Knowledge, Attitude, and Practice of Academic Students about STIs and HIV/AIDS at the University of Fianarantsoa: A Cross-Sectional Study

Introduction: Sexually transmitted infections (STIs) facilitate and increase the risk of HIV transmission. This paper focuses on evaluating the knowledge, attitude, and practice of academic students about sexually transmitted infections and HIV at the university of Fianarantsoa. Materials: An analytical cross-sectional study was conducted among the students at the Andrainjato University. Knowledge was assessed using a score of one point for each correct answer. Results: 1035 students were included and 67.7% (n=701) had good  knowledge about STIs and HIV/AIDS. The sexual transmission (83.9%; n=868) was the most commonly known. On multivariate analysis, being a student at the faculty of medicine (p<0.001, aOR 137.3 [19.1-988]), faculty of Letters (p<0.001, aOR 4.5 [2.8-7.2)]), or the Normal Graduate School  (NGS) (p<0.001, aOR 6.7 [3.3-13.7]), being tested for HIV before (p= 0.002, aOR 1.6 [1.2-2.2]), constituted the major factor of good knowledge about sexual infections. Majority (71.8%, n=743) have had sexual intercourse before, and the median age of their first sexual activities was  18 years (17-20). The use of Condom (44.4%, n=460) was the most practiced STIs prevention method. This is followed by fidelity (19.8%; n=205) and abstinence (11.4%, n=118). Among the students, 29.3% (302) had high-risk sexual behavior during the last three months. Conclusion: The proportion of academic students with good knowledge of STIs and HIV was not satisfying. There was also discordance between the knowledge of STIs prevention and the daily university practice of the students

Les aspergillomes pulmonaires: à propos de 37 cas à Madagascar

L'aspergillome pulmonaire est une colonisation par Aspergillus d'une cavité pulmonaire préformée. Nos objectifs étaient de définir le profil épidémio-clinique et thérapeutique des aspergillomes pulmonaires et essayer de dégager les facteurs favorisants de cette affection à Madagascar. Nous avons réalisés une étude prospective, descriptive, analytique durant 59 mois sur les aspergillomes pulmonaires à Antananarivo Madagascar. Etaient inclus dans cette étude les malades ayant un diagnostic d'aspergillome pulmonaire. Trente-sept (37) cas d'aspergillome pulmonaire étaient recensés parmi les 8 392 patients hospitalisés dans le service de Pneumologie (0,44%). Il s'agit de 29 hommes (78,38%) et 8 femmes (21,61%), d’âge moyen de 43 ans. Les facteurs prédisposant étaient dominés par la tuberculose pulmonaire (89,19%). Le délai moyen d'apparition de l'aspergillome chez les malades ayant un antécédent de tuberculose pulmonaire à bacilloscopie positive (TPM+) était de 8 ans et 6 mois avec un délai extrême de un mois à 23 ans. L'hémoptysie était le mode de révélation le plus fréquent (91,89%). Le traitement était médical chez 27 patients (72,97%) et médico-chirurgical chez 10 patients (27,03%). Vingt sept patients étaient perdus de vue (72,97%), et pour les 10 patients suivis (27,02%), 70% avaient une évolution favorable avec disparition des signes, et 30% présentaient des hémoptysies récidivantes. Le taux de mortalité postopératoire était de 4% et 50% des patients avaient des complications postopératoires. La surveillance des lésions séquellaires de tuberculose pulmonaire qui constituent les facteurs favorisants prédominant d'aspergillome pulmonaire à Madagascar nécessite une attention particulière. La prise en charge de la tuberculose doit être précoce et adaptée surtout dans les pays à forte prévalence tuberculeuse

Clinical Features and Outcome in Adult Cases of Tuberculous Meningitis in Tertiary Care Hospital in Antananarivo, Madagascar

