bluuebunny/crossref_metadata_2025 huggingface dataset:
Les complications des avortements clandestins vus à l’Hôpital Universitaire de Gynécologie et Obstétrique de Befelatanana, Antananarivo
Authors: Rakotondraisoa JM , Andrianampy HA , Rajaonarison JJC , Randriambelomanana JA
Published: April 2024

Introduction. Interruption of pregnancy is still illegal in our country if realized without medical prescription. Our objectives were to determine epidemiological profile and complications of all patients admitted for abortion at the University Hospital of Obstetrics and Gynecology of Befe- latanana. Materials and methods. We carried out this prospective and descriptive study at the University Hospital of Obstetrics and Gynecology of Befelatanana (Antananarivo, Madagascar) from November 1, 2011 to April 31, 2012. We recruited all patients admitted for complication of abortion in our center. Results. During this period, 78 cases of unsafe abortion are recruited compared with 1741 patients admitted. Women were mainly aged un- der 25 years old 43.59% (n=34), singleton 57% (n= 44) and students 24% (n=19). 80% (n= 63) never used contraceptions methods. Financial disorders were mainly the factor of abortion 31% (n= 24). Methods of abortion consisted in oral misoprostol in 47.77% (n= 37) cases and endouterine gestures 32% (n=25). Hemorrhage (n= 55) and infection (n=23) prevailed in complications. Abortions are realized by unskilled personal in 37% cases (n=29). We noticed 7.69% of maternal deaths (n=6). Conclusion. Illegal abortion is often source of serious complications. Large use of birth control methods and serious legislation of use of misoprostol should reduce these complications.
Epidémiologie du torticolis musculaire congénital vu à l’Hôpital Joseph Ravoahangy Andrianavalona, Antananarivo
Authors: Rakotoarisoa AHN , Rakotovao-Razafindramavo E , Razafindrakoto RMJ , Raholijaona BML , Rakotovao FJ , Razanamparany M
Published: April 2024

Introduction. This study aimed to unearth the epidemiological features of congenital muscular torticollis (CMT). Materials and methods. A retrospective study was conducted on CMT stated on outpatients aged below five years old, at the Unit of Rehabilitation in the University Hospital of Antananarivo (CHUA/HJRA) from 1997 to 2006 (ten years period). Results. Seventy two patients were observed in this study, among 1244 pediatric outpatients. Among all congenital diseases, CMT was the third after club foot and congenital hip dislocation. Girls and infants were predominant. We noticed a highly relative frequency of pseudotumor of sternocleidomastoid muscle. Obstetrical traumatisms, suggested by a history of dystocia, were noticed in 33 cases. Conclusion. CMT is among both the greatest occupations and concerns in neck pathology in children.
GeneXpert MTB/RIF dans un pays à faible revenu: expérience du service de Pneumo-phtisiologie du CHU de Fianarantsoa, Madagascar
Authors: Rakotoson JL , Raherimandimby H , Rajaoarifetra J , Zafimahita A , Rakotoson L , Raharimbohitra L , Raholiarisoa L , Solofomalala GD , Rabarijaona M , Raharimanana R , Ralison A
Published: April 2024

Introduction. Description of GeneXpert MTB/RIF assay role for the management of tuberculosis in low burden country. Materials and methods. Pulmonary and extra pulmonary specimens obtained from possible TB patient were collected and examined both through GeneXpert MTB/RIF assay and directed smear microscopy Ziehl Neelsen staining during 7 months period (from July 2012 to January 2013) for a descriptive and prospective study in a pneumological department of Fianarantsoa university hospital. Results. Were collected 592 specimens including sputum samples in 94.7% (n=561), a pleural fluid samples in 4.05% (n = 24), ascetic fluid samples in 0.5%(n= 3), pus in 0,6 %( n = 4). We were accounted 72 tuberculosis cases. GeneXpert MTB/RIF had identified all the 72 (100%) patients with TB, only 27 (55%) of whom were TB directed smear positive. There was 1 case of Rifampicin resistance. Conclusion. The GeneXpert MTB/RIF assay, a highly sensitive, specific and rapid method for diagnosing TB is an important advance. How- ever, strict technical requirements and high cost are limiting its implementation in low income country.
Sévérité et contrôle de l’hypertension artérielle au cours de la maladie rénale chronique au Cameroun
Authors: Kaze-Folefack F , Nono A , Halle MP , Ashuntantang G
Published: April 2024

Introduction. The association of hypertension with chronic kidney disease increases the morbidity and mortality. The aim of this study was to evaluate severity and control of hypertension among chronic kidney disease patients in Cameroon. Materials and methods. This was a cross sectional study on 97 medical files of patients suffering of hypertension and chronic kidney dis- ease at stages 3 to 5 not undergoing dialysis, in whom the treatment of hypertension was prescribed and followed during 8 weeks in outpa- tient nephrology clinics at Yaoundé general hospital. Results. The mean age of patients was 52.2±13.1 years with sex ratio 2:1. Severe hypertension occurred in 82 patients (84.6%) and 65 pa- tients (67%) had stage 4 to 5 chronic kidney disease. Renin angiotensin aldosterone blockers (89%), diuretics (80%) and calcium channel blockers (72%) were the main antihypertensive drugs. The mean number of antihypertensive drugs was 2.9±1.7 per patient and 70 patients (72.2%) were taking at least three antihypertensive drugs. At the end of the study, only 9 patients (9.3%) reached the target blood pressure value, and systolic and diastolic blood pressure reduction was respectively 36.3 mmHg and 19.4 mmHg. The severity of initial blood pressure value was statistically associated with poor control of blood pressure (p=0.004). Conclusion. Two third of patients at an advanced stage of chronic kidney disease were presenting with severe hypertension requiring the prescription of three antihypertensive drugs leading to poor short term control.
Diminution du taux et des complications liées à une infestation placentaire par Plasmodium falciparum par un traitement préventif intermittent chez les femmes enceintes à Toamasina, Madagascar
Authors: Randriamaromanana ZN , Rakotondraisoa JM , Botolahy ZA , Rakotoarijaona A , Randriambelomanana JA
Published: April 2024

