Pan African Medical Journal <p>We publish original scientific studies, comments on currents health initiatives, project and work reports, personal experiences, reviews of current health initiatives, educational articles and paper commenting on clinical, social, political, economical and all other factors affecting health. We are particularly interested in receiving articles and comments reflecting the point of view and experience of professionals working in Africa related to the impact of currents public health initiatives on their daily routine. The Journal is available online here: <a href="" target="_blank"></a></p><p><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--> <!-- /* Font Definitions */ @font-face {font-family:Tahoma; panose-1:2 11 6 4 3 5 4 4 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:1627421319 -2147483648 8 0 66047 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0pt; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-GB;} {mso-style-name:apple-style-span;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 90.0pt 72.0pt 90.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> <!--[if gte mso 10]> <mce:style><! /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0pt 5.4pt 0pt 5.4pt; mso-para-margin:0pt; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} --> <!--[endif] --></p> en-US Brief summary of the agreement Anyone is free: · to copy, distribute, and display the work; · to make derivative works; · to make commercial use of the work; Under the following conditions: Attribution · the original author must be given credit; · for any reuse or distribution, it must be made clear to others what the license terms of this work are; · any of these conditions can be waived if the authors gives permission. Statutory fair use and other rights are in no way affected by the above (Dr Raoul Kamadjeu) (Editor) Thu, 10 Jun 2021 09:05:28 +0000 OJS 60 An analysis of trends and distribution of the burden of road traffic injuries in Uganda, 2011 to 2015: a retrospective study <p><strong>Introduction:&nbsp;</strong>gobally, 1.3 million people die from road traffic injuries every year. Over 90% of these deaths occur in low-and-middle-income countries. In Uganda, between 2012 and 2014, about 53,147 road traffic injuries were reported by the police, out of which 8,906 people died. Temporal and regional distribution of these injuries is not known, hence hindering targeted interventions. We described the trends and distribution of health facility reported road traffic injuries in Uganda from 2011 to 2015.</p> <p><strong>Methods:&nbsp;</strong>we obtained monthly data on road traffic injuries, from 112 districts from the Ministry of Health Uganda. We analyzed the data retrospectively to generate descriptive statistics.</p> <p><strong>Results:&nbsp;</strong>a total of 645,805 road traffic injuries were reported from January 2011 through December 2015 and 2,807 deaths reported from 2011 through 2014. Injuries increased from 37,219 in 2011 to 222,267 in 2014 and sharply dropped in December 2015 to 57,149. Kampala region had the highest number of injuries and deaths (18.3% (117,950/645,805) and 22.6% (634/2807)) respectively whereas Karamoja had the lowest injuries and deaths (1.7% (10,823/645,805) and 0.8% (21/2807)) respectively. Children aged 0-4 years accounted for 21.9% (615/2807) deaths; mostly females 81% (498/615) were affected.</p> <p><strong>Conclusion:&nbsp;</strong>road traffic injuries increased during 2011-2014. Injuries and deaths were highest in Kampala and lowest in Karamoja region. It was noted that health facilities mostly received serious injuries. It is likely that the burden is higher but under reported. Concerted efforts are needed to increase road safety campaigns in Kampala and surrounding regions and to link pre-hospital deaths so as to understand the burden of road traffic crashes and recommend appropriate interventions.</p> Frederick Oporia, Angela Nakanwagi Kisakye, Rebecca Nuwematsiko, Abdulgafoor Mahmood Bachani, John Bosco Isunju, Abdullah Ali Halage, Zziwa Swaibu, Lynn Muhimbuura Atuyambe, Olive Kobusingye Copyright (c) Sun, 02 Sep 2018 00:00:00 +0000 A complicated steroid resistant nephrotic syndrome: a large intracardiac thrombus with bilateral distal embolization <p>Nephrotic syndrome (NS) is a consequence of the reduced ability of the glomerulus barrier to exclude proteins of intermediate size and other macromolecules from urine. Albumin and proteins that modulate the coagulation cascade are among the substances eliminated in urine. This is responsible of thromboembolic complication. The incidence of this extra renal complication is probably underestimated because of asymptomatic thromboembolic events. We report the case of a 23 years old man followed up for an idiopathic nephrotic syndrome since childhood who presented a large intracardiac thrombus complicated by distal embolisation of his two lower limbs, successfully treated by fogartisation-embolectomy and oral anticoagulation.</p> Abdelkader Jalil El Hangouche, Oumaima Alaika, Koffi Augustin Assié, Latifa Oukerraj, Nawal Doghmi, Taoufiq Dakka, Mohammed Cherti Copyright (c) Mon, 03 Sep 2018 00:00:00 +0000 Mumps outbreak in an unimmunized population – Luanshya District, Copperbelt Province, Zambia, 2015 <p><strong>Introduction:&nbsp;</strong>mumps is a vaccine-preventable viral disease that may cause deafness, orchitis, encephalitis or death. However, mumps vaccine is not included in Zambia’s Expanded Program for Immunization. In January 2015, Integrated Disease Surveillance and Response data revealed an increase in reported mumps cases in Luanshya District. We investigated to confirm the etiology and generate epidemiological data on mumps in Zambia.</p> <p><strong>Methods:&nbsp;</strong>we conducted active case finding, examined possible case-patients, and administered a standard questionnaire. A suspected mumps case was defined as acute onset of salivary gland swelling in a Luanshya resident during January - June 2015. Eight case-patients provided serum samples to test for mumps-specific immunoglobulin IgM, and buccal swabs to test for mumps viral RNA by RT-PCR, and genotyping of mumps virus at the Centers for Disease Control and Prevention, Atlanta, Georgia, USA.</p> <p><strong>Results:&nbsp;</strong>from January – June 2015, a total of 283 mumps cases were reported in Luanshya, peaking in April (71 cases) and clustering (81%) in two townships. Of 72 suspected case-patients interviewed, 81% were aged &lt; 15 years (29%, 1 - 4 years) and 61% were female. Common clinical characteristics were buccal tenderness (29%) and fever &gt; 37.5ºC (29%). Mumps virus genotype D was confirmed in five case-patients who tested positive by RT-PCR; six case-patients were sero-positive for anti-mumps IgM antibodies (total seven lab-confirmed cases).</p> <p><strong>Conclusion:&nbsp;</strong>our findings represent the first reported epidemiologic description of mumps in Zambia. While the epidemiology is consistent with prior descriptions of mumps in unimmunized populations and no serious complications arose, this report provides data to inform policy discussions regarding mumps vaccination in Zambia.</p> Ernest Kateule, Ramya Kumar, Modest Mulenga, Victor Daka, Kelvin Banda, Raydel Anderson, Marcia McGrew, Henry C Baggett, Rebecca McNall, Webster Kasongo Copyright (c) Mon, 03 Sep 2018 00:00:00 +0000 L’endométriose de la paroi abdominale: à propos d’un cas <p>L'endométriose de la paroi abdominale, définie comme l’implantation ectopique du tissu endométrial en dehors de la cavité utérine, est une affection rare et souvent méconnue. Elle survient habituellement sur cicatrice d'intervention chirurgicale gynécologique ou obstétricale. La présentation clinique typique est celle d’une masse pariétale associée à des douleurs rythmées par les menstruations. Le diagnostic est confirmé par l’histologie. Le traitement est principalement chirurgical et repose sur l’exérèse complète de la lésion.</p> Tariq Bouhout, Badr Serji, Ebo Usman Egyir, Benyounes El Amri, Imad Bouhout, Mehdi Soufi, Mohammed Bouziane, Tijani El Harroudi Copyright (c) Mon, 03 Sep 2018 00:00:00 +0000 Aspect tdm d’une anomalie de l’arc aortique: variante de Nehausser? <p>Les malformations congénitales par anomalie de position et de développement des arcs brachiaux primitifs représentent 1% des anomalies congénitales cardio-vasculaires. Nous rapportons le cas rare d'un nourrisson de 22 mois, né par voie basse d'une grossesse menée à terme qui a présenté une dyspnée intermittente depuis la naissance associée à une toux. L'angio-scanner cervico-thoracique a permis d'objectiver un arc aortique droit et une artère sub-clavière gauche pré-trachéo-oesophagienne prenant en pince l'œsophage et la trachée à environ 15 mm au-dessus de la carène entrainant une sténose d'environ 70% de la trachée sur une hauteur de 16 mm. Cette malformation complexe représente un type rare d'anomalie de l'arc aortique avec une variante inhabituelle du trajet de l'artère sub-clavière gauche. Elle pose un problème diagnostique et de traitement dans notre contexte du fait des difficultés d'accessibilité au scanner et à la chirurgie.</p> Aida Ida Tankoano, Milckisédek Judicaël Marouruana Somé, Dominique Bicaba, Gisèle Marie Ursule Tapsoba, Adama Jean Honoré Konaté, Dénis Kontogom, Zakari Nikièma Copyright (c) Mon, 03 Sep 2018 00:00:00 +0000 Tumeur du sac endolymphatique au niveau du rocher: à propos d’un cas <p>La tumeur du sac endolymphatique est une tumeur neuroectodermique rare dérivée de l’oreille interne qui possède un faible potentiel de malignité mais avec un pouvoir d’agressivité locale très marqué sans notion de métastase. Il s’agit d’un patient de 60 ans qui a présenté des signes d’appel en faveur d’une atteinte de l’oreille interne accompagné de symptômes en faveur d’une atteinte de l’angle ponto cérébelleux. L’examen radiologique par IRM a montré un processus lésionnel envahissant la mastoïde et l’os temporal. L’examen anatomopathologique confirme la nature tumorale en précisant le type histologique par une étude immunohistochimique en retenant le diagnostic de tumeur sporadique du sac endolymphatique. Cette tumeur peut arriver à n’importe quel âge avec une moyenne de 52 ans pour les cas sporadiques. Sur le plan histologique on distingue deux entités: papillaire et folliculaire. Il faut éliminer les autres diagnostiques différentiels surtout les métastases du carcinome thyroïdien. La difficulté de la résection chirurgicale de ces tumeurs est due à leur vascularisation et à leur infiltration dans les os et les méninges. L'excision complète est la meilleure garantie contre la récidive tumorale.</p> Amine Kessab, Safaa Rokhssi, Meriem Rais, Mohamed Anass Benbouzid, Leila Esskalli, Nadia Cherradi Copyright (c) Mon, 03 Sep 2018 00:00:00 +0000 Anaphylactic shock due to patent blue: case report and review of literature <p>Intraoperative search for the sentinal node using patent blue is considered a non risk procedure. We emphasize the highly exceptional nature of this adverse effect previously observed in other disciplines using this coloring agent. We present a case of allergic reaction to patent blue in a patient who underwent left mastectomy with sentinel lymph node. About 25 min after the dye injection, the patient developed increased heart frequency and allergic skin reaction. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. The patient recovered uneventfully and was discharged from the PACU 3h after the end of surgery without skin changes and was discharged from hospital on the morning after surgery. Allergic reactions with the use of patent blue are far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye. Skin tests done later confirmed allergy to patent blue dye; the tests induced a small syndrome reaction. Surgical personnel who use patent blue dye should be made aware of the risk of allergic reactions, sometimes severe, to this dye.</p> Asma Korbi, Amel Khaskhoussy, Ons Cherif, Ahmed Hajji, Imen Gaddab, Amel Chaabene, Mouna Gara, Fathi Jbeli, Lotfi Grati, Med Salah Rhim, Raja Faleh Copyright (c) Tue, 04 Sep 2018 00:00:00 +0000 Un lymphome T/NK extra-ganglionnaire de type nasal se présentant comme une cellulite orbitaire <p>Le lymphome extra-ganglionnaire T/NK de type nasal est une forme rare des lymphomes malins non hodgkinien. Elle pose un problème diagnostique à cause des symptômes peu spécifiques. Nous rapportons un cas de lymphome T/NK simulant une cellulite orbitaire. Il s'agit d'une patiente de 46 ans, suivie pour maladie de Behçet. Admise dans un tableau clinique de cellulite orbitaire. Le scanner du massif facial montrait une pansinusite avec infiltration orbitaire. En l'absence d'amélioration sous traitement antibiotique. Un traitement chirurgical avec biopsie a été réalisé. L'examen histologique a mis en évidence des signes de vascularite inflammatoire et la patiente a été mise sous corticothérapie avec amélioration clinique. Devant la récidive la patiente a bénéficié d'une reprise chirurgicale avec des biopsies de l'ethmoïde qui ont mis en évidence un lymphome T/NK de type nasal. Le traitement a consisté en une radio-chimiothérapie et la patiente est décédée dans les deux mois. Les lymphomes T/NK sont agressifs, ils touchent essentiellement les cavités naso-sinusiennes. Ils sont responsables d'une angio-destruction et de la nécrose qui rendent les symptômes peu spécifiques et les biopsies souvent négatives, posant un problème de diagnostic différentiel. Le traitement repose sur la radiothérapie et la chimiothérapie et le pronostic reste réservé.</p> Ghizlan EL Amri, Mohamed Zalagh, Fouad Benariba Copyright (c) Tue, 04 Sep 2018 00:00:00 +0000 Pronostic rénal de la néphropathie des vascularites à IgA de l’adulte: étude monocentrique, à propos de 25 cas <p>La néphropathie de la vascularite à IgA conditionne le pronostic de cette affection chez l’adulte. Le but de notre étude était d’étudier les caractéristiques cliniques de cette atteinte rénale chez l’adulte et d’identifier les facteurs de pronostic rénal. Il s’agit d’une étude monocentrique rétrospective portant sur les patients ayant une vascularite à IgA (purpura rhumatoïde) (critères de l’EULAR) avec une atteinte rénale prouvée histologiquement et classée selon la classification de Pillebout. Nous avons analysé la survie rénale et identifier les facteurs de pronostic rénal. Vingt cinq patients ont été inclus (genre ratio M/F = 2,57) d’âge moyen au diagnostic du purpura rhumatoïde de 35,76 ans. Un purpura était présent dans 100% des cas avec une atteinte articulaire dans 28%. Une insuffisance rénale était présente dans 44% des cas. La classification histologique la plus fréquente était la classe II. Une rémission clinique a été observée dans 44% des cas et une évolution vers le stade terminal de l’insuffisance rénale chronique dans 36% des cas. La survie rénale à 195 mois était de 57%. Les facteurs pronostiques identifiés étaient l’atteinte digestive (p = 0,022), l’insuffisance rénale initiale (p = 0,0004), la classification glomérulaire (p = 0001) et la sévérité des lésions histologiques, le traitement par bloqueurs du système rénine angiotensine (p = 0,01) et les échanges plasmatiques (p = 0,03). Notre étude montre que l’atteinte rénale au cours des vascularites à IgA peut être relativement sévère avec un mauvais pronostic rénal. L’identification des facteurs pronostiques cliniques et histologiques pourrait guider l’élaboration d’études thérapeutiques prospectives.</p> Amel Harzallah, Hayet Kaaroud, Narjess Laadhari, Ezzeddine Abderrahim, Rim Goucha, Sami Turki, Fethi Ben Hmida, Samia Barbouch, Taieb Ben Abdallah Copyright (c) Tue, 04 Sep 2018 00:00:00 +0000 Dissection aortique anévrismale chez un adulte infecté par le VIH-1 dans le cadre d’un syndrome de reconstitution immune avec tuberculose <p>Un homme de 35 ans, VIH-1, sans antécédents médicaux et chirurgicaux particuliers, a été hospitalisé à Abidjan, Côte d'Ivoire, dans un contexte fébrile, toux, dyspnée, douleurs thoraciques et à la radiographie pulmonaire, un déroulement de la crosse de l'aorte une semaine après avoir débuté les antirétroviraux (ARV). Les scanners angiothoraciques réalisés ont mis en évidence une ectasie aortique globale étendue avec thrombus mural. Une échocardiographie transoesophagienne conclut à une dissection aortique, type A de Stanford. Le diagnostic de tuberculose a été confirmé par l'isolation en culture de&nbsp;<em>Mycobacterium Tuberculosis</em>. Huit ans après, le patient est encore vivant, sans intervention chirurgicale et se plaint de douleurs thoraciques intermittentes. Sa pression artérielle est stable et a une insuffisance rénale modérée. Nous rapportons un cas rare de dissection aortique anévrismale chez un adulte infecté par le VIH-1 dans le cadre d'un syndrome de reconstitution immune avec tuberculose pulmonaire.</p> Desmorys Raoul Moh, Anani Badjé, Nogbou Frederic Ello, Jean-Baptiste N'takpé, Jean-Baptiste Anzouan-Kacou, Gérard Menan Kouamé, Simplice Ackoundzé, Franck Boccara, Olivier Ba-Gomis, Serge-Paul Eholié, Xavier Anglaret, Christine Danel Copyright (c) Tue, 04 Sep 2018 00:00:00 +0000 A bleeding tumor of the foot <p>Botriomycoma or pyogenic granuloma is a benign vascular tumor very common in daily practice, which often sits at the extremities and is favored by trauma. The evolution is often favorable enamelled by the frequency of recidivism; however some atypical or massively bleeding forms pose diagnostic and therapeutic difficulties. We present a case illustrating this problematic. Botriomycoma or pyogenic granuloma is a non-rare benign vascular tumor, favored by trauma, mainly at the extremities and characterized by post-traumatic bleeding recurrence. Spectacular and massively bleeding forms are rarely reported. We present a case. A 60-year-old woman, with a history of a recessive infra-centimeter nodule of the second left toe. Has consulted for an increase of this nodule up to three centimeters in diameter. She was lost to follow-up for four months, and then she reconsulted for the same tumefaction which became ulcerated and massively bleeding and having increased in volume to reach five centimeters of large diameter. Ultrasound showed a superficial and much vascularized tumor. In view of the very haemorrhagic character and the repercussions on the general condition of the patient, a total resection of the tumor was done urgently and the histology was in favor of a botriomycoma without signs of malignancy. The evolution was favorable. Most botriomyomas are small and at risk of recurrence, but rapidly progressive and massively bleeding tumor forms, as noted case, requires rapid management and collaboration between dermatologist and plastic surgeon.</p> Mohamed El Amraoui, Abdelhafid Achbouk Copyright (c) Tue, 04 Sep 2018 00:00:00 +0000 Lichen with triple involvement: cutaneous, mucous and phanerian <p>Lichen is a common chronic inflammatory dermatitis that can affect the skin, mucous membranes and phaneres. The simultaneous involvement of the three compartments is rare and testifies to the severity and activity of the disease. We present a case of this triple involvement. However, the complete muco-cutaneous and phanerienic forms are rare, testify to the severity of the disease and justify a systemic treatment and a regular and long-term monitoring view the risk of degeneration of the mucous lesions. We report the case of this 60-old-man, followed for papular dermatosis, hyperpigmentary, very itchy, generalized, with involvement of the genital mucosa, in the form of erosive balanitis and nails of the hands and feet. The cutaneous histology was in favor of lichen. The biological examinations did not show any dysthyroidism, liver or autoimmune diseases. The patient was placed on systemic and topical corticosteroids. A pigmentogenic evolution of the cutaneous lesions, a beginning of bleaching of the nail lesions and a resistance of the genital lesions were noted.</p> Mohamed El Amraoui, Badredine Hassam Copyright (c) Tue, 04 Sep 2018 00:00:00 +0000 Le traitement conservateur médical de la fistule œsotracheale <p>Les fistules œsotrachéales représentent une entité pathologique caractérisée par la présence d'une communication anormale entre l'arbre trachéal et l'œsophage. A travers un cas clinique de fistule œsotrachéale suite à l'ingestion d'un corps étranger, nous abordions l'aspect étiopathogénique, évaluer notre principe thérapeutique et faire une revue de la littérature. Il s'agit d'un patient de 15ans admis pour dysphagie évoluant depuis deux mois suite à l'ingestion d'un corps étranger à type de morceau d'os. L'œsophagoscopie sous anesthésie générale a permis l'extraction du corps étranger. Le Transit Oeso-gastro-duodénal (TOGD) en post-opératoire a objectivé l'orifice fistulaire siégeant au niveau de C7. L'absence de l'orifice fistulaire a été notée à J30 post-endoscopie au TOGD de contrôle. Le traitement médical est une alternative thérapeutique de la fistule œsotrachéale et doit être basé sur des critères bien définis.</p> Fatogoma Issa Koné, Kadidiatou Singaré, Siaka Soumaoro, Naouma Cissé, N’Faly Konaté, Kassim Diarra, Yaya Dembélé, Samba Karim Timbo, Mohamed Amadou Keïta Copyright (c) Tue, 04 Sep 2018 00:00:00 +0000 Cancers primitifs de la verge: à propos de 11 cas et revue de la littérature <p>Le cancer de la verge est une pathologie rare en Tunisie ou la circoncision est de pratique courante. Il s'agit dans 95% des cas d'un carcinome épidermoïde. Le traitement repose essentiellement sur la chirurgie. Nous rapportons rétrospectivement les caractères épidémiologique, clinique, thérapeutique et évolutif de 11 cas de cancers primitifs de la verge.</p> Houyem Mansouri, Ines Ben Safta, Med Ali Ayadi, Selma Gadria, Tarek Ben Dhiab, Khaled Rahal Copyright (c) Tue, 04 Sep 2018 00:00:00 +0000 Neuroendoscopic aspiration and lavage of intraventricular empyema following shunt infection in infants <p>Bacterial ventriculitis is one of the most common and serious complications of shunt placement. Shunt infection has varied management and is difficult to treat neurosurgically. We report a case of intraventricular empyema due to shunt infection. Standard management was failed for this case and reaccumulation of pus in the both ventricles. Neuroendoscopic surgery with intraventricular lavage and aspiration using cannula nasogastric tube (NGT) through a single burr hole, has successfully decreased the accumulation of intraventricular empyema. After lavage and aspiration, antibiotic can be distributed effectively to the affected area. Follow up imaging and cerebrospinal fluid (CSF) culture shown a good result and shorter length of stay in the hospital. Neuroendoscopy appears effective and safe for the management of bacterial ventriculitis due to shunt infection in infant. The strategy described in this report might be useful to treat intraventricular empyema.</p> Steven Tandean, Lutfi Hendriansyah, Stanislaus Djokomuljanto, Nico Adi Saputra, Andry Juliansen, Silvia Valentina, Monica Ann Mulry, Julius July Copyright (c) Wed, 05 Sep 2018 00:00:00 +0000 Antibiotics susceptibility pattern of Streptococcus pneumoniae isolated from sputum cultures of human immunodeficiency virus infected patients in Yaoundé, Cameroon <p><strong>Introduction:&nbsp;</strong>the susceptibility of Streptococcus pneumoniae to commonly used antibiotics is threatened by the emergence of resistance of S. pneumonia strains. So, to improve the management of lower respiratory tract infections (LRTIs) in human immunodeficiency virus infected patients, we assessed the antibiotic susceptibility of Streptococcus pneumoniae which is the most common bacterial cause of LRTIs in patients.</p> <p><strong>Methods:&nbsp;</strong>a cross sectional study was carried out from May to October 2014. HIV infected patients suspected of LRTIs attending the Center Medical laboratory and those followed up at the authorized treatment center of Yaounde Military Hospital in Cameroon were enrolled. Sputum was collected from each patient and cultured; identification of microorganisms was performed following standard methods. The disk diffusion method was used for antibacterial susceptibility testing according to the Antibiogram Committee of French Society for Microbiology guidelines.</p> <p><strong>Results:&nbsp;</strong>a total of 51 (25.5%) isolates of&nbsp;<em>S. pneumoniae</em>&nbsp;were recovered from sputum samples obtained from 200 HIV infected patients aged 19-66 years old (mean age: 36±10.087 years old); 144 (72%) of them were female (sex ratio M/F: 1/3).&nbsp;<em>S. pneumoniae</em>&nbsp;carriage was not age dependent (P = 0.384) and was significantly higher in male compared to female (P = 0.008).&nbsp;<em>S. pneumoniae</em>&nbsp;isolates were susceptible to amoxicillin-clavulinic acid (100%), pristinamycin (100%), erythromycin (100%) and cefixime (98.04 %). Highest resistance rates were recorded with fusidic acid (100%), fosfomycin (100%) and tetracyclin (100%).</p> <p><strong>Conclusion:&nbsp;</strong><em>S. pneumoniae</em>&nbsp;is still susceptible to some agents in our study area however; ongoing surveillance for antimicrobial susceptibility remains essential to identify emerging resistance and attempt to limit its spread.</p> Michel Kengne, Marlise Beatrice Bidzogo Lebogo, Julius Mbekem Nwobegahay, Bienvenue Etogo Ondigui Copyright (c) Wed, 05 Sep 2018 00:00:00 +0000 Adherence to complementary feeding guidelines among caregivers of children aged 6-23 months in Lamwo district, rural Uganda <p><strong>Introduction:&nbsp;</strong>malnutrition contributes to half of all deaths among children under-five years in developing countries such as Uganda. Optimal complementary feeding is one of the crucial interventions that could prevent these deaths. This study measured adherence to complementary feeding guidelines and its associated factors among caregivers of children aged 6-23 months in Lamwo district, rural Uganda.</p> <p><strong>Methods:&nbsp;</strong>a household cross-sectional study was used to collect data on adherence to complementary feeding among 349 caregivers. A composite variable with 9 indicators of complementary feeding was used to measure adherence. Univariable and multivariable logistic regression was used for statistical analysis using STATA software.</p> <p><strong>Results:&nbsp;</strong>a household cross-sectional study was used to collect data on adherence to complementary feeding among 349 caregivers. A composite variable with 9 indicators of complementary feeding was used to measure adherence. Univariable and multivariable logistic regression was used for statistical analysis using STATA software.nearly all (97.7%, 341/349) children had ever been breastfed. Complementary feeding was initiated at six months for 47.0% (164/349) of the children. The number of complementary meals ranged from 1-4 meals per day with a mean of 3 meals per day (SD = 0.8). About half (55.8%, 195/349) of the children were given less than the recommended amount of food. Overall only 40.1% (140/349) of all study respondents were adherent to complementary feeding guidelines. The odds of adherence to complementary feeding were higher among caregivers with children aged 6-8 months (AOR = 4.68, 95% CI: 1.91-11.48), children whose fathers had attained 8 or more years of formal education (AOR = 2.27, 95% CI: 1.22-4.19), caregivers with two children under five years (AOR = 5.46, 95% CI: 1.46-20.36), those living in the poorest households (AOR = 3.00, 95% CI: 1.37-6.57) and those who showed willingness to recommend initiation of complementary feeding at six months to another mother (AOR = 1.34 95% CI: 1.06-1.70).</p> <p><strong>Conclusion:&nbsp;</strong>adherence to complementary feeding guidelines was very low in this rural African setting indicating an urgent need for interventions such as health education to improve adherence with consequent reduction in rates of under nutrition. These interventions should target caregivers with older children, fathers with less than 8 years of formal education and those living in the wealthiest households.</p> Harriet Aber, Angela Nakanwagi Kisakye, Juliet Ndimwibo Babirye Copyright (c) Thu, 06 Sep 2018 00:00:00 +0000 Intoxication au M’khinza: à propos de deux observations <p><em>Dysphania ambrosioides</em>&nbsp;ou ansérine, appelée au Maroc M'Khinza est une plante appartenant à la famille des&nbsp;<em>Chenopodiaceae</em>. Utilisée au Maroc pour ses propriétés thérapeutiques notamment antipyrétique, elle peut être toxique si elle est mal dosée. Nous rapportons deux cas d'intoxications colligés au service des urgences médicales pédiatriques de Rabat: un nourrisson de 5 mois et une fille de 10 ans qui, suite à l'ingestion d'infusion de cette plante à des doses indéterminées dans un but antipyrétique avaient présenté respectivement une encéphalopathie toxique et une déshydratation sévère sur gastroentérite aiguë aboutissant aux décès en moins de 12 heures. Ces nouveaux cas de neurotoxicité et d'entérotoxicité au M'Khinza doivent interpeler sur la nécessité de savoir évoquer le diagnostic, d'informer, de lutter contre la banalisation de sa consommation, d'inciter à la recherche sur la pharmacopée traditionnelle permettant d'identifier leurs propriétés thérapeutiques afin de formaliser, rationaliser et codifier leurs prescriptions.</p> Luc Pascal Christian Loulouga Badinga, Nour Mekaoui, Lamiae Karboubi, Badr Sououd Benjelloun Dakhala Copyright (c) Thu, 06 Sep 2018 00:00:00 +0000 Integrated disease surveillance and response strategy for epidemic prone diseases at the primary health care (PHC) level in Oyo State, Nigeria: what do health care workers know and feel? <p><strong>Introduction:&nbsp;</strong>effective diseases surveillance remains an important operational tool in countries with recurrent epidemic prone diseases (EPDs). In Nigeria, insufficient knowledge among Health Care Workers (HCWs) on Integrated Disease Strategy and Response Strategy (IDSR) have been documented. This study assessed knowledge and attitude of HCWs towards IDSR strategy for EPDs at the Primary Health Care (PHC) level in Oyo State, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional facility based study using an interviewer-administered questionnaire was used to obtain information from 531 HCWs. In addition, 7 Key Informant Interviews was conducted. Discrete data were summarized as proportions while chi-square test was used to assess association between variables. A logistic regression model was used to assess predictors of knowledge of HCWs. All statistical significance was set at 5%.</p> <p><strong>Results:&nbsp;</strong>mean age of respondents was 42 ± 8.1 years with female preponderance (86.1%). Community Health Extension Workers (CHEWs) (36.9%) constituted the highest proportion of HCWs. About 70% and 90% of HCWs had good knowledge of EPDs and IDSR surveillance data flow respectively. Majority of HCWs 333(67.3%) knew how to use IDSR form 003 but less than 10% knew how to use other IDSR forms. The majority of HCWs {492(99.4%) and 345(69.7%)} agreed that reporting EPDs is necessary and IDSR tools are simple to use. Number of years post basic qualification was a predictor of HCWs' knowledge (AOR: 1.6; 95% CI: 1.0-2.3).</p> <p><strong>Conclusion:&nbsp;</strong>this study showed poor knowledge on the use of IDSR forms although majority of HCWs had good knowledge and positive attitude towards IDSR strategy for EPDs. Thus, regular evaluation of health workers' knowledge and attitude towards IDSR strategy as a performance function of the surveillance system is recommended.</p> Kola Ademola Jinadu, Akindele Olupelumi Adebiyi, Olubunmi Olutoyin Sekoni, Eniola Adetola Bamgboye Copyright (c) Fri, 07 Sep 2018 00:00:00 +0000 Pattern of pubertal changes in Calabar, South South Nigeria <p><strong>Introduction:&nbsp;</strong>puberty is an essential physiologic process that is characterized by the appearance of secondary sexual features. Secular changes in puberty occur from one generation to another and need to be documented. The assessment of pubertal stages in a child is only useful if recent and reliable reference data from the same population is available for comparison. The study aimed to profile clinical normative sexual maturity characteristics for children in Calabar, South-South Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a cross-section of primary and secondary school pupils aged 6-18 years in the city of Calabar, Nigeria were randomly selected for the study. Sexual maturating rating was assessed using the pubertal staging for breast development and pubic hair as described by Marshall and Tanner (Tanner staging). Testicular volume in boys was measured using the Prader orchidometer. Menarche and "voice break" were established by recall of the event by the girls and boys respectively.</p> <p><strong>Results:&nbsp;</strong>a total of 2,830 children were seen, 1542 (54.5%) boys and 1288 (45.5%) girls. The mean age of onset of pubic hair was 11 years in both boys and girls. Pubertal testicular volume of 4 mls was seen in boys at a mean age of 11 years. Breast development in girls occurred at mean age of 11 years and menarche at 13 years.</p> <p><strong>Conclusion:&nbsp;</strong>in this study, the onset of puberty is occurring at an earlier age than previously reported in Nigeria with a secular trend of a decreasing age at onset of puberty. These sexual characteristics are rather occurring at similar ages reported from western countries.</p> Michael Eteng Eyong, Happiness Uko Ntia, Joanah Moses Ikobah, Edu Michael Eyong, Helen Uket, Callistus Enyuma, Kelechi Uheagbu Copyright (c) Fri, 07 Sep 2018 00:00:00 +0000 Knowledge, attitudes and practices towards rabies prevention among residents of Abuja municipal area council, Federal Capital Territory, Nigeria <p><strong>Introduction:&nbsp;</strong>rabies is a fatal neglected zoonosis killing 55,000 people worldwide annually. It is endemic in Nigeria with 10,000 people exposed annually through dog-bites. To inform adequate intervention due to the rise in reported dog-bite cases, we assessed knowledge, attitudes and practices (KAP).</p> <p><strong>Methods:&nbsp;</strong>we carried out a cross-sectional study among 224 residents in Abuja Municipal Area Council. We used structured questionnaires to collect data on sociodemographic characteristics, knowledge and attitudes on rabies prevention. Knowledge score of ≥ 8 points based on ten-point domain question were regarded as satisfactory. We analyzed data using Epi-Info and Excel for proportions and associations were determined at 5% significance level.</p> <p><strong>Results:&nbsp;</strong>a total of 123 (55%) respondents owned dogs. One hundred and eighty four (82%) respondents had satisfactory knowledge on rabies prevention, about 87% knew where to get dogs vaccinated and would seek medical treatment from the hospital when bitten by a dog. Majority (58%) did not know the frequency of anti-rabies administration for dogs and 63.3% did not know the appropriate first aid actions following dog-bites. Of 123 dog owners, 35% would allow their dogs roam without restriction and 94% reported vaccinating their dogs against rabies. Dog owners were more likely to have satisfactory knowledge of rabies compared to non-dog owners (OR 7.8, 95% CI 1.0-62.0, p = 0.02).</p> <p><strong>Conclusion:&nbsp;</strong>knowledge on rabies is satisfactory but with gaps in the frequency of dog anti-rabies vaccination, appropriate first-aid following dog bites and non restriction of dog movement. To prevent rabies, these gaps need to be addressed through public enlightenment and enforcement of dog movement restrictions laws.</p> Aboyowa Arayuwa Edukugho, Jarlath Udoudo Umoh, Matthew Diem, Oyetunji Ajani, Belinda Uba, Lilian Okeke, Elizabeth Adedire, Adewole Adefisoye, Caroline Edukugho, Patrick Nguku Copyright (c) Mon, 10 Sep 2018 00:00:00 +0000 A qualitative inquiry on the status and adequacy of legal instruments establishing infectious disease surveillance in Nigeria <p><strong>Introduction:&nbsp;</strong>the threat of devastating disease outbreaks is on the rise with several outbreaks recorded across the world in the last five years. The intractable Ebola Virus Disease outbreak in West Africa which spread to Nigeria was a reawakening point. This study aims to review the status and adequacy of the legal framework for disease surveillance in Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a mixed methods approach comprising of document reviews and key informant interviews was used in data collection.</p> <p><strong>Results:&nbsp;</strong>the National Law on disease surveillance in Nigeria. An Integrated Disease Surveillance and Response Policy (IDSR) was developed in 2005 as the means for achieving the International Health Regulations (IHR). All six states claimed to have adopted the national IDSR policy though none could present a domesticated version of the policy. Key informants were concerned that Nigeria does not yet have an adequate legal framework for disease surveillance.</p> <p><strong>Conclusion:&nbsp;</strong>the legal instruments establishing disease surveillance in Nigeria require strengthening and possibly enactment as a National Law in order to address emerging disease threats.</p> Olusesan Ayodeji Makinde, Clifford Obby Odimegwu Copyright (c) Tue, 11 Sep 2018 00:00:00 +0000 Applicability and outcome of laparoscopic adrenalectomy for large tumours <p>Laparoscopic adrenalectomy has been shown to be as safe and effective as conventional open surgery for small and benign adrenal lesions. With increasing experience with laparoscopic adrenalectomy, this approach has become the procedure of choice for the majority of patients requiring adrenalectomy. In our department, from 2011 to 2016, a total of 28 patients with 31 adrenal tumours underwent laparoscopic adrenalectomy regardless of tumour size. Our policy in the department is to exclude adrenal tumours that are potentially malignant or metastatic adrenal tumours for laparoscopic resection. In this a retrospective study, we divided patients into two groups according to tumour size: &lt; 5 or ≥ 5 cm, which was considered as the definition of large adrenal tumours. We compared demographic data and per- and postoperative outcomes. There was no statistical difference between the two groups for per-operative complications (16,6% vs 18,75% , P = 0.71), postoperative complications (16,6% vs 18,75% , P = 0.71), postoperative length of hospital stay (5 vs 8 days P = 0.40), mortality (0% vs 0%) or oncologic outcomes: recurrence and metastasis (8.3% vs 6.25% P = 0.70). The only statistical difference was the operating time, at a mean (SD) 194 (60) vs 237 (71) min (P = 0.039) and the conversion rate (0% vs 12.5% P &lt; 0.01). Laparoscopic adrenalectomy can be done for all patients with adrenal tumours regardless of tumour size, even it needs more time for large tumour but appears to be safe and feasible when performed by experienced surgeons.</p> Alila Mohammed, Hamdane Amine, Sara El Atiq, Bounoual Mohammed, Mouaqit Ouadii, Mazaz Khalid, Ait Taleb Khalid, Ousadden Abdelmalek Copyright (c) Tue, 11 Sep 2018 00:00:00 +0000 Root canal morphology of native Tanzanian permanent mandibular molar teeth <p><strong>Introduction:&nbsp;</strong>research has shown variations in morphology of root canals to differ amongst ethnic groups. We aimed to investigate the root morphology and canal configuration of permanent mandibular molars in a native Tanzanian population.</p> <p><strong>Methods:&nbsp;</strong>146 first and 85 second mandibular molars were collected from Tanzanian patients. After removal of the pulp tissues and staining using Methylene blue ink from the canal system, the teeth were decalcified and rendered clear using 98% methyl salicylate. The teeth were then examined under magnification of 10X for: number of roots, tooth length, number of canals, location of apical foramen, presence of an apical delta and canal configuration using Vertucci's classification.</p> <p><strong>Results:&nbsp;</strong>all mandibular molars had two separate roots. The mean tooth length for mandibular 1<sup>st</sup>&nbsp;and 2<sup>nd</sup>&nbsp;molars were 21.7 mm and 20.5mm, respectively, with no statistically significant difference in mean tooth length between males and females. All the mesial roots 1st and 2<sup>nd</sup>&nbsp;mandibular molars possessed two root canals, while 40.4% and 54.1% of the distal roots of 1<sup>st</sup>&nbsp;and 2<sup>nd</sup>&nbsp;molars, respectively, had two canals. The majority of the examined teeth had their apical foramen located centrally, with an apical delta present in the distal root of one-second molar. Root canal configuration types commonly reported were Type II in the mesial and Type I in the distal roots of the mandibular 1<sup>st</sup>&nbsp;molar; while the 2<sup>nd</sup>&nbsp;molar had, respectively, root types II / IV and type I.</p> <p><strong>Conclusion:&nbsp;</strong>there were observed variations in the morphology of root canals in a Tanzanian population. Caution is advised to clinicians when performing root canal treatment.</p> Habiba Suleiman Madjapa, Irene Kida Minja Copyright (c) Wed, 12 Sep 2018 00:00:00 +0000 Dermatofibrosarcoma protuberans: clinicopathologic presentation in Nigerians <p><strong>Introduction:&nbsp;</strong>dermatofibrosarcoma protuberance (DFSP) is in general a rare low grade malignant sarcoma and possesses a tendency for local recurrence. It has a site predilection for the trunk. Occurrence in the facial area is extremely rare. Ample knowledge of its clinical, histological and biologic characteristics is vital for accurate and prompt recognition.</p> <p><strong>Methods:&nbsp;</strong>over 13 years, clinicohistologic information of cases was retrieved. Histological and immunohistochemical re-evaluation were performed to re-confirm diagnosis. Data collected and analyzed with SPSS Statistics version 20 were presented as frequency tables, charts and proportions as appropriate.</p> <p><strong>Results:&nbsp;</strong>of 191 soft tissue sarcomas, a total of 28 cases were diagnosed as DFSP (14.7%). Facial types occurred in 3 cases (1.6%). Tumour had age and site predilections for the 4<sup>th</sup>&nbsp;decade and trunk respectively. There was an equal gender distribution among cases. Most common clinical presentation was in form of painless protruding nodular mass. General histologic presentation revealed cellular lesions composed of spindle to oval neoplastic cells arranged in a storiform pattern. Mitotic figures were rare. All cases showed positive expressions to CD34.</p> <p><strong>Conclusion:&nbsp;</strong>facial DFSP is rare among Nigerians. Its clinical appearance may mimic other common benign lesions of the head and neck region often resulting in misdiagnoses. A comprehensive knowledge of its clinical and histologic presentations and biologic behavior, combined with its identification with the aid of advanced histologic and radiographic techniques results in prompt confirmatory diagnosis. Appropriate treatment should include adequate surgical excision techniques combined with adjuvant radiotherapy or chemotherapy.</p> Olajumoke Ajibola Effiom, Akanbi Clement Olurotimi Olojede, Olakanmi Ralph Akinde, Adetokunbo Babjide Olawuyi, Abiodun Taofeek Amoo, Godwin Toyin Arotiba Copyright (c) Wed, 12 Sep 2018 00:00:00 +0000 Chondroid and osseous metaplasia in an incidental type II papillary renal cell carcinoma with extensive solid areas: an unraveled molecular character <p>Chondroid and osseous metaplasia in a Type II Papillary renal cell carcinoma (PRCC) with extensive solid areas is a complex histological combination that has not been reported before. A 21 years old male presented with a comminuted fracture of right femur. On hematological investigations he was found to have low RBC count and hemoglobin. Radiological examination revealed an incidental, exophytic complex solid and cystic, mass lesion measuring 7 x 6.5 x 4.9 cm with thickened walls, septation and calcification. It was completely replacing upper pole of the left kidney with extension into perinephric fat. Enlarged para aortic and hilar nodes with necrosis were also noted. Radiological diagnosis was infectious processes such as tuberculosis versus malignancy. Surgical intervention comprising left partial nephrectomy was done. Histopathology and immunohistochemical analysis yielded the above diagnosis. Cytogenetic studies did not reveal gain of chromosome 7 and/or 17 or loss of chromosome Y, a characteristic genetic profile of PRCC. This case could be representative of a unique histological variant of PRCC in which the molecular profile yet needs to be unraveled.</p> Ayesha Ahmed Copyright (c) Thu, 13 Sep 2018 00:00:00 +0000 Létalité de l’insuffisance cardiaque au Centre Hospitalier Universitaire de Libreville (CHUL) et facteurs associés <p><strong>Introduction:&nbsp;</strong>l'insuffisance cardiaque (IC) est une cause fréquente de décès en Afrique. La présente étude a pour but de déterminer le taux de létalité de l'IC et de rechercher les facteurs associés.</p> <p><strong>Méthodes:&nbsp;</strong>il s'agissait d'une étude rétrospective transversale réalisée dans le service de cardiologie du CHUL. Elle portait sur l'analyse de dossiers de patients hospitalisés pour IC gauche ou globale colligés de Janvier 2014 à Décembre 2016.</p> <p><strong>Résultats:&nbsp;</strong>la létalité était de 10,3%. L'âge moyen des patients décédés (n=64) était de 57,4 ± 17 ans. Le délai moyen de prise en charge était de 15± 18 jours et la décompensation faisait suite à un écart de traitement chez 51,4% des patients décédés. L'association hypertension artérielle et diabète augmentait significativement le risque de décès (OR= 2,2 (1,2-6,6)). Les facteurs associés à la létalité étaient essentiellement: l'hypotension artérielle (OR=6,8(3,2-14,1)), l'insuffisance rénale sévère (OR=3,5(1,7-7,2)), un index cardio-thoracique supérieur à 0,7 (OR= 54,4 (15,3-193,1)), une altération sévère de la fraction d'éjection ventriculaire gauche (OR= 3,0(1,5-5,9)) et un taux élevé de NT-proBNP (OR=3,5(1,2-10,5)). La mortalité augmentait significativement avec le nombre de comorbidités. Les décès étaient dus dans 28,4% des cas à une complication extracardiaque.</p> <p><strong>Conclusion:&nbsp;</strong>la létalité de l'IC est liée à la sévérité et à la précocité des lésions. Le retard de prise en charge et les comorbidités aggravent cette létalité. Le dépistage des facteurs de risque et l'éducation thérapeutique pourraient diminuer cette mortalité qui concerne des sujets relativement jeunes.</p> Elsa Ayo Bivigou, Mahutondji Christian Allognon, Francis Ndoume, Jean Bruno Mipinda, Emmanuel Ecke Nzengue Copyright (c) Thu, 13 Sep 2018 00:00:00 +0000 Leucémie agressive à cellules NK (Natural Killer): à propos d'un cas dans la population africaine et revue de la littérature <p>La leucémie agressive à cellules NK (ANKL) fait partie des syndromes lymphoprolifératifs à cellules NK. C'est une entité rare touchant essentiellement les asiatiques, elle est très rarement décrite dans la population africaine (l'intérêt de notre cas). Nous rapportons le cas d'une patiente de 19 ans, d'origine marocaine, qui présente un syndrome d'insuffisance médullaire d'installation brutale avec syndrome tumoral, le diagnostic de la Leucémie à NK a été retenu par l'étude microscopique et immunophénotyique de la moelle osseuse. L'évolution est fatale avec décès de la patiente dans 2 mois après le diagnostic par un choc septique. Le pronostic d'ANKL est très mauvais et la survie médiane après le diagnostic est en moyenne de deux mois. En l'absence d'étude prospective, aucune attitude thérapeutique consensuelle n'est à ce jour établie.</p> Amine Benmoussa, Khaoula Khalil, Fatimazzahra Boufarissi, Ilias Tazi Copyright (c) Thu, 13 Sep 2018 00:00:00 +0000 La mort encéphalique post traumatique: épidémiologie et facteurs de risque <p>Il est possible de prévoir l'évolution d'un patient vers l'état de mort encéphalique et plusieurs équipes se sont intéressées à la recherche de facteurs prédictifs de la mort encéphalique, cependant la difficulté de proposer un modèle cohérent réside dans le choix des critères proposés, qui, dans la plupart des études est subjectif. Il conviendrait d'analyser une population uniforme et de définir des critères universels pour pouvoir prédire avec certitude le passage en mort encéphalique, un score prédictif étant alors parfaitement envisageable.</p> Ahmed Youssef Kada, Kheireddine Abdelouahed Bouyoucef Copyright (c) Thu, 13 Sep 2018 00:00:00 +0000 La varicelle n’est pas toujours bénigne <p>La varicelle est une maladie éruptive due au virus varicelle-zona qui touche essentiellement les enfants et dont l'évolution est habituellement bénigne. Cependant des complications de gravité variable peuvent être observées tel que les complications infectieuses bactériennes et les complications neurologiques. Nous rapportons deux observations de varicelle compliquée. Comme première observation, un nourrisson de 5 mois sans antécédents qui présente depuis six jours une éruption cutanée fait de vésicules et pustules, la symptomatologie s'est aggravée la veille de son admission au service par l'installation d'une détresse respiratoire. Comme deuxieme observation, une fillette de 7 ans, admise au service pour prise en charge d'une convulsion simple, et chez qui l'examen clinique a objectivé des cicatrices de varicelle généralisées et une ataxie cérébelleuse. Bien que la varicelle soit connue comme une affection virale commune, le plus souvent bénigne, plusieurs études ont récemment fait état d'une recrudescence de ses complications, qui semblent responsables de 0,2 à 1,5% des motifs d'hospitalisation des enfants atteints de varicelle.