Suggestive criteria for pulmonary tuberculosis in developing countries.

Tuberculosis (TB) represents a major problem in developing countries. Diagnosis is often difficult and mainly relies on clinical criteria and simple laboratory examinations, as cultural methods and molecular biology are not available in most health facilities. In order to evaluate the reliability of clinical criteria to suggest pulmonary TB, a prospective survey was conducted in Wolisso Hospital, South-West Shewa region, Ethiopia. During the period from April 2006 to September 2008, data from 117 consecutive patients from which the diagnosis of TB was made by either positive sputum examination or by typical chest X-ray were examined. The objective was to identify simple and reproducible clinical and laboratory criteria related to pulmonary TB in low-resource health facilities. Patients' symptoms strongly suggesting pulmonary TB were found to be long-lasting cough (>1month), dyspnoea, chest pain, weight loss, fever, weakness and night sweats; typical TB patients' physical examination showed emaciated condition, with low systolic blood pressure (BP) and low body mass index (BMI); simple laboratory examinations suggestive of TB were high erythrocyte sedimentation rate (ESR) and normocytic anaemia. Absence of both known TB contact and bloody sputum was not significant to rule out TB, and total and differential white blood cells (WBC) count did not help in the diagnosis.

Echocardiography in low-resource rural tropical hospitals.

Cardiopathies are common in tropical regions and echocardiography could be of substantial value. However, it is difficult to practice. We suggest simple techniques with conventional instruments that are available in many rural hospitals, and describe the most common echocardiographic procedures and findings that can be undertaken with short training by non-cardiologist physicians.

Snake bites in Moyen Chari district, Chad: a five-year experience.

Snake bites are of major public health importance in Africa as a cause of morbidity and mortality. Echis ocellatus is responsible for the majority of envenomation cases in West Africa. Antivenom immunotherapy is the only specific treatment available for envenomed patients. From January 1997 to December 2001, 325 patients suffering from snake bites were enrolled in a survey undertaken at Goundi Hospital, Chad. We analysed the percentage of envenomed patients, sex distribution, distribution along the year, lethality, hospital stay and recovery clotting time. Two hundred and ninety-eight patients showed signs of envenomation and were treated with antivenom immunotherapy with three different sera in consecutive periods. Young males were more frequently involved. The overall lethality was 8%. Lethality and hospital stay were significantly different in the differently treated patients. Most of the data in our series were similar to those from other sub-Saharan countries but, overall, the percentage of snake bite victims who were admitted to hospital was higher.