Pan African Medical Journal最新文献

Third and fourth branchial arch anomalies belong to congenital lesions which are extremely rare accounting for <1-4% of branchial arch anomalies. In our case, a 4-year-old boy was admitted to our hospital with a painful mass on the left side of his neck. The imaging and clinical findings are oriented to the diagnosis of suppurative thyroiditis with underlying third/fourth branchial arch anomaly. The diagnosis was confirmed with laryngoscopy and the child was treated with endoscopic cauterization. The presence of specific clinical and imaging findings is not definitive, so the diagnosis relies on having a strong suspicion and knowledge of typical locations. So, our purpose is to present the spectrum of relative imaging findings from at least three imaging modalities in order to increase the level of clinical and radiological suspicion of that rare condition and help with accurate diagnosis and planning of the treatment.

Introduction: isoniazid preventive therapy (IPT) is highly effective at preventing tuberculosis among Persons Living with HIV (PLHIV). However, IPT completion rates in Uganda have not been studied. We examined completion rates for the 6-month course of IPT and factors associated with non-completion among PLHIV in northeastern Uganda.

Methods: we conducted a retrospective cohort study using routinely collected program data in nine Antiretroviral Therapy (ART) sites in northeastern Uganda. The study period covered January 20 15-December 20 17. Non-completion was defined as failure to pick up any of the six IPT refills over 6 months. We abstracted data on IPT treatment site, IPT completion, and demographic and clinical characteristics from the IPT register and patient HIV care card. We used generalized linear regression to identify factors associated with non-completion.

Results: among 543 patients who started IPT, 175 (32%) completed the full 6-month course. Among those who did not complete, 193 (52%) stopped due to drug stockouts, and 175 (48%) were lost to follow-up. Being at World Health Organization (WHO) HIV clinical stages III and IV at initiation were associated with a higher risk of IPT non-completion compared to those who were at WHO clinical staging I and II (aRR 1.4, 95%CI 1.2-1.5).

Conclusion: IPT completion rate among PLHIV in northeastern Uganda was suboptimal, largely due to IPT drug stockouts. The National TB and Leprosy Program should streamline the IPT supply chain to address drug stockouts and improve completion rates.

Introduction: prostate cancer is categorized as the most common cancer in males in 2020 in Kenya at 21.9%. The major challenge with prostate cancer in Low and Middle-Income Countries is the presentation of patients with advanced disease. The rate of prostate cancer screening is low across African countries which has been associated with low knowledge and fatalistic beliefs. The study aimed to assess the effectiveness of community-based health education on prostate cancer fatalism.

Methods: the study design was quasi-experimental. The study was conducted in Kiambu County in the Gatundu North and Kiambu sub-counties in Kenya. A total of 288 men were selected per arm of the study using stratified random sampling. Data were collected using a structured questionnaire at baseline and post-intervention. The intervention was health education through home visits by a Community Health Worker.

Results: in the study, fatalism was associated with prostate cancer screening (P<0.05). There was a significant decrease in prostate cancer fatalism for the attributes of pessimism, pre-determination, and death inevitability in the intervention arm post-intervention. In contrast, in the control arm, there was no significant decrease. Post-intervention, the proportion of respondents with a high perception of fatalism decreased from 51% to 23.6% (P<0.05) in the intervention arm. In contrast, in the control arm, there was no significant decrease.

Conclusion: prostate cancer fatalism significantly influenced prostate cancer screening. Community-based health education significantly reduced pessimism, death inevitability, and pre-destination beliefs about prostate cancer. Tailored culturally relevant health education is an effective strategy to address fatalistic beliefs.

Introduction: the diversity of Plasmodium falciparum genotypes affects the dynamics of malaria transmission and is thought to be one of the factors hampering malaria control efforts. This study aimed to investigate the relationship between Plasmodium falciparum genetic diversity and chloroquine and sulfadoxine-pyrimethamine resistance markers in malaria endemic areas of Burkina Faso.

Methods: in a cross-sectional study, populations residing in Nouna health district were randomly recruited. Blood samples were used for microscopic malaria diagnosis, and genetic polymorphism alleles of msp1 and msp2 genotyping by nested PCR. Restricted fragment length polymorphism analysis was used to identify antimalarial resistance markers. Logistic regression analysis explored the association between msp1/msp2 alleles and antimalarial drug resistance markers. ANOVA was used to explore the association between the mean complexity of infection (mCOI) and prevalence of resistance markers.

Results: the overall prevalence of Plasmodium falciparum infection was 27.1%. The proportions of K1, MAD20, RO33, FC27, 3D7 individuals with mutations in the pfcrt76T gene were 4.3%, 6.9%, 7.0%, 6.8% and 7.1% respectively. Those with mutations in pfmdr1 were 2.7%, 2%, 2.3%, 6.8% and 7.1%. No significant associations were detected between msp1/msp2 alleles and chloroquine or sulfadoxine-pyrimethamine resistance markers. However, the mean complexity of infection (mCOI) was significantly higher in individuals with the pfcrt76T mutation.

Conclusion: overall, this study showed that the genetic diversity of Plasmodium falciparum does not significantly affect the presence of antimalarial drug resistance genes. The competition between different strains (polyclonality) of the parasite within the host was probably unfavorable for mutant strains.

Introduction: COVID-19 is an infectious and contagious disease declared as public health emergency of international concern in 2020. Given its high morbidity and mortality, one of the responses to this pandemic is vaccination, which has posed a serious problem of acceptance among the population in sub-Saharan Africa (SSA) and Cameroon in particular. Thus, the purpose of this study was to contribute to a better response to the pandemic in Cameroon by measuring the effectiveness of the COVID-19 vaccine. We carried out a comparative analysis of morbidity and mortality in vaccinated COVID-19 patients versus unvaccinated COVID-19 patients hospitalized in the three most affected regions of Cameroon.

