause of unnecessary severe maternal morbidity and is independently associated with perioperative illnesses such as cough, chorioamnionitis surgical site infection, and a vertical midline abdominal incision. Thus, there is a need for modifying abdominal fascia closure techniques for patients at risk.

Les vertiges et la perte auditive chez le personnel de santé atteint de COVID-19

Bahri Ghada — 2025-04-08

La maladie à coronavirus 2019 (COVID-19) affecte le système respiratoire. L´étude des caractéristiques cliniques de cette infection a mis en évidence son tropisme au système nerveux qui serait responsable des atteintes neurologiques et sensorielles, en particulier les vertiges et la perte auditive. Déterminer la fréquence et les caractéristiques de l´atteinte neurologique représentée par les vertiges et la baisse de l´acuité auditive chez les professionnels de santé (PS) atteint de la COVID-19. Etude descriptive transversale menée auprès des PS de l´Hôpital Charles Nicolle (HCN) de Tunis atteints de COVID-19 durant la période allant du septembre 2020 á décembre 2020. La collecte de données a été réalisée par un suivi téléphonique régulier de l´état de santé de ces PS pendant la période d´isolement sanitaire. Un total de 482 PS atteints de COVID-19 ont été colligés. L´âge moyen de la population était de 41 ± 10 ans, dont 111 hommes (23%) et 371 femmes (77%). Les principales manifestations neurologiques étaient: les céphalées (71,2%), l´anosmie (60%), les vertiges (21,8%) et l´hypoacousie (1,5%). Les patients présentant des vertiges étaient significativement plus âgés (P=0,035), de sexe féminin (P=0,003), obèses (P=0,014), souffrant de comorbidités (P=0,004) et ayant une ancienneté professionnelle plus importante (P=0,009). Les vertiges étaient significativement associés à la fièvre (P=0,001), aux douleurs abdominales (P=0,001) et à la désaturation (P=0,039). Les symptômes neurologiques dont les vertiges et la perte auditive pourraient être le seul signe avec lequel on pourrait reconnaitre un cas de COVID-19. La sensibilisation à une telle présentation des patients COVID-19 est cruciale pendant cette période de pandémie pour prévenir la propagation infectieuse.

Pulmonary hypoplasia with vertebral anomaly

Ashwin Karnan — 2025-04-08

A 12-year-old girl born to a non-consanguineous marriage presented to the outpatient department with complaints of breathlessness, neck pain, and a history of recurrent respiratory tract infections. Computed tomography (CT) scan of the thorax showed hypoplasia of the right lung with mediastinal shift towards the right side with platybasia, fusion of multiple cervical vertebrae, and presence of bilateral cervical rib. Pulmonary function tests showed a restrictive pattern of lung disease. The patient was diagnosed with pulmonary hypoplasia. The patient improved with intravenous antibiotics, bronchodilators, and chest physiotherapy. The patient has been counseled about her chronic lung disease, the need for prophylactic vaccinations, and spine surgery depending on the neurological function and pain status.

Acquired diaphragmatic eventration

Ashwin Karnan — 2025-04-08

A 65-year-old female presented with complaints of breathing difficulty for the past 6 months that increased in intensity over the past 2 days. The patient has no known comorbid conditions and gave a history of road traffic accident where she had trauma to the chest wall and was managed conservatively. Computed tomography (CT) thorax showed eventration of the right dome of diaphragm. Arterial blood gas analysis showed respiratory failure and the patient was managed with non-invasive ventilator support. Due to persisting symptoms, diaphragmatic plication was done, and the patient improved symptomatically and is currently under follow-up. Diaphragmatic eventration is the elevation of a part or entire side of the diaphragm due to nerve or muscle injury or muscle development. It may be congenital or acquired. It is a rare disease, commonly affecting the left hemidiaphragm, with a male predominance. The gold standard investigation includes fluoroscopy and dynamic magnetic resonance imaging (MRI) scans. Complications are respiratory failure, pneumonitis, pleural effusion and deep vein thrombosis. Conservative management includes oxygen supplementation, physiotherapy, continuous positive airway pressure (CPAP) support and pulmonary rehabilitation. When they fail, plication may be done via open thoracotomy, video-assisted thoracic surgery (VATS), laparoscopic or open surgery. The prognosis is usually good and most patients may not need any intervention.

Post tubercular bronchiectasis with aspergilloma

Ashwin Karnan — 2025-04-08

A 48-year-old diabetic male, presented to the outpatient department with complaints of fever, breathlessness on exertion, and cough with mucopurulent expectoration for the past 15 days. The patient gave a history of pulmonary tuberculosis 4 years back for which he took antitubercular therapy for 6 months. CT thorax showed a cavity with a hypodense lesion and cystic bronchiectatic changes in the left lower lobe. Echocardiography showed a dilated right ventricle with pulmonary arterial hypertension. Sputum for acid-fast bacilli was negative, serum IgG antibody for Aspergillus was raised and Bronchoalveolar lavage galactomannan was positive confirming the diagnosis of Aspergilloma. The patient was treated with Voriconazole, phosphodiesterase-5-inhibitor, oral corticosteroids, oral hypoglycemic agents, and diuretics. The patient improved symptomatically and is currently on follow-up. Aspergillus colonization usually occurs in a previously existing lung cavity. Aspergilloma may be difficult to diagnose due to its complexity. It has around 38% mortality rate. Hemoptysis is the dreaded complication requiring bronchial artery embolization.

Leukemia cutis: a rare dermatological presentation of leukemia

Hemant Juneja — 2025-04-08

Leukemia cutis is defined as the infiltration of malignant leucocytes or the cell precursors into the dermis, epidermis, or subcutis, leading to prominently identifiable dermatological lesions. Leukemia cutis may be seen in conjunction, preceding or following a clinical diagnosis of systemic leukemia. The presence of leukemia cutis is often a marker of poor prognosis and often denotes the presence of extramedullary metastases. We present the clinical image of a 45-year-old patient who presented with chief complaints of continuous high-grade fever with easy fatiguability, dyspnea on exertion along with prominent multiple nodular lesions on the face with symmetrical involvement for 15 days. For further evaluation to assess the possible etiology of the illness, a dermatologist's opinion was sought and a skin biopsy revealed diffuse dense infiltrates of neoplastic cells within the reticular dermis. The reporting histopathologist gave a diagnosis of leukemia cutis. A bone marrow aspiration of the patient was done and a sample was sent for flow cytometry analysis, which was suggestive of Acute myeloid leukemia with monocytic differentiation. After the diagnosis of Acute myeloid leukemia, a specialist opinion was taken from the Oncologist, and the patient was started on a chemotherapy regimen and asked to review for follow-up after 1 month.

Giant basal cell carcinoma in a non-sun exposed area with four years follow-up: a case report

Ghadah Alhetheli — 2025-04-08

Basal cell carcinoma (BCC) is a low-grade malignant tumor that if properly managed has an excellent prognosis. Development of BCC outside the skin areas exposed to sun rays is infrequent. Giant BCC is a rare entity, especially in unexposed areas of the body. It carries a considerable implication on patients' quality of life because of the risk of being a source of infection that may progress to severe sepsis and/or metastasis. An old female presented with a long-standing solitary lesion measuring 7.5x6 cm overlaying the lumber 4-5 vertebral region about 2.5 cm from the line of the sacral promontory. No lymph nodes or distant metastases were detected. For many years, it was misdiagnosed by other physicians as eczema, psoriasis, and fungal infection and accordingly failed to respond to treatment. A histopathological examination of lesional punch biopsy assured the diagnosis of giant superficially spreading BCC. The lesion was excised with a circumferential safety margin of about 5 mm. During the follow-up period of 4 years, no recurrence was detected. Despite being a long-standing giant basal cell carcinoma (GBCC) in a sun-hidden skin area, the growth behaved as a locally malignant lesion without metastasizing. A wide local surgical excision of the GBCC with 5 mm safety margins was feasible, safe, and with a good aesthetic outcome. Importantly, family practitioners should avoid such missed cases through accuracy in their diagnosis and early referral of any atypical cases to a dermatologist.

Air crescent sign in a case of aspergilloma

Aishwarya Kishor Kedar — 2025-04-08

A sixty-year-old female presented with complaints of fever, cough with expectoration, and breathlessness on exertion for 20 days. She had a history of pulmonary tuberculosis 6 years back for which she had fully completed the course. She was vitally stable. Her systemic examination revealed bronchial breath sounds in the left suprascapular area. Chest radiography was done for the patient which revealed fibrotic changes in bilateral lung fields. Her sputum examination came out to be negative for acid-fast bacilli and nucleic acid amplification test. High-resolution computed tomography of the lungs was further carried out which revealed a cavity in the left upper lobe with a rounded mass in it. The mass was separated from the wall of the cavity by a crescent-shaped airspace (Air crescent sign). There was a change in the position of the mass within the cavity after the change in the position of the patient (Monod sign). The patient was further investigated for serum IgG antibody for Aspergillus fumigatus and it came out to be positive thus confirming the diagnosis of fungal ball or aspergilloma. The patient was discharged after antifungal therapy and symptomatic treatment and advised for regular follow-up.

Rare clinical insight: esophageal atresia discovered in an adult

Shakuntala Pandey — 2025-04-08

The rare congenital disorder known as esophageal atresia (EA), which is defined by an interrupted esophagus, is primarily identified in newborns. Adult appearances are extremely rare and create major difficulties for both diagnosis and treatment. The symptoms of esophageal atresia usually appear in the neonatal stage and include profuse drooling, choking, and difficulties in feeding. Adult occurrences are uncommon and typically manifest as persistent symptoms or are unintentionally found. We describe the case of a 35-year-old woman who had a lengthy history of respiratory infections, dysphagia, and regurgitation when she visited the gastroenterology clinic. Her medical history included sporadic aspiration pneumonia and a persistent cough that had been treated symptomatically. A barium swallow examination performed as part of the first evaluation showed an abrupt end of the esophagus, indicating the possibility of a congenital abnormality. Due to the patient's chronic complaints and the intricacy of the situation, a multidisciplinary team of anesthesiologists, thoracic surgeons, and gastroenterologists was gathered. An esophagus reconstruction procedure was scheduled as a surgical repair. The patient underwent excellent surgical tolerance and underwent postoperative monitoring in the intensive care unit. Over several weeks, she progressively transitioned from nasogastric tube feeding to oral consumption. Postoperative complications included transient anastomotic leak, managed conservatively with antibiotics and drainage.

A rare case of arterio-venous malformation of the left lower limb

Souvik Sarkar — 2025-04-08

A 20-year-old male presented to the outpatient department with swelling over the left lower limb from the past 5 years. The swelling was insidious in onset and gradually progressed over 5 years. It was painless initially but now had a dull aching pain which aggravated on walking and got relieved on taking rest. Upon examination, he had a normal build and was vitally stable. The swelling was present on the left lower limb over the shin, single in number with multiple lobules, of size 20 cm x 10 cm, ill-defined margins, with the normal overlying skin, no redness or signs of inflammation, no pulsations and no tenderness on touching. A bruit was heard over the swelling on auscultation with a stethoscope, raising suspicion of arterio-venous malformation. He was then subjected to a color doppler of the lower limb, which was suggestive of arterio-venous malformation (AVM). A left lower limb angiography was then done, which confirmed an AVM in the anterior and anterior-medial aspect of the knee, lower thigh, and upper leg with multiple feeding vessels from a saphenofemoral vein, popliteal artery, anterior tibial artery, and posterior tibial artery. An opinion of an interventional radiologist was then taken who advised to perform a left lower limb angioembolisation.

Echinococcal infection of the liver and the lung

Ashwin Karnan — 2025-04-08

A 62-year-old female presented to the outpatient department with complaints of cough, breathlessness, and right-sided chest pain for the past 10 days. The patient gave a characteristic salty taste of sputum and a history of having a pet dog for 3 years. Computed tomography (CT) scan of the thorax and abdomen showed a cavitary lesion in the right lower lobe with communication to the right pleural space, right-sided effusion, and a hypodense lesion in segment VII of the liver with a calcified wall. Serum IgG for Echinococcus granulosus was positive confirming the diagnosis of hepatopulmonary hydatidosis. The patient was treated with a 90-day course of albendazole and is currently on follow-up and planned for total pericystectomy. Hydatid disease is a zoonotic disease caused by species belonging to Echinococcus. The most common organs involved include the liver and the lungs. Surgery is the treatment of choice for both pulmonary and hepatic hydatid cysts but in inoperable cases, medical management may be tried.

Distal humerus fractures in subjects over 65 years old: about 62 cases in Moroccan population

Anass Abaydi — 2025-04-08

Distal humerus fractures, defined as interruptions of bone continuity below the insertion of the anterior brachial muscle, are relatively rare, representing 1 to 2% of all fractures. These fractures display a bimodal distribution, predominantly affecting young men (12-19 years old) due to violent trauma and elderly women (>80 years old) due to low-energy trauma associated with osteoporosis. This study aims to present the clinical, radiological, and therapeutic outcomes of distal humerus fractures in subjects over 65 years. A retrospective analysis of 62 cases treated surgically with plates at CHU Hassan II in Fes, Morocco, from January 2010 to December 2023 was conducted. Patients included were over 65 years old with non-pathological distal humerus fractures. Data were collected on epidemiology, fracture characteristics, surgical treatment, complications, and functional outcomes. The average age of patients was 73 years, with equal gender distribution. Most fractures resulted from simple falls (56%) and road traffic accidents (33%). Common comorbidities included hypertension, dyslipidemia, obesity, and confirmed osteoporosis. Surgical treatment with plates, predominantly using the posterior approach, showed a high consolidation rate of 89%. Complications included infection, ulnar nerve paresthesia, stiffness, malunion, and nonunion. Functional outcomes, assessed using the Mayo Clinic Elbow Performance Score, were excellent to good in 64.5% of patients, with significant pain relief and satisfactory mobility observed in most cases. In conclusion, managing distal humerus fractures in individuals over 65 is challenging due to anatomical complexity and comorbidities. Conservative surgical treatment with dual plating, particularly parallel plating with anatomical pre-molded plates, provides superior stability and favorable functional outcomes, emphasizing the importance of stable fixation and early rehabilitation.

Factors associated with pelvic organ prolapse: case-control study in two hospitals of Bon-Berger and Saint Georges of the city of Kananga in the Democratic Republic of the Congo

Antoine Tshimbundu Kayembe — 2025-04-08

Introduction: pelvic organ prolapse is a disease or disorder of the pelvic floor that can both worsen or regress, especially in the postpartum period. It carries a high risk of recurrence after surgical treatment. The objective of this study is to identify the factors associated with pelvic organ prolapse in the two hospitals of Bon-Berger and Saint-Georges in the town of Kananga in the Democratic Republic of Congo.

Methods: this is a case-control study that is carried out on the medical records of 134 patients admitted to the gynecology departments of the Bon-Berger Hospitals of Tshikaji and Saint Georges of Katoka, from January 1^st to July 31^st, 2023 and based on non-probability convenience sampling for case selection. The ANOVA test, Chi-test and logistic regression with adjustment are used in the statistical analyses.

Results: the factors associated with the occurrence of pelvic organs prolapse are heavy physical work (aOR: 4.031, 95% CI: 2.760-9.212; p: 0.004), malnutrition in the form of BMI less than 18.5 (aOR: 2.550, 95% CI: 1.360-5.840; p: 0.023), multiparity (aOR: 1.520, 95% CI: 1.234-4.320; p: 0.015), vaginal delivery (aOR: 3.020, 95% CI: 0.063-14.470; 0.002), fetal macrosomia (aOR: 4.290, 95% CI: 3.320-5.550; p: 0.032), pelvic tears (aOR: 2.910, 95% CI: 2.090-5.930, p: 0.006) and menopause (aOR: 3.110, 95% CI: 1.040-9.250, p: 0.001).

Conclusion: these results can serve as a basis for screening women at high risk of suffering from pelvic organ prolapse during gynecological and obstetrical consultations and for in-depth studies seeking the matrix metalloproteinases associated with pelvic organ prolapse to improve its treatment in hospitals of our town of Kananga.

Knowledge, attitudes, and practices regarding diabetic retinopathy among patients with diabetes in Dongola, Northern State, Sudan, 2022: a cross-sectional study

Mohammed Abumhadi — 2025-04-08

Introduction: diabetic retinopathy (DR) is a potential complication of diabetes mellitus (DM). Both are a significant public health burden globally, affecting millions of people. The aim of this study was to assess the knowledge, attitude and practice toward DR among patients with diabetes in Dongola, Northern State, Sudan.

Methods: this was a cross-sectional hospital-based study conducted among patients with diabetes attending Al-Jemaih Diabetic Center, from September 2022 to June 2023. The data were collected through face-to-face interview using a semi-structured questionnaire. Data was analyzed using Statistical Package for Social Science (SPSS), version 26. Statistical tests like Chi-Square, logistic regression tests were performed to explore association and its strength, considering statistical significance at p≤0.05.

Results: among the 241 patients who participated in the study, about two-third, 63.9% (n=154) being females. About half, 55.2% (n=133) had good DR knowledge, which was significantly associated with urban residence (aOR: 2.58, 95% CI: 1.45-4.62; p=0.001). Majority, 79.3% (n=191) reported favorable DR attitude. About two-third, 63.9% (n=154) reported good DR practice. However, only 27.8% (n=67) routinely go for eye check-up. Knowledge was significantly associated with practice (aOR: 2.18; 95% CI: 1.13-4.20; p=<0.019). The most common barrier reported hindering regular eye check-up was misconception that the eye check-up is not necessary, 39.4% (n=65).

Conclusion: despite the good knowledge, favorable attitude and good practices, the regular eye check-up practice was significantly low. Urban residence was significantly associated with knowledge. Similarly, knowledge was found to be significantly associated with practice level. The most common barrier to regular eye check-up was the misconception that it is not important.

Teaching under pressure: assessing burnout among high school teachers

Hicham Guider — 2025-04-08

Introduction: the increasing demands and responsibilities placed upon teachers are causing overwhelming stress. As a result, many teachers struggle with managing their workload effectively, which increases their susceptibility to burnout. This study aims to investigate burnout among high school teachers in Tetouan, Morocco, and explore the various contributing factors.

Methods: a cross-sectional study was conducted involving teachers who completed the Maslach Burnout Inventory and a comprehensive questionnaire covering personal attributes and professional responsibilities. We then used statistical software to analyze the collected data.

Results: the study, involving 258 high school teachers, highlights a significant prevalence of burnout, with levels ranging from moderate to high. Particularly notable is the prevalence of emotional exhaustion, which affected 43% of the participants, whereas depersonalization (46%) and personal accomplishment (47%) exhibited relatively lower levels of concern. In addition, a thorough analysis revealed significant correlations between burnout rates and contributing factors, including gender, number of classes taught, class size, weekly working hours, and engagement in regular physical activity.

Conclusion: this study highlights the substantial prevalence of burnout among high school teachers, emphasizing the urgency of teacher well-being. It enhances the understanding of the association between burnout and different work-related and lifestyle factors, enabling the identification of appropriate interventions. The interaction between burnout and these factors implies the need to further investigate gender-specific and workload-related preventive measures.

Knowledge assessment of women of reproductive age on birth defects: a descriptive cross-sectional study in Kenya

George Nyadimo Agot — 2025-04-08

Introduction: birth defects are defined as structural or functional congenital malformations occurring during intrauterine and detectable prenatally, at birth, or later. Birth defects-awareness creation among women of reproductive age would help in preventing the occurrence of birth defects of known aetiology worldwide. Thus, this study aimed to assess the birth defects knowledge of women of reproductive age.

Methods: we adopted a descriptive cross-sectional study design in eleven purposively selected public hospitals. The study population comprised women with children under five years, and attending child-welfare clinics at the study hospitals. Descriptive analyses consisting of means, standard deviations, medians, and ranges were used to summarize continuous variables, whereas, percentages and proportions were used to summarize categorical variables.

Results: the median age of the study participants was 26 years with a mean of 27 (Standard Deviation=5, Range=17-42). A majority (77%) achieved at least a secondary level of education, while the median gravidity was 2 with a mean of 2 (Standard Deviation=1, Range; 1-8). The study participants' knowledge was above average (67%), implying in every 10 of reproductive age 3 had sub-optimal knowledge of birth defects.

Conclusion: women of reproductive age were substantially deficient in birth defects knowledge in the county. Thus, we would like to recommend to public health policymakers and health care providers to formulate short health messages on birth defects tailored to women attending child welfare and antenatal clinics at all levels of health care including community health services in the county.

Body composition analysis using bioelectric impedance in Bissau: reproducibility and level of agreement between two available devices

Lilica Sanca — 2025-04-08

Introduction: the need to correctly measure and follow body composition as a simple disease prevention metric is important, especially where the healthcare infrastructures are poor. The variety of inexpensive devices available for this purpose is large. However, it is imperative to validate them in relation to the gold standard method, dual-energy absorptiometry X-ray (DEXA). In low-income countries, DEXA measurements aren't available. Thus, easy-to-use, and accurate devices are indispensable. In Guinea-Bissau, two relatively inexpensive, bioelectrical impedance scales, simple to use, are available. However, their accuracy has not been assessed in this setting. The study compares the level of agreement in measurements between, the Tanita® BC-545 and the Omron Karada Scan BF511, in adult volunteers.

Methods: volunteers grouped for athletic and sports modalities at stadiums and sports facilities in Bissau were included. All anthropometric measurements were done in both devices. For statistical analysis, we created Bland-Altman plots to assess their level of agreement.

Results: the study included 274 participants, mean age 27.4 years, 214 (78%) males. For body fat, the median between the Omron and Tanita measures was 2.6 and the interquartile was 5.2. The Omron measured median body mass index, -0.3 kg/m² and 0.8 kg/m²of interquartile below that of the Tanita. For visceral fat, the Omron measured 1% of median and an interquartile of 2% above that of the Tanita. For skeletal muscle, the Omron median measured 11.3% and 11.4 % of interquartile below that of the Tanita. The intra-class correlation coefficient (ICC) for body fat (BF), body mass index (BMI) and skeletal muscle (SM) was 0.99 and for VF it was 1.00 on both devices.