Purpose. We aimed to describe and to assess prognosis factors in tuberculous meningitis in adult patients. Methods. We performed a retrospective study of case records of adult patients. Patients classified as definite, probable, or possible tuberculous meningitis according to standardized definition criteria were included and assessed in the study. Results. Seventy-five patients were included in the study. Tuberculous meningitis was classified as definite in 8 (10.7%), probable in 44 (58.7%), and possible in 23 patients (30.6%). HIV was found in 3% of patients. Patients were in advanced stages at admission in 82.7%. Median duration of symptoms prior to admission was 3 weeks (IQR: 2–5). Median time to diagnosis following admission was 5 days (IQR: 3–8). Median CSF WCC was 75 per mm3 with lymphocytic predominance in 38 cases (52.8%). Median CSF glucose level was 1.48 mmol/L and median CSF protein level was 1 g/L. Mortality rate was 28%. Age ≥ 35 years (aOR: 4.06; 95% CI: 1.16–14.26) and coma (aOR: 12.98; 95% CI: 1.13–149.16) predicted inpatient mortality. Conclusion. Most of the patients experienced more than 3 weeks of diagnostic delay prior to admission. Mortality was high and occurred early after admission. Age and coma were identified as independent prognosis factors

Description de la Qualité de Vie des Patients Présentant une Cardiomyopathie Dilatée

But. – Décrire la qualité de vie de patients présentant une cardiomyopathie dilatée hospitalisés au service de Cardiologie de l’Hôpital Joseph Raseta Befelatanana.Patients et Méthodes. – Nous avons effectué une étude prospective descriptive, basée sur 31 patients, sur une période de 8 mois allant du 15 mai 2017 au 15 janvier 2018 à l’aide du questionnaire Medical Outcomes Study Short Form SF-12.Résultats.  – La prévalence hospitalière de la cardiomyopathie dilatée était de 7,08%. L’âge moyen était de 56,74 ans avec une légère prédominance masculine. Vingt patients (64,52%) étaient en décompensation sur le mode global. Le diamètre télédiastolique moyen du ventricule gauche était de 63,95 mm.  Sur la qualité de vie, 48,39% se sentaient « un peu limité » au cours des efforts physiques modérés et 45,16% se sentaient être « beaucoup limités » à la réalisation des efforts physiques plus importants. Selon les 8 dimensions du SF-12, la santé psychique et la relation avec les autres se situaient au-dessus de la moyenne, contrairement à l’état physique qui était altéré. Le score résumé psychique était au-dessus de la moyenne (54,28±13,04), contrairement au score résumé physique (46,85±24,67).Conclusion. – La cardiomyopathie dilatée est une maladie qui altère la qualité de vie en particulier la santé physique. L’intégration de la réadaptation cardiaque dans la prise en charge de l’insuffisance cardiaque chronique à Madagascar pourrait pallier à ce problème.Mots-clés : Cardiomyopathie dilatée, Insuffisance cardiaque, Qualité de vie, Antananariv

An extensive arterial thrombosis with lower limb ischemia in a COVID‐19 patient: A case report

Key Clinical Message The coronavirus disease 2019 (COVID‐19) pandemic is responsible for huge morbidity and mortality throughout the world. Several serious complications of this disease have been reported. It can cause hypercoagulability, which may lead to venous and arterial thromboembolic diseases. This hypercoagulability state is also associated with high morbidity and mortality. Arterial thrombosis in COVID‐19 is poorly described compared to venous thrombosis and pulmonary embolism. We report a case of an extensive arterial thrombosis leading to a limb ischemia with extremely high D‐dimer in a COVID‐19 patient. A 69‐year‐old man was hospitalized for febrile dyspnea. He is a hypertensive and diabetic patient. On admission, pulse oxygen saturation was 72% on room air. He had cyanosis of the left foot up to the mid‐thigh. The left pedal, posterior tibial, popliteal and femoral pulses were abolished. Chest CT scan was in favor of COVID‐19. He has a high D‐dimer level of 257,344 ng/mL. Arterial Echo‐Doppler found an extensive intraluminal thrombus along the arterial axes of the left lower limb, completely obstructing them, starting from the primitive iliac artery just after its bifurcation with the aorta, and extending distally (external iliac; common femoral; superficial femoral; popliteal; anterior tibial; posterior tibial; fibular and pedal). The patient was diagnosed with COVID‐19 critical form, associated with ischemia of the left lower limb secondary to an extensive arterial thrombosis. He was receiving anticoagulation, and underwent surgical amputation of the ischemic limb. The patient survived the event; however, he was on long‐term oxygen therapy at home. Arterial thrombosis may occur during COVID‐19 and may be responsible for peripheral or central ischemia aggravating morbidity and mortality. The occurrence of these events is related to the D‐dimer value. Anticoagulation is an important part of the management of COVID‐19, especially in severe forms in order to limit the occurrence of these thromboembolic diseases