</p> Anass Ayyad, Maria Rkain, Abdeladim Babakhouya, Noufissa Benajiba Copyright (c) Thu, 13 Sep 2018 00:00:00 +0000 Six stormy years and the audacity to confront a challenging future: taking stock of the Kenyan Doctors’ Union <p>The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) was formed in August 2011. Within the last six years, this union has galvanized the Kenyan doctors together, agitated for healthcare policy reforms and successfully negotiated and registered a Collective Bargaining Agreement (CBA). Though political will and the national citizens' psyche on matters pertaining to public healthcare remain a challenge, this union has made its foot prints on the Kenyan conversation space. KMPDU looks forward to engaging local, regional and international health stake holders to improve the state of the country's health care, key among these being to have a national commission handling all the human resources for health.</p> Aruyaru Stanley Mwenda, Alex Muturi, Fredrick Ouma Oluga Copyright (c) Thu, 13 Sep 2018 00:00:00 +0000 Incontinence urinaire révélant une fistule vésico-utérine: à propos d’un cas <p>La fistule vésico-utérine (FVU) est une lésion rare et ne représente que 4% de toutes les fistules uro-génitales. Elle est le plus souvent consécutive à une césarienne et réalise une communication entre la vessie et l'utérus. Nous rapportons un cas d'une jeune patiente qui présentait une FVU suite à une césarienne. Le but de ce travail était d'analyser les aspects cliniques et thérapeutiques de cette affection.</p> Bounoual Mohammed, Omana Jean Paul, Ahsaini Mustapha, Tazi Karim, Mellas Soufiane, El Ammari Jalaleddine, Tazi Mohammed Fadl, El Fassi Mohammed Jamal, Farih Moulay Hassan Copyright (c) Fri, 14 Sep 2018 00:00:00 +0000 Aspects épidémiologiques et bactériologiques des infections du site opératoire (ISO) dans les services de chirurgie à l’Hôpital National de Niamey (HNN) <p>Ce travail à consister à étudier les aspects épidémiologiques et bactériologiques des souches bactériennes isolées au cours des infections du site opératoire (ISO) à l'Hôpital National de Niamey. Nous avions mené une étude rétrospective, et descriptive sur une période de 24 mois. Toutes les souches isolées à partir de prélèvements bactériologiques effectués chez les patients présentant une infection du site opératoire ont été identifiées et testés aux antibiotiques selon les méthodes classiques conventionnelles. Les analyses bactériologiques ont permis d'isoler 126 souches bactériennes avec une prédominance de&nbsp;<em>S.aureus</em>&nbsp;(n=39, 31%) suivi d'<em>Escherichia coli</em>&nbsp;(n = 29, 23%) et de&nbsp;<em>Pseudomonas aeruginosa</em>&nbsp;(n=12, 9,5%). Les souches d'<em>Escherichia coli</em>&nbsp;étaient sensibles à 100% à l'imipenème. Elles ont montré des résistances marquées à l'ampicilline, l'amoxicilline, l'acide-clavulanique et la ticarcilline. Elles présentaient des résistances variables aux aminosides (62% à la gentamycine, et 78% à l'amikacine), et aux fluoroquinolones (acide nalidixique 74%, pefloxacine 33%, l'ofloxacine 69%, ciprofloxacine 61%). L'ensemble des isolats d'entérobactéries étaient sensibles à l'imipénème. Les souches de&nbsp;<em>S.aureus</em>&nbsp;avaient montré des résistances à la Pénicilline G (88,6%) et à l'oxacilline (83%). Elles avaient montré aussi des résistances de 37% et 57% respectivement à la vancomycine et teicoplanine. Par contre, elles étaient sensibles à la lincomycine et aux aminosides testés. Compte tenu de ces résultats, nous pensons qu'il faudra améliorer les protocoles d'antibioprophylaxie et d'antibiothérapie probabiliste dans les services chirurgicaux. Aussi, mener des études périodiques de surveillances des ISO.</p> Ousmane Abdoulaye, Mahaman Laouali Harouna Amadou, Oumarou Amadou, Ousseini Adakal, Harouna Magagi Larwanou, Laouali Boubou, Djimraou Oumarou, Moussa Abdoulaye, Saidou Mamadou Copyright (c) Fri, 14 Sep 2018 00:00:00 +0000 Sexualité des jeunes en milieu scolaire dans la ville de Likasi en République Démocratique du Congo <p><strong>Introduction:&nbsp;</strong>des nombreuses études sur la sexualité en Afrique subsaharienne, notent un accroissement de l'activité sexuelle des jeunes célibataires, cette sexualité est précoce, instable, multipartenaire, dépendant de l'environnement proche des jeunes et des membres de leurs ménages. Cette étude vise à déterminer la prévalence des jeunes sexuellement actifs et évaluer les facteurs influant sur le comportement sexuel.</p> <p><strong>Méthodes:&nbsp;</strong>il s'agit d'une étude d'observation descriptive transversale couvrant la période allant de Mai à Juin 2017. L'étude a porté sur 249 élèves de 5<sup>éme</sup>&nbsp;et 6<sup>éme</sup>&nbsp;secondaires de 4 écoles de Likasi (CS Kalunga, CS la Borne, College Tutazamie et Lycée Musofi). Les données ont été saisies et encodées avec le logiciel excel 2013.</p> <p><strong>Résultats:&nbsp;</strong>deux cent quarante neuf jeunes ont répondu à l'enquête dont 153 filles et 96 garçons, parmi lesquels 104 sont sexuellement actifs soit une prévalence de 42%. L'âge Moyen au premier rapport sexuel chez le garçon est de 16,7 ans et 17,2 ans chez la fille, 38% ont eu leurs premiers rapports sexuels entre 10 et 15 ans, 56% déclarent avoir eu plus d'un partenaire sexuel. Le media, l'internet, le niveau et milieu de vie sont identifiés comme facteurs qui influencent le comportement sexuel des jeunes.</p> <p><strong>Conclusion:&nbsp;</strong>selon l'ONUSIDA, le SIDA s'est juvenilisé, l'élimination de cette épidémie passe par la promotion d'une sexualité saine et responsable selon la stratégie ABC (Abstinence, Bonne Fidélité, Condom).</p> Roger Tshimanga Mukadi, Maurice Sumaili Mwana Ntambwe, Hermann Tamubango Kitoko, Joseph Malashi Mwisi, Fiston Ilunga Mbayo Copyright (c) Fri, 14 Sep 2018 00:00:00 +0000 Adolescent-parent communication on sexual and reproductive health issues and associated factors among high school students in Woldia town, Northeastern Ethiopia <p><strong>Introduction:&nbsp;</strong>sexual and reproductive health (SRH) communication is most likely to promote healthy sexual practices and to reduce risky sexual behavior among adolescents. Communication is the principal means for parents to transmit sexual values and knowledge to their children. This study aimed to assess adolescent-parent communication on SRH issues among high school students in Woldia town.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted from December 15-31, 2016. Systematic random sampling technique was used to select 693 students from Grades 9 and 10. Data were entered into Epi-info version 3.5.1 and analyzed by usingSPSS version 20. Logistic regression with Odds Ratios(OR) and 95% Confidence intervals (CI) was used to identify the independent predictors of adolescent-parent communication.</p> <p><strong>Results:&nbsp;</strong>674 students accepted to participate in this study giving a response rate of 97.3%. Only 205(30.4%) had discussed on two or more SRH topics with their parents. In logistic regression analyses, mothers who could read and write [AOR=2.0; 95% CI=1.3-3.1] and had diploma certificate [AOR=2.0; 95% CI=1.4-2.9] were more likely to discuss on SRH issues with their children. Adolescents who agreed on the importance of discussion on SRH issues [AOR=2.5; 95% CI=1.3-4.5], whoever gotSRH information [AOR=2.0; 95% CI=1.4-2.9] and those whoever had sexual intercourse [AOR=1.7; 95% CI=1.1-2.6] were more likely to discuss on different SRH issues with their parents.</p> <p><strong>Conclusion:&nbsp;</strong>this study revealed that parent-adolescent communication on SRH issues was inadequate.Therefore, there is a need to equip and educate parents on different adolescents' SRH issues.</p> Molla Temere Mekonen, Hana Abebe Dagnew, Tesfay Ambaye Yimam, Hayat Nuradis Yimam, Melese Abate Reta Copyright (c) Tue, 18 Sep 2018 00:00:00 +0000 Le kyste de la vallécule symptomatique chez l’adulte: à propos de 4 cas <p>Le kyste de la vallécule est une lésion bénigne rare. Ces kystes sont souvent asymptomatiques chez l'adulte. Les auteurs rapportent 4 cas de kystes de la vallécule symptomatique de l'adulte. Trois patients ont consulté pour une dysphagie haute mixte associée à une dysphonie. Le quatrième patient se plaignait d'une sensation de corps étranger dans la gorge. La laryngoscopie a montré une formation kystique dans la région valléculaire gauche dans tous les cas. La tomodensitométrie a confirmé la présence d'une formation kystique de la vallécule. Le traitement a consisté en une marsupialisation du kyste dans deux cas et une résection endoscopique dans deux cas. À partir de ces 4 cas cliniques, nous nous proposons de préciser les particularités diagnostiques et thérapeutiques de cette affection.</p> Mehdi Hasnaoui, Mohamed Masmoudi, Jamel Chefai, Nouha Ben Hmida, Khalifa Mighri, Nabil Driss Copyright (c) Tue, 18 Sep 2018 00:00:00 +0000 Une cause exceptionnelle des péritonites: une perforation iléale par un corps étranger lors de la réduction d’une hernie inguinale <p>La péritonite secondaire est fréquemment rapportée dans la littérature. Les causes sont multiples. Nous rapportons un cas d'une perforation iléale par une cause exceptionnelle. Il s'agit d'une perforation iléale par un corps étranger lors de la réduction d'une hernie inguinale, responsable d'une péritonite grave avec tableau de défaillance multiviscérale.</p> Mohamed Moez Kammoun, Rim Karray, Kais Regaieg, Mabrouk Bahloul, Mounir Bouaziz Copyright (c) Tue, 18 Sep 2018 00:00:00 +0000 Ketosis prone diabetes presenting as fulminant type 1 diabetes <p>Patients with ketosis prone diabetes have been reported primarily in Africans and African Americans. At presentation, both insulin secretion and insulin action are impaired in ketosis prone diabetes patients. Fulminant diabetes is a subtype of type 1 diabetes reported mainly in the Asian populations characterized by diabetic ketosis or ketoacidosis occurring soon after the onset of hyperglycemic symptoms with inappropriately low HbA1c (&lt; 8.5%). We report here the first case of a ketosis prone diabetes presenting as fulminant diabetes.</p> Katerina krompa, Ines Barka, Stéphanie Malard, Sopio Tatulashvili, Camille Baudry, Hélène Bihan, Marinos Fysekidis Copyright (c) Thu, 20 Sep 2018 00:00:00 +0000 Syndrome du canal carpien secondaire à une variété anatomique rare du nerf médian <p>Le syndrome du canal carpien représente l'un des motifs de consultation les plus fréquents en chirurgie de la main, son incidence annuelle est de 300 par 100.000 habitants et 80.000 interventions chirurgicales pour le syndrome du canal carpien sontréalisés chaque année en France. Dans la plupart des cas, le syndrome du canal carpien est idiopathique survenant sans qu'aucune cause puisse être identifiée, cependant en dehors de ces formes l'intrication de plusieurs mécanismes peuvent expliquer la relation cause à effet de cette pathologie. A travers cette observation nous allons essayer de mettre la lumière sur une association exceptionnelle d'un syndrome du canal carpien secondaire à une variété anatomique rare du nerf médian.</p> Amine Tahir, Amine Sdoudi, Mohamed Chahed, Aniss Elbaitil, Lkoutbi Fakherdine, Yasser Sbihi, Driss Bennouna, Mustafa Fadili Copyright (c) Thu, 20 Sep 2018 00:00:00 +0000 L’aspergillose pulmonaire invasive chez un patient immunodéprimé séropositif pour le VIH <p>L'aspergillose pulmonaire invasive est une infection opportuniste parmi les plus rares au cours de l'infection par le VIH. Son pronostic est sombre.&nbsp;<em>Aspergillus fumigatus</em>&nbsp;est l'espèce la plus fréquemment incriminée. Le diagnostic doit être précoce, évoqué sur un faisceau d'arguments cliniques, radiologiques (le scanner thoracique) et mycologiques. L'examen direct du liquide de lavage bronchiolo-alvéolaire (LBA), couplé à la culture permet l'identification de l'<em>Aspergillus sp</em>. L'examen anatomopathologique de biopsies scanno-guidées est nécessaire en cas de négativité du LBA. Le dosage de l'antigène galactomannane est très utile au diagnostic. Le Voriconazole est la molécule à prescrire en première intention avec la nécessité de vérifier l'absence d'interactions médicamenteuses avec les antirétroviraux hautement actifs.</p> Awatif El Hakkouni, Nabil Mansouri Copyright (c) Thu, 20 Sep 2018 00:00:00 +0000 Prélèvement de plaquettes pour la chirurgie cardiaque: première expérience d'aphérèse à l'Hôpital Général de Douala <p>La chirurgie cardiaque sous circulation extracorporelle (CEC) est régulièrement associée à la perte d’une quantité importante de sang. Une bonne anticipation de ces pertes sanguines et une bonne hémostase peropératoire sont reconnues comme moyens permettant de limiter ces saignements post opératoires. Jusqu’à ce jour, la compensation des besoins en plaquettes des patients opérés sous CEC dans notre service se faisait par transfusion de sang total ou de concentrés plaquettaires prélevés à partir de plusieurs donneurs. Nous rapportons la première expérience de prélèvement de concentrés plaquettaires par la technique d’aphérèse à l’Hôpital Général de Douala.</p> William Ngatchou, Isabelle Drezen, Felicité Kamdem, Gisèle Imandy, Cecile Okalla, Albert Nkana, Jean Pierre Hacquebard, Pierre Origer, Joseph Sango, Daniel Lemogoum, Sidiki Mouliom, Anastase Dzudie, Henri Ngote, Romuald Hentchoya, Junette Metogo, Olivier Germay, Eugène Belley Priso, Jean Luc Jansens, Henry Luma, Tome Nadjovski Copyright (c) Thu, 20 Sep 2018 00:00:00 +0000 Klippel-Feil syndrom: a duplicated thumb <p>A 71-year-old woman was admitted to our hospital because of vertigo. At clinical examination a duplicated right thumb was noticed. The Patient revealed that she was suffering from Klippel-Feil Syndrom (KFS). KFS is a rare skeletal disease where a mutation of the GDF6 and GDF3 genes can be found. It is characterized by congenital fusion of any of the 7 cervical vertebrae. There can be associations with other malformations such as congenital elevation of the scapula (Sprengel’s deformity), spina bifida, scoliosis, cleft palate, malformations of the heart, head, face, arms, legs and fingers. Because of these heterogeneous medical conditions treatment for KFS is symptomatic and can include surgery.</p> Aryé Weinberg, Andreas Eberhard Albers Copyright (c) Thu, 20 Sep 2018 00:00:00 +0000 Chirurgie des hyperthyroïdies: à propos de 60 cas <p>L'hyperthyroïdie englobe plusieurs maladies caractérisées par un niveau élevé d'hormones thyroïdiennes circulantes. La thyroïdectomie en est un des principaux traitements. L'objectif de notre étude est d'évaluer, à travers une étude rétrospective, les particularités épidémiologiques, cliniques, thérapeutiques, et évolutives des patients ayant bénéficié d'une prise en charge chirurgicale d'une hyperthyroïdie dans le service d'ORL à l'hôpital militaire Avicenne de Marrakech. Soixante patients ont été colligés avec une prédominance féminine et une moyenne d'âge de 52 ans. La clinique a été dominée par les signes de thyrotoxicoses qui ont été retrouvés chez tous les patients. L'exploration a permis d'identifier 47 cas de goitre multihétéronodulaire toxique ou prétoxique (soit 78.33% des cas), 5 cas de maladies de Basedow (soit 8.33%) et 8 cas d'adénome toxique (soit 13.33%). Une préparation médicale a été de mise chez tous nos patients. Une thyroïdectomie totale a été réalisée chez 50 patients (soit 83.33%) et une loboisthmectomie chez 10 patients (soit 16.33%). En post-opératoire, des complications sont été colligés: un cas de paralysie laryngée transitoire (1,6% des cas), neuf cas d'hypoparathyroïdie transitoire (15% des cas), un cas d'hypoparathyroïdie définitive (1,6% de cas), et un seul cas d'hématome compressif (1,6% de cas). La chirurgie des goitres toxiques réputés hémorragiques et adhérents, doit être réalisée par un chirurgien expérimenté qui doit doubler de vigilance pour minimiser la morbidité représentée essentiellement par la paralysie laryngée et l'hypoparathyroïdie.</p> Youssef Darouassi, Mohamed Amine Hanine, Abdelfettah Aljalil, Amine Ennouali, Brahim Bouaity, Mohamed Mliha Touati, Haddou Ammar Copyright (c) Thu, 20 Sep 2018 00:00:00 +0000 La ponction biopsie rénale: indications, complications et résultats <p>La ponction biopsie rénale (PBR) est une technique indispensable au diagnostic des maladies rénales. Ce geste demeure invasif avec diverses complications, essentiellement hémorragiques. L'objectif de notre travail était d'étudier notre pratique de la PBR, mettre le point sur la technique de la biopsie rénale transcutanée, évaluer ses complications, et déterminer les néphropathies diagnostiquées dans notre région. Il s'agit d'une étude rétrospective, menée entre Janvier 2015 et Juin 2017. Nous avons inclus 69 patients du service de Néphrologie du CHU Mohamed VI, Oujda, Maroc ayant bénéficié d'une biopsie de reins natifs. L'âge moyen des patients au moment de la PBR était de 38,16 ±13 ans (12-77 ans), le sexe ratio (H/F) était de 0,86. Le syndrome néphrotique était l'indication la plus fréquente tout âge confondu. Les néphropathies glomérulaires représentaient 81% des maladies rénales, réparties comme suit: la glomérulonéphrite extra-membraneuse retrouvée chez 19% des patients, la hyalinose segmentaire et focale chez 18%, la glomérulonéphrite lupique chez 11%, les glomérulonéphrites chroniques diagnostiquées dans 11% des cas, la glomérulonéphrite membrano-proliférative chez 7%, la glomérulonéphrite extra-capillaire chez 5% à part égale avec l'amylose rénale. Quatre pour cent (4%) des PBR étaient en faveur d'une néphropathie diabétique. Avec un taux estimé à 2% chacune, l'étude histopathologique avait retrouvé la glomérulonéphrite aigue post-infectieuse, la lésion glomérulaire minime, la néphropathie à IgA, les vascularites, les néphropathies tubulo-interstitielles ainsi que la microangiopathie thrombotique. Cinq pour cent (5%) des PBR étaient aglomérulaires. L'hématurie macroscopique était la principale complication observée dans notre série avec une fréquence de 2,8%. La PBR reste le gold standard du diagnostic de la maladie rénale, cependant le diagnostic syndromique permet au clinicien d'identifier la maladie rénale la plus probable et de guider les thérapeutiques urgentes.</p> Saad Alaoui Mhamedi, Hicham Meghraoui, Mohammed Benabdelhak, Yassamine Bentata, Intissar Haddiya Copyright (c) Thu, 20 Sep 2018 00:00:00 +0000 Diagnostic et prise en charge des cystites à éosinophiles <p>La cystite à éosinophiles est une pathologie inflammatoire de la paroi vésicale. Elle est rare, il n'existe pas des recommandations établies concernant sa prise en charge. Il s'agit d'une étude rétrospective ayant concerné dix observations de cystites à éosinophiles diagnostiquées et prises en charge dans notre service entre 2006 et 2017. L'âge moyen des patients était de 46 ans. On a noté une prédominance masculine. Un terrain atopique était noté dans 3 cas. Le mode de présentation le plus fréquent était des signes urinaires irritatifs dans 9 cas, une hématurie macroscopique dans 8 cas et des algies pelviennes dans 6 cas. Une hyper-éosinophilie sanguine était présente dans 4 cas. La cystoscopie avait montré des pétéchies dans 5 cas, un aspect pseudo-tumoral dans 4 cas et était normal dans un cas. Pour les formes pseudo-tumorales une résection endoscopique a été pratiquée. Quatre patients ont été traités par les anti-inflammatoires non stéroïdien, avec amélioration des symptômes. Six malades ont été surveillés. Après un recul moyen de 50 mois, aucune récidive n'a été rapportée. La cystite à éosinophiles est une pathologie rare. La présentation clinique est non spécifique. La prise en charge repose sur des moyens médicaux non invasifs dans les formes peu symptomatiques.</p> Kays Chaker, Abdelrazek Bouzouita, Marwa Gharbi, Ahlem Blel, Marouene Chakroun, Haroun Ayed, Mohamed Cherif, Mohamed Riadh Ben Slama, Soumaya Rammeh, Amine Derouiche, Mohamed Chebil Copyright (c) Thu, 20 Sep 2018 00:00:00 +0000 Glucose-6-phosphate dehydrogenase deficiency allelic variants and their prevalence in malaria patients in Eritrea <p><strong>Introduction:&nbsp;</strong>glucose 6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymopathy with a relatively high frequency in malaria-endemic regions. In Eritrea, there is scanty knowledge of G6PD deficiency. The aim of the study was to characterize and determine the prevalence of four common G6PD allelic variants.</p> <p><strong>Methods:&nbsp;</strong>three hundred and fourteen dried blood spot samples from unrelated microscopically diagnosed malaria patient Eritrean ethnic groups living in five zobas (regions) of Eritrea were analysed by PCR-RFLP method to identify the G6PD B,&nbsp;<em>G6PD A</em>&nbsp;(A376G),&nbsp;<em>G6PD A</em>-(G202A), and G6PD Mediterranean (C563T) variants. To confirm the RFLP results, samples positive for A376G but negative for G202A variants were subjected to Sanger sequencing and a subset of PCR products (exon 5) directly sequenced to identify A376G and other mutations.</p> <p><strong>Results:&nbsp;</strong>for G6PD genotyping,&nbsp;<em>G6PD B&nbsp;</em>was detected in 87.5% and A376G detected in 12.5% of malaria patients, whereas G202A and C563T were absent. Bivariate statistical analysis showed a statistically significant association between&nbsp;<em>G6PD</em>&nbsp;genotypes and zoba (P &lt; 0.004 &lt; 0.05). Sequencing revealed the expected A376G variant. In exon 5, four common (A376G) mutations, three uncommon mutations rs782669677 (535G→A) and one potentially new mutation (451G→C), relative to the reference, mRNA NM_001042351 were detected. Bioinformatic analysis of these mutations' potential functional impact suggests minimal effect on protein function.</p> <p><strong>Conclusion:&nbsp;</strong>this is the first report indicating that&nbsp;<em>G6PD B</em>&nbsp;and&nbsp;<em>G6PD A</em>&nbsp;genotypes are prevalent in Eritrea. Similar findings were reported in neighboring countries. Further studies including phenotype analysis are needed to corroborate the observed results.</p> Yohannes Ghebremedhin Tseghereda, Joseph Kangethe Nganga, Andrew Nyerere Kimang’a, Tadesse Hagos Mehari, Yishak Gebrekidan Weldemichael Copyright (c) Thu, 20 Sep 2018 00:00:00 +0000 Tuberculose multifocale associée à une toxoplasmose cérébrale sur terrain immunodéprimé à VIH chez un patient immigré africain au Centre Hospitalier de Soissons, France <p>Dans les pays industrialisés et notamment en France, vu les moyens de prévention, dépistage précoce et prise en charge immédiate de l'infection à VIH, la survenue d'infections opportunistes ne se voit presque chez les immigrés et certaines couches socio-professionnelles défavorisées. Nous rapportons donc le cas d'un homme de 42 ans, immigré africain, hospitalisé pour syndrome infectieux dans un contexte d'altération de l'état général, VIH1 positif sous antirétroviraux depuis deux ans, arrêtés depuis quatre mois, une tuberculose pulmonaire traitée et déclarée guérie en février 2017 avec, à l'examen une lenteur à l'idéation, une fièvre à 39,6°C et un amaigrissement. Le nadir CD4 à 12/mm<sup>3</sup>, une charge virale VIH1 à 5,80log. Le scanner thoraco-abdominal et l'IRM cérébrale ont permis de visualiser des lésions intra-abdomino-thoraciques et cérébrales avant la confirmation diagnostique de la tuberculose et de la toxoplasmose. Le patient fut mis sous trithérapie antirétrovirale à quinze jours du traitement antituberculeux, puis au traitement antitoxoplasmique avec une évolution favorable.</p> Mamadou Oury Safiatou Diallo, Moussa Sidibé, Ibrahima Bah, Fode Bangaly Sako, Karamba Sylla, Fode Amara Traoré, Aminata Oumou Sylla, Mamadou Saliou Sow, Ali Abdessand Hachémi, François Boiquigny, Mohamed Cisse Copyright (c) Thu, 20 Sep 2018 00:00:00 +0000 Indications et résultats de la chirurgie de résection des bulles d’emphysème pulmonaire <p>La chirurgie d'exérèse des bulles ou bullectomie, principal moyen thérapeutique dans la prise en charge des bulles d'emphysème pulmonaire, est généralement réservée aux patients dont les bulles sont compliquées ou, sont à l'origine d'une dyspnée invalidante. Le but de notre étude était de déterminer les indications de la bullectomie et d'évaluer les résultats de cette chirurgie dans notre service. Nous avons mené une étude rétrospective descriptive de 24 patients (23 hommes et 1 femme), dont la moyenne d'âge était de 49 ans, et qui ont bénéficié d'une bullectomie entre 2004 et 2013. Les données recueillies étaient les facteurs favorisant la survenue d'un emphysème bulleux, les circonstances de découverte de la bulle, les données des examens radiologiques, les données de l'évaluation fonctionnelle respiratoire et cardiovasculaire, les données de la technique de la bullectomie, les données de l'évaluation clinique et fonctionnelle post opératoire. Le taux de morbidité était de 37,5%. La principale complication était la fuite aérienne persistante (7 cas). Un patient est décédé au 2<sup>e</sup>&nbsp;jour post opératoire suite à une insuffisance respiratoire aiguë. La durée moyenne de suivi était de 26 mois. Durant ce suivi, nous avons observé une amélioration de la dyspnée chez tous les patients et nous n'avons noté aucune complication. La bullectomie est une technique chirurgicale efficace, fiable et sûre qui peut permettre aux patients d'avoir une meilleure qualité de vie pendant quelques années.</p> Assane Ndiaye, David Douglas Banga Nkomo, Souleymane Diatta, Papa Salmane Ba, Magaye Gaye, Modibo Doumbia, Pape Adama Dieng, Pape Adama Dieng, Amadou Gabriel Ciss, Mouhamadou Ndiaye Copyright (c) Thu, 20 Sep 2018 00:00:00 +0000 Inactive hepatitis B carriers: outcomes of patients followed at hôpital principal de Dakar, Senegal <p>The evolutive profile of inactive HBV carriers is variable. Patients can remain inactive, or may evolve into chronic active hepatitis or hepatocellular carcinoma. Aim: to describe the long-term outcome of chronic hepatitis B inactive carriers followed at Hôpital Principal de Dakar. This is a retrospective study including all inactive HBV carriers, followed since 2001, and with regular monitoring of at least 5 years. Transaminases, viral load and screening for hepatocellular carcinoma were performed every 6 to 12 months. We included 52 patients. The mean follow-up was 76.2 months (60-162), the mean age 36 years (13-62 years) and the sex ratio 0.93 (25 men, 27 women). Four patients (7.7%) had an ALT above the normal. Eleven patients (21.1%) had persistently elevated viral load greater than 2000 IU/ml, while in three cases (5.8%), this increase was transient. Twenty-six patients (50%) had a detectable viral load, but still below 2000 IU/ml. Twelve patients (23.1%) had an undetectable viral load for the duration of monitoring. Eleven patients (21.2%) underwent liver biopsy. The activity or fibrosis were minimal in all cases (A or F = 1) or absent (A or F = 0). Only four patients (7.7%), had HBs seroconversion after a follow-up of six, seven and ten years. There was no focal lesion or cirrhosis detected during the follow-up. After a follow-up of at least 5 years, inactive HBV carriers remain inactive in 92.3% of cases. Their evolutive profile is characterized by an absence of elevated liver enzymes but with fluctuations of the viral load. HBs seroconversion rate is low and the risk of progression to hepatocellular carcinoma almost nil.</p> Ibrahima Diallo, Bineta Ndiaye, Cheikh Abdoukhadre Fall, Mouminatou Mbaye, Imane Korch, Papa Silman Diawara, Ababacar Mbengue, Sara Boury Gning, Papa Saliou Mbaye, Fatou Fall Copyright (c) Thu, 20 Sep 2018 00:00:00 +0000 Nævus verruqueux géant chez une adolescente de 15 ans: à propos d’un cas <p><em>Verrucous nevus is a benign tumor showing a linear pattern on Blaschko lines. It is caused by mosaic mutations of the receptor FGFR3 gene. It manifests as an aesthetic disfigurement, but individuals even experience functional complications due to itchiness. Lesions may be localized or extended (giant). In our context, the scarcity of specialized centers in dermatology is a cause of diagnostic delay inducing the patient to undertake unsuitable therapies responsible for infectious or degenerative complications. We report the case of a 15-year old girl with a history of keratotic papules showing a linear pattern along the neck, the right upper limb, the flank since childhood. Histological examination confirmed the diagnosis of verrucous nevus.</em></p> Békaye Traoré, Lamissa Cissé Copyright (c) Mon, 24 Sep 2018 00:00:00 +0000 Patient with CHARGE syndrome <p>A two-years-old boy presenting multiple anomaly syndrome (congenital heart disease, Tetralogy of Fallot, bilateral ear anomalies, and micropenis) was consulted in the Pneumo-allergology unit of Rabat children hospital in Morocco. It was ruled out the possibility of multiple deformities caused by genomic imbalances. The patient was then clinically considered to have CHARGE syndrome, an autosomal dominant multi-system disorder involving defects in multiple organs.</p> Abdelhakim El Yajouri, Chafiq Mahraoui Copyright (c) Mon, 24 Sep 2018 00:00:00 +0000 Métastases au niveau des sites d’introduction des trocarts secondaires à un adénocarcinome de la vésicule biliaire <p>La découverte fortuite de l’adénocarcinome de la vésicule biliaire après cholécystectomie cœlioscopique pour cholécystite aiguë à travers l’examen histologique systématique est rare. Cette situation impose une reprise chirurgicale par voie sous costale pour résection du lit vésiculaire ainsi que des trajets d’introduction des trocarts. Nous présentons un cas d’une patiente de 73 ans qui a été opérée il y a trois ans pour cholécystite aiguë par voie laparoscopique et dont l’examen anatomopathologique a révélé un adénocarcinome tubulo-papillaire de la vésicule mais la patiente a refusé la réintervention. Actuellement, elle consulte pour deux masses de la paroi abdominale antérieure dont une ulcérée. Une tomodensitométrie abdominale a objectivé deux masses tissulaires péritonéo-parietales et le dosage du CA19-9 est largement positif à 946 U/ml (soit 30 fois la valeur normale). Une biopsie sous anesthésie locale a confirmé la récidive tumorale et la patiente a été adressée en oncologie pour chimiothérapie type GEMOX avant réévaluation pour éventuelle chirurgie.</p> Mohamed Essarghini, Ahmed Bounaim Copyright (c) Mon, 24 Sep 2018 00:00:00 +0000 Post-traumatic tremor in child after mild head trauma <p>Despite the fact that movement disorders can be noted after severe traumatic brain injury (TBI), there are very few cases in the literature regarding children with a mild head injury. In addition, their pathophysiological mechanism, radiological features, and treatment options have not been well described yet. Hereby, we report a case of a 3-year-old girl who suffered a head injury after a two-meter fall, resulting in generalized body tremor and dystonia.</p> Ploutarchos Karydakis, Dimitrios Giakoumettis, Ioannis Nikas, Dimitrios Panagopoulos, George Sfakianos, Marios Themistocleous Copyright (c) Tue, 25 Sep 2018 00:00:00 +0000 Evaluation of children with macrocytosis: clinical study <p><strong>Introduction:&nbsp;</strong>in this study, it is aimed to emphasize the causes and importance of macrocytosis in paediatric practice.</p> <p><strong>Methods:&nbsp;</strong>in the paediatric hematology and oncology clinic, 1752 patients evaluated in 2017, patients with macrocytosis were examined retrospectively with clinical and laboratory findings. Patients with macrocytosis were compared with the frequency of severe hematologic diseases such as acute leukemia and bone marrow failure in patients with normocytic and microcytic mean corpuscular volume.</p> <p><strong>Results:&nbsp;</strong>macrocytosis was detected in 72 out of 1752 patients (4.1%) in the study. Acute lymphoblastic leukemia in 11(15.2%), acute myeloid leukemia in 3(4.1%), Fanconi aplastic anemia in 7(9.7%), Diamond-Blackfan anemia in 2(2.7%), aplastic anemia in 1(1.3%), congenital diseritropoetic anemia in 1(1.3%), deficiency of vitamin B12 in 14(19.4%) were diagnosed. Down syndrome was presented in 33 cases (45.8%). The number of patients with acute leukemia diagnosis was 14(0.8%) in the group in which the mean corpuscular volume was either microcytic or normocytic. The incidence of acute leukemia and bone marrow failure was significantly higher in the group with macrocytosis compared between the two groups.</p> <p><strong>Conclusion:&nbsp;</strong>although vitamin B12 deficiency is considered firstly in patients who have undergone cytopenia and macrocytosis in our country, haematological malignancies, bone marrow failures, myelodysplasia and myeloproliferative diseases should be remembered especially in the individuals with Down syndrome at the same time.</p> Hakan Sarbay, Yılmaz Ay Copyright (c) Tue, 25 Sep 2018 00:00:00 +0000 Concentration sérique en fer au cours de la malnutrition de l’enfant: cas d’une zone urbaine et rurale en République Démocratique Congo <p><strong>Introduction:&nbsp;</strong>la malnutrition (protéine énergétique et vitaminique) contribue à la survenue d'une anémie. Parallèlement, l'anémie ferriprive est l'un des troubles nutritionnels les plus répandus au monde et particulièrement dans les pays en voie de développement. Ainsi l'objectif de cette étude est de déterminer le taux de fer chez l'enfant malnutri de 6 à 59 mois et les facteurs liés à sa variation.</p> <p><strong>Méthodes:&nbsp;</strong>il s'agit d'une étude transversale menée sur la période allant du 01 juillet 2013 au 31 juillet 2014. Nous avons colligé 180 enfants malnutris dès leur admission dans un centre de prise en charge nutritionnelle. Un autre groupe a été recruté en périphérie de la ville, dans le village Kawama. Une ponction veineuse a été effectuée et le sang prélevé a subi une centrifugation puis une lecture au spectromètre.</p> <p><strong>Résultats:&nbsp;</strong>il ressort que 93,4 % de l'échantillon soit 170 enfants ont présenté une concentration sérique inférieure à la valeur normale. Par contre 6,59% soit 12 enfants ont présenté un taux de fer entre 610-1300 µg/L de fer sérique avec la médiane qui était à 159,5 µg/L. Parmi les 170 enfants qui avaient un taux de fer sérique de &lt;610 µg/L, 79 enfants soit 42,18% étaient âgés de moins de 24 mois dont 3 (1,78%) âgés de moins de 6 mois. A Kawama, 62 enfants soit 36,47% de l'échantillon total avaient un taux de fer &lt;610. Aucun lien statistiquement significatif entre le fer et les facteurs de risque n'a été trouvé sauf pour la variable provenance où le p était significatif (p&lt; 0,05).</p> <p><strong>Conclusion:&nbsp;</strong>la concentration sérique en fer est en baisse chez les enfants malnutris, aiguë comme chronique à leur admission avec une médiane autour de 159,5 µg/L; ceci justifierait les vastes programmes de fortification en fer des différents aliments et/ou l'administration du fer à la première semaine tout en traitant les complications (paludisme, les infections bactériennes et autres infections parasitaires).</p> Aimée Mudekereza Musimwa, Hermann Tamubango Kitoko, Gray Kanteng Wakamb, Stanis Wembonyama Okitotsho, Oscar Luboya Numbi Copyright (c) Tue, 25 Sep 2018 00:00:00 +0000 The health-related Millennium Development Goals (MDGs) 2015: Rwanda performance and contributing factors <p><strong>Introduction:&nbsp;</strong>the Millennium Development Goals (MDGs) 2015 are the eight international development goals adopted by the Millennium Summit of the United Nations in 2000 to which Rwanda is signatory. In 1990, Rwanda was at least one of the Sub-Saharan Africa countries with poor performance on health-related MDGs indicators. To date, despite the setbacks caused by the 1994 genocide, impressive performance is registered. The objective of the study is to document Rwanda gradual progress to achieving the health-related MDGs 2015 targets from 1990 to 2014/2015.</p> <p><strong>Methods:&nbsp;</strong>the study is retrospective and comparative documenting the period of 1990 to 2014/15.</p> <p><strong>Results:&nbsp;</strong>the performance of Rwanda on health-related MDGs 2015 targets is impressive despite the negative effects of the 1990-1994 civil wars and the 1994 genocide against Tutsi on 1990's levels. In effect, out of 17 health-related MDGs indicators, eleven (11) registered "remarkable" performances, i.e. reached global levels or fastened Vision 2020 targets attainment, two (2) registered "good performances", i.e. reached basic or revised own targets exhibiting overall impressive performance, while four (4) "weaknesses" are observed, i.e. accused gaps until now. The good governance, Vision 2020 effective implementation, consistent resources invested in health sector and the Rwanda Universal Health Coverage implementation contributed greatly to achieving the above health-related MDGs 2015 performance.</p> <p><strong>Conclusion:&nbsp;</strong>Rwanda performance of health-related MDGS 2015 targets is impressive. However, some relative gaps still persist, and hence should be prioritized while implementing the emerging Sustainable Development Goals.</p> Médard Nyandekwe, Jean Baptiste Kakoma, Manassé Nzayirambaho Copyright (c) Wed, 26 Sep 2018 00:00:00 +0000 Rare presentation of chronic ileocecal intussusception secondary to Burkitt’s lymphoma in three years Sudanese boy: a case report and literature review <p>A case report of chronic ileocecal intussusceptions in 3-years old Sudanese boy diagnosed as abdominal Burkett's lymphoma as leading point, who presented to his local hospital severely wasted with prolonged abdominal symptoms. Ultra sound and computed tomographic scan of his abdomen and pelvis with oral contrast confirmed intussusception. He was referred to pediatric surgical department and underwent laparotomy confirming ileocecal intussusception with resection of gangrenous part of his large and small bowel with end-to-end anastomosis. Histopathology of resected part showed infiltration of small bowel with cells of Burkett's lymphoma. This case highlights the importance of considering chronic intussusception, though rare, as a cause of faltering growth in young children with prolonged abdominal symptoms. The multidisplinary approach was highly appreciated and the outcome was satisfactory.</p> Atif Ahmed Mohamed Saad, Tasnim Kkalid, Mohammed Abbas, Karimeldin Mohammed Ali Salih Copyright (c) Wed, 26 Sep 2018 00:00:00 +0000 An unusual case of a posterior mediastinal myelolipoma in a patient with mediterranean anemia <p>A 34-year-old male was admitted at our Department for back pain and a right paravertebral mass at the chest x-ray. His medical history was positive for beta-thalassemia major with normal routinely blood tests. A contrast-enhanced chest computed-tomography showed a 26 x 15 mm right solid paravertebral round-shaped lesion at T8-T9 levels, with a small inner component of adipose tissue (Panel A). Contrast-enhanced magnetic resonance-imaging showed irregular low signal intensity in long TR sequences, with mild enhancement after contrast administration (Panel B, Panel C). Surgical excision of the lesion by means of video-assisted thoracic surgery was scheduled for both definitive diagnosis and therapeutic purpose. Histopathologic examination revealed the presence of adipocytes mixed with mature hematopoietic cells (Panel D). Differential diagnosis included mediastinal myelolipoma (MM) and extramedullary hematopoiesis (EH). In fact, both of them are composed of fat and hematopoietic tissue. Mediterranean anemia is a common finding in patients with EH. However, the presence of a single capsulated tumor and the absence of abnormal hematopoietic cells led to a final diagnosis of MM. The patient is currently alive without recurrence 23 months after surgery. Myelolipoma is a benign tumor usually arising in adrenal glands. Less than 50 cases of MM have been described in the literature to date. Many Authors currently support the role of a triggering condition (both metabolic, infectious and neoplastic), which might be responsible for the growth of ectopic adrenal or hematopoietic tissue. Patient's history, radiologic, and pathologic features must all be taken into due consideration in differential diagnosis between MM and EH.</p> Piergiorgio Muriana, Giampiero Negri Copyright (c) Thu, 27 Sep 2018 00:00:00 +0000 Giant squamous cell carcinoma of the cheek <p>A 60-year-old woman with a history of non-insulin-dependent diabetes reported a case of cutaneous swelling in her right cheek. The swelling had been evolving for 18 months while gradually increasing in size. The dermatologic examination revealed an ulcero-budding lesion, measuring 5cm at large diameter, rounded, with an ulcerated center and a fibrinous base. It was voluminous, sitting on the level of the right cheek pushing the right wing of the nose and causing an occlusion on right eyelid, but the ganglionic areas were free. A skin biopsy was carried out and histology indicated that a moderately differentiated squamous cell carcinoma was present. The patient was referred to the plastic surgery department for surgical removal of the tumor. The cutaneous squamous cell carcinoma is an invasive tumor that develops at the expense of epidermal keratinocytes or mucous membranes in oral, anal or genitals. The major risk factor is the solar exposure.</p> Youssef Zemmez, Naoufal Hjira Copyright (c) Thu, 27 Sep 2018 00:00:00 +0000 Le corticosurrénalome: une cause exceptionnelle d’hyperaldostéronisme primaire <p>Le corticosurrénalome est une tumeur maligne rare de la cortico-surrénale. Il secrète souvent des corticostéroïdes, des stéroïdes sexuels et des précurseurs. Le corticosurrénalome producteur d'aldostérone est très rare, 1cas/10 millions d'habitants. Nous rapportons l'observation d'un homme de 38 ans se présentant pour hypertension artérielle sévère associée à une hypokaliémie profonde (2.2 mmol/l). L'exploration a conclu à un hyperaldostéronisme primaire (aldostérone = 2645pmol/l, rapport aldostérone/rénine = 327pmol/mUI), avec hypersécrétion de glucocorticoïdes. Le scanner abdomino-pelvien a montré une masse surrénalienne gauche de 9cm, mal limitée et hétérogène, infiltrant la graisse autour et le diaphragme, envahissant la veine rénale gauche, avec adénopathie régionale et nodule hépatique de 4 cm. Le patient a eu une néphrectomie élargie, suivie d'une hépatectomie droite deux mois après entrainant une rémission. Un an après le patient a développé des métastases pulmonaires. Nous concluons que l'hyperaldostéronisme primaire peut être un mode de révélation du corticosurrénalome, on devra y penser malgré son caractère exceptionnel.</p> Baha Zantour, Ines Charrada, Zohra Elati, Fatma Larbi Ammari, Fadia Boubaker, Sondes Arfa, Olfa Berriche, Wafa Alaya, Mohamed Habib Sfar Copyright (c) Thu, 27 Sep 2018 00:00:00 +0000 Vraie macrodactylie avec orientation nerveuse <p>La vraie macrodactylie représente une anomalie congénitale rare d'étiologie inconnue, caractérisée par une augmentation de taille de tous les éléments d'un ou plusieurs rayons de la main. Elle est habituellement isolée et comporte une infiltration fibrograisseuse prédominant en palmaire. Elle peut être expliquée par des anomalies d'ordre embryologique ou neurogène; avec ou sans orientation nerveuse selon que le territoire concerné par la macrodactylie comporte une augmentation du volume d'un nerf majeur, le plus souvent le médian. Du point de vue évolutif, il faut distinguer la forme statique (présente à la naissance et restant stable avec la croissance) de la forme progressive (ou la croissance est disproportionnée). Certains syndromes, tumeurs ou malformations peuvent comporter une augmentation de volume d'un doigt sans qu'on puisse parler de vraie macrodactylie. Cette malformation engendre un handicap fonctionnel mais également un préjudice esthétique. Le traitement comporte non seulement la chirurgie mais aussi une prise en charge rééducative.</p> Siham Nasri, Asmae Oulad Amer, Narjisse Aichouni, Imane Kamaoui, Imane Skiker Copyright (c) Thu, 27 Sep 2018 00:00:00 +0000 Colorectal cancer in young adults: a retrospective study of 32 tunisian patients <p>Young people under the age of 40 with colorectal cancer represent a distinct subgroup with a more aggressive disease behaviour compared to older patients. This study aim to provide an updated overview on clinicopathological features, treatment and outcome of colorectal cancer in young adults under the age of 40. In our retrospective study, we reviewed 32 cases of colorectal cancer in young adults aged less than 40 years that were diagnosed at the pathology department of Mongi Slim hospital over a fifteen-year period (April 2000 - November 2014). Our study group included 13 male and 19 female patients (sex-ratio M/F = 0,68) between 17 and 39 years of age (mean = 31,25 years). The presenting clinical symptoms were dominated by altered bowel habits (n=17), followed by bleeding per rectum (n=16). Histopathological examination of the surgical and biopsy specimens established the diagnosis of mucinous adenocarcinoma in nine cases, well-differentiated adenocarcinoma in 11 cases, moderately differentiated adenocarcinoma in six cases, poorly differentiated adenocarcinoma in four cases and signet ring cell carcinoma in two cases. The tumours were classified after surgery as stage I (n = 2) (6%), stage IIA (n = 7) (22%), stage IIB (n=4) (13%), stage IIC (n=1) (3%), stage IIIB (n=8) (25%), stage IIIC (n= 4) (12%), stage IVA (n=4) (13%) and stage IVB (n=2) (6%). During the follow-up period which ranged between one month and 9 years, local recurrence of the tumour occurred in six cases, seven patients had hepatic metastases and seven patients died after a mean follow-up period of seven months. Molecular genetic studies are increasing the understanding of the pathobiology of colorectal cancer and may ultimately allow at-risk patients to be identified at an earlier stage.</p> Faten Limaiem, Sonia Azzabi, Asma Sassi, Saadia Bouraoui Copyright (c) Thu, 27 Sep 2018 00:00:00 +0000 Burnout syndrome et ses facteurs chez les médecins de deux centres Hospitalo-Universitaires d’Antananarivo <p>La profession médicale est un métier stressant, pouvant engendrer un syndrome d'épuisement professionnel ou&nbsp;<em>burnout syndrom</em>&nbsp;(BOS). Le but de cette étude était de déterminer les degrés du BOS (faible, moyen, élevé) de par ses dimensions et les facteurs liés à l'activité professionnelle du médecin qui lui étaient corrélés. Il s'agit d'une étude transversale, en 2012, par auto-questionnaire, auprès des médecins du Centre Hospitalier de Soavinandriana et du Centre Hospitalier Universitaire, Joseph Ravoahangy Andrianavalona. Des tests de corrélation et de régression linéaire ont été effectués (SigmaStat® 3.5). Le taux de réponse à l'enquête a été de 47,1% sur 138 médecins hospitaliers. Le nombre de dossiers retenus était de 48. La population de l'étude était à prédominance masculine (sex ratio: 1,8) avec un âge médian de 37 [25-59] ans. Les internes de spécialité et les médecins assistants représentaient 56,3% de la population. Selon l'ancienneté 16,7% étaient dans le métier depuis moins d'un an. Le&nbsp;<em>burnout syndrom</em>&nbsp;a été observé dans 51,2 % des cas avec un degré élevé pour 4,2% des médecins. Le titre avait une corrélation significative avec le syndrome d'épuisement professionnel et son degré (p=0,0142 et p=0,0362), notamment l'épuisement émotionnel (p=0,0414). L'apparition du BOS n'était ni corrélé avec l'ancienneté du médecin ni avec le secteur d'activité. Le BOS existe en milieu hospitalier, surtout lié au titre du médecin. Il est essentiel de le diagnostiquer au plus tôt pour en éviter ses conséquences délétères.</p> Aurélia Rakotondrainibe, Harifetra Mamy Richard Randriamizao, Noro Seheno Ratsimbazafy, Yvon Mong-Gine, Rakotoarison Catherine Nicole Rakototiana, Felantsoa Auberlin Rakototiana, Marie Lydia Agnès Ravalisoa Copyright (c) Thu, 27 Sep 2018 00:00:00 +0000 A cross-sectional study of traditional practices affecting maternal and newborn health in rural Nigeria <p><strong>Introduction:&nbsp;</strong>certain traditional practices which have negative effects on maternal and child health continue to be practiced in sub-Saharan African countries. A survey was carried out in a rural village in Nigeria to understand the scale and range of these practices.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional study in which trained interviewers administered pre-tested questionnaires on child-bearing women using questionnaires embedded on android devices.</p> <p><strong>Results:&nbsp;</strong>the median age of marriage and pregnancy were 15 and 16 years respectively. Home births were high (90.4%) while non-skilled birth attendant was 87.4%. The community had a son preference index ratio of 1:1.4. Up to 81.5% of mothers responded that one form of unhygienic traditional procedure or the other was performed on their children. Time to initiation of breast feeding was in hours in the majority (76.3%) of mothers, with a high rate of use of prelacteal feeds (85.2%). Being an adolescent mother (AOR 0.403, 95%CI 0.203, 0,797) and utilizing a skilled provider at birth (AOR 0.245, 95%CI 0.088, 0.683) were associated with less likelihood of having an unhygienic procedure performed on children.</p> <p><strong>Conclusion:&nbsp;</strong>the findings of our study suggest that traditional practices which could have negative effects on maternal and child health are still ongoing in the study community. Child protection laws and safeguarding principles could help to reduce these practices and would need to be developed and implemented in these settings where these practices are still prevalent.</p> Jimoh Adenike Oluwayemisi, Adaji Sunday Enema, Adelaiye Hamdalla, Olorukooba Abiola Aira, Bawa Umma, Ibrahim Ismail Habiba, Garba Comfort, Mfuh Anita Lukong, Idris Suleiman, Shittu Oladapo Sunday Copyright (c) Fri, 28 Sep 2018 00:00:00 +0000 Progress towards elimination of measles in Kenya, 2003-2016 <p><strong>Introduction:&nbsp;</strong>measles is targeted for elimination in the World Health Organization African Region by the year 2020. In 2011, Kenya was off track in attaining the 2012 pre-elimination goal. We describe the epidemiology of measles in Kenya and assess progress made towards elimination.</p> <p><strong>Methods:&nbsp;</strong>we reviewed national case-based measles surveillance and immunization data from January 2003 to December 2016. A case was confirmed if serum was positive for anti-measles IgM antibody, was epidemiologically linked to a laboratory-confirmed case or clinically compatible. Data on case-patient demographics, vaccination status, and clinical outcome and measles containing vaccine (MCV) coverage were analyzed. We calculated measles surveillance indicators and incidence, using population estimates for the respective years.