Pan African Medical Journal

Epidemiological, clinical and prognosis aspects of acute generalized peritonitis in South-Kivu Province: descriptive observational study of 278 cases

Jean Paul Buhendwa Cikwanine — 2025-02-20

Introduction: the aim was to determine epidemiological, clinical, therapeutic, and prognostic aspects of acute generalized peritonitis (AGP).

Methods: we conducted an observational, cross-sectional and multicentre study over 2 years of 278 cases of acute generalized peritonitis operated in semi-urban and urban hospitals in South-Kivu Province, Democratic Republic of Congo.

Results: the population of this study was young with a mean age was 28.9 ± 16.1 years with extremes of 1.3 years to 80 years with a sex ratio M:F of 0.8. Peritonitis aetiology was dominated by intestinal perforation 132 cases (47.4%), the admission time in 65, 5% was more than 72 hours. Acute abdominal pain was the most reason for consultation in 93.2% of cases, 11.9% of patients were in hypovolemic shock. In 40.6%, the treatment of patients consisted in intestinal resection with terminal anastomosis, or ileostomy in 32.7%. About the outcomes, 32.4% of the patients had a surgical reoperation and 15.8% of the digestive fistulas were reported. The average duration of the hospitalization was 23.4 ± 20.3 days. Morbidity rate was 14.7%.

Conclusion: the AGP remains one of the abdominal emergencies observed in different semi-urban and urban hospitals of the province of South-Kivu, causing some problems of medical and surgical management, starting from the delay of admission, the severity of the symptoms related to the etiology of the intestinal perforation. In all cases, AGP requires a well-executed resuscitation procedure and surgical technique to improve the prognosis and reduce mortality, which seems to be high in this study.

Prevalence and determinants of anaemia among pregnant women in a high malaria transmission setting: a cross-sectional study in rural Burkina Faso

Moussa Lingani — 2025-02-20

Introduction: anemia, the commonest nutritional deficiency disorder among pregnant women in sub-Saharan Africa, is associated with severe peripartum complications. Its regular monitoring is necessary to timely inform clinical and preventive decision-making. The aim of this study was to assess the prevalence and determinants of anemia among pregnant women in rural areas of Burkina Faso.

Methods: between August 2019 and March 2020, a cross-sectional study was conducted to collect maternal sociodemographic, gynaeco-obstetric, and medical characteristics by face-to-face interview or by review of antenatal care books. In addition, maternal malaria was diagnosed by standard microscopy and the hemoglobin levels (Hb) measured by spectrophotometry. The proportion of anaemia (Hb<11.0 g/dL), moderate (7.0<Hb<9.9 g/dL) and severe (Hb<7.0 g/dL) anaemia were determined. The maternal factors associated with anaemia were identified using regression models with likelihood ratio tests. A p-value < 0.05 was considered statistically significant.

Results: of 594 pregnant women assessed, the mean hemoglobin level (± standard deviation) was 10.7 (±0.1) g/dL, and the prevalence of anemia was 54.4% (323/594). The proportion of moderate, and severe anemia among pregnant women was 49.2% (95% CI: 45.1%-53.2%), and 5.2% (95% CI: 3.7%-7.3%) respectively. Multivariate analysis showed that the young maternal age (<20 years old) (adjusted OR (aOR): 1.5, 95% CI: 1.1-2.3) and the presence of malaria (aOR: 2.0, 95% CI: 1.3-3.2) were independently associated with the presence of maternal anemia.

Conclusion: anemia remains common in the study setting and interventions to strengthen malaria prevention in pregnancy, particularly among young adolescent pregnant women, are required to prevent maternal anemia.

Eosinophilic oesophagitis in a Nigerian adolescent: a case report

Joanah Moses Ikobah — 2025-02-20

Eosinophilic oesophagitis (EoE) is a chronic immune and antigen-mediated disease characterized by symptoms related to oesophageal dysfunction, and histologically, is marked by eosinophilic infiltrate in the oesophageal mucosa. It is prevalent in developed countries and considered rare in developing countries. There is an interplay of allergic and genetic factors in the aetiology of EoE. This is a report of EoE in a 15-year-old female adolescent in Nigeria who presented to the University of Calabar Teaching Hospital with recurrent vomiting, abdominal pain, weight loss, and dysphagia. She had received treatment for Gastro-oesophageal disease three years earlier and was lost to follow-up. Weight on admission was 39 kg and height 170 cm with a BMI below the 3^rd centile. Peripheral blood showed an eosinophil count of four percent. The abdominal computed tomography (CT) scan and upper gastrointestinal (GI) series were normal. Faecal antigen for H. pylori and ova for stool parasites were negative. Histologic findings of proximal and distal oesophageal mucosal biopsies showed greater than 20 eosinophils per high power field. The histology of the stomach and duodenum were normal. She was initially treated with a protein pump inhibitor, with no improvement. Swallowed fluticasone propionate and eliminating peanuts, wheat, egg, and milk from her diet were introduced. Symptoms improved with the patient no longer vomiting and had an increase in weight gain. She was discharged to follow up. This case shows that EoE occurs in developing countries, but diagnosis may be missed. There is a need for a high index of suspicion among gastroenterologists in patients with symptoms suggestive of GERD not responding to therapy.

Factors associated with full childhood vaccination coverage among young mothers in Northern Nigeria

Matthew Ayodele Alabi — 2025-02-20

Introduction: wide regional variation in immunization coverage still persists in Nigeria. Full Immunization Coverage (FIC) for more than 80% of all states in the northern region is lower than 40% relative to their southern counterpart. Studies focusing on young women in the north remain sparse, despite the high prevalence of early marriage and poor health-seeking behavior. This study examines FIC among young women in Northern Nigeria.

Methods: we performed a secondary analysis of the 2013 and 2018 Nigeria Demographic and Health Survey on 1,198 women of children aged 12-23 months in 2013 and 405 in the 2018 dataset. Analysis was limited to young women 15-24 years, residing in Northern Nigeria. We used logistics regression to predict factors associated with FIC.

Results: the proportion of fully immunized children was low, at 11% in 2013 and 18% in 2018. The coverage for most vaccines was low, except for the oral polio vaccine. The children of mothers who had health card [(aOR=18.1,95% C.I (8.1-40.7)], in 2013 and 2018 [(aOR=12.7, 95% C.I (5.9-27.1)], attended ANC [(aOR=8.6, 95% C.I (2.4-30.9)] in 2013 and had facility delivery [(aOR=2.0, 95% C.I (1.0-4.1)] in 2018 were more likely to be fully immunized.

Conclusion: the study found FIC among children of young women in Northern Nigeria was abysmally low. Ownership of health care, antenatal attendance, and facility delivery significantly predicted the odds of FIC. These findings suggest the need for approaches that remove barriers to good health-seeking behavior, especially among young mothers in Northern Nigeria.

Challenges associated with coronavirus disease (COVID-19)-related self-quarantine in Ghana: lessons for future self-quarantine interventions

Stephen Anaman — 2025-02-20

Introduction: self-quarantine was one of the key public health interventions in halting the spread of the coronavirus disease (COVID-19) in Ghana. Despite its success, self-quarantine was bridled with challenges across the country, including in the Eastern Region. Consequently, it was pertinent to ascertain these challenges to inform future self-quarantine interventions in the region and the country. The study aimed to ascertain challenges faced by COVID-19 self-quarantined persons in the Eastern Region of Ghana to inform future policies on self-quarantine in the region and the country in general.

Methods: thirty-five (35) participants were interviewed in both Twi and English. Following the thematic content analysis approach, Atlas. ti software was used to analyse the data. Relevant quotes were extracted from the transcripts to back the various sub-themes in presenting the results.

Results: three global themes emerged from the analyses: socio-economic challenges of self-quarantine (lack of access to essential goods and services, loss of income, and poor housing conditions), health-related challenges (sedentary lifestyle, non-supply of essential personal protective equipment such as face masks, development of oedema and weight gain), and psychological challenges (loneliness, boredom, and anxiety).

Conclusion: COVID-19-related challenges self-quarantined persons faced in the Eastern Region of Ghana were multifaceted, ranging from socio-economic, and health to psychological ones. Consequently, emergency preparedness for future pandemic control using self-quarantine as a tool should bring on board various stakeholders to ensure challenges identified in this study are holistically addressed and do not recur.

Left ventricular recovery in an African cohort of patients with peripartum cardiomyopathy

Dangwé Temoua Naïbé — 2025-02-20

Peripartum cardiomyopathy (PPCM) is a rare and potentially life-threatening disease associated with pregnancy. There are limited data regarding the outcome of PPCM and its predictive factors in sub-Saharan African patients. We prospectively conducted a double-center (cardiology unit of the department of medicine, Regional Hospital Center of Tenkodogo, Burkina Faso and the department of cardiology of the National Referral Teaching Hospital of N´Djamena, Chad) cohort study in patients with PPCM. Patients were consecutively enrolled from January 2015 to December 2017. Outcomes of interest were left ventricular recovery and poor outcome at one year. Ninety-four patients enrolled with a median age of 28 years. At one-year follow-up, 40.5% of them recovered their left ventricular function. Cox multiple regression analysis revealed that higher left ventricle ejection fraction (LVEF), lower natremia and use of betablockers were baseline variables predicting this end-point. Of the entire study population, 26.60% exhibited the composite end-point of death (n=15) or remaining in New York Heart Association (NYHA) class III-IV or LVEF < 35%. Predictors of poor outcome were lower LVEF at baseline, hyponatremia and use of digoxin. The current cohort study demonstrated that PPCM in sub-Saharan Africa is associated with limited myocardial recovery and significant rate of poor outcome at one-year. Therefore, additional studies are needed to better address the disease.

Frequency and correlates of poor glycemic control in patients with type 2 diabetes at Jimma Medical Centre, Ethiopia: a cross-sectional study

Misganaw Asmamaw Mengstie — 2025-02-20

Introduction: the majority of studies in Ethiopia determine the prevalence of glycemic control employed by fasting blood sugar (FBS), which is impacted by a variety of factors. Hence, the purpose of this study was to assess the status of glycemic control using HbA1c and its correlates in patients with type 2 diabetes in Southwest Ethiopia.

Methods: a cross-sectional study was employed among 124 T2 diabetes mellitus (DM) patients at Jimma Medical Center (JMC), Southwest Ethiopia. HbA1c and FBS were estimated using the Cobas 6000 analyzer. The body mass index (BMI) and waist-to-hip ratio were calculated as the standard formula. Data were analyzed by SPSS version 25. Logistic regression analysis was employed to identify independent risk factors associated with poor glycemic control of DM patients.

Results: males comprised 63.7% (n=79) of the total respondents. The mean age of aOR: 2.21, 95% CI 1.13, 4.34; p = 0.01f participants was 51.84 ± 11.6 years; 60.5% (n=75) of T2 DM patients were in poor glycemic control (HbA1c ≥ 7%). In multivariate logistic regression analysis, BMI of ≥ 30, (aOR: 2.21, 95% CI 1.13, 4.34) increased waist-to-hip ratio (aOR: 1.63, 95% CI 0.82, 2.18), high systolic blood pressure (aOR: 1.52, 95% CI 1.11, 6.23), high FBS (aOR: 1.61, 95% CI 1.00, 4.12), and longer duration of DM (aOR: 1.23, 95% CI 0.87, 1.88) were associated with poor glycemic control.

Conclusion: the level of poor glycemic control in the study population is high. Obesity and/or overweight, central obesity, systolic hypertension, and fasting blood sugar levels were all associated with poor glycemic control in T2 DM patients.

The histological prevalence of prostatitis at Potchefstroom Hospital: a cross-sectional study

Prince Kasongo Mwila — 2025-02-20

Introduction: prostatitis is defined as a clinical condition caused by acute or chronic infectious diseases, chronic pelvic pain syndrome, or asymptomatic inflammation of the prostate gland. We conducted a study to determine the prevalence of histological prostatitis in patients with prostatic diseases at Potchefstroom Hospital.

Methods: we conducted a cross-sectional study based on the review of histology report from 1^st January 2015 to 31^st December 2019 coupled to clinical information of patients. A total of 362 cases with complete histopathology report were included in the study. Chi-square and Fisher exact test were used to test statistical significance with a p-value of 0.05 deemed to be significant.

Results: over a total number of 362 patients, the mean age was 69.82±7.9 years. The overall prevalence of prostatitis on histology was 158 (43.65%). Chronic prostatitis was predominant and commonly associated with BPH or PCa in 142 cases (39.23%) on histopathology report, while acute prostatitis was found in 16 patients (4.42%). We further found prostate cancer in 178 patients (49.17%), BPH in 163 (45.03%). The study shows that 41 cases (23.3%) of prostate cancer were associated with prostatitis, and 96 cases (58.9%) of BPH were also associated with prostatitis on histology. The difference was statistically significant p < 0.001. The study revealed that in BPH with prostatitis the median PSA was 15 ng/ml (IQR 9-24), while in BPH without prostatitis the median PSA was 11ng/ml (IQR 7-16). (p < 0.017). This means that prostatitis increases PSA in patients with BPH. However, the presence of prostatitis did not significantly influence the PSA value in patients with prostate cancer.

Conclusion: this study showed that close to half of the histology examined had signs of prostatitis. Chronic prostatitis was more frequent on histology done in our sample. BPH was strongly associated with prostatitis. Prostatitis contributed to a higher PSA values in patients with BPH and did not influence the PSA value in PCa.

Non-scarring alopecia in systemic lupus erythematosus patients at the Lagos State University Teaching Hospital: a cross-sectional study of prevalence, pattern, trichoscopy features and histopathological analysis

Ehiaghe Lonia Anaba — 2025-02-20

Introduction: trichoscopic and histopathological evaluation of non-scarring systemic lupus erythematosus (SLE) alopecia is uncommon. We aimed to document the prevalence, pattern of hair loss, trichoscopic and histopathologic differences between systemic lupus erythematosus patients with and without hair loss.

Methods: this was a cross-sectional comparative study of 75 systemic lupus erythematosus patients, 36 with hair loss from February to December 2020. Trichoscopic evaluation was conducted on all 75 patients. Twenty-three patients (12 with hair loss and 11 without) had scalp biopsies with mucin deposit evaluation. Disease activity was documented using the SLE disease activity index. Data was analyzed using SPSS 22.

Results: the mean age of the patients was 33.7 ± 12.4 years. Non-scarring alopecia was observed in 48%. The pattern of hair loss was <4 patches in 44.4%, mild diffuse in 25%, and severe diffuse in 30.6%. Disease activity was mild in 38.9%. Hair shaft changes included thin hair (97.2%), decreased number of hairs per follicular unit (97.2%), hypopigmented hair (85.7%), and follicular red dots (27.8%). Significant differences between the two groups were; a reduction in size and number of sebaceous glands on histopathology, hair shaft, and scalp pigmentary changes in the hair loss group.

Conclusion: the prevalence of non-scaring alopecia is high in SLE patients with patchy type as the commonest pattern. Trichoscopic and histopathologic differences exist in SLE patients with and without hair loss and the normal-appearing scalp in SLE patients is involved in the inflammatory process. Hair shaft thinning, hypopigmentation, and scalp pigmentary changes occur in SLE.

Prevalence and associated factors of acute diarrhea among under-five children living in Hargeisa Internally Displaced Persons, Somaliland: a community-based cross-sectional study

Ahmed Ismail Mohamed — 2025-02-20

Introduction: in developing countries, diarrhea is a major cause of child death among those under five years old. Dehydration, malnutrition, delayed physical development and early childhood mortality are the major consequences of diarrheal diseases. In Somaliland, diarrheal diseases have been endemic and a major problem since 1994, with epidemics occurring annually. This study aimed to assess the prevalence and risk factors of acute diarrhea among children under five years old living in Hargeisa Internally Displaced Persons (IDPs), Somaliland.

Methods: a community-based cross-sectional study was conducted among mothers of children under five from August to September 2020 in Hargeisa IDPs. A total of 383 mothers were selected using single population proportional formula. Data was entered, cleaned, and analyzed using SPSS version 22. To explore the association between variables, bivariate logistic regression was performed for each independent variable with the dependent variable. Variables with a p-value of < 0.05 were adjusted in multivariate logistic regression. Finally, variables with a p-value < 0.05 were recognized as determinants of acute diarrheal disease.

Results: the prevalence of diarrhea among children under five living in Hargeisa IDPs was 51% (95% CI:46%-56%). Children older than one year (AOR= 3.59, 95% CI: 2.05-5.20), those not exclusively breastfed (AOR= 4.01, 95% CI: 3.27-4.60), those not given colostrum milk (AOR= 36.41, 95% CI: 25.76-47.90), those drinking water stored in jerry-cans (AOR = 4.90, 95% CI: 1.31-8.39), and those with poor hand washing practices (AOR = 5.74, 95% CI: 1.38-7.82) were more likely to develop diarrhea than their counterparts.

Conclusion: this study concludes that the prevalence of diarrhea was very high (51%). Lack of awareness of exclusive breastfeeding and colostrum feeding, storing drinking water in unprotected containers, and poor hand-washing practices were identified as significant predictors for childhood diarrhea (p-value < 0.05).

Investigation of a bacterial meningitis cluster in a refugee settlement, Obongi District, Uganda, March 2023

Brian Agaba — 2025-02-20

On 6 March 2023, Neisseria meningitidis serogroup C was isolated from a cerebral spinal fluid sample from Obongi District, Uganda. This sample was one of many from patients who were presenting with fever, convulsions, and altered consciousness. We investigated to determine the scope of the meningitis cluster, identify risk factors of contracting meningitis, and inform control measures. We reviewed medical records, conducted active community case finding, and conducted key informant interviews in the affected communities to identify cases and factors associated with contracting meningitis. We analysed case data by person, place, and time. Between 22 December 2022 and 1 May 2023, 25 cases with 2 deaths of bacterial meningitis occurred in Palorinya Refugee Settlement, Obongi District. Of these, 4 were laboratory-confirmed with Neisseria meningitidis serogroup C, 6 were probable cases, and 15 were suspected cases. Most (76%) of case-patients were <18 years old with a median age of 12 years (range 1-66 years). None of the case-patients was vaccinated against Neisseria meningitidis serogroup C. Each case-patient was from a different household and there was no epidemiological link between any of the cases. This meningococcal meningitis cluster caused by Neisseria meningitidis serogroup C occurred among non-vaccinated persons mostly aged <18 years in Palorinya Refugee Settlement. We recommended vaccination of at-risk persons.

Polyarthrite rhumatoïde: la rémission sans biothérapie? L´expérience du Burkina Faso (Afrique de l´Ouest)

Aboubakar Ouédraogo — 2025-02-20

Introduction: l'objectif de cette étude était d'évaluer la réponse thérapeutique des patients traités par les antirhumatismaux modificateurs de la maladie (ARMM) pour une polyarthrite rhumatoïde (PR).

Méthodes: il s'agit d'une étude transversale monocentrique descriptive et analytique menée au Burkina Faso de janvier 2019 à décembre 2021 chez des patients atteints d´une PR répondant aux critères American Rheumatism Association/ European League Against Rheumatism. La réponse thérapeutique a été évaluée selon les critères de European League Against Rheumatism, le Clinical Disease Activity Index et the Simplified Disease Activity Index après au moins six mois de traitement.

Résultats: cent trois patients dont 85 femmes ont été inclus. La moyenne d´âge des patients était de 50,14 ans ±15,04 ans. Quatre-vingt-sept patients (84,47%) étaient ACPA positif et 50 patients (48,54%) avaient une atteinte radiologique à l´inclusion. Le DAS28-CRP, le CDAI et le SDAI moyen étaient respectivement de 5,17; 32,16 et 35,48 à l´inclusion contre 2,53; 7,83 et 8,76 après au moins six mois de traitement (p<0,0001). Quatre-vingt-seize patients (93,20%) étaient traités par du méthotrexate. Selon les critères de l´European League Against Rheumatism, 89 patients (86,41%) étaient bons répondeurs, 62 patients (60,19%) étaient en rémission. Une amélioration majeure a été observée chez 53 patients (51,46%) selon l´évaluation par le Clinical Disease Activity Index et the Simplified Disease Activity Index.

Conclusion: malgré l´indisponibilité les biothérapies en Afrique sub-saharienne, la rémission de la PR peut être obtenue par une optimisation du traitement par les ARMM et un tight control.

La chronologie d'évolution des modes de dépistage et de traitement des néoplasies intra épithéliales du col utérin adoptés au Maroc

Mohamed Zraidi — 2025-02-20

Au Maroc le but du Plan National de Prévention et de Contrôle du Cancer (PNPCC) est de contribuer à la réduction de l´incidence, de la mortalité et de la morbidité imputables au cancer du col de l´utérus (CCU), dont l´objectif général est d´améliorer la prise en charge des femmes atteintes du CCU en instaurant un plan de route organisé de dépistage, de diagnostic précoce et de traitement de ce cancer, et comme objectifs opérationnels une: 1) atteinte d´au moins 30% du taux de couverture annuelle par le dépistage du CCU; 2) atteinte d´au moins 80% du taux de participation au dépistage du CCU par cycle de dépistage; 3) atteinte de 100% du taux de prise en charge des lésions pré malignes du col dépistées dans le cadre du programme. Le dépistage du CCU concerne toutes les femmes âgées de 30 ans à 49 ans révolus. Le test de dépistage actuellement retenu est l´Inspection Visuelle du col utérin à l´Acide acétique (IVA), qui sera suivie si positive d´un examen colposcopique voire une biopsie. L´IVA est effectuée au niveau des centres de soins urbains et ruraux par un personnel de santé qualifié. En sachant que le test utilisé auparavant est le frottis cervico-vaginal. La thermo coagulation, encore appelée cold coagulation est actuellement le traitement de choix des lésions intra épithéliales (LIE) qui sont éligibles à ce traitement, et enfin le programme national a introduit la vaccination anti HPV dans le programme national de vaccination (PNI).

Metastatic mucinous adenocarcinoma from breast mimicking a pyogenic granuloma in the gingiva: a case report

Rudra Prasad Chatterjee — 2025-02-20

Mucin-producing adenocarcinomas (MAC) are an extremely rare, indistinct group of neoplasm having either a salivary gland origin or with prominent glandular component. The diagnosis is chiefly based on the histological aspect conjoined with immunohistochemical evaluation as clinico-radiographical features are non-specific. It can arise as a primary metastasis to soft tissues, most commonly from either lung, breast, kidney, or colon. This paper reports a 51-year-old woman with buccolingual gingival swelling having a final diagnosis of metastatic mucinous adenocarcinoma from the breast. A tissue biopsy was performed followed by immunohistochemistry that confirmed the diagnosis. They are extremely rare, making the diagnosis challenging as it may mimic a benign neoplasm. It accounts for approximately 1% of all oral malignant neoplasms having gingival propensity. The clinician should therefore take into account every diagnostic aspect while encountering such oral lesions to achieve proper patient welfare.

Neonatal mortalities without detected risk factors before birth at Mtendeli hospital, Tanzania: a cross-sectional study

Alen Kinyina — 2025-02-20

Introduction: neonatal mortality rate (NMR) is defined as the probability of dying during the first 28 days of life expressed per 1,000 live births. The death of neonates without risk factors at the end of pregnancy could be an indicator of sub-optimal quality care during labor and care of sick neonates. Therefore, this study aimed to determine the factors associated with neonatal deaths happening without detected risks during prenatal period.

Methods: a cross-sectional study was conducted from 2017 to 2021.The recruited pregnant women were those who had a live, term, single-intrauterine pregnancy without detectable fetal abnormality at the time of starting labor. The data were collected through open data kit (ODK) forms that were customized in kobo tool in the tablets. The data analysis was performed using STATA statistical software. The factors associated with neonatal mortality were analyzed in a multiple logistic regression and considered significant if p < 0.05.

Results: among the 4401 enrolled mothers, neonatal deaths were 361 (8.2%). The factors associated with death of neonates without risk factors during prenatal period were low Apgar score [AOR = 4.38: 95%CI (2.33-7.72)], male sex [AOR=2.25: 95%CI (1.12-3.81)], gestational age above 40 weeks [AOR=4.79: (2.50-7.61)] and assisted vaginal delivery [AOR = 2.55: 95%CI (1.12-4.96)].

Conclusion: the increased number of neonatal deaths are associated with sex of neonates, low Apgar score, post maturity and assisted vaginal delivery. The hospital-based studies should be done to address the preventable neonatal deaths with no detected risk factors before birth.

Are growing inequities leaving Africa behind in the post-pandemic public health landscape?

Simon David Taylor-Robinson — 2025-02-20

Letter to the editors

Knowledge, attitudes, and practices of adolescent girls regarding cervical cancer: a cross-sectional study in Enugu State, Nigeria

Kosisochi Chinwendu Amorha — 2025-02-20

Introduction: cervical cancer is the second leading cause of cancer death, among women, globally. The majority of the countries with the highest cervical cancer burden are in sub-Saharan Africa, including Nigeria. This study assessed the knowledge, attitudes, and practices regarding cervical cancer among secondary school students in an all-girls school.

Methods: this cross-sectional study was conducted in Nsukka, Enugu State, Nigeria (April 2021). A 30-item self-administered structured questionnaire was filled by conveniently sampled students in Senior Secondary School (SS 2 and SS 3). Pearson's Chi-square was used to test the association between variables (Statistical significance: P < 0.05).

Results: the mean age of the 103 respondents was 16.10 (± 1.00) years. The most common source of information about cervical cancer was mass media (n = 20, 19.4%). Less than half of the respondents had good knowledge of cervical cancer (n = 44; 42.7%) and had favorable attitudes towards the disease (n = 50; 48.5%). More than half of them had good cervical cancer practices (n = 87; 84.5%). They were highly open to screening (n = 92; 89.3%) and vaccination (n = 93; 90.3%). More respondents who had first-hand experience of cervical cancer from family members were aware of the disease compared to those who did not (71.4% Vs. 33.3%; χ² = 4.113; P = 0.043).

Conclusion: the study highlights the need for adolescent girls to be educated about cervical cancer, to improve their knowledge and attitudes towards the disease, so they can make informed decisions about their practices.

Beaver tail liver and congenital asplenia in a polytrauma patient

Ahmad Alrahmani — 2025-02-20

A 22-year-old male involved in a motor vehicle accident presented to the Emergency Department of King Saud Medical City with facial, neck, and chest injuries. He did not have any previous medical or surgical history. He was conscious, oriented, and vitally stable upon presentation. According to the trauma survey protocol, he underwent a pan-computed tomography (CT) scan following the initial evaluation. A CT scan of the face revealed a nondisplaced fracture of the left palatine bone, a fracture of the left infratemporal wall of the maxillary sinus, and associated hemosinuses. A CT of the neck revealed a C2 fracture involving both lateral masses and the body. A CT of the abdomen revealed an absent spleen and an elongated left lobe of the liver that extended laterally, known as "Beaver tail liver," and occupied the space of the spleen in the left upper quadrant of the abdomen. As an anatomical variant, he also possessed a double inferior vena cava (IVC) with retro aortic right renal vein and hemi azygos continuation of the IVC. Except for thrombocytosis with a platelet count of 606 X 10⁹/L (reference range, 150 X 10⁹/L to 400 X 10⁹/L), his initial blood results were within normal limits. His peripheral blood smear revealed Howell-Jolly's bodies and a mild thrombocytosis. His facial injury was treated conservatively, while his cervical injury was immobilized with a halo. On the seventh post-admission day, he was discharged after applying a halo vest and attending an outpatient clinic appointment.

Acute methotrexate toxicity in a patient with psoriasis: a case report

Hind Abouzahir — 2025-02-20

Aside from rheumatoid arthritis, methotrexate is also used to treat cancer, psoriasis, and other diseases. Side effects with methotrexate are possible, as they are with any medication. This drug is extremely potent and has the potential to produce serious adverse effects. Those who use this medication need to be tracked often. We provide a case of a patient with psoriasis vulgaris who died due to methotrexate administration without proper dosage verification. A female patient in her forties had a history of psoriasis vulgaris of the lower limbs. Under treatment, she developed acute methotrexate toxicity. This drug was taken as an intramuscular injection per day in an infirmary without checking that the dose regimen prescribed was per week. She developed extensive bullous and pustular lesions associated with digestive signs related to generalized toxiderma. But at that point, she had septic shock, which led to her death a few weeks after the methotrexate injection. The medical responsibilities of the doctor, pharmacist, and nurse were discussed. To conclude, methotrexate is not a killer drug in most cases, but it can be extremely harmful if it's overused. Acute toxicity is a potentially fatal condition, and a deeper understanding of its potential toxicity is still necessary.

Delayed pericarditis following ethanol ablation of the vein of Marshall in the treatment of atrial fibrillation: a case report

Hao-Zhen Miao — 2025-02-20

In this case report, we will discuss a 74-year-old female who presented with a chief complaint of abdominal pain, bloating, anorexia, and nausea for four days which preceded after catheter ablation and anhydrous ethanol infusion vein of Marshall (VOM) one month prior. She was admitted and treated as a general patient in the general ward. After hospital admission, a pericardiocentesis was guided by B-scan ultrasonography, resulting in the extraction of 20ml of pericardial effusion, followed by catheterization for drainage. The key takeaway in this report is that anhydrous ethanol infusion VOM may not always be without risks. Hence, during the procedure, it is imperative to carefully administer the appropriate volume of anhydrous ethanol into the VOM to prevent vessel damage and associated complications.

Ureteral duplicity with a left ureterocele: a case report

Reda Tariqi — 2025-02-20

An intravesical ureterocele is a rare condition in which a terminal ureter terminates in a cystic dilation of the bladder. We present the case of a 42-year-old female who presented with irritative lower urinary tract symptoms and left lower back pain. Computed tomography (CT) urography revealed ureteral duplication with a ureterocele complicated by upper tract obstruction. Treatment involved endoscopic ureterocelotomy, which successfully relieved symptoms and resolved renal obstruction.

Trend of Lassa fever cases and factors associated with mortality in Liberia, 2016 - 2021: a secondary data analysis

Emmanuel Dwalu — 2025-02-20

Introduction: Lassa fever (LF) is endemic in Liberia and is immediately reportable. Suspected cases are confirmed at the National Public Health Reference Laboratory. However, there is limited information on the trend and factors associated with mortality. We described the epidemiological characteristics of LF cases and determined factors associated with mortality in Liberia from 2016 to 2021.

Methods: we reviewed 867 case-based LF surveillance data from 2016 to 2021 obtained from the National Public Health Institute of Liberia (NPHIL). The cases that met the suspected LF case definition were tested with RT-PCR. Using Epi Info 7.2.5.0. We conducted univariate, bivariate, and multivariate and analysis. We calculated frequencies, proportions. Positivity rate, case fatality rate, and factors associated with LF mortality using chi-square statistics and logistics regression at 5% level of significance.

Results: eighty-five percent (737/867) of the suspected cases were tested and 26.0% (192/737) were confirmed LF positive. The median age of confirmed LF cases was 21(IQR:12-34) years. Age 10-19 years accounted for 24.5% (47/192) and females 54.2% (104/192). Bong 33.9% (65/192), Grand Bassa 31.8% (61/192), and Nimba counties, 21.9% (42/192) accounted for most of the cases. The median duration from symptom onset to hospital admission was 6 (IQR:3-9) days. A majority, 66% (126/192) of the cases were reported during the dry season (October-March) and annual incidence was highest at 12 cases per 1,000,000 population in 2019 and 2020. The overall case fatality rate was 44.8%. Non-endemic counties, Margibi, 77.8% and Montserrado, 66.7% accounted for the highest case fatality rate (CFR), while 2018, 66.7% and 2021, 60.0% recorded the highest CFR during the period. Age ≥30 years (aOR=2.1,95% CI:1.08-4.11, p=0.027) and residing in Grand Bassa County (aOR=0.3, 95% CI:0.13-0.73, p=0.007) were associated with LF mortality.

Conclusion: Lassa fever was endemic in three of the fifteen counties of Liberia, case fatality rate remained generally high and widely varied. The high fatality of LF has been reported to the NPHIL and is currently being further investigated. There is a need to continuously train healthcare workers, especially in non-endemic counties to improve the LF treatment outcome.

Postoperative maternal complications of caesarean section: a cross-sectional study at the Provincial General Hospital of Kananga in the Democratic Republic of Congo

Antoine Tshimbundu Kayembe — 2025-02-20

Introduction: the maternal complications of caesarean section make it considered a riskier route of delivery than the vaginal route. The caesarean patient in fact combines the risks of giving birth and those of abdominal surgery. The objective of our study is to determine the epidemiological and therapeutic profile of postoperative maternal complications of caesarean section at the Provincial General Hospital of Kananga from January 1^st, 2016 to December 31^st, 2020.

Methods: this is a cross-sectional study of cases of postoperative maternal complications of cesarean section, based on non-probability convenience sampling for case selection. multivariable logistic regression was used in statistical analyses. Our study sample was 302 cases.

Results: the hospital frequency of postoperative complications of cesarean section is 34.12% with the annual average of 60.40 (17.21) cases per year. The postoperative infections are the most frequent complication with more than 52.98% (n=160), treatment is surgical in 59.61% (n=180), the maternal mortality rate due to postoperative complications of cesareans is 5.63% (n=17). Five factors independently associated with postoperative complications of cesarean section were identifying: prolonged labor (aOR: 3.110, 95% CI: 1.040-9.250; p=0.001), defective hygiene of patients (aOR: 1.910, 95% CI: 1.090-10.930; p=0.001), uterine overdistension before caesearan section (aOR: 4.290, 95% CI: 3.320-5.550; p=0.000), multiparity (aOR: 2.070, 95% CI: 1.010-5.210; p=0.006) and emergency cesarean section (aOR: 1.510, 95% CI: 1.250-1.910; p=0.000) in our environment and during the period of our study.

Conclusion: intraoperative complications of caesarean section constitute a real health problem. These five factors independently associated with postoperative complications of cesarean section could be used for screening of high-risk women in obstetrical consultations during pregnancy monitoring.

An overview of a preliminary multicenter retrospective study on food and drug allergies in moroccan pediatric population

Zakaria Zidane — 2025-02-20

Introduction: this study aimed to investigate the prevalence and management of food allergies (FA) and drug allergies (DA) in Morocco. Sparse and conflicting epidemiological data exist on the exact prevalence of allergies in the country. The rise in allergies can be attributed to various factors.

Methods: the study analyzed data from patients with suspected FA and DA who sought medical attention. Statistical tests were used to analyze the data, percentages were computed for qualitative variables, and for quantitative variables, medians or means accompanied by standard deviations (SD) were calculated. The Chi-square test was employed to assess categorical variables. A p-value < 0.05 was considered statistically significant.

Results: Cow's milk was the most reported food allergen (58.2%), followed by egg and nuts (23.4% and 12.1%, respectively). The most affected age group was children under 5 years. Antibiotics were the leading cause of reported drug allergies (44.8%), particularly Beta-lactams. Immediate reactions were commonly associated with antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). Symptoms of FA included acute urticaria, vomiting, anaphylactic shock, and facial edema. Urticaria was the most frequent symptom of DA. Antihistamines and corticosteroids were the main treatments used for both FA and DA.

Conclusion: the prevalence of FA and DA in Morocco remains uncertain due to limited data. There is a need for centralized data collection and awareness among clinicians and the general population regarding allergies. The study highlights the importance of proper diagnosis and management of allergies to ensure patient safety. The findings emphasize the necessity of establishing a mandatory center for allergy care in Morocco to improve the understanding and management of allergic conditions.

Comparative prevalence of diarrheagenic Escherichia coli between children below five years with close contact to food animals in Kisumu County, Kenya

Redemptah Yeda — 2025-02-20

Introduction: diarrheal infections in young children below five years and food animals are caused by diarrheagenic Escherichia coli strains. The study focused on understanding the association between DEC pathotypes in children below five years and food animals to establish the possibility of zoonotic transmission.

Methods: samples from 150 children who presented with diarrhea at the Kisumu County Hospital and 100 stool samples from food animals were collected and processed using culture methods. Molecular identification of the pathotypes was assayed using a primer-specific polymerase chain reaction that targeted the six virulence genes related to the diarrheagenic Escherichia coli pathotypes.

Results: one hundred and fifty-six study subjects (100 children samples and 56 food animals) samples were positive for E. coli polymerase chain reaction detection revealed a prevalence of (23%) among children below five years and a prevalence of (20%) among the food animals. Children samples showed Enteroaggregative Escherichia coli, having high phenotypic frequency of (12%) followed by Enterotoxigenic Escherichia coli, (5.3%) and Enteropathogenic Escherichia (3.3%) the least being mixed infections Enteroaggregative/Enterotoxigenic Escherichia coli and Enteroaggregative/Enteropathogenic Escherichia coli with (1.3%) respectively. The food animals found in children homesteads were detected to harbor pathogenic strains of E. coli. Enteropathogenic Escherichia coli was the most prevalent pathotypes detected in cattle (13%) followed by Enterotoxigenic Escherichia coli detected in goats at (4%) and poultry at (3%).

Conclusion: presence of diarrheagenic Escherichia coli in food animals could serve as reservoirs of transmitting these bacteria to children below five years.

Botox in below knee amputation for the management of post-operative contracture: a systematic review

Ahmmad Alfatih — 2025-02-20

During the 1970s, scientists first used botulinum toxin to treat strabismus. While testing on monkeys, they noticed that the toxin could also reduce wrinkles in the glabella area. This led to its widespread use in both medical and cosmetic fields. The objective of the study was to evaluate the potential use of Botox in managing post-operative contracture after below-knee amputation. We conducted a systematic review In Pubmed, Cochrane Library, Embase, and Google Scholar using the MESH terms Botox, botulinum toxin, post-operative contracture, amputation, and below knee amputation. Our goal was to evaluate the potential use of Botox to manage post-operative contracture in patients who have undergone below-knee amputation. Our findings show evidence in the literature that Botox can effectively manage stump hyperhidrosis, phantom pain, and jumping stump, but no clinical trial has been found that discusses the use of Botox for post-operative contracture. Botox has been used in different ways to manage spasticity. Further studies and clinical trials are needed to support the use of Botox to manage this complication.

Prevalence and factors for anxiety and depression among secondary school teachers from Sfax city of Tunisia in times of the coronavirus disease 2019 pandemic: a cross-sectional study

Nour Regaieg — 2025-02-20

Introduction: teachers have to adapt during the coronavirus disease 2019 (COVID-19) pandemic to many changes that could potentially make them more vulnerable to psychological distress. We aimed to assess anxiety and depression in Tunisian secondary school teachers during the COVID-19 pandemic and to explore their associated factors.

Methods: we conducted a cross-sectional survey concerning Tunisian secondary school teachers between May 1^st, 2021, and June 30^th, 2021, using an online survey platform via Google Forms. Participants were asked to fill in a form including two psychometric tests: the General Anxiety Disorder 7 (GAD-7) and the Patient Health Questionnaire 9 (PHQ-9). We performed both univariable and multivariable logistic regression analyses.

Results: a total of 170 secondary school teachers were included, of whom 22.4% (n=38) were males and 77.6% (n=132) were females. The median age was 45.5 years (Q1=39, Q3=49). The overall anxiety prevalence was 34.7% (n=59) while it was 41.7% (n=71) for depression. In multivariable analysis, anxiety was strongly associated with sleep disturbances (aOR: 5.1; 95% CI: 1.80-14.45; p=0.002) and depression (aOR:33.91; 95% CI:12.32-93.33; p<0.001) while depression was strongly associated with dissatisfaction with working conditions (aOR: 3.99; 95% CI: 1.49-10.65; p=0.006), the irregular wearing of protective masks (aOR: 3.94; 95% CI: 1.33-11.66; p=0.013) and anxiety (aOR=51.63; 95% CI: 17.74-150.25; p<0.001).

