Atypical presentation of a pediatric Pyoderma gangrenosum in an immunocompetent child: Case report

Pyoderma gangrenosum is relatively rare in the pediatric population with only 4% cases, the most common presentation in children is in the form of disseminated ulcerative lesions. The pathophysiology of PG is still poorly understood. Its diagnosis is often delayed, with an average of 2 months; This is explained by the low prevalence of the disease in children and the fact that it is misdiagnosed on the one hand and by confusion with an ecthymagangrenosum. The PG is in fact a diagnosis of exclusion in histology; non-specific aseptic neutrophil infiltration, once the diagnosis of pediatric PG has been confirmed, the search for an underlying etiology should be undertaken. In our case, the balance of immune deficiency was normal

Incidence of Insomnia in OSA patients and its correlations with parameters of polysomnography

Background/Aims: Prevalence of insomnia in obstructive sleep apnoea (OSA) patients has been estimated in many studies and has been found to be a frequent symptom (38% in a recent review 1).Our study aims to estimate the incidence of insomnia in Greek patients presenting to a public hospital sleep clinic, and correlate it with the severity of OSA and parameters of polysomnography (PSG). Methods: 100 patients who visited the sleep unit of the General Hospital ‘Evangelismos’ completed the Athens Insomnia Scale (AIS) and underwent a polysomnographic study. 56% were men, with mean age 54,7±12,5 years and BMI 31,5±6,2. Results: 70% of patients had insomnia. Insomnia (AIS≥6) and OSA (AHI≥5) were coexistent in 71,4 %. There was no correlation between insomnia and severity of OSA. A strong positive correlation was found/evident between difficulty in initiating sleep and number of hypopneas (r: 0,20 p:0,049), diminished functioning during the day and leg movements (r:0,21 p:0,050) and between daytime sleepiness and wake after sleep onset (WASO) (r:0,2 p:0,038). A negative correlation was found between overnight awakenings and sleep efficiency (r: -0,23 p: 0,021). Also, negative correlation was found between early morning awakening and minimum SpO2 (r=0.27, p=0,021), and between insufficient duration of sleep (r:-0,22 p: 0,021) and minimum SpO2. Conclusions: We found a high incidence of insomnia in patients with OSA, which does not correlate with severity of OSA. Contrary to many other studies, insomnia was not more common in women. More studies are required to clarify the significance of the positive correlation between insomnia and number of hypopneas and minimum SpO2

Knowledge sharing practice and associated factors among health care workers at Health facilities, in Gonji Kolella District, West Gojjam Zone zone, North West Ethiopia

Introduction: Even though knowledge sharing is an important strategic resource for organizational success, poor practice of knowledge sharing is a problem in health care facilities. Though most of the health care worker were aware, willing and have an intrinsic motivation to share their knowledge, they practiced it poorly. Hence, assessing the knowledge sharing practice and associated factors among health care workers are important to take appropriate action. Methods: An institutional based cross-sectional quantitative study supported with qualitative data was conducted in selected public health centers Gonji Kolella district from February30 to March30/2014. A total of 291 health workers for the quantitative data and 10 department heads were interviewed for the qualitative part. Logistic regression was used to assess the presence of association between dependent and independent variables using SPSS at 95% CI and 5% margin of error. Results: the study revealed that level of knowledge sharing among health care workers in the selected hospitals was 41.9%. Knowledge sharing opportunity (AOR = 2.65, 95% CI = [1.17-6.01], access to technology (AOR=2.27, 95% CI= [1.17-4.40], familiarizing health care workers to technology (AOR=3.23, 95%CI= [1.28-8.12] and trust on others’ knowledge (AOR =4.78, 95% CI = [1.73-13.22] were independent predictors for knowledge sharing practice. Conclusion: Even though most of the participants were aware, willing and have an intrinsic motivation to share their knowledge, they practiced it poorly for several reasons. The identified main determinants are access to ICT infrastructure, familiarization to available technologies, trust on others’ knowledge and knowledge sharing opportunity. Health center should enhance trusting relationship among health care workers, create knowledge sharing opportunity, avail technological infrastructure and familiarize health care workers to technology to increase knowledge sharing in the organization

How to Train yourself to be Healthier by Best Breathing!