Conclusion: the results indicate a good level of agreement between the two devices. In resource-limited settings, the Omron is likely a reasonable substitute for more expensive body composition devices.

Mucinous cystadenoma of the caecum: a rare cause of recurrent intussusception in a 3-year-old boy (case report)

Jessica Dei-Asamoa — 2025-04-08

Mucinous cystadenoma of the caecum is an exceptionally rare occurrence, particularly in paediatric patients. They have been rarely reported in the appendix, ovary, pancreas, and liver. This is the first report of a mucinous cystadenoma of the caecum (to the best of the authors’ knowledge) in a child. A mucinous cystadenoma of the caecum can serve as a pathological lead point in intussusception. We report a case of a 3-year-old boy with a mucinous cystadenoma of the caecum causing intussusception. The intussusception recurred after an initial successful hydrostatic reduction. He had a laparotomy which revealed a caecal mass for which a limited right hemicolectomy was done. The histological diagnosis of the caecal mass was a mucinous cystadenoma. In intussusception caused by a lead point like a mucinous cystadenoma, an enema reduction may be successful but the intussusception may recur. Physical examination may reveal pathological lead points not detected on ultrasound scans. This case report contributes to the limited literature on mucinous cystadenomas of the caecum and calls for the need for further research to better understand their aetiology, clinical manifestation, histopathological diagnosis, and management strategies.

Pattern of fall and its determinants among elderly patients attending the general outpatient clinic of a tertiary hospital in northern Nigeria: a cross-sectional study

Muazu Shuaibu Ishaq — 2025-04-08

Introduction: falls in the elderly are a neglected health problem in many societies, particularly in the developing world. Many health and social service providers are unprepared to prevent and manage falls and related injuries as they lack sufficient knowledge to identify their predisposing factors. For this reason, this study aims to identify the pattern of falls and its determinants among the elderly in northern Nigeria.

Methods: a cross-sectional study was conducted among 300 elderly patients, selected by systematic random sampling. An interviewer-administered questionnaire was used. Data was analyzed using SPSS version 20. Variables were summarised using percentages and measures of central tendency/dispersion. The chi-square test was used in assessing the significance of associations between categorical variables. A p-value of <0.05 was considered statistically significant. Binary logistic regression analysis was conducted to identify determinants of falls.

Results: the prevalence of falls and fall injuries was 41.4% and 25.4% respectively. The commonest pattern of fall injuries was swellings and pain (31.1%). Tripping was the commonest 60 (49.2%) cause of fall. Age (p<0.026, AOR=4.424, CI=1.192-16.424), presence of dizziness (p<0.015, AOR=0.334, CI=0.138-0.810), use of shoes with uneven (P<0.021, AOR=0.337, CI=0.133-0.851)/ slippery soles (p<0.038, AOR=0.392 CI=0.162-0.948), having slippery mats (P<0.001, AOR=0.086, CI=0.039-0.192), wires/cords exposed (p=0.005, AOR=0.306 CI=0.132-0.705) on the pathways were the determinants.

Conclusion: the high prevalence of falls and fall injuries signifies its importance in health care. This implies that physicians should be proactive in asking, assessing, and assisting the elderly to provide targeted interventions to potentially prevent falls.

Policy recommendations to reduce high cesarean section rate in Türkiye

Mert Küçük — 2025-04-08

According to the latest data, the majority of babies are delivered via cesarean section (C-section) in Türkiye. This is a medically unacceptable situation and reflects the highest rate in the world. Despite Türkiye enacting a law prohibiting elective C-sections, the rate has not decreased; rather increased. Therefore, this article and accompanying annex have been prepared to propose policy recommendations aimed at reducing the C-section rate. This article summarizes what has been done so far and outlines areas for improvement to reduce the C-section rate, offering a different perspective on policy. The C-section rate has reached such a critical level in Türkiye that a concerted effort involving the Turkish Ministry of Health, healthcare and obstetrics societies, physicians, midwives, healthcare professionals, public and the media is necessary. Health authorities in Türkiye should consider all policy recommendations in addressing this issue.

Challenges and adaptations of mental health services during the COVID-19 Pandemic in Uganda

Anita Arinda — 2025-04-08

Introduction: Coronavirus disease (COVID-19) significantly impacted mental health and mental health services worldwide. We sought to explore the challenges faced by mental health services from the perspectives of service users, providers, and policymakers during the COVID-19 pandemic in Uganda and the strategies put in place to ensure the continuity of these services.

Methods: qualitative data were collected using semi-structured interviews with eight mental health service users, four mental health workers, four hospital administrators, four district mental health focal persons, and two policymakers. The data were analyzed using thematic analysis.

Results: the challenges reported by participants included human resource shortages, loss of space for service provision, low funding, drug shortages, changes in patient load, and lack of access to services due to restrictive measures. The adaptations included the use of innovative means like mobile phone technology, reorientation of health facility functioning to COVID-19 restrictions, using different methods to deliver medications, integration of mental health in general health services, and alternative financing for mental health services.

Conclusion: the COVID-19 pandemic posed significant challenges to mental health service provision. Nevertheless, the health system responded by implementing various measures to ensure continuity of care. Further research is needed to evaluate the effectiveness and scalability of these innovations in the long term.

Ownership, coverage, utilisation and maintenance of long-lasting insecticidal bed nets in three Health Districts in Cameroon: a cross-sectional study

Frederick Nchang Cho — 2025-04-08

Introduction: the Bamenda, Santa and Tiko Health Districts are in the highest malaria transmission strata of Cameroon. The purpose of this study was to explore the indicators of ownership and utilisation as well as maintenance of Long-Lasting Insecticidal Nets (LLINs) in three health districts in Cameroon.

Methods: a cross-sectional household survey involving 1,251 households was conducted in the Tiko Health District (THD) in June and July 2017 and in Bamenda and Santa Health Districts in March to May 2018. A structured questionnaire was used to collect data on LLIN ownership, utilisation, and maintenance as well as demographic characteristics.

Results: the average number of LLINs per household was higher in the Bamenda Health District (BHD) compared to the THD (2.5, range; 0-6 vs. 2.4, range; 0-6) as well as the household ownership of at least one LLIN (93.3% vs. 89.0%). The proportion of the defacto population with universal utilisation was higher in BHD compared to THD (13.1% vs 0.2%). In the multinomial regression analysis, households in the SHD (p = 5.5x10-4, OR; 0.3, 95% C.I; 0.1-0.6), were less likely to own at least one LLIN compared to those in THD. Eighty-seven point one percent (87.1%) of household heads admitted that LLINs could be washed, while 50.1% affirmed the correct washing frequency.

Conclusion: ownership of LLINs was low in the THD in comparison to the goal of one for every two household members. Overall, LLINs coverage and accessibility was still low after the free mass distribution campaigns (MDCs), as only 14.6% of children 0-5 years and 16.1% of the entire population used LLIN the night before the survey.

Completion rate of tuberculosis preventive therapy and incidence of tuberculosis among people living with the Human Immunodeficiency Virus on antiretroviral therapy in Ekurhuleni East subdistrict, Gauteng province

Refiloe Mashego Malaka — 2025-04-08

Introduction: the World Health Organization (WHO) has recommended the use of tuberculosis preventive therapy (TPT) as part of a comprehensive care package for the reduction of tuberculosis (TB) incidence among people who are living with human immunodeficiency virus (PLWHA). When used optimally, TPT efficacy ranges between 60% and 90% among adults and children who are living with HIV. Despite the wide adoption of this intervention in South Africa, the country remains heavily burdened with high rates of TB/HIV co-infections, reported to be 59% in 2018. Reported challenges include low uptake and completion rates. This study aimed to determine the TPT completion rate and investigate the incidence of TB among antiretroviral therapy (ART) patients who were initiated on TPT.

Methods: this descriptive cross-sectional retrospective cohort study was conducted among HIV-positive patients who were on ART, 18 years old and above, and had been initiated on TPT between June 2019 and June 2021 at the selected PHC facilities in Ekurhuleni East sub-District. We conducted record reviews and face-to-face interviews to collect data. These were captured onto a Microsoft Excel spreadsheet, cleaned, and coded before importation onto the Epiinfo version 7 statistical software package for statistical analyses.

Results: the study found a majority of female participants, (60.5%). The median age of participants was 39.0 years (IQR=15), with most aged 50 years old and above, (21.3%). The treatment course of TPT was completed at the prescribed 12 months by 196 (30%) of the 395 participants. Only 12 (3%) of the participants were found to have TB, half 6 (50%) of which were breakthrough cases of TB. The reasons for non-completion of TPT included clinicians not offering it to patients, (46/276 (16.7%)). The barriers to TPT completion included not having a treatment supporter, (73.2%); p<0.001, while disclosure of positive HIV status was found to facilitate TPT completion (83.2%); p<0.001.

Conclusion: the observed TPT completion rate of 30% needs to be addressed as it is far below the national threshold of 85%. The barriers and facilitators to TPT completion also require attention to help improve the TPT completion rate.

Epidemiological profile of visceral leishmaniasis in northern Morocco (2009-2018)

Kaoutar Nabah — 2025-04-08

Introduction: visceral leishmaniasis (VL) represents the most serious and severe form of leishmaniasis in Northern Morocco. In this context, the objective of this study was to describe the epidemiological profile of VL in the Tangier Tetouan Al-Hoceima region from 2009 to 2018.

Methods: the epidemiologic data was collected from April 28^th, 2019 to February 2^nd, 2020 from files and investigation reports of cases. Additionally, annual reports for VL from the health services and provincial laboratories of parasitology were consulted. The analysis was conducted using statistical package for the social sciences (SPSS) v26 software.

Results: the study included 304 cases. Chefchaouen province was the highest endemic area (54.5%). The cases in the spring reached 36.5% and were characterized by age ≤5 years old (78.8%), male gender (M/F=1.3) and rural residents (91.4%). The number of inhabitants per household of cases was >5 persons (68.5%). A total of 94.3% and 98% had no suspect cases around or in their homes, respectively. Farmers accounted for 74.5% of cases. Signs of fever were present in 17.4% of cases, with 67.3% of these cases presenting these signs for a duration of more than 30 days. A total of 64.2% cases were diagnosed within a month. The serological test was used for diagnosis in 67.1% of cases and for the treatment, glunantime® was used in all cases (100%).

Conclusion: to eliminate the VL infection, it's necessary to monitor the entomological, mammalogical investigation. Also, to activate the Integrated Vector Control Management Committee at the most endemic province and to inform the community as well as the professionals of health about the VL control measures. A correlational study of the VL socio-economic and climate factors is recommended.

Evaluation of antibiotics in pediatrics using the defined daily doses method and the World Health Organization (WHO) access, watch, and reserve classification (AWaRe 2021): a cross-sectional study

Heni Lutfiyati — 2025-04-08

Introduction: irrational antibiotic use can result in antibiotic resistance, which, in turn, can lead to increased morbidity and mortality, as well as high treatment costs. This phenomenon is more common in children because they are a population that often receives antibiotics. This study aimed to evaluate antibiotic use in pediatric patients in Indonesia using the Defined Daily Doses (DDD) method and the WHO Access, Watch, and Reserve Classification (AWaRe 2021).

Methods: this is an observational study that uses a quantitative approach to calculate the quantity of antibiotic use in pediatric patients in two hospitals in Central Java, Indonesia. A cross-sectional study was conducted at two referral hospitals in Central Java Province, Indonesia, from January to December 2020. The DDD approach was used to examine antibiotic use. Antibiotic use was also classified into three groups based on the World Health Organization´s “AWaRe” categorization: “Access,” “Watch,” and “Reserve.”

Results: a total of 505 pediatric encounters were assessed. The most frequently prescribed antibiotics in pediatric inpatients were cefotaxime accounting for 42.72%, ceftriaxone 22.91% and ampicillin 12.11%. Cephalosporins 69.89% were the most commonly prescribed antibiotic class. The number of antibiotics consumed was 11.08 DDD/100 patient days. Cefotaxime, with a DDD/100 patient days value of 2.95, was the most frequently prescribed antibiotic (47.72%). Evaluation of antibiotics uses based on WHO AWaRe 2021 showed that 31.6% and 68.4% of prescribed antibiotics were in the Access category and watch category, respectively.

Conclusion: antibiotic use was high in the research setting. Over half of the antibiotic use was in the “Watch” group, according to the usage control criteria. Ceftazidime, cefixime, cefotaxime, and ceftriaxone had the highest levels of antibiotic consumption.

Prevalence of metronidazole resistance and Helicobacter pylori infection in Moroccan children: a cross-sectional study

Fatima Zahra Kheir — 2025-04-08

Introduction: the prevalence of Helicobacter pylori (H. pylori) infection in children is very high in Morocco. Eradication rates of H. pylori infection decrease due to the emergence of resistance to antibiotics. Data on the antimicrobial susceptibility of H. pylori in Moroccan children are not available. This study aims to assess the prevalence of H. pylori infection and the metronidazole resistance rate of H. pylori in Moroccan pediatric patients, and their association with epidemiologic factors.

Methods: a cross-sectional study was conducted on 132 pediatric patients who had an indication for upper gastrointestinal endoscopy and attended pediatric hospital Abderrahim Harouchi of the University Hospital Ibn Rochd, Casablanca, Morocco. Detection of H. pylori infection and the susceptibility to metronidazole was performed by classic PCR. Statistical analysis was performed using R Studio software.

Results: the overall prevalence of H. pylori infection was 80.3%. vomiting was significantly associated with H. pylori infection (p-value=0.01). Regarding the resistance rate of metronidazole, we found that the prevalence of H. pylori resistance to metronidazole was high (70.8%) and it significantly increased, especially in pediatric patients living in urban areas (p-value=0.01).

Conclusion: the prevalence of H. pylori infection and resistance rate of metronidazole were very high in Moroccan children. Therefore, triple therapy with metronidazole must be preceded by a study of the bacterium’s susceptibility to the prescribed antibiotics, in particular to metronidazole.

The interplay between programmed death ligand 1 (PD-L1) expression and human papillomavirus (HPV) genotypes in cervical carcinomas: findings of a Nigerian Tertiary Hospital

Sebastian Anebuokhae Omenai — 2025-04-08

Introduction: cervical cancer is primarily driven by high-risk human papillomavirus infections. It is a leading cause of cancer-related deaths among women globally. The emergence of immunotherapeutic approaches, particularly programmed death ligand-1 (PD-L1) inhibitors, has shown promise in various cancers. This study aims to investigate the correlation between PD-L1 expression and HPV status in cervical carcinoma samples from a Nigerian tertiary hospital.

Methods: the study was conducted in the Department of Pathology of our hospital. The study materials were 101 cases of archival formalin-fixed paraffin-embedded (FFPE) tissue blocks that met the study criteria recruited retrospectively from January 2012 to December 2016. Immunohistochemistry for PD-L1 was done and real time PCR for HPV DNA was done using CFX96. The data were then analyzed using SPSS version 23. P < 0.05 was considered significant.

Results: high-risk HPV detection rate was 51%. The two most common genotypes were HPV 16 (84.3%) and HPV 35 (17.6%). The predominant infections were single genotypes occurring in 80.4% of the cases. There was no correlation of HPV status with PD-L1, histological grade or type of cervical carcinoma. High-risk HPV did not show any distribution pattern with age groups of patients.

Conclusion: human papillomavirus 16 is the most predominant cause of cervical carcinoma. There are some environmental variations in the frequency of other genotypes with HPV 35 being relatively more common than HPV 18 in this study. Programmed death ligand-1 was positive in 47% of the cases but did not show any correlation with the HPV infection status.

Combined free flap of muscle-sparing latissimus dorsi and serratus anterior in the repair of child's traumatic foot injury: a case report

Thomas Albert — 2025-04-08

Multi-tissue injuries to the foot are common in the pediatric population. Microsurgical repairs are part of the therapeutic arsenal in pediatric reconstructive surgery. We report the case of a 4-year-old boy involved in a lawnmower accident resulting in complete amputation of the hallux, soft tissue damage, and exposure of the calcaneus and first metatarsal. A combined free flap repair using muscle-sparing latissimus dorsi and serratus anterior was performed. The patient was reviewed at 3 months and 1 year with radio-clinical and podoscopic examination. Weight bearing on the foot and on the flap was completely restored without skin fragility. Aesthetics were assessed using a numerical scale and foot function using the American Orthopaedic Foot and Ankle Society (AOFAS) and Foot and Ankle Outcome Score (FAOS) scores. The results of these scores were good, with a clear improvement at 1 year. Repair of the traumatic foot in children requires a robust surgical strategy to restore function and aesthetics to this complex organ. Our combined free flap of muscle-sparing latissimus dorsi and serratus anterior are the only ones described in the literature. It appears to be a reliable treatment option, with no morbidity and good functional results.

Diagnostic and therapeutic challenge of neuroendocrine endometrial carcinoma: a case report

Hariyono Winarto — 2025-04-08

This article reports a 33-year-old woman with neuroendocrine carcinoma of the endometrium (NECE) with a chief complaint of profuse vaginal bleeding. The patient received emergency radiotherapy to control the bleeding and was discharged. She did not return for four months to undergo a scheduled surgery because she had been hospitalized in another hospital with a COVID-19 infection. She eventually returned due to shortness of breath caused by lung metastasis identified from a chest X-ray. She underwent a total hysterectomy, bilateral salpingo-oophorectomy, and concurrent pelvic and paraaortic lymphadenectomy. The final pathology revealed stage IVB high-grade NECE. The patient died four weeks after surgery from the worsening lung metastases. The aggressive spread, challenging diagnostic nature, and rarity of NECE contribute to the high prevalence of metastasis at the time of diagnosis and poor prognosis. A prospective clinical trial must be performed to formulate an urgently needed guideline for treating NECE.

Factors associated with trachoma in persistently endemic setting in Southern Ethiopia: a community-based cross-sectional study

Dawit Seyum Buda — 2025-04-08

Introduction: in Ethiopia, despite implementing decades-long surgery, antibiotics, facial cleanliness, and environmental improvement interventions, commonly known as the SAFE strategies, persistence and recrudescence of trachoma are common. There is limited evidence that explained the reasons. This study assesses factors associated with trachoma in persistently endemic settings.

Methods: using a World Health Organization (WHO)-endorsed Global Trachoma Mapping Methodology, a two-stage cluster sampling technique was applied to select 1538 study respondents from 52 clusters. Data was collected using ODK and analysed using SPSS 28. A total of 1522 respondents were enrolled.

Results: the mean age of the respondents was 33.4 and 50.5% of the respondents were females. About 32.3% (CI 30%, 34%) of the households reported the presence of at least one member of the family having one or more symptoms of trachoma. Being from poorer household (AOR=1.36, 95% CI:1.0,1.75), presence of a household member who did not receive optimum treatment (AOR=2.8, 95% CI: 1.5, 5.2), and less than 3 doses of treatment (AOR=1.94, 95% CI:1.32, 2.86) and presence of children ever not treated (AOR= 2.5, 95% CI:1.5, 4.2) are associated with increased risk of manifesting symptoms of trachoma. In contrast, having optimally treated members of household (AOR=11.2,95% CI:6.5, 19.3) and face washing with soap (AOR=0.59, 95% CI 36, 0.97) were preventive.

Conclusion: trachoma is a persistent problem in the study districts. Generally, persistent, and recrudescent districts are characterised by segments of population missing optimum treatment as well as poor sanitation and hygiene practices. Our evidence supports the importance of adhering to optimal treatment guidelines, leaving no one behind, and the need for adequate treatment coverage.

Small bowel perforation with ingestion of a fish bone: case report

Maissa Jallali — 2025-04-08

The perforation of the gastrointestinal tract caused by fish bone is rare, with a percentage rate of 1%. Surgical intervention is necessary in less than 1% of cases. We report a case of a 55-year-old male patient who was admitted for a rectus sheath abscess caused by perforation of the small bowel by a fish bone. He was treated surgically. Diagnosing perforation secondary to fish bone ingestion poses challenges due to its presentation.

Awareness and openness to the use of PrEP among a nationally representative sample of South African adults

Lungile Nkosi — 2025-04-08

Introduction: South Africa adopted for pre-exposure prophylaxis (PrEP) in 2016, becoming the first African country to do so. Yet to date, uptake has been underwhelming, only about 165,000 South Africans were reported to be on PrEP in mid-2021. Lack of awareness has been cited as a contributory factor for the low uptake, but this has never been examined using a nationally representative sample.

Methods: we investigated this among a national sample of HIV seronegative adults. Data were from the 2017/2018 South African National HIV Prevalence, Incidence, Behaviour and Communication Survey. Awareness and openness to using PrEP were self-reported. Weighted percentages were calculated overall and by demographic characteristics.

Results: overall, only 3.2% of seronegative adults spontaneously reported PrEP as a way of preventing HIV. Overall, 69.6% were open to using PrEP, from 58.2% in Western Cape, to 78.5% Northern Cape. Openness was highest among the youngest age group (18-29 years, 78.3%) and lowest among the oldest (60+ years, 45.6%). Striking racial differences were observed with openness among Black Africans (75.4%) being 2.5 times higher than Whites (29.0%). Among women, openness was 64.7% among those currently pregnant, 80.4% among those pregnant in the past two years but not now, and 67.8% among those who were not pregnant in the past two years (?(2)=134.2, p<0.001 ). Among males, openness was higher among those circumcised (75.6%) than uncircumcised (64.5%).

Conclusion: planning for broad-scale implementation of PrEP within the South African context could build on knowledge gained from recent implementation and scale-up of relevant biomedical interventions (e.g., ART, voluntary medical male circumcision, and family planning).

Practice of COVID-19 prevention measures and its factors in long-distance truck drivers of Tigray

Aregawi Gebreyesus — 2025-04-08

Introduction: long-distance truck drivers are a population group that moves in and out of a country and can meet with different individuals and can easily expose to COVID-19. Therefore, this study aimed to assess the level of practice and associated factors towards COVID-19 prevention measures in long-distance truck drivers of Tigray.

Methods: this is a cross-sectional study conducted on 350 long-distance truck drivers recruited by systematic random sampling in the Mekelle entry point from July 5^th to July 20^th 2020. Variables with a p-value ≤0.30 in the bivariate regression analysis were entered into the final model of logistic regression to recognize factors. All associations with the practice of COVID-19 prevention were tested for statistical significance with alpha set at the 0.05 level.

