Cause Of Consultation Research Articles

Study about the Manchester Triage System subtriage in patients that visited the Emergency Department due to headache

IntroductionHeadache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of undertriage in patients attending the emergency department due to headache. Material and methodsWe studied a series of consecutive patients who came to the emergency department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. ResultsWe registered a total of 1120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, 2 patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and 5 as not urgent (2%). The percentage of patients undertriaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. ConclusionDuring the study period, at least one in 10 patients attending the emergency department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS undertriaged most patients with warning signs suggesting a potential emergency.

Knee pain in adults

Musculoskeletal complaints account for approximately 25% of consultations in general practice, with the knee being the second most common cause for consultation after the lumbosacral spine. A robust system for evaluation of knee pain in GP consultations is important for diagnostic and management strategies. The time limitations in primary care mean that a focused history and examination is appropriate. This article will take the form of a consultation, beginning with important points to be covered in history taking, discussing examination techniques and findings before considering diagnostic and management strategies.

Spectrum of Skin Changes in the Elderly Population at a Rural Tertiary Care Hospital in Northern India: A Cross-Sectional Study

Introduction: Ageing is a complex, natural process. Due to structural and physiological changes that occur as a consequence of intrinsic and extrinsic aging, the elderly population is highly susceptible to dermatological disorders. These changes are associated with significant morbidity and stress. Hence, it is important to have a better understanding of the dermatological needs of elderly patients. Aim: The aim of this study was to investigate the pattern and frequency of geriatric dermatoses in patients attending the Skin Outpatient Department (OPD) at a tertiary care centre. Materials and Methods: This cross-sectional observational study was conducted at the Department of Dermatology, Venereology, and Leprosy at BPS Government Medical College for Women, Khanpur Kalan (Sonepat), Haryana, India, from September 2022 to February 2023. A total of 300 patients aged 60 years and above, of either sex, who consented to participate were enrolled. Detailed history taking and dermatological examinations were performed, and relevant investigations were carried out. Data was collected, entered into a Microsoft Excel sheet, and analysed for frequency, percentage, and mean of variables. Results: Out of the total 300 patients, 155 (51.66%) were males and 145 (48.33%) were females. The majority of patients belonged to the age group of 60-69 years (n=171, 57%). Wrinkling (n=287, 95.66%) was the most common physiological skin finding, followed by dry skin (n=157, 52.33%). Among pathological dermatoses, infectious dermatoses were present in (n=134, 44.66%) patients, followed by eczemas (n=92, 30.66%). Papulosquamous disorders were seen in (n=17, 5.66%) patients. Hypertension was the most common systemic illness present in (n=53, 17.66%) patients. Conclusion: Physiological and pathological skin changes in the elderly are a common cause of consultation in dermatology OPD. Physiological changes were seen in all patients. Among pathological changes, infections were the leading dermatoses, followed by eczemas and papulosquamous disorders.

Evaluation of Cardiology Consultation Quality and Quantity Requested from Emergency Departments in Turkey

Introduction: Emergency cardiac consultation is a very big part of cardiology practice and there is not any trial evaluating this subject qualitatively and quantitatively with different perspectives yet. We wanted to investigate this process in terms of correlation between emergency physicians and cardiologists. Methods: Patients who are consulted in a cross-sectional and prospectively 5 different public hospitals were included in the study. In order to examine the nature and intensity of the cardiology consultations and also the diagnostic compatibility, electrocardiography (ECG) and to investigate the adequacy of the first medical treatment were chi-square and correlation analyzes. A P value <0.05 was accepted as a statistical significance limit. Results: Totally 627 patients (502 patients by practitioners and 125 patients by emergency medicine specialists) were consulted to cardiology. The most common admission cause was chest pain (%47.8), and the most common cause of consultation was having no/weak idea about patient’s clinical diagnosis (%39.9). The diagnosis consistency of 48% of consulted patients by EMS was excellent while it was 32.1% in practitioners (p=0.001). Good and excellent ECG interpretation of EMS was 72.8% and it was 50.7% in practitioners (p<0.001). Good and excellent first medical treatment were 46.4% in EMS while it was 38,4 in practitioners (p=0.05). Nearly half of consultations (48.8%) were considered as definitely unnecessary or unnecessary by cardiologists. There was statistically significant correlation between the necessity of consultation and last decision (r=0.811, p<0.001). Conclusion: There is a big variability in emergency cardiac consultations from the standpoint of consultation necessity, ECG interpretation, first medical management quality and accurate diagnosis.

