Pan African Medical Journal最新文献

Pregnancy-associated breast cancer (PABC) is a rare and complex condition, posing significant diagnostic and therapeutic challenges, particularly in resource-limited settings such as Tunisia. This study aims to analyze the clinical and therapeutic characteristics of PABC in a Tunisian population to tailor management strategies. We conducted a single-center, retrospective descriptive study of 35 patients diagnosed between January 2004 and December 2023 at the Monastir Maternity and Neonatology Center. Clinical, radiological, histopathological, and prognostic data were collected and analyzed. The incidence of pregnancy-associated breast cancer was 4.8%. The mean age of patients was 35.3 years, with an average delay of 141 days between symptom onset and consultation. Most cancers were non-metastatic, primarily invasive ductal carcinomas. Management included surgery, chemotherapy, and radiotherapy. Recurrence and mortality rates were 22.9% and 17.1%, respectively. The average overall survival was estimated at 106 months, with better prognosis for younger patients without lymph node involvement. This study emphasizes the importance of increased awareness and improved access to care for these patients, as well as the need to strengthen screening and treatment protocols.

Severe asthma is a chronic condition that often requires oral corticosteroid (OCS) therapy, which, when prolonged, may lead to significant adverse effects, including secondary adrenal insufficiency. Advances in biologic therapies have allowed many patients to reduce or discontinue OCS. We describe the clinical course and outcomes of six patients with severe corticosteroid-dependent asthma who underwent a structured OCS tapering protocol under endocrinological supervision. All patients had a history of prolonged OCS use (mean duration >10 years), high-dose inhaled corticosteroids (ICS), and biologic therapy. Adrenal insufficiency was confirmed in three patients (50%), who required continued hydrocortisone replacement due to persistent hypothalamic-pituitary-adrenal (HPA) axis suppression. The other three patients successfully discontinued corticosteroids and demonstrated HPA axis recovery. Notably, no asthma exacerbations occurred during the tapering process. A structured, multidisciplinary corticosteroid tapering protocol is both feasible and safe in patients with severe asthma, particularly when guided by endocrine assessment. ICS exposure may contribute to adrenal suppression, highlighting the need for comprehensive hormonal evaluation in this population.

Introduction: atrial fibrillation is increasingly diagnosed in Kenya due to the persistence of rheumatic heart disease and the rising burden of cardiovascular risk factors. We aim to describe the baseline, clinical, treatment characteristics, and six-month outcomes of patients diagnosed with atrial fibrillation in Kenya.

Methods: a retrospective observational cohort study design was employed. Data were obtained from three Kenyan referral hospitals, including public and private institutions. Baseline and six-month data were collected. Depending on the type of variable, data were summarized descriptively.

Results: two hundred forty participants were enrolled, with a median age of 59.0 (IQR: 42.0-75.8). Women made up 54.4% (n=123) of the cohort. The median body mass index was 24.8 kg/m²(IQR: 21.1-29.2), and 62.8% (n=142) of participants were hospitalized at enrollment. Non-valvular atrial fibrillation (AF) was the predominant type, accounting for 77.4% (n=175) of cases, with persistent AF being the most common subtype (60.5%, n=137). At baseline, 77% (n=174) of participants were on anticoagulation therapy. The proportion with high-risk HAS-BLED and CHA₂DS₂-VASc scores at baseline was 10 (4.4%) and 62 (28.8%), respectively. Hypertension was the most prevalent comorbidity, affecting 39.4% (n=89) of participants. Nearly half (48.6%) had a preserved left ventricular ejection fraction. At the six-month follow-up, all participants remained on anticoagulation therapy. Mortality occurred in 17.7% (n=40) of participants, with cardiovascular causes accounting for 45.0% of these deaths.

Conclusion: the predominant type was non-valvular atrial fibrillation. Enhancing screening for comorbidities and adopting a holistic approach to atrial fibrillation care could lead to better patient outcomes in Kenya.

Introduction: monkeypox, an emerging viral zoonosis, has been declared a public health emergency by the World Health Organization. The smallpox vaccine is effective for prevention against monkeypox, but the perception and acceptability of this vaccine among healthcare workers in Northeastern Nigeria remain unclear. This study aimed to evaluate risk perception and factors associated with smallpox vaccine acceptance among healthcare workers in Northeastern Nigeria.

Methods: an online self-administered questionnaire was used to assess the risk perception and factors associated with smallpox vaccine acceptance among 316 healthcare and support workers in Northeastern Nigeria in a cross-sectional study. The convenience sampling method was used to recruit study participants. The researchers' phone contacts, social media groups, and followers were invited to participate in the study. The data obtained were analyzed using SPSS version 27. Chi-square analysis determines the difference in vaccine acceptance among the dependent variables. Binary regression was employed to evaluate the relationship between the dependent variables and fixed factors. A p-value less than 0.05 was considered significant.

