Hernie discale cervicale post traumatique

Il s'agit d'un patient de 54 ans, tabagique chronique, victime d'un accident de la voie publique avec réception sur le crane. L'examen clinique trouve un patient conscient, avec tétraparésie à prédominance brachiale (grade C de Frankel) et irritation pyramidale (réflexes ostéotendineux vifs au niveau supérieur et inférieur). Le bilan radiologique initial (radios standards et scanner) était sans particularités. Devant ce tableau clinique, une IRM cervicale a été réalisée et a objectivé une hernie cervicale compressive en C5-C6 avec contusion centromédullaire (A). Le patient a été opéré par voie antérieure avec réalisation d'une discectomie C5-C6 et mise en place d'un greffon iliaque et une plaque cervicale (B). L'évolution postopératoire était favorable ; la déambulation a été possible quatre jours après l'opération. L'hernie discale cervicale posttraumatique est rare (3,8% des traumatismes cervicaux). Quand elle est isolée, les investigations paracliniques peuvent passer à coté de cette lésion et c'est l'IRM qui permet de poser le diagnostic et d'apprécier le degré de compression médullaire et radiculaire.Pan African Medical Journal 2015; 2

Healthy Eating and Physical Activity Environmental and Policy Assessment – Measurement Issues and Implications

Current research has suggested that supportive healthy eating and physical activity (HEPA) policy and practice environments play a significant role in shaping the physical activity levels and eating habits of youth. Subsequently, a wide array of audit tools assessing policy and practice environment characteristics across settings that care for youth were developed. However, the extent that available audit tools accurately reflect the policy environment characteristics of the settings that care for the youth population remains unknown. Therefore, this dissertation encompasses four studies. The purpose of the first study was to examine the measurement properties of audit tools currently in use for assessing policy environment characteristics across a variety of settings that care for youth. Fifty-three individual tools that met the inclusion criteria were identified. Reliability and validity data were available for only 11 tools. Reliability coefficients (median) for individual items across tools were 0.62 (kappa), 0.88 (ICC), 74.0% (percent agreement), 0.62 (Pearson correlation) and 0.73 (Cronbach’s α). Validity coefficients (median) for individual items across tools were 0.35 (kappa), 0.98 (ICC), 0.22 (r) and 74.7% (percent agreement). The purpose of the second study was to determine the feasibility of training afterschool program (ASP) leaders to use the Healthy Afterschool Program Index - Physical Activity (HAPI-PA) and the Healthy Afterschool Program Index – Nutrition (HAPI-N) scales] accurately. Forty-four program leaders across South Carolina were recruited. Program leaders were randomized to either in-person or distance training group. Ninety percent of the items in the in-person group and 73% of the items in the distance group had a kappa ≥ 0.70 for the HAPI-PA scale. In comparison, 83% of the HAPI-N scale items in the in-person group and 67% of the items in the distance group had a kappa ≥ 0.70. Equivalency between the two training methods was established for 5 of the 11 items in the HAPI-PA scale and 3 of the 12 items in the HAPI-N scale. The purpose of the third study was to evaluate the responsiveness of the HAPI-PA and HAPI-N scales to policy and practice environment characteristics change. Twenty afterschool programs across South Carolina serving over 1700 children (5-12 years old) participated Baseline data were collected during spring 2013 and post-1 year follow-up data during spring 2014. The HAPI-PA and HAPI-N scales median and interquartile range (IQR) score improved from a baseline score of 9.5 (±5.8) to 13.5 (±2.0) for HAPI-PA and a score 6.5 (±6.5) to 21.0 (±4.0) for HAPI-N after year 1 in the intervention group. For the intervention group the HAPI-PA and HAPI-N scales effect sizes were 0.70 and 2.23, standardized response median were 0.94 and 1.45 and responsiveness index were 1.07 and 2.5, respectively. In comparison, the HAPA-PA and HAPI-N scores showed non- significant changes between baseline and year 1 follow up in the control group in both the median and IQR and using the effect size indices. The purpose of the fourth study was to examine the influence of both the physical and policy and practice environment characteristics of ASP’s settings on the HEPA behaviors of youth. A total of 1,302 children attending 20 ASPs across South Carolina wore accelerometers (ActiGraph GT3X+) for up to 4 non-consecutive days. Policy-level characteristics were evaluated using the HAPI-PA scale. Physical activity space was measured using a measuring wheel (indoor, ft2) and GIS (outdoor, acres). The structure (free-play or organized) of activity opportunities was evaluated via direct observation. For every 5000ft2 of utilized indoor activity space an additional 2.4 and 3.3 minutes/day of sedentary behavior was observed among boys and girls, respectively. A higher ratio of free-play to organized play was associated with higher indoor sedentary behavior among boys and girls (3.9 minutes/day and 10.0 minutes/day, respectively). For every one acre of outdoor activity space used, an additional 2.7 minutes/day of MVPA was observed for boys. A higher free-play to organized play ratio was associated with higher outdoor MVPA for boys and girls (4.4 and 3.4 minutes/day increase, respectively). Policy characteristics were unrelated to MVPA levels and time spent sedentary. In summer, this dissertation found that audit tools are widely used to quantify the impact of supportive HEPA policy and practice environmental characteristics across settings that care for youth, however, little effort is taken to evaluate the measurement properties of such tools. This wok showed that ASP’s site leaders are able to provide accurate information regarding their program HEPA policy and practice environment using a newly developed audit tool (i.e., the HAAND). Furthermore, the HANND instrument appears to be capable of detecting changes in the ASP’s HEPA environment. More effort should be directed towards providing ASP’s with strategies to meet current HEPA policy and practice recommendation