Ethnobotanical study of plants used by traditional healers in Lubumbashi (Democratic Republic of Congo) in the management of typhoid fever

No documented study reports the ethnobotanical knowledge of the medicinal plants involved in the management of typhoid fever in Lubumbashi. This study aims to identify plants and recipes used by traditional medicine practitioners (TMPs) in Lubumbashi to manage typhoid fever. The cross-sectional descriptive survey was carried out on TMPs through a direct interview, making it possible to collect ethnobotanical data. Fifty TMPs consulted (sex ratio M / F = 2.5, age = 45 ± 11 years, experience: 20 ± 13 years) made it possible to list 57 plants. These taxa are mostly shrubs (52%), Microphanerophytes (52%), endemic to tropical Africa (32%), belonging to 28 botanical families dominated by Fabaceae and indicated in 47 other causes of consultation for which diarrhea comes first position. From these 57 plants derived, 67 anti-typhoid recipes were administered orally. The stem bark was the most used part (33%), and the decoction (72%) was the most common preparation method. This study reports for the first time the ethnobotanical anti-typhoidal use of 25 species, among which Ficus sur Forssk. (0.22), and Monotes katangensis DeWild (0.18) has the highest consensus indexes (CI) and Diplorhynchus condylocarpon (Müll.Arg.) Pichona (UVp = 0.19) followed by Albizia antunesiana Harmsa (0.17), the highest usual values ​​(UVp). TMPs use several plants in Lubumbashi to treat typhoid fever. Some are specific to the ecological environment, and others are used in other regions of the continent. Pharmacological studies are underway to assess the therapeutic efficacy of lesser-known plants among those listed.

Management of febrile illness in rural Guinea over a seven-year period: A retrospective study.

Febrile illnesses constitute a major clinical challenge in tropical settings. We aimed to assess the frequency, presentation and management of febrile illness at two health facilities in Forécariah, Guinea, with a focus on appropriateness of antibiotic prescription. This was a retrospective study conducted in patient files in a health center and a district hospital. Proportions of antibiotic prescription were determined by age group and syndromes as well as appropriateness of antibiotic prescription using the WHO model list (2019). From 2014 to 2020, 23,583 of 62,185 (38.0%) visits were related to febrile illness. Most patients with fever were female (56.1%) and evaluated at the health center (81.0%). Gastrointestinal (40.6%) and respiratory syndromes (36.8%), and undifferentiated fever (30.0%) were the most common presentations. Malaria was confirmed in 61.3% of the cohort. Overall, the rate of antibiotic prescription was high (14,834/23,583, 62.9%), mostly among patients aged <5 years (5,285/7,566, 69.9%), those with respiratory (7,577/8,684, 87.3%) and gastrointestinal (6,324/9,585, 66.0%) syndromes. Moreover, 7,432/14,465 (51.4%) patients with malaria were also prescribed an antibiotic. Penicillin (42.0%), cotrimoxazole (26.3%) and quinolones (18.7%) were the most frequently prescribed antibiotics. Overall, appropriateness of antibiotic prescription was low (38.3%), and even more so in patients with respiratory (29.1%) and gastrointestinal (25.8%) syndromes. Febrile illness is a major cause of consultation in rural Guinea. Rate of antibiotic prescription was high, even in confirmed malaria and was often considered inappropriate. There is a pressing need to investigate the etiological spectrum and improve the diagnostic approach of febrile illness in Guinea.

Haemoglobin and white blood cells (WBC) as key haematological indicators of malaria infection in a population in Côte d'Ivoire

Malaria is the main cause of consultation and hospitalisation in health centres and the leading cause of morbidity and mortality in Côte d'Ivoire. To reduce malaria-related deaths, rapid diagnosis and treatment strategies should be adopted. The aim of this study was to determine the relationship between parasite density and selected haematological parameters in infected patients in cities located in southern Côte d'Ivoire. Blood samples were collected in Jacqueville and Tiassalé. The different haematological parameters were identified by an automated haematological analyser. The coefficient of determination (R2) was determined to show the proportion of variation in parasite density and each haematological parameter. A total of 69 patients were sampled. A negative correlation was observed between parasite density and haemoglobin in the general population, in Jacqueville and in Tiassalé. However, this correlation is significant in the general population (p1 = 0.046; Confidence Interval (CI= [-0.0047; -0.00010]) with a correlation intensity (r) different from zero (p2 = 0.05) and in Jacqueville (p1 = 0. 041; CI= [-0.0025; -0.00012]) with a correlation intensity (r) different from zero (p2 = 0.04). In Tiassalé the correlation was not significant. Haemoglobin and WBC can be considered as key haematological indicators of malaria infection in the study population.