Conclusion: secondary school teachers in Tunisia are characterized by a high rate of anxiety and depressive disorders which are related to personal and professional factors on which we can act by supplying of educational institutions by protective masks, the implementation of programs for adjusting working conditions and the practice of non-pharmacological interventions for insomnia management.

An unexpected cause of chest pain

Yoen Young Chuah — 2025-02-20

A 44-year-old woman presented initially at the outpatient clinic with persistent chest pain since morning. She claimed to have swallowed a toothbrush accidentally while brushing her teeth. There was no history of psychiatric disorders including bulimia. A subsequent chest X-ray did not show any radio-opaque object in her esophagus (A). The patient was deferred from further management at a previous emergency department visit due to a lack of X-ray evidence of radio-opaque impaction. Emergent upper endoscopy 7 hours after the incident was performed that found the stalk of the impacted toothbrush at the lower esophagus with superficial ulcerations beneath the stalk (B, with arrows). With a polypectomy snare, the 18 cm toothbrush was successfully removed without immediate complication (C). A proton pump inhibitor was prescribed. In the absence of typical X-ray findings (especially in a child), history and clinical suspicion would be important. Accidental ingestion of toothbrushes is rare. For unknown reasons, young females (mean age was 27.6 years) were more likely to ingest toothbrushes by accident. The majority of reported cases were due to vomiting induction (38%, 19/50) and only 10% (9/50) were due to teeth brushing (our case). Ingested toothbrushes can be easily identified on X-ray if with radiopaque wires in nylon bristles but not all toothbrushes have metallic elements as in our case. Impacted toothbrushes can be removed successfully with endoscopy, spontaneous passage through the rectum does not occur, and surgical removal is rarely needed.

Head lice in the eyelashes

Meryem Benchekroun Belabbes — 2025-02-20

Infection of the eyelashes with head lice is extremely rare. We report the case of a 10-year-old child who presented with a head lice infection of the eyelashes. A 10-year-old male patient presented to the ophthalmology department complaining of itching of the eyelids, redness, watering, whitish discharge, and a burning sensation for one week. The family of the patient reported that the kid had a history of recurrent episodes of head lice for which he was still treated. Visual acuity was 10/10 for both eyes. Slit lamp examination shows translucent oval structures located at the emergence of the upper eyelashes in both eyes: nits (white arrows figure A). One louse is found anchored to the eyelashes of the left eye (grey arrow figure A and B). The rest of the clinical examination including the fundus examination was strictly normal. The treatment was based on using forceps to physically remove the lice and nits from the eyelashes and the application of ophthalmic grade petrolatum ointment to the eyelids about 2-4 times in association with the treatment of the head lice. The treatment was efficient and the eyelashes were clear from both nits and lice after 10 days of treatment. Lice are hominoxius hematophagous arthropod and an obligate parasite of human beings. There are three types of lice: head lice, body lice, and crab lice. Head lice infest mainly schoolchildren and they are transmitted through close head-to-head contact. The treatment is based on the removal of the lice and nits.

Compliance with World Health Organization COVID-19 preventive behaviors in rural counties in Western Kenya: a cross-sectional study

Caleb Nyaranga — 2025-02-20

Introduction: the World Health Organization (WHO) recommended various measures to tackle COVID-19, and were adopted by many governments, targeting behavior change among citizens to lower the transmission. There was a paucity of data on the patterns of compliance with different measures within individuals and whether people adhere to all recommended measures or cautiously prefer few but not others. Understanding compliance behaviors and associated factors is important for developing interventions to increase compliance.

Methods: cross-sectional study was conducted among adults in the western region of Kenya. A sample of 806 participants was selected using a stratified sampling method. A structured questionnaire was used to gather data from the participants. Compliance was assessed with six behaviors: hand sanitation, proper hygiene, no handshaking, social distancing, and other guidelines. Latent analysis was used to identify behavioral patterns. Descriptive statistics were used to assess demographic characteristics, in terms of frequency distribution, and percentages. Multinomial logistic regression was used to assess the association between demographic characteristics and compliance level.

Results: compliance was highest for masking (85.3%), and was lowest for social distancing (60.2%). The majority of participants were found to be full compliers (class 1: 40.5%), there was an increased probability of full compliance among those aged between 18-30 years (OR= 1.042; 95% CI: 0.307-13.052, p < 0.040) compared to those aged ≥70

Conclusion: using facemasks had the highest rate of compliance, followed by hand sanitization and proper hygiene. However, overall, the findings showed that while compliance with some protocol behaviors is high, individuals comply consistently across recommended compliance behaviors.

Monitoring the evolution of vaccine-derived poliovirus in East and Southern African countries, 2010 - 2021

Charles Byabamazima — 2025-02-20

Introduction: the Africa region was certified indigenous wild poliovirus-free in August 2020. Countries in East and Southern Africa have, during acute flaccid paralysis (AFP) and environmental surveillance (ES), detected equally concerning vaccine-derived polioviruses (VDPVs) that have not been systematically documented to guide programming in the sub-region. The study documents trends and salient observations of the VDPVs by country of detection, for 11 years from 2010 to 2021.

Methods: we conducted secondary data analysis, a descriptive study design, by deploying field and laboratory of AFP and environmental surveillance databases of the 20 East and Southern African countries from 2010 to 2021.

Results: a total of 318 VDPVs were reported over the study period. The majority were from AFP cases (58.8%) and the rest equally distributed between healthy community children and environmental surveillance sources. More polioviruses were detected after 2016 than during the period before. We observed that more boys were affected by VDPVs compared to girls. Children under 5 years were more affected than other age groups, with a mean age of 3.6 years. Delay of samples in the field seemed to increase the likelihood of not reporting VDPVs and not mounting timely public health detailed investigations and vaccination responses.

Conclusion: the study provides useful evolutional trends of VDPVs for surveillance and vaccination programming. We also noted that the VDPV2s have been increasing after the 2016 tOPV to oral polio vaccine (bOPV) switch. The COVID-19 pandemic emergence in 2020, led to a decline in AFP, ES surveillance, and immunization activities. Our findings point to the need to implement enhanced tailored childhood immunization recovery strategies and to speed up the use of inactivated polio vaccine (IPV) to boost population immunity.

Toward the design of a tailored training course for birth assistance: an Ethiopian experience

Sabina Maglio — 2025-02-20

Simulation in healthcare has already demonstrated extraordinary potential in high-income countries. However, to date, few authors have explored the possibility of applying simulation-based training in African settings, highlighting the necessity of need-based training protocols capable of addressing economic, social, and cultural aspects. In this framework, this research investigates the main features of a simulation training course on umbilical cord care and placenta management should be considered effective and sustainable in an African healthcare environment. Local facilitators were identified as the best resources for defining course contents and providing technical lectures to mitigate cultural, linguistic, and social issues. For the training program, the design of a new low-cost medium-fidelity simulator was explored and a preliminary evaluation was performed. Finally, the propensity of 25 students to attend a simulation training course was investigated using a questionnaire. The attitude of the enrolled students was positive, endorsing the future introduction of simulation training into the educational offers of Ethiopian colleges.

Patterns of availability and accuracy of risk factor data for cardiovascular diseases among people initiated on antiretroviral therapy at selected health facilities in Khomas region, Namibia: a retrospective, cross-sectional, quantitative study

Roswitha Mahalie — 2025-02-20

Introduction: quality data is a prerequisite for timely decision-making and measuring health outcomes in public health settings. Comorbidities such as cardiovascular diseases (CVDs) among people living with HIV (PLHIV), require a robust system that ensures credible data at all data-producing levels. The study at determining the level of availability and completeness of CVDs risk factors data of PLHIV.

Methods: a quantitative study was conducted to extract CVDs risk factors data retrospectively from 529 patient care booklets (PCBs) between 2004 and 2017. The analysis was done with the Statistical Package for Social Sciences (SPSS) version 25. Pearson Chi-Square was used to test for associations. The level of significance was at p ≤ 0.05.

Results: the study revealed that 72.8% of patients are at risk of CVDs due to incomplete demographics (73.72%) and other systemic data (41.18%). A significant association was found (Pearson Chi-Square test 19.907; p-value of 0.001) between average visits per year, accurate data recording, and active status of the patient. Lost to follow-up (15%) and true retention (27.2%) was significantly associated with the last Antiretroviral Therapy (ART) status of a patient (Pearson Chi-Square test 87.754; p-value of 0.001).

Conclusion: the study that despite concerted efforts to improve data quality, the availability and completeness of data remain unsatisfactory. Lack of harmonised data screening and analysis efforts for CVDs risk factors is found to be a significant risk factor in ensuring integrated routine measuring of CVDs health outcomes for PLHIV.

Small bowel obstruction in adults, Ladd's band is an exceptional cause: a case report

Jaouad Naddouri — 2025-02-20

Malrotation of the gut is a congenital anomaly of foetal intestinal rotation and it's principally discovered in early childhood as acute intestinal obstruction. This condition is veritably rare and constantly silent in adults. Intestinal malrotation in adults is frequently asymptomatic and is diagnosed as a casual finding during a radiological examination performed for other reasons. Infrequently, it can be diagnosed in adults, associated with an acute abdomen. Adult patients rarely present with acute midgut volvulus or internal hernias caused by Ladd's bands. We present a case of an admitted 18-year-old female with a small bowel obstruction due to an intestinal volvulus complicating intestinal malrotation in the presence of Ladd's band. Laparotomic Ladd's procedure was performed successfully with division of Ladd's band, adhesiolysis, appendicectomy, and reorientation of the small bowel on the right and the cecum and colon on the left of the abdominal cavity; the postoperative evolution was favorable. Although it is a rare pathology, it should be kept in mind in cases of patients presenting small bowel obstruction.

Factors associated with immunization status among children aged 12-59 months in Lagelu local government area, Ibadan: a cross-sectional study

Julius Salako — 2025-02-20

Introduction: childhood deaths from preventable causes remain high in Nigeria. Although vaccines are available to combat many of these diseases, vaccine coverage remains low in many at-risk communities. With this study, we aimed to determine factors that might have impacted the use of immunization services in Ibadan, the capital of Oyo State in southwest Nigeria.

Methods: we conducted a community-based cross-sectional study in a peri-urban local government area in Ibadan using a multi-stage cluster sampling technique to identify respondents for this study. The interviewer-administered questionnaire was used to obtain information on respondents and child socio-demographic details. We reviewed the child´s vaccine card to determine vaccine status. Data were analyzed using STATA version 14 at a 5% level of significance.

Results: of the 265 children aged 12 to 59 months who had their vaccine cards appropriately filled, only 65.3% (n=173) received all basic vaccines, while 90.2% (n=239) and 86.8% (n=230) received 3 doses of pentavalent vaccine (PENTA) and pneumococcal conjugate vaccines (PCV-10) respectively. We found a significant difference in the completion of basic vaccination according to the caregiver´s place of residence and the mother´s educational level. Access-related barriers were frequently reported (n=24, 54.5%) as reasons for missing a due vaccine.

Conclusion: improvement in vaccine coverage in this setting is necessary. Targeted health information for mothers may be a cost-efficient and sustainable approach to improve vaccine coverage for under-five children.

Estimating the prevalence and predictors of musculoskeletal disorders in Tanzania: a cross-sectional pilot study

Nateiya Mmeta Yongolo — 2025-02-20

Introduction: musculoskeletal (MSK) disorders account for approximately 20% of all years lived with disability worldwide however studies of MSK disorders in Africa are scarce. This pilot study aimed to estimate the community-based prevalence of MSK disorders, identify predictors, and assess the associated disability in a Tanzanian population.

Methods: a cross-sectional study was conducted in one village in the Kilimanjaro region from March to June 2019. The Gait, Arms, Legs, Spine (GALS) or paediatric GALS (pGALS) examinations were used during household and school visits. Individuals positive in GALS/pGALS screening were assessed by the regional examination of the musculoskeletal system (REMS) and Modified Health Assessment Questionnaire (MHAQ).

Results: among the 1,172 individuals enrolled in households, 95 (8.1%, 95% CI: 6.6 - 9.8) showed signs of MSK disorders using the GALS/pGALS examination and 37 (3.2%, 95% CI: 2.2 - 4.3) using the REMS. Among 682 schools enrolled children, seven showed signs of MSK disorders using the GALS/pGALS examination (1.0%, 95% CI: 0.4 - 2.1) and three using the REMS (0.4%, 95% CI: 0.0 - 1.3). In the household-enrolled adult population, female gender and increasing age were associated with GALS and REMS-positive findings. Among GALS-positive adults, increasing age was associated with REMS-positive status and increasing MHAQ score.

Conclusion: this Tanzanian study demonstrates a prevalence of MSK disorders and identifies predictors of MSK disorders comparable to those seen globally. These findings can inform the development of rheumatology services and interventions in Tanzania and the design of future investigations of the determinants of MSK disorders, and their impacts on health, livelihoods, and well-being.

Relationship between electrolytes and glycated hemoglobin among diabetic patients with poor adherence to antidiabetic medications: a cross-sectional study

Francis Lengeiya — 2025-02-20

Introduction: type 2 Diabetes mellitus is a chronic metabolic disease with devastating effects on patients and results in numerous healthcare challenges in terms of its management and the cost burden among the affected. Successful management involves maintaining optimal glycemic control to prevent complications, with adherence to antidiabetic medications playing a crucial role in achieving this objective. Additionally, maintaining a healthy electrolyte balance is key for overall well-being and physiological function. However, the correlation between glycated hemoglobin and electrolyte balance remains under investigated, particularly in patients with suboptimal adherence. The aim of this research was to study the relationship between glycated hemoglobin and electrolytes among diabetic patients with poor adherence to antidiabetic medications.

Methods: this study was conducted at Samburu County Referral Hospital in Samburu County, Kenya. We employed a descriptive cross-sectional design focusing on adult diabetic patients aged 18 years and above who had visited the diabetic clinic over a three-month period. To evaluate their adherence levels, we employed a Morisky Medication Adherence Scale-8. Seventy-two diabetic patients who got adherence level scores of < 6 were categorized as having low adherence and their blood samples were collected for measuring glycated hemoglobin levels and electrolytes levels particularly potassium, sodium, calcium, magnesium, phosphorus and chloride. Relationship between electrolytes and glycated hemoglobin among diabetic patients with poor adherence to antidiabetics was determined using Karl Pearson correlation.

Results: among the study participants, the lowest hemoglobin A1C (HbA1c) level recorded was 5.1% while the highest was 15.0% and the majority (41.7%) fell within the HbA1c range of 5-7%. A high proportion of individuals (58.3%) with poor adherence to antidiabetics had elevated HbA1c levels, indicating poor glycemic control. The correlations observed between glycated hemoglobin and electrolytes which included magnesium, sodium, chloride, calcium and phosphorus was r= -0.07, -0.32, -0.05 -0.24 and -0.04 respectively.

Conclusion: this study concluded that there is a relationship between electrolytes and glycated hemoglobin among diabetic patients with poor adherence to antidiabetics. A statistically significant negative correlation was observed between glycated hemoglobin and calcium level (r=-0.2398 P ≤0.05) and also sodium (r=-0.31369 P≤0.05). A negative correlation (P≥0.05) was observed between phosphorus, magnesium, chloride and potassium with HbA1c levels though not statistically significant.

Predictive values of ultrasound characters associated with malignant thyroid nodules in Yaoundé: a cross-sectional study

Yannick Mossus — 2025-02-20

Introduction: most ultrasound criteria are defined in developed countries and commonly used in practice to assess the malignancy risk of thyroid nodules. This practice does not take into consideration some aspects of our context as delay of consultation and insufficient iodine intake. The objective of this study was to determine the predictive values of ultrasound characters associated with malignant thyroid nodules in our environment.

Methods: we conducted a cross-sectional, prospective, and analytical study in three hospitals in Yaoundé over a six-month period in 2022. Our sample consisted of thyroid nodules with ultrasound, cytopathological, and histopathological data. The ultrasound characters and histology status of category III thyroid nodules and higher in Bethesda score were analysed in univariate and multivariate statistics to determine their predictive values.

Results: eighty-nine nodules were obtained according to our inclusion criteria. The sex ratio was 0.46 and the average age of the patients was 46 years (IQR=42-59). The cancer prevalence in our sample was 22.47%. On ultrasound assessment, the characters associated to malignant histology (p<0.05) were nodules count, echogenicity, echostructure, presence or absence of microcalcifications, margins, and type of vascularization. Positive predictive values ranged from 26.15 to 57.14%, while negative predictive values ranged from 12.5 to 33.3%.

Conclusion: taken alone, the ultrasound characters of suspected thyroid nodules have poor predictive values. There was a high variability in sensitivity but that was generally good (60-95%) while specificity was low. The prediction of malignant thyroid nodules is correlated with the association of at least two ultrasound criteria supported by clinical arguments.

Prevalence and determinants of health-related quality of life in chronic obstructive pulmonary disease patients in Yaoundé, Cameroon: a pilot study

Abdou Wouoliyou Nsounfon — 2025-02-20

Introduction: the present study aimed to assess the health-related quality of life (HRQL) and identify the factors associated with poor quality of life, among chronic obstructive pulmonary disease (COPD) patients.

Methods: we conducted a cross-sectional study at Jamot Hospital and Polymere Medical Center, Yaoundé, from February 1 to June 30, 2020. All consent adult COPD patients who were followed in both centers during the recruitment period were included. The Saint George's Respiratory Questionnaire (SGRQ) was used to assess HRQL. Poor quality of life was defined by an SGRQ score ≥30. Data analysis was performed using IBM SPSS Statistics 23.0 (IBM Corp., Armonk, New York, USA) software. Multiple logistic regression was used to identify the factors associated with poor quality of life. The statistical significance threshold was set at 0.05.

Results: of the 63 patients invited to participate in the study, only 29 were finally included. Almost 3/5 (58.6%) were males, and their median age (interquartile range, IQR) was 68.0 (57.0 - 74.5) years. The median HRQL score (IQR) was 44.2 (23.2 - 65.0). The prevalence (95% confidence interval, 95% CI) of poor HRQL was 65.5% (48.3 - 82.8) %. The history of exacerbations during the last 12 months [odds ratio (95% CI) = 12.3 (1.1 - 136.7); p=0.04] emerged as the sole independent predictor of poor HRQL.

Conclusion: the prevalence of poor health-related quality of life was high in these COPD patients. The presence of exacerbations in the past 12 months was an independent factor associated with poor HRQL in patients with COPD.

Development and implementation of a nutrition education programme for school-going adolescents in the context of double burden of malnutrition: a narrative essay

Joelle Laure Sobngwi-Tambekou — 2025-02-20

The early prevention of non-communicable diseases in Cameroon schools program was initiated in 2018 to address the alarming trend of obesity among adolescents through a nutrition education intervention aimed at increasing knowledge on nutrition and the benefits of healthy eating and physical activity. The program included: school surveys to document eating habits and health-risky behaviors in students, the development of a training curriculum, training and sensitization sessions for school staff, school vendors and students, and advocacy meetings with parliamentarians and mayors. We carried out a quasi-experimental study to assess the effect of the intervention on the student's knowledge and eating behavior three months after the training sessions. We compared the knowledge of a sample of students from five schools that were part of the program (IG) to that of students that were not (CG). The mean (±SD) score was 14.4/20 (±2.1) and 9.7/20 (±2.7) for IG and CG, respectively (p<0.001). Those who scored above 12/20 accounted for 89.8% of IG vs 23.8% of CG (p<0.001). Other significant achievements of this program are the amendment of the National School Hygiene Policy to include compulsory training in food hygiene and nutrition education for school canteen vendors and the integration of nutrition education sensitization sessions into the routine activities of school healthcare. The study showed that a well-structured multi-sectoral nutritional education program could be the bedrock to improve healthy nutrition among adolescents, thereby serving as a vehicle for non-communicable disease prevention.

High blood pressure and aeronautical fitness: experience at the aeromedical expertise center of Rabat

Fahd Bennani Smires — 2025-02-20

High blood pressure is a major cardiovascular risk factor closely linked to serious cardiovascular events. A real public health problem affecting more than one in three adults. Aircrew does not escape this pathology, despite very strict medical selection and rigorous and regular medical monitoring by the aircrew doctor during revision visits. We conducted a retrospective study at the medical expertise center for aircrew in Rabat which made it possible to collect 34 hypertensive civilian aircrew for 10 years, from January 2012 to December 2022. The median age at the time of the study was 56.5. The aeronautical specialties practiced by our aircrew population were dominated by class 1. The prevalence of hypertension in Moroccan civilian aircrew: out of 2000 monitored annually at the aeromedical expertise center for 10 years, 34 cases were collected, i.e.: 1.7%. The average age of discovery was 49 years and in 23 cases the diagnosis was established by systematic screening during periodic fitness visits. More than 24 aircrews had no family history of hypertension. On the therapeutic level, lifestyle and dietary measures were systematically prescribed in all our aircrew, 18 patients were put on monotherapy, 11 on dual therapy, and 2 on triple therapy. Compared to fitness decisions, they were variable according to the grade of hypertension, the control of complications, and the aeronautical function. The discovery of hypertension in aircrew can jeopardize aviation safety with the risk of subtle or sudden incapacity in flight through neurological or cardiovascular complications, which could impact the fitness decision. However, advances in medicine and the management of hypertension made in recent years have prompted the medical and aeronautical authorities to revise the standards of aptitude.

Assessment of average glandular dose in mammography practice of a teaching hospital in Ghana

Kofi Adesi Kyei — 2025-02-20

Introduction: above the age of 40, women are advised to begin breast examinations and screenings for early detection of breast cancer. The average glandular dose (AGD) provides dosimetric information about the quantity of radiation received by the mammary glands during mammographic exposures. There is, therefore, the need to analyse the radiation dose received by patients presenting for mammography examinations.

Methods: a retrospective cross-sectional design was carried out on the data of 663 participants, conveniently sampled between the months of July 2021 and June 2022. Paired T-test was used to compare imaging parameters for cranio-caudal (CC), medio-lateral (ML), automatic exposure control (AEC), manual exposure control (MEC), and left and right breast. Pearson´s correlation was used to test for relationship between imaging parameters and AGD.

Results: the mean AGD per exposure was 1.9 ± 0.7 mGy for CC projections and 2.3 ± 1.2 mGy for ML projections. The mean AGD per examination for the study was 4.1 ± 1.4 mGy. A positive correlation was found between AGD per examination and exposure factors (tube loading and tube voltage), compressed breast thickness, and compression force. Patient age had no statistically significant relationship with the AGD per examination.

Conclusion: average glandular dose (AGD) was consistent with other findings in literature studies. It was also observed that MEC yielded lower AGD per exposure values than AEC. There was no significant difference in the mean AGD per exposure for left and right breasts.

A comparative study on the use of procalcitonin to distinguish between central fever and infectious causes of fever

Iffat Khanum — 2025-02-20

Introduction: central fever is defined as elevated body temperature without any evidence of infection or drug reaction fever, and currently it has no definitive diagnostic criteria. The current study aims to assess the role of procalcitonin (PCT) in differentiating central fever from fever secondary to infections in patients with neurological insults.

Methods: we conducted a retrospective study of patients admitted with a neurological insult (brain trauma, brain tumors and cerebrovascular accidents) in a tertiary care hospital. All patients who developed fever 48 hours after admission and had procalcitonin, C-reactive protein (CRP), and Erythrocyte sedimentation rate (ESR) done as part of fever evaluation were assessed to include in the study.

Results: out of 70 patients who met inclusion criteria, 37 had infections identified and 33 had no source of infection. The mean age was 42.9 years (± 18) in the infectious group while 40.3 years (± 18.2) in the central fever group and there was male predominance in both groups. In the infectious group there were 25(67.6%) males vs. 12(32.4%) females while in non -infectious group, males vs. females were 18(54.5%) vs. 15(45.5%) and there was no difference in both group (p-value 0.26) Median procalcitonin (PCT) value was 0.09 ng/dl (IQR 0.05- 0.19) in patients with no identified cause of infection and 1.4 ng/dl (IQR 0.5-5.1) in patients with infections with a p-value of <0.001. Although CRP and ESR were low in patients with central fever as compared to those with infections, these differences did not reach statistical significance with p-value of CRP 0.18 and p-value of ESR 0.31 between two groups.

Conclusion: PCT levels were low in patients with central fever and may be considered as a useful biomarker to differentiate between infectious fever from non-infectious fever in patients with brain injury. This can prevent unnecessary antibiotic use in patients without infection.

Carbamazepine-induced Stevens-Johnson syndrome progressing to toxic epidermal necrolysis: a rare clinical image

Ramdinmawii Ralte — 2025-02-20

Stevens-Johnson syndrome is a rare and severe medical illness affecting the skin and mucous membranes. It is frequently caused by an adverse reaction to a medication; however, infections can also be the cause. It is characterized by a skin rash that begins with flu-like symptoms and progresses to the formation of a painful, red, or purplish rash that spreads and blisters. It presents a variety of symptoms, including fever, exhaustion, and general malaise. Here we present a case of a 35-year-old woman admitted to the hospital with complaints of skin rash, pain, and blisters all over her body for 1 week. The patient has been taking carbamazepine for 1 month due to her epileptic episode, after which the skin rash and blisters started to develop, and feel pain. The rash started on her face and spread to the upper limbs and all over her body. She has been receiving a tablet of methylprednisolone 4mg thrice a day, an injection of Tazar 4.5gm thrice a day intravenously, an injection of tramadol 50mg with normal saline infusion, a tablet of Montelukast 10 mg once a day at night time, fusidic acidic ointment. The rash and skin peel off resembling severe burns progressing to toxic epidermal necrolysis.

Effect of integrated supportive supervision on availability of resources for health care service delivery and uptake of services in Ekiti State, Southwest Nigeria, evidence from the Saving One Million Lives program for result supported facilities

Oluwafunmilayo Oluwadamilola Ibikunle — 2025-02-20

Introduction: a world bank performance-based financing program. The Saving One Million Lives program for results supported integrated supportive supervision (ISS) in selected primary health facilities (PHF) in Ekiti State, Nigeria. The study assessed the impact of ISS on health service outputs and outcomes such as infrastructure, basic equipment, human resources for health (HRH), essential drugs, number of children receiving immunization, number of mothers who gave birth in the facility, number of new and continuing users of modern family planning and the number of pregnant women screened for HIV (human immunodeficiency virus).

Methods: a cross-sectional survey of 70 SOME-supported facilities was used for the study. Parametric and non-parametric method of analysis was employed to compare the mean values of study indicators gathered over the 4 rounds of ISS visits from January 2018 to August 2020.

Results: the study demonstrated that ISS approach has a positive effect on PHC service outputs and outcomes such as infrastructure, basic equipment, health human resources (HRH), essential drugs, contraceptives prevalence rate, skilled birth attendant as well as postnatal care. However, there was no significant impact on HIV screening for pregnant women.

Conclusion: integrated supportive supervision approach has a positive effect on the quality of health care delivery in PHCs in Ekiti State, Nigeria. It is therefore recommended that periodic ISS visits should be routinely carried out in all PHCs across the State in the country and can be further extended to secondary and tertiary facilities.

Acute-onset chronic inflammatory demyelinating polyneuropathy following AstraZeneca COVID-19 vaccine: a case report

Emna Smaoui — 2025-02-20

COVID-19 vaccination side effects have been increasingly reported, including new-onset autoimmune diseases such as chronic arthritis, thrombocytopenia, Guillain-Barré syndrome (GBS), and more recently chronic inflammatory demyelinating polyneuropathies (CIDP). Molecular mimicry and vaccine adjuvants appear to be important contributors to immune-mediated neuropathies. However, whether the link between the COVID-19 vaccine and these autoimmune disorders is coincidental or causal remains uncertain. We describe the ever-reported case of acute-onset CIDP following the Oxford/AstraZeneca vaccine in Tunisia. The patient is a 41-year-old man who presented with acute, worsening weakness of the four limbs. The symptoms appeared 15 days after his first dose of the AstraZeneca vaccine. The diagnosis of GBS was initially confirmed according to the clinical features, the albumino-cytological dissociation in the cerebrospinal fluid (CSF), and the electroneuromyography (ENMG) findings. Serum workup for all known infections associated with immune-mediated neuropathy was negative. The patient was treated with plasma exchange without initial improvement followed by aggravation of the symptomatology after an interval of four and a half months. Control ENMG showed signs of CIDP meeting the European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) criteria of 2021. The patient was treated with maintenance intravenous immunoglobulin and oral corticosteroids. Neurological examination 3 months after discharge showed partial improvement. Worldwide, cases of demyelinating polyneuropathies post-COVID-19 vaccination are increasingly reported. The acute onset of CIDP might lead to a misdiagnosis of GBS. Awareness of this complication and distinction from GBS enables early relay with maintenance treatment to prevent relapses and severe complications. Post-COVID neuropathies are found to be more frequently linked to the AstraZeneca vaccine, however, temporal association does not confirm causal association.

Abdominal obesity and associated factors among urban adults in Southwest Ethiopia: a community-based cross-sectional study

Fitsum Endale — 2025-02-20

Introduction: the obesity epidemic is growing faster in developing countries with no exception of Ethiopia. Currently, abdominal obesity is identified as a major risk factor for chronic diseases due to the accumulation of liable fat. However, despite the evidence of certain documented data, abdominal obesity has been on the rise in Ethiopia, especially in urban areas. Therefore, this study aimed to assess the prevalence and factors associated with abdominal obesity among adults in Jimma town, Southwest Ethiopia.

Methods: a community-based cross-sectional study was employed on 845 adults selected using a multi-stage sampling technique. Data were collected using a pretested interviewer-administered questionnaire. Data were entered using Epi-data version 3.1 and exported to STATA version 14 for analysis. Simple linear regression was conducted to identify candidate variables. A multivariable linear regression model was fitted to identify factors associated with abdominal obesity. P-value<0.05 was used to declare statistical significance.

Results: a total of 806 respondents participated in this study, making a response rate of 95.4%. The magnitude of abdominal obesity was found to be 24.6% (95% CI: 21.5, 27.5). Physical activity (β= -2.053; 95%CI: -3.353, -0.454), alcohol consumption (β=1.631; 95%CI: 0.176, 3.087), and age (β=0.319; 95%CI: 0.250, 0.389) were significantly associated with abdominal obesity.

Conclusion: the magnitude of abdominal obesity among adults in the study area was high compared to previous studies. Alcohol drinking, being physically inactive, and age were predictors of abdominal obesity. There is a need for intervention for adults with physical inactivity and alcohol consumption to reduce abdominal obesity.

Gallstone ileus due to duodenal diverticulosis

Alexandre de Hemptinne — 2025-02-20

A 74-year-old man, with no notable medical history, presented at the emergency department with a 3-day history of cramping abdominal pain, bloating, and vomiting. The physical examination was notable for diffuse abdominal tenderness, tympany, and a negative Murphy´s sign. Laboratory studies showed an increased level of C-reactive protein (126 mg/L; reference range < 5 mg/L), a normal complete blood count, and normal levels of liver enzymes. Findings on computed tomography of the abdomen included the presence of gastric distension, a small-bowel obstruction with an endoluminal image suggestive of a gallstone at the transition zone, a normal-shaped gallbladder, no pneumobilia and a duodenal diverticulum (A). During exploratory surgery, the transition zone was observed in the small bowel. Following an unsuccessful attempt to break up the gallstone and facilitate its passage into the cecum, an enterolithotomy was performed to extract a large gallstone measuring five centimeters (B). A normal gallbladder without cholecystoduodenal fistula was found, and the diagnosis of gallstone ileus caused by an impaction of a duodenal gallstone was made. This diagnosis distinguishes itself from ordinary forms of gallstone ileus (cholecystoduodenal fistula with pneumobilia) as well as from “enterolith ileus” caused by bezoar impaction. Histopathological analysis of the resected mass also confirmed the presence of a gallstone. The patient recovered well postoperatively and at a follow-up visit 3 weeks later he remained well with no further abdominal symptoms.

Alteration in maternal serum uric acid levels in pre-eclampsia and associated perinatal outcomes: a cross-sectional study in Ghana

Kwame Adu-Bonsaffoh — 2025-02-20

Introduction: pre-eclampsia (PE) is a multisystemic pregnancy-specific hypertensive disorder associated with significant adverse maternal and perinatal outcomes. Maternal serum uric acid level is hypothesized as a reliable marker for predicting the severity and adverse outcomes of pre-eclampsia and facilitating clinical decisions. This study explored the association between maternal serum uric acid and adverse pregnancy outcomes in pre-eclampsia.

Methods: a cross-sectional study involving women diagnosed with pre-eclampsia was conducted at Korle-Bu Teaching Hospital (KBTH), a tertiary hospital in Ghana. Descriptive analyses were performed and multivariable logistic regression model was used to explore the association between maternal serum uric acid levels and pregnancy outcomes using R software.

Results: we included 100 women with pre-eclampsia comprising 79% and 21% preterm and term pre-eclampsia respectively and with mean gestational age (GA) at diagnosis of 32.35±2.66 weeks and 35.96±1.94 weeks respectively. The mean maternal age of preterm and term pre-eclampsia groups was 29.81±5.29 years and 29.46±5.78 years respectively. Hyperuricemia (serum uric acid >375 µmol/L) occurred in 61% of the pre-eclamptic women. The mean gestational age (in weeks) at diagnosis was significantly lower in the pre-eclamptic women with hyperuricemia compared with those with normal levels of uric acid (33.51±3.03 versus 34.80±2.71). There was a significant negative association (moderate correlation) between maternal serum uric acid levels and birth weight (R= -0.34, p < 0.001) in pre-eclampsia; the statistical significance was limited to preterm only (Pearson R= -0.39, p-value <0.001) but not term pre-eclampsia. Hyperuricemia was significantly associated with low birth weight [aOR: 3.222 (95% CI: 1.098, 10.393)], caesarean section [aOR: 2.281 (95% CI: 1.084, 7.568)] and severe diastolic pressure at birth [aOR: 3.517 (95% CI: 1.123, 11.939)].

Conclusion: hyperuricemia in pre-eclampsia was significantly associated with both maternal (caesarean section and severe hypertension) and neonatal (low birth weight) adverse outcomes. Hyperuricemia seems clinically useful in predicting pregnancy outcomes, especially in preterm pre-eclampsia. Further longitudinal study is recommended in exploring the clinical significance of maternal uric acid levels and pregnancy outcomes in pre-eclampsia.

Prevalence of precancerous lesions and other cervical abnormalities among internally displaced women in Benue State Nigeria

Atenchong Ngwibete — 2025-02-20

Introduction: visual inspection is a low-cost screening strategy that can be used to prevent cervical cancer in women. These techniques can improve screening health outcomes for internally displaced women (IDW) who have poor sexual and reproductive health and rights' behaviors and outcomes. This study aimed to determine the prevalence of precancerous lesions and other clinical features using a visual inspection with acetic acid (VIA) technique during a cervical cancer screening campaign in two internally displaced people (IDP) camps in Benue State, Nigeria.

Methods: this was a cross-sectional study of 166 IDW who voluntarily participated in the study during a VIA cervical cancer screening campaign in two IDP camps in Benue State, Nigeria the screening was done by a group of qualified and trained healthcare workers and data was collected using a structured, pretested questionnaire.

Results: a total of 99(60%) of the women had a first sexual experience at 16 years, while 78(47%) had more than 5 full-term pregnancies. Although only 72(43.4%) of the women acknowledged having more than one sexual partner, over 70% of the women stated that their sexual partner had another sexual partner. The prevalence of precancerous lesions among women was 10.8%. Smoking(p=0.003), age at menarche (p≤ 0.001) and sexual behaviors (p=0.009, p=0.004) were factors that had a statistically significant relationship with the presence of a precancerous lesion among the IDW. The study also highlights the high rate (95%) of cervicitis among the women and the relatively high rate (5.4%) of leukoplakia.

Conclusion: the majority of IDW had sociodemographic and lifestyle characteristics that predisposed them to developing cervical cancer More targeted interventions aimed at improving the sociodemographic and lifestyle characteristics of IDW are recommended. In addition, there is a need to create awareness about cervical cancer among IDW and make screening available in camp facilities for early detection and management.

Factors associated with the use of digital health among healthcare workers in the Buea and Tiko health districts of Cameroon: a cross-sectional study

Bill-Erich Nkongho Mbianyor Agboryah — 2025-02-20

Introduction: digital health has been demonstrated to improve the efficiency and scale of health service delivery in resource-limited settings. Understanding factors influencing its use could accelerate the process of its implementation in routine practice.

Methods: we conducted a cross-sectional analytic study in Buea and Tiko health districts from January to May 2021. We included healthcare workers selected using multistage stratified sampling. Use of digital health was defined as using at least two digital tools and one digital health intervention (DHI) or at least two DHIs by a healthcare worker. Epi Info was used for statistical analysis. Binary logistic regression was used to evaluate factors associated with the use of digital health.

Results: in total, 221 participants were included in the study. The mean age was 33±9.1 years and 76.5% were female. Only 39.4% (n=87) of participants used digital health. The most frequently used digital tools for health-related purposes included: Microsoft (MS) Excel (29.9%), MS PowerPoint (26.8%) and MS Word (39.1%). The main DHIs used were research (30.2%) and diagnosing (24.1%) software. The main use of digital health was for research (75.6%). Owning a laptop (adjusted odds ratio (aOR)=1.98, 95% CI, 1.01 - 3.86), availability of internet connection in the health facility (1.99, 1.05 - 3.7) and receiving professional training in ICT/Computer Sciences (2.04, 1.06 - 3.93), were associated with higher odds of using digital health.

Conclusion: this study shows a low level of use of digital health by healthcare workers. Providing newer devices, internet connection in health facilities and training in ICT for healthcare workers could improve its uptake.

Pelvic organ prolapse: a cross-sectional study during mass campaign in two hospitals in the city of Kananga in the Democratic Republic of Congo

Antoine Tshimbundu Kayembe — 2025-02-20

Introduction: pelvic organ prolapse is a dynamic pathology that can worsen or regress especially postpartum and is the basis of several disorders that bother the patient and alter her quality of life. This study aims to determine the epidemiological, clinical, and therapeutic profile of pelvic organ prolapse in the town of Kananga.

Methods: this is a cross-sectional study of cases of pelvic organ prolapse recorded during the mass campaign organized in the Bon-Berger Hospital of Tshikaji and Saint Georges Hospital of Katoka in the town of Kananga, from January 1 to July 31, 2023. Non-probability convenience sampling was used to select cases.

Results: we recorded 138 cases of prolapse out of 572 patients. The prevalence of pelvic organ prolapse is 24.12% with an average monthly incidence of 19.71 (SD: 4.23) cases per month. The prevalence of recurrence of pelvic organ prolapse is 8.69%. The average age of patients is 54.86 (SD: 11.36) years with an average parity of 7.62 (SD: 1.8) deliveries. Its preoperative symptomatology consists of the intravaginal mass associated with digestive and urinary disorders in 97.00% (n=130), stage III hysterocele predominates in 68.70% (n=92), surgical treatment is the most practiced in 91.79% (n=123) and hysterectomy associated with the treatment of cystocele and rectocele by vaginal surgical access is the most practiced in 80.60% (n=108).

