Complications following COVID-19 infection or vaccination in Libyan International Medical University students and their Families

Coronavirus disease 2019 (COVID-19) caused by a novel strain of coronavirus belonging to the genus Beta coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged as a major pandemic worldwide. This contagious virus had spread in many different forms, and patients have demonstrated a wide range of symptoms, ranging from moderate to severe illness. This study aims to highlight the important associations between SARS-CoV-2 infection, vaccination, and possible complications at the Libyan International Medical University, Benghazi. This crosssectional survey was conducted among students and their families at Libyan International Medical University in Benghazi, Libya. Among the 100 participants, 72% were between the ages of 18 and 39. Up to (59%) of participants were men. As for the infection with COVID-19, 77% of participants were infected. Most of the participants had no chronic diseases (69%); however, the most common chronic disease was diabetes mellitus (13%). 82% of participants were vaccinated; the most common types of vaccines administered were Sinopharm and Sputnik V (24%). Following vaccination, 71% of participants had no COVID-19 infection, while 29% did get the infection. Regarding this study, after COVID-19 infection, 66% of participants had no complications; however, 17% had pulmonary complications, which was the most common complication among the participants. As for the complications following the vaccination, 81% of participants had none, while there were pulmonary and neurological complications in 7­6%. The results of the study showed that the most frequent complications noticed among the participants following the COVID-19 infection and vaccination were pulmonary and neurological complications.

An adapted collaborative care model to manage co-morbidities of depression and chronic non-communicable diseases in Rwanda

Background The World Health Organization has recommended the implementation of the Collaborative Care Model in all countries to manage the comorbidities of depression and chronic non-communicable diseases. In Rwanda depression is major problem not only among patients with chronic illnesses but also in general population considering the unique history of war and genocide in Rwanda. Purpose The purpose of this paper is to describe the process of adaptation and testing of the Collaborative Care Model in the Rwandan healthcare context. Methods The larger study used the Action Research design with mixed method ­sequential explanatory design. A research-practice partnership method and an iterative process was used to adapt and test the Collaborative Care Model. Qualitative content analysis was used to analyse the data. Results Four structural components to the model were adapted including the addition of a registered nurse to the team, relocation of the model to the district level, consultation with a psychiatrist every 3 months and involvement of community health workers. The evaluation indicated that the model was applicable and acceptable. Conclusions Initial evaluation of the Adapted Collaborative Care Model shows promise in Rwanda. Implementation of this model in other Rwandan districts is warranted.

Clinical characteristics of children with autism spectrum disorders: a cross-sectional study of cases attended at three centers specializing in neurodevelopmental disorders in Kinshasa, Democratic Republic of Congo (DRC)

Context and objective. Autism spectrum disorders (ASD) in sub-Saharan African (SSA) countries are poorly studied. The aim of the present study was to describe the socio demographic and clinical characteristics of children with autism and to identify associated factors. Methods. This was a cross-sectional study of children with ASD attended at three specialized centers in Kinshasa. We confirmed a ASD diagnosis through clinical observation using Diagnostic and Statistical Manuel of Mental Disorders four Text Revision (DSM-VI-TR) criteria and standardized autism diagnostic tools. We analyzed socio-demographic and clinical characteristics and main comorbidities of ASD. The comparison of proportions was done using Pearson's chi-square test. One-way ANOVAs were calculated to test differences in averages. Results. A total of 120 children (72.5 % male) were examined. Their mean age at diagnosis was 7.83 ± 3.4 years, while parents were alerted at 1.8 ±0.78 years. Language delays were the main alert sign (54%) and the main symptom (62%). Social interaction disorders (11.7 %) were underreported by parents. The core signs of ASD were disorders of social interaction (90.5%), behavior (80%) and language (62.5%). The main ASD symptoms were associated with epilepsy(p=0.027), cerebral palsy (p=0.026) and hearing impairment (p=0.045). Conclusion. The diagnostic and language delay co-occurring with epilepsy and hearing impairment are the main clinical features of autism in the DRC. This study suggests that screening children for autism and its main comorbidities using a multidisciplinary approach should be a priority in Kinshasa.

