Prevalence of brain fag syndrome and its correlation with stimulant use and socioeconomic/demographic characteristics among university undergraduate students in Nigeria

Background: Brain Fag Syndrome (BFS) is a culture-bound syndrome characterized by cognitive and somatic symptoms, commonly reported among African students. This study aimed to determine the prevalence of BFS among Nigerian university students and examine its associated factors. Methods: A cross-sectional survey was conducted among undergraduate students from a university in the northwest region of Nigeria. The study utilized a self-administered questionnaire to collect data on socio-demographic characteristics, stimulant use, course of study, and academic performance. The presence of BFS was assessed using standardized diagnostic criteria. Results:The study included a total of 625 participants, in their young adulthood. The prevalence of BFS among Nigerian university students was found to be 62.7%. The majority of affected students were aged 20-30, male, and from the Hausa ethnic group. No significant association was found between stimulant use and BFS. However, there was a significant relationship between the course of study and the occurrence of BFS. Academic performance (CGPA) showed a weak negative association with BFS. Other socio-demographic factors such as age, gender, ethnicity, relationship status, birth position, type of home, and family income did not predict the occurrence of BFS. Conclusion: The high prevalence highlights the need for attention to mental health issues among this population. The results emphasize the importance of considering the course of study and academic performance when studying BFS. Further research is warranted to explore the underlying mechanisms and develop effective interventions for students affected by BFS.

Awareness of malocclusion and attitude towards orthodontic treatment among trainee dental surgery technicians in Nigeria

Objective: Malocclusion affects aesthetics, the physical, psychological and social life of a person. The aim of this study was to evaluate the awareness of malocclusion and attitude towards orthodontic treatment among trainee dental surgery technicians in Nigeria. Materials and Methods: This was a descriptive cross-sectional study carried out among 68 final year (sixty-eight) trainee dental surgery technicians in Nigeria. The research instrument was a self-administered close ended questionnaire. Data was analyzed using SPSS version 20. P value (P<0.05) was regarded as significant. Results: Sixty-one (89.7%) of the respondents were females, while 7 (10.3%) were males. Fifty-seven (83.8%) have heard of the term malalignment of teeth, 53 (77.9%) of the students think malalignment is due to external habits. 61 (89.7%) are aware that few teeth may have to be removed for proper positioning of irregular teeth and 51 (75.0%) were aware that the irregular teeth can be corrected even after 40 years of age. More females were aware of malocclusion and had positive attitude towards orthodontic procedures when compared to the males, but the difference was not statistically significant (P>0.05).Conclusion. Majority of the respondents in this study were aware of the term malalignment and had positive attitude towards orthodontic treatment. More females constituted the study population.

Facteurs associés à la mortalité des urgences chirurgicales néonatales à Douala / Determinants of mortality of neonatal surgical emergencies in Douala

Introduction. Les urgences chirurgicales néonatales (UCN) se manifestent de la naissance au 28e jour de vieet nécéssitent un traitement chirurgical dans un délai court. L'objectif de ce travail est d'identifier les facteurs associés à la mortalité des UCN dans quatre hôpitaux de la ville de Douala.Méthodologie. Nous avons mené une étude transversale analytique avec collecte de données rétrospective sur une période de 10 ans, allant du 1er Janvier 2013 au 31 Décembre 2022 dans 4 hôpitaux de la ville de Douala à savoir: l'Hôpital Général, l'Hôpital Laquintinie, l'Hôpital Gynéco-obstétrique et pédiatrique de Yassa, et l'Hôpital Protestant de Ndogbati. Résultats.Laprévalence hospitalièredes urgences chirurgicales néonatalesétait de6,1%. La tranche d'âge la plus représentée était celle de 2 à 7 jours avec un sex-ratio de 1,7. La mortalité était de 48%avec une majorité de décès en post-opératoire (64,4%).Les déterminants de mortalité sur le plan sociodémographique étaient : l'âge à l'admission inférieur à 8 jours (OR= 1,95 ; P<0,001), le sexe masculin (OR=1,51 ; P=0,002); la moyenne prématurité (OR=0,91 ; P<0,001), le poids de naissance < 2500g (OR= 5,15 ; P=0,009), et le délai d'admission > 2 jours (OR=0,73 ; P<0,001). Sur le plan évolutif, les facteurs de mauvais pronostic étaient : les malformations anorectales (OR=2,23; P< 0,001), l'atrésie de l'œsophage (OR=3,63 ; P=0,001), la présence de complications post opératoires (OR= 3,45 ; P<0,001) et le sepsis (OR= 7,87; P=0,037).ConclusionLa mortalité post opératoire est très élevée. Les facteurs associés sont le long délai diagnostic, la prématurité, les pathologies malformatives digestives et le seps

Introduction.Neonatal surgical emergencies (NSE) occur from birth to the 28th day of life and require surgical treatment within a short timeframe. The objective of this study is to identify factors associated with mortality in NSE in four hospitals in the city of Douala. Methodology.We conducted a cross-sectional analytical study with retrospective data collection over a period of 10 years, from January 1st, 2013 to December 31st, 2022, in 4 hospitals in the city of Douala, namely: General Hospital, Laquintinie Hospital, Gynecological-Obstetric and Pediatric Hospital of Yassa, and Protestant Hospital of Ndogbati. Results.The hospital prevalence of neonatal surgical emergencies was 6.1%. The most represented age group was 2 to 7 days with a sex ratio of 1.7. The mortality rate was 48%, with a majority of deaths occurring in the post-operative period (64.4%). Sociodemographic determinants of mortality were: age at admission less than 8 days (OR=1.95; P<0.001), male sex (OR=1.51; P=0.002); moderate prematurity (OR=0.91; P<0.001), birth weight < 2500g (OR=5.15; P=0.009), and admission delay > 2 days (OR=0.73; P<0.001). In terms of progression, factors associated with poor prognosis were: anorectal malformations (OR=2.23; P<0.001), esophageal atresia (OR=3.63; P=0.001), presence of post-operative complications (OR=3.45; P<0.001), and sepsis (OR=7.87; P=0.037). Conclusion Post-operative mortality is very high. Associated factors include delayed diagnosis, prematurity, digestive malformative pathologies, and sepsis.