Conclusion: pelvic organ prolapse is a real public health problem in the city of Kananga, its symptoms are classic and its treatment is surgical via the vaginal route.

Military affected by the first wave of COVID-19 in Senegal: stress and resilience factors during care

Serigne Modou Ndiaye — 2025-02-20

COVID-19 had a psychological impact on the population, particularly those affected. Our objective was to investigate stress and resilience factors in the Senegalese soldiers affected during the first wave of COVID-19. Our retrospective and qualitative study included military personnel listed as contacts, suspects, or positive cases and supported by the Armed Forces Psychological Support Program during the period of isolation. The stress factors were health-related, sociological, and occupational. The conditions and the experience of isolation, stigmatization, and suspension of their professional projects were concerns for the soldiers. They had relied on personal, familial, and professional resources to cultivate resilience during the quarantine. Isolation during the pandemic showed psychological consequences, the foundations of which have been found in our study.

Benefit of intrapleural fibrinolytic therapy in the treatment of complicated parapneumonic effusion and empyema

Takoua Merhabene — 2025-02-20

Our study aimed to assess the benefit of intrapleural fibrinolysis before resorting to surgery to treat complicated parapneumonic effusion and empyema. We conducted a retrospective and descriptive study, including all patients hospitalized in the intensive care unit (ICU) of the Abderhaman Mami hospital, Tunisia for empyema treated with instillation of intrapleural fibrinolytic therapy between the 1^st January 2000 and 31^st December 2016. In all patients, empyema was diagnosed on clinical features, imaging findings (chest X-ray, thoracic echography and/or computed tomography (CT), and microbiological data. The fibrinolytic agent used was streptokinase. The efficiency of intrapleural fibrinolytic therapy was judged on clinical and paraclinical results. Among 103 cases of complicated parapneumonic effusion and empyema, 34 patients were included. The mean age was 34 years [15-81] with a male predominance (sex ratio at 2.77). Median APACH II score was 9. Fifty (50%) of the patients (n=17) had no past medical history; addictive behavior was described in 17 patients (50%). All patients were admitted for acute respiratory failure and one patient for septic shock. Pleural effusion was bilateral in 7 patients. Bacteria isolated were Streptococcus pneumonia (6 cases), Staphylococcus aureus (3 cases, including one which methicillin-resistant), Staphylococcus epidermidis (1 case), anaerobes (5 cases), and Klebsiella pneumoniae (1 case). First-line antimicrobial drug therapy was amoxicillin-clavulanate in 20 patients. A chest drain was placed in all cases in the first 38 hours of ICU admission. The median number of fibrinolysis sessions was 4 [2-9] and the median term of drainage was 7 days [3-16]. No side effects were observed. Video-assisted thoracoscopic surgery was proposed in 5 patients. The median length of hospitalization stay was 15 days [6-31]. One patient died due to multi-organ failure.

A 23-year-female with plexiform neurofibroma type 1: a rare clinical image

Switi Jawade — 2025-02-20

Neurofibromatosis type 1 (NF1) is a hereditary autosomal dominant tumour predisposition condition. This condition is distinguished by benign nerve sheath tumours. Foot NF1-associated neurofibromas are classified as either cutaneous or plexiform. Plexiform neurofibroma of the foot can cause significant functional and cosmetic difficulties. The 23-year-old female patient was admitted to hospital for the treatment of swelling over the lower extremity. The patient had a bike accident many months before and the swelling had been growing slowly. The swelling was painless and the skin was unaffected over months. The skin later become reddish, and patient had increased pain over the lower left foot and difficulty in walking due to the pain. The patient took medical advice. Proper examination revealed that there are multiple plexiform neurofibroma over the leg. Initially, the case was diagnosed as plexiform neurofibroma and incised under local anaesthesia. The initial diagnosis was later overturned and the patient was advised to seek surgical debulking.

Neisseria meningitidis with decreased susceptibility to penicillin G and molecular characterization of the penA gene in strains isolated at University Hospital Centers of Casablanca and Marrakech (Morocco)

Khadija Ait Mouss — 2025-02-20

Introduction: the laboratory diagnosis of meningococcal meningitis relies on conventional techniques. This study aims to evaluate the correlation between the reduced sensitivity to penicillin G of Neisseria meningitidis (N.m) strains and the expression of the altered PBP 2 gene.

Methods: out of 190 strains of N.m isolated between 2010 and 2021 at the bacteriology laboratories of Ibn Rochd University Hospital Centre (IR-UHC) in Casablanca and the UHC Mohammed VI in Marrakech, 23 isolates were part of our study. We first determined their state of sensitivity to penicillin G by E-Test strips and searched for the expression of the penA gene by PCR followed by Sanger sequencing.

Results: of all the confirmed cases of N.m, 93.15% (n=177) are of serogroup B, 75.2% (n = 143) are sensitive to penicillin G and 24.73% (n = 47) are of intermediate sensitivity. No resistance to penicillin G was observed. Reduced sensitivity to penicillin G in N.m is characterized by mutations namely F504 L, A510 V, I515 V, G541 N and I566 V located in the C-terminal region of the penA gene encoding the penicillin-binding protein 2 (PBP2) (mosaic gene).

Conclusion: our study presents useful data for the phenotypic and genotypic monitoring of resistance to penicillin G in N.m and can contribute to the analysis of genetic exchanges between different Neisseria species.

Cervical precancerous and cancerous lesions screening using Pap smear test at Provincial Referral Hospital of Bukavu, Eastern DR Congo: profile and recommendations to stakeholders

Daniel Garhalangwanamuntu Mayeri — 2025-02-20

Introduction: cervical cancer is a health concern worldwide. The South Kivu Province in the Eastern DR Congo is facing many cases of this disease but poorly screened and reported. The objective of this was to determine the prevalence of cell abnormalities at cervical cytology in a tertiary teaching hospital in Bukavu and their association with common risk factors of cervical cancer.

Methods: a cross-sectional study was conducted on 142 women attending the Provincial Referral Hospital of Bukavu (HPGRB) from February to December 2021. Quantitative variables were described by their median following their asymmetric distributions and the qualitative variables in absolute and relative frequencies. Then the Chi-square test was used for the comparison of proportion.

Results: forty-five percent of the participants had between three and five children. Twenty-two (15.5%) of the 142 patients reported to have two or more sexual partners and 17.5% reported the use of hormonal contraception. The prevalence of cell abnormalities at cervical cytology was 17% of which Low- Grade Squamous Intraepithelial Lesion (LSIL) was the most representative (12.9%). There was no statistically significant association between the common cervical risk factors and the occurrence of cell abnormalities.

Conclusion: cervical precancerous lesions are frequent in South Kivu province. The Pap smear test remains an early and affordable screening method and constitutes a secondary prevention strategy in women of 18 years and older in a low-income country such as DR Congo where vaccination against HPV is still hypothetic.

Granulosa cell tumor of the ovary: a series of 6 cases

Rafael Everton Assunção Ribeiro da Costa — 2025-02-20

Granulosa cell tumor (GCT) is a rare ovarian malignancy that represents only 2-3% of all cases. There are two subtypes of GCT: juvenile/JGCT (5% of cases) and adult/AGCT (95% of cases). This study aimed to describe a series of 6 GCT cases. The 6 study patients were managed from June 2011 to November 2022 in a private oncology clinic located in Teresina (PI), Brazil. At diagnosis, the mean patient age was 47 years, and symptoms in 5 patients (83%) were pelvic pain and/or increased abdominal volume. The majority of the patients (N=4/67%) had no comorbidities or findings related to GCT on physical examination. The mean tumor size was 11 cm. Five (83%) tumors were stage Ia and one tumor (17%) was stage III. Regarding tumor subtype, 5 (83%) were AGCT and 1 (17%) was JGCT. Surgical treatment consisted of unilateral salpingo-ophorectomy in 2 patients (33%), total hysterectomy and bilateral salpingo-ophorectomy in 3 patients (50%), and cytoreduction (suboptimal) in 1 patient (17%). After a mean follow-up period of 62.7 months, 5 patients (83%) are still alive and free of disease. One (17%) died from disease progression after 126 months. In the current study, disease-free overall survival was 83%, in a mean follow-up period of 62.7 months.

Cardiovascular risk screening: a 10-year prediction cross-sectional study in a Nigerian agrarian community

Sunday Odunke Nduka — 2025-02-20

Introduction: cardiovascular disease (CVD) is a major public health issue with a high global death rate and a significant death contribution from low-and middle-income countries. Modifiable and non-modifiable risk factors assessment and screening are important in their effective prevention and control. This study was designed to screen and assess cardiovascular risk factors in an agrarian community in Nigeria and to predict their 10-year CVD risk.

Methods: this was a cross-sectional study carried out in the Umueri community in Anambra State, Nigeria. Each participant responded to an epidemiologic survey using the World Health Organization (WHO) cardiovascular risk factors assessment tool with point-of-care screening procedures. The risk assessment for 10-year CV risk was conducted using region-specific WHO/ISH charts. Patients´ characteristics were analyzed and presented in frequencies and percentages.

Results: the mean age, systolic blood pressure, fasting plasma glucose, and total cholesterol of the study population were 54 years ± 1.27, 132 mmHg ± 2.088, 130 mg/dl ± 4.608, and 215 mg/dl ± 10.355 respectively. However, 98 (48.8%) have never had their blood pressure checked. About a quarter of the population had a high predicted risk of developing CVD within 10 years.

Conclusion: most of the assessed cardiovascular risk factors in the community are on average above the normal ranges and their probability risk of developing CVD within the next 10 years is high.

Review of haemovigilance at the Rabat Regional Blood Transfusion Centre in Morocco (2017-2021)

Ilham Lemssahli — 2025-02-20

Introduction: blood transfusion remains an essential therapeutic intervention, but the occurrence of transfusion reactions makes its administration even more complex. Vigilant reporting of such reactions by recipients of blood products is essential for effective haemovigilance. This study aimed to determine the frequency and nature of transfusion reactions.

Methods: conducted over five years (2017-2021) at the Haemovigilance Department of the Rabat Regional Blood Transfusion Centre, this retrospective study exploited incident forms notified by health establishments and data from the regional blood transfusion centre's computer system.

Results: from 1 January 2017 and 31 December 2021, the Rabat Regional Blood Transfusion Centre distributed 435,651 labile blood products to various healthcare establishments, which reported 191 transfusion reactions involving 191 patients. The median age of the patients was 44.3 years, with an overall cumulative incidence of transfusion reactions of 0.44 per 1000 labile blood products delivered. The predominant reactions were non-haemolytic febrile and allergic reactions, accounting for 41.36% and 35.60% respectively. Grade 1 reactions accounted for 87% of all reactions recorded. During the study period, three deaths were recorded, with ABO incompatibility and transfusion-related acute lung injury (TRALI) accounting for two and one case respectively. Transfusion reactions involving erythrocyte components were significantly more frequent than those involving platelet and plasma components.

Conclusion: this study revealed a relatively low incidence of transfusion reactions (0.44%), dominated by non-haemolytic febrile and allergic reactions. Several levels of failure were identified, in particular under-reporting of reactions and inadequate training in transfusion practices and haemovigilance, as well as the need for an effective electronic transfusion reaction reporting system to facilitate reporting and identification of underlying problems and risk factors to improve the quality of transfusion care provided to patients.

Myelomeningocele: congenital neural tube defect anomaly (a rare clinical image)

Shraddha Patil — 2025-02-20

Myelomeningocele is a type of congenital birth defect that affects the spinal cord. It is the most severe form of spina bifida, it is a condition where the neural tube, which normally closes during fetal development to form the spine, fails to close properly. In myelomeningocele, the spinal cord and the nerves that control muscle function in the lower part of the body protrude through an opening in the baby's back. The spinal cord and the protective membranes around it (meninges) protrude through a hole in the vertebrae. That frequently results in a visible sac or bulge on the back, which is often covered by a thin layer of skin. Meningomyelocele, while considered a serious and potentially debilitating condition, is not extremely rare. It is a type of neural tube defect, and the frequency can vary among different populations and regions. The rare case seen in a 16-day-old newborn female was admitted to the outpatient department with a complaint of swelling in her lower back which gradually increased in size. The child was born with normal vaginal delivery with an average birth weight of 3kg. After a detailed examination and investigation, a myelomeningocele clinical diagnosis was made. The physician referred the child to a neonatal intensive care unit for further management and surgical intervention. The specific cause of meningomyelocele is not always known, but both genetic and environmental factors are believed to have a main role. Folic acid supplementation before and during early pregnancy has been instructed mother to minimize the incidence of neural tube abnormalities, therefore good diet and supplementation are essential components of prenatal care.

Melanotic neuroectodermal tumor of infancy arising in the skull: a case report

Hajar Hamadi — 2025-02-20

Melanotic neuroectodermal tumor of infancy is a rare and usually benign neoplasm occurring in children of young age. This pigmented tumor typically presents in the head and neck region, but other locations may be involved. We report in this article a rare case of a 3-month-old girl presenting with a slowly growing mass localized in the anterior fontanelle. The patient's magnetic resonance imaging (MRI) showed a mass extending both extracranial and intracranial, and compressing the adjacent structures. The patient underwent subtotal resection of the mass and a histological study confirmed the diagnosis of melanotic neuroectodermal tumor of infancy. The patient presented later on with a recurrence. An early diagnosis and surgical management for these tumors remain the only guarantees to limit the progression and prevent their recurrence and metastasis.

Behavioral practices towards antibiotic use among health care workers - Sierra Leone, 2021: a facility-based cross-sectional study

Aminata Tigiedankay Koroma — 2025-02-20

Introduction: globally, antimicrobial resistance (AMR) kills around 1.27 million 700,000 people each year. In Sierra Leone, there is limited information on antibiotic use among healthcare workers (HCWs). We assessed antibiotic prescribing practices and associated factors among HCWs in Sierra Leone.

Methods: we conducted a cross-sectional survey among HCWs. We collected data using a questionnaire containing a Likert scale for antibiotic prescribing practices. We categorized prescribing practices into good and poor practices. We calculated adjusted odds ratios (aOR) to identify risk factors.

Results: out of 337 (100%) HCWs, 45% scored good practice. Out of the total, 131 (39%) of HCWS considered fever as an indication of antibiotic resistance and 280 (83%) HCWs prescribed antibiotics without performing microbiological tests and 114 (34%) prescribed a shorter course of antibiotics. Factors associated with good practice were being a doctor (aOR=1.95; CI:1.07, 3.56), the internet as a source of information (aOR=2.00; CI: 1.10, 3.66), having a high perception that AMR is a problem in the health-facility (aOR=1.80; CI:1.01, 3.23) and there is a connection between one´s prescription and AMR (aOR=2.15; CI:1.07, 4.32).

Conclusion: this study identified a low level of good practice toward antibiotic prescription. We initiated health education campaigns and recommended continuous professional development programs on antibiotic use.

The management of rare disease patients from a grassroot perspective: the role of patients´ organizations in the global recognition of rare diseases in Cameroon

Rose-Danielle Ngoumou — 2025-02-20

Introduction: rare diseases (RD) are extremely complex health conditions. Persons affected by these conditions in Cameroon are often neglected in society and health systems through the inexistence of policies and programs. In Cameroon, there exists no program or policy conceived to addresstheir needs in terms of access to quality health care, timely and reliable diagnosis, treatments, education, etc. The consequence is that persons living with a RD (PLWRD) and their families do not participate in social life. The unique fate of PLWRD reveals that the principle of social justice and equity is flawed in Cameroon. However, patients, in order to survive in society, rely on patients' organizations (PO) to improve their quality of life (QoL) and advocate for a better consideration in the society. The aim of this paper is to highlight how initiatives from a grassroot perspective like POs can inform decision-makers to address the needs of PLWRD and their families.

Methods: the study associated a systematic literature review and semi-structured interviews with parents of children suffering from a RD and who are members of a PO. Through the systematic literature review we highlighted the impact POs have in the development of research on RDs, patient literacy, patient empowerment and advocacy while semi-structured interviews brought out the needs of patients and their families

Results: findings, on the one hand show that, in Cameroon PLWRD face a number of challenges like the incurability of their condition, catastrophic medical expenses, stigmatization and marginalization, etc. and though in POs their QoL still remains poor. On the other hand, where POs are empowered they are key actors in research on RDs and help decision-makers on having a better insight into the type of RD that exists across a geographical area, the sociodemographic profile of patients, etc. for a better management of PLWRD.

Conclusion:the study suggests that the ministry of public health should create a network with existing RD POs to adequately meet the needs of PLWRD.

Knowledge and management practices of infant teething symptoms among mothers in a tertiary facility in Ghana

Abubakari Wuni — 2025-02-20

Introduction: teething is a natural process that all infants go through, and most toddlers obtain their first tooth around six months. However, misconceptions about teething and its remedies are still prevalent. The study assessed the knowledge and management practices of infant teething symptoms among mothers whose children were admitted to the Pediatric ward of Tamale Teaching Hospital.

Methods: the study adopted a prospective descriptive cross-sectional design with a quantitative data collection method. A total of 251 mothers were selected using a convenient sampling strategy, and a structured questionnaire was used for data collection.

Results: the study found that 79.7% and 20.3% of respondents had good and poor knowledge of teething, respectively. Also, 65.3% and 34.7% of the mothers had good and poor practices, respectively, in the management of teething symptoms. Marital status (p= 0.029) and type of ward (p= 0.020) were significantly associated with mothers' knowledge of teething. Furthermore, mothers less than 30 years of age (OR, 2.07; 95% CI:1.19-3.57; p= 0.009) and mothers with formal education (OR, 2.22; 95% CI: 1.22-3.81; p= 0.004) were more likely to have good management practices for teething symptoms.

Conclusion: most mothers have a good understanding of child teething, but they do not think delayed eruptions indicate systemic disease. They identified taking the child to the hospital during teething symptoms and administering Paracetamol to relieve the symptoms as standard practices. However, more education is needed to differentiate between teething signs and other ailments and to prevent substandard first aid practices during teething.

Anal disorders in pregnant and postpartum women: epidemiological, diagnostic and therapeutic aspects in 10 maternities of Bamako in Mali

Adégné Togo — 2025-02-20

Bowel transit disturbances favored by pregnancy and injuries during childbirth would be triggering or aggravating factors for anal pathologies. The objective of this work was to study the epidemiology, diagnosis, and treatment of anal pathologies during pregnancy and 6 weeks after delivery. We carried out a prospective, multi-centric, and analytical study in 10 obstetric units in Bamako from June 1^st, 2019, to May 31^st, 2020. After informed consent, we enrolled all first-trimester pregnant women admitted to the hospitals and who were followed up through the postpartum. We conducted a rectal examination in each participant and an anoscope in those with an anal symptom. Hemorrhoidal diseases were diagnosed in the case of external hemorrhoids (thrombosis or prolapse) or internal hemorrhoids. During the study period, we followed up 1,422 pregnant women and we found 38.4% (546) with anal pathologies (hemorrhoidal diseases in 13% (192), anal fissure in 10.5% (150) and anal incontinence in 8.6% (123). Risk factors for the hemorrhoidal disease were age of patient ≥30 years old aRR=5.77, 95% CI 4.57-7.34; p=0.000; a existence of chronic constipation aRR=2.61, 95% CI 1.98-3.44; p=0.000; newborn weight >3500 g aRR= 1.61, 95% CI 1.25-2.07; p=0.000 and fetal expulsion time >20 minutes aRR= 6.04, 95% CI 5.07-7.27; p=0.000. The clinical signs observed were constipation, anal pain, bleeding, and pruritus. The treatment was based on counseling on hygiene and diet, the use of laxatives, local topicals, and analgesics along perineal rehabilitation. Anal pathologies were common during pregnancy and 6 weeks after delivery. Pregnant women must be screened systematically for such pathologies. Early diagnostic and appropriate treatment would reduce serious complications.

Hepatitis B vaccine birth dose coverage among hepatitis B-exposed and hepatitis B-unexposed infants: evidence from the Healthy Beginning Initiative program in Benue State, Nigeria

Babayemi Oluwaseun Olakunde — 2025-02-20

Introduction: Nigeria offers universal hepatitis B birth-dose vaccine (HepB-BD) for the prevention and control of hepatitis B (HepB). While prior studies suggest low coverage of HepB-BD in Nigeria, there is a paucity of evidence on the association between the uptake of HepB-BD and maternal HepB status. This study aimed to determine HepB-BD coverage and the associated factors among infants of HepB-positive and -negative women in Nigeria.

Methods: the study was a secondary analysis of data from the Healthy Beginning Initiative program conducted between June 2016 and October 2018 in Benue State, Nigeria. The analysis was restricted to data from a cohort of 6269 mothers who had HepB screening during pregnancy and completed the HepB infant immunization question in the post-delivery survey. The association between the coverage of HepB-BD and maternal HepB status, sociodemographic characteristics, and obstetric factors were determined using crude and adjusted relative risks.

Results: about 10% of the women tested HepB positive. The coverage of HepB-BD was 64% (63.2% among infants of HepB-positive mothers and 63.8% among HepB-negative mothers). The likelihood of infants of HepB-positive mothers receiving HepB-BD was not significantly different from infants of HepB-negative mothers (aRR=0.97, 95%CI= 0.92-1.04). Among HepB-positive mothers, infants of mothers younger than 20 years (aRR=1.49, 95%CI=1.03-2.16) or those who received antenatal care (aRR=1.41, 95%CI=1.16-1.71) were more likely to receive HepB-BD, while mothers with no previous pregnancies (aRR=0.73, 95%CI=0.59-0.91) were less likely to receive HepB-BD. Among HepB-negative mothers, infants of less-educated mothers were less likely to receive HepB-BD (aRR=0.96, 95%CI=0.92-0.99), whereas infants of mothers who received antenatal care (aRR=1.23, 95%CI=1.16-1.31) or had an institutional delivery were more likely (aRR=1.29, 95%CI=1.23-1.36) to receive HepB-BD.

Conclusion: our findings highlight the need to improve HepB-BD uptake, particularly among HepB-exposed infants who are at risk of perinatal transmission of HepB.

Willingness of WHO staff to work in health emergencies in the African Region: opportunity for phased deployment of staff and ensure continuity of health services

Abdou Salam Gueye — 2025-02-20

A human resource base that ensures appropriate deployment of staff to emergencies, addressing different shock events in emergencies, without disrupting continuity of service is germane to a successful response. Consequently, the WHO Health Emergencies programme in the African Region, in collaboration with Africa Centre for Disease Control (ACDC) launched the African Volunteer Health Corps (AVoHC) and Strengthening and Utilization of Response Group for Emergencies (SURGE), an initiative aimed at ensuring a pool of timely responders. We explored the willingness of WHO staff to work in emergencies. A call for expression of interest to be part of the Elite Emergency Experts (Triple E) was published on 5^th July 2022 via email and was open for 5 weeks. The responses were analyzed using simple descriptive statistics and presented with graphic illustrations. A total of 1253 WHO staff, from all the six WHO regions, cutting across all cadre, applied to the call. The applicants had various trainings and experiences in emergency and have responded to mostly disease outbreaks. Two-third of the applicants were males. This paper did not explore reasons for the willingness to work in emergencies. However, contrary to fears expressed in literature that health workers would not want to work in emergencies with potential for infections, the applicants have worked mostly in infectious emergencies. Literature identified some themes on factors that could impact on willingness of health workers to work in emergencies. These include concerns for the safety of the responders and impact of partners, child and elderly care, as well as other family obligations, which emergency planners must consider in planning emergency response.

Management of adverse events in a Moroccan regional hospital: a state of art and perspectives

Khadija Elwardi — 2025-02-20

Introduction: the risk management system is useful to identify, analyze, and reduce the risk occurrence of adverse events (AEs) in health services. This system suggests useful improvements to patients and to the whole institution and also contributes to the acquisition of a collective and organizational safety culture. This study presented a state of the art of the management of AEs identified in different services of a regional hospital in the north of Morocco.

Methods: this is a retrospective cross-sectional exploratory study carried out from 2017 to 2019 using observations and semi-structured interviews, which were recorded, re-transcribed, and analyzed. Data was also collected from audit reports, results of investigations of the nosocomial infection control committee and the risk management commission, AEs declaration sheets, and meetings reports.

Results: a number of 83 AEs were recorded, 10 of which were urgent. The reported events were related to care, infection risk, the drugs circuit, and medico-technical events. Two hundred cases of nosocomial infections were also recorded, of which 75 occurred in the intensive care unit and 35 in the maternity service. Surgical site infections were the most frequently reported complication. Adverse events were related to organizational failure, equipment problems, and errors related to professional practices.

Conclusion: our findings may guide the improvement of the event management system in order to reduce the occurrence of future incidents. Thus, improving the risk management system requires setting up training strategies for staff on the importance of this system and its mode of operation.

Flipped classroom model versus conventional teaching method: effects on nursing students' self-directed learning readiness in a research methodology course

Paulina Chigwara Chikeme — 2025-02-20

Introduction: the effectiveness of the flipped classroom model (FCM) method for building self-directed learning readiness (SDLR) in a research methodology course has not yet been scientifically researched. This study aims to assess the effect of FCM on SDLR among Nigerian nursing students enrolled in a research methodology course.

Methods: sixty-four 400-level nursing students from two government-owned universities in Southeast Nigeria were recruited for this quasi-experimental study. They were randomly divided into two groups, the experimental group, and the control group, and exposed to FCM and conventional teaching methods (CTM) throughout the months of April and July 2021. Before and after the intervention, the validated self-directed learning readiness scale (SDLRS) was used to gather data, and a structured questionnaire was used to collect demographic data.

Results: the SDLR was high if the SDLRS mean score was ≥3.75. Pre-test results from SDLR showed overall scores of 3.99 ± 0.39 and 3.95 ± 0.35 for CTM and FCM, respectively, while post-test results showed overall scores of 3.84 ± 0.77 for CTM and 4.01 ± 0.81 for FCM. The mean scores between the pre-and post-tests were statistically different (p=0.030).

Conclusion: the FCM had a positive effect on Nigerian nursing undergraduates' SDLR and should be encouraged as it provides a viable alternative to the traditional teaching method.

Dengue epidemic in Burkina Faso: concerns about the informal use of traditional herbal remedies

Kampadilemba Ouoba — 2025-02-20

To the editors of the Pan African Medical Journal

COVID-19 vaccine acceptance among pregnant women: a multicentre cross-sectional survey in Port Harcourt, Nigeria

Hannah Emmanuel Omunakwe — 2025-02-20

Introduction: effective COVID-19 vaccines for the prevention of severe illness have been available for more than one year now. This study was carried out to ascertain vaccine hesitancy and its associations among pregnant women receiving antenatal care in Port Harcourt, a large cosmopolitan town in Nigeria.

Methods: we conducted a cross-sectional online survey over 2 months among consenting pregnant women receiving antenatal care in the 3 largest obstetric service centers in Port Harcourt to evaluate COVID-19 vaccine hesitancy and its associations.

Results: the prevalence of vaccine hesitancy was 669 (72.2%). Of the respondents, 27 (2.9%) had been infected or had a close family member infected with SARS-CoV-2, and 897 (96.8%) of them had heard of the COVID-19 vaccine; however, only 133 (14.4%) had been vaccinated against COVID-19. The safety of the mother in 260 (32.8%) and the safety of the unborn baby in 114 (14.4%) of the respondents were the reasons for vaccine hesitancy. A small proportion of women 7(0.9%) were hesitant on religious grounds. Tertiary education, use of childhood immunization for previous infants delivered, and availability of COVID-19 vaccine in the antenatal clinic at no cost to the women, were statistically significant predictors of vaccine uptake among the respondents.

Conclusion: the prevalence of vaccine hesitancy among pregnant women in Port Harcourt was 72.2%. Higher academic achievement and availability of the COVID-19 vaccine in the antenatal clinic were predictors of vaccine uptake, while reasons for hesitancy were mostly due to safety concerns for the mother and unborn baby.

Knowledge, attitudes, and practices of pharmacy staff on cosmetic products in Lomé, Togo

Julienne Noude Teclessou — 2025-02-20

To the Editors of the Pan African Medical Journal

A case of chronic elephantiasis

Anjana Ledwani — 2025-02-20

A 72-year-old male presented with swelling over the left lower limb over the past 30 years, which has gradually increased in size in the past 5–6 years with the association of skin changes. The patient has been diagnosed with stage 4 lymphedema for 10 years and has been on a course of tablets of Diethylcarbamazine 100mg thrice daily for four weeks, which he repeats every six months. The patient now complains of increased pain and a burning sensation over the left foot, along with severe difficulty walking, for the past 15 days. Upon examination, the left leg is enlarged, non-pitting, and malodorous, and it has hard induration and hyperpigmented, cobblestone-like lesions that extend from the left foot to a few inches below the anterior superior iliac spine. The surrounding area was erythematous, warm to the touch, and tender. Multiple chronic, nonhealing ulcers with an erythematous base were seen on the posterior aspect of the ankle. The patient was febrile and the white blood cell count was raised (16,000/microliter). Lymphatic filariasis is a neglected tropical disease that is still rampant, affects 120 million people worldwide, and can lead to various complications in the chronic stage. The current patient presented to us in the advanced stage with chronic skin changes, non-healing ulcers, various papillomatous growths with secondary infection, and sepsis. Treatment modalities include chemotherapy with Diethylcarbamazine (DEC), control of superadded infection, wound care, and hygiene maintenance. Surgery can be done in extreme cases, which includes reconstructive surgery or surgical excision.

Lupus vulgaris revealed by chronic nasal ulceration

Anjana Ledwani — 2025-02-20

A 40-year-old male presented to the outpatient department with complaints of itching and ulceration around the nose for the past 1 year. On examination, the patient was conscious, oriented, vitally stable, and had an erythematous plaque with crusting and loss of hair around the nose with bilateral micro nares with a depressed nasal bridge and deviated nasal septum to the left side. The patient had no significant past, personal, and family history and had no history of any addictions. Relevant investigations were done, the erythrocyte sedimentation rate (ESR) was raised (110mm/hr), and the Mantoux test was done which showed an induration of 30mm which was strongly positive for tuberculosis. Chest X-ray was within normal limits and sputum for acid-fast bacilli was negative. An incisional biopsy was done from the lesion over the nose, which showed caseating granuloma with epithelioid cells and Langhans giant cells along with lymphocytes and plasma cells suggestive of lupus vulgaris. The patient was started on anti-tubercular treatment consisting of a fixed-dose combination of isoniazid, Rifampicin, Pyrazinamide, and Ethambutol according to the weight band. The patient is on regular follow-up and is showing signs of clinical improvement. Lupus vulgaris is the most common type of skin tuberculosis. It is also known as Tuberculosis Cutis Luposa. It occurs due to the chronic infection of Mycobacterium tuberculosis and is transmitted by hematogenous and lymphatic spread. The contiguous extension is the most common. It mainly affects the head and neck region. Diagnosis is done by a histopathological finding of tuberculoid granuloma with lymphocytes, plasma cells, central caseation, epithelioid cells, and giant cells. The treatment comprises anti-tubercular drugs for 6-9 months.

Peeling paint dermatosis

Ashwin Karnan — 2025-02-20

A 4-month-old infant presented with complaints of inability to take feeds, peeling skin all over the body, with a history of loose stools two weeks back. There was no significant past or birth history. On examination, the infant was irritable, with generalized oedema present, dehydrated, weight for height in 62^nd percentile, pulse rate 130 beats/minute, respiratory rate 32 breaths/minute, blood pressure 80/60 mmhg, reduced breath sounds on auscultation. Chest X-ray done. Relevant blood investigations were done which showed anaemia, hypoalbuminemia, and dyselectrolytemia. A diagnosis of flaky paint dermatosis was made. The infant was treated with intravenous fluids, total parenteral nutrition, intravenous albumin, multivitamins, and other supportive medications. The infant improved clinically after 8 days, discharged, and the mother was advised to continue exclusive breastfeeding. Protein-energy malnutrition occurs due to inadequate protein and calories in the body, either due to increased need or due to reduced intake. Kwashiorkor is the less common type with an incidence of 3 per 1000 person months in the age group of 2-3 years. Clinically it is characterized by irritability, generalized oedema, distended abdomen, organomegaly, and dermatosis. Skin changes include dry skin which progresses to keratosis and hyperpigmentation. Gradually the fragile skin peels away exposing the hypopigmentation below. Treatment is protein and calorie supplementation and gradual introduction to enteral feeds.

Gastroduodenal artery aneurysm - an extremely rare but insidious cause of abdominal pain: a case report

Dawood Shehzad — 2025-02-20

An arterial aneurysm is a localized weakening of the artery wall that results in pathological dilatation. All intra-abdominal artery aneurysms are labeled as visceral artery aneurysms (VAA), apart from the aorto-iliac artery aneurysms. VAA´s are rare, gastroduodenal artery aneurysms (GDAA), constituting 1.5% of visceral artery aneurysms. A woman in her early 80s´ presented with chronic epigastric pain, weight loss, and nausea. Conservative management was unsuccessful. Imaging revealed a GDAA, prompting endovascular coil embolization. Subsequent evaluation confirmed Polyarteritis Nodosa (PAN), treated with rituximab. The report underscores the diagnostic challenges, emphasizing the need for a multidisciplinary approach using imaging and angiography. GDAA's potential life-threatening rupture necessitates prompt intervention, as illustrated in this case. The rare association with PAN, although infrequent, underscores the importance of considering underlying etiologies in multiple visceral aneurysms. Early diagnosis and intervention are pivotal for this uncommon yet potentially lethal condition.

Tubercular lymphadenitis with scrofuloderma

Ashwin Karnan — 2025-02-20

A 27-year-old male presented to the outpatient department with complaints of multiple swelling in the neck for the past 6 months associated with evening rise of temperature, loss of weight, and loss of appetite with no significant past and personal history. On examination of the neck, there were multiple, hard, mobile, discrete, non-tender, cervical lymph nodes of size 2-2.5cm with no active discharge and overlying skin showing signs of healed ulceration. The tuberculin skin test was positive, showing an induration of 20mm. Fine needle aspiration cytology from the lymph node showed caseating granulomatous inflammation suggestive of tuberculosis. A dermatologist's opinion was taken and a biopsy from the overlying skin showed central necrosis with peripheral granuloma formation suggestive of scrofuloderma. The patient was started on anti-tubercular treatment and at one month follow up there was regression of lymph nodes. Scrofuloderma is one of the cutaneous manifestations of tuberculosis, accounting for approximately 2% of extrapulmonary tuberculosis. It is also called tubercular colliquative cutis and occurs from the direct extent of disease from deep structure for example: lymph node, joint, bone, or epididymis. It is mostly seen in the adolescent age group and commonly involves the neck, axilla, and groin. They may be single or multiple. Treatment is therapy with isoniazid, rifampin, ethambutol, and pyrazinamide for 9-12 months.

Un mélanome choroïdien de découverte fortuite sur un œil amblyope

Taha Boutaj — 2025-02-20

Nous rapportons le cas d'un patient de 37 ans, amblyope profond de l'œil gauche depuis l'enfance non suivi, qui consulte dans le cadre du dépistage de la rétinopathie diabétique à la suite du diagnostic récent d'un diabète. L'examen ophtalmologique du patient retrouve une acuité visuelle à 10/10^e au niveau de l'œil droit, et de 1/10 à l'œil gauche. Le segment antérieur est normal. Le fond d'œil trouve à l'œil gauche une volumineuse masse achrome bourgeonnante dans la rétine temporale, entourée d'un décollement séreux rétinien avec la présence de plis en inter papillo-maculaire (A). L'échographie oculaire retrouve un processus choroïdien hyperéchogène en champignon, vascularisé au Doppler (B). L'imagerie par résonance magnétique (IRM) orbitaire objective un processus intra orbitaire gauche limité, de signal d'intensité moyenne après injection de gadolinium (C). Après réunion pluridisciplinaire, le diagnostic de mélanome choroïdien a été fortement suspecté. Un bilan d'extension comprenant une IRM cérébrale, une tomodensitométrie (TDM) thoraco-abdomino-pelvienne et une échographie abdominale est revenu normal. Devant la volumineuse masse, un traitement conservateur n'a pas pu être réalisé. Le patient a donc été énucléé, puis adressé en service d'oncologie pour complément de prise en charge après confirmation anatomo-pathologique de la pièce opératoire.

Modeling the effect of imported malaria on the elimination programme in KwaZulu-Natal province of South Africa

Peter Joseph Witbooi — 2025-02-20

Introduction: with imported malaria cases in a given population, the question arises as to what extent the local cases are a consequence of the imports or not. We perform a modeling analysis for a specific area, in a region aspiring for malaria-free status.

Methods: data on malaria cases over ten years is subjected to a compartmental model which is assumed to be operating close to the equilibrium state. Two of the parameters of the model are fitted to the decadal data. The other parameters in the model are sourced from the literature. The model is utilized to simulate the malaria prevalence with or without imported cases.

Results: in any given year the annual average of 460 imported cases, resulted in an end-of-year season malaria prevalence of 257 local active infectious cases, whereas without the imports the malaria prevalence at the end of the season would have been fewer than 10 active infectious cases. We calculate the numerical value of the basic reproduction number for the model, which reveals the extent to which the disease is being eliminated from the population or not.

Conclusion: without the imported cases, over the ten seasons of malaria, 2008-2018, the KwaZulu-Natal province would have been malaria-free over at least the last 7 years of the decade indicated. This simple methodology works well even in situations where data is limited.

Tackling financial insecurity for autoimmune rheumatic diseases in developing countries in sub-Saharan Africa is of utmost importance

Jan René Nkeck — 2025-02-20

To the editors of the Pan African Medical Journal

Tackling the non-communicable disease epidemic: a framework for policy action in low- and middle-income countries

Mark Fordjour Owusu — 2025-02-20

Health policy frameworks for the prevention and control of non-communicable diseases have largely been developed for application in high-income countries. Limited attention has been given to the policy exigencies in lower- and middle-income countries where the impacts of these conditions have been most severe, and further clarification of the policy requirements for effective prevention is needed. This paper presents a policy approach to prevention that, although relevant to high-income countries, recognizes the peculiar situation of low-and middle-income countries. Rather than a narrow emphasis on the implementation of piecemeal interventions, this paper encourages policymakers to utilize a framework of four embedded policy levels, namely health services, risk factors, environmental, and global policies. For a better understanding of the non-communicable disease challenge from a policy standpoint, it is proposed that a policy framework that recognizes responsible health services, addresses key risk factors, tackles underlying health determinants, and implements global non-communicable disease conventions, offers the best leverage for prevention.

Etude rétrospective sur 60 cas de rupture utérine du centre de maternité de Monastir, Tunisie

Imen Ben Farhat — 2025-02-20

La rupture utérine est une complication obstétricale redoutable. Le but de notre travail est d'étudier les caractéristique épidémiologiques, les éléments de pronostic maternel et fœtale ainsi que les différentes modalités thérapeutiques de la rupture utérine survenue sur utérus sain et cicatriciel. Nous avons mené une étude rétrospective monocentrique descriptive et analytique, portant sur 60 cas de rupture colligées au service de gynécologie obstétrique du centre de maternité et de néonatologie de Monastir, s'étalant de 2017 jusqu'en 2021. Les patientes ont été classées selon la présence ou non d'une cicatrice utérine. Soixante patientes ont été incluses. La majorité des cas de rupture étaient survenus sur utérus cicatriciel (n=55). Le signe clinique le plus retrouvé a été l'anomalie de rythme cardiaque fœtal. Aucun décès maternel n'a été enregistré et le taux de mortalité périnatale a été de 11%. Nous avons trouvé un indice de masse corporelle (IMC) moyen et un taux de macrosomie fœtale et une parité moyenne significativement plus élevés dans le groupe utérus sain que celui dans le groupe utérus cicatriciel (p=0,033, 0,018 et 0,013 respectivement). Les complications maternelles étudiées (hémorragie du post partum, hystérectomie, transfusion sanguine, hospitalisation prolongée) ont été significativement plus fréquentes en cas de rupture utérine (RU) sur utérus sain (p=0,039; p=0,032; p=0,009; p=0,025 respectivement). La rupture utérine est un accident obstétrical mettant en jeu le pronostic fœtal et maternel. L'anomalie de rythme cardiaque d'un foetus (RCF) est le signe révélateur le plus fréquemment trouvé. Le traitement est conservateur dans la majorité des cas. Le pronostic est meilleur en cas d'utérus cicatriciel.

