Antananarivo Madagascar Research Articles

Ruptured Ectopic Pregnancy: Epidemiological Profiles and Prognostic in a Reference Hospital in Antananarivo Madagascar

Introduction: Ectopic pregnancy (EP) is a serious condition and the leading cause of maternal death in the first trimester of pregnancy. The objectives of this study were to identify the epidemiological profiles, clinicals ectopic pregnancy ruptured to prevent complications and ensure early and appropriate treatment. Methods: We performed a prospective descriptive study over a period of two years from first January 2018 to December 2019. Results: Among the 14968 deliveries during the study period, 269 cases of ruptured EP were compiled, giving a frequency of 2.80%. The average age of onset was 28 years. The risk factors the most identified was the pelvic infection. The spontaneous abortion was predominant. Most of the EP was in ampullary position in 72.49 %. Radical treatment dominated the management in 79.55 % of cases. The totality of the patients was a satisfiable issue. Conclusion: The precocious detection of EP in all women who bleed in the first trimester of pregnancy is primordial. The decrease in frequency requires the sensibilization of the population on their health to avoid the many risk factors of ruptured EP and their complications.

Evaluation of the Impact of Chemical Pollution on the Quality of the Environment in Rice Fields in the Commune of Ankadikely Ilafy, Antananarivo Madagascar

In the northern peripheral zone of the Urban Commune of Antananarivo (Madagascar), rice fields are irrigated by wastewater in its raw state or after treatment, of a mixed and biodegradable nature, which contains nitrates N-NO3- , Cl-, H2 PO4- , and metallic trace elements with excessive concentrations of heavy metals (Pb, Cr, Cu, Zn and Mn) that can be introduced into the environment, for example, by industrial effluents and waste. The direct effects of the use of these waters in irrigation are soil acidification, enrichment in fertilising elements (NPK) mainly from domestic waste and fertilisers used by farmers and in organic matter, and then the accumulation of trace metal elements in the soil from the plant, during the years of monitoring. However, according to the field studies, we found the following: on the one hand, chromium inputs (dry season 0.45mg/L and rainy season 0.71mg/L), conductivity (dry season 2236µS/cm and rainy season 268.6µS/cm), turbidity (dry season 42.9NTU and rainy season 78.59NTU), variable in quantity and quality during these two seasons, with high and out of range levels observed in the irrigation water. These levels can only be explained by intense emissions from the various discharges into the untreated watercourses located in the study area. This shows the direct impact of chemical pollution discharged into the rice fields on the physico-chemical and metallic quality of the water and then the soil. Then, conversely, the soil of the rice fields (SRi) of our study site shows an efficient purifying power, but according to the respective seasons according to the measurement of the water at the entrance and exit of these rice fields, where during the dry season 2015, the increasing purifying order for the elimination of the different parameters is as follows: COD (24.85%) BOD5 (25.84%) EC (27.98%) NO3- (38.333%) Turbidity (44.11%) Cr (45.31%) TSS (66.44%); and during the wet season 2016, this order is: BOD5 (6.47%) COD (8.54%) EC (19.02%) NO3- (38.02%) Turbidity (40.57%) TSS (58.13%) Cr (73.53%). However, some forms of these parameters are poorly retained by the soil and are easily leached to the groundwater. Thus, it can be seen that the efficiency of soil purification depends on the element in question and the volume of irrigation.

GLYCATED HEMOGLOBIN A1C: IMMUNOTURBIDIMETRY AND IMMUNOFLUORESCENCE METHODS

Objective: to compare the two immunological methods of HbA1c determination available at the two university hospital centers in the capital of Madagascar. Methods:Prospective comparative study between two HbA1C assay techniquesat the University Hospital Center Joseph RavoahangyAndrianavalona and University Hospital Center Joseph RasetaBefelatanana both localized at Antananarivo Madagascar was conducted. The two techniques used are immunoturbidimetry and immunofluorescence. Fifty samples were run simultaneously on both techniques to assess the dispersion and correlation of HbA1C values. A history of haemoglobin abnormalities is previously researched in the medical records for the samples. Results:The correlation coefficient for the 2 techniques is 0.97. The Bland –Altman plot shows a funnel-shaped appearance. The Interclass Correlation Coefficient is 0.851 CI [-0.036 - 0.962]. No hemoglobin abnormalities were documented in any of the 50 samples Conclusion: It is essential to keep the same technique for monitoring HbA1c. Our study shows poor reproducibility for the two techniques compared. A strong relationship between the technique used and the HbA1c value was found for the extreme values. It is important to specify the technique used to support prescribers.