Breathing is so natural that the "best way to breathe" has never been identified or promoted as such.  Having episodes of  life-threatening laryngospasm prompted research and study on breathing, resulting in the discovery that nasal inhaling is "best" by shutting one's mouth and concentrating on getting more oxygenation.  "SAM More Oxygen" describes the "best way to breathe:   SHUT your mouth.  AIR in thru nose.  MOUTH exhale or stay shut or cough harshly to clear throat and lungs" (but when doing a series of SAMs, cough harshly every third and fourth time to help clean your lungs and larynx)."  The discovery occurred while in laryngospasm.  Intensely aware of the miserable duration of previous barely effective horrible mouth clearing trying-to-breathe efforts, a conscious decision of "I am not going to go thru this again because it is torture", the mouth was shut against all natural impulses to use mouth breathing to clear my choking laryngospasm; and, amazingly, air inhalation thru the nose occurred enabling a strong cough which opened the airway; repeating the sequence many times enabled calmer more efficient return to normal breathing. The process was quickly called "SAM" and it worked every time ever since. It went into medical publication and many grateful letters were received from people who found it giving relief never before as fast or effective. Since then, research and study of breathing clearly shows the SAM More Oxygen will help many medical problems and maintain good health.   But you need to practice it over and over to remember to do it.  Regular breathing automatically returns but it is not "best breathing." When relaxing watching T.V. or on your computer, best breathe by gentle SAMs.  Do a few when you wake up every morning--get a little more oxygen to help wake up and energize for the day.  Remind each other too to SAMMO

PRISE EN CHARGE DES LEUCEMIES AIGUES DE L’ADULTE VUES AU CHU JOSEPH RAVOAHANGY ANDRIANAVALONA ANTANANARIVO MADAGASCAR “TREATMENT OF ADULTS ACUTE LEUKEMIA VIEWS AT THE UNIVERSITY HOSPITAL CENTER JOSEPH RAVOAHANGY ANDRIANAVALONA (CHUJRA) ANTANANARIVO”

Introduction: Acute leukemia is a rare but serious disease affecting both children and adults. It represents 15% of malignant hemopathies in Madagascar. Its evolution is quickly fatal in the absence of fast and specific care. The objective of our study is to describe the diagnostic and therapeutic management of adult acute leukemias in Madagascar in order to improve the prognosis. Method: It wasa retrospective, descriptive study performed in the Oncology Department of CHUJRA for 5 years (January 2013 to December 2017). Patients over 15 years old with acute leukemia were included. Results: Of the 47 cases collected, 37 were selected including 8 cases of ALL and 29 cases of AML, with a male predominance (sex ratio 2.26), an average age of 30.5 years mainly affecting the age group included between 30 and 39 years old. The main clinical signs were the signs of anemia (92%), followed by the infectious syndrome (59%), the haemorrhagic syndrome (49%), the extra-haematological locations (49%) and the tumor syndrome (30%). The hemogram confirmed signs of bone marrow failure with anemia in 89%, leukocytosis in 59%, leukopenia in 19%, neutropenia in 41% and thrombocytopenia in 92%. At the cytological level, MAHs predominated (78% with 34% M1 subtype) compared to ALL (22% with 87% L2 subtype). The treatment was exclusively symptomatic in 70% of the cases, and 30% of the patients benefited from chemotherapy, palliative for the majority. Survival time ranged from 20 to 154 days for chemotherapy patients versus 5 to 90 days for the rest. However, a significant proportion of discharges against medical advice (49%), lost to follow-up (8%) limited the evaluation of the evolution of the disease. Conclusion: Faced with a real difficulty in the management of acute leukemias in Madagascar, improving the prognosis requires an improvement of the technical plateau