Evaluation d´une formation en sécurité transfusionnelle auprès des étudiants en médecine au Maroc

Ouadii Abakarim — 2025-02-20

Introduction: la formation médicale au sein des facultés de médecine et des hôpitaux du monde entier abordent peu le sujet de la médecine transfusionnelle et nécessitent un renforcement des programmes universitaires actuels. Les indications transfusionnelles sont plus fréquentes que ce qui est recommandé, ce qui contribue à augmenter les risques liés à cette procédure. Pour pallier à ceci, une formation par objectif structuré a été organisée en gestes et soins infirmiers sous le thème de la sécurité transfusionnelle. Le but de notre étude était d´évaluer l´appréciation de cette formation par les étudiants en médecine et le degré de sa maitrise auprès de cette population.

Méthodes: il s´agit d´une étude transversale, descriptive et monocentrique. Nous avons effectué une enquête auprès des étudiants en 3^e année de médecine. Un questionnaire d´appréciation auto administré, ainsi qu´une grille d´évaluation des compétences acquises, rempli par les médecins formateurs au cours de la séance. L´analyse des données a porté sur la statistique descriptive à l´aide du logiciel.

Résultats: trois-cent-quatre-vingt-quatre (n=384) étudiants ont été convoqué à cette formation dont 275 (71,6%) ont participé à l´étude. Le taux de satisfaction globale était de 93,8%. Les objectifs et l´organisation étaient concluants à 95,6%. La qualité de la formation était satisfaisante à 90,3%. Le choix du thème de la station était convenant à 80%, la fluidité de la séance à 86,3%, la qualité de l´organisation et du débriefing à 89%, l´interaction entre formateurs et apprenants à 90,2%, la motivation des formateurs et la réflexion suscitée chez les apprenants à 92%. Nous avons noté que 93% des étudiants n´ont jamais participé à une formation sur la sécurité transfusionnelle. La maitrise des compétences globales était totale à 67%, partielle à 26% et absente à 7%. Les étudiants ont maitrisé les mesures de vérifications de l´identité et du groupage du produit à transfuser à 97%, le principe de l´interprétation du contrôle ultime pré transfusionnel à 96%, le but du contrôle ultime au lit du malade à 93% avec maitrise de sa réalisation technique à 83%.

Conclusion: la formation en sécurité transfusionnelle a reçu un accueil favorable avec une maîtrise satisfaisante. Cette expérience peut être facilement étendue à d´autres thèmes.

Bird Fancier's lung: a rare clinical image

Anjana Ledwani — 2025-02-20

A 19-year-old male college student presented to the Outpatient Department with complaints of dyspnea, dry cough, and cold for the past 1 month not responding to any treatment with no significant past and personal history. On a detailed history, the patient revealed passive smoking and breeding pigeons at his home for the past 3 years. On examination, he was conscious, and oriented, pulse rate of 104 beats/minute, Respiratory rate-20 breaths/minute, oxygen saturation of 96% on room air, blood pressure of 130/80mm Hg, and bilateral fine crepitations on the respiratory system examination. All routine investigations were done. Chest X-ray showed bilateral nonhomogeneous opacities spread in the batwing pattern. High-resolution computed tomography (HRCT) of the thorax was done which was suggestive of bilateral ground glass opacification with centrilobular nodules. Induced sputum was sent for ZN staining, which was negative. Pigeon serum proteins, feathers, and droppings-specific degree of total immunoglobulin G (IgG) testing was done, which was positive. The patient was advised to avoid contact with birds and started on oral glucocorticoids. At 22-weeks follow-up, the Patient showed drastic improvement clinically and radiologically. Bird fancier's lung is a type of hypersensitivity pneumonitis caused by recurrent exposure to avian antigens. Pathophysiology is exposure to antigen causing immune complex formation with the influx of neutrophils leading to inflammation and ultimately fibrosis. Patients usually present with progressing dyspnoea, cough, and chest discomfort. The mainstay of treatment is corticosteroids along with cessation of exposure to the antigens. However, if left untreated, it can lead to fibrosis and irreversible damage.

Clofazimine-induced skin pigmentation

Ashwin Karnan — 2025-02-20

A 54-year-old male presented to the outpatient department with complaints of black discoloration of skin and nails for the past 1 month. The patient gave a history of multi-drug resistant sputum positive tuberculosis for which he is on antitubercular drugs (Isoniazid, Ethambutol, Pyrazinamide, Clofazimine, Bedaquiline, Levofloxacin, and Ethionamide) for the past 9 months. A dermoscopy was done which showed yellow globules in a honeycombing pattern and hyperpigmentation with sparing of the sweat glands. A diagnosis of Clofazimine-induced hyperpigmentation was made. As a physician, with tuberculosis nearing elimination, monitoring and managing the adverse effects of drugs is important. Clofazimine is a riminophenazine dye that has both anti-microbial and anti-inflammatory action. It is absorbed orally and is known to accumulate in tissues. It has a very long half-life of about 70 days and is excreted in small amounts in bile, urine, and sweat. It is used in leprosy, multidrug-resistant tuberculosis, lepra reaction, and in other mycobacterial infections. Clofazimine-induced pigmentation is reversible but takes months to years to clear after stopping the drug.

Hypopion inverse secondaire à un accès de toux

Taha Boutaj — 2025-02-20

Le tamponnement par huile de silicone est l´un des moyens thérapeutiques utilisés dans les décollements de la rétine complexes par déhiscences inférieures et/ou postérieures. Il est cependant source de complications notamment le passage en chambre antérieure ou « inversed hypopion ». Nous rapportons le cas d´un patient qui se présente aux urgences pour baisse de l´acuité visuelle brutale a l´œil droit secondaire à un accès de toux. L´examen ophtalmologique retrouve une acuité visuelle sans correction réduite aux mouvements des doigts. Le tonus oculaire était à 27mmHg. L´examen des annexes est sans particularités. L´examen à la lampe à fente du segment antérieur objective une émulsion de silicone en chambre antérieure en suspension cachant la moitié de la pupille formant un « pseudo-hypopion inverse » ou « hyperpion » siliconé. Le reflet de l´implant intra-oculaire était visible. Le fond d´œil était inaccessible. L´examen de l´œil controlatérale était normal. Le traitement consistait en lavage de la chambre antérieure avec aspiration de l´huile de silicone. L´évolution était favorable: l´AV est remontée à 3/10 avec un tonus normal.

Une cause rare d´hypercorticisme: un phéochromocytome sécrétant l´ACTH (à propos d´un cas)

Kaoutar Rifai — 2025-02-20

La sécrétion ectopique d´Adrenocorticotropic hormone (ACTH) par un phéochromocytome est une cause très rare du syndrome de Cushing, posant des difficultés diagnostiques et thérapeutiques. Nous rapportons le cas d´une patiente chez qui ce diagnostic a été suspecté devant un syndrome de Cushing sévère associé à une mélanodermie, une hypertension artérielle résistante à une trithérapie et un diabète déséquilibré sous insulinothérapie. Biologiquement, les dérivés méthoxylés urinaires, le cortisol libre urinaire de 24 heures ainsi que l´ACTH étaient très élevés. L'imagerie a montré une masse surrénalienne gauche de 3,5 cm. La patiente a bénéficié d´une surrénalectomie gauche après une préparation médicale avec une bonne évolution clinico-biologique. L´étude anatomopathologique a confirmé le diagnostic de phéochromocytome. Notre cas illustre l´intérêt du dosage des dérivés methoxylés devant tout syndrome de Cushing ACTH dépendant associé à une masse surrénalienne. Ceci dans le but d´assurer une prise en charge précoce et d´éviter les complications pouvant engager le pronostic vital.

Prévalence et facteurs prédicteurs des troubles post-traumatiques chez les accidentés de la voie publique

Rim Feki — 2025-02-20

Introduction: les troubles post-traumatiques survenant à la suite d'un accident de la route ont un impact tant sanitaire qu'économique.

Méthodes: notre étude prospective, vise à déterminer la prévalence de ces troubles, et à dégager leurs facteurs de risque auprès de sujets victimes d'accidents de la route et hospitalisés au service de chirurgie orthopédique et de traumatologie du Centre Hospitalo-Universitaire de Sfax-Tunisie.

Résultats: soixante-dix sujets ont été inclus dans notre étude. La prévalence de l'état de stress aigu était de 37,1% et il a été associé au sexe féminin, au niveau scolaire bas, à la présence d'antécédents médicochirurgicaux, à la passivité au cours de l'accident, à la sévérité des lésions, et à la présence d'une symptomatologie anxieuse et dépressive. Le trouble stress post-traumatique était constaté chez 40% des sujets et il a été associé au milieu de résidence urbain, à la passivité au cours de l'accident, et à la symptomatologie anxieuse et dépressive. Des scores faibles des stratégies de coping fonctionnelles et des scores élevés des stratégies de coping dysfonctionnelles ont été significativement associés à ces deux troubles. Le niveau scolaire bas, la résidence en milieu urbain, un niveau élevé d'anxiété et de dépression et la stratégie de coping de déni apparaissent comme des facteurs de risque indépendants de l'état de stress aigu et du trouble stress post-traumatique.

Conclusion: il s'avère ainsi important de déterminer un profil de personnes plus exposées aux troubles post-traumatique afin de permettre un dépistage précoce par les médecins avec lesquels les accidentés pourraient avoir des contacts dans les suites de leurs accidents.

Prevalence of alcohol and other psychoactive substance abuse and association with depression among medical students in Niger Delta University, Bayelsa State

Tamaraemumoemi Emmanuella Okoro — 2025-02-20

Introduction: alcohol and other psychoactive substances have adverse health effects, particularly on young people. This study determined the prevalence of alcohol and other psychoactive substance abuse and its association with depression among Niger Delta University, Bayelsa State, Nigeria, medical students.

Methods: a cross-sectional study involving 243 medical students who completed a patient-rated version of the Mini International Neuropsychiatric Interview (MINI-PR). For analyzing the data, descriptive and inferential statistics were employed.

Results: most respondents were 18 to 24 years old (67.1%), and 52.7% were male; the prevalence of major depressive episodes (current) and lifetime alcohol and other psychoactive use was 30.5%, 25.5%, and 21%, respectively. Also, the prevalence of current alcohol abuse and dependence was 5.8% and 4.9%, respectively. Alcohol use (χ²: 12.57, p = 0.001) and abuse (χ²: 22.33, p = 0.001) were significantly associated with depression. Psychoactive substance use was significantly associated with depression (χ²: 12.91, p = 0.001). The odds of having depression increased with the use of alcohol (OR: 3.54; 95% CI: 1.71-7.33) and psychoactive substances (OR: 4.52; 95% CI: 1.88-10.88).

Conclusion: alcohol and psychoactive substance use were significantly associated with depression. Organizing interventions to reduce such unhealthy social practices among medical students is necessary.

Assessment of knowledge and self-efficacy among health professionals and clinical scientists following the Cameroon HIV/AIDS Research Forum (CAM-HERO 2022) research methodology and bioethics training

Peter Vanes Ebasone — 2025-02-20

To inform public health policymakers that the generation of local evidence-based knowledge is key. Research capacity in low- and middle-income countries (LMIC) to generate medical knowledge is often weak and insufficiently resourced and efforts to tackle these challenges are not standardized. Continuous research training can equip researchers with the required knowledge and research skills, but its effectiveness largely depends on the quality and pertinence of the training methods used. We aim to assess the effectiveness of the Cameroon HIV/AIDS Research Forum (CAM-HERO) 2022 Research Methodology and Bioethics Training with the objective to describe the knowledge gained and the self-efficacy of health professionals and clinical scientists. A survey was conducted during the one-day training among health professionals and clinical scientists. Participants took an online self-administered questionnaire before and after the training related to the topics taught. The questionnaire consisted of two parts: 1) 18 Multiple Choice Questions (MCQs) to assess knowledge and 2) Nine items to evaluate self-efficacy using a five-point Likert scale. Mean scores were calculated, analysed, and compared using paired t-test for the pre- and post-test results. A total of 30 participants (57% women) completed the socio-demographic form. The median age (IQR) of participants was 33.5 (13.3) years. We registered 38 respondents for the pre-test and 33 respondents for the post-test. There was a rise in knowledge mean score from 13.0 to 14.8 (p=0.001) and an improvement in the perception of self-efficacy with a mean score increase from 2.9 to 3.7 (p < 0.001). Knowledge and perception of self-efficacy on research methodology improved among participants after the training. These results suggest that the CAM-HERO 2022 training had an immediate positive impact on skills and self-efficacy. Hence, we recommend the implementation of this training on a larger scale, periodically, and with long-term follow-up to evaluate its impact.

Acquired methemoglobinemia induced by indoxacarb poisoning: a case report

Dhouha Ben Braiek — 2025-02-20

Indoxacarb, a large-spectrum non-organophosphorus oxadiazine insecticide, is broadly used in farming whose mechanism of action is the blockage of voltage-gated sodium channels of insects. There is restricted data on human poisoning. We report a case of an 18-year-old male patient without comorbidities presented with unconsciousness and cyanosis after the intentional ingestion of indoxacarb in a suicide attempt. Methemoglobinemia was clinically suspected and was successfully treated after methylene blue injection, associated with supportive and symptomatic management. This case emphasizes the importance of considering methemoglobinemia after indoxacarb ingestion in addition to its early recognition and timely injection of methylene blue which led to complete recovery without sequelae.

Essential thrombocythemia: nutritional management in weight loss and malnutrition

Isabela de Souza da Costa Brum — 2025-02-20

Essential thrombocythemia is the category of myeloproliferative syndromes, generally characterized by a group of clonal stem cell diseases that present a disturbance in the growth of one or more sets of hematopoietic cells. All long clinical treatment, patients may experience gastrointestinal disorders and other metabolic processes that can lead to weight loss and malnutrition. Cytokine is involved in the control of appetite, digestive, and metabolic processes in the body, it can be assumed that increased stimulation could impair the control of these processes leading to loss of body mass. Effective and systematic nutritional intervention is required to ensure patient compliance with treatment and improved nutritional status.

HIV prevalence and associated factors among married women, Mozambique, 2015: analysis of the 2015 National AIDS Indicator Survey (IMASIDA)

Samuel Nuvunga — 2025-02-20

Introduction: epidemiological estimates from the 2021 Joint United Nations Program on HIV/AIDS (UNAIDS) emphasize the existing gender disparities, where women face a higher risk of HIV/AIDS exposure. In Mozambique, as of 2021, the HIV prevalence rate among the adult population stood at 12.5%, with an even more concerning rate of 15.4% among women of reproductive age.

Methods: a cross-sectional study was carried out with secondary data from the Survey on National Indicators of Vaccination, Malaria, and HIV/AIDS (IMASIDA 2015), where we included married women, both civil marriage and common law marriage of reproductive age 15-49 years. Statistical analyses, including chi-squared tests and logistic regression models, accounting for survey design, were employed to assess associations.

Results: the study findings showed that HIV prevalence was higher among married women aged 35-49 years (aOR=2.5; 95% CI: 1.3-4.6; p=0.005), those without formal education (aOR=7.7; 95% CI: 1.1-52.9; p=0.038) and those with primary education (aOR=9.8; 95% CI: 1.6-60.1; p=0.014), those who experienced domestic violence (aOR=1.8; 95% CI: 1.0-3.2; p=0.04), had an uncircumcised partner (aOR=1.9; 95% CI: 1.2-3.1; p=0.008), and had three or more lifetime sex partners (aOR=3.6; 95% CI: 2.9-7.3; p<0.001). Women who were in one lifelong union had a lower risk of HIV positivity (aOR=0.5; 96%CI: 0.3-0.8, p=0.005).

Conclusion: the findings of this study highlight sociodemographic, behavioral, and violent factors associated with HIV prevalence among women. These findings underscore the importance of targeted interventions and education programs aimed at reducing HIV transmission among females and promoting safer sexual practices.

Pregnancy in Morrison Pouch: a case report

Frank Martin Sudai — 2025-02-20

Abdominal pregnancy is a rare form of ectopic pregnancy (accounting for 1% of all ectopic pregnancies). Depending on gestational age and its location various symptoms and signs may be exhibited. This study aimed to report a case of abdominal pregnancy occurring in the Morrison Pouch with a primary presentation of right upper quadrant pain and to highlight complications that may arise in the management of abdominal pregnancy located in the Morrison Pouch. A 22-year pregnant woman at gestation of 22 weeks presented with a right upper quadrant mass and pain. Ultrasound examination revealed a live extrauterine singleton at Morrison Pouch, full blood count showed severe anemia. The patient received a blood transfusion in seven days and underwent emergency laparotomy after experiencing sudden acute internal hemorrhage but died a few hours post laparotomy due to hemorrhagic shock. Abdominal pregnancy carries a high risk of maternal hemorrhage as described in this case.

Virological non-suppression and associated factors among adult patients receiving antiretroviral therapy at selected health facilities in uMgungundlovu district of KwaZulu Natal, South Africa: a cross-sectional study

Slindile Zondi — 2025-02-20

Introduction: virological non-suppression is not only associated with increased risk of transmission of the Human Immunodeficiency virus (HIV) to others; perinatally and sexually, but it also decreases the life expectancy among the individuals who are on antiretroviral therapy (ART). This study sought to determine the level of virological non-suppression among ART patients from selected health facilities of a sub-district in UMgungundlovu district. This sub-district has high HIV transmission rates in KwaZulu Natal (KZN) and had one of the highest HIV prevalence in the district in 2018; population weighted HIV prevalence of 36.3% among men and women aged 15-49 years old, which was twice the average national prevalence of 18.8%.

Methods: this descriptive, cross-sectional, and quantitative study was conducted among participants who were HIV-positive, 18 years old and above, and initiated on ART between January 2017 and January 2019 at selected PHC facilities of Vulindlela sub district. Health facility treatment registers, patient medical files and face-to-face interviews were used to collect the data and these were captured onto an Excel spreadsheet, cleaned, coded before importation into Epiinfo 17 for statistical analyses. Logistic regression analyses were conducted to investigate the factors associated with virological non-suppression.

Results: the study found a majority of participants were females (240/401 (60%)). The mean age of the participants was 38.1 (SD=11.2), with most participants who were between the ages of 29 and 39 years old (167 (41.7%)). Virological non-suppression was observed among 10% (40/401) of participants. The odds of virological non-suppression were higher among participants who were married (aOR 4.76, 95% CI 1.49-15.19; p=0.008).

Conclusion: a virological non-suppression of 10% translates to viral suppression of 90%, which is below the target of UNAIDS 95-95-95 strategy. Hiding and skipping medication indicate how non-disclosure continues to hinder HIV treatment adherence. High odds of virological non-suppression among married participants indicate non-disclosure of the positive HIV status, or lack in spousal support.

Stakeholder views on continuing professional development for doctors working in public primary care facilities in central Uganda: a qualitative study

Jane Frances Namatovu — 2025-02-20

Introduction: the primary care workforce in the public sector of Uganda is under the district health system. The doctors in this workforce provide leadership and frontline promotive, preventive, curative, rehabilitative, and palliative care. Their numbers are still low and therefore need effective support through continuing professional development (CPD). Part of the support is influenced by stakeholders whose views on CPD in the district health system are important. This study therefore explored the stakeholders’ views on the CPD of doctors working in the district health system in central Uganda.

Methods: a qualitative exploratory study was done, and data was collected using an interview guide through in-depth interviews among ten purposively selected CPD stakeholders influencing different aspects of CPD activities of doctors working in public general hospitals and health center IVs. The interviews were recorded and transcribed verbatim and manually analyzed using deductive thematic analysis.

Results: five themes were categorized into; CPD practices, facilitators, benefits, challenges, and suggestions. Each of the themes had subthemes; CPD practices; training, mentorship and apprenticeship, support supervision, and quality improvement projects. Facilitators; internet services, grants, health facility managers, facility-based CPD providers, and regional CPD guidelines. Benefits; motivation, knowledge, teamwork, and renewal of practicing licenses. Challenges; workload, allowances, access, documentation, mindset, quality, structure of public health system, and sustainability. Suggestions; training needs analysis, collaboration, monitoring, e-CPD platforms, CPD resource centers, and individual CPD responsibility.

Conclusion: the stakeholders’ views are an indication that effective CPD is a collaborative effort from both the primary care doctors and those in the leadership of the health care system.

Belief, knowledge, attitude and practices towards COVID-19 amongst residents of Abuja, Nigeria: implications for pandemic preparedness

Henry Chijioke Onyegbutulem — 2025-02-20

Introduction: coronavirus disease, (COVID-19), was a pandemic with high global morbidity and mortality, partly due to a lack of preparedness. People´s knowledge, belief, attitude, and perception of disease outbreaks may affect their response, and this may impact their health-related behavior. This study was designed to determine the pattern of belief, knowledge, attitude, and practices (BKAP) of residents of Abuja, Nigeria, towards the COVID-19 pandemic. The outcome of the study may help to make informed decisions on future pandemic preparedness.

Methods: a cross-sectional study with data collected online about the local perceptions and common concerns, beliefs, misconceptions, attitudes, and conspiracy theories amongst residents of the FCT. A self-reported validated e-questionnaire prepared on Google Forms was used. The obtained data was downloaded on Excel sheet and then exported to SPSS for analysis.

Results: there were one thousand eight hundred and seventy-three (1,873) respondents, 1017 (54.3%) females and 856 (45.7%) males. Participants were majorly knowledgeable, the majority (31.2%) were in the 41-50 years age group. Surprisingly, about 17% did not know that wearing a face mask could prevent COVID-19. About 25% still met in crowded places, and slightly more than 33% did not wear outdoor masks. The highest knowledge of COVID-19 was found among people in the age range 41-50 years, females, University graduates, married people, and healthcare personnel, particularly doctors.

Conclusion: our study concludes that the overall population of Abuja had good knowledge and, a positive attitude, with pockets of poor attitudes and bad practices born out of misconceptions and infodemics.

Prevalence and associated factors of a positive Plasmodium falciparum antigen test among pregnant women at the Bamenda Regional Hospital, Cameroon: a cross-sectional analytical study

Dobgima Walter Pisoh — 2025-02-20

Introduction: approximately 25 million pregnant women in sub-Saharan Africa are at risk of malaria despite various preventive methods. This study aimed to determine the prevalence of Plasmodium falciparum parasite and its associated factors in pregnant women in Bamenda.

Methods: a hospital-based cross-sectional study conducted in March and April 2021 including pregnant women attending ANC at the Bamenda Regional Hospital. A questionnaire was used to collect data. The positive Plasmodium falciparum test was determined using a malaria rapid diagnostic test. A frequency table was used to describe the data, and a Chi-square to determine the association between independent and dependent variables. Factors significantly associated with a positive test were included in a multivariable model.

Results: among the 380 participants, 70 had a positive rapid diagnostic test (prevalence: 18.4%). Living in rural area (OR: 4.93, 95% CI: 1.86-13.14), not using insecticide-treated nets (OR: 109.95, 95% CI: 49.43-271.73), not using indoor residual spraying (OR: 15.21, 95% CI: 3.25-271.35), first and second trimesters of gestation compared to third trimester (OR: 20.27, 95% CI: 7.33-61.29; OR: 2.75, 95% CI: 1.49-5.33 respectively) and presence of mosquito breeding site (OR = 99.75, 95% CI: 38.84-340) were associated with positive test on bivariate analysis. Following multivariate logistic regression, the presence of mosquito breeding sites (AOR: 21.89, 95% CI: 5.25-121.13), and not using insecticide-treated nets (AOR: 10.82, 95% CI: 3.13-40.37) remained significantly associated.

Conclusion: the prevalence of positive Plasmodium falciparum test is high among pregnant women. Numerous risk factors are associated with positive Plasmodium falciparum among these women.

Prevalence of modifiable risk factors for cardiovascular disease among school-going children and adolescents in Eldoret, Kenya

Karani Magutah — 2025-02-20

Introduction: Cardiovascular disease (CVD) prevalence in Kenya is rising. Overweight, pre-hypertension and physical inactivity at younger ages is contributory. These risk factors are inadequately documented among Kenyan children and adolescents, hampering CVD prevention.

Methods: this cross-sectional study randomly sampled 384 participants from Eldoret, Kenya. After ethical considerations, physical activity was assessed. Body mass index (BMI), Waist-Hip-Ratio (WHR) and Waist-Height-Ratio (WHtR) were determined, and blood pressure (BP) was measured.

Results: participants were 14.6±2.7 years, and 62.6% were female. Eight percent had BMI ≥25.0 kg/m². Of these, 87% were in secondary schools. Using SBP, 27.9% had CVD risk (42.5% and 20% for males and females ≥13 years and 26.5% and 27% for those <13 years, respectively). For DBP, 12.8% had elevated-to-hypertensive BP (13.2% and 8.3% for males and females ≥13 years and 11.8% and 25.4% for those <13 years, respectively). Combining SBP and DBP, 8.1%, mostly males, had elevated-to-hypertensive BP. Using respective WHR cutoffs of 0.90 and 0.85, 31% (boys) and 15.6% (girls) were at CVD risk. For WHtR, 39.6% of boys were >0.463 cut-off (0.493±0.02) against 32.4% for girls >0.469 cut-off (0.517±0.05). Of these, 52.6% (boys) and 69.7% (girls) were in secondary schools. Overall, 45% of participants were sports-inactive and 77.2% did minimal physical activities.

Conclusion: among school-going children and adolescents in Eldoret, Kenya, the prevalence of CVD risk factors was high, especially among boys and in high schools. Large proportions had elevated BP, BMI, WHR and WHtR, and, further, were sedentary, posing a high CVD risk. Lifestyle interventions to mitigate this are urgently needed.

Opportunities and challenges on hospital preparedness to handle motorcycle accidents in Busia County, Kenya: an exploratory qualitative study

Olipher Makwaga — 2025-02-20

Introduction: motorcycles continue to be a popular mode of transport in Kenya. However, the related injuries cause significant morbidity and mortality and remain to be a major and neglected public health issue. This raised the crucial need for hospital preparedness in managing morbidities and in reducing mortalities. This formed the basis of this paper which aims to document the challenges and opportunities in the healthcare system in handling motorcycle accidents in a Kenyan border town in Busia County.

Methods: we drew data from an exploratory qualitative study that was carried out in 2021. All six referral hospitals purposively included in the study. The study targeted a total of 25 top level facility managers as key informants on the facility level opportunities and challenges in handling motorcycle accidents. Descriptive data were analyzed using SPSS version 20.

Results: the hospitals were not well prepared to handle motorcycle accidents. The major challenges were understaffing in critical care services; inadequate/lack of equipment to handle motorcycle injuries; inadequate/lack of infrastructure i.e. surgical wards, emergency rooms, inadequate space, functional theatre; lack/inadequate supplies; overstretched referral services arising from the hinge burden of motorcycle accidents in the area; inadequate specialized personnel to provide trauma/care services; mishandling of cases at the site of accident; inability of victims to pay related bills; inappropriate identification of victims at the facility; lack/inadequate on-job training. Some opportunities that currently exist include health system interventions which are not limited to employment of more professionals, improvement of infrastructure, provision of equipment and increase of budgetary allocation.

Conclusion: the study reveals vast challenges that are faced by hospitals in managing patients. This calls for the government to step in and capitalize on the proposed opportunities by the health managers to be able to manage morbidities and bring down mortalities due to motorcycle accidents.

The future of PrEP: novel long-acting HIV prevention agents for adolescent women

Sharon Owuor — 2025-02-20

Adolescent girls and young women in Africa are at high risk of HIV and should be considered a key population for HIV prevention initiatives. Oral Tenofovir/Emtricitabine as pre-exposure prophylaxis (PrEP) has been shown to be effective on an individual and population level among key populations in Europe, Australia, and the US. However, studies in Sub-Saharan Africa in a generalised epidemic have been less promising with adherence to daily tablets identified as a major problem. Long-acting PrEP drugs are being developed as a response to this problem. The first of these long-acting agents, injectable Cabotegravir given every two months has shown superiority to oral PrEP and has been approved by the US Food and Drug Administration (FDA). Another long-acting PrEP drug in development is Lenacapavir which is an investigational, first-in-class long-acting HIV-1 capsid inhibitor that can be given as a six-monthly injection. These long-acting drugs could be a highly effective public health HIV prevention intervention. If made readily available to a vulnerable population of adolescent young women who are at high risk of HIV they could play an important role in protecting this key population against HIV and potentially reduce the population level risk of HIV.

Masticator space abscess mimicking a malignant tumor

Sameh Mezri — 2025-02-20

Differentiation of masticator space affections may be difficult regarding the complexity of the anatomy and the access. Infection may be a serious condition due to the risk of extension in the upper aerodigestive space and the infratemporal fossa. Magnetic resonance imaging (MRI) with ADC study can help to discriminate differential diagnosis. A 59-year-old male presented a right cheek swelling progressively increasing in size for a month under ten days of amoxicillin-clavulanic acid therapy. Physical examination revealed a firm, ill-defined, and painful mass in the parotid region, with severe trismus. The parotid duct and salivary flow have normal physical aspects. The patient had facial paresis with hypoesthesia but no cervical lymphadenopathy. A biologic test showed a C-reactive protein level of 24.5 mg/dL. Contrast-enhanced CT (A) showed a cystic formation within the masticatory space centered on the lateral pterygoid muscle and the temporal muscle, with lateral extension encompassing the masseter muscle. Malignancy was suspected. MRI showed an expansive lesion process developing in the right masticatory space, with extended heterogeneous signal in the masseter, temporal, and lateral pterygoid muscles, including internally enhanced necrotic zones, also extending to the pterygo-palatine process. (B, C, D). We underwent a surgical exploration and we have a discharge of pus. A bacteriological sample was negative. A biopsy of the surrounding tissues concluded with an inflammatory remodeling of the masseter muscle. The evolution was marked by the normalization of clinical and radiologic signs under 14 days of Cefotaxime and Metronidazole.

Necrotizing fasciitis in the orbital and submandibular areas of the right face: a rare clinical image

Emmanuel Lalrinchhana — 2025-02-20

Necrotizing means the process of dying tissues or deterioration of the tissue. Inflammation of the fascia is referred to as fasciitis. It is a sporadic infection caused by a bacterium that spreads promptly throughout the body, and it could be tragic and terminal. Necrotizing fasciitis is typically caused by group A Streptococcus, according to public health experts (group A strep). A 58-year-old diabetic male patient was brought with a case of uncomfortable swelling on the right submandibular and orbital areas for 3-5 days followed by a portion of the orbital region displayed scabbing of necrosed skin, and the overlying skin was oedematous and reddish. Also, he was reported having excruciating facial pain, mostly in the orbital area after some time, and had to have facial surgery to remove the necrosis-affected parts, which are primarily in the orbital region of the right face, because his condition persisted after the treatment and did not improve for a while. The presence of fascial necrosis during surgery and the analysis of tissue samples revealed group A streptococcal infection, which later validated the diagnosis. For medical intervention, the patient was treated with injection Piperacillin and Tazobactam 4.5 gram I/V Q8H, injection Pantoprazole 40mg I/V x OD, injection Ondansetron 4mg x Q8H and injection tramadol 100mg in 100ml normal saline I/V x BD. Surgical intervention- debridement with complete removal of the necrosed skin. Necrotizing fasciitis is a rare illness but one that has a high risk of significant morbidity, without surgery, mortality is very close to 100%.

Diode laser surgery for the treatment of denture-induced fibrous hyperplasia: a case report

Er-Raji Samir — 2025-02-20

Denture-induced fibrous hyperplasia (DIFH) is a persistent lesion caused by low-intensity chronic injury of the tissue in contact with an ill-fitting, over-extended denture. This fibrous connective tissue lesion commonly occurs in oral mucosa in patients showing important alveolar ridge atrophy. Surgical excision is the treatment of choice for DIFH. This article describes a successful laser surgery to remove a DIFH on a lower alveolar ridge of a patient wearing an ill-fitting completely removable denture. The use of a diode laser may result in less surgical time, less bleeding during surgery, more vestibular depth, better re-epithelialization of the wound, and no need for suturing.

An unusual representation of spider bite with erythema and facial puffiness: a rare clinical image

Yogesh Zamare — 2025-02-20

Spider bites are generally considered harmless, with most causing only mild local reactions. In this case, we present a case of a rare and atypical clinical image resulting from a spider bite. During our home visit, we encountered a 68-year-old female in a rural residence with a unique lesion on her face, accompanied by localized pain. She verbalizes to have visited a local clinic 1 week ago for treatment, and she was on medication tablet cetirizine 10mg twice a day, tablet diclofenac 50mg twice a day, and ointment orasore gel 12mg three times a day. Upon examination, multiple areas of redness and facial puffiness, swelling, and erythema are seen that spread on the left side of her face. However, the client reports no improvement in her condition. She was then taken to the hospital for further management and treatment. This case emphasizes the importance of considering uncommon presentations of spider bites in clinical practice. The rarity of such occurrences underscores the need for a comprehensive approach to diagnosis and management. By presenting this rare clinical image, we aim to increase awareness among healthcare professionals, fostering early recognition and appropriate intervention in cases of unusual spider envenomation.

Health-related quality of life in patients with dyspepsia presenting at the University of Benin Teaching Hospital, Benin City, South-South Nigeria: a cross-sectional study

Oziegbe Egbo — 2025-02-20

Introduction: Health-related quality of life (HRQoL) examines the impact of the symptoms of dyspepsia on the daily life of sufferers. There are a few published studies related to HRQoL of persons with dyspepsia in Africa.

Methods: this was a hospital-based cross-sectional study involving 324 dyspeptic patients referred for upper gastrointestinal endoscopy to the University of Benin Teaching Hospitals (UBTH) The ROME IV criteria were used to recruit patients with dyspepsia. The short form Nepean Dyspepsia Index (SF NDI) was used to assess HRQoL in all participants. Upper gastrointestinal endoscopy was performed on all 324 dyspeptic patients.

Results: the mean age of patients was 47.6 ± 15.6 years. Three hundred (92.6%) patients had significantly impaired HRQoL with an SF NDI mean score of 31.3 ± 9.1. Interference with daily activities and eating and drinking subdomains were more impaired than other subdomains of HRQoL (p < 0.001). There was no statistical difference between the impaired HRQoL in patients with functional dyspepsia and organic dyspepsia (p = 0.694). Among patients with organic dyspepsia, those with upper gastrointestinal cancers had significantly worse HRQoL SF NDI mean (sd) scores (39.7 ± 5.9) compared with patients with gastritis, peptic ulcer disease and GERD with (30.3 ± 9.2, 31.5 ± 9.7 and 32.9 ± 7.1 respectively) (p = 0.01).

Conclusion: health-related quality of life is significantly impaired in patients with dyspepsia and those with upper gastrointestinal cancers having overall worse scores. The physical, social and psychological well-being of a majority of patients with dyspepsia in South-South Nigeria is negatively affected by dyspepsia.

Monkeypox with genital ulcer as the first symptom

Jianping Zhou — 2025-02-20

A 35-year-old male patient presented to our clinic in early December 2023 with superficial painless ulcers on the genital for one month. After questioning him, we learned he had high-risk homosexual behavior recently. The examination confirmed that his human immunodeficiency virus (HIV) status was positive, and the serological test for syphilis was negative. But 5 days later, his condition deteriorated rapidly, the genital ulcer turned so painful that he could not sleep. At the same time, he had a high fever, muscle soreness, and headache. His physical examination showed obvious swelling of the penis, and there were multiple regular circular ulcers with a white peripheral border and purplish-red central bottom on the glans penis. Ulcerative sores were present in his oral cavity. In addition, red papules appeared on his face, palms, soles, and back, and were accompanied by a bilateral enlarged inguinal lymph node. With these findings, we confirmed monkeypox virus infection through real-time PCR in skin lesions of the glans penis finally. The patient received supportive care and took cefuroxime orally by himself. Twenty-three (23) days later, the symptoms disappeared completely.

An evaluation of obstetrical data collection at health institutions in Mbarara Region, Uganda and Benue State, Nigeria

Rajan Bola — 2025-02-20

To the Editors of the Pan African Medical Journal

Effect of postpartum family planning intervention and associated factors during child immunization in Addis Ababa, Ethiopia

Sawra Getnet Gelaw — 2025-02-20

Introduction: World Health Organization (WHO) recommends postpartum family planning (PPFP) as a critical component of health care that has the potential to save millions of maternal and infant lives in low- and middle-income countries.

Methods: participants in our randomized, controlled trial were mothers coming for vaccination of their child in three selected health centers in Addis Ababa during the first 10 weeks postpartum. Eligible mothers were randomly assigned to intervention (pamphlet-supported counseling about the benefits of family planning) and non-intervention (routine care) arms. Data were collected when mothers came with their infants for a routine measles vaccination at nine months of life. Family planning (FP) use was compared between the groups using logistic regression, and bivariate and multivariate analyses. The study also used Kaplan Meier and Cox regressions to compare the median time of PPFP use and its correlation using SPSS version 26. The research was undertaken from December 2019 to June 2021.

Results: a total of 347 women (177 control, 170 intervention) enrolled in the study. Fifty-eight percent were 24-30 years old. Young age, knowledge about FP, previous use of an FP method, and being married were found to be independent predictors for PPFP use. When comparing intervention and non-intervention groups, there was no significant effect on contraceptive use (adjusted OR 0.633 [95% CI 0.385-1.040]).

Conclusion: pamphlet-supported counseling of mothers in the first 10 weeks postpartum did not increase PPFP at nine months postpartum. Successful interventions will likely require holistic strategies, especially in resource-limited settings. The trial had been registered with clinicaltrials.gov (NCT04521517) on September 24, 2019.

Epidemiological, clinical and therapeutic profiles of mantle cell lymphoma cared for in a Moroccan center: a review of 14 cases

Ouadii Abakarim — 2025-02-20

Mantle cell lymphoma (MCL) accounts for 3-10% of non-Hodgkin's lymphomas (NHL). We identified 14 patients with mantle cell lymphoma, with an average number of 3.5 new cases/year. A male predominance was observed with a sex ratio equal to 6. The average age of our patients was 64.4±14.1 years, with an average diagnostic delay of 6.57 months. Regarding the clinical presentation, adenopathy was the most reported physical sign (78.6%) followed by B symptoms (57.1%). Disseminated stages were the most frequent in our series: stages IV (78.5%) and III (7.1%) versus stages I (0%) and II (7.1%). The extra-ganglionic localizations observed were hepatic 5 cases (31.1%), pulmonary 04 cases (25%), medullary 4 cases (25%), pleural 2 cases (12.5%) and prostate 1 case (6.2%). All diagnosed cases are mantle cell lymphomas, of which 12 cases (85.7%) are classical and 2 cases (14.3%) indolent. The high-risk group is, according to international prognostic index (MIPI) MCL prognostic score, the most represented in our series: 0-3 = 6 cases (42.9%), 6-11 = 8 cases (57.1%). The therapeutic protocol chosen 1^st line: 9 patients treated with R-DHAP, three with R-CHOP, one with DHAOX and one with R-CVP. Second line: two patients treated with R-DHAP, one after R-CHOP and the other after R-CVP. Two patients received autologous hematopoietic stem cell transplant at the end of the treatment. The evolution was marked by the death of 7 patients, 3 lost to follow-up and 4 still followed. Additionally, the study highlights characteristics and treatment patterns of mantle cell lymphoma, emphasizing its predominance in males, delayed diagnosis, frequent dissemination, and high-risk classification, with chemotherapy as the primary treatment modality and a challenging prognosis contributing to a comprehensive understanding of mantle cell lymphoma presentation and management.

