The Pan African Medical Journal最新文献

Introduction: post-traumatic stress disorder (PTSD) is a topical issue due to the increase in armed conflicts and terrorist attacks in recent decades. The PCL-5 scale is used to screen and monitor patients with PTSD. The aim of our work was to validate a literary Arabic version of this scale on a population of Tunisian soldiers.

Methods: the translation of the PCL-5 scale into Tunisian literary Arabic was performed according to the back-translation technique described by Werner and Campbell and recommended by Brislin. Cross-cultural validation was conducted in 7 steps according to Vallerand's method. Data collection was conducted at the psychiatry department of the Military Hospital of Tunis from February 2019 to December 2020.

Results: we recruited 300 military personnel, 150 of whom were followed for PTSD. Cronbach's alpha was 0.98 indicating good internal consistency. The study of inter-item correlations revealed a total Spearman index of 0.75. This index indicates a good homogeneity of the translated scale items. Construct validity was checked using the Kaiser-Meyer-Olkin index (K-M-O) and Bartlett's test of sphericity. The latter was significant (p<0.000), and the K-M-O index was 0.969, indicating that the correlations between the items were of good quality.

Conclusion: our study showed that the Arabic version of the PCL-5 scale has satisfactory psychometric properties comparable to those of the original version.

Infantile malignant osteopetrosis (IMOP) is a rare bone resorptive disorder with an autosomal recessive inheritance pattern. It is characterized by increased bone density due to osteoclastic failure in differentiation or function. The clinical manifestations of IMOP start at birth or infancy with varied rings according to the type and degree of osteopetrosis. We presented a 3-year-old female patient referred to us due to chronic anaemia six months ago. The physical examination revealed hepatosplenomegaly, axial hypotonia, and visual impairment. Blood investigation revealed pancytopenia and hypocalcemia. Radiologic studies revealed a generalized increase in bone density, abnormal metaphyseal remodelling, and rain atrophy. The bone marrow aspiration (BMA) shows dry tap and hypocellularity of all cell lines. IMOP was diagnosed depending on clinical, radiologic, and BMA results. In conclusion, IMOP is relatively uncommon. Accurate diagnosis should be made through clinical, BMA, and radiologic investigations, especially in a resource-limited setting, as performed in our case.

Introduction: the aim of our study was to evaluate the efficacy of dexamethasone added to bupivacaine and sufentanil in spinal anesthesia to improve postoperative analgesia after femur upper extremity surgery.

Methods: we conducted a prospective controlled, randomized double-blinded clinical trial including patients proposed for surgery of the upper extremity of the femur under spinal anesthesia. The patients were randomly allocated to receive intrathecally 10 mg hyperbaric bupivacaine 0.5% with 5µg sufentanil and 2 ml normal saline (control group) or 10 mg hyperbaric bupivacaine 0.5% with 5 µg sufentanil and 8 mg dexamethasone (Dexa group). The patients were evaluated for onset time and duration of sensory block, duration of pain-free period, overage consumption of morphine in the 6 first postoperative hours, hemodynamic parameters, nausea, and vomiting, or other complications.

Results: fifty-eight patients were analyzed. There were no signification differences in demographic data and onset time of the sensory block between the two groups. Sensory block duration was 121.55 ± 16.42 minutes in the control group and 183.62 ± 33.93 minutes in the Dexa group which was significantly higher in the Dexa group (P<0.001). The pain-free period was longer in the Dexa group than in the control group (P<0.001). There was a reduction in morphine consumption during the first 6 postoperative hours in the Dexa group against the control group (p=0.02). The frequency of complications was not different between the two groups.

Conclusion: the addition of intrathecal dexamethasone in spinal anesthesia improved the postoperative analgesia after femur upper extremity surgery.

Recent studies about anterior cruciate ligament (ACL) surgery have focused on a better control of rotational stability, but ACL reconstruction is always a topical issue. The purpose of our study was to evaluate clinical and radiological outcomes after the use of the technique for anatomical reconstruction of the ACL with fascia lata, according to Macintosh technique modified by J.H Jaeger. We conducted a study of a continuous series of 80 patients between 2005 and 2019. All patients were assessed according to the International Knee Documentation Committee (IKDC) score and the Lysholm and Tegner scale. All our patients were rated as excellent with an average score of 92. Occasional lateral residual pain was reported by 8 patients. Residual jerk accounted for 2.5%. Radiological examination did not show ballooning or arthrosis at the last follow-up. Anterior cruciate ligament reconstruction is a common procedure that has become more reliable over time. But pivot shift (Jerk test) requires a lateral tenodesis "external rotation", especially in athletes.

Rapid scale-up of surveillance activities is the key to successful coronavirus disease 2019 (COVID-19) pandemic prevention and mitigation. Ethiopia did not have a sufficient number of active surveillance officers for the public health COVID-19 response. Training of surveillance officers was needed urgently to fill the gap in the workforce needed. Subject-matter experts from the United States and Ethiopia developed applicable training modules including background on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), contact investigation, and communications. The training modules were delivered live in real-time via web-based virtual presentation. Seventy-seven health surveillance officers were hired, trained, and deployed in two weeks to assist with surveillance activities in Ethiopia. Electronic capacity building is needed in order to improve Web-based training in resource-limited settings where internet access is limited or unreliable. Web-based synchronously delivered course was an effective platform for COVID-19 surveillance training. However, strengthening public and private information technology capacity, literacy, and internet availability will improve Web-based education platforms in resource-limited countries.

