Pan African Medical Journal最新文献

Surabaya as a metropolitan city is required to be able to provide health services that can reach the entire community. Therefore, the Surabaya city government empowers the community to play an active role in the health sector by forming the Great Surabaya Cadres (in Indonesian, KSH = Kader Surabaya Hebat). Great Surabaya Cadres have three tasks, which include data collection and updating of residents' health data; collaborating with health workers at the health center in implementing the integrated development place program (in Indonesian, Posbindu), integrated service place for toddlers (in Indonesian, Posyandu balita), and integrated service place for the elderly (in Indonesian, Posyandu lansia) and implementing the "Jumantik" program as an effort to control dengue fever. It can be concluded that Great Surabaya Cadres have an important role in supporting the achievement of health programs initiated by the government.

Introduction: sigmoidectomy is the definitive treatment of Sigmoid Volvulus (SV). It can be done either by laparotomy or laparoscopy. Our objective was to describe the left iliac fossa sigmoidectomy with mechanical anastomosis recently introduced in our practice, assess our results after 5 years and evaluate its feasibility in our setting.

Methods: we conducted a prospective, descriptive and analytic study on all patients admitted for uncomplicated SV with successful non-surgical decompression and treated by a left iliac fossa sigmoidectomy with mechanical anastomosis. This study was held, from May 2016 to May 2021, at the Visceral Surgery Department of Principal Hospital of Dakar, Senegal. We studied the demographic variables, the data of the preoperative planning (time between sigmoid decompression and surgery, moment of the sigmoidectomy, mechanical bowel preparation or not, type of anesthesia), the peroperative findings (length and diameter of the sigmoid loop), the surgical procedure (the type of staplers used for the mechanical anastomosis, the duration of the operation, incidents or accidents during sigmoidectomy), the immediate and long-term postoperative course.

Results: we collected 53 patients with a mean age of 50 years ± 17. They were 50 men and 3 women. Mechanical colonic preparation was performed in 18 patients (Group 1) and 35 patients did not benefit from a mechanical bowel preparation before surgery (Group 2). The mean length of the sigmoid loop was 74.5cm ± 16.5. The mean diameter of the descendant branch was 7.8cm ± 0.7 for Group 1 and 5.5cm ± 1 for Group 2 with p = 0.01. One linear cutter stapler was used for the side-to-side anastomosis. It was a 100mm in 43% (n=23) of cases. The terminalization of the side-to-side anastomosis was performed with 1 linear stapler in 37 cases, 2 linear staplers in 15 cases and 3 linear staplers in 1 case. The median duration of the operation was 50 minutes for Group 1 and 37 minutes for Group 2 with p = 0.004. Morbidity was nil in Group 1. In Group 2, we had 1 anastomotic leakage and 1 anastomotic stenosis. Mortality was nil in the 2 groups. The mean hospital stay was 5 days ± 3.7. The mean follow-up was 31 months with no recurrence or incisional hernia.

Conclusion: this surgical method is rapid, simple, reproducible and feasible in our setting with a good postoperative course. Colonic mechanical preparation may not be necessary.

Gitelman syndrome is an autosomal recessive, chronically salt-losing tubulopathy depicted by renal potassium wasting, hypokalemia, hypocalciuric, hypomagnesemia, metabolic alkalosis, and hyperreninemic hyperaldosteronism with average or low blood pressure. This case report describes a 10-year-old boy who presented with acute respiratory tract infection with respiratory distress, myalgia, generalized muscle weakness, and significant biochemical changes like hypokalemia, hypomagnesemia, and metabolic alkalosis associated with failure to thrive. Further investigations, like genetic testing, showed a SLC12A3 gene mutation, a pathogenic homozygosity variant, proving the diagnosis of Gitelman syndrome. The child needed Intensive Care Unit (ICU) admission for life-threatening electrolyte imbalances with Electrocardiogram (ECG) changes for the acute care and later, requiring a multidisciplinary team approach for the management. The early presentation of Gitelman syndrome in young children must be kept in mind, as it could be missed. The persistent metabolic alkalosis, hypokalemia and hypomagnesemia should raise the concern about the possibility of chronic salt-losing nephropathic conditions.

Introduction: hepatitis B is a global public health issue affecting about 2 billion people, with 350 million chronic carriers. There is growing pressure to test pregnant women for hepatitis B in Nigeria, as studies show high rates of the virus in both mothers and children. Objectives: this cross-sectional study aimed at determining the sero-prevalence of hepatitis B surface antigen among pregnant women and their newborns and identifying risk factors associated with hepatitis B surface antigen positivity among pregnant women receiving care in tertiary hospitals in Ekiti State, Southwest Nigeria.

Methods: two hundred women were recruited into the study from Federal Teaching Hospital, Ido-Ekiti, and Ekiti State University Teaching Hospital, Ado-Ekiti between 1^st May 2022 and 31^st October 2022. The presence of risk factors for hepatitis B infection was sought in the mothers. Maternal venous blood and umbilical cord blood were analyzed for the presence of hepatitis B surface antigen. Data analysis was carried out using a statistical program for social sciences (SPSS) version 28 (SPSS Inc., Chicago, Illinois, USA).