COVID-19 vaccine hesitancy in KwaZulu-Natal, South Africa: A survey of unvaccinated adults

Background: Concerns and misconceptions surrounding coronavirus disease 2019 (COVID-19) vaccines may account for vaccine hesitancy and low uptake. Aim: To determine prevalence of COVID-19 vaccine hesitancy, vaccine-related misconceptions, and predictors of vaccine hesitancy among South Africans. Setting: Community setting in five districts in KwaZulu- Natal province. Methods: Between August 20, 2021, and September 27, 2021, we conducted a cross-sectional survey, interviewing 300 unvaccinated adults amid the national vaccination campaign. Predictors of hesitancy were identified through multivariable logistic regression analysis. Results: Participants had a median age of 29 years (IQR: 23­39), 86.7% were Black African, 63.2% were male, 53.3% resided in rural communities, and 59.3% (95% CI: 53.8% ­ 64.9%) were classified as vaccine hesitant. The primary reason for not vaccinating was a lack of trust in the vaccine (62.1%). Factors associated with reduced vaccine hesitancy included age (participants aged 35­49 years: OR: 0.28, 95% CI: 0.18­0.64, p = 0.003; participants over 50 years: OR: 0.18, 95% CI: 0.07­0.47, p = 0.0004), previous COVID-19 infection (OR: 0.31, 95% CI: 0.11­0.87, p = 0.03), and receiving vaccine information from healthcare workers (OR: 0.32, 95% CI: 0.10­1.0, p = 0.05). Unemployed (OR: 2.14, 95% CI: 1.1­4.2, p = 0.03) and self-employed individuals (OR: 2.98, 95% CI: 1.27­7.02, p = 0.01) were more likely to be vaccine hesitant. Conclusion: COVID-19 vaccine hesitancy rates are high in KwaZulu-Natal. Uptake could be enhanced by healthcare workers leading information campaigns with messages targeting younger individuals, the unemployed, and the self-employed. Contribution: This survey provides evidence to improve COVID-19 vaccination uptake in South Africa.

Comparing cardiorespiratory fitness and physical activity levels between third- and fifth-year medical students in a South African university

Background: Cardiovascular disease (CVD) risk factors such as sedentary behaviour, decreased physical activity (PA), and low cardiorespiratory fitness lead to an increased and accelerated risk of cardiovascular disease and mortality. Medical students tend to adopt sedentary lifestyles due to a demanding curriculum. This may have a negative effect on CVD risk factors and cardiorespiratory fitness levels of medical students. Objectives: To compare physical activity and cardiorespiratory fitness levels in a cohort of third- and fifth-year undergraduate medical students in a South African university. Methods: Data from 123 third-year and 139 fifth-year medical students in the Graduate Entry Medical Programme (GEMP) at the Faculty of Health Sciences, University of the Witwatersrand, were collected. Measurements included CVD risk factors, height, weight, blood pressure, waist circumference, cardiorespiratory fitness, physical activity vital signs and pre-participation health screening questionnaires. Descriptive statistics were presented as mean ± standard deviation or median [interquartile range] depending whether the data were normally distributed or not. Results: Both groups had low cardiorespiratory fitness when compared to norm values (GEMPI VO2 peak was 29.1 ± 5.9 ml.kg1.min-1 and GEMPIII VO2 peak was 30.0[11.0] ml.kg-1.min-1). Most participants did not meet WHO physical activity requirements (GEMP I: 72%; GEMP III: 78%). There were significant differences in BMI (p=0.046), diastolic blood pressure (p=0.034) and VO2 peak (p=0.00001) between students meeting and not meeting WHO physical activity requirements (p<0.05). Conclusion: Third- and fifth-year medical students at a South African university fail to meet recommended WHO physical activity levels and are below cardiorespiratory fitness norms. Therefore, medical institutions should promote and implement targeted physical activity interventions to reduce the prevalence of low fitness levels and the associated health hazards among their students.

Knowledge and awareness of hepatitis B amongst students of Pamo University of Medical Sciences (PUMS), Port Harcourt, Rivers State, Nigeria

Background: Globally, 296 million people were infected by hepatitis B in 2019, with 1.1 million deaths. Africa is one of the endemic regions. Good knowledge and awareness of hepatitis B remain pivotal to the biosafety of medical students. This study sought to determine the levels of knowledge and awareness of hepatitis B among students of Pamo University of Medical Sciences (PUMS), Port Harcourt, Nigeria, and the predicting factors associated with this knowledge and awareness. The is with the aim of providing recommendations for improving and sustaining biosafety levels for medical and other health-related students of the University. Methodology: The study was a descriptive cross-sectional design conducted amongst 528 randomly selected medical students of PUMS, Port Harcourt, Nigeria. Structured questionnaires were interviewer-administered to collect socio-demographic information and participants' responses to questions on knowledge and awareness of hepatitis B. Data were analysed using SPSS version 26.0 and relationships of socio-demographic characteristics and predictive factors with knowledge and awareness of hepatitis B were tested using binary logistic regression analysis with p value for statistical significance set at <0.05. Results: A total of 528 students participated in the study, 202 (38.3%) males and 326 (61.7%) females. Most participants (296, 56.1%) were between 15-19 years of age with mean age of 19 ±2.43 years. The mean (±SD) of participants responses with good knowledge of hepatitis B was 249±121.5 while for good awareness, it was 181±88.3. The percentage average for good knowledge and good awareness was 47.2% and 34.2% respectively, with positive correlation between knowledge and awareness of hepatitis B (r=0.720, p<0.0001). Age was significantly associated with participants percentage average knowledge (OR=0.77, 95% CI 0.70-0.84, p<0.0001) and awareness of hepatitis B (OR=0.84, 95%CI 0.78-0.90, p=0.004). No other factor was significantly associated with knowledge and awareness of hepatitis B except Ijaw tribe (OR=0.4, 95%CI 0.24-0.66, p=0.034) and attendance of Federal Government College (OR=0.4, 95% CI 0.24-0.68, p=0.046). Conclusion: The percentage average good knowledge of 47.2% and awareness of 34.2% for hepatitis B in this study are low, although most participants in the study were between the ages of 15-19 years and in their first and second year of study. This gives room for improvement in knowledge and awareness of hepatitis B with progression in age and year of training. Good knowledge and awareness of hepatitis B are central to the biosafety of medical students. It is recommended that the National Universities Commission (NUC) and the Medical and Dental Council of Nigeria (MDCN) review the current medical school curriculum to increase the teaching of medical and health-related students that will impact more on knowledge and awareness of infectious diseases and infection prevention and control.