Laboratory specimen rejection rate and associated factors among referred specimens at Debre Markos Referral Hospital, Ethiopia: prospective cross-sectional study

Bewket Mesganaw — 2025-02-20

Introduction: laboratory errors mostly emerge from the pre-analytical phase, mainly those related to collection, handling, transportation, and storage of diagnostic specimens. Specimen rejection due to improper sample collection, may lead to poor patient outcomes, such as incorrect diagnosis, inappropriate treatment, and death. This study aimed to assess the specimen rejection rate and associated factors among referred specimens at Debre Markos Referral Hospital.

Methods: a prospective cross-sectional study design was applied from January 2020 to April 2020 to investigate specimen rejection rate and associated factors among referred specimens. The study population was all laboratory specimens referred for viral load, CD4 count, gene expert, and early infant diagnosis to the Debre Markos Referral Hospital laboratory. The statistical analysis was done with Statistical Package for Social Sciences version 20.0 software.

Results: of the total of 2750 specimens submitted to the laboratory from January 2020 to April 2020, 37 (1.34%) specimens were rejected due to different reasons like insufficient volume, hemolysis, and an inappropriate specimen container. Specimen collector training status and experience had a significant association with the specimen rejection rate.

Conclusion: the results of our study show that the specimen rejection rate among referred specimens was high, indicating that more interventions are required to decrease the specimen rejection rate.

Post-intervention perceptions on the antiretroviral therapy community group model in Trans Nzoia County, Kenya

Violet Naanyu — 2025-02-20

Introduction: the increasing number of people receiving antiretroviral therapy (ART) in sub-Saharan Africa has stressed already overburdened health systems. A care model utilizing community-based peer-groups (ART Co-ops) facilitated by community health workers (CHW) was implemented (2016-2018) to address these challenges. In 2018, a post-intervention study assessed perceptions of the intervention.

Methods: forty participants were engaged in focus group discussions consisting of ART Co-op clients, study staff, and health care providers from Kitale HIV clinic. Data were analyzed thematically for content on the intervention, challenges, and recommendations for improvement.

Results: all participants liked the intervention. However, some reported traveling long distances to attend ART Co-op meetings and experiencing stigma with ART Co-ops participation. The ART Co-op inclusion criteria were considered appropriate; however, additional outreach to deliberately include spouses living with HIV, the disabled, the poor, and HIV pregnant women was recommended. Participants liked CHW-directed quarterly group meetings which included ART distribution, adherence review, and illness identification. The inability of the CHW to provide full clinical care, inconvenient meeting venues, poor timekeeping, and non-attendance behaviors were noted as issues. Participants indicated that program continuation, regular CHW training, rotating meetings at group members´ homes, training ART Co-ops leaders to assume CHW tasks, use of pill diaries to check adherence, nutritional support, and economically empowering members through income generation projects would be beneficial.

Conclusion: the intervention was viewed positively by both clinic staff and clients. They identified specific challenges and generated actionable key considerations to improve access and acceptability of the community-based model of care.

Efficacy of daprodustat for patients on dialysis with anemia: systematic review and network meta-analysis

Hammad Ali Fadlalmola — 2025-02-20

Chronic kidney disease (CKD) is commonly complicated by anemia. Treating dialysis-dependent patients with anemia, including daprodustat and other inhibitors of prolyl hydroxylase of hypoxia-inducible factor, recombinant human erythropoietin (rhEPO), and iron supplements. We conducted this study to test our postulation; daprodustat is superior to rhEPO and other conventional treatments respecting efficacy and safety parameters. We made systematic search through PubMed, Web of Science, Scopus, and Cochrane. Seven unique trials were eventually included for systematic review; six of them with a sample size of 759 patients entered our network meta-analysis (NMA). Daprodustat 25-30 mg was associated with the greatest change in serum hemoglobin (MD=1.86, 95%CI= [1.20; 2.52]), ferritin (MD= -180.84, 95%CI= [-264.47; -97.20]), and total iron binding capacity (TIBC) (MD=11.03, 95%CI= [3.15; 18.92]) from baseline values. Dialysis-dependent patients with anemia had a significant increment in serum Hemoglobin and TIBC and a reduction in serum ferritin, in a dose-dependent manner, when administered daprodustat.

Clinical image of omphalocele: a rare congenital defect of the abdominal wall

Swati Rathod — 2025-02-20

We here report the case of a 1.8-kg baby girl with omphalocele born naturally via vaginal birth to a primipara mother at 37 weeks gestation. Omphalocele is a congenital malformation of the abdominal wall in which the organs of the abdomen stick out through an opening in muscles in the area of the umbilical cord. These organs are covered by a transparent membrane. The patient underwent a 2d ultrasound which revealed biventricular hypertrophy, intact ventricular septum, small patent foramen ovale with left-to-right shunt, and good biventricular systolic function. Trisomy 18 is the most frequent abnormality associated with omphalocele (22% to 89% of fetuses having omphalocele) followed by trisomy 13. Survival rates for babies who have an omphalocele and serious problems with other organs are about 70 percent. Omphalocele occurs when the gut contents fail to rotate and return to the abdominal cavity after normal embryonic herniation into the umbilical cord during weeks 6-10 of development. This study involved patients with a minor omphalocele (a defect measuring ≤4 cm) or a giant omphalocele. In the case of untreatable omphalocele, the intestine which remains outside the abdomen is 90%. The evidence demonstrates the association between congenital omphalocele and maternal tobacco and alcohol consumption. Women consuming multivitamin pills, most of which include folic acid, should be informed of the risk of having children with omphalocele, which occurs while the baby is developing in the womb.

Molecular analysis of genetic mutations in non-small cell lung cancer in Morocco

Ouafaa Morjani — 2025-02-20

Non-small cell lung cancer (NSCLC) is a significant global health issue with diverse molecular profiles affecting treatment responses. Yet, NSCLC's molecular epidemiology in Morocco is largely unexplored. This study focuses on NSCLC genetic mutations, specifically in adenocarcinoma, among Moroccan patients to contribute to understanding NSCLC in this population. Ninety-four patients diagnosed with lung adenocarcinoma were analyzed. Formalin-fixed paraffin-embedded tissue samples were processed, and deoxyribonucleic acid (DNA)/ribonucleic acid (RNA) was extracted using standardized protocols. Mutations were detected using the AmoyDx Pan Lung Cancer Polymerase Chain Reaction (PCR) Panel kit, and their frequencies were assessed through statistical analysis. Epidermal Growth Factor Receptor (EGFR) mutations were detected in 22.34% of patients, predominantly exon 19 deletions (66.66%) and exon 21 L858R mutations (23.80%). Anaplastic lymphoma kinase (ALK) gene fusion was observed in 3.19% of patients, and KRAS mutations in 1.06%. No mutations were found in other tested genes. A slightly higher mutation rate was noted in females (54.16%) compared to males (45.84%). The study reveals a distinct mutation profile in Moroccan NSCLC patients, with a notable prevalence of EGFR mutations, albeit lower than in some Asian populations. The significance of EGFR mutations in treatment response aligns with global findings, highlighting the importance of understanding regional molecular variations for personalized therapy. Despite limitations in sample size and clinical data, this study sheds light on the genetic landscape of NSCLC in Morocco. The observed mutation rates, particularly in EGFR, underscore the potential for targeted therapies in Moroccan NSCLC patients, emphasizing the need for further research to refine treatment strategies tailored to this population.

Factors associated with COVID-19 in children aged 0 to 15 in Niger, 2020

Habibatou Idé Amadou — 2025-02-20

On January 30, 2020, the WHO declared COVID-19 a global health emergency. Children were affected in less severe forms. Niger had implemented measures in a context where children were a source of contamination. The aim was to determine the factors associated with COVID-19 in children in Niger from February to August 2020 through an analysis of the national database. We conducted an analytical cross-sectional study including all COVID-19 suspects in the database. We used Excel and Epi Info 7.2.4. software for data extraction and analysis. Frequencies and proportions were calculated, and in a logistic regression, we estimated the ORs of association with their 95% confidence intervals, the factors associated with COVID-19 at the threshold of p<0.05. Of 572 notified cases of suspected COVID-19 in children aged 0-15, 11.36% were positive. The median age of infected children was 10 years [IQR: 5- 13 years]. The male/female sex ratio was 2.1. Children aged 11 to 15 accounted for 49.2%, 61.5% lived in Niamey, 4.6% had comorbidities. The notion of travel was 12.3% and 40% had a notion of contact, 24.4% had a fever, 23.2% had a cough, 18% were hospitalized, and a case-fatality rate of 1.5%. In etiological analysis, the factors associated with COVID-19 were sex ORa=0.51 [0.28-0.93] p=0.028, presence of symptoms ORa=2.29 [1.23-4.25] p=0.008 and notion of contact ORa=0.32 [0.13-0.77] p=0.011. Exposed children were sensitive to COVID-19, and all age groups were affected, with a predominance of males. We recommend barrier measures adapted to young people, and early detection and management of infected children.

Verrucous carcinoma: a difficult differential diagnosis

Brendan Guegan — 2025-02-20

A woman aged 85 years old was followed up for a giant verrucous carcinoma of the oral cavity. Looking at the patient´s history, P16 was not over-expressed, Ki67 was expressed in basal layers, and no HPV was detected. Significant squamous hyperplasia of verrucous architecture with parakeratosis. Ulcerated areas are present on the surface. The chorion is the site of a moderate lymphocytic and plasma cell inflammatory infiltrate associated with numerous neutrophils in intraepithelial exocytosis with the formation of superficial micro-abscesses. Treatment with external radiotherapy, with an incomplete response rate, is to be completed with surgical removal. Difficult diagnosis between verrucous hyperplasia, proliferative verrucous leukoplasia and verrucous carcinoma. The essential rule in this type of lesion is the importance of deep and multiple biopsies, to rule out conventional squamous cell carcinoma and to distinguish verrucous carcinoma from verrucous hyperplasia and proliferative verrucous leukoplasia.

Superior ophthalmic vein thrombosis in unique double origin: a case report

Taha Boutaj — 2025-02-20

Superior ophthalmic vein thrombosis (SOVT) is a rare orbital pathology. It can cause serious complications if it isn´t diagnosed appropriately. It can be secondary to many etiologies, septic or aseptic ones. Diabetic ketoacidosis (DKA) may disturb the vascular endothelium and promote a prothrombotic state. The presence of which is related to a significantly increased risk of morbidity and mortality. We report the case of a 45-year-old woman who presented a SOVT revealing DKA. Orbit magnetic resonance imaging (MRI) showed thrombosis of the right superior ophthalmic vein. A treatment based on thrombolytic treatment, associated with antibiotic coverage and a glycemic balance was initiated. This case highlights the importance of considering both infection and diabetes as an important part of the diagnosis and management of SOVT.

Sampling efficiency and screening of Aedes albopictus for yellow fever virus in Niger Delta region of Nigeria

Chioma Cynthia Ojianwuna — 2025-02-20

Introduction: Aedes albopictus, like Aedes aegypti, is a virulent vector of arboviruses especially the well-documented spread of yellow fever around the world. Although yellow fever is prevalent in Nigeria, there is a paucity of information in the Niger Delta region on the distribution of Aedes mosquito vectors and molecular detection of the virus in infected mosquitoes. This study sampled Aedes mosquitoes around houses associated with farms from four communities (Otolokpo, Ute-Okpu, Umunede, and Ute Alohen) in Ika North-East Local Government Area of Delta State, Nigeria.

Methods: various sampling methods were used in Aedes mosquito collection to test their efficacy in the survey. Mosquitoes in holding cages were killed by freezing and morphologically identified. A pool of 15 mosquitoes per Eppendorf tube was preserved in RNAi later for yellow fever virus screening. Two samples were molecularly screened for each location.

Results: seven hundred and twenty-five (725) mosquitoes were obtained from the various traps. The mean abundance of the mosquitoes was highest in m-HLC (42.9) compared to the mosquitoes sampled using other techniques (p<0.0001). The mean abundance of mosquitoes was lowest in Center for Disease Control (CDC) light traps without attractant (0.29). No yellow fever virus strain was detected in all the mosquitoes sampled at the four locations.

Conclusion: this study suggests that Aedes albopictus are the mosquitoes commonly biting around houses associated with farms. More so, yellow fever virus was not detected in the mosquitoes probably due to the mass vaccination exercise that was carried out the previous year in the study area. More studies are required using the m-HLC to determine the infection rate in this endemic area.

Management and outcomes of vestibular anorectal malformations in a low-income country hospital

Mahumaneng Esther Mokaila — 2025-02-20

Introduction: anorectal malformations (ARM) are among the most common congenital anomalies in pediatric surgery. Early detection and management of vestibular fistulas are crucial for optimal outcomes, capitalizing on the pliability of sphincter muscles and the preservation of somatosensory integration. This study aimed to assess the incidence, clinical presentation, and management outcomes of vestibular fistula ARM in a low-income hospital setting.

Methods: a retrospective audit was conducted on female pediatric patients aged up to 12 years treated for vestibular fistula ARM from January 1, 2011, to June 30, 2016. Data were collected from medical records, and patients were categorized into one of three surgical management groups. Clinical assessments, preoperative procedures, and surgical interventions were meticulously documented.

Results: among 656 neonates, the incidence of vestibular fistula ARM was 8.2%. Patients presented at various ages, with 69.4% being early presenters. Notably, 11.1% of cases presented after 30 weeks of age. Functional fistula, constipation, and bowel obstruction were common presenting symptoms. Associated anomalies were relatively low. The choice of surgical approach varied, with a predominant 3-stage at 68%. Complication development did not significantly differ between surgical groups (p-value 0.083). Immediate postoperative complications were minimal, but complications at definitive anoplasty varied among the surgical groups. Anal strictures and fistula recurrence were noted. At 12 months post-surgery, anal strictures persisted in 9 participants.

Conclusion: this study highlights the challenges and outcomes associated with vestibular fistula ARM in a resource-constrained setting. The 3-stage approach, despite its historical preference, demonstrated suboptimal outcomes. A 2-stage procedure appears to offer a balanced alternative, particularly suitable for low-income healthcare systems. Further research and collaborative efforts are essential to refine the management of vestibular fistula ARM and improve patient outcomes.

Impact of the COVID-19 pandemic on handwashing practices among community members in the middle belt of Ghana: evidence from a cross-sectional study

Edward Anane Apraku — 2025-02-20

Handwashing is an effective public health intervention for preventing the spread of coronavirus (COVID-19). Maintenance of clean hands is particularly important during the pandemic, to break the cycle of human-to-human transmission of the virus. This study explored the potential impact of the COVID-19 pandemic on the handwashing behaviours of residents before and during the pandemic. A mixed-method cross-sectional design using standardised questionnaire was used to examine hand handwashing behaviours among residents before and during the COVID-19 pandemic in the middle belt of Ghana. However, this paper reports on the quantitative data on handwashing behaviour only. A total of 517 participants between 18 to 60 years were randomly selected from the Kintampo Health and Demographic Surveillance System (HDSS) database. Descriptive statistics were performed and McNamar test was used to estimate the difference in the handwashing behaviour of residents. Majority of the respondents were females (54.6%). The majority of them 77.0% (398) usually wash their hands with soap and water. Those who washed hands 4 to 6 times a day before the pandemic increased from 39.9% (159) to 43.7% (174). About 34.8% (180) had received training on hand washing and television 53.3% (96) emerged as the main source of training. Ownership of handwashing facilities increased from 11.4% (59) to 22.8% (118) during the pandemic. The odds of handwashing after handshaking were lower 0.64 (95% C1: 0.44-0.92,) during the pandemic. Television (53.3%) was the main source of training for respondents who had received training on handwashing (34.8%). The odds of owning a handwashing facility during the pandemic were 3 times higher than before (OR = 2.97, 95% CI: 1.94 - 4.65). The odds of handwashing after sneezing were 1.8 (95% CI: 1.19-2.92) times higher during the pandemic. Handwashing behaviours during the pandemic improved among residents than before. However, there is a need to intensify health education and media engagement on proper handwashing practices to protect the population against infectious diseases.

Unraveling the quality of implementation of sexual and reproductive health projects among adolescents and youths in low-income regions: a case study of the JADES 2 project in Niger in 2021

Alphonse Euphrème Ahlou — 2025-02-20

Introduction: many young people globally grapple with early pregnancies and sexually transmitted diseases (STD), especially in regions like Africa and particularly Niger due to high poverty rates. Various sexual and reproductive health (SRH) projects aim to address these challenges. This study evaluated the JADES 2 project's implementation of SRH services provided focusing on the quality of these services in Niger in 2021.

Methods: a cross-sectional evaluative study was conducted based on Donabedian and Bruce's theory from March 10 to August 15, 2021, in Niger. The evaluation was carried out through the analysis of supervision data, administration of questionnaires, and semi-structured interviews in 9 Integrated Health Centers and Youth-Friendly Centers. Across these sites, 203 adolescents and young people, as well as 9 healthcare workers involved in providing SRH services, were interviewed. The composite indicator in the field developed by the World Health Organization (WHO) in 2000 was used.

Results: the quality score estimated for the project was 67% indicating that the services provided was of good quality. The majority (56%) of surveyed people were very satisfied with the services received, and 65% were aware of at least two methods of preventing Sexually transmitted infections (STIs) and three methods of preventing early pregnancies.

Conclusion: the SRH services implemented are of acceptable quality. The study identified gaps in the process of service provision, particularly regarding confidentiality and the availability of inputs and medications.

Health managers´ perspectives of community health committees´ participation in the annual health sector planning and budgeting process in a devolved unit in Kenya: a cross-sectional study

Mildred Nanjala Wamalwa — 2025-02-20

Introduction: health sector planning and budgeting are concerned with identifying priorities that guide budgetary allocation to improve health outcomes. Engaging the community in this process empowers them to manage their own health. Despite the benefits and the availability of legislation and structures to mainstream community participation, their involvement is minimal and marred with challenges. This study, therefore, aimed to examine the level and perspectives of health managers on community health committees´ (CHC) participation in health sector planning and budgeting.

Methods: the study utilized a cross-sectional research design, incorporating both quantitative and qualitative research methods. Study participants were involved in planning and budgeting. Quantitative data were collected from 100% (n=170) of health managers, while qualitative data were gathered from 100% (n=3) of county department of health executives and 94% (n=83) of community health committee members. Descriptive statistics were utilized to analyze quantitative data, while qualitative data were analyzed thematically.

Results: although 87% of the health managers agreed that community health committee participation is beneficial, only 11% of them were satisfied with their participation, and 54% rated CHC participation as low; furthermore, over 50% of health managers disagreed that Community Health Unit (CHUs) have the necessary skills to effectively participate in the process, that adequate budget and time are allocated for CHC participation, and that feedback about the process is provided to them.

Conclusion: the county health department of health should allocate more funds and design sustained capacity-building programs to enhance CHC participation in health sector planning and budgeting.

Parental behaviors regarding fever in young children in Benin: study of population survey data

Gbènonminvo Enoch Cakpo — 2025-02-20

Introduction: the search for care of parents in case of the febrile episode of children is not always systematic. This study aims to improve knowledge on health care research in cases of fever in children under five years of age in Benin.

Methods: this study used data from the Benin Demographic and Health Survey 2017-2018. Counselling or seeking care is defined as any child under 5 years of age who has a fever in the two weeks prior to the interview. Univariate and multivariate logistic regression analyses were performed using generalized linear model.

Results: a total of 2465 children were surveyed. The model predicting seeking appropriate advice or care in febrile children in Benin was distance from the nearest health center, region, maternal age, and socioeconomic status. Indeed, febrile children whose mothers perceived difficult geographical access to the health center were 30% less likely to seek care, compared to children whose geographical access to the health center was easy (aOR=0.70 (0.54-0.90)). In addition, mothers living in the Hill region were more likely (AOR=5.73 (3.53-9.45)) to seek appropriate advice or care compared to those living in Alibori. In terms of socioeconomic status, children whose mothers were very wealthy were more likely to have their mothers seek care (aOR=1.93 (1.33-2.81)).

Conclusion: interventions to improve universal primary health care coverage in terms of geographic accessibility, awareness and health literacy are the best allies for routine care.

Left-sided fibrothorax: a sequela of chronic tubercular empyema

Gaurang Aurangabadkar — 2025-02-20

A 70-year-old male patient presented to the respiratory medicine outpatient department (OPD) with chief complaints of left-sided chest pain and dyspnea on exertion for the last 2 years. The patient also had complaints of cough with occasional mucoid expectoration for the last 2 months. A detailed history revealed a history of left-sided tubercular empyema in 2018, in which the patient had taken anti-tubercular treatment for 6 months, and was informed that he did not go to the pulmonologist for regular follow-up as advised. A chest X-ray posteroanterior (PA) view was done, which revealed the presence of left-sided pleural thickening along with left-sided lung volume loss (red arrow) and compensatory hyperinflation of the right lung. Fibrothorax is defined as pleural fibrosis that may occur secondary to an inflammatory reaction due to connective tissue diseases, asbestos exposure-related pleural diseases, or drug reaction, with the commonest cause being tubercular empyema, especially in a country with a high tuberculosis burden such as India. In this patient, given the history of chronic tubercular empyema, this chest X-ray image highlights the long-standing and often debilitating sequelae of tuberculosis. Therefore, we wish to emphasize the importance of the comprehensive and multi-disciplinary approach that is needed in the treatment of tubercular empyema with the active involvement of a thoracic surgeon, to prevent the development of such complications in patients with pleural tuberculosis.

Navigating the complexity of Guillain-Barré syndrome and Miller-Fisher syndrome overlap syndrome: a pediatric case report

Kamal Chafiq — 2025-02-20

Guillain-Barré syndrome/Miller-Fisher syndrome (GBS/MFS) overlap syndrome is an extremely rare variant of Guillain-Barré syndrome (GBS) in which Miller-Fisher syndrome (MFS) coexists with other characteristics of GBS, such as limb weakness, paresthesia, and facial paralysis. We report the clinical case of a 12-year-old patient, with no pathological history, who acutely presents with ophthalmoplegia, areflexia, facial diplegia, and swallowing and phonation disorders, followed by progressive, descending, and symmetrical paresis affecting first the upper limbs and then the lower limbs. An albuminocytological dissociation was found in the cerebrospinal fluid study. Magnetic resonance imaging of the spinal cord showed enhancement and thickening of the cauda equina roots. The patient was treated with immunoglobulins with a favorable clinical outcome.

Visualizing inverted sinonasal papilloma through multimodal imaging

Suhit Naseri — 2025-02-20

Inverted sinonasal papilloma (ISP) is a rare, benign tumor that originates from the Schneiderian membrane lining of the sinonasal tract. Although it is a benign neoplasm, ISP can recur locally and potentially progress to malignancy. Inverted sinonasal papilloma (ISP) is most commonly found in males aged 40-70 years and accounts for about 0.5-4% of all sinonasal tumors. A 72-year-old male with right nasal obstruction underwent a CT scan, which revealed a heterogeneously enhancing soft tissue density lesion in the right nasal cavity (A). A nasal endoscopy further revealed a gray mass in the right nasal cavity with slough and mucopurulent discharge between the lateral wall and septum (B). Grossly, pink-tan-gray, soft to moderately firm polypoid growth is seen (C). Histologically, it is characterized by an endophytic growth pattern, with the tumor growing inward into the underlying stroma (D). The tumor is composed of a mixture of squamous and respiratory epithelium, often with areas of metaplasia, dysplasia, and carcinoma in situ. The stroma is fibrous, with a variable inflammatory infiltrate. Immunohistochemically, the tumor cells express markers of squamous differentiation. The exact cause of ISP is not fully understood, but chronic inflammation, exposure to Human papillomavirus, and genetic alterations are thought to play a role. The treatment of ISP involves complete surgical removal, followed by close clinical and radiological follow-up to monitor for malignant transformation. In conclusion, ISP is a rare benign tumor that can potentially recur or progress to malignancy. Early diagnosis and complete surgical removal are important for the management of ISP.

Sero-prevalence of syphilis and associated risk factors among pregnant women attending antenatal care at an urban-poor health centre in Kampala, Uganda: a cross-sectional study

Andrew Simiyu — 2025-02-20

Introduction: syphilis and its outcomes remain a healthcare system burden with adverse consequences such as stillbirths, neonatal deaths and spontaneous abortions among others. The situation might have worsened because the COVID-19 pandemic has caused a major attention drift from other diseases. Additionally, much as testing for syphilis is a routine practice among pregnant mothers, its proportion is not known in urban health care setting. A study to determine the prevalence of syphilis among pregnant mothers in an urban poor setting is warranted.

Methods: a cross-sectional study was conducted among pregnant women who attended antenatal care at Kawaala Health Centre IV in Kampala Capital City between December 2019 to March 2020. Informed consent was sought from study participants prior to data collection using structured questionnaires. Whole blood was collected and tested using SD Bioline HIV/syphilis duo rapid test kit (SD Standard Diagnostics, INC, Korea). Data analysis was done using STATA 14.2.

Results: one thousand one hundred and sixty-nine pregnant women participated in the study, with a mean age of 25 years. About 27% of them had completed only primary-level education. Approximately 6% of the participants were HIV seropositive. The prevalence of syphilis was 5.9% (69/1169). HIV positivity (aOR: 4.13, 95%CI: 2.05-8.34), elevated blood pressure (aOR: 2.84, 95%CI: 1.42-5.69), and status of previous pregnancy (aOR: 0.21, 95%CI: 0.05-0.89) were significant predictors of the risk of syphilis among pregnant women in this setting.

Conclusion: the prevalence of syphilis among pregnant women in urban poor settings is not low and so must not be underestimated. The potential drivers of syphilis among pregnant women are HIV, elevated blood pressure, and status of previous pregnancy. There should be increased awareness about routine syphilis testing among pregnant mothers attending antenatal care.

Bilateral hemothorax secondary to adrenal hemorrhage

Ashwin Karnan — 2025-02-20

A 24-year-old male presented to our emergency department with complaints of difficulty in breathing, and left-sided abdominal and flank pain associated with generalized weakness for the past 6 days. Computed tomography showed bilateral pleural effusion of 51HU suggestive of hemothorax with an ill-defined heterogenous mass lesion in the left suprarenal region with free fluid in the abdomen. Ultrasound-guided (USG) pigtail was done for the left pleural effusion. Embolization of the bleeding vessel was done and the patient was taken for emergency laparotomy. Biopsy from the mass lesion showed adrenal cortical carcinoma. Adrenal hemorrhage is characterized by bleeding into the suprarenal glands. The adrenals derive rich arterial supply from three main arteries namely the superior, middle, and inferior suprarenal arteries. Biochemical markers include hyponatremia, hyperkalemia, hypoglycemia, anemia, and leukocytosis. Adrenal hemorrhage may be the initial presentation of an underlying adrenal mass lesion. Treatment modalities and prognosis are variable depending upon the etiology. Complications include retroperitoneal hemorrhage and hypovolemic shock.

Acute primary chylous peritonitis mimicking acute abdomen: a case report and literature review

Hanen Zenati — 2025-02-20

Acute chylous peritonitis is an uncommon medical condition that can occur suddenly, resulting in the buildup of chylous fluid in the peritoneal cavity. It is considered idiopathic because the exact cause is often unknown. The symptoms of acute chylous idiopathic peritonitis can mimic other abdominal emergencies, making it challenging to diagnose and manage, requiring a multidisciplinary approach. We present a case report of acute idiopathic chylous peritonitis miming acute abdomen, how was successfully treated with surgery, and provide a comprehensive review of the available literature on this topic. Chylous peritonitis is a rare condition whose clinical presentation mimics an acute abdomen. It is necessary to undertake careful exploration. An emergent laparotomy is indicated to treat the peritonitis and search for and treat the underlying cause.

Thoracic extramedullary hematopoiesis: a rare clinical image

Ashwin Karnan — 2025-02-20

A 22-year-old male presented to the outpatient department with complaints of fever, cough with expectoration, and breathlessness for the past 8 days. The patient is a known case of thalassaemia major with a history of splenectomy 10 years back. Chest X-ray showed bilateral homogenous shadows with suspicion of eosinophilic pneumonia, septic emboli, or metastases to the lung. Computed tomography of the thorax showed multiple well-defined para-osseous soft tissue density masses suggestive of thoracic extramedullary hematopoiesis. Chronic anemia may lead to extramedullary hematopoiesis due to failure of erythropoiesis in the bone marrow. Etiology includes myeloproliferative disorders and hemoglobinopathies. These masses are usually hypervascular and fine needle aspiration is preferred over biopsy. Treatment modalities include excision, radiotherapy, and repeated blood transfusion to decrease extramedullary hematopoiesis.

Evaluation of surveillance system and response for maternal and perinatal mortalities in Meda Welabu District, Ethiopia, 2023

Eshetu Zemen — 2025-02-20

The weekly disease surveillance system (WDSS) serves as a precursor to possible public health emergencies. The Meda Welabu Woreda Bale Zone in Ethiopia has reporting rates of 87% overall timeliness and 88% completeness in 2023, falling short of the 100% objective. Low reporting rates could mean that epidemics in the province are only discovered later. In the Meda Welabu Woreda Bale Zone of Ethiopia, the study was carried out to assess the WDSS maternal and perinatal death surveillance response (MPDSR). Using the most recent Centers for Disease Control (CDC) criteria for assessing public health monitoring systems, we carried out a descriptive cross-sectional analysis. Data from the health workers were gathered through key informant interviews and questionnaires given by the interviewer. Using checklists, the availability of resources was evaluated. Twenty-two health personnel and twelve Health Extension Workers were questioned; of them, 15 (44%) were females. Nurses made up 18 (53%) of the health personnel. Only sixteen (47%) of the respondents were aware of the WDSS goals, compared to thirty-four (53%) who were aware of the deadlines for submitting data to the next level. A total of eight (24%) responders received training in using the WDSS. 26(76%) respondents said they would be willing to continue participating in the WDSS, whereas 6 (18%) respondents said they had analyzed the data from the WDSS. Of the health facilities, seven (50%) reported having issues with the district public health emergency officer. However, low attention to immediately report on maternal and perinatal death(42.9%). It was concluded that the WDSS was adaptable, reasonable, and easy to use. That was erratic and premature, though. We suggest that healthcare professionals in the province receive training on maternal and perinatal death surveillance response. In Meda Welabu Woreda Bale Zone conducted an evaluation in 2023 of the weekly disease surveillance system, maternal and perinatal death surveillance response. Launched in 1998, the system tracks weekly trends of diseases under surveillance to provide an early warning of any dangers to public health, but maternal and perinatal death surveillance were included on 2013. On the other hand, in 2023, the overall completion and timeliness of reports was 88%, falling short of the 100% aim. Low rates of reporting could mean that outbreaks and quality of service in the province were discovered later than expected. Using current centers for disease control criteria and interviewer-administered data, a descriptive cross-sectional study was undertaken.

Congenital multiple tracheal diverticula

Ashwin Karnan — 2025-02-20

A 30-year-old male presented with complaints of chronic productive cough, breathing difficulty and occasional dysphonia. The patient had no significant personal or family history. The chest X-ray was unremarkable. Computed tomography of the chest revealed scattered ground glass opacities with tree-in-bud appearance in the right middle and lower lobes with multiple air-filled hypodense areas around the trachea suggestive of tracheal diverticula, which was confirmed by bronchoscopy. The patient was treated with intravenous antibiotics, mucolytics and chest physiotherapy. The patient underwent endoscopic laser cauterization and is currently on follow-up. Tracheal diverticula also known as tracheocele are outpouching from the tracheal wall. It can be single or multiple invaginations of the tracheal wall. They are common in males and are usually incidental findings where the patient is often asymptomatic. They may be congenital or acquired (either due to chronic lung disease or iatrogenic). Congenital diverticula are smaller than acquired and have the same structural anatomy as the trachea. The vast majority are located at the right posterolateral aspect of the trachea. Multidetector computed tomography is essential for diagnosis. Treatment modalities include conservative management in asymptomatic patients and fulguration, transcervical or endoscopic resection in symptomatic patients.

Post-intubation tracheal stenosis: a rare clinical image

Ashwin Karnan — 2025-02-20

A 27-year-old male presented to the outpatient department with complaints of cough and breathlessness on exertion for the past 15 days. The patient gave a history of pneumonia 6 weeks back for which he was admitted, intubated in view of respiratory failure, treated with intravenous antibiotics, and extubated after 8 days. Post-discharge, the patient developed the above-mentioned complaints. Fibre optic flexible bronchoscopy showed significant tracheal stenosis (cuff type), biopsy taken which was suggestive of chronic granulation tissue with fibroblast infiltration. The trachea is a tubular structure that has a length of 10 to 12cm and a diameter of 22mm in males and 18mm in females. Tracheal stenosis following intubation or tracheostomy is a rare complication, but airway injury is commonly seen irrespective of the time period. High cuff pressure or prolonged intubation period may lead to ischemia and inflammation. Granulation tissue is formed with fibroblast proliferation, causing scarring and ultimately stenosis. Bronchoscopy is the mainstay of investigation. Treatment options include resection surgery, laser ablation, balloon dilatation, and stenting.

Ruptured pulmonary hydatid cyst: a rare clinical image

Ashwin Karnan — 2025-02-20

A 43-year-old female presented to the respiratory medicine outpatient department with complaints of dry cough, fever, and breathlessness for the past 3 months. The patient has a salty taste of saliva with no comorbidities and no significant past or personal history. A computed tomography scan of the thorax showed well-defined multiple rounded cystic lesions on the right lower lobe with internal air-fluid level with moderate loculated hydropneumothorax. Serum IgG for echinococcus granulosus was positive. The patient was started on Tablet Albendazole 400mg twice daily. Echinococcosis is a rare infectious disease that occurs mainly due to echinococcus granulosus or echinococcus multilocularis. The liver is the most common site of infection followed by the lungs, spleen, kidneys, heart, and bone. Cysts may rupture leading to secondary infection, suppuration, or pneumothorax. Immunoelectrophoresis, ELISA, and hemagglutination are serological evidence of echinococcosis. They may be treated surgically or pharmacologically. Albendazole is the drug of choice given for at least 3-6 months. Enucleation, pericystectomy, cystotomy, and segmental resection are the surgical methods available.

Comorbidity and concomitant medication use in an integrase strand transfer inhibitor naïve cohort on first-line dolutegravir-based antiretroviral therapy

Nivriti Hurbans — 2025-02-20

Introduction: people living with HIV/AIDS using antiretroviral therapy sometimes present with comorbid conditions or co-infections. This could lead to an increased risk of drug interactions due to the concomitant use of drugs. The aim of the study was to explore the overall impact of dolutegravir on such comorbidities and the effect of concomitant medication on the safety and efficacy of dolutegravir.

Methods: data was collected using a survey questionnaire and a retrospective review of medical records of a prospective study sample. Medical records were retrospectively reviewed for up to 12 months after dolutegravir initiation. Concomitantly used drugs and supplements that were identified to have a potential interaction with dolutegravir were further characterized. Descriptive and summary statistics were used to describe the data, t-tests were performed on blood glucose levels and cross-tabulations were done on some variables.

Results: of the 461 participants enrolled into the study, 172 (37.3%) and 54 (11.7%) experienced comorbidity and coinfection respectively. More than 50% of the participants used concomitant medicines. Metformin use led to increased blood glucose levels (p=0.009); participants on rifampicin (n=8) received an additional daily dose of dolutegravir. Virological outcomes in participants on sodium valproate (n=2) and St John´s wort (n=1) did not show safety concerns, whilst 3 dolutegravir discontinuations were observed in participants using supplements and antacids containing divalent cations.

Conclusion: even though dolutegravir was safe and effective in the study population, with possible drug interactions leading to treatment discontinuations in only 3(0.7%) participants, further investigation into dolutegravir-induced hyperglycemia needs investigation.

Posterior sternoclavicular joint dislocation in a young male: a case report

William Ngatchou — 2025-02-20

The traumatic dislocation of the posterior sternoclavicular joint is a serious injury with possibly severe complications and therefore has to be managed with the greatest caution. We report the case of a young male with a posterior dislocation of the medial clavicle with compression of the brachiocephalic artery as well as the esophagus. Open reduction and placement of a wire cerclage were performed with a good postoperative outcome.

Spleen-preserving surgery for splenic hydatid cyst: a case report

Tariq Bouhout — 2025-02-20

Hydatidosis is a zoonosis due to the development of the larval form of Echinococcus granulosus in humans. This disease is very frequent in many countries of North Africa such as Morocco. The most frequent locations of hydatid cysts are the liver (75%) and the lungs (15.4%). Splenic hydatid cyst occurs in only 5.1% of cases. The diagnosis remains challenging and is made upon a hundle of clinical, radiological, biological, and histological arguments. In this paper, we report a case of spleen-preserving surgery for a splenic hydatid cyst to suggest the best management of these hydatid cysts and avoid recurrences.

Rosette cataract thirty years after trauma

Amine Zahaf — 2025-02-20

A 48-year-old healthy woman presented with complaints of diminution of vision in the right eye for the last 8 months. She reported having undergone trauma to her right eye at the age of 18. Visual acuity was 20/40 right eye. The slit lamp biomicroscopy of the right eye showed a central endonucleus cataract with white axial opacities organized in a distinctive Rosette pattern, forming six distinct quadrangular 'petals´ (yellow arrow) and a transparent outer epinuclear shell (blue arrow). Notably, the absence of zonular rupture differentiates it from a subluxated cataract. Cataracts with a Rosette or stellate-shaped appearance are typically seen in blunt or ocular injuries. Prior to surgery, patients must be checked for associated lesions, especially zonular dehiscence.

Use of a toll-free call center for COVID-19 response and continuity of essential services during the lockdown, Greater Kampala, Uganda, 2020: a descriptive study

Elizabeth Katana — 2025-02-20

Introduction: on March 21, 2020, the first case of COVID-19 was confirmed in Uganda. A total lockdown was initiated on March 30 which was gradually lifted May 5-June 30. On March 25, a toll-free call center was organized at the Kampala Capital City Authority to respond to public concerns about COVID-19 and the lockdown. We documented the set-up and use of the call center and analyzed key concerns raised by the public.

Methods: two hotlines were established and disseminated through media platforms in Greater Kampala. The call center was open 24 hours a day and 7 days a week. We abstracted data on incoming calls from March 25 to June 30, 2020. We summarized call data into categories and conducted descriptive analyses of public concerns raised during the lockdown.

