Search

According to National Authority for Health, the isolated dosage of TSH, in first-line, is a sufficient supply for the diagnosis and monitoring of thyroid dysfunction. The purpose of this study are to determine the prevalence of prescriptions of thyroid test, evaluate the practices on the prescription of thyroid tests compared to international recommendations. It is a descriptive retropective study within a period of 12 months. All the files with a request for TSH and / or thyroid hormone were included in this study. All files with a previous thyroid check-up or as part of a dysthyroidism follow-up assessment were excluded. Among the 72600 prescriptions for biochemical tests, 184 corresponded to the prescription of thyroid tests, it means 0.25% compared to other biochemical blood tests recorded. Among the 184 prescriptions requesting thyroid tests,117 files were retained. The mean age of the patients was 42.3 years, with a sex ratio of 0.18. One hundred sixteen files included a request of TSH dosage; 28,21% included only a TSH dosage and 70.94% included a request of simultaneous TSH dosage with one of two thyroid hormones. One prescription (0.85%) asked for a thyroid hormones dosage only without preliminary TSH dosage. TSH ranged from The number of thyroid hormone dosage in first-line in this study is important. Their prescription should be adapted to current recommendations in order to avoid the additional cost of unnecessary dosages for patients.&nbsp

Background: Hemophilia, a constitutional bleeding disease, has always been present in Madagascar considering children who died after bleeding circumcision, as reported in the family history of the diagnosed patients. Hemophilia is serious because of the potentially fatal risk of hemorrhage. The aim of this study was to evaluate the clinical, outcome and therapeutic aspects of inpatients with hemophilia in the Surgical Resuscitation Unit of JRA Hospital in Antananarivo. A descriptive and observational study was led about patients with hemophilia cared in the Surgical Resuscitation Unit from January 2011 to March 2018, studying age, type and severity of hemophilia, reason and duration of hospitalization, treatment instituted and outcome of patients. Results and comments: Thirty-six hemophiliacs (0.2%) were enrolled. The mean age was 9.52 years old; 52.78% were with hemophilia B and 47.22% with hemophilia A, mainly severe. Clinical manifestations were muscle hematomas (25.71%), gum bleeding (14%), epistaxis (14.28%), gastrointestinal bleeding (11.42%), intracranial hemorrhage (11.42%), post circumcision bleeding (11.42%), hematuria, intraperitoneal hematomas and hemarthrosis. Treatment was based on factor concentrate substitution when available. The length of stay ranged from one to thirty days. The evolution was favorable except for two deaths related to delayed management of intracranial hemorrhage. Three patients with hemophilia A developed inhibitors. The results showed that throughout these years of study, a change in management was noted alongside. Conclusion: Hemophilia cases requiring hospitalization were managed in surgical resuscitation unit. The evolution was mainly related to the availability of clotting factor concentrates in coagulation factors, the delay in taking care of the patients and the presence of specialized staff.

Sexually transmitted diseases (STD) are public health concerns worldwide. The aim of our study is to assess infection and coinfection with HIV, hepatitis B, hepatitis C and syphilis among men having sex with men in Mahajanga which is a western coastal town of Madagascar. We conducted a prospective and descriptive preliminary study in the laboratory of the University Hospital Center PZAGA in Mahajanga during a period of three months, from December 2014 to February 2015. We included 100 MSM in our study. Their mean age was 36 yrs (16 to 55 yrs). We found 30% of seropositive men among our sample. HIV positive men are mainly part of the age group [20–29 yrs]. The mean age of positive men was respectively 38 yrs., 36 yrs., 48 yrs. and 39 yrs. for HIV, for HBV, HCV, and syphilis. We found respectively for hepatitis B, hepatitis C and syphilis 7%, 1% and 11% positive samples. We found no co-infection HIV and HCV for them. But we found 5% of coinfection HIV-HBV, 4% of coinfection HIV-syphilis and 1% of coinfection of HIV, HBV and syphilis. We highlighted a very high rate of HIV positivity among MSM living in Mahajanga. Efforts have to be made in order to sensitize them about risky behaviors.

