ABSTRACT
The aim of this study was to determine the frequency of confirmed malaria among patients with fever in the central Highlands of Madagascar, the clinical utility of treating this fever, and the involvement of community general practitioners in improving malaria management. This descriptive, prospective study took place from July 1, 2009, through June 30, 2010. Patients consulting for fever were classified into 2 groups: the first (G1) included all children younger than 5 years and the second group (G2) children 5 years or older and adults. In G1, 1383 cases of fever included 145 (10.5%) confirmed cases of malaria. The corresponding numbers in G2 were 1172 and 276 (23.5%). The prevalence of malaria was highest between December and May. In G1, the main clinical signs associated with a positive rapid diagnostic test (RDT) were pallor, jaundice, seizures, and failure to eat. In G2, a positive RDT was associated with pallor, coma, and jaundice. Treatment of patients with positive RDTs was based on quinine (51%) or artemisinin-based combination therapy (49%). Malaria remains endemic in the central Highlands of Madagascar. Efforts should be undertaken to improve prescription of antimalarial drugs.
Subject(s)
Malaria/diagnosis , Malaria/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Fever/etiology , General Practice , General Practitioners , Humans , Infant , Madagascar , Malaria/complications , Male , Middle Aged , Practice Patterns, Physicians' , Prospective Studies , Time Factors , Young AdultABSTRACT
OBJECTIVE: To assess whether patients with chronic obstructive pulmonary disease treated with heliox have a better prognosis than those treated with standard therapy. DESIGN: Retrospective analysis over 18 months. SETTING: Academic emergency department. PATIENTS: Eighty-one patients admitted with exacerbation of chronic obstructive pulmonary disease and respiratory acidosis. INTERVENTIONS: Use of helium-oxygen mixture as an adjunctive therapy. MEASUREMENTS AND MAIN RESULTS: The following data were collected: age, gender, medical history, vital signs, arterial blood gas at admission, emergency room treatment, requirement for intubation, admission in intensive care unit, length of stay, and evolution. Patients were classified into two groups according to whether heliox was used as a therapeutic agent (heliox group) or not (standard group). Chi-square test and Student's t-test were used for statistical analysis (significant at p <.05). In both groups, the following data were similar: age, gender, medical history, vital signs, initial arterial blood gas, and emergency room treatment. Significant decreases in intubation, and mortality rate were identified in the heliox group. Significant decreases in intensive care unit stay and in-hospital stay were observed for survivors in the heliox group. CONCLUSION: Use of heliox seems to improve prognosis in patients with severe acute exacerbation of chronic obstructive pulmonary disease. Prospective randomized studies are needed to confirm these results.
Subject(s)
Helium/therapeutic use , Hypoventilation/drug therapy , Oxygen Inhalation Therapy/methods , Oxygen/therapeutic use , Pulmonary Disease, Chronic Obstructive/drug therapy , Aged , Female , France/epidemiology , Humans , Hypoventilation/etiology , Hypoventilation/mortality , Male , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/mortality , Retrospective Studies , Treatment OutcomeABSTRACT
Hepatocellular carcinoma (HCC) etiology and incidence in Madagascar are not well established. The work presented here is the first documented study on HCC in Madagascar. The study was undertaken at the Centre Hospitalier de Soavinandriana, Antananarivo, from October 1995 to October 1996. Hepatocellular carcinoma was reported in 19 out of 22 patients with liver tumor included in the study. In 6 cases, patients developed post alcoholic cirrhosis HCC. Hepatitis B virus markers were detected in 48% of cases (13/19). The HBs Ag was detected in 42% of cases (8/19) in association with HBe Ag in 16% of cases (3/19), and hepatitis C virus antibodies in 11% of cases (2/18). In 3 cases, the etiology remained unknown. Hepatocellular carcinoma appeared the most frequent liver cancer, mainly due to post-hepatitis B cirrhosis. The introduction of hepatitis B vaccine in EPI (Expanded Program of Immunization) is recommended in order to reduce the percentage of hepatitis B virus carriers in the malagasy population and furthermore the incidence of HCC.