Risk factors for chronic obstructive pulmonary disease (COPD) in a tertiary health institution in Lagos, Nigeria

Objective: To describe the clinical characteristics and identifiable risk factors for Chronic Obstructive Pulmonary Disease (COPD) in a real-world clinical setting. Design: Cross-sectional study among patients with COPD. Setting: The Respiratory clinic of the Lagos University Teaching Hospital. Participants: Consecutive patients with spirometry confirmed COPD on follow-up for ≥3 months. There were 79 participants. Intervention: None Main outcome measure: COPD risk factors, disease severity, comorbidities, and the severity of airflow limitation. Results: The mean age of the participants was 63.3± 12.4 years, and 47 (59.5) were male. There was a high symptom burden (73.4% had COPD assessment test (CAT) score >10), 33 (41.8%) and 4 (5.1%) had GOLD 3 and GOLD 4 airflow limitation, respectively. Risk factors were identified for 96.2% of the participants: history of asthma in 37 (46.8%), tobacco smoking 22 (27.8%), occupational exposure 15 (19%), biomass exposure 5 (6.6%), post-tuberculosis 3 (3.8%), old age (3.8%), and prematurity 1 (1.3%). Fifty-nine (74.7%) had Asthma COPD Overlap (ACO). There were no significant associations between the risk factors and disease severity. Participants with ACO had lower lung function and a high frequency of allergic rhinitis. Conclusion: Asthma was the most commonly identifiable risk factor for COPD, underscoring asthma risk reduction and management optimisation as priorities toward COPD burden mitigation. Future studies need to validate these findings and identify the predominant COPD phenotypes in our setting.

Acute kidney injury among hospitalised patients who died due to COVID-19 in the Eastern Cape, South Africa

Background: Acute kidney injury (AKI) commonly occurs in coronavirus disease 2019 (COVID-19) patients who have been hospitalised and is associated with a poor prognosis. This study aimed to determine the incidence of AKI among COVID-19 patients who died in a regional hospital in South Africa. Methods: This retrospective record review was conducted at the Mthatha Regional Hospital in South Africa's Eastern Cape province. Data were collected between 10 July 2020 and 31 January 2021. Results: The incidence of AKI was 38% among the hospitalised patients who died due to COVID-19. Most study participants were female, with a mean age of 63.3 ± 16 years. The most common symptom of COVID-19 at the time of hospitalisation was shortness of breath, followed by fever and cough. Half of the patients had hypertension, while diabetes, human immunodeficiency viruses (HIV) and tuberculosis (TB) were other comorbidities. At admission, the average oxygen saturation was 75.5% ± 17. Conclusion: The study revealed a high incidence of AKI among hospitalised patients who died due to COVID-19. It also found that those received adequate crystalloid fluids at the time of admission had a lower incidence of AKI. Contribution: Acute kidney injury can be prevented by adequate fluid management during early stage of COVID-19. Majority of COVID-19 patients were referred from lower level of care and primary care providers have their first encounter with these patients. Adequate fluid resuscitation in primary care settings can improve the outcome of hospitalised COVID-19 patients.

Improving outcomes in co-morbid diabetes and COVID-19: A quasi-experimental study

Background: High-risk people living with diabetes (PLWD) have increased risk for morbidity and mortality. During the first coronavirus disease 2019 (COVID-19) wave in 2020 in Cape Town, South Africa, high-risk PLWD with COVID-19 were fast-tracked into a field hospital and managed aggressively. This study evaluated the effects of this intervention by assessing the impact of this intervention on clinical outcomes in this cohort. Methods: A retrospective quasi-experimental study design compared patients admitted pre- and post-intervention. Results: A total of 183 participants were enrolled, with the two groups having similar demographic and clinical pre-Covid-19 baselines. Glucose control on admission was better in the experimental group (8.1% vs 9.3% [p = 0.013]). The experimental group needed less oxygen (p < 0.001), fewer antibiotics (p < 0.001) and fewer steroids (p = 0.003), while the control group had a higher incidence of acute kidney injury during admission (p = 0.046). The median glucose control was better in the experimental group (8.3 vs 10.0; p = 0.006). The two groups had similar clinical outcomes for discharge home (94% vs 89%), escalation in care (2% vs 3%) and inpatient death (4% vs 8%). Conclusion: This study demonstrated that a risk-based approach to high-risk PLWD with COVID-19 may yield good clinical outcomes while making financial savings and preventing emotional distress. Contribution: We propose a risk-based approach to guide clinical management of high risk patients, which departs significantly from the current disease-based model. More research using randomised control trial methodology should explore this hypothesis.

