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High blood pressure and aeronautical fitness: experience at the aeromedical expertise center of Rabat 高血压与航空健康:拉巴特航空医学专业中心的经验
Pub Date : 2024-02-01 DOI: 10.11604/pamj.2024.47.41.42262
Fahd Bennani Smires, Zakaria Iloughmane, M. Elghazi, Meryem Zerrik, H. Echchachoui, M. Chemsi
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.
高血压是与严重心血管事件密切相关的主要心血管风险因素。这是一个真正的公共健康问题,每三个成年人中就有一个以上受到影响。尽管空勤人员经过了非常严格的医疗筛选,并且空勤医生在复查期间进行了严格和定期的医疗监测,但他们也未能逃脱这一病症。我们在拉巴特的空勤人员医疗专业中心进行了一项回顾性研究,收集了 34 名高血压民用空勤人员从 2012 年 1 月到 2022 年 12 月的 10 年资料。研究时的年龄中位数为 56.5 岁。空勤人员从事的航空专业以一级为主。摩洛哥民航机组人员的高血压患病率:在航空医学专业中心 10 年间每年监测的 2000 人中,收集到 34 例病例,即:1.7%。发现者的平均年龄为 49 岁,其中 23 例是在定期体检时通过系统筛查确诊的。超过 24 名机组人员没有高血压家族史。在治疗方面,我们为所有空勤人员系统地制定了生活方式和饮食措施,18 名患者接受了单一疗法,11 名接受了双重疗法,2 名接受了三重疗法。与健身决定相比,这些决定根据高血压的等级、并发症的控制和航空功能而有所不同。发现空勤人员患有高血压会危及航空安全,有可能在飞行中因神经或心血管并发症而导致微小或突然丧失能力,这可能会影响适任决定。然而,近年来在医学和高血压管理方面取得的进步促使医疗和航空当局修订了适任标准。
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引用次数: 0
A long term complication clitoral cyst: after female genital mutilation 女性生殖器切割后阴蒂囊肿的长期并发症
Pub Date : 2023-01-01 DOI: 10.11604/pamj.2023.46.23.31939
Özgür Şahin, Erol Nadi Varlı, Abdirahman Omar Moallim, Harun Egemen Tolunay
Female genital mutilation (FGM) was seen in 30 countries, especially in Africa and also in Asia and the Middle East. According to WHO data, Somalia is where FGM is performed most frequently. Our study aimed to evaluate the recordings of patients with FGM who were diagnosed with a traumatic clitoral cyst. We identified the clitoral cysts cases between February 2015 and August 2020. We collected clinical, surgical, sociodemographic, and histopathological details such as age, marital status, patient resume, age at which FGM was performed, complaints, size of the cyst consultation reasons, FGM procedural long-term complications, sexual function, husband polygamic relationship status, and histological findings. A total of 21 patients diagnosed with clitoral cysts were included in the study. The technique was easily applied in every patient, and the cysts were removed intact, except in 2 patients. There were no intraoperative complications; only minimal bleeding was seen. Except for one patient, all had unilocular cysts, and the final pathological examination revealed an epidermal inclusion cyst. We observed a neuroma developed due to genital trauma due to FGM in one of our patients. Female circumcision and its consequences are not familiar to many healthcare professionals in the developed world. We want to increase awareness of female circumcision and its long-term complication of clitoral cysts among healthcare professionals worldwide.