Étude des facteurs associés à la supplémentation en vitamine A en routine à l'âge de six mois au centre de santé de Thiès en 2019-2020 (Sénégal) / NA

Introduction :La supplémentation en vitamine A (SVA) est une intervention à haut impact en matière de survie de l'enfant. Le Sénégal, conformément aux recommandations de l'Organisation mondiale de la santé, préconise la SVA dès six mois et tous les six mois jusqu'à cinq ans. Cependant, les données sur le délai de la SVA sont limitées. L'objectif était d'identifier les facteurs associés à la SVA en temps voulu, c'est-à- dire juste à l'âge de six mois. Méthodes : Cette étude transversale a eu lieu à Thiès, une ville située à 70 km de Dakar, capitale sénégalaise. La population d'étude était constituée de 400 enfants âgés de 06 à 11 mois et vus lors des séances de vaccination de routine au centre de santé de référence du district sanitaire de Thiès. La collecte des données a eu lieu du 02 décembre 2019 au 21 janvier 2020 à l'aide d'un entretien individuel avec les mères et du carnet de santé mère-enfant. Le délai de SVA est déterminé en faisant la différence entre la date de naissance et la date où l'enfant a reçu la capsule de vitamine A. Une régression logistique a été réalisée de sorte à identifier les facteurs qui influent sur ce délai ; estimant l'odds ratio ajusté et son intervalle de confiance à 95% (IC95%). Résultats : Les enfants sont nés de mères âgées en moyenne de 27,08±6,34 ans. La proportion de ceux ayant reçu les capsules de vitamine A était de 97,24%. En revanche, seuls 59,28% avaient bénéficié de cette supplémentation en temps voulu, c'est-à-dire juste à l'âge de six mois. Les facteurs positivement associés à la SVA en temps voulu étaient la résidence en zone périurbaine (ORa= 3,81 ; IC95%=1,63 ­ 10,1 ; p-value=0,004), le statut maternel sans emploi (ORa=1,75 ; IC95% =11,12 ­ 2,75 ; p-value=0,015), l'âge maternel supérieur ou égal à 35 ans (ORa=2,94 ; IC95%=1,41 ­ 6,48 ; p-value=0,005), le sexe féminin (ORa=1,77 ; IC95%=1,15 ­ 2,74, p-value=0,009), la vaccination par le PENTA 3 juste à l'âge de 14 semaines (ORa=13,5 ; IC95%=2,67 ­ 247, p-value=0,012). Conclusion : La couverture en SVA à l'âge approprié est faible. Beaucoup d'enfants ont bénéficié de la SVA avec un retard ; ce qui les expose à la malnutrition. Les interventions de promotion de la SVA devraient inclure la distribution des suppléments de vitamine A à l'aide des visites à domicile dans la zone urbaine de Thiès, l'aménagement du temps de travail des femmes, la sensibilisation des jeunes mères, l'intégration desservices de vaccination et de supplémentation en vitamine A. Ces efforts de promotion devraient prendre en compte la dimension genre

Organisation et le fonctionnement de la surveillance épidémiologique de la rougeole dans le district sanitaire de Yopougon-est, Côte d'Ivoire de janvier 2022 à juin 2022 / NA

La rougeole est une maladie infantile banale, peut être mortelles quand elle est sous-estimée. Nous avons initié cette étude dont l'objectif général est d'analyser le système de surveillance épidémiologique de la rougeole dans le district sanitaire de Yopougon-Est.MéthodesNous avons procédé à une évaluation normative de la surveillance épidémiologique de la rougeole réalisée en 6 (Six) mois dans ledit district sanitaire. Les critères de sélection nous ont permis de sélectionner 30 personnels de santé impliqués dans la surveillance de la rougeole. RésultatsLes médecins étaient les plus représentés (40%), suivi des infirmiers (33,3%). Les agents avaient plus de 3 ans de service (73,3%). Plus de la moitié des agents étaient formés (56%) la moyenne d'année de service était de 5,33 ans.Dans notre étude, 93,3 % des agents connaissaient la définition d'un cas de rougeole. Les seuils d'alerte et épidémique étaient connus par 56,6% des agents enquêtés. La disponibilité des registres de consultation, fiche de notification hebdomadaire de cas au niveau des structures de santé étaient de 86,7 %. Pour la transmission des données, 70% des enquêtés avaient déclarés que les rapports se transmettaient au district hebdomadairement.Les prélèvements de sang avaient été réalisés chez tous les cas suspects (100%). Les cas confirmés de rougeole représentaient 26,8 % des échantillons.ConclusionLa rougeole est une maladie de l'enfance qui est évitable par la vaccination. Cependant à défaut de vaccination, il est impérieux de mettre en place une organisation pour la détection des cas de rougeole afin d'éviter des épidémies

Connaissances, attitudes et perceptions de la césarienne chez les gestantes suivies en CPN dans 6 maternités de Kinshasa / NA

