Pan African Medical Journal最新文献

Desmoplastic fibroma, also known as desmoid fibroma of bone, is a rare benign bone tumor, accounting for approximately 0.1 to 0.3% of all bone tumors. It was first described by Jaffe in 1958. This tumor has a slow progression with locally aggressive behavior, without metastasis or malignant transformation. For radiological diagnosis, magnetic resonance imaging (MRI) is the modality of choice to assess local extension within the bone and, when present, into the surrounding soft tissues. The definitive diagnosis is histological: the tumor is composed of tissue poor in fibroblasts and rich in collagen fibers, identical to the histology of desmoid fibromas of the soft tissues. Histological differential diagnosis can be challenging, particularly with low-grade fibrosarcomas. The treatment of choice is surgical, consisting of wide tumor resection whenever the location allows. A high rate of local recurrence characterises post-treatment evolution in cases of intralesional excision.

Introduction: food insecurity is increasing at an alarming rate, contributing to gender variation in illness and undermining the 2030 nutrition goals. Evaluating its components could aid interventions aimed at addressing gender-specific diseases such as hypertension. This study assessed gender differences in food insecurity and its association with elevated blood pressure (EBP) in Ondo State, Nigeria.

Methods: this community-based cross-sectional study used a four-stage systematic random sampling to select 769 adults aged 18 years and older. Food insecurity experience scale survey module components (Worried, Healthy, Fewfoods, Skipped, Ateless, Ranout, Hungry, and Wholeday) were defined, and participants were categorized into: food secure (0 point) and food insecure (≥1 point). Obesity and abdominal adiposity were determined by body mass index (≥30kg/m²) and waist-height ratio (≥0.5), respectively. The EBP was defined as BP≥140/90mmHg. Multivariable logistic regression was performed at p<.05.

Results: a proportion of 54.9% men and 45.1% women participated in the study. Their mean ages and monthly incomes (±standard deviation) were 32.3±11.6 years, 33.9±11.7 years, and $51.1±41.0, $46.9±37.3, respectively. Women were more food insecure (44.1%, 35.8%) and experienced Worried (34.9%, 23.9%), Healthy (34.3%, 25.8%), Fewfoods (22.8%, 18.0%), Skipped (36.0%, 26.3%), Ateless (25.4%, 20.4%), Ranout (14.4%, 10.2%), Hungry (11.8%, 10.1%) and Wholeday (5.8%, 4.5%) than men, respectively. Men (9.2%) had EBP more than women (8.6%). The EBP was associated with marital status (aOR=2.53, CI=1.09, 5.87, p=.03), worried (aOR=6.33, CI=2.25, 17.78, p=<.001), ranout (aOR=5.98, CI=1.02, 35.01, p=.04) and abdominal adiposity (aOR=2.44, CI=1.38, 5.31, p=.03) among men, but occupation (aOR=1.41, CI=1.04, 1.91, p=.03) and physical inactivity (aOR=3.63, CI=1.04, 14.30, p=0.04) among women.

Conclusion: gender difference was observed in food insecurity, which significantly contributed to EBP among men, while occupation and physical inactivity predisposed women to EBP. Interventions in controlling hypertension should incorporate schemes that address lack and inadequate access to food, and maintain a healthy body weight through a quality diet and physical exercise among Nigerian adults.

Ectodermal dysplasias are characterized by abnormalities in two or more ectodermal structures, including hair, sweat glands, nails, etc. and are a rare group of congenital disorders. It is characterized by the triad of three conditions, namely hypohidrosis, hypotrichosis, and hypodontia. The phenotypic expression of ectodermal dysplasia may be variable, often raising problems in clinical assessments and care, particularly in the paediatric age group, where early manifestations can be subtle or nonspecific. While most cases reveal a clear inheritance pattern, sporadic presentations in the absence of similar complaints in the family are uncommon and raise significant diagnostic difficulties. Early identification and multidisciplinary treatment are imperative to mitigate complications such as recurrent infections, thermoregulatory dysfunction, and psychosocial impact. In this report, we highlight the clinical presentation, diagnostic evaluation, and management considerations in a 10-year-old male child diagnosed with a sporadic case of ectodermal dysplasia.