女性生殖器切割(FGM)在30个国家,特别是在非洲,也在亚洲和中东看到。根据世卫组织的数据,索马里是实施女性生殖器切割最频繁的地方。我们的研究旨在评估诊断为外伤性阴蒂囊肿的女性生殖器切割患者的记录。我们在2015年2月至2020年8月期间确定了阴蒂囊肿病例。我们收集了临床、手术、社会人口学和组织病理学细节,如年龄、婚姻状况、患者简历、进行女性生殖器切割的年龄、主诉、囊肿大小咨询原因、女性生殖器切割手术的长期并发症、性功能、丈夫一夫多妻关系状况和组织学结果。本研究共纳入21例诊断为阴蒂囊肿的患者。除2例患者外,所有患者的囊肿均被完整切除。无术中并发症;仅见少量出血。除1例外,其余均为单眼囊肿,最终病理检查为表皮包涵性囊肿。我们观察到一个神经瘤的发展,由于生殖器创伤,由于女性生殖器切割在我们的一个病人。发达国家的许多卫生保健专业人员对女性割礼及其后果并不熟悉。我们希望提高女性包皮环切术及其阴蒂囊肿的长期并发症的认识,在世界各地的医疗保健专业人员。
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引用次数: 0
Exploring data trends and providers' insights on measles immunization uptake in south-west Nigeria 探索尼日利亚西南部麻疹免疫接种的数据趋势和提供者的见解
Pub Date : 2023-01-01 DOI: 10.11604/pamj.2023.46.28.37572
Marcus Ilesanmi, Babatunde Olujobi, Oluwapelumi Ilesanmi, Valerie Umaefulam
Introduction: measles outbreak remains a recurring episode and continues to be responsible for millions of deaths globally every year. This study examines measles immunization coverage and uncovers barriers and enablers to effective provision and uptake of measles immunization services from the supply end and provider´s perspective in a developing nation´s context.
导言:麻疹暴发仍然是一个反复发作的事件,每年继续在全球造成数百万人死亡。本研究考察了麻疹免疫覆盖范围,并从发展中国家的供应端和提供者的角度揭示了有效提供和吸收麻疹免疫服务的障碍和促进因素。
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引用次数: 0
Brain computed tomography perfusion analysis in HIV-seropositive adults with and without neurocognitive impairment in Nigeria: outcomes and challenges of a pilot study 尼日利亚有和无神经认知障碍的艾滋病毒血清阳性成人的脑计算机断层扫描灌注分析:一项试点研究的结果和挑战
Pub Date : 2023-01-01 DOI: 10.11604/pamj.2023.46.15.36320
Godwin Ogbole, Richard Efidi, Joseph Odo, Chinonye Okorie, Tomiwa Makanjuola, Abiodun Adeyinka, Christina Sammet, Baiba Berzins, Akpa Onoja, Adesola Ogunniyi, Ann Ragin, Babafemi Taiwo
Introduction the significance of cerebrovascular disease in HIV-associated neurocognitive disorder (HAND) in a homogeneous black population has not yet been determined. This incident case-control study used CT perfusion imaging to quantify and compare regional cerebral blood flow parameters in neuro-cognitively impaired and unimpaired HIV+ participants of the Ibadan Cohort on Neuro AIDS (ICON) in Nigeria. Methods this was an incident case-control study consisting of twenty-seven HIV+ adults, classified based on Frascati criteria into neurocognitive impaired (n=18) and unimpaired (n=9) groups, who had brain computed tomographic perfusion (CTP) with a 64-slice Toshiba T scanner. The standard deviation (SD) of regional mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV) values were calculated for bilateral basal ganglia (BG), frontal, parietal, temporal, and occipital regions from CT perfusion maps. The regional mean values and variability (SD) in the CTP measures were compared in the groups using an independent student t-test. Results differentially higher variability in the bilateral CBF measures in the parietal (right; OR = 1.14, x̄ =5.61, p=0.041, CI=0.27-11.35/left; OR = 1.16, x̄=7.01, p=0.03, CI=5.6-13.47) and time to peak (TTP) measures in the basal ganglia (right; OR = 3.78, x̄=0.88, p=0.032, CI=0.081-1.67/left; OR = 2.44, x̄=1.48, p=0.020, CI=0.26-2.71) and occipital (right; OR = 2.18, x̄=1.32, p=0.018, CI=0.25-2.38/left; OR = 1.93, x̄=1.08, p=0.034, CI=0.086-2.06) regions were observed in the cognitively impaired group compared to the unimpaired group. Conclusion the study evidence suggests that alterations in cerebral perfusion implicated in HIV-associated neurocognitive disorder may be possibly demonstrated using CTP, a readily available resource in most African countries saddled with the highest burden of HIV.