A systematic review of clinical characteristics, co-morbidities and outcomes of COVID-19 in children and adolescents

Background: COVID-19 is a major global health challenge that has affected all age groups and gender, with over 5 million deaths reported worldwide to date. The objective of this study is to assess available information on COVID-19 in children and adolescents with respect to clinical characteristics, co-morbidities, and outcomes, and identify gaps in the literatures for appropriate actions. Methodology: Electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for observational studies such as case series, cross-sectional and cohort studies published from December 2019 to September 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide. Data extracted included (i) patient demography (age and gender), (ii) clinical characteristics including vaccination status and presence of co-morbidities, (iii) clinical management including the use of sequential organ failure assessment (SOFA) scores, oxygen requirement, use of mechanical ventilation, and (iv) disease outcomes including length of hospital and intensive care unit (ICU) admission, recovery, complications with sequelae, or death. Data were analyzed using descriptive statistics. Results: A total of 11 eligible studies were included with a total of 266 children and adolescents; 137 (51.5%) females and 129 (48.5%) males. The mean age of the children was 9.8 years (range of 0 ­ 19 years), and children ≥ 6 years were more affected (40.7%) than age groups 1 ­ 5 years (31.9%) and < 1 year (27.4%). The major co-morbidities were respiratory diseases including pre-existing asthma (3.4%), neurologic conditions (3.4%) and cardiac pathology (2.3%). Majority (74.8%, 199/266) of the patients were discharged without sequelae, 0.8% (2/266) were discharged with sequalae from one study, and mortality of 1.9% (5/266) was reported, also from one study. SOFA scores of patients at admission were not stated in any of the study, while only one study reported patient vaccination status. Conclusion: It is recommended that safe vaccines for children < 1 year of age should be developed in addition to other preventive measures currently in place. SOFA scores should be used to assess risk of COVID-19 severity and monitor prognosis of the disease, and vaccination status of children should be documented as this may impact the management and prognosis of the disease.

Vitamin D status and COVID-19 severity

Background: Age, body mass index (BMI) and pre-existing comorbidities are known risk factors of severe coronavirus disease 2019 (COVID-19). In this study we explore the relationship between vitamin D status and COVID-19 severity. Methods: We conducted a prospective, cross-sectional descriptive study. We enrolled 100 COVID-19 positive patients admitted to a tertiary level hospital in Johannesburg, South Africa. Fifty had symptomatic disease (COVID-19 pneumonia) and 50 who were asymptomatic (incidental diagnosis). Following written informed consent, patients were interviewed regarding age, gender and sunlight exposure during the past week, disease severity, BMI, calcium, albumin, magnesium and alkaline phosphatase levels. Finally, blood was collected for vitamin D measurement. Results: We found an 82% prevalence rate of vitamin D deficiency or insufficiency among COVID-19 patients. Vitamin D levels were lower in the symptomatic group (18.1 ng/mL ± 8.1 ng/mL) than the asymptomatic group (25.9 ng/mL ± 7.1 ng/mL) with a p-value of 0.000. The relative risk of symptomatic COVID-19 was 2.5-fold higher among vitamin D deficient patients than vitamin D non-deficient patients (confidence interval [CI]: 1.14­3.26). Additional predictors of symptomatic disease were older age, hypocalcaemia and hypoalbuminaemia. Using multiple regression, the only independent predictors of COVID-19 severity were age and vitamin D levels. The patients exposed to less sunlight had a 2.39-fold increased risk for symptomatic disease compared to those with more sunlight exposure (CI: 1.32­4.33). Conclusion: We found a high prevalence of vitamin D deficiency and insufficiency among patients admitted to hospital with COVID-19 and an increased risk for symptomatic disease in vitamin D deficient patients.