Results: around 293 (83.7%) with a 95% CI of (79.7-87.6%) of the long-distance truck drivers who participated in this study had good practice towards COVID-19 prevention measures. Having a previous test for COVID-19 is positively significantly associated with good practice towards COVID-19 prevention methods. However, individuals who had a history of COVID-19-like symptoms in the last four months and who have non-communicable diseases are 78% and 84% of the time less likely to practice COVID-19 prevention measures respectively.

Conclusion: based on this study, the practice of COVID-19 prevention measures among the long-distance truck drivers of Tigray was very good. The results of this study suggest that more emphasis should be placed on drivers who have non-communicable diseases and providing COVID-19-like symptoms to the drivers.

Determinants of mortality among neonates admitted to neonatal intensive care unit at public hospitals, in the Somali region, eastern Ethiopia: unmatched case-control study

Zemenu Shiferaw Yadita — 2025-04-08

Introduction: neonatal death is a global issue in both developed and developing countries. Evidence on determinants of neonatal mortality is scarce, particularly in the pastoralist and agro-pastoralist areas of Ethiopia, including the Somali region. This study aimed to identify the determinants of mortality among neonates admitted to neonatal intensive care units at selected public hospitals, in the Somali region, eastern Ethiopia.

Methods: an unmatched case-control study design was employed from January 1^st-30^th, 2020. The total sample size was 312 neonates (156 cases and 156 controls) who were admitted to the neonatal intensive care unit from January 2018 to December 30^th, 2019. A simple random sampling technique was used to select neonates. The data were collected by a structured checklist. Data entry and analysis were done by EpiData version 4.6 and SPSS version 23, respectively. Binary logistic regression using bivariate and multivariable analysis was done to identify determinants. Odds ratios were computed at 95% CI and a P-value <0.05 was considered statistically significant.

Results: a total of 310 neonates with complete medical charts (155 cases and 155 control) were included in the study. Lack of antenatal care (AOR 4.71; 95%CI: 1.41-15.75), rural residence (AOR=8.38; 95%CI: 2.22-31.69), premature rupture of membrane (AOR=4.29; 95%CI:1.21-15.19), five-minutes APGAR score below-seven (AOR=9.87; 95%CI: 2.30-42.33), prenatal asphyxia (AOR=14.71; 95%CI:2.79-77.33) and length of hospital stay ≤3 days (AOR=15.09;95%CI: 2.89-78.62) were significantly associated with neonatal mortality.

Conclusion: this study identifies rural residence, lack of antenatal care, premature rupture of membranes, low APGAR scores, prenatal asphyxia, and short hospital stays as determinants. Hence, improving access to basic health services such as antenatal care and early screening for pregnant mothers and newborns is critical. By prioritizing these interventions, healthcare systems can effectively work towards reducing neonatal mortality rates, ultimately improving the health outcomes of infants and their mothers.

Differentials in lifestyle practices and determinants among hypertensive adults from three geopolitical zones in Nigeria

Mobolaji Modinat Salawu — 2025-04-08

Introduction: hypertension is a major public health problem globally. The occurrence has been associated with unhealthy lifestyles (such as high salt consumption, physical inactivity, excessive intake of alcohol and unhealthy diet), which are very critical for hypertension control. The study was conducted to assess the lifestyle practices and their determinants among adults with hypertension in Nigeria.

Methods: data on 762 adults living with hypertension were extracted from a cross-sectional survey conducted across three States (Abia, Kano and Oyo States) in Nigeria. A semi-structured pre-tested, interviewer-administered questionnaire was used for data collection. Knowledge of lifestyle practices was categorized into good and poor at 25^th percentile cut-off point. Overall lifestyle practice was grouped into healthy and unhealthy practices. Healthy lifestyle practice was defined as score of four and above while unhealthy lifestyle practice was defined as score of three and below; in all the 7 specific domains of lifestyle practices assessed (maximum obtainable was 7). The cut off was chosen based on 90% sensitivity from the Receiver Operating Curve (ROC) distribution of the scores. Data was summarized using descriptive statistics, Chi-square test and binary logistic regression were used to explore associations and determine predictors of lifestyle practices. Level of significance was set at 5%.

Results: the mean age of the respondents was 55.4±16.3 years. About one-quarter of the respondents (24.3%) had good knowledge of lifestyle practices. Overall, 11.8% of respondents were engaged in good lifestyle practices. Independent predictors of good lifestyle practices were earning monthly income of N30,000 and above [AOR=1.58; 95% CI (1.03-2.42)], being a farmer [AOR=1.09; 95% CI (0.55-2.18)] and artisan [AOR=1.50; 95% CI (0.70-3.14)].

Conclusion: the poor knowledge of lifestyle practices and engagement among adults with hypertension found in this study underscore the need to emphasize integrating lifestyle education for effective management of hypertension.

Associations of anaemia with blood pressure in women of reproductive age: a cross-sectional study in Johannesburg, South Africa

Xolisa Nxele — 2025-04-08

Introduction: South Africa has approximately 8.45 million adults living with human immunodeficiency virus (HIV) with women being higher at risk. Anaemia is proportional to HIV severity and a predictor for cardiovascular disease. In this study, we aimed to determine associations between anaemia, HIV, and blood pressure among women of childbearing age in Roodepoort, a suburb within the city of Johannesburg.

Methods: in this cross-sectional study premenopausal women were recruited from a primary healthcare facility, Johannesburg. Socio-demographics, lifestyle behaviours, and medical history, including HIV status, were collected. Anthropometrical measurements and blood pressure (BP) were obtained, and venous blood was drawn to determine hemoglobin (Hb) concentration. Multiple and logistic regression analyses were performed to determine the association between hemoglobin (Hb), HIV and blood pressure (BP).

Results: of 228 women, 72% were pregnant and 22% HIV positive. Pregnant women had lower BP (SPB: 104 ± 11 vs 115 ± 11 mmHg, p<0.001; diastolic BP (DBP): 68 ± 8 vs 80±10 mmHg, p<0.001) compared to non-pregnant women. Hb levels were lower among HIV positive compared to HIV negative participants (11.4 ± 1.6 vs 12.1 ± 1.4 g/dL, p=0.010). More HIV positive women were classified as anaemic (37% vs 16%, p=0.003). In unadjusted multiple linear models, Hb concentration was associated with systolic blood pressure (SBP) (β 1.20 (95% CI, 0.28, 2.33), p=0.013) and DBP (β 1.94 (95% CI, 1.08,2.80) p<0.001), and in unadjusted logistic regression models, women with anaemia had increased odds for hypertension (OR 1.18 (95% CI, 1.20, 2.80), p=0.006). However, in both cases, significance was lost when adjusting for covariates.

Conclusion: the results suggest anaemia may be a risk factor for hypertension and should be investigated in larger, homogenous samples.

Tuberculous otomastoiditis in children complicated by homolateral sigmoid sinus thrombosis: a case report

Fadoua Ouzidan — 2025-04-08

Tuberculosis is a major public health problem in Morocco and most of the developing countries but tuberculous otomastoiditis is quite rare. Here we report a case where a seven-year-old patient had chronic right otomastoiditis and retro-auricular fistula, whose specificity is its persistence after prolonged unsuccessful medical and surgical therapy for more than 2 months, and its complication by homolateral sigmoid sinus thrombosis. Computed Tomography (CT) scan of temporal bones showed complete destruction of right mastoid cells and a hypodense complement in the right middle ear. A right drainage through the retro auricular fistula with mastoid bone biopsy confirmed the tuberculous otomastoiditis diagnosis. The clinical and radiological outcome was favorable after anti-tuberculosis treatment for 6 months. Tuberculosis otomastoiditis is well described in the literature. However, its very low incidence often impedes consideration when faced with these latent infections. This is more so the case when concomitant pulmonary symptoms are absent. Thus, the importance of such publications is a reminder to think beyond the frequent diagnosis and prevent serious complications due to delayed treatment.

Multiple aggregated yellow-white globules: a basal cell carcinoma dermoscopic feature in skin of color

Sara Oulad Ali — 2025-04-08

To the editors of the Pan African Medical Journal

Fistule esotrachéale post-traumatique causée par un couteau: un rapport de cas

Moussa Seck Diop — 2025-04-08

les fistules oeso-trachéales (FOT) secondaires à une plaie par arme blanche sont rares et sous-diagnostiquées. Le scanner thoracique et l´opacification œsophagienne aident au diagnostic. Leur traitement est chirurgical. Nous rapportons le cas d´un patient ayant présenté une FOT après avoir reçu un couteau dans le dos. Admis à 6 heures, il se plaignait d´une douleur médio-thoracique. L´examen retrouvait une plaie paravertébrale droite, avec la lame du couteau en intrathoracique. L´imagerie montrait la lame traversant le médiastin supérieur, un hémo-pneumothorax droit et des bulles d´air médiastinales. L´exploration chirurgicale retrouvait une petite FOT réparée par suture directe des orifices trachéal et œsophagien avec plastie de recouvrement. L´alimentation fut autorisée à J14 après un contrôle n´objectivant pas de fistule résiduelle. Les suites opératoires furent simples. Ainsi, les FOT sont rares mais potentiellement graves. Leur diagnostic précoce et leur traitement chirurgical encadrés d´une bonne nutrition et une gestion de l´infection permettent de réduire leur morbi-mortalité.

Sarcome d'Ewing extrasquelettique de l'espace parapharyngé à propos d'un cas

Fatine Aboutajdine — 2025-04-08

Le sarcome d'Ewing extrasquelettique est une tumeur maligne le plus souvent retrouvée chez les enfants et les adolescents dont la localisation cervico-faciale reste rare. Dans l'espace parapharyngé, le diagnostic est souvent tardif avec un pronostic péjoratif. Nous rapportons le cas clinique d'une patiente âgée de 37 ans, admise en urgence pour dyspnée inspiratoire dans un tableau d'asthénie et d'anorexie. L'imagerie par résonance magnétique (IRM) cervicale a objectivé un processus au dépend de l'espace parapharyngé droit obstruant la quasi-totalité de la lumière pharyngée. L'étude anatomopathologique, immunohistochimique et cytogénétique, a conclu à un sarcome d'Ewing extrasquelettique. Le bilan d'extension était négatif. La patiente a reçu de la chimiothérapie. Le sarcome d'Ewing extrasquelettique de l'espace parapharyngé est une entité très rare: seulement 4 cas ont été retrouvés dans la littérature. Néanmoins les caractéristiques cliniques et paracliniques restent semblables. C'est un néoplasie qui doit être connue afin de porter un diagnostic précoce en vue d'améliorer le pronostic et la prise en charge.

Diplopia as a sign of third nerve palsy due to intracranial aneurysm: a case report

Restiana Hilda Islami — 2025-04-08

Third nerve palsies that result from head injuries or intracranial aneurysms may sometimes show symptoms of aberrant regeneration and only partially heal. The usual characteristics of oculomotor nerve palsy, caused by compression of the third cranial nerve, are severe ptosis, deficiencies in elevation, depression, and adduction, and a dilated, poorly responding pupil on the afflicted side. The parasympathetic fibres are usually spared from a vasculopathic lesion and impacted by compressive lesions because they are situated in the peripheral segment of the oculomotor nerve as it leaves the brain stem. When pupillary mydriasis coexists with acute third cranial nerve palsy, an aneurysm at the junction of the internal carotid and posterior communicating arteries has to be thoroughly and quickly explored using the necessary neuroimaging techniques.

Repair of an iatrogenic lacrimal fistula: a case report

Oumayma Elmansouri — 2025-04-08

Lacrimal cutaneous fistula is an uncommon yet clinically significant condition leading to persistent epiphora, recurrent infections, and significant patient discomfort. It can be congenital or acquired. Timely identification and appropriate surgical management are crucial to alleviate symptoms and restore normal lacrimal system functionality. This case report describes the presentation and surgical management of an iatrogenic lacrimal cutaneous fistula in a 68-year-old patient. The surgical intervention involved a novel stripping technique, which successfully resolved the fistula without requiring special instruments. The patient’s post-operative recovery was positive, with complete closure of the fistulous tract and restoration of normal lacrimal system function. This report underscores the efficacy of the stripping technique for managing iatrogenic lacrimal fistulas and suggests its consideration for similar cases.

Left supraclavicular parathyroid carcinoma: diagnostic difficulties through a case report

Moad El Mekkaoui — 2025-04-08

Parathyroid carcinoma is a very rare malignant tumour of the parathyroid gland, accounting for less than 0.005% of all cancers, and less than 1% of the aetiologies of primary hyperparathyroidism. This case report aims to describe the incidental discovery of a non-secreting parathyroid carcinoma in a left supraclavicular location and to report on the diagnostic difficulties encountered, together with a review of the literature and current management issues. A 43-year-old female presented with a left supraclavicular swelling with no associated signs. Imaging revealed left supra-clavicular adenopathy (Troisier lymph node) associated with a hetero-multi-nodular goiter classified EU-TIRADS 5. The abdominopelvic region was strictly normal. The patient underwent a total thyroidectomy with a left mediastino-recurrent curage and a homolateral laterocervical functional curage. Pathological examination was consistent with parathyroid carcinoma in the left supraclavicular region.

Determinants of time-to-recovery from hypertension by application of Weibull-Inverse Gaussian shared frailty model

Yeshambel Kindu Yihuna — 2025-04-08

Introduction: hypertension is a major public health problem that is responsible for mortality. In Ethiopia, hypertension is becoming a double burden due to urbanization. The study aims to identify factors that affect the time to recovery from hypertension.

Methods: in this study, a retrospective study design was used, and the data was collected in the patient´s chart from September 2016 to January 2018. Weibull-Inverse Gaussian shared frailty model was employed to identify factors associated with the recovery time of hypertension.

Results: eighty-one percent of the sampled patients were recovered to a normal condition, and nineteen percent of the patients were censored. The median survival time for hypertensive patients to attain a normal condition was 13 months. Weibull-Inverse Gaussian shared frailty model was used for predicting the recovery time of hypertension patients. Unobserved heterogeneity in residences, as estimated by the Weibull-Inverse Gaussian shared frailty model, was θ = 0.385 and p-value = 0.00.

Conclusion: age, systolic blood pressure, related disease, creatine, blood urea nitrogen, the interaction between blood urea nitrogen and age. Therefore, health-care providers give great attention, prioritize those identified factors and provide frequent counseling about reducing hypertension disease.

Benefits of preoperative embolization before resection of a giant convexity meningioma: a case report

Putri Arifin — 2025-04-08

Meningiomas are typically benign and asymptomatic, but complicated or symptomatic cases may necessitate immediate intervention. Specifically, a giant meningioma with high vascularization poses a surgical challenge due to increased risk. In this report, a case of a giant meningioma managed with preoperative embolization (POE) before surgery was presented. A 24-year-old woman presented with severe bilateral visual disturbances and chronic headaches. Upon examination, magnetic resonance imaging (MRI) showed a giant meningioma measuring 97 mm in maximum diameter. Subsequent angiography indicated a significant tumor blush, primarily supplied by the right anterior cerebral artery (RACA) and the right middle cerebral artery (RMCA), with additional dural supply from the distal branches of the right and left middle meningeal artery (R-L MMA). Following this, endovascular embolization was performed, achieving 75% occlusion of the MMA using polyvinyl alcohol (PVA). The tumor was subsequently resected, attaining Simpson grade 1 on the fifth day post-embolization. Theoretically, preoperative embolization offered several advantages, including tumor devascularization, reduced operative blood loss, improved tumor visualization, and potentially higher rates of achieving Simpson grades I or II resection. The MMA was frequently targeted for embolization in meningioma cases, with no additional neurological deficit observed afterward. The optimal timing for resection typically fell within 1-7 days after embolization. During surgery, the patient experienced 1000 ml of bleeding over a 7-hour duration. The results showed that preoperative embolization provided significant benefits in reducing bleeding, shortening operating time, and facilitating mass resection, thereby affecting long-term recurrence rates, reported at 9% over 10 years.

Syndrome sérotoninergique secondaire à l'association de paroxétine et amitriptyline: à propos d'un cas

Kaouthar El Mir — 2025-04-08

Le syndrome sérotoninergique est dû essentiellement à une cause iatrogénique par un médicament sérotoninergique, caractérisé par un polymorphisme symptomatique qui peut le faire confondre avec d´autres situations cliniques retardant le diagnostic et mettant en jeu le pronostic vital, à la lumière d´un cas clinique et d´une revue de la littérature, nous rapportons le cas clinique d´un patient qui a présenté un état de confusion avec une agitation psychomotrice et une hyperréfléxie et des myoclonies spontanées suite à la prise simultanée de la paroxétine et l´amitriptyline. Le diagnostic de syndrome sérotoninergique a été retenu après avoir éliminé les autres éventuels diagnostics, nécessitant une hospitalisation en unité de soins intensifs. Cette présentation clinique souligne l'importance de bien connaître les manifestations cliniques du syndrome sérotoninergique pour assurer une prise en charge thérapeutique précoce et adaptée.

Spontaneous multiple keloids: a case report

Aishwarya Kishor Kedar — 2025-04-08

An aberrant healing reaction to cutaneous injury or inflammation that spreads outside the original wound's boundaries causes keloidal scars. We present the case of a sixty-year-old male patient who initially came with complaints of respiratory system but had spontaneous lesions over his body for 50 years which remained undiagnosed. It was confirmed on histological examination to be keloids. The patient was treated with intralesional triamcinolone acetonide 40 mg plus an injection of lignocaine hydrochloride 2% in the ratio of 1:1 which provided him with a significant reduction in scar appearance over one month and thereby reducing his psychological burden. It is uncommon for spontaneous keloid scars to occur without any prior trauma or surgical intervention. Also, it details a manifestation of spontaneous keloid scars that manifest as numerous sizable lesions at various body locations. This study provides evidence in favor of such spontaneous appearance of keloid scars.

Relationship between homocysteine, vitamin B9, vitamin B12 levels methylenetetrahydrofolate reductase (C677T, A1298C) polymorphisms, and cryptogenic stroke in Tunisian adults´ patients: a case-control study

Lamia Mbarek — 2025-04-08

Introduction: the relationship between elevated plasma homocysteine (Hcy) and stroke has been established, but this association remains indistinct in cryptogenic stroke in adults. Our aim is to investigate the association between homocysteine, vitamins B9 and B12, and cryptogenic stroke. Furthermore, to determine the correlation between methylenetetrahydrofolate reductase (MTHFR) polymorphism and biochemical levels in plasma.

Methods: we conducted a retrospective case-control study including 100 cryptogenic stroke patients aged 18-50 years and 100 participants with age-and-sex-matched healthy controls. Clinical, radiological, and outcome data from cerebral venous thrombosis (CVT) patients were recorded. Homocysteine, vitamin B9, and vitamin B12 were analyzed. Deoxyribonucleic acids (DNAs) from both groups were tested. MTHFR C677T mutation was assessed by restriction fragment length polymorphism (PCR). All analyses were performed using Statistical Package for the Social Sciences (SPSSV.20) software. Multivariable logistic regression analysis was performed to identify factors associated with stroke risk and clinical outcomes.

Results: a total of 200 cases were included in this study, 50% (n=100) patients with cryptogenic stroke (mean age of 40.49 ± 6.2 years, sex-ratio=1.5) and 50% (n=100) healthy cases (mean age of 39.09 ± 5.8 years, sex-ratio=1.5). The elevated plasma level of Hcy and vitamin B9 levels deficiency increase the risk of cryptogenic stroke occurrence (aOR:2.5; 95% (0.71-5.25), P=0.01), (aOR:3.1; 95% (1.6-9.6), p=0.02 respectively). Additionally, vitamin B9 deficiency was significantly associated with elevated Hcy levels (4.57 ± 3.59; p=0.001). Genetic analysis revealed a significant association between homozygous TT genotype of the MTHFR C677T polymorphism, elevated Hcy levels (20.4 ± 7.07; p=0.001) and vitamin B9 deficiency (4.9±3.9; p=0.001). Furthermore, the combined CT/AC genotype was associated with elevated Hcy level (21.6 ± 9.6; p=0.001) and vitamin B9 deficiency (2.9 ± 1.0; p=0.04).

Conclusion: the presence of homozygote MTHFR C677T or dual heterozygous MTHFR C66T and A1298C, which leads to elevated Hcy and deficiency of vitamin B9 plasma levels, is correlated with an increased risk of cryptogenic stroke occurrence among adult Tunisian patients.

Dermatofibrosarcoma protuberans: unmasking a rare clinical image

Shivali Kalode — 2025-04-08

Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing, soft tissue tumor, with a prevalence of 0.8-4.5 cases per 1 million per year. As the name suggests, the tumor often involves the dermis and soft tissues, with pedunculation and spread in advanced stages. It accounts for between 1% and 6% of all soft tissue sarcomas and 18% of all cutaneous soft tissue sarcomas. Here, we report a case of a 72-year-old male, who presented in the dermatology outpatient department with an exophytic overgrowth over his right elbow in the last 15 years which has progressively increased in size with a noncontributory family history. Physical examination revealed a lobulated, soft, non-tender, and mobile mass over the right elbow. Surgical excision was performed under local anesthesia. The excised specimen measured 6 x 5.5 x 1.5 cm. The specimen was sent to the histopathology section of the Department of Pathology. Microscopically, H&E staining revealed predominantly spindle cells arranged in storiform pattern, cytoplasm is moderate and eosinophilic with oval to elongated, hyperchromatic nuclei. Intervening fibrous septa and inflammatory infiltrate are also seen. Since metastatic potential is common, follow-up every 6 months was advised.

Adenoid cystic carcinoma of maxillary sinus: report of two cases

Anouar Ben Ameur El Youbi — 2025-04-08

Adenoid cystic carcinoma infrequently affects paranasal sinuses. It's a slowly progressing, aggressive cancer with a tendency to invade nerves. The research underscores the significance of prompt diagnosis and effective management of adenoid cystic carcinoma. Two cases of adenoid cystic carcinoma of the maxillary sinus are presented. The first, a 73-year-old woman, presented with right nasal obstruction. The second, a 53-year-old woman, presented with a hard palatal mass and right nasal obstruction. The biopsy confirmed adenoid cystic carcinoma in the first patient. Given the extent of the tumor, she was referred to radiotherapy to complement the therapeutic treatment. The second patient underwent mass excision, also confirmed to be adenoid cystic carcinoma, followed by radiation therapy. Adenoid cystic carcinoma of the maxillary sinus is often diagnosed at an advanced stage due to its slow growth and local regional spread, making its diagnosis and therapeutic management particularly challenging.

