Pan African Medical Journal

Prevalence and associated factors with non-alcoholic fatty liver disease in a group of obese women in Tunisia

Fatma Boukhayatia — 2026-04-17

Introduction: non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease, often undiagnosed, and its prevalence is closely linked to obesity and diabetes. This study aimed to screen for NAFLD in obese women and identify factors associated with both steatosis and fibrosis.

Methods: a cross-sectional study was performed on 40 obese female patients. Data were collected through clinical examination, laboratory tests, anthropometric measurements, dietary survey. The assessment of NAFLD was based on the use of Fibroscan.

Results: mean age was 43.56±12.75 years. The majority of the patients (65%) were inactive. The mean duration of obesity was 19.95±12.93 years, and morbid obesity was observed in 45% of the patients. Steatosis was detected in 75% of the population with 38.5% in its advanced stage, while fibrosis was identified in 90% of patients, of which 37.5% were in the advanced stage. Multivariable analysis revealed that the duration of obesity progression was positively associated with both the presence (B=0.12, 95% CI 1.00-1.26; p=0.034) and the severity (B=0.08, 95% CI 1.00-1.17; p=0.029) of steatosis. An active lifestyle was negatively associated with the severity of steatosis (aOR=0.14, 95% CI 0.02-0.80; p=0.027), while fiber deficiency intake was positively associated with the severity of fibrosis (aOR=7.04, 95% CI 1.30-37.88; p=0.023).

Conclusion: these findings underscore the importance of early screening for NAFLD in this population and suggest that tailored nutritional management may be beneficial in addressing obesity-related liver conditions.

Adolescents' knowledge and perceptions of sexual and reproductive health rights and access to services in the greater Banjul Area, the Gambia

Binta Jallow — 2026-04-17

Introduction: adolescents in the Gambia face significant challenges in accessing sexual and reproductive health (SRH) services, hindered by sociocultural barriers, inadequate education, and systemic limitations. Despite representing a significant proportion of the population, limited research addresses the sociocultural and institutional factors shaping their SRH awareness and access. This study bridges these gaps by assessing adolescents' knowledge, perceptions, and access to SRH services while identifying the associated barriers and determinants in the Greater Banjul Area.

Methods: this cross-sectional study included 424 secondary school students aged 15-19 years in grades 10 and 11 of selected private and public schools. Data were collected using structured questionnaires and analyzed with descriptive statistics, chi-square tests, and logistic regression.

Results: revealed that only 34.2% of participants were aware of SRH rights, and only 12.7% had attended formal SRH training. Knowledge gaps were evident, with only 24.1% aware of contraception rights and 23.6% understanding consent rights. Barriers associated with these findings included lack of information (41.5%), cultural taboos (34.9%), and fear of judgment (22.9%). Only 22.4% accessed SRH services, mainly in public clinics (8.3%), with a satisfaction rate of 15.1%. Logistic regression showed public school students had less access (AOR = 0.320, 95% CI: 0.190–0.539, p < 0.001) and fewer barriers (AOR = 0.253, 95% CI: 0.107–0.601, p =0.002).

Conclusion: this study emphasizes the need for age-appropriate SRH education, expanded youth-friendly services, and community engagement to reduce cultural barriers and improve equitable access for Gambian adolescents.

Chronic tubercular thoracic empyema

Ashwin Karnan — 2026-04-17

A 46-year-old female, a farmer, presented with complaints of fever, right-sided chest pain, breathlessness, loss of weight, and loss of appetite for the past 3 months. She had tubercular pleural effusion 3 years back, for which she only took treatment for 2 months. A chest X-ray, and high-resolution computed tomography of the patient's thorax showed loculated right pleural effusion with thickening of the pleura with bilateral pulmonary cysts and centrilobular nodules in the tree-in-bud pattern. The patient was taken up for thoracoscopy. loculations were broken, pleural fluid drained, and multiple pleural biopsies were taken. Histopathological examination showed multinucleated giant cells and central caseating necrosis surrounded by epithelioid histiocytes, confirming the diagnosis of tuberculosis. The patient was started on antitubercular therapy and is currently on follow-up. Empyema is defined as the presence of pus in the pleural cavity. Alcoholism, intravenous drug abuse, poor oral hygiene, diabetes, and liver cirrhosis are the common risk factors. It has 3 stages: exudative stage, fibro-purulent stage, and chronic organizing stage. Computed tomography scan is the most definitive study, with the hallmark sign being the split pleura sign. Diagnostic and therapeutic modalities include thoracocentesis, tube thoracostomy and intrapleural fibrinolytics, video-assisted thoracoscopic surgery, and medical thoracoscopy. The prognosis is poor if not treated appropriately, with 1-year mortality around 20%. Treatment depends upon the causative organism, which could be tubercular, community-acquired, or hospital-acquired infection. Complications include fibrothorax, bronchopleural fistula, sepsis, empyema necessitans, and respiratory failure.

Heterotaxy syndrome with biliary atresia: a case report

Amal Irfan Khazi — 2026-04-17

We report the case of a late preterm female neonate, born at 36 weeks' gestation, with heterotaxy syndrome, severe congenital heart defects (dextrocardia, situs inversus, left atrial isomerism, complete atrioventricular septal defect (AVSD), and double outlet right ventricle), and biliary atresia. The association of biliary atresia with heterotaxy syndrome is exceptionally rare and adds complexity to the patient´s management. The patient underwent a laparoscopic Kasai procedure, which resulted in significant clinical improvement. This case highlights the importance of early diagnosis, a multidisciplinary approach, and timely surgical intervention in managing rare and complex conditions.

Prevalence and determinants of adverse pregnancy outcomes among teenage mothers in the Limbe Health District of Cameroon

Ndip Esther Ndip — 2026-04-17

Introduction: teenage pregnancy constitutes a serious health and social problem worldwide. World estimates report about 16 million births to adolescent mothers, most of them occurring in low and middle-income countries often accompanied with adverse outcomes. Cameroon's adolescent fertility rate of 138 births per 1000 women aged < 19 is the highest in Central Africa. This study aimed to determine the prevalence and determinants of adverse teenage pregnancy outcomes among adolescents in the Limbe Health District.

Methods: cross-sectional study was conducted among 220 participants from November 2022 to May 2023. A multistage sampling technique was used to recruit participants. Descriptive statistics and logistic regression were used to summarize the data and identify factors associated with adverse teenage pregnancy outcomes respectively. Statistical significance was set at p<0.05.

Results: the findings showed that the prevalence of adverse teenage pregnancy outcomes was 34.8%, with caesarean delivery (20.9%), preterm delivery (12.7%), low birth weight (19.5%), and neonatal mortality (9.1%) being the main adverse outcomes of teenage pregnancy. The determinates of caesarean delivery were drug use (AOR= 5.02, 95% CI: 1.98-12.71), premature delivery (AOR= 13.19, 95% CI: 2,25-77.25), and physical exercise (AOR= 0.16, 95% CI: 0.06-0.45), for premature delivery were age group 17-19 years (AOR= 0.20, 95% CI: 0.07-0.60) and smoking (AOR= 6.93, 95% CI: 1.57-30.60), for low birth weight, were age group (AOR= 0.17, 95% CI: 0.08-0.39), delivered prematurely (AOR= 2.46, 95% CI: 1.11-5.43), and followed medical prescription (AOR= 0.21, 95% CI: 0.09-0.46) and finally for neonatal mortality were residence (AOR= 0.32, 95% CI: 0.16-0.67) and those who were properly fed (AOR= 6.61, 95% CI: 1.26-34.69).

Conclusion: there is a high prevalence of adverse pregnancy outcomes among teenage mothers in the Limbe Health District. Awareness on pregnancy prevention needs to be raised among this population in order to reduce the burden of teenage pregnancy and its associated consequences on both the mother and the child.

Epidemiological surveillance of tuberculosis-HIV co-infection and genotypic strains of the Mycobacterium tuberculosis complex in four departments at the Centre Hospitalier Universitaire de Référence Nationale in N'Djamena, Chad

Gildas le Djimbaye Togde — 2026-04-17

Introduction: the comorbidity of infectious diseases is a real public health challenge in Chad. The main objective of this study is to determine the prevalence rate of HIV/TB co-infection among patients of the Centre Hospitalier Universitaire de Référence Nationale (CHU-RN), as well as the frequency of circulating Mycobacterium tuberculosis complex (MTBc) genotypic strains within the institution.

Methods: a cross-sectional analytical and prospective study was conducted from January to November 2024 in four departments of the CHU-RN in N'Djamena. Patient samples were collected, decontaminated, and analyzed using techniques such as the GeneXpert MTB/RIF test, MGIT culture, and spoligotyping.

Results: one hundred and fifty-six (156) patients were included, with a majority of men at 65% and an average age of 38.28 years. Approximately 69.2% of the samples were positive for MTBc and the TB/HIV co-infection rate was 7.4%. The MTBc Cameroon strain was the most represented, with 43%, followed by the CAS-Delhi strain at 29%. Among the strains found at the CHU-RN, two lineages were revealed: L3 and L4. Rifampicin resistance of MTBc was 13%.

Conclusion: the identification of MTBc genotypic strains shows high genetic diversity with a predominance of certain strains involved in co-infection with HIV at the CHU-RN. Targeted intervention is necessary to control the transmission of tuberculosis.

Systemic sclerosis: key clinical features of a rare and progressive disease

Anshu Tikariha — 2026-04-17

Systemic sclerosis (SSc) is a rare connective tissue disorder. Ischemia may lead to ulcerations and, in severe cases, digital resorption. A 53-year-old Indian female presented to the physiotherapy department with a primary complaint of neck pain, numerical pain rating scale (NPRS) of 5 during shoulder elevation, along with difficulty in hand function and mouth opening. She was diagnosed with SSc 20 years ago and was on regular pharmacological treatment. On observation, as depicted in (A), she had a mask-like face with microstomia and prominent radial furrowing, characteristic of systemic sclerosis. Panel B illustrates both hands with acro-osteolysis, sclerodactyly, onycholysis, digital ulcers, and multiple finger flexion contractures. On examination, the shoulder range of motion (ROM) was normal. Still, mild tightness was noted in the trapezius, levator scapulae, and pectoralis major, along with marked weakness of the serratus anterior manual muscle testing (MMT) grade 2/5. There was a significant restriction in both active range of motion (AROM) and passive range of motion (PROM) wrist and finger mobility, with a complete loss of precision grips. Mouth opening was moderately restricted (grade 2 limitation). A home exercise program was prescribed, including hot water fomentation, self-stretching, strengthening, cervical stabilization, hand and facial exercises. After four weeks, neck pain was relieved entirely (NPRS 0), with minimal improvement in active finger mobility and unchanged mouth opening. This case highlights the characteristic musculoskeletal manifestations of SSc, emphasizing the importance of physiotherapy and regular follow-ups in maintaining function and delaying disability in this progressive condition.

Barriers to health insurance uptake in Rwanda: a nationwide cross-sectional survey

Roger Muremyi — 2026-04-17

Introduction: achieving universal health coverage by 2030 is a key objective for Rwanda, ensuring equitable access to health insurance. However, approximately 10% of the population remains uninsured. This study aims to identify socio-economic and demographic factors associated with health insurance uptake in Rwanda.

Methods: we analyzed secondary data from the Fifth Integrated Household Living Conditions Survey (EICV 5), comprising 14,580 households. Multivariable logistic regression was performed to assess factors associated with health insurance uptake. Descriptive statistics were used to summarize the characteristics of the surveyed households.

Results: the study population had a mean household size of 4.8 individuals, with 62% residing in rural areas. Among household heads, 56% were male, 44% were female, 38% had no formal education, and 64% were employed. Multivariable logistic regression analysis revealed that household heads in the highest wealth quantile had higher odds of being insured (aOR: 3.82, 95% CI: 3.37-4.33; p < 0.001) compared to those in the lowest quintile. Those with no formal education had lower odds of being insured (aOR: 0.57, 95% CI: 0.46-0.71; p < 0.001) than those with higher education. Residents of Kigali City had greater odds of being insured (aOR: 1.52, 95% CI: 1.31-1.75; p < 0.001) compared to residents in other regions. Females were more likely to be insured than males (aOR: 1.21, 95% CI: 1.11-1.34; p < 0.001), while single household heads had lower odds of insurance uptake (aOR: 0.61, 95% CI: 0.60-0.74; p < 0.001) compared to married counterparts. Younger individuals were less likely to be insured (aOR: 0.32, 95% CI: 0.29-0.49; p < 0.001) compared to older adults.

Conclusion: health insurance uptake in Rwanda is significantly influenced by socio-economic and demographic factors, including wealth status, education level, geographic location, gender, marital status, and age. Targeted interventions should prioritize vulnerable groups, such as low-income and less-educated individuals, young adults, and rural residents, to improve insurance coverage.

Nutcracker syndrome caused by an enlarged splenic artery in a patient with cirrhosis: a case report

Abdellatif Outrah — 2026-04-17

Nutcracker syndrome is a rare condition caused by the compression of the left renal vein. We present the case of a 40-year-old woman with cirrhosis and splenomegaly, who developed nutcracker syndrome secondary to an enlarged splenic artery compressing the left renal vein. This case highlights the importance of considering unusual anatomical variations in cirrhotic patients presenting with flank pain. Early diagnosis can guide appropriate management and avoid complications.

Major contributors to motorcycle accidents in Busia County, Kenya

Olipher Makwaga — 2026-04-17

Introduction: in Busia, motorcycles are a significant contributor to the number of road traffic injuries. Despite the impact they have on the healthcare system, motorcycle accidents have not received much attention due to a lack of local data and inadequate public policy responses in the country. Therefore, this study aimed to identify the risk factors that predict motorcycle accidents.

Methods: this study utilized a cross-sectional mixed-method approach involving interviews with 423 motorcycle riders to explore factors associated with motorcycle accidents. Additionally, seven focus group discussions were conducted to gather more in-depth information. Data analysis was carried out using multiple logistic regression.

Results: out of the 423 riders interviewed, 243 (57.5%) had been involved in an accident. The likelihood of being in an accident was higher for riders who had consumed alcohol (OR=1.8, 95% CI: 1.2-2.7, p=0.004) and for those not using reflector jackets (OR=2.5, 95% CI: 1.4-4.4, p=0.002). Riders who carried only one passenger at a time were at lower risk (OR=0.6, 95% CI: 0.3-1.0, p=0.037) compared to those carrying multiple passengers. Overtaking from both sides increased the risk of accidents compared to overtaking from the right side (OR=2.1, 95% CI 1.3-3.5, p=0.003). Additionally, not wearing helmets and a lack of driving training were found to be associated with accidents (chi-square, p < 0.05). Qualitative analysis revealed similar factors as predictors of motorcycle accidents as the quantitative findings.

Conclusion: the results indicated several major contributors to motorcycle accidents. The study shows that riders do not adhere to traffic rules. Legal action is needed for those who do not comply with traffic rules and regulations.

Multiple antibiotic resistance indexing and molecular identification of Escherichia coli isolated from clinical and nonclinical sources in Port Harcourt Metropolis, Nigeria

Doubra Otis Isaiah — 2026-04-17

Introduction: the emergence of antibiotic resistance in E. coli strains has led to a variety of clinical illnesses in both humans and animals, with consequences for human health and the environment.

Methods: this cross-sectional study was conducted to determine the risk of increased antibiotic resistance by calculating the multiple antibiotic resistance (MAR) index of E. coli in Port Harcourt, Rivers State, Nigeria. A higher MAR index close to 1 was interpreted as having a higher level of antibiotic resistance, while a lower MAR index close to 0 is an indicative of little to no resistance. In this study, a total of 200 samples from clinical (urine and stool) and non-clinical sources (soil and poultry) were randomly collected following ethical approval. Escherichia coli was isolated on Eosin Methylene Blue agar and identified using standard biochemical tests. The antimicrobial susceptibility profile was determined using the disk diffusion methodology with Mueller-Hinton agar according to the instructions of the Clinical and Laboratory Standards Institute (CLSI). Escherichia coli isolates were amplified in this investigation using a 16s rRNA gene-based polymerase chain reaction (PCR) technique.

Results: for both 73% clinical (n=100) and 35% non-clinical (n=100) isolates, amoxicillin/clavulanic acid showed the highest rate of resistance with 82.2% (60 of 73) and 100% (35 of 35) respectively, whereas nitrofurantoin showed the lowest rate of resistance at 1.4% (1 of 73) clinical and no resistance was found for the nonclinical E. coli isolates. The study presumptively finds a higher resistance to 4 drug classes, with 42%, and the lowest of 1% to 6 drug classes of antibiotics. Additionally, MAR indices > 0.2 were observed in this study, which indicates excessive use of antibiotics. MAR index of 0.4 was the most frequent, with a 25% prevalence. The results of this investigation show that a MAR index of 0.4 suggests widespread antibiotic resistance, with 25% of the bacterial isolates from both sources exhibiting resistance to the tested antibiotics. A MAR index > 0.2 in this study indicates that 14.8% of the E. coli isolates were ineffective against the tested antibiotics. The bacteria isolates in this study have developed resistance to multiple antibiotics if the MAR index is greater than 0.2, which is an indication of overuse or inappropriate antibiotic use. The genotypic test verified 82.9% non-clinical E. coli (found in environmental soil and poultry samples) and 82.2% clinical E. coli (found in patient urine and stool samples). In this study, E. coli isolates were genotypically identified using the 16s rRNA gene.

Conclusion: the high levels of MAR indices in E. coli as presented in this study could be indicative of antibiotic treatment failures in both clinical and nonclinical settings, which can serve as a potential reservoir of drug-resistant E. coli that are harmful and therefore require continuous monitoring.

Diagnosis and management of bilateral and multiple semicircular canal dehiscence: a case report

Taha Benatiya Andaloussi — 2026-04-17

Semicircular canal dehiscence (SCCD) is a rare inner ear disease caused by an anatomical defect in the bony covering of the semicircular canal (SCC). This condition most commonly affects the superior semicircular canal, and less frequently involves multiple canals in one or both ears. Although the clinical and physiological features of a single SCCD are well known, there are only a few reported cases of multiple semicircular canal dehiscences. Thus, their clinical and physiological characteristics require further investigation. We present the case of a 59-year-old male patient of Moroccan ethnicity who presented with chronic imbalance and mild dizziness, induced by loud noises. As a dentist, he experienced extreme difficulty while drilling his patients' teeth, exhibiting nausea, tachycardia, and sweating. Clinical oto-vestibular and neurological examinations, tonal audiometry, and videonystagmography (VNG) revealed peripheral vestibular syndrome. Bilateral multiple SCCD was subsequently confirmed using high-resolution computed tomography imaging of the temporal bone. The clinical manifestations in this case were primarily neurovegetative symptoms of vestibular dysfunction. Functional assessments revealed vibratory-induced down-beating nystagmus and left preponderance on caloric testing. Computed tomography (CT) imaging confirmed dehiscence in the posterior and superior semicircular canals on the right side, and posterior semicircular canal dehiscence on the left side.

High proportion of hepatitis B virus-infected patients at a mild stage of disease progression: a cross-sectional study in a single reference laboratory in Cameroon

Laure Ngono — 2026-04-17

Introduction: hepatitis B causes significant suffering owing to acute and chronic infection leading to complications such as cirrhosis and hepatocellular carcinoma. Chronic Hepatitis B infection can be identified by the simultaneous use of virological, serological and biochemical markers involved in monitoring the progression of the disease. In Africa, only 1% of people infected are screened, and few benefit from antiviral treatment. This study aimed to determine the relationship between serological, biochemical and virological markers involved in the follow-up of patients with chronic viral hepatitis B virus infection at the Centre Pasteur du Cameroun.