Introduction. Malaria still represents a burden for many areas in the world especially in Madagascar. Pregnant women and children under 5 years-old were the mainly affected. Our aim was to analyze the rate and the different complications of placental infestation in our region. st st Methods. We carried out a prospective study during two years from January 1 , 2009 to December 31 , 2011 at the Department of Obstetrics and Gynecology of the University Hospital of Toamasina. We performed a research of placental infestation of P. falciparum among all women who had delivered. Results. Five hundred forty one pregnant women were included in this study : 256 had received at least one dose of ITP/SP, and 285 never used chemoprophylaxis. There was no statistical significant difference between these two groups. Fetal hypotrophy (4.21% vs 0.78%) and intra uterine fetal death (1.75% vs 0) prevailed in complications. Placental infestation was significantly frequent in case of use of ITP/SP (7.01% vs 0.39%). Fetal complications were significantly associated with placental infestation of P. falciparum (p= 0.00001). Conclusion. Placental infestation of P. falciparum represents the main cause of fetal hypotrophy in malaria endemic areas. Research of pla- cental infestation should be performed in case of fetal hypotrophy.
La territorialisation de la politique de santé : pour une efficacité plus accrue
Authors: Emile E , Rabesalama SSEN
Published: April 2024

Population health problems have a common image in a country. But this common image, seen as a national average, has always presented disparities in each territorial delimitation. Compared to the national average, the incidence rates of disease can spend, ten or twenty or fifty times worse from one area to another. Synthesize actions at a national policy proves so risky in terms of efficiency. So, it is necessary that health goals in national health policy reflect the inclusion of health determinants in different countries of the territories to ensure that the ans- wers are as relevant as possible in terms of strategies. This is one way to increase the efficiency of health policies.
Relation entre complications respiratoires et facteurs prédictifs au cours de la chirurgie bariatrique à l'Hôpital de Dax, France
Authors: Andrianimaro FM , Tohaina D , Mananjo DA , Lambert D , Raveloson NE
Published: April 2024

Objective. To study the relationship between respiratory complications and predictive risk factors for Bariatric Surgery at Hospital Dax. Methods. This is a single-center, prospective study. We included all patients who underwent bariatric surgery including bypass and sleeve. The study involved three steps: preoperative looking for predictive factors, intraoperative and postoperative looking respiratory complications. Results. We included 32 patients with a mean age of 44.22 years and the sex-ratio of 0.28. 6 patients (18.75%) had a difficult intubation and 8 patients (25%) desaturated. 4 patients (12.5%) had an abnormal chest X-ray and they are all smoking. 5 of the 8 patients (62.5%) who have a desaturated present Obstructive Sleep Apnea Syndrome (OSAS). The relationship between body mass index (BMI) and the incidence of desaturation was highly significant (p=0.0015). 50% desaturation are found in carriers of COPD. The 72.22% of respiratory complications are mainly observed in patients classified 3 of the American Society of Anesthesiologists (ASA 3) (p=0.033). Conclusion. We have demonstrated that perioperative respiratory complications are primarily related to pre-existing predictors. These factors are Obstructive Sleep Apnea Syndrome (OSAS), high body mass index, presence of chronic respiratory disease, smoking, and other criteria of difficult intubation.
Lithiase du haut appareil urinaire : aspects épidémiologiques, cliniques et thérapeutiques dans la région de Thiès, Sénégal
Authors: Diallo Y , Kouka SC , Kane R , Dia AA , Charara Z , Ndiaye A , Diamé A , Sylla C
Published: April 2024

Introduction. The aim of this workis to study the epidemiological, clinical and therapeutic aspects of the upper urinary tract calculi in the region of Thiès. Patients and methods. This is a retrospective study on patients cared for stones of HAU between January 2008 and December 2012, the Urology services in hospital regional and Saint Jean de Dieu. Results. During the study period, a total of 282 cases of urolithiasis, 52 (18.42%) patients had upper urinary tract calculi. The age of our patients was 42.7±5.20 years. The sex ratio was 1.7. The consultation period ranged from 6 months to 5 years. Of complications such as pyone- phrosis or chronic renal failure were each found in 13.5 % (n=7) of patients. Of the 42 patients, the surgical nephrolithotomy alone was the most common treatment performed with 52% (n=22) of cases. A nephrectomy was performed in 10 % (n=4) patients. Extracorporeal lithotripsy was performed in 10 patients in our series. The macroscopic appearance was in the calculations blackish majority spiculated and between 0.5 and 3 cm size. Wewere 11.9 % (n=5) of staghorn calculi. The postoperative course was un event ful in 80.9 % (n=34) of cases. The average hospital stay was 7 days. Conclusion. The management must both support the clinical aspects but also the factors of stone formation. Some hospital structures have their reliever adequate technical facilities for treatment of calculi of theurinary tract.
Les nouveaux diabétiques observés à l’Hôpital Joseph Raseta Befelatanana d’Antananarivo (2002-2003)
Authors: Raherison RE , Ramilitiana B , Raharinavalona SA , Rakotomalala DP
Published: April 2024