Results: among 10,167 calls, two-thirds (6,578; 64.7%) involved access to health services, 1,565 (15.4%) were about social services, and 1,375 (13.5%) involved COVID-19-related issues. Approximately one-third (2,152; 32.7%) of calls about access to health services were requests for ambulances for patients with non-COVID-19-related emergencies. About three-quarters of calls about social services were requests for food and relief items (1,184; 75.7%). Half of the calls about COVID-19 (730; 53.1%) sought disease-related information.

Conclusion: the toll-free call center was used by the public during the COVID-19 lockdown in Kampala. Callers were more concerned about access to essential health services, non-related to COVID-19 disease. It is important to plan for continuity of essential services before a public health emergency-related lockdown.

A review of epidemiology of lymphatic filariasis in Nigeria

Timothy Waje — 2025-02-20

Lymphatic filariasis is a neglected tropical disease that affects the lymphatic system of humans. The major etiologic agent is a nematode called Wuchereria bancrofti, but Brugia malayi and Brugia timori are sometimes encountered as causative agents. Mosquitoes are the vectors while humans the definitive hosts respectively. The burden of the disease is heavier in Nigeria than in other endemic countries in Africa. This occurs with increasing morbidity and mortality at different locations within the country. The World Health Organization recommended treatments for lymphatic filariasis include the use of: Albendazole (400mg) twice per year in co-endemic areas with loa loa, Ivermectin (200mcg/kg) in combination with Albendazole (400mg) in areas that are co-endemic with onchocerciasis, ivermectin (200mcg/kg) (DEC) (6mg/kg) and albendazole (400mg) in areas with diethylcarbamazine citrate without onchocerciasis. This paper covered a systematic review, meta-analysis, and scoping review on lymphatic filariasis in the respective geopolitical zones within the country. The literature used was obtained through online search engines including PubMed and Google Scholar with the heading “lymphatic filariasis in the name of the state”, Nigeria. This review revealed an overall prevalence of 11.18% with regional spread of Northwest (1.59%), North Central and North East, (4.52%), South West (1.26%), and South-South with South East (3.81%) prevalence. The disease has been successfully eliminated in Argungu local government areas (LGAs) of Kebbi State, Plateau, and Nasarawa States respectively. Most clinical manifestations (31.12%) include hydrocele, lymphedema, elephantiasis, hernia, and dermatitis. Night blood samples are appropriate for microfilaria investigation. Sustained MDAs, right testing methods, early treatment of infected cases, and vector control are useful for the elimination of lymphatic filariasis for morbidity management and disability prevention in the country. Regional control strategies, improved quality monitoring of surveys and intervention programs with proper records of morbidity and disability requiring intervention are important approaches for the timely elimination of the disease in Nigeria.

Identifying opportunities for global surgery in Cameroon: an analysis of existing health policies and events

Berjo Dongmo Takoutsing — 2025-02-20

Introduction: the burden of diseases amenable to surgery, obstetrics, trauma, and anesthesia (SOTA) care is increasing globally but low- and middle-income countries are disproportionately affected. The Lancet Commission on Global Surgery proposed National Surgical, Obstetrics, and Anesthesia Plans as national policies to reduce the global SOTA burden. These plans are dependent on comprehensive stakeholder engagement and health policy analysis. Objective: in this study, we analyzed existing national health policies and events in Cameroon to identify opportunities for SOTA policies.

Methods: we searched the Cameroonian Ministry of Health´s health policy database to identify past and current policies. Next, the policies were retrieved and screened for mentions of SOTA-related interventions using relevant keywords in French and English, and analyzed using the 'eight-fold path´ framework for public policy analysis.

Results: we identified 136 policies and events and excluded 16 duplicates. The health policies and events included were implemented between 1967 and 2021. Fifty-nine policies and events (49.2%) mentioned SOTA care: governance (n=25), infrastructure (n=21), service delivery (n=11), workforce (n=11), information management (n=10), and funding (n=8). Most policies and events focused on maternal and neonatal health, followed by anesthesia, ophthalmologic surgery, and trauma. National, multinational civil society organizations and private stakeholders supported these policies and events, and the Cameroonian Ministry of Public Health was the largest funder.

Conclusion: most Cameroonian SOTA-related policies and events focus on maternal and neonatal care, and health financing is the health system component with the least policies and events. Future SOTA policies should build on existing strengths while improving neglected areas, thus attaining shared global and national goals by 2030.

Assessment of the effect of pre-conception care on preventing mother-to-child transmission of HIV in Nyeri County

Lulu Nazi Ndapatani — 2025-02-20

Introduction: the provision of essential preconception care services for HIV-positive pregnant women is crucial to prevent HIV transmission to infants. This includes pregnancy intention screening services, adequate viral load monitoring and suppression before conception, and necessary nutritional support. In Nyeri County, the prevalence of Mother-to-Child Transmission (MTCT) of HIV is 5.3%, which is higher than the global threshold of 5%. This study aims to evaluate the impact of pre-conception care services in preventing HIV transmission to infants in Nyeri County. The study objectives are to assess the utilization of pre-conception care services among HIV-positive women, specifically focusing on pregnancy intention screening, viral load monitoring and suppression, and access to nutritional assessment services before pregnancy. Additionally, the study aims to investigate the relationship between the provision of pre-conception care services and infant HIV outcomes.

Methods: this cross-sectional retrospective descriptive study employed stratified sampling to select eight level 4 and level 5 hospitals in Nyeri County. The target population consisted of HIV-infected women seeking postnatal care in these facilities, with a sample size of 252 women who had HIV-exposed infants under two years old and were receiving post-natal care at the respective hospitals. Sociodemographic characteristics, including age, marital status, and education level, were collected. Data analysis involved both descriptive and inferential statistics.

Results: our findings revealed that only 34.2% of HIV-positive women seeking postnatal care had received information or services related to pregnancy intention screening, a crucial aspect of pre-conception care. Almost half (46.4%) of the women who participated in the study had undergone viral load measurements before pregnancy, which is another critical component of preconception care. Additionally, 85.6% of these women had received nutritional services during pregnancy from their healthcare providers. Interestingly, all women who received any pre-conception care services reported that their infants were alive and tested HIV-negative.

Conclusion: preconception care is crucial in preventing mother-to-child transmission of HIV. Efforts should be made to ensure that all HIV-infected women planning to conceive have access to preconception care services.

Ureteral stent encrustation in an HIV patient treated with disposable flexible ureteroscope: a case report

Lin Xiong — 2025-02-20

Human immunodeficiency virus prevalence was increasing worldwide. Medication-associated urinary calculi are very commonly caused by medications used to treat HIV-positive patients. We present a case of an HIV-positive 39-year-old male with ureteral stent encrustation and kidney stone. Ureterolithotripsy using a disposable flexible ureteroscope is performed. The postoperative evolution was favorable. The disposable flexible ureteroscope is effective in the treatment of HIV combined with ureteral stent encrustation.

Integrating traditional medicine into the African healthcare system post-Traditional Medicine Global Summit: challenges and recommendations

Martin Ikhoyameh — 2025-02-20

The World Health Organization (WHO) held the inaugural Traditional Medicine Global Summit in India in 2023 to promote the evidence-based integration of traditional medicine (TM) into the global healthcare system. This summit offers many opportunities for Africa, where most people rely on TM for health care. TM is widely accepted and affordable in the region but faces many challenges that limit its potential. This article identifies some of the most pressing challenges to incorporating TM into standard healthcare in Africa. It also proffers useful recommendations on how these issues may be addressed while identifying key stakeholders whose contributions may hamper or enhance the realization of WHO´s goals for TM in the continent.

Placenta accreta: étude descriptive rétrospective de 46 cas pris en charge au Service de Gynécologie-obstétrique du Centre Hospitalier Universitaire Farhat Hached de Sousse, Tunisie

Badra Bannour — 2025-02-20

Le placenta accreta est une anomalie d'insertion placentaire rare mais grave. Ce travail a pour objectif d'analyser les caractéristiques épidémiologiques, cliniques, paracliniques et évolutives du placenta accreta, d'étudier la prise en charge thérapeutique et d´évaluer la morbidité et la mortalité maternelle et néonatale. Nous avons mené une étude rétrospective, descriptive, au service de gynécologie obstétrique du CHU Farhat Hached de Sousse regroupant les cas de placentas accretas confirmés histologiquement sur une période de 4 ans allant du 1^er janvier 2015 au 31 décembre 2019. Un canevas d'étude a été établi et dans lequel les données épidémiologiques, cliniques, paracliniques, thérapeutiques et évolutives ont été relevées à partir des dossiers des malades et des comptes-rendus opératoires. Dans notre série, nous avons recensé 46 cas du placenta accreta. L´âge moyen de nos patientes était de 35± 4,61 ans. Chacune de nos patientes avait un utérus cicatriciel. Le terme moyen d'accouchement était 34 semaines d'aménorrhées. Le mode d'accouchement était une césarienne pour toutes nos patientes. Une hystérectomie de première intention a été réalisée chez 40 patientes et un traitement conservateur chez 6 patientes. Seize patientes ont développé des complications maternelles. Aucun cas de décès maternel n'a été observé. Le placenta accreta est une pathologie rare associée à une morbidité materno-fœtale importante.

Fréquence hospitalière des crises non épileptiques psychogènes à Bamako

Gaoussou Keita — 2025-02-20

Poser le diagnostic de crise non épileptique est difficile en absence de vidéo-électroencéphalogramme. La commission d´expert de la ligue international contre l´épilepsie propose une démarche diagnostic permettant de poser le diagnostic selon un degré de certitude avec ou en absence de vidéo-électroencéphalogramme. Notre objectif était de déterminer la fréquence hospitalière des crises non épileptiques psychogènes en absence de vidéo-électroencéphalogramme. A l´aide du registre de consultation externe, nous avons identifié les patients suivis pour épilepsie avec deux électroencéphalographies inter-critiques normaux, entre janvier 2020 et octobre 2021. Un examen des dossiers médicaux des patients et une évaluation de la validité du diagnostic ont été effectués. Sur 64 patients évalués avec électroencéphalogramme intercritique normal, 19 ont été inclus comme souffrant de crise non épileptique psychogène, soit 26,68%. La moyenne d´âge était de 23,94 +/- 9,4 ans. Les femmes représentaient 68,4%. Les patients suivis en neurologie ont représenté 84%. Un antécédent de traumatisme dans l´enfance était retrouvé dans (47,4 %). La première crise était précédée d´événements stressants dans 47,36%. Le trouble stress posttraumatique était le plus représenté avec 73,7% des cas. L´âge moyen était de 20,95 +/-9,8 ans pour la première la crise et la durée moyenne d´évolution des crises était de 3 ans +/- 2 ans. Cette étude illustre la possibilité de poser un diagnostic présomptif de crise non-épileptique psychogène en absence de vidéo-EEG.

Predictors of tuberculosis treatment outcomes among people living with HIV in some States in Nigeria

Olalere Samuel Olajide — 2025-02-20

Introduction: tuberculosis (TB) and Human Immunodeficiency Virus (HIV) remain major public health threats globally and worse when they co-exist in susceptible individuals. The study examined TB treatment outcomes and their predictive factors among people living with HIV (PLHIVs).

Methods: a review of TB/HIV co-infected patients who had TB treatments across comprehensive antiretroviral therapy (ART) sites with ≥500 patients was conducted in seven United States of America President's Emergency Plan for AIDS Relief (PEPFAR)-supported States in Nigeria. Data on patient background, HIV and TB care, and TB treatment outcomes were collected using an Excel abstraction template. The data was analyzed using SPSS and an association was examined using a chi-square test while binary logistic regression was used to determine predictors of TB treatment outcomes (P< 0.05).

Results: two thousand six hundred and fifty-two co-infected patients participated in the study. The mean age of participants was 37 ± 14 years. A majority had TB treatment success (cured = 1059 (39.9%), completed = 1186 (44.7%)). Participants who had pulmonary TB, virally suppressed and commenced isoniazid (INH) before TB diagnosis were more likely to have a favorable TB treatment outcome compared to those who had extrapulmonary TB (AOR = 7.110, 95% CI = 1.506 - 33.565), virally unsuppressed (AOR = 1.677, 95% CI = 1.036 - 2.716) or did not commence INH before TB diagnosis (AOR = 1.486, 95% CI = 1.047 - 2.109).

Conclusion: site of infection, immune status, exposure to ART, and INH prophylaxis were found to predict TB treatment outcomes among PLHIVs. Stakeholders should ensure early commencement of ART and INH prophylaxis for PLHIVs.

Laparoscopic repair of Morgagni hernia by primary closure with extra-abdominal suture: a case report and review of the literature

Makoto Hasegawa — 2025-02-20

We report a case of a Morgagni hernia repaired by primary closure with an extra-abdominal suture. Moreover, we reviewed cases of laparoscopically repaired Morgagni hernia, in which the size of the hernia defect was known, to establish a size criterion for mesh utilization. An 87-year-old woman presented to our hospital with right upper abdominal pain and vomiting. She had no history of abdominal surgery or trauma. Chest radiography and computed tomography (CT) revealed a Morgagni hernia, with the stomach and transverse colon herniated into the right chest cavity. Initially, an endoscopic repair was performed for the herniated stomach due to her age, which was successful. However, she had a recurrence 2 days later, prompting us to perform a semi-emergent laparoscopic surgery. Laparoscopic examination revealed a Morgagni defect, with the omentum, transverse colon, and stomach herniated, with the stomach reduced by pneumoperitoneum. Fortunately, the herniated organs could be easily relocated into the abdomen with no adhesions. The hernia defect measured 6 x 3 cm. We performed primary closure with an extra-abdominal suture. No sac resection was performed. The operation lasted 98 min. Oral intake was initiated on postoperative day 1, and the patient was discharged on postoperative day 3 without complications. Chest radiography and CT scans at 1 month postoperatively showed no recurrence, and the patient remained asymptomatic at the 9-month follow-up examination. According to our review findings, primary closure is an efficient method for small hernia defects (rule of thumb: width, <4 cm; length, <7 cm).

Cervical cancer screening and treatment costing in Senegal

Abdou Diop — 2025-02-20

Introduction: in Senegal, cervical cancer is the leading cause of cancers among women. This study estimated the costs associated with cervical cancer screening and treatment for precancerous lesions from the health system perspective.

Methods: we estimated costs for screening, diagnostics, and treatment. We conducted a cross-sectional study in seven regions with primary data collected from 50 health facilities. Data collection included structured questionnaires, with secondary data from the Ministry of Health and other sources. A mixed-methods approach combined ingredients-based costing and financial expenditures to estimate direct medical and non-medical costs. All costs are reported in 2019 USD.

Results: average costs were $3.71 for visual inspection with acetic acid, $16.49 for Pap smear, and $46.65 for human papillomavirus deoxyribonucleic acid (HPV DNA) testing. Screening cost drivers were clinical exam supplies and clinical equipment for visual inspection with acetic acid, offsite processing of specimens for Pap smear, and lab equipment costs for HPV DNA procedure. The average cost of diagnosis via colposcopy alone was $25.73, and colposcopy with biopsy/endocervical curettage was $74.96. The average cost of treatment followed by one visit for pre-cancerous lesions was $195.24 for loop electrosurgical excision, $47.35 for cryotherapy, and $32.35 for thermal ablation. Clinical equipment and lab costs were the largest contributors to colposcopy and endocervical curettage/biopsy expenses. Clinical equipment made up the largest portion of cryotherapy, loop electrosurgical excision, and thermoablation costs.

Conclusion: this study is the first to estimate the costs of HPV screening and treatment in Senegal, which can be used to inform decision-making on cervical cancer investments.

Prevalence and predictors of depression and anxiety among workers at two points of entry in Botswana during the COVID-19 pandemic

Keatlaretse Siamisang — 2025-02-20

Introduction: points of entry (POE) staff are particularly prone to depression and anxiety during outbreaks. The study aimed to determine the prevalence and predictors of depression and anxiety among POE staff in Botswana.

Methods: this was a cross sectional study at Sir Seretse Khama International Airport (SSKIA) and Tlokweng border from 02/12/2021 to 24/02/2022 during the COVID-19 outbreak. The Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 item scale (GAD-7) were used to screen for depression and anxiety respectively. Logistic regression was used to determine predictors of depression (PHQ-9≥10) and anxiety (GAD-7 ≥10).

Results: a total of 276 POE workers participated in the study of which 60 (21.7%) had an abnormal PHQ-9 score (had depression). Anxiety levels were abnormal in 31 (11.2%) participants. The predictors of depression were working at SSKIA (Adjusted odds ratio (AOR) 0.22, 95% Confidence interval (CI) 0.08-0.65), age >39 years (AOR 0.15, 95% CI 0.03-0.68), having a diploma (AOR 0.27, 95% CI 0.008-0.89), having a degree or higher (AOR 0.23, 95% CI 0.07-0.80), history of asthma (AOR 4.43, 95% CI 1.17-16.72), experience of stigma and discrimination (AOR 2.93, 95% CI 1.01-8.55) and having older people (>65 years) in the household (AOR 4.61, 95% CI 1.64-12.99). The predictors of anxiety were having chronic medical conditions (AOR 5.76, 95% CI 1.34-24.78) and experience of stigma and discrimination (AOR 6.82, 95% CI 1.42-32.46).

Conclusion: depression and anxiety were detected in a significant number of participants. Multiple risk factors were identified. Public health interventions should target these risk factors.

A public health development intervention between acceptability and feasibility: descriptive-interpretive discussion of an example

André Nana Yakam — 2025-02-20

Introduction: the National Tuberculosis Control Program (NTP) in Cameroon participated between 2016 and 2018 in a multi-country operational study of the Union against Tuberculosis and Lung Disease (The UNION) aiming at demonstrating the efficiency and feasibility of systematic tuberculosis preventive treatment (TPT) with 3 months of an isoniazid/rifampicin (3RH) combination in under-five child contacts of bacilliferous TB patients. Cameroon was one of the participating countries of the study. Despite the promising results communicated following this study, the coverage of TPT with 3RH in Cameroon remains low. We explored the intervention under aspects of acceptability and perceived feasibility.

Methods: key participants and stakeholders in this descriptive interpretative study in Cameroon were interviewed in five focus groups or individually (31 individuals). The Focus Group Discussion (FGD) and interview transcripts were analysed for different components of acceptability using a theoretical framework and the results discussed confronting them with the main objective of the study, i.e. demonstrating feasibility.

Results: the children's parents expressed overall positive feelings about and acceptance of the intervention, emphasizing the unexpected empathy shown by the health staff. The involved field staff, too, showed unreserved acceptance. On the other hand, managers at the intermediate and central levels showed scepticism as to the process of initiation of the study as well as to its feasibility in the given context, neglecting aspects of resources necessary for a scaling-up and of prioritisation.

Conclusion: the adoption of a public health strategy, also internationally recognized as an effective and efficient intervention, requires more than the demonstration of its acceptability or feasibility during the term of a showcase project introduced by an external development partner. Adoption is conditioned by adoption and circumspect planning involving at each stage the stakeholders on all levels of the program.

Facteurs pronostiques de la mortalité néonatale au CHU Sourô Sanou de Bobo-Dioulasso, Burkina Faso: une étude transversale

Cheick Ahmed Ouattara — 2025-02-20

Introduction: afin de contribuer à la réduction de la mortalité néonatale au Burkina Faso, nous avons identifié les facteurs pronostiques de la mortalité néonatale au Centre Hospitalier Universitaire Sourô Sanou.

Méthodes: il s'est agi d'une étude transversale et analytique couvrant la période du 25 juillet 2019 au 25 juin 2020 qui s'est déroulée dans le service de Néonatalogie. Elle a consisté à une revue des dossiers de patients, des registres de consultations et d´hospitalisation. Les facteurs pronostics de mortalité néonatale ont été identifiés par un modèle de Cox-Snell.

Résultats: les données de 1128 nouveau-nés ont été analysées. La mortalité néonatale était de 29,8%. La plupart de ces décès (89%) étaient survenus en période néonatale précoce. Le poids moyen à l'admission des nouveau-nés était de 2 285,8 ± 878,7 et 43,6% avaient un poids normal. Huit cent vingt et un (821(38,58%)) et 758(35,62%) nouveau-nés avaient été hospitalisés pour une infection et une prématurité respectivement. Le lieu de l'accouchement (HR autre structure= 1,43[1,17-1,74]), le sexe du nouveau-né (HR masculin = 1,29[1,10 - 1,52]), son poids à l´admission (HR poids < 1000g = 5,45[3,81 - 7,79]) et le diagnostic principal (HR asphyxie= 1,64[1,30-2,08]) étaient les facteurs pronostics de mortalité néonatale.

Conclusion: le relèvement des plateau-techniques pour l'investigation étiologique des infections, la prise en charge efficiente des nouveau-nés de faible poids et souffrant de détresse respiratoire permettraient de réduire considérablement la mortalité néonatale intra hospitalière à Bobo-Dioulasso.

Congenital combined venolymphatic malformation (ISSVA classification VM-LM): a rare clinical image

Shraddha Patil — 2025-02-20

Venolymphatic malformations (VLMs) are uncommon congenital defects characterized by abnormal venous and lymphatic channel development. Venolymphatic malformation is a congenital defect that appears on the flexor aspect of the elbow at birth. A 7-year-old male child came to a rural hospital with care of swelling over the right elbow. As narrated by the father, the child has had swelling over the forearm since birth. The swelling was initially small in size, but gradually progressed to the current size (A). The child was taken to a local hospital where symptomatic treatment was given. The child was advised for Fine Needle Aspiration Cytology (FNAC) of which finding shows single scaper spindle-shaped cells along with cyst macrophages against the hemorrhagic background. On X-ray, the upper forearm shows soft tissue swelling with ill-defined radio densities at the soft tissue plane (B). Magnetic Resonance Imaging (MRI) examinations reveal flow vascular malformations such as venous malformation/hemangioma in the forearm and arm (C). An MRI of the brain was performed, and the results were normal. On the ultrasound examination, a significant well-defined, solid, hypoechoic lesion is shown in the intramuscular plane of the right arm's biceps muscle (2.7 x 2.3 x 2.3 cm) (D). A few small cystic areas were noted within the lesion. Minimal vascularity was seen in the lesion with significant peripheral vascularity. There are multiple duct-like structures seen in the right forearm swelling below the posterior aspect elbow. The child was brought for re-embolisation sclerotherapy done at the level of the elbow with sethol and bleomycin and contrast +foam +air had been instilled. The second pocket has been closed and the procedure was uneventful. Patients with venolymphatic malformations are managed with observation, surgical excision, and sclerotherapy. Long-term follow-up is essential for individuals with congenital combined vascular venolymphatic malformation to detect any changes in symptoms or consequences. This may involve regular clinical evaluations, imaging studies, and adjustments to treatment as needed. Additionally, patient education and support are essential to help individuals manage their condition and optimize their quality of life.

Paralysie faciale bilatérale; une présentation atypique d´une maladie de Lyme (cas clinique)

Sophie Collignon — 2025-02-20

La neuroborréliose de Lyme est une zoonose rare dont le diagnostic peut se révéler difficile particulièrement en faible zone endémique. Nous rapportons le cas d´un homme de 35 ans avec un tableau de dorsalgies invalidantes précédée d´une monoplégie faciale traitée à tort comme une paralysie a frigore puis comme une lombosciatalgie post traumatique. L´apparition d´une diplégie faciale permettra enfin d´évoquer et de confirmer le diagnostic. L´administration de ceftriaxone permettra la résolution progressive des symptômes.

The future of telerehabilitation: embracing virtual reality and augmented reality innovations

Waqar Mohsin Naqvi — 2025-02-20

The integration of virtual reality (VR) and augmented reality (AR) into the telerehabilitation initiates a major change in the healthcare practice particularly in neurological and also orthopedic rehabilitation. This essay reflects the potential of the VR and AR in their capacity to create immersive, interactive environments that facilitate the recovery. The recent developments have illustrated the ability to enhance the patient engagement and outcomes, especially in tackling the complex motor and cognitive rehabilitation needs. The combination of artificial intelligence (AI) with VR and AR will bring the rehabilitation to the next level by enabling adaptive and responsive treatment programs provided through real-time feedback and predictive analytics. Nevertheless, the issues such as availability, cost, and digital gap among many others present huge obstacles to the mass adoption. This essay provides a very thorough review of the existing level of virtual reality and augmented reality in rehabilitation and examines the many potential gains, drawbacks, and future directions from a different perspective.

Prevalence and predictors of arthritis among adults in a rural set-up in Kenya: a cross-sectional study

Shem Nyarunda Kinara — 2025-02-20

Introduction: arthritis is a significant public health problem affecting many people globally. Exposure to various risk factors puts individuals at risk of developing arthritis. Therefore, this study aimed to assess the prevalence and predictors of arthritis among residents of a rural set-up in Nyamira County, Kenya.

Methods: a community-based cross-sectional study design was employed. Simple random sampling was utilized to select households from a household list. All the residents of the sampled household above 40 years were included. Descriptive analysis was done to describe the study population. Bivariate and multivariate analysis was also done to identify statistically significant arthritis-related variables.

Results: the prevalence of arthritis was 44.6%. Previous joint injury/infection [AOR=2.74; 95%CI=1.59-4.77; p<0.001], being unemployed [AOR=2.77; 95%CI=1.50-5.21; p=0.001], age above 51 years, and hypertension [AOR=1.90; 95%CI=1.03-3.53, p=0.040] were associated with an increased risk of arthritis. Conversely, being male [AOR=0.42; 95% CI=0.22-0.75; p=0.005], standing for > 2 hours [AOR=0.48; 95%CI=0.29-0.81; p=0.006], and constant shifting from sit to stand positions [AOR=0.45; 95% CI=0.26-0.76; p=0.003] were associated with a lower risk of arthritis. Most participants (75%) had an arthritis knowledge score of more than 66%.

Conclusion: the study found a high prevalence of arthritis in the community. Arthritis was strongly associated with various risk factors under study. Therefore, there is a need to take preventive measures for modifiable factors to enhance a reduced prevalence of arthritis.

De novo p.Glu61Ter mutation in GCH1 in a Moroccan patient with dopa-responsive dystonia: a case report

Ahmed Bouhouche — 2025-02-20

Dopa-responsive dystonia (DRD) is a hereditary movement disorder due to a selective nigrostriatal dopamine deficiency. It is characterized by onset in childhood or adolescence with marked diurnal fluctuation with or without Parkinsonian features, and is caused by mutations in GCH1 gene. We report in this study the clinical and genetic features of the first DRD Moroccan patient. Using a gene panel sequencing, we identified a heterozygous nonsense variant p. Glu61Ter in GCH1. A subsequent targeted segregation analysis by Sanger sequencing validated the presence of the mutation in the patient, which was found to have occurred de novo. The objective of this study is to report the first description of DRD in Morocco, and highlights the importance of new generation sequencing technology in the reduction of medical wandering and the management of hereditary diseases.

Impact of the SARS-CoV-2 pandemic on acute coronary syndrome patients admitted to an urban academic hospital in Soweto, South Africa

Suzan Leon — 2025-02-20

Introduction: recent worldwide data has shown a concerning decline in the number of acute coronary syndrome (ACS) related admissions and percutaneous coronary intervention (PCI) procedures during the coronavirus disease 2019 (COVID-19) pandemic. We suspected a similar trend at Chris Hani Baragwanath Hospital (CHBAH).

Methods: a retrospective descriptive study was conducted to evaluate and compare all ACS-related admissions to the cardiac care unit (CCU) at CHBAH in the pre-COVID-19 (November 2019 to March 2020) and during COVID-19 periods (April 2020 to August 2020).

Results: the study comprised 182 patients with a mean age of 57.9 ±10.9 years (22.5% females). Of these, 108 (59.32%) patients were admitted in the pre-COVID-19 period and 74 (40.66%) during COVID-19 (p=0.0109). During the pre-COVID-19 period, 42.9% of patients had ST-segment-elevation myocardial infarction (STEMI), 39.2% with non-ST-segment -elevation myocardial infarction (NSTEMI) and unstable angina (UA) was noted in 18.52%. In contrast, STEMI was noted in 50%, NSTEMI in 43.24% and UA in 6.76% of patients during the COVID-19 period. A statistically significant difference in STEMI and NSTEMI-related admissions was not noted, however, there was a greater number of admissions for UA during the pre-COVID-19 period (18.52% vs 6.76%, P =0.013). Only a third of the patients with STEMI received thrombolysis during the pre-and COVID-19 periods (30.4% vs 37.8%, P=0.47). No difference in the number of PCI procedures was noted between the pre-and during the COVID-19 periods (78.7% vs 72.9%, P=0.37).

Conclusion: there was a difference in overall ACS admissions to the CCU between pre-and during COVID-19 periods, however no difference between STEMI and NSTEMI in both periods. A higher number of UA admissions was noted during the pre-COVID-19 period. During both periods, the use of thrombolysis was low for STEMI and no difference in PCI was noted.

Lymphome primitif laryngé: à propos d´un cas

Madiha Chalout — 2025-02-20

Le lymphome primitif du larynx, une entité rare, constitue moins de 1% de tous les cancers laryngés. Son traitement dépend de son stade et de sa gravité. Nous présentons le cas exceptionnel d´une femme de 64 ans, non-fumeuse, souffrant d´une dysphagie aux solides et d´une sensation de corps étranger. Une laryngoscopie et des biopsies ont révélé une tumeur polyploïde sur le repli ary-épiglottique gauche, confirmée comme un lymphome malin non hodgkinien B diffus à grandes cellules. La patiente a bénéficié d´une chimiothérapie suivie d´une radiothérapie, avec une amélioration notable sur les 2 années de suivi, sans récidive locale. En raison de sa rareté et de la variété des symptômes, la prise en charge optimale de ce type de cancer reste controversée, nécessitant une approche diagnostique et thérapeutique spécifique, ce qui en fait un cas intéressant à publier.

Crise vaso-occlusive drépanocytaire sévère: aspects cliniques, étiologiques et thérapeutiques au CHU Sylvanus Olympio de Lomé

Koffi Mawuse Guedenon — 2025-02-20

Introduction: la crise vaso-occlusive (CVO) est la plus fréquente manifestation de la drépanocytose et la première cause d´hospitalisation des enfants atteints. L´objectif de cette étude est de décrire les aspects cliniques des CVO sévères, de déterminer les étiologies des syndromes infectieux qui les accompagnent et de décrire leur prise en charge.

Méthodes: il s'agit d'une étude transversale descriptive portant sur 137 drépanocytaires majeurs hospitalisés pour CVO sévères du 1^er janvier 2009 au 31 décembre 2011 dans le service de pédiatrie du CHU Sylvanus Olympio.

Résultats: les drépanocytaires homozygotes SS étaient les plus nombreux (n=98; 71,5%), suivis des doubles hétérozygotes SC (n=28; 20,5). Le délai moyen de consultation était de 4,7 ± 4,4 jours. Le traitement avant l´admission comportait des antibiotiques (28,5%). Les CVO étaient surtout ostéo-articulaires (70,8%). Dans 98,5% des cas, une infection bactérienne associée a été confirmée (48,9%) ou présumée (49,6%). Les principales étiologies étaient le syndrome thoracique aigu (26,3%), l´ostéomyélite aiguë (10,9%), l´infection urinaire (6,6%), la septicémie (3,6%). Un germe a été isolé chez 14,6% des patients, Escherichia coli (30%) étaient en tête suivi de Klebsiella pneumoniae (25%), Staphylococcus aureus (15%), Salmonella typhi (10%), Streptococcus pneumoniae (5%), le Streptocoque D (5%), l´Enterobacter (5%) et l´Acinetobacter (5%). Le taux de mortalité était de 2,2%. La durée moyenne d´hospitalisation était de 11,4 ± 8,8 jours.

Conclusion: les CVO drépanocytaires sévères sont en majorité associées aux infections bactériennes en milieu tropical. Une antibiothérapie adaptée et précoce constitue le moyen thérapeutique indispensable pour prévenir ou traiter ces patients.

Prevalence and factors associated with early postnatal care utilization among women of reproductive age in Tanzania: analysis of Tanzania demographic health survey 2015/16

Hamidu Adinani — 2025-02-20

Introduction: postnatal care (PNC) is critical for the health and survival of the mother and the newborn. The timing of the first postnatal checkup is crucial for the early identification and treatment of complications. Late or zero attendance of postnatal checkups negatively influences the health of the mother and the newborn. The study's purpose is to determine the prevalence and factors associated with early postnatal care utilization among women of reproductive age (WRA) in Tanzania.

Methods: this is an analytical cross-sectional study, using Tanzania demographic health survey data for 2015/16. Women of reproductive age (15-49 years) who gave birth 5 years prior the survey were analyzed. Data analysis was performed using Stata software Version 15. The Poisson regression analysis was used to assess factors associated with early PNC.

Results: the prevalence of early PNC utilization in Tanzania was 36%. The identified determinants for early PNC were geographical zone, place of residence, access to media, place of delivery and mode of delivery. The prevalence of early PNC was higher among mothers with access to media, with caesarian delivery and to those with facility delivery. The prevalence was low among mothers who lived in rural areas, from southwest and lake zones.

Conclusion: the coverage of early PNC was found to be low in Tanzania. Interventions informed by the identified factors need to be designed and implemented to improve the coverage of early PNC.

Vitamin B12 deficiency presenting as progressive blindness in a 33-year-old HIV-positive female patient on Efavirenz-based regimen: case report

Gloria Lubega — 2025-02-20

Optic neuritis is a rare presentation of vitamin B12 deficiency. We describe a 33-year-old female patient living with HIV presenting with progressive loss of vision for one week. She had a history of severe peripheral neuropathy that was managed with vitamin B12-containing tablets approximately three years before presenting with progressive loss of vision. On examination, she had no perception of light in the left eye and no perception of hand motion in the right eye. The fundus in her left eye had mild blurring of disc margins. Results from tests done showed a haemoglobin of 12.9g/dl, MCV 101fl, a serum vitamin B12 of 78pmol/l, and cytomegalovirus (CMV) test showed no active disease. She was diagnosed with optic neuritis and started on 30 mg tablets of prednisolone for one week with slight improvement. She was then started on vitamin B12 injections 1 mg daily for 10 days and thereafter, monthly for 6 months. She reported gradual improvement and regained her sight after 5 months treatment of with Vitamin B12 injections. Ophthalmic manifestations of vitamin B12 deficiency are not common and may present without haematological signs therefore, a high index of suspicion is required for early diagnosis and management of vitamin B12 deficiency.

Outcome of hospitalized patients with COVID-19 and predictors at the Buea Regional Hospital, South West region of Cameroon

Clovis Nkoke — 2025-02-20

Introduction: there is a paucity of data on the epidemiology of COVID-19 infection in Cameroon with a few studies limited to big urban cities. The objective of this study was to describe the clinical characteristics and outcomes of hospitalized patients with COVID-19 at the Buea Regional Hospital, in the South West region of Cameroon.

Methods: this was a retrospective cross-sectional study. The medical records of hospitalized patients with COVID-19 were reviewed from 2020 to 2021. Hospitalized patients with laboratory-confirmed COVID-19 were included. Binary logistic regression was used to identify factors associated with mortality.

Results: two hundred and ten (210) patients were included in this cohort. There were 114 (54.7%) men. The mean age was 60 ±17.1 years. The common co-morbidities were hypertension (46.7%), diabetes mellitus (31%), and HIV infection (5.7%). The most common symptoms were dyspnea (93.3%), fatigue (93.8%), cough (77.6%), and fever (71.4%). The median oxygen saturation was 85% and the median respiratory rate was 24 cycles per minute. More than 80% had crackles on lung examination. Death occurred in 57 (27.1%) patients. In binary logistic regression, the factors independently associated with mortality were heart failure (aOR: 6.7, p=0.034), SBP < 100 mmHg (aOR: 8.1, p<0.001), RR > 24 cpm (aOR: 3, p=0.016), SaO₂<90% (aOR: 6.2, p=0.031), blood glucose > 150mg/dL (aOR: 3.3, p=0.02), and CRP > 50 mg/L (aOR: 3.3, p=0.036). For every 1 mg/dL rise in blood glucose, the odds of death increased by 1% (p=0.011). For every 1 mg/L rise in the C-reactive protein (CRP), the odds of death increased by 1% (p=0.054).

Conclusion: over half of hospitalized patients with laboratory-confirmed COVID-19 infection in the South West region of Cameroon were males. Hypertension and diabetes were common co-morbidities. More than a quarter of these patients died. Furthermore, having heart failure, low systolic blood pressure (SBP), low oxygen saturation, elevated respiratory rate, high CRP and blood glucose levels on admission were associated with poor prognosis.

Evaluation of radiographic quality of root canal obturation performed by undergraduate and postgraduate clinical dental students in a Nigerian hospital

Deborah Mojirade Ajayi — 2025-02-20

Introduction: the three-dimensional fluid-tight obturation of the root canal system ends the endodontic treatment process and the technical quality of obturation of the root canal (RC) is a determinant of the outcome of the treatment. This final stage of RCT is critical in the outcome of treatment, thus the need to have adequate and quality obturation. The audit of the performance of students in this aspect evaluates performances and identifies where there is a need for improvement. Therefore, we set out to evaluate the quality of root canal obturation performed by undergraduate and postgraduate clinical dental students.

Methods: a cross-sectional study that evaluated the root canal obturation performed by undergraduate and postgraduate students in a teaching hospital, for 1 year. The radiographic evaluation was done by calibrated assessors. The radiographs were viewed under magnifying lenses (x3.5). The adequacy of length and homogeneity of the density of obturation were the outcome variables assessed in all the categories of teeth treated among patients who are 18 years and above, seen during the study period.

Results: eighty-four maxillary and 36 mandibular teeth were root-filled in 97 patients with a mean age of 37.6 years ± 14.7 SD. A good proportion (47.5%) of the root fillings were done by the postgraduate doctors. Most of the canals (69.4%) had acceptable lengths while density was acceptable in only 37.7%. Slightly over half of canals with acceptable length (64 out of 127; 50.4%) were reported in teeth with single canals (p=0.000) likewise with density (28;40.6%). Overall acceptable length and root filling density was 28.9% and there was no statistical significance in the performances of the operators in relation to the length of root filling (p=0.109), and density (p=0.55).

Conclusion: the overall acceptable length and root filling density was 28.9% among both undergraduate and postgraduate students. The adequacy of root canal filling may be dependent on experience, the complexity of the tooth, and the method of instrumentation.

Les alertes de thrombolyse des accidents vasculaires cérébraux ischémiques: expérience de la clinique internationale Al Badie au secteur libéral de Fès (étude transversale de 60 cas)

Imane Najmi — 2025-02-20

La thrombolyse intraveineuse est le traitement de référence de l'accident vasculaire cérébral (AVC) ischémique aigu. Nous reportons dans cette étude le circuit des patients au cours de l´alerte de thrombolyse au secteur libéral au Maroc. C´est une étude prospective portant sur tous les patients, admis aux urgences de la clinique privée internationale Al Badie depuis janvier 2022 jusqu´en septembre 2023, pour un déficit neurologique d´installation brutale dans un délai de 12 heures. Les caractéristiques épidémiologiques, cliniques et étiologiques ainsi que les délais extra et intra-hospitaliers étaient recueillis. Soixante patients étaient inclus dans l´étude. Le délai d´admission moyen des patients était de 198,36 ± 79,23 minutes. Le score NIHSS (National Institutes of Health Stroke Scale) moyen était de 10,41 ± 4,97. Le délai moyen d´imagerie était de 26,68 ± 9,63 minutes. Le diagnostic d´AVC ischémique était le plus fréquent (85%) suivi des « stroke mimics » (11.6%). Treize patients ont bénéficié d´une thrombolyse par la tenecteplase. Le délai moyen entre l´admission et le début de la thrombolyse était de 107,15 ± 24,48 minutes. L´imagerie de contrôle à 24 heures de la thrombolyse a objectivé une transformation hémorragique symptomatique chez 3 patients. Six patients étaient transférés au CHU Hassan II pour thrombolyse et/ou thrombectomie mécanique. Après 3 mois, 4 patients étaient autonomes (score de Rankin modifié entre 0 et 2). Notre expérience montre qu´il s´avère impératif d´améliorer les délais extra et intra-hospitaliers de prise en charge afin d´augmenter la proportion des patients thrombolysés.