EVALUATION DU TEST GENEXPERT MTB/RIF DANS LA PRISE EN CHARGE DIAGNOSTIQUE DE LA TUBERCULOSE AUX CHU BEFELATANANA ET FENOARIVO

Résumé: Introduction: Nous avons réalisé ce travail pour évaluer l’apport du test GeneXpert MTB/RIF dans le diagnostic de la tuberculose toute localisation confondue, la tuberculose pulmonaire à bacilloscopie négative (TPB-) et la tuberculose pleurale dans deux services de Pneumologie de deux Centres Hospitaliers Universitaires à Antananarivo. Méthodes: Il s’agit d’une étude rétrospective transversale descriptive et analytique de Janvier 2016 à Mars 2019 réalisée chez des patients suspects de tuberculose dans les deux services. Résultats: Deux cent vingt-et-un (50.92%) patients ont été retenus pour l’étude du test GeneXpert MTB/RIF pour la tuberculose toute forme confondue. Les prélèvements pulmonaires représentaient 81% des prélèvements totaux et le reste sont d’origine extra-pulmonaire. La bacilloscopie était positive dans 60.13% (N=153) des cas aux Centre de Diagnostic et de Traitement (CDT), et dans 72% (N=136) des cas dans les laboratoires de référence. Le test GeneXpert MTB/RIF a trouvé 57.72% (N=221) de résultats positifs. Une résistance à la rifampicine a été retrouvée chez 5 patients. Trente-quatre (75.5%) des 45  résultats de culture colligés étaient positifs. Pour tous les prélèvements, le test GeneXpert MTB/RIF a trouvé plus de résultats positifs que la bacilloscopie, et ses résultats ont été tous confirmés par la culture. La valeur de p est significative (<0.05) pour la comparaison des tests des crachats. Cinquante (11.52%) patients ont été inclus dans l’étude du test GeneXpert MTB/RIF pour la TPB-. Les résultats positifs trouvés par une deuxième bacilloscopie dans les laboratoires de référence et le test GeneXpert MTB/RIF sont respectivement de 12.5% et de 58% chez des patients ayant eu au préalable une bacilloscopie négative aux CDT. Pour l’étude de l’apport du test GeneXpert MTB/RIF dans le diagnostic de la pleurésie tuberculeuse, nous avons trouvé les valeurs de la sensibilité, la spécificité, la valeur prédictive positive (VPP) et la valeur prédictive négative (VPN) pour le liquide pleural respectivement de: 20%, 100%, 100% et 62.5%, et pour la pièce biopsique pleurale respectivement de : 15%, 100%, 100% et 58.82% en considérant l’examen anatomo-pathologique comme examen de référence. Conclusion: Le test GeneXpert MTB/RIF est très performant pour le diagnostic de la tuberculose pulmonaire mais l’est moins pour le diagnostic de la tuberculose extra-pulmonaire. Mots-clés: GeneXpert MTB/RIF, diagnostic, tuberculose, TPB-, pleurésie tuberculeuse   Abstract: Introduction: We have realied this study to evaluate GeneXpert MTB/RIF’s part in the diagnosis of all areas combined tuberculosis, pulmonary tuberculosis with negative microscopy and pleural tuberculosis in two Pneumology departments of  two university hospital centers in Antananarivo. Methods: It is a descriptive and analytic retrospective cross-sectionnal study from January 2016 to March 2019 done in patients where tuberculosis was suspected in the two departments. Results: Two hundred and twenty-two (50.92%) patients were selected for GeneXpert MTB/RIF study for all areas combined tuberculosis. The pulmonary samples represented 81% of all samples and the restis from extra-pulmonary origins. The microscopy was positive in 60.13% (N=153) of the cases in the Diagnosis and Treatment Centers, and in 72% (N=136) of the cases in the reference laboratories. The GeneXpert MTB/RIF test has found 57.72% (N=221) positive results. A resistance to rifampicine has been found in 5 patients. Thirty-four (75.5%) of the 45 gathered culture results were positive. For all samples, the GeneXpert MTB/RIF has found more positive results than the microscopy, and its results were all confirmed by the culture. P-value was significant (<0.05) for sputum tests. Fifty (11.52%) patients were included in the GeneXpert MTB/RIF study of negative microscopy pulmonary tuberculosis. The positive results found by a second microscopy in the reference laboratories and the GeneXpert MTB/RIF test were  respectively 12.5% and 58% in patients having previously had a negative microscopy in the Diagnostic and Treatment Center. For the GeneXpert MTB/RIF’s contribution in pleural tuberculosis’diagnosis, we have found respectively a sensitivity, a specificity, a positive predictive value, a negative predictive value for pleural fluid of : 20%, 100%, 100% and 62.5% and for pleural biopsy of : 15%, 100%, 100% and 58.82% by considering histology as gold standard. Conclusion: The GeneXpert MTB/RIF test is a very effective tool for pulmonary tuberculosis diagnosis but less effective for extra-pulmonary tuberculosis diagnosis