Introduction. Diabetes mellitus is a heavy burden on public health in low-income countries. In Madagascar, few studies are available regarding diabetes mellitus in its discovery time. The aim of our study was to report the epidemiological and clinical aspects during discovery time of diabetes in Endocrinology service for a period of 12 months. Methodology. This is a descriptive retrospective survey realized in the service of Endocrinology of the Befelatanana Hospital, Antananarivo, from December 1st , 2002 to November 30, 2003. The retained patients were those who had newly diagnosed diabetes. Results. One hundred thirty patients were selected for the study. The incidence of diabetes in the service was 17.8%. The average age of patients was 46.9 years. The sex ratio was 1.06. One hundred two patients (78.5%) were type 2 diabetics. The average time between the first clinical manifestations of diabetes and diagnosis was 25 days. Most of our patients were symptomatic at the time of the discovery of their diabetes. The main signs associated with diabetes were physical asthenia (70%), weight loss (65.3%), polyuria (63.8%) and polydipsia (61.5%). Inaugural keto-acidosis had occurred in thirteen patients (10%). Coronaropathy occupied the first place (24.6%) in regarding degenerative complications already found at diagnosis of diabetes. Diabetic foot infection was the most common infectious complication. Insulin therapy was prescribed in 76.9% of our patients after hospitalization. Conclusion. In our practice, diabetes is often diagnosed late and at stage of complications. Efforts in screening for this disease are neces- sary; the results of this study will be used by practitioners as a tool to reinforce this strategy.
La viabilité financière des centres de santé de base à Madagascar : vers une nécessité de système de mutuelle et d’assurance maladie
Authors: Emile E , Rabesalama SSEN
Published: April 2024

Primary Healthcare Centers, serving as the first contacts of the population in care services are an important link in the health system. But to respect the logic of providing services with inevitable costs, they are in a financial fragility keeping only very few financial availability or deficit. Besides, the population in the poor majority struggling to bear the expenses of increasingly expensive. This study showed that the starting of a mutual health will both reduce the population in health spending while giving financial boost to health facilities for better health provision.
Les cas de retraitement de la tuberculose observés à l’unité de Pneumologie au CHU Mahajanga, Madagascar (2008-2011)
Authors: Tiaray M , Rajaoarifetra J , Ravahatra K , Ramaro B , Raharimanana RN , Ralison A
Published: April 2024

Introduction. Tuberculosis is a public health problem in Madagascar. In spite of implementation by the National Program against tuberculosis in Madagascar of Directly Observed Treatment Short Course strategy, there are patients who remain or become again with tuberculosis. They are more suspect to develop multidrug resistance. Patients and methods. This study is retrospective, spreading for 4 years (01/01/08 - 31/12/11) and get goal to report epidemiological, clinical, paraclinical, therapy and evolution aspects of retreatment cases carried out in the Pulmonology Unit of CHU Mahajanga, Madagascar in order to improve management of tuberculosis. Results. During this period, the retreatment cases are 6.67% of notified tuberculosis. The median age was 46.04 years ± 1.89 (range: 20-78), and sex-ratio 3. History of contact with tuberculosis patient was found in 36.54% and 59.62% were alcoholic and smokers. The clinical signs weren’t different of the usual features of tuberculosis. Smear-positive tuberculosis was 96.16% with 70% (n=35/50) relapse, 16% (n=8/50) treatment after default and 14% (n=7/50) treatment after failure. Multidrugs resistant were 0.64% of notified tuberculosis, 9.62% of retreatment and 17.86% of culture-positive. The Chest X-ray found cavitary disease in 57.68%. The diagnosis was late 3.92 months. All of them are HIV seronegative. The treatment with 2SEHRZ/6EHRZ can afford us to obtain 69.23% cured. The death-rate was 3.85%. Conclusion. Early treatment and well manage allows us to improve management of tuberculosis and to avoid the emergence of multidrug- resistant.
Infections communautaires chez les diabétiques Malgaches hospitalisés à de l’Hôpital Joseph Raseta de Befelatanana, Antananarivo, Madagascar
Authors: Raherison RE , Raharinavalona SA , Randriamboavonjy RL , Rakotoarivelo RA , Randria MJD , Rakotomalala DP
Published: April 2024

Introduction. Our goal was to describe the epidemiological, clinical, biological and issue profiles of community-acquired infections in Malagasy diabetic patients in order to improve their management. Patients and methods. This is a monocentric retrospective and descriptive study achieved from 1st January to 31 October 2012 in the Endocrinology’s unity of the Joseph Raseta Befelatanana Hospital, Antananarivo. We recruited all diabetic patients admitted for communityacquired infections in this unity during this period. Results. We selected 108 patients. The mean age was 54.43 years (16 to 90 years) and the sex ratio (male / female) 0.86. Infection revealed the diabetes in 34.26% of cases. The type 2 diabetes accounted for 81.48% of our patients. The average time of hospitalization was 15.9 days (1 - 75 days). The most frequent infections were community-acquired pneumonia in 19.44 cases (n=21), diabetic foot infections in 14.81 cases (n=16) and pyelonephritis in 12.04 cases (n=13). The average blood glucose on admission was 351 mg/dL (85 - 714 mg/dL). Principals organisms found were tubercle bacilli and gram-negative bacteria (Citrobacter freundii, Proteus mirabilis, Klebsiella pneumoniae, Escherichia coli, Enterobacter spp). The mortality rate was 10.18%. The average length of stay was 16.02 days (1 - 120 days). Conclusion. Infections were frequent cause of hospitalization at diabetics. They were dominated by respiratory, cutaneous and urinary infections. They were responsible for an important mortality and a long length of hospitalization. Thus, their tracking and their prevention are important by the improvement of the patient’s education.
Profil épidémio-clinique des diabétiques admis pour hypoglycémie sévère à l’Hôpital Joseph Raseta Befelatanana d’Antananarivo
Authors: Raherison RE , Raharinavalona SA , Ratsimbazafy SNJ , Randriamboavonjy RL , Randriamboavonjy DP , Raveloson NE
Published: April 2024

