Pan African Medical Journal最新文献

Introduction: in January 2021, a national COVID-19 vaccine campaign was launched in Morocco. The national pharmacovigilance system was strengthened to assess any adverse events related to the COVID-19 vaccine. The objective of this study was to analyse the factors associated with severe Adverse Events Following Immunization (AEFI) related to COVID-19 vaccines in the Casablanca-Settat region in Morocco.

Methods: this multicentric, cross-sectional study was conducted among individuals who reported AEFI after COVID-19 vaccines. Factors associated with the occurrence of severe AEFI were analysed using logistic regression.

Results: a total of 1257 reports (2538 AEFI) were analysed. The AstraZeneca vaccine was responsible for 65% of the AEFI. 74% of cases occurred after the first dose, and 92% were considered non-serious. Among the 95 serious cases, 51% presented their first AEFI within 24 hours of vaccination. Age ≥65 years (OR = 2.63; p < 0.001), male gender (OR = 1.75; p = 0.03), and a number of AEFI per patient ≥3 (OR = 2.08; p < 0.001) were associated with serious AEFI.

Conclusion: although the majority of cases were non-serious, this study highlights the importance of vigilance, particularly for at-risk populations such as the elderly, men, and patients with a high number of AEFI.

This study analyzed the therapeutic effectiveness, ADRs, and their influencing factors in multidrug-resistant tuberculosis (MDR-TB) patients. We conducted a cross-sectional study involving patients in four referral hospitals in Yogyakarta province. The data was collected from the medical records and the Tuberculosis Information System (SITB) of the Ministry of Health of the Republic of Indonesia from January 2020 to June 2023. Of the 65 patients, 31 (47.7%) showed the expected clinical response. The factors affecting the therapeutic effectiveness were occupation and medication adherence. The most frequent ADR found was gastrointestinal disorders (19.9%). Based on the severity levels, the most frequently found ADRs were levels 1 and 3, at 60.1% and 26.1%, respectively. In conclusion, more than half of all the MDR-TB patients still showed an inadequate clinical response, with almost 40% of MDR-TB patients experiencing ADRs.

Molar pregnancy is an uncommon diagnosis in perimenopausal women and poses a high risk of complications, including hemorrhagic shock and malignant transformation. We report the case of a 51-year-old woman who presented with severe abdominal pain and profuse vaginal bleeding. Imaging revealed a markedly enlarged uterus with a large intracavitary mass, and serum β-hCG levels were elevated. The patient developed hemorrhagic shock and underwent an emergency hemostatic hysterectomy. Histopathological examination confirmed a complete hydatidiform mole with early invasive features, without choriocarcinoma. Postoperative imaging showed no metastases, and the patient received methotrexate-based chemotherapy with favorable response, evidenced by a progressive decline in β-hCG levels. This case underscores the importance of considering gestational trophoblastic disease in the differential diagnosis of abnormal uterine bleeding in perimenopausal women. Early recognition and timely surgical intervention, followed by appropriate chemotherapy and monitoring, are crucial to avoid potentially life-threatening complications.

Introduction: Diabetes Mellitus (DM) is a serious, chronic medical condition. It requires ongoing medical follow-up and patient self-management. However, poor self-management and diabetes complications are the result of inadequate diabetes self-care knowledge. Hence, this study aimed to investigate diabetes self-care knowledge and associated factors among diabetes patients in North-Central, Ethiopia.

Methods: a facility-based cross-sectional study design was employed among 355 diabetes patients at North-Central, Ethiopia, public and private health facilities from March 22^nd to April 30^th, 2022. A systematic sampling technique was applied to select study participants. The data were collected using a structured interviewer-administered questionnaire and by reviewing patient charts. We used Epidata version 4.6 to enter the data, and SPSS version 23 was used for data analysis. Both bivariable and multivariable logistic regression were used to identify contributing factors for diabetic patients´ self-care knowledge.

Results: among the total participants, 54% had good knowledge about diabetes self-care. Variables like, educational level diploma and above (AOR: 3.407, 95% CI: 1.337-8.684), monthly income of 2000 birr and above (AOR: 4.384, 95% CI: 1.548-12.411), respondents with regular follow-up (AOR: 8.910, 95% CI: 2.903-17.349), and those who have ever attended diabetes health education (AOR: 5.554, 95% CI: 1.820-16.953) were significantly associated with having good diabetes self-care knowledge.

Conclusion: more than half of the participants have good knowledge of diabetes self-care. As per our results, educational level, monthly income, regular follow-up, and having experience in diabetes-related health education were independent determinants of having good knowledge about diabetes self-care.

Vaccines against SARS-CoV-2 were rapidly developed to combat the COVID-19 pandemic. Rare cases of Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT) have been reported after the AstraZeneca COVID-19 vaccination. We present a case of a 51-year-old healthy man who developed fever, unconsciousness, thrombocytopenia, multiple thromboses, and macrophage activation syndrome one week after receiving the first dose of the AstraZeneca COVID-19 vaccine. Initial anti-PF4 antibody tests were negative, but subsequent ELISA confirmed their presence. Despite plasma exchange and steroid therapy, the patient developed neurological deficits, gastrointestinal hemorrhage, multiple cerebral infarcts, and died. This case illustrates the risk of fatal vaccine-induced immune thrombotic thrombocytopenia after an AstraZeneca COVID-19 vaccination and emphasizes the need for early recognition and specialized testing, including PF4 ELISA, to improve patient outcomes. Reporting such cases raises awareness, supports timely diagnosis, and guides appropriate management while reinforcing the importance of vaccination.

Introduction: Mauritians living with neurological disability face limited medical care, accessibility issues, and cultural stigma, which prevent community reintegration. We aimed to investigate the perspectives of Mauritians with neurological disability and their family caregivers during COVID-19 lockdown.

Methods: following a phenomenological epistemology, this qualitative study employed an inductive reflexive thematic analysis of semi-structured interviews with neurorehabilitation patients (N=18) and their primary caregivers (N=22). Patients with stroke (N=22), spinal cord injury (N=11), and traumatic brain injury (N=1) were included, excluding those who did not experience cognitive and/or physical disability.

Results: the analysis developed six themes: (1) caregiver burnout: "I do everything"; (2) barriers to treatment: "the kind of care we get"; (3) poor social support: the disability taboo; (4) geographical barriers: a world not built for you; (5) financial burden: "sinking us into a hole"; and (6) isolation: a double-sided coin. Unexpectedly, lockdowns benefitted socially isolated patients, resulting in strengthened familial bonds, subjective gains in recovery, fewer experiences of stigma, and reduced fatigue. Rehabilitation care is limited, and patients lose motivation to pursue medical care. As a result, medical care was not highly affected by the COVID-19 lockdowns. Instead, shortages and rising prices of medication posed issues.

Conclusion: the widespread lack of resources for patients on financial, rehabilitation, and social levels prevents patient return to the community and causes high rates of caregiver burnout. We recommend patient-centric strategies at the grassroots, community, and national levels to enhance accessibility, improve inclusivity, support caregivers, and reduce barriers to neurorehabilitation services.