QUALITY CONTROL MANAGEMENT ISSUES OF ROUTINE COAGULATION TEST IN A LOW-INCOME COUNTRY (MADAGASCAR)

Introduction: Reliability of biological assays results depends closely on the quality of the 3 biological stages: pre-analytical, analytical, and post-analytical. In each stage, a quality program including internal quality control (IQC) and external quality assurance (EQA) has to be assessed to ensure test result accuracy and precision. The coagulation laboratory plays an important role in the diagnosis and treatment of people with blood disorders, so though several lack of facilities in Malagasy labs, QC has to be implemented. Thus, this study aimed to analyze IQC and EQA in hemostasis tests in the Hematology laboratory of the CHU-HJRA in Antananarivo Madagascar in order to improve its analytical phases quality. Methods: This retrospective descriptive and analytical study was conducted from January 1st, to October 31st, 2021 in the Hematology laboratory of CHU-JRA within the routine coagulation tests (Prothrombin time PT and Activated partial prothrombin time aPTT). Regarding the EQA, percentage of deviation from the peer groups results were calculated. Then in order to analyze IQCs results, coefficient of variation and biases of IQCs results, corresponding respectively to precision and accuracy, were calculated and Levey-Jennings graphs were analyzed. Results: Regarding global results of EQA, 50% were within consensus compared to peer-group. And regarding IQC, for precision, one coefficient of variation for both PT and aPTT exceeded 5%, and for accuracy, no bias exceeds 10% deviation from the expected result. Levey-Jenningss plot showed more than 90% of the results to be within M±2 SD range. A violation 10x Westgard rules, corresponding to a systematic error was observed. Conclusion: Each out-of-control results has to be analyzed as part of strengthening quality program guaranteeing coagulation tests reliability.

Troponin level in SARS-CoV-2 patients in a biochemistry lab in Antananarivo Madagascar

Objective: To describe the epidemiological and biological profile and the cardiac troponin level of patients infected with SARS-CoV-2 who underwent troponinemia testing. Methods: Retrospective descriptive and analytical study during a period of 5 months in which were included all patients with COVID-19, hospitalized at the Joseph Ravoahangy Andrianavalona University Hospital (CHU-JRA) in Antananarivo Madagascar and having performed a high sensitive cardiac troponin (hs-cTn) determination at the Biochemistry Laboratory of the same Hospital. . Study parameters were demographics, reasons for admission, medical history, oxygen saturation and patient outcome and paraclinical parameters were troponin level, chest CT image. Results: Among the 103 cases collected, 46.6% had an elevated hs-cTn level and mostly patients aged 71 to 80 years. Of the 43 patients who died, 60.5% were men. Most had cardiovascular risk factors, oxygen desaturation and critical parenchymal damage on chest CT. There was a significant difference between hs-cTn positivity and female gender and that therapeutic management was corrected after the troponin result. Among the deceased patients, 28 (65,11%) have high troponin levels. Conclusion: Troponin testing is important in patients with COVID-19 to detect the risk of mortality due to cardiovascular complications.