</p> <p><strong>Results:&nbsp;</strong>the coverage of first dose MCV (MCV1) increased from 65% to 86% from 2003-2012, then declined to 75% in 2016. Coverage of second dose MCV (MCV2) remained &lt; 50% since introduction in 2013. During 2003-2016, there were 26,188 suspected measles cases were reported, with 9043(35%) confirmed cases, and 165 deaths (case fatality rate, 1.8%). The non-measles febrile rash illness rate was consistently &gt; 2/100,000 population, and "80% of the sub-national level investigated a case in 11 of the 14 years. National incidence ranged from 4 to 62/million in 2003-2006 and decreased to 3/million in 2016. The age specific incidence ranged from 1 to 364/million population and was highest among children aged &lt; 1 year.</p> <p><strong>Conclusion:&nbsp;</strong>Kenya has made progress towards measles elimination. However, this progress remains at risk and the recent declines in MCV1 coverage and the low uptake in MCV2 could reverse these gains.</p> Ngina Kisangau, Kibet Sergon, Yusuf Ibrahim, Florence Yonga, Daniel Langat, Rosemary Nzunza, Peter Borus, Tura Galgalo, Sara A Lowther Copyright (c) Fri, 28 Sep 2018 00:00:00 +0000 Double localisation secondaire cutanée et sinusienne révélant un adénocarcinome à cellules claires du rein: un cas avec revue de la littérature <p>Situé au troisième rang des cancers urologiques, le cancer du rein métastase habituellement au niveau du poumon, des os et du foie. Nous rapportons ici le cas clinique de métastases cutanée et sinusienne ayant révélées un cancer du rein chez un sujet de sexe masculin âgé de 70 ans.</p> Eliane Ndounga, Jean Felix Peko, Jean Bernard Nkoua Mbon Copyright (c) Mon, 01 Oct 2018 00:00:00 +0000 Breast diseases in women over the age of 65 in Monastir, Tunisia <p>As life expectancy is on the rise, it is predicted that a growing number of people will live beyond the age of 65 and therefore a higher number of elderly women will have breast diseases requiring significant health care and services. This study is aimed at investigating the characteristics, the treatment and outcomes of women older than 65 years old treated for breast diseases at our institution. This was a retrospective study covering the period from January 2003 to December 2011. It involved 92 patients aged over 65 and treated for breast disease in the Maternity Center of Monastir, Tunisia. The data included characteristics of patients and tumors, treatment and outcomes that were obtained through data extraction sheets. We reported a study of 92 women over the age of 65 of whom 77 women had malignant breast disease (83.6%) and 15 benign breast diseases (16.4%). Breast cancer was discovered at a mean age of 72.5 ± 6.6 years. Distant metastases were found in 5.3% of cases and infiltrative ductal carcinoma was detected in 85.7% of patients. Hormonal receptors were positive for estrogens in 64.7% of cases. Surgical treatment was performed in 73 patients and adjuvant treatment was prescribed for 67 women (86%). The complication rate was 16.6% among the 73 patients who underwent surgery. Benign breast diseases represented 16.3% of the mammary pathologies. Abscesses and fibrocystic mastopathy were the most frequent histological diagnoses. Despite great interest in geriatric gynecological pathology worldwide, many questions related to how optimally treat this patient population remain unanswered. In this study, a surgical treatment was performed in 94.8% of breast cancer patients and the complication rate was 16.6%.</p> Anis Haddad, Olfa Zoukar, Amira Daldoul, Hanene Bhiri, Khechine Wiem, Houda Mhabrich, Sonia Zaied, Raja Faleh Copyright (c) Mon, 01 Oct 2018 00:00:00 +0000 Une cataracte de dessiccation en "plumes de paon" <p>La cataracte de dessiccation est une complication fréquente de la chirurgie du segment postérieur par vitrectomie. En effet, le contact entre le gaz utilisé pour le tamponnement interne et la cristalloïde postérieure peut induire une cataracte précoce sous-capsulaire postérieure, survenant dans les vingt-quatre heures, aussi dénommée en «feuille de fougère». Celle-ci est liée à une déshydratation des couches postérieures du cristallin ou à un blocage des échanges métaboliques de part et d'autre de la cristalloïde postérieure. Histologiquement, on retrouve des vacuoles ou des opacités linéaires en forme de plume au niveau du cortex sous-capsulaire postérieur, le plus souvent régressives. Cependant, les gaz de longue durée d'action favorisent une opacification permanente du cristallin, qui est souvent très adhérente et dont la dissection lors d'une phakoexérèse peut se compliquer d'une rupture capsulaire postérieure. Nous rapportons le cas d'un patient âgé de 54 ans, opéré de décollement de rétine de l'œil droit par vitrectomie associée à une cryopexie de la déhiscence rétinienne et un tamponnement par hexafluorure de soufre (SF6), et chez qui l'examen à j1 du post opératoire trouve un aspect de cataracte sous-capsulaire postérieure en « plumes de paon ».</p> Ghita Bouayad, Abdelbarre Oubaaz Copyright (c) Mon, 01 Oct 2018 00:00:00 +0000 Étude anthropométrique et pelvimétrique externe chez les nullipares de Lubumbashi: facteurs de risque et score prédictif de la dystocie mécanique <p><strong>Introduction:&nbsp;</strong>la morbi-mortalité maternelle et périnatale reste élevée dans la majeure partie de l'Afrique subsaharienne par rapport au reste du monde. Dépister, avant le travail, les femmes à risque de dystocies mécaniques et les référer à un hôpital mieux équipé pour accouchement contribue à la stratégie visant à réduire la morbi-mortalité. L'objectif de cette étude est de développer un score prédictif de la dystocie mécanique lors de l'accouchement chez les nullipares congolaises.</p> <p><strong>Méthodes:&nbsp;</strong>il s'agit d'une étude transversale analytique sur les nullipares avec des grossesses uniques dans 7 maternités de la ville de Lubumbashi (RDC). La taille, le poids et les mensurations pelvimétriques externes maternelles ont été récoltés et analysés. Une analyse univariée et une analyse multivariée étaient réalisées. La discrimination du score était évaluée à l'aide de la courbe ROC.</p> <p><strong>Résultats:&nbsp;</strong>nous avons recruté 535 nullipares au cours de la période d'étude, dont 126 (23,55%) avaient accouché par césarienne indiquée pour dystocie mécanique. Après modélisation logistique, trois critères sont ressortis comme facteurs prédictifs de dystocie mécanique: la taille maternelle &lt;150cm (ORajusté=2,96 [1,49-5,87]), le diamètre bi-ischiatique &lt;8cm (ORajusté=15,96 [3,46-73,56]) et le diamètre prépubien de Trillat &lt;11cm (ORajusté=2,34 [1,36-4,01]). L'aire sous la courbe ROC du score est de 0,6549 avec une sensibilité de 23,81%, une spécificité de 97,80% et une valeur prédictive positive de 76,92%.</p> <p><strong>Conclusion:&nbsp;</strong>il a été observé que les valeurs de 10<sup>ème</sup>&nbsp;percentile des trois mesures anthropométriques maternelles étaient prédictives de la dystocie mécanique. Lorsqu'elles étaient utilisées ensemble, ces trois valeurs permettaient de développer un score de dépistage à faible coût pour une utilisation dans les milieux à faible revenu.</p> Fanny Kaj Malonga, Olivier Mukuku, Micrette Tshanda Ngalula, Prosper Kakudji Luhete, Jean-Baptiste Kakoma Copyright (c) Tue, 02 Oct 2018 00:00:00 +0000 Epidemiology of head injuries and helmet use among motorcycle crash injury: a quantitative analysis from a local hospital in Western Kenya <p><strong>Introduction:&nbsp;</strong>injury from motorcycle is a considerable cause of deaths and disability in the world. It is becoming one of the most serious public health problems, not only in developed countries but more in low and middle-income countries.</p> <p><strong>Methods:&nbsp;</strong>descriptive cross sectional study for patients who sustained head injuries related to motorcycle crashes between March 2017 and March 2018. Participant bio data, injury history and neurological examination findings were collected using pretested interviewer administered questionnaires. Frequencies, Mean (SD) and chi-square was employed in the analysis. Results were considered significant at p&lt;0.05.</p> <p><strong>Results:&nbsp;</strong>a total of 341 motorcycle crash injury patients participated in the study. One hundred and forty three (42%), sustained head injuries while 198 (58%) sustained other types of injury. In regard to safety helmets, 94 (28%) wore helmets at the time of crash. One hundred and forty three (42%), of the respondents without helmets at the time of crash sustained head injuries. Riders and passengers who wore helmets at the time of motorcycle crash, suffered less frequent head injuries compared to those who did not wear helmets and this was statistically significant (χ2=55.78, P&lt;0.00). Non use of safety helmet during crash was associated with sustaining mild to severe head injury. Most of the crashes 165 (48.3%), occurred as a result of collision between motorcycles versus vehicle. Majority of the crashes occurred in the afternoon hours 174 (51%). The days of the week recording the highest number of injuries were Friday (16.1%) and Monday (15.8%). The day of Involvement in motorcycle crash during the week was not significantly associated with head injury (χ2=13.103, p=0.785).</p> <p><strong>Conclusion:&nbsp;</strong>majority of motorcycle crash injury victims sustained head injury. Few of the victims used safety helmets at the time of the motorcycle crash. Use of helmets was protective of sustaining mild to severe head injuries among crash injury victims.</p> Peter Kiteywo Sisimwo, Geoffrey Mose Onchiri Copyright (c) Tue, 02 Oct 2018 00:00:00 +0000 Acceptabilité du vaccin antivirus du papillome humain: enquête auprès des parents <p>Le but de ce travail est d'évaluer les connaissances des parents des filles en âge de vaccination sur le vaccin anti virus du papillome humain (HPV), leur acceptabilité du vaccin et les facteurs associés au refus. Nous avons mené une enquête auprès des parents de filles âgées de 8 à 15 ans, suivies pour diverses pathologies au service de pédiatrie du CHU Mohamed VI de Marrakech, Maroc, portant sur le profil des parents, leur connaissances sur le cancer du col de l'utérus, l'HPV, et le vaccin anti HPV, l'acceptabilité de vacciner leur filles et les arguments liés au refus. Quatre vingt seize questionnaires ont été inclus dans l'analyse. Le cancer du col est considéré fréquent pour 58% des parents. Seuls 5% connaissaient le vaccin anti HPV. Leur source d'information à tous était les médias. Personne n'avait d'idée sur le coût du vaccin et sa tolérance. Aucune fille n'était vaccinée contre l'HPV. Soixante trois pour cent des parents voudraient bien vacciner leurs filles, ce taux a augmenté à 82% après sensibilisation des parents. Treize pour cent des parents étaient hésitants alors que 24% ont refusé de vacciner pour cause d'effets secondaires majoritairement (51%). Les parents refusant le vaccin étaient en majorité de sexe masculin, de niveau socio-économique et culturel moyen, et ignoraient le virus et le vaccin dans 91% des cas. Cette étude a permis de soulever les éléments de réticences face au vaccin anti HPV afin d'optimiser les stratégies de communication auprès des parents.</p> Naima Baddouh, Noureddine Rada, Fatima Ezzahra Elalouani, Ghizlane Draiss, Mohammed Bouskraoui Copyright (c) Tue, 02 Oct 2018 00:00:00 +0000 Une cause inhabituelle d’ictère <p>L'atteinte hépatique est fréquente au cours de l'hyperthyroïdie. Elle est le plus souvent asymptomatique. Une hyperthyroïdie révélée par un ictère est rarement décrite dans littérature. Nous vous rapportons une observation à Dakar (Sénégal). Il s'agissait d'un patient de 52 ans qui avait consulté notre service pour un ictère associé à un prurit. Les explorations biologiques montraient une augmentation des alanine aminotranférases (1,1 N), des aspartate aminotranférases (1,5 N), des phosphatases alcalines (3 N), des gamma glutamyl transférases (1,3 N) et de la bilirubinémie (22 N). L'échographie abdominale était normale. Une cause toxique ou médicamenteuse, un obstacle sur les voies biliaires, une hépatite virale ou auto immune ainsi qu'une cholangite biliaire primitive ont été exclu. Le dosage des hormones thyroïdiennes montrait une élévation de la T4 libre à 24 ng/dL (9-20 ng/dL) et un taux plasmatique indétectable de TSH inférieure à 0,01µUI/mL (0,35-4,94 UI/mL). Les anticorps anti récepteurs de la TSH étaient positifs à 7,04 UI/L (N &lt; 1,75 UI/L). L'échographie thyroïdienne objectivait un goitre diffus homogène hypervasculaire. Le diagnostic d'une atteinte hépatique secondaire à une maladie de Basedow sans dysfonction cardiaque était retenu. L'évolution clinique et biologique était favorable sous carbimazole. L'ictère peut être révélatrice d'une hyperthyroïdie. La recherche des signes cliniques et biologiques d'une hyperthyroïdie est obligatoire devant un ictère inexpliqué.</p> Salamata Diallo, Boundia Djiba, Marie Louise Bassène, Mamadou Ngoné Gueye, Mame Aissé Thioubou, Mariéme Poléle Fall, Cheikh Ahmadou Bamba Cissé, Daouda Dia, Mouhamadou Mbengue, Mamadou Lamine Diouf Copyright (c) Tue, 02 Oct 2018 00:00:00 +0000 Intérêt du clou rétrograde dans les fractures du fémur distal: à propos de 07 cas <p>Ce travail rapporte une série de sept cas de fractures de l’extrémité inférieure du fémur traitées par enclouage centromédullaire rétrograde au service de traumatologie orthopédie au centre hospitalier Ibn Sina durant la période du 30/05/2010 au 30/04/2015. L’âge moyen de nos patients est de 54 ans avec une légère prédominance Masculine (57,1%). Les accidents de la voie publique ont représenté la principale étiologie (71,4%) et le côté droit était le plus touché (57,1%). Sur le plan opératoire, le délai moyen de l'intervention était de 2 jours. La rachi anesthésie a été réalisé dans cinq cas. La durée moyenne d’hospitalisation était de 5 jours. L’ensemble de nos patients ont consolidé dans un délai moyen de 4 mois, avec un cas de retard de consolidation à 6 mois. Nous avons obtenu de bons résultats fonctionnels avec une flexion moyenne du genou à 120°, avec un seul cas de flexion limité à 90°. Dans notre série, on avait constaté un seul cas de retard de consolidation et un seul cas de pseudarthrose. Nous n’avons noté aucun décès ni sepsis superficiel ou profond, ni complication thromboembolique ou embolie graisseuse, nos résultats étaient en général satisfaisants, ce qui nous donne le droit de dire que l’enclouage rétrograde du fémur reste une technique d’ostéosynthèse qui a toute sa place dans le traitement chirurgical des fractures distales du fémur.</p> Redouane Hani, Mohamed Ben Aissi, Moncef Boufettal, Mohamed Kharmaz, Mohamed Saleh BerradaMohamed Saleh Berrada Copyright (c) Tue, 02 Oct 2018 00:00:00 +0000 Syndrome d’activation macrophagique révélant un lymphome T sous-cutané chez un adolescent de 16 ans <p>Le syndrome d'activation macrophagique (SAM) est une atteinte multisystémique, liée à une intense activation du système immunitaire correspondant à une infiltration plus ou moins diffuse des tissus par des macrophages activés. Il associé des signes cliniques (fièvre, hépato splénomégalie, adénopathie) et des anomalies biologiques (bi ou pancytopénie, cytolyse hépatique, élévation des LDH, coagulopathie) à une hémophagocytose .Il peut être primaire chez l'enfant ou secondaire à diverses affections. Nous rapportons le cas d'un adolescent de 16 ans admis au service de pédiatrie pour leucopénie fébrile avec altération de l'état général et des lésions érythémateuses circulaires étendues au niveau des membres inférieurs. Le diagnostic de syndrome d'activation macrophagique était retenu devant les signes cliniques, biologiques et cytologiques compatibles. La biopsie cutanée de ces lésions était en faveur d'un lymphome T sous-cutané type panniculite. A travers ce travail nous insistons sur la particularité de cette observation clinique vu la rareté de ce type de lymphome T sous cutanée et beaucoup plus au cours de cette tranche d'âge, ainsi sur l'intérêt de penser au lymphome T sous cutanée devant un SAM qui pourrait mettre en jeu le pronostic vital, lorsque il est associé à des lésions sous cutanée érythémateuses.</p> Mohamed Hbibi, Sara Benmiloud, Safae Rahmouni, Ilhame Tadmouri, Sana Abourazzak, Sana Chaouki, Fatima Zahra Souilmi, Mounia Lakhdar Idrissi, Mostapha Hida Copyright (c) Tue, 02 Oct 2018 00:00:00 +0000 Pneumomédiastin spontané: à propos de 18 cas <p>Le pneumomédiastin spontané se définit par la présence d'air au niveau du médiastin en l'absence de cause traumatique ou iatrogène. Son diagnostic repose sur la radiographie thoracique. Le recours à d'autres examens paracliniques, tels que la tomodensitométrie thoracique ou la fibroscopie bronchique ou digestive, s'impose parfois. L'évolution est le plus souvent favorable. Nous rapportons 18 cas de pneumomédiastin spontané, colligés au service des maladies respiratoires du CHU Ibn Rochd de Casablanca entre 2006 et 2017. Il s'agit de 13 hommes et de cinq femmes dont la moyenne d'âge était de 24 ans. La symptomatologie clinique était dominée par la douleur thoracique rétrosternale. Les circonstances de survenue du pneumomédiastin étaient des quintes de toux dans sept cas, une crise d'asthme dans cinq cas, une consommation de narguilé et des vomissements Itératifs dans deux cas chacun, un accouchement et une exacerbation d'origine bactérienne de BPCO dans un cas chacun. L'évolution était favorable dans tous les cas avec une résorption spontanée du pneumomédiastin. Aucune récidive n'est survenue après un recul moyen de 3 ans.</p> Chaanoun Khadija, Zaghba Nahid, Benjelloun Hanane, Yassine Nabiha Copyright (c) Tue, 02 Oct 2018 00:00:00 +0000 Maladie de Verneuil: un diagnostic à ne pas méconnaitre devant une lésion tumorale vulvaire et périnéale <p>Les auteurs rapportent le cas d'une patiente de 58 ans, nulligeste, aux antécédents de maladie de Niemann-Pick qui a consulté pour une tuméfaction vulvo-périnéale de 10 cm, fluctuante et fistulisé avec une ulcération. La patiente était fébrile et présentant un état général altéré. Cette masse a fait craindre le développement d'une tumeur maligne vulvaire nécrosée et infectée sur une dermatose chronique. Elle a eu une incision en vue de drainage des collections purulentes associée à des biopsies multiples qui ont infirmé la présence d'un processus néoplasique. L'association lésionnelle et leurs distributions ont fait porter alors le diagnostic d'une hidradenite suppurative ou maladie de Verneuil. Ensuite le problème posé était celui du choix de la conduite de prise en charge ultérieure parmi les traitements médicamenteux et chirurgicaux décrits. Les auteurs discuteront à travers ce cas et une brève revue de la littérature récente les modalités du diagnostic, les complications et la prise en charge thérapeutique de cette maladie.</p> Anis Haddad, Olfa Zoukar, Sonia Hammami Copyright (c) Wed, 03 Oct 2018 00:00:00 +0000 About a rare disease misdiagnosed as malignant lymphoma or tuberculosis: Kikuchi-Fujimoto’s disease <p>Kikuchi-Fujimoto's disease KFD is a rare and benign cause of cervical lymphadenopathy. It is an anatomoclinical entity of unknown etiology. The confirmation of the diagnosis is always provided by histological lymph node study. The clinical picture sometimes evokes lymphoma or tuberculosis. The evolution is generally favorable with spontaneous healing after a few weeks. We report the case of a 26-year-old woman who had consulted for cervical lymphadenopathy associated with fever. The cervical lymph node biopsy concluded to Kikuch-Fujimoto's disease. The evolution was marked by rapid regression of lymphadenopathy under corticosteroid treatment.</p> Jawad Lahma, Zakaria Arkoubi, Reda Hejjouji, Sophia Nitassi, Ali El Ayoubi, Razika Bencheikh, Mohammed Anas Benbouzid, Abdelilah Oujilal, Leila Essakalli Copyright (c) Wed, 03 Oct 2018 00:00:00 +0000 Rhinolithiasis: about an observation of a rare condition <p>Rhinolithiasis is a rare condition often neglected or unknown that tends to disappear in developed countries and corresponds to a solid calcification by gradual deposition of calcareous salts around a central resorbable or non-resorbable foundation of varying shape and size. The most common symptom is a long-term unilateral purulent rhinorrhea and unilateral nasal obstruction. Nasal endoscopy and imaging are interesting for the positive diagnosis but especially to highlight the anatomical anomalies or related pathologies. Therapeutic management requires endonasal extraction of the rhinolith under general anesthesia. We report an observation of rhinolithiasis treated in our department associating a significant deformation of the nasal pyramid to osteolysis.</p> Jawad Lahma, Reda Hejjouji, Imane Azzam, Abdelilah Oujilal, Leila Essakalli Copyright (c) Wed, 03 Oct 2018 00:00:00 +0000 Egg on a string sign <p>A 2850g male infant was born at 36 weeks gestation to a 26-year-old gravida 1 para 1 mother who did not receive routine prenatal care. Upon delivery he was hospitalized to the neonatal intensive care unit for severe respiratory distress. On physical examination, the infant had marked central cyanosis and a soft systolic murmur. Chest X-ray showed "egg on a string" sign raising suspicion for transposition of the great arteries, which was confirmed by urgent echocardiography and cardiac catheterization. Transposition of the great arteries is the most common cyanotic congenital heart lesion that presents in neonates. The hallmark of the condition is ventriculoarterial discordance and the classic "egg on a string" appearance on chest roentgenograms is found in one third of patients. A continuous infusion of prostaglandin E1 is the mainstay of emergent treatment followed by surgical arterial switch procedure.</p> Ipek Güney Varal, Pelin Dogan Copyright (c) Wed, 03 Oct 2018 00:00:00 +0000 A stitched jaw in the newborn: subglosso-palatal membrane <p>Subglosso-palatal membrane (SPM) is an extremely rare entity and only a few neonatal cases have been reported in the literature. Anatomically, SPM is a fibrous tissue, extending from the floor of the mouth to the palate. Majority of the cases are recognized during the first feeding with the inability of opening the mouth and latching, thus feeding difficulty is the major sign that prompt the physician to consider the diagnosis. Simple surgical resection of the fibrous band is sufficient for the treatment; however, the practical importance of this entity is that physicians should keep in mind the possible co-occurrence of other congenital anomalies such as cleft lip and palate, micrognathia, microglossia and temporomandibular joint disorders in these infants. We present the case of a 3230g male infant was born at 40 weeks gestation to a 30-year-old gravida 2 para 1 mother via cesarean section. Upon delivery he was noted to have severely restricted oral opening due to a mucous intra-oral band vertically connecting the floor of the mouth to the midline of the hard palate. Tongue movements were intact. The pregnancy history was unremarkable, the mother denied having taken any drugs, there was no family history of congenital anomalies or consanguinity. Immediate surgical resection of the aberrant tissue was performed in the operating room with minimal hemorrhage following excision. The physical examination of the infant was otherwise unremarkable and detailed genetic assessment was also normal. The infant was discharged home on full oral feedings on day 5.</p> Pelin Dogan, Ipek Güney Varal Copyright (c) Wed, 03 Oct 2018 00:00:00 +0000 Trends of blood-borne infectious diseases in a rural blood donation center of southeast Gabon (Koula-Moutou) <p><strong>Introduction:&nbsp;</strong>blood-borne pathogens such as human immunodeficiency virus (HIV), hepatitis B and C (HBV and HCV) viruses and&nbsp;<em>Treponema pallidum</em>&nbsp;remain a major public health problem in sub-Saharan Africa. The purpose of this study was to assess the frequency and clinical implications of HIV, HBV, HCV and&nbsp;<em>Treponema pallidum</em>&nbsp;markers in blood donors in a rural area of Southeast Gabon (Koula-Moutou) from 2012 to 2017.</p> <p><strong>Methods:&nbsp;</strong>hepatitis B surface antigen (HBsAg), anti-HIV, anti-HCV and anti-<em>Treponema pallidum</em>&nbsp;antibodies were screened using rapid diagnostic tests.</p> <p><strong>Results:&nbsp;</strong>of a total of 5,706 blood donors, 1,054 (18.5%) were seropositive for at least one infectious marker and 59 (5.6%) had serologic evidence of multiple infections. The overall seroprevalence of HIV, HBsAg, HCV, and syphilis was 3.1%; 5.9%; 6.2% and 3.3%, respectively. HIV, syphilis and HCV distributions were associated with neither the sex nor the age of the donors. Only HBsAg seroprevalence was significantly higher in donors of the age group 26-35 years old compared to donors of the age group 36-45 years (OR = 1.43 (95% CI: 1.01-2.04), P = 0.045). There was a significant increase in the frequencies of HIV and syphilis and a regression of HBsAg and HCV among blood donors.</p> <p><strong>Conclusion:&nbsp;</strong>this study presents the epidemiology of the main pathogens detected in blood donors in a rural area in Gabon. We found that the overall distribution of transfusion transmitted infectious diseases were lower than those observed in the general population but could be underestimated due to the use of rapid diagnostic tests (RDTs) in the screening process of the blood donations.</p> Cyrille Bisseye, Landry Erik Mombo, Stéphane Meyet Me Bie, Apollinaire Edou, Jean-Marie Eko Mba, Jean-Charles Etho-Mengue, Kévin Mbacky, Arnaud Mongo-Delis, Bertrand M’batchi, Bolni Marius Nagalo Copyright (c) Wed, 03 Oct 2018 00:00:00 +0000 Hépatite virale B: aspects cliniques, paracliniques et évolutifs dans le service d’Hépato Gastroentérologie de l’Hôpital Aristide Le Dantec: à propos de 728 cas <p>L’hépatite virale B constitue un problème majeur de santé publique en Afrique subsaharienne avec environ 65 millions de porteurs chroniques et 56.000 décès par an. Notre étude avait pour but d’étudier les aspects épidémiologiques, paracliniques, thérapeutiques, évolutifs des patients atteints d’hépatite virale B suivis dans notre service et de décrire leurs profils sérologiques. Nous avons réalisé une étude rétrospective, longitudinale de 2010 à 2014 dans le service d’hépato gastroentérologie de l’hôpital Aristide Le Dantec de Dakar. Nous avons inclus tous les patients suivis en ambulatoire ou hospitalisés qui avaient une positivité de l’AgHBs. Nous avons colligé 728 cas de patients infectés par le virus de l’hépatite B. Ils étaient constitués de 7 cas d’hépatite aiguë, de 442 cas d’infections chroniques, de 161 cirrhotiques et de 118 cas de carcinome hépatocellulaire. L’âge moyen était de 33 ans [14 - 83 ans] avec un sex-ratio de 2,2. Les circonstances de découverte étaient représentées par le dépistage systématique (26,2%), les douleurs de l’hypochondre droit (23%) et le don de sang (18,6%). Il y avait 59 patients monoinfectés par le virus de l’hépatite B qui étaient au stade d’hépatite chronique active. Les porteurs inactifs étaient au nombre de 118. Par insuffisance d’exploration liée à des contraintes économiques, le statut sérologique était indéterminé chez 252 patients. Un traitement antiviral B n’a pu être institué que chez 58 patients. Sous Ténofovir, la réponse virologique et biochimique était respectivement de 85% et 100% après 120 semaines de traitement. Le virus de l’hépatite B est une cause majeure d’hépatopathie au Sénégal.</p> Salamata Diallo, Marie Louise Bassène, Mamadou Ngoné Gueye, Mame Aissé Thioubou, Daouda Dia, Mouhamadou Mbengue, Mamadou Lamine Diouf Copyright (c) Wed, 03 Oct 2018 00:00:00 +0000 Abscessed inguinal metastasis as an initial presentation of testicular cancer <p>A 24-year-old man presented to the emergency service with fever, malaise and a large abscessed tumor located in the left inguinal region.He had a history of hydrocele and varicocele treated surgically in childhood.One year before admission, a small nodule approximately 1 x 2 cm appeared in his left inguinal region; this nodule increased in size and was accompanied by a weight loss of approximately 15 kg. On arrival, a large abscessed and ulcered adenopathy 20 x 18 x 11 cm with purulent secretion was seen in the area associated with a 5 cm left testicular tumor. Imaging studies revealed a 1 cm left subpleural lung nodule on short axis. A radical left orchiectomy and a biopsy of the abscessed adenopathy were performed and the histopathologic report showed a mixed germ cell tumor. Tumor markers after orchiectomy were LDH 1124 IU/L, β-hCG 197mIU/mL, AFP 172 ng/mL. Wide spectrum antibiotics were started in addition to wide surgical debridement of the abscess with a favorable clincial response. After surveillance, the patient was discharged to receive ambulatory chemotherapy. Inguinal ganglionic metastasis associated with testicle cancer is a rare finding.The history of inguinal and/or scrotal surgery could explain this phenomenon as a result of an alteration of regional lymphatic drainage.When this group of patients develops testicular cancer, involvement of an inguinal node is described in up to 2-10% of cases.Despite this, routine inguinal lymphadenectomy is still controversial in this scenario.</p> Carlos Eduardo Salazar-Mejía, Enrique González-Nava Copyright (c) Thu, 04 Oct 2018 00:00:00 +0000 Abdominal eggshell calcifications in the newborn: meconium peritonitis <p>Meconium peritonitis is a sterile chemical peritonitis caused by intestinal perforation in-utero or shortly after birth and perforation usually occurs due to intrauterine obstruction. Its incidence is approximately 1 in 35,000 births and the mortality was reported to be 60-80%. The radiographic findings of meconium peritonitis are pneumoperitoneum, intestinal obstruction and abdominal calcifications. The classic eggshell calcification occurs owing to the defensive mechanism of the body against the inflammation in an effort to surround the meconium in the abdominal cavity. In a newborn with abdominal distension, meconium peritonitis should be kept in mind, especially if calcified foci are seen on plain abdominal radiographs, since timely diagnosis and surgery improves the survival rates. We present the case of a female newborn of 34 weeks' gestational age was admitted to the neonatal intensive care unit (NICU) with marked abdominal distension. The pregnancy was complicated by maternal polyhydramnios and a cesarean section was performed due to fetal distress. The infant was noted to have a grossly distended abdomen; however, the physical examination was otherwise unremarkable. The abdominal radiograph revealed distension of the bowel loops and free air with multiple peritoneal calcifications (Figure 1). Surgery, performed on day 1 of life, demonstrated ileal atresia and perforation in the distal part of the ileum. Solid meconium, which leaked into the abdominal cavity was removed and the atresic bowel was resected and anastomosed. The infant regained bowel function on postoperative day 7 and discharged home on the third week after gradual advancement to full enteral feeding.</p> Ipek Guney Varal, Pelin Dogan Copyright (c) Thu, 04 Oct 2018 00:00:00 +0000 Infarctus médullaire aigu: un diagnostic méconnu au pronostic sévère <p>L’infarctus médullaire est un diagnostic relativement méconnu, qui engage à court terme le pronostic, aussi bien vital que fonctionnel du patient. La vascularisation médullaire est l’une des plus complexes de l’organisme en raison du nombre important d’artères qui y contribuent. La rareté des accidents vasculaires médullaires et la faible accessibilité des vaisseaux médullaires aux investigations expliquent que nos connaissances restent limitées. Nous rapportons le cas d’un patient de 62 ans, diabétique de type 2 sous antidiabétiques oraux depuis 13 ans et suivi pour un psoriasis depuis 4 ans, a été amené à l’hôpital dans la nuit par son fils devant l’installation brutal d’un déficit des 2 membres supérieurs. Ce déficit était précédé de cervicalgie aiguë lors d’une montée brutale du patient en pratiquant sa prière quotidienne. A son admission, le patient était conscient, tension artérielle: 120/86mmhg, fréquence cardiaque: 89 battements/min, apyrétique. L’examen clinique révélait une diplégie brachiale flasque. Il n’y avait pas de troubles sensitifs ni de troubles sphinctériens et l’examen des paires crâniens était normal. Une IRM (Imagerie par Résonnance Magnétique) médullaire était réalisée en urgence, mettant en évidence un hyper signal T2 et une diffusion centrale bilatérale réalisant un aspect de « Snake-eyes » (A et B). Le bilan étiologique avait révélé la présence d’une plaque d’athérome à l’origine de l’artère carotide interne gauche. Le diagnostic d’infarctus médullaire sur embolies fibrocartilagineuses a été retenu. Une rééducation fonctionnelle est commencée précocement ainsi qu’un traitement par antiagrégant plaquettaire.</p> Mohamed Amine Mnaili, Ahmed Bourazza Copyright (c) Thu, 04 Oct 2018 00:00:00 +0000 Hepatic rupture from haematomas in patients with pre-eclampsia/eclampsia: a case series <p>Hepatic rupture from haematomas is a rare complication of severe preeclampsia/eclampsia especially when complicated with the haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome. It is associated with poor maternal and foetal outcomes as demonstrated by three cases we describe. The first case had eclampsia at 31 weeks gestation with features of abruptio placentae and at caesarean section we found haemoperitoneum of 1.5 litres, a 10cm liver rupture and a still birth. She subsequently died in ICU within 24 hours of surgery; the second case had eclampsia at 35 weeks and ended up as a table death during emergency caesarean section. She had 4 litres of haemoperitoneum, hepatic rupture, placental abruption and a stillbirth; the third case had pre-eclampsia at 33 weeks with markedly elevated liver enzymes. She had one litre haemoperitoneum, right lobe hepatic rupture and a stillbirth. She recovered after conservative management. Severe pre-eclampsia/eclampsia associated hepatic rupture calls for rapid and aggressive intervention with prompt multidisciplinary management to avert adverse outcomes.</p> Takura Innocent Kanonge, Felix Chamunyonga, Nellia Zakazaka, Claitos Chidakwa, Mugove Gerald Madziyire Copyright (c) Thu, 04 Oct 2018 00:00:00 +0000 Une cause rare et méconnue de douleur abdominale: l’appendagite épiploïque: à propos d’un cas <p>Les appendagites épiploïques primitives sont des causes rares d’abdomen aigu. Elles sont souvent prises pour une appendicite aiguë ou une sigmoïdite diverticulaire et le diagnostic est posé au cours d’une intervention chirurgicale. Nous rapportons un cas où la tomodensitométrie a permis de poser le diagnostic et nous insisterons sur l’aspect imagerie qui permet de sursoir ainsi à une chirurgie inutile.</p> Siham Alaoui Rachidi Copyright (c) Thu, 04 Oct 2018 00:00:00 +0000 Etiology and pathogenicity of bacterial isolates: a cross sectional study among diarrheal children below five years in central regions of Kenya <p><strong>Introduction:&nbsp;</strong>bacterial agents are among pathogens implicated to cause diarrhea in children resulting to huge mortality and morbidities. Bacterial etiologies causing diarrhea in children below five years are rarely investigated in Central Kenya, which would otherwise guide prescription and target health education.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study approach was applied on 163 randomly selected stool samples from children below five years who presented with diarrhea in Murang`a and Muriranja`s hospitals. The objective was to determine the bacterial agents of diarrhea. Enteric bacterial pathogens were cultured using appropriate media and identified. Statistical analyses were performed using STATA v.13. Chi-square or Fisher exact-test were used to check for evidence of relationship whenever applicable.</p> <p><strong>Results:&nbsp;</strong>there were nearly equal distributions in gender 86 (52.8%) female vs. 77 (47.2%) male, majority (35.6%) aged between 0-12 months. Bacterial isolates were highly diverse in female than the male, children aged 49-60 months and least among those aged 0-12 months. A total of 188 bacterial isolates belonging to 11 genera were recovered. The predominant bacteria was nonpathogenic Escherichia coli 85 (45.2%), while 13 (6.9%) Escherichia coli were positive for virulence genes, including 8 (4.3%) positive for LT and STp Shiga-like or Enterotoxigenic Escherichia coli, 3 (1.6%) positive for eae and bfpA Enteropathogenic Escherichia coli and 2 (1.1%) positive for Enteroaggregative Escherichia coli gene. Others included: Salmonella 21 (11.2%), Pseudomonas 14 (7.4%), Shigella 14 (7.4%), Klebsiella 12 (6.4%), Aeromonas 8 (4.3%), Enterobacter 7 (3.7%), Proteus 8 (4.3%), Citrobactor 3 (1.6%), Yersinia 2 (1.1%) and Vibrio 1 (0.5%).</p> <p><strong>Conclusion:&nbsp;</strong><em>salmonella</em>&nbsp;was the major bacterial isolate and majority of the bacteria were statistically significant cause of diarrhea (p=0.001).</p> Oliver Waithaka Mbuthia, Scholastica Gatwiri Mathenge, Micah Ongeri Oyaro, Musa Otieno Ng'ayo Copyright (c) Thu, 04 Oct 2018 00:00:00 +0000 L’épiphysiolyse fémorale supérieure chez un malade en paralysie cérébrale suite à une crise convulsive <p>L'épiphysiolyse fémorale supérieure (EFS) correspond à un glissement de l'épiphyse fémorale supérieure par rapport au col fémoral qui le plus souvent se fait en arrière et en dedans, sous l'effet du poids du corps. Cette affection survient le plus fréquemment lors de la puberté. Nous rapportons le cas d’un enfant atteint de paralysie cérébrale avec spasticité des quatre membres, ce qui représente une entité très rare.</p> Yassine Nhamoucha, Mohammed Tazi, Hicham Abdellaoui, Othmane Alaoui, Saad Andaloussi, Mohammed Oukhoya, Lamyae Chater, Karima Atarraf, Mounir Arroud, Abderahman Afifi Copyright (c) Fri, 05 Oct 2018 00:00:00 +0000 An algorithm to improve the accuracy of emergency weight estimation in obese children <p><strong>Introduction:&nbsp;</strong>during medical emergencies in children, accurate and appropriate weight estimations may ultimately influence the outcome by facilitating the delivery of safe and effective doses of medications. Children at the extremes of habitus, especially obese children, are more at risk of an inaccurate weight estimation and therefore may be more at risk of medication errors. The objective was therefore to develop an algorithm to guide accurate emergency weight estimation in obese children.</p> <p><strong>Methods:&nbsp;</strong>relevant medical evidence was reviewed regarding weight estimation and its role and timing in the resuscitation of obese children. This was used as the basis for a weight-estimation algorithm.</p> <p><strong>Results:&nbsp;</strong>there was limited evidence regarding the way the weight-estimation systems should be used in obese children other than that the dual length- and habitus-based systems were the most accurate. The methods included in the algorithm were the Broselow tape, the Mercy method, parental estimates, the paediatric advanced weight prediction in the emergency room/ eXtra Length-eXtra Large (PAWPER XL) tape and the Traub-Johnson formula. The algorithm recognised several ways in which weight estimation could be tailored to the clinical scenario to estimate both ideal and total body weight.</p> <p><strong>Conclusion:&nbsp;</strong>weight-estimation in obese children must be conducted appropriately to avoid medication errors. This algorithm provides a framework to achieve this.</p> Mike Wells, Lara Nicole Goldstein Copyright (c) Fri, 05 Oct 2018 00:00:00 +0000 Un cas rare de luxation astragalo-scapho-calcanéenne interne <p>Nous rapportons un cas d'un jeune patient ayant présenté à la suite d'un accident de sport une luxation astragalo-scapho-calcanéenne interne où il a bénéficié d'un traitement orthopédique avec un bon résultat clinique et radiologique.</p> Soufiane Aharram, Abdelhafid Derfoufi, Abdessamad Kharraji, Jawad Amghar, Mohammed Benhamou, Abdelkarim Daoudi, Omar Agoumi Copyright (c) Fri, 05 Oct 2018 00:00:00 +0000 Tuberculose multifocale révélée par une pancytopénie: à propos d’un cas <p>Patiente de 58 ans, admise dans un tableau de polypnée avec signes de lutte respiratoire et désaturant à 65% à l’air ambiant et une fièvre à 38,5°C, l’hémogramme trouve une pancytopénie, l’ionogramme objctive une légère cytolyse hépatique et la radio des poumons objective un aspect de miliaire bilatérale. Les recherches de BK dans les expectorations étaient négatives ainsi que le Gene Xpert. L’étude anatomo-pathologique de la biopsie ostéomédullaire montre un granulome épithélio-giganto-cellulaire sans nécrose caséeuse et la PCR met en évidence le mycobacterium tuberculosis dans le prélèvement de biopsie ostéo-médullaire. Une biopsie hépatique a mis en évidence un granulome épithélioïde sans nécrose caséeuse. Le diagnostic de tuberculose multifocale avec atteinte pulmonaire, hématopoïétique et hépatique était retenu. La miliaire tuberculeuse est l’une des atteintes sévères dans le cadre de la tuberculose, les bacilloscopies sont souvent négatives et le diagnostic peut être retenu par d’autres prélèvements notamment l’étude du liquide céphalo-rachidien et la biopsie ostéomédullaire. La biopsie d’autres organes peut apporter le diagnostic dans de rares cas. L’avènement de la PCR comme technique de biologie moléculaire a permis de raccourcir le délai de diagnostic et donc la mise en route du traitement qui parfois doit être administré avant même d’obtenir la certitude diagnostique compte tenu de la mise en jeu du pronostic vital au cours de ces atteintes sévères.</p> Nabil Tiresse, Mohamed Allaoui Copyright (c) Fri, 05 Oct 2018 00:00:00 +0000 Pycnodysostose: à propos d’un cas <p>La pycnodysostose est une maladie osseuse génétique très rare associant une ostéocondensation, un syndrome dysmorphique et un retard de croissance. Rappeler les anomalies phénotypiques, les signes radiologiques, la prise en charge thérapeutiques et évolutifs de la Pycnodysostose chez un enfant de 11 ans. Enfant de 11 ans, a été réferé par son dentiste pour évaluation de son état clinique. Il est de parents consanguin de premier degré, qui présentait depuis l'âge de 3 ans des fractures spontanées à répétition. L'examen trouvait un syndrome dysmorphique fait de bosse frontale, fontanelle antérieure persistante, micrognathie, malformations des doigts, malposition dentaire, ongles incurvées, thorax asymétrique, attitude scoliotique du rachis dorsal, avec retard statural important (-4DS). Les radiographies du squelette montraient une densification des os de la base du crâne, une persistance de la fontanelle antérieure, une malposition dentaire, une densification diaphysaire et métaphysaire des os longs prédominants au niveau des membres inférieurs avec présence des cals vicieux et des phalanges grêles des mains. L'ostéodensitométrie était normale. Devant les signes cliniques et les manifestations radiologiques, le diagnostic retenu est une pycnodysostose. Un conseil génétique a été proposé pour la famille ainsi qu'une prise en charge dentaire et orthopédiques. La pycnodysostose est une entité rare de diagnostic parfois difficile et tardif, elle pose un problème du diagnostic avec l'ostéoporose. Le traitement est essentiellement préventif des fractures et des caries dentaires.</p> Abdelhakim Elyajouri, Mohammed Benyahia, Rachid Abilkassem, Aomar Agadr Copyright (c) Mon, 08 Oct 2018 00:00:00 +0000 Subcutaneous nodules revealing systemic sarcoidosis: a case report <p>57-year-old patient, treated for high blood pressure, never treated for tuberculosis and without toxic habits, having presented for one month a cutaneous lesions prevailing on the two upper limbs and on the face, painless, without pruritus, associated to redness eye and dyspnea stage II of the mMRC; the clinical examination revealed papules, subcutaneous nodules of 0.5cm on average and not exceeding 1cm for the most voluminous on the arms and forearms and on the face and the left eyelid, a lupus pernio is also present on the nose. Some lesions have presenting inflammatory signs. The pathological anatomy study of a skin biopsy revealed a granuloma with epithelioid and giant cells without caseous necrosis, suggesting the diagnosis of sarcoidosis first. A chest x-ray showed mediastinal lymphadenopathy and bilateral interstitial syndrome confirmed on thoracic computed tomography. The exploration of respiratory function reveals a restrictive ventilatory disorder supporting pulmonary parenchymal involvement. Ophthalmological examination shows anterior uveitis. The angiotensin converting enzyme assay is high and the tuberculin skin test reveals an anergy. The patient was treated by corticosteroids; synthetic antimalarials will be prescribed when no response or insufficient response happens. Subcutaneous sarcoidosis, also known as Darier-Roussy, and lupus pernio, are uncommon but specific of sarcoidosis. Their presence is often associated with systemic involvement, particularly thoracic.</p> Nabil Tiresse, Hajar Benataya Copyright (c) Mon, 08 Oct 2018 00:00:00 +0000 Interstitial pneumonia in a glassblower: think to chronic beryllium disease! <p>Chronic beryllium disease (CBD) is an occupational illness with varying severity. In this report, we describe a 27 year old man, glassblower, who developed a fatal CBD after six months of unknown Beryllium's exposure. The diagnosis was suspected on histological examination and then consolidated by confirmation of Beryllium's exposure at the working area. Physicians should be aware of the potential risk to develop CBD in glassblowers. These workers should benefit from early medical surveillance using the Beryllium lymphocyte proliferation test (BeLPT) and therefore from suitable management.</p> Amira Jamoussi, Takoua Merhabene, Mona Mlika, Henda Neji, Faouzi El Mezni, Jalila Ben Khelil, Mohamed Besbes Copyright (c) Tue, 09 Oct 2018 00:00:00 +0000 Assessing stress among medical students in Anbar governorate, Iraq: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>a high prevalence of stress has been recorded among medical students worldwide. Additionally, high levels of personal distress may have a negative effect on the cognitive functioning and learning abilities of medical students.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted using medical students in the Al-Anbar governorate; data collection was carried out from February to March 2018. The assessment of stress levels among these students was administered using the Kessler10 Psychological Distress instrument (K10).</p> <p><strong>Results:&nbsp;</strong>231 students (77.5%) reported at least some degree of stress, ranging between severe (30.2%), moderate (25.5%) and mild (21.8%). The highest proportion of students with stress (11.5%) was reported by first-year students; this proportion largely fell within the moderate and severe categories. There was a significant statistical association between gender and stress level.</p> <p><strong>Conclusion:&nbsp;</strong>there is a high level of stress among medical students in Falluja and Anbar Universities; this may require special programmes to identify any predisposing factors.</p> Ameel Farooq Al Shawi, Abdulrahman Nassir Abdullateef, Mohammad Anmar Khedher, Mohammad Saadon Rejab, Russul Nadhim Khaleel Copyright (c) Tue, 09 Oct 2018 00:00:00 +0000 Hydrocéphalie sur thrombophlébite du sinus sagittal supérieur par ostéite de la voûte à <i>Aspergillus fumigatus</i> sur terrain immunocompétent <p>Les auteurs rapportent dans une observation, une association pathogénique inhabituelle de lésions crânio-encéphaliques. Elle se caractérise par l'association d'une ostéite de la voûte à&nbsp;<em>Aspergillus fumigatus</em>, d'une thrombophlébite sous-jacente, elle-même compliquée d'une hypertension intracrânienne par hydrocéphalie. Nous rapportons le cas d'un homme de 43 ans, sérologie VIH (virus d'immunodéficience humaine) négative avec une notion d'infection multi-récidivante du scalp frontal. Ce patient a été traité avec succès par une dérivation du liquide cérébrospinal (LCS), du Kétoconazole et de l'héparine de bas poids moléculaire. Nous discutons à la lumière de la littérature les différents aspects physiopathologiques et de la prise en charge de cette exceptionnelle association pathogénique.</p> Romuald Kouitcheu, Dominique N'Dri Oka, Guy Varlet Copyright (c) Tue, 09 Oct 2018 00:00:00 +0000 L’apport de la radio-chimiothérapie concomittante dans la prise en charge du carcinome indifférencié du nasopharynx de l’adulte <p>L'objectif de l'étude et d'Analyser les caractéristiques épidémiologiques, cliniques, thérapeutiques et évolutives du carcinome indifférencié du nasopharynx de l'adulte. Il s'agit d'une étude cohorte rétrospective portant sur 163 patients âgés de 17 ans et plus, traités pour un carcinome indifférencié du nasopharynx non métastatique. L'âge moyen des patients était de 46,5ans, avec un sexe-ratio de 1,7. 35,57% des patients étaient atteints de tumeurs localement évoluées (T3-T4) et 52,27% avec une atteinte ganglionnaire régionale avancée (N2-N3). Sur le plan thérapeutique une chimiothérapie neoadjuvante a été réalisée chez 77% des patients et 93,8% des patients ont bénéficié d'une radio-chimiothérapie concomitante. Après un recul moyen de 40,8 mois la survie globale était de 92,9% et la survie sans récidive (SSR) était de 78,9%. L'analyse de la survie sans récidive SSR en fonction des différents facteurs pronostiques a montré une différence statistiquement significative pour l'atteint ganglionnaire avec des taux de SSR à trois ans de 88%, 82,6%, 80,8% et 61,5% en cas de tumeur classée N0, N1, N2 et N3 respectivement (p = 0,02). Le cancer du nasopharynx est une maladie complexe, mais des progrès ont été accomplis grâce à des percées en radiothérapie et en biologie moléculaire. La radio-chimiothérapie concomitante représente le standard thérapeutique des stades cliniques supérieur ou égal à T2, ou supérieur ou égal à N1. Les techniques innovantes d'irradiation semblent prometteuses et pourraient pallier aux problèmes de toxicité tardive tout en assurant un excellent taux de contrôle local.