Objectifs: Evaluer le niveau de connaissances, décrire les attitudes ainsi que les perceptions des gestantes sur la césarienne. MéthodesIl s'agissait d'une étude descriptive transversale qui s'est déroulée durant la période allant du 01 Février au 30Avril 2023 (soit 3mois) dans les services des consultations prénatales (CPN) des 6 6 structures de la Ville Province de Kinshasa ; les Cliniques Universitaires de Kinshasa (CUK), le Centre Hospitalier Roi Baudoin 1, l'Hôpital Saint Joseph(HSJ), les Maternités de Kintambo, de Binza et de Kingasani. Un total de 481 gestantes était interrogé dans l'ensemble des formations sanitaires sélectionnées. Les données sociodémographiques et celles relatives à la connaissance, attitude et perception sur la césarienne ont été récoltées par interview et analysées à l'aide des statistiques descriptives. L'évaluation de connaissances était faite selon la cotation suivante; moins de 50% de bonnes réponses (MAUVAISES) ;entre 50% et 70% de bonnes réponses (MOYENNES) et plus de 70% de bonnes réponses ( BONNES ). L'échelle de Likert a servi à l'évaluation des attitudes et perceptions sur la césarienne. Résultats Sur les 481 gestantes interviewées, seulement 16,1% avaient un antécédent personnel de Césarienne, l'âge de moyen de gestantes était de 29 ans, mariées pour la plupart (87,9%), employée (56,4%) avec un niveau d'étude secondaire (49,3%) et un niveau socio-économique moyen (53,8%). La source d'information sur cette intervention était diversifiée chez 39,8% de gestantes et les CPN n'ont contribué que dans 22,4%. Le niveau de connaissance était satisfaisant chez 73, 3% de gestantes. L'attitude des gestantes était négative chez 70,1% la perception par contre était positive à 64,4 %. Conclusion: La majorité de gestantes avait un niveau suffisant de connaissances sur la césarienne et une perception positive alors qu'elle garde une attitude négative face à cette intervention.

Objectives: Evaluate the level of knowledge, describe the attitudes and perceptions of pregnant women about cesarean section. Methods This was a cross-sectional descriptive study which took place during the period from February 1 to April 30, 2023 (i.e. 3 months) in the prenatal consultation services (PCS) of the 6 health structures in the City Province of Kinshasa; the University Clinics of Kinshasa (UCK), Roi Baudoin 1 Hospital Center, Saint Joseph Hospital (SJH), Kintambo, Binza and Kingasani maternity wards. A total of 481 pregnant women were interviewed in all the selected health facilities.ResultsAmong the 481 pregnant women interviewed, only 16.1% had a personal history of Caesarean section, the average age of pregnant women was 29 years, most of them married (87.9%), employed (56.4%) with a secondary education level (49.3%) and a socio-economic level. average economic (53.8%). The source of information on this intervention was diversified among 39.8% of pregnant women and antenatal cares only contributed to 22.4%. The level of knowledge was satisfactory in 73.3% of pregnant women. The attitude of the pregnant women was negative at 70.1%, the perception on the other hand was positive at 64.4%.Conclusion:The majority of pregnant women had a sufficient level of knowledge about caesarean section and a positive perception while they maintain a negative attitude towards this intervention

Job satisfaction among nurses in area hospitals of Djidja and Covè: Determinants and development of intervention in 2021 in Benin

In Benin, nurses complain of insufficient job satisfaction. This study is the third part of a mixed research project. The aim of this article was to develop an intervention to improve nurses' job satisfaction. Participatory action research with intervention mapping was carried out in 2021. Purposive sampling was used. Interviews and panel discussions were held with 40 participants, nurses and administrative staff from the Djidja and Covè area hospitals. A number of internal factors contributed to the nurses' job satisfaction. However, external factors also militated in favor of insufficient job satisfaction among nurses. This confirms the results of quantitative evaluation of nurses' job satisfaction, in line with a number of authors. The panelists agreed ona major workshop and satisfaction improvement program. They agreed on quantified objectives, a logic model, terms of reference, a logical framework and an evaluation plan. Participants also agreed on the development of nursing work management tools. The determinants of nurses' job satisfaction are examined in depth, some of which are confirmed, also confirming a lack of job satisfaction. The workshop will focus on three interventions selected from the literature, merged and adapted by the participants. None of these interventions has been tested in sub-Saharan Africa. Intervention implementation and evaluation will be the subject of future research. Key words: Benin; Job satisfaction; Nurses; Action research; Determinants; Intervention.Pour citer cet article: ADOGNIBO S. Gérardetal. Job satisfaction among nurses in area hospitals of Djidja and Covè: Determinants and development of intervention in 2021 in Benin. Revue de Médecine et de Santé Publique

Profil évolutif de la limboconjonctivité endémique des tropiques à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé / Gynecological cancer in oncology practice in Lomé

Introduction. La limbo-conjonctivite endémique des tropiques (LCET) est une kérato-conjonctivite allergique récidivante du jeune enfant qui s'améliore après la puberté mais peut persister. Le but de cette étude était de déterminer le profil évolutif de la LCETdans notre pratique. Méthodologie. Étude longitudinale descriptive menée dans l'unité d'ophtalmologie de l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé. Tous les dossiers de LCET reçus de janvier 2011 à décembre 2019 avec un recul d'aumoins deux ans de suivi ont été recensés. Les patients qui ont accepté de participer après apptéléphonique ont été inclus de janvier à mai 2021.Les variables d'étudeétaient: âge, sexe, acuité visuelle (AV), caractéristiques de la LCET selon Diallo, pronostic fonctionnel et anatomique en post puberté (plus de 15 ans). Résultats. Au total,30 patients (60 yeux) ont été étudiés. Le sex-ratio était de 2. La moyenne d'âge était de 15 ans ± 9 ans. Initialement, le prurit était le maitre symptôme (96,7%). Après un recul moyen de cinq ans, l'AV était utile chez tous les patients (100%) et la LCET stade 2 plus représentée (60%). Le nombre moyen de récidives était de trois. Les patients post pubertaires on eu une amélioration anatomique dans 56.7% des caset une aggravation dans 10%des casConclusion. Notre travail confirme l'amélioration post pubertaire globale de la LCET, nonobstant quelques formes graves depronosticpéjoratif pour la fonction visuelle.