Methods: we conducted a cross-sectional study of patients' electronic records registered in the Laboratory Information System of the Centre Pasteur du Cameroun from 2011 to 2021. HBs antigen-positive patients with viral load, HBe antigen and liver transaminases assays were included. Chronic HBV infection phases were classified in 5 phases according to EASL which are: Phase 1: HBeAg-positive chronic HBV infection, Phase 2: HBeAg-positive chronic hepatitis B, Phase 3: HBeAg-negative chronic HBV infection, Phase 4: HBeAg-negative chronic hepatitis B, Phase 5: HBsAg-negative phase.

Results: we registered 1652 patients, 43.9% females and 56.1% males. The median age of women and men was 31 [>25;38] years and 33 [6;40] years respectively. The transaminase levels were normal in the most patients (65.5% for ALT and 76.2% for AST), low Hepatitis B viral load (<2000 IU/mL) in 68.5% of cases and 90.1% were negative for HBe antigen. Regarding viral Hepatitis B stage, 3.4%, 6.5% and 28.1% were in stage 1,2 and 4 respectively. Most (62.0%) fell in stage 3 representing the mild HBeAg-negative chronic HBV infection.

Conclusion: our results show that a high proportion of HBV-infected patients referred at Centre Pasteur du Cameroun are at a mild stage of disease progression.

Stakeholders´ perspectives on addressing climate change and respiratory health impacts in Nigeria

Olayemi Oluseun Akinnola — 2026-04-17

The impacts of climate change on respiratory health are increasingly becoming a significant challenge in Nigerian cities, particularly in Lagos and Ogun States. Engaging stakeholders in discussions about climate change and health is crucial for addressing these challenges. The climate change and respiratory health (C2Rest) Nigeria Study team facilitated a stakeholder engagement to discuss climate change and health impacts in Nigeria, aiming to explore feasible solutions relevant to research, policy, and practice. A stakeholder meeting was conducted on April 23^rd, 2024, involving participants from Lagos and Ogun States. The framework for the activities was adapted from Gardner´s climate change engagement pathways, which examine key drivers (8 questions), barriers (7 questions), and adaptation pathways (3 questions). Data were collected through note-taking, written contributions, audio and video recording, and subsequently transcribed and analysed thematically. A total of 42 registered participants, comprising government officials, academicians, healthcare professionals, community and religious leaders, attended the stakeholder engagement meeting. Participants made group presentations and submitted a total of 380 written contributions. There were varying views on the drivers of climate change, but there was consensus that the most vulnerable populations include the poor, homeless, pregnant women, children, the elderly, and individuals with underlying health conditions. An important barrier identified was the sociocultural belief that climate change is an act of God or spirits. Financial constraints were a recurrent theme in discussions about mitigation and adaptation to climate change. This report provides valuable information on the most vulnerable population to the effects of climate change in Nigeria and identifies sociocultural beliefs and financial constraints as key barriers to the adoption of effective mitigation and adaptation behaviors.

Déficit congénital sévère en facteur VII découvert fortuitement en péri-partum: à propos d'un cas

Youssef Aarjouni — 2026-04-17

Le facteur VII, ou proconvertine, est une protéine de la coagulation dépendante de la vitamine K, intervenant dans la voie extrinsèque de la coagulation. Son déficit congénital constitue une affection rare à transmission autosomique récessive et peut se manifester par des épisodes hémorragiques de sévérité variable. Nous rapportons le cas d´une patiente de 22 ans, primigeste, chez qui un trouble de la coagulation a été découvert de manière fortuite en péripartum à la suite d´un épisode d´épistaxis. Le bilan biologique a révélé un effondrement du temps de prothrombine ainsi qu´un allongement significatif de l'International Normalised Ratio (INR), conduisant au diagnostic d´un déficit sévère en facteur VII. Compte tenu du risque hémorragique, une prise en charge obstétricale spécifique a été mise en place. L´accouchement par césarienne a été réalisé sous anesthésie générale, après une préparation préopératoire comprenant une transfusion de plasma frais congelé et l'administration d´un antifibrinolytique. L'intervention s´est déroulée sans complications, et l'évolution post-opératoire a été favorable, sans épisode hémorragique notable. À travers cette observation, nous mettons en lumière l'importance du dépistage précoce et d´une prise en charge adaptée du déficit en facteur VII dans un contexte obstétrical, afin de minimiser les risques hémorragiques tant pour la mère que pour le nouveau-né.

Experiences with facility delivery services within the context of a maternal neonatal health project in Gombe State, Northeast Nigeria: a qualitative study

Maryam Al-Mujtaba — 2026-04-17

Introduction: a maternal neonatal health (MNH) project implemented in Gombe State improved uptake of facility delivery services from 27% to 65%. The project supplied health commodities to health facilities, provided women with cost-free transportation, and implemented the Village Health Worker program. Village health workers are lay indigenous women trained to provide community-based maternal and newborn care and to facilitate linkage to health facilities. We explored women's experiences with facility delivery services within the context of the MNH project.

Methods: qualitative data were obtained through focus group discussions with women who delivered within the last 12 months. Participants were asked questions related to their experiences with the access and use of facility delivery services. Data were organized with NVivo 12 (Pro for Windows) and analyzed using directed content analysis.

Results: six focus group discussions were conducted with 58 participants. Mean age was 25.1 (± 5.3) years old. All the women preferred facility delivery over home delivery for quality care. Most women reported experiencing immediate and respectful care with facility delivery services, and healthcare workers' competence and attitude were more important than the gender of the healthcare worker. However, for some women use of facility delivery services was limited due to the use of traditional birth attendants, absent husbands at the onset of labor, imminent delivery, long distance to the facility, expensive transportation fees, healthcare worker absenteeism and long clinic wait times.

Conclusion: maternal neonatal health projects should be designed to ameliorate the effects of socio-economic and facility level factors that limit use of facility delivery services.

Tobacco and alcohol use among adolescents and young adults in aspirational districts in India: NFHS-5 based secondary analysis

Shiv Kumar Mudgal — 2026-04-17

Introduction: an early initiation of alcohol and tobacco use is associated with addiction and significant health complications. This study aimed to determine the prevalence and associated factors of tobacco and alcohol usage among adolescents (15-19 years) and young adults (20-24 years) in India's aspirational districts.

Methods: data from India's biggest demographic and health survey, the National Family Health Survey-5 (NHFS-5), 2019-21, were reviewed. Alcohol and tobacco (in any form) usage were measured using the self-reported binary responses. Multivariate binary logistic regression was used to examine relationships with different demographic variables.

Results: among the 47,343 individuals, tobacco usage was substantially higher in men than women (adolescents: 15.9% versus 1.2%; young adults: 31.8% versus 2.2%). The prevalence of alcohol usage was also higher among men (adolescents: 8.1% versus 0.4%; young adults: 21.8% versus 1.0%), with statistical significance (p < 0.0001) for all sex-related differences. Use of tobacco and alcohol was significantly associated with illiteracy, male gender, and young adults. A higher prevalence was observed among Christians in rural areas and lower socio-economic settings.

Conclusion: the results highlight the necessity of targeted efforts by appropriate stakeholders and governmental agencies to lower alcohol and tobacco usage, particularly among vulnerable populations. More research is required to determine the root causes of these habits and the related health risk behaviours.

Cytokines in HIV-1 patients on combination antiretroviral therapy with persistent low-level viremia at a tertiary hospital in Western Kenya

Rose Undisa — 2026-04-17

Introduction: persistent low-level viremia (pLLV) in HIV-1 participants on combination antiretroviral therapy (cART) is a significant predictor of immune activation and virologic rebound. Elevated cytokine levels are linked to pLLV, yet the roles of pro- and anti-inflammatory cytokines remain unclear in settings such as Kenya. This study assessed IL-17, IFN-γ, IL-10, and TGF-β in HIV-1 pLLV and virally suppressed participants at Moi Teaching and Referral Hospital (MTRH) to explore alternative biomarkers for virologic monitoring in resource-limited settings.

Methods: cross-sectional study of 82 age- and gender-matched HIV-1 participants on first-line cART, -41 pLLV (50-500 copies/ml), and 41 virally suppressed (<50 copies/ml) was conducted using MTRH database data. Plasma cytokines (IL-17, IFN-γ, IL-10, TGF-β) were measured by ELISA (Zeptometrix, USA), and viral loads by RT-PCR (Abbott, USA). Data were analyzed using Mann-Whitney U, Chi-squared, and logistic regression tests.

Results: the median (IQR) levels of IL-17, IFN-γ, IL-10, and TGF-β (pg/ml) were significantly higher in pLLV participants on first-line cART compared to virally suppressed participants: 23.8 (21.3-25.8) vs. 15.5 (12.7-18.2); 28.3 (23.5-31.2) vs. 11.4 (8.8-14.8); 45.2 (34.0-53.7) vs. 28.4 (22.6-31.6); and 56.9 (50.0-67.8) vs. 27.7 (19.5-34.7) p<.001. The odds (95% CI) of being suppressed were reduced by TGF-β 0.329(0.035-0.361), IFN-γ, 0.360 (0.270-1.501), and IL-17 0.938 (0.691-1.273), but increased by IL-10 1.106 (0.675-1.811), though not statistically significant.

Conclusion: persistent low-level viremia (pLLV) presents with elevated pro-inflammatory ( IL-17, IFN-γ) and anti-inflammatory cytokines (IL-10, TGF-β) levels. Recommendation: exploring other cytokines in pLLV could enhance understanding of cytokine levels and viral suppression and may help refine HIV-1 treatment.

Vertèbre de poisson impactée dans le larynx d'un nourrisson: à propos d'un cas inhabituel

Aminata Diop Nakoulima — 2026-04-17

L'inhalation de corps étrangers (CE), accident fréquent chez l'enfant, peut mettre en jeu le pronostic vital. Différents types de corps étrangers peuvent être retrouvés, mais la localisation laryngée est rare. Nous rapportons le cas d´un nourrisson de sexe masculin, âgé de 8 mois, qui a été reçu pour difficulté respiratoire avec dysphonie et stridor. A l'admission, l'enfant présentait une dyspnée laryngée sévère. La tomodensitométrie cervicale retrouvait un corps étranger radio-opaque laryngé. L'extraction endoscopique ramenait une vertèbre de poisson impactée dans la sous-glotte. Les corps étrangers des voies respiratoires inférieures de localisation laryngée sont rares et la découverte de vertèbre de poisson exceptionnelle.

Pseudo-puberté précoce sur syndrome de McCune-Albright: à propos d'un cas

Kaoutar Rifai — 2026-04-17

Le syndrome de McCune-Albright est une maladie rare dont le diagnostic positif est clinique et doit être évoqué devant la triade clinique: les tâches café au lait; la dysplasie fibreuse osseuse; et une endocrinopathie. La prise en charge thérapeutique dépend de l'atteinte endocrinienne ainsi que de la sévérité de l'atteinte osseuse. Nous rapportons un cas original d'une fillette âgée de 2 ans et 8 mois présentant une pseudo-puberté précoce révélant un syndrome de McCune-Albright. Le diagnostic a été évoqué devant la survenue d'une prémature ménarche et d'une prémature thélarche associées à des tâches café au lait. Biologiquement, le taux d'œstradiol était élevé à 179ng/ml avec des taux de FSH, LH bas. Un test au LHRH a été réalisé objectivant un profil plat de FSH LH avec un pic LH/FSH< 1 confirmant l'origine périphérique de la puberté précoce. La radiographie du poignet a montré un aspect hétérogène de la trame osseuse en faveur de la dysplasie fibreuse osseuse. Pour freiner les saignements vaginaux et pour réduire l'hyperoestrogénie; un traitement par les inhibiteurs de l'aromatase de 3^e génération "Létrozole" a été prescrit chez notre patiente avec une bonne évolution clinicobiologique. Notre cas clinique illustre la nécessité de réaliser un examen clinique minutieux y compris l'examen cutanéomuqueux devant toute puberté précoce afin d'assurer un diagnostic étiologique précis et un traitement adapté.

Assessment of knowledge, attitude, and practice regarding statutory rape and its management among healthcare workers in emergency wards in Ibadan, Nigeria

Million Teklay Solomon — 2026-04-17

Introduction: statutory rape is a critical public health and legal issue with severe consequences for survivors in Nigeria and is related to insufficient healthcare training, hindering effective case management. This study assessed the knowledge, attitudes, and practices (KAP) of healthcare workers in emergency wards in Ibadan to identify gaps and challenges in statutory rape management.

Methods: a cross-sectional study was conducted among 198 healthcare workers in Ibadan, using structured questionnaires and analyzed with descriptive statistics, t-tests, and chi-square tests.

Results: the study revealed significant gaps in healthcare workers' KAP concerning statutory rape. While 81.3% of healthcare workers were aware of the term "statutory rape," only 75.3% understood the legal provisions related to it, such as the legal age of consent. Doctors had significantly higher KAP scores than nurses in all domains: knowledge (p= 0.0029), attitude (p= 0.0044), and practice (p= 0.0028). Despite recognizing the severity of statutory rape (76.3%), 33.3% of healthcare workers had never managed such cases, and many reported infrequent encounters with statutory rape cases. A significant proportion (65.2%) of healthcare workers identified inadequate forensic training as a major barrier, while (83.3%) cited legal and reporting constraints, and (31%) mentioned geographical access limitations. The most commonly reported physical and psychological symptoms observed in survivors included genital injuries (93.4%), psychological trauma (86%), STDs and infections (81.3%), bleeding (85.4%), and extra-genital injuries (69.2%).

Conclusion: this study highlights deficiencies in healthcare workers´ knowledge and preparedness in statutory rape case management. Strengthening forensic training, legal awareness, and healthcare-legal collaboration is essential to improving response effectiveness.

A leg ulcer revealing Parkes Weber syndrome in a child

Leila Debono — 2026-04-17

A 13-year-old male child with no prior history presented to the pediatric emergency room for a lesion on the anterior aspect of his left leg associated with pain throughout the limb. On clinical examination, significant hypertrophy of the left lower limb was noted. In the thigh and calf of the same limb, several veins were prominent, enlarged, and followed a tortuous course. The lesion in question, located on the lower part of the medial aspect of the leg, was rounded, with loss of substance, minimally oozing, and clean, without necrosis or associated signs of ischemia. The femoral, popliteal, and pedal pulses were present and symmetrical with the contralateral pulses. The right lower limb was unharmed. The cardiac examination found no murmur or added noise, or signs of heart failure. The mucocutaneous examination did not reveal any abnormalities, notably no angiomas. A Doppler ultrasound was performed, revealing multiple arteriovenous communications. The assessment was completed by a computed tomography (CT) angiography of the left lower limb, which confirmed high-flow arteriovenous malformations with thrombosis of the left internal iliac vein and the left superficial femoral vein, consistent with Parkes-Weber syndrome. The CT scan also noted skeletal hypertrophy of the left lower limb with muscular hypertrophy and thickening of the soft tissues of the left leg with skin irregularity and loss of substance in the middle third, suggesting an ulcer. The patient was put on anticoagulant treatment with local treatment of his ulcer using 10% povidone iodine and petroleum jelly. The course was marked by an improvement in the ulcer lesion and disappearance of the pain.

United States aid cut: alternatives for sustainable financing for health

Gafar Bolaji Alawode — 2026-04-17

Recent United States (US) foreign aid cuts, notably through Executive Order 14169 signed on January 20, 2025, have disrupted health programs in low- and middle-income countries (LMICs), threatening progress in combating HIV/AIDS, tuberculosis, and malaria. With 37 LMICs relying on US aid for over 10% of their health budgets, the funding pause has led to closures of critical health facilities, such as 200 in Afghanistan, impacting 1.84 million people. This commentary explores sustainable financing solutions, emphasizing the Debt-to-Health Swap (D2H), where debt is forgiven in exchange for health investments. Successful D2H examples include Spain´s agreements with Cameroon, Ethiopia, and the Democratic Republic of Congo, which bolstered HIV, TB, and malaria programs. Additional mechanisms like climate financing, through initiatives like the Green Climate Fund, and health taxes are proposed, though challenges like high debt servicing costs, exceeding 3% of GDP in LMICs by 2024-persist. The commentary urges LMICs and regional bodies, such as the African Union, to advocate for D2H in global forums, integrating it into debt relief discussions to enhance health system resilience. By fostering collaboration between creditors, health organizations, and governments, D2H can unlock resources for infectious diseases, maternal health, and climate-related health risks, ensuring sustainable development.

Migration of African healthcare professionals: the need for equitable healthcare worker migration

Estifanos Haimanot — 2026-04-17

Healthcare professional migration has been a major issue in the African healthcare system. This is due to push factors such as economic instability, inadequate work conditions, insufficient support, and a lack of infrastructure, which have all contributed to the increased migration rates in sub-Saharan countries. On the contrary, pull factors like optimal work conditions, better work-life balance, and financial benefits have attracted African healthcare workers to settle abroad, where this issue has been exacerbated during the post-pandemic COVID-19 era. It is crucial for governments, healthcare organizations, and stakeholders to invest in proper resources, training, and autonomy to better support the working conditions and rights of African healthcare workers. Governments, Non-Governmental Organizations (NGOs), healthcare organizations and stakeholders must utilize a global agenda and implement policies, partnerships, and technological solutions for a more equitable, accessible, and dependable healthcare system.

Perineal endometriosis on an episiotomy scar: diagnosis based on clinical, radiological, and hormonal criteria (case report)

Abdoulrazak Egueh Nour — 2026-04-17

Endometriosis is a chronic, non-cancerous gynecological disorder that is typically observed in women of fertile age. It describes the presence of functional endometrial components, glands and stroma outside the endometrial cavity, most often involving pelvic structures such as the ovaries, peritoneum, and uterine ligaments. Perineal endometriosis is a rare form of extrapelvic endometriosis, with an estimated incidence of between 0.3% and 1%. We report the case of a 36-year-old woman, gravida 1 para 1(G1P1), with a history of vaginal delivery and no known history of endometriosis, who presented with a painful mass located on the right perineal scar two years after undergoing a mediolateral episiotomy. The mass was associated with cyclical pain and significantly impaired quality of life. Clinical examination, combined with ultrasound and magnetic resonance imaging (MRI), suggested the diagnosis of perineal endometriosis in the absence of other endometriotic lesions. As the patient declined surgery, hormonal therapy was initiated, resulting in marked symptom improvement at 8-month follow-up. Although histological confirmation was not obtained, the typical clinical presentation, evocative MRI features, and favorable response to hormonal therapy supported the diagnosis of perineal endometriosis. This under-recognized entity should be systematically considered in women of reproductive age presenting with cyclical perineal pain following episiotomy.

Barriers to effective sample management in viral load testing in Machakos County, Kenya: a convergent parallel mixed-method study

Christine Mutewa Kathinzi — 2026-04-17

Introduction: viral load (VL) monitoring is a critical component of HIV management, yet systemic and logistical barriers compromise the quality and reliability of VL sample management in many low- and middle-income countries. In Machakos County, Kenya, these challenges persist, contributing to a relatively low viral suppression rate of 81% and achievement of UNAIDS 95-95-95 strategy. This study determined barriers to effective VL sample management in Machakos County, Kenya, with a focus on equipment maintenance, human resource capacity, and supply chain performance across public and private facilities.

Methods: a convergent parallel mixed-methods design was employed across 71 health facilities (61 public, 10 private) served by four VL hubs: Machakos Level 5, Matuu Level 4, Athi River Level 4, and Kangundo Level 4 hospitals. Quantitative data was collected from 205 healthcare workers using structured questionnaires. Descriptive statistics, Fisher’s Exact Test, and Odds Ratios (OR) with 95% Confidence Intervals (CI) assessed associations between barriers and sample management outcomes. Qualitative data was obtained through 38 key informant interviews with clinicians from Comprehensive Care Clinics and Maternal and Child Health units (public n=32, private n=6). Transcripts were thematically analyzed using Braun and Clarke’s framework, and a word cloud visualized common terms. Findings were triangulated for contextual depth. Ethical approval was obtained from the Kenya Medical Research Institute- Scientific Ethics Review Unit, with clearance from the Machakos County Department of Health. Informed consent was obtained and confidentiality were strictly maintained.