248.8: Mycobacterium tuberculosis Colitis and Cytomegalovirus in A Renal Transplant Recipient: An Infrequent Association

Introduction: Chronic diarrhea, infectious or inflammatory, is a frequent cause of consultation in transplant recipients. Immunosuppressants are the most common reason, but microorganisms like cytomegalovirus (CMV), clostridium difficile, campylobacter, are often reported. Tuberculosis can occur, but it has a low prevalence, described between 0.3 and 1.7%. Method: We described a 32-year woman with a history of membranoproliferative glomerulonephritis, recipient of a deceased-donor kidney transplant 12 years ago. She received basiliximab and steroids as induction therapy and maintenance with tacrolimus, mycophenolate and deflazacort. She consulted with a 7-day history of liquid diarrhea, no blood, nor mucus with abdominal pain, nausea, and fever up to 39°C. She manifested a 10kg loss of weight in a 6 month-period with no other symptoms. Upon admission, she had tachycardia, mild abdominal pain in left flank. Blood workup showed normal leukocytes and platelets, absolute lymphocyte count of 0.8x103/ L, hemoglobin 8.9g/dL, creatinine 1.51mg/dL, high C-reactive protein, and low level of albumin. Low iron, TSAT and high ferritin level. Normal folic acid and vitamin B12. Coproscopic showed blood, no leukocytes. Blood cultures, molecular panel identification of multiple gastroenterology pathogens (filmarrayTM), VIH, viral load with transcriptase-polymerase-chain-reaction (PCR) in blood for CMV were negative. Chest radiography was normal. Contrast abdominal tomography showed thickening and enhacement of the walls of the cecum, hepatic flexure, ileocecal valve and distal ileum. In ascending colon, a 4cm decreased of the lumen was seeing. Multiple round nodes smaller than 10mm after contrast were observed. Total colonoscopy showed colitis in transverse and left colon with 80% stenosis of the lumen. Biopsy documented active chronic colitis with a marked ulcerative component. No microorganisms, dysplasia or malignancy were observed. Real time-PCR was processed for CMV in colonic tissue and PCR for mycobacterium tuberculosis (MT) both reported positive. Co-infection with intestinal CMV and MT was diagnosed. She was treated with valganciclovir for 4 weeks and tetraconjugate with isoniazid(H), rifampicin(R), pyrazinamide(Z), ethambutol(E) and pyridoxine. During treatment, presented elevated transaminases and uric acid attributed to hepatotoxicity for H. It was switched to moxifloxacin with improved in hepatic profile. Moxifloxacin, R and Z were continued for 9 months. The patient had resolution of the diarrhea, recovery of weight, anemia and renal function. Conclusion: CMV is a common etiological agent in kidney transplant recipients with diarrhea, co-infection with other microorganisms, such as, MT can worsen the clinical course and without treatment can lead to death. Having a high index of suspicion is essential. A rigorous diagnostic approach is necessary and performing PCR on tissue can contribute to allow early diagnosis and timely treatment.

Joint pathology in musculoskeletal lumbar pain: a dialogue between a neurologist and a rheumatologist

Skeletal-muscular (nonspecific) lumbar pain (lumbodynia), often with spread to the leg (lumboishialgia), is one of the most common causes of consultations with a physician and temporary disability in the population. In many cases, the development of pain is associated with lesions of the lumbar facet joints (LFJ) and sacroiliac joint (SI). What are the causes, clinical features, and diagnosis of lumbar pain caused by lesions of the LFJ and SI? What should be the medical tactics for lumbar pain caused by LFJ and SI lesions? What is the actual practice of treating such patients? Leading experts discuss the problem of managing patients with lumbar musculoskeletal pain:Parfenov Vladimir Anatolievich – Dr. Sci. (Med.), Professor, Neurologist, Head of the Department of Nervous Diseases and Neurosurgery, Sklifosovskiy Institute of Clinical Medicine? First Moscow State Medical University (Sechenov University)Karateev Andrey Evgenyevich – Dr. Sci. (Med.), Head of the Laboratory of Pathophysiology of Pain and Clinical Polymorphism of Musculoskeletal Diseases Nasonova Research Institute of Rheumatology.

