Pan African Medical Journal最新文献

Uterine leiomyosarcoma is a rare aggressive uterine malignancy that arises from a smooth muscle of the uterus which accounts for 2-5% of all uterine malignancies. Definitive treatment is surgery with a high rate of recurrences. Our patient presented with lower abdominal pain and mass per abdomen which was diagnosed to be uterine leiomyosarcoma. A 56-year-old woman of East Indian origin presented with abdominal pain and a huge rapidly growing suprapubic abdominal mass with an almost monthly doubling. Her CA 125 and Lactate dehydrogenase (LDH) level was elevated and Computed Tomography (CT) scan showed a large irregular-shaped abdominopelvic solid heterogeneously enhanced lesion with focal central hyperdensity and areas of necrosis causing mass effect. A primary cytoreductive surgery was performed and the histopathology report confirmed the diagnosis of uterine leiomyosarcoma. A combination chemotherapy of six cycles was given to prevent recurrence. No recurrence was detected during her more than two years follow-up period. As the cases are rare in nature, screening is impractical. Hence, the diagnosis of uterine leiomyosarcoma is done by histopathologic examination after surgery.

The emergence of severe acute respiratory syndrome coronavirus 2 has made it crucial to develop safe vaccines. Three main types of vaccines are currently available. Although they have proven to be very secure, they have caused various adverse effects. We here report a rare case of livedo reticularis following the administration of COVID-19 vaccine in a 54-year-old woman. It occurred 24 hours after vaccination, accompanied by respiratory, digestive, and neurological disorders and deterioration in general condition. Examinations revealed skin lesions compatible with livedo reticularis, mild inflammatory syndrome and hypercholesterolemia. Imaging showed no abnormalities. Immunological tests were positive for lupus anticoagulant. The patient received symptomatic treatment, with improvement in neurological and joint symptoms and a slight regression of skin rashes. After three months, the lupus anticoagulant test remained positive, confirming post-vaccination antiphospholipid syndrome (APS). The association of livedo reticularis with COVID-19 vaccine should not be underestimated and its degree of severity remains to be determined. More data and cases need to be collected for a more in-depth and detailed analysis.

Introduction: hepatitis is an inflammatory disease of the liver; it is a major threat to public health and is more prevalent worldwide. Hepatitis B virus (HBV) is the leading cause of cirrhosis and hepatocellular carcinoma (HCC) with increasing mortality and burden of disease particularly in Asia and sub-Saharan Africa. Therefore, this study intended to assess the prevalence of HBsAg, associated risk factors, and liver enzyme abnormalities among individuals with diabetes mellitus (DM) in Aksum town public hospitals, Tigray, northern Ethiopia.

Methods: a hospital-based cross-sectional study was conducted among 359 randomly selected individuals with diabetes mellitus in public hospitals of Aksum town from February 10 to May 10, 2021. A pre-tested structured questionnaire was used to collect the data. Data was entered into Epi-Data version 3.1 and analysis was made using the statistical software SPSS version 21 for Windows. Bivariate and multivariate Logistic regression model was applied to show association between the dependent and independent variables; P <0.05 and 95% confidence interval was considered for statistical significance.

Results: in this study, 359 individuals with DM were included with a mean age (mean ± SD) of 46.44 ±16.58 years. The percentage of female participants was 44.3% (159/359). The prevalence of HBsAg among individuals with diabetes mellitus in Aksum town public hospitals was 12.8% (95% CI:8.9-17.0%). The associated risk factors were being employed [AOR:13.38, 95% CI 2.79-64.11; p<0.05], having history of multiple sexual partner [AOR:3.49, 95% CI 1.33-9.12; p<0.05], having history of body incision or piercing [AOR:3.80, 95% CI 1.12-12.90; p<0.05], liver enzyme abnormalities [AOR:6.90, 95% CI 2.17-21.94; p<0.005], and being single and widowed in marital status [AOR:4.42, 95% CI1.62-12.07; p<0.05].

Conclusion: based on the HBsAg positivity, the prevalence of HBV among individuals with diabetes mellitus in this study area was high, as compared to the national findings. Therefore, integrated efforts should be made at the community and health facility level to raise awareness of the associated risk factors, and reduce the spread of HBV; targeted screening of HBV among people with diabetes is also important to minimize liver abnormalities.

Introduction: previous studies in African populations have not extensively described the spectrum of thyroid dysfunction using the profile of thyroid hormones. Although iodine deficiency is a common thyroid disorder in Africa, it does not represent the entire spectrum of thyroid dysfunction seen in patients. This retrospective study aimed to describe the spectrum of thyroid dysfunction among patients seen at the Korle-Bu Teaching Hospital (KBTH), a tertiary care hospital in Accra, Ghana.

Methods: a retrospective analysis of medical records of all consultations on thyroid disorders seen at the Internal Medicine Department of KBTH between January 2019 and December 2021 was conducted. Information on patient demographics, and thyroid hormone profiles (triiodothyronine - FT3, thyroxine - FT4, and thyroid stimulating hormone - TSH) were extracted and subjected to descriptive statistics. The thyroid hormone profiles of the subjects were analyzed and classified into thyroid dysfunction categories using guidelines from the American Thyroid Association (ATA).

