Pan African Medical Journal最新文献

Neonatal adrenal hemorrhage is a rare condition with various risk factors in the pediatric population. Adrenal hemorrhage commonly affects the right side in about 70% of the cases and bilateral in about 10%. It is usually asymptomatic but can cause adrenal insufficiency and sudden death. Neonatal adrenal hemorrhage should be considered even when there are no risk factors, as it can occur spontaneously with unspecific clinical presentations. Ultrasonography can confirm diagnosis, a relatively cheap and safe modality, especially for resource-limited settings. In this case report, we present a two-day-old with progressive scrotal hematoma and inguinal ecchymosis with no risk factors. Magnetic resonance imaging confirmed right adrenal hemorrhage; however, the newborn deteriorated fast, reaching mortality within 24 hours of admission. This case illustrates the importance of recognizing the condition to allow for an evidenced approach, which may include conservative waiting, as unwarranted intervention can have negative outcomes.

Hyper immunoglobulin M (IgM) syndromes are a collection of uncommon primary combined immunodeficiency disorders. They are characterized by recurrent bacterial infections due to low levels of IgG, IgA, and IgE, while IgM levels remain normal or high. These conditions stem from a mutation in the CD40 ligand gene or disruptions in the CD40-signaling pathway. Those affected face increased susceptibility to frequent bacterial infections, an elevated likelihood of autoimmune issues, and early-onset malignancies. These syndromes are rare and account for a small fraction of immunodeficiency cases. We describe a case of an African infant, who had a prolonged pediatric intensive care unit admission due to recurrent and severe infections which took a prolonged course of medication to be treated. After a diagnostic workup, a diagnosis of X-linked hyper IgM syndrome was established, and currently, our child is on monthly replacement of IV immunoglobulin and daily prophylactic cotrimoxazole tablets. Early diagnosis of primary immunodeficiency disorders reduces the incidence of infections and the severity of complications. This case demonstrates the consequences of delayed diagnosis and resulting in a prolonged hospital stay.

This study aims to analyze the impact of muscle transfer on the glenohumeral joint in children with obstetric brachial plexus palsy (OBPP) using MRI by comparing preoperative and 5-year follow-up postoperative imaging findings to determine whether tendon transfers affect the alignment and configuration of the glenohumeral joint. Ten children with obstetric brachial plexus palsy (OBPP) participated in our prospective observational study, and we performed a tendon transfer technique. Every patient had an MRI of both shoulders done at preoperative and at the 5-year mark following the procedure. The glenoid form, glenoid version, humeral head hypoplasia (HHH), and percentage of the humeral head anterior (PHHA) were the parameters that were evaluated. The glenoscapular angle (GSA) was used to evaluate the glenoid version. Following tendon transfer surgery, MRI data show a regression of humeral head hypoplasia, and a statistically significant difference (p=0.0057) was observed between preoperative and postoperative results. Three individuals additionally recovered a normal glenoid shape. None of the remaining patients had a type 3 form; all had a type 2 form. Additionally, compared to the postoperative side, the damaged preoperative side's GSA was much more retroverted (p < 0.05). The mean PHHA for the afflicted shoulder was 25.8%, ranging from 0% to 40%, compared with 40.5% for the postoperative affected shoulder, indicating an improvement in humeral head subluxation (PHHA). As a result, the two results did not differ statistically. While tendon transfers led to only minor improvements in humeral head subluxation, they greatly improved glenoid retroversion and humeral head hypoplasia. It has been established that MRI is a useful diagnostic technique for glenohumeral anomalies due resulting from obstetric brachial plexus palsy.

This case presents a patient who experienced hypoxia and hypotension following the infusion of industrial-grade anhydrous ethanol into the vein of Marshall (VOM) during atrial fibrillation radiofrequency ablation. The hypotension lasted for at least three days, requiring dopamine support, while hypoxia persisted for over a week. The prolonged nature of these symptoms posed a diagnostic challenge. A thorough review of the patient's medications and an extensive literature search suggested that the use of industrial-grade anhydrous ethanol may have been the cause. This case highlights the potential risks associated with the use of non-medical grade substances in clinical procedures, emphasizing the importance of careful material selection to avoid severe complications.

Introduction: family-led mid-upper arm circumference (FL-MUAC) is a community-based acute malnutrition screening approach that is centered on training the mother or caregiver to use colour-coded MUAC tapes to screen children for malnutrition. A scoping review was conducted to summarise available evidence and evaluate the use of the FL-MUAC approach in the screening for acute malnutrition in Africa. A systematic literature search was performed using electronic databases to identify relevant research documents investigating the FL-MUAC approach. The search sources included PubMed, Google Scholar, and institution websites such as the Emergency Nutrition Network (ENN) and The State of Acute Malnutrition. Documents were screened and assessed for eligibility and data was extracted from the eligible documents. Twelve documents were eligible for review based on the inclusion and exclusion criteria. Eight peer-reviewed articles and four operational documents were included in the scoping review. The results show that the FL-MUAC approach has been used by mothers and caregivers to monitor their children's nutrition status in sixteen countries including Zimbabwe, Niger, Kenya, Chad, and Mali. In the sixteen countries where the approach has been implemented, there has been evidence of improved acute malnutrition screening coverage and increased frequency of screening, low hospitalization rate, and high cure rate of malnutrition cases attributed to the FL-MUAC approach. In conclusion, the FL-MUAC approach is still being piloted in most African countries. In addition, available evidence shows that FL-MUAC has the potential to be effective in early diagnosis and improved coverage for acute malnutrition. However, there is a need to integrate the FL-MUAC into healthcare systems and promote the standardization of monitoring and evaluation indicators.