Insights into the clinical profile and comorbidities of factitious disorder in a multispeciality setting in southwest Nigeria: A cases series and review

Background: Factitious disorder (FD) is an under-recognized and under-diagnosed mental condition. Healthcare professionals often have challenges to diagnose and treating the disorder. As a result, needless and endless medical resources are recommended to assess and evaluate those affected. FD may present as a physical condition, a psychological disorder, or maybe both depending on the prominent symptoms. However, there is a strong correlation between having FD and psychiatric symptoms. Main Text: FD occurs in early adulthood, with a mean age of onset of 25 years in both genders, although with differing demographic features. The lifetime prevalence of FD imposed on oneself in clinical settings is 1.0%, 0.1% in the overall population (ranging between 0.007% and 8.0%) and occurs more in female health care professionals. FD may make up 0.6%­3.0% of psychiatric referrals, and it accounts for 3-5% of doctor-patient contacts. In actuality, 1-2% of hospital admissions and an average of 6-8% of all psychiatric admissions have been underreported. The study aimed to highlight the signs and symptoms of FD identified in a psychiatry department of a multispecialty center and to increase the awareness of health practitioners. A critical review of the literature was done with an emphasis on psychological symptoms. PubMed, Mendeley, and Google Scholar were thoroughly searched and full-text publications of journals from 2010-2021 were included. Conclusion: FD is a diagnostic puzzle that necessitates adequate, prompt medical attention as well as social support because of the potentially fatal consequence. A stronger patient-therapist relationship can strengthen the patient's conscious self-control to minimize the symptoms; therefore the healthcare provider has to be openminded. For the diagnostic enigma to be removed and for ease of treatment, additional research, increasing awareness among medical professionals and the general public, accurate evaluation, diagnosis, and psychotherapy should be encouraged. These case studies will contribute to the knowledge base of FD and improve the quality of care.

Comorbid anxiety and depression among women receiving care for breast cancer: analysis of prevalence and associated factors

Background: Living with breast cancer has been associated with increased risk for common mental health problems including depression and anxiety. However, the prevalence of comorbid anxiety and depression (CAD) and their associated factors have received little attention especially in low- and middle-income countries (LMICs) including Ghana. Objectives: This study examined the prevalence of CAD and its correlates in the context of breast cancer. Methods: Participants were 205 women receiving care for breast cancer at a Tertiary Hospital in Ghana. The Hospital Anxiety and Depression Scale (HADS) and socio-demographic questionnaires were administered to the participants. Results: Findings from the study showed that the prevalence of CAD, anxiety and depression was 29.4%, 48.5% and 37.3% respectively. CAD was significantly predicted by patients' English language reading ability, shared decision making and good doctor-patient relationship. Anxiety was significantly predicted by shared decision making and good doctor-patient relationship whereas depression was significantly predicted educational status, patients' English language reading ability, shared decision making and good doctor-patient relationship. Conclusion: The findings suggest relatively high prevalence of comorbid anxiety and depression which could negatively impact breast cancer treatment outcomes and therefore, improved interpersonal relationships between doctors and their patients as well as literacy skills are warranted

Experiences of psychiatric nurses caring for mental healthcare users with a comorbid disorder

Background: Caring for mental healthcare users (MHCUs) with a comorbid disorder of human immunodeficiency virus (HIV) and schizophrenia has always been challenging and requires expertise, skill, intuition and empathy. Objectives: The objective of this study was to explore and describe the experiences of psychiatric nurses caring for MHCUs with a comorbid disorder of HIV and schizophrenia. Method: A qualitative, exploratory, descriptive and contextual research design was used. Eight participants were selected through purposive sampling for individual in-depth interviews to collect data. Thematic analysis was used to analyse data. Results: Three themes emerged from this study. The first theme is that the psychiatric nurses experienced deep frustration because they were capable but unable to manage MHCUs with HIV and schizophrenia because of poor infrastructure and other contributing barriers. The second theme identified that the psychiatric nurses experienced discrimination against MHCUs compromising their holistic recovery. Lastly, the psychiatric nurses identified the need for health care workers in general hospitals and communities and families of MHCUs with a comorbid disorder to be educated in mental health issues to ensure continuous medical care. Conclusion: The results of this study showed that psychiatric nurses became exhausted when trying to cope with difficult nursing situations. The challenges they faced had negative consequences for the mental health of the psychiatric nurses and compromised patient care. Contribution: This study adds knowledge to nursing practice, nursing education and nursing research by implementing recommendations to mitigate the challenges of psychiatric nurses caring for MHCUs with HIV and schizophrenia.