Mechatronic Design of a Prototype Orthosis to Support Elbow Joint Rehabilitation

Injuries in the elbow area, such as lateral and medial epicondylitis, are the leading causes of consultation with health specialists. Therefore, this research proposes the mechatronic design of an orthosis with a graphic interface that supports professionals in the rehabilitation of the elbow joint through the execution of flexion–extension and pronation–supination movements. For the development of the rehabilitation prototype, mechatronic design, co-design, and IDEF0 methodologies are used, performing activities such as actuator characterization, simulations, and modeling, among others. Through the execution of a case study in a real environment, the device was validated, where the results suggest a functional and workable prototype that supports the treatment of pathologies in the elbow area through the execution of the mentioned movements, supposing that this is a low-cost alternative with elements to improve, such as the industrial design and new functionalities. The developed proposal shows potential as an economical product that health professionals can use. However, some limitations related to the design and functionalities in the application domain were identified.

The Frequency of Primary Healthcare Contacts Preceding the Diagnosis of Lower-Extremity Arterial Disease: Do Women Consult General Practice Differently?

Background. Women with lower-extremity arterial disease (LEAD) are often underdiagnosed, present themselves with more advanced disease at diagnosis, and fare worse than men. Objective. To investigate to what extent potential gender differences exist in the frequency and reasons for general practitioner (GP) consultation six months prior to the diagnosis of LEAD, as potential indicators of diagnostic delay. Methods. Individuals older than 18 years diagnosed with LEAD, sampled from the Julius General Practitioner’s Network (JGPN), were included and compared with a reference population, matched (1:2.6 ratio) in terms of age, sex, and general practice. We applied a zero-inflated negative binomial (ZINB) regression model. Results. The study population comprised 4044 patients with LEAD (43.5% women) and 10,486 subjects in the reference population (46.3% women). In the LEAD cohort, the number of GP contacts was 2.70 (95% CI: 2.42, 3.02) in women and 2.54 (2.29, 2.82) in men. In the reference cohort, 1.77 (95% CI: 1.62, 1.94) in women and 1.63 (95% CI: 1.50, 1.78) in men. In the LEAD cohort, 21.9% of GP contacts occurred one month prior to diagnosis. In both cohorts and both sexes, the most common cause of consultation during the last month before the index date was cardiovascular problems. Conclusions. Six months preceding the initial diagnosis of LEAD, patients visit the GP more often than a similar population without LEAD, regardless of gender. Reported gender differences in the severity of LEAD at diagnosis do not seem to be explained by a delay in presentation to the GP.

Assessment of sexuality among women in Morocco

IntroductionHaving a healthy active sex life is essential to maintain good physical health and offer the possibility of establishing moments of mental well-being. Until now, not many studies have addressed this health aspect in our context, while problems related to intimate relationships remain one of the most frequent causes of consultation in psychiatry.ObjectivesThe objectives of our study are: to assess sexuality among Moroccan women, analyze their sexual behavior with an epidemiological description, determine their sources of information, and identify the potential causes that could lead to lower their libido.MethodsWe conducted a cross-sectional study with around hundreds of women in the general population using the female sexual function index (FSFI), associated with a questionnaire that includes age, place of residence, origin, marital status, number of children, profession, social status, age of first sexual experience, details of different sexual practices, sources of information related to genital life, the means of contraception and the presence of comorbidities.ResultsPreliminary results show a limited understanding of sexuality among women of low socioeconomic status. Women with a high level of education are more fulfilled and this is due to the ease of access to information and care. Depression contributes greatly to lower libido and marital conflict.ConclusionsSexuality remains today one of the most taboo subjects in our country and more among the female population. Hence the need for sex education begins with self-knowledge, understanding of different practices, and psychological support for all women from a young age toward enduring a healthy flourishing sex life.DisclosureNo significant relationships.