Results: among the VL hubs assessed, 88.8% reported having a designated VL focal person, and 73.2% indicated that couriers had received some form of training. Despite these structural provisions, critical technical gaps persisted. Only 6.8% of facilities had calibrated centrifuges, 2.4% conducted preventive maintenance, and 2.4% calibrated their temperature monitoring devices-pointing to widespread neglect of equipment quality assurance protocols. Further, 58.5% of facilities reported incidents of sample freezing, often attributable to inconsistent cold chain practices. These deficits were not isolated but interrelated, collectively undermining the integrity of VL sample handling. Bivariate analysis revealed statistically significant associations between effective sample management and calibrated temperature devices (OR: 3.4; 95% CI: 1.6-7.0; p = 0.01), absence of sample freezing (OR: 2.8; 95% CI: 1.3-6.2; p= 0.03), and trained couriers (OR: 1.5; 95% CI: 0.9-2.7; p= 0.06), accentuating the importance of technical reliability alongside human resource readiness. The VL hubs with preventive maintenance showed significantly higher odds of effective sample management (OR: 4.5; 95% CI: 2.0-10.1; p< 0.001). Only 5.4% of facilities reported consistent availability of VL collection materials. Qualitative insights highlighted sporadic equipment servicing, recurrent stockouts, and poor coordination between facility-level operations and county logistics.

Conclusion: persistent systemic barriers-such as inadequate equipment maintenance and fragmented supply chain management-undermine the effectiveness of VL sample management in Machakos County. Strengthening technical quality protocols, institutionalizing regular equipment maintenance, and enhancing supply chain coordination through the National AIDS and STI Control Program (NASCOP) and county health departments are critical to improving diagnostic reliability and advancing Kenya’s HIV viral suppression targets.

Fever of unknown origin: multidrug-resistant Escherichia coli presenting as infectious spondylodiscitis

Emanuel Narvaez Gallifa — 2026-04-17

A 71-year-old man with a past medical history of benign prostatic hyperplasia and recurrent bacteriuria was referred to our infectious diseases department for persistent fever lasting 4 weeks following cystoscopy and two urine cultures growing ESBL-producing K. pneumoniae and E. faecalis. He did not take medications. Review of systems was positive for fever and general malaise. Vital signs were normal. Physical examination showed poor dentition and decreased breath sounds on the left. Initial laboratories showed leukocytosis (11,800/cm³), neutrophilia (9,620/cm³), and elevated C-reactive protein (CRP) 69.4 mg/L; urinalysis was positive for leukocyte esterase. Urine culture grew difficult-to-treat resistant P. aeruginosa. Chest X-ray was unremarkable; Computed Tomography (CT) scan showed air in the retroperitoneal space adjacent to the psoas muscle and interaortocaval adenopathies measuring up to 32 mm. Treatment began with ampicillin and was escalated to ceftazidime/avibactam plus polymyxin E. By day 6, he developed cramps, paresthesia, and pain in his lower extremities and a new left inguinal lymphadenopathy. Magnetic Resonance Imaging (MRI) revealed changes consistent with spondylodiscitis at T11-L1. Culture and biopsy of T11-L1 grew E. coli resistant to fluoroquinolones and aminoglycosides. Blood cultures grew MDR-ESBL-producing E. coli; repeat urine culture was negative. Additional infectious workup, including PCR assays for tick-borne pathogens and tuberculosis, was negative. Fever rose to 39°C, CRP to 127.7 mg/L, and procalcitonin to 1.30 ng/mL. Meropenem was initiated for 1 week, then de-escalated to complete a 6-week course. He underwent three lumbar irrigations. No medication-related adverse effects occurred. He recovered and was discharged.

Revision of medicine prices and sales price evolution in Moroccan pharmacies

Fatima Zahra Bimegdi — 2026-04-17

Introduction: Morocco adopted a new medicines pricing policy in 2013 that introduced price revisions following the implementation of Decree No. 2-13-852. This study aims to describe the evolution in medicine price decreases in Moroccan pharmacies following the price revisions published by the Ministry of Health.

Methods: as part of a retrospective descriptive study, all the price revision lists over five years (2014-2019) were crossed with the databases of sales of medicines sold in pharmacies.

Results: price decrease affected 1704 medicines, 54% of which were originator drugs. All therapeutic classes were involved, 22.7% were anti-infective, and 18.5% were for the cardiovascular system. Medicines with a public selling price between 5 and 10 US dollars (25.4%) were the most affected by the drop, even if it has concerned all price ranges. 22.8% of medicines decreased by less than or equal to 0.1 US dollar, and 28.7% recorded decreases of less than or equal to 1% of the public selling price. Five medicines (0.3%) have been reduced by over 70%, with 73.2% as a maximum drop percentage.

Conclusion: following the implementation of Decree no. 2-13-852, a series of medicine price revisions was adopted. All price ranges and therapeutic classes were affected by the price decrease, with several variations. However, complementary policies are still needed to improve access to medicines.

Post-fall sacral swelling

Haruka Hikichi — 2026-04-17

A 54-year-old woman presented with a progressively enlarging, painless swelling over the sacral region. She reported repeated falls over the preceding several weeks, attributed to the adverse effects of antidepressant medications. Physical examination revealed a 15-cm, soft, non-tender mass with mild erythema over the sacrum (panel A). The patient was afebrile. Laboratory findings, including white blood cell count, erythrocyte sedimentation rate, and C-reactive protein, were within normal limits. Computed tomography revealed a well-circumscribed, homogeneous, low-density fluid collection in the subcutaneous tissue over the sacrum (panel B). Aspiration yielded hemorrhagic, turbid fluid (panel C). Cytology results were negative for malignancy, and cultures were negative for bacterial growth. A diagnosis of sacral bursitis was made. Bursitis is an inflammation of a synovium-lined bursa, typically occuring in large joints such as the shoulder, knee, hip, and elbow. Sacral bursitis is rare and often misdiagnosed as an abscess, hematoma, or soft tissue tumor. In this case, the absence of systemic symptoms, normal inflammatory markers, and negative cultures helped rule out an infectious etiology. Imaging findings also lacked the features suggestive of septic bursitis, such as peribursal fat stranding and wall thickening. Most cases of non-infectious bursitis can be managed conservatively. This patient was treated with rest, analgesics, and aspiration drainage, with gradual resolution of symptoms.

Unusual hydrocephalus from retrocerebellar arachnoid cyst sparing the fourth ventricle

Devyansh Nimodia — 2026-04-17

A 17-year-old male presented to our medicine outpatient department with complaints of worsening headache, nausea and intermittent vomiting for the past two months. He had similar complaints in the past, which were relieved by taking. The patient was advised to do a computed tomography scan of the brain, which revealed a cerebrospinal fluid (CSF) density cystic lesion measuring approximately.8.5 x 6.7 x 8.2 cm noted in the retro cerebellar region extending to the quadrigeminal cistern, causing moderate compression of bilateral cerebellar hemispheres and cerebral aqueduct leading to moderate dilatation of bilateral lateral ventricles, 3^rd ventricle (A). Notably, the fourth ventricle remained of normal size (B), which is a rare occurrence in such cases where obstruction of CSF flow typically affects the fourth ventricle. The patient was operated on by transventricular approach with endoscopic third ventriculocystostomy and endoscopic third ventriculostomy (ETV). The postoperative course was uneventful. The patient was further advised to do MRI CSF flowmetry, which was not done for financial reasons. Retrocerebellar cysts are rare and can sometimes obstruct CSF pathways, leading to hydrocephalus. This case is unique because the fourth ventricle remained unaffected despite significant hydrocephalus involving the lateral and third ventricles. One possible explanation is that the cyst’s primary impact was at the level of the quadrigeminal cistern and aqueduct of Sylvius, leading to an obstructed outflow of CSF from the third ventricle, while the CSF circulation through the fourth ventricle remained relatively unimpeded. This case also emphasizes the importance of early surgical intervention.

Lipome géant latéro-cervical chez un nourrisson de 6 mois: à propos d'un cas

Cheikh Diene Niang — 2026-04-17

Les lipomes sont des néoplasmes d'origine mésenchymateuse qui intéressent la région de la tête et du cou dans 13% des cas. Cependant, ils sont rarement décrits dans la littérature chez la population pédiatrique. Nous rapportons le cas d'un nourrisson de 6 mois, sans antécédents pathologiques particuliers, admis pour la prise en charge d'une volumineuse masse latéro-cervicale gauche évoluant depuis 4 mois. L'examen oto-rhino-laryngologique (ORL) retrouvait une volumineuse masse latéro-cervicale gauche s'étendant jusqu'au niveau sous-mental d'environ 7cm de grand axe sans signe de compression. Le scanner cervical objectivait une masse de densité graisseuse, compatible avec un lipome. Le patient a bénéficié d'une cervicotomie exploratrice avec exérèse de la masse. Les résultats histologiques étaient en faveur d'un lipome. On note une évolution clinique satisfaisante sans récidive avec un recul de 15 mois. Les lipomes cervicaux, bien que rares chez la population pédiatrique, doivent être évoqués devant une tuméfaction cervicale chez le nourrisson. Sa description clinique se rapproche de celle du lymphangiome kystique.

Fetal demise due to stab wound with umbilical cord transection: a case report

Skander Abid — 2026-04-17

Intrauterine fetal demise due to penetrating abdominal trauma is rare, and complete umbilical cord transection is exceptionally uncommon. We report the case of a 29-week pregnant woman who sustained multiple abdominal stab wounds, leading to fetal death and complete transection of the umbilical cord. The maternal and fetal risks associated with trauma rise significantly with gestational age. Despite advances in emergency care, management of trauma in pregnancy remains complex and lacks standardized protocols. A multidisciplinary approach in specialized settings is essential to improve maternal and fetal outcomes. This case is reported due to its rarity and to underscore the importance of early recognition and coordinated intervention in traumatic injuries during pregnancy.

The well-being of mothers caregiving for children with cerebral palsy: a Tunisian cross-sectional study

Ikram Haddada — 2026-04-17

Introduction: cerebral palsy (CP) is the most common physical disability in childhood. Caring for a child with functional limitations and long-term dependence poses significant challenges for many families. Despite this, the experiences and needs of mothers of children with CP remain understudied. This study aims to assess fatigue, caregiving burden, psychological distress, and sleep disorders (SDs) among a group of Tunisian mothers of children with CP.

Methods: this cross-sectional study explored the well-being of Tunisian mothers caring for children with CP. Participants were evaluated using the Checklist Individual Strength (CIS), Zarit Caregiver Burden Scale (ZCBS), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI).

Results: a total of 71 participants were recruited. Of all participants, 39.4% reported moderate to severe burden, and 53.5% reported severe fatigue. The prevalence of clinically significant depressive or anxious symptoms was found to be 63.4% and 53.5%, respectively. The prevalence of SDs was 74.6%. The most affected components of the PSQI were sleep latency, sleep quality, and sleep dysfunction. Sleep quality was significantly related to epilepsy in children (p=0.012), mothers' age (p=0.027), mothers' depression (p=0.008), or anxiety (p=0.001). No significant association was found between mothers' burden or fatigue and low sleep quality.

Conclusion: our findings highlight the prevalence of fatigue, burden, serious psychological distress, and SDs among mothers of children with CP. Consequently, medical personnel and social workers should be more attentive to the needs of these mothers who often silently endure the emotional and physical strains of caregiving.

Impact of community-led enhanced structured health education on youths' knowledge of alcohol's effects in Kiambu county, Kenya: a quasi-experimental study

Antony Kimata Mukui — 2026-04-17

Introduction: alcohol is the most widely consumed substance globally, contributing to 2.6 million deaths annually, including 320,000 involving youths. In Africa, alcohol is linked to high mortality rates and increased Disability-adjusted Life Years. In Kiambu, Kenya, youth alcohol consumption stands at 28.9%, surpassing the national average of 11.2%. This study explores the impact of community-led, enhanced, structured health education on youths' awareness of alcohol's effects.

Methods: a quasi-experimental study was conducted in Gatundu South (intervention) and Kabete (control) sub-counties in Kiambu from May 2022 to May 2023. Fourteen Community Health Promoters delivered monthly one-hour sessions in Gatundu South, totaling 12 sessions, covering 12 topics. Quantitative datasets were collected using the WHO's Alcohol AUDIT and questionnaire, while qualitative datasets were gathered through focus group discussions (FGDs) and key informant interviews (KIIs) and analyzed thematically. Kenyatta University's ethics committee granted study approval. R software supported data analysis, including mean knowledge scores, Chi-Square, ordinal logistic regression, Difference-in-Difference analysis, and Cohen's d.

Results: youth in the intervention group experienced a significant increase in "very high knowledge" from 57% to 92.6%, compared to a smaller rise in the control group from 26.1% to 39.5%. Post-study, Kabete had 2.6% of participants in the very low knowledge category, versus 0% in Gatundu. The intervention showed a significant impact (DiD: 1.8, Cohen's d: 1.161). FGDs and KIIs indicated limited awareness and access to screening services.

Conclusion: the intervention improved knowledge of alcohol-related harm, encouraged healthier behaviors, and reduced adverse effects.

Long live the kidney despite every threats: a case report

Kubra Kaynar — 2026-04-17

Kidneys are functionally affected by the diseases of other organs. Here, we present an elderly predialysis patient with a functioning kidney for 10 years of nephrological follow-up despite many comorbidities. A 75-year-old male patient with a medical history of hypertension for 15 years and 60 pack years of cigarette smoking, was diagnosed as muscle invasive bladder cancer (MIBC) and synchronous centrally located clear cell renal cell carcinoma (ccRCC) in the left kidney. At admission, the patient had an Estimated Glomerular Filtration Rate (eGFR) (CKD-EPI-cre) of 54mL/min/1.73m², after left nephrectomy eGFR of the patient decreased to 35mL/min/1.73m². After ten years of follow-up, the patient's right kidney had been functional with an eGFR of 24mL/min/1.73m² despite radical cystectomy with urinary diversion, radical nephrectomy, heavy smoking, cardiorenal syndrome, chronic obstructive pulmonary disease, and hypertension. It is well known that comorbidities such as hypertension, smoking, cancers, infections, pulmonary and heart diseases contribute to irreversible kidney damage and are additive to decreasing kidney function. Appropriate and early diagnosis and treatment of these comorbidities permit healthy aging of the kidneys without the need for dialysis.

Hydrocele of the canal of nuck mimicking an inguinal hernia in a 34-year-old pregnant woman: a case report

Celsus Ukelina Undie — 2026-04-17

Hydrocele of the canal of Nuck (HCN) is a rare condition in females that commonly presents in infancy and early childhood. It occurs when fluid accumulates within a patent part of the processus vaginalis causing a swelling in the groin. Clinicians would typically not consider it while evaluating inguinal swellings in adult females. Consequently, patients are likely to remain undiagnosed until complications set in. Herein, we present a clinically rare case of HCN in a pregnant adult female. We also aim to report how easily the diagnosis was missed, and to remind the medical community of other likely causes of inguinal swelling that could mimic an inguinal hernia. We managed a gravid 34-year-old university graduate with a spontaneous swelling on the left inguinal region. The swelling was a painless, firm, irreducible mass of 3 months’ duration. She was gravida 1, para 0, in her first trimester. There was no associated symptom. Abdominal ultrasound scan found a well-defined mass of size 2.30 x 3.88cm around the left Hesselbach's triangle containing homogenous fluid, with minimal vascularity on colour Doppler interrogation. The working diagnosis was irreducible left inguinal hernia in a pregnant woman. This was later discovered to be a misdiagnosis. She was booked for inguinal herniorrhaphy, but HCN was found intraoperatively. Diagnosis of HCN is a challenge as it is seldom made on the basis of clinical findings alone. A high index of suspicion should be entertained by clinicians for early diagnosis and appropriate management.

Impact of long COVID-19 on employees of the mining industry in South Africa: a cross-sectional study

Henry Fomundam — 2026-04-17

Introduction: coronavirus disease 2019 (COVID-19) was declared a pandemic in March 2020, and most patients recover within a few days or weeks. However, some patients suffer from long COVID, which is characterized by prolonged symptoms of varying severity. Given the importance of the mining sector to the South African economy, it is critical to comprehend the impact of long COVID on the mining sector.

Methods: we carried out a cross-sectional study that included data extraction from participant medical records and responses to study questionnaires. We used unique identifiers to anonymize participant information and match data from medical records to participant questionnaires.

Results: data from 239 medical records and 362 questionnaires were provided by employees from three mines. About 7% of people with COVID-19 were identified as having long COVID. In addition, there was no difference in productivity between people with and without long COVID.

Conclusion: our findings are not generalizable to the entire mining sector due to the limited number of participants who provided data. Additional studies that include a larger sample size are required to obtain more robust estimates of the prevalence of long COVID in the mining industry and explore potential effects of various treatment interventions for patients with long COVID.

Risk factors for hypertension in patients with type 2 diabetes mellitus in the Casablanca-Settat region, Morocco: a cross-sectional study

Houda El Alami — 2026-04-17

Introduction: hypertension in patients with type 2 diabetes mellitus (T2DM) is a major problem that increases the risk of morbidity and mortality. Although the prevalence of this disease is high in the T2DM population, the risk factors for it remain understudied. The objective of this study is to identify the risk factors combined with hypertension in Moroccan patients with T2DM.

Methods: this cross-sectional study was conducted between January 2017 and July 2018 in primary healthcare centers. A total of 503 T2DM patients were included. Inclusion criteria: adults (≥18 years) with T2DM for ≥1 year. Exclusion criteria: type 1 diabetes, gestational diabetes, cognitive impairment, or missing data. Data on demographics, clinical history, and biochemical markers were analyzed using SPSS. Logistic regression identified independent risk factors, reported as adjusted OR with 95% CI. A p-value <0.05 was considered statistically significant.

Results: a total of 503 patients with T2DM were included (71% female, 29% male), with a mean age of 58.4 ± 10.2 years. The prevalence of hypertension was 70.2%. Patients with hypertension were significantly older (mean age: 61.2 ± 9.8 years vs. 52.6 ± 10.5 years, p ≤ 0.001). The most common cardiovascular risk factors were dyslipidemia (54.1%), obesity (mean BMI: 30.8 ± 5.6 kg/m²), and a sedentary lifestyle (50.6%). Multivariable logistic regression identified older age (OR: 4.74, 95% CI: 2.47-9.10; p ≤ 0.001), longer diabetes duration (OR: 2.28, 95% CI: 1.14-4.53; p = 0.018), BMI levels (OR: 1.05, 95% CI: 1.00-1.10; p = 0.019), dyslipidemia (OR: 2.07, 95% CI: 1.28-3.33; p = 0.003), and therapeutic modifications (OR: 1.98, 95% CI: 1.11-3.53; p = 0.020) as significant risk factors.

Conclusion: in this study, we found that hypertension is highly prevalent among patients with T2DM. Our findings indicate that older age, longer diabetes duration, therapeutic modifications, dyslipidemia, and higher BMI levels are significant risk factors for diabetes.

Takotsubo cardiomyopathy due to a pheochromocytoma: a case report

Fatima Toulali — 2026-04-17

Takotsubo cardiomyopathy is typically triggered by severe adrenergic surges secondary to various stress factors. In rare cases, excessive catecholamine secretion due to a pheochromocytoma may be the cause. It is typically manifested by dyskinesia of the apex of the left ventricle. In this case report, we describe an atypical case of takotsubo cardiomyopathy, characterized by hypokinesia of the apical and mid-segments of the inferior wall of the left ventricle, which led to the discovery of an underlying pheochromocytoma. Although this association is rare, it is crucial to consider it, especially in atypical forms, as once the tumor is resected, the phenomenon becomes reversible.