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引用次数: 0
Chronic recurrent multifocal osteomyelitis of clavicle: a rare isolated location: a case report 锁骨慢性复发性多灶性骨髓炎:罕见的孤立部位:1例报告
Pub Date : 2023-01-01 DOI: 10.11604/pamj.2023.46.53.39452
Khaled Kamoun, Wajdi Arfa, Malek Ben Chaalia, Wajih Oueslati, Leila Abid, Mourad Jenzri
Chronic recurrent multifocal osteomyelitis (CRMO) is a rare disease. It is a non-microbial inflammatory bone affection that occurs more often in children with insidious onset and non specific presentation making diagnosis challenging. The aim of this study was to report a case of CRMO with unusual location. A 9-year-old child had a painful swelling over the medial side of clavicle with fixed mass. Radiographs showed osteolytic lesion on the medial part of clavicle extending to the acromioclavicular joint with soft tissue edema in magnetic resonance imaging (MRI). No inflammatory markers in biological exam. Needle biopsy, initially performed, suspected bone infection but children didn´t recover after 2 weeks of antibiotics. Surgical biopsy, histology sections was compatible with CRMO diagnosis. Children received a non steroid inflammatory drug with positive response, pain relief and decreasing of the clavicle swelling. CRMO should be suspected and biopsy is some time helpful in such unusual location.
慢性复发性多灶性骨髓炎(CRMO)是一种罕见的疾病。这是一种非微生物性炎症性骨病变,多发生在发病隐匿且无特异性表现的儿童中,使诊断具有挑战性。本研究的目的是报告一例异常位置的CRMO。一个9岁的孩子在锁骨内侧有一个疼痛的肿胀和固定肿块。x线片示锁骨内侧溶骨性病变延伸至肩锁关节,MRI显示软组织水肿。生物学检查未见炎症标志物。最初进行针活检,怀疑骨感染,但儿童在使用抗生素2周后未恢复。手术活检、组织学切片与CRMO诊断相符。儿童接受非类固醇消炎药治疗,反应积极,疼痛缓解,锁骨肿胀减轻。在这种不寻常的位置,应怀疑CRMO,活检有时是有帮助的。
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引用次数: 0
A propos de 39 cas de diverticules sous-uretraux de la femme: experience monocentrique sur 30 ans 约39例女性尿道下憩室:单中心经验超过30年
Pub Date : 2023-01-01 DOI: 10.11604/pamj.2023.46.51.41246
Salim Lachkar, Ahmed Ibrahimi, Imad Boualaoui, Hachem El Sayegh, Yassine Nouini
Nous rapportons l´analyse rétrospective de 30 années d´expérience concernant 39 femmes atteintes de diverticule sous-urétral. L´âge moyen est de 37 ans (24-56 ans). La parité moyenne est de 2 (1-7). Soixante-cinq pourcent (65%) des accouchements sont dystocique, avec utilisation de forceps dans 43% des cas. Des antécédents infectieux urologiques ou gynécologiques sont présents chez toutes les patientes. Les symptômes révélateurs sont hétérogènes et sont principalement les infections urinaires récidivantes (26 cas), la pollakiurie (23 cas), l´écoulement urétral post-mictionnel (21 cas), la douleur vaginale (17 cas) et une sensation de boule vaginale (15 cas). Le bilan radiologique est varibale: urographie intra-veineuse, urétrocystographie rétrograde et mictionnelle, échographie ou IRM. La diverticulectomie par voie transvaginale est le traitement pour toutes les patientes, sans complication per-opératoire rapportée. A 4 ans les résultats sont satisfaisants. Nous déplorons 4 récidives diverticulaires. Ces données fournissent des informations importantes sur les caractéristiques cliniques, les résultats diagnostiques et les résultats à long terme de la diverticulectomie transvaginale, permettant ainsi une meilleure prise en charge de cette affection rare.