Co-morbidités, infection a COVID-19 et pathologies chirurgicales. Cas du service de chirurgie viscérale et générale de l'hôpital Souro Sanou de Bobodioulasso (Burkina Faso). / Co-morbidities, covid-19 infection and surgical pathologies. Case of the department of visceral and general surgery of Souro Sanou hospital in Bobo-Dioulasso (Burkina Faso)

Le Burkina Faso a enregistré son premier cas de Covid-19 le 09 mars 2020 mais c'est au premier avril 2020 que le service de chirurgie générale et viscérale du Centre Hospitalier Universitaire Sourô SANOU (CHUSS) de Bobo-Dioulasso a enregistré son premier cas de COVID-19 et pathologie chirurgicale. En six mois, soit entre avril et septembre 2020, notre service a enregistré quatre cas, tous des malades de sexe masculin et testés positifs à la maladie de la Covid-19 après un prélèvement oropharyngé techniqué à l'aide de la trousse de RT-PCR Detection kit for 2019-n COV RNA (Da An Gene Co) et la Plate forme AriaMx (Real-Time PCR System).Les quatre malades étaient âgés respectivement de 63 ans, 70 ans, 60 ans et 66 ans et étaient pris en charge pour un traumatisme fermé du thorax, une gangrène de jambe, une tumeur vésicale et un adénocarcinome gastrique. Deux patients étaient décédés dans le service. Les deux autres avaient été transférés dans le centre régional spécialisé dans la prise en charge de la maladie COVID-19 avec une évolution favorable. L'impact de la Covid-19 en 2020 constaté dans le service de chirurgie générale et viscérale du CHUSS, a été une diminution de 82% des activités chirurgicales.

Burkina Faso recorded its first case of Covid-19 on March 09, 2020 but it was on April 1, 2020 that the general and visceral surgery department of the Center Hospitalier Universitaire Sourô SANOU (CHUSS) in Bobo-Dioulasso recorded its first case of COVID-19 and surgical pathology. From April to September 2020, our service recorded four cases, all male patients and tested positive for Covid-19 disease after an oropharyngeal sample performed using the RT- kit. PCR Detection kit for 2019-n COV RNA (Da An Gene Co) and the AriaMx (Real-Time PCR System) platform. The four patients were aged 63, 70, 60 and 66, respectively, and were being treated for blunt chest trauma, leg gangrene, bladder tumor and gastric adenocarcinoma. Two patients died in the ward. The other two had been transferred to the regional center specializing in the management of the COVID-19 with a favorable outcome. The impact of Covid-19 in 2020, observed in the general and visceral surgery department of the CHUSS, was a 82% decrease in surgical activities.

COVID-19 et maladies auto-immunes dans un centre de traitement des épidémies à Dakar / COVID 19 and autoimmune diseases in an outbreak treatment center in Dakar