Diagnóstico y tratamiento de la anemia ferropénica en la asistencia primaria de España

Background and objective: Iron deficiency anemia is a frequent cause of consultation in routine medical practice. Knowing how it is diagnosed and treated in Primary Care can allow us to detect if there is any area for improvement.Method: Descriptive multicenter survey-type study with 12 questions to find out the aspects of greater variability in the management of iron deficiency anemia. The population under study are physicians from Primary Care Centers nationwide who treat these patients.Results: 732 physicians answered the form. 51.8% consider iron deficiency anemia a serious disease. To make the diagnosis, 80.7% check the ferritin and only 27.2% the transferrin saturation index (IST). 71.6% performed control tests every 3 months. 57.9% prescribe iron only for 3 months. 47% end treatment when Hb normalizes. When the patient is referred, the majority do so to the digestive service, followed by hematology, internal medicine, and gynecology.Conclusions: Despite the fact that almost 52% of those surveyed consider iron deficiency anemia a serious disease and that ferritin is the most useful biochemical determination for its diagnosis, around 20% do not use it. On the other hand, the IST, which can often help distinguish iron-deficiency anemia from inflammatory anemia, is only requested by slightly more than 27%, which can lead to diagnostic errors. On the other hand, on some occasions, the treatment is insufficient since the majority treat the patients for only 3 months and 47% finish the treatment when the Hb normalizes without taking into account the ferritin result. Although the diagnosis and treatment of iron-deficiency anemia in Primary Care has improved, it is likely that many patients would benefit from greater use of ferritin and IST and from longer-lasting treatments.

Therapeutic approach to acute otitis media in primary care in an urban area. Delayed antibiotic prescription evaluation

Background and objectivesAcute otitis media (AOM) is one of the most frequent causes of consultation and antibiotic prescription in pediatrics. The objective of this work is to evaluate the practice of delayed antibiotic prescription in AOM in pediatrics in primary care. Material and methodsObservational, retrospective study, through reviewing of medical records in a Primary Care Center of Aragon Community of children with OMA in which doctors perform delayed prescription. Logistic regression analyzes possibly related to antibiotic prescription factors. Results1390 episodes of AOM are analyzed in 696 patients. Immediate antibiotic prescription is performed in 67.6% (95% CI: 65.1–70.0%) of episodes, exclusive symptomatic in 13.7% (IC 95: 11.9–15.6%), and delayed antibiotic in 18.7% (IC 95: 16.7%–20.8%), finally being given in 53.5% (IC 95: 47.4–59.5%) of these. Factors significantly related to final antimicrobial dispensation in delayed prescription are aged between 0 and 2 years (OR 1.89, 95% CI: 1.25–2.87), bilaterality (OR 2.54, 95% CI: 1.48–4.35), ear pain (OR 0.49, CI 95: 0.29–0.82), fever (OR 2.67, IC 95: 1.95–3.65), bulging (OR 3,63; IC 95: 2,50–5,29) and otorrhea (OR 25.98; IC 95: 12.75–52.92). The same factors have influence on global prescription of antibiotics. Amoxicillin (74.6%) is the most indicated antibiotic, followed by Amoxicillin-Clavulanic (17.0%). ConclusionsDelayed prescription in AOM seems to be useful to reduce antibiotics consumption, being necessary to advance in its implantation.

Development of the Fellowship Program in Musculoskeletal Rehabilitation Medicine at Philippine General Hospital in the University of the Philippines Manila

Musculoskeletal conditions are among the leading causes of consultations in Rehabilitation Medicine. A fellowship program in Musculoskeletal Rehabilitation Medicine was proposed to enrich physiatrists’ knowledge and skills in evaluating and managing musculoskeletal conditions. In this paper, we shared the process of developing the curriculum of the fellowship program, which was proposed to and eventually approved by the Postgraduate Institute of Medicine, College of Medicine, University of the Philippines Manila.&#x0D; A core group of consultants, considered as experienced clinicians and educators in Musculoskeletal Rehabilitation Medicine in the study institution, designed the program from the scope of training to learning competencies, outcomes, and assessment methods.&#x0D; To our knowledge, developing the fellowship program in this constantly evolving area in Rehabilitation Medicine is the first of its kind in the Philippines and a milestone in the history of postgraduate education in the longest-running training program for aspiring physiatrists.

Atypical Positional Vertigo: Definition, Causes, and Mechanisms.

Paroxysmal positional vertigo is a frequent cause for consultation. When approaching these patients, we try to differentiate central from peripheral causes, but sometimes we find manifestations that generate diagnostic doubts. In this review, we address atypical paroxysmal positional vertigo, reviewing the literature on the subject and giving a provisional definition of atypical positional vertigo as well as outlining its causes and pathophysiological mechanisms.