Introduction. Tropical endemiclimbo-conjunctivitis (TELC) is a recurrent allergic kerato-conjunctivitis in young children which improves after puberty but may persist. The aim of this study was to determine the evolutionof TELCin our setting. Methodology. This was a longitudinal descriptive study conducted in the ophthalmology unit of the Yaoundé Gyneco-Obstetric and Pediatric Hospital. All TELC files received from January 2011 to December 2019 with a follow-up of at least two years of follow-up were identified. Patients who agreed to participate after a phone call were included from January to May 2021. The variables of interest were: age, sex, visual acuity (VA), TELC classification according to Diallo, functional and anatomical prognosis in post puberty (more than 15 years).A totalof30 patients (60 eyes) were recruited. The sex ratio was 2. The average age was 15 ± 9 years. Initially, pruritus was the main symptom (96.7%). After an average follow-up of five years, VA was usefulin all patients (100%) and TELCstage 2 was the most frequent stage (60%). The mean number of recurrences was three. Postpubertal patients had anatomical improvement in 56.7% of cases and worsening in 10%of cases. Conclusion. Our study confirms the overall postpubertal improvement ofTELC, except some serious forms with poor prognosis ofvisual function

Prise en charge des hémopathies malignes au centre national d'oncologie médicale et de radiothérapie Alassane Ouattara d'Abidjan / Managem ent of hem atologic neoplasm sat the Centre National d'Oncologie Médicale et de Radiothérapie Alassane Ouattara ofAbidjan

Introduction. Les hémopathies malignes sont des proliférations anormales et anarchiques de cellules hématopoïétiques à point de départ médullaire ou périphérique. Notre étude qui avait pour objectif de faire le bilan de la prise en charge des hémopathies malignes au Centre national d'oncologie médical et de radiothérapie Alassane Ouattara. Méthodes. Il s'agissait d'une étude rétrospective descriptive d'une durée de 2 ans 3 mois allant du 1er janvier 2018 au 31 Mars 2020 portant sur 80 dossiers de malades porteurs d'hémopathies malignes et prise en charge dans le centre. Résultats. Notre étude a permis de recenser 2,2% d'hémopathies malignes sur les 3650 cas de pathologies cancéreuses recensées au CNRAO, soit une incidence 26,66 cas/an avec un sex-ratio 1,2. Les syndromes lymphoprolifératifs (SLP) sont les plus fréquents (96,25 %), sous trois principales formes: lymphomes malins non hodgkiniens (LMNH) non Burkitt (51,25%), leucémie myéloïde chronique (20%) et le myélome multiple (16,25%). Les LMNH représentent 51,25% des HM recensées avec 41,46 % de lymphomes de haut grade de malignité. La chimiothérapie était de mise chez tous nos patients. Ainsi sur 41 cas de LMNH, seulement 12 (29,27%) ont bénéficié du protocole R-CHOP. On notait 46,34% de réponse complète. Dans notre étude, le LH représentait 8,75% il était traité à 71,43% avec le protocole ABVD avec une réponse complète chez 6 patients. 37,5% des patients porteurs de leucémie myéloïde chronique ont reçu le Rituximab; ils ont été traités par les protocoles COP (31,25%), CHOP (31,25%), RCVP (12,5%) et R-CHOP (25%). La réponse thérapeutique était complète à 68,75%. Le protocole utilisé dans le traitement du myélome multiple a été le VMCD-REV à 76,92% avec pour réponse thérapeutique complète chez 6 patients, 3 réponses partielles et 4 en cours de traitement. Conclusion. Les SLP qui sont les plus fréquents des HM avec trois principales formes: LMNH non Burkitt, leucémie myéloïde chronique et myélome multiple. Nous avons cependant des difficultés quant à la mise en route de la chimiothérapie.

Introduction. Hematologic neoplasms are abnormal and anarchic proliferations of hematopoietic cells with a medullary or peripheral starting point. Our study aimed to report the management of hematological malignancies at the Centre National d'Oncologie Médicale et de Radiothérapie Alassane Ouattara (CNRAO). Methods. This was a descriptive retrospective study lasting 2 years 3 months from January 1st, 2018 to March 31st, 2020 concerning 80 patients with hematologic neoplasms who were managed in the CNRAO. Results. Hematologic neoplasms represented 2.2% of cancers (80/3650) at CNRAO, giving an annual incidence of 26.66 cases. The sex ratio was 1.2. Lymphoproliferative syndromes were the most common subgroups (96.25%). These were mainly non-Burkitt non Hodgkin lymphoma (51.25%), high grade lymphomas (41.46%), chronic lymphocytic lymphoma (20%) and multiple myeloma (16.25%). Chemotherapy was administered to all patients. Among 41 cases of non-Hodgkin lymphoma, 12 (29.27%) benefited from the R-CHOP protocol and full response was observed in 46.34% of them. We found 7 patients with Hodgkin lymphoma (8.75%) and the ABVD protocol was used for 6 cases (71.43%). Six out of these seven patients were in complete response. Among the 16 patients with chronic lymphocytic leukemia, 6 (37.5%) received Rituximab. The distribution of the patients with chronic lymphocytic leukemia was as follows: COP 31.25%, CHOP 31.25%, RCVP 12.5% and R-CHOP 25% and 68.75% had full response. The most common treatment protocol for multiple myeloma was VMCD-REV (76.92%). Six patients had complete response, 3 had partial response and 4 were in the course of treatment. Conclusion. In our practice, hematologic neoplasms are mainly lymphoproliferative syndromes and the most common varieties are non-Burkitt non Hodgkin lymphoma, high grade lymphomas, chronic lymphocytic lymphoma and multiple myeloma. We have difficulties in getting chemotherapy started.