Goodhill syndrome: a case report

Anouar Ben Ameur El Youbi — 2025-02-20

Conductive hearing loss with a normal tympanic membrane is a common reason for otolaryngology consultation, with otospongiosis being the most frequent cause and House syndrome being extremely rare, requiring systematic investigation. We report the case of a 31-year-old woman who presented with conductive hearing loss with a normal tympanic membrane. A temporal bone computed tomography (CT) scan confirmed a House-Goodhill syndrome due to fixation of the malleus head. Surgical intervention was considered to remove the attic bone synostosis with the malleus head, resulting in a significant clinical improvement. The Goodhill syndrome is a rare condition that causes hearing loss with a normal eardrum. The surgery can highly improve the hearing function.

Effect of hepatitis B vaccination on HBV-infection among school children in Yaounde; ten years after the introduction of HBV vaccine into routine Immunization Program in Cameroon

Philippe Salomon Nguwoh — 2025-02-20

Introduction: since the introduction of the anti-HBV vaccine into the Expanded Program on Immunization (EPI) in 2005 in Cameroon, vaccination coverage has reached 99.0%. This coverage would indicate an increase in the number of children immune to Hepatitis B Virus (HBV) and a decrease in susceptibility to HBV-infection. This study was conducted to evaluate the effect of the HBV vaccine on pediatric HBV-infection in Yaounde, Cameroon.

Methods: this school-based cross-sectional study was conducted from February to May 2016 among 180 children from Nkomo public school. The study population was stratified into two groups: vaccinated (n=95) versus (vs) unvaccinated (n=85). Screening for HBV biomarkers was done using a rapid panel test for detection (HBsAg, HBeAg and anti-HBc) and anti-HBs titer using enzyme linked immunosorbent assay (ELISA). Statistical analyses were done using SPSS v. 22 with p < 0.05 considered significant.

Results: the mean age was 9.65 years. HBsAg (p=0.019) and anti-HBc (p=0.001) rates were detected in children aged ≥10 years and children aged < 10 years (95.95% [71/74]) were vaccinated vs 22.64% (24/106) for those aged ≥10 years (OR: 80.86; 95% CI: 23.36%-279.87%, p < 0.0001). According to anti-HBV vaccination status, HBsAg rate varied from [9.41% (8/85) to 1.05% (1/95), p=0.025], HBeAg rate varied from [2.35% (2/85) to 0% (0/95), p= 0.42] and anti-HBc rate ranged from [12.94% (11/85) to 2.10% (2/95), p= 0.011].

Conclusion: despite the variability of the anti-HBs titer, vaccination against HBV has a positive effect on the reduction of HBV-infection in children in tropical settings such as Cameroon.

Characterization of genital chlamydia amongst female sex workers in Nairobi, Kenya

Priska Bwana — 2025-02-20

Introduction: genital chlamydia, which is caused by diverse Chlamydia trachomatis (C. trachomatis) genotypes, is largely asymptomatic. We aimed to identify C. trachomatis genotypes causing genital chlamydia among female sex workers attending a sex workers outreach program clinic in Nairobi, Kenya.

Methods: this cross-sectional study was conducted between 18 ^th April 2017 and 19 ^th March 2021. Genitourinary complaints from eligible female sex workers were documented using a structured questionnaire. Endocervical swabs were collected for laboratory analysis. C. trachomatis plasmid DNA was extracted, PCR-amplified, and sequenced. Consensus sequences were generated and aligned with reference sequences to determine the C. trachomatis genotypes. Bivariate analysis was used to determine the association between genitourinary complaints and genital chlamydia.

Results: endocervical swabs were collected from a total of 348 participants. Of these, 46 (13.2%) were positive for C. trachomatis. Most (297, 85.3%) of the participants presented with pelvic discharge with or without other symptoms. Fifteen (15, 4.3%) had abdominal pain and 3 (0.9%) had an itchy vulva. There was no statistically significant relationship between clinical presentation and genital chlamydia. Twenty-three samples were successfully sequenced. Each sequence was at least 90% identical to each of the 13 references C. trachomatis genotypes A, B, C, D, E, F, G, Ia, J, L1, L2, L2b and L3.

Conclusion: we found no significant association between individual genitourinary complaints and genital chlamydia infection. The C. trachomatis genotypes circulating amongst female sex workers in Nairobi could be related to genotypes A, B, C, D, E, F, G, Ia, J, L1, L2, L2b, and L3.

Bowel function after anterior rectal resection for cancer: short and long-term prospective evaluation with low anterior rectal syndrome (LARS) score in a cohort of Cameroonian patients

Guy Aristide Bang — 2025-02-20

Introduction: bowel dysfunction is the most common and disabling complication after anterior rectal resection (ARR) for cancer. We aimed to evaluate these complications in a cohort of Cameroonian patients, using the low anterior rectal syndrome (LARS) score.

Methods: we conducted a descriptive and analytical cross-sectional study, in two university hospitals of Yaoundé (Cameroon). Prospectively, we collected the records of all patients aged at least 18 years who had an ARR indicated for rectal cancer from January 2015 to March 2018. Alive patients among them were subsequently received in consultation at 1 and 3 years after surgery, for short and long-term assessment of their digestive function using the LARS score.

Results: during the study period, 28 patients underwent anterior rectal resection for rectal cancers. Short-term bowel function was evaluated in 23 patients. Their mean age was 48.42 ± 12.2 years and 14 were males. LARS was present in 10 of them (43.47%) and classified as “minor” in the majority of cases (n=6). The commonest bowel dysfunction at this term was splitting of stool (56.53%). Long-term digestive function was evaluated in 11 patients; LARS was found in 3 of them (27,27%) and classified as minor in all cases. Perfect continence was significantly improved (p=0.003) in the long term compared to the short-term status. Continence (p=0.049) and urgency (p=0.048) were better in patients who had a low colorectal anastomosis compared to those who had a colo supra-anal anastomosis.

Conclusion: after ARR for cancer, there is a high prevalence of LARS in the short term with an improvement in the long term.

A giant ovarian mass

Haithem Aloui — 2025-02-20

It was a 36-year-old patient with no significant medical history. She presented with rapidly progressive abdominal distension and chronic pelvic pain without other associated symptoms. On examination, the abdomen was soft but distended, with filling of the left vaginal cul-de-sac without pain upon uterine mobilization. Ultrasound revealed a mass occupying the entire abdominal cavity, with finely echogenic, multiseptated fluid content, no endocystic vegetation, and non-vascularized on Doppler. Pelvic magnetic resonance imaging (MRI) showed a 35cm mass with multiple septations, multiple papillary cystic projections at the margins, non-enhancing after left ovarian injection classified as ovarian-adnexal reporting and data system (ORADS-4). Tumor markers: Alpha-fetoprotein, CA19-9, and ACE were requested and returned negative, while CA125 marker was positive at 52 U/mL. During surgery, the mass appeared whitish, with a dual solid-cystic component, vascularized, adherent to the posterior peritoneum. Homolateral annexectomy was performed along with cytology of peritoneal fluid and peritoneal biopsies. The pathological examination of the operative specimen revealed a 40cm structure filled with greenish fluid, having thickened and richly vascularized lining with areas of fibrosis. It was lined by a single-layered epithelium consisting of small, regular nuclei with scant cytoplasm. The diagnosis concluded with a serous cystadenoma, without signs of malignancy. The postoperative course was uneventful, and the patient was discharged on postoperative day 3.

Diagnostic and therapeutic wandering in the face of a pregnancy on cesarean scar

Haithem Aloui — 2025-02-20

A 36-year-old patient with a history of cesarean section presented with a pregnancy halted at 8 weeks of gestation. Initial treatment with misoprostol (CYTOTEC*) failed to induce expulsion of the products of conception. Following a 24-hour observation period, a second misoprostol regimen also proved ineffective. Subsequently, ultrasound-guided aspiration was performed on day 4, revealing an isthmic gestational sac, an open cervix, and minimal dark bleeding. Initial aspiration yielded trophoblastic tissue, followed by profuse bright red hemorrhage. Intrauterine tamponade was achieved using a size 18 Foley catheter filled with 60 ml of saline and left in place for 48 hours. Hemoglobin levels dropped from 11 to 6 g/dl, necessitating transfusion with 4 units of packed red blood cells. After 14 days, the patient presented with hemorrhagic shock. Endovaginal ultrasound demonstrated significant abdominal hemorrhage and evidence of retained trophoblastic tissue. Intraoperatively, a pregnancy on a cesarean scar with uterine wall rupture was identified. Excision of the pregnancy and its myometrial bed was performed, followed by uterine reconstruction. The patient was discharged on postoperative day 2 with satisfactory clinical progress.

Frequency and determinants of phytotherapy use in patients with type 2 diabetes in the Dschang Health District, Cameroon: a cross-sectional study

Michelle Carolle Dongmo Demanou — 2025-02-20

Introduction: phytotherapy is widely used in Africa for the management of many diseases. Data on the use of phytotherapy in people with type 2 diabetes are scarce. We aimed to determine the frequency and factors associated with the consumption/use of phytotherapy products among patients with type 2 diabetes in the Dschang Health District.

Methods: we conducted a cross-sectional study from January to May 2022, including community-dwelling or hospitalized patients with type 2 diabetes who had lived in the Dschang Health District for at least one year. Informed consent was obtained from all patients. Data were collected using a pre-designed questionnaire. Variables collected included socio-demographic characteristics, diabetes knowledge and practices, and perceptions of care.

Results: we included 403 (249 women) patients with type 2 diabetes with a mean (SD) age of 63 (± 14.86) years). Among them, 240 (59.55%) used phytotherapy, either in combination with conventional treatment (168 (41.69%) participants) or not (72 (17.86%) participants), to treat diabetes. The most common reasons for using phytotherapy were easy accessibility and belief in its efficacy. Most patients used both treatments because they thought the combination was more effective. In univariable analysis, we observed a statistically significant association between level of education (p=0.003), socioeconomic level (p<0.001), place of residence (p=0.003), duration of diabetes (p=0.007), and use of phytotherapy. In multivariable analysis, only age between 51 and 60 years (OR: 0.50, 95% CI 0.298 - 0.8521; p=0.01) was associated with the use of phytotherapy.

Conclusion: people living with T2D in the Dschang Health District frequently use phytotherapy as an antidiabetic remedy, especially those aged between 51 and 60 years, those with low education level, low socioeconomic level and medium duration of diabetes. There is a need to evaluate its effectiveness in treating diabetes and its adverse effects.

Immunoglobulin G (IgG) specific responses to recombinant Qβ displayed MSP3 and UB05 in plasma of asymptomatic Plasmodium falciparum-infected children living in two different agro-ecological settings of Cameroon

Loveline Ngu — 2025-02-20

Introduction: in areas with intense perennial malaria transmission, limited data is available on the impact of environmental conditions especially rainfall on naturally acquired immunity against promising malaria vaccine candidates. For this reason, we have compared IgG antibody responses specific to Plasmodium spp. derived MSP3 and UB05 vaccine candidates, in plasma of children living in two areas of Cameroon differing in rainfall conditions.

Methods: data about children less than 5 years old was collected during the years 2017 and 2018. Next malaria asymptomatic P. falciparum (Pf) infected children were selected following malaria test confirmation. MSP3 and UB05 specific IgG antibody responses were measured in participant´s plasma using enzyme-linked immunosorbent assay (ELISA).

Results: interestingly, IgG antibody responses specific to UB05 were significantly higher (p<0.0001) in Pf-negative children when compared to their asymptomatic Pf-infected counterparts living in monomodal rainfall area. In contrast, a significantly higher (p<0.0001) IgG response to MSP3 was observed instead in asymptomatic Pf-infected children in the same population. In addition, IgG responses specific to UB05 remained significantly higher in bimodal when compared to monomodal rainfall areas irrespective of children´s Pf infection status (p<0.0055 for Pf-positive and p<0.0001 for negative children). On the contrary, IgG antibody responses specific to MSP3 were significantly higher in bimodal relative to monomodal rainfall areas (P<0.0001) just for Pf-negative children.

Conclusion: thus IgG antibody responses specific to UBO5 are a better correlate of naturally acquired immunity against malaria in Pf-negative Cameroonian children especially in monomodal rainfall areas.

Prevalence and associated factors of malnutrition among under-five children living in slum areas of Bahir Dar Town, Ethiopia

Meron Tedla — 2025-02-20

Introduction: child malnutrition is one of the most serious and least addressed health problems in the world and in Ethiopia. The prevalence of malnutrition, underweight, and wasting was 44%, 29%, and 10% respectively. The Amhara region has the highest rates of malnutrition at 52%, 33.4%, and 9.9% for children under five. The aim of this study was to assess the prevalence of malnutrition and its associated factors among children under five living in the slum areas of Bahir Dar City.

Methods: a community-based cross-sectional study was conducted with 680 children aged 6-59 months in slum areas of Bahir Dar Town. Study participants were selected using a mass sampling technique and data were collected from April to June 2018 using a pre-tested structured questionnaire and anthropometric measurements. Finally, the collected data were coded, entered, cleaned, recorded, and stored, and the data were processed using EPI INFO and exported to the SPSS version 25.0 statistical package. Logistic regression analysis and interpretation were performed using bivariate and multivariate analysis.

Results: a total of 680 children participated. The prevalence of stunting, underweight, and wasting was 46.2% (95% CI; 42.5-49.1), 24.3% (95% CI; 21.2-27.6), and 11.3% (95% CI; CI; 9.2-13.9). Income groups included children [AOR=3.476 (95% CI, 1.959-6.167)], male children [AOR=2.586 (95% CI; 1.532-4.365)] and mother's educational level [(AOR=2.600) (1.623) - 4.164)] were significantly associated with malnutrition.

Conclusion: the results of this study showed that the prevalence of malnutrition due to stunting and wasting was high among children under five years of age. The gender of the child, the educational level of the mother, and the monthly income of the family were found to be significantly related to malnutrition. Promoting the use of family planning, preventing diarrheal diseases, and vaccinating children through nutrition education programs are important activities to improve the nutritional status of children.

One case of condyloma acuminata

Lin-na Lv — 2025-02-20

A 16-year-old man presented to the dermatological department with a chronic history of cauliflower-like mass on the penis. He recalled that he first found several mung bean-sized papules on the glans without ulcers or bleeding but adopted no treatments. Thereafter the papules were gradually spread to the prepuce and the sizes of the initial lesions were enlarged dramatically. He complained of occasional itch and tingling on the glans but denied urethral discharge. On physical examination, the vital signs were within the normal ranges. The expanding and reddish papules and plaque were loosely attached to the glans and prepuce but the shaft of the penis was spared. Weighting pros and cons and after fully informed consent, we started with fractional surgery to remove the majority and the pathological examination confirmed the diagnosis. Fulguration was utilized on the remaining mass and thereafter 10 sessions of hyperthermia treatment were proposed. Punctually, the lesion completely diminished. No recurrence was detected within 6 months of follow-ups.

Fundamental dermatology education of medical doctors at a regional hospital in Johannesburg, South Africa

Tamara Romanini — 2025-02-20

Introduction: dermatology is a prevalent field of global health and dermatological conditions are amongst the most frequent complaints affecting communities, yet dermatology has become an overlooked aspect of the medical school curricula and many medical schools have failed to provide doctors with training to manage these conditions confidently and adequately. This study aimed to determine the baseline dermatological knowledge of medical doctors and determine the influence of fundamental dermatology education on hospital medical staff at a regional hospital in Johannesburg, South Africa.

Methods: the knowledge and confidence of 33 medical doctors were tested using a pre-test and post-test quasi-experimental design. Participants completed an online questionnaire followed by an image-based test consisting of 20 questions to determine their level of confidence in diagnosing and managing common dermatological conditions. The participants then attended a sixty-minute educational session based on common dermatological conditions. Following this, their level of confidence and knowledge on the subject was re-assessed using the same online test. Pre and post-intervention confidence and test scores were compared.

Results: the pre-intervention test mean score was 67.11%. The post-intervention mean score was 92.50%. The difference between means (post-intervention - pre-intervention) ± SEM was 25.39 ± 4.81. The intervention significantly improved overall test scores (p-value < 0.0001). Many participants felt that their undergraduate training was insufficient in preparing them for the management of common dermatological conditions.

Conclusion: the baseline knowledge and confidence of medical doctors in managing common dermatological conditions was poor and such educational interventions have significant value in improving the ability of medical doctors in managing common dermatological conditions. More time should be dedicated to dermatology training at an undergraduate level.

Asymmetric fracture dislocation of the hips: case report

Hassan Hachicha — 2025-02-20

Bilateral asymmetric hip fracture dislocation is an extremely rare entity. The injury is caused by a high velocity mechanism. We reported a case of bilateral hip fracture dislocation and its management. A 30-year-old man with no previous medical or surgical history was involved in a road accident involving a high-speed collision between two trucks. X-rays of the pelvis revealed asymmetrical bilateral fracture-luxation of the hips. The reduction of the hips was done under general anesthesia. Asymmetrical bilateral traumatic dislocation fracture of the hip is a rare serious injury. Reduction must be performed within 6 hours. Short- and long-term monitoring of the patient is essential.

La gestion des données du système d'information sanitaire de routine en période de crise sécuritaire dans le district sanitaire de Tombouctou, au Mali en 2023

Bocar Mahamane Traore — 2025-02-20

Introduction: un système d'information sanitaire (SIS) efficace garantit la production, l'analyse, la diffusion et l'utilisation d'informations fiables et actualisées sur les déterminants de la santé. Cependant, il peut rencontrer des obstacles qui entravent son fonctionnement, il en est ainsi des conflits armés, qui limitent l'accès et la qualité des services des soins. Notre étude visait à contribuer à l'amélioration de la gestion des données du système d'information sanitaire de routine dans le district sanitaire de Tombouctou en situation de crise sécuritaire.

Méthodes: une étude transversale descriptive, réalisée du 15 avril au 08 septembre 2023 dans le district sanitaire de Tombouctou auprès des agents impliqués dans le SIS. Les données obtenues à partir d'un questionnaire d'enquête ont été analysées sur Epi Info version 7.2.2., et traitées sur Microsoft Word et Excel 2016.

Résultats: au total, 6 formations sanitaires ont été enquêtés. Les niveaux de collecte, d'analyse et de feedback étaient à des taux très faibles. Par rapport à la qualité des données: 100% de complétude, 92,40% de promptitude et 68,11% d'exactitude. Les contraintes majeures étaient: faible implication des agents de santé dans le SIS (22,22%), insuffisance de formation sur le Système d'Information Sanitaire de Routine (SISR) (29,63%), la supervision (47,06%), l'inaccessibilité à internet (66,67%), le sentiment d'insécurité (37,04%) et la peur (61,76%) dans les formations sanitaires.

Conclusion: nos résultats présentent un faible niveau de processus, une mauvaise couverture réseau, une insuffisance en personnel qualifié pour la gestion du SIS et une insécurité grandissante. Une étude mixte plus large permettrait de mieux les comprendre.

Factors associated with mortality among laboratory-diagnosed drug-resistant tuberculosis patients on treatment, KwaZulu-Natal Province, 2017-2019

Moshibudi Poncho Phafane — 2025-02-20

Introduction: tuberculosis (TB) remains a leading cause of death in South Africa. KwaZulu-Natal (KZN) is one of the provinces with a high burden of TB/drug-resistant TB cases and deaths. We determined predictors for mortality among drug-resistant TB patients on treatment in KZN province.

Methods: we conducted a retrospective cohort study using secondary data from the Electronic Drug-Resistant Tuberculosis Register. We used a modified Poisson regression model with robust standard errors to determine predictors for drug-resistant TB mortality.

Results: of the 7,692 eligible patients, 1,234 (16.0%) died. Males predominated (707, 57.3%) and the median age was 36 years (Interquartlile Range: 29-45 years). The majority (978, 79.2%) were HIV-TB co-infected with 911 (93%) on antiretroviral treatment (ART). The predictors included HIV-TB co-infection without ART (aIRR 3.4; 95% CI: 2.3-5.1), unknown ART status (aIRR: 1.8; 95% CI: 1.4-2.3), aged ≥60 years (aIRR: 2.1; 95% CI: 1.6-2.7), previous drug-resistant TB (aIRR: 1.5; 95% CI: 1.2-1.8) and exposure to second-line drugs (aIRR: 1.7; 95% CI: 1.4-2.0). Other predictors were hospitalization during treatment initiation (aIRR 2.5; 95% CI 2.0-3.1), initiation in other treatment facilities (aIRR: 2.2; 95% CI: 1.6-2.9) and rifampicin-resistant (aIRR: 1.2; 95% CI: 1.1-1.4). Bedaquiline fumarate was a significant protective factor against death (aIRR: 0.5; 95% CI: 0.4-0.5).

Conclusion: older age, HIV co-infection without ART, hospitalization for treatment initiation, exposure to second-line drugs and a previous episode of drug-resistant TB were predictors for DR-TB mortality. Early treatment initiation and provision of antiretroviral treatment for all co-infected patients may reduce DR-TB mortality in the Province.

Un cas de kyste ovarien géant au cours de la grossesse

Imen Ben Farhat — 2025-02-20

L'incidence des kystes ovariens au cours de la grossesse a considérablement augmenté depuis la pratique systématique de l'échographie chez la femme enceinte. Cette fréquence est comprise entre 0,3 et 5,4%. Le principal risque de complication des kystes ovariens durant la grossesse est la torsion annexielle, évaluée autour de 8%. L'échographie reste l'examen de référence pour caractériser une tumeur ovarienne durant la grossesse. En dehors des complications, l'expectative est recommandée au cours de la grossesse vue le risque maternofoetal de la chirurgie. Lorsqu'un acte chirurgical est indiqué, la cœlioscopie est la voie d'abord de choix au cours du 1^er et du 2^è trimestres. Les modalités de l'accouchement ne doivent pas être modifiées par la tumeur ovarienne, excepté en cas de complication de suspicion de malignité ou d'obstacle prævia comme le cas de notre patiente. Nous présentons le cas d'une patiente âgée de 34 ans sans antécédents médicaux pathologique opérée pour un kyste ovarien bénin il y 10 ans, G3P3, utérus sain qui nous consulte à 38 SA pour suivi de la grossesse. Par ailleurs, une seule consultation prénatale a été faite au cours de suivi avec à l´échographie de premier trimestre. Un kyste ovarien de 5 cm. Nous avons relevé lors de la réalisation de l'échographie obstétricale la présence d´une image kystique uniloculaire anéchogène pur à paroi régulière faisant un obstacle prævia. Une césarienne prophylactique a été décidée avec kystectomie en même temps passées sans incidents.

Épidémiologie et facteurs de risque de la prématurité dans le nord-ouest algérien

Nabila Heroual — 2025-02-20

Introduction: les naissances prématurées continuent d´être la principale cause de mortalité infanto-juvénile, mais aussi des handicaps sensorimoteurs et des difficultés neurodéveloppementales dans le monde. Le taux d´accouchement prématuré est en augmentation notamment en Algérie. L´objectif de ce travail est de déterminer la fréquence des naissances prématurées dans la wilaya d´Oran et d´identifier les facteurs de risque.

Méthodes: nous avons exploité les données d´une étude transversale multicentrique réalisée dans l´ensemble des 13 maternités publiques de la wilaya d´Oran incluant les parturientes ayant accouché d´un enfant né vivant et/ou mort-né dont l´âge gestationnel était supérieur ou égal à 24-36 semaines d´aménorrhées révolues et le poids ≥500 grammes. Les facteurs démographiques, médicaux et socio-comportementaux de la mère ont été relevés. Une régression logistique a été élaborée pour étudier les facteurs prédictifs de prématurité.

Résultats: le taux d´accouchement prématuré était de 9,9% (45/452). L´âge moyen des parturientes était de 30,4 ± 6 ans. Les grossesses multiples représentaient 2,2% des naissances. Les facteurs liés à la prématurité étaient la menace d´accouchement prématuré (ORa=4,68; IC95%: 2,27-9,64), l´absence de suivi médical de grossesse (ORa=2,83; IC95%: 1,83-6,05) et l´hypertension artérielle gravidique (ORa = 3,69, IC à 95%: 1,83-8,8).

Conclusion: le taux de naissance prématurée retrouvé rejoint les taux observés dans les pays voisins. L´étude a permis d´identifier des facteurs prédictifs dont certains sont déjà ciblés par le programme national de périnatalité. Cependant, il reste indispensable de poursuivre les efforts déployés pour améliorer le suivi et la prise en charge des grossesses et des naissances prématurées à tous les niveaux de soins.

Risk factors for breast cancer among women in Freetown, Sierra Leone, 2017: a case-control study

Philip Pelema Gevao — 2025-02-20

Introduction: breast cancer is the most commonly diagnosed malignancy and an important cause of cancer death among females worldwide. The disease accounted for 25% (1.67 million) of new cancer cases and the fifth cause of cancer deaths. Incidence of all types of cancers is approximately 25% in Sierra Leone. However, there was no documented evidence on risk factors for breast cancer among women in the country. The main aim of this study was to assess risk factors associated with breast cancer among women screened for breast cancer in Freetown Sierra Leone.

Methods: we conducted a case-control study on breast cancer involving 116 confirmed breast cancer cases and 116 controls. Questionnaire was designed to collect data on socio-demographic, reproductive and behavioral risk factors. Analysis was carried using logistic regression to assess the associations between breast cancer and the risk factors.

Results: in the final multiple logistic regression, had formal educational level, (aOR 0.1, 0.03-0.26, p= 0.001) physical activity for more than 30 minutes per week (aOR 0.5 0.9-0.7, p=0.001). Cigarette smoking (a OR 4. 8, 1.2-18.5, p=0.023) and family history of breast cancer (aOR 9.9 Cigarette smoking (OR 4.4, 1.2-18.5, p=0.023) and family history of breast cancer (OR 9.9, 2.7-36.45, p=0.040) were identified as the main risk factors for breast cancer. This study did not find any statistically significant associations between reproductive risk factors and breast cancer.

Conclusion: risk factors for breast cancer among women in Sierra Leone include educational level, physical activity, cigarette smoking and family history of breast cancer. We recommended screening program for women above 40 years and had history of breast cancer. Also, to establish breast cancer registry.

The need for active and integrated involvement of the community and health professionals in the prevention and control of dengue hemorrhagic fever in Indonesia

Muhammad Farid Dimjati Lusno — 2025-02-20

Successful control and prevention of dengue fever requires active involvement from all parties. For this reason, three innovative programs are needed, namely: i) increasing knowledge, attitude and practice (KAP) of the community and health professionals as capital in controlling dengue fever in a sustainable manner; ii) application of "3M Plus" to suppress vector breeding in household settings; iii) promotion of the "Jumantik" program as an effective community empowerment approach to prevent and control dengue fever based on community independence. It was concluded that successful control of dengue fever requires integration of the community and health workers through various innovative programs.

Adherence to antiretroviral therapy among people living with HIV attending medication-assisted treatment clinics in Dar es Salaam, Tanzania: a cross-sectional study

Johnson Dominic Mshangila — 2025-02-20

Introduction: the prevalence of human immunodeficiency virus (HIV) among people who inject drugs (PWIDs) in Tanzania is estimated at 35%, significantly surpassing the 4.6% HIV prevalence of the general population. People who inject drugs living with HIV have been reported to exhibit lower adherence to antiretroviral therapy (ART), leading to increased rates of mortality, morbidity, and HIV transmission. This study assessed adherence to ART and associated factors among PWIDs in Dar es Salaam.

Methods: this cross-sectional study involved 277 PWIDs living with HIV who attended MAT clinics in Dar es Salaam from May to July 2022. Antiretroviral therapy adherence was assessed using a validated one-month self-recall medication adherence scale, and associated factors were obtained through a structured questionnaire. Statistical analyses included chi-square tests, Fisher exact tests, and log-binomial regression. Data were analyzed using STATA version 15, with a p-value of <0.05 considered statistically significant.

Results: this study found that 83% of the study participants had a high level of adherence to ART. Additionally, the results revealed that PWIDS who consume alcohol were less likely to have high adherence to ART (aPR 0.820). On the other hand, higher odds of ART adherence were observed among participants who had family support (aPR 1.028) and those who had adequate knowledge of ART benefits (aPR 1.285).

Conclusion: the government and development partners should implement novel interventions such as alcohol reduction programs, ART education, and expanded HIV community outreach services. These interventions have the potential to improve ART adherence and reduce HIV transmission among PWIDs.

A rare case of chronic hypersensitivity pneumonitis with pleural lipoma

Ashwin Karnan — 2025-02-20

A 72-year-old female presented with complaints of dry cough, breathlessness, and mild chest pain, on and off for the past 2 years. She had no comorbidities, no significant past or personal history, and gave a history of having 3 pet pigeons at home for the past 3 years. Chest X-ray was unremarkable. The computed tomography of the chest showed bilateral ground glass opacities with mosaic attenuation predominantly in the upper lobes suggestive of hypersensitivity pneumonitis with a hypodense lesion (-90HU) in the pleural space suggestive of pleural lipoma. Serum pigeon-specific IgG was elevated. The patient was started on oral prednisolone 1mg/kg and advised to avoid exposure to pigeons. At 2 month follow up there was remarkable improvement in symptoms. Pleural lipomas are the most common benign soft tissue tumor of the pleura. They originate from the parietal pleura and may extend into the subpleural, pleural, or extra-pleural space. They are usually asymptomatic but, in some cases, may cause pleural irritation and cough. CT scan is the investigation of choice. Any rounded tumor, originating from the parietal or mediastinal pleura, homogenous, without any calcification, with an adipose density of -50 to -150 HU and not enhanced by an injected contrast medium, is a lipoma. Pleural lipomas usually need no treatment other than observation but in rare cases of large tumors, video-assisted thoracoscopic surgery may be needed.

Lemierre's syndrome with septic pulmonary emboli

Ashwin Karnan — 2025-02-20

A 32-year-old male presented to the emergency department with complaints of breathing difficulty, chest pain, and fever for the past 2 days. The patient gave a history of pharyngitis 3 weeks back, for which he was treated with oral antibiotics. Chest X-ray of the patient showed bilateral nodular opacities, with suspicion of cannonball metastases or pulmonary embolism. Contrast-enhanced computed tomography (CT) showed an intraluminal filling defect of the right internal jugular vein with bilateral nodular opacities in the lung with positive feeding vessel signs suggestive of septic pulmonary emboli. Blood culture showed methicillin-resistant Staphylococcus aureus growth. The patient was treated with appropriate intravenous antibiotics for 21 days, anticoagulants, and oxygen support. The patient improved symptomatically and is currently on follow-up. Lemierre's syndrome is a rare disease with high mortality, characterized by thrombosis of the internal jugular vein and bacteremia following a recent oropharyngeal infection. The causative organism is thought to spread directly from the peritonsillar space to the jugular vein, with subsequent septic thromboembolism. Contrast-enhanced computed tomography is the gold standard investigation of choice. Treatment usually involves intravenous antibiotics.

Serpentine supravenous hyperpigmentation: a rare clinical image

Ashwin Karnan — 2025-02-20

A 39-year-old male presented with complaints of left arm skin discoloration associated with itching for the past 2 weeks. The patient has a known case of signet ring cell carcinoma of the stomach for the past 6 months and has completed 6 cycles of intravenous 5-fluorouracil through a peripheral venous catheter. A biopsy of the skin showed melanophages with perivascular mononuclear cell infiltration. A diagnosis of 5-fluorouracil-induced hyperpigmentation was made. The patient was treated with topical steroid application and antihistamine and is currently on follow-up. Serpentine supravenous hyperpigmentation was described by Hrushesky in 1976 which is a cutaneous reaction to intravenous antineoplastic agents. It is seen in 2-5% of patients receiving intravenous chemotherapy drugs but is a benign and self-limiting disease. The chemotherapy agents include cyclophosphamide, actinomycin, bortezomib, doxorubicin, and 5-fluorouracil. The exact mechanism is unclear, but possible hypotheses include endothelial damage leading to extravasation of the drug and interference with melanogenesis, direct stimulation of melanocytes, hyperthermia-related increased expression of melanocyte-stimulating hormone receptor, and hyperpigmentation secondary to increased blood flow. The condition is reversible, usually months to years after cessation of the drug. It can be prevented by using a central chemo port for drug administration.

Factors associated with oocyte recovery rates during in-vitro fertilization among Nigerian women

Amina Mohammed-Durosinlorun — 2025-02-20

Introduction: the availability of oocytes is fundamental to in vitro fertilization (IVF). The factors associated with optimal or suboptimal oocyte recovery rates (ORR) in low-resource settings are not well known. This study aimed to determine the factors associated with ORR by comparing demographic and IVF cycle data of women undergoing IVF in our Centre.

Methods: this was a prospective study of 110 infertile women undergoing IVF at Nisa Premier Hospital, Abuja Nigeria, from October 2020 to September 2021. All women had reached the stage of oocyte retrieval or further, after receiving ovarian stimulation with our routine protocols. Treatment was monitored by serial transvaginal ultrasonography. The oocyte retrieval procedures were performed under conscious sedation, 36 hours after the ovulatory trigger. Optimal ORR was when eggs were obtained from at least 80% of follicles punctured. Sub-optimal ORR was when it was less than 80%. Data analyses utilized SPSS statistical software and a p-value of < 0.05 was considered significant.

Results: the mean age of all women was 34.1±4.9 years. Sixty-nine women (62.7%) had sub-optimal ORR while 41 (37.3%) had optimal ORR. Six women (5.5%) had no oocytes retrieved. Significantly more women with sub-optimal ORR were obese (70.6 vs 29.4%) and had higher follicle-stimulating hormone (FSH) levels (8.11 vs 6.34 miu/ml), p-value- 0.039. Women with sub-optimal ORR had higher mean prolactin levels (17.10 ± 13.93 miu/ml) than women with optimal ORR 11.43 ± 6.65 miu/ml), p-value- 0.019). Significantly more oocytes (5.99 vs 10.37, p-value 0.001), and MII oocytes (5.78 vs 7.56, p-value 0.035) were retrieved in women with optimal than sub-optimal ORR. The duration of stimulation, total amounts of gonadotropins administered, and fertilized oocytes were not significantly different among both groups (p-value >0.05).

Conclusion: this study has shown the factors associated with ORR in our setting to be basal FSH, prolactin, and obesity.

Barry-Perkins-Young syndrome

Ashwin Karnan — 2025-02-20

A 28-year-old male presented with complaints of fever, cough with expectoration and difficulty in breathing for the past 5 days. Patient is a fruit seller by occupation and gives history of similar illness in the past due to recurrent sinusitis and a significant treatment history for infertility for the past 2 years. Computed tomography of the chest showed tree in bud appearance predominantly in the upper lobes, with cystic and tractional bronchiectasis changes in the bilateral lower lobes. A transrectal ultrasound confirmed obstructive azoospermia for which he was advised vasoepididymostomy. A diagnosis of Young´s syndrome was made, and he was treated with intravenous antibiotics. Young´s syndrome also known as Barry-Perkins-Young syndrome or sinusitis-infertility syndrome is a rare, inherited syndrome commonly seen in middle-aged men with chronic rhinosinusitis, nasal polyps, infertility and bronchiectasis. It is named after Dr. Donald Young, a urologist who first described it. The exact cause is unknown, but childhood exposure to mercury and genetic factors are speculated. Treatment involves control of sinus, lung infection and surgical/assisted measures for reproduction.

Postoperative discovery of molar pregnancy

Haithem Aloui — 2025-02-20

This concerns a 52-year-old patient presenting with abdominal-pelvic pain and diffuse bloating. Upon gynecological examination, an enlarged uterus is noted. Endovaginal ultrasound reveals a 7 cm intracavitary fibroid with suspected degeneration. The patient underwent a hysterectomy. Intraoperatively, the surgeon observes a soft consistency of the uterus and decides to proceed with bilateral annexectomy. Upon dissection of the operative specimen, the typical appearance of a molar pregnancy is noted. This finding is confirmed by anatomopathological examination. The patient had a good postoperative recovery.

Prevalence and risk factors for extended-spectrum β-lactamase producing antimicrobial-resistant E. coli in urinary tract infections among inpatients in the tertiary hospitals in Zanzibar (Tanzania): a prospective cross-sectional study

Muhiddin Hamada Omar — 2025-02-20

Introduction: Extended-spectrum β-lactamase (ESBL) production among Enterobacteriaceae, such as E. coli, has been increasing worldwide, which causes treatment failure for urinary tract infections. Therefore, this study aimed to determine the prevalence and risk factors for the production of ESBL in E. coli from patients with urinary tract infections (UTI) in Zanzibar.

Methods: a prospective cross-sectional study was conducted from January 2018 to December 2021 in Zanzibar. Data were retrieved from a routine bacteriological laboratory culture report from urine samples of 4306 patients at the Lancet Laboratory. In addition, the patient's social demographics and clinical data were retrieved by examining the medical records in the respective hospitals. All inpatients older than fifteen years diagnosed with urinary tract infections (UTI) and requested urine culture and sensitivity were included. The Chi-square and Fischer's exact tests were used to compare antibiotic resistance. In addition, a binary logistic regression analysis was used to predict ESBL production risk factors.

Results: the prevalence of E. coli-producing ESBL was 13.4% (578/4030). Infection of ESBL. E. coli was prevalent in females 52.6% (n=304) compared to male patients, 47.4% (n=274), and the majority 38.8% (n=224), were people of young age, between 16-30 years. The average age of patients was 31.5±10.2 years, with minimum age of 16 years and a maximum age of 72 years. In multivariate analysis, results shown that previously hospitalised patients aOR: 6.35, 95% Cl 3.37-11.92; p=0.001, long hospital stays aOR:10.34, 95% Cl 3.03-22.29;p <0.001, prior use of penicillin aOR: 7.78, 95% Cl 2.99-29.11; p < 0.001, and prior use of cephalosporin drugs aOR: 4.64, 95% Cl 2.99-9.96; p=0.001, were strongly associated with the emergence of ESBL-producing E. coli in urinary tract infection patients. ESBL E. coli showed high resistance to amoxicillin 99.5% (n=575), ampicillin 97.8.% (n=570), cotrimazaxole 86.2% (n=344), ceftriaxone 73.7% (n=344), ciprofloxacin 73.2% (n=423), and ceftaxime 59.5% (n=426). There was a less resistance to ampicillin -cloxacillin 44.3% (n=256), gentamicin 22.5% (n=22.5), and norfloxacin 18.9% (n=109) respectively. Isolates were shown to be more susceptible to meropenem at 1.6% (n=9).

Conclusion: the overall prevalence of ESBL-producing E. coli is 13.4%. The risk of emergence ESBL was higher in patients with previous history of hospitalisation, long hospital stay, prior use of penicillin and cephalosporin drugs. High level of antimicrobial resistance observed against most commonly used antibiotics in treatment of urinary tract infections. The clinicians should rely on microbiological diagnosis in treatment of UTIs to reduce risk of treatment failure. Further study should be carried out to assess the prevalence and resistance pattern of other uropathogens and other risk factors.