Results: most participants (43.0%) strongly agreed that monkeypox is highly harmful, while only 9.8% believed it was less harmful than smallpox. Notably, 51% did not consider monkeypox a biological weapon aimed at reducing Africa's population; however, 32% still held this belief. There was a significant correlation (p < 0.05) between risk perception and willingness to receive the smallpox vaccine for monkeypox, although occupational risk perception did not significantly influence vaccination willingness (p > 0.05). vaccine safety, marital status, and professions were associated with the acceptance of the smallpox vaccine.

Conclusion: the healthcare workers surveyed generally felt at low risk for monkeypox yet exhibited a high willingness to accept the smallpox vaccine. Factors such as profession and perceived safety of the smallpox vaccine were linked to vaccine acceptance. Providing healthcare workers with training on vaccine safety, efficacy, and building trust regarding vaccine development is recommended.

Introduction: the aim was to evaluate the predictive value of tumor size, TIRADS classification, lymph node involvement, and demographic factors in guiding central neck dissection (CND) in patients with thyroid cancer.

Methods: this retrospective cross-sectional study included 437 patients, selected through convenience sampling, who underwent total thyroidectomy for thyroid cancer at a tertiary hospital in Riyadh, Saudi Arabia, from 2010 to 2023. Data collected included age, sex, BMI, tumor size, TIRADS level, lymph node status, and fine-needle aspiration (FNA) results. Associations with the performance of CND were analyzed using Pearson correlation coefficients and descriptive statistics.

Results: lymph node involvement, defined as histopathologically confirmed central lymph node metastasis, was the strongest independent predictor of CND (r = 0.5285, p < 0.0001), followed by tumor size (r = 0.4200, p < 0.0001) and TIRADS score (r = 0.2128, p = 0.0467). Age showed a weak but statistically significant association with CND (r = 0.1426, p = 0.0031), while sex and BMI had no significant impact. The majority of nodules were classified as TIRADS 3 to 5 (87.17%), and patients undergoing CND tended to be older with larger tumors and higher TIRADS categories.

Conclusion: lymph node involvement, tumor size, and TIRADS classification are meaningful predictors of surgical management in thyroid cancer. Integrating these factors into preoperative evaluation supports a personalized approach to CND, potentially reducing unnecessary procedures and improving patient outcomes. These findings support the development of standardized, risk-adapted surgical criteria for central neck dissection in thyroid cancer.

Few studies have focused on obesity in young people in our context, despite its increasing prevalence. The purpose of this study was to determine the prevalence of adolescent obesity in schools and identify associated factors. We conducted a multicenter cross-sectional study in four schools in the commune of Koumassi during students' medical check-ups. Adolescents with a body mass index (BMI) above 25 kg/m² or a BMI-for-age curve beyond IOTF 30 were included. Data were collected using a structured questionnaire, and statistical analysis was performed with SPSS software. The chi-square test was used, with significance set at p= 0.05. A total of 94 pupils were recruited, representing a prevalence of overweight children of 1.82%. There was a female predominance (73%), with a sex ratio of 0.36, and a peak prevalence between 12 and 14 years. In family history, 16% of children had at least one parent with obesity, and 44% came from low socioeconomic households. Obesity was grade I in 45.7% of cases. The average number of daily meals was two, and 41.5% of students practiced extracurricular sports. Factors associated with the onset of obesity were female sex (p = 0.01), age (p = 0.02), waist circumference (p = 0.003), and hip circumference (p = 0.005). Obesity is a reality in school settings. Combating this condition necessarily involves lifestyle changes combined with action by various public health stakeholders.

Introduction: the purpose of this study was to identify the factors associated with mothers' first therapeutic recourse for children under five years in areas implementing tracer interventions of the high-impact community package in Benin.

Methods: we conducted an analytical cross-sectional study involving mothers and their youngest child under five years of age. A multistage random sampling method was applied. The dependent variable was mother's first therapeutic recourse during her youngest child's most recent illness episode. A multivariate logistic regression was performed to identify factors associated with mothers' first therapeutic recourse.

Results: a total of 448 mothers of children under five years were included. Following the youngest child's most recent illness episode, 52.45% of mothers initially resorted to modern medicine or community health workers, while 47.55% engaged in self-medication, consulted traditional medicine practitioners, or did not seek care at all. Factors associated with mothers' health care' seeking for children under five during the most recent illness episode of their youngest child included Christian or Muslim faith, knowledge of a community health worker, availability of a household toilet, and residence in northern regions of Benin.

Conclusion: the identified factors highlight the importance of addressing modifiable elements such as promoting the role of community health workers to improve mothers' timely use of their services.