Etude de la morbidité et de la mortalité chez les patients hospitalisés vaccinés versus les patients hospitalisés non vaccinés contre la COVID-19 dans trois régions du Cameroun

Jean Yves Bevela — 2025-04-08

Introduction: la COVID-19 est une maladie infectieuse et contagieuse déclarée urgence de santé publique de portée internationale en 2020. Compte tenu de la forte morbidité et mortalité, l'une des réponses à cette pandémie est la vaccination, qui a posé un sérieux problème d'acceptation au sein de la population en Afrique subsaharienne (ASS) et au Cameroun en particulier. Ainsi, le but de cette étude était de contribuer à une meilleure réponse à la pandémie au Cameroun en mesurant l'efficacité du vaccin contre la COVID-19. L'objectif de notre travail était de faire une analyse comparative de la morbidité et de la mortalité chez les patients vaccinés atteints de COVID-19 versus les patients non vaccinés atteints de COVID-19, hospitalisés dans les trois régions les plus touchées du Cameroun.

Méthodes: nous avons mené une étude Cas-Témoins avec comme Cas les patients vaccinés contre la COVID-19 et Témoins les patients non vaccinés contre la COVID-19. Nous avons observé la survenue des manifestations cliniques sévères chez des patients vaccinés et non vaccinés atteints de COVID-19 en cours d'hospitalisation pour étudier l'influence de la vaccination sur le devenir de ces patients sur la période allant du 1^er mai 2021 au 31 mars 2022; dans les unités de prise en charge COVID-19 de l'Hôpital Central de Yaoundé, l'Hôpital Général de Douala, l'Hôpital Laquintinie de Douala et l'Hôpital Régional de Bafoussam.

Résultats: nous avons mené notre étude chez 218 patients hospitalisés COVID-19, soit 109 patients vaccinés et 109 patients non vaccinés dont 51,4% de femmes. L'hypertension artérielle (60,6%) et le diabète (27,5%) étaient plus présents chez les patients non vaccinés. La durée médiane d'hospitalisation était de sept jours pour les patients vaccinés et de cinq jours pour les patients non vaccinés. Le coma (0,7% chez les vaccinés et 79,8% chez les non vaccinés), troubles de la conscience (8,3% chez les vaccinés et 57,8% chez les non vaccinés), céphalées (46,8% chez les vaccinés et 18,3% chez les non vaccinés), pneumonie (78% chez les vaccinés et 78,9% chez les non vaccinés), paludisme (31,2% chez les vaccinés et 19,3% chez les non vaccinés), embolie pulmonaire (14,7% chez les vaccinés et 22% chez les non vaccinés) et maladies thromboemboliques veineuses (1,1% chez les vaccinés et 14,7% chez les non vaccinés) étaient les principales manifestations cliniques sévères. La prévalence de la mortalité était de 1,8% chez les patients vaccinés et de 79,8% chez les patients non vaccinés.

Conclusion: quatre patients vaccinés sur 1000 étaient moins susceptibles de décéder en cours d'hospitalisation par rapport aux patients non vaccinés. Ce qui renforce la place de la vaccination pour le contrôle de l'infection à COVID-19.

Factors associated with colostrum feeding practice among mothers who attended child immunization clinic in Dire Dawa City, Eastern Ethiopia

Natnael Dechasa Gemeda — 2025-04-08

Introduction: colostrum is yellow to orange-colored milk produced during the first few days of lactation and it is rich in nutrients and antibodies that have a greater role in the health of the newborn baby. Despite the World Health Organization's recommendation that every newborn baby has to be fed breast milk colostrum within one hour of delivery, poor colostrum feeding practice is still a common problem in Ethiopia. Therefore, this study aimed to assess colostrum feeding practice and associated factors among mothers who attended child immunization clinic at the public health facilities of Dire Dawa City, Eastern Ethiopia, 2021.

Methods: a health facilities-based cross-sectional study was employed from February 1/2021 to, March 2/2021 in the public health facilities of Dire Dawa City among 292 mothers. The data were collected by systematic random sampling technique, entered into Epi data 4.2, and analyzed using the Statistical Package of Social Sciences 25.0 version. Bivariate and multivariable logistic regression analysis was employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05, considered statistically significant. Frequency tables and descriptive summaries were used to describe the study variables.

Results: in this study 68.8% [95% CI: 63.4-74.3] of the mothers had good colostrum feeding practices. In multivariable analysis living in urban [AOR=2.52, 95% CI=1.08-5.88], secondary and above education [AOR=2.79, 95% CI=1.12-6.98], having antenatal care visit [AOR=3.12, 95% CI=1.12-9.21], counselled on timely initiation of breastfeeding [AOR=2.59, 95%, CI=1.02-6.59], counselled on colostrum feeding [AOR=2.65, 95%, CI=1.12-6.30], birth attended by healthcare professional [AOR=3.20, 95% CI=1.23-8.31], source of information [AOR=3.89, 95%, CI=1.54-9.82] and good knowledge on colostrum feeding and breastfeeding [AOR=3.53, 95%, CI=1.56-7.96] were found to be associated with practice of colostrum feeding.

Conclusion: in the present study, mothers who had good colostrum feeding practices were low. Socio-demographic, obstetrics, and knowledge-related factors were associated with colostrum feeding practice. Promoting antenatal care visits and maternal education on colostrum feeding is recommended to increase the colostrum feeding practice of the mothers.

A challenging case of a multiple large stones in enterocystoplasty: a case report

Youssef Kadouri — 2025-04-08

In recent years, the utilization of enterocystoplasty for bladder function enhancement has increased, albeit accompanied by risks such as stone formation, necessitating vigilant follow-up. We report a case of a 60-year-old female with a neobladder who presented with back pain, constipation, and pelvic heaviness, revealing multiple large stones in imaging. Stone analysis showed calcium oxalate and magnesium. Enterocystolithotomy was performed to manage the condition. Enterocystoplasty, a standard treatment for bladder cancer, can lead to stone formation due to factors like urinary stasis and infections. Giant stones are rare but require prompt treatment, often involving neocystolithotomy. Controlling risk factors and selecting appropriate treatment based on stone size and surgical expertise are key to improving patient outcomes.

Effectiveness of a community-based health education intervention on prostate cancer fatalism: a quasi-experimental study

Ruth Gathoni Mbugua — 2025-04-08

Introduction: prostate cancer is categorized as the most common cancer in males in 2020 in Kenya at 21.9%. The major challenge with prostate cancer in Low and Middle-Income Countries is the presentation of patients with advanced disease. The rate of prostate cancer screening is low across African countries which has been associated with low knowledge and fatalistic beliefs. The study aimed to assess the effectiveness of community-based health education on prostate cancer fatalism.

Methods: the study design was quasi-experimental. The study was conducted in Kiambu County in the Gatundu North and Kiambu sub-counties in Kenya. A total of 288 men were selected per arm of the study using stratified random sampling. Data were collected using a structured questionnaire at baseline and post-intervention. The intervention was health education through home visits by a Community Health Worker.

Results: in the study, fatalism was associated with prostate cancer screening (P<0.05). There was a significant decrease in prostate cancer fatalism for the attributes of pessimism, pre-determination, and death inevitability in the intervention arm post-intervention. In contrast, in the control arm, there was no significant decrease. Post-intervention, the proportion of respondents with a high perception of fatalism decreased from 51% to 23.6% (P<0.05) in the intervention arm. In contrast, in the control arm, there was no significant decrease.

Conclusion: prostate cancer fatalism significantly influenced prostate cancer screening. Community-based health education significantly reduced pessimism, death inevitability, and pre-destination beliefs about prostate cancer. Tailored culturally relevant health education is an effective strategy to address fatalistic beliefs.

Exploring the relationship between Plasmodium falciparum genetic diversity and antimalarial drugs resistance markers in a malaria-endemic region of Burkina Faso

Moustapha Nikiema — 2025-04-08

Introduction: the diversity of Plasmodium falciparum genotypes affects the dynamics of malaria transmission and is thought to be one of the factors hampering malaria control efforts. This study aimed to investigate the relationship between Plasmodium falciparum genetic diversity and chloroquine and sulfadoxine-pyrimethamine resistance markers in malaria endemic areas of Burkina Faso.

Methods: in a cross-sectional study, populations residing in Nouna health district were randomly recruited. Blood samples were used for microscopic malaria diagnosis, and genetic polymorphism alleles of msp1 and msp2 genotyping by nested PCR. Restricted fragment length polymorphism analysis was used to identify antimalarial resistance markers. Logistic regression analysis explored the association between msp1/msp2 alleles and antimalarial drug resistance markers. ANOVA was used to explore the association between the mean complexity of infection (mCOI) and prevalence of resistance markers.

Results: the overall prevalence of Plasmodium falciparum infection was 27.1%. The proportions of K1, MAD20, RO33, FC27, 3D7 individuals with mutations in the pfcrt76T gene were 4.3%, 6.9%, 7.0%, 6.8% and 7.1% respectively. Those with mutations in pfmdr1 were 2.7%, 2%, 2.3%, 6.8% and 7.1%. No significant associations were detected between msp1/msp2 alleles and chloroquine or sulfadoxine-pyrimethamine resistance markers. However, the mean complexity of infection (mCOI) was significantly higher in individuals with the pfcrt76T mutation.

Conclusion: overall, this study showed that the genetic diversity of Plasmodium falciparum does not significantly affect the presence of antimalarial drug resistance genes. The competition between different strains (polyclonality) of the parasite within the host was probably unfavorable for mutant strains.

The impact of the Khartoum war on dental education

Nada Tawfig Hashim — 2025-04-08

The relentless conflict in Khartoum has severely crippled higher education, especially in specialized fields like dental education. The war has wreaked havoc on academic schedules, severely damaging infrastructure, and creating an atmosphere of pervasive uncertainty and stress for students and faculty alike. Academic continuity has been shattered, with courses and training programs facing frequent disruptions, leaving students struggling to complete their studies and gain essential practical experience. Faculty members, too, are under immense pressure, dealing with the dual burdens of maintaining educational standards and ensuring personal safety. This commentary delves into the devastating and far-reaching consequences of the ongoing conflict on dental education in Khartoum, highlighting the urgent need for comprehensive recovery and support strategies to restore this critical field.

Acute suppurative thyroiditis in a child with congenital third/fourth branchial arch anomaly: a case report

Theodora Dermitzaki — 2025-04-08

Third and fourth branchial arch anomalies belong to congenital lesions which are extremely rare accounting for <1-4% of branchial arch anomalies. In our case, a 4-year-old boy was admitted to our hospital with a painful mass on the left side of his neck. The imaging and clinical findings are oriented to the diagnosis of suppurative thyroiditis with underlying third/fourth branchial arch anomaly. The diagnosis was confirmed with laryngoscopy and the child was treated with endoscopic cauterization. The presence of specific clinical and imaging findings is not definitive, so the diagnosis relies on having a strong suspicion and knowledge of typical locations. So, our purpose is to present the spectrum of relative imaging findings from at least three imaging modalities in order to increase the level of clinical and radiological suspicion of that rare condition and help with accurate diagnosis and planning of the treatment.

A rare case of idiopathic giant bullous emphysema or vanishing lung syndrome

Aishwarya Kishor Kedar — 2025-04-08

A thirty-eight-year-old female presented with the complaints of fever, cough with expectoration and breathlessness on exertion since 2 months. There was no history of pulmonary tuberculosis, other infections or any comorbid condition. She had a history of tobacco chewing since 20 years. On examination, she was conscious and oriented to time, place and person, pulse rate was 110/minute, respiratory rate was 26/minute, saturation was 89% on room air, blood pressure was 120/80 mmHg, febrile (100.4° Fahrenheit). Her systemic examination revealed bilaterally decreased breath sounds with hyperresonant note on right side of chest. Her arterial blood gas analysis was suggestive of type I respiratory failure. Sputum examination was negative for acid-fast bacilli. Chest radiography was done which revealed a large air space with air fluid level in right upper zone. High resolution computed tomography of the lungs was further carried out for the patient which showed avascular, giant apical bulla with an air fluid level, compressing surrounding lung parenchyma on right side. There were panacinar and paraseptal emphysematous changes in bilateral lung fields. Her laboratory investigations revealed a total leukocyte count of 18000/mm³. She tested negative for hepatitis B, hepatitis C and human immunodeficiency virus. Serologic testing for connective tissue disease was negative. Alfa-1 antitrypsin concentration was 1.0 g/L which was also within normal range. A diagnosis of vanishing lung syndrome was made. Vanishing lung syndrome is a rare condition causing formation of giant emphysematous bullae in upper lobes and occupies at least one-third of one or both hemithoraces causing compression of surrounding lung parenchyma also known as idiopathic giant bullous emphysema. Patient was treated with antibiotics and supportive treatment and was referred for Video-Assisted Thoracoscopic Surgery with bullectomy.

Low completion rate for the 6-months course of isoniazid preventive therapy among people living with HIV, North Eastern Uganda, 2015-2017

Daniel Eurien — 2025-04-08

Introduction: isoniazid preventive therapy (IPT) is highly effective at preventing tuberculosis among Persons Living with HIV (PLHIV). However, IPT completion rates in Uganda have not been studied. We examined completion rates for the 6-month course of IPT and factors associated with non-completion among PLHIV in north-eastern Uganda.

Methods: we conducted a retrospective cohort study using routinely collected program data in nine Antiretroviral Therapy (ART) sites in north-eastern Uganda. The study period covered January 2015-December 2017. Non-completion was defined as failure to pick up any of the six IPT refills over 6 months. We abstracted data on IPT treatment site, IPT completion, and demographic and clinical characteristics from the IPT register and patient HIV care card. We used generalized linear regression to identify factors associated with non-completion.

Results: among 543 patients who started IPT, 175 (32%) completed the full 6-month course. Among those who did not complete, 193 (52%) stopped due to drug stockouts, and 175 (48%) were lost to follow-up. Being at World Health Organization (WHO) HIV clinical stages III and IV at initiation were associated with a higher risk of IPT non-completion compared to those who were at WHO clinical staging I and II (aRR 1.4, 95%CI 1.2-1.5).

Conclusion: IPT completion rate among PLHIV in north-eastern Uganda was suboptimal, largely due to IPT drug stockouts. The National TB and Leprosy Program should streamline the IPT supply chain to address drug stockouts and improve completion rates.

Schizophrenia and medication adherence among the population in Morocco: a cross-sectional study at the University Psychiatric Center of Casablanca

Imane Salihi — 2025-04-08

Introduction: schizophrenia is a chronic, disabling, and serious disease. It represents a challenge because of its prevalence and its consequences in terms of morbidity and mortality for patients, but also for their families and society. Patients often fail to adhere to their treatment, and this has a severe negative effect on the prognosis of the disease. Thus, the identification of the predictive factors influencing this compliance is very important for adequate management and a favorable evolution. The aim of the study is to assess the predictive factors of non-adherence in patients with schizophrenia.

Methods: a cross-sectional study of 320 patients diagnosed with schizophrenia according to the DSM-5 criteria, was conducted at the University Psychiatric Centre of Casablanca, Morocco. Epidemiological, clinical, and therapeutic data were collected using a hetero-questionnaire, while medication adherence was assessed using the Medication Adherence Rating Scale (MARS). The positive and negative symptoms scale (PANSS) was used to assess the severity of symptoms in patients with schizophrenia.

Results: in our study, the total sample comprised 320 (100%) patients, classified into two groups: 82 (25.62%) were categorized as adherent, while 238 (74.38%) were non-adherent, and 72% were male. The non-adherent group was young (p=0.003), and a significant proportion had no educational background (p=0.015), lived alone (p=0,001), in urban areas (p=0.031), non-regular follow-up (p=0.045) and had a toxic history (p=0.0001), early age of onset of the disease (p=0.002). Moreover, this group exhibited more severe schizophrenic symptoms (p=0.02), lacked insight into their condition (p=0.046), and predominantly used typical antipsychotics (p=0.019) with a high frequency of intake (p=0.0001). Sedation emerged as a predominant side effect (p=0.036) of treatment. Notably, a high frequency of hospitalizations (p=0.005) exhibited a strong association with medication non-adherence. The mean age of the sample was 32.9 years (standard deviation: 10.8), with a mean age of disease onset reported at 25.5 years (standard deviation=4.9).

Conclusion: this study highlights the prevalence of non-adherence among patients with schizophrenia, with significant associations observed with demographic factors, the severity of symptoms, treatment patterns, and hospitalization frequency, emphasizing the urgent need for tailored interventions to enhance medication adherence and improve patient outcomes in managing schizophrenia.

Cross-cultural adaptation and reliability of patient asthma knowledge questionnaire in the regional Indian language Marathi: a cross-sectional study

Vishakha Sitaram Nalage — 2025-04-08

Introduction: patient education is the cornerstone of the clinical management of bronchial asthma. The patient asthma knowledge questionnaire is a valid and reliable tool to assess the disease specific knowledge in the patients with bronchial asthma. To the best of our knowledge and literature search, there is no tool available in Marathi language to assess the knowledge of bronchial asthma in patients.

Methods: standard translation guidelines for cross-cultural adaptation were followed. Forward and backward translations were performed by the eligible translators (T1 and T2) as per the guidelines. Synthesis of the translated versions was performed by translators and recording observer (T12). Recommendations by the expert committee were done to develop a pre-final version. The pre-final version was then tested on 30 individuals with bronchial asthma. The reliability of the translated version was assessed by the internal consistency and intra-class correlation coefficient.

Results: thirty (30) bronchial asthma patients were recruited (with a mean age of 63SD±14.36, 16 male and 14 female) to test the pre-final version, and probing of each item was done to test the equivalence. It showed that the patient comprehended the intent behind each inquiry, and that was gauged on the Likert scale. A total of 102 adults (60.8% female and 39.2% male) with a mean age of 41±11 years were included in the study to examine test-retest reliability. Between the total scores obtained from the first and second applications of the questionnaire within a two-week period, there was no discernible variation. The internal consistency reliability (Cronbach´s alpha) was 0.79 and the Intra-class correlation coefficient was 1.000.

Conclusion: Marathi Version of the patient asthma knowledge questionnaire (PAKQ) is cross-culturally adapted and reliable; it will prove to be a beneficial tool to assess the disease-specific knowledge of bronchial asthma.

Challenges in managing neonatal ileal atresia in limited-resource settings: a case report

Frank Martin Sudai — 2025-04-08

Neonatal ileal atresia is a form of intestinal obstruction characterized by narrowing, complete closure, or absence of a segment of the ileum. This case involves a 5-day-old female neonate presented with abdominal distension and bilious vomiting. The neonate, delivered via spontaneous vertex birth weighing 2.9 kg, showed no fever and maintained stable vital signs during examination. Physical assessment revealed abdominal distension, hyper-tympanic areas, dullness in the lower quadrants, reduced bowel sounds, and a patent anus with an empty rectum. Imaging studies confirmed intestinal obstruction from dilated small bowels, leading to explorative laparotomy identifying ileal atresia, necessitating cecostomy placement. Despite surgical intervention, the neonate experienced nutritional complications and unfortunately passed away three days postoperatively. This case underscores the complexities of early diagnosis and management in neonates with intrauterine conditions, particularly in resource-limited settings with limited access to total parenteral nutrition.

Postnatal care utilization and associated factors among women who gave birth within the last 12 months in northwest Ethiopia: a cross-sectional study

Tesfahun Hailemariam — 2025-04-08

Introduction: postnatal care after birth is a crucial component in saving the lives of mothers and new-borns. A paucity of evidence indicated that women's unwillingness to receive care after birth remains a challenge in resource-limited settings in general and in Ethiopia in particular. This study aimed to assess the level of postnatal care utilization and factors affecting it in northwest Ethiopia.

Methods: a community-based cross-sectional study was conducted from October to November 2020. A total of 811 women who had given birth within the last year were involved in the study. Both random and fixed effects were reported using an adjusted odds ratio with a 95% confidence interval and a p-value of <0.05.

Results: the study revealed that postnatal care utilization was 19.85% (95% CI: 20.8-29.4) in northwest Ethiopia. Maternal education of secondary and above (AOR =2.65; 95% CI: 1.43, 4.94); facility delivery (AOR = 3.99; 95% CI: 2.44, 6.55); membership in women associations in the community (AOR = 1.6; 95% CI: 1.07, 2.4); four or more ANC contacts (AOR = 1.51; 95% CI: 1.03, 2.22); having health education at health post level (AOR = 1.77; 95% CI: 1.21, 2.58), and birth order (AOR = 2.64; 95% CI: 1.21, 5.78) were significantly associated with postnatal care utilization.

Conclusion: postnatal care utilization is low in rural northwest Ethiopia compared to findings from most resource-limited settings. The existing health system should consider community-based intervention strategies focusing on maternal health education, healthcare accessibility, and promoting women's participation in the community to be more effective in improving postnatal care utilization.