</p> Zenab Alami, Touria Bouhafa, Abderrahmane Elmazghi, Khalid Hassouni Copyright (c) Wed, 10 Oct 2018 00:00:00 +0000 Multiple subacute bilateral cerebral infarcts in a 9-year-old Nigerian male: a case of childhood primary angiitis of the central nervous system <p>A Primary Angiitis of the Central Nervous System (PACNS) is ill-defined, complex and rare in children. Clinical presentation is variable, diagnosis is challenging and it is life-threatening but treatable. The index case is a 9-year old male who presented with progressively slurred speech, progressive weakness of the limbs, hemifacial weakness and vomiting. There were no clinical or laboratory features of systemic vasculitis. Neuroimaging showed multiple subacute infarcts in both cerebral hemispheres. He responded well to immunosuppressive therapy. The case report aims to underscore the need for high index of suspicion, early neuroimaging for progressive nonspecific decline in neurologic function and the treatable nature of the condition if diagnosis is made early.</p> Christian Chukwukere Ogoke, Ifeanyi Innocent Ike, Augustine Emeka Osuji, Kingsley Asinobi, Chukwudi Ernest Okeke Copyright (c) Wed, 10 Oct 2018 00:00:00 +0000 Occupational skin disorders in a subset of Nigerian hairdressers <p><strong>Introduction:&nbsp;</strong>hairdressing is associated with a wide range of disorders. This is particularly true in the African hairdresser, who is saddled with the responsibility of "taming" the rather difficult-to-manage African hair, and is thus exposed to a wide range of chemical, biological and physical materials in the hair grooming process. We therefore sought to determine the prevalence and pattern of occupational skin disorders among hairdressers in Ibadan, one of the oldest and largest cities in Nigeria.</p> <p><strong>Methods:&nbsp;</strong>this was a cross sectional study of hairdressers conducted in 2013 in Ibadan, Nigeria. Hairdressers and their apprentices were interviewed using a structured questionnaire, following which a thorough physical examination was performed to identify any skin disorder.</p> <p><strong>Results:&nbsp;</strong>a total of 226 hairstylists were recruited. The prevalence of occupational skin disorders in the study was 68.13%. The prevalence of specific skin disorders was 32.74% for nail disorders; 28.75% for traumatic skin disorders; and 2.64% for hand dermatitis.</p> <p><strong>Conclusion:&nbsp;</strong>there is a high prevalence of occupational skin disorders among hairdressers, and this may have personal and public health implications.</p> Joseph Archibong, Eshan Henshaw, Adebola Ogunbiyi, Adekunle George Copyright (c) Wed, 10 Oct 2018 00:00:00 +0000 Compression médullaire au cours d’une spondylodiscite tuberculeuse: à propos d’un cas <p>Patient âgé de 76 ans, admis en pneumologie pour prise en charge d'une spondylodiscite tuberculeuse découverte par un tableau clinique associant amaigrissement, fièvre prolongée et douleur lombaire lancinante qui datent de 2 mois auparavant, confirmée par tomodensitométrie lombaire. Le diagnostic a été retenu suite à l'étude Gene Xpert sur liquide de ponction biopsie au niveau de l'anomalie vertébrale L1 qui a mis en évidence le mycobacterium tuberculosis. Trois semaines après début de traitement le patient a présenté un déficit moteur au niveau des 2 membres inférieurs suivi d'un déficit sensitif. Ces anomalies ont été confirmées sur IRM qui a montré des anomalies du signal somatique de L1 avec tassement du corps vertébral (A), ces lésions sont réhaussées après injection de gadolinium (B) qui a montré également une rupture corticale postérieure avec épidurite en regard. Cet aspect radiologique a permis de confirmer le diagnostic de compression médullaire sur spondylodiscite tuberculeuse. Quelques jours après le patient a présenté des signes de sepsis sévère compliqué d'un choc septique suite auquel le patient était décédé. La compression médullaire est l'un des aspects rares apparaissant au cours d'une spondylodiscite ayant un potentiel élevé de complications irréversibles en absence d'intervention précoce pour décompression médullaire. La chirurgie et le traitement antibacillaire démarré précocement sont garants d'une évolution favorable à moyen et à long terme.</p> Nabil Tiresse, Ahmed Abid Copyright (c) Wed, 10 Oct 2018 00:00:00 +0000 Pathological changes of renal biopsy in Sjögren Syndrome <p>We are presenting the case of a 53-year-old woman with a history of Sjögren syndrome and a secondary antiphospholipid syndrome admitted at the Nephrology department for the evaluation of renal failure. The patient was initially diagnosed with tubulointerstitial nephritis and subsequently a membranoproliferative type I glomerulonephritis, secondary to cryoglobulins during the course of the disease. Repeated renal biopsies were required to confirm the diagnosis.</p> Nery Sablón-González, Noel Lorenzo Villalba, Yanet Parodis López, Juan Manuel Fernández, Silvia Marrero-Robayna, Melek Kechida, Rafael Camacho-Galan, Jose Carlos Rodríguez- Pérez Copyright (c) Wed, 10 Oct 2018 00:00:00 +0000 Vomissements associés à une stagnation pondérale et convulsions : penser à une anomalie du cycle d’urée <p>Dans certaines maladies métaboliques héréditaires, les vomissements peuvent apparaître comme un symptôme étant au premier plan, en particulier les anomalies du cycle de l'urée, qui sont habituellement diagnostiqués en période néonatale ou dans l'enfance. Nous en rapportons un cas de révélation tardive par un état de mal convulsif. Nous rapportons le cas d'une patiente âgée de 13 ans, qui a été hospitalisé pour prise en charge d'un état de mal convulsif et un retard staturo-pondéral. L'interrogatoire a révélé la notion de vomissements chroniques avec des troubles du comportement, ralentissement idéomoteur et céphalées. L'examen a trouvé une ataxie. La ponction lombaire et le scanner cérébral sont normaux. Une ammoniémie nettement augmentée est mise en évidence 75 micromoles/l (11-50). La chromatographie des acides aminés dans le sang a montré une augmentation de la glutamine et de l'alanine, La chromatographie des acides aminés dans les urines a montré une augmentation des acides aminés basiques évoquant un déficit du cycle de l'urée par déficit de l'enzyme Argininosuccinate lyase. La patiente a été traité en urgence par une alimentation exclusivement glucidolipidique, et par benzoate de sodium permettant une amélioration de l'état clinique, et une reprise de poids. Les crises convulsives ont été maîtrisées par le phénobarbital. L'enquête familiale a trouvé une sœur âgée de 20 ans suivie depuis l'âge de 3 ans pour crises convulsives traité par le phénobarbital dont le bilan métabolique réalisé dans notre service a objectivé la même anomalie du cycle de l'urée que sa sœur. A tout âge, devant une encéphalopathie avec épilepsie, vomissement, stagnation pondérale et hyperammoniémie, il faut penser à un déficit du cycle de l'urée. Le diagnostic est très souvent posé lors d'un accès neuro-digestif aigue associant vomissements, troubles de conscience et/ou crises convulsives.</p> Brahim El Hasbaoui, Saloua Boujrad, Rachid Abilkacem, Aomar Agadr Copyright (c) Wed, 10 Oct 2018 00:00:00 +0000 A rare location of thyroglossal duct cyst in a newborn <p>Thyroglossal duct cyst of the tongue is a rare entity. Occurrence in the anterior part of the tongue is exceptional. We report in this paper a rare case of thyroglossal cyst of the anterior part of the tongue, discovered in a five-days-old newborn at delivery. Images have shown a cystic mass with homogenous liquid content. A transoral complete resection of the lesion was performed, with no postoperative complication. The histological analysis confirm the diagnosis of lingual thyroglossal duct cyst. There were no recurrence with a follow-up of eight months.</p> Amel El Korbi, Rachida Bouatay, Jihène Houas, Karim Ben Ameur, Khaled Harrathi, Jamel Koubaa Copyright (c) Wed, 10 Oct 2018 00:00:00 +0000 Anaesthesia for cleft lip surgeries in a resource poor setting: techniques, outcome and safety <p><strong>Introduction:&nbsp;</strong>cleft lip and palate is one of the more common congenital malformation and the most common craniofacial anomalies in children. The treatment is expensive and requires specialised care. Access to this care in middle and low income countries is compounded by socioeconomic status of patients and their relation and also the inadequacy of expertise in medical personnel and infrastructure. Objective: the study aimed to review the techniques of anaesthesia used in a low resource setting in terms of the techniques, outcome, and safety.</p> <p><strong>Methods:&nbsp;</strong>this is a retrospective review of 79 cases done in a resource poor setting. Information regarding the patients, surgeries and modes of anaesthesia were retrieved from the case notes.</p> <p><strong>Results:&nbsp;</strong>a total of 62 patients were operated with incomplete cleft accounting for 37 (59.7%), complete 23(37.1%), and 2 (3.2%) as bilateral. Forty-six (74.2%) of patients had their surgery done with ketamine anaesthesia without endotracheal intubation, 14 (22.6%) had regional anaesthesia and 2 patients (3.2%) had general anaesthesia with endotracheal intubation.</p> <p><strong>Conclusion:&nbsp;</strong>this study demonstrates that with careful planning and expertise, cleft lip repair can be done safely in resource poor setting.</p> Olumide Adeleke Akitoye, Babatunde Oludare Fakuade, Thomas Oseghae Owobu, Akinwale Adeyemi Efunkoya, Adetokunbo Rafel Adebola, Sunday Olusegun Ajike Copyright (c) Fri, 12 Oct 2018 00:00:00 +0000 Fasciite nodulaire de la fosse infra-temporale: à propos d’un cas <p>La fasciite nodulaire est une lésion bénigne à prolifération rapide de cellules myofibroblastiques, qui se développe aux dépens d'un fascia musculaire au sein du tissu sous-cutané. Sa croissance rapide et sa richesse cellulaire et mitotique font qu'elle est souvent prise à tort pour un sarcome. D'où l'importance de poser un diagnostic précis pour éviter des chirurgies inutiles et souvent mutilantes.Nous rapportons dans cette observation une localisation exceptionnelle de cette tumeur au niveau de la fosse infra-temporale.</p> Abdelouahid Taleuan, Dounia Kamal, Moad Sebti, Moahamed Nourdine Elalami Copyright (c) Fri, 12 Oct 2018 00:00:00 +0000 Implementing infection prevention and control capacity building strategies within the context of Ebola outbreak in a "Hard-to-Reach" area of Liberia <p><strong>Introduction:&nbsp;</strong>in August 2014, WHO declared that Ebola outbreak ravaging West Africa including Liberia had become a Public Health Emergency of International Concern (PHEIC). Infection prevention and control (IPC) among healthcare workers was pivotal in reducing healthcare worker infection and containing the recent EVD outbreak. Hard to reach areas (HTRA) presents peculiar challenges in public health emergencies. We present the result of IPC capacity building strategies deployed in Gbarpolu County: an HTRA of Liberia.</p> <p><strong>Methods:&nbsp;</strong>between April to October 2015, we conducted IPC training and mentorship at the county, district and facility levels in a selected HTRA of Liberia using the keep Safe, Keep Serving manual and the WHO core components of infection control. Serial follow-up assessments and mentoring using the Liberian Minimum standard tool for safe care in Liberian health facilities (MST) were done.</p> <p><strong>Results:&nbsp;</strong>180 (100%) facility based healthcare workers were trained: including 59 clinicians (32%) and 121 (67%) non-clinicians. 100% of the healthcare workers in four selected very HTRAs were trained and underwent facility based-mentorship. Compliance with IPC practice increased: the MST score increased from 75% to 90% and for the MST score for waste management and isolation increased 60% to 87%.</p> <p><strong>Conclusion:&nbsp;</strong>strengthening the capacity of healthcare workers for IPC was instrumental for containing the EVD epidemic but also critical for routine safe and quality services. A culture of IPC among healthcare workers in HTRA can be implemented through capacity building and training.</p> Michael Ogbonnaya Oji, Mesfin Haile, April Baller, Nathalie Trembley, Nuha Mahmoud, Alex Gasasira, Victor Ladele, Catherine Cooper, Francis Ndivo Kateh, Tolbert Nyenswah, Peter Nsubuga Copyright (c) Fri, 12 Oct 2018 00:00:00 +0000 Assessment of the knowledge, attitude and practice of health care workers in Fako Division on post exposure prophylaxis to blood borne viruses: a hospital based cross-sectional study <p><strong>Introduction:&nbsp;</strong>accidental exposure to blood and body fluid presents a serious public health concern, especially among healthcare workers (HCW) and constitutes a risk of transmission of blood borne viruses. Infections acquired through occupational exposure are largely preventable through strict control measures such as the use of safe devices, proper waste disposal, immunization and prompt management of exposures including the use of Post Exposure Prophylaxis. This study aimed to assess the knowledge, attitude and practice of healthcare workers on post exposure prophylaxis and also determine the factors influencing reporting of occupational exposures among HCW in Fako Division, Cameroon.</p> <p><strong>Methods:&nbsp;</strong>this was a hospital based cross-sectional study conducted from February 2016 to July 2016 involving the administration of questionnaires to 216 health care workers in Fako division. Data collected was analyzed with SPSS version 22 and results presented as percentages and tables. Pearson chi-square test was used to determine statistically significant relationship between different factors with reporting of occupational exposures among health care workers in Fako division.</p> <p><strong>Results:&nbsp;</strong>a high proportion of participants 125(58%) had poor knowledge on Post Exposure Prophylaxis and 131(60.6%) of participants proved to have a positive attitude towards post exposure prophylaxis. 50.9% (110/216) of all participants had at least one occupational exposure with a low uptake 19.1(21/110) of Post Exposure Prophylaxis recorded among participants who were exposed. There was a statistically significant relationship between years of experience (p-value = 0.006, CI= 0.151-0.745) and category of health care worker (p-value= 0.022, CI=0.314-14.215) with reporting of occupational exposure (p-value&lt; 0.05).</p> <p><strong>Conclusion:&nbsp;</strong>this study recorded among participants a poor knowledge on post exposure prophylaxis and poor practice though a majority of study participants had possitive attitude towards PEP. Therefore, a formal training for all health care workers on post exposure prophylaxis to blood borne viruses, strict monitoring and evaluation of health care worker's adherence to standard precautions, adequate reporting of exposures and uptake of post exposure prophylaxis is recommended.</p> Che Henry Ngwa, Elvis Akwo Ngoh, Samuel Nambile Cumber Copyright (c) Fri, 12 Oct 2018 00:00:00 +0000 Megacystis microcolon intestinal hypoperistalsis syndrome <p>A 34-year old gravida03 para02 woman with fetal bilateral hydronephrosis (A), greatly distended bladder and mild polyhydramnios, detected during a prenatal ultrasound. Based on the ultrasonography findings, megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) was suspected. MMIHS is an unusual disorder with the incidence of 1:1500, characterized by a massively enlarged fetal urinary bladder, microcolon, hypoperistalsis throughout the intestinal tract and incomplete intestinal rotation. A female infant was born at 34 weeks of gestation by an emergency caesarean section because of breech presentation during labor. The neonate weighed 4.2 kg with an Apgar score of 4 in 1 min and 6 in 5 min. Physical examination showed massive distended abdomen (B) and bladder, as well as bilateral palpated enlarged kidneys. Abdominal plain x-ray showed a dilated stomach and minimal gas in the distal bowel segments (C). An abdominal ultrasound imaging showed dilated stomach with distal duodenal atresia. Fluoroscopy gastrografin revealed narrow bowel loops and jejuna malrotation at the right side. Kidney-urinary-bladder ultrasonography showed distended urinary bladder, bilaterally enlarged kidneys, with tortuous and dilated ureter. A vesicostomy was performed to facilitate the drainage of urine (D). Presence of ganglion cells on rectal biopsy excludes Hirschsprung disease. The condition is fatal and surgical correction often remained unsuccessful. MMIH is an autosomal recessive disorder so genetic counseling is suggested for future pregnancies.</p> Nishat Fatema, Houda Nasser Al Yaqoubi Copyright (c) Fri, 12 Oct 2018 00:00:00 +0000 Fournier’s gangrene: prospective study of 34 patients in South Indian population and treatment strategies <p><strong>Introduction:&nbsp;</strong>Fournier's gangrene (FG) is a fulminant necrotizing fasciitis of the perineum and genitalia. The objective of this study was to study the etiology and microbiology associated with FG and to study the debridement and reconstructive procedures required in these patients.</p> <p><strong>Methods:&nbsp;</strong>this was a prospective follow up study conducted from September 2011 to November 2012 at Coimbatore medical college hospital, Coimbatore, India. Patients presenting to the outpatient department and emergency department with the clinical diagnosis of FG were included in the study.</p> <p><strong>Results:&nbsp;</strong>a total of 34 patients were studied in the study period. The mean age of presentation in years was 50±11.13. The male to female ratio was 33:1. The source of the infection was most commonly anorectal. Diabetes mellitus was the most common co morbid factor associated. Most commonly the disease was polymicrobial with escherichia coli being the commonest grown organism. The average number of wound debridement required was 2.9±1.42. Primary closure of the scrotal skin defect was the most common reconstructive procedure performed. Mortality associated with the disease in our series was 11.8%.</p> <p><strong>Conclusion:&nbsp;</strong>although FG is a relatively rare disease, it is still prevalent in Indian population. Incidence of FG in HIV patients is high, even though it is not the commonest of the co morbid condition. The mortality can be kept to minimal with aggressive medical and surgical management. Extensive raw area following the infection and wound debridement can be managed by simple reconstructive procedures with good outcome.</p> Vigneswara Srinivasan Sockkalingam, Elankumar Subburayan, Elango Velu, Sujith Tumkur Rajashekar, Anusha Mruthyunjaya Swamy Copyright (c) Fri, 12 Oct 2018 00:00:00 +0000 Prévalence du burnout en milieu d'anesthésie réanimation dans le centre tunisien <p><strong>Introduction:&nbsp;</strong>l'épuisement professionnel serait particulièrement préoccupant en milieu d'anesthésie réanimation. En plus de ses répercussions socio-économiques, il altère la qualité des soins prodigués et le pronostic des malades. Notre but est d'évaluer sa prévalence chez le personnel d'anesthésie-réanimation dans le centre tunisien.</p> <p><strong>Méthodes:&nbsp;</strong>il s'agit d'une enquête multicentrique transversale réalisée au sein des services d'anesthésie-réanimation dans les sept centres hospitalo-universitaires du centre tunisien et portant sur tout le personnel médical et paramédical consentant. L'instrument de mesure utilisé est le&nbsp;<em>Maslach burnout Inventory</em>.</p> <p><strong>Résultats:&nbsp;</strong>deux cent quatre-vingt-trois personnes ont participé à l'étude (72,19%). L'âge moyen était de 40,2 ± 9,38 ans avec une prédominance féminine. L'analyse de l'échelle de Maslach a révélé que 94,71% des participants étaient concernés par le burnout. Les scores moyens d'épuisement émotionnel, de dépersonnalisation et d'accomplissement professionnel étaient respectivement de 28,65 ± 11,92; 8,62 ± 6.65 et 34,58 ± 8,07. Un niveau élevé à modéré de burnout a été trouvé respectivement dans 13,3% et 26,2% des cas. Un niveau bas a été trouvé dans 55,21% des cas. Les répercussions du burnout sont dominées par les conduites additives (52,65%) et les idées suicidaires (4,59%).</p> <p><strong>Conclusion:&nbsp;</strong>le burnout apparaît de plus en plus comme une réalité palpable chez le personnel d'anesthésie réanimation. Ces conséquences sont graves aussi bien sur le plan individuel que social.</p> Salah Mhamdi, Mohamed Said Nakhli, Mohamed Kahloul, Nadia Latrech, Mohamed Ben Rejeb, Majdi Khadhraoui, Ajmi Chaouch, Walid Naija Copyright (c) Fri, 12 Oct 2018 00:00:00 +0000 Determinants of bed net use among older people in Nigeria: results from a nationally representative survey <p><strong>Introduction:&nbsp;</strong>the use of bed nets is a well-recognized and cost-effective preventive measure against malaria. However, little is known about factors associated with the use of bed nets among older people in Nigeria. Therefore, this study aimed to examine the determinants of bed net use among older Nigerian adults.</p> <p><strong>Methods:&nbsp;</strong>data from the first wave of the Nigeria General Household Survey-Panel were used, which included 3,439 participants aged 50 years and above. Log-binomial models were used to model the association between participants' sociodemographic characteristics and the use of bed nets.</p> <p><strong>Results:&nbsp;</strong>the frequency of bed net use was 26%. The adjusted prevalence ratio (PR) of bed net use was lower in women (PR = 0.83, 95% CI: 0.73-0.96), older age groups (60-69 years: PR=0.85, 95% CI:0.75-0.97; 70 years and above: PR = 0.80, 95% CI: 0.69-0.94), female-headed households (PR = 0.69, 95% CI: 0.53-0.89) and among those in the highest tertiles of per-capita household expenditure (PR=0.77, 95% CI: 0.66-0.90). However, the frequency of bed net use was higher among older adults residing in the rural areas (PR = 1.84, 95% CI: 1.55-2.18) and those who reported never having attended school (PR=1.15, 95% CI: 1.01-1.30).</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of bed net use among older adults is lower compared to previously reported data for younger adults, suggesting an increased risk of the older adults of exposure to malaria. Female sex, age ≥ 60 years, level of education, economic status, and rural vs urban residence were important determinants of bed net use among older adults.</p> Saliu Balogun, Hakeem Yusuff, Bilkis Adeleye, Mariam Balogun, Abodunrin Aminu, Kehinde Yusuf, Prudence Tettey Copyright (c) Mon, 15 Oct 2018 00:00:00 +0000 Prevalence and impact of sickle cell trait on the clinical and laboratory parameters of HIV infected children in Lagos, Nigeria <p><strong>Introduction:&nbsp;</strong>sickle cell disease and HIV infection are prevalent in sub-Saharan Africa. While Haemoglobin S (HbS) contributes to significant morbidity and mortality in the homozygous or double heterozygous states, in the carrier state it confers a survival advantage in disease conditions such as malaria. However the interaction between sickle haemoglobin and HIV infection, especially in children remains largely unknown. This study aimed to assess the prevalence and impact of sickle cell trait on the clinical and laboratory parameters of HIV infected children in Lagos, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study among HIV infected children in an HIV treatment centre in Lagos, Nigeria. Socio-demographic and clinical characteristics were obtained and blood sample collected for haemoglobin electrophoresis, HIV RNA viral load and haematologic profile. Data was analysed with SPSS version 20.</p> <p><strong>Results:&nbsp;</strong>the prevalence of sickle cell trait was 18.8% among the 208 study participants, with none having sickle cell disease (SCD). Participants with SCT were significantly younger (OR = 4.0 95% CI (1.74-9.24)), more likely to be from the Yoruba ethnic group (OR = 3.3 95% CI [1.45-7.52)), had more opportunistic infections (OR = 2.4 95% CI (1.18-5.03), and lower mean HIV RNA viral load (p = 0.05) at baseline. However response to HIV care and treatment was similar in both groups of participants.</p> <p><strong>Conclusion:&nbsp;</strong>the finding of absence of SCD, low prevalence of SCT, and lower HIV viraemia in HIV infected children with SCT may have implications for childhood survival which requires further clarification in future studies.</p> Agatha Nkiruka David, Munirah Yewande Jinadu, Agatha Eileen Wapmuk, Titilola Abike Gbajabiamila, Jane Ogoamaka Okwuzu, Ebiere Clara Herbertson, Oliver Chukwujekwu Ezechi Copyright (c) Mon, 15 Oct 2018 00:00:00 +0000 Predictors of post neonatal mortality in Western Kenya: a cohort study <p><strong>Introduction:&nbsp;</strong>to determine the predictors of mortality in infants in Siaya, western Kenya, ahead of novel tuberculosis (TB) vaccine trials in the same population.</p> <p><strong>Methods:&nbsp;</strong>in a study to determine tuberculosis incidence, 2900 infants aged 0-45 days, weighing ≥ 1700g were enrolled. Four monthly follow up visits were conducted for at least 12 months. HIV testing was done at six weeks of age. Free ancillary care was provided. Deaths were reported by parents, study staff and community workers. Cox proportional Hazard analysis was used to identify risk factors. The period of analysis commenced at six weeks old and was censored at 12 months of age.</p> <p><strong>Results:&nbsp;</strong>included in the analysis were 2528 infants with 2020 person years of follow up (pyo). There were 117 deaths (4.6 %). The post-neonatal mortality rate was 58 (95% CI: 48, 69) per 1000 pyo. In multivariate analysis, health facility births were protective against mortality (Hazard Ratio (HR) 0.54; 95% CI: 0.34, 0.84) and infant HIV infection at baseline was associated with increased mortality (HR 10.3; 95% CI: 6.40, 16.7). HIV uninfected infants born to HIV infected mothers had increased hazards of mortality (HR 1.73; 95% CI: 1.03, 2.90). Gender, weight at six weeks, maternal education and occupation were not significant predictors of mortality.</p> <p><strong>Conclusion:&nbsp;</strong>infant mortality was high and was associated with being born outside a health facility, maternal HIV infection and HIV infection of the infant. Measures to decrease mother to child transmission and other HIV control measures need to be strengthened further to see incremental reductions in infant mortality.</p> Grace Kaguthi, Videlis Nduba, Martien Wilhelm Borgdorff, Suzanne Verver Copyright (c) Mon, 15 Oct 2018 00:00:00 +0000 An unusual case of aggregatibacter aphrophilus liver abscess <p>Liver abscess of oropharyngeal origin in an immunocompetent patient is a rare condition. Furthermore, microbiologic diagnosis of liver abscess can be challenging due to the tremendous diversity of the microorganisms implicated and culture difficulties under laboratory conditions. We report a case of a previously healthy 23-year-old male, who presented multiple liver abscesses, attributed to aggregatibacter aphrophilus, an obligatory oral gram-negative microorganism, that normally is a component of the commensal oral microbiota and non-virulent. The etiopathogenic microorganism was identified after needle aspiration of a liver abscess cavity. Treatment with broad-spectrum antimicrobials and percutaneous catheter drainage under computed tomography guidance of both abscesses, resulted in full recovery.&nbsp;<em>A. aphrophilus</em>&nbsp;represents a rare entity of liver abscess in healthy individuals and suggests that a pathogen of oropharyngeal origin should be suspected when an overt source of infection cannot be documented.</p> Ilias Papakonstantinou, Zoi Psaroudaki, Efstathia Perivolioti Copyright (c) Wed, 17 Oct 2018 00:00:00 +0000 Pattern of ultrasonographic findings of disorders of the ankle joint complex in patients presenting with ankle pain at the department of diagnostic imaging, university of Nairobi <p><strong>Introduction:&nbsp;</strong>the ankle joint is a frequently injured joint. It is also affected by inflammatory, infectious and tumoral lesions. Ultrasound is a safe and cost-effective imaging tool when evaluating the ankle joint, as most structures are superficial and accessible. The aim of the study was to determine the pattern of ultrasonographic findings of disorders of the ankle joint complex in patients presenting with ankle pain.</p> <p><strong>Methods:&nbsp;</strong>a total of 43 consecutive patients with ankle pain referred for an ankle radiograph or ankle ultrasound were examined. Statistical analysis was done using SPSS version 20.</p> <p><strong>Results:&nbsp;</strong>abnormalities were found in 60% of the examinations performed. The abnormalities were more common in female patients accounting for 61.4% of the abnormalities detected. The most common finding was synovial hypertrophy seen in 26% of the patients.</p> <p><strong>Conclusion:&nbsp;</strong>ankle ultrasound was able to identify a large number of pathologies. This demonstrates the usefulness of ultrasound in the evaluation of a patient with ankle pain.</p> Muhammad Omar Bashaeb, Timothy Musila Mutala, Ian Mathenge Muriithi Copyright (c) Wed, 17 Oct 2018 00:00:00 +0000 Lupus néonatal chez un enfant dont la mère est suivie pour une dermatomyosite <p>Le lupus néonatal est une entité rare qui serait due à la transmission d'auto anticorps maternel à l'enfant pendant la grossesse. Nous rapportons un cas. Il s'agissait d'un enfant de sexe féminin âgé de 2 mois reçu en consultation avec des lésions érythémateuses maculaires du visage et du tronc. La mère de l'enfant était suivie pour une dermatomyosite diagnostiquée sur la base des lésions cliniques, de la faiblesse musculaire et d'une élévation des enzymes musculaires. Toutefois, on ne disposait pas d'un bilan d'auto-immunité chez cette dernière. A l'examen, on notait des lésions érythémateuses atrophiques en aile de papillon de part et d'autre de la pyramide nasale. Des lésions satellites au front, avec des cheveux roux. Le reste de l'examen était sans particularité. Le bilan biologique demandé ne fut pas honoré par les parents qui ont aussi refusé la pratique d'une biopsie. Ces lésions auraient pu faire évoquer une dermite séborrhéique, une rosacé, ou une dermatite atopique. Cependant la rosacé est très rare chez l'enfant, c'est une pathologie de la peau blanche. Dans la dermite séborrhéique, les lésions ne sont pas atrophiques. La dermatite atopique débute habituellement à l'âge de 3 mois. Les lésions ont régressé en 15 jours sous dermocorticoïde.</p> Lamissa Cisse, Yamoussa Karabinta Copyright (c) Wed, 17 Oct 2018 00:00:00 +0000 Troubles socio-émotionnels de l’enfant en milieu Konzo, un syndrome paralytique de nature épidémique associé à une intoxication cyanhydrique d’origine alimentaire en Afrique sub-saharienne <p><strong>Introduction:&nbsp;</strong>l’objectif de cette étude était d’élucider le profil socio-émotionnel de l’enfant en milieu Konzo, une paralysie toxico-nutritionnelle sévissant en Afrique sub-saharienne.</p> <p><strong>Méthodes:&nbsp;</strong>nous avons évalué le profil socio-émotionnel de 210 enfants dont 123 avec konzo et 87 présumés contrôles sains (4-17 ans d’âge) après interview structuré avec les parents lors d’une enquête épidémio-clinique du konzo en 2011 au Congo-Kinshasa. Le profil neurocognitif était documenté par le KABC-II, le BOT-2 et l’indice global des signes neurologiques du Konzo (IGSNK). Les tests associatifs ont été réalisés par le test de Chi-carré, la régression logistique, dans le cas échéant par modèle linéaire généralisé, au seuil de signification de 0,05.</p> <p><strong>Résultats:&nbsp;</strong>dans l’ensemble, l’irritabilité, la violence physique ou l’inhibition avec ou sans tristesse étaient respectivement retrouvés dans 46,0%, 30,2%, 18,7%; avec un risque accru pour le Konzo (OR = 2,6; IC95%: 1,4 - 4,8; p = 0,001). Le trouble socio-émotionnel était associé à l’insuffisance pondérale (OR: 0,49; IC95%: 0,31 - 0,78; p = 0,002) et à un IGSNK élevé (OR: 1,33; IC 95%: 1,1-1,63; p=0,019); et par ailleurs aggravait les déficits cognitifs dans le Konzo (interaction statut neurologique χ troubles socio-émotionnels, D = 6,297; p = 0,013). Des performances cognitives élevées étaient observées chez les enfants non-Konzo mais avec troubles socio-émotionnels. La concentration moyenne (écart-type ± ET) de thiocyanate urinaire était plus élevé (554,8 ± 371,6 µmol/l) chez les enfants Konzo avec troubles socio-émotionnels.</p> <p><strong>Conclusion:&nbsp;</strong>l’enfant vivant en milieu Konzo présente des troubles socio-émotionnels. Leur nature psychopathologique et l’impact sur la cognition nécessitent des études approfondies.</p> Daniel Okitundu Luwa E-Andjafono, Marie-Therese Sombo Safi Ayanne, Guy Bumoko Makila-Mabe, Jean-Pierre Banea Mayambu, Dieudonné Mumba Ngoyi, Michael Boivin, Jean-Jacques Tamfum-Muyembe, Désiré Tshala-Katumbay Copyright (c) Wed, 17 Oct 2018 00:00:00 +0000 The prevalence of hepatitis B and C among blood donors at the National Blood Transfusion Center (CNTS) in Burundi <p><strong>Introduction:&nbsp;</strong>in Burundi, blood safety is one of the concerns of the Ministry of Public Health and Fight against AIDS. To this end, all donor blood bags must be screened for hepatitis B and C, that is the reason why the National Blood Transfusion Center (CNTS) has an Enzyme-Linked Immunosorbent Assay (ELISA); better chain to perform these tests properly. This study aimed to highlight the prevalence of hepatitis B and C among blood donors at the National Blood Transfusion Center of Burundi for a period from the January the 1<sup>st</sup>&nbsp;to the 30<sup>th</sup>&nbsp;of June 2016.</p> <p><strong>Methods:&nbsp;</strong>this retrospective study was conducted among blood donors (both sexes) aged between 18 years and 50 years. The objective was to collect from the registration registers and the monthly activity reports, the results of the ELISA test obtained after the diagnosis of hepatitis B and C of the blood donors from 1<sup>st</sup>&nbsp;January to 30<sup>th</sup>&nbsp;June 2016.</p> <p><strong>Results:&nbsp;</strong>in our series of 8,993 samples tested, the prevalence of HBV was 1.04% and HCV was 1.12%. No association VHB- HCV was recorded.</p> <p><strong>Conclusion:&nbsp;</strong>this study showed a low prevalence rate which shows a clear improvement in preventative measures for donor selection and screening tests.</p> René Kwizera, Amani Moibéni, Farha Shenawy, Mohamed Youssif Copyright (c) Wed, 17 Oct 2018 00:00:00 +0000 A paraduodenal hernia revealed by bowel obstruction: case report and literature review <p>Internal hernias are defined as the protrusion of abdominal viscera through an aperture in the intraperitoneal recesses, they are considered as a rare cause of intestinal obstruction. The paraduodenal hernias are the most common type of congenital hernia especially the left-sided ones. We report a case of a 46 year-old man presenting a left paraduodenal hernia with acute small bowel obstruction, which was firstly (preoperatively) assigned to a tumoral cause.</p> Mustapha Ben Moussa, Ismail Nouhi, Taib Lachguar, Mohamed El Absi, El Hassan El Faricha El Alami, Mohamed El Ouanani, El Mahjoub Echarrab, Mohamed El Amraoui, Mohamed Rachid Chkof Copyright (c) Wed, 17 Oct 2018 00:00:00 +0000 Hépatite virale B et insuffisance rénale: prévalence et facteurs associés au Centre National Hospitalier et Universitaire de Cotonou <p><strong>Introduction:&nbsp;</strong>les relations entre les reins et l'hépatite B sont complexes. L'objectif de cette étude était de déterminer la prévalence et les facteurs associés à l'atteinte rénale chez des personnes vivant avec le virus de l'hépatite B (PVVHB) à Cotonou.</p> <p><strong>Méthodes:&nbsp;</strong>il s'agissait d'une étude transversale à visée descriptive et analytique, menée dans le service d'hépato-gastroentérologie du CNHU-HKM de mai à août 2017. Elle avait inclus les patients porteurs d'Ag HBs reçus dans la période. Une insuffisance rénale était retenue si le débit de filtration glomérulaire estimé par la formule du MDRD était en dessous de 90 mL/min/1,73m<sup>2</sup>.</p> <p><strong>Résultats:&nbsp;</strong>105 patients porteurs d'Ag HBs étaient inclus. Parmi eux, 65 (61,9%) étaient sous traitement anti-VHB (dont 62 sous ténofovir). Des 105 patients, 41 avaient une insuffisance rénale (39%). Cette insuffisance rénale était associée à 2 cas d'atteinte tubulaire et 4 cas d'atteinte glomérulaire. La fonction rénale s'était dégradée dans le temps chez 22 patients (21%) et s'était améliorée chez 6 patients (5,7%). En analyse univariée, les facteurs associés à la survenue d'une insuffisance rénale étaient l'âge supérieur à 50 ans (p = 0,0125), la présence d'une hypertension artérielle (p = 0,0037), une fonction rénale initialement altérée (p &lt; 0,0003) et les co-médications (p = 0,0007). Le traitement anti-VHB n'était pas associé à la survenue d'une insuffisance rénale (p = 0,2887).</p> <p><strong>Conclusion:&nbsp;</strong>la prévalence de l'insuffisance rénale chez les PVVHB était élevée (39%). L'âge, l'hypertension artérielle, une insuffisance rénale préexistante et les co-médications étaient identifiés comme des facteurs associés au déclin de la fonction rénale chez les PVVHB.</p> Jean Séhonou, Aboudou Raïmi Kpossou, Taofick Oyétoundé Amanda, Comlan N’dehougbea Martin Sokpon, Rodolph Koffi Vignon, Jacques Vigan Copyright (c) Wed, 17 Oct 2018 00:00:00 +0000 Diabète de type 1 post-traumatique chez un soldat de l’armée <p>L'influence du stress comme facteur précipitant l'apparition du diabète de type 1 est un sujet largement étudié dans la littérature. La relation entre les traumatismes physiques et psychologiques et le diabète ont été un sujet rarement étudié en milieu militaire. Le diabète post-traumatique reste toujours un sujet controversé. Nous rapportons le cas d'un soldat tunisien, sans antécédents personnels ou familiaux d’auto-immunité, qui a été diagnostiqué pour un diabète de type 1 au décours d’une agression physique lors de conflits sociaux entre les forces de l’ordre et les citoyens.</p> Ach Taieb, Yosra Hasni, Asma Ben Abdelkarim, Amel Maaroufi, Maha Kacem, Molka Chaieb, Koussay Ach Copyright (c) Thu, 18 Oct 2018 00:00:00 +0000 Profil clinique et facteurs associés au syndrome de l’intestin irritable chez les étudiants en médecine à Cotonou, Bénin <p><strong>Introduction:&nbsp;</strong>le syndrome de l'intestin irritable (SII) est un trouble fréquent qui motive souvent une consultation en médecine générale et en gastroentérologie. L'objectif de l'étude était de déterminer la prévalence du SII, décrire ses caractéristiques cliniques, déterminer ses facteurs associés et la répercussion sur la scolarité chez les étudiants en médecine de Cotonou.</p> <p><strong>Méthodes:&nbsp;</strong>cette étude transversale descriptive et analytique était menée au cours de la période du 1<sup>er</sup>&nbsp;août au 29 septembre 2017, chez les étudiants en médecine. Les critères diagnostiques étaient ceux de Rome IV, l'échelle de Bristol, échelle de Cungi et HADS score. L'analyse des données était effectuée grâce au logiciel SPSS 20.0.</p> <p><strong>Résultats:&nbsp;</strong>sur un total de 315 étudiants inclus, 44 (14%) avaient un SII. Les facteurs associés du SII étaient le sexe féminin (OR [IC95%] = 2,4 [1,2-4,7]; p = 0,00), la prise régulière d'aliment gras (OR [IC95%] = 2,0 [1,1-3,9]; p = 0,03), un état de stress élevé à sévère (OR [IC95%] = 2,2 [1,1-4,7]; p = 0,02) et un état d'anxiété modéré à sévère (OR [IC95%] = 1,9 [0,9-3,6]; p = 0,04). L'absentéisme pour SII était rare (1 cas; 2,3%).</p> <p><strong>Conclusion:&nbsp;</strong>le SII est fréquent chez les étudiants en médecine de Cotonou. Les facteurs associés modifiables identifiés étaient le stress, l'anxiété et la consommation régulière des aliments gras. Aucune répercussion notable sur la scolarité n'était notée.</p> Jean Sehonou, Leoubou Roger Samuel Dodo Copyright (c) Fri, 19 Oct 2018 00:00:00 +0000 Uptake of health insurance by the rural poor in Ghana: determinants and implications for policy <p><strong>Introduction:&nbsp;</strong>financing access to healthcare services in developing countries remains a major challenge despite recent advances towards implementation of various health insurance policies in many low and middle-income countries. The use of health insurance is considered an important means to achieve universal health coverage. However, uptake of health insurance in most developing countries remains low as a result of several challenges. Empirical evidence of factors restraining enrolment is rare in many developing countries including Ghana. This paper therefore sought to investigate the factors associated with the uptake of health insurance products and the implications thereof for policy, using Awutu Senya West District of Ghana as case study.</p> <p><strong>Methods:&nbsp;</strong>a logit model was used to analyze data from 178 respondents randomly selected from two microfinance groups operating in the study area.</p> <p><strong>Results:&nbsp;</strong>the results indicate that insurance uptake is higher among younger people, but lower among women. Older women are however more likely to take up health insurance compared to older men. In addition, the study reveals that insurance uptake increases with level of education but decreases with household size.</p> <p><strong>Conclusion:&nbsp;</strong>the study concludes that even though the premium on health insurance coverage in Ghana is arguably low, socio-demographic characteristics such as age, sex, literacy level and household size affect the decision to enrol. Adequate public sensitization on the benefits of the scheme and decreasing the statutory age for exemption from premium payment are some of the measures suggested to enhance health insurance uptake in Ghana and other developing countries.</p> Aaron Alesane, Benjamin Tetteh Anang Copyright (c) Fri, 19 Oct 2018 00:00:00 +0000 A diffuse large B cell lymphoma emerging with breast cancer relapse <p>The prevalence of secondary cancers associated with the breast cancer treatment has increased, which is due to the administration of cytotoxic/hormonal drugs as well as radiotherapy. A 54-year-old female patient with a history of breast cancer for 4 years and receiving tamoxifen the hematology clinic with fatigue and nosebleed. Laboratory parameters were revealed pancytopenia. The bone marrow biopsy finding was compatible with CD20 positive high-grade B cell lymphoma resembling diffuse large B cell lymphoma. The patient started to receive a chemotherapy. Her hemogram values displayed an improvement after the second cycle. However, interim PET-BT, performed after the fourth cycle, showed an incomplete response in cervical lymphatic nodes. Then, a tru-cut biopsy was performed resulting in breast cancer metastasis. This is an unusual case of secondary-DLBCL presenting with pancytopenia and occuring 4 years after the diagnosis of breast cancer. In conclusion, clinicians should carefully set the dosage of chemotherapy drugs to avoid the long-term side effects associated with such drugs.</p> Abdulkadir Karismaz, Mehmet Hilmi Dogu, Gülben Huq, Sermin Altindal, Osman Yokus, Elif Suyani Copyright (c) Fri, 19 Oct 2018 00:00:00 +0000 Evaluation of the tuberculosis surveillance system in the Ashaiman municipality, in Ghana <p><strong>Introduction:&nbsp;</strong>tuberculosis (TB) was the leading cause of death from an infectious illness globally with an estimated 10.4 million new cases and 1.4 million deaths in 2015. In Ghana, from the 2013 TB prevalence survey conducted by the National Tuberculosis Control Programme, the incidence is estimated as 165 per 100,000 population and a mortality rate of 7.5 per 1,000 infected people. The Tuberculosis surveillance system is part of the general framework of the Integrated Disease Surveillance and Response. This evaluation was to assess whether the system is meeting its set objectives, assess its usefulness and describe its attributes.</p> <p><strong>Methods:&nbsp;</strong>the TB surveillance system of the Ashaiman municipality was evaluated using Centre for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems 2006. Records review from 2014 to 2016 was done to assess objectives of the system and surveillance data source of 2016 was used to assess attributes. Interviews were conducted at the various levels using semi-structured questionnaire and data analysis done with Epi info 7 and Microsoft Excel to run frequencies and percentages.</p> <p><strong>Results:&nbsp;</strong>the surveillance system is well structured with standardized data collection tools. The system was found to be useful, though it just partially met its objectives. It was also found to be simple, flexible and fairly stable with average timeliness. It had low acceptability and is not geographically representative. It had low sensitivity of 45/100,000 and a low predictive value positive of 6.6%.</p> <p><strong>Conclusion:&nbsp;</strong>the surveillance system was found to be useful but partially met its objectives. There is the need to improve the sensitivity, predictive value positive timeliness and acceptability.</p> Rita Patricia Frimpong-Mansoh, Benedict Nii Laryea Calys-Tagoe, Esi Forewaa Therson-Coffie, Kwadwo Odei Antwi-Agyei Copyright (c) Fri, 19 Oct 2018 00:00:00 +0000 A rare tumour in the cerebellopontine angle: endolymphatic sac tumour <p>We present a case of a papillary tumour at the cerebellopontine angle in a 54-year-old man. He presented with right-sided ear pain associated with dizziness and hearing loss. The radiological diagnosis was in favor of acoustic neurinoma. Surgical excision was performed and the diagnosis of the endolymphatic sac tumour was made. Endolymphatic tumour is a low grade adenocarcinoma that originates from the endolymphatic sac. The definitive diagnosis requires a combination of clinical features, radiological finding and pathological correlation.</p> Abderrahim Elktaibi, Amal Damiri, Issam Rharrassi, Mohamed Reda Elochi, Mohamed Oukabli, Ali Akhaddar, Mohamed Boucetta, Abderrahmanne Al Bouzidi Copyright (c) Fri, 19 Oct 2018 00:00:00 +0000 HIV related hypochlorhydria does not appear to respond to anti-retroviral therapy in Zambian adults: a case control study <p><strong>Introduction:&nbsp;</strong>Human Immunodeficiency Virus (HIV) infection is associated with hypochlorhydria but the mechanism is unknown. The objective of this study was to determine effects of anti-retroviral therapy (ART) on gastric physiology as measured by validated markers.</p> <p><strong>Methods:&nbsp;</strong>we studied HIV infected individuals who were either ART-naïve or on treatment with undetectable viral loads. We measured H.pylori IgG antibodies, pepsinogen (PG) 1 and 2 levels and fasting gastrin-17 using Biohit GastroPanel®. Gastric antral biopsies and juice were obtained for histology and pH respectively. Also included were historical data from HIV negative participants (n = 72) in a previous study, for reference.</p> <p><strong>Results:&nbsp;</strong>we enrolled 84 HIV positive individuals with a median age 42 years (IQR 37-40 years). 55(66%) were female, 32(38%) were ART naïve, and 52(62%) were on ART. Hypochlorhydria (pH&gt;4) was present in 48(57%) of the HIV positive and 18(25%) of the HIV negative individuals (OR 4: 95% CI 1.9-8.5, P&lt;0.001) with no significant effect of ART (OR 0.9: 95% CI 0.3-2.3, P = 0.82). Hypochlorhydria was not associated with the serological detection of corpus atrophy using low PG 1:2 ratio (OR 2.1: 95% CI 0.5-10.2, P = 0.37) or GastroPanel® algorithm, (OR 0.7: 95% CI 0.01-60.1, P = 1.0). ART reduced the frequency of low PG 1:2 ratio (P = 0.001), but not the histological detection in the antrum of atrophy or non-atrophic gastritis.</p> <p><strong>Conclusion:&nbsp;</strong>ART use is associated with reduced serological evidence of corpus atrophy but has no effect on fasting pH, supporting earlier data that suggest that the mechanism of HIV-associated hypochlorhydria is multifactorial.</p> Violet Kayamba, Aaron Shibemba, Kanekwa Zyambo, Douglas Corbett Heimburger, Douglas Morgan, Paul Kelly Copyright (c) Mon, 22 Oct 2018 00:00:00 +0000 A novel and easy technique for restoring grossly decayed mandibular molar with a modified cast-post <p>The article addresses the difficulty of restoring a grossly carious molar tooth, where very little tooth structure is left after caries excavation. When enough sound tooth structure is missing for satisfying the ferrule effect, a clinician can follow this technique and easily restore such teeth. A step by step procedure, including instrumentation and materials and a new impression technique, is described in detail, with clinical photographs. This technique results in the fabrication of a robust and extremely retentive post and core on which to place fixed prosthodontic restorations. A 2 and half year study showed that the tooth well in function with no signs of any problem. The author has restored around many decayed molars using this technique. Over a period of three years, no failure was reported. With an increasing demand on the dentist for restoring a structurally compromised teeth, this technique provides the patients with a robust prosthodontic solution.</p> Tej Jitesh Joshi, Gaurang Mistry, Devanand Shetty, Omkar Shetty, Sahil Singh, Shraddha Rumde Copyright (c) Mon, 22 Oct 2018 00:00:00 +0000 Trend of vaccine preventable diseases in Iraq in time of conflict <p><strong>Introduction:&nbsp;</strong>Iraq has passed through a series of successive conflicts, economic sanction and violence. The overall health sector in Iraq has been plunged and the services are facing a continuous shortage in vaccines, medicines and other supplies, and access of people to the basic health services being more impaired. The objective of this study was to portray the trend of vaccine preventable diseases in Iraq during the past 17 years to provide baseline information for disease burden estimation.