The External Evaluation of the Quality is an important procedure for assessing the performance of a laboratory. The aim of the present study is to assess the performance of the the biochemistry laboratory of Joseph Ravoahangy Andrianavalona by the dosage of the most prescribed 4 emergency biochemical parameters. It is a retrospective evaluative study of the performance of the biochemistry laboratory of Joseph Ravoahangy Andrianavalona University Hospital Center on a period of 4 months from January 2019 to April 2019 involving 8 samples of External Evaluation of the Quality provided by the Quality Insurance Association of the clinical Biology Laboratories in France. Serum creatinine, blood glucose, uremia and serum electrolytes were dosed on the 8 samples which carried out 32 dosages. During a period of 4 months the accuracy was 94% for the 32 carried out dosages. The precision had been 97% if the Variation Coefficient Ratio (VCR) was below 1.50. The monthly assessment of the 3 studied parameters: serum creatinine, blood glucose and uremia were always good during the 4 months. The imprecision (VCR >1.50) concerned the disease control of the sodium levels in February. The University Hospital Center Joseph Ravoahangy Andrianavalona Biochemistry laboratory was efficient during the External Evaluation of the Quality. Therefore, these results were reliable and contribute to the improvement of the diagnosis, the monitoring and the aftercare of the patients. Every laboratory for medical analysis ought to organize a periodical External Evaluation of the Quality to monitor and improve biological analysis results.

Hemophilia is a hereditary bleeding disorder related to X chromosome due to a coagulation factor deficiency Sixty six patients with hemophilia PwH A and fifty four patients with hemophilia B are until now registered at the HTC in Madagascar The objective of this study is to describe the epidemioclinical and therapeutic profile of arthritis in Malagasy hemophiliacs at the HTC This is a monocentric retrospective and descriptive study extending over a period of months from September to March including cases of arthropathy The age group between and and patients with hemophilia A severe were the most affected Hemarthrosis has been frequent in to times a year Arthropathy reached the knees in of cases and has been debilitating in almost all of cases Care has been essentially based on clot factor substitution Repetition of hemarthrosis episodes leads to arthropathy which can be avoided by early infusion of concentrate clot factor

Background: Currently, the prognosis of hematological malignancies continues to improve in developed countries. In developing countries, such as Madagascar, data on hematological malignancies treatment and outcome are often rare, incomplete, or nonexistent. Until 2011, there was only one cancer center in Madagascar. The Medical Oncology Unit of the Military Hospital of Antananarivo, Madagascar, managed hematological malignancies since December 2012. This pathology represents there the fourth most frequent cancer. Objectives: We aimed to describe the therapeutic aspects and outcome of hematological malignancies managed at this center. Methods: This was a longitudinal study (descriptive and analytic) carried out from December 1, 2012 to August 31, 2015 (33 months). We included all patients followed, then, excluded those without pathologic evidence, cases of monoclonal gammopathy of unknown significance, and cases of solid cancers. Results: We followed up 57 cases of hematological malignancies. The mean age was 49.4 ± 15.5 years and sex ratio (male/female) was 1.71. A total of 34 patients (60%) received specific treatment and 40% of the patients undertook only symptomatic treatment. The median follow-up time was 60 days and mean survival time was estimated at 410 ± 61 days for all patients combined. The mean survival time varied significantly according to the nosological subgroup and to the type of treatment received (P = 0.004). At the end of the study 20 patients (35.1%) died and 17 patients (29.8%) were lost to follow-up. Conclusions: Our results are globally similar to the results found in other African studies. Improving diagnosis, establishing a hematopoietic stem cell transplant center, and improving access to specific therapies should improve the prognosis of our patients.