Tracheobronchial calcification: an incidental finding in a patient on long-term Warfarin treatment

Aishwarya Kishor Kedar — 2025-04-08

A 90-year-old woman with nonvalvular chronic atrial fibrillation on Tab Warfarin since past 20 years came with complaints of right lower limb pain following a road traffic accident. Her vitals were within normal range. On right femoral anteroposterior radiograph, she was diagnosed to have right distal femur fracture. The patient was planned for open reduction and internal fixation for the same. Preoperative investigations were done which included chest radiograph, electrocardiogram and laboratory investigations. Chest radiograph revealed diffuse tracheobronchial tree calcification as an incidental finding. Patient had no respiratory complaints. Electrocardiogram showed atrial fibrillation. Laboratory testing revealed normal serum calcium levels of 8.9 mg/dl, serum phosphorous levels of 3 mg/dl, parathyroid hormone levels of 15 pg/ml and vitamin D levels of 50 ng/ml. Bone mineral density test revealed a t- score of -3 and a diagnosis of osteoporosis was made. Patient was operated for open reduction and internal fixation and given Tab Denosumab for osteoporosis. The patient was discharged in a vitally stable state with no change of medication of Warfarin. The association between chronic Warfarin therapy and progressive tracheobronchial calcification is well established. The mechanism by which Warfarin causes tracheal calcification is unknown, but it may inhibit the normal formation of vitamin K-dependent proteins that prevent cartilage and connective tissue from calcifying. This condition is distinct from tracheobronchial osteochondroplastica, a tracheobronchial calcification disease in the elderly in which the airways are unevenly affected and multiple calcified nodules form within the anterolateral wall of the trachea. It is important to exclude serum calcium and phosphorus imbalances, such as those seen in hyperparathyroidism. If airway calcification is localized or associated with tracheobronchial narrowing or wall thickness, relapsing polychondritis and amyloidosis should be considered. It is not a contraindication to continuing Warfarin treatment. We report a case of tracheobronchial calcification identified as an incidental finding in a patient on long-term treatment with Warfarin for chronic atrial fibrillation.

Prevalence and factors associated with uncontrolled type 2 diabetes among patients in Kirehe District, Rwanda: a cross-sectional study

Symaque Dusabeyezu — 2025-04-08

Introduction: the increase in type 2 diabetes mellitus (T2DM) is a major public health issue on a global scale. A continuous rise in blood sugar levels, even if there are no symptoms of diabetes, leads to tissue degeneration and, in certain cases, fatal diseases.

Methods: in this cross-sectional study, the researcher examined the prevalence of uncontrolled type 2 diabetes mellitus among patients in Kirehe District Health Facilities from October 2023 to February 2024. The target population was 333 patients and the sample size was 201 patients who visited the non-communicable disease clinics throughout the time of data collection, those with T2DM diagnosis for at least a year, and non-pregnant women.

Results: the mean age was 57.23 years with an 11.06 standard deviation. Females represented 58.7% (n=118) while males were 41.3% (n=83). The prevalence of uncontrolled type 2 diabetes mellitus was 72.6% (n=146). Patients who had ever been lost to follow-up were more likely to have uncontrolled T2DM (AOR=3.24, 95% CI: 1.06-5.90, p=0.036) compared to those who regularly visited the health facility for care and follow-up. Patients who had comorbidities to diabetes were more likely to have uncontrolled T2DM (AOR=2.48, 95% CI: 1.31-4.68, p=0.005) compared to those who did not have comorbidities.

Conclusion: the prevalence of uncontrolled T2DM is high; healthcare providers have a responsibility to perform home visits to reduce the lost to follow-up rate and to conduct regular screening sessions for diabetes comorbidities.

Impact psychologique de la pandémie COVID-19 sur les patients hémodialysés chroniques dans l'oriental marocain: étude transversale

Kaouthar El Mir — 2025-04-08

Introduction: les hémodialysés chroniques sont une population fragile, qui ont été extrêmement influencée par la pandémie COVID-19 qui a eu des répercussions graves chez les personnes ayant des comorbidités et une dépression de système immunitaire ce qui expose davantage les hémodialysés chroniques à un haut risque infectieux et de développer une forme grave de COVID-19, ce présent travail vise à évaluer l'impact de la pandémie COVID-19 sur la santé mentale et sur la qualité de vie des hémodialysés chroniques.

Méthodes: enquête transversale descriptive, réalisée auprès de 175 hémodialysés chroniques. Nous avons utilisé l'échelle Mini International Neuropsychiatric Interview Moroccan Arab Version 5.0.0, échelle de stress perçu et échelle de la qualité de vie des hémodialysés chroniques (KDQOL-SFTM 1.3).

Résultats: cent soixante-quinze (175) participants ont été recrutés, dont 76 patients ont été atteints du COVID-19. L'infection au COVID-19 était significativement liée à l'âge (p=0,018) aux troubles psychiatriques (p=0,00), à un antécédent de tentative de suicide (p=0,006) et au niveau élevé du stress (p=0, 01). La qualité de vie des hémodialysés chroniques était significativement altérée chez les malades atteints du COVID-19 (p=0,00), surtout chez les sujets âgés (p=0,034), vivant seuls (p=0,004), ayant des antécédents organiques (p=0,04), psychiatriques (p=0,00), ou toxiques (p=0,003), ainsi que chez les malades présentant une forme symptomatique (p=0,001), des complications (p=0,00), ou hospitalisation secondaire à COVID-19 (p=0,00), et chez ceux ayant un stress sévère (p=0,00).

Conclusion: la santé mentale et la qualité de vie des hémodialysés chroniques ont été essentiellement influencées négativement au cours de la pandémie COVID-19.

Invasive fungal infection in patients with hematologic malignancies: epidemiology and prognostic factors

Maroua Jebari — 2025-04-08

Invasive fungal infections (IFI) are emerging opportunistic diseases that occur mainly in immunocompromised patients. Our study aimed to analyze the epidemiology of IFIs in patients with hematological malignancies, and the prognostic factors. Our retrospective study included patients hospitalized in the hematology department between January 1^st, 2010, and August 31^st, 2020, and in whom the diagnosis of IFI was made according to the EORTC criteria 2008. We found 29 IFIs among 6989 admissions (0.4%). IFIs were proven in 16 cases and probable in 13 cases. The median age was 35 years. The sex ratio was 0.9. The predominant IFI was invasive pulmonary aspergillosis (n=14) followed by fungemia (n=13). Candida albicans was the most isolated species in blood cultures (5/9). The mortality rate was 48%. In multivariate analysis, disease status, time to start antifungal treatment, and lactate levels are significant factors of excess mortality. IFIs are responsible for significant morbidity and mortality. The challenge lies in the precocity of starting the treatment as well as the vigilance given to the factors of poor prognosis.

A comparative study of food safety knowledge among mobile food vendors and canteen food handlers in markets in Kano Metropolis, Northwest Nigeria

Usman Muhammad Ibrahim — 2025-04-08

Introduction: foodborne diseases are an emerging public health challenge due to the global increase in vended food. This study aimed to compare food safety knowledge among mobile and canteen food handlers in Kano metropolis.

Methods: a comparative cross-sectional design was used to study 310 mobile food vendors and 310 canteen food handlers selected using a multi-stage sampling technique. Data were collected by interviewer-administered questionnaire and analyzed at univariate, bivariate, and multivariate levels using SPSS version 20 at 5% α level of significance.

Results: the mean ages (±SD) of mobile and canteen food vendors were 24.6±9.1 and 32.1±10.3 years, respectively. Majority of them were females (66.2% mobile and 61.5% canteen food vendors). Good knowledge of food safety and hygiene was found among 22 (7.2%) and 67 (23.3%), mobile and canteen food vendors, respectively. Mobile food vendors who worked for less than 35 hours per week were 70% less likely to have good knowledge of food safety [AOR=0.3, 95%CI=0.2-0.6, p<0.001] relative to those who worked for ≥35 hours per week. Among canteen food vendors, marital status [AOR=1.7, 95%CI=1.2-1.3, p=0.002], hours of food vending per week [AOR=2.7, 95%CI=1.6-4.3, p<0.001], and job description [AOR=0.5, 95%CI=0.3-0.9, p=0.008], were independent predictors of food safety knowledge.

Conclusion: knowledge of food safety and hygiene was found to be suboptimal among both canteen food vendors and mobile food vendors. The government should ensure regular training and supervision of food vendors for compliance with food safety guidelines.

Calcinosis universalis in juvenile dermatomyositis

Maryem Ferjani — 2025-04-08

A 5 years-old female Tunisian child was admitted in our department for inflammatory polyarthralgia, progressive limb weakness, severe muscle fatigability and fever. On physical examination she had heliotrope eyelid edema, extensive calcalreous depositis in her four extremities, trunk, abdomen and on the back with Gottron' papules. Muscle enzymes were high particularly Creatinine Phosphokinase (CPK). Electromyography showed a myogenic process and muscle biopsy revealed characteristic signs of inflammatory muscle disease. Radiographic studies revealed extensive deep muscular calcareous deposits regarding joints. Juvenile Dermatomyositis (DM) complicated with calcinosis universalis was retained. Although intensive glucocorticoids combined with methotrexate was given, the calcific nodules gradually increased in size, ulcerated frequently and restricted her joint mobility. This case illustrates an extreme rare form of calcinosis which occurs more commonly in juvenile DM than in adult DM. There is until now no successful treatment of calcinosis universalis identified to date. Few reports described successful treatment with immunoglobulins, probenecid, aluminum hydroxide, warfarin, and diltiazem. Further investigation of disease mechanisms is needed so more effective therapeutic strategies may be developed.

A clinical presentation of herpangina with ulcerative lesion over uvula

Pawan Banduji Itankar — 2025-04-08

A 23-year-old male patient came to the outpatient department (OPD) with complaints of an ulcerative lesion over the uvula, fever, headache, and throat pain for 3 to 4 days, and no past medical history. He took antibiotics (azithromycin) and nonsteroidal anti-inflammatory drugs (NSAIDs) (paracetamol+ibuprofen) for three days after taking NSAIDs only the pain subsided but didn´t get relief from the ulcerative lesion. Therefore, an antiviral (Acicylovir) prescribed for five days helps to relieve associated symptoms, and the ulcerative lesion healed completely. Enteroviruses (i.e group A coxsackie virus) are the source of the viral infection known as herpangina, which often strikes children under the age of ten years; though it can strike anybody at any age depending on the immunity of an individual and is seen during autumn and summer season for 7 to 10 days. Clinically, it is an acute self-limiting tiny ulcerative or vesicular lesion in the posterior oropharynx, uvula, and throat region accompanied by an intense fever associated with headache and loss of appetite. Uses of antibiotics are ineffective in such conditions.

Healthcare use and sexually transmitted infections treatment-seeking: a mixed methods cross-sectional survey among hard-to-reach fishing communities of Lake Victoria, Uganda

Ali Ssetaala — 2025-04-08

Introduction: Uganda´s fishing communities experience a high burden of sexually transmitted infections (STIs) including human immunodeficiency virus (HIV), with limited access to healthcare. Knowledge on healthcare use and treatment seeking will help identify unmet needs and facilitate appropriate allocation of resources.

Methods: between 2014-2015, a mixed methods cross-sectional survey was conducted in four fishing communities on Lake Victoria, Uganda, as part of preparedness for HIV trials. The goal was to understand health problems (having any illness, medical condition, or injury in the past 12 months), perceptions of healthcare, health services use, and factors associated with seeking STI care. Data were collected from participants aged 13-49 years; quantitatively using a structured questionnaire and qualitatively via focus group discussions (FGDs) and key informant interviews (KIIs). Information covered recent health problems, health services use, and healthcare perceptions. Multivariable logistic regression modeling was used to determine factors associated with seeking care for STIs.

Results: participants´ median (interquartile range) age was 29 (23-35) years, more than half (51.9%, 763/1,469), were females, and the majority (60.4%, 888/1,469) had up to seven years of formal education. Most participants reported having had health problems (76%, 1,117/1,469). The most frequently reported health issues were STI symptoms (52.6%, 587/1,117). Lack of health services was mentioned as one of the reasons for not seeking care during the FDGs and KIIs. Adolescents, 13-19 were less likely to seek care for STIs symptoms than adults of 20 or more years (aOR= 0.5 (95% CI 0.3-0.9)). Females were more likely to seek STI treatment (aOR= 1.4 (95% CI 1.0-2.1)), as were participants who worked mainly in bars, restaurants or lodges (aOR= 2.0 (95% CI 1.1-3.6)).

Conclusion: in these communities, adolescents have low treatment seeking for STIs symptoms.

Maxillary intraosseous hemangioma: case report

Anas Douami — 2025-04-08

Maxillary intraosseous hemangiomas are rare benign vascular lesions, accounting for less than 1% of all primary bone tumors. Clinical examination often reveals a hard, painless swelling mass that is rarely pulsatile. Imaging not only helps to make a positive diagnosis but also contributes to therapeutic management. We report a case of a left maxillary intra osseous hemangioma Some authors have proposed exclusive embolization as a treatment for maxillary angiomas, but this requires several sessions for complete devascularization.

High sensitivity C-reactive protein in pre-eclamptic women living with HIV at a tertiary hospital in Zambia: a preliminary study

Zebedia Kabaya — 2025-04-08

Introduction: pre-eclampsia affects an estimated 8% of pregnant women and contributes to over 12% of global maternal deaths. High-sensitivity C-reactive protein (hs-CRP) is a potential marker of pre-eclampsia. However, little is known about hs-CRP levels in women with pre-eclampsia in Zambia. This study examined whether hs-CRP levels differ between women who develop pre-eclampsia compared with controls overall and in subgroups of women living with and without HIV.

Methods: a case-control study was conducted among 40 pregnant women who developed preeclampsia (cases) and 40 normotensive pregnant women (controls) living with (n=20) and without HIV (n=20) at women and newborn hospital from February to May 2022. Standard ELISA kits were used to determine hs-CRP levels. The conditional logistic regression model calculated the odds ratios for hs-CRP and other predictor variables with their 95% confidence intervals.

Results: the median hs-CRP levels were higher among the cases than controls (7.84mg/ml vs 6.13mg/ml, p<0.001). Similar hs-CRP levels were observed among pre-eclamptic women living with HIV on antiretroviral therapy (ART) compared to HIV-negative women (7.92mg/ml vs 7.17mg/ml, p=0.862). On the other hand, normotensive women living with HIV on ART had different hs-CRP levels than HIV-negative women (6.60mg/ml vs 3.96mg/ml, p<0.001). Multivariable conditional logistic regression showed that pregnant women with higher levels of hs-CRP (AOR=1.01, 95% CI=1.01, 1.01) were more likely to have pre-eclampsia after adjusting for significant predictors. Pre-eclampsia was less likely among women living with HIV on ART (AOR=0.26, 95% CI=0.07, 0.99), married (AOR=0.15, 95% CI=0.03, 0.71), and multiparous (AOR=0.16, 95% CI=0.03, 0.80).

Conclusion: high-sensitivity C-reactive protein levels were higher among the cases than controls. However, similar levels were observed in the subgroup of women living with HIV on ART. Participants with high hs-CRP levels had the highest odds of preeclampsia, suggesting that hs-CRP may be useful in predicting preeclampsia.

Cost analysis of outpatient services for major external structural birth defects: an ingredient approach in selected hospitals in Kiambu County, Kenya

George Nyadimo Agot — 2025-04-08

Introduction: major external structural birth defects (MESBDs) are known to exert an enormous economic burden on individuals and health services; however, they have been vastly underprioritized as a public health problem in settings where cost analyses are limited. This study aimed at conducting a cost analysis of outpatient services for MESBDs in selected hospitals in Kiambu County, Kenya.

Methods: a cross-sectional descriptive survey was conducted in four hospitals selected for providing outpatient corrective and rehabilitative services to the under-fives. An ingredient approach was used to gather data retrospectively on the cost drivers for castings, bracings, and tendonectomies from healthcare providers' perspectives for a one-year time horizon from January 1^st, 2018, to December 31^st, 2018. Prevalence-based morbidity data were extracted from outpatient occupational therapy clinic registers, whereas staff time was gathered through face-to-face inquiries. Associated cost drivers of 349 cases were quantified, valued using prevailing market prices, and categorized as recurrent costs. The unit economic costs were calculated as average costs, expressed in U.S. dollars, and inflated to the U.S. dollar Consumer Price Index from January 2018 to December 2018.

Results: the unit economic cost of all the cases was estimated at $1,139.73; $1,143.51 for neural tube defects (NTDs), $1,143.05 for congenital talipes equinovarus (CTEV), and $1,109.81 for congenital pes planus.

Conclusion: the highest economic burden of MESBDs was associated with NTDs, and CTEV, respectively. We recommend further research to estimate the economic costs of MESBDs among school-going pupils to inform the equitable allocation of resources for health and childhood developmental programs.

Dietary practice and nutritional status of low-income earners in a rural adult population in Delta State, Nigeria: a cross-sectional study

Ogbolu Nneka Christabel — 2025-04-08

Introduction: due to the inability of low-income populations to access nutritious foods or basic education, these groups usually consume unhealthy diets, which frequently lead to nutrition issues like obesity, malnutrition, and other health morbidities. The purpose of the study was to evaluate the nutritional knowledge, dietary practices, nutritional status, and factors influencing the dietary habits of low-income persons living in a rural constituency in Southern Nigeria.

Methods: a cross-sectional study was carried out on 419 consenting low-income adults (18 years and older) using a simple random technique, in order to collect data on their socio-demographic traits, nutritional knowledge, dietary practices, and nutritional status. Statistical Package for Social Sciences (SPSS) version 22.0 was used to analyze the data generated.

Results: the respondents´ the average age was 40.9 ± 15.68 years while 224 (53.5%) of those surveyed were females. The proportion of responders with a secondary education was highest 279 (66.6%). The most common occupation among respondents was farming 151 (36.1%) and petty trading 135 (32.2%). Overall, 314 (74.9%) of low-income adults had poor dietary habits, and 245 (60.6%) had poor nutrition knowledge. Occupation and gender were significantly associated with nutritional status P<0.05. The majority of respondents 56.2% (235) were overweight or obese, and multivariate logistic regression analysis shows that respondents with concern about gaining weight were more likely to be overweight or obese (OR=1.065, 95% CI=0.832-1.363).

Conclusion: the findings from the study indicate that inadequate nutritional knowledge and poor dietary habits, reflected in respondents' body weight are likely to increase the risk of non-communicable diseases, necessitating the need for nutritional education among rural populations.

Proximal connection anomalies of the coronary arteries to the aorta: retrospective experience in a Moroccan university hospital and literature review

Nouhaila Lahmouch — 2025-04-08

Proximal connection anomalies of the coronary arteries to the aorta represent a rare pathology, with an angiographic prevalence close to 1%. The prognosis of this condition is contingent upon its anatomical form. Some instances are linked to sudden deaths, while others may be associated with myocardial ischemia. Utilizing computed tomography (CT) coronary angiography as the optimal imaging tool, one can identify the origin and course of the ectopic artery. Current guidelines suggest surgical correction as the primary intervention for symptomatic abnormalities when a risky form is identified. To enhance the management of these anomalies, the establishment of comprehensive multicenter observational registers is imperative. Our study, a retrospective analysis spanning two years, focuses on 10 cases of proximal connection anomalies of coronary arteries to the aorta diagnosed in the Cardiology department of the Mohammed V Military Hospital of Rabat. By presenting this series and conducting a literature review, we elucidate the anatomical, epidemiological, physiopathological, clinical, angiographic, and CT angiography features of these anomalies, along with insights into therapeutic management.

The Daily Mile reduces depressive and anxiety symptoms in school-going Ugandan adolescents aged 16-17

Davy Vancampfort — 2025-04-08

Introduction: school-based physical activity (PA) programs such as The Daily Mile (TDM) might be vital in the prevention and treatment of mental health problems in adolescents in low-income countries. The aim of this single-arm non-controlled pilot intervention study was to investigate TDM on symptoms of anxiety and depression in adolescents aged 16-17 years in Uganda.

Methods: The Daily Mile (TDM) took place between February and April 2022. In total 177 adolescents (62.7% girls) completed the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 Questionnaire (GAD-7) pre and post-12 weeks TDM.

Results: moderate effect sizes were found for reductions in PHQ-9 (Cohen´s d=-68, 95% CI=-0.84 to -0.52, P<0.001) and GAD-7 (Cohen´s d=-0.54, 95%CI=-0.68 to -0.38, P<0.001) following TDM. In those with at least mild symptoms, large effect sizes were observed for reductions in PHQ-9 (Cohen´s d=-0.94, 95%CI=-1.14 to -0.72, P<0.001) and GAD-7 (Cohen´s d =-0.85, 95% CI=-1.07 to -0.62, P<0.001) following TDM. The prevalence of mild depression dropped from 70.1% to 50.8% and moderate depression from 28.2% to 15.3%, while the prevalence of mild anxiety dropped from 54.8% to 38.4%, and moderate anxiety from 21.5% to 10.7% (all P<0.001). Rates of severe depression and anxiety did not drop significantly.

Conclusion: The Daily Mile (TDM) might potentially reduce mild and moderate symptoms of anxiety and depression in school-going adolescents in low-income countries such as Uganda. For more severe cases, additional support is needed.

Religious leaders´ willingness to promote the uptake of human papillomavirus vaccine among their congregants in Mavoko Sub-County, Machakos County, Kenya

Faith Kaaria — 2025-04-08

Introduction: cervical cancer is a significant health challenge in Kenya and sub-Saharan Africa, with high mortality linked to late presentation and low awareness. Despite its prevalence, preventive interventions like human papillomavirus (HPV) vaccination face low utilization. Religious leaders play a pivotal role in influencing health decisions, yet their attitudes toward HPV vaccination remain understudied. Therefore, this study aims to determine religious leaders' willingness to promote HPV vaccine uptake in Mavoko Sub-County, Machakos County, Kenya.

Methods: a cross-sectional study involving 198 religious leaders chosen through systematic random sampling method was done in the month of December 2023 in Machakos County, Kenya. Data on socio-demographics and attitudes towards HPV vaccination were collected using structured, self-administered questionnaires. Attitudes were gauged on 11 statements. Analysis was performed using IBM SPSS 22.0, employing descriptive statistics and Chi-square tests to assess associations, with significance set at p < 0.05. Results were visually presented using tables, charts and graphs.

Results: the study had a 96.6% response rate. Majority were male (51.5%), Protestant Christians (48%), and pastors (29.8%). Most participants had positive attitudes towards the HPV vaccine, with no significant socio-demographic associations found.

Conclusion: the study reveals positive attitudes among religious leaders towards promoting HPV vaccine uptake among their congregants. Despite some concerns and misconceptions, the majority of participants expressed willingness to advocate for vaccination.

Diode laser removal of lower lip mucocele: a case report

Youssef Amal — 2025-04-08

Mucocele is a common benign cyst pathology of minor salivary glands of the oral mucosa. The most common location for these lesions is the lower lip. It mainly occurs due to chronic trauma or habit of lip biting or sucking. Such parafunctional habits lead to the alteration of minor salivary glands and mucous accumulation. This case report presents a patient with lower lip mucocele resulting from a lip-sucking habit due to the presence of maxillary central incisor midline diastema. The mucocele removal was performed with a diode laser, and the midline diastema was closed with composite in order to eliminate the parafunctional habit of lip sucking and prevent a possible relapse.

