Pan African Medical Journal最新文献

Central Retinal Artery Occlusion (CRAO) is a serious ophthalmic emergency characterized by sudden, painless vision loss in one eye. This condition leads to rapid and significant visual impairment if not treated promptly. This case illustrates an adult man with hypertension presented with unilateral, painless, sudden vision loss occurring 13 hours before admission. Examination revealed a visual acuity of 1-meter counting finger in the affected eye, a cherry red spot, and a pale retina. Diagnosed with CRAO, immediate interventions included ocular massage, and acetazolamide loading alongside systemic antihypertensive medication. Visual acuity improved significantly, with the patient able to see 5/30 on the nasal side and can maintain this visual acuity until 6 months follow-up. Immediate and aggressive treatment for CRAO can lead to significant visual recovery even when initiated beyond the traditionally recommended time frame, underscoring the need for quick recognition and intervention in CRAO cases.

Since its inception in 2003, the African Society of Human Genetics (AfSHG) has been central to the promotion of genetics research on the continent, and facilitated the networking of African researchers within Africa and abroad, thereby significantly contributing to the career development of African geneticists. The continuation of these accomplishments was stimulated by the 12^th international conference of AfSHG held jointly with the 1^st Congress of the Malian Society of Human Genetics (MSHG) in Bamako, Mali from September 18^th to 21^st 2019. The main theme of the conference was "Human Genetics and Genomics as a Unifying Factor for Harmony and Progress in Africa". The goals of the meeting were to promote the work conducted mainly by African researchers and to contribute to scientific knowledge through genetic research. Despite challenges due to security issues in Mali, this conference attracted many scientists, including key experts in genetics and associated fields, making the conference successful scientifically and geographically. Overall, 172 delegates from 24 countries attended. Sessions on various topics relevant to Africa were held. These included the genetics of infectious diseases, cancer, and rare diseases as well as bioinformatics, pharmacogenomics, population genetics, and ethical, legal, and social issues, particularly with respect to genetic research in African populations. The need for genetic data sharing to improve research and health and the focus of actionable research for African populations was stressed throughout the meeting.

Methemoglobinemia (MetHb) is a life-threatening condition that reduces the oxygen-carrying ability of hemoglobin. Acquired methemoglobinemia usually results from exposure to specific oxidizing agents. Symptoms and complications depend on the MetHb level, which can sometimes be fatal. We present a case of a 6-week-old infant exhibiting hypoxia alongside gastroenteritis, fever, poor oral intake and low activity, with confirmed methemoglobinemia in blood gas analysis. Despite negative results in the workup for underlying causes, including genetic testing conducted later, methylene blue administration only partially reduced methemoglobinemia level. Treatment involved managing diarrhea by transitioning to a hydrolyzed formula. Interestingly, an incidental discovery of partial central venous sinus thrombosis occurred during the diagnostic process, although no established correlation with methemoglobinemia was evident in the literature. This case report illustrates the complex presentation of methemoglobinemia in a previously healthy infant, occurring concurrently with gastrointestinal infection and unexpected thrombosis. It underscores the need for interdisciplinary collaboration and comprehensive management in addressing such multifaceted clinical scenarios in pediatric practice. This case emphasizes the importance of considering diarrhea as a possible cause of methemoglobinemia, especially in infancy. It also highlights the need for increased clinical awareness and prompt management approaches towards the various presentations of acquired methemoglobinemia in pediatric populations.

Introduction: the purpose of our study is to evaluate the efficacy of azathioprine as first-line treatment in patients with relapsing-remitting multiple sclerosis (RRMS) or progressive multiple sclerosis (PMS), who were supposed to be treated with beta-interferons but, due to limited resources, received azathioprine instead.

Method: among the 31 patients, 17 had relapsing-remitting MS (RRMS), 11 had primary progressive MS (PPMS), and 3 had secondary progressive MS (SPMS). Patients received azathioprine orally at a dose of 3 mg/kg/day over 2 years. The effect of azathioprine was assessed using the Expanded Disability Status Scale (EDSS) score. Compare means t-test was used to determine the treatment performance.