Awareness of long-term foot complications in people living with diabetes mellitus in Mauritius: a cross-sectional study

Sameenah Khodabux — 2026-04-17

Introduction: Mauritius has a high disease burden of diabetes mellitus and ranked twelfth globally according to the International Diabetes Federation. According to the non-communicable disease survey 2021, it was found that 19.9 % of the Mauritian population suffers from Type 2 diabetes mellitus. The long-term diabetic foot complications contribute to premature mortality and increased morbidity. Proper knowledge of diabetic foot complications and good foot care practices may help mitigate the long-term burden of diabetic foot complications in Mauritius in particular and Africa in general. The main objective of this study was to evaluate the awareness of long-term diabetic foot complications and practice of proper foot care among people living with DM in Mauritius.

Methods: a cross-sectional study was conducted among people living with Diabetes Mellitus (DM) attending Non-Communicable Disease (NCD) clinics at Dr. Abdool Gaffoor Jeetoo Hospital (regional hospital), Mauritius and its nearby primary healthcare centers, which serve a majority of the urban and semi-urban population.

Results: the study showed good knowledge about diabetic foot complications and average foot care practicing among the participants. A significant positive correlation between knowledge and practice scores (r = 0.477, p < 0.05) was found, indicating that increased knowledge was associated with better foot care practices. There was a significant negative association between practice score and glycaemic control (r= -0.311, p< 0.001) as well as a negative association between knowledge score and HbA1c. (r=-0.226, p<0.001). It can be deduced that people living with DM with controlled HbA1c had better knowledge about diabetic foot complications and practiced good foot care. The work status of a patient with DM had a significantly better coefficient on knowledge score OR 7.534 [1.392-40.779]. This was found to be statistically significant (p < 0.05). This implies that as the work status of people living with diabetes mellitus improves, the person is 7.534 times more likely to have improved knowledge of diabetic foot complications.

Conclusion: despite having good knowledge on long-term diabetic foot complications, the participants did not practice proper foot care, which could be a result of a lack of education on foot care among people living with DM or a lack of motivation from healthcare professionals, relatives and friends.

The prevalence and severity of late postnatal anaemia amongst women at the Buea and Limbe Regional Hospitals in Cameroon

Nancy Labu Nji — 2026-04-17

Introduction: late postnatal anaemia is not routinely investigated in lower-middle and low-income countries. Hence, it remains undiagnosed and untreated. There are quality of life, morbidity, and mortality implications of anaemia in this period. The objective of this study was to determine the prevalence, severity, and factors predisposing to late postnatal anaemia amongst women in the Buea Regional Hospital (BRH) and the Limbe Regional Hospital (LRH), Cameroon.

Methods: a cross-sectional study amongst 355 women between the 6^th to 27^th week postpartum was conducted. Data collection using a structured questionnaire and capillary hemoglobin (Hb) was measured with the Sejoy® Hemoglobinometer. Late postnatal anaemia was defined by a Hb < 12g/dl between the 6^th to 27^th week postpartum. The prevalence of anaemia was calculated as the proportion of women with a haemoglobin level less than 12g/dl in the LPNP concerning the total population of women studied. The severity of anaemia was categorized into mild, moderate, and severe. The relationship between late postnatal anaemia (LPNA) and predictor variables was analyzed by the binary logistic regression method for odds ratios and p-values. Data analysis using SPSS version 23 with statistical significance set at a p-value < 0.05 at a 95% confidence interval.

Results: there were 109 women out of the 355 participants with anemia, giving a prevalence of 30.7%. A majority of whom had mild and moderate anemia, that is 61 (56%) and 46 (43.1%) respectively, with only 1 (0.9%) participant with severe anemia. Level of education (p= 0.030), trimester of commencing antenatal care consultations (p=0.001), prenatal anemia (p=0.003), the baby’s birth weight (p= 0.047), and mucocutaneous pallor (p<0.001) were significantly and independently associated with late postnatal anemia.

Conclusion: late postnatal anaemia is relatively common in this study setting, demonstrating a prevalence of 3 in 10 women affected. However, most cases are with mild to moderate anaemia. Determinants found were a low level of education, late commencement of antenatal care, prenatal anaemia, and mothers with low-birth-weight babies, plus mucocutaneous palor.

Unveiling dengue fever prevention and control strategy in Ethiopia: a policy landscape analysis

Chalachew Sisay — 2026-04-17

Introduction: dengue fever is an emerging mosquito-borne viral disease in Ethiopia. To sustainably address its incidence and impact, a strong policy framework is essential for enhancing prevention and control efforts. This study aimed to explore existing operational policies and identify the facilitators and barriers to implementing tailored, country-specific strategies.

Methods: the study employed a mixed-methods design. A desk review analysis, utilizing the policy triangle framework, examined existing operational policy documents, analyzing their content, context, actors, and processes. Additionally, eight key informant interviews were conducted with stakeholders, leading to the development of a thematic analysis based on the study objectives.

Results: six dengue fever prevention and control policy documents were identified. Two from the Ministry of Health and four from the Ethiopian Public Health Institute lacked details regarding target populations, geographic areas, risk levels, and the focus of interventions across different contexts. A qualitative review revealed that the lack of tailored, country-specific intervention strategies, the absence of dedicated programs, and insufficient budget allocation to dengue fever prevention and control. Furthermore, collaboration among ministries and health stakeholders was poor, and the application of operational research was limited.

Conclusion: the identified gaps emphasize the urgent need for a comprehensive strategy to address dengue prevention and control. This involves developing tailored, country-specific intervention strategies and establishing a dedicated dengue program with sufficient resources. Robust early warning surveillance systems, coupled with strengthened intra- and inter-sectoral collaboration, are crucial for coordinated dengue fever control. Implementing cost-effective, locally adapted integrated vector management strategies, guided by a one health approach.

Diagnostic and therapeutic challenges of a heparin-induced thrombocytopenia in HIV immunodeficiency: in regards to a pediatric case (a case report)

Mouna Zouine — 2026-04-17

We are dealing with a female infant case who had a cerebral venous thrombosis, revealing a secondary immunodeficiency, owing to a human immunodeficiency virus infection. After anticoagulant treatment with low-molecular-weight heparin (LMWH), it came to light that she had a severe thrombocytopenia, suggesting a thrombocytopenia induced by an auto-immune origin of heparin. Within a developing country in which means of confirmation are not always available, it was difficult to identify whether severe thrombocytopenia was owing to HIV infection, sepsis, or heparin. The therapeutic decision was therefore difficult, because stopping anticoagulation can lead to a cerebral thrombosis extension.

Parental acceptance of human papillomavirus vaccine for female adolescents in Abia State, southeastern Nigeria: a pre-implementation study

Chidinma Ihuoma Amuzie — 2026-04-17

Introduction: cervical cancer is the second most common cancer amongst women in Nigeria, with an incidence rate of 26.2 per 100,000 and mortality rate of 14.3 per 1000 adult women. Vaccination is the primary prevention if initiated prior to Human Papillomavirus (HPV) infection. However, vaccine hesitancy remains a threat to the uptake of the HPV vaccine. This study identified the pattern and predictors of parental acceptance of HPV vaccines for their female adolescents in Abia State, Nigeria prior to state level introduction.

Methods: we conducted a community-based cross-sectional study between August and September 2023 among parents of female adolescents residing in Abia State. A multistage sampling technique was used to select the study respondents. An interviewer-based, semi-structured questionnaire was administered to the respondents. Analysis was done using IBM SPSS version 26. Univariate analysis was used to present the socio-demographic characteristics of the respondents in frequencies and proportions. The association between parental acceptance and the independent variables was assessed using the chi-square test. Logistic regression was used to identify the independent predictors of parental acceptance of HPV vaccination. The level of significance was 5%.

Results: a total of 1,016 respondents participated in this survey, with a mean age of 42.2 ± 10.5 years. The prevalence of parental HPV vaccine acceptance was 63.0% (95% CI: 59.8 - 66.0). The major sources of information on the HPV vaccine were the healthcare workers (43.0%) and social media (37.8%). Among respondents who would accept the HPV vaccine for their female adolescents, the commonest reason was for the prevention of HPV transmission (58.3%). Most of the respondents who declined willingness reported lack of information (63.9%), followed by fear of adverse effects (32.9%) as the triggers for non-acceptance of the vaccine. The most preferable source of HPV vaccine recommendation mentioned by the respondents were healthcare workers (92.7%). Female (aOR=1.44, 95% CI: 1.02 - 2.03), good knowledge of HPV infection (aOR=2.87, 95% CI: 1.82 - 4.53) and good knowledge of HPV vaccine (aOR=18.52, 95% CI: 10.52 - 32.61) were the predictors of HPV vaccine acceptance.

Conclusion: prior to the introduction of HPV vaccine into the routine immunization of Abia State, Nigeria, most parents surveyed indicated that they would accept HPV vaccine for their female adolescents. Sex, knowledge of HPV infection and HPV vaccine were the independent predictors of parental acceptance of HPV vaccine. We recommend the raising of awareness campaign on HPV vaccine benefits and safety, prioritizing healthcare workers and the social media as the major channels of communication to support HPV vaccination.

Prévalence et facteurs associés à l´hyperuricémie au cours du diabète de type 2 en milieu hospitalier Dakarois (Sénégal)

Ngoné Diaba Diack — 2026-04-17

Introduction: l'hyperuricémie augmente la morbi-mortalité cardiovasculaire au cours du diabète de type 2 (DT2). L'objectif de cette étude était de déterminer la prévalence de l'hyperuricémie asymptomatique dans une population de diabétique de type 2 ainsi que ses déterminants.

Méthodes: il s'agissait d'une étude transversale menée au Centre Hospitalier National de Pikine et au Centre Hospitalier Abass Ndao (Dakar, Sénégal). Elle concernait des diabétiques de type 2 suivis en ambulatoire sans antécédents et/ou symptomatologie de goutte. Des prélèvements à jeun étaient effectués pour le dosage des paramètres métaboliques (acide urique, HbA1c, exploration lipidiques, magnésémie).

Résultats: nous avions inclus 90 patients. Les patients étaient âgés en moyenne de 59,6 ± 8,8 ans. Il s'agissait de 24 hommes et 66 femmes. Le diabète évoluait depuis 5 ans en moyenne avec une médiane d'HbA1c à l'inclusion à 7,2%. La prévalence de l'hyperuricémie était de 31,1% (n=28). Après analyse multivariée, les facteurs indépendamment associés à l'hyperuricémie étaient le sexe masculin (odds ratio ajusté ORa: 3,9, IC à 95%: 1,3-12,1; p=0,015), un DFG inférieur à 60ml/min (ORa: 7,7, IC à 95%: 1,2-48,3; p=0,029). Une corrélation positive et significative était retrouvée entre le taux de triglycérides et l'uricémie (r=0,5; p< 0,001). La magnésémie était inversement corrélée à l'uricémie (r=-0,3; p=0,051).

Conclusion: l'hyperuricémie est fréquente chez les diabétiques de type 2. Il est nécessaire de la dépister en particulier chez le sujet de sexe masculin, présentant une altération de la fonction rénale et/ou une hypertriglycéridémie.

Epidemiological characteristics and pathogen profiles of non-Escherichia coli gram-negative urinary tract infections in pregnant women: insights from Makassar, Indonesia

Kadri Rusman — 2026-04-17

Introduction: urinary tract infections (UTIs) during pregnancy pose significant health risks for both mother and fetus. While Escherichia coli is the most common causative agent, non-Escherichia coli gram-negative bacteria also contribute to UTIs, with their specific prevalence and characteristics in pregnant women needing further elucidation, particularly in local contexts. This study aimed to identify gram-negative non-Escherichia coli bacteria causing UTIs in pregnant women and to determine their epidemiological characteristics in Makassar, Indonesia.

Methods: a cross-sectional study was conducted at the Clinical Microbiology Laboratory of Hasanuddin University Hospital, Makassar, from July to August 2024. The study utilized 38 non-Escherichia coli bacterial isolates from urine cultures of pregnant women diagnosed with UTIs at various community health centers. After re-culturing on MacConkey Agar, bacterial identification was performed using the API 20e system. Epidemiological data were collected from medical records and questionnaires.

Results: among 38 non-Escherichia coli isolates, Enterobacter cloacae was most prevalent (34.2%), followed by Klebsiella pneumoniae spp. pneumoniae (23.7%). Most isolates (76.3%) were lactose fermenters. Epidemiologically, the 25-34 age group dominated (71.0%), with the highest UTI incidence in first pregnancies (47.4%) and the second trimester (44.7%). Significantly, 97.4% of pregnant women with UTI symptoms did not seek treatment.

Conclusion: Enterobacter cloacae is the most common non-Escherichia coli gram-negative UTI bacterium in this Makassar cohort. Key epidemiological characteristics were elucidated, revealing a substantial proportion of women not seeking treatment for UTI symptoms. These findings underscore the importance of local surveillance and targeted health education interventions for pregnant women regarding UTI management.

Le syndrome de Cushing paranéoplasique chez le jeune adulte, une entité rare avec un réel challenge diagnostic: à propos d'un cas

Ghizlane Sabbar — 2026-04-17

Le syndrome de Cushing paranéoplasique est une cause rare du syndrome de Cushing ACTH-dépendant, rarement observée chez le jeune adulte, et pose souvent le problème de diagnostic étiologique. Nous rapportons le cas d'une jeune patiente de 16 ans, qui a présenté un tableau d'hypercorticisme sévère sans diagnostic étiologique initialement, d'où l'aggravation de son tableau clinique menant à la réalisation d'une surrenalectomie bilatérale de sauvetage. La pathologie tumorale en cause a été diagnostiquée plusieurs mois après grâce à l'imagerie fonctionnelle. La patiente a bénéficié d'une exérèse chirurgicale avec une nette amélioration. Notre cas illustre à la fois une forme rare du syndrome de Cushing ACTH dépendant, ainsi que l'âge très jeune de sa survenue, et montre la difficulté d'établir un diagnostic étiologique précis, ce qui nécessite souvent l'utilisation de technique d'imagerie plus poussée.

Clinical features and natural history of pelvic organ prolapse in South Kivu (Eastern DRC): a cross-sectional study

Eloge Ilunga-Mbaya — 2026-04-17

Introduction: pelvic organ prolapse, a common condition, is a real public health problem in developing countries. Its anamnestic and clinical features may present particularities in these environments. The objective of this study was to assess when women present for treatment and the reasons for delay in seeking care. The authors also describe the clinical particularities of prolapse in the East of the Democratic Republic of Congo.

Methods: a cross-sectional study conducted on 217 women with pelvic organ prolapse consulting for the first time. Descriptive statistics and logistic regression were performed to describe clinical features and determinants of delay in seeking care.

Results: the mean age was 46.38±14.12. Women under the age of 41 represents a third of the population or 36.4%. Young people (18-30 years old) represented 16.6%. Mechanical symptoms were the main reasons for consultation (63.1%) followed by sexual disorders (21.2%). Half of the population had a lateral cystocele (50.5%) followed by medio-lateral cystocele (32.1%). The average duration of symptoms was 6.67±6.85 years. The farming profession proved to be a determinant of consultation delays with adjusted Odds ratio « aOR » 3.10, 95% Confidence interval « CI », 1.055-3.481 (aOR: 3.10, 95% CI 1.055-3.481; p=0.017) and urban residence a protective factor (aOR: 0.48, 95% CI 0.24-0.97; p=0.04).

Conclusion: prolapse affects women of all ages but especially a large proportion of young people in genital activity. The clinic of pelvic organ prolapse in our environment can present particularities and the time is long between the first symptoms occurrence and the decision to consult. Delays in consulting are essentially linked to the profession of farmer and the fact of residing in town is a protective factor for late consultations.

Epidemiology and clinical outcomes of advanced maternal age: a cross-sectional study at Saint-Joseph Hospital and the University Clinics of Kinshasa in the Democratic Republic of Congo

Antoine Tshimbundu Kayembe — 2026-04-17

Introduction: advanced maternal age is defined as women aged 35 years or older at the estimated date of delivery based on the woman's physiology. Pregnancies at this maternal age are at risk for adverse obstetric outcomes. The objective is to determine the epidemiological and clinical profile of elderly mothers at Saint-Joseph Hospital and the University Clinics of Kinshasa in the Democratic Republic of Congo.

Methods: this is a cross-sectional study of a series of records of elderly mothers who were followed and gave birth in the maternity wards of Saint-Joseph Hospital and the University Clinics of Kinshasa from January 1, 2018, to December 31, 2022, using non-probability convenience sampling for case selection. Descriptive analyses were performed in the statistical analyses.

Results: the birth rate among advanced mothers was 28.7% with their average age of 38.65 (SD: 2.64) years, housewives, married mothers and those with university education were present respectively in 62.78%, 95% and 49.75% of cases, their average parity was 3.69 (SD: 1.96) deliveries and primiparous mothers were present in 43.2% of cases. The spontaneous abortion´s history was present in 43.2% of cases, scarred uterus history in 29.61% of cases, pregnancy-induced hypertension´s history in 6.1%, and pre-eclampsia´s history in 2.53% of cases. The advanced maternal age was significantly associated with the occurrence of pre-eclampsia (aOR: 3.5, 95% CI: 1.3-9.5, p=0.002), pregnancy-induced hypertension (aOR: 2.3, 95% CI: 1.7-7.8, p=0.012), prematurity (aOR: 2.7, 95% CI: 1.4-5.0, p=0.001), low birth weight (aOR: 2.5, 95% CI: 1.1-63, p=0.002) and admission to neonatal unit (aOR: 2.5, 95% CI: 1.0-6.3, p=0.020).

Conclusion: the pregnancy in mothers with advanced maternal age is a real public health problem, primiparas with university education, married women, and housewives with a history of spontaneous abortion and scarred uterus are more affected. Adverse obstetric outcomes include preeclampsia, pregnancy-induced hypertension, prematurity, low birth weight, and admission to the neonatal unit.

Ovarian relapse in a child with B-ALL: a case report

Meriem Cheikhna — 2026-04-17

This case presents an 8-year-old girl diagnosed with B-cell acute lymphoblastic leukemia (B-ALL), who relapsed after 3 years of treatment and 1 year of complete remission, with an unusual extramedullary relapse in the ovary. Ovarian relapse of B-ALL is extremely rare in children, making this case noteworthy in scientific literature. The patient had an initial diagnosis of B-ALL with a deletion of chromosome 12, a genetic alteration previously associated with the ETV6-RUNX1 fusion gene, which is typically linked to a favorable prognosis but also carries a 20% risk of late relapse. The relapse was initially asymptomatic and went undetected until clinical symptoms of pelvic pain appeared. Imaging with pelvic ultrasound confirmed the ovarian involvement. The relapse was treated with standard chemotherapy protocols for B-ALL, resulting in a partial response. This case underscores the importance of considering extramedullary relapse in the differential diagnosis for pediatric ALL patients who present with atypical symptoms after remission. It also suggests that routine pelvic ultrasound could be a useful tool for early detection of ovarian and other extramedullary relapses, which are often associated with bone marrow relapse. The main take-away from this case is the necessity for vigilant follow-up, including targeted imaging, in ALL patient's post-remission to ensure early identification of extramedullary relapses, which can otherwise be easily overlooked. The presence of chromosome 12 deletion and its association with late relapse highlights the need for ongoing surveillance even in patients with initial favorable genetic abnormalities.

Clinical predictors and antibiotics sensitivity of bacterial pathogens of pharyngotonsillitis among children aged 1-17 years in a Tertiary Hospital, Abakaliki, Southeast, Nigeria

Sunday Ogo Nweke — 2026-04-17

Introduction: clinical presentations that possibly predict bacterial pharyngotonsillitis are invaluable in early institution of care, so as to reduce morbidity from the disease. This is augmented by knowledge of antibiotic sensitivity pattern of the commonly isolated pathogens in the locality. The study was aimed at determining the relationship between clinical presentations and laboratory diagnosis of bacterial pharyngotonsillitis and to determine the antibiotics susceptibility pattern of the isolates.