Introduction. Hypoglycemia is the most frequent acute complication of diabetes.It is considered severe when its treatment requires the intervention of a third person. Then, it consists a diagnostic and therapeutic emergency. In our knowledge, few studies were dedicated to the dia- betic’s hypoglycemia in Madagascar. The objective of our study is to determine the epidemio - clinic profile of diabetics admitted for severe hypoglycemia in the unity of Endocrinology in the Joseph Raseta Befelatanana Hospital of Antananarivo. Patients and methods. This is a descriptive and retrospective study including diabetics admitted in this unity for severe hypoglycemia on a period of 20 months ( from 1st january 2013 to 31st august 2014). Results. Seventy five diabetics were selected for the study. The hospital frequency of severe hypoglycemia was 3,73%. The middle age of patients was 59,17 years. The sex - ratio was 1,5. Forty eight patients (64%) were in coma. The middle blood glucose was 35 mg/dL. Forty five patients were under insulin before their admission. Kidney failure was the first etiological factor (21,33%), followed by quantitative food intake inadequate (13,33%) and recent introduction of an antidiabetic drug (10,67%). Eleven cases of death have been recorded. Conclusion. Severe hypoglycemia often occurs in elderly diabetics, with degenerative complications of diabetes. The prevention rests on the therapeutic education of patients, the screening of the degenerative complications of diabetes and the adaptation of antidiabetic drug accord- ing to these complications.
Mortalité des pathologies chirurgicales dans le service de Réani- mation polyvalente du Centre Hospitalier Universitaire(CHU) Tambohobe, Fianarantsoa
Authors: Rasamoelina N , Rakotovao AM , Rakotomahenina H , Rabarijaona M , Raveloson NT , Razafimahefa SH
Published: April 2024

Introduction. The objective of this study was to determine the main causes of surgical related death in intensive care at Fianarantsoa. Patients and methods. This is a retrospective descriptive study of all cases of death recorded among patients hospitalized for surgical pathologies in the multi-purpose intensive care unit of the University Hospital of Fianarantsoa Tambohobe for eighteen from January 1st, 2015 to June 30th, 2016. Results. One thousand two hundred and fifty-six patients were included in this study. The mean age was 36.45 with a range of 15-92 years old. Among them, 51.2% were female with a sex ratio of 0.95. The mortality rate was 6.8% (n = 85). Ninety-four percent of patients who died had come to hospital after 48 hours of onset of symptoms with high mortality rate of 38.8%. More than half of those who died (67.1%, n = 57) had economic low resources. The transport was by public or private means in 96.5% of patients who died but not by ambulances assisted by health care provider. The main causes of death were operations for neurosurgical (cerebral) disorders (29.4%), obstetrical pathologies (25.9%) and surgical and urological pathologies visceral (23.5%). They were represented by burnings (33.3%, 2 deaths of 6 cases), neurocranial trauma (21.4%, 25 deaths out of 92 cases) and polytrauma (12.2%, 6 deaths 49 cases). Conclusion. The consultation’s delay or arrival delay may predict high mortality rate in case of surgical pathologies in intensive care.
Association des troubles fonctionnels intestinaux et reflux gastro- œsophagien à l’Hôpital Universitaire de l’Amitié de Bangui
Authors: Camengo Police SM , Mbeko Simaleko M , Longo JDD , Boua-Akélélo NP , Service G
Published: April 2024

Introduction. To determine the prevalence of the association of the irritable bowel syndrome (IBS) and of the gastroesophageal reflux (GER) in gastroenterology consultation in middle central african hospital. Patients and methods. We led a descriptive longitudinal survey of a length of 8 month in university hospital of the "Amitié" of Bangui. The diagnosis of the IBS was kept on the Rome III criteria and the one of GER on the clinical and endoscopic signs. We had included the patients of at least 18 years, at which the diagnosis of GER and the IBS was kept. The studied variables were epidemiological, clinical and endoscopic. Results. Among 341 patients having consulted during the period of survey, the GER-IBS association was recovered among 96 patients (28.1%). It was about 37 men (38.5%) and of 59 women (61.5%). The middle age of the patients was of 43.7 years. The frequent clinical signs of GER were heartburn (n=96) and regurgitations (n=71). The clinical demonstrations of the IBS were characterized by abdominal pain (n=96), an abdominal bloating (n=96) and constipation (n=92). The predominant signs were the signs of IBS in 81 cases (84.4%). Upper GI endoscopy demostrated 72 cases of peptic esophagitis. Conclusion. The association of GERD and IBS is frequent in a African population.
Pyonéphrose : Aspects cliniques et thérapeutiques à propos de 19 cas
Authors: Diallo Y , Kouka SC , Kane R , Ndiaye A , Niang A , Sylla C
Published: April 2024