Quality of life in children with atopic dermatitis seen in the department of dermatology at the university hospital, Antananarivo Madagascar

Quality of life in children with atopic dermatitis seen in the department of dermatology at the university hospital, Antananarivo Madagascar

Contamination by NOx type Pollutants in the Leach Ate from the Andralanitra Garbage Dump (Antananarivo Madagascar)

The study concerns the analysis of physic-chemical parameters in order to establish the state of pollution of a garbage dump site. The interpretation of the data is done by standardized principal component analysis. Thus, leachate samples were taken at 9 study stations in wet and dry periods. The results show that among the parameters studied, there is a high content of BOD5 (592,035 mg/L), EC (16,786 mS/cm) and COD (1373,684 mg/L). The concentration level of nitrates and nitrites greatly exceeds the norm; for the old landfill, the NO2- contents vary from 191,527 mg/L to 875,206 mg/L and the NO3- ranging from 384,926 mg/L to 1584,021 mg/L, we thus observe the influence of humidity on the concentrations of physic-chemical parameters. Furthermore, the chemical composition and mass concentrations of pollutants at the sites are highly dependent on the nature of the waste and the degree of pollution differs from one site to another. The considerable increase in the content of these pollutants is favored by bacterial activities during the transformation of the organic matter present in the leachate. However, the importance of the degree of contamination of the landfill favoring the pollution of the receiving environment is confirmed.

Comparison of Bis-Plus-D and API 20 Strep for the Identification of Streptococci in the Laboratory of the University Hospital of Befelatanana Antananarivo Madagascar

Background: In medical analysis laboratories, techniques for identifying bacteria are currently becoming more and more numerous. The objective of this study is to compare the Bis-Plus-D and the API 20 Strep for the identification of streptococci

Comparison of Bis NEG-D and API 20E for the Identification of Gram-negative Bacilli in the Laboratory of the University Hospital of Befelatanana Antananarivo Madagascar

In medical analysis laboratories, techniques for identifying bacteria are currently becoming more and more numerous. The objective of this study is to compare the 2 bacterial identification systems Bis NEG-D and Api 20E for the identification of gram-negative bacilli. This is a qualitative evaluation of the Bis NEG-D compared to the gold standard Api 20E. During the study period, 32 Gram-negative bacilli isolates were identified simultaneously using Api 20E and Bis NEG-D. The samples are represented by 12 (37.5%) blood samples for blood culture, 12 (37.5%) urine samples for cytobacteriological examination of the urine, 06 (18.8%) pus samples for bacteriological examination of pus, a sample of the cerebrospinal fluid (3.1%) and a vaginal sample (3.1%).The bacteria identified were represented by Enterobacter spp, Escherichia col,i Klebsiella pneumonia, Shigella spp, Salmonella typhi, Acinetobacter baumannii, Pseudomonas spp, Proteus mirabilis, Raoultella ornithinolytica and Bukholderia cepacia. This study showed a concordance of 90.6% (29/32) and a discordance of 9.4% (3/32) between the results of Api 20E and Bis NEG-D. Concerning the probability scores, they vary between 95% to 100% for Api 20E and between 79.3% to 100% for Bis NEG-D. This study also compared the pros and cons of using Api 20 E and Bis NEG-D. The Bis-NEG-D is valid and can be used by medical analysis laboratories like the Api 20E, especially if these laboratories do not need to perform a lot of bacterial identification tests.

Place of Middle Meatotomy in the Management of Rhinologic Chronic Sinusitis

Introduction: Middle meatotomy is an effective surgical technique in the management of chronic sinusitis rebels to medical treatment. It is an optimal therapeutic option in the face of a chronic sinusitis particularly of rhinological origin.
 Patients and method: It is a descriptive retrospective study over an 11-year period from January 2009 to December 2019 at the service of Otolaryngology and Cervico-facial surgery (ORL-CCF) at the Andohatapenaka University Hospital Antananarivo Madagascar. Our study includes subjects who have benefited from an average meatotomy on chronic sinusitis.
 Results: We collected 320 patients of average age of 33.78 years. Repetitive maxillary sinusitis and rhinogenic allergies are the determinants of chronic sinusitis. Nasal obstruction was the constant functional sign and anterior rhinoscopy revealed a red nasal mucosa with enlarged inferior turbinate. All of our patients received an incidence X-ray of Blondeau. The average meatotomy was achieved in all our patients and among them, a proportion of 12.50% of the cases operated at the same time of a medium meatotomy and opening of other meatus. Complementary turbinal surgery was used in 25% of cases.
 Therapeutic efficacy was assessed subjectively by the subject’s functional signs. Favourable trends were reported in 75.30% of cases.
 Conclusion: Chronic sinusitis is a naso-sinus condition requiring medical-surgical management. The middle meatotomy is the first step in the surgical management of chronic rhinological sinusitis rebellious to medical means.