Background: Anemia is a public health problem with major health consequences. According to the WHO, anemia worldwide is 1.62 billion people (95% confidence interval (CI): 1.50-1.74 billion), which corresponds to 24.8% Of the population (95% CI: 22.9-26.7%).Methods: We studied the clinical and biological data of hospitalized patients who applied for a complete blood count in hematology laboratory of Joseph Ravoahangy Andrianavalona Antananarivo hospital between January and April 2017.Results: Sixty-four percent of hospitalized patients had anemia. Anemia was more common in women. Anemia was encountered mainly in intensive care unit (33.9%) and occurred in perioperative cases in the majority of cases (33.4%).Conclusions: Anemia is a common symptom in hospitals, particularly in intensive care unit. In the Malagasy hospital environment, etiologies are numerous, in particular hemorrhage, sickle cell disease or cancer.

Introduction: Chronic Myeloid Leukemia is a myeloproliferative disorder affecting hematopoietic stem cells. The specific cytogenetic abnormality is translocation (9; 22) which leads to the BCR-ABL fusion gene. Methods: We did a bone marrow aspiration in our laboratory of haematology of university hospital Joseph Ravoahangy Andrianavalona Antananarivo. We studied myelogram and compared its result to the cytogenetic result. Results: Men were the most affected by this pathology and diagnostic average age was 51.2 years. Splenomegaly leukocytosis and myelemia were often present. Myelogram showed granulocytic hyperplasia and the t (9; 22) were present in all the patients. Conclusion: Diagnosis is based on data from the NFS, the myelogram, the search for the Philadelphia chromosome and BCR-ABL fusion gene. These specialized techniques are still inaccessible for Malagasy patients.

Monoclonal gammopathies are common abnormalities and their incidence increases with age. They are detected in roughly 3 % of people older over 50 years and up to 7 % of those over 70 years. Multiple myeloma (MM) is characterized by the proliferation of plasma cells within the bone marrow and excess secretion of monoclonal immunoglobulins. In Madagascar, late performance of biological examinations such as serum protein electrophoresis overestimates MM rates. We studied 54 patient records between March 2009 and January 2015 in the biology laboratory of the Joseph Ravoahangy Andrianavalona university hospital in Antananarivo (Madagascar). Monoclonal gammopathy was associated with multiple myeloma in most cases (88.9 %). Patients' median age was 64.2 years. Men were slightly more affected than women. It is discovered most frequently due to bone symptoms (83.3 %), and anemia is always present. Monoclonal gammopathy is mostly IgG. The bone marrow study showed medullary plasmacytosis. This disease appears most often in the elderly and has a slight male predominance. Bone marrow cytology is mandatory for diagnosis.

Background and objectives Hepatitis B virus (HBV) infection is a major public health problem in Madagascar. Its severity is related to the risk of chronicity, especially in case of neonatal contamination. Our objectives were to investigate the prevalence of HBV infection among pregnant patients at the Befelatanana obstetrics and gynecology teaching hospital department (BOGTH) by detecting HBsAg and to evaluate the risk of HBV mother to child transmission by screening for HBeAg. Methods We conducted a 6-month prospective study in the BTHOGD from February 2012 to July 2012. All pregnant patients consulting for antenatal care were screened for HBV serologic markers. Results The prevalence of HBsAg was 1.9% (20 out 1050 screened patients). The average age was 26.51 years (25–30 years). Most patients tested were unaware of their hepatitis B status and only 0.38% had been vaccinated before pregnancy. Only 1 (5%) of the 20 patients with HBsAg was positive for HBeAg. Conclusion Hepatitis B is very frequent in pregnant patients in Madagascar and it is recommended that all pregnant patients be routinely screened for HBsAg. This screening of maternal infection would allow applying prophylactic measures to neonates to decrease the risk of disease chronicity.