Introduction. Pyonephrosis is a serious and rare affection. Our goal was to describe the clinical and therapeutic features of pyonephrosis in our context. Patients and methods. This is retrospective study over a period of 10 years between January 2004 and December 2014 that allowed to collect 19 cases at 3 urological services. Results. The average mean age of our patients was 49 year old (extremes of 26 and 72 years). The sex ratio was 1.37. The majority of our patients consulted late with an average of 24 months. The infectious and painful syndromes were found in all patients. There was a deteriora- tion of general condition in 13 of our patients (68.42%). The Urine cultures was identified microorganisms in all patients. Renal function was impaired in 21.05% of patients. The diagnosis was demonstrated on a CT scan for all patients. All patients underwent pre and post operative intensive care. In 11 patients (57.89%) nephrostomy was first act before total nephrectomy. The post operative course period was simple with 57.89% (n=11). We recorded 5 death or 26.3% of cases. Patients were followed for a period of 1 to 5 years. The main causes of death were operations for neurosurgical (cerebral) disorders (29.4%), obstetrical pathologies (25.9%) and surgical and urological pathologies visceral (23.5%). They were represented by burnings (33.3%, 2 deaths of 6 cases), neurocranial trauma (21.4%, 25 deaths out of 92 cases) and polytrauma (12.2%, 6 deaths 49 cases). Conclusion. Pyonephrosis is a severe infection. Treatment of causal pathology is important to in preventing the affection.
Facteurs prédictifs de mortalité précoce des accidents vasculaires cérébraux dans le service ATUR du CHU/JRB (30 cas)
Authors: Mananjo DA , Andrianimaro FM , Randriamasy C , Randriamidona B , Rasolonjatovo TY , Raveloson NE
Published: April 2024

Introduction. More than half of stroke patients died during their Intensive Care Unit stay. The prognosis of these patients varies depending on the neurological and vital signs during the acute phase. The study of these prognostic factors allows clinicians to contribute to the survival of these patients. We seek to identify predictors of stroke death in the first 24 hours of hospitalization. Patients and methods. It is a retrospective descriptive and transversal study in this unit since the 1st of December to the 31st of March 2012. Results. Of 30 patients included, the average age of the population was 59.07± 11.92 years (33-85 years) with a female predominance (sex ratio = 0.66). Five deaths were recorded during the first day of hospitalization. After varied united analysis, factors implicated were: history of hypertension and stroke, Glasgow < 9 and anisocoria on admission, severe hemiplegic, pulmonary rales and hyperthermia on admission or at the 24th hours, hypotension in 24th hour, hyperglycemia at the entrance, the diagnosis of hemorrhagic stroke. Other variables for which p were not significantly proven cause of death were: age, gender, toxic habits, diabe- tes, time of admission, hemiplegic isolated, hypotension at the entrance and ischemic strokes. Conclusion. According to our results, stroke requires early and appropriate treatment. Some prognostic factors are modifiable; a formalized management could reduce mortality in the acute phase.
Aspects épidémio-clinique et thérapeutique des hémorragies digestives vues au CHU Tambohobe Fianarantsoa
Authors: Rakotovao MA , Fanantenantsoa R , Rasamoelina N , Rakotoarivelo RA , Razafimahefa SH
Published: April 2024

Introduction. The gastrointestinal bleeding remains a significant cause of morbidity and mortality. It is a medical and surgical emergency. In Madagascar, the gastrointestinal bleeding lays a major public health. The aim of our study vas to describe epidemioclinical, paraclinical and therapeutic aspects of gastrointestinal bleeding in order to improve their management. Patients and methods. We conducted a study of 383 patients presenting gastrointestinal bleeding, and admitted to the emergency room of University Hospital Fianarantsoa during 5 years. Results. Mean age was 45 years with a male predominance. The 30.02% of the patients presented an unexplored antecedent of gastrointes- tinale bleeding. Oesophageal variceal and peptic ulcers were the most common etiology respectively 27.93% and 26.63%.The mortality was 4.17% and caused by delayed management, because of financial problem. Conclusion. Preventive treatment of hemorrhagic relapse is essential to improve prognosis. The digestive endoscopy, multidisciplinary care and other means are essential in the management of gastrointestinal bleeding.
Aspects bactériologiques des fractures ouvertes infectées au CHU JRA Antananarivo
Authors: Rakotozafindrabe ALR , Ralahy MF , Rakotondrazafy T , Tojomananjara S , Rabemazava ZAL , Razafimahandry HJC
Published: April 2024

Introduction. The principal risk of an open fracture is infection. Knowledge of bacteriology of these infections should guide the prophylactic and Treatment attitude. Our study aims to describe the aspects of bacterial infections through the cases treated for open fractures at HUJRA. Patients and methods. This is a retrospective descriptive survey of open fractures and infectious complications over a twenty months, since January 2012 to August 2013. Results. Among the 124 open fractures identified, 9 cases of osteitis were found, in which 6 cases were a leg fracture. The type III B of Gustilo classification was the most represented with 4 cases. Staphylococcus aureus was the most identified germs (n=5). These five colonies were all susceptibles to gentamicin, four out of five were susceptible to amoxicillin- Clavulanic Acid combination. One colony was resistant to oxacillin (MRSA) but susceptible to amoxicillin-clavulanic acid. Four fractures had gram-negative bacilli. The average length of hospitalization was 42 days. Conclusion. Staphylococcus aureus was the organism most commonly involved in infection of open fractures. Appropriate and prolonged antibiotics associated with surgical debridement prove to be efficient to treat these infections.
Analyse comparative du lupus érythémateux aigu et du lupus érythémateux chronique
Authors: Sendrasoa FA , Ranaivo IM , Andrianarison M , Raharolahy O , Ramarozatovo LS , Rapelanoro Rabenja F
Published: April 2024