Antibiotic resistance of bacteria responsible for lower respiratory tract infections seen in the University Hospital of Befelatanana Antananarivo Madagascar

The majority of bacteria responsible for Lower Respiratory Tract Infections (LRTIs) are multiresistant to antibiotics. The objectives of this study are to describe the antibiotic resistance of these bacteria in LRTIs and to describe the factors associated with these infections. It is a prospective study of 54 respiratory samples of patients with LRTIs for a period of six months from July 2019 to December 2019 in the laboratory of the University Hospital of Befelatanana Antananarivo. The microbiological results showed 12 (22%) isolates of nonfermenting gram-negative bacilli, 10 (19%) isolates of streptococci and 6 (11%) isolates of enterobacteria. Regarding the isolates of nonfermenting gram-negative bacilli, the antibiotic resistance, varies from 42% (amikacin) to 100% (cotrimoxazole). Concerning the isolates of streptococci, it varies from 0% (vancomycin) to 80% (penicillin G). And the antibiotic resistance of the isolates of enterobacteria varies from 0% (imipenem and amikacin) to 100% (amoxicillin). Concerning the associated factors, subjects aged 40 and over (58.6%) (p = 0.84; NS), men (71.4%) (p = 0.01) and subjects hospitalized in intensive care units (70.3%) (p = 0.004) are the most affected by LRTIs. In brief, the knowledge of antibiotic resistance of bacteria responsible for LRTIs allows better patient management.

Clinical Profile and Management of Patient with Amyotrophic Lateral Sclerosis in Neurology Unit Antananarivo Madagascar

Clinical Profile and Management of Patient with Amyotrophic Lateral Sclerosis in Neurology Unit Antananarivo Madagascar

Factors of Non-adherence to Antidiabetic Drugs in Type 2 Diabetics, Antananarivo Madagascar

<i>Introduction</i>: The non-adherence to therapy of diabetics is grafted with heavy morbidity and mortality. Our study aims to determine the factors of non-adherence with antidiabetic drugs in type 2 diabetics. <i>Methods</i>: This was a descriptive and analytical cross-sectional study, carried out in the Endocrinology Unit of the Joseph Raseta University Hospital Center. Befelatanana, Antananarivo, over a period of 7 months. Adherence to treatment was assessed by the Morisky scale. <i>Results</i>: We retained 104 patients with an average age of 58.36 years, consisting of 52.88% of women. Adherence was high, medium, and low in 6.73%, 31.73% and 61.54% of cases, respectively. From their attending physician, explanations of the diabetic disease and their treatment were received by 90.38% and 66.35% of patients, respectively. However, these patients were aware of their disease and treatment in 18.27% and 41.35% of cases, respectively. The most observed non-adherence factors were the absence of an appointment given by the physician (30.77%), the feeling of well-being (24.04%), the lack of money (21.15%), forgetting (20.19%) and advice from a traditional practitioner (16.35%). Only the doctor's explanation for diabetes treatment was significantly associated with medication nonadherence (p=0.0310). <i>Conclusion</i>: Continuing medical education for physician is essential so that they can strengthen therapeutic education and follow-up for their diabetics.

University Preventive Medicine: The Case of Ankatso University Housing Estates in Antananarivo Madagascar

Background: In Madagascar, few studies have been carried out on the health needs of students and university preventive medicine which have an important role in the conduct of studies. This study consists in determining the activities of university preventive medicine in Ankatso Antananarivo and the factors linked to this service allowing students to have a better living condition. Methods: This is a retrospective, cross-sectional and descriptive study, representative of students residing in Ankatso university housing estates. Results: A total of 101 students were interviewed. Among them, only 56.4% knew of the existence of university preventive medicine with female predominance. Among those who knew of the existence of preventive medicine, 48.50% knew of its activities. The frequency of illness has been rare in almost all university housing estates. The main health problems declared by the students were fatigue (89.1%), headache (78.2%), digestive pain (62.4%) and depression (51.5%). The majority of the students had not commented on preventive medicine. Nevertheless 42.9% and 16.7% of the students coming from Ambolokandrina and Ambatomaro noticed respectively a lack of information and an insufficiency of the preventive medicine service of Ankatso. Conclusion: Students require good care in the event of illness, information about preventive medicine and the availability of this service in all university campuses.