Results: for RRMS, the mean EDSS score ranged between 4.2 and 3.6±1.4. A total of 82.4% of patients were stable or improved, with a very highly significant difference (P= 0.000). For PPMS, the mean EDSS score remained constant at 5.7 ±0.4. A total of 54.5% of patients showed stability or improvement, with a highly significant difference (P= 0.005). In the case of SPMS, the mean EDSS score ranged between 4.5 and 4.1±1.3. A total of 66.7% of patients were stable or improved but with a non-significant difference (P= 0.1).

Conclusion: the results of this study confirm that azathioprine is beneficial in the treatment of different types of multiple sclerosis in Morocco.

Introduction: cardiovascular magnetic resonance imaging is considered the standard of care for many clinical cardiovascular applications. Magnetic resonance imaging is a scarce resource in sub-Saharan Africa, with a paucity of cardiac magnetic resonance imaging clinical services and research. The aim of this audit was to review the cardiac magnetic resonance imaging service provided at a public tertiary hospital in Cape Town, Western Cape Province, South Africa.

Methods: a retrospective, descriptive audit via quantitative record review of Tygerberg Hospital´s cardiovascular magnetic resonance imaging service was conducted from the inception thereof on 1^st April 2015 up to 31^st October 2022.

Results: a total of 1,403 cardiovascular magnetic resonance imaging scans met the inclusion criteria. The mean age of the study population was 43 years, and 52% were female. The most common patient comorbidities were modifiable cardiovascular risk factors, including hypertension (22%; n=306), cigarette smoking (9.6%; n=134), diabetes mellitus type II (6.7%; n=94) and dyslipidaemia (4.4%; n=62). Sixty-three percent (n=888) of scans were performed after hours. In 93% of scans, intravenous gadolinium-based contrast agents were administered. Nonischaemic cardiomyopathy dominated the indications (56.7%; n=976) and final diagnosis (42%; n=589). The most common incidental extracardiac finding was hilar or mediastinal lymphadenopathy (6%; n=82).

Conclusion: the recently established, functional cardiovascular magnetic resonance imaging service at Tygerberg Hospital serves a unique patient population with a comparatively differently distributed cardiac disease spectrum, contributing to research diversity.

The intrauterine device (IUD) is a widely utilized contraceptive method. In cases of uterine rupture, an IUD can migrate to the intra-abdominal or pelvic cavity, leading to various complications such as gastrointestinal perforation. The aim of this study was to report a case of a 29-year-old woman presented with acute left lumber pain. A computerized tomography scan revealed a left para tubal collection measuring 5x6cm, with the IUD located outside the uterine cavity and penetrating the rectum. Surgical intervention was performed, resulting in the complete retrieval of the device and closure of the perforation. The case report highlights the potential for serious complications associated with IUD use and the need for healthcare providers to be vigilant and to promptly recognize and manage them through a multidisciplinary approach.

Introduction: cardiac pacing is the only lifesaving procedure which is effective for major cardiac conduction disorders. In sub-Saharan Africa, few pacemakers are implanted, compared to Western countries. This study aimed to describe the indications for cardiac pacing in four hospitals in Senegal, to evaluate its practical modalities, to identify pacemaker's complications and their predisposing factors and to evaluate the main challenges for cardiac pacing in Senegal.

Methods: we carried out a retrospective study over four years and eight months, from January 2015 to July 2019 in four hospitals in Dakar (Senegal). All patients who received a single-chamber or double-chamber permanent pacemaker were included. Variables included age, gender, symptoms, comorbidities, ECG results, cardiac pacing indications, implantation data, type of procedure, vein approach, use of temporary stimulation lead, data on the characteristics of the pacemaker and probes, and complications.