Introduction. Acute, subacute and chronic lupus erythematosus are distinguishable according to their clinical aspects, pathological features, evolution and their association with systemic involvement. We aim to analyse and compare the prevalence and characteristics of the main clinical and immunological manifestations of acute cutaneous lupus erythematosus and chronic cutaneous lupus erythematosus. Patients and methods. We conducted a retrospective study during 10 years in patients seen in the department of Dermatology in Joseph Raseta Befelatanana Hospital, Antananarivo. Results. Seventy nine patients were included. Thirty nine patients presented acute cutaneous lupus erythematosus (ACLE) and 40 patients presented chronic cutaneous lupus erythematosus (CCLE). The sex ratio were 0.02 for the ACLE and 0.14 for the CCLE. The patients with ACLE had a higher prevalence of arhtralgia and renal manifestations compared with patients with CCLE. There was no difference between the 2 groups on laboratory abnormalities. Analysis of patient subgroup with discoid lupus erythematosus (DLE) showed the absence of corre- lation between the topography of the lesions and systemic involvement. However, patients with generalized DLE had a higher prevalence of ANA compared with patients with localized DLE. Conclusion. Our study showed a significant different in ACLE and CCLE.
Evolution épidémiologique de la tentative de suicide aux Urgences d’Antananarivo
Authors: Raobelle ENA , Rafehivola IH , Rakotoroalahy M , Bakohariliva HA , Raharivelo A , Rajaonarison BH
Published: April 2024

Introduction. To present epidemiological analysis of attempted suicide in hospital. Patients and methods. This is a descriptive and retrospective study in two hospitals in Antananarivo during a period of three years, from 2009 to 2011. Results. Between 2009 and 2011, the total number of patients hospitalized for attempted suicide was 758. The attempted suicide was over- represented between 15 and 25 years old. The average age was 26.32 years. The sex ratio was 0.83. The majority of our patients were sin- gle (n = 372) and active in the tertiary sector (52%). Ingestion of product with organophosphate was the most common (n = 276). Conclusion. The attempted suicide was increasingly encountered. Social factors were predominated among the risks, so multidisciplinary intervention is predominant for the prevention.
Fréquence de l’insuffisance rénale vue chez les insuffisants cardiaques à l’Unité de Cardiologie de l’Hôpital de Befelatanana, Antananarivo
Authors: Ramilitiana B , Randriamihangy NA , Ramiandrisoa RL , Rakotoniaina DM , Meudje Youmbi CF , Rakotoarimanana S , Rabearivony N , Randriamarotia WHF
Published: April 2024

Introduction. Impaired renal function is frequent during cardiac decompensation and is associated with a high cost of care, increased frequency of readmissions in hospital and mortality. Our study aimed to determine the frequency of hypercréatininemia on those who have heart failure, to seek a relationship between Left Ventricular Ejection Fraction (LVEF) and Glomerular Filtration Rate (GFR) and to report therapeu- tic aspects of heart failure in cardiology unit at hospital of Befelatanana. Patients and methods. We have carried out a retrospective, descriptive and analytical study from june 2013 to may 2014. Results. Hypercreatininemia was detected in 70.7% of patients having heart failure patients. The average age of the 35 patients involved in the study was 53.8 years old. The average of LVEF was 36.9%. The average initial GFR was 75 m1/mn (minimal value: 25.6 ml/mn) and the average GRF in the end of the hospitalization was 70.2 ml/mn (minimal value: 19.4 ml/mn). All patients received furosemide and angiotensin- converting enzyme (ACE) inhibitor or angiotensin II type 1 receptor blockers (ARBs), 40% had received beta-blockers and 54.3% had taken spironolactone. Conclusion. Impaired renal function was frequent among patient having heart failure in cardiology unit at hospital of Befelatanana. Use of adequate doses of furosemide and compliance with recommendations on treatment of heart failure may reduce that frequency.
Dépistage et profil épidémio-clinique de dysfonction érectile chez les diabétiques de type 2 à Antananarvo, Madagascar
Authors: Raharinavalona SA , Razanamparany T , Raherison RE , Vololontiana HMD , Rakotomalala ADP
Published: April 2024

Introduction. Erectile dysfunction (ED) is a real nuisance for quality of life. It is particularly common in diabetics. However, the population has less attention. Our study aims to report the role of the physician in the diagnosis of this disorder and to describe the epid emio-clinical aspects of this ED. Patients and methods. This is a cross-sectional, descriptive and analytical study of 165 type 2 diabetics, hospitalized in 2 sites in Antananarivo over a 6 months period. Erectile function was assessed by the International Erectile Function Index (IIEF5). Results. Eighty five patients (51.5%) thought that diabetes could influence their sexuality. In 12.1% of cases, the physician has occupied this ED. The mean age of our patients was 58.57 years-old; their diabetes had evolved for 6 years. For 78.7% of patients, diabetes was uncontrolled. One hundred and twenty patients (72.7%) had ED with 18.1% low, 27.3% moderate and 27.3% severe. The most commonly as sociated cardiovascular risk factors were smoking (36.36%) and hypertension (33.33%).The poor glycemic control and the high blood pressure are associated with a heightened risk of ED. Conclusion. The prevalence of ED in our diabetics was high, but few were detected. The early diagnosis of this disorder thus remains a challenge to organize a better psychological and medicinal charge.
Aspects epidemio-cliniques des cardiomyopathies du peripartum dans les services cardiologiques de Befelatanana, Antananarivo
Authors: Andriamiharisoa SN , Randriamihangy NA , Ramilitiana B , Raveloson FH , Ralison F , Rakotoarimanana S , Rabearivony N
Published: April 2024

Peripartum cardiomyopathy (PCM) is defined as an idiopathic cardiomyopathy during the peripartum period. It is frequent in de veloping countries like Madagascar. We aimed to describe the epidemio-clinical profile of the PCM in the cardiology departments, in the teaching hospital of Joseph Raseta Befelatanana. We performed a retrospective study from 1st january 2010 to 31st august 2012. We enrolled 30 pati ents. Risk factors were dominated by the age over 30 years old (56,66%). Patients were classified NYHA IV in 60% of cases and they were arrived after 1 month of evolution in 33.33% of cases. The diagnosis was made clinically in patients presenting with global heart failure in 90% of cases. Left ventricular ejection fraction was reduced in 100% of cases. The rate of thrombo-embolic or hemodynamic complications was high (33.33%). One of our patients died (3.33%). Pre-natal consultation is essential to detect women with risk.
Facteurs de retard de prise en charge des infections ostéo-articulaires de l’enfant au Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, Antananarivo
Authors: Andriamanarivo LRC , Rabemanantsoa T , Raherison AR , Fanomezana SM , Hunald FA , Andriamanarivo ML
Published: April 2024