</p> <p><strong>Methods:&nbsp;</strong>this study was built on collection and treatment of morbidity data related to vaccine preventable diseases (tuberculosis, poliomyelitis, measles, mumps, rubella, diphtheria, tetanus, pertussis, and hepatitis B) that were registered by the Department of Health Statistics during the years (2000-2016). The incidence rates were plotted on a timeline to define the trend of each disease. Data were also categorized by gender and age groups (less than five years, 5 to 15 years and 15 years and more).</p> <p><strong>Results:&nbsp;</strong>diphtheria, rubella, and tuberculosis showed a slowly down going trend of incidence while mumps demonstrated a peak at 2016. Hepatitis B showed an up going trend of incidence while measles showed a secular trend every 4-5 years.</p> <p><strong>Conclusion:&nbsp;</strong>vaccine preventable diseases are still causing outbreaks; precipitated by fluctuation of vaccine coverage. Tuberculosis has been reemerged after a relatively long period of control.</p> Riyadh Lafta, Ashraf Hussain Copyright (c) Mon, 22 Oct 2018 00:00:00 +0000 Insuffisance cardiaque sur cœur normal révélant une malformation artériole-veineuse complexe du membre inferieur chez un enfant: à propos d'une observation et revue de la littérature <p>Les malformations artérioveineuses (MAV) sont des anomalies vasculaires congénitales à haut débit très rares chez l'enfant. Leurs localisations atypiques et leurs manifestations cliniques variables rendent leur diagnostic et leur prise en charge souvent tardifs. Nous rapportons le cas d'un enfant pris en charge au Centre Hospitalier National d'Enfants Albert Royer de Dakar. Un garçon âgé de 9 ans nous a été adressé d'une structure sanitaire en milieu rural pour la prise en charge d'une insuffisance cardiaque. L'examen clinique à l'admission montrait une altération de l'état général, un syndrome d'insuffisance cardiaque globale et une volumineuse masse inguino-crurale droite, chaude, étendue à la paroi abdominale latérale droite (fosse iliaque et flanc droit), à limites mal définies. L'auscultation de cette masse objectivait un thrill et un souffle diffus. L'échographie cardiaque montrait une HTAP sévère avec retentissement important sur les cavités cardiaques, sans atteinte structurelle du cœur. Le diagnostic de MAV a étè confirmé par une échographie doppler de la masse complétée par un angioscanner. Ils mettaient en évidence des fistules artérioveineuses multiples au sein de la masse. Le diagnostic d'une MAV complexe de la racine de la cuisse droite au stade IV de Schöbinger a étè retenu. La prise en charge médicale a consisté au traitement de l'insuffisance cardiaque à base de furosémide, de spironolactone, et de captopril, en vue d'une stabilisation hémodynamique pour une éventuelle cure chirurgicale. Les malformations artérioveineuses des membres, en particulier de l'extrémité proximal du membre inférieur sont encore méconnues chez l'enfant, d'où les erreurs et retards diagnostiques fréquents. Leur évolution est imprévisible d'où la nécessité d'un diagnostic précoce et d'un suivi attentif impliquant une collaboration pluridisciplinaire entre pédiatres, chirurgiens et radiologues.</p> Ndèye Fatou Sow, Mohamed Lèye, Idrissa Basse, Yaay Joor Dieng, Mame Aïta Seck, Djénéba Fafa Cissé, Amadou Sow, Mohamed Fattah, Awa Kane, Morgiane Houngbadji, Papa Moctar Faye, Amadou Lamine Fall, Ndèye Ramatoulaye Diagne Guèye, Ousmane Ndiaye Copyright (c) Mon, 22 Oct 2018 00:00:00 +0000 Giant vesical lithiasis, complication of enterocystoplasty: case report <p>Frequent and recurrent pathology, bladder stone is a constant complication in enterocystoplasty enlargement. The occurrence of this lithiasis is due to some factors such as urinary tract infections, mucus secretion by the intestine segment moved, poor urinary emptying and foreign bodies (sutures, staples) intra-vesical. Clinical signs are not specific. However the formation of giant lithiases remains exceptional. Some cases have been documented in the literature. The occurrence of this affection must be prevented by dietary measures and regular follow up. New therapies for the control of mucus in the bladder tank have been emerged. Open surgical remains the most common. Today, one port trocar endoscopy enables to handle and extracted lithiases of every size.</p> Robert Nang, Hadiya Hinchi, Taoulouth Lafia, Mohamed Rami, Rachid Belkacem Copyright (c) Mon, 22 Oct 2018 00:00:00 +0000 Profile and use of licit psychotropic substances in the former Rabat-Sale-Zemmour-Zaër Region (Morocco): the case of tiflet city <p><strong>Introduction:&nbsp;</strong>psychopharmacology today faces serious challenges, especially related inappropriate drug choices, abuse and resulting side effects. The aim of this pharmacy based study in the City of Tiflet was to profile the prescription and usage patterns of psychotropic drugs.</p> <p><strong>Methods:&nbsp;</strong>this study was conducted in the pharmacies of the City of Tiflet (Morocco). Descriptive statistics of 5125 prescriptions collected from 21 pharmacies were analysed, and summarized as means, percentages and proportions where appropriate.</p> <p><strong>Results:&nbsp;</strong>the patterns of psychotropic drugs use were similar, compared to Western Countries, especially for anxiolytics/hypnotics, neuroleptics and anti-depressants. A poor monitoring of the treatment, and the lack of control of its side effects were major concerns. General practitioners ranked first among doctors who prescribed psychotropic drugs (48.5%), followed by psychiatrists (41.7%), and the rest of the prescriptions come from other specialists (neurologists, cardiologists, gynaecologists...). Among psychotropic drugs, anxiolytics dominated prescriptions (52.0%), followed by neuroleptics (29.0%) and anti-depressants (19.0%). Men consumed more psychotropic drugs than women (51.8% against 48.2% respectively).</p> <p><strong>Conclusion:&nbsp;</strong>anxiolytics/hypnotics constitute the main class of psychotropic drugs prescribed in the Tiflet City, followed by neuroleptics and anti-depressants. Nearly half of the population currently receive prescribed psychotropic drugs from general practitioners. Psychiatrists are less involved in the prescription and monitoring of these patients. This could predispose the population to addiction, drug misuse, intoxication, and at times, misdiagnosis of serious psychiatric illnesses. Our study highlights the urgency of reinforcing psychotropic prescription regulation and monitoring in Tiflet city.</p> Khadija Karjouh, Fatima-Zahra Azzaoui, Ahmed Ahami, Samira Boulbaroud Copyright (c) Tue, 23 Oct 2018 00:00:00 +0000 Etude sur le diabète aigu cétosique inaugural dans un hôpital du Centre-Est Tunisien <p>La cétose est une complication aiguë du diabète qui consiste en une accumulation de corps cétoniques sanguins. Malgré la haute prévalence du diabète cétosique décrite, il existe très peu d’informations concernant l’épidémiologie de cette complication inaugurale du diabète en Tunisie. L’objectif était de déterminer les caractéristiques épidémiologiques et clinico-biologiques des cétoses inaugurales dans un hôpital du Centre-Est tunisien. Il s’agit d’une étude rétrospective, transversale et exhaustive, à propos de patients admis pour une cétose inaugurale sur une période allant de janvier 2010 à août 2016. La population d’étude a été divisée en 2 groupes selon la présence ou pas d’une auto-immunité anti pancréatique: groupe DAI (diabète de type 1 auto-immun) regroupe tous les patients avec une auto-immunité, et le groupe DNAI (diabète cétosique non auto-immuns) sans auto-immunité. Il s’agit de 391 patients, de sex ratio 266 hommes/125 femmes, d’âge moyen de 34±14,33 ans. La prédominance masculine était nette: 68% dans la population générale. L’âge de la cétose était significativement plus précoce dans le groupe DAI. Un facteur précipitant la cétose était retrouvé chez 77,7% de la population globale d’étude, significativement plus fréquent dans le groupe DAI que dans le groupe DNAI. Le facteur le plus retrouvé était les infections virales. Les Anticorps anti thyroïdiens étaient significativement importants dans le groupe DAI. La cétose est un facteur de décompensation inaugurale fréquent du diabète en Tunisie. La population la plus importante a été décrite chez l’adulte jeune masculin, avec l’absence d’une auto-immunité, et un profil clinique du diabète de type 2.</p> Ach Taieb, Asma Ben Cheikh, Yosra Hasni, Amel Maaroufi, Maha Kacem, Molka Chaieb, Koussay Ach Copyright (c) Tue, 23 Oct 2018 00:00:00 +0000 Dépôts cornéens de ciprofloxacine en post chirurgie de cataracte <p>Nous rapportons le cas d’un patient âgé de 62 ans, opéré de cataracte de l’œil gauche par phacoémulsification avec suites simples; il a reçu en post opératoire un traitement comprenant la ciprofloxacine en collyres. Le patient a été perdu de vue pendant 2 mois sans arrêter le traitement; il se présente avec une opacité para-centrale, blanche, d’allure cristalline, correspondant à un dépôt cornéen de ciprofloxacine. Le collyre antibiotique a été immédiatement suspendu et le patient a bénéficié d’un débridement chirurgical très superficiel, et a été mis sous agents mouillants à fortes doses, avec cicatrisation complète de l’ulcération en regard du dépôt cornéen, mais il a gardé une opacité épithéliale para-pupillaire inférieure ne gênant toutefois pas la vision.</p> Ghita Bouayad, Abdelbarre Oubaaz Copyright (c) Tue, 23 Oct 2018 00:00:00 +0000 Hypothermia in trauma patients arriving at an emergency department by ambulance in Johannesburg, South Africa: a prospective study <p><strong>Introduction:&nbsp;</strong>normal body temperature is considered to be between 36 and 38°C. Temperatures that are too low may negatively affect physiological functions. In trauma cases, factors that promote the development of hypothermia include concomitant hypoxia, hypotension, decreased levels of consciousness, contact with cold surfaces, exposure to low ambient temperatures and the administration of cold fluids. Studies on emergency department related hypothermia in Africa are sparse. This study investigated instances of hypothermia in a sample of trauma cases arriving by ambulance to an emergency department in Johannesburg, South Africa.</p> <p><strong>Methods:&nbsp;</strong>core body temperatures of 140 trauma cases were measured upon arrival and 30 minutes later. Ambient temperatures outside the hospital, inside the ED and in the resuscitation areas were also recorded. Additional information was gathered describing the equipment available to the ambulance crews for temperature, control and rewarming.</p> <p><strong>Results:&nbsp;</strong>seventy-two (51%) of the cases were found to have core body temperatures less than 36°C upon arrival. Twenty-nine (21%) the cases were considered clinically hypothermic (core temperatures of less than &lt;35°C). After 30 minutes, 79 (56%) of the participants had core body temperatures of less than 36°C and 39 (28%) remained lower than 35°C. Patients were not warming up in the ED as expected. Rather, some had become colder. The study also found that the ambient temperature in the triage area fluctuated and was recorded as less than the recommended 21°C in 95 (68%) of the cases. In addition, the majority of ambulances that transported these cases lacked appropriate equipment on board to properly facilitate temperature control and rewarming.</p> <p><strong>Conclusion:&nbsp;</strong>fifty-one percent of the trauma cases arriving by ambulance had core temperature &lt;36°C. Many became even colder in the ED. Attention needs to be given to the early identification of hypothermia, the regulation of ambient temperatures inside the ED including the provision of appropriate heating and rewarming devices on ambulances.</p> Craig Vincent-Lambert, Cecile May Smith, Lara Nicole Goldstein Copyright (c) Tue, 23 Oct 2018 00:00:00 +0000 The prevalence and social determinants of fruit and vegetable consumption among adults in Kenya: a cross-sectional national population-based survey, 2015 <p><strong>Introduction:&nbsp;</strong>low fruit and vegetable consumption contributes significantly to the burden of disease. The study aimed to assess the prevalence and correlates of fruit and vegetable (FAV) consumption among adults in a national survey in Kenya.</p> <p><strong>Methods:&nbsp;</strong>a national cross-sectional study based on a stratified cluster random sampling was conducted in 2015. The total sample included 4479 individuals 18-69 years, (females = 60.0%; median age 38.0 years, Inter Quartile Range 23) from Kenya. Sociodemographics, health risk behaviour and anthropometric data were collected using the WHO-STEPS questionnaire.</p> <p><strong>Results:&nbsp;</strong>on average, participants had 0.78 servings of fruits a day, 1.31 servings of vegetables a day, and 2.09 servings of FAV. Only 12.4% of respondents had two or more servings of fruit a day, 7.4% had three or more servings of vegetables a day and 94.0% had less than five servings of FAV a day. In adjusted logistic regression analysis, higher education (Odds Ratio=OR: 1.68, Confidence Interval = CI: 1.18, 2.39), greater wealth (OR: 1.61, CI: 1.04, 2.48), and being a Kikuyu (OR: 2.17, CI: 1.46, 3.23) or Luo (OR: 1.58, CI: 1.05, 2.37) were associated with two or more servings of fruits daily. Urban residence (OR: 0.44, CI: 0.23, 0.82) and being male (OR: 0.72, CI: 0.53, 0.98) decreased the odds, and older age (OR: 1.68, CI: 1.05, 2.69) and being Luo (OR: 2.84, CI: 1.53, 5.27) increased the odds of having three or more servings of vegetables daily. Being male (OR: 0.71, CI: 0.52, 0.99) and being Luo (OR: 0.40, CI: 0.23, 0.70) decreased the odds and urban residence (OR: 2.50, CI: 1.27, 4.96) increased the odds of inadequate (&lt; five servings) FAV consumption.</p> <p><strong>Conclusion:&nbsp;</strong>a high prevalence of inadequate FAV consumption was found, and risk factors identified, such as being female, lower education, urban residence, and not being Luo, that may help in guiding strategies to increase FAV consumption.</p> Supa Pengpid, Karl Peltzer Copyright (c) Wed, 24 Oct 2018 00:00:00 +0000 Factors associated with adolescent school girl’s pregnancy in Kumbo East Health District North West region Cameroon <p><strong>Introduction:&nbsp;</strong>teenage pregnancy is a social problem in Cameroon in general and in Kumbo East in particular. This results in physical, psychological and socio-economic consequences on the teenage mother, family and the society as a whole. In spite of studies and interventions that have been and are being implemented, the prevalence of unplanned teenage pregnancy in Kumbo East Health District is still high, suggesting that more efforts are required to achieve effective preventive measures. The aim of this study was to determine factors associated with adolescent school girl's pregnancy in Kumbo East health district.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional descriptive study design was used and a simple random sampling technique was used to select 293 respondents aged 15 to 19year. The district hospital antenatal clinics and the Health Centres were selected. Data was obtained from 292 participants under the age of 20 years who were willing using a questionnaire administered through face-to-face interviews.</p> <p><strong>Results:&nbsp;</strong>the study show a high prevalence (60.75%) of teenage pregnancy in the sampled antenatal clinics of Kumbo East Health District attributable to inadequate considerations given to factors associated with school girl's pregnancy. This study has indicated that the age of teenager at first pregnancy, low contraceptive use, socio-economic status and physical violence are factors that are greatly associated with teenage pregnancy. Among the reasons contributing to the low use of contraceptives are: sexually activity, lack of knowledge, fear of side effects, including sterility, condoms disappearing in the womb and inequality of power with sexual partners. This study shows that teenagers obtain information mainly from school (53%) and relatives (20%).</p> <p><strong>Conclusion:&nbsp;</strong>the use of contraceptive alone may not reduce teenage pregnancy, however double method is very effective but addressing the impact of poverty on teenagers, empowering them on their rights and information in order to make right choices is very important.</p> Layu Donatus, Dohbit Julius Sama, Joyce Mahlako Tsoka-Gwegweni, Samuel Nambile Cumber Copyright (c) Thu, 25 Oct 2018 00:00:00 +0000 Sténose trachéale révélant un lupus érythémateux systémique <p>L'atteinte respiratoire dans le cadre du lupus érythémateux systémique (LES) est moins connue que les atteintes cutanées, articulaires et rénales. Le tableau clinique est assez variable et dominé par les atteintes pleurales. La sténose trachéale est inhabituelle voire exceptionnelle au cours de cette pathologie. Nous rapportons un cas assez particulier d'un lupus érythémateux systémique révélé par une sténose trachéale avec un syndrome sec oculo-buccal.</p> Safae Elidrissi, Hind Serhane, Salma Aitbatahar, Hafsa Sajiai, Lamyae Amro Copyright (c) Thu, 25 Oct 2018 00:00:00 +0000 Acute parenchymal hemorrhage of three cases report after burr hole drainage of chronic subdural hematoma <p>Chronic subdural hematoma (CSDH) is one of the most common neurological diseases, which mainly occurs among elderly people and usually develop after minor head injuries. Over the years, a simple burr hole evacuation of the hematoma has been accepted as the widespread method for most cases of CSDH, but acute parenchymal hemorrhage is a rare and deadly complication after surgery. We report three elderly cases of post-operative parenchymal hemorrhage and analyse the underlying factors and formulate relevant strategies in this article. Three advanced age patients had been admitted to our department with gradually increasing headache and limb activity disorder urgently and underwent an emergency operation of burr hole drainage of CSDH in frontal-temporal region after preoperative evaluations and examinations. Unfortunately, acute post-operative parenchymal hemorrhage occoured in three advanced age patients. Ultimately, the patients achieved satisfying outcome with no significant neurological deficit through conservative treatment. The exact mechanism of such uncommon complications are difficult to explain and remain poorly understood. Advanced age, hypertension, amyloidosis, high perfusion triggered by rapid hematoma release, cerebrospinal fluid (CSF) loss, oral anticoagulant, primary disease aggravation were the main mechanisms which were speculated in our report. Simultaneously, positive measures could be adopt to prevent this rare complication.</p> Yang Wang, Xiangping Wei Copyright (c) Thu, 25 Oct 2018 00:00:00 +0000 Extra and intracranial metastasis as an initial presentation of testicular cancer <p>A 24-year-old man presented with a 9-month history of a progressively increased painless left testicle. One month before admission, a round tumor appeared on his right forehead; this was associated with a persistent frontal headache of moderate intensity. The tumor progressively increased and was accompanied by altered consciousness characterized by stupor and confusion, which motivated his being taken to the emergency room. On initial evaluation, he had a Glasgow Coma Score of 13 with a proportionate left hemiparesis and a left pyramidal syndrome. The left testicle was increased in size, indurated, painless to palpation, and associated with a large left hydrocele. A brain MRI was performed that showed a heterogeneous lobulated intra and extracranial right frontal lesion. The intracranial component was vascularized and hemorrhagic, 8.2 x 7.1 x 6.8 cm with partially defined borders and vasogenic edema which shifted the midline 30 mm to the left and infiltrated the superior sagittal sinus. This predisposed right subfalcine and uncal herniation as well as left hydrocephalus. Extension studies showed metastatic lung and liver lesions. Laboratory studies revealed an alpha-fetoprotein level of 1210 ng/mL with a normal β-hCG level (1.11 mIU/mL). A diagnosis of poor-risk germ-cell tumor was made and a chemotherapy scheme was planned; however, the patient died due to acute neurological deterioration 48 hours after admission.</p> Carlos Eduardo Salazar-Mejía, Marusia González-Villarreal Copyright (c) Thu, 25 Oct 2018 00:00:00 +0000 Revue de la littérature sur l’impact du vieillissement démographique sur l'évolution des dépenses médicales: pays de l'Organisation de Coopération et de Développement Economiques et Maroc <p>L'objectif de cette étude est de faire un point sur la littérature analysant la relation entre le vieillissement démographique et l'augmentation des dépenses médicales dans des pays où ce phénomène est déjà prégnant ainsi qu'au Maroc. Les 19 premiers articles les plus cités qui sont produits au cours de la période: 1995-2014, concernent les pays de l'OCDE et où l'impact du vieillissement sur les dépenses de santé est évalué quantitativement. En ce qui concerne le Maroc, la recherche a porté sur des publications émanant des instances gouvernementales nationales qui relatent l'évolution de la consommation médicale et son lien avec l'âge. Pour les pays de l'OCDE, les études qui incluent la proximité du décès dans les modèles d'explication des dépenses de santé, concluent que cette dernière explique mieux que l'âge la hausse des dépenses de santé. Quatre auteurs ont mis en évidence que les modèles d'explication des dépenses qui ne tiennent pas compte de l'approche du décès surestiment les résultats de projection. Dix études avancent que la hausse des dépenses de santé est imputable à des facteurs autres que le vieillissement démographique. Pour le Maroc, seul un rapport sur l'Assurance Maladie Obligatoire fait émerger un lien entre l'âge et les dépenses puisque la prévalence des maladies chroniques qui touchent davantage les personnes âgées occasionne des dépenses importantes à l'assurance maladie. Compte tenu de la vitesse du vieillissement au Maroc, il est nécessaire d'élaborer des études permettant la compréhension de la dynamique des dépenses de santé.</p> Imane Sninate, Ahmed Bennana Copyright (c) Thu, 25 Oct 2018 00:00:00 +0000 Bacterial contamination of Ugandan paper currency notes possessed by food vendors around Mulago Hospital complex, Uganda <p><strong>Introduction:&nbsp;</strong>paper currency notes, exchangeable fomite, that is continuously contaminated because of the poor handling and storage practices. Objective: the general objective of the study was to determine the bacterial contamination of paper currency notes possessed by food vendors around Mulago National Referral Hospital Complex.</p> <p><strong>Methods:&nbsp;</strong>a total of sixty paper notes of six denominations (1000, 2000, 5000, 10000, 20000, 50000) were collected from different food vendors. Each note was preserved in a sterile falcon tube and transported to the microbiology lab for bacteriological examination. Data from questionnaires was analyzed using SPSS version 23 (IBM SPSS Statistics).</p> <p><strong>Results:&nbsp;</strong>all sampled paper notes had bacterial contamination. The bacterial counts ranged from 4×10<sup>2</sup>&nbsp;cfu/ml to 6.8×10<sup>9</sup>&nbsp;cfu/ml, with the Shs.1000 notes having the highest average total bacterial load of 2.17×10<sup>9</sup>&nbsp;cfu/ml and highest average total coli form counts of 21.5×10<sup>2</sup>&nbsp;cfu/ml. The fifty thousand shillings note had no coliform detected. Of the analysed 60 samples, 27(45%) samples contained &lt;i&gt;<em>Staphylococcus aureus&lt;/i&gt;</em>. None of the sampled paper notes had &lt;i&gt;<em>Escherichia coli&lt;/i&gt;</em>.</p> <p><strong>Conclusion:&nbsp;</strong>the study revealed that most of Ugandan paper notes are contaminated with bacteria including potential pathogens that cause disease in healthy individuals and opportunistic pathogens that may cause disease in hospitalized and immunocompromised patients. This study showed that the most contaminated note denominations were those of low denomination (Shs.1000 and Shs.2000) which had the highest bacterial count. The study revealed the paper currency notes were stored in different places where the commonest was the drawer and kept with different items, the commonest being pens. Hence, great care must be taken while handling money during the preparation and handling of food to avoid cross contamination.</p> Muhumuza Allan, Catherine Atuhaire, Musisi Nathan, Francis Ejobi, Samuel Nambile Cumber Copyright (c) Thu, 25 Oct 2018 00:00:00 +0000 L’esthésioneuroblastome pédiatrique: une lésion maligne exceptionnelle (à propos d’un cas et revue de la littérature) <p>L'esthésioneuroblastome (ENB) est une tumeur maligne rare représentant 3% des cancers des cavités naso-sinusiennes; son origine se situe au niveau de l'épithélium olfactif. Elle touche généralement des sujets de 30 à 50 ans. Elle est exceptionnelle chez l'enfant. Le diagnostic est souvent tardif, du fait du caractère longtemps confiné de la tumeur et le pronostic dépend des extensions locorégionales (notamment cérébrales et orbitaires). Nous rapportons un cas de cette affection à localisation sphénoïdale chez un sujet de 03 ans découverte suite à une cécité d'installation rapide dont on discute les particularités cliniques, radiologiques, anatomopathologiques, thérapeutiques et pronostique tout en insistant sur la précocité de la prise en charge conditionnant le pronostic qui restait malheureusement toujours péjoratif du fait du taux de récidives assez élevé ainsi que la survenue de métastases à distance, notamment pulmonaires et osseuses.</p> Mehdi Borni, Brahim Kammoun, Fatma Kolsi, Mohamed Zaher Boudawara Copyright (c) Thu, 25 Oct 2018 00:00:00 +0000 Hypertension and prehypertension among adolescents attending secondary schools in urban area of South-East, Nigeria <p><strong>Introduction:&nbsp;</strong>in the past, the need for regular blood pressure screening in children was doubtful, and the main reason against it is that hypertension is an adult illness and there is no evidence that screening healthy children for hypertension was worthwhile. We did this study to determine the prevalence of hypertension and prehypertension as well as some risk factors for hypertension among secondary school adolescents in an urban area of the South-East, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional study of 984 adolescents aged 10-19 years in secondary schools in Awka South Local Government Area of Anambra state, South-East, Nigeria. The multi-stage sampling method was used to select the subjects. Data were collected from all eligible subjects with the aid of a questionnaire administered to them. Weight, height, and blood pressure were measured and recorded.</p> <p><strong>Results:&nbsp;</strong>nine hundred and eighty-four adolescents were recruited for this study, and they comprised 470 (47.8%) males and 514 (52.2%) giving a male: female ratio of 1:1.1. Their ages ranged from 10-19 years. The mean systolic blood pressure and mean diastolic BP were 110.5±10.2mmHg 71.5±8.5mmHg respectively. Prevalence of hypertension and pre-hypertension were 6.3% and 5.0% respectively. There were a higher proportion of females (7.3%) than males (5.4%) with hypertension, and more females (5.8%) than males (4.2%) with prehypertension but these were not statistically significant. Overweight and obesity were significantly associated with hypertension.</p> <p><strong>Conclusion:&nbsp;</strong>hypertension exists among secondary school adolescents in Awka South Local government area of Anambra state, with a prevalence of 6.3%, early detection and treatment will forestall the early development of complications.</p> Chijioke Elias Ezeudu, John Onuora Chukwuka, Joy Chinelo Ebenebe, Wilson Chukwuneke Igwe, Ifeoma Egbuonu Copyright (c) Thu, 25 Oct 2018 00:00:00 +0000 Prise en charge chirurgicale des méningiomes intracrâniens à Nouakchott, Mauritanie <p>Les méningiomes constituent une pathologie couramment rencontrée en neurochirurgie, pourtant les données sur leur épidémiologie, leurs caractéristiques cliniques et leur prise en charge thérapeutique restent rares par rapport aux gliomes. Notre but est de dégager un profil épidémiologique et d'évaluer la qualité de de la prise en charge des méningiomes intracrâniens (MIC) au CHN de Nouakchott, Mauritanie. Nous avons revu dans cette étude rétrospective, les observations des patients opérés d'un MIC, entre septembre 2013 et septembre 2016. Trente-deux patients ont été opérés d'un MIC (26,6%). L'âge moyen était de 45,12 ans (± 13,8 ans) dont 75% étaient des femmes. La durée moyenne d'hospitalisation était de 13 jours (± 7jours). Le délai avant le diagnostic était en moyenne de 10 mois (± 5mois). La taille moyenne des MIC était de 5,07 cm (± 2,00cm) avec des extrêmes allant de 2,5cm à 10,5cm. L'IRM a été réalisée chez 46,8% en complément de la TDM cérébrale. Dans notre série 38% des MIC sont localisés sur la convexité. Le délai d'attente opératoire était de 23.91 jours (±17jours). La qualité d'exérèse chirurgicale selon le score de Simpson était de Grade I (66%), Grade II: (19%), Grade III: (6%), Grade IV: (9%). Le type histologique de la classification de l'OMS 2007 étaient de, Garde I (93%), Grade II-III (7%). La mortalité opératoire globale était de (n=3, 9,4%). Le perfectionnement du plateau technique dans le service de neurochirurgie, de radiologie et des moyens anesthésie-réanimation prochainement, va contribuer à l'amélioration de nos résultats et à la diminution de la mortalité.</p> Ahmed-Salem Kleib, Brahim Hamad Ngaidé, Ahmedou El Mokhtar Eleit, Seck Mame Diack, Sidi Salem-Memmou, Sidi-Mohamed Salihy, Outouma Soumaré Copyright (c) Fri, 26 Oct 2018 00:00:00 +0000 Enorme kyste amygdaloïde cervical à propos d'un cas <p>Les kystes amygdaloides sont des tumeurs bénignes kystiques dysembryologiques qui se développent au niveau de la partie antéro-latérale du cou, ils représentent 2% des tumeurs latéro-cervicales du cou, ils comptent parmi les plus fréquentes des anomalies branchiales, ils représentent 6,1 à 85,2% des anomalies de la deuxième fente. Ils sont dus à la persistance du sinus cervical au cours de la différenciation de l'appareil branchial. Ils se manifestent par une tuméfaction latéro-cervicale située au bord antérieur du muscle sterno-cléido-mastoïdien. Leur nature kystique est confirmée par l'échographie et la TDM. Le traitement consiste à l'exérèse chirurgicale. Nous rapportons le cas d'une femme de 24 ans qui a consulté pour une énorme tuméfaction latéro-cervicale gauche qui évolue depuis 3 ans sans autres symptomatologies associes. Une cervicotomie exploratrice avec étude anatomo-pathologique ont été réalisées, le diagnostic histolgique retenu était un kyste amygdaloïde sans signes de malignité. L'objectif de ce travail est d'analyser les caractéristiques anatomo-cliniques et discuter des modalités de prise en charge et les indications thérapeutiques de cette affection.</p> Ahmed Rouihi, Bouchaib Hemmaoui, Noureddine Errami, Fouad Benariba Copyright (c) Fri, 26 Oct 2018 00:00:00 +0000 Place des gestes associés à l’ostéotomie de Scarf dans le traitement de l’hallux valgus <p>Devant la multiplicité des techniques proposées pour le traitement de l'hallux valgus, nous proposons d'évaluer l'ostéotomie Scarf associée ou non à une ostéotomie phalangienne et/ou une ostéotomie Weil. Il s'agit d'une étude rétrospective de 29 patients, dont un cas bilatéral, opérés entre 2011 et 2016 par une ostéotomie de Scarf du premier rayon avec un geste associé dans 80% des cas. Les résultats ont été analysés selon la satisfaction des patients, l'indice de Groulier et les mesures radiologiques. Le score global de Groulier donnait une bonne évaluation objective du résultat prenant en compte les données radiologiques et anatomiques qui influencent le résultat final en cas d'insuffisance de correction. Le recul moyen était de 3 ans et 5 mois. Une diminution significative du valgus phalangien (de 34,17% à 16,1%), du métatarsus varus (de 15,13% à 9,93%) et de l'angle articulaire distal métatarsien (de 17,63% à 12,73%) étaient retrouvés. Les patients sont satisfaits et très satisfaits dans 83% des cas. Les complications sont dominées par l'hypo-correction dans 13,3% des cas et nous n'avons noté aucun cas de pseudarthrose ou de nécrose de la tête de M1. Nos résultats sont comparables à ceux de la littérature. Nous insistons sur le caractère surtout fonctionnel de la chirurgie de l'hallux valgus qu'il convient d'intégrer dans une correction globale de l'avant-pied. L'ostéotomie de Scarf nécessite une technique rigoureuse, elle est fiable par ses résultats et présente comme limite les grosses déformations surtout de l'angle articulaire distal métatarsien.</p> Zied Bellaaj, Skander Ben Dhia, Mohamed Allagui, Issam Aloui, Youssef Othmen, Makram Zrig, Mustapha Koubaa, Abderrazek Abid Copyright (c) Mon, 29 Oct 2018 00:00:00 +0000 La fréquence des symptômes physiques dans les troubles anxio-dépressifs: étude transversale chez une population de 202 consultants psychiatriques <p><strong>Introduction:&nbsp;</strong>les symptômes physiques associés aux troubles anxio-dépressifs ont fait l'objet de plusieurs études depuis plusieurs décennies, vu leurs fréquences et leurs conséquences. Le but de notre étude est de préciser la fréquence des principaux symptômes physiques des troubles anxieux: trouble panique (TP), trouble anxiété généralisée (TAG), troubles phobiques (TPh), et dépressifs: épisode dépressif majeur (EDM) dans le cadre d'un trouble dépressif).</p> <p><strong>Méthodes:&nbsp;</strong>nous avons mené une étude transversale à visée descriptive, réalisée sur un échantillon de 202 consultants dans un Service de Psychiatrie.</p> <p><strong>Résultats:&nbsp;</strong>l'âge moyen des patients est de 42 ans (19 à 70 ans), avec une légère prédominance féminine: 118 (58%). Les troubles anxio-dépressifs constatés sont: l'EDM: 113(56%), le TP: 61 (30.2%), le TAG: 55 (27.2%) et les TPh: 30 (14.9%). La fréquence des patients présentant de 2 à 5, et plus de 5 symptômes était respectivement de 15.9% et 39.6% dans les troubles dépressifs, et de 9.5% et 62.9% dans les troubles anxieux. Les symptômes les plus rapportés sont d'ordre cardiopulmonaire (75%), général (73.8%) et neurologique (65.8%).</p> <p><strong>Conclusion:&nbsp;</strong>les symptômes physiques qui accompagnent les troubles anxio-dépressifs, sont variables et souvent nombreux. Ils peuvent aggraver le pronostic de ces troubles psychiatriques, en rendant difficile leur prise en charge. Un dépistage précoce de ces troubles, en portant une attention particulière à ces symptômes physiques, permettra de prévenir ces complications.</p> Yassine Otheman, Asmaa Fakir, Mohamed Kadiri, Mohamed Zakariya Bichra Copyright (c) Mon, 29 Oct 2018 00:00:00 +0000 Thromboses des artères rénales révélant un syndrome des anticorps anti phospholipides <p>Le syndrome des anticorps antiphospholipides est une thrombophilie définie par l'association d'un événement clinique thrombotique artériel et/ou veineux, ou obstétrical à la présence durable d'anticorps antiphospholipides. Nous rapportons le cas d'une jeune patiente admise pour une insuffisance rénale aigue sur thrombose bilatérale des artères rénales et chez qui le bilan immunologique a révélé la présence d'anticoagulant circulant de type lupique faisant retenir le diagnostic d'anticorps antiphospholipides. La prise en charge rapide de la thrombose des artères rénales par angioplastie a permis la récupération d'une fonction rénale normale.</p> Wafaa Arache, Abdelali Bahadi, Driss El Kabbaj Copyright (c) Tue, 30 Oct 2018 00:00:00 +0000 Fibrome utérin associé à un STUMP (tumeurs musculaires lisse de malignité incertaine): à propos d'un cas <p>Les STUMP sont des tumeurs musculaires lisses dont les caractéristiques morphologiques ne permettent pas de les ranger de façon formelle en tumeur bénigne ou maligne. Nous rapportons ici le cas d’une patiente âgée de 44 ans sans antécédents pathologiques notables qui consulte pour une augmentation du volume abdominal. Une échographie pelvienne et une TDM TAP ont été réalisées objectivant une énorme masse à double composante tissulaire et liquidienne au dépend de l’utérus. La patiente a bénéficié d’une laparotomie exploratrice avec découverte de deux masses: une au dépend de l’utérus et l’autre en rétropéritonéal. Le résultat anatomopathologique était en faveur d’un myome utérin associé à un STUMP.</p> Mohammed Karam Saoud, Imane Benchiba, Nisrine Mamouni, Sanaa Errarhay, Chahrazad Bouchikhi, Abdelaziz Banani Copyright (c) Tue, 30 Oct 2018 00:00:00 +0000 Could Nodding Syndrome (NS) in Northern Uganda be an environmentally induced alteration of ancestral microbiota? <p>Hippocrates stated in 460-C.370 BC that, "All diseases begin in the Gut." This statement may be beginning to have meanings in the advent of new diseases such as Nodding Syndrome (NS) and Autism Spectrum Disorder (ASD). Interestingly, a recent publication from China in the journal of microbiology in 2017 suggests that high grain diet had dynamically shifted the composition of mucosa-associated microbiota and induced mucosal Injuries in the colon of Sheep. NS is a devastating childhood neurological disorder characterized by atonic seizure, cognitive impairment, head nodding, wasting and stunted growth. In addition, NS in Northern Uganda is clustered in time (those who were in IDPs), in space (discretely observed on either sides of the two rivers of Aswa and Pager) and in person (onset mainly between the ages of 5-15 years) and therefore exhibits spatial temporality. The first case of NS was noticed in Kitgum district in 1997, one year after the reported displacement of that community into IDP. Prior to that internal displacement, there were no reported cases of NS. The same scenario occurred in the IDPs of Odek, Gulu district where the population was displaced into IDPs in 2001 and approximately a year later in 2002, cases of NS began to appear. In the IDPs, children that eventually developed NS fed nearly exclusively on food ration provided by relief agencies and roughly a year later, cases of NS began to appear. In the other East African countries, there were no reported cases of NS prior to internal displacement and dependence on food ration. The observed common factors in the three East African regions where NS occurs at endemic proportion are perhaps: Internal displacement and feeding on relief food. These researchers suggest that NS may have perhaps resulted from dietary and environmental factors during IDPs which may have been foreign to their GIT and links this observation to the concept of microbiota-gut-brain axis.</p> Denis Anywar Arony, Suzanne Gazda, David Lagoro Kitara Copyright (c) Tue, 30 Oct 2018 00:00:00 +0000 Approach to childhood interstitial lung disease in resource limited setting <p>Childhood interstitial lung disease (ChILD) is a rare disease and sensitization is needed in the recognition, diagnosis and treatment approaches. There is no formal approach to diagnosis or therapy in resource limited regions. We present a case of a 4-month infant who presented with all the criteria for diagnosis of ChILD. Lung biopsy being the gold standard is a challenge in our setting and diagnosis was based on clinical signs and imaging after ruling out of other similar respiratory conditions by way of individual trials of therapy. Monotherapy with prednisone showed clinical improvement within days of initiation.</p> Varsha Vekaria-Hirani, Adil Waris Copyright (c) Wed, 31 Oct 2018 00:00:00 +0000 Une localisation rare du lipome au niveau parotidien: à propos d'un cas <p>La localisation des lipomes au niveau parotidien est très rare. Nous rapportons un nouveau cas avec une revue de littérature concernant un patient de 55 ans, qui a consulté pour une masse au niveau de la région parotidienne évoluant depuis quatre ans, à la palpation on a trouvé une formation de consistance molle, mobile et indolore, le patient a bénéficié par la suite d'une imagerie (échographie et IRM), d'où le diagnostic final d'un lipome parotidien a été retenu, le traitement était conservateur sur le choix du patient.</p> Siham Alaoui Rachidi, Anas Lahlou Mimi, Nizar El Bouardi, Youssef Lamrani Alaoui, Meriem Boubbou, Mustapha Maaroufi, Badr Alami Copyright (c) Wed, 31 Oct 2018 00:00:00 +0000 Occlusion intestinale aiguë révélant une grossesse abdominale: à propos d'un cas <p>La grossesse abdominale (GA) se définit comme la nidation et le développement de l'œuf fécondé dans la cavité péritonéale. Elle reste une variété rare de grossesse ectopique, dont la découverte peut être fortuite simulant une urgence chirurgicale. Nous rapportons un cas rare d'une occlusion intestinale aiguë fébrile révélant une grossesse abdominale chez une patiente âgée de 27ans sans antécédents pathologiques particuliers, reçue pour la prise en charge d'un syndrome occlusif évoluant depuis une semaine. L'examen physique retrouvait un abdomen distendu luisant, sensible dans son ensemble et météorisé. Le bilan biologique montrait des globules blancs à 20300, le taux d'hémoglobine à 7,2g/dL. L'exploration chirurgicale avait objectivé un hémopéritoine de 2000ml, une masse retro-utérine encapsulée, adhérent fortement au méso-sigmoïde et au sigmoïde responsable d'une sténose du colon descendant. Il a été réalisé une exérèse monobloc dont l'effraction montrait un placenta accolé au méso-sigmoïde relié au fœtus une annexectomie droite, une colostomie.</p> Ibrahima Sitor Souleymane Sarr, Magatte Faye, Papa Mamadou Faye, Mamadou Seck, Ousmane Ka, Madieng Dieng Copyright (c) Wed, 31 Oct 2018 00:00:00 +0000 Déficit congénital en facteur VII de coagulation: à propos de deux cas familiaux <p>Le déficit en facteur VII est rare, sa prévalence est estimée à 1/1.000.000. Sa transmission est autosomique récessive. L'expression peut aller de la simple épistaxis à l'hémorragie cérébrale. Le but de notre travail est de mettre l'accent sur les particularités cliniques et l'intérêt du dépistage de ce rare déficit. Nous rapportons deux observations de deux frères porteurs de ce déficit. Il s'agit d'un enfant âgé de 8 ans, issu d'un mariage non consanguin, benjamin d'une fratrie de deux, dans ses antécédents on note une hémorragie post circoncisionnelle, admis au service pour prise en charge d'épistaxis à répétition depuis l'âge de 4ans. Un bilan d'hémostase a été réalisé objectivant un taux de prothrombine (TP) bas, un temps de céphaline activée (TCA) normal et le dosage factoriel a révélé un déficit en facteur VII avec un taux à 26%. L'évolution est marquée par des transfusions espacées du plasma frais congelé (PFC) suite à des épistaxis et des plaies. Le dépistage familial n'a pas été réalisé. Son frère ainé, consulte à l'âge de 11 ans pour épistaxis de grande abondance, l'examen somatique a été sans particularité. Vu ses antécédents le patient a bénéficié d'un bilan avec dosage du facteur VII révélant un taux à: 55%, et un dépistage chez les parents est prévu. La découverte d'un cas doit motiver à mener une enquête familiale afin de dépister d'autres porteurs de ce déficit et avoir un conseil génétique qui aidera à éviter des manifestations graves voir mortelles tout en sachant que les études n'ont pas montré de corrélation entre le taux du facteur et la gravité du tableau.</p> Noufissa Benajiba, Anass Ayyad, Chourouk Aabdi, Rim Amrani, Maria Rkain, Mohammed Benajiba Copyright (c) Wed, 31 Oct 2018 00:00:00 +0000 Rectal seed bezoar due to sunflower seed: a case report and review of the literature <p>Seed bezoars are a subcategory of phytobezoars, caused by consumption of indigestible vegetable or fruit seeds. We present the case of a 64-year-old male patient, who presented at the Emergency Department, complaining of constipation, tenesmus and rectal pain. History and digital examination revealed a rectal seed bezoar due to sunflower seeds, impacted in the lower rectum. The patient underwent manual disimpaction under general anaesthesia, after conservative measures failed. Seed bezoars represent a different pathophysiological process compared to fibre bezoars. They are usually found in the rectum of patients without predisposing factors, causing constipation and anorectal pain. History taking and digital rectal examination are the cornerstones of diagnosis, with manual disimpaction under general anaesthesia being the procedure of choice.</p> Dimitrios Manatakis, Maria Sioula, Ioannis Passas, Helen Zerbinis, Christos Dervenis Copyright (c) Wed, 31 Oct 2018 00:00:00 +0000 The prevalence of painful diabetic neuropathy in 300 Moroccan diabetics <p>Painful diabetic neuropathy is a frequent complication of diabetes. Its diagnosis is clinical. Our goal is to determine the prevalence of painful diabetic neuropathy in this population. We also analyzed the relationship between this neuropathy and certain parameters, concerning the patient and his diabetes. It is a cross sectional study conducted at the department of endocrinology and internal medicine of Avicenne hospital Marrakech-Morocco, among a cohort of 300 diabetic outpatients. We used the DN4 questionnaire (Douleur Neuropathique en 4 questions), for diagnosis. The results showed a prevalence of 15%. In this study: advanced age, female gender, duration of diabetes greater than 10 years, and the lack of medical follow up were found to be statistically significant risk factors for painful diabetic neuropathy, in addition to some diabetes-related comorbidities such as hypertension, dyslipidemia, sedentary life style and diabetic retinopathy. Painful diabetic neuropathy remains undertreated, in fact 74% of our patients did not receive any specific treatment, knowing that the progress in developing effective and well-tolerated therapies has been disappointing.</p> Zakaria Chahbi, Bouchra Lahmar, Sanae El Hadri, Lahoussaine Abainou, Said Kaddouri, Hassan Qacif, Hicham Baizri, Mohamed Zyani Copyright (c) Thu, 01 Nov 2018 00:00:00 +0000 Observance to antiretroviral treatment in the rural region of the Democratic Republic of Congo: a cognitive dissonance <p><strong>Introduction:&nbsp;</strong>this study aimed to understand the influence of local media, religion and cultural beliefs on the therapeutic compliance of patients living with HIV.</p> <p><strong>Methods:&nbsp;</strong>this study was conducted in two rural hospitals in the Central Kongo province of the Democratic Republic of Congo. Semi-directional interviews were conducted with patients on antiretroviral therapy using a phenomenological qualitative method.</p> <p><strong>Results:&nbsp;</strong>our results indicated that patients living with HIV in the rural region of the Democratic Republic of Congo are in a constant state of tension between the messages for compliance to antiretroviral treatment advocated by caregivers, and those broadcasted by audiovisual media, religious leaders and local beliefs. This dissonance constitutes a real barrier to therapeutic compliance.</p> <p><strong>Conclusion:&nbsp;</strong>collaborative strategies between healthcare providers, patients, as well as religious, media and traditional organizations are urgently needed.</p> Simon-Decap Mabakutuvangilanga Ntela, Nathalie Goutte, Jean-Manuel Morvillers, Cyril Crozet, Mathieu Ahouah, Marie-Claire Omanyondo-Ohambe, Bernard Ntoto-Kunzi, Félicien Tshimungu Kandolo, Monique Rothan-Tondeur Copyright (c) Fri, 02 Nov 2018 00:00:00 +0000 Seroprevalence of hepatitis B and C virus infections among diabetic patients in Kisangani (North-eastern Democratic Republic of Congo) <p><strong>Introduction:&nbsp;</strong>the link between diabetes mellitus and hepatitis B and C Virus infections has not yet been studied in the Democratic Republic of Congo, a country where diabetes mellitus is a growing disease and the prevalence of hepatitis B and C viruses infections is high. The aim of this study was to determine the seroprevalence of these viruses in diabetic patients.</p> <p><strong>Methods:&nbsp;</strong>we conducted a descriptive cross-sectional study in diabetic subjects attending Kisangani University Clinics and General Hospitals of Kisangani City as well as the Diabetics Association of Oriental Province. The control group consisted of volunteer blood donors recruited from the Kisangani Provincial Blood Transfusion Center. Blood glucose was measured with the spectrophotometer; for hepatitis B and hepatitis C viruses serology, we used rapid test kits (Determine TM® HBsAg and Hexagon® HCV test) and ELISA if seropositivity by rapid tests. The analysis was done by SPSS software.</p> <p><strong>Results:&nbsp;</strong>seroprevalence of hepatitis C virus in diabetics was 24.8% compared to 1.9% in volunteer blood donors (p = 0.0000); that of hepatitis B virus was 3.4% versus 3.5% in volunteer blood donors (p = 0.906). Hepatitis C virus infection was more common in type 2 diabetics (p = 0.006) and significantly associated with age of diabetic patients (p = 0.002).</p> <p><strong>Conclusion:&nbsp;</strong>the seroprevalence of hepatitis C virus and not hepatitis B virus infection is significantly high in diabetic subjects, particularly type 2 diabetics, in the Democratic Republic of Congo and suggests systematic screening for this infection in any diabetic patient.</p> Paul Kambale Kombi, Salomon Batina Agasa, Jean Paulin Mbo Mukonkole, Lucien Bolukaoto Bome, Camille Atoba Bokele, Charles Kayembe Tshilumba Copyright (c) Fri, 02 Nov 2018 00:00:00 +0000 Epigastralgies révélant un lymphome pancréatique primitif à grandes cellules B chez un patient jeune: à propos d’un cas <p>Le lymphome malin non hodgkinien (LMNH) primitif du pancréas est une localisation extrêmement rare des LMNH extraganglionnaires représentant moins de 0,7% de tous les LMNH et moins de 0,5% des tumeurs malignes pancréatiques, touchant essentiellement le sujet âgé et très rarement le sujet jeune (l'intérêt de notre cas). Son diagnostic est difficile simulant cliniquement l'adénocarcinome de pancréas et les pancréatites chroniques. Nous rapportons le cas d'un patient de 25ans, suivi pour lymphome non hodgkinien (LNH) diffus à grandes cellules B de localisation pancréatique primitive révélé par des épigastralgies avec ictère foudroyant d'installation brutale dans un contexte d'altération de l'état général et diagnostiqué sur une biopsie de la loge duodéno-pancréatique. Le diagnostic et la prise en charge précoce de ces tumeurs agressives permettent d'améliorer significativement leur pronostic.