Gastroduodenal intussusception as a rare complication of gastrointestinal stromal tumor: a case report

Mujaheed Suleman — 2025-04-08

Intussusception is a common and well-known surgical pathology. Intussusception in adults is rare, accounting for only 5% of all intussusceptions. Gastrointestinal stromal tumors (GIST) are common mesenchymal tumors of the stomach that can act as a pathological lead point for intussusception. Herein, we present an uncommon case of gastroduodenal intussusception in an elderly female patient due to gastric GIST which was successfully managed surgically by partial gastric resection. This case report creates awareness that clinicians should have gastric intussusception as their differential diagnosis for gastric outlet obstruct and highlights the importance of further radiological investigations.

Lymphangiome kystique du mésocolon: à propos d´un cas

Abdelkrim Chetibi — 2025-04-08

Le lymphangiome kystique (LK) intrapéritonéal est une pathologie bénigne malformative rare, d'origine lymphatique, sa symptomatologie clinique est très diversifiée. Le diagnostic est évoqué par l'imagerie et confirmée par l'histologie. Nous rapportons ici le cas d'une femme âgée de 54 ans, consultant pour des douleurs abdominales chroniques sans retentissement sur l'état général. Le bilan radiologique est revenu en faveur d'une formation kystique mésentérique bénigne pouvant être compatible avec un lymphangiome kystique. Une exérèse chirurgicale complète de la masse kystique après ponction-aspiration est pratiquée par laparotomie médiane, les suites postopératoires sont simples. L'examen histologique de la tumorectomie permet de confirmer le diagnostic d'un LK du mésocolon. À 12 mois, la patiente est asymptomatique et aucune récidive n'est observée.

Severe congenital kyphoscoliosis

Souvik Sarkar — 2025-04-08

A 6-year-old female child came to the outpatient department with complaints of exertional dyspnea and occasional cough. The child was diagnosed with congenital kyphoscoliosis and had frequent visits to the orthopedic clinic because of pain. We performed a spirometry, which showed a restrictive pattern. The child´s head was leaning forward, with a stiff back and curved shoulders. Cobb´s angle was measured which was approximately 58°. The child was screened for cardiac anomalies and genitourinary abnormalities but was not suffering from any of the other ailments. She was advised chest physiotherapy and breathing exercises, but looking at the progressive nature of the vertebral defect, she was referred to a spine surgeon for corrective surgery.

An unusual presentation of autosomal dominant polycystic kidney disease in a newborn

Aditi Rawat — 2025-04-08

A 2.3 kg female newborn born to a primigravida with no history of consanguinity at 36 weeks of gestation, by cesarean section for preterm labor. Antenatal history was suggestive of oligohydramnios with an amniotic fluid index of 7 and bilaterally enlarged fetal kidneys. No history of renal disorders is present in the family. The baby cried immediately after birth. On examination, vitals were stable without any respiratory distress. Abdominal examination revealed a massively enlarged abdomen with visible dilated veins (A) and bilateral ballotable masses suggesting renomegaly. There were no facial or body dysmorphisms for syndromic association. The blood pressure was within the normal range. Ultrasound abdomen showed enlarged hyperechoic kidneys with multiple cysts throughout the renal parenchyma (B). No cysts were seen in the liver and spleen. The baby was passing urine adequately. The renal function test showed serum urea of 45mg/dl serum creatinine of 1.5mg/dl at 48 hours of life, serum sodium of 138 meq/L, and serum potassium of 4.7 meq/L. Genetic testing confirmed biallelic mutation in the PKD1 gene on chromosome 16. A final diagnosis of autosomal dominant polycystic kidney disease (ADPKD) was made. As there were no clinical symptoms like oliguria, respiratory insufficiency, or hypertension, the baby was discharged on the 7^th day of life. Regular follow-up was explained for monitoring renal functions and hypertension as there is an 8% and 15% risk of chronic kidney disease and hypertension respectively by adolescence. Usually, the presentation is in adulthood but this unique case has a rare prenatal presentation despite being of autosomal dominant variety.

Rheumatoid ulcer in a case of rheumatoid arthritis with pulmonary tuberculosis

Souvik Sarkar — 2025-04-08

A 49-year-old male, non-diabetic and non-hypertensive, diagnosed with rheumatoid arthritis, previously treated with methotrexate and leflunomide, presented with a painful lesion on his right lower limb, fever with chills, and a cough with expectoration for 2 months. He had stopped his rheumatoid arthritis medication 6 months prior. On examination, he was emaciated and febrile, had a pulse rate of 108 bpm, blood pressure of 80/50 mmHg, and oxygen saturation of 88% on ambient air. The lesion was a 3 cm ulcer on the right knee with an undermined edge, regular margin, and healthy granulation tissue without discharge. Cultures from the ulcer showed no growth for bacteria or tuberculosis. Rheumatoid factor and anti–cyclic citrullinated peptide (anti-CCP) were elevated. Chest computed tomography (CT) revealed a cavity in the left upper lobe and fibrotic changes in the bilateral lower lobes. Sputum examination and cartridge-based nucleic acid amplification test (CBNAAT) detected acid-fast bacilli without rifampicin resistance. The patient was started on oral anti-tubercular treatment (isoniazid, rifampicin, pyrazinamide, ethambutol) and received daily ulcer dressings. A rheumatologist recommended starting oral steroids and would review after completing the intensive phase of anti-tubercular treatment.

Profil des usagers de substances psychoactives: état des lieux après 13 mois d´activités du centre de soins « Colibri Sud »

Cherileila Thiombiano — 2025-04-08

Pour améliorer l'accès aux soins des usagers de substances psychoactives dans la ville de Bobo-Dioulasso, le centre de soins"Colibri Sud" a été créé. Cette étude avait pour objectif de décrire le profil des usagers de substances psychoactives qui ont fréquenté le Centre Médical "Colibri Sud" après 13 mois d'activités. Il s'est agi d'une étude transversale descriptive sur des données collectées du 1^er mars 2022 au 31 mars 2023. Les variables collectées étaient le sexe, l'âge, la profession et le type de substance consommée. L'analyse des données a été faite avec le logiciel STATA 16. Un test de Fisher exact de 5% a été considéré comme significatif. Au total, 116 patients ont été inclus dans notre étude. Les substances les plus consommées étaient le cannabis (75,86%), les benzodiazépines (25%), les opiacés (11,2%), les barbituriques (6,9%), la cocaïne (3,44%). Les polyconsommateurs représentaient 15,50%. Les patients de moins de 30 ans étaient les plus représentés (67,24%) ainsi que les travailleurs du secteur informel (40,52%) et les élèves/étudiants (31,03%). Le centre est fréquenté par une population masculine à majorité jeune, le cannabis reste la substance la plus consommée. Cependant les benzodiazépines, les opiacés et la polyconsommation jadis rare est maintenant non négligeable. Au regard des profils retrouvés, l'accessibilité aux tests chromatographiques de détection et de quantification de ces substances psychoactives est plus que nécessaire pour une meilleure prise en charge. Aussi les actions entreprises doivent être surtout en faveur des élèves et étudiants.

A severe case of Duchenne muscular dystrophy manifested with scoliosis and muscle contractures in 21-year-old male: a rare clinical image

Deeplata Mendhe — 2025-04-08

Duchenne muscular dystrophy (DMD) is a severe and progressive genetic condition that causes muscular degeneration and weakening due to a lack of dystrophin, a necessary muscle protein. Duchenne muscular dystrophy, which is typically diagnosed in early childhood, causes loss of mobility and other difficulties, having a substantial influence on the quality of life and life expectancy of people affected. It is inherited as an X-linked recessive inheritance. Here we report a case of a 21-year-old male with muscle weakness and wasting in the whole body, with severe crippling deformities and contractures with scoliosis. He had developed the symptoms of DMD at the age of 3 years and had been confined to a wheelchair for the past 11 years. He had a thin and emaciated appearance, poor nourishment with signs of malnutrition prominent bones and visible ribs, as well as reduced activity level. Deformities were seen with flexion contractures in the fingers and wrist, showing a claw-like appearance of the hand. Contractures and equines foot deformity were seen as contributing to difficulties in ambulation. There was no observable gait due to the patient´s inability to walk, and he relied on a wheelchair for mobility. He had undergone various investigations, including an enzyme test in which the creatine kinase is extremely elevated at 4800 U/L with a reference level of 24-195 U/L. Also, a genetic blood test showed the deletion of Exon 45. He is currently receiving corticosteroid tablets prednisone (1mg) and deflazacort (1.3mg) once a day and has been receiving home-based physiotherapy after completion of physiotherapy at the hospital.

Birth defects and their impact on child morbidity and mortality in developing settings

George Nyadimo Agot — 2025-04-08

Despite the notable gains that have been realized in reversing perinatal, neonatal, and childhood morbidity and mortality, insignificant actions on birth defects undermine the desired outcomes. A yearly upward trend of birth defects (44.04-205.28 per 100,000 livebirths) between 2014 and 2018 attributed to known genetic, unknown multifactorial inheritance, and socio-demographic environmental factors, with an estimated unit economic cost of $ 1,139.73 for outpatient services was observed in Kiambu County, Kenya. Thus, interventions anchored on social health insurance would suffice.

The utility of low-cost negative pressure wound therapy in Cameroon

Lahin Amlani — 2025-04-08

Musculoskeletal injuries are common in Cameroon. Negative pressure wound therapy (NPWT) can effectively manage complex wounds including open fractures, however high cost and unavailability prevent its widespread use. We sought to evaluate the feasibility and efficacy in Cameroon of a low-cost NPWT (LCNPWT) device built from an aquarium pump costing less than $100. We performed a prospective case series including all patients with musculoskeletal injuries managed with LCNPWT at Baptist Hospital Mutengene, Mutengene, Cameroon from 15^th March 2021 to 15^th March 2022. Patient demographics, wound characteristics, and wound photographs were collected at intake and at each dressing change (performed every 3 days). All treatment was provided inpatient, and outcomes were recorded at hospital discharge. Forty-one patients (mean age 40 years, 58% male) received LCNPWT. The most common injury mechanisms were road traffic-related accidents (n=16, 42%) and gunshots (n=8, 21%). Wound characteristics were recorded for 38 patients of which 24 (63%) had infected wounds and 3 were bacteremic (13%) on presentation. All patients received antibiotics. The average duration of LCNPWT was 5.9 days (standard deviation 3.1 days). For 15 patients with documented outcome data, LCNPWT was successful in achieving wound closure in 12 (80%). Five patients failed limb salvage, with 4 receiving amputations and 1 dying during hospitalization. Eighty-three percent of providers (15 providers) reported LCNPWT as beneficial in managing wounds. Low-cost NPWT device was effective for managing contaminated and complex wounds in a resource-limited setting.

Patterns of diet and anemia during pregnancy in the Province of Sidi Kacem, Morocco

Najoua El Aski — 2025-04-08

Introduction: the objective of this study is to examine dietary habits and certain cooking practices, evaluating their influence on the prevalence of anemia in pregnant women and exploring other factors associated with anemia in Morocco, specifically in the province of Sidi Kacem.

Methods: the research utilized a survey conducted over a one-year duration, spanning from August 01, 2018, to August 01, 2019, employing a cross-sectional, and analytical methodology. The prevalence of anemia in pregnant women was determined based on complete blood count tests, using hemoglobin (Hb) levels and World Health Organization (WHO) thresholds. An anonymous structured questionnaire was used to assess the dietary practices of the participants. The impact of these practices on anemia was analyzed using multivariate logistic regression models. Data analysis was conducted using Statistical Package for the Social Sciences (SPSS) software version 26.

Results: the anemia rate among pregnant women in the province of Sidi Kacem was 43.03%. The findings of the binary logistic regression analysis revealed a statistical association between anemia, the main sources of iron in the diet, the frequency of consumption of caffeine-containing beverages (tea, coffee) with meals, the use of specific cooking techniques that could influence the iron content of foods, and the daily diet.

Conclusion: the prevalence of nutritional challenges in Morocco poses a barrier to human development and enhanced health outcomes. A comprehensive understanding of the severity of these deficiencies is imperative for tailoring interventions that are contextually relevant to each region within the country.

Well-differentiated squamous cell carcinoma of the clitoris: a rare case repor

Shivali Kalode — 2025-04-08

Squamous cell carcinoma (SCC) can impact many different organs, including the vagina and vulva skin, that are covered with squamous epithelial lining. With a yearly prevalence as low as 2.6 per 100,000 people, Vulvar carcinoma is a rather uncommon type of gynecological neoplasia. It commonly manifests in people 70 years of age and older. Our case study is about the well-differentiated squamous cell carcinoma (WDSCC) of the clitoris in a female patient who is 65 years of age. However, there is an increasing number of women aged 35 to 45 who are being diagnosed with this type of cancer. The biopsy of the clitoris revealed severe dysplastic squamous epithelial cells, diagnostic for WDSCC of the clitoris. In the past, the gold standard for treating even mild invasive vulva carcinomas involved a radical vulvectomy with a wide margin of tumor excision, an en bloc resection of the inguinal and frequently the pelvic lymph nodes. At the moment, a less drastic and more customized course of action is advised.

Synovial sarcoma under the lens: a case report

Shivali Kalode — 2025-04-08

Synovial sarcoma, an uncommon malignant tumor, can occur in various anatomical sites but mostly involves joints. It is invasive locally and tends to spread to other sites. We report a male patient, 56 years old, who had swelling above his right ankle. Soft tissue edema was observed across the lateral malleolus in imaging examinations. A synovial sarcoma was diagnosed on histopathology. A complete resection was performed and postoperative treatment with doxorubicin and cyclophosphamide was given for 2 months. The 5-year survival rate is only expected between 27-55%. Furthermore, many authors concur that synovial sarcomas are among the most frequently misdiagnosed soft tissue cancers due to their sluggish growth pattern, benign radiographic appearance, capacity to fluctuate in size, and potential to induce pain similar to that brought on by ordinary trauma. Therefore, the case emphasizes the need for additional study to identify the best diagnostic approaches for synovial sarcoma.

Leriche syndrome with wound myiasis

Yoen Young Chuah — 2025-04-08

A 67-year-old man presented with progressive shortness of breath and claudication for one week. He has a thirty-year history of heavy smoking. Physical examination revealed a gangrenous, suppurative wound and myiasis on the right great toe (A, B). In addition, a non-pulsating right popliteal artery was observed. His laboratory analysis revealed leukocytosis, bandemia (an increased number of immature white blood cells), and an elevated C-reactive protein (CRP) level. A computed tomography scan uncovered atherosclerosis affecting the distal abdominal aorta, iliac arteries, and femoral vessels that is compatible with Leriche syndrome (C). Antibiotic treatment with cefoperazone/sulbactam was administered, along with surgical debridement of the gangrenous toe (D). To improve local blood circulation, percutaneous transluminal angioplasty (PTA) was performed on the right common femoral artery (E, F). Dual antiplatelet agents were prescribed, and the patient was advised to quit smoking. Our patient has had an uneventful clinical course and was successfully discharged after a three-week hospitalization. Leriche syndrome is a progressive disease characterized by claudication, erectile dysfunction, and diminished distal pulses. Hyperlipidemia, diabetes mellitus, and smoking are the risk factors. Long-term smoking history in our patient is a prominent risk factor attributable to Leriche syndrome, which causes hypoperfusion at distal extremities that may lead to wound formation. Moist, gangrenous wounds associated with Leriche syndrome may attract flies, increasing the risk of myiasis. This presentation represents the initial documented case of wound myiasis in a patient diagnosed with Leriche syndrome, thus offering valuable insights into this infrequently encountered clinical association.

Intravitreal bevacizumab causes rapid regression of disc neovascularization associated with large optic disk melanocytoma: a case report

Ogugua Ndubuisi Okonkwo — 2025-04-08

Optic disk melanocytoma (ODM) is a rare ophthalmic tumor that can present with local compressive effects such as retinal vascular occlusion (RVO) that results in neovascularization of the disk (NVD) and is reportedly challenging to treat. We report the case of a 37-year-old Black African male with a two-year history of painless nonprogressive blur in his right eye vision. Findings on ocular examination include best corrected visual acuity right eye 6/18 and left eye 6/6, right eye relative afferent pupillary defect, and a large dark brown pigmented mass covering the optic disc measuring 4.8 mm x 4.6 mm. NVD was present along the superior disc margin and whitening of the superotemporal retinal vessels. Fluorescein angiography confirmed a superotemporal retinal vascular occlusion with non-perfusion and dye leakage from the NVD. Intravitreal bevacizumab and scatter retinal laser resulted in complete NVD regression within four weeks and no recurrence in 18 months. This case report suggests that earlier treatment with Intravitreal bevacizumab and scatter retinal laser photocoagulation is effective for the regression and stabilization of NVD associated with ODM. Aggressive ODM could be a feature in younger-age Africans. Yearly monitoring is required to detect an increase in ODM size that could suggest malignant transformation.

Prevalence and determinants of hypertension in a semi-urban population: a cross-sectional study in Dschang (West Region of Cameroon)

Sylvain Raoul Simeni Njonnou — 2025-04-08

Introduction: hypertension is a major public health problem worldwide, associated with considerable morbidity and mortality. Although the national prevalence of hypertension is well established, its prevalence in semi-urban areas is poorly known. This study aimed to establish the prevalence and determinants of hypertension in a semi-urban area.

Methods: we conducted a cross-sectional community study in the adult population of the Dschang Health District from February to May 2022. Consent to participate was obtained and data was collected through a face-to-face interview using a predesigned questionnaire. Collected variables included sociodemographic characteristics, previous education on weight loss, salt, alcohol, and tobacco consumption, and blood pressure level after 45 min of rest.

Results: we recruited 706 participants with a mean age of 53.11 years. The prevalence of hypertension was 57.6%, with 13.02% for grade 1; 64.87% for grade 2 hypertension, and 22.11% for grade 3. The determinants significantly associated with hypertension in multivariate analysis were: age over 40 years (aOR:3.23, 95% CI 1.91 - 5.47; p<0.001), being a civil servant (aOR:4.82, 95% CI 2.44 - 9.54; p<0.001), being unemployed (aOR:2.95, 95% CI 1.32 - 6.57; p =0.008), tobacco consumption (aOR:1.93, 95% CI 1.49 - 2.38; p <0.001), hypertension among siblings (aOR:4.56, 95% CI 1.30 - 15.95; p =0.017), diabetes mellitus (aOR:3.09, 95% CI 1.61 - 5.94; p <0.001), obesity (aOR: 2.8, 95 CI 1.10 - 7.74; p<0.001), previous therapeutic education (over salt consumption: [aOR:1.7 95% CI 1.08 - 2.67; p<0.001], alcohol consumption: [aOR: 2.12, 95% CI 1.24 - 3.61; p<0.04] and weight loss [aOR:2.51, 95% CI 1.76 - 3.57; p<0.001]), presence of palpitations (aOR: 22.63, 95% CI 1.83 - 278.6; p=0.015) and reduced vision (aOR:1.97, 95% CI 1.08 - 3.6; p=0.026).

Conclusion: a high prevalence of hypertension was found in the Dschang Health District. Sociodemographic characteristics, family and personal history and some clinical manifestations were associated with hypertension. There is a need to implement hypertension prevention strategies in semi-urban settings.

Job precarity impacts the mental health of contractual teachers in Morocco: between fatigue and psychological distress

Fatima Bouizzal — 2025-04-08

Introduction: since the Ministry of National Education introduced contractual recruitment in 2016, Morocco has faced significant challenges related to the well-being of its contractual teachers. This study investigates the impact of job precarity on the mental health of these teachers, specifically focusing on fatigue and psychological distress.

Methods: we collected responses from 245 contractual teachers across Morocco’s 12 regions, utilizing the Individual Strength Checklist (CIS) to assess fatigue and the General Health Questionnaire (GHQ) for psychological distress. Our findings reveal that teachers' average scores on the CIS (51.7 ± 19.7) and GHQ (12.3 ± 4.6) were notably high, indicating significant job-related stress and emotional suffering.

Results: our study indicates that teachers had very high average scores on the CIS (51.7 ± 19.7) and GHQ (12.3 ± 4.6), suggesting that they experienced considerable job-related stress and emotional distress. Our research revealed that 31% of teachers reported experiencing weariness, while 26% reported experiencing psychological distress. Additionally, out of the individuals who reported experiencing chronic exhaustion, 39% specifically experienced fatigue alone, while 61% experienced both fatigue and psychological discomfort. This suggests a significant association between these two conditions.

Conclusion: the research emphasizes that Moroccan contractual teachers have a shared experience of exhaustion and mental anguish, which is worsened by the uncertainty of their job. Specific interventions are required to address and alleviate these unique effects on teachers' well-being, thereby enhancing the entire educational atmosphere.

South African medical rehabilitation services delivery: a mixed method exploring the views of stakeholders on availability, accessibility, quality, affordability, equity, effectiveness, and efficiency

Senzelwe Mazibuko — 2025-04-08

Introduction: South Africa has endeavored to provide access to rehabilitation to more people with the greatest needs via its National Rehabilitation Policy. To achieve the aim of the Framework and Strategy for Disability and Rehabilitation Services in South Africa, scientific knowledge on rehabilitation services would be essential to inform implementation, yet little is known in the KwaZulu-Natal (KZN) province. This paper describes South African rehabilitation services delivery focused on availability, accessibility, quality, affordability, equity, effectiveness, and efficiency based on stakeholders´ perspectives in KZN.

Methods: a mixed method study design was employed to investigate 99 stakeholders' opinions on rehabilitation services in three districts of South Africa´s KZN province (eThekwini, Amajuba and King Cetshwayo) using focus group discussions, interviews, and a survey. The stakeholders included practitioners (physiotherapists, occupational therapists, social workers, psychologists, nutritionists, dietitians, audiologists, speech therapists, and bio kineticist), district rehabilitation managers, provincial rehabilitation managers, and representatives from the provincial office of social development. Whilst quantitative data were analysed using descriptive statistics, thematic analysis was employed for the qualitative data.

