36 research outputs found
Surgical Management of Severe Abdominal Trauma Patients in the Surgical Department of the Toamasina CHU, Madagascar
No full textSevere abdominal trauma represents an absolute surgical emergency. The objective of our study is to report the surgical management of severe abdominal trauma in a low-resource center. This was a 31-month observational study from January 2018 to August 2020. We have 44 cases of severe abdominal trauma. The sex ratio was 4.5. The mean age of patients with severe abdominal trauma was 31.43182 years. A penetrating wound to the abdomen was seen in 68.18%. The circumstance of the trauma was a liability accident in 70.45%. A shortened laparotomy was performed. The mean duration of the operation was 45.63636 minutes. No perioperative death was reported during the performance of the shortened laparotomy. Controlling emergency surgery improves the vital prognosis of polytrauma patients
Comparaison de deux scores pronostiques dans les hémorragies digestives hautes non variqueuses dans un centre hospitalier d’Antananarivo
No full textPerceptions et indicateurs de syndrome de
No full textContexte : Le syndrome d’épuisement professionnel peut toucher tous les professionnels, notamment ceux œuvrant dans les champs sanitaire ou social. Il tend à s’accroître chez les étudiants en médecine. But : Déterminer la survenue, la sévérité du burnout syndrom (BOS) et les perceptions subjectives corrélées au BOS, relatées par des stagiaires en réanimation chirurgicale. Méthode : Il s’agit d’une étude prospective, longitudinale sur l’année universitaire 2013–2014, des étudiants de quatrième et cinquième année de la Faculté de médecine d’Antananarivo (Madagascar). L’évaluation du BOS a été faite à l’aide du questionnaire de Maslach. Les caractéristiques des stages et les opinions des étudiants ont été analysées par des tests de comparaison et de corrélation. Résultats : Soixante-quatorze stagiaires au service de réanimation chirurgicale du centre hospitalo-universitaire Andrianavalona (Antananarivo) ont été évalués. Parmi les fiches d’enquête recueillies, 65 ont été retenues. Le syndrome d’épuisement professionnel était présent à 66,1 % des étudiants, parmi lesquels chez 6,5 % à un degré important. La sévérité du BOS et l’épuisement émotionnel étaient corrélés avec la charge de travail. La dépersonnalisation était sévère pour 35,4 %, inversement liée aux avis positifs sur l’enseignement, l’encadrement des stages. Pour 36,9 %, l’épuisement émotionnel était sévère, corrélé avec des difficultés sur le plan relationnel. Conclusion : Les stages en réanimation chirurgicale demandent une grande implication de tous ceux qui y œuvrent. Assurer de bonnes conditions de travail est essentiel pour limiter la survenue du BOS
Assessment of enteral nutrition through feeding stomas or gastric tubes in digestive surgery
No full textOstomy feeding remains a reference approach for enteral nutritional assistance. In Madagascar, the techniques are still conventional surgical procedures due to the lack of adequate endoscopic equipment. This study aims to evaluate the benefits and risks of enteral nutrition with a two-week follow-up. Included patients who had benefited from enteral nutrition by tube feeding using nasogastric, gastrostomy, and jejunostomy tubes over six months in Joseph Ravoahangy Andrianavalona Hospital. Prevalence, age and gender, current body mass index (BMI), weight, nutritional grade, initial pathology, psychological status, comorbidities, type of feeding stoma, and the surgical technique (gastrostomy or jejunostomy) were studied. After 15 days, the effectiveness of enteral nutrition was assessed using BMI, serum albumin, C-Reactive Protein (CRP) level, as well as postoperative complications and quality of life. The patient's outcome on the 15th day has been determined. The Chi-square test analyzed the associations and Mann Whitney test compared the effects of enteral nutrition by ostomy and gastric tube use. Forty-two patients were included, aged 47(17-78). The sex ratio was 0.5. Initially, the body mass index was 17(12-23) kg/m², the serum albumin value 3.4 (2.5-4.7) gr/dl with a median CRP level of 16 (2-74.2) mg/l. Nutritional assistance resulted in a weight variation between baseline and 15th day. Comparing enteral nutrition by ostomy and gastric tube, only variation of C Reactive Protein on the 15th day has a significative difference. Mortality was 33% (gastrostomy), 31% (jejunostomy), 24% (nasogastric tube). Nutritional support and the choice of ostomy or gastric tube for enteral nutrition were not associated with mortality. The effectiveness of nutritional assistance is still questionable in this study if the results are more promising in the literature. The death rate linked to the initial pathology and the general state of the patients is still considerable, hence the interest in decision-making in multidisciplinary consultation meetings. [Med-Science 2023; 12(1.000): 161-6
IMPACT OF COVID-19 ON PEOPLE LIVING WITH HIV IN MADAGASCAR: A SARS-COV2 SERO-PREVALENCE SURVEY
No full textBackground: In Madagascar, no study has reported the impact of COVID-19 on people living with HIV (PLHIV). The present work aimed to analyze the seroprevalence of SARS-CoV-2 in Malagasy PLHIV before and during the three waves of COVID-19 pandemic.This is a retrospective study.
Materials and Methods: We conducted a retrospective serological survey in PLHIV followed up for HIV viral load (VL) monitoring at the Centre d’Infectiologie Charles Mérieux Madagascar (CICM) between June 2019 and April 2022. The presence of IgM and/or IgG antibodies against SARS-CoV-2 nucleoprotein was detected using a rapid diagnostic test (COVID-PRESTO®).
