Douleurs induites par les soins : la réalité au Centre Hospitalier Universitaire de Befelatanana Antananarivo, Madagascar

La douleur induite par les soins correspond à la douleur survenant lors des actes à visé diagnostique et/ou thérapeutique. A notre connaissance, nous n'avons pas encore des données disponibles pour les douleurs induites par les soins à l'Hôpital de Befelatanana. Nos objectifs étaient de décrire le profil épidémiologique de la douleur induite par les soins, d'identifier les principaux facteurs influençant sur l'intensité de la douleur et leurs retentissements chez les patients. Il s'agissait d'une étude rétrospective, transversale type un jour donné menée dans les douze services de Médecines au Centre Hospitalier Universitaire de Befelatanana en Novembre 2013. Cent deux patients ont été retenus dans l'étude et trois cent vingt trois actes douloureux étaient enregistrés soit une prevalence hospitaliere de 69,86%. Le genre féminin prédominait dans 52% des cas (n=53) avec un sex-ratio à 0,92. L'âge moyen était de 46 ans. Les ponctions vasculaires étaient l'acte prédominant dans 49,54% (n=109) des cas. Les infirmiers réalisaient les soins dans 47,05% (n=48) des cas. L'information verbale était la mesure préventive utilisée dans 57,84% des cas (n=59). Le transport par marche à pied et à dos d'homme représentait 16,67% des cas (n=17). Les patients naïfs des gestes étaient plus anxieux. Ces patients gardaient de mauvais souvenir dans 64,71% des cas (n=66). La fréquence de douleur induite par les soins était trop élevée. Un effort important est nécessaire pour réduire la douleur induite par les soins

Rosai-Dorfman Disease Involving Multiple Organs: An Unusual Case with Poor Prognosis

Rosai-Dorfman disease is a rare, benign histiocytic proliferative disorder that usually affects the lymph nodes. Although extranodal involvement has been reported in diverse sites, manifestation in the cardiovascular system is extremely rare. Specifically, cardiac involvement in Rosai-Dorfman disease is an extraordinarily infrequent event. We describe a case of a 36-year-old female who presented Rosai-Dorfman disease of multiple organs including the heart, with poor prognosis

Atopic dermatitis: A global health perspective

The International Society of AD (ISAD) organized a roundtable on global aspects of AD at the WCD 2023 in Singapore. According to the Global Burden of Disease (GBD) consortium, at least 171 million individuals were affected with AD in 2019, corresponding to 2.23% of the world population, with age‐standardized prevalence and incidence rates that were relatively stable from 1990 to 2019. Based on the panel experience, most AD cases are mild‐to‐moderate. Without parallel data on disease prevalence and severity, the GBD data are difficult to interpret in many regions. This gap is particularly important in countries with limited medical infrastructure, but indirect evidence suggests a significant burden of AD in low‐and‐medium resource settings, especially urban areas. The Singapore roundtable was an opportunity to compare experiences in World Bank category 1 (Madagascar and Mali), 3 (Brazil, China) and 4 (Australia, Germany, Qatar, USA, Singapore, Japan) countries. The panel concluded that current AD guidelines are not adapted for low resource settings and a more pragmatic approach, as developed by WHO for skin NTDs, would be advisable for minimal access to moisturizers and topical corticosteroids. The panel also recommended prioritizing prevention studies, regardless of the level of existing resources. For disease long‐term control in World Bank category 3 and most category 4 countries, the main problem is not access to drugs for most mild‐to‐moderate cases, but rather poor compliance due to insufficient time at visits. Collaboration with WHO, patient advocacy groups and industry may promote global change, improve capacity training and fight current inequalities. Finally, optimizing management of AD and its comorbidities needs more action at the primary care level, because reaching specialist care is merely aspirational in most settings. Primary care empowerment with store and forward telemedicine and algorithms based on augmented intelligence is a future goal

The diagnosis of fungal neglected tropical diseases (fungal NTDs) and the role of investigation and laboratory tests: An expert consensus report

