Epidemiological, clinical and therapeutic profile of the umbilical cord prolapse at the Befelatanana University Hospital Centre of Obstetric Gynecology in Antananarivo, Madagascar

Background: Umbilical cord prolapse is a major obstetrical emergency that threatens the fetal prognosis during labor. The objective of this study was to describe the epidemiologic and clinical profile of pulsatile cord prolapse at the Befelatanana University Hospital of Obstetric Gynecology.Methods: It is about a retrospective cross-sectional study conducted at the Befelatanana University Hospital of Obstetrics and Gynecology in Antananarivo over a period of 3 years, from January 1st, 2012 to December 31st, 2014. We have identified all cases of umbilical cord prolapse. We studied obstetric, neonatal and maternal parameters.Results: We found 70 cases of pulsatile umbilical cord prolapse, a prevalence of 0.28% of deliveries. The average age of the patients was 28 ± 3.2 years with extremes ranging from 18 to 43 years. Multiparous women predominated with (51.43%) Pregnancy was long term, with 71.43% of cases associated with placenta praevia, lateral prolapse of the limb, long cord and contracted pelvis. The prolapse of the cord was 1st degree with 44.29% of cases. All patients had received (100%) of oxygen therapy. Almost all patients were caesarized (95.71%). Neonatal complications were represented by admission to neonatal intensive care unit (32.86%), perinatal asphyxia (31.43%), prematurity (28.57%), neonatal infection (4.29%) and neonatal death (10%).Conclusions: The umbilical cord prolapse is relatively rare. Fetal extraction in the shortest possible time, especially when the cord is externalized, which is the main determining factor of neonatal prognosis

Self-medication with oral contraceptives in the Urban District of Antananarivo

Background: Oral contraception is the second hormonal contraceptive method most used in the world. Currently, self-medication with oral contraceptives experienced resurgence, most often with no medical supervision. This study aims to estimate the prevalence of self-medication with oral contraceptives, identify the socio-economic status and identify the reasons why women aged 21 to 49 of the Urban District of Antananarivo (UDA) practice self-medication with oral contraceptives.Methods: A cross-sectional survey was conducted, where an interviewer-administered questionnaire has been used to collect data. Targeted female respondents aged 21-49 were asked about their contraceptive use during the twelve months preceding the survey.Results: Self-medication prevalence rate is 59.1%, considering oral contraception users. Moreover, it is higher among married women, those aged <36, less educated and having more than two children. Financial problem, affordability of the pills, former use of pills and information by their surroundings are the reasons why women self-medicate. Women who received a medical prescription at the first take of the pills are more likely to presently practice self-medication.Conclusions: This study demonstrates the evidence of a high prevalence of self-medication in the UDA. Self-medication can be harmful: the fight against its risks should get reinforced

Challenges in Diagnosing Paediatric Malaria in Dar es Salaam, Tanzania.

Malaria is a major cause of paediatric morbidity and mortality. As no clinical features clearly differentiate malaria from other febrile illnesses, and malaria diagnosis is challenged by often lacking laboratory equipment and expertise, overdiagnosis and overtreatment is common. Children admitted with fever at the general paediatric wards at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania from January to June 2009 were recruited consecutively and prospectively. Demographic and clinical features were registered. Routine thick blood smear microscopy at MNH was compared to results of subsequent thin blood smear microscopy, and rapid diagnostics tests (RDTs). Genus-specific PCR of Plasmodium mitochondrial DNA was performed on DNA extracted from whole blood and species-specific PCR was done on positive samples. Among 304 included children, 62.6% had received anti-malarials during the last four weeks prior to admission and 65.1% during the hospital stay. Routine thick blood smears, research blood smears, PCR and RDT detected malaria in 13.2%, 6.6%, 25.0% and 13.5%, respectively. Positive routine microscopy was confirmed in only 43% (17/40), 45% (18/40) and 53% (21/40), by research microscopy, RDTs and PCR, respectively. Eighteen percent (56/304) had positive PCR but negative research microscopy. Reported low parasitaemia on routine microscopy was associated with negative research blood slide and PCR. RDT-positive cases were associated with signs of severe malaria. Palmar pallor, low haemoglobin and low platelet count were significantly associated with positive PCR, research microscopy and RDT. The true morbidity attributable to malaria in the study population remains uncertain due to the discrepancies in results among the diagnostic methods. The current routine microscopy appears to result in overdiagnosis of malaria and, consequently, overuse of anti-malarials. Conversely, children with a false positive malaria diagnosis may die because they do not receive treatment for the true cause of their illness. RDTs appear to have the potential to improve routine diagnostics, but the clinical implication of the many RDT-negative, PCR-positive samples needs to be elucidated.\u