Results: A seroprevalence of 2.5% was found in the 877 patients tested before March 2020, compared to 25.4% (512/2,011) between March 2020 and April 2022. This seroprevalence was 21.7%, 22.3% and 60.1% after the first, second and third waves of COVID-19, respectively. We observed a marginally significant difference (p = 0.043) in SARS-CoV-2 seroprevalence between patients on highly active antiretroviral therapy (HAART) (27.5%) and those who were not (23.7%). No statistically significant difference was observed between PLHIV with undetectable HIV VL (27.4%) and the different detectable VL categories (p>0.05).
Conclusions: Our data show the presence of antibodies to SARS-CoV-2 among PLHIV as early as December 2019 in Madagascar. At least 25.4% (512/2,011) of Malagasy PLHIV have been in contact with SARS-CoV-2 since March 2020. There is no significant relation between HIV-1 VL and SARS-CoV-2 seroprevalence. Additional studies with more robust assays in the general population are needed for a detailed knowledge of SARS-CoV-2 impact in Madagascar
First results of hormone receptors' status in Malagasy women with invasive breast cancer
No full textInternational audienceINTRODUCTION:Breast cancer is the most common malignancy tumor amongst Malagasy women registered at the pathology unit of the "Institut Pasteur de Madagascar". In Madagascar, there is no laboratory practicing hormone receptors' status on these tumors. Until now no study about hormone receptors' status of Malagasy women with invasive breast cancer was performed. So it will be the first study talking about this topic. The aim of this study was to determine hormone receptors' status in Malagasy women with invasive breast cancer.METHODS:This retrospective and descriptive study was based on patients' medical files from 2009 to 2011. It included all invasive breast cancer diagnosed in Malagasy women at the pathology laboratory located at the "Institut Pasteur de Madagascar", in Antananarivo. Along this period this laboratory has sent paraffin blocks of invasive breast carcinoma in two pathological laboratories in France.RESULTS:We collected 77 cases of invasive breast cancer along this period. The mean age was 48.8 +/- 10.7, ranging from 26 years to 70 years. There were 46.8 % (n = 36) women with progesterone receptor positive (PR+), 53.2 % (n = 41) with progesterone receptor negative (PR-). For the estrogen receptor, 61.0 % (n = 47) were positive and 36.4 % (n = 28) were negative. ER+/PR+ represented 44.2 % (n = 34); ER-/PR- 33.8 % (n = 26); ER +/ PR- 16.8 % (n = 13); ER-/PR+ and ER-/PR- represented respectively 2.6 % (n = 2).CONCLUSION:Patients in our study had more important rate of ER-, PR- and a less important rate of ER+/PR+, PR+. These results suggest that more study related to Hormone Receptor profile should be conducted in Malagasy women with breast cancer
Bilan d’une cure chirurgicale d’aspergillome pulmonaire secondaire a une lesion sequellaire de tuberculose au CHU/JRA
No full textLa prise en charge d’un aspergillome pulmonaire, dans le cas des lésions limitées accessibles, est une des activités courantes en chirurgie thoracique dans les pays endémique à la tuberculose comme Madagascar. Sur une période allant de janvier 2005 en mars 2010, 15 patients, ancien tuberculeux, atteints d’une aspergillome pulmonaire sont traités par une résection segmentaire ou une lobectomie. La circonstance de découverte repose sur la clinique par des tableaux très polymorphes. L’imagerie garde une place importante. L’examen histologique des pièces d’exérèse chirurgicale confirme le diagnostic. Tous les patients ont été opérés de manière élective. Le résultat a été pour l’ensemble des patients jugés satisfaisant. Ces patients sont suivis pendant 1 à 39 mois. L’étude des résultats à distance est encore en cours et est fondamentale si le traitement chirurgical a un effet bénéfique sur la survie et la qualité de vie des malades. Le but de ce travail a été, à partir de la revue de la littérature et de notre petite expérience, de définir quels éléments pertinents mis en exergue sur le sujet.Pan African Medical Journal 2013; 14: 8
Comparing the drivers of medical student emigration intention across two African nations
No full textHigh Seroprevalence of IgG Antibodies to Multiple Arboviruses in People Living with HIV (PLWHIV) in Madagascar
No full textTo estimate the prevalence of IgG antibodies against six arboviruses in people living with HIV-1 (PLWHIV) in Madagascar, we tested samples collected between January 2018 and June 2021. We used a Luminex-based serological assay to detect IgG antibodies against antigens from Dengue virus serotypes 1–4 (DENV1–4), Zika virus (ZIKV), West Nile virus (WNV), Usutu virus (USUV), Chikungunya virus (CHIKV), and O’nyong nyong virus (ONNV). Of the 1036 samples tested, IgG antibody prevalence was highest for ONNV (28.4%), CHIKV (26.7%), WNV-NS1 (27.1%), DENV1 (12.4%), USUV (9.9%), and DENV3 (8.9%). ZIKV (4.9%), DENV2 (4.6%), WNV-D3 (5.1%), and DENV4 (1.4%) were lower. These rates varied by province of origin, with the highest rates observed in Toamasina, on the eastern coast (50.5% and 56.8%, for CHIKV and ONNV, respectively). The seroprevalence increased with age for DENV1 and 3 (p = 0.006 and 0.038, respectively) and WNV DIII (p = 0.041). The prevalence of IgG antibodies against any given arborvirus varied over the year and significantly correlated with rainfalls in the different areas (r = 0.61, p = 0.036). Finally, we found a significant correlation between the seroprevalence of antibodies against CHIKV and ONNV and the HIV-1 RNA plasma viral load. Thus, PLWHIV in Madagascar are highly exposed to various arboviruses. Further studies are needed to explain some of our findings