Introduction : Les patients présentant une affection systémique ont un risque accru d'infections. Leur prise en charge au cours de la pandémie au COVID19 constitue un défi qui doit prendre en considération plusieurs aspects. Nous rapportons les caractéristiques épidémiologiques, cliniques, et évolutives des patients COVID positifs suivis pour une maladie auto-immune (MAI). Patients et méthode : étude rétrospective, descriptive et analytique menée au centre de traitement des épidémies du centre hospitalier universitaire (CHU) Le Dantec de Dakar durant les périodes du 30 Avril au 30 Octobre 2020 puis du 30 Décembre 2020 au 30 Avril 2021. Etaient inclus tous les dossiers des patients suivis pour une maladie systémique hospitalisés pour COVID-19 confirmée à la RT-PCR. Résultats : treize patients étaient inclus dans l'étude, composés de 8 femmes et de 5 hommes. L'âge moyen était de 59 ans [16 à 74 ans]. Il s'agissait de 8 cas de maladies auto-immunes systémiques (MAIS) : polyarthrite rhumatoïde (n=3 ; 37,5%), Sjögren primitif (n=2 ; 25%), lupus systémique, dermatomyosite, arthrite à cellules géantes chacun 1 cas (12,5%) et 5 cas de maladies auto-immunes spécifiques d'organes (MASO) : maladie de Basedow (n=1 ; 20% de MASO), thyroïdite de Hashimoto (n=1 ; 20%), myasthénie (n=1 ; 20%), diabète de type 1 (n=1 ; 20%) et maladie de Biermer (n=1 ; 20%). Les formes cliniques étaient modérées (6 cas ; 46,1%), sévères (2cas ; 15,4%) et critiques (2cas ; 15,4%). Huit patients (8/13) avaient au moins une comorbidité associée. Deux décès (2/13) étaient notés. Conclusion : il n'a pas été trouvé une augmentation des complications sévères dues au COVID-19 chez les patients suivis pour une maladie auto-immune. Leur pronostic n'est pas différent de celui de la population générale.

COVID-19 complications in a small-town hospital in South Africa

South Africa has experienced three deadly waves of the COVID-19 pandemic with devastating consequences, but little is known about the experiences in small-town hospitals in the country. Between May 2020 and June 2021, author GC treated ~100 confirmed COVID-19 cases. This retrospective case series report describes 10 of these cases, 7 with unusual complications and 3 with sudden death.

Comorbidity in context: Part 1. Medical considerations around HIV and tuberculosis during the COVID-19 pandemic in South Africa

Infectious diseases pandemics have devastating health, social and economic consequences, especially in developing countries such as South Africa. Scarce medical resources must often be rationed effectively to contain the disease outbreak. In the case of COVID-19, even the best-resourced countries will have inadequate intensive care facilities for the large number of patients needing admission and ventilation. The scarcity of medical resources creates the need for national governments to establish admission criteria that are evidence-based and fair. Questions have been raised whether infection with HIV or tuberculosis (TB) may amplify the risk of adverse COVID-19 outcomes and therefore whether these conditions should be factored in when deciding on the rationing of intensive care facilities. In light of these questions, clinical evidence regarding inclusion of these infections as comorbidities relevant to intensive care unit admission triage criteria is investigated in the first of a two-part series of articles. There is currently no evidence to indicate that HIV or TB infection on their own predispose to an increased risk of infection with SARS-CoV-2 or worse outcomes for COVID-19. It is recommended that, as for other medical conditions, validated scoring systems for poor prognostic factors should be applied. A subsequent article examines the ethicolegal implications of limiting intensive care access of persons living with HIV or TB

Comorbidity in context: Part 2. Ethicolegal considerations around HIV and tuberculosis during the COVID-19 pandemic in South Africa

The COVID-19 pandemic has brought discussions around the appropriate and fair rationing of scare resources to the forefront. This is of special importance in a country such as South Africa (SA), where scarce resources interface with high levels of need. A large proportion of the SA population has risk factors associated with worse COVID-19 outcomes. Many people are also potentially medically and socially vulnerable secondary to the high levels of infection with HIV and tuberculosis (TB) in the country. This is the second of two articles. The first examined the clinical evidence regarding the inclusion of HIV and TB as comorbidities relevant to intensive care unit (ICU) admission triage criteria. Given the fact that patients with HIV or TB may potentially be excluded from admission to an ICU on the basis of an assumption of lack of clinical suitability for critical care, in this article we explore the ethicolegal implications of limiting ICU access of persons living with HIV or TB. We argue that all allocation and rationing decisions must be in terms of SA law, which prohibits unfair discrimination. In addition, ethical decision-making demands accurate and evidence-based strategies for the fair distribution of limited resources. Rationing decisions and processes should be fair and based on visible and consistent criteria that can be subjected to objective scrutiny, with the ultimate aim of ensuring accountability, equity and fairness