Chondroma of the scalp

A 26 year old man, with no specific past or family history, presented with slow growing subcutaneous mass in the right parietal region of about 4 cm. Skin examination revealed a firm subcutaneous nodule that was movable over the underlying bone. Physical examination was not remarkable other than above-described skin lesion. X-rays of the skull (A) and CT scan (B) showed a subcutaneous mass next to the right parietal eminence measuring 17×39 mm and containing calcifications. Surgery resection of the tumor was complete and easy (C). The nodule was not attached to underlying skull. The postoperative course was unremarkable. Histological examination confirmed the diagnosis of soft-tissue chondroma (D). Extraskeletal chondroma is a rare, benign cartilaginous tumor of the soft tissue. It presents as a solitary subcutaneous mass measuring less than 3 cm in diameter that is usually painless and slowly growing. It is most frequently found in the hands and feet of adults in the fourth and fifth decades. Its location in the scalp is exceptional and atypical. Complete excision is recommended for the treatment of extra skeletal chondroma.Pan African Medical Journal 2015; 2

Successfull management of a cervical oesophageal injury after an anterior cervical approach: a case report

The anterior surgical approach for spinal repair, with or without the insertion of stabilizing hardware, is an established procedure in the management of anterior cervical spine (ACS) pathology. Esophageal injury during this approach is a rare complication that can be life threatening. No treatment protocol has yet been standardized. In addition to conservative measures, several surgical approaches have been presented, ranging from primary repair to reconstruction with local, regional, or distant flaps. The SCM muscle flap, used as reinforcement of a primary suture or as a patch to the lesion is in our opinion an effective treatment for persisting or recurring esophageal fistulae after anterior cervical spine surgery

Anévrismes intracrâniens multiples

A 33 years old woman, treated for hypertension on monotherapy for a year, was admitted on emergency for sudden onset headache. Clinical examination revealed a conscious patient, blood pressure= 13/7, with the presence of frank meningeal syndrome, no fever. Cerebral CT showed subarachnoid hemorrhage at the right middle cerebral valley. The arteriography objectified three aneurysmal dilations at the right posterior communicating artery of about 8.3mm, also at the M2 segment of the right middle cerebral arterys of about 4 mm (A) and finally at the left cerebral bifurcation of about 4mm (B). The patient underwent endovascular treatment of the two right aneurysms and was given a three months appointment to secure the aneurysm. The prevalence of intracranial aneurysms in the general population is evaluated from 1 to 5%. Only 15% of these patients have multiple aneurysms and 7% of them have more than four aneurysms. The therapeutic strategy is to first secure the aneurysm bled and subsequently treating other aneurysms according to their size and risk of bleeding.Pan African Medical Journal 2016; 2

Health literacy research in the Eastern Mediterranean Region: an integrative review

© 2019, Swiss School of Public Health (SSPH+). Objectives: This integrative review examines health literacy research in the Eastern Mediterranean Region (EMR) and describes: (1) assessments and screening tools used to measure levels of health literacy, and (2) the focus, methods, and findings of health literacy research in the region. Methods: A total of 246 records were identified through a systematic search of online databases from 1950 to 2017, to include: ProQuest Middle East and Africa, MEDLINE, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic OneFile, Web of Science, Scopus, and Google Scholar. The final sample included 49 full-text articles. Results: This research described 7 studies which used existing or new health literacy measures. Levels of health literacy in the EMR were similar to those for Europe and the United States. Low health literacy in EMR countries was more prevalent among females than males. The relationships between health literacy and knowledge, behavior and health outcomes varied across countries. Conclusions: To our knowledge, this study is the first in the EMR. Appropriately designed studies should better define health literacy needs due to variations in socioeconomic status within subregions. Future health literacy measures must consider stronger psychometric properties to guide development and validation

The Healthy Afterschool Activity and Nutrition Documentation Instrument

Policies call on afterschool programs to improve the physical activity and nutrition habits of youth attending. No tool exists to assess the extent to which the afterschool program environment meets physical activity and nutrition policies

Impact of community-based participatory initiative on children\u27s pedometer-determined physical activity

Abstract of poster that presented at 2013 AAHPERD National Convention & Exposition, Charlotte, NC , 23-27 April 2013

Physical activity and healthy eating environmental audit tools in youth care settings: A systematic review

There is a growing interest in evaluating the physical activity (PA) and healthy eating (HE) policy and practice environment characteristics in settings frequented by youth (≤18 years)