Methods: a hospital-based descriptive cross-sectional study was carried out over period of seven (7) months from 3^rd November, 2020, to 28^th May, 2021. The participants were consecutively recruited. Structured questionnaire was used to obtain information on socio-demographics of the participants. Throat swabs were taken from participants and sent to Medical Microbiology Research Laboratory of Alex Ekwueme Federal University Teaching Hospital, Abakaliki for microscopy, culture and sensitivity. Descriptive statistical analysis was used to determine frequencies and percentages. Univariate analysis was used to find any association between dependent variable and independent variables.

Results: of the 150 participants that were recruited, 58.7% were males, giving a male-to-female ratio of 1.4:1. The median age of participants was 5.0 years with an interquartile range of 3-8 years. Bacterial isolates were noted in 54 (36%). There was an overlap between the clinical features seen in participants with positive bacteria culture and those seen in negative (sterile) culture. The positive predictive values using clinical features to predict pharyngotonsillitis of bacterial origin were low. Most of the isolated organisms were more susceptible to cephalosporins (ceftriaxone and cefuroxime) than the penicillin (penicillin V and amoxicillin clavulanate).

Conclusion: an overlap observed between the clinical presentations of the participants with positive throat culture and those without in this study makes clinical features unreliable in predicting pharyngotonsillitis of bacterial origin. Hence routine throat swab for bacteriology culture should be done for all children presenting with features suggestive of pharyngotonsillitis before commencement of antibiotics. However, where such services are not readily available, the use of cephalosporins empirically is recommended.

Mothers' intentions to discuss menstruation-related topics with their daughters using the theory of planned behavior

Alemi Kebede Olika — 2026-04-17

Introduction: there is a scarcity of research on mothers' intentions to engage in communication about menstruation-related topics with their daughters in Ethiopia. Therefore, the purpose of this study, which was based on the theory of planned behavior, was to investigate the characteristics that are linked to mothers' intentions to discuss menstruation-related topics with their daughters.

Methods: between July 5-25, 2022, 390 mothers of adolescent girls aged 10 to 19 were selected as a sample and participated in the study.

Results: a regression analysis revealed a strong association between mothers' intentions to discuss menstruation with their daughters and all three theory of planned behavior (TPB) components-attitudes, subjective norms, and self-efficacy. Self-efficacy was the factor that was significantly linked to greater intentions to discuss menstruation, followed by the attitude that mothers have about menstrual communication.

Conclusion: these findings support the assumptions of the TPB as applied to mother-daughter menstrual health communication. These findings suggest that building self-efficacy and helping mothers feel responsible for educating their daughters about menstruation would be most important in attempting to increase mothers´ intentions to engage in mother-daughter communication on a wide variety of topics. Therefore, funding for parent-targeted programming should be allocated to increase parents' intentions to engage in mother-daughter communication. This programming should focus on helping mothers develop self-efficacy and a sense of responsibility for educating their daughters about multiple sexual and reproductive topics, including menstruation.

Seroprevalence and persistence of humoral immunity in response to SARS-CoV-2 vaccination and mild infection in Morocco: a cross-sectional study

Nouhaila Najimi — 2026-04-17

Introduction: assessing the seroprevalence and persistence of humoral immunity through population-based serological surveys is crucial for predicting reinfection risk and optimizing vaccination strategies. In Morocco, a mass vaccination campaign against SARS-CoV-2 has been launched to achieve herd immunity and reduce virus transmission. This study evaluated the humoral immune response to the BBIBP-CorV and ChAdOx1 nCoV-19 vaccines in healthy donors with varying doses and infection histories.

Methods: IgG levels were measured via Vircell COVID-19 ELISA, and NAb levels were assessed via the GenScript Surrogate Virus Neutralization Test (sVNT). The study included individuals with different vaccination doses and prior infection histories.

Results: the third vaccine dose produced the highest IgG titers, while nonvaccinated individuals and those receiving two doses had lower levels. Prior SARS-CoV-2 infection led to increased antibody levels, suggesting that hybrid immunity offers prolonged protection. The highest NAb titers were observed in individuals receiving three doses, with 96% of nonpreviously infected individuals being positive for NAb. Risk factor analysis indicated that prior infection (OR = 8.64, 95% CI: 2.52-29.6, p < 0.001) and three doses (OR = 22.1, 95% CI: 2.74-178, p < 0.001) increased immunity.

Conclusion: hybrid immunity, involving prior infection and full vaccination, offers enhanced and longer-lasting protection. These results support the need for targeted vaccination strategies to optimize immunity and reduce the risk of adverse outcomes, especially in high-risk populations.

Semen quality of male partners of infertile couples attending a private specialist infertility hospital in Kumasi, Ghana: a retrospective descriptive analysis

John Jude Annan — 2026-04-17

Introduction: since the establishment of the fertility center in 2014, no review has been conducted on the pattern of semen abnormalities. This study was therefore aimed at evaluating the range of semen abnormalities in our patient population.

Methods: this was an ethically approved retrospective descriptive study that retrieved and analyzed the semen analysis results of male partners of infertile couples, over a six-year period since the establishment of the fertility center. All data were entered into a Microsoft Excel spreadsheet and transported to R-statistical software version 3.4.2 for statistical analysis. Mean ± standard deviation (SD) was calculated for age, semen pH, volume, concentration, and motility. Categorical variables were represented by frequency (N) and percentages (%). The Chi-square test was used to determine age groups and calendar year´s association with seminal fluid characteristics. Statistical significance was set at p<0.05.

Results: there were 1,224 eligible semen results with a mean age of 39.6 (SD 8.1) and a range of 21-78 years. More than half (56.7%) were very young (less than 40 years). Age group 30-39 had the highest number of clients, 622 (50.8%). The rate of abnormal semen quality was 36%. The most common semen abnormalities were oligospermia 30.5%, teratozoospermia 28.8%, asthenozoospermia 27.3%, hyperviscous semen 18.5%, and hypospermia 20.1%. The mean (SD) of semen volume and sperm concentration differed significantly between the age groups, with a p-value of 0.0000341 for semen volume and a p-value of 0.01 for sperm concentration.

Conclusion: the most common semen abnormalities were oligospermia, teratozoospermia, asthenozoospermia, hyperviscous semen, and hypospermia, with the rate of abnormal semen quality being 36%. Younger men are seeking fertility treatment with their partners.

Ewing family tumors of soft tissue: a case report

Anass Haloui — 2026-04-17

The Ewing family tumors (EFT) of soft tissue represent a spectrum of neoplasms of uncertain histogenesis, arising in soft tissue without bone involvement. They include Extraskeletal Ewing Sarcoma and Primitive Neuroectodermal Tumor. These tumors are morphologically indistinguishable from Ewing sarcoma of the skeletal system. Known to be translocation-associated neoplasms, they share a common non-random translocation leading to the fusion of the EWSR1 gene on the 22q12 region, with one of the many members of the ETS family of transcription factors. Occurring mainly in adolescents and young men under the age of 30, EFT´s may arise virtually anywhere, but are most common in deep soft tissues of the extremities. The purpose of this work is to report a rare case of an EFT arising in the upper arm of a 14-year-old boy, who presented with a painful right arm mass evolving for 6 months, while highlighting the main histological, immunohistochemical and molecular features of this rare condition, along with an original flow chart of a relevant diagnostic approach for differential diagnosis.

Evaluation of two methods for detecting anti-A and anti-B hemolysins in blood donors: a prospective study in Abidjan

Amah Patricia Victorine Goran-Kouacou — 2026-04-17

Introduction: anti-A and anti-B hemolysins are IgG antibodies capable of causing intravascular hemolysis during non-ABO-identical transfusions, particularly with plasma-rich components. Their identification in blood donors is crucial for transfusion safety. This study aimed to compare the performance of indirect agglutination and functional hemolysis assays in detecting these antibodies.

Methods: we conducted a prospective comparative study involving 300 voluntary blood donors recruited at Cocody University Hospital between January and March 2025. Each sample was tested using two parallel methods: (1) an indirect agglutination assay performed after thermal inactivation of IgM antibodies; and (2) a functional hemolysis test employing guinea pig complement. Hemolysin titers were considered significant if ≥32 for agglutination or ≥8 for hemolysis. Multivariable logistic regression analysis was used to identify independent factors associated with a positive hemolysis test result.

Results: agglutination detected 54 positive cases (18.0%), and hemolysis identified 30 cases (10.0%). Significant titers were found in 7.4% (agglutination) versus 60.0% (hemolysis) of positive cases. Approximately 70% of positive donors were blood group O with either method. Overall concordance between methods was 92% (κ = 0.67). The agglutination method had 100% sensitivity and 91.1% specificity. A history of pregnancy was the only factor significantly associated with a positive hemolysis test (adjusted odds ratio = 2.77; 95% CI: 1.08-7.14; p = 0.033).

Conclusion: the functional hemolysis test more specifically identifies antibodies with potential transfusion risk. In resource-limited settings, targeted screening based on ABO group, antibody titers, and donor immunological history (especially pregnancy) could improve transfusion safety.

Ovarian hyperstimulation revealing a functional gonadotroph adenoma: a case report

Amel Rahal — 2026-04-17

We report the case of a functional gonadotropic adenoma (FGA) in a 32-year-old woman, initially revealed by ovarian hyperstimulation. Hormonal investigations strongly suggested an FGA; pelvic ultrasound revealed macrofollicular ovarian enlargement. Despite a clear clinical picture, diagnosis was delayed until the appearance of cranial tumor syndrome with ophthalmological impairment and pituitary dysfunction. The ophthalmological emergency necessitated urgent surgery, allowing both decompression of the optic pathways and a reduction in hyperestrogenism. Despite their rarity, it is essential to recognize FGA to avoid potentially fatal complications.

Assessment of environmental surveillance for the detection of poliovirus implementation in the metropolitan districts of South Africa, 2020-2023

Daudi Manyanga — 2026-04-17

Introduction: South Africa began using environmental surveillance (ES) in July 2019 to supplement acute flaccid paralysis surveillance. A study is evaluating sites in eight metropolitan health districts for performance improvement and expansion of ES within and across neighbouring countries.

Methods: we conducted a descriptive analysis of secondary ES to detect poliovirus supplemented with qualitative field visits and focused group discussions at 16 ES sites in the eight metropolitan districts of South Africa. The study covered data from January 2020 to December 2023, and tests were conducted to examine the relationship between practices and laboratory results.

Results: in 2021, the National Institute for Communicable Diseases (NICD) Laboratory received 567 ES samples for poliovirus detection, with 97.9% arriving within 72 hours of collection. Monthly sampling increased from 102 (18%) in 2020 to 184 (32.5%) in 2021, showing a 14.5% change with a p-value of 0.0085. There was no statistically significant difference in enterovirus isolation rates between sites trained virtually and in person in the long term, with a 16.5% difference and a p-value of 0.0977. Some ES sites showed high enterovirus isolation rates despite not having specific peak hours, suggesting operational variability in densely populated cities and other areas.

Conclusion: the ES assessment in South Africa has made progress in identifying enteroviruses at all sites. However, irregularities in monthly sampling and peak hours for sample collection need attention. The study suggests using a similar training approach in areas with accessibility challenges and updating guidelines with special consideration for major cities.

Multilocus sequence type analysis of coagulase-negative staphylococci from the neonatal intensive care unit of a teaching hospital in Ghana

Innocent Afeke — 2026-04-17

Introduction: coagulase-negative staphylococci (CoNS) have emerged as significant pathogens in neonatal intensive care units (NICUs), especially as a leading cause of neonatal sepsis. In low-income countries, efforts to prevent sepsis-related mortality are hampered by a lack of comprehensive molecular data on bacterial isolates responsible for these infections. This study aims to address this gap by generating whole-genome sequencing data, identifying novel multilocus sequence (MLS) types, and investigating antibiotic resistance genes in Staphylococcus epidermidis and Staphylococcus haemolyticus from the NICU of Ho Teaching Hospital in Ghana.

Methods: a total of 123 CoNS isolates were tested for minimum inhibitory concentrations (MIC) of 13 antibiotics using VITEK2, and 16 isolates (7 S. epidermidis and 9 S. haemolyticus) were selected for further genomic analysis. Genomic DNA was extracted and sequenced using an Illumina NovaSeq 6000 platform. Draft genome sequences were assembled using MEGAHIT and annotated with Prokka. MLS types were identified using the Center for Genomic Epidemiology´s MLST tool, and antibiotic resistance genes were detected via the Comprehensive Antibiotic Resistance Database (CARD) and BlastArg-annot Nt tools.

Results: draft genome sequences were established for 7 S. epidermidis and 9 S. haemolyticus isolates and deposited in public databases. Five novel MLST types were discovered: ST89, ST90, and ST91 for S. haemolyticus, and ST993 and ST994 for S. epidermidis. These novel strains exhibited multidrug resistance, with multiple antimicrobial resistance genes identified in their genomes. Three of the newly identified MLST types were isolated from the blood of neonates, while two others were found on the nasal mucosa of clinical staff and a baby cot.

Conclusion: our findings highlight the presence of multidrug-resistant and novel CoNS MLST types in the NICU, suggesting an urgent need for a nationwide database on CoNS MLST types circulating in Ghana. Such data would be critical for developing informed public health policies and strategies to manage neonatal sepsis in the Region.

Épidémiologie des troubles du sommeil en milieu rural au nord du Bénin en 2022

Mendinatou Agbetou — 2026-04-17

Introduction: les troubles du sommeil sont variés et de plus en plus fréquents chez les sujets africains, mais leur réelle prévalence est peu connue sur le continent. L´objectif de cette étude était de déterminer la prévalence des troubles du sommeil et les facteurs associés à la qualité du sommeil en milieu rural à Nikki au Bénin en 2022.

Méthodes: il s'est agi d'une étude transversale à visée analytique réalisée chez les sujets âgés d'au moins 18 ans dans la commune de Nikki en 2022. La sélection des patients a été effectuée par sondage aléatoire à deux degrés. Les troubles du sommeil ont été diagnostiqués sur la base d'échelles validées telles le Pittsburg Sleep Quality Questionnaire, le Questionnaire de Berlin, le Score d'Epworth, le Restless Legs Syndrome Questionnaire, l'Index de Sévérité de l'Insomnie et le Munich Parasomnia Screening Questionnaire.

Résultats: au terme de l'étude, 879 participants ont été inclus. Une prédominance féminine a été observée avec un sex ratio (F/H) de 1,9. La qualité du sommeil était mauvaise chez 52,21%. La prévalence de l'insomnie était de 9,44%, celle du syndrome des jambes sans repos de 21,39% et 21,16% pour la somnolence diurne. Un syndrome d'apnée du sommeil était présent chez 2,50% des participants. Le sexe masculin et le tabagisme actif étaient associés à la mauvaise qualité du sommeil avec respectivement p=0,03 et p=0,021.

Conclusion: les troubles du sommeil sont fréquents en milieu rural à Nikki, nécessitant des campagnes de dépistage de masse pour en réduire la charge.

Determinants of unmet family planning needs among women of reproductive age between 15 and 49 years in Siaya County, Kenya

Ruth Anyango Ameso — 2026-04-17

Introduction: unmet need for family planning is still a major public health issue, impacting maternal and child health outcomes. In Kenya, 14% of women desire to avoid or delay a pregnancy but are not using contraceptives. Unmet need differs across counties, with Siaya having a high unmet need at 21% despite the target to eliminate unmet need for family planning. This study sought to establish determinants of unmet family planning needs among Women of Reproductive Age (WRA) between 15 and 49 years in Siaya County, Kenya. Specifically, the study sought to address three specific objectives: to determine the level of unmet needs among WRA, socio-demographic characteristics of WRA, assess the level of knowledge on family planning and to determine attitudes towards family planning among WRA.

Methods: the study presents findings from the baseline phase of a larger quasi-experimental study design. It utilized a mixed research design. The study adopted the World Health Organization's 30 by 30 2-stage cluster sampling method. The FANTA sample size formula was applied to arrive at 724 respondents. A total of 728 women of reproductive age participated in the study. The study included sexually active WRA, married women, or women in a companion. The study targeted over 67,023 women already in such unions and sexually active, which served as the sampling frame for the study. The current study, being a baseline study, results after the health education intervention will be presented in another study. Results were presented in tables and figures. Ethical guidelines and procedures upheld during the study included informed consent, voluntary participation of participants, confidentiality, data security measures, assent for the minors, and usage of research licenses and approval from the ethics from the school. Data analysis was done using IBM SPSS version 28.0. The statistical analysis was undertaken in two steps: bivariate analysis and multivariate analysis.

Results: a total of 728 women of reproductive age participated in the study. The majority (45.2%) of the women were aged 25 to 34 years. Results showed that most (64.0%) of the women demonstrated a high level of knowledge, scoring 80% or above. However, only 2.7% had a low level of knowledge, with aggregate scores below 50%. The majority (75.5%) of the women had a positive attitude, with 24.5% having a negative attitude. The prevalence of unmet need was 52.7%. The proportion of unmet need was significantly more (COR = 1.61; 95%CI = 1.19 - 2.19; p = 0.002) among women with a low or moderate level of knowledge on family planning compared to those women with a high level of knowledge. Women aged 15 to 24 years were 3.43 times more likely to have unmet need for family planning compared to those aged 35 to 49 years (COR = 3.43; 95%CI = 2.23 - 5.26; p <0.001). Women with a negative attitude towards family planning had a significantly higher unmet need for family planning (COR = 1.53; 95%CI = 1.09 - 2.16; p = 0.015) compared to those women with a positive attitude.

Conclusion: the study concludes that social-demographic factors such as education, age, or economic activity significantly influenced the unmet needs for family planning. Knowledge significantly influenced the unmet needs for family planning, where WRA with lesser knowledge were more likely to experience unmet needs. Lastly, Attitudes such as perceived harm of using contraceptives and stigmatization from their use significantly increased the odds of unmet family planning needs.

Déterminants du refus de la vaccination contre le papillomavirus humain chez les parents des enfants de 9 à 14 ans au sein des ménages d'Aliodan en 2024, Côte d'Ivoire: étude transversale quantitative

Marie Noelle Ano Ama Kounangui — 2026-04-17

Introduction: l'étude réalisée dans le district sanitaire de Treichville dans les ménages du quartier d'Aliodan, situé dans l'aire de santé de Marcory d'Anoumabo en Côte d'Ivoire, visait à identifier les déterminants de refus de la vaccination contre le virus du papillome humain (VPH) chez les parents d'adolescentes âgées de 9 à 14 ans.

Méthodes: il s'agit d'une étude transversale de type analytique à collecte prospective. Une analyse univariée a été réalisée à l'aide des tests exacts KHI 2 et Fischer pour comparer des groupes de variables. Une régression logistique multivariée pas à pas descendante a été utilisée pour identifier les déterminants du refus à la valeur p=0,05.

Résultats: au total, 181 répondants ont été interrogés. Avec 62,98% de femmes contre 37,02% d'hommes avec un sex-ratio de 1,7. L'âge moyen était de 41,43 ± 11,19. Le taux de refus de la vaccination a été constaté chez 22,10% des enquêtés contre 77,90% qui n'avaient pas refusé de faire vacciner leurs enfants. Les déterminants du refus des parents des adolescents étaient liés aux parents ayant affirmé avoir scolarisé leurs adolescentes (p=0,0003; ORaj.= 0,1932; IC95%= [0,0795; 0,4693]), à l'origine ethnique étrangère (p=0,0106; ORaj.= 3,1636; IC95%= [1,3079; 7,6523]), aux parents sans appartenance religieuse (p=0,0002; ORaj.= 8,4600); IC95%= [0,7944; 3,9284]), à la difficulté d'accès aux transports (p=0,0111; ORaj.= 0,0534; IC95%= [0,0056; 0,5120]). Les sources d'information issues de la télévision ou des réseaux sociaux (p=0,0106; ORaj.=0,1322; IC95% = [0,0280; 0,624]).