Infections in children sickle followed in the outpatient at UPFR Hematology HJRA Antananarivo Madagascar “Infections chez les enfants drépanocytaires suivis en consultation externe à l’UPFR Hématologie HJRA Antananarivo Madagascar”

Résumé: Introduction: Les infections sont responsables d’une part importante de morbi-mortalité chez les enfants drépanocytaires. Notre objectif est d’évaluer le profil épidémio-clinique des infections chez les enfants drépanocytaires suivis en consultation externe. Matériels et méthodes: Nous avons réalisé une étude rétrospective  sur 56 enfants drépanocytaires fébriles sur une période de 6 mois (Janvier- Juin 2015). Nous avons analysé les caractéristiques cliniques et paracliniques de ces enfants drépanocytaires. Résultats: La tranche d’âge de 0 à 5 ans était la plus touchée. Le suivi était irrégulier chez tous nos patients. Sur le plan clinique, 4 cas de Streptococcus pneumoniae, 1 cas de Mycobactérium tuberculosis et 1 cas de Plasmodium falciparum ont été diagnostiqués. L’antibiothérapie probabiliste dans la majorité des cas était basée sur les céphalosporines de 3ème génération. L’évolution était  favorable dans 85,71% des cas. Conclusion: Les complications infectieuses sont fréquentes chez les enfants drépanocytaires à Madagascar. Mots clés : drépanocytose, enfants, infections, Madagascar  Abstract: Introduction: The infections are responsible for a large share of morbidity and mortality in sickle cell children. Our objective is to evaluate the epidemiological and clinical profile of infections in children with sickle cell disease outpatients. Materials and Methods: We perfomed a retrospective study of 56 febrile affected children on a 6 month period (January – June 2015). We analyzed the clinical and laboratory characteristics of these affected children. Results: The age groups of 0-5years were the most affected. Follow up was irregular in all our patients. Clinically, 4 cases of Streptococcus pneumonia, 1 case of Mycobacterium tuberculosis and 1 case of Plasmodium falciparum were diagnosed. The empiric antibiotic therapy in the majority of cases was based on the 3rd generation cephalosporins. The outcome was favorable in 87,5% of cases. Conclusion: Infectious complications are common among affected children in Madagascar.  Keywords: sickle cell anemia, children, infections, Madagasca

LEUCEMIE MYELOIDE CHRONIQUE CHEZ UN NOURRISSON VU AU SERVICE D’HEMATOLOGIE ONCOLOGIE DU CHUJRA ANTANANARIVO “CHRONIC MYELOID LEUKEMIA IN A INFANT SEEN AT THE SERVICE OF HEMATOLOGY ONCOLOGY OF CHUJRA ANTANANARIVO”