Results: of the 99 participants, 73 (74%) were female, and ages ranged from 23 to 56 years (median=29 years, IQR=12.5 years). The emerging themes were availability, accessibility, equity, quality, efficacy, and efficiency of rehabilitation. Rehabilitation services were mostly (78%, n = 42) available at the tertiary level in urban areas, and few (45%, n = 42) in rural areas. No private rehabilitation facility was found in any rural setting. Accessibility was generally agreed to be poor (with patients traveling more than 10 kilometers to access services) but with the agreement that transport routes from surrounding areas were safe and reliable for patients to reach their setting (median=2.5, IQR=1.0). This study´s participant's general sentiment on affordability and equity tended to be mixed but skewed towards agreeing that the services were indeed affordable, and provided without any social class biases. Also, the general sentiment of the participants on the quality, effectiveness, and efficiency of rehabilitation services in their settings tended to be positive.

Conclusion: rehabilitation at the primary level results in accessible services as they become closer to needy communities. We recommend prioritization of human resources and budgeting for rehabilitation services at the primary level to improve access to people in rural areas.

Physical activity counselling in people with suicidal ideation: a secondary analysis of a pilot study in Ugandan primary care settings

Davy Vancampfort — 2025-04-08

Introduction: primary care settings are ideal to implement suicide risk reduction initiatives in low-and middle-income countries. Health staff working in primary care settings are often over-burdened and under-resourced. Task-shifting through lifestyle counseling by lay health workers might be a relevant intervention. The aim of this secondary analysis from a pilot study exploring the efficacy of lay health worker (LHW)-led physical activity (PA) counselling for primary care patients with mental health problems (PCMH) was to investigate the efficacy of PA on reducing suicidal ideation.

Methods: from 130 Ugandan PCMH screened in two centers, 8.5% (n=11) reported suicidal ideation. These 11 PCMH (9♀, median age= 52 years, interquartile range= 37 years) participated once weekly for 8 weeks in group PA counselling based on the mental contrasting and implementation of intentions framework. All participants completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the Simple Physical Activity Questionnaire (SIMPAQ) pre- and immediately post-intervention.

Results: in PCMH with suicidal ideation (PHQ-9 item 9≥1) the prevalence of suicidal ideation dropped to 9% post-intervention, i.e. only one patient reported suicidal ideation post-intervention. Following the intervention, significant (P<0.05) increases in walking, exercising and incidental PA (SIMPAQ) levels, and reductions in depressive and anxiety symptoms were observed.

Conclusion: our data demonstrate that LHW-led PA counselling might be promising intervention in reducing suicidal ideation in primary care patients in low-resourced settings. Randomized controlled trials are warranted to confirm these beneficial findings.

Determinants of mother-to-child transmission of hepatitis B virus among pregnant women in southwestern Nigeria

Musa Ayinde — 2025-04-08

Introduction: hepatitis B virus (HBV) infection is a serious public health problem in sub-Saharan Africa and a common cause of liver disease globally. This study aimed to determine the seroprevalence and the rate of mother-to-child transmission of HBV after the age of viability.

Methods: the study was a cross-sectional study that involved 543 eligible consenting pregnant women and newborns of Hepatitis B surface antigen (HBsAg) positive mothers. A one-step rapid HBsAg strip was used to screen eligible patients for HBV infection. Venous blood sample (5mls) was taken from every HBsAg-positive woman for Hepatitis B e Antigen (HBeAg), Hepatitis B e antibody (HBeAb), Hepatitis B core Antibody (HBcAb) and Hepatitis B surface Antibody (HBsAb). In addition, 2mls of cord blood was taken to assay for HBsAg and HBV DNA. Data was analysed using SPSS version 22.

Results: of 543 pregnant women screened, 18 (3.3%) of them were HBsAg-positive with all of them testing negative for HBeAg. HBV DNA was detected in the cord blood of 4 (22.2%) new-borns delivered while 2 (11.1%) tested positive for HBsAg; the above finding indicated that only 4 of the neonates had detectable HBV DNA (>100copies/ml) in their cord blood.

Conclusion: findings from this study demonstrate a low prevalence of HBV infection among pregnant women after the age of viability in Ogbomoso. HBV DNA analysis rather than HBsAg was shown to be more sensitive and specific in determining the risk of intrauterine infections.

Management of a rectal entrapped foreign body: a case report

Hiba Ben Hassine — 2025-04-08

Entrapped rectal foreign bodies are being encountered more frequently in clinical practice. They are most often related to sexual behavior or sexual assault. The presence of rectal foreign bodies poses a complex challenge for contemporary surgeons due to multiple factors such as the nature of the object, individual anatomy, duration since insertion, potential accompanying injuries, and degree of local contamination. Managing these cases proves challenging, typically because patients often delay presentation after multiple unsuccessful attempts at self-removal. This study aimed to report the case of a male who presented with an entrapped rectal foreign body related to his sexual behavior. As we could not extract the object with the transanal approach, he was treated by an operative method. Managing patients with rectal foreign bodies presents challenges that require a systematic approach. While most cases can be effectively managed conservatively, surgical intervention may be necessary.

Malnutrition and micronutrient deficiencies among elderly persons attending University College Hospital, Ibadan: a pilot study

Temitope Hannah Farombi — 2025-04-08

Introduction: malnutrition and micronutrient deficiencies are pressing health concerns, particularly among the elderly. As this population is vulnerable to nutritional imbalances, understanding the prevalence and contributing factors is crucial for designing targeted interventions. This pilot study focuses on assessing the extent of these issues among elderly people attending a geriatric center in the University College Hospital, Ibadan.

Methods: this study employs a cross-sectional design, involving a sample of elderly individuals attending a geriatric center at the University College Hospital, Ibadan. Anthropometric measurements and dietary assessments were conducted using the Mini Nutritional Assessment (MNA) tool. A structured questionnaire was used to gather information on socio-demographic factors and other medical parameters. Continuous and categorical variables were compared respectively by Student’s t-test or Chi-square test respectively.

Results: in this study, findings indicated that none of the participants exhibited malnutrition. Instead, 72.7% demonstrated a normal nutritional status, while 27.3% were identified as being at risk of malnutrition. A lesser fraction had deficiency of vitamins A (10%) and D (1%). Furthermore, males aged 60-69 years and those above 80 years showed a higher likelihood of a favorable nutritional assessment compared to females.

Conclusion: the study revealed an absence of malnutrition among the elderly individuals attending the geriatric center in the University College Hospital, Ibadan. Notably, females had a higher probability of malnutrition compared to males. These findings underscore the importance of targeted nutritional interventions, especially among at-risk groups, to promote the overall well-being of this population.

Intracerebral hemorrhage as a complication of reversible cerebral vasoconstriction syndrome in the postpartum periods: a case report

Nazla Ananda Rachmi Puti — 2025-04-08

Reversible cerebral vasoconstriction syndrome (RCVS) is a cerebrovascular condition marked by the diffuse, reversible narrowing of multiple segments of cerebral arteries. This syndrome predominantly affects women and most commonly presents around the age of 42. It can develop spontaneously or be induced by factors such as the postpartum period or exposure to vasoactive substances. This case report describes an uncommon presentation of RCVS in a 24-year-old woman who developed an intraparenchymal hemorrhage shortly after a spontaneous vaginal delivery, despite the absence of conventional stroke risk factors. Diagnostic imaging with digital subtraction angiography (DSA) revealed multifocal vasoconstriction in the right and left anterior and middle cerebral arteries, along with the vertebrobasilar system, an indication of RCVS. Notably, vasoconstriction improved following intra-arterial nimodipine administration. This case underscores the importance of considering RCVS in postpartum women presenting with headaches and neurological deficits, as timely magnetic resonance imaging, computed tomography (CT) angiography, or brain angiography is critical for accurate diagnosis and optimal management, ultimately reducing the risk of poor prognosis.

Combined recession-resection in the management of paralytic strabismus: simplification of the complex (a case report)

Kafin Rifqi — 2025-04-08

Oculomotor nerve palsy presents the greatest challenge in clinical treatment among the other cranial nerves that innervate extraocular muscle. With a complex technique of periosteal fixation using Callahan suture commonly used, a simpler and more effective technique is demanded to be proven. Here we present a case of paralytic exotropia due to oculomotor nerve palsy on a 32-year-old male along with evidence supporting our decision of surgical management. A 32-year-old male with a chief complaint of squint in both eyes was examined at an outpatient eye clinic. The patient had congenital isolated partial oculomotor nerve palsy and the examination revealed severe ptosis on both eyes with 40 prism diopter exotropia and no limitation in the forced duction test. The patient's posterior segment examination showed normal results, and a diagnosis of bilateral paralytic exotropia due to isolated partial oculomotor nerve palsy was considered. The patient underwent a 7.5 mm rectus lateral recession with a 6 mm rectus medial resection on his right eye, with a promising result after a 3-week follow-up. When treating paralytic strabismus resulting from isolated oculomotor nerve palsy, a combination of medial rectus resection and lateral rectus recession yields good results and long-term stability.

Practice towards care and maintenance of peripheral intravenous cannula among nurses and midwives in teaching hospitals, Amhara, Ethiopia

Demewoz Kefale — 2025-04-08

Introduction: nearly 80% of hospital patients called for a peripheral intravenous catheter (PIVC) for important medications and fluid therapies. Peripherally inserted intravenous cannulation is the most common procedure done in patient care delivery. Even though insertion of IV cannula is essential and common, there are different limitations starting from insertion without vibrant indication to improper management and care of these devices. Patients can experience multiple adverse events during the insertion. The objective of this study was to investigate the care of peripheral intravenous cannulation by nurses and midwives in the Amhara Region, Ethiopia, 2022.

Methods: an institutional-based cross-sectional study was conducted. Data was collected using structured interviewer-administered questionnaires plus an observational checklist. A simple random sampling technique was used to select 415 nurses and midwives. Data were entered using Epi Data version 3.1 and analyzed using SPSS version 25. Bi-variable and multivariable analyses were conducted to examine the association between independent and outcome variables.

Results: the findings of this study revealed that 4.9% of respondents had good practice for the care of peripheral intravenous cannulation. Work experience (AOR= 7.269, 95% CI= 1.68, 31.40), having special training on care of peripheral intravenous cannulation (AOR= 10.12, 95% CI= 4.32, 19.45) and presence of protocol guideline (AOR=3.31, 95% CI= 2.83, 12.87) were significantly associated with good practice on the care and maintenance of peripheral intravenous cannulation.

Conclusion: findings showed that poor peripheral intravenous cannulation practice and care which was predicted by work experience, existence of guidelines, and training. As a result, Nurses and midwifes must keep up to speed with focused in-service training, access, and/or follow thorough protocol guidelines for the management of peripheral intravenous cannulation.

Retraction: "Sudden transient blindness following ureteroscopy: an uncommon complication of a common procedure (a case report) (Pan African Medical Journal. 2024;47:201. doi: 10.11604/pamj.2024.47.201.42952)"

The Pan African Medical Journal — 2025-04-08

This article retracts the published article "Sudden transient blindness following ureteroscopy: an uncommon complication of a common procedure (a case report)" Pan African Medical Journal. 2024;47:201. doi: 10.11604/pamj.2024.47.201.42952 by Wael Gazzah, Sedki Masmoudi, Hamza Chakroun, Rayen Lahouar, Bacem Zaidi, Badreddine Ben Khalifa, Sahbi Naouar, Braiek Salem.

Retraction: "Prevalence and associated factors of a positive Plasmodium falciparum antigen test among pregnant women at the Bamenda Regional Hospital, Cameroon: a cross-sectional analytical study (Pan African Medical Journal. 2024;47:99. doi: 10.11604/pam

Pan African Medical Journal — 2025-04-08

This article retracts the published article "Prevalence and associated factors of a positive Plasmodium falciparum antigen test among pregnant women at the Bamenda Regional Hospital, Cameroon: a cross-sectional analytical study (Pan African Medical Journal. 2024;47:99. doi: 10.11604/pamj.2024.47.99.40899)" by Dobgima Walters Pisoh, Achuo Ascensius Ambe Mforteh, William Ako Takang, Joseph Bakowe, Theodore Tameh, Merlin Boten, Audrey-Fidelia Eyere Mbi-Kobenge, Sama Julius Dohbit.

Evaluating lay first responder (LFR) first aid kit supplies usage and appropriateness in Western Kenya

Ashwin Jitendra Kulkarni — 2025-04-08

Introduction: low- and middle-income countries (LMICs) disproportionately bear 90% of global mortality from trauma, yet robust emergency medical services (EMS) are often lacking to address the prehospital injury burden. Training lay-first responders (LFRs) is the first step toward formal (EMS) development in (LMICs). However, a gap remains as LFR first aid kit supply usage, appropriateness, and decay rates have yet to be studied but remain critical information for building sustainable LFR programs.

Methods: we trained and equipped 101 LFRs in Kakamega County, Kenya in December 2023. During 3-month follow-up post-training, LFRs were surveyed with a 24-question multiple choice and free-response cross-sectional survey. Survey items included LFR demographics, patient encounters, first aid kit supplies usage, supply appropriateness, and local capacity for re-supply. Demographic data, usage statistics, appropriateness of current and potential kit additions, and local manufacturing capacity were collected and analyzed. Likert scales were utilized for categories consisting of "recommendation", "potential recommendation", and "not recommended" based on 100% - 75.0%, 74.9% - 60%, and 59.9% - 0% agreement, thresholds used in prior Delphi studies and meta-analyses. The survey design followed the Checklist for Reporting of Survey Studies (CROSS) guidelines to ensure quality standards.

Results: of 101 total LFRs, 82 participated (82/101= 81.2% response rate). Participating LFRs were 80.5% men, and 65.9% had transportation-related occupations. LFRs reported 394 assisted incidents over three months (median= 4.0, IQR: 3.0, 5,0). Gloves, gauze/bandages, and towels were the most used supplies employed in 88.9%, 61.3%, and 34.7% of incidents, respectively. For current first aid kit item appropriateness, LFRs reached a consensus agreement on gloves (92.7%), gauze/bandages (91.5%), and towels (79.3%). For potential first aid kit additions, LFRs recommended alcohol wipes/hand sanitizer (89.0%) and tape (77.2%) but did not recommend water bottles or traffic cones. Lay-first responders (LFRs) agreed (90.2%) on the importance of local supply production and desired a streamlined resupply protocol.

Conclusion: a survey on first aid kit supplies usage and appropriateness from Western Kenya demonstrated materials for body substance isolation, wound care, and hemorrhage management are critical to supply. Organized protocols for local materials resupply are essential to ensure program sustainability and continuity.

Evaluation of tuberculosis surveillance system in a municipality in Ghana during the COVID-19 pandemic: a cross-sectional study

Alex Ansah Owusu — 2025-04-08

Introduction: public health surveillance is the ongoing systematic identification, collection, collation, analysis, and interpretation of disease occurrence and public health event data, to take timely and robust action, such as disseminating the resulting information to the relevant people, for effective and appropriate action. Tuberculosis (TB) is an infectious disease caused by the micro-organism Mycobacterium tuberculosis. The main objective of this study was to describe the operation and performance of the TB surveillance system in a municipality in Ghana during the COVID-19 pandemic.

Methods: this was a cross-sectional study, which employed qualitative and quantitative data collection methods. The process was guided by the Updated Centres for Disease Control and Prevention (CDC) Surveillance System Evaluation Guidelines. The study was conducted in the La Nkwantanang Madina Municipality (LaNMMA).

Results: the system was found to be useful for planning, monitoring, and evaluation of TB control activities as well as the development of priorities for TB control programmes. The system was found to be simple and flexible with good data quality. However, stability, sensitivity (44.2%), predictive value positive (8.7%) and acceptability were all found to be poor. Even though the downstream flow of information was found to be excellent, the upstream flow of information was found to be poor.

Conclusion: it was concluded that the system was performing poorly. The system was not achieving most of the objectives for which it was set up. The Ghana Health Service should take measures to strengthen and improve the LaNMMA TB surveillance system in the post-pandemic era.

The rare coexistence of gastric and esophagus squamous cell carcinoma: a case report

Yahya El Harras — 2025-04-08

Squamous cell carcinoma (SCC) of the stomach is a rare entity with fewer than 100 cases of primary SCC reported in the literature, while esophageal SCC is prevalent and more common. However, a synchronous squamous cell carcinoma found in the esophagus and stomach remains very uncommon. We present the case of a 64-year-old with a history of dysphagia who had an endoscopy that showed an impassable stenosis of the middle esophagus, with histopathology in favor of an esophagus squamous cell carcinoma. A computed tomography scan (CT-SCAN) then showed an exophytic mass of the lesser curvature of the stomach with the biopsy in favor of a squamous cell carcinoma. Our case report aims to keep in clinicians´ and anaomopathologists´ minds that esophageal SCC may coexist with gastric SCC and that the role of imaging is important in the diagnostic procedure.

The epidemiology of laboratory-confirmed Hepatitis B Virus infection in the general population of South Africa, 2016-2018

Mashudu Teresa Lamola — 2025-04-08

Introduction: despite the introduction of the Hepatitis B Virus (HBV) vaccine in South Africa in 1995, HBV remains endemic. South Africa's HBV vaccine coverage for the third dose was 71% in 2015. Information on the HBV prevalence in South Africa in recent years is limited, therefore, we estimated HBV prevalence and described annual trends.

Methods: we conducted a retrospective descriptive study of data extracted from the Notifiable Medical Conditions Surveillance System, and estimated HBV prevalence per 100,000 population using the mid-year population estimates obtained from Statistics South Africa, for the 2016-2018 period.

Results: in total, 105 308 laboratory-confirmed HBV cases were analysed, of which 50.2% (53 895/105 308), 95%CI (49.9-50.5) were males. HBV prevalence for males was 34.1 in 2016, 84.1 in 2017, and 72.3 per 100,000 population in 2018. The age group with the highest HBV cases and prevalence were ages 15-49 years having 80.5%(n=84 718), with 52.2 in 2016, 123.3 in 2017, and 99.6 per 100,000 population in 2018. Between 2016 and 2018, South Africa had an overall HBV prevalence of 33.8, 82.6, and 68.8 per 100 000 population, respectively. KwaZulu-Natal province had the highest number of HBV cases with 37.8% (n=39 851) however, Mpumalanga province had the highest HBV prevalence with 73.2 in 2016, 188.8 in 2017, and 126.5 per 100,000 population in 2018.

Conclusion: our results indicated a high HBV prevalence is reflective of the group prior to the HBV vaccine introduction in South Africa.

Cartographie de l´accès aux services de prise en charge de l´hypertension par les médecins généralistes au Burkina Faso en 2020

Relwendé Aristide Yameogo — 2025-04-08

Introduction: l'hypertension artérielle (HTA) constitue un problème de santé publique au Burkina Faso. Sa prise en charge n'est pas du seul ressort du spécialiste mais nécessite la participation de tous les acteurs dans le cadre d'un réseau de soins avec une implication de ceux qui sont au premier plan. L'objectif de cette étude était d'analyser la capacité de la prise en charge de l'HTA au Burkina Faso et d'en fournir une cartographie.

Méthodes: il s'est agi d'une enquête transversale en ligne auprès des médecins généralistes du Burkina Faso à travers les réseaux sociaux. L'échantillonnage a été faite sur la base du volontariat.

Résultats: notre étude a concerné 182 médecins généralistes avec un sex-ratio de 2.7:1. L'âge moyen des médecins était de 31 ans avec une expérience professionnelle moyenne de 2,7 ans. Le bilan minimum de l'OMS pour la prise en charge de l'HTA était disponible pour 80% des médecins et dans 74% des villes. La majeure partie des médecins (96%) se limitait à la bithérapie anti-hypertensive avec une prescription fréquente des inhibiteurs calciques (75,8%) des inhibiteurs de l'enzyme de conversion (51,6%) et des diurétiques (40,7%). L'avis des spécialistes était demandé en cas de non contrôle de l'HTA (52,8%) avec une faible interaction avec les médecins spécialistes: seulement 20,3% de contre-référence. Les médecins (93%) souhaitaient participer à un réseau de soins de prise en charge de l'HTA mais ont besoin de formation dans 98,4% des cas.

Conclusion: le Burkina Faso a une répartition inégale des moyens de prise en charge de l'HTA. Les compétences des médecins doivent être renforcées pour améliorer la qualité de la prise en charge. Un meilleur management des ressources et la mise en place d'un réseau de soins permettraient de mieux coordonner les activités et améliorer la prise en charge de l'HTA.

Right-sided infective endocarditis complicated with aortic pseudoaneurysms and systemic embolism in a 27-year-old female with ventricular septal defect: a case report

Zineb Agoumy — 2025-04-08

Infective endocarditis (IE) is one of the most frequent complications of ventricular septal defect (VSD) in adults, but is rarely associated with multiple systemic embolisms and aortic pseudoaneurysms. The authors report a case of a 27-year-old female known to have an asymptomatic neglected VSD. She was admitted to our unit with complaints of prolonged fever and chills. Physical examination detected hyperthermia at 38.7°C and pathognomonic holosystolic murmur detected by cardiac auscultation. Laboratory blood test showed evidence of acute staphylococcus infection and imaging investigations revealed perimembranous restrictive VSD, with vegetations exclusively present in the right heart ventricle, in addition to mycotic aneurysms on the aortic arch and multiple systemic embolism. A targeted antibiotic therapy was initiated along with an urgent heart surgery with a good evolution. This case showcases the need to look for systematically systemic embolism in endocarditis of the right ventricle (RV) associated with a communication of the right and left cavities, and the possibility of an eventual paradoxical embolism within VSD in case of an inverted right to left shunt. Furthermore, it highlights that congenital VSD can be the underlying condition of a severe endocarditis in case of acute staphylococcus bacteremia.

