Pan African Medical Journal最新文献

Primary ovarian parasitic disease is rare and can masquerade as advanced ovarian carcinoma; we report the first detailed case in a post-menopausal woman that underscores this diagnostic trap. A 51-year-old woman with chronic raw-seafood ingestion presented with bilateral adnexal masses (7cm left, 5cm right), low-grade fever, leukocytosis (13.2 × 10⁹/L), markedly elevated C-reactive protein (135mg/L) and CA-125 (69.5U/mL), and imaging suggesting ovarian malignancy with ascites. Intra-operatively, a "frozen pelvis" with dense adhesions, multiple abscesses and omental cake was found; frozen section excluded neoplasia, leading to total hysterectomy, bilateral salpingo-oophorectomy, appendectomy and abscess debridement guided by infectious-disease principles. Histopathology revealed chronic suppurative granulomatous inflammation with parasitic remnants consistent with echinococcal disease, and the patient remains disease-free at 5 years. Clinicians should include parasitic infection in the differential of complex pelvic masses in patients with raw-food exposure; complete excision adhering to anti-infective surgical protocols prevents misdiagnosis as malignancy and avoids unnecessary oncologic overtreatment.

Introduction: diagnosis of multi-drug-resistant (MDR) tuberculosis (TB) has been revolutionized by the introduction of the GeneXpert MTB/RIF test, which is much faster and easier to use than traditional methods. Concerns have been raised about false positive results for rifampicin susceptibility, especially in cases of samples with low bacillary loads and settings with a low burden of MDR-TB. The objective of this study was to assess the concordance between initial GeneXpert MTB/RIF results and subsequent diagnostic testing for rifampicin susceptibility in patients with suspected MDR-TB in Lusaka, Zambia.

Methods: this was a retrospective cohort study of patients who started MDR-TB treatment in Lusaka province, Zambia, from 2019 to 2021. Initial GeneXpert MTB/RIF bacillary load and rifampicin susceptibility, as well as results for any confirmatory testing on rifampicin resistance (including repeat GeneXpert MTB/RIF, phenotypic drug susceptibility testing, and line probe assay results) and patient outcomes were collected from patient files.

Results: the study included 342 patients. Initiation of MDR-TB treatment was based on rifampicin resistance detected by GeneXpert MTB/RIF in all patients. Twenty-nine percent of patients had a very low bacillary load in the initial sample. Additional diagnostics for rifampicin resistance were available in 56% of patients, and revealed rifampicin susceptibility in 28% of tested patients. Rifampicin-susceptible TB was found more often if the bacillary load in the initial sample was very low (78% versus 18%; p=0.0001).

Conclusion: false positive results for rifampicin susceptibility on GeneXpert MTB/RIF appear to be common in Lusaka, Zambia, especially in patients with very low bacillary loads on the initial test. Repeat testing to confirm MDR-TB prior to initiation of treatment can be considered in this group.

Extracorporeal shock wave lithotripsy (ESWL) is a cornerstone non-invasive therapy for urolithiasis. While major complications are rare, bowel perforation represents a serious life-threatening event. We present the case of a 36-year-old male with a history of recurrent renal stones who developed an acute abdomen four hours after supine ESWL for a right proximal ureteral calculus. Computed tomography revealed pneumoperitoneum and mesenteric stranding. Emergency laparotomy confirmed a jejunal perforation with secondary peritonitis, which was managed with primary repair and ureteral stenting. The patient made a full recovery. This case highlights a severe but rare complication of a common urological procedure. It underscores the critical need for high clinical suspicion in any patient presenting with abdominal pain post-ESWL, as prompt diagnosis via cross-sectional imaging and immediate surgical intervention are paramount for survival. A multidisciplinary approach is essential for optimal management.

Introduction: hydroxyurea (HU) is a proven, safe, and effective treatment for sickle cell disease (SCD) but is underutilized in Tanzania. Caregivers´ beliefs influence medication usage in children with chronic diseases. This study assessed caregivers´ beliefs about HU and their effect on HU use among children with SCD in Dar-es-Salaam.

Methods: a cross-sectional study enrolled 374 caregivers from four hospitals in Dar-es-Salaam. We adapted the "Belief About Medication Questionnaire" to assess caregivers´ beliefs about HU necessity and concerns. Scores of ≥15 indicated high necessity/concerns. Caregivers were categorized into four belief patterns: positive (high necessity, low concerns), negative (low necessity, high concerns), ambivalent (high necessity, high concerns), and indifferent (low necessity, low concerns).

Results: seventy percent of caregivers reported HU usage, 63% exhibited positive beliefs, with 95% of them reporting HU use. Caregivers with an indifferent belief category made up 43% of those with non-positive beliefs, and only 7% of them reported HU use. Thirty-eight percent of caregivers were concerned about HU's long-term effects, whereas 67% perceived that HU protects their children´s health from worsening. Caregivers with positive beliefs were 14 times more likely to report HU use than those with indifferent HU beliefs (IRR 14.3, 95% CI: 5.5 - 36.9). Participants from national hospitals were three times more likely to have positive beliefs than those attending regional hospitals (aOR 3.3, 95% CI 2.1 - 5.1).