Ocular comorbidities in children with strabismus in Benin city

Background: Strabismus is the misalignment of the visual axis. Certain comorbidities have been found to be associated with strabismus.These must be identified and treated. Objective: The aim of this study was to determine the ocular comorbidities associated with strabismus in children 15 years and below presenting to the eye clinic of University of Benin Teaching Hospital, Benin City, from January 2014 to December 2014. Patients and Methods: This is a prospective hospital­based observational study of consecutive patients seen in the eye clinic. Results: Fifty­five children presented with strabismus accounting for 2.6% of the total number of 2112 new cases. There were 30 males (54.5%) and 25 females (45.5%) giving a male­to­female ratio of 1:0.83. The age range was from 5 months to 14 years. The mean age was 4.7 years with a standard deviation of ± 3.4 years. Thirty­seven (67.3%) of the patients were under 5 years of age. Forty­seven (85.5%) patients had esotropia, six (10.9%) had exotropia, and two (3.6%) had hypertropia. Vision­impairing comorbidities included refractive error in 33 (64.7%) patients, cataract in 9 (17.6%) patients, corneal opacity in 1 (2.0%) patient, and retinopathy of prematurity in 1 (2.0%) patient. Nonvision­impairing disorders were microcornea, conjunctivitis,and nasolacrimal duct obstruction. The relationship between ocular comorbidity and types of strabismus was not statistically significant (P > 0.05). Conclusion: Detailed assessment to identify the comorbidities associated with strabismus is recommended.This could improve the management of this condition

Anxiety disorders: Psychiatric comorbidities and psychosocial stressors among adult outpatients

Background: Anxiety disorders are the most prevalent class of lifetime mental disorders according to South African research. However, little is known about the prevalence of factors that might complicate treatment among adults in a psychiatric outpatient setting. Aim: To explore the psychiatric comorbidities and psychosocial stressors among a population of adults treated for anxiety disorders at the outpatient unit of a tertiary psychiatric facility in Bloemfontein. Methods: In this retrospective cross-sectional study, clinical files of all mental healthcare users receiving treatment were reviewed to identify those with a current or previous diagnosis of one or more of the following anxiety disorders: generalised anxiety disorder (GAD), panic disorder, social anxiety disorder (SAD) and agoraphobia. Results: Of the 650 available records, 103 (15.8%) included at least one anxiety disorder. Of those, 65.1% had GAD, 34.0% had panic disorder and 29.1% had SAD. Agoraphobia was diagnosed in 14.6% of patients almost exclusively as comorbid with panic disorder. Additional psychiatric disorders were present for 98.1% of patients and 36.9% had multiple anxiety disorders. The patients had a history of relational problems (64.1%), educational and occupational stressors (55.3%), abuse and neglect (28.2%), other problems related to the social environment (24.3%) and self-harm (23.3%). Conclusion: Clinical practice should take the high rates of comorbidity into account and the importance of integrated substance-related interventions in mental healthcare settings is clear. Diagnostic practices regarding agoraphobia without panic, and the comorbidity of anxiety and personality disorders should receive further attention. Clinicians should be aware of the potential impact of the frequently reported psychosocial stressors

Comorbidité diabète-obésité aspects épidémiologiques, cliniques, paracliniques et thérapeutiques à l'hôpital national de Niamey et à la polyclinique Magori : à propos d'une étude prospective sur 226 cas colligés allant du 25 janvier au 25 juillet 2018