Introduction: Chronic myelogenous leukemia (CML) is a myeloproliferative disorder due to monoclonal myeloid proliferation without maturation blockade, predominant in the granular lineage. Our goal is to report a case of chronic myeloid leukemia in an infant to clarify the particularity of management and follow-up. Observation: This was an 18-month-old male infant who was referred for splenomegaly. The blood count showed leukocytosis at 450Giga / L with balanced myelemia. The Philadelphia chromosome was positive for cytogenetic examination of the bone marrow. The patient had received specific treatment with Imatinib. Clinical and haematological remission was obtained after 2 months of treatment. No side effects were noted. Discussion: Chronic myelogenous leukemia is rare in infants. The therapeutic protocol in children is not yet standardized but only obtained from that of the adult. Management requires increased surveillance to try to detect early side effects, especially stunting. Conclusion: Our patient is the first, youngest diagnosed with chronic myeloid leukemia in Madagascar. Treatment evolution was favorable, but long-term side effects remain to be monitored.   Keywords: Chronic myelogenous leukemia, infant, tyrosine kinase inhibitor, Madagasca

Diuretic-Resistant Edematous Syndrome in Heart Failure: Look for Hypothyroidism

Postpartum thyroiditis occurs in women after delivery and can cause both thyrotoxicosis and hypothyroidism. We report the case of a 29 years old female patient who presented with dyspnea, ascites and asthenia two months after delivery. It was a heart failure with a reduced left ventricular ejection fraction (LVEF = 36%) and a mild systolic pulmonary artery hypertension (sPAP = 37,3 mmHg) contrasting with very significant and persistent congestive signs in spite of diuretic treatment. Cardiovascular risk was low. The thyroid tests showed hypothyroidism (TSH = 8,1 mUI/l, T4L = 2,9 pmol/l). Improvement in general condition of the patient and congestive signs were obtained five days after a levothyroxine therapy. Thyroid biological test should be part of the etiological research of heart failure in the peripartum period, especially when the patient’s cardiovascular risk is low

Assessment of iron Parameters and Transient Elastography (FibroScan) Pattern amongPatients with Chronic Viral Hepatitis Infection in Jos, Nigeria

Background:The long-termeffect of excess iron deposition in the liver include fibrosis and cirrhosis which may progress to hepatocellular carcinoma. We assessed iron parameters among patients with chronic viral hepatitis B and C infection (CVHBI; CVHCI) to determineif any correlation existed with the degree of fibrosis in the liver. Methods: A cross-sectional descriptive study was carried out on 186 patients, made up of 132 patients withCVHBI and 54 patients with CVHCI. Serum ferritin and C-reactive protein were done by ELISA, serum iron and total iron binding capacity (TIBC) by colorimetric technique while transferrin saturation (Tsat) was calculated using serum iron and TIBC values. Liver fibrosis was assessed using fibroscan.Obtained data wereanalysed using SPSS version 20 and p values < 0.05 were considered statistically significant.  Results: The mean values for serum ferritin, iron, TIBC and Tsat were 218.1±325.6µg/L, 25.1±22.8µmol/L, 71.13 ± 35.92µmol/L and 45.2 ± 49.9% respectively. There were no significant differences in iron parameters between patients with CVHBI and CVHCI. Elevated serum ferritin was found in 15.2% and 20.4% of CHBVI and CHCVI patients respectively; while an elevated Tsat was seen in 22.7% and 24.1% of CHBVI and CHCVI patients respectively. Using a combination of elevated serum ferritin and Tsat, the prevalence of iron overload was found to be1.6%. Fibroscan scores did not differ significantly between patients with orwithout elevated iron parameters. Conclusion:Chronic viral hepatitis infection is associated elevated iron parameters though withminimal effect on liver fibrosis. Conflict of interest: Ni