Introduction: unmet family planning needs remain a significant health challenge. In Kenya, 14% of women have an unmet need. In Siaya County unmet need is 21% among the women, and this is high. This study seeks to determine the intervening role of community health education on the reduction of unmet needs among women of reproductive age in Siaya County.

Methods: the study employed a quasi-experimental design with non-randomized, geographically distinct clusters. Assignment to the intervention and control arms was based on geographic allocation to avoid contamination into an intervention group that received structured health education for six months, and a control group, which did not. Data were collected at two time points (baseline and end line). The design enabled a difference-in-differences analysis to determine changes in outcomes between the groups over time. The FANTA formula by Robert Magnani determined the sample size of 1,448 respondents for the study. The WHO 30 by 30 two-stage cluster sampling method was used to sample the number of women of reproductive age. Data analysis was done using IBM SPSS version 28.0, with both bivariate and multivariate analyses conducted. Unmet needs for family planning were modeled using a generalized linear mixed-effects model (GLMM).

Results: one thousand four hundred and forty-seven (1447) women of reproductive age (WRA) were interviewed at baseline and end line. There was a 17.1% increase in high family planning (FP) knowledge and a 12% rise in positive attitudes in the intervention, and a decline in the control group. Despite an increase in unmet need for FP in both study arms, the rise was lower in the intervention (6.7%) compared to the counterfactual (20.8%). The intervention had a protective effect against worsening of unmet need (aOR=0.31, 95% CI=0.10-1.00; p=0.051). This effect had borderline statistical significance (p=0.051). Family planning (FP) uptake decreased in the control group by 11.3% but increased in the intervention group by 6.6%, with aOR=2.42, 95% CI=0.92-6.40, p=0.075 indicating marginal statistical significance (p=0.075).

Conclusion: the intervention improves knowledge and attitudes, mitigates worsening of unmet FP needs, and promotes FP uptake.

Introduction: radioiodine therapy with iodine-131 is a standard treatment for hyperthyroidism. Nevertheless, the variability in individual response underscores the need to identify reliable predictors of treatment failure. The study aimed to determine the clinical and biological factors associated with the failure of the first course of radioactive iodine therapy in hyperthyroid patients.

Methods: this was a retrospective cohort study conducted between 2012 and 2018, including 171 patients treated for hyperthyroidism with radioiodine therapy at the Salah Azaiez Institute. Demographic, clinical, biological, and therapeutic data were collected and analysed.

Results: the median age was 49 years, with a female predominance (sex ratio: 0.41). Graves' disease accounted for 73.7% of cases, and resistance to antithyroid drugs was the main indication for radioiodine therapy (68%). A fixed dose of iodine-131 was administered (mean: 14 ± 2.6 mCi). Treatment failure after the first course occurred in 22.2% of patients (n=38). Failure was significantly associated with higher administered doses (p=0.007), TSH receptor antibody positivity (p=0.005), and the presence of ophthalmopathy (p=0.013).

Conclusion: failure after radioiodine therapy appears to be influenced by biological markers (TSH receptor antibodies) and specific clinical factors (ophthalmopathy). These results support individualised dosing strategies and highlight the need for multicenter studies to standardise treatment protocols in nuclear medicine centers in Tunisia.

This study aims to present the results and limitations of surgery for lower limb lipoedema and lymphedema in a resource-limited surgical setting. This was a cross-sectional, analytical, prospective, in-hospital study covering 15 years. We surgically treated 119 patients, including 18 with lipoedema (15.1%), 69 with stage 2 lymphedema (57.9%), and 32 with elephantiasis (26.9%). We included 81 women (68%) and 38 men (31.9%). The majority (57.7%) of patients with lymphedema were between 30 and 49 years of age. Plastic and excisional surgery was performed in 42.2% of patients with stage 2 lymphedema and in 87.5% with stage 3 (elephantiasis). Lipoedema surgery consisted primarily of liposuction (77.7%). No lymphatic network reconstruction was performed. Our results, at 2 years' post-surgery, were very satisfactory, with limb symmetry in 83.3% of patients operated on for lipoedema, in 84.2% of patients operated on for stage 2 lymphedema, and in 85% of patients operated on for elephantiasis. Surgery for lower limb lipoedema, lymphedema, and elephantiasis is feasible in a resource-limited setting, although challenges remain. The lack of lymphatic network reconstruction constitutes our limitations. Microsurgery is necessary for optimal results.