Conclusion: les facteurs socioculturels et pratiques ont contribué au refus des parents du vaccin contre le virus du papillome humain (VPH). D'où la nécessité de renforcer la formation des professionnels et des leaders communautaires pour les campagnes de sensibilisation de masse.

Ankyloglossia unveiled: a clinical image highlighting the impact of tongue tie on oral mobility

Meenakshi Dagar — 2026-04-17

A 12-year-old male patient presented with complaints of being unable to speak properly since birth. Clinical examination showed the frenulum attaches at the tip of the tongue, limiting its ability to extend outward, restricted movement of the tongue, and the patient was not able to extend his tongue beyond his lower lip. His medical and family history was clear; his parents told him he also had difficulty breastfeeding during his breastfeeding days. On systemic examination, there was no sign of hypotonia, cerebral palsy, which may be responsible for restricted tongue movement. Differential diagnoses included macroglossia, submucosal cleft palate, Down syndrome, Pierre Robin Sequence, and Ehlers-Danlos Syndrome (EDS). Diagnosis was based on clinical presentation and exclusion of other conditions. Treatment involved surgical intervention, frenotomy, and then advice for speech therapy and maintaining oral hygiene.

Determinants of uterine synechiae at hysteroscopy: a case-control study in Kinshasa, Democratic Republic of Congo

Emmanuel Nzau-Ngoma — 2026-04-17

In most cases, synechiae originate from traumatic uterine procedures in a gravid or non-gravid uterus. The aim of this study was to identify determinants of uterine synechiae in a population of Kinshasa. A case-control study was conducted at the Endo-conception Clinic in Kinshasa, DRC, from March 1^st, 2018, to February 28^th, 2023. Cases were patients with uterine synechiae in hysteroscopy, and controls were patients with normal hysteroscopy. The comparison of proportions was made using the Pearson Chi-square test and Fisher's Exact. The Student's t-test was used to compare means whose variables were normally distributed and the comparison of the medians of parity and gravidity was made with the U Mann-Whitney test. The test was significant for a p-value < 0.05. A total of 223 patients with synechiae (cases) and 472 patients with normal hysteroscopy (controls) were collected. The mean age was 38.41 years ± 6.60 for cases and 36.91 years ± 6.86 for controls. Comparing cases to controls, history of curettage was present in 69.1% versus 37.3%, history of uterine surgery in 58.7% versus 35.6% and dysmenorrhea in 17.9% versus 8.9%. Factors associated with uterine synechiae were dysmenorrhea (aOR: 2.51, 95% CI 1.54 - 4.19; p=0.000), history of curettage (aOR: 3.32, 95% CI 1.97 - 5.60; p = 0.000) and uterine surgery (aOR: 2.96, 95% CI 2.08 - 4.21; p = 0.000). The findings demonstrate a notable frequency of uterine synechiae in patients with a history of curettage, uterine surgeries, and dysmenorrhea in cases compared to controls, identifying them as determinants of the condition.

Co-infection VIH-tuberculose pulmonaire aux cliniques universitaires de Lubumbashi: aspects épidémiologiques et cliniques

Patrick Mutombo Tshibang — 2026-04-17

Introduction: l´objectif de cette étude est de présenter un aperçu des caractéristiques épidémiologiques et cliniques de la co-infection VIH-Tuberculose pulmonaire aux cliniques universitaires de Lubumbashi.

Méthodes: il s´agit d´une étude descriptive transversale qui a porté sur l´analyse des dossiers de patients tuberculeux qui ont été hospitalisés au service de médecine interne de cliniques universitaires de Lubumbashi, dans le sud-est de la République démocratique du Congo, au cours de l´année 2019.

Résultats: la co-infection VIH-tuberculose a concerné 37 patients sur un total de 66 ayant été colligés (56,0%). La tuberculose du patient infecté par le VIH en comparaison avec celle du patient non infecté, dans notre série, était caractérisée par une relative prédominance des patients d´âge supérieur ou égale à 40 ans (56,8% vs 34,4%, p=0,004), du sexe féminin (78,9% vs 46,8%, p=0,01), de cas de récidive (37,8% vs 27,5%), et de l´antécédent de diabète sucré (8,1% vs 3,4%). Un peu plus du tiers des coinfectés, soit 37,4%, provenaient des quartiers périphériques de la ville de Lubumbashi, caractérisés pour la plupart d´entre eux par une conjoncture socio-économique défavorable. Les formes à microscopie négative, donc sans confirmation bactériologique, étaient les mieux représentées parmi les co-infectés (48,6% vs 34,4%). Le taux de décès à l´issue de l´hospitalisation a été de 13,5% chez les co-infectés. Il était associé aux facteurs ci-après: la tuberculose à microscopie positive (21,0% vs 5,5%), le sexe masculin (18,1% vs 6,6%), le diabéte sucré (33,3% vs 11,7%) et l´âge supérieur à 40 ans (19,0% vs 6,2%).

Conclusion: la co-infection VIH-tuberculose pulmonaire est donc une situation fréquente en hospitalisation aux cliniques universitaires de Lubumbashi avec un profil épidémiologique et clinique marqué par la présence de facteurs pouvant impacter négativement son pronostic à court terme.

Utilization of health management information systems for decision making among healthcare professionals in Ketu North Municipality, Ghana: a descriptive cross-sectional study

Victor Zeng — 2026-04-17

Introduction: Health Management Information System (HMIS) helps provide evidence-based decision-making, policy planning and adequate use of resources in the health system. The health system collects data but using it for decision making at the lower level remains a challenge. This study assessed the utilization of HMIS by sub-district health staff in Ketu North Municipality.

Methods: a descriptive cross-sectional study was conducted among 219 health workers in six sub-municipalities using a structured questionnaire. Data was analyzed using SPSS Version 25 to determine association using Pearson's Chi-square/Fisher´s exact test. Multivariable logistic regression was used to identify factors associated with HMIS utilization.

Results: healthcare workers who were given feedback on the data collected were 3.91 times likely to utilize HMIS for decision making compared to those who did not receive feedback (aOR: 3.91, 95% CI:1.63 - 9.38, p=0.002). Healthcare workers who had low knowledge on HMIS were 2.56 times more likely to utilize HMIS for decision making compared to those healthcare workers with high knowledge on HMIS (aOR: 2.56, 95% CI: 1.04-6.31, p=0.041).

Conclusion: the study revealed that healthcare professionals have limited knowledge on the use of HMIS. HMIS utilization was not affected by health facility type, employee category, or access to HMIS. Also, the study observed that health professionals who had access to feedback were more likely to utilize the information for decision-making purposes. Continuous training is recommended for healthcare staff to improve HMIS utilization.

Metabolic/bariatric clinical practice in Lagos, Nigeria: a retrospective review of the cases and outcomes of our 10-year experience

Abuchi Okaro — 2026-04-17

Obesity is recognized as a major public health hazard, as it is linked to multiple chronic diseases. Globally, metabolic or bariatric surgery has been proven to be a safe and effective treatment for obesity, yet access to metabolic or bariatric surgery in Nigeria, West Africa continues to be limited. This study reviews the ten-year experience of an individual bariatric surgeon and his team in Nigeria. The patient database was used to collate and record all patient specific information. This database was then accessed to extract required information on patients treated in our specialist clinics between January 2012 and June 2022. There were a total of 381 consecutive patients. The mean age was 41.4 years (+/- 9.1). Females made up 314 (82.4%) in the cohort. Mean initial body mass index (BMI) was 42.4kg/m² (+/- 8.7). 220 (57.7%) had endoscopic intra-gastric balloon placement, 157 (41.3%) underwent laparoscopic sleeve gastrectomy, and 4 (1%) patients underwent laparoscopic gastric bypass. Complications occurred in 8 (3.6%) patients following the intra-gastric balloon and 4 (2.5%) patients following the lap sleeve gastrectomy. There was 1 mortality (0.6%) following lap sleeve gastrectomy. The mean weight loss was 16kg (+/- 9.7) after the intra-gastric balloon and 28.7kg (+/- 14) after the Lap sleeve gastrectomy at the end of year 1. Our results from this study demonstrate that metabolic or bariatric surgical services provided by our appropriately trained and motivated team of specialists can be delivered safely in this highly selected sector of the population of Nigeria.

Multiples complications dans les suites opératoires d'une prothèse totale de hanche: à propos d'un cas

Johnny Cizemba — 2026-04-17

Nous présentons le cas d'un patient de 70 ans, opéré pour une fracture du col du fémur gauche Garden 4. Le traitement avait consisté en une prothèse totale de hanche (PTH) primaire dont l'évolution à court terme était marquée par 6 complications, ayant nécessité 3 reprises chirurgicales. La disponibilité des moyens logistiques, la rapidité dans les gestes ont permis d'obtenir une issue acceptable.

Association between periodontal inflamed surface area and estimated glomerular filtration rate among pre-dialysis chronic kidney disease patients

Olusoji Ayodele Onabanjo — 2026-04-17

Introduction: periodontitis increases systemic inflammatory burden and the effect of this could be worsening renal function of chronic kidney disease patients (CKD). The purpose of this study was to evaluate the relationship between renal function and periodontal inflammation among CKD population attending a tertiary institution in Nigeria.

Methods: a total of 120 pre-dialysis CKD patients were enrolled in this study and their serum creatinine level was measured for the estimation of glomerular filtration rate (eGFR). The burden of periodontal inflammation was evaluated using periodontal inflamed surface area (PISA). Simple and Multiple linear regression analysis was done to explain the relationship between renal function and periodontal inflammation.

Results: a total number of 120 participants, made up of 68 (56.7%) males and 52 (43.3%) females diagnosed of chronic kidney disease (CKD). On simple and multiple linear regression analysis, PISA was significantly associated with eGFR (β = -0.017, 95% CI -0.026 to -0.009; P < 0.001). Pearson correlation analysis also suggested a moderate correlation between PISA and eGFR (r=-0.5, p<0.001).

Conclusion: this study suggests that renal function and periodontal inflammation might be related, increasing the severity of periodontitis, which could possibly lead to decreased renal function.

Déterminants de la pratique « WASH » par les ménages dans la commune de Djougou au Bénin en 2024

Comlan Cyriaque Degbey — 2026-04-17

Introduction: plusieurs pays en développement, dont le Bénin, rencontrent des difficultés en matière d'accès à l'eau potable et aux services d'hygiène et d'assainissement (WASH). Djougou, située au nord du Bénin, fait face à des défis similaires. Cette étude avait pour objectif d'analyser les déterminants de la pratique WASH par les ménages dans cette commune en 2024.

Méthodes: il s'agissait d'une étude transversale à volet analytique réalisée entre le 27 mai et le 13 juin 2024. Un échantillon de 165 chefs de ménage a été sélectionné aléatoirement dans deux arrondissements ruraux (Barei et Bariénou) et deux urbains (Djougou I et Djougou II). Les données ont été collectées à l'aide d'un questionnaire et d'une grille d'observation, puis analysées à l'aide du logiciel Epi Info 7.2.5.0.

Résultats: l'étude avait révélé que 49,09% des ménages n'avaient pas accès à des sources d'eau améliorées. Les principales sources d'eau étaient les puits non couverts (49,09%), les forages (27,88%), les puits couverts (12,12%) et l'eau de la Société Nationale des Eaux du Bénin (SONEB) (10,91%). La défécation à l'air libre était pratiquée par 37,58% des ménages. Le niveau d'instruction, le revenu, la distance aux points d'eau améliorés et leur disponibilité influençaient les choix en matière de source d'eau et d'assainissement.

Conclusion: l'accès insuffisant aux services WASH à Djougou est influencé par divers facteurs socio-économiques. Il est crucial d'améliorer l'accès aux infrastructures WASH, en particulier dans les zones rurales, pour répondre aux besoins des ménages et réduire les pratiques d'assainissement inadéquates.

Thyroid-associated orbitopathy following COVID-19: a case report

Sabrine Mekni — 2026-04-17

Studies have shown a link between COVID-19 vaccination and the development of Graves' disease (GD) and Graves' orbitopathy (GO). However, to the best of our knowledge, this is only the second reported case of clinically overt GO following COVID-19 infection. Herein, we report a 48-year-old female patient who was initially treated in 2017 with radioactive iodine therapy for a toxic thyroid adenoma. In 2021, the patient was diagnosed with COVID-19. Ten days later, she developed bilateral, active, moderate-to-severe GO, accompanied by elevated thyrotropin receptor antibody (TRAb) levels. She was treated with intravenous methylprednisolone followed by oral prednisone and later underwent orbital decompression surgery, followed by strabismus surgery due to worsening diplopia. No complications occurred postoperatively, and her symptoms improved significantly. This case contributes to the literature by suggesting a potential association between COVID-19 infection and the onset of autoimmune diseases, including GO.

National availability, prices and affordability of essential medicines: a comprehensive analysis using WHO/HAI methodology in Chad

Frank Edgard Zongo Ragomzingba — 2026-04-17

Introduction: in Chad, the pharmaceutical sector faces many challenges, including essential medicine availability, affordability, and pricing. The country has a weak health system with limited access to medical care for the population. This study aims to assess the availability, affordability, and pricing of essential medicines in Chad from 1^st June to 31^st July 2023.

Methods: we conducted a descriptive and cross-sectional study including public, private, and contractual sectors. Availability of essential medicines was measured as a percentage (%) of the surveyed outlets, and pricing was computed using the median price ratio (MPR).

Results: our results showed that the average medicine availability ranged between 39.59% to 67.37%. In the public sector, average availability ranges from roughly 46% at the health center level to 61.4% at the provincial pharmacy level, with a 52.6% average across all health institutions. In the private sector, it is around 38% for private wholesalers, 48% for pharmacies, 58.4% for pharmaceutical depots, and 48% contractual sector. Provinces with the lowest availability rates were Batha, Kanem, Lac, and Hadjer Lamis, with percentages ranging between 39% and 43%. In terms of cost, the lowest priced generics (LGPs) are 9 times less than originator pharmaceuticals in the contracted sector, 4 times less in the public sector, and 2 times less in the private sector.

Conclusion: this study's findings highlight the critical need to provide access to essential medicines and reduce their costs in Chad. Efforts should be undertaken to implement World Health Organization (WHO) guidelines for universal access to essential medicines in Chad.

Legal protection of traditional medicine knowledge in Indonesia: integrating local wisdom and modern regulations

Umaira Hayuning Anggayasti — 2026-04-17

To the editors of the Pan African Medical Journal

Complex bladder and small bowel injury induced by gamma nail fixation: a case report

Ghassane El Omri — 2026-04-17

Trochanteric fractures in elderly patients are frequently treated with gamma intramedullary nails. Although commonly performed, this procedure can result in rare but severe complications such as visceral perforation. The case involves an elderly woman who suffered iatrogenic perforation of both the urinary bladder and small intestine during gamma nail insertion. The complication was not immediately recognized, and the patient presented several weeks later with severe sepsis and pelvic peritonitis. Imaging and cystoscopy confirmed the diagnosis. Emergency surgery allowed for small bowel resection and bladder repair, with the nail left in place. The postoperative course was complicated by a vesicocutaneous fistula requiring urinary diversion. This case exemplifies the consequences of insufficient intraoperative imaging during gamma nail fixation in elderly patients. Prompt recognition and multidisciplinary management are essential to reduce morbidity and improve outcomes in such rare but life-threatening scenarios.

La tuberculose abdominale: une expérience de 13 ans

Fatma Medhioub Kaaniche — 2026-04-17

La tuberculose abdominale (TBA) est une forme rare mais grave de tuberculose extra-pulmonaire. Nous avons mené une étude prospective descriptive, incluant tous les patients hospitalisés à l´Hôpital régional de Mahres, pour une tuberculose abdominale entre janvier 2012 et décembre 2024. Nous avons inclus 14 patients. Les facteurs de risque comprenaient des antécédents personnels de tuberculose (28,5%), familiaux (21,4%), le diabète sucré (21,4%), la consommation de lait non pasteurisé (28,5%) et le contact avec des animaux (21,4%). Les principales localisations étaient péritonéales (42,8%) et intestinale (42,8%), avec atteinte ganglionnaire mésentérique dans 21,4% des cas. Une atteinte extra-abdominale était présente chez 35,7% des patients. Le diagnostic reposait sur des méthodes microbiologiques (42,8%), histologiques (35,7%) et /ou cliniques (21,4%). Tous les patients ont reçu une polychimiothérapie d´une durée médiane de 11 mois, bien tolérée sauf dans 14,2% des cas. La tuberculose abdominale reste une entité rare, aux formes cliniques variées et souvent trompeuses, soulignant l'importance d´une suspicion précoce et d´une prise en charge multidisciplinaire.

Prevalence and associated risk factors of hypertension among university staff: a cross-sectional study at the University of Juba, South Sudan

Kon Paul Alier — 2026-04-17

Introduction: hypertension refers to an average systolic blood pressure greater than or equal to 140 mmHg and/or diastolic blood pressure greater than or equal to 90 mmHg. In South Sudan, published evidence on the disease is scarce. This study aimed to assess the prevalence and associated risk factors of hypertension among the University of Juba staff.

Methods: a cross-sectional study among 409 University of Juba staff was conducted. Data collection used a structured questionnaire and blood pressure measurements and body weight were made using a Littman Stethoscope Classic III, mercurial sphygmomanometer and weighing scale fitted with a stadiometer, respectively. Sample was estimated using Cochran´s formula. Institutional ethical clearance was obtained from the College of Medicine and the University of Juba Directorate of Research and Publication. Permission was also obtained from each college and informed consent from each respondent. The software Epidata Manager 4.6.0.6 and IBM SPSS 23.0 were used for data entry and analysis respectively. Descriptive statistics, chi-squared tests and multivariate logistic regression analysis were performed to explore factors associated with hypertension.

Results: out of 409 participants, the majority were aged 28-37 (n=147) years, more than two thirds (n=260) were males, the prevalence of hypertension was 24%. At 95% confidence interval, significantly associated risk factors were age (aOR: 5.86, 95% CI: 2.51-13.70; P<0.001), alcohol consumption (AOR: 2.20, 95% CI:1.16-4.17; P=0.016) and body mass index ≥ 25 (AOR: 2.42, 95% CI: 1.41-4.14; P<0.001).

Conclusion: close to a quarter of the University of Juba staff is hypertensive. Age, alcohol consumption and increased body mass index were significantly associated with the disease. The study recommends tailored preventive interventions against hypertension at the university.

Retinitis pigmentosa with pre-mRNA processing factor 31 mutation: a case report of a Moroccan patient

Mariyam Khallouqi — 2026-04-17

To report the clinical findings of a Moroccan patient presenting with retinitis pigmentosa (RP), together with pre-mRNA processing factor 31 (PRPF31) mutations. The patient experienced night blindness a few months before being diagnosed with RP in July 2023, and several ophthalmic examinations were carried out, including best-corrected visual acuity (BCVA) measurement, slit-lamp biomicroscopy, dilated ophthalmoscopy, fundus photography, optical coherence tomography (OCT), and electroretinogram (ERG). A genetic analysis was carried out to identify the causative genes in order to better understand the disease and facilitate the path to therapy. The variant found was in the PRPF31 gene at position c.1165C>T p(Gln389**), generating a stop codon and a loss of 110 amino acids. This mutation has previously been described as pathogenic and induces autosomal dominant RP. This is the first description of a Moroccan case presenting RP with a PRPF31 mutation. More cases are needed to better define the clinical progression and the range of mutations.