Introduction : La croissance rapide de la prévalence du diabète sucré et de l'obésité dans les pays en développement et au Niger en particulier, constitue à la fois une réalité et une menace pour la santé comme dans tous les pays subissant la triple transition démographique, épidémiologique et nutritionnelle. Ces deux maladies sont une cause importante de mortalité et de multiples complications. Les enjeux médicaux et financiers font de ces deux maladies un problème majeur de santé publique. Objectif : Contribuer à l'amélioration de la prise en charge des patients vivant avec le diabète et l'obésité. Méthode : Il s'agissait d'une étude prospective transversale qui s'est déroulée en unité de diabétologie située dans le service de médecine interne de l'Hôpital National de Niamey et à la polyclinique Magori du 25 janvier 2018 au 25 juillet 2018. Résultats : L'étude avait concerné 226 patients diabétiques et obèses sur un ensemble de 1007 patients diabétiques consultés soit une fréquence de 22,55%. Le sexe féminin prédominait avec 74,80% pour un sex-ratio (H/F) de 0,33. La moyenne d'âge était de 52,06 ±12,54 ans. Au total 86,30% des patients résidaient en milieu urbain et 57,10% possédaient un niveau socioéconomique jugé moyen. 42,5% avaient une profession dont 33,20% n'avaient pas dépassés le niveau d'étude secondaire. Le diabète de type 2 avait été le plus retrouvé chez 85,80% avec une ancienneté moyenne de 7,35 ± 6,96 ans. Le dosage de l'HbA1c n'a pu être réalisé chez 32,2% de patients et parmi ces patients un déséquilibre du diabète (HBA1c ˂ 7%) a été retrouvé chez 68% de cas. La glycémie moyenne était de 9,08± 4,09 mmol/l avec des extrêmes allant de 1,68 mmol/l à 21,76 mmol/l. 81% des patients avaient une obésité selon l'indice de masse corporel avec une notion de diabète familiale chez 55,8% et une obésité familiale chez 50,9%. Le trouble de comportement alimentaire était le facteur Comorbidité diabete-obesité : Aspects épidémiologiques, cliniques, paracliniques et thérapeutiques déclenchant de l'obésité le plus fréquent chez nos patients soit 55,75%. L'obésité a précède la survenue de diabète chez 80,97% de nos patients. La moyenne de l'IMC était de 29,08±5,42kg/m². L'âge, l'HTA, la ménopause, la sédentarité et les dyslipidémies étaient les principaux facteurs de risque associés à la comorbidité diabète-obésité soit respectivement 52,65%, 52,65%, 44,24%, 26,54% et 18,14% de cas. Les aspects évolutifs ont été marqué par hypoglycémie dans 51,76% de cas, une neuropathie périphérique dans 57,07%, les infections uro-génitale dans 42,92% de cas, les complications métaboliques suivis des complications respiratoires et ostéo-articulaires dans respectivement 42,03%, 31,41% et 26,99%. Près de 80,10% de patients étaient sous mesures hygiéno-diététiques et 51,33% avaient une activité physique jugée régulière. Les antidiabétiques oraux étaient utilisés par 53,1% de nos patients, 42% étaient sous insuline et 46,01% faisaient souvent recours au traitement traditionnel. Une relation significative a été retrouvée entre le type de l'obésité et le sexe (p ˂ 0,0001) ; l'IMC et le sexe (p=0,035) ; le type et la durée d'évolution du diabète (p=0,012) ; le traitement aux ADO et l'âge (p=0,007) ; l'insulinothérapie et l'âge (p=0,001) ; la durée du diabète et ses complications chroniques (p=0,006) ; le type d'obésité et ses complications (p=0,027). Conclusion : L'épidémie de « diabésité » nécessite une véritable prise de conscience sur le plan politique et une prise en charge énergique d'un point de vue médical

Comorbidities and Neuromyelitis Optica - Spectrum Diseases : What are the current Data ?

Neuromyelitis optica (NMO-SD) or Devic disease is an acute transverse myelitis associated with an optic neuritis united -or bilateral. It is an inflammatory disease very disabling evolving by thrust. The long-term prognosis is also difficult to predict due to comorbidities which determine the evolution and the quality of life of patients. The objective of our study was to determine the different types of co-morbidities found in patients with NMO -SD.Methods: It was a descriptive study through a review of the literature on PubMed with the combination (Neuromyelitis optica, comorbidity). The data analysis was made on the software SPSS 23 Results: Total 27 articles were published and available on PubMed (June 2017). Among these 27 work we included ten (10) specific studies of co-morbidities in the NMO-SD. Three categories of illnesses have been reported in these 10 articles including coexisting diseases with the NMO-SD without any risk factor common or similar