Introduction: the apelin family plays a role in the proliferation and migration of trophoblasts. Based on this, we aimed to investigate the relationship between diastolic notching in uterine artery Doppler and serum apelin-13 and apelin-36 concentrations between 11 and 14 weeks of gestation.

Methods: forty-four (44) pregnant women with diastolic notching in uterine artery Doppler and 44 without diastolic notching were compared in terms of serum apelin-13 and apelin-36 concentrations.

Results: the two groups were similar in terms of demographic characteristics (p > 0.05). The median apelin-13 concentration was found to be 45.4 pg/mL in the uterine artery notch-positive group, while it was 41.02 pg/mL in the uterine artery notch-negative group (p = 0.770). The median apelin-36 concentration was 546.06 pg/mL in the uterine artery notch-positive group, while it was 536.6 pg/mL in the uterine artery notch-negative group (p = 0.570). Participants were regrouped as high or normal pulsatility index (PI) according to uterine artery PI, and both groups were compared in terms of apelin-13 and apelin-36 concentrations. Median serum apelin-13 and apelin-36 concentrations were also similar in the high and normal uterine artery PI groups (p = 0.445, p = 0.402, respectively).

Conclusion: although the number of participants was too small to draw a definitive conclusion, no significant relationship between diastolic notching or increased resistance in the uterine artery and serum apelin-13 and apelin-36 concentrations could be detected.

Infectious diseases remain a significant public health challenge in Saudi Arabia and other low-and middle-income countries. While the Kingdom has invested in advanced digital platforms such as Raqueem, HESN, and NPHIES, surveillance practices remain largely compliance-driven, resulting in delays, inefficiencies, and limited engagement in primary health care (PHC). A value-based model can transform surveillance into a resilient, outcome-driven system aligned with Saudi Vision 2030 and International Health Regulations (IHR). This commentary proposes a framework that integrates outcome indicators, digital platforms, and community perspectives, operationalised through a value-based balanced scorecard (VBSC). Key policy options include implementing outcome-based KPIs, strengthening digital integration, enhancing workforce capacity, regular monitoring and evaluation, promoting inter-sectoral coordination, and addressing barriers through policy support. The framework bridges compliance with value generation, ensures cost-effectiveness, and enhances public trust. It provides a replicable model for other low-and middle-income countries seeking to modernise their surveillance systems while improving efficiency, resilience, and accountability.

Insufficient daily dietary iodine intake is responsible for a range of disorders collectively referred to as iodine deficiency disorders (IDD), including endemic goiter and hypothyroidism. The city of Man, located in a goiter-endemic area, has not previously been the subject of a study evaluating the iodine content of household cooking salt. The purpose of this study was to assess iodine content in household cooking salt in the city of Man, a goiter-endemic area in Côte d'Ivoire, and to identify factors contributing to iodine degradation. We conducted a one-month descriptive cross-sectional study focused on measuring the iodine content of salt samples randomly collected from households and commercial outlets. A total of 160 households and 2 wholesale suppliers were included. The iodine content of household salt was found to be below WHO standards (<15 ppm) in 81% of cases, below the national standard (<30 ppm) in 85% of cases, and entirely non-iodized in 10% of samples. The city had two retail outlets, both of which sold salt with iodine content below the recommended standard. Storage methods using transparent plastic and polyethylene containers were strongly associated with low iodine levels in salt (p=0.0063), whereas metallic containers were associated with normal iodine levels (p=0.0063). Storage time did not significantly influence iodine degradation (p=0.075). There is a deficiency in iodine content of household cooking salt, falling below both the WHO. This finding calls for routine monitoring by relevant authorities and the implementation of preventive measures. Further studies are needed to evaluate the effectiveness of such interventions.