[Comparison of efficacy of chloroquine versus sulfadoxine-pyrimethamine in malaria prevention in pregnant women in the Toamasina region (Madagascar)]. / Comparaison de l'efficacité de la chloroquine versus sulfadoxine-pyriméthamine dans la prévention du paludisme chez la femme enceinte dans la région de Toamasina (Madagascar).

Malaria still represents a great cause of death in sub-Saharan African areas, mainly among pregnant women. We conducted this prospective study during two years in a malaria-endemic stable region in the east of Madagascar (Toamasina) with an aim to compare the efficacy of weekly chloroquine (CQ) and the use of intermittent presumptive treatment by sulfadoxine-pyrimethamine (SP). 519 pregnant women were included in this study (CQ = 285; SP = 256). Socio-demographical characteristics of each group were identical. We found more peripheral parasitemia (CQ = 8.07% vs SP = 2.73%; P = 0.0068) and severe malaria in the CQ group (CQ = 1.75% vs SP = 0%; P = 0.0332). Anemia was more frequent in the CQ group (CQ = 4.21% vs SP = 0.35%; P = 0.0038). Placental infestation rate was also higher in the CQ group (CQ = 7.01% vs SP = 0.39%; P = 0.00001). Low birth weight and fetal death were lower in the SP group respectively [(CQ = 4.21% vs SP = 0.78%; P = 0.0121) and (CQ = 1.75%vs SP = 0%; P = 0.0332)].

Aspects du paludisme a Plasmodium falciparum pendant la grossesse selon les cas observes au CHU de Toamasina Madagascar

Objectif: Decrire les facteurs de risque; les signes cliniques et les complications du paludisme a Plasmodium falciparum pendant la grossesse. Methodes: Il s'agit d'une etude prospective de 12 mois portant sur les patientes enceintes presentant une parasitemie positive au Plasmodium falciparum vues au Service Maternite du Centre Hospitalier de Toamasina. Resultats: Quarante cas de paludisme etaient diagnostiques sur 642 femmes enceintes soit une frequence de 6;23. La transmission etait maximale pendant les saisons humides. L'age inferieur a 19 ans (47;5); la primiparite (62;5)predominaient chez les femmes avec parasitemie positive a Plasmodium falciparum. Les taux de frequentation des consultations prenatales et de la prise d'au moins une dose de etaient faible respectivement de 27;5et de 22;5. La valeur predictive positive des signes cliniques classiques du paludisme etait faible.Les complications etaient dominees par l'anemie maternelle et l'hypotrophie foetale respectivement 40(p0;0001) et 5(p0;05). Conclusion: L'approche diagnostique du paludisme basee sur les symptomes avait une valeur predictive positive faible pendant la grossesse. Une goutte epaisse ou au moins un test de diagnostic rapide doit etre systematiquement realisee devant tout acces febrile

[Brain tuberculoma in the child in Antananarivo]. / Tuberculome cérébral de l'enfant à Antananarivo.

Brain tuberculoma is a rare localization of extra-pulmonary tuberculoma and considered as the most severe. A 14-year-old girl, without past medical history presented intracranial hypertension, with cerebellar syndrome and visual disorder The laboratory findings were normal. Serological test for HIV was negative. Cerebral scan showed intracranial mass lesions occupying the left back of the head region, with central calcification, an oedema and a four-ventricle dilatation. Histopathological examination after neurological operation revealed a tuberculosis. The progress was favourable after administration of antituberculous chemotherapy Although tuberculoma remains one of the causes of cerebellar tumour potentially curable, its diagnosis cannot be clearly established without neuroimaging and histology

A short synthesis of troglitazone: an antidiabetic drug for treating insulin resistance.

Troglitazone was obtained in 5 steps from 4-bromo-1,1-dimethoxy-3-methylbut-2-ene with an overall yield of 7.5%. The formation of the chromane ring was achieved by condensing an unsaturated acetal with trimethylhydroquinone in the presence of bis(trifluoromethylsulfonyl)imide.