</p> Benmoussa Amine, Lasri Najat, Tazi Ilias Copyright (c) Fri, 02 Nov 2018 00:00:00 +0000 Cavernomatose cérébrale sporadique révélée par une crise convulsive: à propos d’un cas <p>La cavernomatose cérébrale est une pathologie rare pouvant être sporadique ou familiale autosomique dominante. Elle est caractérisée par la présence de cavernomes multiples du système nerveux central. Souvent asymptomatique, la pathologie peut se révéler par des symptômes variés comme l’hémorragie cérébro-méningée, les céphalées ou l’épilepsie. Nous rapportons un cas de cavernomatose cérébrale sporadique chez un patient de 55 ans sans antécédent pathologique particulier révélé par une crise d’épilepsie. A travers cette observation et une revue de la littérature, nous faisons le point sur les aspects cliniques et radiologiques (scanner et IRM) de cette pathologie.</p> Doumbia Amadou, Koné Youssouf, Maïga Oumou, Koné Abdoulaye, Diarra Bréhima, Dembélé Adama, Diallo Mamahadou Copyright (c) Fri, 02 Nov 2018 00:00:00 +0000 Age at diagnosis predicted survival outcome of female patients with breast cancer at a tertiary hospital in Yogyakarta, Indonesia <p><strong>Introduction:&nbsp;</strong>breast cancer is the most common cancer in women in Indonesia. Patients' survival depends on various factors, namely patient-, tumor-, and treatment-related factors. Survival analysis on Indonesian patients has only been reported in a few studies. This study aimed to identify the factors that are associated with five-year overall survival (OS) among patients with breast cancer at a local tertiary hospital in Indonesia.</p> <p><strong>Methods:&nbsp;</strong>a retrospective cohort study was conducted at Dr Sardjito Hospital, Yogyakarta. Female patients diagnosed with breast cancer between January and December 2009 were studied. Socio-demographic and clinicopathological data were collected from the medical and pathological records. The five-year OS rate was assessed using Kaplan Meier method and prognostic factors were analyzed using Cox regression.</p> <p><strong>Results:&nbsp;</strong>a total of 213 eligible patients with breast cancer were recruited. The five-year OS probability of the breast cancer patient was 51.07%. The majority of the patients (151, 70.9%) presented an advanced stage at the time of diagnosis. In the bi-variable analysis, cases who were younger, of a lower educational status, at a more advanced stage, with a bigger tumor size, and a central tumor location showed a worse five-year OS compared to their counterparts (p = 0.005, 0.001, 0.004, 0.011 and 0.023, respectively). In the multivariable analysis, age was an independent predictor for the OS (HR = 3.73; 95% CI = 1.0-13.6, p = 0.046).</p> <p><strong>Conclusion:&nbsp;</strong>the five-year OS of breast cancer patients in the local tertiary hospital was 51.07%. The patients' age at diagnosis was the only significant prognostic factor for the patients' survival.</p> Evi Susanti Sinaga, Riris Andono Ahmad, Siddharudha Shivalli, Susanna Hilda Hutajulu Copyright (c) Wed, 07 Nov 2018 00:00:00 +0000 Profil épidémio-clinique et évolutif des cardiomyopathies dilatées au Centre Hospitalier Universitaire de Brazzaville, Congo <p>L'objectif de cette étude est de contribuer à l'amélioration de la prise en charge des patients porteurs de cardiomyopathies dilatées (CMD) à Brazzaville. Cette étude prospective et analytique, a été réalisée au CHU de Brazzaville entre le 1<sup>er</sup>&nbsp;Janvier 2014 et le 30 Juin 2015. Elle a inclus les patients hospitalisés dans le service de cardiologie pour une insuffisance cardiaque (IC) en rapport avec une CMD. L'étude a porté sur 100 patients. La fréquence hospitalière de la CMD était de 32,1%. Il s'agissait de 38 hommes (38%) et 62 femmes (62%), âgés en moyenne de 52,9 ± 17,1 ans. L'IC était globale dans 72 cas (72%). L'ECG s'inscrivait en rythme sinusal (95%), et objectivait une hypertrophie ventriculaire gauche (40%), un bloc de branche gauche (16%), et une fibrillation auriculaire (5%). La fraction d'éjection du ventricule gauche (VG) était en moyenne de 33,4 ± 6,8%, et le diamètre télédiastolique du VG de 65,5 ± 7,0 mm. Le traitement comportait un diurétique de l'anse (100%), un IEC/ARA2 (100%), un bêtabloquant (38%), un digitalique (30%), un anti-aldostérone (16%), et un anti-vitamine K (11%). Au terme d'un suivi de 12 mois, le taux de létalité globale était de 9%, le taux de réhospitalisation de 12%, et le taux de perdus de vue de 41%. Cette étude a montré que la CMD est une affection fréquente, et une des principales causes d'insuffisance cardiaque. La durée de suivi brève et le nombre important de perdus de vue ne permettent pas d'en évaluer la survie dans notre contexte.</p> Stéphane Méo Ikama, Bijou Moualengue, Jospin Makani, Solange Flore Mongo-Ngamami, Bertrand Ellenga-Mbolla, Igor Ondze-Kafata, Christian Kouala-Landa, Thierry Raoul Gombet, Gisèle Kimbally Kaky Copyright (c) Wed, 07 Nov 2018 00:00:00 +0000 Irrational use of antibiotics in the Moshi Municipality Northern Tanzania: a cross sectional study <p><strong>Introduction:&nbsp;</strong>irrational use of antibiotics includes prescription of incorrect doses, self-medication and treatment of non-bacterial illness. As a direct consequence of irrational antibiotic use, resistance to the commonly available antibiotics has been increasing rapidly. This phenomenon is associated with poorer health outcomes, longer hospitalization, increased cost to both the patient and government, and increased mortality. The aim of this study was to determine the prevalence of, and examine factors associated with, irrational use of antibiotics in the Moshi municipality, Northern Tanzania.</p> <p><strong>Methods:&nbsp;</strong>we conducted a cross-sectional descriptive study between April and May 2017 in the Moshi municipality. Twelve drug outlets, of which five were pharmacies and seven accredited drug dispensing outlets (ADDOs), were selected at random. On exiting these outlets, all adults who had purchased antibiotics were interviewed using structured questionnaires.</p> <p><strong>Results:&nbsp;</strong>a total of 152 adults were enrolled in this study. The median (QR) age was 31 years (25-42). The majority, 94 (61.8%), of the participants were female. ADDOs contributed 81 (53.3%) and pharmacies contributed 71 (46.7%) of all participants. Overall, 135 (88.8%) of antibiotic purchases were irrational. The most prevalent form of irrational antibiotic use was non-prescription usage; 116 of the 152 (76.3%) purchases fell in this category. Purchases of the incomplete dosage and purchases for non-bacterial illness were also widespread. Poor knowledge about the use of antibiotics had a significant association with irrational use of antibiotics (aOR=5.1, 95% CI: 1.80-15.15).</p> <p><strong>Conclusion:&nbsp;</strong>irrational use of antibiotics is highly prevalent in this population. Non-prescription use of antibiotics is the most prevalent form. Poor knowledge about antibiotic use plays a significant role in irrational antibiotic use. There is a need to review the accessibility of antibiotics in drug outlets.</p> Erick Alexander Mboya, Leah Anku Sanga, James Samwel Ngocho Copyright (c) Thu, 08 Nov 2018 00:00:00 +0000 The role of mycobacterium tuberculosis antigen specific cytokines in determination of acid fast bacilli culture status in pulmonary tuberculosis patients co-infected with human immunodeficiency virus <p><strong>Introduction:&nbsp;</strong>the interaction between&nbsp;<em>Mycobacterium tuberculosis</em>&nbsp;and HIV leads to rapid progression of tuberculosis (TB) and human immunodeficiency virus (HIV)-induced immunosuppression. Diagnosis of TB in these patients is more difficult due to its atypical presentations giving contradicting results. The overall aim of this study was to evaluate the ability of pro-inflammatory cytokine (Th1) and anti-inflammatory cytokine (Th2) to discriminate between culture-positive and -negative smear status in HIV-TB co-infected patients.</p> <p><strong>Methods:&nbsp;</strong>in a prospective cohort, a total of 86 study participants were recruited: 46 culture-negative and 40 culture-positive. Blood and sputum samples were collected from all participants. The blood was then analyzed using FACSCalibur flow cytometer to immunophenotype the cells and ELISA performed for cytokine profiles. Sputum samples were analyzed to determine smear status using direct microscopy and Lowenstein Jensen medium. Statistical analyses were performed using R software. Independent samples t-test was used to compare means between the two groups, while the medians were compared using two-sample Wilcoxon rank sum test. Pearson's Chi-square test was used to compare the proportion of male and female participants across the culture and AFB smear status. In order to determine the predictive power of Th1 and Th2 in discriminating Pulmonary Tuberculosis status (PTB) (culture status was used as a confirmatory test), binary logistic regression models were fitted for Th1 covariates [IFN-<sub>γ</sub>, TNF-<sub>α</sub>, IL-2 and IL-12(p70)] and Receiver Operating Characteristic (ROC) curves plotted.</p> <p><strong>Results:&nbsp;</strong>the overall mean age of the participants was 39 years (SD=12), 42% being male. Although, lymphocytes counts were higher in culture-positive relative to culture-negative, the CD8, CD19, and CD16/CD56 were comparable in the two groups. The CD4 counts differed between the two groups (P=0.012). The Th1 showed a better discrimination between culture-positive and -negative PTB individuals; IFN-<sub>γ</sub>&nbsp;(P=0.001), TNF-<sub>α</sub>&nbsp;(P=0.001), IL-2 (P=0.001) and IL-12(p70) (P=0.016). The Th2 cytokines (IL-4, IL-6 and IL-10) were comparable between the culture-positive and -negative groups. However, when the combination of Th1 cytokines [IFN-<sub>γ</sub>, TNF-<sub>α</sub>, IL-2 and IL-12(p70)] was fitted in binary logistic regression models, the predictive power was high with area under curve (AUC) being 89.7% in discriminating PTB.</p> <p><strong>Conclusion:&nbsp;</strong>this study provides evidence for the ability of a combination of Th1 cytokines in discriminating against culture-positive and culture-negative PTB.</p> Job Kisuya, Alex Chemtai, Evans Raballah, Wilson Okumu, Alfred Keter, Collins Ouma Copyright (c) Thu, 08 Nov 2018 00:00:00 +0000 Acidocétose diabétique chez l’enfant: aspects épidémiologiques et pronostiques <p><strong>Introduction:&nbsp;</strong>au Congo, les données concernant l'acidocétose diabétique (ACD) chez l'enfant sont anciennes et rares. Notre étude avait pour objectifs de décrire les caractéristiques sociodémographiques de l'ACD et d'identifier les facteurs de risque de décès.</p> <p><strong>Méthodes:&nbsp;</strong>de Janvier 2013 à Juin 2016, nous avons réalisé une étude analytique portant sur l'ACD chez l'enfant au CHU de Brazzaville. Les variables sociodémographiques, cliniques, paracliniques et évolutives ont été étudiées. Les tests de Chi-2, de Fischer et l'odds ratios ont servi pour l'analyse univariée et le modèle de régression logistique pour l'analyse multivariée.</p> <p><strong>Résultats:&nbsp;</strong>sur 172 enfants hospitalisés pour un diabète, 55(31%) l'étaient pour une acidocétose. Il s'agissait de 33(60%) filles, l'âge moyen: 11,1± 4,9 ans (extrêmes 1 mois et 17 ans), 61,8% des parents avaient un bas niveau socioéconomique. L'acidocétose était révélatrice dans 67,2 % de cas. Le diagnostic avant l'hospitalisation était erroné: 50%. Le facteur déclenchant était souvent infectieux (52,7%). La létalité était de 12,7%. Les facteurs de risque de décès en analyse univariée étaient : l'âge &lt; 5 ans (p=0,000006), le délai de consultation supérieur à 7 jours (p= 0,001), la déshydratation sévère (p = 0,0006), les troubles hémodynamiques (p= 0,0006), la dénutrition sévère (p= 0,02), le Glasgow &lt; 9 (p= 0,007) et la diarrhée (p= 0,001).</p> <p><strong>Conclusion:&nbsp;</strong>l'importance et la gravité de l'acidocétose imposent des mesures de prévention axées sur la sensibilisation, l'information, l'éducation et la maîtrise des facteurs de risque de décès.</p> Aymar Pierre Gildas Oko, Fayçal Khalil Zaharo Ali, Steve Vassili Missambou Mandilou, Judicaël Kambourou, Lombet Letitia, Jesse Pierre Yolaine Poathy, Moyen Engoba, Mamadou Ildevert Cyriaque Ndjobo, Henri Germain Monabeka, Georges Marius Moyen Copyright (c) Fri, 09 Nov 2018 00:00:00 +0000 Increased urinary sodium excretion is associated with systolic blood pressure in first degree relatives of hypertensive patients in Ibadan, Southwestern Nigeria <p><strong>Introduction:&nbsp;</strong>understanding the risk factors of hypertension has led to a better understanding of the pathogenesis, prevention and reduction in morbidity of hypertension. It is well known that offsprings of hypertensive parents have an increased risk of developing hypertension. It is therefore necessary to explore the physiological differences between normotensive patients with and without a positive family history of hypertension with respect to their urinary excretion of sodium.</p> <p><strong>Methods:&nbsp;</strong>this study was carried out at the University College Hospital, Ibadan Nigeria, to determine if normotensive patients with a positive family history of hypertension are different with respect to their urinary excretion of electrolytes and blood pressure. It examined the relationship between 24-hour urinary excretion of sodium, chloride and potassium, urea and creatinine and blood pressure in subjects with and without family history of hypertension. It was a case-control study of sixty-two subjects: normotensive patients first degree relatives of primary hypertensive patients and normotensive patients without positive family history.</p> <p><strong>Results:&nbsp;</strong>the mean (SD) systolic blood pressures for subjects with and without family history of hypertension were significantly different: 120.0(22.25) and 105.0(17.50) respectively, (p=0.001). The mean arterial blood pressures were significantly different: 86.4(10.2) mmHg and 80.1(8.1) mmHg respectively (p=0.010). The mean (SD) 24-hour urinary excretion of sodium for normotensive patients with and without positive family history of hypertension were 180.5 (45.50) mEq/L, and 156.0(36.25) mEq/L respectively. Systolic blood pressure and 24-hour urinary excretion of sodium was also higher in normotensive subjects with a positive family history of hypertension.</p> <p><strong>Conclusion:&nbsp;</strong>systolic blood pressure and twenty-four hour urinary excretion of sodium were higher in normotensive subjects with a positive family history of hypertension than in those without a family history of hypertension.</p> Samuel Ajayi, Adewole Adebiyi, Solomon Kadiri Copyright (c) Fri, 09 Nov 2018 00:00:00 +0000 Electrocardiographie couplé à l’échocardiographie transthoracique de repos dans le diagnostic des atteintes cardiaques chez le diabétique de type 2: les enseignements d’une série transversale au Burkina Faso <p>Le diabète est un puissant facteur de risque cardio-vasculaire indépendant. Les auteurs se proposent de décrire les anomalies électrocardiographiques et échocardiographiques observées chez les diabétiques de type 2 suivis dans le département de médecine du CHUSS. Une étude transversale descriptive a été réalisée d’avril à septembre 2014 incluant tous les diabétiques de type 2 consentants. Tous ont bénéficié d’un recueil de données cliniques, d’une électrocardiographie et d’une échocardiographie doppler. Un total de 155 diabétiques a été enquêté. L’âge médian de la population était de 55 ans (IIQ: 47-64) à prédominance féminine (Sex ratio 0,5). Les anomalies électrocardiographiques étaient représentées par les troubles de la repolarisation (31%) et les troubles du rythme auriculaire (16,12%). Sur le plan échocardiographique, l’hypertrophie du ventricule gauche (VG) était rapportée dans 20,64%. L’oreillette gauche était dilatée dans 14,19%, une dilatation VG dans 1,3% des cas. Une altération de la fraction d’éjection VG était notée dans 3,87% des cas. Les entités nosologiques étaient représentées par la cardiomyopathie hypertensive dans 27 cas (54%), la cardiopathie ischémique dans 19 cas (38%), la cardiomyopathie dilatée dans 2 cas (4%) et la cardiomyopathie diabétique dans 2 cas (4%). L’insuffisance cardiaque était notée dans 22 cas (44%) indépendamment de l’atteinte cardiaque présentée. Les anomalies électrocardiographiques et échocardiographiques sont fréquentes dans la population de diabétique de type 2 au CHUSS de Bobo-Dioulasso. Une meilleure collaboration entre cardiologues et diabétologues et la mise en place d’un plateau technique adéquat de dépistage serait un préalable pour une meilleure stratification du risque cardiaque dans cette population.</p> Somnoma Jean-Baptiste Tougouma, Yibar Kambiré, Jonas Bado, Aimé Arsène Yaméogo, Téné Marceline Yaméogo, Samba Sidibé, Carole Gilberte Kyelem, Alassane Ilboudo, Macaire Ouédraogo Copyright (c) Fri, 09 Nov 2018 00:00:00 +0000 Prevalence and correlates of stunting among the school-age population in North-Central Nigeria <p><strong>Introduction:&nbsp;</strong>stunting remains a huge public health concern among developing Nations. However, the burden of this problem among the school-age population appears to have been eclipsed by most nutritional surveys that focus more on the under-fives. This study aimed to demonstrate the prevalence, and identify socio-demographic factors that are associated with stunting among the school-age children in North central Nigeria.</p> <p><strong>Methods:&nbsp;</strong>this was a descriptive cross-sectional study that involved 450 pupils, aged 6-12 years from 10 randomly selected primary schools in Jos, Plateau state. Anthropometric indices were measured using standard techniques and the Height-for-age z-scores were generated using the WHO Anthroplus software. Socio-demographic details were obtained using semi-structured questionnaires. Data were analysed using EPI infoTM statistical software</p> <p><strong>Results:&nbsp;</strong>the mean age of the subjects was 9.3 ± 1.8 years and the male to female ratio was 1:1.1. The prevalence of stunting was 10.5%. The prevalence of stunting was significantly higher among pupils that attended public schools (p&lt;0.0001), those whose mothers had less than secondary level of education (p=0.0427), those between the ages of 10-12 years (p&lt;0.0001), those from the lower socio-economic class (p=0.0021), and those whose family sizes were larger than six family members (p=0.0063).</p> <p><strong>Conclusion:&nbsp;</strong>the substantial burden of stunting among the school age population has significant correlation with certain socio-demographic factors. Addressing these factors by alleviating poverty, promoting maternal literacy and encouraging family planning may, perhaps, lessen the burden of stunting among the school-age group in Northern Nigeria.</p> Idris Abiodun Adedeji, Mohammed Faruk Bashir, David Danjuma Shwe, Collins John Copyright (c) Fri, 09 Nov 2018 00:00:00 +0000 Insuffisance rénale révélant un myélome multiple avec des lésions radiologiques historiques <p>Il s'agit d'une patiente âgée de 54 ans, admise pour insuffisance rénale sévère. Elle a présenté une dyspnée stade II évoluant depuis un mois avec des douleurs thoraciques et douleurs osseuses associées à une anurie. L'examen clinique a retrouvé une hypertension à 160/80mmHg, un syndrome glomérulaire avec 2+ de protéine, 2+ de sang et une diurèse à 300cc. L'examen pleuro-pulmonaire a montré des rales crépitants basithoraciques bilatéraux. Sur le plan biologique, on a mis en évidence une insuffisance rénale sévère à 107mg de créatinine, urée à 1.65g/l,une hyperkaliémie à 7.8mmol/l, CRP à 78mg/l, une anémie normochrome normocytaire avec une Hb à 5.7g/dl et une hyperleucocytose à 13570 sans thrombopénie. Elle avait une hyperprotidémie à 144g/l, une normoalbuminémie à 33g/l, une hypercalcémie à 116g/l et une hyperphosphorémie à 120mg/l. L'électrophorèse des protéines sériques a objectivé un pic monoclonal de gammaglobulines à 60g/l avec à l'immuno-électrophorèse des protéines plasmatiques une gammapathie de type IgG kappa. La recherche de la protéine de Bence Jones était négative. Le myélogramme a montré une plasmocytose à 10%. Sur le plan radiologique, de multiples géodes à l'emporte pièce ont été visualisé sur la radiographie du crane de profil réalisant un aspect historique. La patiente a été mise sous protocole CDT1 à base de dexaméthazone, thalidomide 100mg et endoxan orale.</p> Nadia Bouchemla, Abderrahim Nadri, Meriem Chettati, Wafaa Fadili, Inass Laouad Copyright (c) Mon, 12 Nov 2018 00:00:00 +0000 Connaissances, attitudes et pratiques des femmes en âge de procréer du District de Santé de la Mifi sur la prévention du cancer du col de l’utérus, Cameroun <p><strong>Introduction:&nbsp;</strong>décrire les connaissances, les attitudes et les pratiques des femmes en âge de procréer sur la prévention du cancer du col de l'utérus.</p> <p><strong>Méthodes:&nbsp;</strong>il s'est agi d'une étude transversale descriptive menée chez les femmes en âges de procréer. Les données ont été collectées face à face à l'aide d'un questionnaire. L'analyse a été faite par épi info version avec un intervalle de confiance de 95%.</p> <p><strong>Résultats:&nbsp;</strong>il ressort de notre étude que 78,11%(464/594) de femmes connaissaient l'existence du cancer du col de l'utérus. Mais 58,59% et 60,27% de femmes ne connaissaient aucun facteur de risque et moyen de prévention respectivement. Seulement 7% connaissent l'existence d'un vaccin. Concernant l'attitude, 31,31% (186/594) avaient déjà désiré les informations sur la prévention du cancer du col de l'utérus, 26,94% (160/594) ont eu l'initiative de faire le test de dépistage et seulement 7,41% (44/594) ont fait le dépistage. Les difficultés évoquées étaient principalement le manque d'information 69,82% et le moyen de sensibilisation le plus fréquemment cité était les medias 75,9%.</p> <p><strong>Conclusion:&nbsp;</strong>malgré le bon niveau de connaissance sur l'existence du cancer du col de l'utérus, le niveau d'information sur les facteurs de risque et les moyens de prévention restent faibles. Le programme de sensibilisation devait être axé sur les facteurs de risque, les moyens de prévention et l'organisation des campagnes de dépistage. Ces informations peuvent permettre d'améliorer la planification des interventions de prévention.</p> Rama Djouedjon Dakenyo, Bruno Kenfack, Noel Vogue, Eva Fomo Tsakoue, Maurice Ela Ebode, Samuel Nambile Cumber Copyright (c) Mon, 12 Nov 2018 00:00:00 +0000 Should condoms be available in secondary schools? Discourse and policy dilemma for safeguarding adolescent reproductive and sexual health in Rwanda <p><strong>Introduction:&nbsp;</strong>as a response to challenges associated with adolescent reproductive and sexual health, policy makers in Rwanda have instituted preventive measures against risky sexual behaviours among adolescents. There is an ongoing debate on whether condoms should be made available in secondary schools to minimise risks related to unprotected sex in the context of a growing number of unintended pregnancies among school girls. This paper aims to examine the proposal of condom provision in Rwandan secondary schools through the analysis of policy narratives and the claims-making process.</p> <p><strong>Methods:&nbsp;</strong>a narrative policy analysis was used to understand the claims and counter claims surrounding the debate on the provision of condoms in secondary schools. Documents that were consulted include: the national reproductive health policy, the girls' education policy, the national behaviour change and communication policy for the health sector, the Rwanda national policy on condoms, the adolescent sexual reproductive health and rights policy and the Rwanda family planning policy.</p> <p><strong>Results:&nbsp;</strong>social and cultural norms in the Rwandan context consider adolescent sexual practices as immoral and thus reject the idea of providing condoms in secondary schools. However, some stakeholders promoting reproductive health suggest that ignoring that some adolescents are sexually active will prevent them from accessing appropriate reproductive and sexual health protective programmes. Consequently, adolescents will be exposed to risky sexual behaviours, a situation which may be counter productive to the overarching goal of safeguarding adolescent sexual health which might impact their long-term education goals.</p> <p><strong>Conclusion:&nbsp;</strong>making condoms available in secondary schools evokes different meanings among the debaters, underscoring the complex nature of the condom provision debate in Rwanda. This paper calls for a revision of policies related to adolescent reproductive and sexual health in order to answer to the issues of risky sexual behaviours among secondary school students.</p> Germaine Tuyisenge, Celestin Hategeka, Ruben Alba Aguilera Copyright (c) Tue, 13 Nov 2018 00:00:00 +0000 An evaluation of rational prescribing in hospital outpatient practice in Sierra Leone and assessment of affordability of a prescription as an outcome <p><strong>Introduction:&nbsp;</strong>medicines are the most frequently used intervention in healthcare. Rational and cost-effective prescribing is especially important in countries where access to effective medicines may be challenged by affordability issues. This study describes the prescribing patterns of doctors in government hospitals in Freetown, Sierra Leone, considering the scope for rationalising prescribing and reducing cost to the patient.</p> <p><strong>Methods:&nbsp;</strong>a descriptive, retrospective, cross-sectional study was conducted at four hospitals, using selected World Health Organisation (WHO) indicators applied to 600 prescriptions, after systematic random sampling. The data was analysed using SPSS.16 and the Index of Rational Drug Prescrib-ing (IRDP) calculated. The Spearman's rank coefficient was used to examine possible associations between the number of medicines prescribed as generics and from the National Essential Medicines List (NEML) and cost of the prescription respectively. Affordability was determined from the average number of days of work required to purchase a prescription, based on the minimum wage of the lowest paid government worker in Sierra Leone.</p> <p><strong>Results:&nbsp;</strong>the mean number of medicines per prescription from the four hospitals was 4.37(range 4.18-4.56) with 57% prescribed generically and 64% from the NEML. An antibiotic and injection were found on 72% and 26% of prescriptions respectively. The overall IRDP was 2.65/5. The aver-age cost per prescription was Le. 29,376.30 ($6.78), equivalent to 43 days of work of the lowest paid government worker.</p> <p><strong>Conclusion:&nbsp;</strong>in this study, opportunities were identified for significant rationalisation and improvement in cost-effective prescribing.</p> Christine Princess Cole, Philip Routledge Copyright (c) Tue, 13 Nov 2018 00:00:00 +0000 Etiologies of non-genetic epilepsies of child and adolescent, newly diagnosed in Ouagadougou, Burkina Faso <p><strong>Introduction:&nbsp;</strong>in sub-Saharan Africa, epilepsy is common and mainly concerns children before the age of 15 years. The data on childhood epilepsy is parcel, but a high prevalence of non-genetic epilepsy is frequently reported. EEG, TDM and MRI devices are rare. The aim of this work was to study the etiological aspects of non - genetic epilepsy of the child and adolescent, newly diagnosed in Ouagadougou, Burkina Faso.</p> <p><strong>Methods:&nbsp;</strong>this was a cross-sectional, descriptive, multicentric study, from 01/01/2016 to 31/12/2016, involving patients aged 0 to 18 years old, epileptic, newly diagnosed, in the city of Ouagadougou. Each patient included in the study was to have had an EEG and brain CT scan and/or brain MRI and to gather the anamnestic and electro clinical arguments for non-genetic epilepsy. Sociodemographic, clinical, EEG and neuroradiological data were analyzed. An univariate analysis was used to determine the electro-clinical and neuro-radiological characteristics associated with epilepsies of structural causes.</p> <p><strong>Results:&nbsp;</strong>in all 115 patients were collected, with an average age of onset of epilepsy of 8.2 years, a male predominance with a sex ratio to 1.67. Risk factors of epilepsy was present in 74.8%; They were dominated by perinatal events in 79.1%. Focal seizures, daily frequency of these seizures and focal epilepsy, were predominant, respectively in 53%, 58% and 60.9% of cases. Brain scan and Brain MRI where performed in 90.4% and 9.6% of patients, respectively. The brain sequelaes of perinatal adverse events, the sequelae of central nervous system infections, and the sequelae of cranial and brain trauma, with 34.8%, 14.8%, and 5.2% respectively, were the main causes of non- genetic epilepsies of the child and adolescent. No cause was identified in 37.4% of cases.</p> <p><strong>Conclusion:&nbsp;</strong>the improvement of policies in the field of maternal and child health and the generalization of the control of infectious and parasitic diseases, including malaria, may contribute to the reduction of non-genetic epilepsy in sub-Saharan Africa.</p> Djingri Labodi Lompo, Ousséini Diallo, Ben Aziz Dao, Romaric Bassole, Christian Napon, Jean Kabore Copyright (c) Tue, 13 Nov 2018 00:00:00 +0000 Lactating mothers' perception towards diarrheal disease in Bench-Maji Zone, South-West Ethiopia: mixed study design <p><strong>Introduction:&nbsp;</strong>acute diarrheal diseases are the leading cause of preventable death, especially among children under-five in developing countries. Worldwide and nationwide diarrheal disease is the second leading cause of death in under-five year children. Therefore, the aim of this study is to assess perception of lactating mothers' toward diarrheal disease in Mizan-Aman District, South-West Ethiopia.</p> <p><strong>Methods:&nbsp;</strong>community based cross-sectional quantitative study supplemented by qualitative study was employed. A total of 383 selected households with the lactating mothers were involved in the study. Data was collected through face-to-face interview technique by trained data collectors. Data was entered and analyzed using SPSS version 16. Multiple logistic regressions analysis was used to identify the independent predictors. Odds ratio, with 95% confidence level and P &lt; 0.05 were used to determine statistically significant association.</p> <p><strong>Results:&nbsp;</strong>the majority of the respondents had primary education (44.4%) and from rural area (52.2%). Multiple logistic regression analysis showed that the residence area [AOR = 4.79, CI (1.33,7.78), P&lt;0.003], educational status [AOR = 0.72, CI (0.55,1.29), P&lt;0.045], Wealth index [AOR = 8.9, CI (0.99,17.45), P&lt;0.001], knowledge [AOR = 2.34, CI (1.2-4.3) P&lt;0.023]. Perceived susceptibility [AOR = 0.44, CI (0.33,11.33), P&lt;0.001] and perceived severity of their child towards diarrheal disease [AOR= 0.24, CI (1.23,7.99), P&lt;0.033] had significant associations with the perception of the diarrheal diseases among lactating mothers'.</p> <p><strong>Conclusion:&nbsp;</strong>lactating mothers' perceptions towards their children of getting diarrheal disease and danger of the disease with primary education and above were better protected than mothers with no education. Thus, implementing effective information educational communication (IEC) programs that emphasize on the benefit of complying with nationally recommended practice to prevent diarrheal disease is important to reduce the risk.</p> Wadu Wolancho Debancho, Abraham Tamirat Gizaw, Fira Abamecha Ababulgu Copyright (c) Tue, 13 Nov 2018 00:00:00 +0000 Seroprevalence of dengue virus among children presenting with febrile illness in some public health facilities in Cameroon <p><strong>Introduction:&nbsp;</strong>a routine diagnosis of Dengue virus (DENV) infection is not usually conducted in hospitals. Because symptoms overlap, many potential febrile illnesses due to DENV may be confused for malaria, typhoid or paratyphoid (enteric) fever. The absence of data on DENV exposure rates among children attending health facilities could undermine management of this disease. This study aimed to investigate the seroprevalence of dengue virus infection in children presenting febrile illness in some public health facilities in Cameroon.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was performed in children ≤ 15 years attending seven urban and three semi-urban public hospitals of Cameroon. From each volunteer, 2ml of whole blood was collected and tested for dengue virus IgM, malaria (Pf/Pan antigens) and enteric fever (Typhoid IgM) using rapid diagnostic tests (RDT); in order to allow the healthcare workers to quickly put the positive cases under appropriate treatment. Positive cases of dengue virus infection were confirmed by indirect ELISA. Data analysis were performed using the statistical package for social sciences software, version 22.1.</p> <p><strong>Results:&nbsp;</strong>a total of 961 children were enrolled in the study and 492 (51.2%) were infected with at least one of the three pathogens. Overall, DENV IgM seroprevalence among febrile children was 14.4% (138/961). About 390 (40.6%) and 22 (2.3%) had malaria (Pf/Pan Ag) and enteric fever (Typhoid IgM) respectively. Co-infection with dengue virus was found in 51 (5.3%) participants. The dengue virus IgM seroprevalence was higher in Bankim (19.3%), Ntui (18.3%) and Douala (18.2%).</p> <p><strong>Conclusion:&nbsp;</strong>dengue virus infection seroprevalence appears to be low in children presenting with febrile illness in the studied health centres in Cameroon but call for more attention and research to further characterise the circulating strains of the dengue virus.</p> Salomon Bonsi Tchuandom, Thibau Flaurant Tchouangueu, Christophe Antonio-Nkondjio, Abel Lissom, Jean Olivier Ngono Djang, Etienne Philemon Atabonkeng, Assumpta Kechia, Godwin Nchinda, Jules-Roger Kuiate Copyright (c) Tue, 13 Nov 2018 00:00:00 +0000 Human immunodeficiency virus awareness and condom use among female adolescent prostitutes in Lagos, Nigeria <p><strong>Introduction:&nbsp;</strong>the cornerstone of HIV prevention among female adolescent prostitutes is awareness promotion complemented with advocacy on consistent and correct use of condom. The study aimed at reviewing HIV awareness and condom use among female adolescent prostitutes in Lagos communities, Nigeria.</p> <p><strong>Methods:&nbsp;</strong>it was a mixed-method study realized through a questionnaire-based survey and in-depth interviews of adolescent sex workers in Oyingbo and Yaba communities of Lagos State, Nigeria; conducted between 1<sup>st</sup>&nbsp;of April, 2014 and 30<sup>th</sup>&nbsp;of September, 2014. SPSS version 17.0 and content analysis were used in analyzing quantitative and qualitative data respectively.</p> <p><strong>Results:&nbsp;</strong>97.3% had heard about HIV/AIDS; with 86.9% being tested for HIV in the preceding 6 months. While there was consistent use of male condom in 99.7% of the respondents, 90% had experience with the use of female condom, however, 95.5% would allow non- use of condom for higher financial reward.</p> <p><strong>Conclusion:&nbsp;</strong>although the level of awareness of HIV/AIDS was high among the respondents, there is need to improve on the level of awareness and preventive strategies for HIV/AIDS, with more emphasis laid on the consistent and correct use of condom in this highly vulnerable class of people.</p> Babatunde Ajayi Olofinbiyi, Sogo Angel Olofinbiyi, Oladele Simeon Olatunya, Babatunde Olaniyi Rosiji, Rebecca Oluwafunke Olofinbiyi, Olunike Blessing Olofinbiyi, Olabode Oluwadare Akintoye, Oluwole Dominic Olaogun Copyright (c) Wed, 14 Nov 2018 00:00:00 +0000 Darier and Ferrand dermatofibrosarcoma of the breast <p>Darier and Ferrand dermatofibrosarcoma (DFS) is a cutaneous mesenchymal tumor, rare, representing 0.1% of malignant skin tumors and less than 5% of adult soft tissue sarcomas. The favorite sites are the trunk, followed by the extremities proximal then the head and neck. It often occurs in patients in their 3<sup>rd</sup>- 4<sup>th</sup>&nbsp;decades and presents clinically as plate or nodule lesion. It is a tumor with intermediate malignancy potential, good prognosis after complete resection, slow growth, very high risk of local recurence, but with low metastatic potential. Due to its rarity, very few studies have been devoted to it. We report an exceptional localization revealed by a mass in the breast. It is a 43-year-old patient who has consulted for an increase in the volume of the right breast, the clinical examination finds a mass ulcero-budding of 12cm/10cm. The biopsy shows the presence of a histiocytofibroma, a mastectomy was performed, and the histopathological examination with immunohistochemistry showed an intense and diffuse CD34 positivity, a focal positivity of AML (smooth muscle actin) and a constant negativity of desmin and PS100 thus confirming that it is a DFS. CT scan does not find any metastasis and a surveillance was adopted. It is a rare tumor and our observation is among of the first cases of mammary siege described in the literature. The main treatment remains a large surgery with margins of resection of at least 4 to 5cm, postoperative radiotherapy is advocated by second recurence. Systemic chemotherapy is not recommended, rigorous clinical practice must be maintained, because of slow evolution and high recurence of this tumor.</p> Nora Naqos Copyright (c) Wed, 14 Nov 2018 00:00:00 +0000 Prevalence of HIV related oral lesions in people living with HIV and on combined antiretroviral therapy: a Nigerian experience <p><strong>Introduction:&nbsp;</strong>oral lesions comprise significant clinical features of HIV infection and are often indicators of immune suppression. However, the advent of antiretroviral therapy has significantly reduced its prevalence. The aim of this study was to relate the prevalence of oral lesions of HIV to treatment outcome of Combined Antiretroviral Therapy (cART) in a Nigerian HIV adult population.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted on 491 People Living with HIV (PLWHIV) on cART from two HIV centres in Lagos state, Nigeria. The EC-clearing house guidelines were employed to categorise oral lesions. Presence or absence of these lesions was reconciled with CD4+ cell count as a measure of efficacy of cART treatment.</p> <p><strong>Results:&nbsp;</strong>a total of 491 PLWHIV on cART were enrolled, 366 (74.5%) were females and 125 (25.5%) were males. Age ranged between 18-80 years, with a mean of 41.2 ± 9.1 years. On examination, 12 (2.4%) patients presented with HIV oral lesions. Oral hyperpigmentation (10, 2.0%) was the most common lesion seen, followed by oral ulcers (2,0.4%). Majority (75%) of the affected patients were on a Lamivudine containing regimen. 7 out of the 12 patients with oral lesions had CD4+ cell count between 200-500 cell/mm<sup>3</sup>&nbsp;prior to cART initiation. Eleven (92%) of the patients with oral lesions had significant improvement of their CD4+ cell count after cART administration.</p> <p><strong>Conclusion:&nbsp;</strong>the prevalence of oral lesions in HIV patients on cART therapy in Lagos is low. Oral hyperpigmentation and oral ulcers are the most frequent lesions seen. The presence or absence of oral lesions were not associated with CD4+ cell count. Therefore, we conclude that the oral lesions seen in HIV patients on cART may not be a direct manifestation of the disease.</p> Eweka Olutola Mary, Ogbenna Ann Abiola, Gbajabiamila Titilola, Ogundana Oladunni Mojirayo, Akanmu Alani Sulaimon Copyright (c) Wed, 14 Nov 2018 00:00:00 +0000 Prevalence and risk factors of asymptomatic bacteriuria among children living with HIV in Lagos, Nigeria <p><strong>Introduction:&nbsp;</strong>HIV/AIDS has gradually become a chronic disorder following the success of combination chemotherapy. As a result of the persisting immune deficiency, certain risk factors predispose affected individuals to infections. The aim of the study was to determine the prevalence and identify risk factors of asymptomatic bacteriuria among HIV infected children.</p> <p><strong>Methods:&nbsp;</strong>this was a case control study conducted at the Lagos University Teaching Hospital from July 2010 to June 2011.Eighty-five children living with HIV were consecutively selected from the HIV clinic of the Lagos University Teaching Hospital and compared with 85 age and sex matched HIV negative controls for the occurrence of asymptomatic bacteriuria. Mid-stream urine samples were obtained from the participants and the samples were analyzed for microscopy, culture and sensitivity. Demographic and clinical data was obtained from the caregivers and clinical notes respectively. Data were analyzed utilizing SPSS version 17.</p> <p><strong>Results:&nbsp;</strong>the prevalence of asymptomatic bacteriuria was 24.7% among children living with HIV and 8.2% among un-infected children (p value 0.004). The stage of the disease, CD4 count, sex as well as age were risk factors for asymptomatic bacteriuria among children living with HIV.</p> <p><strong>Conclusion:&nbsp;</strong>asymptomatic bacteriuria is a prevalent problem among children living with HIV infection and urinary screening should be routine in the work up of febrile children living with HIV.</p> Adeseye Michael Akinsete, Chinyere Ezeaka Copyright (c) Wed, 14 Nov 2018 00:00:00 +0000 Les traitements du cancer de la vulve: expérience du Centre d’Oncologie d’Oujda <p>Le cancer de la vulve est une affection néoplasique rare, représentant moins de 5% des cancers génitaux de la femme. L'objectif de ce travail est de décrire le profil épidémiologique, clinique, paraclinique, thérapeutique et évolutif du cancer de la vulve chez la population de la région Oriental du Maroc, ceci à travers une analyse rétrospective de toutes les patientes suivies pour un cancer de la vulve, de juin 2007 à janvier 2014, et traitées au sein de l'Hôpital d'Oncologie du Centre Hospitalier Universitaire Mohamed VI de Oujda au Maroc. Notre analyse rétrospective a porté sur 34 patientes, d'une médiane d'âge de 65,7 ans, dont 52,9% étaient des multipares. Le motif de consultation dominant était le prurit dans 94.1% des cas. La moyenne du délai de consultation était de 16 mois, allant de 2 mois à 8 ans. L'ignorance et la pudeur ont été les causes majeures de ce retard diagnostique, puisque 73.5% des patientes avaient déjà une maladie localement avancée au diagnostic. Le traitement chirurgical a été proposé à 61.4% des cas, il a consisté en une vulvectomie radicale avec un curage inguinal bilatéral dans 68.5% des cas. Le recours à la radiothérapie adjuvante a été indiqué chez 41.2% des cas, 5.9% des patientes ont bénéficié d'une radiothérapie néo adjuvante, et 20,6% d'une radiothérapie exclusive associée à une chimiothérapie concomitante. La chimiothérapie palliative a été proposée pour 8.8% des patientes. Le taux de survie globale à 3 ans est à 65%, le taux de récidives locorégionales ou à distance est de 17.3% des cas. Les particularités culturelles et sociales des patientes de la région de l'Oriental du Maroc, qui sont suivies pour un cancer de la vulve, sont des facteurs influençant le traitement et ses résultats. Des efforts de prévention et de sensibilisation supplémentaires sont à mener afin de réduire l'incidence des stades localement avancés, et de permettre un traitement curatif à cette population.</p> Zineb Dahbi, Fouad Elmejjatti, Farid Naciri, Amine Guerouaz, Asmae Oabdelmoumen, Ali Sbai, Loubna Mezouar Copyright (c) Thu, 15 Nov 2018 00:00:00 +0000 Cholécystectomie laparoscopique sur situs inversus <p>La coeliochirurgie est la technique de référence pour le traitement de la lithiase vésiculaire symptomatique. Jusqu’à ce jour, seuls 42 cas de cholécystectomie laparoscopique chez des patients présentant un&nbsp;<em>situs inversus</em>&nbsp;ont été publiés. Ainsi, nous rapportons un nouveau cas d'un patient, suivi pour cardiopathie congénitale complexe à type de ventricule unique sur situs inversus et dextrocardie. C’est un patient qui était hospitalisé pour prise en charge chirurgicale de lithiase vésiculaire symptomatique. Une cholécystectomie laparoscopique était réalisée. La disposition des trocarts et l’abord chirurgical étaient complètement inverses et symétrique par rapport à l’abord laparoscopique normal.</p> Rachid Boufettal, Driss Erguibi, Amal Hajri, Anass Idrissi, Saad Rifki Jai, Farid Chehab Copyright (c) Thu, 15 Nov 2018 00:00:00 +0000 Level and factors associated with uptake of Human papillomavirus infection vaccine among female adolescents in Lira District, Uganda <p><strong>Introduction:&nbsp;</strong>the principal burden of human papillomavirus (HPV) infections is cervical cancer. Cervical cancer ranks as the fourth most common malignancy in women affecting 500,000 women each year with an estimated 266,000 deaths. Uganda has one of the highest cervical cancer incidence rates globally with an age-standardised incidence rate per 100,000 of 47.5. This study assessed the level and the factors associated with uptake of HPV vaccine by female adolescents in Lira district, Uganda.</p> <p><strong>Methods:&nbsp;</strong>a mixed methods approach was employed using a survey among 460 female adolescents. We collected data using an interviewer-administered questionnaire. We interviewed five key informants and conducted ten in-depth interviews. Uptake was defined as completing three doses of the vaccine as per the recommended schedule. Prevalence risk ratios were used as measures of association and were computed using modified poison regression. Content analysis was used for qualitative data.</p> <p><strong>Results:&nbsp;</strong>the mean age of the respondents was 13.97 (SD=1.24). Uptake was at 17.61% (81/460). The factors associated with uptake of HPV vaccine were: attaining ordinary level of education (aPR 1.48, 95%CI 1.11-1.97), positive attitude towards the vaccine (aPR 3.46, 95%CI 1.70-7.02), receiving vaccine doses from different vaccination sites (aPR 1.59, 95% CI 1.10-2.28) and encouragement from a health worker (aPR 1.55, 95%CI 1.15-2.11) or Village Health Team (aPR 3.47, 95%CI 1.50-8.02) to go for the vaccine. Other factors associated with uptake of HPV vaccine included; the existence of community outreaches (aPR 1.47, 95%CI 1.02-2.12), availability of vaccines at vaccination sites (aPR 4.84, 95%CI 2.90-8.08) and receiving full information about the vaccine at the vaccination site (aPR 1.90, 95%CI 1.26-2.85).</p> <p><strong>Conclusion:&nbsp;</strong>HPV vaccine uptake was low in Lira district. Efforts to improve uptake of HPV vaccine should focus on ensuring a consistent supply of vaccines at the vaccination sites, health education aimed at creating a positive attitude towards the vaccine, sensitisation of the adolescents about the vaccine and conducting community outreaches.</p> Esther Kisaakye, Justine Namakula, Christine Kihembo, Angela Kisakye, Peter Nsubuga, Juliet Ndimwibo Babirye Copyright (c) Thu, 15 Nov 2018 00:00:00 +0000 Outcome of open excisional breast biopsies in Abakaliki, South-East Nigeria <p><strong>Introduction:&nbsp;</strong>open excisional breast biopsy is a known modality for treatment of breast lumps especially in developing countries. Other sophisticated methods are available for management of breast lumps in more advanced nations. Our aim in this study was to review the outcome of open excision breast biopsies in our setting with a view to improving patient management.</p> <p><strong>Methods:&nbsp;</strong>this study was conducted at the National Obstetric Fistula Centre, Abakaliki, South East Nigeria among women who had excision breast biopsy between January 2015 and December 2016. Data was analysed using Statistical Package for Social Sciences (SPSS), version 21.</p> <p><strong>Results:&nbsp;</strong>a total of 107 case folders were reviewed in this study. The mean age of the women was 27 ± 10 years. Overlying breast incision was the preferred route in 78(72.9%), periareolar incision in 28(26.2%), and Gillard Thomas's method (infero-lateral submammary sulcus incision) used in one patient with bilateral multiple breast lumps (0.9%). The complications recorded in this study were haematoma in 3(2.8%), wound infection in 5(4.7%) and wound breakdown in 1(0.9%). Hypertrophic scar was found in 2(1.8%) patients at follow-up. Overall, most patients were satisfied with the aesthetic outcome of their surgery.</p> <p><strong>Conclusion:&nbsp;</strong>open excision breast biopsy is a useful modality for management of breast diseases in our setting. Complication rates are minimal. Both overlying and periareolar breast incisions results in aesthetically satisfactory scar in our practice. Inferior-lateral sub mammary sulcus skin incision is useful when the lumps are multiple and located at different quadrants of the breast. Appropriate use of drain helps to reduce the incidence of haematoma.</p> Maradona Ehikioya Isikhuemen, Monday Osaze Eliboh, Uche Emmanuel Eni, Kenneth Chinedu Ekwedigwe, Ileogben Sunday-Adeoye Copyright (c) Thu, 15 Nov 2018 00:00:00 +0000 Glomus tumor of the leg: a case report <p>Glomus tumors are uncommon benign tumors developing from the neuro-myo-arterial glomus body. They are typically located in the fingers. The extra-digital involvement is unusual and makes diagnosis difficult. Only few cases have been reported in literature. We report an exceptional case of a glomus tumor of the lower leg in a 65-year-old male. The diagnosis was clinically suspected and confirmed by a biopsy. Surgical excision gave immediate pain relief. The aim of this report is to make the surgical community more aware of this entity based on the analysis of our own experience and a review of the literature.