Urinary stone analysis at the Military Hospital of Marrakech: Fourier transform infrared spectroscopic study

Kawtar Benkhaldoun — 2026-04-17

Urolithiasis is a growing global health concern, influenced by a combination of genetic, environmental, and lifestyle factors. Accurate analysis of urinary stone composition is essential for effective diagnosis, treatment, and recurrence prevention. Fourier transform infrared (FTIR) spectroscopy has become a gold standard technique for stone analysis due to its precision and efficiency. This study aimed to evaluate the biochemical composition of urinary stones using FTIR spectroscopy and to identify trends related to patient demographics at the Avicenne Military Hospital in Marrakech. A total of 136 urinary stones were collected from patients between February 2020 and November 2023. Stone samples were analyzed using FTIR spectroscopy, and their composition was correlated with patient age and sex. Only the predominant constituent of each stone was considered for classification. The patient cohort included 82 men and 54 women, with an average age of 52.9 years. Calcium oxalate was the most prevalent component (35.3%), followed by struvite (20.5%), carbapatite + cystine (19.1%), and urate (13.2%). Mixed stones were common, with the majority containing two or more constituents. Calcium oxalate stones were more frequent in men, while struvite and urate stones were more associated with women and older age groups. Variations in stone composition were observed across different age and sex groups, reflecting underlying metabolic and infectious factors. Fourier transform infrared spectroscopy offers a reliable, rapid, and non-destructive method for analyzing urinary stone composition. Understanding the chemical makeup of stones provides essential insights for individualized patient management and targeted prevention strategies. This study highlights the importance of routine stone analysis in optimizing clinical care and reducing recurrence rates.

Epidemiological, pathological, and molecular characteristics of lung cancer in Casablanca, Morocco: a retrospective study

Zineb Khadrouf — 2026-04-17

Introduction: lung cancer remains a significant global health concern, responsible for the highest number of cancer-related deaths worldwide. In Morocco, it is the most prevalent cancer among men. This study aimed to describe the epidemiological characteristics of lung cancer and to explore the molecular profile of lung adenocarcinoma cases.

Methods: a retrospective analysis was carried out over a 24-month period, from January 2020 to December 2021, at the Pathology Department of Ibn Rochd University Hospital in Casablanca, Morocco, encompassing 1,426 lung cancer cases. Statistical analyses were performed using GraphPad Prism 8 software.

Results: our study reveals that the mean age was 59.9±12.06 years (median: 61 years, IQR: 54-67). A clear male predominance was observed in 75.9% (n=1,083). The most common histological type was adenocarcinoma, representing 49.6% (n=708). In adenocarcinoma cases, thyroid transcription factor-1 (TTF-1) expression was positive in 95.5% (n=469). Programmed death-ligand 1 (PD-L1) was mostly negative, with a tumor proportion score (TPS) <1% in 59.7% (n=83), 1-49% in 13.7% (n=19), and ≥50% in 26.6% (n=37). Anaplastic lymphoma kinase (ALK) expression was positive in only 4.1% (n=3) of cases. Epidermal growth factor receptor (EGFR) mutations were found in 22.2% (n=24), predominantly Ex19Del in 66.6% (n=16). All ALK-positive cases were PD-L1 negative (100%, n=3), while PD-L1 expression (TPS≥1%) was detected in 38.9% (n=7) of EGFR-mutated adenocarcinomas.

Conclusion: this study characterizes lung adenocarcinoma as the predominant histological type, elucidates its principal molecular features and enables the determination of possible correlations between EGFR status, PD-L1 and ALK expression among Moroccan patients.

Alopecia revealing a gastric trichobezoar in a child

Leila Debono — 2026-04-17

A 10-year-old girl, with no particular medical history, consulted the pediatric emergency room for alopecia and pallor observed by the mother for several months. The admission examination found a pale patient with mild alopecia over the frontal scalp but more pronounced at the eyebrows. The abdominal examination revealed a small, painless, and mobile epigastric mass, with no hepatomegaly or splenomegaly. The lymph node areas were free. Height and weight growth were normal according to age. The emergency abdominal ultrasound revealed that the mass corresponded to unidentified gastric contents, requiring additional computed tomography (CT) scanning. On the abdominal CT scan, the appearance was in favor of an endoluminal gastric mass, suggesting a trichobezoar. The history taken again in the young girl revealed trichophagia, of which the mother was unaware. The patient underwent surgical treatment after a transfusion due to the discovery of anemia, with good progress. The child was referred for psychiatric consultation for follow-up on her trichophagia.

Investigation of the underlying factor structures of social interaction impairments in children diagnosed with autism spectrum disorder at autism centers, Addis Ababa, Ethiopia: principal component analysis of the autism treatment evaluation checklists

Worku Abie Liyew — 2026-04-17

Introduction: social interaction impairments are the main feature of individuals diagnosed with autism spectrum disorder (ASD), making it a significant area of concern for both the children affected and their families. This study aimed to investigate the underlying factor structures of social interaction impairments in children diagnosed with autism spectrum disorder at autism centers in Addis Ababa, Ethiopia.

Methods: a cross-sectional study was conducted among 145 children diagnosed with autism spectrum disorder. Various traits of social interaction impairments associated with autism were measured using the Autism Treatment Evaluation Checklist. A principal component analysis (PCA) employing a varimax rotation was used to identify the underlying factor structures of social interaction impairments.

Results: six-factor structures of social interaction impairments were identified: challenges in interpersonal relationships and affection (eigenvalue: 4.99, variance: 13.437%), emotional insensitivity (eigenvalue: 1.714, variance: 11.837), poor gesture and attention (eigenvalue: 1.648, variance: 10.652), social withdrawal (eigenvalue: 1.40, variance: 8.932), behavioral resistance (eigenvalue: 1.270, variance: 8.011), and limited sharing (eigenvalue: 1.044, variance: 6.771). These factors accounted for approximately 60% of the total variance.

Conclusion: the social interaction impairments in autism are multidimensional, presented in six distinct patterns. It is important to consider these patterns when supporting children with autism spectrum disorder.

Factors influencing birth preparedness and complication readiness during pregnancy in Turkana County, Kenya

Leila Chepkemboi Kibet — 2026-04-17

Introduction: pregnancy, childbirth, and the postnatal period involve risks that can lead to serious complications, but these can be reduced when mothers and families are aware of key obstetric danger signs and follow a birth preparedness plan.

Methods: a convergent mixed-methods community-based cross-sectional study was conducted among 331 pregnant women in August 2024. Additionally, six key informant interviews and six focus group discussions were held with health workers, pregnant women, and their partners. Quantitative data were analyzed using SPSS v27.0, while qualitative data underwent content analysis. Bivariate and multivariate logistic regressions were employed to identify factors influencing birth preparedness.

Results: only 17.2% of pregnant women were prepared for birth and complications. Awareness of key danger signs was low: 13.5% during pregnancy, 8.9% during labor and childbirth, and 21.9% in the postpartum period. Factors significantly associated with higher odds of birth preparedness included: being a housewife (AOR= 5.6), receiving health education on danger signs (AOR= 4.68), having good knowledge of danger signs during pregnancy (AOR= 3.39), and receiving any form of community support (AOR= 2.74).

Conclusion: birth preparedness and awareness of obstetric danger signs are low among pregnant women in Turkana County. Influencing factors include socio-demographic, cultural, economic, and infrastructural challenges. Qualitative research identified cultural beliefs, the utilization of conventional remedies, and inadequate infrastructure and distance as significant roadblocks to health services. To enhance birth preparedness and complication readiness (BPCR) initiatives in Turkana County, it is recommended that targeted, context-specific health education be implemented during antenatal care clinics. This should involve delivering accurate and relevant health education on obstetric danger signs and the importance of birth preparedness through these clinics. Addressing knowledge gaps among pregnant women and their partners is essential to reduce delays in seeking emergency obstetric care. The Ministry of Health and county governments should expand health facility capacity and provide regular training on focused antenatal care and communication. Community health workers should be recruited and supported to promote antenatal care (ANC) attendance and institutional deliveries through local outreach. To improve access to health centres, county governments and international non-governmental organizations (INGOs) should tackle physical, financial, and social barriers by improving transportation and reaching remote areas.

Visualizing intraluminal duodenal diverticulum in adults: a rare clinical entity

Hanane Aksim — 2026-04-17

We report the case of a 72-year-old woman admitted to our clinic for etiological assessment of chronic epigastralgia resistant to usual treatments. Her medical and surgical history was unremarkable. On clinical examination, the patient was conscious, normocardiac, normotensive, eupneic, and apyretic. Abdominal examination was unremarkable, apart from a slight epigastric tenderness with no tenderness or contracture. Given this clinical picture, a laboratory work-up was carried out. It revealed a correct hemoglobin level. Leukocyte count, C-reactive protein, renal function, and lipasemia were normal. No hydroelectrolytic disorders were found, and the remainder of the laboratory work-up was unremarkable. An oeso-gastro-duodenal fibroscopy revealed two intraluminal duodenal diverticula (Panel A, arrows) in the second duodenum separated by a thin border (Panel B, arrow). Differential diagnoses included choledochal cyst, duodenal duplication, and duodenal ulcer. The diagnosis of an uncomplicated intraluminal duodenal diverticulum was made. Intraluminal duodenal diverticulum is a rare entity. It originates from a congenital malformation of the descending part of the duodenum. Incomplete recanalization of the duodenum during embryonic development is considered to lead to a pulsion diverticulum, finally resulting in a “windsock-like” configuration. Diagnosis is established by duodenoscopy and/or barium meal. Treatment is indicated in selected, symptomatic cases only. In the case presented here, the diverticulum was discovered by chance during an etiological work-up for chronic epigastralgia, and treatment was not indicated as long as the diverticulum was uncomplicated.

Impact of child marriage on adolescents' health and socioeconomic development: an essay on Ethiopian perspective

Andamlak Gizaw Alamdo — 2026-04-17

Early marriage is a worldwide health concern that is prevalent in Southern Asia, South America, and Sub-Saharan Africa. Early marriage has been associated with numerous adverse outcomes, including an increased risk of unintended pregnancy, poor economic status, discontinuation of education, sexually transmitted infections, higher divorce rates, adverse pregnancy outcomes, maternal and child mortality, and various negative physical and social consequences for young women and their children. Child marriage in Ethiopia is one of the highest rates in the world. Although the country has shown an overall reduction in the prevalence of child marriage, the problem is still striking and demands the attention of all stakeholders who are working on children's and adolescents' health and well-being. The most challenging side of early marriage in Ethiopia is that it is linked with a diverse and highly deep-rooted issues such as religion, culture, ethnicity, and other conditions. Examining the customs surrounding child marriage, and involving the society, families, and the young people in the planning, implementation and evaluation of all programs concerning child marriage is critical.

Screening for anti-HCV antibodies in a cohort of people living with HIV at “Zia Angelina“ Medical Centre, Kampala, Uganda

Francesco De Maria — 2026-04-17

To the editors of the Pan African Medical Journal

Treatment outcomes among patients with drug-resistant tuberculosis managed with BPaL/BPaLM regimen in the Southeast Zone of Nigeria

George Ikpe — 2026-04-17

Introduction: the treatment of multidrug-resistant tuberculosis (MDR-TB) has been challenging, often associated with life-threatening adverse events and poor treatment outcomes. The recent World Health Organization (WHO) recommendation of the BPaLM regimen, consisting of bedaquiline, pretomanid, linezolid, and moxifloxacin for treatment of pre-extensively drug-resistant tuberculosis (Pre-XDR) and rifampicin-resistant tuberculosis (MDR-TB/RR), has been shown to have favorable treatment outcomes. This study focused on the outcomes of patients managed with this regimen in the southeastern zone of Nigeria between November 2023 and October 2024, following approval by the National Tuberculosis and Leprosy Control Program (NTBLCP) in November 2023.

Methods: patient demographic and clinical data were collected from DR-TB treatment registers, active drug safety monitoring forms (aDSM), and laboratory registers using an abstraction tool. Data were analyzed using descriptive statistics such as frequency and percentages for variables such as age, gender, adverse events, new and retreatment cases, treatment outcomes such as completed treatment, cured, loss to follow-up (LTFU), and death.

Results: out of the 212 patients enrolled for treatment during the period, 202 patients were treated for MDR-TB/RR with BPaLM, while 10 were treated for Pre-XDR with BPaL. The TSR for the MDR-TB/RR category is 89%, while the TSR for the Pre-XDR category is 100%. More than 6.7% of the patients in the MDR-TB/RR category were LFTU, and another 6.7% died. Over 86% of the patients treated had no documentation for adverse events, while 54% of the MDR-TB/RR cases were new cases.

Conclusion: using the BPaLM regimen for DR-TB treatment results in favorable patient outcomes.

Epidemiology of overweight and obesity in school children and adolescents in Cameroon: a comparative study in urban and semi-urban settings

Chris Nadège Nganou-Gnindjio — 2026-04-17

Introduction: over the past three decades, the number of overweight children in Africa has doubled. We aimed to determine the prevalence of overweight and obesity in children and investigate the associated factors in urban and rural areas of Cameroon.

Methods: this was a cross-sectional study on adolescents and children aged between 3 and 19 years, recruited at 22 multi-staged randomly selected schools in Yaounde (urban setting) and Mbouda (semi-urban setting), Cameroon, from December 2017 to June 2018. We collected socio-demographic data, relevant history, and anthropometric measurements. Overweight and obesity were diagnosed according to the International Obesity Task Force for children and adolescents. Associated factors were assessed through multivariate analysis with logistic regression and presented with their OR and 95% confidence interval.

Results: a total of 2398 students were included in the study. The median age was 15 years (IQR 12-17 years). The prevalence rates of overweight and obesity were 27.2% and 9.8% in the semi-urban area vs 27.3% and 30.4% in the urban area (p< 0.001). The prevalence of abdominal obesity was 19.7% in the semi-urban area vs. 15.2% in the urban area (p=0.004). The factors associated with overweight and obesity were increased waist circumference (aOR = 1.03, 95% CI = 1.02 - 1.05, p <0.001), an urban residence (aOR = 2.57, 95% CI = 1.84 - 3.59, p <0.001), increased number of meals per day (aOR = 1.11, 95% CI = 1.01 - 1.23, p =0.034), motorised transport to school (aOR = 1.49, 95% CI = 1.20 - 1.85, p <0.001).

Conclusion: the prevalence of childhood obesity is greater in urban than semi-urban areas of Cameroon. There are many factors associated with the onset of this pathology in our setting, the control of which could be the subject of prevention.

Pulmonary metastatic paraganglioma with angiosarcomatous differentiation: a rare case report and literature review

Shengmin Huang — 2026-04-17

Paragangliomas are rare neuroendocrine tumors that can rarely undergo malignant transformation. Angiosarcomatous differentiation is an exceptionally uncommon event with limited reports. This case describes a patient with a previously irradiated vagal paraganglioma that transformed into a metastatic pulmonary paraganglioma with angiosarcomatous features, highlighting the importance of long-term surveillance in irradiated paragangliomas. The patient presented with shortness of breath due to persistent pleural effusion. Despite receiving thoracentesis and palliative radiation therapy, the patient ultimately expired from hypoxic respiratory failure after two months. We add to the limited literature on sarcomatous transformation in paragangliomas and emphasize the importance of considering secondary malignancies in paragangliomas with unusual transformation, and potentially worse prognosis.

A rare case of ocular IgG4-related disease in a pediatric patient

Khadija Mouaddine — 2026-04-17

Orbital IgG4 disease is a rare cause of bilateral exophthalmos. We report, through this observation, the first case of this disease in a child in our country. Our patient is a 13-year-old girl presenting with bilateral exophthalmos evolving for 4 months. The ophthalmic examination revealed preserved visual acuity with grade 1 papilledema. Orbital imaging showed the presence of a bilateral fusiform intraconical process encompassing the optic nerve and oculomotor muscles with grade III exophthalmos. There was no argument on imaging or bone marrow smear of a neoplastic origin. The urinary catecholamine dosage, immunological assessment, and angiotensin-converting enzyme (ACE) level were normal. An initial biopsy with immunohistochemistry (IHC) revealed reactive lymphocytic infiltration without signs of infection or tumor. The patient underwent intravenous steroid boluses, which rapidly improved her symptoms, then switched to oral steroids, but with multiple relapses during the regression. Surgical decompression was performed. A second biopsy revealed chronic fibrotic and inflammatory changes expressing IgG4, consistent with IgG4 disease. The IgG4 level returned to normal. The diagnosis of orbital hyper-IgG4 syndrome was made based on the histological findings. The patient received a corticosteroid bolus and rituximab, with good progress.

Successful management of a massive subretinal hemorrhage with intravitreal t-PA, perfluoropropane, and bevacizumab: a case report

Nihal El Arari — 2026-04-17

Massive subretinal hemorrhage is a rare but vision-threatening complication of proliferative diabetic retinopathy. Rapid and effective intervention is essential to preserve visual function. We report the case of a 40-year-old woman with type 2 diabetes who presented with a sudden, severe bilateral visual acuity drop. Fundoscopy revealed a massive subretinal hemorrhage in the left eye. She was treated with intravitreal injections of tissue plasminogen activator (t-PA), perfluoropropane (C3F8), and bevacizumab. Post-treatment, the hemorrhage resolved with significant visual improvement. Minimally invasive treatment with t-PA, gas tamponade, and anti-VEGF agents is effective in managing massive subretinal hemorrhage and improving visual outcomes.

Assessment of the National Disease Surveillance System in The Gambia, January 2025: best practices and lessons learned

Violet Mathenge — 2026-04-17

Introduction: the global trend of emerging and re-emerging diseases has highlighted surveillance as a fundamental pillar in ensuring global health security. The Gambia undertook a surveillance system assessment as part of a structured approach for surveillance system strengthening. We describe the best practices, key gaps, and critically analyse the system’s capacity to collect complete, timely, and accurate data and the use of data for meaningful decision making.

Methods: we conducted a retrospective cross-sectional study to assess both core and supporting surveillance functions. A total of 74 public and private health facilities, comprising 16 hospitals and 58 primary health care facilities from rural and urban settings, were randomly sampled from a sampling frame of 195 facilities. Data were collected by MoH staff from both central and regional levels with support from officers from the WHO Country Office. Frequency distribution tables were prepared, and proportions were calculated, stratified by region and health facility levels.

Results: national surveillance guidelines were available in 66% of the health facilities. Standard case definitions for priority diseases were present in 91% of the health facilities. More than half (66%) of the health facilities could handle specimens until shipment. Overall, 20%, 32% and 42% of the health facilities analysed data by person, place, and time, respectively. All regions had demonstrated the capacity to transport samples to a higher-level laboratory. At the central level, there was no budget line for surveillance or epidemic response.

Conclusion: investments in emergency preparedness and response mechanisms, building workforce capacity, and strengthening sample collection and transportation were evident. However, gaps remain in data analysis, implementation of eIDSR, and preparedness planning. Improving coordination, securing sustainable funding mechanisms, and implementation of EBS and CBS present key opportunities for system improvement.

A cross-sectional study on the quality of life of patients with type 2 diabetes attending a General Hospital in Lagos State

Oyenike Oyeronke Ekekezie — 2026-04-17

Introduction: diabetes mellitus is a progressive chronic disease that requires long-term management. This exerts a significant burden on patients, impacting their quality of life (QoL). The study aimed to assess the QoL and its determinants among patients with diabetes mellitus attending a general hospital in Lagos, Nigeria.

Methods: a total of 306 patients diagnosed with diabetic mellitus were consecutively recruited from the clinic within the three-month study period. The World Health Organization quality of life (WHOQOL-BREF) tool was used for data collection. Multivariable logistic regression analysis was performed to explore the association between QoL and some clinical variables.

Results: the majority of the respondents, 79.1% (n=242), were 50 years old and above, with a mean age of 53.7 + 0.6; 62.4% (n=191) females, 82.7% (n= 253) married, and 56.2% (n= 172) traders. The mean total QoL score was 52.9%. More than half, 55% (n= 163) of the patients had a good overall QoL score, while 76% (n= 233) perceived they had a good QoL. On multivariate regression analysis, QoL was significantly associated with normal fasting plasma glucose (aOR: 0.383, 95% CI: 0.191-0.768; p= 0.007); and adherence with therapy guidelines (aOR: 4.565, 95% CI: 2.375-8.774; p= 0.000).