Frequency and pattern of intrauterine hysteroscopic lesions among women coming for IVF in the city of Yaoundé

Background: Hysteroscopy is an essential tool to make intrauterine assessment in infertile patients. Diagnosis and appropriate correction of intrauterine anomalies are considered essential in order to increase chances of conception. Ourobjective was to determine the frequency and pattern of intra uterine anomalies identified among women attending hysteroscopy at the Gynaecological Endoscopic Surgery and Human Reproduction Teaching Hospital Paul et Chantal Biya ­Yaoundé (GESHRTH). Methodsand results.Thiswas a cross sectional retrospective study of 96 women attending diagnostic or operative hysteroscopy at the GESHRTH between January 2020 and December 2021.The mean age was 38.7 ±7.6 years. Fifty-nine (61.5%) of the patients were nulliparous. Primary and secondary infertility were found respectively in fifty-two patients (54.2%) and forty-four patients (45.4%). Eleven patients (11.5%) were post-menopausal. Concerning previous surgery, 29 patients (30.2%) have had a myomectomy, 28 patients (29.1%) curettage,16 patients (16.6%) laparoscopy, eight (8.3%) hysteroscopy and one (1%) caesarean section. In all, 92 patients (95.8%) had abnormal intra uterine findings consisting of endometrial polyps (43.7%), sub-mucosal fibroids (42.7%), uterine cavity adhesions (20.8%), endometrial atrophy (4.1%), foetal bone (2%), uterine septum (1%) and non-absorbable suture thread (1%).Conclusion: Abnormal uterine findings were identified in 95.8% of patients attending hysteroscopy at GESHRTH. Most frequent findings were polypsin 43.7%, sub-mucosal fibroids in 42.7% and synechiae in 20.8%. The overall per operatory complication rate was 6.2%.

Introduction. Le recours à l'hystéroscopie constitue une étape indispensable au bilan cavitaire des patientes infertiles. Le diagnostic et la prise en charge adéquate des lésions intra cavitaires permettent d'améliorer les chances de conception.L'objectif de cette étude était de déterminer la fréquence et les caractéristiques des anomalies intra cavitaires chez les patientes opérées d'une hystéroscopie au Centre Hospitalier de Recherche et d'Application en Chirurgie Endoscopique et Reproduction Humaine Paul et Chantal Biya ­Yaoundé (CHRACERH).Méthodes et résultats. Nous avons mené une étude descriptive transversale de Janvier 2020 à Décembre 2021 et recruté 96 patientes. L'âge moyen était de38,7 ±7,6 ans. Soixante-neuf patientes (61,5%) étaient nullipares. Cinquante-deux (54,2%) et quarante-quatre (45,5%) présentaient une infertilité primaire et secondaire respectivement. Onze patientes (11,5%) étaient ménopausées. Concernant les antécédents chirurgicaux,nous avons identifié une myomectomie chez 29 patientes (30,2%), un curetage utérin chez 28 (29,1%), une cœlioscopie chez 16 (16,6%), une hystéroscopie chez huit (8,3%) et une césarienne chez une (1%). Au total, 92 (95,8%) des patientes avaient des anomalies cavitaires objectivées. Il s'agissait de polypes endométriaux (43,7%), fibromes sous-muqueux (42,7%), synéchies utérines (20,8%), atrophie de l'endomètre (4,1%), métaplasie osseuse (2%), cloison utérine (1%) et corps étranger à type de fil de suture nonrésorbable (1%).Conclusion.Les anomalies intra-cavitaires étaient retrouvées chez 95,8% des patientes réalisant une hystéroscopie au CHRACERH. Les anomalies les plus représentées étaient les polypes endométriaux (43,7%), les fibromes sous-muqueux (42,7%) et les synéchies utérines (20,8%). Le taux global de complications opératoires était de 6,2%.

Risque de transmission de certains arbovirus à travers le don de sang à Bamako / Risk of transmission of certain arbovirus through blood donation in the city of Bamako

Introduction. Au Mali, le dépistage de certains virus tels que la dengue, Zika et la fièvre de la vallée du Rift n'est pas systématique au centre national de transfusion sanguine (CNTS). Le risque peut être considérable en raison de leurs courtes périodes de virémie asymptomatique dans la population dont l'incidence est variable et parfois extrêmement élevée. Cette étude avait pour objectif d'explorer la possibilité de transmission de certains arbovirus à travers le don de sang au CNTS de Bamako. Méthodes. Il s'agissait d'une étude transversale, de juillet 2019 à juin 2020 à Bamako. Au total deux cents (200) donneurs de sang du CNTS ont été inclus. Les examens ont été réalisés au Centre d'Infectiologie Charles Mérieux (CICM) de Bamako avec le dépistage du génome des virus responsables de la Dengue, de la fièvre de la Vallée du Rift, et du Zika à l'aide de la technique de la RT-PCR en temps réel. Le Test de Dépistage Rapide (TDR) a été utilisé pour la détection des anticorps IgG et IgM spécifiques de la Dengue. Résultats. Le sexe masculin représente 84% (168/200). Le TDR a détecté 4,5% (9/200) de Dengue IgG positifs et aucun cas de Dengue IgM positif. La technique de RT-PCR n'a détecté aucun des trois virus. Conclusion. Cette étude prouve que le risque de transmission de certains arbovirus à travers le don de sang existe, mais il semble être minime au CNTS de Bamako

Background. In Mali, screening for certain viruses such as dengue, Zika, and Rift Valley fever is not systematic at the national blood transfusion center (CNTS). The risk can be considerable due to their short periods of asymptomatic viremia in the population with variable and sometimes extremely high incidence. The objective of this study was to explore the possibility of transmission of certain arboviruses through blood donation at the CNTS of Bamako. Methods. This was a cross-sectional study, from July 2019 to June 2020 in Bamako. A total of two hundred (200) blood donors from the CNTS were included. The examinations were performed at the Centre d'Infectiologie Charles Mérieux (CICM) in Bamako with the screening of the genome of viruses responsible for Dengue, Rift Valley fever, and Zika using the real-time RT-PCR technique. The Rapid Screening Test (RST) was used for the detection of Dengue-specific IgG and IgM antibodies. Results. Male sex represented 84% (168/200). The RDT detected 4.5% (9/200) of IgG positive Dengue and no IgM positive Dengue cases. The RT-PCR technique did not detect any of the three viruses. Conclusion. This study proves that the risk of transmission of certain arboviruses through blood donation exists, but it seems to be minimal at the CNTS of Bamako.