A typical case of herpes zoster

Souvik Sarkar — 2025-02-20

A 59-year-old male presented to the outpatient department with a painful rash on the lateral aspect of the thorax, fever with chills, and occasional cough for 1 week. He was a previously diagnosed case of a human immunodeficiency virus (HIV) infection and was taking irregular anti-retroviral therapy (ART). The patient was also a habitual alcoholic and had a past history of tuberculosis 2 years back. On examination, he was emaciated, afebrile to touch, had a pulse rate of 88 beats per minute, and a blood pressure of 90/60 mmHg. On examination of the rash, there was a dermatomal distribution along the lateral aspect of the right hemithorax. It had multiple erythematous papules, with some grouped vesicles and hemorrhagic pustules. The CD4 count of the patient was 114. The patient was initiated on oral acyclovir 800 mg five times daily, oral gabapentin 100 mg three times daily, and local application of lidocaine ointment. He was also restarted on regular anti-retroviral drugs, and gradually, the pain of the patient was relieved, and the rashes decreased, leaving a scar.

Tuberculosis of prostate: a rare clinical image

Shreya Giri Goswami — 2025-02-20

Tuberculosis is a prevalent disease in India, primarily involving the lungs, lymph nodes, and abdomen. While it commonly involves the kidneys and epididymis in the genitourinary tract, occurrence in the prostate is extremely rare (2.6%). It raises suspicion towards benign hyperplasia and often bladder carcinoma, therefore often goes overlooked and undiagnosed. These lesions are often secondary. Early lesions are challenging to detect while advanced ones may result in an enlarged, fluctuant, and tender prostate on palpation. A 74-year-old male presented in the outpatient department of urology with complaints of increased frequency of micturition, poor streaming, and nocturia for 2 months. There was no history of constitutional symptoms such as fever, evening rise of temperature, or weight loss. The patient was hypertensive but did not give any history of tuberculosis in the past. The blood picture revealed no abnormalities. The patient was not immunocompromised. Ultrasonography revealed an enlarged prostate of size 28.9 gm with smooth outlines. Prostate-specific antigen (PSA) was 10.2 ng/ml. Prostatitis and benign hyperplasia were considered differentials. The patient underwent transurethral resection of the prostate (TURP) in view of the given differentials. The microscopic examination of the TURP chips revealed epitheloid granuloma. Caseous necrosis in between the prostate glands and stroma surrounded by Langhans giant cells and lymphocytes. The histopathological diagnosis of tubercular prostatitis was given. Chest X-ray was normal. Polymerase chain reaction (PCR) and Mantoux test were positive pointing towards tuberculosis. Antitubercular therapy (ATT) was started as per the national protocol.

Sexual gender-based violence among adolescent girls and young women during COVID-19 pandemic, Mid-Eastern Uganda

Patience Mwine — 2025-02-20

Introduction: global studies indicate that sexual gender-based violence (SGBV) may increase during pandemics including COVID-19. The Mid-Eastern region in Uganda was of concern due to the high prevalence of intimate partner sexual violence among adolescent girls and young women (AGYW). Due to limited data, we investigated factors associated with SGBV among AGYW during the COVID-19 pandemic in Eastern Uganda, in April 2022.

Methods: we listed all AGYW 10-24 years who obtained SGBV services at 10 high-volume health facilities from March 2020 to December 2021, the main COVID-19 period in Uganda. We conducted a case-control study among these AGYW. A case was ≥1 SGBV episode experienced by an AGYW aged 10-24 years residing in the Tororo and Busia districts. For every randomly selected case from the health facility line list, we identified two neighbourhood-matched AGYW controls who reported no SGBV. We interviewed 108 and 216 controls on socio-demographics, socio-economics, and SGBV experiences during COVID-19. We conducted logistic regression to identify associated factors.

Results: among 389 SGBV cases, the mean age was 16.4 (SD± 1.6: range 10-24) years, and 350 (90%) were aged 15-19 years. Among 108 cases interviewed, 79 (73%) reported forced sex. Most (n=73; 68%) knew the perpetrator. In multivariate analysis, self-reported SGBV before the COVID-19 period [aOR=5.8, 95%CI: 2.8-12] and having older siblings [aOR=1.9, 95%:CI 1.1-3.4] were associated with SGBV during the period. Living with a family that provided all the basic needs was protective [aOR=0.42, 95%: CI 0.23-0.78].

Conclusion: previous SGBV experiences and family dynamics, such as having older siblings, increased the odds of SGBV during the COVID-19 pandemic in Uganda. Conversely, a supportive family environment was protective. Identifying, supporting, and enacting protective interventions for SGBV victims and socioeconomically vulnerable AGYW could reduce the burden of SGBV during similar events.

Genetic characterization of group A rotavirus in children with acute gastroenteritis in Kericho County Referral Hospital, Kenya

Beth Khayeli Nyamanga — 2025-02-20

Introduction: approximately over 80% of mortalities due to rotavirus occur in countries that have limited resources, especially in sub-Saharan Africa and South Asia. The study was intended to determine the genetic characteristics of rotavirus A in children exhibiting gastroenteritis at Kericho County Referral Hospital.

Methods: the study design was cross-sectional. Consecutive sampling was engaged obtaining a sample size of 200 stool samples. Genetic characterization of group A rotavirus strains was done using Enzyme-Linked Immunosorbent Assay. Positive samples underwent Sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Afterwards viewing of the RNA double strands of the rotavirus genome in gels was done using Silver Nitrate. The positive samples underwent RT-PCR amplification followed by sequencing on the pieces of the VP7 or VP4 gene obtained.

Results: one hundred and six (53%) samples from males and 94 (47%) from females. Twenty-three samples were positive hence a prevalence of 11.5%. The most affected demographics were children of guardians with secondary school education (51%). The most affected social economic status was housewives (46.5%). The most affected age was 21-30 months at 26.5%. Long electropherotypes were in 22 samples (96%). The G3 genotype of rotavirus A was prevalent 16/23 (69.57%).

Conclusion: rotavirus prevalence was 11.5%. The G3 genotype was the most prevalent in circulation. The occurrence of non-typable strains indicated that the strains may be diversified emphasizing the need to include emerging strains within the vaccines in use. Hence the need to continuously monitor the effects in older children.

Ethical clearance paper as a bottleneck

Subah Abderehim Yesuf — 2025-02-20

The significance of the ethical review process in human-based research undertakings cannot be overemphasized as it is necessary to uphold ethical standards and protect participants. However, the review process per se can act as a bottleneck, potentially hindering research progress and leading to academic dishonesty. The present work explores the benefits and challenges of ethical review, emphasizing issues like intellectual theft, forced authorship, and the stifling of independent researchers. Proposed solutions include leveraging previously approved designs, empowering experienced professors for clearance, establishing panels of researchers, creating voluntary ethical approval offices, utilizing private consultancy offices, and establishing a transnational ethical clearance authority. In conclusion, this work stresses the importance of finding mechanisms to streamline the ethical review process while maintaining ethical standards to foster integrity in research and combat academic dishonesty.

Male midwifery practice and acceptability: attitudes, beliefs, and associated factors among expectant mothers in Savelugu Municipal Hospital, Northern Region of Ghana

Rashidatu Monne — 2025-02-20

Introduction: male midwifery is a relatively new phenomenon in Ghana and most expectant mothers still do not recognize their contribution to reproductive healthcare. This study aims to assess the acceptability of male midwifery practice among expectant mothers in Savelugu Municipal Hospital.

Methods: this was a descriptive cross-sectional study. A total of 391 mothers were recruited using a simple random sampling technique. Data was collected using a structured questionnaire and analyzed using SAS JMP Pro V16.0.

Results: approximately 75.7% of mothers would go to a hospital where male midwives examine and attend to them, and 71.9% accepted to be delivered by a younger male midwife. Also, 70.1% agreed to share their obstetric information with a male midwife, and 43.5% agreed that their religious beliefs allowed them to be delivered by a male midwife. Mothers who had no formal education (aOR=2.23, 95% CI: 1.040-4.788, p=0.039) were more likely to go to a hospital where male midwives examine and attend to them than the others, and mothers who were employed (aOR=3.91, 95% CI: 1.770-8.631, p=0.001) were more likely to accept to be delivered by a male midwife who is younger than them than the others.

Conclusion: a significant portion of expectant mothers are open to receiving care and examinations from male midwives, even opting to go to hospitals where male midwives are available for maternal care. This suggests that male midwives can contribute to the health of expectant mothers significantly and should be encouraged to practice their profession.

Prevalence and risk factors associated with uncontrolled blood pressure in rural areas in Settat City, Morocco

Manar Aarrad — 2025-02-20

Introduction: high blood pressure, commonly known as hypertension, is one of the most widespread chronic diseases in the world. It is a serious problem whose management is essential to maintain stable blood pressure levels in the short term, and to prevent neuro-cardio-vascular complications in the long term. This study aims firstly to explore the characteristics of uncontrolled blood pressure among patient´s residents of rural areas in Settat City, and secondly to determine its prevalence and identify associated risk factors.

Methods: this is a cross-sectional, descriptive, and analytical study which took place between March and August 2023, and targeted a population of hypertensive patients following up at primary healthcare facilities in rural areas in Settat City. A questionnaire was developed and evaluated to ensure its reliability before being administered to study participants, anthropometric measurements and blood pressure readings were also taken.

Results: four hundred hypertensive patients were surveyed, 53% (212) of whom had uncontrolled blood pressure, with a mean age of 56.94 (±13.10 years), and a marked female preponderance, illustrated by 72.3% (289) were female. The risk factors associated with uncontrolled blood pressure were: male gender (aOR: 2.53, 95% CI 1.13-5.65), monthly income (aOR: 5.64, 95% CI 3.04-10.46), diabetes (aOR: 3.16, 95% CI 1.77-5.63), monotherapy (aOR: 8.42, 95% CI 2.85-24.90), poor compliance with medication (aOR: 7.48, 95% CI 4.21-13.29), and stress (aOR: 2.22, 95% CI 1.14-4.33).

Conclusion: the level of blood pressure control was unsatisfactory in this population, underscoring the imperative of educating hypertensive patients about management measures and reinforcing the quality of primary health services.

Sudden transient blindness following ureteroscopy: an uncommon complication of a common procedure (a case report)

Wael Gazzah — 2025-02-20

Perioperative vision loss following non-ophthalmic surgical procedures represents a rare but potentially serious complication. Although its occurrence in urology is infrequent, the consequences for patients and legal implications are significant. We present the case of a 53-year-old woman with no notable medical history, treated for renal lithiasis. Following the ureteroscopy, the patient experienced a sudden reduction in visual acuity. The diagnosis made was that of posterior ischemic optic neuropathy. This case illustrates a rare complication associated with ureteroscopy, highlighting the importance of increased awareness and rigorous postoperative monitoring, especially in patients with risk factors such as anemia or hypertension. Fortunately, the patient's rapid and complete recovery is encouraging, suggesting that early identification and appropriate management can lead to a favorable prognosis.

Rare clinical image on steatocystoma multiplex in scrotum region

Achal Maroti Gulghane — 2025-02-20

A 41-year-old man came to the hospital with scrotal rashes that had been present for 15 years. The rashes have grown in size and number over time without causing any pain. There was no prior medical history that would have suggested a Sexually Transmitted Disease, trauma, or scrotal irritation. He does not take immunosuppressive medications, nor is he a known diabetic. There aren't any indicators of hypercalcemia. No history of steatocystoma multiplex in scrotum region disease or any other disease. On examination, tenderness was noted over the scrotum, and small nodules and rashes were present but no mass was felt. and the rest of the head-to-foot examination was normal. Routine blood parameters showed leucocytosis (15,000 WBC/mm³) and normal levels of urea (27mg%), creatinine (0.9 mg%), electrolytes (Na-140, K-3.4) and sugar (110mg%). physical assessment, the primary result came from a scrotal examination, which showed many nodular tumour’s affecting the scrotal surface, sparing the penis and other portions of the scrotum. The biggest nodule was around 8 mm by 6 mm in size. There were no sore spots or ulcers on the lesions. Multiple opacities were visible in the location of the lesions on the scrotal X-ray. The incisional biopsy's histology revealed calcium deposits encircled by pseudo capsules and histiocytic inflammation in the scrotum's dermis. aesthetic reasons, he asked to be removed. An excellent surgical result was achieved by wide local excision of the lesion followed by direct closure. The removed lesion's histology did not change. multiple opacities were visible in the location of the lesions on the scrotal.

Bullous pemphigoid: a rare clinical image

Shraddha Patil — 2025-02-20

Bullous pemphigoid (BP) is the most common autoimmune blistering illness, accounting for 70% to 80% of all subepidermal immunobullous cases. Bullous pemphigoid primarily affects the elderly, especially those who are between 60 to 80 years of age. Bullous pemphigoid is a rare autoimmune blistering illness characterized by the development of autoantibodies directed towards basement membrane zone components such as BP180 and BP230. It primarily affects the elderly, with a peak occurrence during the seventh and eighth decades of life. We present a rare case of an 80-year-old male with a bullous pemphigoid. The patient reported widespread blistering and erosions on his back skin, and upper and lower arms, as well as itching, discomfort, and pain. The patient was presented to the hospital with a serious complaint of tense blisters. Blisters are frequently seen on the arms, and upper and lower extremities, the patient is taking corticosteroids, prednisolone, intravenous immunoglobin, and anti-inflammatory drugs. A skin biopsy is recommended for the patient. There are various therapeutic options for this sickness, including anti-inflammatory medications, pharmaceuticals that decrease antibody formation, and treatments that improve antibody removal. Systemic corticosteroids are frequently used as first-line therapy, sometimes in conjunction with immunosuppressive medications like azathioprine or mycophenolate mofetil in resistant cases. Emerging drugs, such as rituximab and intravenous immunoglobulin, show promise in situations where standard therapy fails. Despite therapeutic improvements, blood pressure remains a complex illness linked with significant morbidity and death, emphasizing the need for ongoing research to enhance diagnostic procedures and create tailored therapeutics.

Characterization of Helicobacter pylori iceA and babA2 virulence genes in dyspeptic patients at a teaching hospital in Ghana

Richard Harry Asmah — 2025-02-20

Introduction: Helicobacter pylori (H. pylori) infection is endemic in Africa. It is a major aetiological factor in the development of peptic ulcer disease and distal gastric cancers. Existing data shows that clinical outcomes are dependent on the virulence of the infecting strain, host´s susceptibility, and environmental factors. In Ghana, a previous study showed that the majority of symptomatic individuals harboured cagA and vacA virulent strains. The main objective of this study was to characterize and assess the significance of other virulence factors, specifically iceA and babA2 in Ghana.

Methods: H. pylori iceA and babA2 genes were investigated in dyspeptic patients at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. The study employed a cross-sectional design consecutively recruiting patients with upper gastrointestinal symptoms for endoscopy. Nucleic acid was extracted from gastric biopsies using a commercial kit (QIAGEN DNeasy tissue kit). H. pylori babA2 and iceA genes were amplified using extracted deoxyribonucleic acid (DNA) and primers by polymerase chain reaction (PCR).

Results: majority, (71.1%), of the study participants, were H. pylori positive when tested with urease-campylobacter-like organism (CLO). In total, 46 H. pylori urease CLO-positive samples were randomly analyzed by PCR for iceA, of which, 12 (26%) and 7 (15%) were found to have iceA1 and iceA2 respectively. Of the CLO-positive samples, 9 were randomly analysed for babA2 by PCR. Three samples were babA2 positive and 6 were babA2 negative.

Conclusion: in Ghana, although H. pylori is endemic, iceA prevalence is rather low and probably exerts a limited effect on bacterial virulence. Further evaluation would be required, not only to determine association with other virulence factors but more importantly, inter-relationships with wider host and environmental factors that impact on disease pathogenesis.

A scoping review of the social determinants of maternal health in the MENA region

Chaimae Moujahid — 2025-02-20

One crucial step to improving maternal health outcomes in any region is understanding the social determinants of maternal health, which vary significantly across the world´s geographical areas and within individual countries. The variability in these determinants is manifested in the Middle East and North Africa (MENA) region. Using a scoping review process, we identified articles analyzing social factors influencing maternal health outcomes in the MENA region. A total of 50 articles were included in this review. Several social factors impact independently or in association with maternal health outcomes or utilization of maternal health in the MENA region. These factors include: residing in an area of conflict, residing in a rural region, low accessibility and quality of health care, low level of education, antagonistic relationship with spouse and family-in-law, cultural practices such as female genital mutilation and early marriage, traditional practices, and beliefs, low household wealth, women´s financial security, women's bad childbirth history, and interpersonal violence. Multi-sector collaboration across governmental ministries, non-governmental organizations, local authorities, healthcare delivery programs, and community members is critical to creating long-term solutions in maternal health for MENA nations. Together they must address traditional practices harmful to women, poor accessibility, availability, and affordability of health services. To benefit women, a long-term commitment of organizations at local, national, and international levels to social investments in women´s education, financial status, and cultural norms is recommended for MENA nations.

Update on the epidemiology of obstructive sleep apnea syndrome in Central Eastern Tunisia over 11 years

Rania Bouchech — 2025-02-20

Introduction: obstructive sleep apnea syndrome (OSAS) is the most common sleep-related breathing disorder. Knowledge about OSAS incidence trends could be extremely useful in assessing health needs and implementing preventive measures accordingly. This study aimed at the epidemiological and clinical specificities of OSAS and to give an update on its current chronological trends.

Methods: we conducted a retrospective study including all cases of OSAS diagnosed over 11 years, from January 1, 2012, to December 31, 2022, at the Sleep Unit of the Neurophysiology Department of the Sahloul University Hospital, Tunisia.

Results: overall, 848 new cases of OSAS were diagnosed. The mean annual number of OSAS cases was 74.8/year. The crude incidence rate (CIR) was 12.3/100000 inhabitants/year, it was significantly increasing over the years (rho=0.7; p=0.01). The median age was 56 (IQR= [48–64]) years, it increased significantly during the study period from 54 years (IQR= [43–63]) in 2012 to 58 years (IQR= [50.5–65]) in 2022 (rho=0.7; p=0.015). The median BMI was 35.5 (IQR= [31.3–40.3]) kg/m². The median BMI of patients diagnosed with OSAS increased significantly from 34.6 kg/m² to 38.3 kg/m² (rho=0.75; p=0.008). This equated to an annual increase in median BMI of 0.41 kg/m². The median AHI showed a significant upward trend for all patients, rising from 26.30 events/h in 2012 to 34.07 events/h in 2022 (rho=0.68; p=0.02).

Conclusion: the CIR of OSAS is related to BMI and age. Thus, we assume that it will continue to increase in the coming years with the rise in obesity and the aging of the population.

Factors linked to the late diagnosis of breast cancer and the initiation of treatment

Kalil Cissé — 2025-02-20

Breast cancer is the first cancer in women in terms of incidence and mortality. In Morocco, it is a public health problem. Its prognosis is strongly linked to the stage at which it is diagnosed. It is a pathology for which diagnosis means are highly developed today, ranging from early detection to the demonstration of infra-clinical lesions, which has markedly improved the prognosis in developed countries. This work aims to identify the factors that lead patients to consult at an advanced stage in our daily practice. It is a retrospective study carried out from January 2018 to December 2018 including 525 patients with breast cancer followed in the medical oncology department of the Mohammed VI University Hospital in Marrakech. The average age was 54. The average time for consultation was 10.3 months. 63% of patients were from rural areas. Delayed diagnosis affected women above 35 years of age (80%). The most common method of detection was self-examination in 74% of cases. Inflammation (2.66%), ulceration (1.14%), signs of metastases (17.14%), and isolated breast nodes (79.4%) were other reasons for consultation. 82.2% of patients were locally advanced at the time of diagnosis. The time for treatment in our study was 3.7 weeks. In our practice, it is the conjunction of ignorance, poverty, socio-cultural habits, and difficult geographical access that are the essential factors in the late diagnosis of breast cancer.

Prevalence and factors associated with burnout among junior medical doctors at a South African tertiary public sector hospital

Malebo Kgatle — 2025-02-20

Introduction: burnout is a syndrome characterized by emotional exhaustion, depersonalization and emotional exhaustion that occurs due to exposure to stressful conditions over a long period. It can lead to poor job performance, apathy, and lack of productivity. This study looks at the prevalence of burnout in medical interns in a tertiary hospital in South Africa and the factors that may contribute to burnout.

Methods: an analytical cross-sectional study was conducted. Medical interns working in Chris Hani Baragwanath Hospital in 2019 were invited to participate. The participants filled questionnaire that had demographic information, the Maslach Burnout Inventory Scale, a scale to rate the rotations that they believed contributed towards their burnout and factors they think contributed towards their burnout. Our data was analyzed using Stata.

Results: out of a possible 165 potential participants, 101 medical interns enrolled. 95% of the participants reported burnout. Statistically significant factors contributing towards burnout were lack of resources and poor relations with support staff and senior staff. The medical rotation that was reported by the participants to contribute most towards their burnout was internal medicine.

Conclusion: burnout in this population of medical interns is alarmingly high. Higher than reported in similar studies in South Africa and internationally.

Sexual practices, their influencers, and utilization of HIV services among female sex workers in Mombasa County, Kenya

Robert Abuga Mokinu — 2025-02-20

Introduction: female sex workers (FSWs) are vulnerable to acquiring HIV and other sexually transmitted infections due to unprotected sex. Understanding and addressing the gaps in safer sex among FSWs can help to reduce HIV acquisition and transmission. This study described sexual practices, their correlates and use of HIV services among FSWs in Mombasa County, Kenya.

Methods: participants were recruited for a baseline survey by a time-location cluster randomized design at predetermined intervals from five bars and five clubs in Mombasa County until a sample size of 160 was reached. Descriptive statistics and inferential analysis using R were conducted, and p<0.05 was regarded as statistically significant.

Results: nearly all (99%) of the participants were unmarried, and 11% had tertiary education. Ninety-eight percent (98%) reported vaginal intercourse, 51% reported using alcohol/drugs before sex, and 28% practiced unprotected intercourse. About 64% had tested for HIV within three months, 14% believed that it is safe to reuse condoms, and 10% that it is safe to engage in unprotected sex. In bi-variate analysis, FSWs were more likely to engage in unprotected intercourse if they reported more frequent sex, more frequent sex with regular clients, poor HIV knowledge, alcohol/drug use, and violence. In multivariate analysis, risky sexual practices were associated with frequency of sexual intercourse, alcohol/drug use, and poor HIV knowledge.

Conclusion: female sex workers engage in unprotected sex while under the influence of substances, belief in re-using condoms and have high frequency of sexual intercourse. Inadequate knowledge of HIV and substance use significantly correlated with unprotected sex. Interventions to address these modifiable factors are needed to mitigate the risk of HIV among FSWs.

Unexpected cause of lower limb edema

Kaoutar Khabbache — 2025-02-20

A 16-year-old male patient, with no notable personal medical history, was consulted for edema in the lower limbs. The familial medical history reveals a 25-year-old maternal uncle undergoing treatment for renal insufficiency at the hemodialysis stage. The onset of symptoms traces back to the age of 13 when the child experienced episodes of intermittent painful edema in the lower limbs. This prompted the patient to consult several doctors and undergo various assessments; inflammatory, renal, hepatic, and cardiac functions were all found to be normal. The clinical examination revealed unilateral edema in the left lower limb extending to the ankles. Additionally, multiple millimeter-sized erythematous maculopapular lesions were observed on his trunk, back, and umbilicus, corresponding to diffuse angiokeratomas, while the rest of the clinical examination was unremarkable. Fabry disease, a lysosomal disorder, was suspected due to the history of renal disease in a young relative and the presence of lymphedema and angiokeratoma. Confirmation of Fabry disease was achieved through enzymatic assay, indicating a high value of Lyso-GL-3 level (90.5 ng/ml, with a cut-off value of 0.0-3.5), and further supported by a molecular study revealing the presence of a hemizygous mutation c.602C>T (p. (Ser201Phe)). Cardiac ultrasound and ophthalmic assessment yielded normal results, and renal function showed no abnormalities with negative proteinuria. The patient was proposed for enzyme replacement therapy.

Analysing lapsing rates among first-time blood donors at a blood centre in Zimbabwe using survival analysis

Delson Chikobvu — 2025-02-20

Introduction: blood centres are often faced with the problem of donor lapsing resulting in loss of donors from the already strained donor pool. In Zimbabwe, 70% of the donated blood comes from younger donors aged 40 years and below, who at the same time, have high attrition rates. This study seeks to apply the concept of survival analysis in analysing blood donor lapsing rates.

Methods: in analysing the donor lapsing and retention rates, data on 450 first-time blood donors at the National Blood Service Zimbabwe, in Harare´s blood bank for the period 2014 to 2017 was extracted from the donors´ database. The Cox proportional hazards (Cox PH) and Kaplan-Meier methods were applied in the analysis. Donor demographic characteristics suspected of having effect on donor lapsing and retention were identified and analysed.

Results: the study findings show that 56.9% of the donors had lapsed by the end of the four-year study period. Results from the multiple Cox PH model indicate that donor age had a significant effect on blood donor retention time (p = 0.000918 < 0.05). The hazard ratio (HR) = 0.615 with 95% CI: (0.461; 0.820) shows that the relatively older donors had a lower hazard (38.5% lower) of lapsing compared to the hazard for younger donors. The effect of gender, blood donor group and donation time interval on donor retention and attrition were not statistically significant. Male donors had HR = 1.03; 95% CI (0.537; 1.99) with (p = 0.922 > 0.05) and donors with a 4-month interval between donations had HR = 1.31; 95% CI (0.667; 2.59) with (p = 0.430 > 0.05).

Conclusion: the study confirmed the problem of donor attrition faced by blood centres. The age of the donor had a significant effect on the retention time of blood donors before lapsing. The older the blood donor, the lower the risk of lapsing. The Zimbabwe National Blood Service (NBSZ) Blood Centre authorities should have a critical mass of individuals above 40 years as potential blood donors because of their reliability in blood donation according to the study findings.

Factors in postoperative length of hospital stay among surgical patients in a rural Ethiopian hospital: an observational study

Eyasu Samson Kebede — 2025-02-20

Introduction: surgical site infection is associated with longer postoperative hospital stays. We explored factors associated with longer postoperative hospital stays among patients in the surgical ward of a primary rural hospital in Ethiopia, where laboratory facilities for microbiological confirmation of surgical site infections were not available.

Methods: an observational study was performed for patients ≥ 18 years of age who underwent elective or emergency surgery from 22^nd June 2017 to 19^th July 2018. Data were taken from paper-based medical records and patient interviews. The primary outcome was postoperative length of hospital stay. Data were analyzed by multivariable linear regression using Stata software, version 13.

Results: seventy-five patients were enrolled, sociodemographic data was obtained from 14 of these patients by interview, and 44 patients had complete outcome and covariate data and were included in regression analysis. Median length of preoperative hospital stay was 3.0 (interquartile range 2.0) days. Postoperative length of hospital stay was longer by 3.8 days (95% confidence interval (CI) 1.05-6.55; p=0.008), 4.7 days (95% CI 1.64-7.66; p=0.004), and 5.9 days (95% CI 2.70-9.02; p=0.001), for patients 35-54 years, 55-64 years and the 65+ years respectively, compared to patients who were 18-34 years of age. Patients who received preoperative antibiotics stayed 5.3 days longer (95% CI 1.67-8.87; p=0.005) compared to those who were not given preoperative antibiotics.

Conclusion: age and improper use of preoperative antibiotics compound the risk for postoperative length of stay. Infection prevention protocols, including staff training, and surveillance for surgical site infections are critical for improving hospital outcomes.

Sexual violence and associated factors among female large-scale industry workers in Bahir Dar city administration, Amhara region, Ethiopia

Melkamu Atalel — 2025-02-20

Introduction: sexual violence is currently a serious public health problem affecting women´s health. Globally, 1 in 3 women faces sexual violence in their lifetime. Female industry workers are at an increased risk of sexual violence. Assessing the magnitude and factors associated with sexual violence among female industrial workers is important for interventions. The objective was to assess the prevalence and factors associated with sexual violence among female large-scale industries workers in Bahir Dar, Ethiopia, 2021.

Methods: institution-based cross-sectional study was conducted on 807 female industry workers from September to October 2021. Participants were selected by systematic random sampling. The data were collected by a structured questionnaire. Data entry and analysis were done by Epi data v.3.1 and SPSS v.23, respectively. Multivariable logistic regression analysis was done to identify factors. Adjusted odds ratios were computed at 95%CI. A P-value below 0.05 was used to declare association.

Results: the prevalence of sexual violence were 59.4% (95% CI; 56.0%-62.6%). The significantly associated factors include; age less than twenty-five (AOR=4.01, 95%CI; 2.81, 10.83), never-married women (AOR=3.07, 95%CI; 1.11, 8.46), being secondary education (AOR=2.65, 95%CI; 1.51, 4.66), being contract employee (AOR=4.65, 95%CI; 1.92, 11.22), drinking alcohol (AOR=3.01, 95%CI; 1.49, 6.09), and night work shift (AOR=9.01, 95%CI; 4.53, 17.93).

Conclusion: high rate (59.4%) of sexual violence was reported. Age, marital status, educational status, contract type of work agreement, drinking alcohol, and working night work shift were risk factors. Hence, emphasis on creating safe working environment & transportation, education on reproductive rights and reporting of sexual violence.

Epidemiology, treatment outcome and resistance profile of pulmonary tuberculosis cases at the Niamey national anti-tuberculosis center in Niger: a retrospective study

Mamane Djika — 2025-02-20

Introduction: tuberculosis remains a major public health problem, with continuing high levels of prevalence, and mortality. In Niger, the incidence of tuberculosis remains high. This study aims to investigate the epidemiology of pulmonary tuberculosis at the National Anti-Tuberculosis Center of Niamey in Niger.

Methods: this study used a quantitative approach with a retrospective and descriptive design. Data were obtained from positive pulmonary tuberculosis cases detected by microscopy on Ziehl-Neelsen stained sputum at the National Anti-Tuberculosis Center (NATC) in Niamey, Niger covered the period between June 2017 and January 2020. 955 pulmonary TB patients were recorded whose diagnosis was based either on clinical-radiological arguments (thus negative microscopy) or positive microscopy. This form was used to collect data recorded in the clinical case registers, registers, and Excel files of the GeneXpert platform of the NATC laboratory.

Results: eighty-nine-point eleven percent (89.11%) of the patients were microscopy-positive. Among the study population, men were the most affected by tuberculosis with 80.03%. The 25-34 age group, representing 23.77%, was the most affected. 6.93% of patients were co-infected with tuberculosis and HIV. All patients were put on treatment, with a therapeutic success rate of 72.38% and a therapeutic failure rate of 10.95%. Among the cases of therapeutic failure, 80.90% had Mycobacterium tuberculosis complex detected and 27.14% were resistant to Rifampicin.

Conclusion: Niger continues to have a tuberculosis epidemic which requires monitoring. Improving the diagnostic system for more effective management of the disease is important for appropriate diagnosis and treatment.

Intérêt du sulfate de magnésium pour la stabilité hémodynamique en cœliochirurgie: étude prospective contrôlée randomisée

Imen Zouche — 2025-02-20

Introduction: au cours de la chirurgie laparoscopique, l'insufflation du dioxyde de carbone pour la création de pneumopéritoine augmente la pression artérielle, la fréquence cardiaque et la résistance vasculaire systémique. Le but de notre étude était d´étudier l'efficacité de sulfate de magnésium dans la prévention des réactions hémodynamiques indésirables associées au pneumopéritoine chez les patients subissant une cholécystectomie laparoscopique.

Méthodes: nous avons mené une étude clinique prospective contrôlée randomisée en double aveugle incluant des patients proposés pour cholécystectomie laparoscopique et répartis en deux groupes équivalents: le groupe Mg²⁺ ayant reçu en intraveineux lent 50 mg/kg de sulfate de magnésium avant l'insufflation de pneumopéritoine et le groupe S ayant reçu le même volume de 0,9% de solution saline. Notre critère de jugement principal était les variations de la pression artérielle systolique (PAS) peropératoires relatives au pneumopéritoine notamment à une minute après l'insufflation. Les critères de jugement secondaires étaient le retentissement hémodynamique du pneumopéritoine en termes de PAS, pression artérielle diastolique (PAD), pression artérielle moyenne (PAM), et fréquence cardiaque (FC) de deux minutes après l´insufflation jusqu´à l´extubation et en post opératoire ainsi que la présence d´éventuels effets indésirables liés à l´administration du sulfate de magnésium.

Résultats: nous avons inclus 70 patients répartis en deux groupes de 35. La PAS était significativement supérieure chez le groupe S à l'insufflation (T0), 3 min, 4 min et 5 min après l'insufflation, et à 60 min post opératoire. La FC était significativement plus élevée chez les patients du groupe S par rapport au groupe Mg²⁺ à 7 min et 8 min après l'insufflation. Aucune différence significative des mesures de la PAD et de la PAM n'a été observée entre les deux groupes. Aucun effet indésirable lié à l'administration de magnésium n´a été noté.

Conclusion: le sulfate de magnésium administré avant l'insufflation du pneumopéritoine a assuré une meilleure stabilité hémodynamique peropératoire au cours de la coeliochirurgie.

Severity of neuromeningeal tuberculosis in Morocco: a critical evaluation of epidemiological trends and treatment efficacy

Fadia Bejja — 2025-02-20

Introduction: neuromeningeal tuberculosis (NMT) is a significant public health challenge in Morocco because of its acute severity and high mortality rates. This study aims to comprehensively evaluate the epidemiological, clinical, therapeutic, and disease progression characteristics of NMT in the Kenitra province.

Methods: a retrospective analysis was conducted on the medical records of patients diagnosed with NMT at the Diagnostic Center of Tuberculosis and Respiratory Diseases in Kenitra from 2014 to 2017.

Results: among the 33 identified NMT cases, predominantly males (57.6%) were affected, with an age range of 4-76 years and a median age of 25 years. Extrapulmonary manifestations were prevalent, constituting 78.8% (n=26) of all cases, with meningeal localization in 45.5% (n=15) of confirmed cases. Furthermore, 9.1% (n=3) of cases were associated with unconfirmed cerebral tuberculosis (TB), and 12% (n=4) exhibited miliary TB. Familial transmission and comorbidities were identified as significant factors in disease progression. More than half of the patients received standardized antibacillary treatment during hospitalization, which lasted between 9 and 12 months. Treatment outcomes were generally positive (73%), but a 12% case fatality rate and 15% loss to follow-up were observed.

Conclusion: this study highlights the complex clinical and public health challenges posed by NMT in Morocco. It emphasizes the need for improved health strategies that not only increase public awareness but also enhance the accessibility and quality of diagnostic services and treatment options.

Childbirth experiences and satisfaction with birth among women in selected Nigerian healthcare facilities during COVID-19 pandemic: a mixed method

Chikaodili Ndidiamaka Ihudiebube-Splendor — 2025-02-20

Introduction: childbirth experiences are women´s personal feelings and interpretations of birth processes, which could be difficult to describe and explain. The outbreak of Coronavirus disease (COVID-19) instilled tension and worries in all Nigerian citizens and could also affect the birth experiences and satisfaction of women. Thus, this study explored the experiences of childbirth and satisfaction with birth among women in selected Nigerian healthcare facilities during COVID-19 pandemic.

Methods: the study adopted a concurrent triangulation mixed method design, which utilized an in-depth interview and questionnaire to obtain different but complementary data. Sample sizes of 304 and 15 women were recruited for quantitative and qualitative data, respectively. Analysis was done using descriptive statistics and thematic content analysis.

Results: the majority of the participants perceived childbirth to be labor and delivery (3.66 ± 3.16); participants were mostly satisfied with reception received from staff (2.35 ± 2.29) and respecting their privacy (2.04 ± 1.52). Five (5) themes and 18 subthemes emerged from qualitative data. The themes were: understanding of childbirth, satisfaction with care, hospital experiences, unique experiences during birth, and social support.

Conclusion: women had more positive and less negative but unique childbirth experiences. The majority expressed satisfaction within the care given by qualified and competent health workers, despite the challenges posed by COVID-19 pandemic. The provision of physical and emotional support by intimate partners, midwives´ and family members during delivery had a significant influence on maternal satisfaction with the entire birth experience.

Determinants of low birth weight in Franceville, Southeast Gabon

Yann Vital Sima Biyang — 2025-02-20

Introduction: birth weight is a critical indicator of neonatal health and predicts future developmental outcomes. Despite its importance, there is a notable lack of research on the determinants of low birth weight (LBW) in southeast Gabon. This study aims to fill this gap by identifying factors contributing to LBW at the Centre Hospitalier Universitaire Amissa Bongo in Franceville.

Methods: this retrospective analysis covered the period from February 2011 to May 2017, focusing on postpartum women and their infants. Data were analyzed using R software (version 4.3.2), employing both descriptive statistics and logistic regression. Statistical significance was determined at a p-value of less than 0.05.

Results: among the 877 births analyzed, the prevalence of LBW was 8.4%. Bivariate analysis identified several factors associated with an increased risk of LBW, including, primigravida women (COR (95%CI) =0.59 (0.36-0.98), P = 0.036), primiparous women (COR (95%CI) =0.58 (0.36-0. 94), P = 0.024), women with a gestational age <37 weeks (COR (95%CI) =0.07 (0.04-0.11), P<0.001), women with ≤2 antenatal visits (COR (95%CI) =0.39 (0.18-0.93), P= 0.021), and women who underwent cesarean delivery (COR (95%CI) =0.46 (0.26-0.84), P = 0.008). However, multivariate analysis showed that only gestational age (AOR (95%CI) = 0.07 (0.04-0.11), P<0.001) and cesarean delivery (AOR (95%CI) = 0.48 (0.25-0.95), P = 0.03) were significantly associated with LBW.

Conclusion: this study highlights the importance of gestational age and delivery method in the prevalence of LBW in southeast Gabon. These findings underscore the need for targeted interventions to address these risk factors, thereby improving neonatal health outcomes.

Occlusion abdominale révélant un lymphome colique: à propos d´un cas

Mohamed Zioui — 2025-02-20

Le lymphome du colon est une tumeur gastro-intestinale maligne rare qui peut être révélé par une complication exceptionnelle et grave qui est l´occlusion intestinale. Son traitement repose sur la chirurgie et l´immunochimiothérapie. Nous rapportons le cas d´un lymphome diffus à grandes cellules B colique révélé par une occlusion, diagnostiqué sur une pièce opératoire chez un homme de 64 ans qui a été en rémission complète après six cures R-CHOP.

Extra-axial primary meningeal pleomorphic xanthoastrocytoma: a case report

Emna Mili — 2025-02-20

Pleomorphic xanthoastrocytoma (PXA) is a rare low-grade glial neoplasm of the central nervous system accounting for less than 1% of all astrocytomas. Similar to other gliomas, it can rarely arise from glial nests in the meninges, manifesting as an extra-axial mass mimicking a meningioma. Extra axial PXA is an extremely rare entity. Therefore, there are no standardized guidelines. In this article, we report the fourth case, so far, of a solitary primary extra-axial PXA mimicking a meningioma in a 23-year-old woman who presented with temporal seizures and features of raised intracranial pressure. Through this case, we tried to discuss all treatment options.