The diagnosis of fungal Neglected Tropical Diseases (NTD) is primarily based on initial visual recognition of a suspected case followed by confirmatory laboratory testing, which is often limited to specialized facilities. Although molecular and serodiagnostic tools have advanced, a substantial gap remains between the desirable and the practical in endemic settings. To explore this issue further, we conducted a survey of subject matter experts on the optimal diagnostic methods sufficient to initiate treatment in well-equipped versus basic healthcare settings, as well as optimal sampling methods, for three fungal NTDs: mycetoma, chromoblastomycosis, and sporotrichosis. A survey of 23 centres found consensus on the key role of semi-invasive sampling methods such as biopsy diagnosis as compared with swabs or impression smears, and on the importance of histopathology, direct microscopy, and culture for mycetoma and chromoblastomycosis confirmation in well-equipped laboratories. In basic healthcare settings, direct microscopy combined with clinical signs were reported to be the most useful diagnostic indicators to prompt referral for treatment. The survey identified that the diagnosis of sporotrichosis is the most problematic with poor sensitivity across the most widely available laboratory tests except fungal culture, highlighting the need to improve mycological diagnostic capacity and to develop innovative diagnostic solutions. Fungal microscopy and culture are now recognized as WHO essential diagnostic tests and better training in their application will help improve the situation. For mycetoma and sporotrichosis, in particular, advances in identifying specific marker antigens or genomic sequences may pave the way for new laboratory-based or point-of-care tests, although this is a formidable task given the large number of different organisms that can cause fungal NTDs

Mucocutaneous Manifestations Among HIV-Infected Patients in Madagascar: Cross-Sectional Study

BackgroundMore than 90% of HIV-infected patients present with at least one mucocutaneous manifestation during the course of their disease. Insufficient data are available regarding dermatologic findings among HIV-infected patients in Madagascar. ObjectiveThis study aimed at evaluating the spectrum of mucocutaneous manifestations and their relationship with CD4 cell counts in HIV-infected patients in Madagascar. MethodsA cross-sectional study on HIV-positive patients attending the Department of Infectious Diseases in the University Hospital of Antananarivo in Madagascar was conducted from January 2013 to March 2020. HIV-positive patients older than 18 years and receiving antiretroviral therapy as well as those awaiting antiretroviral therapy commencement were included. ResultsAmong 328 patients enrolled in this study, 167 (51%) presented with at least one type of mucocutaneous lesion. Oral candidiasis was the most common presentation, followed by seborrheic dermatitis and Kaposi sarcoma. Decreases in CD4 cell counts were substantially correlated with oral candidiasis, syphilis, and condyloma acuminatum. ConclusionsAccording to our findings, oral candidiasis, syphilis, and condyloma acuminatum may serve as clinical indicators for predicting the immune status of patients. As HIV infection progressed and immune function declined, an increase in cutaneous manifestations was observed

Cutaneous Manifestations of Lupus Erythematosus in Antananarivo (Madagascar)

Introduction: Lupus erythematosus is a serious autoimmune inflammatory disease. Mucocutaneous manifestations are themain clinical manifestations, so our aim is to determine the different cutaneous manifestations of lupus erythematosus in Antananarivo.Methods: A retrospective study was conducted over a period of 5 years from January 2007 to December 2011 in the medical derpartment of Joseph Raseta Befelatanana University Hospital.. All patients who presented lupus erythematosus were included.Results: Among 57,509 patients seen in Joseph Raseta Befelatanana University Hospital, sixty seven cases of lupus erythematosus were included. The mean age was 35.08 years [minimum: 9; maximum: 69 years]. The sex ratio was 0.06. Among these 67 patients, forty six presented cutaneous manifestations (68, 65%). As specific lesions in lupus, chronic cutaneous lupus was observed in 47.82%, acute cutaneous lupus in 30.43% and subacute cutaneous lupus in 06.52% of patients. The other dermatological manifestations found were alopecia in 52.17%, photosensitivity in 43.47%, Raynaud's phenomenon in 17.39% and bullous lesions in 06.52% of patients.Conclusion: A little difference was found in epidemiological, clinical and paraclinical aspects in lupus Malagasy patients and Africans. Lupus erythematosus is still a under-diagnosed disease in Madagascar. A deeper understanding of the cutaneous manifestations of SLE is essential for diagnosis and prognosi