Renal hydatid cyst: a rare case

Ashwin Karnan — 2025-04-08

A 32-year-old male, farmer, presented with chief complaints of fever, right-sided flank pain, and burning micturition for the past 3 weeks. The patient gives a history of having pet dogs at home. Computed Tomography (CT) urogram showed a well-defined multiseptated calcified cystic lesion of size 9 x 7 cm involving the right kidney's upper, mid, and lower pole. A diagnosis of urinary tract infection or complex kidney cyst was considered. Urine examination showed hydatid cysts, Serum IgG for Echinococcus and Casoni test was positive. Pre-operatively the patient was treated with the tablet Albendazole and with the help of a general surgeon and urosurgeon, the patient underwent laparoscopic cystectomy. The patient improved symptomatically and is currently on follow-up. Echinococcosis is a zoonotic disease commonly caused by E. granulosus. The liver and lungs are the most common sites followed by the brain, bones, kidney, and pancreas. Renal hydatid disease accounts for about 2% of hydatid diseases. It more commonly affects children than adults. Ultrasonogram is the mainstay of diagnosis showing cystic mass with daughter cysts. Other diagnostic modalities include the Casoni test, Ghedine-Weinberg test, and serum IgG antibodies for Echinococcus. Medical management of renal hydatid disease is not possible. Treatment options include percutaneous repair, minimally invasive surgery or open surgery. Surgical management involves cystectomy or pericystectomy and in cases where renal parenchyma is involved, partial or complete nephrectomy may be done.

Level of knowledge, and risk perception of mpox disease among primary healthcare workers in Nigeria: a cross-sectional study of Jigawa, Oyo and Lagos States

Damola Bakare — 2025-04-08

Introduction: in Nigeria, studies on mpox among primary healthcare workers are scarce despite increasing incidence of mpox disease between 2017-2022. This study aimed to assess primary healthcare workers knowledge and perception of mpox in Nigeria.

Methods: we conducted a cross-sectional survey among primary healthcare workers in Nigeria (Oyo, Lagos, and Jigawa) to represent different health system capacities and socio-economic contexts. Knowledge of mpox was evaluated in four domains: general knowledge, transmission, signs and symptoms, and prevention and treatment. Each correct response received a score of 1. We categorize the level of knowledge based on the score using the mean score as the cut-off by re-classifying the composite score of respondents for each state into a binary outcome of "good knowledge" if the mean composite score was greater or equals to the mean of overall knowledge score for the three states (16.1), and "poor knowledge" if the mean score equals to sixteen or less than sixteen (≤16). Factors associated with mpox knowledge were explored using multivariable logistic regression at a 5% significance level. Perception of mpox was assessed using five constructs from the health belief model, measured on 3-point Likert scales. Factors associated with each construct were analyzed using Kruskal-Wallis and Mann-Whitney-U tests.

Results: in our study on healthcare workers, 78.3% (n=239) were aware of mpox disease. Their overall knowledge was moderate, particularly regarding transmission. Meanwhile, less than 50% knew mpox can be transmitted through sharing utensils, and 65.3% (n=156) understood contact with infected animals could lead to transmission. Lagos had lower overall knowledge scores (15.3±2.3) compared to Jigawa (16.9±2.3) and Oyo (16.3±2.5) (p<0.001). Perceived susceptibility was similar across states (p=0.127), and 97.5% (n=233) believed mpox can affect anyone, while 47.3% (113) felt they couldn't contract it. Jigawa exhibited higher perceived severity (p<0.001) and barriers to prevention (p<0.001).

Conclusion: primary healthcare workers in all settings had limited knowledge of mpox transmission, with the perception of mpox varying by state and participants' socio-economic characteristics. The responsibility of HCW encompasses a range of activities that include diagnosis, patient care and education, and public health interventions amongst others. Hence it is important to educate HCWs on mpox disease to successfully curtail the spread of mpox.

Pourquoi le peau à peau est-il toujours largement méconnu dans nos services de maternité?

Saadi Rania — 2025-04-08

Aux éditeurs de Pan African Medical Journal

Gastric foveolar adenoma in the duodenal bulb: case report

Walid El Ouardi — 2025-04-08

Foveolar-type adenomas are very rare lesions, representing approximately 2.7% of duodenal adenomas with gastric phenotype, histologically characterized by tall columnar cells resembling gastric foveolar epithelium and a tubulovillous structure with various degrees of dysplasia. Their risk of progression to adenocarcinoma is related to the size of the polyp and the presence of high-grade dysplasia. The recommended therapeutic approach is the endoscopic resection. our clinical case reports a rare case of a patient in whom gastric foveolar adenoma was incidentally discovered as an 8 mm sessile polyp in the duodenal bulb resected entirely by en-bloc mucosectomy technique. Through this case, we draw attention to the existence of bulbar adenomas, which carry a risk of dysplasia and progression to adenocarcinoma.

Understanding adolescent health care services in Ghana: a scoping review

Sheila Agyeiwaa Owusu — 2025-04-08

Over the last several decades, successful interventions in the health of newborns, infants, and children mean more children survive to become adolescents. There has been a global demand to improve health and care delivery for the adolescent population guided by the United Nation’s Sustainable Development Goals by 2030. However, with this deadline fast approaching and with a rising adolescent population, this demand is ever more critical. Adolescent health requires a similar rights-based approach to ensure equitable distribution of healthcare interventions and service delivery going forward. This scoping review aims to explore the existing landscape of adolescent-responsive healthcare and service delivery in Ghana. It was conducted using the Joanna Briggs Institute(JBI) guidelines and reported according to the PRISMA-Scr standards. We searched the PubMed database from inception through May 2022 using the following search criteria: “Ghana” + “Adolescent” + “Health”. A total of 3172 studies were identified based on the search strategy outlined above, out of which 248 met the inclusion criteria. Both quantitative and qualitative analyses were conducted on all 248 studies to help synthesize findings. Overall, this review found that adolescent health care receives significant attention in Ghana, majority of which is focused on sexual and reproductive health (SRH). The studies available were a plethora of cross-sectional methods with large sample sizes, but their limited numbers of longitudinal studies and randomized control trials (RCTs) that could yield more robust evidence. This review is a call to action for a more comprehensive range of youth-driven, youth-responsive studies, interventions, and health programs that represent the whole range of challenges that confront adolescents in Ghana. This increased attention to adolescent needs will support a healthy cohort as they age into adulthood.

Tortuosité veineuse rétinienne idiopathique bilatérale de découverte fortuite

Daouda Konaté — 2025-04-08

La tortuosité veineuse rétinienne est caractérisée par une présentation anormalement sinueuse des veines de la rétine. Elle peut s´associer à diverses pathologies médicales de la rétine. Les principaux diagnostics différentiels sont: la rétinopathie hypertensive qui peut entrainer des tortuosités veineuses, des hémorragies et des exsudats; la rétinopathie diabétique ou la tortuosité veineuse est présente en raison de l´ischémie rétinienne chronique et le syndrome de bas débit rétinien chronique qui peut provoquer une dilatation veineuse généralisée. Nous rapportons un cas isolé de tortuosité veineuse bilatérale de la rétine de cause inconnue et sans conséquence visuelle découvert par hasard lors d´un examen systématique du fond d´œil chez un jeune homme de 24 ans sans antécédant pathologique connu. L´enquête clinique familiale réalisée sur cinq membres de la famille appartenant à trois générations différentes n´a pas retrouvé des cas similaires puisque cette présentation clinique rare a souvent été décrite comme héréditaire. Nous avons retenu le diagnostic de tortuosité veineuse rétinienne idiopathique bilatérale idiopathique. L´examen cardio vasculaire demandé s´est révélé normal. La prise en charge ophtalmologique a consisté en une surveillance régulière de l´acuité visuelle et du fond d´œil. Lors du dernier contrôle il y a trois semaines nous avons constaté que les veines restent tortueuses dilatées sans impact fonctionnel avec une acuité visuelle 10/10 P2 aux deux yeux.

Serum electrolytes in children with heart failure on diuretic therapy at Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania: a cross-sectional study

Samuel Raymond Mushi — 2025-04-08

Introduction: diuretic therapy is among the cornerstones of the management of heart failure in children with acquired or congenital heart diseases (CHD). Electrolyte derangements have been reported by various studies to be among the most common side effects following diuretic therapy. Despite that, there is limited documentation on the magnitude of this problem in our setting. This study, therefore, aimed to identify clinical characteristics and determine the magnitude of electrolyte abnormalities among children with heart failure who were on diuretic therapy at Jakaya Kikwete Cardiac Institute, Tanzania.

Methods: this was a hospital-based cross-sectional study was conducted among children with heart failure admitted at Jakaya Kikwete Cardiac Institute (JKCI), Dar es Salaam, Tanzania. A pretested structured questionnaire was used to collect data on socio-demographics, clinical characteristics, and levels of serum electrolytes.

Results: a total of 385 children whose ages ranged from 1 month to 18 years were enrolled in this study. Most of them (271 (70%)) were below 5 years and their median age was 2.1 (IQR=0.8-6) years. Ventricular septal defect (VSD) was the most common acyanotic CHD, observed in 122 children out of 385 (31.6%). Nearly half (186 (48%)) of the children were in class IV of the Ross Heart Failure Classification. Slightly more than half of the study participants (202 (53%)) and 182 (47%) of the children had hyponatremia and hypocalcemia respectively. Only 8% (32/385) had hypokalemia. There was no observed association between hyponatremia and furosemide dosage (P=0.33) in children in this study.

Conclusion: a significant number of children with heart failure on diuretic therapy had hyponatremia and hypocalcemia hence, routine electrolytes monitoring is recommended.

Retraction of biomedical publications with Tunisian affiliation: causes, characteristics, and legislation regarding breaches of scientific integrity

Amira Maoui — 2025-04-08

Introduction: breaches of research integrity have risen during these years. Tunisia´s stance regarding scientific integrity remains unknown. The aim of our study was to identify the reasons for the retraction of Tunisia-affiliated publications in the biomedical field, to describe the characteristics of these retractions, and to assess the position of Tunisian legislation regarding breaches of research integrity.

Methods: I compiled up to November 3^rd, 2023, and retracted biomedical papers using the PubMed and Retraction Watch databases. For each eligible retracted article, a descriptive study of the collected variables was carried out. These included the reasons for retraction, characteristics related to the article, authors, and journal.

Results: the search identified 22 eligible publications. Reasons for retraction were categorized into six groups. Plagiarism accounted for 45.5% of cases. The first retraction dated back to 2005, with an average number of retracted publications being 1.22 and a median retraction time of 347 days. Among the retracted publications, 77.3% included a retraction notice. A post-retraction citation was found in 81.3% of cases. None of the retracted articles were written by a single author. An international collaboration was found in 27.3% of cases. Ninety-five point five percent of journals offered open access with 81.8% using a gold open access model. In terms of bibliometrics, eleven articles were published in highly reputed journals.

Conclusion: Tunisia is not spared from breaches of scientific integrity. The controversies relating to the categories of breaches call for standardization. The legislative framework for this phenomenon also remains to be developed in Tunisia.

Visualizing drug-induced Stevens-Johnson syndrome: a clinical image

Shivali Kalode — 2025-04-08

Steven Johnson syndrome (SJS) is an acute, self-limited condition that manifests as severe mucosal erosions with cutaneous macules that are erythematous and spread widely. Although being uncommon with an annual incidence of 0.05 to 2 cases per million people SJS has a significant impact on public health due to its high rates of morbidity and mortality. Here, we are presenting a case of a 53-year-old male, who presented in the dermatology department with a chief complaint of fever and extensive rashes over the trunk and bilateral upper limbs for a day. It was also associated with pain which was sudden in onset, burning type, continuous, localized, and severe in intensity, aggravated on touching with no relieving factor. The past history of the patient revealed that he took an injection of gentamycin intramuscularly from a general practitioner and developed this type of reaction. The patient was well-oriented and on examination, had hyperpyrexia, and generalized cutaneous eruptions on the trunk and bilateral upper limbs. This cutaneous eruption consists of purpuric macules which were tender on touch. All routine investigations were done and were in normal limits except for the raised erythrocyte sedimentation rate (ESR). Further, the skin biopsy was performed and sent to the histopathology section in the department of pathology. The labeled skin biopsy consists of a single, irregular, brownish tissue piece with skin attached measuring 0.5 x 0.5 cm. Microscopically, hematoxylin and eosin (H&E) staining revealed predominantly full-thickness necrosis and necrotic keratinocytes with few red blood cells, pigment incontinence, and parakeratosis, features suggestive of drug-induced Stevens-Johnson syndrome. The patient was treated under the expert guidance of a dermatologist with systemic steroids, Inj. Prednisolone 10 mg qid (four times a day) for 7 days was gradually tapered to 10 mg tid (three times a day) for 7 days, 10 mg bid (twice a day) for 5 days, then Tab Prednisolone 10 mg once daily for 5 days respectively.

Pure tone and speech audiometry of presbyacusis in a tertiary hospital in Kaduna, Nigeria: a cross-sectional study

Usman Ibrahim Dansani — 2025-04-08

Introduction: presbyacusis is age-related hearing loss, manifesting as a bilateral symmetrical sensorineural hearing loss of adult-onset. It has different audiometric configurations and is associated with a decline in speech discrimination sensitivity. The objectives of the study were to determine the degree of hearing loss; types of presbyacusis; and speech discrimination score (SDS) of presbyacusics and to compare the SDS in different types of presbyacusis in patients seen at a tertiary hospital in Kaduna, Nigeria.

Methods: a descriptive cross-sectional study, involving 41 presbyacusics seen at the ear, nose and throat (ENT) clinic of a tertiary hospital in Kaduna. Participants had clinical evaluation; pure tone and speech audiometry with clinical audiometer Avant A2D+ Med Rx, USA. Results were analysed using SPSS version 20. Analysis of variance (ANOVA) and t-test were used to evaluate the difference between Speech discrimination scores in different types of presbyacusis, the level of significance was set at a p-value < 0.05.

Results: hearing threshold ranged from 26.3-107.5 dBHL, mean of 55.7±18.2 dBHL. Moderate hearing loss (46.3%) was the most prevalent degree of hearing loss. Neural presbyacusis (28.8%) was the commonest. Speech reception threshold (SRT) ranged from 30-85dBHL mean of 61.8±14.9 dBHL, and SDS ranged from 0-98% mean of 69.38±20.0%. SDS of sensory presbyacusis was statistically higher than cochlear-conductive, and neural presbyacusis (p-value 0.026 and 0.001 respectively) while the metabolic was higher than neural presbyacusis (p-value 0.005).

Conclusion: neural presbyacusis was the commonest, moderate hearing loss was the most prevalent degree of hearing loss and sensory presbyacusis had the best SDS.

Adult pulmonary sequestration: a hidden cause of recurrent hemoptysis (case report)

Amani Kacem — 2025-04-08

Pulmonary sequestration (PS) is a rare congenital malformation where abnormal lung tissue lacks a connection to the airways and receives blood supply from systemic arteries. This case report describes a 30-year-old man with recurrent hemoptysis diagnosed with intralobar PS (ILS) as the cause. He underwent video-assisted thoracoscopic surgery to clip and section the aberrant artery, resulting in a successful outcome with no further bleeding. The case emphasizes considering ILS in diagnosing hemoptysis, even in adults with atypical presentations, and highlights the utility of CT angiography in identifying the abnormal blood supply for definitive diagnosis and guiding minimally invasive surgical treatment.

Strengthening health financing at sub-national level in Kenya: a stakeholder and needs mapping through a mixed methods approach

Alex Olateju Adjagba — 2025-04-08

Introduction: health financing aims to ensure that the overall goal of the health system is attained. Countries with decentralised healthcare systems such as Kenya, face further challenges due to limited public financial management capacity within sub-national governments. While partner support has proved impactful in addressing these challenges, there is a paucity of evidence on the nature and distribution of the support in Kenya. This study sought to examine the current technical support and health financing support offered by partners across the 47 counties in Kenya.

Methods: the study used a descriptive cross-sectional design with a mixed methods approach. Quantitative data were collected from organisation representatives using semi-structured questionnaires and analysed using Microsoft Excel. Qualitative data were collected through key informants and in-depth interviews involving county Department of Health officials in 15 counties in Kenya. Interview recordings were transcribed and thematically analysed using NVIVO version 14.

Results: twenty (20) organisations reportedly provided health financing support to counties with planning, budgeting and health financing advocacy being the most supported work streams by partners. While each county had more than one partner supporting health financing activities, the western counties had more partners compared to other regions of Kenya. Whereas partner support was well acknowledged at the county level, there was a lack of coordination and alignment of partner activities with county priorities.

Conclusion: these findings highlight the essential need for national governments to ensure effective coordination of the technical assistance provided by partners to subnational levels and to ensure equitable distribution of support and alignment with county health priorities and needs.

Knowledge, attitudes, and practices of health personnel in the management of diarrhea: case of the Logone and Chari Department, Far North Cameroon

Landry Beyala — 2025-04-08

Introduction: management of diarrheal diseases is presented in the Integrated Management of Childhood Illnesses (IMCI) document, but is not standardized in adults. The objective of this study is to assess the knowledge, attitudes, and practices (KAP) of healthcare personnel with regard to the management of diarrhea.

Methods: a descriptive cross-sectional study was conducted among health care givers in health facilities in four (4) health districts (HDs) of Logone and Chari Department of Far North Cameroon in 2016. Consenting participants, selected exhaustively in the health facilities, responded individually to a semi-structured questionnaire administered face to face on a smartphone Open Data Kit (ODK) format. Statistical analyses of the data allowed us to highlight frequencies and proportions of variables such as the definition of diarrhea, the causes of diarrhea, diagnostic techniques and methods, and the management of these diseases.

Results: a total of 77 professionals participated in this study, of whom 56% were nurse assistants, 22% were nurses, and 5% were physicians; 78% of them knew the World Health Organization (WHO) definition of diarrhea. Twenty-two (29%) reported having IMCI and 82% of them practiced it. Seventy-seven (100%) reported they administered a rehydration solution according to the dehydration status of the first-line patient. Metronidazole (23%), amoxicillin (17%), and cotrimoxazole (14%) are the antimicrobials frequently prescribed in children less than 5 years of age.

Conclusion: health care providers in Logone and Chari Department have different opinions regarding diarrheal diseases as well as on the management of its diseases. To improve the management of diarrhea, it would therefore be important to set up a standard document for the management of its diseases while ensuring its implementation by health professionals.

Volumineuse masse intracardiaque révélée par un accident vasculaire cérébral: à propos d´un cas

Amngar Bekoutou — 2025-04-08

Les masses intracardiaques peuvent être révélées par un accident vasculaire cérébral ischémique. Elles sont parfois difficiles à différencier par échocardiographie. Déterminer leur nature est un élément important de la prise en charge. Nous rapportons le cas d´un homme de 58 ans, hypertendu non traité, tabagisme actif, suivi pour un psoriasis, une bronchopneumopathie chronique obstructive (BPCO) et un nodule du lobe supérieur gauche avec suspicion de cancer du poumon. Il est hospitalisé pour un accident vasculaire cérébral ischémique qui est thrombolysé avec un remaniement hémorragique. L´échocardiographie systématique révèle une volumineuse masse intra auriculaire gauche évocatrice de myxome intra auriculaire. L´analyse histologique de la pièce chirurgicale confirmera ce diagnostic. Les myxomes auriculaires gauches peuvent rester longtemps asymptomatiques et être révélés par des complications emboliques systémiques. L´échocardiographie oriente le diagnostic et l´analyse anatomopathologique le confirme. La prise en charge doit être multi disciplinaire.

Critical incidents in gynaecology: a one year audit in an academic hospital in Johannesburg, South Africa

Christopher Chikwiri — 2025-04-08

Introduction: critical incidents are among the ten leading causes of death and disability worldwide. Improving patient safety is a global priority and one way of achieving this goal is to report and analyse critical incidents. We aimed to establish the incidence, describe the profile, patient outcomes and avoidable factors associated with gynaecological critical incidents in an academic hospital in Johannesburg, South Africa.

Methods: this is a retrospective descriptive analysis of critical incidents in patients admitted to gynaecology wards at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) from 1^st January 2019 to 31^st December 2019. All medical records of patients identified to have experienced critical incidents were reviewed and demographic information, timing of admission, critical incidence markers and avoidable factors were extracted and analysed.

Results: there was a total of 176 critical incident events and 2082 gynaecology admissions during the 1-year study period. Only 158 critical incident files were available and complete to enable analysis. This gave a critical incidence rate of 7.6% (158/2082). The mean age (SD) of the patients was 41.1 (14.8) years and the median (IQR) duration of admission was 6 (3-10) days. The main causes of critical incidents were omission of procedures (n=45, 17.5%), deaths (n=34, 13.2%), massive transfusion (n=30, 11.7%), repeat laparotomies (n=29, 11.3%) and fistula/organ damage (n=19, 7.4%). There were 111 (70.3%) avoidable factors in the 158 critical incident cases. Most of the avoidable factors were medical care related, 53 (47.8%), followed by administrative factors, 33 (29.7%) with patient-related factors in the least at, 25 (22.5%). Critical incident forms were only filled out in 39 out of the 176 (22.2%) patients identified to have suffered a critical incident.

Conclusion: the critical incidents rate in this institution is within the range reported in the literature however underreporting is a major concern. The leading causes of critical incidents were omission of procedure, followed by deaths. Approximately two-fifths of the critical incidents were associated with some form of harm, ranging from mild disability to deaths. Most of the avoidable factors were health system-related (medical care and administrative). The department should focus on improving critical incident reporting systems and the quality of care to reduce the number of critical incidents.

Carcinosarcome de la voie biliaire principale: à propos d'un cas

Khalid Rabbani — 2025-04-08

Les carcinosarcomes des voies biliaires sont des tumeurs très rares. Leurs diagnostics et leurs prises en charge demeurent difficile. Nous rapportant le cas d'un patient chez qui le diagnostic a été suspecté devant un ictère cholestatique associé à une altération de l'état général. Biologiquement, la bilirubine, la phosphatase alcaline (PAL) et les gamma-glutamyl transférase (GGT) étaient élevés. L'imagerie a montré une tumeur de la tête du pancréas. L'exploration chirurgical, la biopsie tumorale et l'étude anatomo-immunohistochimique ont confirmé l'origine biliaire. Le but de notre cas est de montrer la difficulté du diagnostic et de la prise en charge ainsi que l'importance de l'étude anatomopathologique et immunohistochimique pour la confirmation du diagnostic.