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

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

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

Novel Streptococcus suis Sequence Type 834 among Humans, Madagascar

Two cases of meningitis caused by Streptococcus suis occurred in Madagascar, 1 in 2015 and 1 in 2016. We report the characterization of the novel sequence type, 834, which carried the mrp+/sly+/epf+ virulence marker and a mutation G→T at position 174, leading to a substitution mutS1 to mutS284