Introduction. Bone and articular infection is the invasion of bone or cartilage tissue with its destruction, by a pathogenic micro-organism. It is a serious pathology frequently encountered in infantile trauma. Aim: To report the epidemiological, radiological, microbiological aspects and the pre-hospital management of bone and joint infections inside the pediatric surgery department of the Ravoahangy Andrianavalona university hospital center. Materials and method. We carried out a descriptive cross-sectional retrospective study over a period of 14 months (january 2016 to february 2017). Were included in this study, all children hospitalized and treated for osteo-articular infections in the department, with radiographic and bacteriological. Results. Fifty-three cases were identified. The average age was 9.77 years with a sex ratio of 1.4. The mean time from the first suspected symptom to hospitalization was 73.3 weeks. Forty two percent had a notion of trauma in the affected limbs. Seventy-five percent had massages before hospitalization. Six out of 10 patients had antibiotics without antibiograms before admission. On admission, chroni c fistula was found in 45.29% of cases. The most frequent lesion found on radiography was sequestration in 40.06% of which 35% related to m assage. The pathology showed osteomyelitis in 66.04% of cases. The most frequent location was the lower limbs. The most common germ involved was Staphylococcus aureus (75.47% of cases). Conclusion. Insufficient resources, traditional massages, lack of knowledge about the disease and the rarety of specialized services favour the evolution towards the chronicity of osteo-articular infections and management becomes heavy in our context.
Découverte fortuite angiographique d’un anévrysme de l’artère coronaire chez une patiente présentant une cardiomyopathie dilatée hypokinétique
Authors: Raveloson HFR , Miandrisoa RM , Rakoto Sedson O , Fouché R , Rakotoarimanana S
Published: April 2024

Coronary artery aneurysm (CAA) is an uncommon disease, characterized by abnormal dilatation of a localized portion or diffuse segments of the coronary artery. CAA is frequently asymptomatic. Our aim is to report a sighting of a chance discovery of an artery aneurysm in a patient with hypokinetic dilated cardiomyopathy. Here, we report a 69-year-old woman presenting a giant aneurysm of the left anterior descending coronary artery associated with a dilated cardiomyopathy with heart failure due to hypertension. Coronary angiography permitted the diagnosis of CAA. Computed tomography scanning (CT scan) and magnetic resonance imaging (MRI) confirmed the diagnosis and excluded arteriovenous or aorto-pulmonary fistulas.
Un nouveau cas de réinfection à Toxoplasma gondii chez une femme enceinte non infectée par le virus de l’immunodéficience humaine
Authors: Rabarikoto HF , Raveloson HFR , Rabetsimamanga LAZ , Castera-Pietrera P , Maugey-Laulom B , Andriampanalinarivo HR , Randaoharison PG
Published: April 2024

Congenital infection due to Toxoplasma gondii is a severe embryo-fetopathy when occurring at the onset of pregnancy. We reported a case of fetal congenital toxoplasmosis. This mother was previously immunized but reinfected during pregnancy. The diagnosis was made prenatally, guided by a systematic morphological ultrasound examination of the third trimester of pregnancy. Positive maternal serology and the pres- ence of T. gondii in the amniotic fluid and positive IgM antibodies antitoxoplasmic in fetal blood confirmed the diagnosis.
A propos d’une localisation inhabituelle du kyste osseux solitaire chez l’enfant: l’os métacarpien
Authors: Dendane MA , Lamaalmi N , Amrani A
Published: April 2024

Solitary bone cyst of the metacarpal bone is uncommon. We report such a lesion in a boy of seven years who presented with a cystic lesion of the third right metacarpal bone. Radiographic, pathologic and intra-operative findings were consistent with a solitary bone cyst. He was treated successfully with curettage, replacement with a cortico-medullar autogenous graft and immobilization.
Carcinome épidermoïde gingival invasif géant: imageries médicales d’un cas
Authors: Ranoharison HD , Rajaonarison Ny Ony Narindra LH , Randrianantenaina FR , Hasiniatsy NRE , Rafaralahivoavy T , Ahmad A
Published: April 2024

The gengival localization of the squamous cell carcinoma is not common and the giant forms are unusual. Our aim was to describe the radiological aspects of this disease. We report the case of a 43 years old man presenting with a giant squamous cell carcinoma invasive of the gencive. Standard radiography, orthopantomography, and computed tomography allow to analyze the osteolytic lesion and locoregional invasion of this type of cancer.
Maladie de Castleman: un diagnostic à éliminer en cas d’adénopathie cervicale en milieu tropical
Authors: Tiaray MH , Rakotomizao J , Ernestho-ghoud IM , Ranaivomanana VF , Randriamavo SH , Raharisolo VC , Andrianarisoa ACF
Published: April 2024

Castleman’s disease is due to a lymphoproliferative disorder by polyclonal proliferation of B cells inside lymphoid organ. Two types exist: the localized form which is usually benign and multicentric form which is more severe. The main risk is the development of lymphoma. Our aim is to report a case of a 56 years old female malagasy patient. Her medical history was unremarkable. She presented with a localized hyalino-vascular form on the right side of neck lymph node. After the ablation of the nodes, none relapse was noticed.
Difficulté diagnostique d’un tuberculome intracrânien dans un pays à faible revenu
Authors: Tiaray M , Ranaivomanana VF , Ravahatra K , Rakotomizao J , Rajaoarifetra J , Josoa M , Rakotoson JL
Published: April 2024