Urinary tract infection in diabetics hospitalized in Befelatanana Hospital, Antananarivo: Epidemiological, clinical, biological profiles and risk factors for multidrug‐resistant bacterial infection

Key Clinical Message The main type of urinary tract infection in hospitalized diabetics in Antananarivo is acute pyelonephritis; Escherichia coli is the most isolated uropathogen; imipenem, amikacin, fosfomycin and ceftriaxone are the major antibiotics for which Escherichia coli retain good sensitivity; Type 2 diabetes is predictive factor for infection by multidrug resistant bacteria. Abstract This study aimed to describe the epidemiological‐clinical profiles of diabetics hospitalized for bacterial urinary tract infections in the Endocrinology Department of Befelatanana Hospital, to identify the main bacteria responsible, their antibiotic sensitivity profile and the factors associated with multidrug‐resistant bacterial infection. A cross‐sectional study was conducted between March 2017 and March 2020 involving all diabetics hospitalized for documented community‐acquired bacterial urinary tract infection during this period. The hospital prevalence of urinary tract infections was 4.64%. The mean age of the patients was 59.06 ± 14.26 years and the sex ratio was 0.15. The main sign was fever (55.76%). The main clinical form was uncomplicated acute pyelonephritis (38.46%). Fifty‐seven bacterial uropathogens were isolated. The most frequent was Escherichia coli (77.19%). Escherichia coli was sensitive to ertapenem and nitrofurantoin in 100% of cases, to Amikacin in 97.5% of cases, to Fosfomycin in 94.4% of cases and to Ceftriaxone in 80.65% of cases. Thirteen patients were infected with multidrug‐resistant bacteria, all of them are extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae. Only the type of diabetes was associated with multidrug‐resistant bacteria infection. The epidemiological‐clinical and biological characteristics of urinary tract infections in our diabetics are similar to those reported in the literature. Compliance with the rules of proper antibiotic use is imperative to limit the emergence and spread of multidrug‐resistant bacteria

Hospitalization of HIV positive patients in a referral tertiary care hospital in Antananarivo Madagascar, 2010-2016: Trends, causes and outcome.

BACKGROUND:During the last few years, significant efforts have been made to improve access to antiretroviral therapy which led to dramatic reduction in AIDS-related events and mortality in HIV positive patients at the global level. However, current data in Africa suggested modest impact of widespread antiretroviral therapy scale-up especially regarding HIV-related hospitalization. In this study, we aimed to describe causes of hospitalization and factors associated with AIDS-defining events and inpatient mortality. MATERIALS AND METHODS:A retrospective study was performed on medical records of HIV positive patients admitted for at least 24 hours in the Infectious Diseases Unit of the University Hospital Joseph Raseta Befelatanana Antananarivo. Cause of hospitalization was considered as the main diagnosis related to the symptoms at admission. Diagnostic criteria were based on criteria described in WHO guidelines. AIDS-defining events were defined as diseases corresponding to WHO stage 4 or category C of CDC classification. RESULTS:From 2010 to 2016, 236 hospital admissions were included. AIDS-defining events were the most frequent cause of hospitalization (61.9%) with an increasing trend during the study period. Tuberculosis (28.4%), pneumocystis pneumonia (11.4%), cerebral toxoplasmosis (7.2%) and cryptococcosis (5.5%) were the most frequent AIDS-defining events. Tuberculosis was also the most frequent cause of overall hospitalization. In multivariate analysis, recent HIV diagnosis (aOR = 2.0, 95% CI: 1.0-3.9), CD4<200 cells/μl (aOR = 4.0, 95%CI: 1.9-8.1), persistent fever (aOR = 4.4, 95%CI: 2.1-9.0), duration of symptoms≥ 6 weeks (aOR = 2.6, 95%CI: 1.2-5.4) were associated with AIDS-defining events. Overall inpatient mortality was 19.5%. Age≥55 years (aOR = 4.9, 95%CI: 1.5-16.6), neurological signs (aOR = 3.2, 95%CI: 1.5-6.9) and AIDS-defining events (aOR = 2.9, 95%CI: 1.2--7.2) were associated with inpatient mortality. CONCLUSIONS:AIDS-defining events were the most frequent cause of hospitalization during the study period. Factors associated with AIDS-defining events mostly reflected delay in HIV diagnosis. Factors associated with mortality were advanced age, neurological signs and AIDS-defining events