Comparison of Marine Spatial Planning Methods in Madagascar Demonstrates Value of Alternative Approaches

The Government of Madagascar plans to increase marine protected area coverage by over one million hectares. To assist this process, we compare four methods for marine spatial planning of Madagascar's west coast. Input data for each method was drawn from the same variables: fishing pressure, exposure to climate change, and biodiversity (habitats, species distributions, biological richness, and biodiversity value). The first method compares visual color classifications of primary variables, the second uses binary combinations of these variables to produce a categorical classification of management actions, the third is a target-based optimization using Marxan, and the fourth is conservation ranking with Zonation. We present results from each method, and compare the latter three approaches for spatial coverage, biodiversity representation, fishing cost and persistence probability. All results included large areas in the north, central, and southern parts of western Madagascar. Achieving 30% representation targets with Marxan required twice the fish catch loss than the categorical method. The categorical classification and Zonation do not consider targets for conservation features. However, when we reduced Marxan targets to 16.3%, matching the representation level of the “strict protection” class of the categorical result, the methods show similar catch losses. The management category portfolio has complete coverage, and presents several management recommendations including strict protection. Zonation produces rapid conservation rankings across large, diverse datasets. Marxan is useful for identifying strict protected areas that meet representation targets, and minimize exposure probabilities for conservation features at low economic cost. We show that methods based on Zonation and a simple combination of variables can produce results comparable to Marxan for species representation and catch losses, demonstrating the value of comparing alternative approaches during initial stages of the planning process. Choosing an appropriate approach ultimately depends on scientific and political factors including representation targets, likelihood of adoption, and persistence goals

New Insight into the Antifibrotic Effects of Praziquantel on Mice in Infection with Schistosoma japonicum

Schistosomiasis is a parasitic disease infecting more than 200 million people in the world. Although chemotherapy targeting on killing schistosomes is one of the main strategies in the disease control, there are few effective ways of dealing with liver fibrosis caused by the parasite infection in the chronic and advanced stages of schistosomiasis. For this reason, new strategies and prospective drugs, which exert antifibrotic effects, are urgently required.-induced liver fibrosis was inhibited by PZQ treatment for 30 days. Furthermore, we analyzed the effects of praziquantel on mouse primary hepatic stellate cells (HSCs). It is indicated that mRNA expressions of Col1α1, Col3α1, α-SMA, TGF-β, MMP9 and TIMP1 of HSCs were all inhibited after praziquantel anti-parasite treatments.The significant amelioration of hepatic fibrosis by praziquantel treatment validates it as a promising drug of anti-fibrosis and offers potential of a new chemotherapy for hepatic fibrosis resulting from schistosomiasis

A new world malaria map: Plasmodium falciparum endemicity in 2010

Background: transmission intensity affects almost all aspects of malaria epidemiology and the impact of malaria on human populations. Maps of transmission intensity are necessary to identify populations at different levels of risk and to evaluate objectively options for disease control. To remain relevant operationally, such maps must be updated frequently. Following the first global effort to map Plasmodium falciparum malaria endemicity in 2007, this paper describes the generation of a new world map for the year 2010. This analysis is extended to provide the first global estimates of two other metrics of transmission intensity for P. falciparum that underpin contemporary questions in malaria control: the entomological inoculation rate (PfEIR) and the basic reproductive number (PfR). Methods: annual parasite incidence data for 13,449 administrative units in 43 endemic countries were sourced to define the spatial limits of P. falciparum transmission in 2010 and 22,212 P. falciparum parasite rate (PfPR) surveys were used in a model-based geostatistical (MBG) prediction to create a continuous contemporary surface of malaria endemicity within these limits. A suite of transmission models were developed that link PfPR to PfEIR and PfR and these were fitted to field data. These models were combined with the PfPR map to create new global predictions of PfEIR and PfR. All output maps included measured uncertainty. Results: an estimated 1.13 and 1.44 billion people worldwide were at risk of unstable and stable P. falciparum malaria, respectively. The majority of the endemic world was predicted with a median PfEIR of less than one and a median PfRc of less than two. Values of either metric exceeding 10 were almost exclusive to Africa. The uncertainty described in both PfEIR and PfR was substantial in regions of intense transmission. Conclusions: the year 2010 has a particular significance as an evaluation milestone for malaria global health policy. The maps presented here contribute to a rational basis for control and elimination decisions and can serve as a baseline assessment as the global health community looks ahead to the next series of milestones targeted at 20

Pachycondyla Rakotonirina and Fisher, sp. nov.

