RESUMEN
OBJECTIVE: To evaluate the feasibility of the implementation of a commercial rapid molecular diagnostic test (Xpert MTB/RIF) for the routine diagnosis of smear-negative or extrapulmonary tuberculosis (TB) and its diagnostic accuracy, and to assess HIV prevalence in a real-life setting in Madagascar. This study was set in a tertiary care hospital in Madagascar. METHODS: A prospective cohort study was conducted of all consecutive cases with suspected smear-negative and/or extrapulmonary TB over a 2-year period. Cases were classified as proven, probable, or possible TB cases, or as having an alternative diagnosis. RESULTS: Of the 363 patients included, 183 (50.4%) had suspected smear-negative pulmonary TB and 180 (49.6%) had suspected extrapulmonary TB. For proven cases, the sensitivity, specificity, positive and negative predictive values of Xpert MTB/RIF were 82.4%, 98.8%, 98.3%, and 86.6%, respectively; for proven and probable cases grouped together, these values were 65%, 98.8%, 98.5%, and 64%, respectively. The diagnostic accuracy was slightly lower for extrapulmonary TB compared to smear-negative pulmonary TB. The prevalence of HIV infection was 12.1%, but almost half of these cases did not have TB (alternative diagnosis group). CONCLUSIONS: The implementation of a rapid diagnosis programme for TB in a resource-poor setting is feasible. The performance of the Xpert-MTB/RIF was remarkable in this difficult-to-diagnose population. HIV prevalence in this study was much higher than the prevalence reported in the general population in Madagascar, in patients with TB and patients with conditions other than TB.
Asunto(s)
Antituberculosos/uso terapéutico , Técnicas de Diagnóstico Molecular , Esputo/microbiología , Tuberculosis Pulmonar/microbiología , Adulto , Estudios de Factibilidad , Femenino , Humanos , Madagascar , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Mycobacterium tuberculosis/genética , Prevalencia , Estudios Prospectivos , Rifampin/uso terapéutico , Sensibilidad y Especificidad , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/genéticaRESUMEN
A stroke is the sudden onset of focal neurological deficits presumed to have mecanism vascular and is the leading cause of acquired motor disability in adults. To improve stroke management, we examined the motor disability of patients presenting with stroke, their course, and its determinant factors. This retrospective descriptive study reviewed case records from the neurology unit of the Befelatanana University Hospital from january to december 2015. We included all patients who had a stroke with motor impairment of any upper or lower limbs, with or without computed tomography of the brain, that is, 227 (36.50 %) of the 622 patients admitted to the neurology unit. The mean age of onset was 55.41 years with a sex-ratio 1.16. Predominantly, we found perforating artery strokes (51.54 %), ischemic strokes (36.12 %), and right limb location deficits (50.22 %). Stroke patients were managed with physical therapy from the beginning of the acute stage, that is, from the admission (77.53 %). Two third of the motor deficits were steady (67.84 %), with a median NIHSS=8 and MRS=4 at hospital discharge. The mortality rate was 8.37 % (6.60 % during the first week and 1.77 % after that). We found no significant determinant factors. Hospital mortality decreased during the study. The lack of overcoming of motor disability was due to the short follow-up period, which included only the acute stage. These findings point out the utility of a neurovascular unit (UNV) for reducing disabilities and developing a network for stroke management during the acute stage in Madagascar.
Asunto(s)
Trastornos del Movimiento/rehabilitación , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/complicaciones , Femenino , Hospitales Universitarios , Humanos , Madagascar , Masculino , Persona de Mediana Edad , Trastornos del Movimiento/etiología , Modalidades de Fisioterapia , Estudios RetrospectivosRESUMEN
Pernicious anemia is uncommon in Africa. The purpose of this report is to describe a case of pernicious anemia observed in Madagascar. The revealing manifestation was encephalomyelitis with combined medullar sclerosis that responded favorably to vitamin B12 replacement therapy. Clinical symptoms included paresthesia associated with allodynia of all four extremities and with tetrapyramidal syndrome, medullar ataxia and minor cognitive disturbances ongoing for 5 months. Hemogram testing revealed macrocytic anemia. Serum cobalamin level was low. Anti-intrinsic factor antibody was detected. Spinal cord magnetic resonance imaging showed diffuse high-signal intensity along the posterior spinal cord extending from C1 to C4. Vitamin B12 replacement therapy led to full regression of clinical signs after six weeks. Association of central nervous system involvement with macrocytic anemia suggests vitamin B12 deficiency and pernicious anemia should be suspected. This disease can be considered as a curable form of myelitis in Africa and Madagascar.
Asunto(s)
Anemia Perniciosa/diagnóstico , Encefalomielitis/etiología , Anemia Perniciosa/tratamiento farmacológico , Encefalomielitis/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Clima Tropical , Vitamina B 12/uso terapéutico , Vitaminas/uso terapéuticoRESUMEN
La myosite ossifiante progressive est une maladie genetique rare. Les auteurs en rapportent un cas chez une jeune fille de 10 ans qui presentait de multiples tumefactions douloureuses d'apparition spontanee et progressive au niveau du tronc et des membres. Ces tumefactions etaient associees a une febricule et un hallux valgus bilateral. Les aspects radiologiques et tomodensitometriques etaient largement suffisants pour confirmer le diagnostic. Le traitement etait purement medical; a base d'anti-inflammatoire. L'evolution etait marquee par l'apparition d'autres ossifications des fascias et des muscles aboutissant a des raideurs articulaires tres invalidantes. Les particularites de cette pathologie rare sont discutees a travers une revue de la litterature
Asunto(s)
Niño , Miositis Osificante , OsteogénesisRESUMEN
Neurocysticercosis is endemic in Madagascar. It is caused by fecal-oral contact and is common in developing countries where hygiene and sanitation are poor. Cerebral involvement is more frequent than spinal involvement. Definitive diagnosis remains difficult and no consensus has been established on optimal workup. The aim of this report describing two cases of cerebral cysticercosis in Madagascar was to assess the utility of various clinical and laboratory findings and to propose a diagnostic algorithm that is compatible with locally available facilities.