Pan African Medical Journal最新文献

Castleman's disease is a rare lymphoproliferative disorder. It typically presents with lymphadenopathy and may be associated with sometimes severe systemic manifestations. It can occur in two clinical forms: the unicentric form, which is limited to a single lymph node or lymph node region, generally has a favorable prognosis and is primarily treated with surgical excision; and the multicentric form, which is more severe, characterized by diffuse lymph node involvement and excessive cytokine production, particularly interleukin-6 (IL-6), which accounts for the systemic symptoms. Treatment in the multicentric form includes monoclonal antibodies targeting IL-6, immunosuppressants, chemotherapy, or corticosteroids, depending on the underlying cause. The disease may be associated with human herpes virus 8 (HHV-8) infection, especially in immunocompromised patients. We report the case of a 65-year-old patient presenting with polyadenopathy and Raynaud's phenomenon. Imaging revealed multiple lymphadenopathies along with hepatosplenomegaly. An exploratory cervicotomy was performed, followed by histopathological examination and immunohistochemical analysis, which confirmed the diagnosis of multicentric Castleman disease. This clinical case underscores the importance of considering Castleman disease in the differential diagnosis of unexplained polyadenopathies, particularly when accompanied by atypical systemic manifestations.

Introduction: uninterrupted availability of tracer essential health commodities is critical for service readiness and resilient healthcare delivery. Despite reforms, Kenyan public hospitals, including Kitui County Referral Hospital continue to experience recurrent stock-outs of essential items.

Methods: this cross-sectional mixed-methods study assessed the availability of 155 tracer commodities across 22 departments at Kitui County Referral Hospital from July 2023 to June 2024. Quantitative data were collected using structured stock audits guided by the Ministry of Health 647 checklist, and qualitative insights from 12 key informant interviews. Data were analyzed using SPSS v26 and thematic analysis. Triangulation enhanced data analysis and interpretation.

Results: only 2 of 22 departments (9.1%) met the WHO-recommended 80% availability threshold. Availability ranged from 29% in the non-pharmaceutical store to 100% in the dental and nutrition departments. Critical shortages affected high-demand areas like the intensive care unit (73%) and maternity unit (67%), with frequent stock-outs of intravenous solusets and pediatric electrodes. Supply bottlenecks included delayed deliveries from the Kenya Medical Supplies Authority (51-60% order fulfillment) and reliance on manual inventory systems. Only 22.7% of staff had inventory management training, but trained departments showed significantly higher availability (p = 0.029). Supervisory oversight and forecasting tool use also influenced availability.

Conclusion: tracer essential commodity availability at Kitui County Referral Hospital remains inadequate due to systemic supply chain inefficiencies and weak inventory management. Prioritizing staff training, digital inventory systems, and stronger supervision are actionable strategies to reduce stock-outs and support Kenya´s Universal Health Coverage goals.

Uganda's mental health services are at a breaking point. Suicide ideation affects 10.6% of the population, nearly triple the global average, while Butabika National Referral Hospital, the country's only national psychiatric facility, is overcrowded, under-resourced, and unsafe. The national helpline is dominated by crisis calls about suicidal distress, and reports of abuse, forced sedation, and neglect highlight governance failures. Vulnerable groups, including HIV-positive adolescents, older adults, and women facing violence, are disproportionately underserved. Yet Uganda spends less than 1% of its health budget on mental health. Evidence from Ugandan-led innovations shows reform is both feasible and cost-effective: mobile psychotherapy reduced youth depression with over 85% engagement, and task-shifting increased depression detection by 37%. Globally, every dollar invested in treatment for depression and anxiety yields four in productivity gains, while untreated depression costs Uganda nearly US$390 million annually. Criminalisation of attempted suicide further undermines care, deterring those most in need. The path forward is clear: increase funding, decriminalize suicide, scale digital and community-based models, and strengthen data systems. Uganda does not lack evidence or solutions; it lacks political will. Without urgent reform, the human and economic toll will escalate further.

Retained intrauterine fetal bone is a rare event that happens after an induced pregnancy termination, usually illegal, especially during the second and third trimesters, due to the incomplete evacuation of fetal tissues. It can cause secondary infertility as bone fragments can work as an intrauterine contraceptive device. We present a case of compromised fertility due to the presence of fetal bony sequestra in the uterine cavity in a 36-year-old female who presented with secondary infertility of eight years duration, following a history of second-trimester voluntary termination of pregnancy. Diagnostic evaluation included ultrasound and hysterosonography. Hysteroscopy confirmed the presence of a fetal bone fragment in the uterine cavity. The patient underwent operative hysteroscopy under loco-regional anesthesia for the removal of the bony sequestra. Pregnancy occurred six months following treatment, and she delivered a term live baby. Retained intrauterine fetal bones should be considered as a possible cause of infertility in women with a history of second-trimester abortion.