Conclusion: this study suggests that compliance with therapy guidelines was associated with the greatest odds of having good QoL. With our finding that higher levels of education were significantly associated with good QoL, it is recommended that health literacy become part of the management of patients with diabetes to enhance their QoL. There is a need to specifically target and improve the QoL of underweight patients with diabetes, as they are at a higher risk of having poor QoL, when compared with their overweight and obese counterparts that receive more attention.

Penis trauma after fish bites: a case report

Amrizal Amrizal — 2026-04-17

Penile trauma is challenging because it impacts both physical and mental well-being. It is uncommon because the penis is well-protected by its position. We report the case of an 11-year-old boy who presented with penile glans partial amputation and total transection of the urethra resulting from a fish bite injury while swimming in the river. The patient received emergency care, including wound irrigation, anti-tetanus shots, broad-spectrum antibiotics, pain medication, and pre-op preparation for surgical debridement. Meatoplasty for the conservation of the penile glans was performed. The patient was given antibiotics for five days and a urinary catheter for 14 days. Suture removal was done on the 21^st day after surgery. After three months, the patient was free of urinary problems, and there was no stricture in the new meatus.

Experiences and perspectives of parents on their care roles in two Rwandan public neonatal units: a qualitative study

Agnes Mukaruziga — 2026-04-17

Introduction: family integrated care (FICare) is increasingly regarded as best practice in neonatal units. However, little is known about how parents experience and perceive their care roles in neonatal units in low-resource settings such as Rwanda. This study explored lived experiences, attitudes, and perceptions of caregivers regarding parental care roles in two neonatal units in Rwanda.

Methods: a qualitative study using semi-structured face-to-face interviews was conducted in one tertiary and one secondary neonatal unit in Kigali, Rwanda. A pragmatic content analysis approach was applied without a guiding theoretical framework.

Results: sixteen caregivers (14 mothers, 1 father, 1 aunt) were interviewed; their infants had a mean gestational age of 29.5 weeks (SD±1.45). Seven themes emerged: experiences in the neonatal unit, current caregiver roles, readiness to provide care, attitudes towards extended roles, perceived benefits, barriers, and support needs. Parents reported emotional distress related to their infants´ illnesses and the hospital setting. They were already engaged in tasks such as feeding, hygiene, and bonding. Most expressed willingness to take on more responsibilities if supported through education and guidance. Reported barriers included limited skills, maternal illness, financial constraints, and restricted access to infants due to hospital policies and infrastructure.

Conclusion: parents in two Rwandan neonatal units expressed a strong desire to participate more actively in their newborns' care. Efforts to expand their care roles should be encouraged and supported, where possible and safe, through structured education, accessible infrastructure, and emotional and material support from healthcare professionals.

Diagnostic challenges of longstanding nasal cutaneous tuberculosis in an endemic setting: a case report

Anke van der Linden — 2026-04-17

Nasal cutaneous tuberculosis (TB) is a rare manifestation of extrapulmonary tuberculosis and presents a diagnostic challenge, particularly in its paucibacillary form. As demonstrated in this case, achieving laboratory-confirmed diagnosis in paucibacillary TB remains a significant challenge, often resulting in missed or delayed diagnoses and increased severity of disease on presentation. We report an atypical case involving a 19-year-old male with extensive nasal destruction progressing for fourteen years. In this case, lupus vulgaris was ultimately diagnosed after extending the tissue culture duration beyond 35 days, despite prior exclusion of TB as the cause. The patient completed antituberculosis therapy with resolution of the active disease, and he was referred for further management of his facial deformity. The delayed diagnosis led to significant tissue destruction, which could have been prevented with earlier confirmation and treatment of the infection. We propose that, in diagnostically difficult cases, the investigating team consider extending the specimen culture time to the maximum before definitively excluding tuberculous disease.

Multisystem inflammatory syndrome in children associated with COVID-19: a case report and literature review

Mohamedraza Akbar Ebrahim — 2026-04-17

Given the rarity of multisystem inflammatory syndrome related to COVID-19 (MIS-C). This case report highlights the high index of suspicion to diagnose MIS-C in a child who presented with symptoms suggestive of acute gastroenteritis. While admitted in the hospital, she deteriorated with worsening of symptoms, clinical decline, deranged laboratory markers, and significant radiological findings, even though on antibiotics. She had acute myocarditis with myocardial dysfunction on echocardiography and raised cardiac enzymes. Intravenous human immunoglobulin (IVIG) was given, but there was additional need for inotrope (norepinephrine) and methylprednisolone albeit the preliminary echocardiogram was normal. Early recognition of MIS-C with rapid escalation of care post IVIG administration is needed to prevent morbidity and mortality.

Sellers of unpasteurized animal milk in unregulated markets: a key factor for human brucellosis control in El-Oued province, Algeria

Bachir Khezzani — 2026-04-17

To the editors of the Pan African Medical Journal

Persistent truncus arteriosus: one trunk, one defect - an image telling the story

Zaynab Laoufi — 2026-04-17

Persistent truncus arteriosus is a rare congenital heart defect characterized by a single arterial trunk arising from the heart and supplying the systemic, pulmonary and coronary circulations. It is frequently associated with a large ventricular septal defect (VSD), leading to mixing of oxygenated and deoxygenated blood. This malformation results from the failure of the embryonic truncus arteriosus to divide into the aorta and pulmonary artery during fetal development. We present the case of a 19-year-old woman with a history of persistent truncus arteriosus diagnosed during infancy. Surgical correction was proposed but declined due to a lack of resources. She was admitted for evaluation of syncope. Clinical examination revealed a diastolic murmur at the left sternal border. Electrocardiogram (ECG) showed frequent premature ventricular contractions (PVCs) in bigeminy. Transthoracic echocardiography revealed a large ventricular septal defect (VSD) underlying a single arterial trunk, consistent with persistent truncus arteriosus, with a well-functioning truncal valve exhibiting mild regurgitation. Twenty-four-hour Holter monitoring confirmed frequent PVCs, including short runs of non-sustained ventricular tachycardia. The patient was treated with a beta-blocker and spironolactone, showing fewer PVCs at one-month ECG follow-up, and was referred for surgical management.

High-grade astroblastoma initially misdiagnosed as papillary meningioma: a case report

Anass Haloui — 2026-04-17

Astroblastoma is a well-circumscribed glial neoplasm that typically occurs in the cerebral hemisphere of children and young adults, usually presenting with symptoms of increased intracranial pressure such as headaches, vomiting, and seizures. It is characterized histologically by papillary or pseudopapillary architecture, astroblastic pseudorosettes, vascular hyalinization, and lack of fibrillarity. However, these morphological features are not considered pathognomonic to astroblastomas and may be encountered in several central nervous system tumors, such as ependymoma and papillary meningioma, complicating the diagnostic process. In this report, we describe the case of an astroblastoma in an 18-year-old male presenting with symptoms of intracranial hypertension. Imagery revealed a right cerebral hemispheric mass with a particularly misleading fronto-ethmoidal dural attachment, which, in conjunction with the deceptive papillary architecture, prompted the initial misdiagnosis of papillary meningioma on two consecutive occasions before diagnostic revision. This article aims to highlight the main reasons for this diagnostic confusion, along with providing key clinical, radiological, histological, and molecular features of relevance to the differential diagnostic approach.

High-output cardiac failure and severe pulmonary hypertension due to congenital hepatic hemangioma: a case report

Sowmya Srinivas — 2026-04-17

Hepatic hemangioma is a benign tumor, but may lead to poor outcomes because of various complications. Very rarely presents with high-output congestive heart failure and severe pulmonary hypertension and, if not diagnosed and treated timely can be fatal. We report a challenging case of a term male baby admitted with abdominal distention and respiratory distress on day 2 of life. Post-natal ultrasonography and magnetic resonance imaging (MRI) confirmed the diagnosis of liver hemangioma. Echocardiography (ECHO) showed severe pulmonary hypertension and high-output congestive heart failure. Baby was finally treated with hepatic lobectomy and resection of the hemangioma, which resulted in resolution of pulmonary hypertension and cardiac failure. In infants with cardiorespiratory compromise secondary to cardiac failure and pulmonary hypertension, coexisting congenital hemangioma should be considered as one of primary causes.

Broken heart after heart attack- post-MI Takotsubo syndrome: a case report

Nadeem Kassam — 2026-04-17

Takotsubo cardiomyopathy (TCM) is a common differential for acute myocardial infarction (AMI), and although its coexistence is considered rare, it may be more common than previously believed. Diagnosing TCM after an AMI is particularly challenging, as initial imaging typically supports AMI. We report the case of a 61-year-old male who presented with anterior ST-elevation myocardial infarction (STEMI) and underwent successful primary percutaneous coronary intervention (PCI) to the left anterior descending artery. Initial echocardiography demonstrated preserved apical function; however, the patient was readmitted with chest pain, diaphoresis, and dyspnea. Suspecting stent thrombosis, repeat coronary angiography confirmed patent stents, but echocardiography revealed severe left ventricular dysfunction with apical ballooning, consistent with TCM. This case underscores the importance of considering TCM as a possible concomitant or subsequent condition in patients with recent Acute Coronary Syndrome (ACS).

Le syndrome d'Aicardi-Goutières avec présentation atypique: mutation du gène RNASEH2B chez un nourrisson sans microcéphalie ni calcifications intracrâniennes (à propos d'un cas)

Samir Iddir — 2026-04-17

Le syndrome d'Aicardi-Goutières (SAG) représente une encéphalopathie génétique rare fréquemment confondue avec d'autres pathologies neurologiques pédiatriques. Nous rapportons le cas d'un nourrisson de 14 mois ayant développé une régression psychomotrice à partir de l'âge de 6 mois, avec une présentation atypique caractérisée par l'absence de microcéphalie et de calcifications intracrâniennes. L'imagerie par résonance magnétique (IRM) cérébrale a révélé uniquement une légère atrophie cortico-sous-corticale. Après exclusion systématique des étiologies infectieuses et métaboliques, l'analyse génétique a identifié une mutation homozygote du gène RNASEH2B, confirmant le diagnostic de SAG. Ce cas démontre l'hétérogénéité phénotypique du syndrome et l'importance cruciale du séquençage génétique dans le diagnostic des encéphalopathies précoces d'origine indéterminée, même en l'absence des marqueurs cliniques et radiologiques classiques.

Idiopathic hypereosinophilic syndrome associated with multivessel coronary artery ectasia: a case report

Mehdi Ayoub Laaroussi — 2026-04-17

We report a rare case of idiopathic hypereosinophilic syndrome (iHES) associated with extensive multivessel coronary artery ectasia (CAE), a vascular complication seldom described in this condition. A 56-year-old man with known iHES presented with progressive exertional chest pain. Coronary angiography revealed diffuse ectasia of all major epicardial coronary arteries, with a critical stenosis in the mid-right coronary artery. Secondary causes of eosinophilia were excluded, and no clinical or serological evidence of vasculitis or connective tissue disease was found. The patient was treated with corticosteroids, immunosuppressants, and dual antiplatelet therapy, with a favorable outcome. This case illustrates the potential for eosinophil-mediated vascular injury in iHES and emphasizes the need for comprehensive cardiovascular assessment in patients with persistent hypereosinophilia, even in the absence of systemic symptoms. Increased awareness of this underrecognized manifestation may help guide timely diagnosis and management.

Epidermal nevus: a rare presentation of congenital epidermal hamartoma in a young female

Anshika Kishor Singh — 2026-04-17

A 22-year-old female visited the outpatient department at Mahatma Gandhi Ayurved College Hospital and Research Centre in Salod (H), Wardha, with a skin lesion on her right breast that had been present for the past two years. She reported no previous treatment, no family history of similar skin conditions, and only occasional itching without any noticeable changes in the size or appearance of the lesion. Clinical examination revealed a linear arrangement of darkened, raised papules that had merged into a rough, plaque-like formation, following the embryonic Blaschko´s lines. The lesion was non-tender, and there were no signs of inflammation or systemic involvement. Based on its presentation, possible conditions such as nevus sebaceus, inflammatory linear verrucous epidermal nevus (ILVEN), and acanthosis nigricans were considered. However, the absence of inflammation and the pattern of the lesion supported a diagnosis of epidermal nevus. Although a skin biopsy was not performed, the visual and clinical features were strongly indicative. Epidermal nevi are non-cancerous skin growths arising from localized overproliferation of epidermal cells, often due to genetic mosaic mutations occurring during embryonic development. These lesions typically appear early in life but may go unnoticed or develop slowly, as seen in this case. Histopathological findings in such conditions usually show thickened skin layers and surface projections without gland involvement. While benign, these nevi can occasionally be linked with broader syndromic conditions or show changes later in life. This case is important not only for its clinical presentation in a young adult but also for the insight it offers into a rare skin condition within the context of integrative and ayurvedic medical learning.

Factors associated with under-five child mortality: an analysis of the Rwanda Demographic Health Survey (RDHS) 2019/2020

Julienne Nyirarukundo — 2026-04-17

Introduction: under-five mortalities (U5M) are significant in determining the level of health development of a country. Most countries work to reduce the U5M rate; however, not all achieve the goal, including Rwanda. This study intends to explore factors associated with under-five mortality in Rwanda.

Methods: the study is a quantitative retrospective study using cross-sectional survey data of the Rwanda Demographic Health Survey 2019-2020. Permission for access to data was obtained from the DHS program website. The children dataset (KR) was used with a total of 8092 children. Data analysis used STATA-15 software. Descriptive information had been presented using frequency tables, charts, and graphs. A bivariate analysis using Chi-square was conducted to determine factors associated with U5M. Variables with significant association (P<0.05) in the bivariate analysis were considered for multivariate analysis with logistic regression. P-value <0.05 was declared as a significant association.

Results: the mortality level in 2019/2020 was at 3.66% linked to maternal and child-related factors; low birth weight was (AOR=6.93, 95% CI=4.44-10.81). Postnatal checkup was (AOR= 0.42, CI=0.22-0.81); (P-value <0.009). Delivery at health facility (AOR =0.32, CI=0.13-0.77); (P-value =0.011). The significant socio-economic factors of U5M were the number of household members (p-value=0.002), (AOR=0.59, 95% CI=0.42-0.83) and the partner´s education of secondary level (OR=0.47,95% CI=0.27-0.82); (P-value=0.008) and higher level (AOR=0.29,95% CI=0.11-0.78); (P-value=0.015).

Conclusion: results showed that low birth weight and inadequate post-natal check-up visits are the main associated factors of under-five child mortality. In contrast, the remaining factors were all found to be protective.

Left vocal cord paralysis revealing chronic mediastino-pulmonary silicosis: a case report

Abdellatif Outrah — 2026-04-17

Silicosis is one of the most common occupational lung diseases, resulting from prolonged inhalation of crystalline silica dust. We report the case of a 66-year-old man with a history of silica exposure who presented with hoarseness due to left vocal cord paralysis. Imaging revealed calcified mediastinal lymphadenopathy compressing the left recurrent laryngeal nerve, leading to the diagnosis of chronic mediastino-pulmonary silicosis. This rare presentation highlights the need to consider silicosis as a differential diagnosis in cases of unexplained vocal cord paralysis, especially in individuals with occupational exposure to silica.

Use of anticoagulants in children: a cross-sectional study at Albert Royer Children Hospital and Cardio-Pediatric Surgery Center of Fann University Hospital in Dakar, Senegal

Awa Kane — 2026-04-17

Introduction: the use of anticoagulants in children is less frequent and requires more precautions (higher doses, unsuitable formulations, risk of treatment-related complications). We aimed to describe the challenge of using anticoagulants in children in a sub-Saharan hospital.

Methods: we conducted a cross-sectional study at the Albert Royer National Children's Center and the Cardio-Pediatric Surgery Center of Fann University Hospital, with a prospective recruitment over a 6-month period. All patients aged 0 to 15 years who had received anticoagulant treatment and biological monitoring were included.

Results: thirty-one patients were included. The mean age was 13 years (extremes: 13 days and 15 years) with 58.1% of girls (N=18). Among the causes of thrombotic events requiring anticoagulation, cardiac diseases were the most common in 80.6% (N=25), followed by tumor, autoimmune and traumatic causes at equal proportions of 3% (N=1). Treatment was preventive in 61.2% (N=19) of cases and curative in 38.8% (N=12). The most commonly used anticoagulant was vitamin K antagonist (VKA) in 70.9% of cases (N=22); followed by low molecular weight heparin (LMWH) in 61.29% (N=19); then unfractionated heparin (UFH) in 45.1% (N=14). One patient received rivaroxaban. All patients who received LMWH were treated with 200 IU/kg/day. The median dose of UFH was 8.3 IU/kg/h. For patients receiving VKA; 52.9% (N=9) had a dosage less than 0.1mg/kg/day. In 63.2% (N=12) of cases, the switch molecule was VKA. The median time to achieve the target INR was 13.5 days. Complications occurred in 9 patients (29.03%): heparin-induced thrombocytopenia (N=2), vitamin K antagonist overdose (N=6) and epistaxis (N=1).

Conclusion: this study shows, on the one hand, that children are mostly under-dosed with anticoagulants; on the other hand, when the effective dose is reached, nearly one-third of anticoagulation-related accidents occur in this population.

A cross-sectional study of dietary non-adherence and perceived barriers of people living with type 2 diabetes mellitus in a rural community in the Ashanti region of Ghana

Ernestina Armah — 2026-04-17

Introduction: diabetes is undergoing an epidemiologic transition in sub-Saharan Africa, driven by factors such as the westernization of the African diet and changes in personal lifestyle. This transition of the African diet is seen more in urban than rural communities. Dietary counseling is subject to non-adherence because people living with type 2 diabetes mellitus (T2DM) are often counseled on diets that are usually difficult to come by in rural communities, and are unpalatable for some. This study, therefore, aimed to investigate dietary non-adherence and perceived barriers to the recommended diet among individuals living with T2DM in a rural community in Ghana.

Methods: a descriptive cross-sectional survey design with a quantitative approach was used to assess the dietary adherence/non-adherence to dietary counseling of 208 T2DM participants receiving care at the New Edubiase Government Hospital. Dietary non-adherence was measured as an outcome variable against predictors such as socio-demographic factors, biological risk factors, duration of T2DM, presence of comorbidities (hypertension), and knowledge of T2DM.

Results: females were the majority, 73.6% (n=153), and the average age was 58 (SD ±11.9). The prevalence of non-adherence was 39.42% (n=82). About 24.5% (n=51) of the participants ate fruits and vegetables 25% (n=52) every time in their main meal. A total of 43.3 % (n=90) of the participants were engaged in inappropriate dietary habits. The majority cited food unavailability 84.6% (n=176), inaccessibility 80.8% (n=164), and financial constraints 60.1% (n=125) as perceived barriers to dietary non-adherence. The majority, 65.9% (n=137) of the participants, indicated that food preferences and taste contribute to non-adherence to diabetic diets. Among participants who adhered to the recommended diet, females with tertiary education and T2DM onset of less than 5 years were associated with higher adherence (females -aOR = 7.33, 95% CI = 2.33-22.99, P = .001, aOR = 3.69, 95% CI = 1.53-8.88, P = .001). Participants who did not use complementary herbal remedies had higher odds of adhering to dietary recommendations compared to those who used herbal remedies (aOR = 6.53, 95% CI = 2.34-18.23, P = 0.001). Among participants who were not adhering to recommended diets were those who had poor knowledge of T2DM management and a high Waist-to-Hip Ratio (WHR) (aOR = 7.97, 95% CI = 2.61-24.31, P = 0.001, aOR = 0.06, 95% CI = 0.01-0.33, P = 0.001).

Conclusion: the high rates of non-compliance with dietary recommendations underscore the need for comprehensive and targeted interventions to address the multifaceted barriers faced by persons living with T2DM in rural communities.