Molecular Diagnosis of Two Major Implantation Mycoses: Chromoblastomycosis and Sporotrichosis

International audienceChromoblastomycosis and sporotrichosis are the two main implantation mycoses that are now recognized as fungal neglected tropical diseases (NTDs). Their laboratory diagnosis mainly relies on direct microscopy, histopathology, and identification of the fungus by culture. However, to be appropriately used, these techniques require mycological expertise that is not widely available and may be absent in peripheral health care facilities in endemic areas. In addition, they lack sensitivity and specificity, and the culture for isolation and identification can have a long time-to-results period. Molecular methods, including matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), have been developed in well-equipped reference laboratories. They greatly improve the rapidity and accuracy of diagnosis; in particular, for species identification. Recently, PCR and sequencing have paved the way for more user-friendly point-of-care tests, such as those based on LAMP or RCA technologies, which can be used in basic healthcare settings and even in field consultations

Motifs d’Hospitalisation des Patients en Dermatologie à Antananarivo, Madagascar

Introduction: The Dermatology Department of the University Hospital Center of Befelatanana in Antananarivo deals with both outpatient and inpatient dermatoses. Two outpatient studies were conducted in 2001 and in 2006. But, this will be the first for Madagascar regarding hospitalization. So our aim is to determine the epidemiological-clinical profile of dermatoses seen in hospitalization.Patients and methods: This descriptive retrospective study was conducted from 1 February 2006 to 28 February 2012 in Dermatology department at the University Hospital Befelatanana. The register of hospital consultants and files were used to fill out data collection form.Results : We collected 286 patients seen in the Dermatology department. The mean age was 37.70 years (5- 98 years) with a sex ratio 0.49. Our study showed the importance of autoimmune diseases (33.3%) that are dominated by systemic lupus erythematosus (n = 51). It is a serious chronic pathology evolving by push. The management of severe toxidermia (25,1%) is done in hospital as in any other country. The mean duration of hospitalization was 34 days. The mortality rate was 3.49%.Conclusion: The serious forms of dermatological pathologies require management in hospital.

Observance Thérapeutique Au Cours Des Dermatoses Chroniques A Madagascar

Introduction: Therapeutic compliance is the adequacy of the patient's behavior regarding medical recommendations. In Madagascar, No survey has not yet been published in that regard. Thus, our purposes are to determine the compliancy rate of patients with chronic diseases in dermatology and to identify the factors affecting their therapeutic compliance.Methods: Monocentric descriptive and retrospective study performed in the dermatology department of Joseph Raseta Befelatanana University Hospital center, On a 6 months duration, among patients with chronic dermatoses.Results: We counted 133 patients with a compliancy rate of 35.34%. Several parameters particularly age, gender, educational level, salary, understanding of pathology and treatment, duration of follow-up, were considered and correlated with the rate of compliance to assess factors of good and bad compliance.Conclusion: In order to improve the therapeutic observance in care unit, It is necessary to intervene on the standard of living of the patients suffering from chronic dermatoses and to promote the therapeutic education accompanied by psychological support to make them understand their pathology as well as the appropriate treatment

A Case of Fluoroquinolone-Resistant Leprosy Discovered after 9 Years of Misdiagnosis

We report a case of misdiagnosed leprosy in a 21-year-old Malagasy male, who, improperly treated, developed secondary mycobacterial resistance to fluoroquinolone. The patient contracted the infection 9 years prior to the current consultation, displaying on the right thigh a single papulonodular lesion, which progressively spread to the lower leg, back, and face. Initial administration of ciprofloxacin and prednisolone led to temporary and fluctuating improvement. Subsequent long-term self-medication with ciprofloxacin and corticosteroid did not heal the foul and nonhealing ulcers on the legs and under the right sole. Histopathological findings were compatible with lepromatous leprosy. Skin biopsy was positive for acid-fast bacilli and PCR assay confirmed the presence of a fluoroquinolone-resistant strain of Mycobacterium leprae (gyrA A91V). After 6 months of standard regimen with rifampicin, clofazimine, and dapsone, clinical outcome significantly improved. Clinical characteristics and possible epidemiological implications are discussed