Mediastinite Descendante Necrosante Aigue: Quatre Annees D’experience Dans Un Centre Hospitalier A Madagascar

Background: The acute mediastinitis also called Descending Necrotizing Mediastinitis or Cervico-mediastinitis necrotizing fasciitis is a disease which is the result of a spread of severe cervical infection down to the mediastinum. Method: A retrospective study was done at the surgical intensive care unit of Joseph Ravoahangy Andrianavalona’s hospital about the management of descending necrotizing mediastinitis from 1 st January 2009 to 31st December 2012. Result: Fourteen cases were reported during four years. The mean age of the patients was 30 years and 8 months, the sex ratio was 1.33. The most common cause found in every cases were severe cervical infections such as fasciitis by dental origin, peritonsillar abcess, sore throat, combined with the administration of non steroid antiinflammatory, of corticoid, of inappropriate antibiotic and also the patients’ health status. The suspicion of diagnosis is made clinically with chest pain associated with dyspnea, fever or septic shock and confirmed by radiologic findings. Conclusion: Nowadays, the mortality rates is high about 71, 42% for our cases. Collaboration of the thoracic surgeons and anesthetists is recommended for an early trancervical drainage of the mediastinitis. In Madagascar, the fasciitis by odontogenic infection is the most common cause of mediastinitis due to the lack of dental care

Protected area surface extension in Madagascar: Do endemism and threatened species remain useful criteria for site selection ?

The ‘hotspot approach’ considers that endemism and threatened species are key factors in protected area designation. Three wetland and forest sites have been proposed to be included into Madagascar’s system of protected areas (SAPM – Système des Aires Protégées de Madagascar). These sites are Manambolomaty (14,701 ha) and Mandrozo (15,145 ha) in the west and Bemanevika (37,041 ha) in the north. Biodiversity inventories of these three sites recorded 243 endemic species comprised of 44 reptiles, 54 amphibians, 104 birds, 23 small mammals, 17 lemurs and one fish. Of these 243 species, 30 are threatened taxa comprising two Critically Endangered (CR), 11 Endangered (EN) and 17 Vulnerable (VU) species. The long term ecological viability of these sites has been shown by population stability of the two Critically Endangered flagship species, the Madagascar fish eagle (Haliaeetus vociferoides) in Manambolomaty and Mandrozo and the recently rediscovered Madagascar pochard (Aythya innotata) in Bemanevika. Other threatened species and high biological diversity also justifies their inclusion into Madagascar’s SAPM

Bilan d’une cure chirurgicale d’aspergillome pulmonaire secondaire a une lesion sequellaire de tuberculose au CHU/JRA

La prise en charge d’un aspergillome pulmonaire, dans le cas des lésions limitées accessibles, est une des activités courantes en chirurgie thoracique dans les pays endémique à la tuberculose comme Madagascar. Sur une période allant de janvier 2005 en mars 2010, 15 patients, ancien tuberculeux, atteints d’une aspergillome pulmonaire sont traités par une résection segmentaire ou une lobectomie. La circonstance de découverte repose sur la clinique par des tableaux très polymorphes. L’imagerie garde une place importante. L’examen histologique des pièces d’exérèse chirurgicale confirme le diagnostic. Tous les patients ont été opérés de manière élective. Le résultat a été pour l’ensemble des patients jugés satisfaisant. Ces patients sont suivis pendant 1 à 39 mois. L’étude des résultats à distance est encore en cours et est fondamentale si le traitement chirurgical a un effet bénéfique sur la survie et la qualité de vie des malades. Le but de ce travail a été, à partir de la revue de la littérature et de notre petite expérience, de définir quels éléments pertinents mis en exergue sur le sujet.Pan African Medical Journal 2013; 14: 8

Un pseudo-mesotheliome pleural révélant un carcinome urothelial metastatique

Les auteurs illustrent à travers une observation d’une évolution métastatique pleurale agressive et rare d’un carcinome urothélial des voies excrétrices supérieures à l’origine d’un aspect radiologique atypique et peu décrit de pseudo-mésothéliome. Dans notre cas, l’instillation au BCG Pasteur par la nephrostomie percutanée et par le pleurix au profit d’une lourde chimiothérapie nous a permis de contourner l’évolution vers les complications aiguës liée à cette pathologie en l’occurrence la pleurésie maligne