Conclusion: health-care level and caregivers´ education impact HU beliefs and use. Targeted interventions to address specific obstacles across different caregiver subgroups are essential to improve HU beliefs and usage.

The coexistence of relapsing polychondritis in patients under follow-up for systemic lupus erythematosus is rarely reported in the literature, with a prevalence of about 1%. We here report the first Moroccan case, a 44-year-old female patient who, after nine years of lupus, developed relapsing polychondritis and achieved clinical remission after four years of follow-up with hydroxychloroquine and low-dose prednisone. In our literature review, we identified 23 cases of lupus associated with relapsing polychondritis. These are two distinct pathologies in which the autoimmune mechanism is thought to be involved. This case highlights the importance of mutual surveillance to detect early the occurrence of either condition, despite their rarity.

Introduction: tuberculosis (TB) is one of the major public health threats and the leading infectious disease worldwide. Assessing TB treatment outcomes and associated risk factors is crucial for effective treatment and control. This study aimed to investigate TB treatment outcomes and their related factors in Hargeisa, Somaliland.

Methods: a five-year, hospital-based retrospective study was conducted at Hargeisa TB Hospital, Somaliland, from January 1^st, 2019, to December 31^st, 2023. A total of 6127 registered patients, including only 6069 TB patients with complete information, were included in the study. Demographic, clinical, and treatment characteristics of the study participants were gathered from the TB register using a pretested structured data abstraction template. Data were entered and analyzed using R 4.2.2 software, with a p-value < 0.05 considered statistically significant.

Results: the overall successful treatment outcome was 81.2%. Among all TB patients, 31.9% of males and 21.8% of females completed their treatment. Younger patients (<20 years) showed a higher likelihood of success, as indicated by adjusted odds ratio (AOR= 2.89, 95% CI: 2.35-3.56), followed by patients aged 20-40 (AOR= 2.43, 95% CI: 1.98-2.98) and 40-60 (AOR= 1.54, 95% CI: 1.23-1.93). Patients with extrapulmonary tuberculosis (EPTB) had lower odds of successful treatment compared to those with pulmonary TB (AOR= 0.75, 95% CI: 0.66-0.86). Human Immunodeficiency virus (HIV)- negative patients were more likely to achieve a successful outcome (AOR= 2.75, 95% CI: 1.82-4.10), and the likelihood of success increased progressively over the years, with 2023 showing the highest odds (AOR= 2.66, 95% CI: 2.14-3.30).

Conclusion: the overall treatment outcome was below the World Health Organization (WHO) target (90%). Therefore, the study recommends improvements in TB treatment strategies, focusing on at-risk groups for less treatment success, including older individuals and HIV-coinfected TB patients.

Introduction: acute drug intoxication (ADI) is a common reason for emergency department visits and intensive care unit admissions. The objective of our study was to describe the population presenting to the emergency department for ADP and to identify predictive factors for hospitalization.

Methods: this was a cross-sectional study conducted over a 30-month period (July 1, 2021 - December 31, 2023). We included all patients admitted with a diagnosis of acute drug poisoning.

Results: a total of 41 cases of ADP were recorded. Independent predictive factors for hospitalization included: poly-drug poisoning (OR = 3.3; 95% CI [2.6-6.7]; p = 0.031), toxic dose exposure (OR = 1.7; 95% CI [1.1-3.5]; p = 0.04), paracetamol poisoning (OR = 1.4; 95% CI [1.2-2.7]; p = 0.02), oral antidiabetic drug poisoning (OR = 1.1; 95% CI [1.1-2.8]; p = 0.01), benzodiazepine poisoning (OR = 1.9; 95% CI [0.8-3.2]; p = 0.02), miosis (OR = 1.2; 95% CI [1.2-4.2]; p = 0.043), seizures (OR = 1.3; 95% CI [0.8-2.1]; p = 0.001), sinus bradycardia (OR = 1.3; 95% CI [0.7-2.7]; p = 0.031), and conduction disturbances (OR = 1.8; 95% CI [1.4-4.2]; p = 0.02).

Conclusion: these findings highlight the substantial number of potentially avoidable hospitalizations. Developing a specific guideline for drug poisoning could help standardize management in emergency settings.

Multisystem inflammatory syndrome in adults (MIS-A) is a rare and severe entity occurring after SARS-CoV-2 infection, and it is often underrecognized in adults. The purpose of this study is to describe the clinical, paraclinical, therapeutic, and prognostic characteristics of MIS-A through a structured review of the literature. A search was conducted in PubMed, Scopus, and Web of Science databases up to May 2024. Articles included were clinical case reports or case series of MIS-A in adults. Eighteen (18) articles were included. MIS-A mainly manifests as persistent fever, multiorgan involvement, marked inflammatory response, and frequently negative SARS-CoV-2 PCR but positive serology. Treatment is based on immunoglobulins, corticosteroids, and, in some cases, anti-IL-6 therapy. Although rare, MIS-A represents a medical emergency to be considered in the aftermath of COVID-19 infection, even in asymptomatic cases. Diagnosis is based on nonspecific clinical and biological criteria, which makes recognition challenging. Early immunomodulatory treatment can improve prognosis.