Introduction: digitising health worker payments could improve their well-being, that of users of health service points and the performance of the health system. The purpose of this study was to identify factors associated with the acceptability of mobile payments among health workers in the Koumpentoum health district.

Methods: we conducted a cross-sectional, descriptive and analytical study in the Koumpentoum health district, in eastern Senegal, in January 2023. Recruitment was exhaustive, involving all health staff and community stakeholders. A questionnaire was developed and administered remotely via phone calls. It was used to gather information on socio-professional characteristics, knowledge, attitudes, practices and the acceptability of mobile payments by healthcare workers. Binomial logistic regression was used to identify factors associated with the acceptability of mobile payments by health workers.

Results: a total of 418 health workers were surveyed, 87.3% of whom were community actors. All respondents said that digital payments in their context were represented by transfers via mobile applications, and 86.6% were in favor of its use in the healthcare sector. The majority of them (91.5%) would accept being paid through this method. Reasons for adoption included positive perceptions of convenience, speed and security, while reasons for non-adoption were lack of network access, errors and transfer fees. Factors favoring the acceptability of mobile healthcare payments included less than 5 years of professional experience (ORa= 7.91 [2.65-34.38]; p= 0.001), a satisfactory experience with mobile digital payments (ORa= 4.18 [1.3-18.92]; p= 0.031), acceptability of mobile payments in daily life (ORa= 5.81 [1.37-23.29]; p= 0.013) and performance expectations (ORa= 7.3 [3.42-16.05]; p < 0.001).

Conclusion: this study conducted in the Koumpentoum health district indicated a high level of acceptance of mobile payments among health workers. Despite this, potential challenges such as lack of network access and transfer fees were noted. While the integration of mobile payments in the health sector in Koumpentoum appears promising, measures are needed to overcome these identified obstacles.

Coats disease is a rare abnormality characterized with retinal telangiectasia and aneurysms with retinal exudation, most often seen in young males and usually affecting only one eye. A 12-year-old boy came in with a three-month history of vision loss and pain in his right eye, alongside progressively worsening blurred vision over the last year. His visual acuity was reduced to only light perception in the right eye, while his left eye maintained 5/5 vision. The intraocular pressure was 43.4 mmHg in the right eye and 15 mmHg in the left eye. Conjunctival hyperaemia, mild corneal edema, iris neovascularization, xantocoria, and dilated pupil was found in anterior segment. Ophthalmoscopy showed retinal telangiectasia in all quadrants and total bullous exudative retinal detachment. Coats disease cases that present at an advanced stage have fewer treatment options and generally a worse prognosis.

Bilateral scrotal masses may present as polyorchidism or benign neoplasms. Epidermoid cysts (ECs) are common benign cutaneous lesions that are characterized by encapsulated sebaceous cysts containing keratin. These cysts can undergo complications such as ruptures, infections, or daughter cyst formation. A 29-year-old male presented with an asymptomatic scrotal mass. On physical examination, intrascrotal masses were palpated superior to each testis. An ultrasonographic evaluation revealed that the two masses were discrete and located superior to the right and left testis, respectively. The parenchymal echogenicity of these lesions was comparable to that of normal testicular parenchyma. Under the clinical impression of benign scrotal lesions, the provisional diagnosis was of bilateral testicular masses due to polyorchidism. Surgical intervention involved the complete excision of both masses. The subsequent histopathological examination revealed the definitive diagnosis of ECs. This case illustrates that despite the advantages of Doppler imaging, ultrasonography may yield less accurate results than histopathological findings.

Acute heart failure is associated with high hospitalization and mortality rates. A strong, independent risk factor for mortality in patients with heart failure is acute kidney injury, and the condition caused by this connection between disturbances in heart function and proper kidney functioning is cardiorenal syndrome (CRS). This case report discusses the role of continuous renal replacement therapy (CRRT) in the management of a CRS case with septic shock due to pneumonia. A 56-year-old female patient with a history of acute heart failure developed complications of acute kidney dysfunction and was diagnosed with CRS type 1. Standard management was conducted in the intensive cardiac care unit, but the condition of the patient worsened. The patient was admitted to the intensive care unit and underwent CRRT, after which the kidney function and hemodynamic performance of the patient improved. Therefore, the use of CRRT can be a therapeutic option for CRS patients. CRRT acts as an ultrafiltration mechanism that removes circulating cytokines from the blood, reduces volume overload, and addresses electrolyte imbalance, thus enhancing the functioning of the heart and kidneys and potentially improving prognoses.