我们报告了对39名患有尿道下憩室的女性30年经验的回顾性分析。平均年龄37岁(24-56岁)。平均奇偶性是2(1-7)。65%(65%)的分娩是困难的,43%的病例使用镊子。所有患者均有泌尿科或妇科感染史。症状各不相同,主要为复发性尿路感染(26例)、尿失禁(23例)、排尿后尿流(21例)、阴道疼痛(17例)和阴道球感(15例)。影像学检查包括静脉曲张:静脉内尿路造影、逆行和尿路造影、超声或mri。经阴道憩室切除术是所有患者的治疗方法,无术后并发症报告。4岁时,结果令人满意。我们报告了4例憩室复发。这些数据为经阴道憩室切除术的临床特征、诊断结果和长期结果提供了重要信息,从而有助于更好地管理这种罕见的疾病。
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引用次数: 0
Presentation and challenges in management of COVID-19 in sickle cell disease: case report 镰状细胞病中COVID-19治疗的表现和挑战:病例报告
Pub Date : 2023-01-01 DOI: 10.11604/pamj.2023.46.25.32057
Sheliza Parvez Thaver, Saliha Shafik Dawood, Nahida Zahir Walli
Sickle cell has predominantly been a disease of the Sub Saharan Africa. There is scanty data in Africa and none in Tanzania regarding patients with sickle cell disease infected with COVID-19 especially in the paediatric group. This is concerning because a large population of children living with sickle cell disease are found in this part of the world where scarcity of resources also prevail. This is the first paediatric case of sickle cell disease and COVID-19 reported in Tanzania; highlighting the presentation and challenges faced in management. It is also the first case in literature describing secondary infection in a child with COVID-19 and underlying sickle cell disease. Our patient was a female child of African origin with underlying sickle cell disease who had recurrent admissions. She presented with cough, fever, chest and abdominal pain and was managed for acute chest syndrome and vaso-occlusive crisis. During the second admission, she developed respiratory distress, infection with COVID-19 was confirmed and managed accordingly. However, she was re-admitted due to bilateral arm pain and physical findings were suggestive of secondary respiratory bacterial infection. She was then started on a different treatment plan. Despite challenges faced in the management of the patient, the outcome was favourable. It is important to recognize the presentation of COVID-19 in children with sickle cell disease and challenges faced in management so that the epidemiologic characteristics, spectrum of the disease and its outcomes can be understood better in the context of Sub Saharan Africa.
镰状细胞病主要是撒哈拉以南非洲的一种疾病。关于感染COVID-19的镰状细胞病患者,特别是儿科患者的数据在非洲很少,在坦桑尼亚也没有。这是令人担忧的,因为在世界的这一地区发现了大量患有镰状细胞病的儿童,而这一地区也普遍缺乏资源。这是坦桑尼亚报告的首例小儿镰状细胞病和COVID-19病例;强调管理的表现和面临的挑战。这也是文献中第一例描述患有COVID-19和潜在镰状细胞病的儿童继发感染的病例。我们的病人是一名非洲裔女性儿童,患有潜在的镰状细胞病,曾多次入院。她表现为咳嗽、发烧、胸腹疼痛,因急性胸综合征和血管闭塞危象而接受治疗。第二次入院时出现呼吸窘迫,确诊感染COVID-19并进行相应处理。然而,由于双侧手臂疼痛,她再次入院,体检结果提示继发性呼吸道细菌感染。然后她开始了一个不同的治疗计划。尽管在患者管理方面面临挑战,但结果是有利的。重要的是要认识到COVID-19在患有镰状细胞病的儿童中的表现以及在管理方面面临的挑战,以便更好地了解撒哈拉以南非洲地区的流行病学特征、疾病范围及其结果。
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引用次数: 0
Entangled epidemics: tackling vaccine-preventable diseases in the era of frequent epidemics in Africa 纠缠的流行病:在非洲频繁流行的时代处理疫苗可预防的疾病
Pub Date : 2023-01-01 DOI: 10.11604/pamj.2023.46.32.37485
Vinie Kouamou, Seth Inzaule