Diagnostic biologique des dermatophytoses

AbstractDermatophytoses are very common causes of consultation in dermatology. The diagnosis of these superficial infections, affecting the skin, nails and hair, is usually not clinically obvious and requires mycological analysis, especially for infections of the scalp and nails. Direct microscopic examination of clinical samples using clearing agents provides a quick response and should be combined with cultures on specific media. Histological analysis, which is considered the gold standard for the diagnosis of onychomycosis, is seldom performed and as direct examination, allows only visualisation of fungal elements without precise identification of the fungi. Accurate identification of the causative agent is necessary to initiate an appropriate treatment but also for setting prophylactic measures. However, conventional methods often lack sensitivity and species identification from cultures may require up to four weeks. Thus, the use of fluorochromes may greatly enhance the sensitivity of direct examination, as the use of culture media containing antifungal deactivators may enhance the sensitivity of cultures. Finally, despite the commercial availability of PCR-based kits, the biological diagnosis of dermatophytosis still relies on standard mycological procedures (direct examination and specific cultures), which remain the most informative and the least expensive procedures.

Migraine and Neuroticism: A Scoping Review.

Headache is the first cause of consultation in neurology, and one of the most frequent reasons for consultation in general medicine. Migraine is one of the most common, prevalent, and socioeconomically impactful disabling primary headache disorders. Neuroticism can be conceptualized as a disposition to suffer anxiety and emotional disorders in general. Neuroticism has been associated with various mental and physical disorders (e.g., chronic pain, depression), including migraine. With the aim to explore in depth the relationship between migraine and neuroticism, and contribute to the understanding of this relation in order to provide a better treatment for migraine patients based on a personalized and more comprehensive approach, a scoping review was performed using PubMed, Scopus, and Web of Science. Databases were searched independently by the two researchers, reaching a final set of 18 articles to be included. The search terms were: migraine and neuroticism. Neuroticism seems to be highly prevalent in migraine patients. Findings reveal that migraine patients with comorbid depression and anxiety showed higher levels of neuroticism. Depression has been associated with an increased risk of transformation from episodic to chronic migraine whereas neuroticism might be a mediator factor. Neuroticism also might be a mediator factor between childhood maltreatment and migraine. The revision conducted confirms that: (1) Migraine patients usually have a higher level of neuroticism and vulnerability to negative affect, compared to non-migraineurs and tension-type headache patients. (2) Neuroticism is associated with migraine. Nonetheless, more research is needed to clarify potential moderators of this relationship and the role of neuroticism itself in this disease. This knowledge might be useful in order to promote a better management of negative emotions as part of intervention programs in migraine.

Management of Severe and Complicated Malaria in Adults in the Emergency Department of the Regional Hospital of Maradi (Niger)

Introduction: In sub-Saharan Africa malaria is the 1st cause of consultation and hospitalization and the 2nd cause of death in health centres. Maradi region is one of the most malaria-endemic areas with periods of high prevalence, particularly during the rainy season, due to the heavy rainfall that occurs between May and October. Methods: This is a descriptive cross-sectional study conducted in the emergency department of the Regional Hospital Centre of Maradi from August 1st to August 31st, 2017. Results: 104 patients were admitted to the adult emergency department for severe malaria out of 305 admissions to the centre, i.e., a prevalence of 34.1%. Our sample was composed of 53.84% men (n=56). The average age of our patients was 38.6 years with extremes ranging from 15 to 90 years. Most of the patients had no comorbidity (80.76% of cases). Thick blood drop was used for diagnosis in 93.25% of cases (n=97). The main clinical manifestations were: neurological forms (34, 61% n=36), severe anemia (31, 73% n=33). Conclusion: This study shows that malaria is a major public health problem in sub-Saharan Africa and particularly in Niger because of its prevalence, severity and morbidity.

Nouveautés dans la prise en charge des céphalées

Headaches are one of the most common causes of consultation in primary care. Due to their polymorphic character and sometimes severe etiologies, it is very important to properly classify these symptoms and to look for possible associated signs of severity. It is with this objective that the international classification of headache delivered its 3rd version in 2018 with the ICHD-3. In addition, revised and validated severity criteria were also published in 2018 under the name SNNOOP10. At the same time, the concept of green flags which could allow to diagnose a primary headache without further investigations has emerged. In terms of treatment, the development of CGRP neuropeptide antagonists has allowed a major advance in the treatment of the severe forms of migraine. Finally, integrative medicine is taking on a central role.