Antenatal Diagnosis and Management of Nuchal Cystic Hygroma: A Case Report in the Yaounde Central Maternity, Cameroon

Ultrasonographic evaluation, as a routine component of antenatal care, has significantly contributed to in utero assessment of pregnancy status. The detection of fetal abnormalities by ultrasound, however, has raised clinical questions and created parental dilemmas concerning the outcomes of such pregnancies. A relatively frequent anomaly observed on routine ultrasonographic examination is the posterior nuchal cystic hygroma. Most cases of cystic hygromas are associated with chromosomal abnormalities. Only 2–3% survival rate is reported when fetal cystic hygromas are diagnosed in utero. This information should be helpful when counseling patients whose pregnancies involve fetuses with this anomaly. We report a case of nuchal cystic hygroma diagnosed in the second trimester of pregnancy with the aid of an ultrasonographic morphological analysis. The parents requested termination of the pregnancy.Keywords antenatal; diagnosis; cystic hygrom

Primary umbilical endometriosis: Radical excision (omphalectomy) and laparoscopic management of associated pelvic endometriosis in a low resource tertiary hospital

Primary umbilical endometriosis (PUE) is a rare condition affecting 0.5 – 1% of all extragenital endometriosis cases. We reviewed the data of five women with umbilical endometriosis retrospectively. The age range was 29 – 46 years, and they were all nulligravid at presentation. Common clinical presentation was umbilical pain and masses, dysmenorrhea, and primary infertility. Radical umbilical excision was performed to remove the nodule as a definitive treatment. Diagnostic laparoscopy was performed, followed by varying degrees of operative laparoscopic procedures. They all had endometriosis in the pelvis. Three out of five women operated became pregnant and had live births. Complete resolution of clinical symptoms with a reduction in umbilical and menstrual pain scores occurred. In resource-constrained settings, diagnosis, and treatment of PUE may be challenging. Clinical suspicion and appropriate case management are critical for good reproductive outcomes and quality of life.   L'endométriose ombilicale primaire (PUE) est une maladie rare affectant 0,5 à 1 % de tous les cas d'endométriose extragénitale. Nous avons examiné les données de cinq femmes atteintes d'endométriose ombilicale rétrospectivement. La tranche d'âge était de 29 à 46 ans, et ils étaient tous nulligravides à la présentation. Le tableau clinique commun était la douleur et les masses ombilicales, la dysménorrhée et l'infertilité primaire. Une excision ombilicale radicale a été réalisée pour retirer le nodule comme traitement définitif. La laparoscopie diagnostique a été réalisée, suivie de divers degrés de procédures laparoscopiques opératoires. Ils avaient tous une endométriose du bassin. Trois femmes opérées sur cinq sont tombées enceintes et ont eu des naissances vivantes. Une résolution complète des symptômes cliniques avec une réduction des scores de douleur ombilicale et menstruelle s'est produite. Dans les milieux à ressources limitées, le diagnostic et le traitement du PUE peuvent être difficiles. La suspicion clinique et une prise en charge appropriée des cas sont essentielles pour de bons résultats en matière de reproduction et une bonne qualité de vie

Congenital Amputation Involving the Hands and Feet: A Case Report

Background: Congenital amputation of the limbs is not uncommon. However, it is very rare when this involves both the upper and lower limbs. Method: This is a case report of a child who presented with congenital amputation involving both the upper and lower limbs. Results: The patient was a 10 day old baby girl that was delivered by a 21 year old woman. She is the first and only child of the woman, whose pregnancy was uneventful and was carried to term. There is no family history of congenital anomalies. The findings on examination were: amputation of the index, middle and ring fingers at the level of metacarpophalangeal joints on both hands and a partial amputation (at the level of the middle phalanx) of the left little finger. There were forefoot amputations on both lower limbs. Scars were noticed over the amputation stumps with no associated congenital anomaly. Conclusion: Congenital amputation involving all limbs as an isolated entity is a rare condition; the cause of which is probably as a result of congenital amniotic bands. Keywords: Congenital amputation, limbs, scar, amniotic bands. Nigerian Journal of Medicine Vol. 17 (4) 2008: pp. 457-45

Nigerian stakeholders\u27 perceptions of a pilot tier accreditation system for Patent and Proprietary Medicine Vendors to expand access to family planning services

Background: Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are often the first point of care for many Nigerians, and when sufficiently trained, they contribute to the expansion of family planning services. Nigeria\u27s task shifting policy and existing regulatory and licensing bodies provide the enabling environment for PPMVs to be stratified and trained. This study explored the perceptions of stakeholders toward the pilot three-tier accreditation system instituted by the Pharmacists Council of Nigeria with support from the IntegratE project. Methods: Two rounds of qualitative phone interviews were conducted among stakeholders in Kaduna and Lagos states in 2020 and 2021. In addition, there were two rounds of phone interviews with CPs and PPMVs (program recipients) from Lagos and Kaduna states. All participants were purposively selected, based on their involvement in the IntegratE project activities. Interviews were recorded, transcribed, and coded using Atlas.ti software. Thematic analysis was conducted. Results: Fifteen stakeholders and 28 program recipients and 12 stakeholders and 30 program recipients were interviewed during the first and second rounds of data collection respectively. The data are presented around three main themes: 1) the pilot three-tier accreditation system; 2) enabling environment; and 3) implementation challenges. The accreditation system that allows for the stratification and training of PPMVs to provide family planning services was perceived in a positive light by majority of participants. The integrated supportive supervision team that included representation from the licensing and regulatory body was seen as a strength. However, it was noted that the licensing process needs to be more effective. Implementation challenges that need to be addressed prior to scale up include bottlenecks in licensing procedures and the deep-rooted mistrust between CPs and PPMVs. Conclusion: Scale up of the three-tier accreditation system has the potential to expand access to family planning services in Nigeria. In other resource-poor settings where human resources for health are in short supply and where drug shops are ubiquitous, identifying drug shop owners, training them to offer a range of family planning services, and providing the enabling environment for them to function may help to improve access to family planning services