Results: out of the 215 patients with thyroid disorders enrolled, 85.1% (n=183) were females and 14.9% (n=32), were males. The mean age of patients was 45±14 years, with most of the patients within the age range of 31-50 years (49.3%; n=106). The most reported thyroid function dysfunction was primary hyperthyroidism (57.7%), followed by primary hypothyroidism (22.3%), subclinical hyperthyroidism (9.3%), euthyroid sick syndrome (6.5%), and subclinical hypothyroidism (4.6%) respectively.

Conclusion: primary hyperthyroidism was the most commonly diagnosed thyroid dysfunction. Hyperthyroidism has been associated with cardiac morbidity and mortality. Timely interventions are required to reduce the morbidity risks and burden associated with the hyperthyroid state.

The current scientific publication architecture and business models are structured to privilege high-impact Western journals. This has been perpetuated in academia and by funding agencies, where a researcher´s value is often measured by the number of publications and where these papers are published. However, the current system renders journals from low- and middle-income countries, including African journals, largely invisible. Indeed, it is important to answer the fundamental question of why we conduct research. Most would argue that research is only ethically grounded if its core purpose is to create impact and improve lives. There is compelling evidence that the time lag from evidence generation to translation into policy is about 17 years. There is no evidence that publishing in a high-impact journal is more likely to create an impact. Indeed, the move by many universities away from using the impact factor as a measure of academic value is increasingly welcomed. It has become critical to redefine and restructure academic merit. In this essay, we will explore the Afro-centric dimensions of the publish-or-perish rhetoric and its impact on tenure in African academia. We argue that context-relevant and alternative metrics are needed to redefine academic merit, as well as the intentionality of African governments and universities to invest in, trust, and value their own journals as non-negotiables in giving African journals the visibility and trust they deserve. We present an African Population and Health Research Centre (APHRC) approach, supported by the Gates Foundation, intentional in decolonizing the global publication space, and clearly aligns with its mission of improving lives in Africa through research.

Introduction: rubella poses a significant public health threat, particularly in developing countries, where congenital rubella remains a preventable concern. This cross-sectional study examined rubella seroprevalence among children aged 10 and under from May to September 2016 in Jos, Nigeria.

Methods: using a multistage sampling method, eligible participants who had not been vaccinated against the rubella virus and consented to participate in the study were recruited across schools in the city. Rubella-specific IgG and IgM antibodies were detected from eluted serum collected from the participants using the enzyme-linked immunosorbent assay (ELISA). Data analysis and visualization was done using the R software version 4.3.1.

Results: of the 405 participants investigated in this study, 336 (82.96%) tested positive for rubella IgG, while 9 (2.22%) tested positive for rubella IgM. Factors such as age ≥ 5 years and lack of Western education showed significant associations with rubella seropositivity.

Conclusion: this study highlights the seroprevalence of rubella IgG and IgM antibodies among children aged 10 and under in Jos, Nigeria. The significant associations between rubella seropositivity and factors such as age ≥ 5 years and lack of Western education underscore the necessity for an effective rubella vaccination program to prevent congenital rubella syndrome (CRS).

Introduction: suboptimal use of donor funds and poor health systems performance is rife across most developing countries; to address this, results-based financing (RBF) models were developed. However, it is imperative to explore the emic and context specific influence of results-based financing in health systems performance. This study therefore sought to explore the influence of results-based financing on health worker motivation and governance, temporal perspective, distributional principle, and policy coherence. Finally, the influence of results-based financing on interrelations across donors, technical partners, and health workers was explored.

Methods: the study adopted a qualitative, exploratory, descriptive, phenomenological design using audio-recorded face-to-face semi-structured interviews to capture diverse perspectives from the remaining and available two health financing experts, two technical partner organization representatives, and six health workers who have been implementing results-based financing from 2011 to 2022 in the Marondera district of Zimbabwe. Data was transcribed and collectively analyzed using NVIVO software.

Results: improved staff motivation, better governance, health system development, equity, and policy consistency were attributable to results-based financing, notwithstanding several challenges including understaffing, increased workload, procurement red tape, financial rigidity, and delays in subsidy payments, which eroded gains of better performance. Additionally, a lack of continuum of care due to user fees faced by the poor at higher levels of care, and limited engagement between donors and healthcare facility workers were also observed. Conclusion: reinforcing pinpointed positives is vital for sustaining realized health gains; however, urgent attention is required to address the challenges to safeguard the milestones achieved thus far.

COVID-19, caused by SARS-CoV-2, has been declared an international public health emergency. Patients with COVID-19, even without a history of liver disease, frequently present with liver test disturbances. Due to the multisystemic involvement of COVID-19, the pathogenesis of liver injury is likely to be multifactorial, involving systemic inflammation, small vessel thrombosis, hepatic hypoxia, and potential drug toxicity, ruling out direct infection of hepatocytes by SARS-CoV-2. COVID-19 can cause severe acute hepatitis. We report the case of a 25-year-old man admitted to emergency with abdominal pain who presented with acute severe liver failure before respiratory signs.