THE SYSTEM OF COOPERATION OF ACTORS IN OPEN AND DISTANCE LEARNING

The purpose of this article is to show the mechanism of cooperation at the level of teaching staff, students and administrative and technical staff as the three main actors in open and/or distance learning (ODL). The participatory observation approach carried out within the ODL organization in management sciences at the University of Antananarivo (Madagascar) has made it possible to bring out the result of the configuration of community - organic cooperation based on social identification and solidarity. The ODL platform constitutes a fundamental mechanism for ensuring the functioning of cooperation between stakeholders.

Epidemiology and associated factors of atopic dermatitis in Malagasy children

BackgroundLittle is known about the epidemiology and associated factors of childhood AD in the markedly different, low-income, tropical environment like Madagascar.MethodsWe aim to assess the epidemiology and associated factors of AD in individuals fewer than 15 years of age in Antananarivo Madagascar. It was a retrospective and descriptive study over a period of 7 years (2010 to 2016) in children 6 months to 14 years in the Department of Dermatology, Joseph Raseta Befelatanana Antananarivo Madagascar. The diagnosis of AD was based on clinical data.ResultsThe prevalence of AD was 5.6% in children aged 6 months to 14 years. The details of 151 cases of atopic dermatitis were analyzed. The mean age of patients was 4 years. There was a female preponderance (sex ratio: 0.7). A family history of AD was noted in 56 cases (37%). No association between breast-feeding and AD was found. The age of onset of AD was before the age of 3 months in 7.5% and between 6 months to 5 years in 70%. Children born in March (dry season) had the highest risk of AD. Consultations for AD increased during the winter (from July to October; p = 0.005). However, the prevalence of AD was similar in urban and rural areas.ConclusionWeather may have an impact on the prevalence of atopic dermatitis in Madagascar. No significant correlation was found between the duration of breastfeeding and AD, as well as urbanization.

Gestational Trophoblastic Neoplasia: Clinical and Therapeutic Profile in Madagascar

Gestational trophoblastic disease (GTD) develops from abnormal cellular proliferation of trophoblasts following fertilization. This includes complete and partial hydatidiform mole (HM) and gestational trophoblastic neoplasia (GTN). The aim of this study was to report the epidemiological, clinical and therapeutic profile of gestational trophoblastic neoplasia (GTN) over period of ten years in the department of Oncology Radiotherapy at the University Hospital Joseph Ravoahangy Andrianavalona (HJRA) Antananarivo Madagascar. Medical records of women diagnosed with GTD in the department of Oncology Radiotherapy at HJRA from January 1st, 2007 to September 2017 were retrospectively reviewed. Only patients with the FIGO diagnosis GTN were included, while those with the histological diagnosis of hydatidiform mole (HM), also sometimes classified as GTD, were not included in this study. Also excluded were all cases with incomplete or missing data. Twenty four patients were included. Median age of patients at the time of diagnosis was 37 years (range 18 - 60). Most patients developed GTN following molar pregnancy (75%), had disease duration from antecedent pregnancy of less than 6 months (58.20%), and had the pre-treatment hCG level more than 10,000 IU/L (58.27%). At diagnosis, 14 patients (58.33%) had localized disease (M0). Most common metastatic sites at initial diagnosis were the liver and brain (20.83%). After a median follow-up from initial diagnosis of six months (range 1 - 24), 58.33% were lost to follow up. This represented an increase in the percentage of patients lost to follow up prior to completion of therapy, when compared with our previous results for an earlier time period. GTN in Malagasy woman displays an aggressive clinic profile. Finding ways to increase treatment compliance provides the best way to minimize recurrences of this potentially deadly disease.