Breast cancer molecular diagnostics in Rwanda: a cost-minimization study of immunohistochemistry versus a novel GeneXpert® mRNA expression assay

Objective To compare the financial and time cost of breast cancer biomarker analysis by immunohistochemistry with that by the Xpert® STRAT4 assay. Methods We estimated costs (personnel, location, consumables and indirect) and time involved in breast cancer diagnosis at the Butaro Cancer Centre of Excellence, Rwanda, using time-driven activity-based costing. We performed a cost-minimization analysis to compare the cost of biomarker analysis for estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 status with immunohistochemistry versus STRAT4. We performed sensitivity analyses by altering laboratory-specific parameters for the two methods. Findings We estimated that breast cancer diagnosis in Rwanda costs 138.29 United States dollars (US$) per patient when conducting biomarker analysis by immunohistochemistry. At a realistic immunohistochemistry antibody utilization efficiency of 70%, biomarker analysis comprises 48.7% (US$ 67.33) of diagnostic costs and takes 33 min. We determined that biomarker analysis with STRAT4 yields a reduction in diagnosis cost of US$ 7.33 (10.9%; 7.33/67.33), and in pathologist and technician time of 20 min (60.6%; 20/33), per patient. Our sensitivity analysis revealed that no cost savings would be made in laboratories with antibody utilization efficiencies over 90%, or where only estrogen and/or progesterone receptor status are assessed; however, such operational efficiencies are unlikely, and more laboratories are pursuing human epidermal growth factor receptor-2 analysis as targeted therapies become increasingly available. Conclusion Breast cancer biomarker analysis with STRAT4 has the potential to reduce the required human and capital resources in subSaharan African laboratories, leading to improved treatment selection and better clinical outcomes.

A critical analysis of discovery health's claims-based risk adjustment of mortality rates in South African private sector hospitals

In 2019, Discovery Health published a risk adjustment model to determine standardised mortality rates across South African private hospital systems, with the aim of contributing towards quality improvement in the private healthcare sector. However, the model suffers from limitations due to its design and its reliance on administrative data. The publication's aim of facilitating transparency is unfortunately undermined by shortcomings in reporting. When designing a risk prediction model, patient-proximate variables with a sound theoretical or proven association with the outcome of interest should be used. The addition of key condition-specific clinical data points at the time of hospital admission will dramatically improve model performance. Performance could be further improved by using summary risk prediction scores such as the EUROSCORE II for coronary artery bypass graft surgery or the GRACE risk score for acute coronary syndrome. In general, model reporting should conform to published reporting standards, and attempts should be made to test model validity by using sensitivity analyses. In particular, the limitations of machine learning prediction models should be understood, and these models should be appropriately developed, evaluated and reported.

Exploring a community's understanding of HIV vaccine-induced seropositivity in a South African research setting

Background. The high HIV prevalence and incidence in South Africa makes it suitable for recruitment of participants for large-scale HIV preventive vaccine trials. However, fear of vaccine-induced seropositivity (VISP) may be a barrier for community acceptability of the trial, for volunteers to participate in HIV preventive vaccine trials and for uptake of an efficacious vaccine. Prior to 2015, when the first phase 1 safety HIV vaccine trial was undertaken at Setshaba Research Centre, Soshanguve, the local community stakeholders and healthcare workers were naive about HIV vaccine research and HIV preventive vaccines. Objective. To explore knowledge and perceptions regarding VISP among community stakeholders and healthcare workers in peri-urban Soshanguve, Tshwane.Methods. Using a quantitative-qualitative mixed-methods study design, surveys (n=50) and in-depth interviews (n=18) were conducted during July - August 2015. Participants included community stakeholders, community advisory board members and healthcare workers, who were >18 years old and had attended community educational workshops during September 2014 - May 2015. Audio recordings of interviews were transcribed verbatim and coded using content thematic analysis. Data were further analysed by sex, age and educational level.Results. Of a maximum score of 2 on knowledge on VISP, the 50 survey participants (mean age 33.78 years; 45 females) obtained an average of 0.88 (44%). Of 17 in-depth interviewees (one interview could not be transcribed; mean age 30.9 years; 12 females), 8 (47%) displayed some knowledge about VISP, of whom only 5 defined VISP correctly. Women were more knowledgeable about VISP than men; 5 of 12 women (42%) came close to defining VISP correctly, while none of the 5 men did so. The main fear of trial participation expressed by most participants (n=6) was testing HIV-positive as a result of the vaccine. While some participants believed that the community's perceptions of VISP would negatively affect HIV vaccine trial support and recruitment efforts, others noted that if trial participants understand the concept of VISP and are part of support groups, then they would have the information to combat negative attitudes within their community. Conclusion. Most participants had an inaccurate and incomplete understanding of VISP. Many feared testing HIV-positive at clinics; therefore, education on improving a basic understanding of how vaccines work and why VISP occurs is essential. In addition, assessing participant understanding of HIV testing, transmission and VISP is critical for recruitment of participants into HIV vaccine trials and may improve acceptability of an HIV preventive vaccine

A doctor at a PHC clinic: A 'must-have' or 'nice-to-have'?