Results: the mean age of the women was 30.43 years (SD 4.524). Thirty-three (16.5%) of the women studied were into hospital-related professions while 6 (3%) were hairdressers. Sixteen (16) of the 200 women tested positive for HBsAg giving a maternal sero-prevalence of 8% while only 1 of the 200 babies tested positive for HBsAg with a neonatal sero-prevalence of 0.5%. The vertical transmission was 6.25%.

Conclusion: high endemicity of hepatitis B virus infection in pregnancy was demonstrated in the study. It has, therefore, become imperative to strengthen the structure of the various preventive arms of hepatitis B infection in pregnancy such as advocacy on increased community awareness and handling of risk factors, widespread vaccination campaigns, and routine testing during prenatal care.

Access to medicines remains a significant challenge in low-and middle-income countries. In Nigeria, access to medicines is particularly difficult due to a mix of factors such as high out-of-pocket expenditure, inequitable distribution of healthcare facilities, and health workforce brain drain. Recently, this has been further exacerbated by adverse macroeconomic factors such as high inflation and currency devaluation due to weak international trade. In this paper, the authors examine the rising cost of medicines in Nigeria's private and public pharmacies over a period of 12 months from March 2023 to February 2024. By conducting market research and a quantitative analysis of price changes across three drug classes, the study reveals consistent price increases for medicines sold in the public and private sector; with the most increase occurring in the private sector. The findings highlight that these price pressures, in addition to limiting access to medicines, can affect healthcare businesses adversely, leading to more job losses and worsening inequality. The paper concludes with a discussion of the necessity of robust social protection policies to mitigate the financial burden on patients.

Pyogenic granuloma is a noncancerous inflammatory tumor of the skin or mucous membranes. The most frequent causes include hormonal changes, drugs, or localized chronic inflammation. We report the case of an 11-year-old girl who presented with a bleeding gingival swelling and no significant medical history. The pyogenic granuloma presented as a sessile, lobulated, and violaceous lesion with fibrinous ulcerations and telangiectasias. The tumor recurred despite six surgical excisions. In this case report, we treated the latest recurrence with topical corticosteroids and triamcinolone injections, resulting in complete remission with no side effects. This case emphasizes the necessity for diagnostic certainty and the potential of corticosteroids as a less invasive and effective treatment for recurring pyogenic granuloma.

Bilateral adducted recurrent paralysis is a serious complication of thyroid surgery. The management of such conditions is a real challenge for ENT surgeons. Combined endoscopic and external cordopexy offers a way to alleviate laryngeal dyspnea and restore acceptable voice quality while preserving the anatomical integrity of laryngeal structures. From January 2012 to April 2023, we conducted a cross-sectional descriptive observational study with retrospective data collection, including 7 patients with bilateral post-thyroidectomy recurrent paralysis who had undergone combined cordopexy. Outcomes were assessed using the Likert satisfaction scale. All patients were female, with a mean age of 49 years. Dyspnea was observed in all patients. Nasofibroscopy showed paramedian adduction of the vocal cords in 4 cases and median adduction in 3 cases. Combined cordopexy was performed on the right in 42.9% of cases and on the left in 57.1%. Patient satisfaction, assessed using the Likert scale, showed that, in terms of respiratory outcomes, 2 patients were very satisfied and 3 were satisfied. One patient was very satisfied and 3 were satisfied with the quality of their voice. Two patients were not satisfied with their breathing. Combined endoscopic and external cordopexy is a simple, reversible, minimally invasive technique that can be used, in the management of bilateral post-thyroidectomy recurrent paralysis, with satisfactory results.

Recent approvals of long-acting (LA) antiretroviral treatment (ART) support an innovative alternative to daily oral pills that can improve adherence and treatment outcomes among adolescents and youth (AY) with HIV. We solicited stakeholder feedback on the implementation of LA ART for AY in low-and middle-income countries (LMICs) through a consensus-building forum at the 2022 International Workshop on HIV and Adolescence. We used the nominal group technique to generate, record, discuss, vote on, and rank perceived barriers and facilitators to implementing LA ART for AY. All in-person attendees were invited to participate and were assigned to six groups, each representing an intentional mix of AY, clinicians, researchers, program implementers, and policymakers. We collected self-reported de-identified demographics and group rankings of barriers and facilitators. Responses were coded and categorized using the social-ecological model's five levels of influence. One hundred and thirty-seven (137) Workshop delegates (67.9% male, 27.7% female; 0.7% non-binary, and 46.7% less than 35 years old) participated in the group discussions. A large proportion of participants (51.9%) reported working in public health/program implementation. Most participants (88.4%) were from and/or worked in the African region. We identified 55 barriers and 48 facilitators of LA ART implementation and ranked them in social-ecological categories of public policy, community, institutional/organizational, interpersonal, and individual levels. The highest number of ranked barriers was at the institutional/organizational level. The themes of "equitable access" and "choices of ART" were cross-cutting across individual and interpersonal levels. Other cross-cutting themes were the "cost of LA ART" and the "need for funding and sustainability of LA ART programs". Proposed facilitators addressed identified barriers at each social-ecological level of influence and emphasized peer engagement. Our nominal groups identified key barriers and proposed facilitators at five different social-ecological levels, which can inform implementation science-guided design and equitable implementation of youth-centered LA ART in LMICs and globally.