A first description of benign metastasizing leiomyoma of the lung from madagascar: A brief review of the literature

Benign metastatic leiomyoma (BML) spreading in the lung is rare entities predominantly in a young woman. To our knowledge, our observation is the first description of benign metastasizing leiomyoma of the lung from Madagascar.We describe a case of 44-year-old of Malagasy origin, asymptomatic, non-smoking woman who had a history of hysterectomy for myoma three years earlier. Chest computed tomography (CT) revealed multiple well defned nodular shadows in the lung. One tumor of the middle lobe was resected by lateral thoracotomy. The resected lesion consisted of benign spindle cells and was diagnosed as BML. Through this clinical case, we present the first case report of a BML patient from Madagascar. The aim of this article is to take stock of the knowledge relating to this rare affection, and to propose management in accordance with the current literatur

Protected area surface extension in Madagascar: Do endemism and threatened species remain useful criteria for site selection?

The ‘hotspot approach’ considers that endemism and threatened species are key factors in protected area designation. Three wetland and forest sites have been proposed to be included into Madagascar’s system of protected areas (SAPM – Système des Aires Protégées de Madagascar). These sites are Manambolomaty (14,701 ha) and Mandrozo (15,145 ha) in the west and Bemanevika (37,041 ha) in the north. Biodiversity inventories of these three sites recorded 243 endemic species comprised of 44 reptiles, 54 amphibians, 104 birds, 23 small mammals, 17 lemurs and one fish. Of these 243 species, 30 are threatened taxa comprising two Critically Endangered (CR), 11 Endangered (EN) and 17 Vulnerable (VU) species. The long term ecological viability of these sites has been shown by population stability of the two Critically Endangered flagship species, the Madagascar fish eagle (Haliaeetus vociferoides) in Manambolomaty and Mandrozo and the recently rediscovered Madagascar pochard (Aythya innotata) in Bemanevika. Other threatened species and high biological diversity also justifies their inclusion into Madagascar’s SAPM.RÉSUMÉL’endémisme et les espèces menacées constituent les éléments clef pour la création des aires protégées. Trois zones humides de Madagascar ainsi que leurs forêts avoisinantes sont proposées pour la protection sous le nouveau système des aires protégées malgaches connu sous le sigle SAPM (Système d’Aires Protégées de Madagascar) : Manambolomaty (14.701 ha) et Mandrozo (15.145 ha) à l’Ouest et Bemanevika (37.041 ha) dans le Nord. Les inventaires biologiques entrepris dans ces trois sites ont montré que 243 espèces y sont endémiques, avec 44 reptiles, 54 amphibiens, 104 oiseaux, 23 petits mammifères, 17 lémuriens et un poisson. Parmi ces 243 espèces, 30 sont menacées d’extinction avec deux qui sont en danger critique d’extinction (CR), 11 en danger (EN) et 17 vulnérables (VU). La survie écologique à long terme de ces sites a été avérée avec la découverte de la stabilité des populations des deux espèces indicatrices en danger critique d’extinction que sont le Pygargue de Madagascar (Haliaeetus vociferoides) à Manambolomaty et Mandrozo et une espèce récemment redécouverte, le Fuligule de Madagascar (Aythya innotata) à Bemanevika. La stabilité de plusieurs autres espèces menacées ainsi que la diversité biologique de ces sites justifient leur inclusion dans le SAPM. Les sept associations locales, deux à Manambolomaty, deux à Bemanevika et trois à Mandrozo, ont supporté le programme de suivi de ces sites ainsi que de ces espèces indicatrices en montrant ainsi leur engagement dans le processus de création des aires protégées. Le Peregrine Fund a travaillé dans ces sites en vue de mettre en synergie ses objectifs de conservation avec le développement socio-économique local

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century