Background. Many patients have their healthcare needs met at primary healthcare (PHC) clinics in KwaZulu-Natal (KZN), without having to travel to a hospital. Doctors form part of the teams at many PHC clinics throughout KZN, offering a decentralised medical service in a PHC clinic. Objectives. To assess the benefit of having a medical doctor managing patients with more complex clinical conditions at PHC clinic level in uMgungundlovu District, KZN. Two key questions were researched: (i) were the patients whom the clinic doctors managed of sufficient clinical complexity that they warranted a doctor managing them, rather than a PHC nurse clinician? and (ii) what was the spectrum of medical conditions that the clinic doctors managed? Methods. Doctors collected data at all medical consultations in PHC clinics in uMgungundlovu during February 2020. A single-page standardised data tool was used to collect data at every consultation. Results. Thirty-five doctors were working in 45 PHC clinics in February 2020. Twenty-six of the clinic doctors were National Health Insurance (NHI)-employed. The 35 doctors conducted 7 424 patient consultations in February. Staff in the PHC clinics conducted 143 421 consultations that month, mostly by PHC nurse clinicians. The doctors concluded that 6 947 (93.6%) of the 7 424 doctor consultations were of sufficient complexity as to warrant management by a doctor. The spectrum of medical conditions was as follows: (i) consultations for maternal and child health; n=761 (10.2%); (ii) consultations involving non-communicable diseases (NCDs), n=4 372 (58.9%) ­ the six most common NCDs were, in order: hypertension, diabetes, arthritis, epilepsy, mental illness and renal disease; (iii) consultations involving communicable diseases constituted 1 745 (23.5%) of cases; and (iv) consultations involving laboratory result interpretation 1 180 (15.9%).Conclusion. This research showed that at a PHC clinic the more complex patient consultations did indeed require the skills and knowledge of a medical doctor managing these patients. These data support the benefit of a doctor working at every PHC clinic: the doctor is a 'must-have' member of the PHC clinic team, offering a regular, reliable and predictable medical service.

Aspects particuliers des myomes utérins en IRM multimodale en milieu tropical / Features of uterine myomas explored with multimodal MRI in a tropical environment

Objectif. Décrire les caractéristiques de la prise en charge des myomes utérins dans une unité d'IRM multimodale en Afrique subsaharienne. Matériels et méthodes. Étude transversale descriptive rétrospective, d'une durée de 08 mois, réalisée au service d'imagerie médicale de l'hôpital mère enfant de Bingerville. Nous avons inclus les patientes dont le motif et ou les résultats des examens faisaient mention de myomes utérins. Les paramètres étudiés étaient l'âge des patientes, le motif d'examen et les résultats de l'examen d'IRM. Résultats. Nous avons recruté 103 patientes. Leur âge moyen était de 40 ans. Dans 95,1% des cas, les indications portaient sur la cartographie et l'exploration des myomes utérins déjà connus. Les myomes étaient de découverte fortuite dans 5% des cas. Les myomes étaient uniques dans 9% et en nombre supérieur à 5 dans 61% des cas. Ils étaient majoritairement hyalins, en isosignal homogène T1 FSE (86%), en hyposignal homogène T2 PROPELLER et diffusion (97%) avec rehaussement homogène (85%). Il y avait des complications dégénératives dans 12% des cas et mécaniques dans 3% des cas. Elles étaient corrélées à un nombre de myomes supérieur à 5 (p=0,05), mais pas à la taille des myomes ni à l'âge des patientes. Les pathologies pelviennes associées (53%) étaient : lésions ovariennes non tumorales (45%), adénomyose (30%) et cancer du col utérin (25%). Conclusion. À Abidjan, les myomes utérins sont une pathologie de la femme en activité génitale, en période préménopausique. L'IRM est utilisée quasi exclusivement en seconde intention après l'échographie pour la cartographie préopératoire ou pré embolisation. La découverte de pathologies associées dont le cancer du col, devrait faire préférer l'IRM pour toute exploration diagnostique et pré thérapeutique

Objective. To describe the characteristics of the management of uterine myomas in a multimodal MRI unit of Sub-Saharan Africa. Methods. This was a cross sectional retrospective descriptive study of eight months duration that was carried out in the medical imaging department of the mother and child hospital in Bingerville. The patients whose indications and/or results of the MRI mentioned uterine myomas were included. The parameters studied were the age of the patients, the reason and the results of the MRI examination. Results. We studied 103 patients. Their average age was 40 years. In 95.1% of the cases, the indications were for mapping and exploring already known uterine myomas. Incidental myomas accounted for 5%. The myomas were unique in 9% and more than 5 in 61%. They were mostly hyaline, in homogeneous T1 FSE isosignal (86%), in homogeneous T2 PROPELLER and diffusion hyposignal (97%) with homogeneous enhancement (85%). Degenerative complications were noted in 12% and mechanical complications in 3%. They were correlated with a number of myomas greater than 5 (p=0.05) but not with size of myomas or age of patients. Associated pelvic diseases (53,4%) were mainly non tumoral ovarian lesions (45%), adenomyosis (30%) and cervical cancer (25%). Conclusion. In our setting, uterine myomas affect mainly the genitally active woman in the premenopausal period. MRI is used almost exclusively as a second line after ultrasound, for preoperative or preembolization mapping. The discovery of associated pathologies, including cervical cancer, should make MRI preferable for all diagnostic and pre-therapeutic exploration.

A review of the epidemiology, diagnosis, treatment, vaccines and economic impact of human monkeypox (Mpox) outbreaks

The current monkeypox outbreak is a public health emergency of international concern and is coming in the wake of the SARS-CoV-2 pandemic. Human monkeypox is a viral zoonotic infection caused by monkeypox virus, an enveloped double-stranded DNA virus of the genus Orthopoxvirus and family Poxviridae that also contain smallpox, cowpox, Orf, and vaccinia viruses. Online databases including PubMed, Google Scholar and Web of Science were searched to obtain relevant publications on the epidemiology, treatment, vaccines and the economic impacts of the current monkeypox (Mpox) outbreak.