Whilst the largely limited health system and funds are already overstretched while responding to multiple epidemics, ongoing vaccine-preventable diseases (VPD) including polio and measles continue to be a public health threat and expose the weaknesses of the public health system in many African countries. The surge in VPD outbreaks during epidemics appears to be a common trend in Africa, often due to reduced vaccination coverage. The World Health Organization reported that, in 2021, nearly 25 million children missed their first measles dose, 5 million more than in 2019. The drop in childhood immunizations was partly attributed to the COVID-19 pandemic which has caused significant interruption in public health services delivery and reduced vaccination coverage. Vaccines help reduce the incidence of VPD. Therefore, effective VPD outbreak response mechanisms and strategies that include ramping up catch-up campaigns for immunization during epidemic troughs including the provision of vaccines outside clinics as well as assessing newer vaccine delivery models during pandemics are essential to minimize the impact of VPD outbreaks during emerging epidemics. Ensuring access to vaccines to address outbreaks and provide supplemental vaccination is essential if we are to be a VPD-free region.
虽然基本上有限的卫生系统和资金在应对多种流行病时已经超负荷,但包括脊髓灰质炎和麻疹在内的持续疫苗可预防疾病(VPD)继续构成公共卫生威胁,并暴露了许多非洲国家公共卫生系统的弱点。流行期间流行性腹泻暴发的激增似乎是非洲的一个共同趋势,通常是由于疫苗接种覆盖率降低。世界卫生组织报告称,2021年,近2500万儿童未接种首次麻疹疫苗,比2019年多500万。儿童免疫接种率下降的部分原因是COVID-19大流行导致公共卫生服务严重中断,疫苗接种覆盖率下降。疫苗有助于减少VPD的发病率。因此,有效的VPD疫情应对机制和战略,包括在流行低谷期间加强免疫接种补充运动,包括在诊所外提供疫苗,以及在大流行期间评估较新的疫苗递送模式,对于尽量减少新出现的流行病期间VPD疫情的影响至关重要。确保获得疫苗以应对疫情并提供补充疫苗接种是必不可少的,如果我们要成为一个无vpd的区域。
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引用次数: 0
Exogenous Cushing syndrome 外源性库欣综合征
Pub Date : 2023-01-01 DOI: 10.11604/pamj.2023.46.45.41228
Ashwin Karnan, Anjana Ledwani
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引用次数: 0
Usage and parental knowledge of antibiotics in children undergoing (adeno) tonsillectomy in northern Tanzania 坦桑尼亚北部接受(腺)扁桃体切除术的儿童抗生素的使用和家长知识
Pub Date : 2023-01-01 DOI: 10.11604/pamj.2023.46.59.41190
Denis Robert, Gerjon Hannink, Jesca Godlisten Lyimo, Maroeska Rovers, Niels van Heerbeek
Introduction: Antimicrobial Resistance (AMR) is a growing concern globally, mostly being contributed by a limited understanding of antibiotic utilization as a result of inappropriate acquisition and prescription. Parental awareness is essential in optimizing their usage and preserving the effectiveness of these crucial medications. The current study investigates the usage and parental knowledge of antibiotics in children undergoing (adeno) tonsillectomy ((A)TE) in Northern Tanzania.
抗菌素耐药性(AMR)是一个日益受到全球关注的问题,主要是由于不适当的获取和处方导致对抗生素使用的了解有限。父母的意识对于优化它们的使用和保持这些关键药物的有效性至关重要。目前的研究调查了坦桑尼亚北部接受(腺)扁桃体切除术((A)TE)的儿童抗生素的使用和父母的知识。
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引用次数: 0
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The Pan African Medical Journal
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