Methods: we conducted a Case-control study with patients vaccinated against COVID-19 as Cases and patients not vaccinated against COVID-19 as controls. We observed the occurrence of severe clinical manifestations in vaccinated and unvaccinated COVID-19 patients during hospitalization to study the influence of vaccination on the outcome of these patients over the period from May 01, 2021, to March 31, 2022; in the COVID management units of Yaoundé Central Hospital, Douala General Hospital, Douala Laquintinie Hospital and Bafoussam Regional Hospital.

Results: we conducted our study in 218 hospitalized COVID-19 patients, 109 vaccinated and 109 unvaccinated patients, 51.4% of whom were women. Arterial hypertension (60.6%) and diabetes (27.5%) were more prevalent in unvaccinated patients. The median length of hospital stay was 07 days for vaccinated patients and 05 days for unvaccinated patients. Coma (0.7% in vaccinated patients and 79.8% in unvaccinated patients), consciousness disorders (8.3% in vaccinated patients and 57.8% in unvaccinated patients), headaches (46.8% in vaccinated patients and 18.3% in unvaccinated patients), pneumonia (78% in vaccinated patients and 78.9% in unvaccinated patients), malaria (31.2% in vaccinated patients and 19.3% in unvaccinated patients), pulmonary embolism (14.7% in vaccinated patients and 22% in unvaccinated patients) and venous thromboembolism (1.1% in vaccinated patients and 14.7% in unvaccinated patients) were the main severe clinical manifestations. The prevalence of mortality was 1.8% in vaccinated patients and 79.8% in unvaccinated patients.

Conclusion: four out of 1000 vaccinated patients were less likely to die during hospitalization compared to unvaccinated patients. This reinforces the importance of vaccination in controlling COVID-19 infection.

In recent years, the utilization of enterocystoplasty for bladder function enhancement has increased, albeit accompanied by risks such as stone formation, necessitating vigilant follow-up. We report a case of a 60-year-old female with a neobladder who presented with back pain, constipation, and pelvic heaviness, revealing multiple large stones in imaging. Stone analysis showed calcium oxalate and magnesium. Enterocystolithotomy was performed to manage the condition. Enterocystoplasty, a standard treatment for bladder cancer, can lead to stone formation due to factors like urinary stasis and infections. Giant stones are rare but require prompt treatment, often involving neocystolithotomy. Controlling risk factors and selecting appropriate treatment based on stone size and surgical expertise are key to improving patient outcomes.

Introduction: the relationship between elevated plasma homocysteine (Hcy) and stroke has been established, but this association remains indistinct in cryptogenic stroke in adults. Our aim is to investigate the association between homocysteine, vitamins B9 and B12, and cryptogenic stroke. Furthermore, to determine the correlation between methylenetetrahydrofolate reductase (MTHFR) polymorphism and biochemical levels in plasma.

Methods: we conducted a retrospective case-control study including 100 cryptogenic stroke patients aged 18-50 years and 100 participants with age-and-sex-matched healthy controls. Clinical, radiological, and outcome data from cerebral venous thrombosis (CVT) patients were recorded. Homocysteine, vitamin B9, and vitamin B12 were analyzed. Deoxyribonucleic acids (DNAs) from both groups were tested. MTHFR C677T mutation was assessed by restriction fragment length polymorphism (PCR). All analyses were performed using Statistical Package for the Social Sciences (SPSSV.20) software. Multivariable logistic regression analysis was performed to identify factors associated with stroke risk and clinical outcomes.

Results: a total of 200 cases were included in this study, 50% (n=100) patients with cryptogenic stroke (mean age of 40.49 ± 6.2 years, sex-ratio= 1.5) and 50% (n=100) healthy cases (mean age of 39.09 ± 5.8 years, sex-ratio= 1.5). The elevated plasma level of Hcy and vitamin B9 levels deficiency increase the risk of cryptogenic stroke occurrence (aOR: 2.5; 95% (0.71-5.25), P=0.01), (aOR: 3.1; 95% (1.6-9.6), p=0.02 respectively). Additionally, vitamin B9 deficiency was significantly associated with elevated Hcy levels (4.57 ± 3.59; p=0.001). Genetic analysis revealed a significant association between homozygous TT genotype of the MTHFR C677T polymorphism, elevated Hcy levels (20.4 ± 7.07; p=0.001) and vitamin B9 deficiency (4.9±3.9; p=0.001). Furthermore, the combined CT/AC genotype was associated with elevated Hcy level (21.6 ± 9.6; p=0.001) and vitamin B9 deficiency (2.9 ± 1.0; p=0.04).

Conclusion: the presence of homozygote MTHFR C677T or dual heterozygous MTHFR C66T and A1298C, which leads to elevated Hcy and deficiency of vitamin B9 plasma levels, is correlated with an increased risk of cryptogenic stroke occurrence among adult Tunisian patients.

Serotonin syndrome is an iatrogenic disorder induced by serotonergic drug. It is characterised by a symptomatic polymorphism that may create confusion with other clinical conditions, delaying diagnosis and putting the vital prognosis at risk. In light of a case report and a literature review, we here report the clinical case of a patient presenting with confusion, psychomotor agitation, hyperreflexia and spontaneous myoclonus following simultaneous use of paroxetine and amitriptyline. The diagnosis of serotonin syndrome was made after ruling out other possible diagnoses. The patient was admitted to the intensive care unit. This clinical case highlights the importance of thoroughly understanding the clinical manifestations of serotonin syndrome to ensure early and appropriate therapeutic management.