Pachycondyla nosy Rakotonirina and Fisher, sp. nov. (Figures 5, 15, 52, 53, 54, 76) Holotype worker: Madagascar, Antsiranana, Makirovana Forest, -14.1707, 49.9541, 415 m, 28 Apr 2011, ex rotten log (B.L. Fisher et al.) collection code: BLF26582, specimen code: CASENT0231239 (CASC). WORKER. Diagnosis: Anterior margin of clypeus wide and straight, weakly medially notched; eyes medium, with 14 ommatidia; metanotal groove an incomplete dotted line; numerous slender erect hairs lacking and pubescence reduced from posterior face of petiole node; anterior surface of third abdominal segment straight, not forming a shallow impression; antennal scape and outer surface of each tibia covered with long, erect hairs. Measurements (1 specimen): HW: 1.44, HL: 1.62, CI: 89, SL: 1.25, SI: 87, PW: 1.09, WL: 2.34, NH: 0.76, NL: 0.58, NW: 0.80, DNI: 138, LNI: 131. Description: Head rectangular, broadest at midlength; posterior cephalic margin more or less straight. Head dorsum densely and finely reticulate-punctate; lateral section generally punctate and sparsely punctulate toward lateroventral angle. Eyes medium, with 14 ommatidia, and located at anterior fourth of head when viewed from the front. Antennal scape short, not reaching posterior cephalic margin; scape with long, erect hairs roughly equal in length to its maximum diameter. Anterior clypeal margin broadly straight, with weak median notch. Mandibles sparsely punctate with a smooth and shiny surface. With mesosoma in dorsal view, metanotal groove a simple, shallowly dotted line; in lateral view, dorsal outline roughly a continuous line; mesopleural suture obsolete; posterior margin of propodeum narrowly lamellate and projecting into a blunt angle near midlength. In dorsal view, promesonotum with reticulate-punctulate sculpture close to dorsolateral angles and punctate towards the midline; propodeum punctulate. Petiole nodiform, with convex posterior margin in lateral view; in dorsal view, posterior margin slightly convex, anterior margin broadly rounded; sculpture coarsely punctate. Anterior face of first gastral segment straight, not forming a shallow cavity. First two gastral tergites rugulose punctate, with smooth and shiny spaces between coarse punctures. Erect standing hairs present; pubescence abundant on head dorsum and promesonotum and sparse on the rest of body dorsum. Body color dark red, with brown tip of gaster and appendages. QUEEN. Measurements (2 specimens): HW: 1.65-1.68, HL: 1.74-1.75, CI: 95-96, SL: 1.35-1.36, SI: 80- 83, PW: 1.35-1.38, WL: 2.56, NH: 0.80-0.88, NL: 0.55-0.60, NW: 0.86-0.89, DNI: 147-155, LNI: 144-146. Two winged queens were captured using malaise traps from the montane humid forests in the north and in the central eastern Madagascar. They have the usual characteristics of alate queens, including three ocelli, developed thoracic sclerites, more abundant standing slender hairs; much broader head, and a wider, more anteroposteriorly flattened petiolar node. Distribution and biology: Pachycondyla nosy is known from northeastern Madagascar, where a colony nest was found in a rotten log in Makirovana Forest. The species also occurs in the disjunct montane rainforests of the PN Montagne d’Ambre and the PN Andasibe (Fig. 76), where two alate queens were recorded from malaise traps. Additional material examined: Province Antsiranana: PN Montagne d'Ambre [Petit Lac road], 1125 m, montane rainforest (R. Harin'Hala) (CASC); Province Toamasina: 7 km SE PN Andasibe Headquarters, 1050 m, montane rainforest (R. Harin'Hala) (CASC).Published as part of Rakotonirina, J. C. & Fisher, B. L., 2013, Revision of the Pachycondyla sikorae species-group (Hymenoptera: Formicidae) in Madagascar, pp. 447-485 in Zootaxa 3683 (4) on pages 471-47