Results: six-hundred and-twenty (620) permanent cardiac pacemakers were implanted. That is to say an implantation rate of 41 per million population in Senegal. The mean age of the patients was 71±11.77 years. The male gender was in the majority with a sex ratio of 1.19. Eighty-five percent (n=527) of our patients were symptomatic before implantation while 15% (n=93) were asymptomatic. The symptoms were mainly dyspnea in 41% (n=254), dizziness in 32% (n=322) and syncope in 21.3% (n=132). The most found indication was a complete atrioventricular block in 73.7% (n=457), followed by high-degree AVB in 9.2% (n=57). Sinus dysfunction represented 2.4% of indications (n=15). All devices were purchased by patients themselves or their families without government subsidies. Dual-chamber stimulation was the most used mode in 67.1% (n=416) of the patients. Single-chamber stimulation was also used in 32.9% of cases (n=204). The pacemakers were new in 96.1% of cases (n=596) and reused in 3.9% (n=24). The evolution of our patients was generally favorable. Complications occurred in 4.53% of our patients (n=28); mainly leads dislodgements in 1.94% (n=12), infections in 1.29% (n=8), pocket hematomas in 0.65% (n=4), pneumothorax in 0.65% (n=4).

Conclusion: implantations in Senegal are most often salvage implantations with a predominance of complete atrioventricular blocks over sinus dysfunction. Complications of cardiac pacing in our study were mostly lead dislodgment and infections. The challenges facing cardiac stimulation in our country remain the lack of a national registry for implantation database and above all, a lack of accessibility to pacemakers which may be improved by the availability and use of reused pacemakers but also by the introduction of subsidies for cardiac electronic devices by African governments.

Uterine leiomyosarcoma is a rare aggressive uterine malignancy that arises from a smooth muscle of the uterus which accounts for 2-5% of all uterine malignancies. Definitive treatment is surgery with a high rate of recurrences. Our patient presented with lower abdominal pain and mass per abdomen which was diagnosed to be uterine leiomyosarcoma. A 56-year-old woman of East Indian origin presented with abdominal pain and a huge rapidly growing suprapubic abdominal mass with an almost monthly doubling. Her CA 125 and Lactate dehydrogenase (LDH) level was elevated and Computed Tomography (CT) scan showed a large irregular-shaped abdominopelvic solid heterogeneously enhanced lesion with focal central hyperdensity and areas of necrosis causing mass effect. A primary cytoreductive surgery was performed and the histopathology report confirmed the diagnosis of uterine leiomyosarcoma. A combination chemotherapy of six cycles was given to prevent recurrence. No recurrence was detected during her more than two years follow-up period. As the cases are rare in nature, screening is impractical. Hence, the diagnosis of uterine leiomyosarcoma is done by histopathologic examination after surgery.

The emergence of severe acute respiratory syndrome coronavirus 2 has made it crucial to develop safe vaccines. Three main types of vaccines are currently available. Although they have proven to be very secure, they have caused various adverse effects. We here report a rare case of livedo reticularis following the administration of COVID-19 vaccine in a 54-year-old woman. It occurred 24 hours after vaccination, accompanied by respiratory, digestive, and neurological disorders and deterioration in general condition. Examinations revealed skin lesions compatible with livedo reticularis, mild inflammatory syndrome and hypercholesterolemia. Imaging showed no abnormalities. Immunological tests were positive for lupus anticoagulant. The patient received symptomatic treatment, with improvement in neurological and joint symptoms and a slight regression of skin rashes. After three months, the lupus anticoagulant test remained positive, confirming post-vaccination antiphospholipid syndrome (APS). The association of livedo reticularis with COVID-19 vaccine should not be underestimated and its degree of severity remains to be determined. More data and cases need to be collected for a more in-depth and detailed analysis.

Pneumococcal meningitis is the most severe bacterial meningitis rarely complicated by acute myelitis. We report a case of a 54-year-old female who presented with pneumococcal meningoencephalitis. After eight days of hospitalization, the patient presented a sudden onset of bilateral lower leg weakness and bladder and bowel sphincter dysfunction. A neurological examination revealed a flaccid paraplegia. A magnetic resonance imaging (MRI) of the brain and the complete spinal cord was performed and showed cervical and thoracic myelitis. The patient was successfully treated with antibiotics and intravenous steroids. This case emphasizes the importance of considering myelitis as an acute complication of bacterial pneumococcal meningitis, with a good prognosis depending on early recognition and administration of appropriate therapy.