</p> Mohamed Ali Sbai, Sofien Benzarti, Wafa Gharbi, Wadia Khoffi, Riadh Maalla Copyright (c) Thu, 15 Nov 2018 00:00:00 +0000 Young man with painful black dots on left foot <p>A 30-year-old previously healthy man was admitted to the emergency room due painful black dots on the left foot. On physical examination, multiple erythematous macules with central black dots on left heel (A) were observed. After topical anaesthesia (lidocaine 40mg/g cream), several spines were removed. The patient was seen in a dermatology consultation complaining of local pain 22 days later. Dermatological examination revealed local erythema, and dermoscopy showed several punctiform wounds, some centered by dark brown pinpoint dots or dashes (B). The diagnosis of injuries caused by spicules of cactus in the heel was made. The removal of the fragments from the patient's foot and the follow-up visits to dermatologist led to a successful treatment that allowed the patient to return to work promptly. He was walking on an ecologic trail in Arraial do Cabo, Rio de Janeiro, when the pain started (C). Encounters with cactus spines, needles, prickles and glochids (barbed hairs) are rarely reported. Common signs of a retained cactus spine include: sharp pain as pressure is applied to the site, and discoloration of the skin. Smaller spines of the cactus plant break off easily on contact, and the fragments frequently get embedded in the skin and soft tissues. The lesion is predominantly aseptic. The most frequently affected area by cactus spine-related injuries are extremity and non-fluctuant tender skin papules which is the most frequently presented. Dermoscopy can be useful in helping to promptly detect and remove remaining embedded spines as seen in this cactus injury. Clinicians should consider injuries by cactus's spines in the differential diagnosis of retained foreign material.</p> Fred Bernardes Filho, Loan Towersey Copyright (c) Fri, 16 Nov 2018 00:00:00 +0000 Bullous cutaneous reactions <p>Allopurinol (xanthine oxidase inhibitor) is indicated for the treatment of symptomatic hyperuricemia, the treatment of gout and the treatment and prevention of uric and calcium lithiasis. It is one of the leading drugs for severe toxic dermal reactions, such as Lyell Syndrome (NET), Stevens-Johnson Syndrome (SJS) and Dress Syndrome (Drug reaction with eosinophilia and systemic symptoms). We report the case of a 45-year-old woman who was hospitalized for bullous skin rashes, without pathological history, the patient had generalized erythematous and bullous rash (A, B and C) one week after taking allopurinol, prescribed by his rheumatologist for a gout. The diagnosis of bullous Cutaneous reaction due to allopurinol was retained, allopurinol was discontinued and the course was favorable with the disappearance of cutaneous lesions.</p> Mohamed Jira, Taoufik Amezyane Copyright (c) Fri, 16 Nov 2018 00:00:00 +0000 Analyse ergonomique semi-quantitative des contraintes biomécaniques du rachis cervical parmi les opérateurs sur écran dans les établissements universitaires tunisiens <p><strong>Introduction:&nbsp;</strong>évaluer les contraintes biomécaniques associées aux cervicalgies parmi les opérateurs sur écran.</p> <p><strong>Méthodes:&nbsp;</strong>étude ergonomique réalisée au prés de 325 opérateurs sur écran dans 25 établissements de l’université du centre tunisien, basée sur une étude anthropométrique du poste du travail sur écran et une analyse semi-quantitative sur des enregistrements vidéo des activités des travailleurs conduits sur une période représentative de 30 minutes.</p> <p><strong>Résultats:&nbsp;</strong>la prévalence des cervicalgies évaluée à 72,3%, a concerné une population de travailleurs qui exerçait avec un siège et un plan de travail inadaptés (84,6%) et un écran bas situé par rapport au regard horizontal (81,2%). L’analyse semi-quantitative par enregistrement vidéo du poste de travail a conclu que la nuque était maintenue en flexion franche de plus de 40 degrés sur 69% du temps global du travail. La flexion latérale a été visible sur 50,3% du temps de travail et la rotation droite ou gauche sur 57,4% du temps de travail. Ainsi, Les opérations de prise d’information de l’écran, de regard du clavier et de consultation des documents se sont dégagées comme les plus de contraignantes pour la nuque sur le plan gestuel et postural.</p> <p><strong>Conclusion:&nbsp;</strong>nos résultats mettent en évidence l’importance des contraintes biomécaniques associées à la conception du poste de travail sur écran non conforme aux dimensions anthropométriques ergonomiquement recommandées. Ces contraintes sont associées à une prévalence élevée des cervicalgies traduisant la nécessité d’aménagement ergonomique de ces postes de travail pour prévenir ce fléau.</p> Amira Omrane, Olfa Jlassi, Salma Kammoun, Ines Tka, Awatef Kraiem, Mohamed Adnène Henchi, Taoufik Khalfallah, Lamia Bouzgarrou Copyright (c) Mon, 19 Nov 2018 00:00:00 +0000 Cutaneous leiomyosarcoma on the trunk: unusual presentation with an aggressive course – case report and review of literature <p>Primary cutaneous leiomyosarcoma (PCL) are soft-tissue sarcoma, arising in the dermis, with or without extension into the subcutis. They are thought to have an indolent course compared to their subcutaneous counterparts, they may recur but rarely metastases. We report the case of a patient with a PCL arising in the anterior trunk wall who developed pulmonary, bone and retroperitoneal metastases 6 years after wide surgical excision of the primary tumor.</p> Lina Hmida, Feryel Letaief, Raoudha Doghri,, Khalil Mahjoubi, Amina Mokrani, Yosra Yahiaoui, Azza Gabsi, Nesrine Cheraiet, Henda Rais, Mouna Ayadi, Amel Mezlini Copyright (c) Mon, 19 Nov 2018 00:00:00 +0000 Lymphangiome kystique du cordon spermatique: à propos d’un cas <p>Nous rapportons le cas d'un nourrisson âgé de 1 an, admis à notre formation pour prise en charge d'une tuméfaction inguino-scrotale gauche évoluant depuis 4 mois et augmentant progressivement de volume et devenant douloureuse. L'examen clinique a trouvé un enfant conscient, stable sur le plan hémodynamique et respiratoire, apyrétique; avec une tuméfaction inguino-scrotale gauche molle transilluminable douloureuse à la palpation. Une échodoppler inguinale a objectivé une masse multiloculée de 30 mm. Une TDM abdomino-pelvienne a été en faveur d'un lymphangiome kystique (A) objective l'image clinique de la tuméfaction; (B) objective sur une TDM abdomino-pelvienne l'image en faveur d'un lymphangiome kystique; (C) objective l'aspect du lympangiome après exploration par voie inguinale qui était en contact intime avec le cordon spermatique et arrivant jusqu'au scrotum; on a opté pour la résection du kyste après dissection minutieuse tout en préservant les éléments nobles. (C) montre l'état final après 3 mois. La nature du kyste a été confirmée par l'étude anatomopathologique. Le recul est actuellement de 6 mois; on a remarqué l'apparition de la tuméfaction au niveau controlatéral.</p> Mohamed Amine Oukhouya Copyright (c) Mon, 19 Nov 2018 00:00:00 +0000 Thrombose bilatérale post-traumatique des artères rénales <p>La thrombose post-traumatique des artères rénales est une complication rarement vue, secondaire à des lésions vasculaires rénales soit par lésion intimale ou compression vertébrale. La conduite diagnostique reste un sujet de discussion compliqué nécessitant la prise en considération de plusieurs facteurs de la part du médecin et du malade.</p> Ilyas Derdabi, Hajar El Jouadi, Leila Jroundi Copyright (c) Mon, 19 Nov 2018 00:00:00 +0000 Epidemiology of bacterial meningitis in children admitted to Gondar University Hospital in the post pneumococcal vaccine era <p><strong>Introduction:&nbsp;</strong>community acquired bacterial meningitis (CABM) is responsible for high mortality and disabling sequelae. Introduction of pneumococcal conjugate vaccine (PCV-10) and&nbsp;<em>haemophilus influenzea</em>&nbsp;type b (Hib) has changed the epidemiological and clinical features of patients presenting with CABM as it is shown in different literatures over the last decade. The aim of this study was to assess the clinical and epidemiologic features and outcomes of CABM after the introduction of PCV-10 in Gondar University Hospital (GUH).</p> <p><strong>Methods:&nbsp;</strong>this is a retrospective study among children between 2 months and 14 years of age discharged from Gondar University Hospital. All patient records discharged with a diagnosis of meningitis at GUH were reviewed from September 2011 - September 2013. The data was collected using a structured questionnaire from the patient record charts and analysis was done using SPSS-20.</p> <p><strong>Results:&nbsp;</strong>80 cases (1.6%) of CABM out of 4996 admissions were identified. There were 60 (75%) cases of CABM using WHO criteria of cerebrospinal fluid leukocytosis (CSF) &gt; 100cells/mm<sup>3</sup>, or 10-100cells/mm<sup>3</sup>&nbsp;with either hypoglycorrhea or increased protein; and 20 (25%) with culture confirmation.&nbsp;<em>S. Pneumoniae</em>&nbsp;was the most frequent pathogen identified in 14 (70%) children. The most common age group were infants 2-12 month old (n = 32, 40%). Children with adverse outcomes had shown a higher frequency of being older children (p = 0.045), loss of consciousness (p = 0.046), seizure at admission (p &lt; 0.01), and a positive CSF culture (p = 0.03).</p> <p><strong>Conclusion:&nbsp;</strong>introduction of PCV-10 has shown a decreased admission rate, mortality, and neurologic sequelae due to CABM.</p> Ashenafi Tazebew Amare, Zemene Tigabu Kebede, Henry Delois Welch Copyright (c) Tue, 20 Nov 2018 00:00:00 +0000 Comparative analysis of serum trace element levels in women with invasive cervical cancer in Lagos, Nigeria <p><strong>Introduction:&nbsp;</strong>trace elements although present in minute quantities in human blood, they play a vital role in many biochemical enzymatic reactions and have been examined critically as a potential key factor in various human diseases including cancers. This study was aimed to determine the association between serum levels of trace elements and invasive cancer of the cervix.</p> <p><strong>Methods:&nbsp;</strong>this was an analytical cross-sectional study carried out among women seen at the Lagos University Teaching Hospital (LUTH). Fifty histologically diagnosed patients with squamous cells carcinoma of the cervix, who had not had any treatment and 100 cancer-free volunteers were recruited. A structured interviewer-administered questionnaire was used to collect relevant data following which venous blood sample was obtained from each participant. Serum zinc, copper and selenium concentrations were then measured. The associations of serum trace elements and invasive cervical cancer were tested using the independent sample t-test. All significances were reported at P&lt;0.05.</p> <p><strong>Results:&nbsp;</strong>there were significantly low serum levels of zinc and selenium in cervical cancer patients with no significant difference seen in the serum level of copper among cervical cancer patients compared to their cancer-free control counterparts.</p> <p><strong>Conclusion:&nbsp;</strong>these alterations in trace elements levels may be important in the pathogenesis of cervical cancers; however, future robust prospective studies are needed to determine if routine provision of these supplements will result in improved cervical cancer treatment outcomes in Nigerian women.</p> Kehinde Sharafadeen Okunade, Olayemi Olubunmi Dawodu, Omolola Salako, Gbemisola Eniola Osanyin, Adeyemi Adebola Okunowo, Rose Ihuoma Anorlu Copyright (c) Tue, 20 Nov 2018 00:00:00 +0000 Prevalence and risk factors of gestational diabetes mellitus in a population of pregnant women attending three health facilities in Limbe, Cameroon: a cross-sectional study <p><strong>Introduction:&nbsp;</strong>there are few studies regarding gestational diabetes mellitus (GDM) in the South West Region of Cameroon. We aimed at determining the prevalence and risk factors of GDM in three health facilities in the Limbe health district, Cameroon.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was carried in one secondary and two primary healthcare facilities in Limbe, Cameroon during the period 1<sup>st</sup>&nbsp;November 2016 to 31<sup>st</sup>&nbsp;January 2017. We administered a pretested questionnaire on 200 consenting pregnant women at 24-28 weeks' gestation. We carried out a 2-hr oral glucose tolerance test after fasting overnight. GDM was diagnosed when ≥1 plasma glucose (PG) test result was abnormal according to the IADPSG criteria (FPG ≥92 mg/dL, PG 1-hr 180mg/L, PG 2-hr 153 mg/dL). Data analysis was with Epi-Info<sup>TM</sup>&nbsp;version 3.5.4. Associations were analyzed with the Pearson's chi squared and Fischer's exact test where appropriate. Statistical significance was set at p &lt; 0.05.</p> <p><strong>Results:&nbsp;</strong>the prevalence of GDM was 20.5% and respondents' mean age was 27.8 (SD 5.7) years. Majority, 13.5% participants had abnormal FPG alone, while 3.5% had any two abnormal values. GDM was associated with: advanced maternal age (OR 3.4: 95% CI 1.7-7.0; P&lt;0.001), BMI≥30 kg/m<sup>2</sup>&nbsp;(OR 6.2 : 95% CI 2.9-13.1, P&lt;0.001), past history of unexplained stillbirth (OR 5.7: 95% CI 2.5-12.9, P&lt;0.001) and history of macrosomia (OR 8.5:95% CI 3.8-19, P&lt;0.001).</p> <p><strong>Conclusion:&nbsp;</strong>with the high prevalence of GDM, identification of its associated factors has the potential to be a target of intervention to prevent poor obstetrical outcomes.</p> Thomas Obinchemti Egbe, Elvis Songa Tsaku, Robert Tchounzou, Marcelin Ngowe Ngowe Copyright (c) Tue, 20 Nov 2018 00:00:00 +0000 Does pre-diagnostic loss to follow-up among presumptive TB patients differ by type of health facility? An operational research from Hwange, Zimbabwe in 2017 <p><strong>Introduction:&nbsp;</strong>while there are many studies assessing the pre-treatment loss to follow-up (LFU) among tuberculosis patients in public sector, there is no evidence from private-for-profit health sector and pre-diagnostic LFU from Zimbabwe. We aimed to assess the gaps in the cascade of care of presumptive TB patients registered during January-June 2017 in different types of health facilities in Hwange district, Zimbabwe.</p> <p><strong>Methods:&nbsp;</strong>this was a cohort study involving review of routine programme data. Pre-diagnostic LFU was defined as the proportion of presumptive TB patients not tested using sputum microscopy or Xpert MTB/RIF. A log binomial regression was done to assess factors associated with pre-diagnostic LFU.</p> <p><strong>Results:&nbsp;</strong>of 1279 presumptive TB patients, 955(75%) were tested for TB and 102(8%) were diagnosed as having TB. All TB patients were started on treatment. Pre-diagnostic LFU (overall 25%) was significantly higher among patients visiting private-for-profit health facilities (36%), local self-government run council health facilities (35%) and church-run mission health facilities (25%) compared to government health facilities (14%). Pre-diagnostic LFU was significantly higher among patients in rural areas (30%) compared to urban areas (18%). Type of health facility was associated with pre-diagnostic LFU after adjusting for HIV status and area of residence.</p> <p><strong>Conclusion:&nbsp;</strong>while pre-diagnostic LFU was high, there was no pre-treatment LFU. Pre-diagnostic LFU was especially high in private-for-profit and council health facilities and rural areas. National TB Programme should take immediate steps to improve access in rural areas and support the private-for-profit and council health facilities by improving sputum collection and transport.</p> Munekayi Padingani, Ajay Kumar, Jaya Prasad Tripathy, Nyasha Masuka, Sidingiliswe Khumalo Copyright (c) Wed, 21 Nov 2018 00:00:00 +0000 Schistosoma mansoni infection and its association with nutrition and health outcomes: a household survey in school-aged children living in Kasansa, Democratic Republic of the Congo <p><strong>Introduction:&nbsp;</strong>schistosomiasis (SCH) is an important public health problem in developing countries and school-aged children are the most affected. This study explored health and nutritional status and their correlation with SCH in children attending primary school (3rd to 6th class) living in the area of Kasansa in the Democratic Republic of Congo.</p> <p><strong>Methods:&nbsp;</strong>across-sectional household survey was carried out in Kasansa health area in February 2011. Children whose parents reported to attend primary school (3<sup>rd</sup>&nbsp;to 6<sup>th</sup>&nbsp;class) were included. Socio-demographic characteristics, information on morbidity history and risk factor were collected using a semi-structured questionnaire.&nbsp;<em>S. mansoni</em>&nbsp;and malaria infection were assessed using the Kato-katz technique and rapid diagnostic test, respectively. Haemoglobin concentration was also performed using a portable HemoControl device. Bivariate and multiple logistic regressions were used to assess risk factors for&nbsp;<em>S. mansoni</em>.</p> <p><strong>Results:&nbsp;</strong>a total of 197 school aged children participated in the study with a median age of 12 years and 53.8% of them were boys. The overall health status of the children was poor with very high prevalences of&nbsp;<em>S. mansoni</em>&nbsp;infection (89.3%), malaria infection (65.1%), anaemia (61.4%) and stunting (61.0%). Regular contact with river water was the most important risk factor (OR: 11.7; p&lt;0.001) related to SCH infection. A low haemoglobin concentration was significantly associated with a SCH infection (OR: 12.3; p=0.003) and egg load was associated with stunting (OR: 12.4; p=0.04). Children from farmers were more at risk for low school performance (OR: 5.3; p=0.03).</p> <p><strong>Conclusion:&nbsp;</strong>high prevalence of&nbsp;<em>Schistosoma mansoni</em>&nbsp;and malaria infection was observed in the study population living in Kasansa area. Moreover, they presented a high burden of anaemia, chronic malnutrition and low school performance. An integrated disease control and management of these diseases and their consequences, endorsed by surveillance, is needed.</p> Madeleine Mbuyi Kabongo, Sylvie Linsuke, Sylvain Baloji, Faustin Mukunda, Inocêncio da Luz Raquel, Christine Stauber, Jean-Pierre Van Geertruyden, Pascal Lutumba Copyright (c) Wed, 21 Nov 2018 00:00:00 +0000 Biopsy proven lupus nephritis in a black male patient in West Africa with systemic lupus erythematosus: case report <p><em>Lupus nephritis</em>&nbsp;(LN) is a complication of systematic&nbsp;<em>lupus erythematosus</em>&nbsp;(SLE) with significant impact on morbidity and mortality. It is known commonly to affect females but has worse prognosis when males or blacks are affected. In a setting with deficiency in health care delivery, the diagnosis and adequate management of SLE patients becomes difficult and hence less cases of&nbsp;<em>lupus nephritis</em>&nbsp;in black males have been reported. We present a case of a male black patient with SLE who presented with&nbsp;<em>neurolupus, serositis</em>, skin manifestations and Class IV/V&nbsp;<em>lupus nephritis</em>&nbsp;on histology. Our case highlights the challenges in the management of&nbsp;<em>lupus nephritis</em>&nbsp;and the complications with immunosuppression in an attempt to induce remission. There is the need for high index of suspicion for the diagnosis of&nbsp;<em>lupus nephritis</em>&nbsp;especially in black males for prompt management to get the best outcome.</p> Elliot Koranteng Tannor, Kwame Yeboah-Mensah Copyright (c) Thu, 22 Nov 2018 00:00:00 +0000 Tumeur bénigne de la cavité buccale: granulome idiopathique de la langue <p>Le granulome de la cavité buccale constitue la circonstance de découverte de plusieurs pathologies comme la sarcoïdose, la maladie de Crohn, la tuberculose, la syphilis et les tumeurs malignes. Son origine idiopathique est classique dans le syndrome de Melkerson Rosenthal. A ce propos, nous rapportons l'observation originale d'un granulome idiopathique de la langue non secondaire à un syndrome de Melkerson Rosenthal et faisant partie des tumeurs bénignes de la cavité buccale. Il s'agit d'une patiente âgée de 60 ans sans antécédents pathologiques particuliers qui a présenté un mois avant son admission une gêne au cours de la mastication secondaire à une tuméfaction au niveau du bord libre de la langue. A l'examen, elle avait une excroissance au niveau du bord latéral droit de la langue faisant 15mm de grand axe. Sa langue n'était pas plicaturée et il n'y avait pas d'adénopathies cervicales. Le reste de l'examen somatique était sans particularités. L'IRM de la cavité buccale avait montré une lésion tissulaire nécrosée du bord libre droit de la langue mobile, d'allure suspecte mesurant 15x12x19mm sans signes d'extension au pédicule lingual homolatéral ni au plancher buccal et sans adénomégalies cervicale. La biopsie de la lésion de la langue avait montré des granulomes épithélioïdes et giganto-cellulaires sans nécrose caséeuse et sans signes histologiques de malignité. Sur le plan biologique, il n'y avait pas de syndrome inflammatoire, ni de leucopénie ou de lymphopénie. Le bilan étiologique à la recherche d'une étiologie sous-jacente était négatif: sérologie syphilis, bilan phosphocalcique, dosage de l'enzyme de conversion de l'angiotensine, intradermo réaction à la tuberculine, radiographie du thorax, scanner thoraco-abdomino pelvien et examen ophtalmologique. Finalement, le diagnostic de granulome idiopathique a été retenu devant l'absence d'arguments en faveur de son caractère secondaire.</p> Ines Kechaou, Imène Boukhris Copyright (c) Thu, 22 Nov 2018 00:00:00 +0000 Evaluation of sexual and gender-based violence program in Harare City, Zimbabwe, 2016: a descriptive cross-sectional study <p><strong>Introduction:&nbsp;</strong>in Zimbabwe, there is a gap between sexual violence (SV) survivors' health care needs versus the existing facilities. Harare city started Sexual Gender Based Violence (SGBV) project in 2011, with the aim to reduce SV morbidity.Only 592 (42%) of 1425 SV survivors reported for medical services within 72 hours in 2015. HIV post-exposure prophylaxis (PEP) is effective within 72hours of post exposure. We evaluated the program performance in Harare city.</p> <p><strong>Methods:&nbsp;</strong>we conducted a process-outcome evaluation using a logic model. We purposively recruited all eight SGBV sites and key informants. We randomly selected 27nurses into the study. Interviewer-administered questionnaires and checklists were used to collect data. To generate frequencies, means and proportions we used Epi info 7.</p> <p><strong>Results:&nbsp;</strong>the program adequately received inputs except for counselling rooms (1/8). About 4285 survivors were recorded from 2013-2016. Of these, 97% were counselled, 93% received HIV test, 41% reported to the clinic within 72hrs of post-rape, and 12% received PEP. About 16% of the total survivors were followed up. The programme failed to meet its targets on decentralised sites (8/10), awareness campaigns(16/32) and sensitisation activities(16/32). About 500(12.5%) IEC materials were distributed. All 96-targeted supervisory visits were achieved. Two ofeight district supervisors were trained. Majority of health workers(25/35) citedlack of awareness as major reasons for underperformance.</p> <p><strong>Conclusion:&nbsp;</strong>availability of resources did not translate to program performance. Most survivors were not reporting to the clinic timeously due to the low level of awareness of the programme to the community, hence were not protected from getting HIV through PEP. The programme was not well disseminated, as most supervisors were not trained. Following this evaluation, we distributed150 IEC materials to each of the eight facilities. A follow-up study on outcomes of clients referred for services and training of district officers were recommended.</p> Zvanaka Sithole, Notion Tafara Gombe, Tsitsi Juru, Prosper Chonzi, Gerald Shambira, Peter Nsubuga, Mufuta Tshimanga Copyright (c) Thu, 22 Nov 2018 00:00:00 +0000 Tumeur de la voie excrétrice supérieure et hydronéphrose due à un syndrome de la jonction pyélo-urétérale: une association rare <p>L'association tumeur de la voie excrétrice supérieure et hydronéphrose due à un syndrome de la jonction pyélo-urétérale est une entité rare. En effet, les tumeurs de la voie excrétrice supérieure et l'hydronéphrose ont classiquement une relation de cause à effet. Cette dernière est due le plus souvent à l'obstruction par une tumeur de l'uretère ou de la jonction pyélo-urétérale. Nous rapportons le cas d'un patient de 66 ans, aux antécédents de tabagisme et de pyélonéphrite droite, présentant des douleurs lombaires droites évoluant par intermittence depuis plusieurs mois sans hématurie. L'échographie a montré une dilatation des cavités pyélo-caliciels avec réduction majeur de l'index cortico-médullaire du rein droit. L'uroscanner a douté entre une dysplasie kystique du rein droit, et une hydronéphrose droite sur syndrome de la jonction pyélo-urétérale avec des images bourgeonnantes intra rénales faisant suspecter une tumeur pyélique. Le bilan a été complété par une cytologie urinaire quie est revenue positive. Une néphro-urétérectomie droite par laparotomie a été réalisé et l'examen anatomopathologique a confirmé qu'il s'agit bien d'un carcinome urothélial des voies excrétrices supérieures.</p> Soufiane Ennaciri, Jean Paul Omana Copyright (c) Thu, 22 Nov 2018 00:00:00 +0000 Evaluation of the adverse events following immunization surveillance system in Guruve district, Mashonaland Central 2017 <p><strong>Introduction:&nbsp;</strong>an adverse event following immunisation is any untoward medical occurrence which follows vaccination. Frequency of adverse events ranges from 13% to 34% and they should be reported regardless of severity. From the beginning of 2016 to mid-2017, Guruve district in Zimbabwe did not report any AEFIs. This suggests the surveillance system may be failing to detect adverse events. We therefore evaluated the AEFI surveillance system in Guruve district.</p> <p><strong>Methods:&nbsp;</strong>we conducted a surveillance system evaluation using the updated Centers for Disease Control guidelines for evaluating public health surveillance systems. We interviewed health workers and caregivers of babies under 2 years in Guruve district. We also reviewed all records on AEFI surveillance for the period of January 2016 to November 2017.</p> <p><strong>Results:&nbsp;</strong>we recruited 31 health workers and 33 caregivers into the study. Between January 2016 and mid-2017, 39% of the caregivers had children who had suffered AEFIs and 45% of the health workers had encountered AEFIs but none had been notified. The main reasons for failure to report AEFIs included health workers' fear of personal consequences and caregivers thinking that an adverse event was not serious enough to report. Knowledge of the surveillance system was good amongst the majority of health workers. All the resources needed by the surveillance system were available.</p> <p><strong>Conclusion:&nbsp;</strong>we concluded that health workers in Guruve district were afraid to report adverse events following immunization and caregivers were reluctant to report mild adverse events hence the surveillance system was performing poorly and was not useful. However, the stability of the system and the good knowledge gives a good foundation for improving the surveillance system.</p> Mutata Constantine, Tshuma Cremance, Tsitsi Patience Juru, Shambira Gerald, Gombe Tafara Notion, Nsubuga Peter, Tshimanga Mufuta Copyright (c) Thu, 22 Nov 2018 00:00:00 +0000 Unusual hematoma after spinal anesthesia <p>A 45-year-old female, obese with a BMI of 39.5 was scheduled to undergo hysteroscopy for endometrial hyperplasia under spinal anesthesia. She was diagnosed with well controlled diabetes and hypertension. She took neither antiaggregant nor anticoagulants and biological values were normal. In the operating theater, in sitting position, we could not detect the spinous process so we used the line of iliac crests as landmark for the level L4-L5. After several unsuccessful attempts to perform the spinal anesthesia at different levels, a swelling rapidly progressive and extensive appeared at the points of puncture. The intervention was reported and immediate lumbar scan showed a big subcutaneous hematoma in front of the last thoracic vertebras measuring 12x28x20 cm. Hemodynamic values, hemoglobin and the size of the hematoma remained stable and surgical abstention was decided. Hematoma was caused by probable injury of the posterior branch of spinal artery, favored by difficult spinal anesthesia for patient obesity and lumbar hyperlordosis, hence the interest of ultrasound localization both for level L4-L5 and for spinous process in obese patient. Three weeks later, hematoma was completely resolved and hysteroscopy performed under general anesthesia. Biopsy revealed endometrial adenocarcinoma.</p> Jaouad Laoutid, Omar Laghzaoui Copyright (c) Thu, 22 Nov 2018 00:00:00 +0000 A challenging case of fungating malignant melanoma <p>We present the case of a 43-yearr-old male present with left arm pain from a football-sized mass over his left shoulder and arm. He had a history of 3cm melanoma on his left back 3 years ago and underwent resection and adjuvant radiation. However, he had recurrence of melanoma a year later with metastases to the left supra clavicular lymph nodes. He underwent further resection followed by multiple regimens of chemotherapy, which included vemurafenib, dabrafenib and trametinib. Unfortunately, his melanoma was aggressive and remained refractory to the currently available standard therapies. Physical examination as visualized in the figure. The patient eventually opted for a palliative total upper extremity amputation including shoulder joint. World Health Organization estimates around 132,000 new cases of melanoma are diagnosed globally every year. Melanoma is the fifth leading cancer in males and seventh leading cancer in females in the United States. Melanoma is deadliest of all skin cancers and its incidence continues to rise. While recent targeted immunotherapies have improved the survival period of melanoma, metastatic melanoma can be fatal even with the currently available therapies. The single most important preventive measure is to avoid excessive ultraviolet radiation and there should be heightened awareness of its risk factors among both clinicians and patients. Patient's education on prevention and early recognition are paramount for battling melanoma and for better outcomes. Novel biological therapies have undoubtedly made substantial progress and will likely change the landscape in the treatment of melanoma in the near future.</p> Krishna Mohan Baradhi Copyright (c) Thu, 22 Nov 2018 00:00:00 +0000 Hydronéphrose géante sur urétérocèle compliquée de lithiase urétérale <p>L'hydronéphrose géante est définie comme une importante dilatation des cavités pyélo-calicielles occupant une grande partie de la cavité abdominale, ou une dilatation contenant plus d'un litre d'urine débordant la ligne médiane. Elle est dûe le plus souvent à un syndrome de la jonction pyélo-urétérale. L'obstruction par urétérocèle compliquée de lithiase est une cause très rare. Nous rapportons le cas d'un patient de 45 ans, ayant comme antécédent des douleurs lombaires droites non explorées, qui a consulté pour une masse abdominale évoluant depuis quelques années associée à une constipation intermittente. L'examen clinique a objectivé une distension abdominale asymétrique avec une matité débordant la ligne médiane. L'échographie a montré une formation liquidienne multi-cloisonnée occupant toute la région abdomino-pelvienne droite et refoulant les structures digestives. L'uroscanner a dévoilé une énorme dilatation urétéro-pyélo-calicielle droite (pyelon mesurant 15,2cm) laminant complètement le parenchyme rénal avec absence d'excrétion du produit de contraste, en amont d'une urétérocèle compliquée d'un calcul de 2cm. Une néphro-urétérectomie a été réalisée par laparotomie et les suites post opératoires ont été simples.</p> Soufiane Ennaciri, Moulay Hassan Farih Copyright (c) Mon, 26 Nov 2018 00:00:00 +0000 A case of idiopathic giant megacolon in an obese patient <p>43-year-old man complaining of abdominal nausea starting 15 days earlier and vomiting was admitted to our emergency department. The patient was affected by a severe obesity with a BMI of 55.5; there was also a history of diabetes and hypertension. The abdomen was distended, diffusely painful, tympanic to percussion and the Blumberg sign was intensely positive; WBC count was 24,000x10<sup>3</sup>&nbsp;with marked neutrophilia, hemoglobin 9.6g/dl, with haematocrit 30.6%. A distended colon was present at plain RX abdomen while the CT could not be performed due to the high BMI of the patient. At laparotomy a giant idiopathic megacolon was found and a Hartmann procedure was performed. The patient was discharged 15 postop with no complication. The anatomopathological examination documented a normal colon tissue. Diagnosis in obese patients is often difficult because they are paucisintomatic and the physical examination is difficult to achieve.</p> Pietro Fransvea, Francesco Cortese Copyright (c) Mon, 26 Nov 2018 00:00:00 +0000 The contribution of the polio eradication initiative on the operations and outcomes of non-polio public health programs: a survey of programs in the African region <p><strong>Introduction:&nbsp;</strong>the effect of the Global polio eradication initiative (PEI) on public health programs beyond polio is widely debated. PEI contribution to other health programs has been assessed from the perspective of polio-funded personnel, which may introduce bias as PEI staff are probably more likely to show that they have benefited of other programs. We set out to identify and document how public health programs have benefited from the public health capacity that was provided at the country level as part of the PEI program in a systematic and standardized manner.</p> <p><strong>Methods:&nbsp;</strong>between July and November 2017, we conducted a mixed-methods cross-sectional study, which combined two methods: a multi-country quantitative survey and a qualitative study. We created a self-administered electronic multi-lingual questionnaire in English, French and Portuguese. The qualitative study, which followed an interim analysis of the quantitative survey, comprised interviews with national and subnational level staff in a few countries.</p> <p><strong>Results:&nbsp;</strong>a total of 127 public health workers from 43 of the 47 countries in the African WHO Region responded online. Most of the respondents 56/127 (42.7%) belonged to the immunization sector and 51/127 (38.9%) belonged to the emergencies and outbreaks sector. Respondents who identified themselves with the immunization (50/64 (78%)) and maternal health program (64/82 (78%)) reported the highest level of greatly benefiting from PEI resources. A total of 78/103 (76%) respondents rated PEI’s contribution data management system to their program very high and high. Of the 127 respondents, the majority 91 (71.6%) reported that the withdrawal of PEI resources would result in a weakening of surveillance for other diseases; 88 (62.9%) reported that there would be inadequate resources to carry out planned activities and 80 (62.9%) reported that there would be poor logistics and transport for implementation of activities. Cameroon, DRC, Nigeria and Uganda participated in the qualitative study. Each country had between 7-8 key informants from the national and sub-national level for a total of 31 key informants. Polio funds and other PEI resources have supported various activities in the ministries of health of the four countries especially IDSR, data management, laboratories and development of the public health workforce. Respondents believed that the infrastructure and processes that PEI has created need to be maintained, along with the workforce and they believed that this was an essential role of their governments with support from the partners.</p> <p><strong>Conclusion:&nbsp;</strong>there is a high awareness of the PEI program in all the countries and at all levels which should be leveraged into improving other child survival activities for example routine immunizations. Future large-scale programs of this nature should be designed to benefit other public health programs beyond the specific program. The public health workforce, surveillance development, data management and laboratory strengthening that have been developed by PEI need to be maintained.</p> Peter Nsubuga, Ben Masiira, Luka Ibrahim, Nestor Ndakala, Norbert Dongmo Copyright (c) Mon, 26 Nov 2018 00:00:00 +0000 Ameloblastic carcinoma: a clinicopathologic analysis of cases seen in a Nigerian Teaching Hospital and review of literature <p><strong>Introduction:&nbsp;</strong>ameloblastic carcinoma is a rare malignant odontogenic neoplasm that exhibits histological features of ameloblastoma in combination with cytological atypia. It may arise de novo or secondarily through malignant de-differentiation of pre-existing ameloblastoma or odontogenic cyst. Secondary ameloblastic carcinomas often results from repeated surgical intervention, which is a mainstay of odontogenic tumor management in resource limited settings. To date, relatively few cases of ameloblastic carcinomas have been reported and many cases have been misdiagnosed as ameloblastoma. This is due to its wide range of clinicopathological feature which range from indolent to aggressive. It may present as an aggressive ulcerated mass or as a simple cystic lesion; hence, it often challenging to delineate from its benign counterpart, ameloblastoma.</p> <p><strong>Methods:&nbsp;</strong>this study reviewed the clinicopathological data on 157 cases of odontogenic tumors diagnosed over a 10 years period from the pathology archive of the Oral Pathology Unit of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria.</p> <p><strong>Results:&nbsp;</strong>of all these cases, we identified that 64.9% were Ameloblastomas, while 8.3% were ameloblastic carcinomas. Primary subtypes of ameloblastic carcinoma constituted 23.08%, while 69.23% of the cases were of the secondary subtype. We also found that the secondary subtype of ameloblastic carcinomas showed a higher mean duration value of 7.7 years. Most lesions were found in posterior mandible and presented with ulceration, perforation and ill-defined borders radiographically.</p> <p><strong>Conclusion:&nbsp;</strong>this study is among the few that have documented higher frequency of secondary ameloblastic carcinoma in the scientific literature.</p> Olujide Oladele Soyele, Kehinde Emmanuel Adebiyi, Olufunlola Motunrayo Adesina, Adeola Mofoluwake Ladeji, Adetayo Aborisade, Abiodun Olatunji, Henry Ademola Adeola Copyright (c) Tue, 27 Nov 2018 00:00:00 +0000 Research Ethics Committees (RECs) and epidemic response in low and middle income countries <p>The recent Ebola and Zika virus epidemics in some parts of Africa and Asia have showcased the porosity in disaster preparedness and response, not only in the affected countries, but on a global scale. For the Ebola epidemic, scientifically robust research was started late during the course of the epidemic, with waste of resources and lost research opportunities. Research Ethics Committees have a significant role to play with regards to epidemic response for the future. This paper presents key challenges and opportunities for ethics review during emergencies, specifically for low and middle income countries. There is no better moment to test the efficacy and safety of drugs or vaccines for infected, or at risk populations than during the disaster itself. The main mantras that form the back bone of research ethics review (Helsinki Declaration, the CIOMS International Ethical Guidelines for Biomedical Research Involving Human Subjects, WHO and the ICH guidelines for Good Clinical Practice) are increasingly showing their limitations. Most protocols are generally from developed countries where the funding originates. Not only is the direct transposition to Low and Middle Income Country (LMIC) settings inappropriate on its own, also, using such guidelines in times of public health disasters might be time consuming, and might also lead to wastage of research opportunities, especially when sociocultural peculiarities, and anthropological research arms are completely excluded or avoided within the care and research packages. Governments should include RECs as key members during the elaboration, and daily functioning of their national public emergency response packages. Developing simple research ethics review guidelines, involvement of health care staff in ethics training, community mobilization, and incorporation of anthropological research during the medical response, research and communication phases, are imperatives in epidemic response.</p> Luchuo Engelbert Bain, Chia Gerald Ngwain, Julius Nwobegahay, Jeffery Gabriel Sumboh, Rogers Nditanchou, Paschal Kum Awah Copyright (c) Wed, 28 Nov 2018 00:00:00 +0000 Meckel’s diverticulum causing intestinal obstruction in the newborn <p>The causes of neonatal bowel obstruction are variable and dominated by malformations and the Meckel diverticulum must remain exceptional. We report a case of neonatal bowel obstruction in a six day old male neonate admitted on account of inability to pass stool, abdominal distension and bilious vomiting. The radiologic additional examinations are non-specific. Exploratory laparotomy found obstruction at the site of a Meckel's diverticulum.</p> Mohamed Amine Oukhouya, Saad Andaloussi, Hicham Abdellaoui, Mohammed Tazi, Abdelhalim Mahmoudi, Aziz Elmadi, Khalid Khattala, Youssef Bouabdallah Copyright (c) Wed, 28 Nov 2018 00:00:00 +0000 Syndrome de Sturge Weber Krabbe: entité exceptionnelle (à propos d'un cas) <p>Nous rapportons le cas d'un syndrome de Sturge Weber diagnostiqué au sein du Service de Radiologie de CHU Hassan II de Fès. A partir de cette observation, nous montrons les aspects cliniques, diagnostiques et thérapeutiques ainsi qu'évolutifs de cette entité neuro radiologique exceptionnelle.</p> Siham Alaoui Rachidi, Anas Lahlou Mimi, Amal Akammar, Youssef Lamrani Alaoui, Meriem Boubbou, Mustapha Maaroufi, Badr Alami Copyright (c) Wed, 28 Nov 2018 00:00:00 +0000 Tumeur pseudo papillaire et solide du pancréas <p>Les tumeurs pseudopapillaires et solides du pancréas (TPPS) sont des tumeurs épithéliales rares. Dans la plupart des cas, il s’agit de tumeurs survenant chez la femme jeune dans la deuxième ou la troisième décennie de la vie. La survie après résection primaire approche 90% à 5 ans. Nous rapportons le cas d’une jeune patiente de la vingtaine qui présente une tumeur pseudopapillaire et solide du pancréas découverte devant des douleurs abdominales sans perturbations des bilans biologiques. La tomodensitométrie (TDM), l'imagerie par résonance magnétique (IRM) et l'échographie endoscopique ont révélé une masse bien limitée se développant au dépend de l'isthme pancréatique. L'exérèse complète de la tumeur a été réalisée. L’examen anatomopathologique confirmait le diagnostic de tumeur pseudopapillaire et solide du pancréas. En conclusion, les tumeurs pseudopapillaires et solides du pancréas doivent être évoquées comme un des diagnostics différentiels de toute masse pancréatique en particulier chez les jeunes femmes. L'exérèse chirurgicale procure un bon pronostic.</p> Houcine Maghrebi, Amin Makni, Rami Rehaim, Anis Haddad, Wael Rebai, Mouna Ayadi, Amine Daghfous, Fadhel Fteriche, Faouzi Chebbi, Rachid Ksantini, Mohamed Jouini, Montasser Kacem, Zoubeir Ben Safta Copyright (c) Wed, 28 Nov 2018 00:00:00 +0000 Giant abdomino scrotal hydrocele: a case report with literature review <p>Abdominoscrotal hydrocele (ASH) is a condition in which the hydrocele sac is extended beyond the scrotum to the abdomen via the inguinal canal. The treatment is ordinarily surgical. Different approaches have been described like paramedian laparotomy, an inguinal or inguino scrotal approach. We report a case of giant unilateral hydrocele in an 18 year old male, occupying a large part of the abdomen with urinary symptoms. Ultrasonography and CT showed typical cystic mass in hourglass shape that we have approached surgically by scrotal incision and we removed all the cyst. Pathological examination found a hydrocele with no signs of malignancy. Urinary symptoms disappeared postoperatively. This is a rare entity that evolves often painless and little reported in the literature. The etiology and pathogenesis of this disease is discussed.</p> Abdelfattah Latabi, Mohammed Amine Lakmichi, Zakaria Dahami, Mohammed Said Moudouni, Ismail Sarf Copyright (c) Wed, 28 Nov 2018 00:00:00 +0000 Levonorgestrel only emergency contraceptive use and risk of ectopic pregnancy in Eldoret Kenya: a case-control study <p><strong>Introduction:&nbsp;</strong>ectopic pregnancy is one of the causes of maternal morbidity and mortality in Sub-Saharan Africa. Levonorgestrel (LNG) only emergency contraceptive pill is a well-established emergency contraceptive pill that is administered within 72 hours after unprotected intercourse. This study aimed at determining whether or not there is a significant association between levonorgestrel emergency contraceptive use and the occurrence of ectopic pregnancy.</p> <p><strong>Methods:&nbsp;</strong>case-control (1:3) study among 79 women with ectopic pregnancy (cases) matched against 237 women without (controls) at Moi Teaching and Referral Hospital in Eldoret, Kenya; Sociodemographic and clinical data were collected using a questionnaire. Association between ectopic pregnancy and LNG-EC was assessed using Pearson chi-square test. The relationship between outcome and exposure (while adjusting for confounders) was assessed using logistic regression model.</p> <p><strong>Results:&nbsp;</strong>The mean age was 27.15 years. Both cases and controls were similar by age (p = 0.990), educational level (p = 0.850), marital status (p = 0.559), employment status (p = 0.186) and parity (p = 0.999). Seventy-eight (24.7%) participants had a history of miscarriage. A higher proportion of the cases had history of using LNG-EC compared to the controls (32.9% vs. 7.2%, p &lt; 0.001). The use of LNG-EC portended more than nine times increased odds of ectopic pregnancy compared to other contraceptive methods {OR = 9.34 (95% CI: 3.9 - 16.0)}.</p> <p><strong>Conclusion:&nbsp;</strong>levonorgestrel only emergency contraceptive use was associated with ectopic pregnancy. One of the limitations of this study is that we could not control for all confounders of ectopic pregnancy.</p> Sahara Shurie, Edwin Were, Omenge Orang’o, Alfred Keter Copyright (c) Thu, 29 Nov 2018 00:00:00 +0000 Formes évolutives postérieures de la persistance de la vascularisation fœtale bilatérale à l'hôpital régional de Gao <p>La persistance de la vascularisation fœtale (PVF) est une anomalie de la résorption du système vasculaire hyaloïdien. Formes évolutives postérieures bilatérales de la persistance chez un garçon âgé de 2 ans qui a consulté pour une leucocorie de l'œil droit. L'examen a retrouvé une leucocorie bilatérale, une esotropie de l'œil droit et une exotropie de l'œil gauche. Le fond d'œil droit retrouve une bande fibrovasculaire rétinien tendu jusqu’à l’ora serrata, associé à un décollement total de la rétine et des remaniements pigmentaires périphériques. Le fond d'œil gauche note une bande fibrovasculaire rétinien tendu de la papille à l’ora serrata, associée à un décollement partiel temporal inférieur en antérieur et des remaniements pigmentaires périphériques.</p> Ibrahima Conaré, Mahamadou Mallé Copyright (c) Mon, 03 Dec 2018 00:00:00 +0000 Perforation cæcale néonatale inaugurale du diagnostic d’un mégacôlon congénital <p>Les perforations intestinales spontanées sont rares chez un nouveau-né à terme. Nous rapportons le cas d'un nouveau-né issu d'une grossesse de 41 semaines d'aménorrhée, qui avait présenté à trois jours de vie, un pneumopéritoine inaugural d'un mégacôlon congénital. L'exploration chirurgicale avait mis en évidence une perforation cæcale diastatique associée à une disparité de calibre recto-sigmoïdienne. La prise en charge avait consisté à la réalisation d'une cæcostomie d'urgence après lavage de la cavité péritonéale. L'examen histologique des fragments biopsiques avait permis de confirmer le diagnostic du mégacôlon congénital. Les suites opératoires étaient simples et la cure radicale avait eu lieu six mois plus tard.</p> Abdoulaye Diallo Harouna, Idrissa Salahoudine, Abdelhalim Mahamoudi, Aziz El Madi, Khattala Khattala, Youssef Bouabdallah Copyright (c) Mon, 03 Dec 2018 00:00:00 +0000 Corps étranger intra urétral inhabituel chez un adolescent schizophrène: à propos d’un cas <p>L'auto insertion d'un corps étranger s'observe généralement chez les patients ayant une psychose chronique dans le but d'automutilation ou érotique. Le diagnostic est parfois difficile s'il est rapporté tardivement ou si le patient est non coopérant, d'où l'intérêt d'un bilan d'imagerie complémentaire. Le traitement comporte deux volets: l'extraction de corps étranger soit par voie endoscopique ou chirurgie ouverte et la prise en charge psychiatrique de la maladie mentale. Nous rapportons une observation inhabituelle d'un adolescent de 16ans schizophrène qui s'est introduit une aiguille dans son urètre depuis 2ans dont le diagnostic a été fait à l'aide l'urétrocystographie rétrograde et mictionnelle, et grâce à des artifices techniques, l'aiguille a été enlevée endoscopiquement sans avoir recours à la chirurgie ouverte malgré l'ancienneté de l'incident avec bien sûr complément de prise en charge psychiatrique.