The involvement of the central nervous system is one of the most severe expressions of tuberculosis. It represents 1% of the whole of tuberculosis. Tuberculoma is one of clinical featuring of this form. Its diagnosis is difficult to confirme and can be posed only by the anatomopa- thological examination of the lesion after biopsy or aspiration. We report in this article a case of single brain tuberculoma histologicaly confirmed in a women 58 years-old, immunocompetent without other tubercular localization. Some residual neurological after-effect is frequently reported in case of tuberculosis in central nervous system in spite of an adequate treatment.
Syndrome de Sturge-Weber bilatéral : aspects cliniques et scanographiques à propos de deux cas
Authors: Nguefack S , Moifo B , Moulion Tapouh JR , Abdouramani O , Mah E , Gonsu Fotsin J
Published: April 2024

The Sturge-Weber syndrome associated a facial port-wine stain skin on the territory of the trigeminal nerve (V1), a venous lepto-meningeal angioma and ipsilateral choroidal angioma. We report two cases of Sturge Weber syndrome in two children aged 14 months and 45 months with bilateral involvement of the trigeminal territory. We emphasized the difficulty of clinical diagnosis due to poor detection of facial port-wine stain skin on black skin and the central role of diagnostic imaging. Both cases were diagnosed during a CT-scan for epilepsy with hemiparesis. Skin lesions were identified after the imaging diagnosis in the first case.
Tuberculose isolée du pied chez l'enfant : à propos de 3 cas
Authors: Raherison AR , Ralahy MF , Andriamanarivo R , Rabemazava A , Andriamanarivo ML
Published: April 2024

Osteoarticular tuberculosis infection of the foot is a rare form of extra pulmonary tuberculosis in children. It is usually associated with other outbreaks. We report three cases of unusual form of isolated foot tuberculosis. The diagnosis was made at a late stage. The combination pain and chronic purulent fistula were the call signs. Inflammatory syndrome and anemia were the main biological signs. The X-ray revealed an osteolysis, bone remodeling and periostal reaction. Histological review after bone biopsy confirmed the diagnosis. Our patients have benefited from a tuberculosis antibiotic treatment 12 months, coupled with a member of immobilization and rest up. Good bone recovery was observed at the end of treatment. Any spontaneous limb pain followed by a local deformation (swelling, fluctuation) deserves all the attention to a possible infection musculos- keletal research. Every bones and joints infection must be the subject of a histological examination to remove tuberculosis.
Tuberculose pulmonaire multirésistante associée à une cryptococcose neuroméningée en zone rurale à propos d’une observation
Authors: Ulrich Davy K , Josaphat IB , Dieudonné M , Jean Baptiste MK , Jean Bruno B
Published: April 2024

Opportunistic infections are common complications of advanced immuno-deficiency in individuals with Human Immunodeficiency Virus (HIV) infection. Following involvement of the lung, the central nervous system (CNS) is the second most commonly affected organ. We report first description in rural areas Gabon one case of concurrent cryptococcal meningitis and multi-drug resistant pulmonary tuberculosis (MDR-TB) in HIV infected person. A high suspicion of multiple opportunistic infections should be kept in mind in HIV seropositive individuals.
Rhabdomyosarcome alvéolaire primitif intratesticulaire : à propos d'un cas
Authors: Ranaivomanana AHM , Randriamanovontsoa NE , Ranaivomanana VF , Randrianjafisamindrakotroka NS , Rafaramino F
Published: April 2024

The authors report the case of a patient 57 years who had a loco-regional recurrence and distant of alveolar rhabdomyosarcoma of the testicle. After three months of unilateral single orchiepididymectomie, salvage chemotherapy was performed. The patient is in complete remission after 18 months of decline. We discuss a relevant literature data regarding the epidemiology, diagnosis, therapy and evolution.
Perforation intestinale sur ingestion volontaire de cure-dents : à propos d’un cas à Ndjamena
Authors: Kaimba BM , Edzimbi A , Akouya SD , Hervé P
Published: April 2024

Toothpick perforation represents 9% of intestinal perforations caused by foreign bodies. We here report the case of a 24 year old man who consulted for diffuse abdominal pain, nausea, vomiting and fever six days after swallowing toothpick. On physical examination we found right iliac fossa tender mass; inflammatory and infectious syndromes were found. Abdominal plain film and abdominal CT scan couldn’t identify the toothpick. We therefore undergo a surgical exploration, during which we found a tooth- pick into the peritoneal cavity and an ileum perforation localize 45 cm from the ileocecal junction. We performed a suture of the perforation and a toilet of the abdominal cavity. The postoperative course was simple, and the patient was discharged on day 6.
Nodule hépatique : quelle attitude adoptée ?
Authors: Ranoharison HD , Rajaonarison Ny Ony NLH , Ahmad A
Published: April 2024

The discovery of hepatic nodule is an intriguing situation. Though diagnosis is easy, malignant tumor is the haunting both for the patient and clinician. However, several resources are available to the clinician for diagnosis; including radiological investigations which should be inter- preted taking account the clinical and the biological contexts. Ultrasonography is the most common means to discover hepatic nodules. But, it is completed by CT scan or MRI which assess the kinetics of tumor vasculature. At the end of these investigations, presumptive diagnosis of benign or malignant tumor could be made. However, if doubt persists, biopsy of the nodule with histological examination represents the last bulwark for the diagnostic.