Methemoglobinemia is a common complication of dapsone poisoning. Its´ treatment usually relies on methylene blue infusion. The aim of this study was to report a case of an acute dapsone poisoning with methemoglobinemia treated only with ascorbic acid and activated charcoal. A 16-year-old female voluntary ingested 3 grams of dapsone in an attempt of suicide and presented with desaturation and tachypnea. Lab findings were compatible with methemoglobinemia. After two days of treatment with ascorbic acid and activated charcoal, we observed the disappearance of desaturation and tachypnea. Methemoglobinemia can be treated with ascorbic acid and activated charcoal in limited resource settings.

Introduction: the Exacto® Triplex HIV/HCV/HBsAg (Biosynex, Strasbourg, France) consists in lateral flow, immunochromatographic rapid diagnostic test simultaneously detecting human immunodeficiency virus (HIV)-1 and HIV-2 and hepatitis C virus (HCV)- specific antibodies (IgG and IgM) and hepatitis B virus (HBV) surface antigen (HBsAg) in serum, plasma and whole blood. We herein evaluated its diagnostic performances in the Central African Republic (CAR).

Methods: cross-sectional study was conducted on prospectively collected panel of 550 sera from adult inpatients living in Bangui, including 200 HIV-positive, 100 HBsAg-positive, 50 HCV-positive, 200 negatives to three viruses according to reference immuno-enzymatic serological tests including Murex HCV (Diasorin, Saluggia, Italy) for HCV, Murex HBsAg (Diasorin) for HBV, Genscreen ULTRA HIV Ag-Ab HIV-1/2 Version 2 (Bio-Rad, Marnes-la-Coquette, France) and Murex HIV 1.2.0 Ag/Ab Combination (Diasorin), the 2 tests associated in the parallel algorithm for the reference strategy for the diagnosis of HIV in CAR. Serum samples were tested blindly in duplicate. The findings are reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Results: the Exacto® Triplex showed 99.5% (95% CI; 98.5-100.0), 96.0% [90.6-100.0] and 99.0% [97.1-100.0] sensitivities for HIV, HCV and HBsAg, respectively. The specificity, positive and negative predictive values (PPV and NPV) were 100.0% for all three viruses. The Youden's J index and Cohen's κ coefficient were 0.99 for HIV and HBsAg. For HCV, Youden's J and Cohen's κ coefficient were 0.96 and 0.98, respectively. In the epidemiological context of the CAR, the PPV and NPV for all three viral infections were high (≥99.0% to 100%).

Conclusion: taken together, our STROBE-compliant study demonstrates that the Exacto® Triplex HIV/HCV/HBsAg showed high sensitivity and specificity for HIV and HBsAg (≥99.0%), and relatively high sensitivity (96.0%) and high specificity (100%) for HCV. These analytical performances are within the limits required by the WHO (i.e. sensitivity ≥99.0% and specificity ≥98.0%) for HIV and HBV. The Exacto® Triplex HIV/HCV/HBsAg is user-friendly at low cost, and appears highly desirable for routine use in the CAR, and likely other Central African countries.

Introduction: health outcomes in hospitals can be improved through regular conduct of clinical audit. This study assessed physicians´ knowledge, attitude, and practice of clinical audit at the University of Port Harcourt Teaching Hospital (UPTH) in Rivers State.

Methods: a descriptive cross-sectional study involving 460 doctors selected through convenience sampling. A pretested self-administered questionnaire was administered, and data was analysed using the Statistical Package for Social Research (SPSS) 23.0.

Results: a total of 457 questionnaires were analyzed giving a response rate of 99.3%. Only 57 (12.5%) of the 457 respondents had a correct understanding of the clinical audit process. Most respondents (75.1%) agreed that clinical audit is important in improving patient care, however only 29.9% were aware that the hospital has a clinical governance structure. Seventy-three (16.0%) doctors had received training in different forms of clinical audit, while 148 (33.0%) were involved in different clinical audit activities, with mortality audit being the most common clinical audit type (81, 17.7%).

Conclusion: physicians at the University of Port Harcourt Teaching Hospital have poor understanding of the clinical audit process. The integration and scale-up of clinical audit activities as part of an overall clinical governance system in the teaching hospital is recommended.

There is a growing trend in complementary and alternative medicine (CAM) usage among the population with medical conditions. However, there is hesitancy for medical practitioners to integrate its application with the current treatment modality, despite governance by the authority. Hence, our objective is to systematically evaluate the healthcare perception towards integrating CAM in their practices. We systematically searched three large and renowned databases i.e., Scopus, Web of Science and PubMed, regarding "Perception on Integrating CAM Usage in Patient's Treatment among Healthcare Practitioners" from 2016 until 2020. At least two independent reviewers comprehensively screened and extracted the data from the accepted articles. A total of 15 studies were included in the final qualitative synthesis following a strict and rigorous assessment checked using MMAT 2018 checklist. The studies included providing the richness of information due to the qualitative nature of the study design. There were three main domains extracted i.e. knowledge, attitude, and perspective of the healthcare practitioner towards CAM integration. Limited knowledge of CAM among healthcare providers may be the possible main reason for non-supportive attitude and negative perspective on CAM. However, those who showed an inclination towards CAM were found to be more open and ready to learn about CAM if it provides benefits to the patients. There is a heterogeneity of perception towards CAM integration from healthcare providers' point of view. A proactive and systematic CAM literacy awareness program may help to improve their understanding and possibly gain more trust in its application.