Medecine tropicale : revue du Corps de sante colonial最新文献

Retrospective analysis of the medical records of patients who underwent acute appendectomy in the Gastrointestinal Surgery Department of the Desgenettes Military Hospital in Lyon, France from the 1st of November 2009 to the 21th of February 2011, turned up two cases of appendicular parasitosis for a prevalence of 3.3%. Both patients presented acute appendicular oxyuriasis caused by Enterobius vermicularis that was discovered inadvertently after appendectomy. This unexpected diagnosis raises questions about the exact role of parasites in the physiopathology of appendicitis. Though appendicitis is the most common surgical emergency in France, appendix vermicularis is rare. In comparison, developing countries and particularly endemic areas such as sub-Saharan Africa show considerably higher appendicular parasitosis prevalence rates and greater variety in the parasites involved. The purpose of this article is to describe the different parasites with potential to affect the appendix, to discuss the different pathophysiological mechanisms underlying acute appendicitis, and to recall the need for medical treatment after appendectomy.

The purpose of this report is to describe the first case of left ventricular non compaction diagnosed in Djibouti. The patient was a 74-year-old Djiboutian woman with symptomatic heart failure. Echocardiography is the key tool for assessment of left ventricular non compaction. This rare cardiomyopathy is probably underdiagnosed in Africa.

Epidural analgesia is the most effective method for pain relief during labor. This 10-year exploratory descriptive study on factors underlying women's decisions to request or refuse labor epidural analgesia (LEA) was carried out at a level III maternity hospital in Antananarivo, Madagascar. All patients underwent a pre-anesthesia check-up (PAC) between 32 and 34 weeks of amenorrhea. During the PAC, a questionnaire was administered to determine socio-economic aspects, level of education, and knowledge about labor pain and LEA. In addition, LEA was proposed and patients were asked to explain their reasons for accepting or refusing the procedure. The purpose of this report was to describe the factors underlying acceptance or refusal of EA by nulliparous women. A total of 41 nulliparous women were included. Fourteen (34.14%) accepted LEA and 27 (63.86%) refused. Mean age was 27 years in the acceptance group and 25 years in the refusal group. No patient had good knowledge about LEA. Nulliparous women that accepted EA had a higher socio-economic level, expected stronger labor pain, were better informed about EA, and expressed greater confidence in medical care. In addition to economic aspects, the main reasons for refusing EA involved fear and family background.

The purpose of this report is to present the findings of a retrospective study (2008-2009) to determine the seroprevalence of hepatitis B and C virus in blood donors at the Blood Transfusion Center of Military Teaching Hospital Mohammed V in Rabat, Morocco. Samples from 19,801 consecutive blood donors were analyzed by the immuno-enzymatic method (Enzyme Linked Immunosorbent Assay, third generation). The overall seroprevalence of HBV and HCV was 0.8% and 0.2% respectively. A total of 98 units were rejected because of elevated alanine transaminase. No case of co-infection was found. From 1991 to 2010, HBV and HCV seropositivity showed a significant declining trend. In spite of the low prevalence observed, this study confirms that the risk of transfusion transmitted infection exists and thus underlines the need to implement preventive strategies to improve blood transfusion safety.

Unlabelled: Funding for healthcare poses a major problem in developing countries. The purpose of this study was to assess public perceptions toward the implementation of mutual healthcare coverage in rural Senegal.

Methods: A descriptive transversal study was conducted from 24/09/07 to 05/10/07 in a randomly selected sample of 208 heads of households living in the rural communities of Ngogom and Réfane. Data were collected by means of individual interviews and focus group discussions. Topics included population health, community solidarity, health insurance and implementation of mutual healthcare insurance.

Results: The sample population was 94% male, 91% married, 36% uneducated and 11% unemployed. Household income was irregular in 36% and 84% had no savings. In case of medical emergency, 43% relied on family for assistance, 36% had no recourse and 21% would have to contract, a loan. Nearly half the sample population, i.e., 46%, were familiar with the principle of mutual healthcare insurance and 98% wanted to join. The main reasons for wanting to join were to reduce medical costs (57%), improve access to care (25%) and build community solidarity (11%). In focus groups, people expressed the need for micro health insurance. Findings also showed good community dynamics and a tradition of pooling resources to implement collective activities.

Conclusion: The public perception of mutual healthcare insurance is favorable. However, due to economic difficulties, support from political and health authorities will be needed.

Frizzy hair syndrome is frequent. It is due to sideways growth and tight coiling of the hair fiber. It is often secondary to unsuitable grooming practices causing ingrown hair (pili incarnati) followed by infection andor damage. The fragility of frizzy hair promotes alopecia due to chronic traction, use of hair relaxers, and perming. Treatment of complications is difficult so awareness of precautionary measures is important.

Sera obtained from 31 domestic and feral animals in Djibouti were assayed for leptospiral antibodies using the microscopic agglutination test. Antibodies were detected in 26 samples (84%), corresponding to 116 positive reactions. The most common antigen serogroups were Icterohaemorrhagiae and Australis. The highest titre was recorded for serovar Munchen (1:1280) in sera from Somalian wild asses and goats. This study shows a broad dispersion and high prevalence of the different Leptospira serogroups tested. High biodiversity has been previously reported in tropical countries and is thought to be linked to the wide range of reservoir mammals. Additional study will be needed to identify the reservoirs of the different serogroups in this part of Africa.

A cerebrovascular accident or stroke is a sudden-onset cerebral deficit of vascular origin lasting more than 24 hours. These events represent the second leading cause of death in the world and take a particularly heavy toll in third world countries. The purpose of this study was to describe cerebrovascular lesions (type, location, size) as well as patient age and gender in Cameroon. Brain CT-scan and MRI findings from 50 stroke patients admitted to two health centers in Douala were reviewed. Data showed that 74% of patients were over 50 years of age, the 51-60 year group being the most affected. Patients were male in 64% of cases. Ischemic stroke accounted for 60% of cases versus 40% for hemorrhagic stroke. The most affected sites were the sylvian territory site in ischemic stroke and the temporal lobe in hemorrhagic stroke, acconting for 43.3% and 35% of cases respectively. The median size of ischemic and hemorrhagic lesions were 2.81 cm3, and 26.98 cm3 respectively. Hemorrhagic stroke and lacunar infarcts were more common in this sample. Discrepancies between results at the two hospitals may be due to the use of different imaging techniques. Indeed, MRI is known to be more sensitive than CT-scan for acute detection of stroke lesions.

The purpose of this report is to describe two cases of pericardial effusion with pre-tamponade leading to diagnosis of underlying hypothyroidism. Both patients were women with large longstanding pericardial effusion. The first patient was 47-years-old and the second was 46. Diagnosis of hypothyroidism, whose clinical features were equivocal in the first case case and frank in the second, was confirmed by hormone tests. Treatment consisted of pericardial drainage and hormone replacement therapy with increasing doses. Outcome was favorable in both cases with restoration of euthyroidism. Clinical status was satisfactory in both cases with a follow-up of five months in the first patient and three months in the second. Pericardial effusion with pretamponade is an exceptional complication of prolonged hypothyroidism that should be considered in patients presenting with large longstanding but well tolerated pericardial effusion with no evidence of infection or inflammation.