</p> Mustapha Ahsaini, Mohammed Bounoual, Soufiane Mellas, Jalaleddine El Ammari, Mohammed Fadl Tazi, Mohammed Jamal El Fassi, Moulay Hassan Farih Copyright (c) Mon, 03 Dec 2018 00:00:00 +0000 Outcomes of tunneled internal jugular venous catheters for chronic haemodialysis at the University College Hospital, Ibadan, Nigeria <p><strong>Introduction:&nbsp;</strong>vascular access is an important aspect of haemodialysis treatments and determinant of patient outcomes. Arteriovenous (AV) fistula has been described as the preferred haemodialysis vascular access for patients on chronic dialysis. There continues to be a challenge with the creation of AV fistula, due to shortage of vascular surgeons skilled in the AV fistula creation particularly in source limited setting. We described the outcomes of the tunneled internal jugular venous catheters amongst our patients at the University College Hospital (UCH) Ibadan.</p> <p><strong>Methods:&nbsp;</strong>a retrospective study of patients on maintenance haemodialysis at the UCH, Ibadan, we reviewed the records of all patients on chronic dialysis over a period of 5 years. Information obtained include demographics, types and aetiology of renal failure, types of vascular access, observed complications and outcomes.</p> <p><strong>Results:&nbsp;</strong>a total number of 147 catheters were inserted during the period under review, 94 were in males while 53 were females. The age range was 18-85 years while the mean age was 46.3 ± 17.2 years. The range and mean duration for Tunneled Dialysis Catheter (TDC) carriage were (30 - 1,440) and 220±185 days respectively. The observed immediate complications of TDCs were failed first attempt 7(4.7%), reactionary haemorrhage 5(3.4%), arrhythmia 3(2.0%), haemothorax 2(1.4%) while death during catheter placement was recorded in 2(1.4%) cases. Catheter related infection was the commonest long-term complications and occurred in 15 cases (10.1%), while being diabetic increased the risk of developing catheter related complications. One tenth of our patients with End Stage Renal Disease on TDC had kidney transplantation while catheter related mortality was 16.3%.</p> <p><strong>Conclusion:&nbsp;</strong>internal jugular tunneled dialysis catheters despite its shortcomings, has been a safe procedure with good outcomes among our patients on maintenance haemodialysis.</p> Yemi Raheem Raji, Samuel Oluwole Ajayi, Olusegun Aminu, Busayo Abiola, Oluwafemi Efuntoye, Babatunde Lawal Salako, Ayodeji Arije, Solomon Kadiri Copyright (c) Mon, 03 Dec 2018 00:00:00 +0000 Connaissances, attitudes et pratiques des parents face à la vaccination contre la poliomyélite à Abéché-Tchad <p><strong>Introduction:&nbsp;</strong>au Tchad, la transmission de la poliomyélite a été interrompue en 2000, mais les importations à partir du Nigéria et la faiblesse des couvertures vaccinales constituent un risque majeur de relance de la maladie. L'objectif de ce travail était d'analyser les connaissances, attitudes et pratiques des parents vis-à-vis de la vaccination contre la poliomyélite des enfants âgés de 0 à 5 ans au Tchad.</p> <p><strong>Méthodes:&nbsp;</strong>cette étude transversale a été réalisée dans les six arrondissements d'Abéché. Seuls les ménages qui avaient des enfants de moins de 5 ans ont été inclus. Les données ont été recueillies par des entretiens avec les parents et tuteurs d'enfants éligibles à l'aide d'un questionnaire testé et validé.</p> <p><strong>Résultats:&nbsp;</strong>nous avons interrogé 210 ménages. Aucune famille ne possédait de carnet de vaccination de leurs enfants. Cependant, 97% ont déclaré avoir des enfants ayant participé aux campagnes de vaccination de masse. Près de 97% connaissaient la poliomyélite et 98% avaient entendu parler des campagnes de vaccination. Les canaux d'information les plus cités étaient la radio (98%) et les agents vaccinateurs (72%). Seul 3% des parents interrogés ont déclaré avoir refusé la vaccination. Il existait une association entre l'influence négative de l'entourage et la non vaccination des enfants (p = 0,005).</p> <p><strong>Conclusion:&nbsp;</strong>les connaissances sur la maladie et le vaccin sont bonnes au Tchad malgré l'existence de rumeurs concernant notamment les effets des vaccins. L'absence de carnet de vaccination a limité l'analyse des résultats de l'enquête, uniquement déclarative avec un taux de vaccination très élevé déclaré. Dans le cadre de l'éradication, le carnet est indispensable pour accompagner la politique de prévention.</p> Abderahim Mahamat Nadjib, Harvey Attoh-Touré, Adam Abdel-mahamoud, Sabine Baron, Solène Brunet-Houdard, Emmanuel Rusch, Leslie Grammatico-Guillon Copyright (c) Tue, 04 Dec 2018 00:00:00 +0000 Une cataracte inhabituelle: régressive à noyau pétaloïde <p>Nous rapportons le cas d'une patiente de 38 ans, sans antécédents médico-chirurgicaux, victime d'un traumatisme contusif de l'œil droit par coup de pierre il y a 20 ans, avec baisse de l'acuité visuelle progressive depuis 10 ans. L'examen ophtalmologique note au niveau de l'œil droit une acuité visuelle à mouvement des doigts, et un tonus oculaire à 11mmHg. L'examen du segment antérieur après dilatation objective une cataracte régressive, dont le noyau présumé est de forme pétaloïde, les bords et les sutures des pétales sont denses. Une échographie oculaire est réalisée vu l'inaccessibilité du fond d'œil, ainsi que l'examen de l'œil gauche n'objective aucune anomalie.</p> Ahmed Bennis, Idriss Andaloussi Benatiya Copyright (c) Tue, 04 Dec 2018 00:00:00 +0000 Fertility sparing surgery for ovarian sex cord stromal tumors: a nine case series <p>Ovarian Sex Cord Stromal Tumors (SCST) are a rare disease carrying a good prognosis. They generally affect young women; therefore fertility preservation is a critical issue. Fertility Sparing Surgery (FSS) showed promising results in both oncologic safety and fertility preservation. A retrospective case series involving 9 patients diagnosed with SCST and treated with fertility sparing surgery at our institution was conducted between January 2000 and May 2015. The median age was 24 years old (10 to 39). The main clinical manifestation was pelvic pain seen in seven patients. Five patients complained about menstrual cycle disorders. The nine patients went through fertility sparing surgery; seven had conservative staging and the other two had a unilateral salpingo-oophorectomy. Three patients out of nine had a pelvic unilateral lymphadenectomy. Two patients received adjuvant chemotherapy. Only two patients presented locoregional recurrence that occurred respectively after 7 and 192 months. The treatment combined chemotherapy and surgery based on mass resection. One patient achieved a natural pregnancy after the treatment. FSS seems to be a suitable approach for SCST. However, more case series and meta-analysis should be conducted.</p> Montassar Ghalleb, Hatem Bouzaiene, Sarah Sghaier, Hanen Bouaziz, Monia Hechiche, Jamel Ben Hassouna, Khaled Rahal Copyright (c) Wed, 05 Dec 2018 00:00:00 +0000 Menstrual hygiene management practices among primary school girls from a pastoralist community in Kenya: a cross sectional survey <p><strong>Introduction:&nbsp;</strong>pubescent girls from developing countries are confronted with diverse menstrual hygiene management (MHM) challenges, especially at school. Girls from rural pastoralist communities experience insurmountable MHM barriers. Inadequate coping strategies adopted result in sub-optimal school performance, absenteeism and physical problems. We conducted a study to assess MHM practices among primary school girls from a pastoralist community in Kenya.</p> <p><strong>Methods:&nbsp;</strong>a cross sectional survey was done among primary school girls in Kajiado County, Kenya. Accent was sought. We administered structured questionnaires which sought information on socio-demographics, knowledge, perceptions and practices.</p> <p><strong>Results:&nbsp;</strong>we enrolled 320 girls; with mean age of 14.9 years. Their parents were mostly (69.4%) self-employed pastoralists. Good menstruation knowledge was observed in 51.6%, while 45.5% reported diverse perceptions about menstruation. Majority, (80.9%) used sanitary towels as absorbents, but 40.3% delayed changing by &gt; 6 hours. Poor MHM practices were documented in 28.8% and 32.2% kept the issue secret. Factors associated with poor MHM practices on univariable analysis were age (p=0.016), religion (p=0.037), non-discussions (p=0.001), lack of sanitary pads (p&lt;0.0001), lack of latrine privacy (p=0.031), lack of water (p=0.001) and teasing by boys (p=0.016). On logistic regression, factors that independently influenced MHM practices were inadequate latrine privacy (p=0.031) and fear of teasing by boys (p=0.016).</p> <p><strong>Conclusion:&nbsp;</strong>a third of pubescent pastoralist girls had poor MHM practices largely determined by inadequate latrine privacy and fear of teasing by boys.</p> Eleen Korir, Florence Nafula Okwara, Gaudencia Okumbe Copyright (c) Wed, 05 Dec 2018 00:00:00 +0000 Rupture utérine sur utérus sain: complication du misoprostol (à propos d’un cas et revue de la littérature) <p>La rupture utérine sur utérus sain au 2<sup>ème</sup>&nbsp;et 3<sup>ème</sup>&nbsp;trimestre de grossesse est une complication obstétricale rare et grave mettant en jeu les pronostics vitaux maternels et fœtaux et le devenir obstétrical des patientes en l'absence de diagnostic et de prise en charge immédiate. Elle survient majoritairement sur un utérus cicatriciel et reste anecdotique sur un utérus sain. Nous rapportons le cas d'une patiente primigeste ayant présenté une rupture utérine sur un utérus non cicatriciel lors d'un déclenchement de travail par le misoprostol pour mort fœtale in utero (MFIU) sur retard de croissance intra utérin (RCIU) et oligoamnios sévère à 31 semaines d'aménorrhée (SA). Nous discutons à travers ce cas et la revue de la littérature, l'extrême prudence qu'il faut garder pour utiliser le misoprostol en cas de déclenchement du travail ainsi que les signes d'appel cliniques, les facteurs de risque, la méthodologie diagnostique et la prise en charge thérapeutique de cette entité rare mais potentiellement grave.</p> Meryem Belmajdoub, Fatima Zohra Fdili Alaoui, Hikmat Chaara, Abdelilah Melhouf Copyright (c) Thu, 06 Dec 2018 00:00:00 +0000 Manifestations thromboemboliques chez 36 patients Ouest Africains infectés par le VIH <p>Chez les patients infectés par le VIH, la maladie thromboembolique est une complication dont le risque est accru. En Côte d'Ivoire, dans le service<br>de référence de prise en charge médicale des personnes atteintes du VIH/SIDA, aucune étude n'a été menée sur la question. L'objectif de notre<br>étude est de décrire les manifestations thromboemboliques colligées dans le Service des Maladies Infectieuses et Tropicales (SMIT) chez les patients<br>infectés par le VIH, traités ou non par les antirétroviraux. Il s'est agi d'une étude rétrospective des dossiers de patients infectés par le VIH, hospitalisés,<br>et présentant une thrombose veineuse profonde (TVP), artérielle et/ou une embolie pulmonaire de la période de janvier 2005 à juillet 2015. Le<br>diagnostic a été posé par l'écho-Doppler des vaisseaux et/ou l'angioscanner thoracique. L'analyse a porté sur les aspects diagnostiques,<br>thérapeutiques et évolutifs. Les dossiers de 36 patients dont 23 femmes (64%), sex-ratio H/F à 0,57, et âge moyen de 43±12 ans ont été retenus.<br>Les thromboses veineuses profondes (TVP) ont été retrouvées chez 26 (72,2%) patients, des embolies pulmonaires (EP) chez neuf (25%) patients,<br>une thrombose artérielle chez un patient (2,8%). La TVP était unilatérale dans 81% des cas et plus située à gauche (77%). L'EP était unilatérale et<br>à droite dans 100% des cas et la thrombose artérielle était bilatérale dans 2,7% des cas. Chez les patients atteints de TVP, la veine fémorale (39%)<br>et la veine poplitée (35%) étaient les sièges plus fréquents de thrombose. L'EP concernait les artères pulmonaires dans 77,8% des cas et la thrombose<br>artérielle concernait les carotides internes gauche et droite. La majorité des patients était sous traitement antirétroviral (69%). Les infections<br>opportunistes fréquemment associées étaient les candidoses orales (31%) et la tuberculose (33%). L'évolution a été marquée par neuf décès (25%).<br>Cette étude rapporte une fréquence élevée des TVP au cours de l'infection à VIH. D'autres études s'avèrent nécessaires pour mieux appréhender le<br>rôle du VIH dans la survenue de la maladie thromboembolique.</p> Frédéric Nogbou Ello, Lidaw Déassoua Bawe, Gisèle Affoué Kouakou, Chrysostome Melaine Mossou, Doumbia Adama, Alain N'douba Kassi, Dine Mourtada, Eboi Ehui, Aristophane Tanon, Christophe Konin, François Eba Aoussi, Aka Rigobert Kakou, Serge Paul Eholié Copyright (c) Thu, 06 Dec 2018 00:00:00 +0000 Risk factors and poor prognostic factors of preeclampsia in Ibn Rochd University Hospital of Casablanca: about 401 preeclamptic cases <p>Preeclampsia is a gestational pathology that complicates 2 to 8% of pregnancies and is one of the major causes of maternal and fetal morbidity and<br>mortality worldwide. The aim of this work was to study the epidemiological profile of preeclampsia in Casablanca and to identify risk factors as well<br>as factors of poor maternal and fetal prognosis. 401 preeclamptic cases were collected in the gynecology-obstetrics "C" Service of Lalla Meryem<br>Maternity of Ibn Rochd University Hospital of Casablanca (2010-2011) were included in this study and a statistical analysis with the SPSS software<br>version (16.0) was performed. We used the Chi-2 test to analyze qualitative variables and Student's test and ANOVA (analysis of variance) for<br>quantitative variables. The incidence of preeclampsia was (7.1%). The epidemiological profile was that of a primipara (57.6%), average age 30 years<br>and (66.8%) of pregnancies were not followed. Multiparity was a factor of poor maternal prognosis (p = 0.007). The low gestational age and no<br>prenatal care were factors of maternal as well as fetal prognosis. Risk factors frequently found in our patients were obesity (15.21%) and chronic<br>hypertension (5.73%) as vascular-renal history; abortion (16.46%) and perinatal death (5.24%) as obstetric history. Preeclampsia is a common<br>obstetric pathology in our context. Better prenatal care and early diagnosis could reduce its incidence.</p> Meriem Benfateh, Souadou Cissoko, Houssine Boufettal, Jean-Jacques Feige, Naima Samouh, Touria Aboussaouira, Mohamed Benharouga, Nadia Alfaidy Copyright (c) Thu, 06 Dec 2018 00:00:00 +0000 Dural ectasia: a manifestation of type 1 neurofibromatosis <p>Dural ectasia denotes circumferential expansion or dilatation of the dural sac, and has been frequently reported in association with type 1<br>neurofibromatosis (NF1). The pathogenesis has not been defined, but its correlation with NF1 infers a congenital malformative hypothesis. The neural<br>elements in the dilated sleeve typically are not enlarged or abnormal, nevertheless the enlarged area contain an increased amount of cerebrospinal<br>fluid. The dura in the area of ectasia is extremely thin and fragile, and erodes the surrounding bony structures destabilising the spine and permitting<br>spectacular spinal deformities. We present a case: a 40-year-old woman suffering from neurofibromatosis type 1 who developed a thoracic dural<br>ectasia and anterior meningocele.</p> Ilyas Derdabi, Hajar El Jouadi, Meryem Edderai Copyright (c) Fri, 07 Dec 2018 00:00:00 +0000 Grossesse sur cicatrice de césarienne: à propos d’un cas et revue de la littérature <p>La grossesse sur cicatrice de césarienne est une forme rare de la grossesse ectopique qui peut engager le pronostic vital et fonctionnel de la patiente par hémorragie ou par rupture utérine précoce. Nous rapportons le cas d'une grossesse ectopique sur cicatrice de césarienne diagnostiquée à 7 semaines d'aménorrhée suite à des métrorragies chez une patiente de 23 ans, 3<sup>ème</sup>&nbsp;geste 2<sup>ème</sup>&nbsp;pare, porteuse d'un utérus bi-cicatriciel. Grâce à l'échographie endovaginale le diagnostic a été précoce et le traitement a été conservateur. A travers cette observation et la lumière d'une revue de la littérature, nous discuterons les caractéristiques diagnostiques et thérapeutiques de cette rare entité, dont la connaissance par les praticiens permet d'améliorer le pronostic.</p> Meryem Belmajdoub, Sofia Jayi, Hikmat Chaara, Abdelilah Melhouf Copyright (c) Mon, 10 Dec 2018 00:00:00 +0000 Knowledge and practices of health practitioners on treatment of Buruli ulcer in the Mbonge, Ekondo Titi and Muyuka Health Districts, South West Region, Cameroon <p><strong>Introduction:&nbsp;</strong>after tuberculosis and leprosy, Buruli ulcer (BU) is the third most common mycobacterial infection. Buruli ulcer begins as a localized skin lesion that progresses to extensive ulceration thus leading to functional disability, loss of economic productivity and social stigma. This study is aimed at assessing the knowledge and practices among health practitioners on the treatment of BU in the Mbonge, Ekondo Titi and Muyuka Health Districts of the South West Region of Cameroon.</p> <p><strong>Methods:&nbsp;</strong>this is a cross-sectional study that investigates participants' knowledge and practices on the treatment of BU. The study uses a qualitative method of structured questionnaires in the process of data collection.</p> <p><strong>Results:&nbsp;</strong>seventy percent (70%) of the participants acknowledged they encounter cases of BU in their respective Hospitals or Health centers. Among these, 48% agreed they managed BU in their facilities and up to 91.7% noted that their community members are aware that BU is managed in their facility while seventy percent of the medical practitioners indicated they cannot identify the various stages of BU. Eighty-one percent of the practitioners from Muyuka HD indicated they could not identify the various stages of BU. More than 63% of the practitioners regarded BU patients as normal people in their communities however, practitioners that practiced for less than 5 years were likely not to admit BU patients in the same room with other patients. Beliefs such as being cursed (47.06%) and being possessed (29.41%) were reported by practitioners that acknowledged the existence of traditional beliefs in the community.</p> <p><strong>Conclusion:&nbsp;</strong>despite the fact that a majority of the health practitioners knew what BU is, most of them demonstrated lack of knowledge on the identification of the various stages and management of the illness. Practitioners demonstrated positive attitude towards patients although they would not admit them in the same room with other patients. Considering the poor knowledge on identification and management demonstrated by most of the practitioners, management of the disease would be inadequate and may even aggravate the patient's situation. Training and onsite mentorship on screening, identification and management of BU is therefore highly recommended amongst health personnel practicing in endemic areas.</p> Frankline Sanyuy Nsai, Samuel Nambile Cumber, Ngwayu Claude Nkfusai, Vecheusi Zennobia Viyoff, Nkemngu Blake Afutendem, Rosaline Yumumkah Cumber, Joyce Mahlako Tsoka-Gwegweni, Jane-Francis Tata Kihla Akoachere Copyright (c) Mon, 10 Dec 2018 00:00:00 +0000 Apport de l’épreuve d’effort dans la prise en charge des cardiopathies ischémiques <p>L’épreuve d’effort un moyen diagnostic utile pour les cas de suspicion d’angor avec une faible sensibilité mais une bonne spécificité. Elle est également très utile dans l’évaluation du risque, de l’efficacité du traitement et la guidance des prescriptions médicales après contrôle des symptômes d’ischémie. L’objectif de notre travail était d’analyser l’apport de l’épreuve d’effort à la prise en charge des cardiopathies ischémiques dans le Service de Cardiologie du CHU YO. Il s’est agi d’une étude rétrospective sur 60 patients ayant bénéficié d’une épreuve d’effort de janvier 2012 à décembre 2013. L’épreuve d’effort a été réalisée sur tapis roulant selon le protocole de Bruce modifié. Soixante patients ont bénéficié d’une épreuve d’effort durant notre période d’étude. L’âge moyen des patients était de 49 ± 10,8 ans. Le sex-ratio était de 1,2. Tous les patients avaient effectué l’épreuve d’effort sur tapis roulant. Un antécédent de coronaropathie était noté chez 22 patients. La recherche d’une insuffisance coronarienne était l’indication de l’épreuve d’effort dans 83% des cas. Elle était démaquillée dans 78% des cas. L’épreuve d’effort était arrêtée pour effort maximal dans 46 cas (soit 77%). La durée moyenne de l’effort était de 11,7 mn ± 3,2. Dix pour cent des patients avaient eu une épreuve d’effort positive et 10% une épreuve d’effort litigieuse. Notre étude va en outre contribuer à vulgariser d’avantage cet examen qui reste peu prescrit dans notre environnement et même parmi les médecins cardiologues. Cependant, des efforts restent à faire afin d’améliorer la qualité de la pratique de cet important examen dans la prise en charge des coronaropathies dans un contexte de pays à ressources limitées.</p> Joel Bamouni, Dangwé Temoua Naibe, Relwendé Aristide Yameogo, Dakaboué Germain Mandi, Georges Rosario Christian Millogo, Nobila Valentin Yameogo, Jonas Koudougou Kologo, Anna Thiam-Tall, Lucie Adélaïde Valérie Nébié, Patrice Zabsonré Copyright (c) Wed, 12 Dec 2018 00:00:00 +0000 Oesophageal varices in patients with liver cirrhosis attending a major tertiary hospital in Ghana <p><strong>Introduction:&nbsp;</strong>oesophageal variceal bleeding is a potentially fatal consequence of portal hypertension in cirrhotic patients. In Ghana, bleeding oesophageal varices (OV) are a significant cause of acute upper gastrointestinal bleeding with comparatively high mortality. This study was to determine the prevalence of OV and its clinical correlate in cirrhotic patients.</p> <p><strong>Methods:&nbsp;</strong>this was a cross sectional hospital based study of 149 subjects with liver cirrhosis from 5<sup>th</sup>&nbsp;November, 2015 to 4<sup>th</sup>&nbsp;November, 2016. Demographic and other clinical data were collected using standardized questionnaire. Liver function, full blood count, HBsAg and anti-HCV Ab tests were done for all patients. All patients underwent an abdominal ultrasound to assess liver and document ascites. Upper GI endoscopy (UGIE) was done to screen for and grade varices.</p> <p><strong>Results:&nbsp;</strong>a total of 149 patients with a mean age of 45 ± 12.28 years were evaluated. Men were 77.85% and 22.15% were women, with male to female ratio of 3.5:1. By Child-Pugh Classification, 12 (8.16%) patients were in class A, 64 (43.54%) in class B and 71 (48.3%) in class C at presentation. On UGIE, 135 (90.60%) had varices and 14 patients (9.40%) had no varices. One hundred and eleven of the varices (82.22%) were large varices and the rest (17.78%) small varices.</p> <p><strong>Conclusion:&nbsp;</strong>majority of cirrhotic patients present late with advance disease to this referral centre. Most have large varices on their first screening endoscopy. Prophylactic treatment should be considered for all cirrhotics especially patients with decompensated liver cirrhosis when UGIE cannot be done immediately.</p> Amoako Duah, Kofi Nyaako Nkrumah, Kenneth Tachi Copyright (c) Thu, 13 Dec 2018 00:00:00 +0000 Inversion utérine non puerpérale chronique: à propos d’un cas <p>L'inversion utérine non puerpérale chronique est une situation clinique extrêmement rare, 85% des inversions sont puerpérales exposant l'accouchée au risque d'hémorragie de la délivrance cataclysmique. Nous rapportons le cas d'une patiente de 70 ans qui s'est présentée en consultation pour prolapsus uro-génital du 3<sup>ème</sup>&nbsp;degré, une hystérectomie totale sans conservation annexielle a été réalisée par un double abord: voie vaginale complétée par une laparotomie mettant en évidence une inversion utérine à contenu annexielle bilatérale. La voie abdominale a permis en plus d'une bonne exposition chirurgicale, l'exclusion d'un contenu digestif ou urinaire pris dans l'inversion avant la réalisation de l'hystérectomie. Bien que rare et de diagnostic difficile, l'inversion utérine non puerpérale aiguë est une urgence médico-chirurgicale.</p> Ahmed Touimi Benjelloun, Assia Makayssi, Simohamed Ennachit, Mohamed Elkarroumi Copyright (c) Thu, 13 Dec 2018 00:00:00 +0000 Profil du facteur Von Willebrand dans la grossesse: étude descriptive chez 390 femmes enceintes au Maroc <p>Le facteur Von Willebrand (vWF) est une glycoprotéine qui joue un rôle important dans l'hémostase, dont son déficit quantitatif ou qualitatif induit la maladie de Willebrand (MV). Le but est de mettre le point sur la répartition des taux de vWF dans la population marocaine chez les femmes enceintes et sa variabilité en fonction du groupe sanguin ABO. Il s'agit d'une étude transversale qui a intéressé 390 femmes enceintes provenant de la région Rabat-Salé-Kenitra dont la taille de l'échantillon a été calculée sur la base d'une prévalence de 1% correspondant à la prévalence mondiale de la MW avec une marge d'erreur de 5% et un niveau de confiance de 95%. Trois cent dix-sept cas sur 390 femmes enceintes se sont révélés avec des taux élevés aux normes (&gt; 160%) en vWF soit 81,28%. Les taux de facteur VIII (FVIII) varient en parallèle de façon significative p &lt; 0,001 avec les taux de vWF avec un cœfficient de correlation (r) de&nbsp;<em>Pearson</em>&nbsp;à 0,597. La distribution des groupes sanguins A,B et O a eu une influence sur le taux de vWF avec une différence significative p &lt; 0,001 entre les quatre groupes: niveau moyen le plus bas chez le groupe O (188,54±57,02), suivi par le groupe A (203,19±54,46), puis le groupe AB (219±38,95), et enfin le groupe B (221,15±48,63). Nos résultats confirment d'une part l'élévation des taux de vWF pendant la grossesse et d'autre part l'influence du groupe sanguin ABO sur les taux du vWF.</p> Mamad Hassane, Souad Benkirane, Youssef Motiaa, Fatima Dahmani, Mohammed Elkhorassani, Azlarab Masrar Copyright (c) Tue, 18 Dec 2018 00:00:00 +0000 Atypical presentation of cystic schwannoma of the sphenoid sinus: a nonsolitary mass with osseous, intracranial and cavernous sinus invasion <p>Although nearly half of all schwannomas involve the head and neck region, nasal and paranasal sinus presentations are quite rarely seen. Cystic schwannoma, characterized by cyst formation lined by S-100 protein positive membrane-like structures is very uncommonly seen in sphenoid sinus with only a single previously reported case. Here we report a young patient of cystic schwannoma of the paranasal sinuses having epicenter in the sphenoid sinus. The tumor had caused extensive erosion of the skull base and paranasal sinuses and extended intracranially that radiologically mimicked as infected mucocele causing loss of vision. This case denotes the aggressive behavior of such uncommon tumors.</p> Gautam Dutta, Daljit Singh, Hukum Singh, Ghanshyam Singhal, Ravindra Kumar Saran Copyright (c) Wed, 19 Dec 2018 00:00:00 +0000 A huge absence of skin on the trunk: aplasia cutis congenita <p>A 2590 g female infant was born at 39 weeks' gestation to a 34-year-old gravida 4 para 4 mother via cesarean section. Upon delivery she was noted to have an absence of skin on the huge part of the trunk. Lesion was unilateral, gelatinous and covered by a thin membrane. The pregnancy history was unremarkable, the mother denied having taken any drugs and there was no family history of congenital anomalies or consanguinity. The physical examination of the infant was otherwise unremarkable. Conservative treatment was recommended by dermatologist with gentle cleansing and application of local antibiotics. Ultrasonographic evaluation of abdomen and kranium, echocardiographic evaluation and detailed genetic assessment were normal. The patient was discharged home on full oral feedings on day 6 and recommended follow up at the outpatient dermatology clinic. Definition of aplasia cutis congenita (ACC) is, complete or partial absence or scarcity of skin at birth. ACC can occur anywhere in the body but majority of cases occur on the scalp. In most cases ACC is an isolated skin defect but some cases might be seen with congenital malformations involving the cardiovascular, gastrointestinal and central nervous systems. ACC is a rare condition with an incidence of 1/10,000 to 3/10,000 births and the exact mechanism is still unknown. Several factors like genetics, teratogens, intrauterin infections can lead to this condition. Most cases occur sporadically but rare familial cases have been reported. Physicians should remember the possible co-occurrence of other congenital anomalies in these infants.</p> Pelin Dogan, Ipek Güney Varal Copyright (c) Wed, 19 Dec 2018 00:00:00 +0000 Apport du Holter ECG dans le bilan étiologique des infarctus cérébraux à Brazzaville, Congo <p>Déterminer la prévalence des troubles rythmiques au cours des infarctus cérébraux et identifier les facteurs prédictifs de la fibrillation atriale (FA) paroxystique. Il s'est agi d'une étude transversale, descriptive et analytique, menée à Brazzaville entre janvier 2012 et décembre 2016. Elle a porté sur une série consécutive de 267 patients victimes d'un accident vasculaire cérébral ischémique transitoire (n = 17) ou constitué (n = 250), documenté par un scanner cérébral. Tous ces patients ont bénéficié d'un enregistrement Holter ECG dès 24h, réalisé dans le cadre de la recherche étiologique. Les principales anomalies rythmiques enregistrées ont été répertoriées et la régression logistique a permis l'identification des facteurs prédictifs de survenue de la FA paroxystique. Il s'agissait de 164 hommes (61,4%) et 103 femmes (38,6%), âgés en moyenne de 60,2 ± 12,1 ans (extrêmes: 22 et 94 ans). Les principaux facteurs de risque cardiovasculaire identifiés étaient une hypertension artérielle (HTA) dans 214 cas (80,1%), un diabète sucré dans 36 cas (13,5%), et un tabagisme dans 18 cas (6,7%), avec un taux de cumul de 1,5 facteur par individu. L'examen Holter ECG, normal dans 216 cas (81%), était pathologique dans 51 cas (19%). Les principales anomalies enregistrées consistaient en des extrasystoles ventriculaires bénignes (n = 32), une FA paroxystique (n = 7), des extrasystoles supraventriculaires (n = 5), une tachycardie ventriculaire (TV) non soutenue (n = 4), une TV soutenue (n = 2) et un bloc auriculo-ventriculaire type Mobitz II (n = 1). La fréquence de la FA paroxystique était de 2,6%. En analyse bivariée, il n'a pas été noté de corrélation entre la FA paroxystique et le sexe (p = 0,890), l'HTA (p = 0,818), le diabète (p = 0,839), le tabac (p = 0,969). En analyse multivariée, seul l'âge était prédictif de la survenue d'une FA paroxystique au cours des infarctus cérébraux (OR = 1,11;p = 0,0134). Il ressort de cette étude préliminaire que les troubles du rythme emboligènes sont relativement rares au cours des infarctus cérébraux à Brazzaville. La FA paroxystique, quoique peu fréquente, reste essentiellement corrélée à l'âge. Sa recherche systématique chez les sujets âgés contribue à améliorer la prise en charge.</p> Stéphane Méo Ikama, Jospin Makani, Ghislain Mpandzou, Paul Macaire Ossou-Nguiet, Bernice Mesmer Nsitou, Munka Nkalla Lambi, Edgard Matali, Thierry Raoul Gombet, Suzy Gisèle Kimbally Kaky Copyright (c) Wed, 19 Dec 2018 00:00:00 +0000 Corps étranger iléo-caecal mimant une maladie de Crohn: rapport de cas <p>L'ingestion du corps étranger est une situation fréquente en gastro-entérologie, cependant la localisation iléo-caecale reste très rare. L'objectif de ce travail était de rapporter le cas exceptionnel d'un corps étranger iléo-caecal révélé par des syndromes sub-occlusifs. Il s'agit d'un patient âgé de 22 ans sans antécédents pathologiques notables, qui s'est présenté avec un syndrome de Koening évoluant dans un contexte d'altération de l'état général. Le diagnostic d'un épaississement iléo-caecal inflammatoire réactionnel à un corps étranger est posé grâce à l'étude anatomo-pathologique d'une pièce opératoire de résection iléo-caecale après que l'endoscopie, l'histologie des biopsies et l'imagerie scannographique étaient non contributives. En l'absence d'orientation anamnestique, la localisation iléo-caecale d'un corps étranger pose un réel problème de diagnostic différentiel avec les pathologies inflammatoires, infectieuses et tumorales du carrefour iléo-caecal. Elle peut être révélée par des complications à type d'occlusion ou de perforation où l'imagerie tient une place primordiale. L'endoscopie joue toujours un rôle diagnostique et thérapeutique essentiel dans la prise en charge des corps étrangers ingérés limitant ainsi la morbidité chirurgicale quoique celle-ci demeure parfois incontournable et l'étude anatomo-pathologique met en évidence un granulome à corps étranger constitué. Le corps étranger iléo-caecal est une situation rarement rapportée et doit dorénavant être considéré devant toute symptomatologie du carrefour iléo-caecal afin d'éviter au patient les effets secondaires et les complications des traitements lourds.</p> Khaoula El Montacer, Fouad Haddad, Souhaila El Mansouri, Mohammed Tahiri, Wafaa Hliwa, Ahmed Bellabah, Wafaa Badre Copyright (c) Wed, 19 Dec 2018 00:00:00 +0000 Non postoperative biloma in Mauritania: Case report and literature review <p>Biloma is used to describe abnormal accumulation of bile outside biliary tract. It is a very rare condition with extrahepatic diffused or encapsulated collection of bile, mostly post-operative or post traumatic. A 72-year-old woman was referred to our hospital with acute abdominal pain located in right upper quadrant. Clinical examination suspected abdominal collection. Imagery (ultrasound and computed tomography scan) demonstrated a large well-defined intra-abdominal collection. Percutaneous ultrasound guided drainage of abdominal collection revealed a bile fluid. Drain was removed a week later and complete resolution of symptoms was obtained in two weeks. Even in the absence of specific diagnostic indications, radiological images may play a key role in the evaluation of suspected biloma in patients with appropriate medical history and clinical characteristics.</p> Ahmedou Moulaye Idriss, Yahya Tfeil, Jiddou Sidi Baba, Ahmedou Mohamed Abdallahi, Ahmed Bezeid Copyright (c) Thu, 20 Dec 2018 00:00:00 +0000 Leiomyosarcoma of scrotum: case report <p>Scrotal leiomyosarcoma is rare tumor. It presents as a painless, slow-growing cutaneous lesion. It’s often mistaken for a benign condition. It is best treated by wide local excision. A case of scrotum leiomyosarcoma is presented in a 63 year old patient who was treated for the first time as having a benign lesion.</p> Tariq Bouhout, Badr Serji, Ebo Usman Egyir, Benyounes El Amri, Imad Bouhout, Mehdi Soufi, Mohammed Bouziane, Tijani El Harroudi Copyright (c) Thu, 20 Dec 2018 00:00:00 +0000 Diagnosis of abdominal pregnancy still a challenge in low resource settings: a case report on advanced abdominal pregnancy at a tertiary facility in Western Kenya <p>Abdominal pregnancy is a rare form of ectopic pregnancy, occurring in 1: 10,000 to 1: 30,000 pregnancies and accounting for up to 1.4% of all ectopic pregnancies. It is classified as primary or secondary depending on the site of fertilization. However, when it does happen, it may remain unnoticed until term because the pregnancy can appear normal during clinical examination. Advanced abdominal pregnancy is associated with high mortality rate for both the mother and the baby at 1-20% and 40-95% respectively. We report a case of a 30-year-old female para 2+0, gravida 3 at 35 weeks + 1 day who presented at a Tertiary facility in Eldoret Kenya with one-day history of per vaginal bleeding and 2 weeks history of no fetal movements. The importance of this case report is to highlight the challenges associated with diagnosis of advanced abdominal pregnancy in low resource settings. Ultrasound alone cannot be relied on to make the diagnosis. Whenever an induction is not working, abdominal pregnancy should be considered.</p> Sahara Shurie, John Ogot, Philippe Poli, Edwin Were Copyright (c) Thu, 20 Dec 2018 00:00:00 +0000 Complete excision of a large pancreatic neuroendocrine neoplasm <p>Pancreatic neuroendocrine tumours localized to the pancreas and amenable to complete surgical resection are rarely reported. In West Africa, such patients present too late for surgery to be considered. In the reported case, a patient with persistent epigastric pain underwent a computed tomographic examination which led to the discovery of a large (6cm x 5cm) localized tumour in the body and tail of the pancreas. Complete resection of the tumour was performed. Histological examination showed a pancreatic neuroendocrine tumour without capsular invasion. Adjuvant chemotherapy was deemed unnecessary. The patient remains symptom free 2 years after the procedure with no evidence on subsequent imaging of tumour recurrence. Although extremely rare, large pancreatic neuroendocrine tumours may still be amenable to complete excision.</p> Rudolph Darko, Frank Edwin, Jehoram Anim Copyright (c) Thu, 20 Dec 2018 00:00:00 +0000 Prise en charge du syndrome alport au cours de la grossesse: à propos d’un cas et revue de la litterature <p>La survenue d'une grossesse chez une patiente porteuse d'un syndrome d'alport est une situation rare vu les répercussions de cette néphropathie sur la fertilité. Nous rapportons un cas de syndrome d'alport associé à la grossesse chez une parturiente âgée de 28 ans. La survenue d'une menace d'accouchement prématuré avec une élévation des chiffres tensionnels a nécessité l'hospitalisation de cette femme pour une éventuelle prise en charge. Une revue de la littérature discutant les différentes complications materno-fœtales et s'intéressant á la prise en charge au cours de la grossesse est également présentée.</p> Taher Berrada, Oumaima M’hamdi, Intissar Benzina, Fatema Zahra Lamine, Najia Zraidi, Abdelaziz Baidada Copyright (c) Thu, 20 Dec 2018 00:00:00 +0000 Corps étranger post traumatique de la paroi thoracique de diagnostic tardif: à propos d’un cas <p class="ArticleParagraph">Il s'agit d'un patient de 63 ans, aux antécédents de plaie traumatique de la face externe droite du thorax il y a 6 ans qui a été suturée. L'examen montrait une tuméfaction en regard de la cicatrice qui était molle et indolore. L'échographie réalisée était en faveur d'une structure hyperéchogène entourée d'une masse tissulaire sans caractère vasculaire. L'exérèse réalisée a permis de visualiser à l'ouverture de la pièce un corps étranger métallique entouré d'un tissu réactionnel. Les corps étrangers localisés dans les parties molles sont pour la plupart post traumatiques. Leur diagnostic est aisé avec la clinique et l'imagerie surtout si le traumatisme est localisé. Dans le cadre d'un polytraumatisme, ils peuvent être méconnus et leur diagnostic fait tardivement. L'imagerie garde une place de choix dans le diagnostic.</p> Abdourahmane Ndong, Pape Ousmane Ba Copyright (c) Thu, 20 Dec 2018 00:00:00 +0000 An unusual complication of Meckel’s diverticulum: Littre’s hernia <p>Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract. Any hernia sacs containing Meckel’s diverticulum is called Littre’s hernia.It was described for the first time in 1700 by Alexis Littre. The diagnosis is unlikely to be made preoperatively and Surgery is the treatment of choice. We report a rare case of Littre’s hernia who presented with clinical signs of intestinal obstruction.</p> Tariq Bouhout, Badr Serji, Ebo Usman Egyir, Benyounes El Amri, Imad Bouhout, Mehdi Soufi, Mohammed Bouziane, Tijani El Harroudi Copyright (c) Fri, 21 Dec 2018 00:00:00 +0000 Lipome intramédullaire: à propos d'une observation <p>Les lipomes intramédullaires sont des lésions bénignes rares qui représentent environ 1% de l'ensemble des tumeurs de la moelle épinière. Nous rapportons un nouveau cas de lipome intramédullaire non dysraphique confirmé histologiquement. Il s'agissait d'une patiente âgée de 46 ans ayant bénéficié d'une biopsie chirurgicale pour un lipome médullaire il y a 6 mois. Nous ne disposons pas de documents radiologiques antérieurs à cette chirurgie. Elle présente actuellement des rachialgies, des troubles sensitifs, des troubles de la marche et une faiblesse musculaire d'aggravation récente. L'IRM médullaire objective une formation en hypersignal T1 et T2 bien limitée de 8 cm x 2,5 cm prenant le cône terminal. L'imagerie par résonance magnétique occupe une place primordiale dans l'exploration des lipomes intramédullaires, elle permet le diagnostic précoce et ainsi une prise en charge chirurgicale avant la survenue de complications neurologiques irréversibles.</p> Soukaina Wakrim, Najwa Touil, Ousmane Traore, Omar Kacimi, Nabil Chikhaoui Copyright (c) Wed, 26 Dec 2018 00:00:00 +0000 Métastase géante sous cutanée d'un carcinome vésiculaire de la thyroïde: à propos d'un cas <p>La localisation secondaire sous-cutanée de carcinome vésiculaire de la thyroïde est inhabituelle. Elle représente au plus 5,8% de sites métastatiques préférentielles de la thyroïde. Il s'agit d'une femme de 60 ans, présentant une énorme tuméfaction hypervasculaire du tissu sous-cutané du crâne, d'évolution lente, après 7 ans d'une lobectomie droite de la thyroïde. Le bilan anatomo-pathologique a conduit au diagnostic de carcinome vésiculaire de la thyroïde. Une intervention chirurgicale consistait à réduire la lésion du crâne ainsi qu'une thyroïdectomie a été réalisée. Actuellement, elle est en attente d'un traitement par l'iode radio-actif. La métastase de carcinome vésiculaire du scalp existe malgré que c'est rare. Toutefois, à ce stade le pronostic reste défavorable.</p> Ny Ony Tiana Andrianandrasana, Malala Razakanaivo, Marie Ida Rahantamalala, Florine Josoa Rafaramino Copyright (c) Wed, 26 Dec 2018 00:00:00 +0000 Carcinome épidermoïde du bassinet découvert par un envahissement pariétal et cutané: une présentation inhabituelle <p>A travers cette étude clinique nous présentons un cas rare de carcinome épidermoïde du bassinet avec envahissement cutané de la paroi abdominale chez une patiente aux antécédents d'infections urinaires hautes à répétition sur des calculs rénaux. Le motif de consultation était la découverte d'une lésion cutanée lombaire droite. L'uro-scanner montrait une masse rénale droite étendue aux parties molles adjacentes dont la biopsie a révélé un carcinome épidermoïde du bassinet. Après une revue de la littérature, c'est le premier cas d'un carcinome épidermoïde du bassinet découvert par un envahissement cutané.</p> Maher Slimane, Manel Hadidane, Hatem Bouzaiene, Maha Driss, Olfa Jaidane, Houda Henchiri, Monia Hechiche, Khaled Rahal Copyright (c) Wed, 26 Dec 2018 00:00:00 +0000 Le rhinosclérome une infection chronique rare des fosses nasales <p>Il s'agit d'une patiente âgée de 80 ans, hypertendue, consultant pour une obstruction nasale bilatérale non améliorée par le traitement symptomatique. L'examen des fosses nasales a montré une lésion granulomateuse pseudotumorale hyper vascularisée et saignante au contact de part et d'autre de la partie antérieure de la cloison nasale (A) avec un aspect granulomateux du reste de la muqueuse septale. Le scanner du massif facial a montré une lésion tissulaire des fosses nasales de part et d'autre du septum se rehaussant modérément après injection des produit de contraste (PDC) sans lyse osseuse en regard (B). La biopsie a conclu au diagnostic de rhinosclérome. Une bithérapie incluant une cycline avec Cotrimoxazole a été prescrite mais sans disparition de la lésion nasale. D'où le recours à une chirurgie endonasale avec exérèse de la masse septale. L'examen histologique définitif a confirmé le diagnostic de rhinosclérome. La patiente a été mise sous ciprofloxacine pendant 1 mois. L'évolution était bonne avec désobstruction des fosses nasales avec un recul de 1 an. En conclusion, le rhinosclérome est une infection granulomateuse des fosses nasales due à une entérobactérie de la famille Klebsiella (<em>Klebsiella Rhinoscleromatis</em>). Le traitement est essentiellement médical. La chirurgie s'adresse aux lésions pseudotumorales obstructives résistantes au traitement médical.</p> Souha Kallel, Abdel Mounem Ghorbel Copyright (c) Wed, 26 Dec 2018 00:00:00 +0000 Factors associated with acceptability of HIV self-testing (HIVST) among university students in a Peri-Urban area of the Democratic Republic of Congo (DRC) <p><strong>Introduction:&nbsp;</strong>this paper examines the acceptability of HIV self-testing (HIVST) by students in a university in the DRC and identifies factors associated with uptake of HIVST.</p> <p><strong>Methods:&nbsp;</strong>a cross-sectional study was conducted with a sample of 290 students from Kikwit University. Data were summarized using proportions and predictions of acceptability of HIVST by logistic regression.</p> <p><strong>Results:&nbsp;</strong>the average age of students was 22.5 years, with the majority of the students being male (57%). Just over half the students sampled, reported being sexually active (51.8%). One hundred and sixty four (75%) reported that they had one sexual partner and fifty-six (25%) two or more sexual partners in the past year. Sixty-six percent had used condoms during their last sexual encounter. The acceptability of HIVST was high (81.4%) and 66.1% of students stated that they would confirm the self-test at a local health facility. The knowledge about the importance of the self-test (OR 5.02; 95% CI:1.33-18.88; p=0.017), the perception that counseling pre and post-test were important (OR 2.91; 95% CI:1.63-5.19; p &lt; 0.0001) and the willingness to realize the test with a partner (OR 2.46; 95% CI:1.43-4.23; p=0.034) were factors associated with HIVST.</p> <p><strong>Conclusion:&nbsp;</strong>the acceptability of HIVST was high and therefore its implementation is feasible in our country. However, prior to implementation, additional factors such as cost; access of HIVST; false reassurance of the test; missed early infections in the window period, limited counseling and linkage to care options, need to be considered.</p> Ben Bepouka Izizag, Hippolyte Situakibanza, Tathy Mbutiwi, Richard Ingwe, Florian Kiazayawoko, Aliocha Nkodila, Madone Mandina, Murielle Longokolo, Evelyne Amaela, Marcel Mbula Copyright (c) Thu, 27 Dec 2018 00:00:00 +0000 The outbreak of diphtheria in Indonesia <p>Diptheria is commonly caused by the aerobic gram-positive bacteria,&nbsp;<em>corynebacterium diphtheria</em>. We herein report an unusual case of diphtheria outbreak in Indonesia in 2017 and its possible causes and current management.</p> Ramadhan Tosepu, Joko Gunawan, Devi Savitri Effendy, La Ode Ali Imran Ahmad, Amrin Farzan Copyright (c) Thu, 27 Dec 2018 00:00:00 +0000 Maternal serum level of TNF-α in Nigerian women with gestational diabetes mellitus <p><strong>Introduction:&nbsp;</strong>alterations in the circulating level of tumour necrosis factor-α (TNF-α) has been proposed to be involved in the pathogenesis of gestational diabetes mellitus (GDM), but its role is not completely understood, findings from studies done across different ethnic groups are often inconsistent. We carried out this study to determine maternal serum level of TNF-a and it's association with body weight status in a group of Nigerian women with GDM.</p> <p><strong>Methods:&nbsp;</strong>a cross sectional analytical study conducted among 169 pregnant women, 85 with GDM and 84 with normal gestation. Diagnosis of GDM was made between 24-28 weeks gestation according to the WHO diagnostic criteria. Maternal serum level of TNF-α was measured and compared between the study groups.</p> <p><strong>Results:&nbsp;</strong>maternal serum TNF-α level was significantly higher in the pregnant women with GDM than in the controls (2.50 ± 0.30 vs. 2.10 ± 0.30 pg/ml, p &lt; 0.05). Also when comparing the serum TNF-α levels of the pregnant women with GDM and the controls for each level of body mass index, serum TNF-α levels remained significantly higher in both the normal weight and overweight pregnant women with GDM compared to their matched controls (2.40 ± 0.30 vs. 1.90 ± 0.20 pg/ml, p &lt; 0.05) and (2.60 ± 0.30 vs. 2.30 ± 0.20 pg/ml, p &lt; 0.05) respectively.</p> <p><strong>Conclusion:&nbsp;</strong>it is concluded that pregnant women with GDM in this study have higher maternal serum TNF-α level compared to the pregnant women with normal glucose tolerance regardless of body weight status.</p> Abdullahi Mohammed, Ibrahim Sambo Aliyu Copyright (c) Fri, 28 Dec 2018 00:00:00 +0000 Lymphœdème compliqué de papillomatose verruqueuse <p>Les lymphœdèmes des membres (LOM) sont dus à un dysfonctionnement du système lymphatique responsable d'une stase de la lymphe dans les tissus interstitiels et secondairement d'une augmentation de volume du membre atteint. On les classe en lymphœdèmes primaires (LOP) et lymphœdèmes secondaires (LOS). Au niveau du membre supérieur, les LOS après traitement d'un cancer du sein sont les plus fréquents; au niveau du membre inférieur, les LO sont soit secondaires (iatrogéniques ou infectieux), soit primitifs le plus souvent sporadiques, parfois familiaux ou peuvent faire partie des syndromes malformatifs et/ou génétiques plus complexes. Le diagnostic de LO est essentiellement clinique. L'érysipèle reste la principale complication des LO, d'autres anomalies sont fréquemment visibles: aspect jaunâtre de la peau et des ongles, lymphangiectasies, papules kératosiques avec papillomatose, plaques lichénifiées. Le principal diagnostic différentiel des LOM est le lipœdème, défini par une répartition anormale des graisses allant des hanches jusqu'aux chevilles et atteignant presque exclusivement les femmes obèses. Nous rapportons l'observation d'un homme de 30 ans qui présente depuis la puberté un lymphœdème du membre inferieur gauche compliqué par une papillomatose verruqueuse. Il s'agit d'un lymphœdème congénital à révélation tardive.</p> Fatima-zahra Agharbi Copyright (c) Fri, 28 Dec 2018 00:00:00 +0000