Clinical course of myasthenia gravis at the department of neurology in Antananarivo Madagascar

Introductionla myasthénie auto-immune est une maladie rare, agissant au niveau de la jonction neuromusculaire. Elle peut engager le pronostic vital surtout lors d´une atteinte respiratoire. La rémission complète est possible sous traitement. Nos objectifs étaient de décrire l'évolution clinique sous traitement de nos patients myasthénique pour améliorer ultérieurement notre prise en charge et pour obtenir une première base de données malgaches.Méthodesune étude rétrospective descriptive fut menée au sein du Service de Neurologie de l´Hôpital Universitaire Befelatanana entre janvier 2010 et décembre 2017, incluant tout patient diagnostiqué comme myasthénie auto-immune après un test à la prostigmine positif.Résultatsvingt-cinq patients (0,42%) sur 5814 hospitalisés étaient inclus. Seule l´évolution de 16 patients était connue (64%) dont 14 étaient sous traitement médical et 3 d´entre eux avaient une thymectomie. La durée moyenne de suivi était de 24 mois. Parmi les patients traités, 8 s´étaient améliorés, 2 étaient décédés. Chez les patients thymectomisés, 2 s´étaient améliorés, 1 était décédé.Conclusionla myasthénie reste une pathologie rare, grave, mais l´amélioration sous traitement est possible même en absence d´un plateau technique adéquat pour sa prise en charge à Madagascar. En ce moment, un projet avec l´association des patients myasthéniques à Madagascar est en cours pour pouvoir bénéficier des appareils respiratoires utiles surtout lors des crises myasthéniques.

EPIDEMIO-CLINICAL PROFILE OF CERVICAL SPINE TRAUMA AT CHU-JRA MADAGASCAR

The cervical spine trauma is a frequent and serious lesion involving not only the vital prognostic but also functional. The target of this work was to determinate the epidemiological clinical profile and the issue related to the management of cervical spine traumatism in Madagascar. It was the 3 years retrospective works with 41 cases of the cervical spine trauma hospitalized and supported in a department of neurosurgery and resuscitation at CHU-JRA Antananarivo Madagascar. We included all patients’ records for traumatized cervical spine and incomplete files have been excluded. While the targeted period, 41 cases of the cervical spine trauma has been studied, 24, 39% of traumatized was between 21-30 years old with a clear male predominance of 80, 48% (sex ratio 4, 1). The etiology is dominated by a fall and the majority was of domestic accident (46,34%). The cervical wounded was part of polytrauma, 58, 53 % of the case are brain injury. Clinically, 39, 02% of the patients were tetraplegic and the standard radiograph represented the requested radiological tool in 82.92%. The mortality rate was 21, 95%. The cervical spine trauma remains pathology difficult to manage because of the respiratory risk which requires a managing in reanimation and the prognostic vital is reserved for complete quadriplegics.

THE THORACIC AND LUMBAR SPINE INJURIES SEEN AT CHU-HJRA MADAGASCAR

Thoracolumbar spine injury is a frequent and serious lesion with functional prognosis. The objective of this study was to determine the epidemiological-clinical profile and the therapeutic aspects of thoracic and lumbar spine injuries in Madagascar. This was a retrospective, single centered 3-years study of 98 cases of thoracic and/or lumbar spine trauma hospitalized and managed in the neurosurgery department at Joseph Ravoahangy Andrianavalona Antananarivo Madagascar University Hospital center. During the targeted period, 98 trauma cases were studied, of which 24.39% of the traumatized were between 21 and 30 years old with a clear male predominance of 80.48% (sex ratio 4.1). Etiology is dominated by a drop in 36.72% of cases. It was part of a polytrauma that included head trauma in 58.53%. Clinically, 39.02% of the patients were tetraplegic and the standard radiograph represented the requested radiological tool in 82.92%. The mortality rate was 21.95%. Thoracic and lumbar spine injuries are serious and several Frankel A type neurological deficits are usually irreversible despite rapid management