Background: Chronic renal failure is a worldwidepublic health issue. In Madagascar, this condition of heavy care is a medical challenge in a low-income country. In 2016, an estimated 8,000 - 10,000 people with kidney failure and only 1.26% have access to hemodialysis. About 30 patients were able to access live organ transplantation abroad.Our objectives are to set up an HLA histocompatibility laboratory providing HLA typing, search for anti-HLA antibodies, and crossmatch. Evaluate the available structures of the Immunology laboratory. Look for partner laboratories for more specialized research. Materials and methods: The Joseph Ravoahangy Andrianavalona University Hospital Immunology Laboratory is equipped with a conventional PCR and real-time PCR platform, an ELISA immunoassay platform, and inverted fluorescence microscope. Results: The techniques to be implemented in Madagascar for the HLA Laboratory are the HLA typing of the donor and the recipient by the PCRSSP and microlymphocytotoxicity (LCT) technique. The search for anti-HLA antibodies will be done by ELISA and LCT and crossmatch in LCT.We have created cooperation with the Réunion France histocompatibility laboratory for the identification of recipient and donor HLA antibodies and crossmatch by Luminex. Conclusion: The presence of HLA platform in Madagascar will allow preparing the establishment of a future kidney transplant in the country but also for improved management of patients waiting on abroad transplant list in regards of donor selection and post-transplant monitoring. Keywords: Kidney transplant, HLA laboratory, Developing country, Madagascar

Background: Malignant hemopathies constitute a group of pathologies having in common the anomalies of the bone marrow or of the lymphatic system cells. In developed countries, the number and actual distribution of cancers is provided by cancer registries. In Madagascar there is no effective cancer registry and only two studies on malignant hemopathies have been carried out to date, but neither has described their epidemiology and clinical aspects. Thus, we aimed to describe the epidemiology and clinical aspects of malignant hemopathies managed in the Medical Oncology Unit of the Military Hospital of Antananarivo.Methods: It was a cross-sectional and descriptive study carried out at this unit from 1st December 2012 to 31st August 2015 (33 months). Authors included all patients followed, then excluded those without pathologic evidence, cases of monoclonal gammapathy of unknown significance and cases of solid cancers.Results: We followed up 57 cases of malignant hemopathies. The mean age was 49.39±15.46 years and the sex ratio was 1.71. Superficial lymphadenopathy was the most frequent warning signs (31.58%) and lymphomas were most represented (52.63%). There was a significant association between warning signs and diagnosis (p value

Currently, there are 122 hemophiliacs in Madagascar followed at the hemophiliac treatment center of the Joseph Ravoahangy Andrianavalona University Hospital Center (JRA UHC), 55 present hemophilia B and 67 of hemophilia A. In hemophilic patients, the diagnosis of hemarthrosis is obviousin front of articular inflammation. It’s important to determinate the main risk factor as well as predisposition indicators tothe occurrence of "spontaneous" hemarthrosis in hemophiliacsfor prevention andearly careanticipation. In this prospect, the search for potentpredisposition indicator such as immunologicalfactorsis important. This is a case control study on all hemophiliacs seen at (JRA UHC) with hemarthrosis for 7 months. We have descriptively studied the qualitative and quantitative variables consisting in the determination of rheumatoid factors (RF) and the titer of antistreptolysin O (ASLO). Then we studied the statistical correlations. During the study period, we included 30 hemophiliac subjects with hemarthrosis who had an average age of 16.8 years. We had as much hemophiliac A as hemophiliac B; 23.3% practiced sporting activity; 10% had history of angina, involvement of the knee joint predominated at 44% (left 24%). RF positive were present in 26.7% (8/30) predominant in hemophiliacs aged from 19 to 36 (62.5%). The ASLO positive titer was found in 43.3% (13/30) predominant in children from 5 to 13 years (38.5%) with a maximum rate of 1600IU / l. There was no significant relationship between the positivity of the parameters with the presence or absence of hemarthrosis with a value of p = 0.231 and p = 0.06 respectively (p > 0.05). A large number of hemophiliac patients had a combination of clinical and biological signs in relation to diagnose rheumatic fever and rheumatoid arthritis which must be monitored as this could predict the occurrence in the short and medium term of these diseases which could be mistaken for hemarthrosisrelated to hemophilia.

La leucemie a tricholeucocytes est une hemopathie maligne rare. En Afrique subsaharienne, tres peu d’etudes ont ete realisees. Le diagnostic repose sur l’identification morphologique des cellules tumorales sanguines et/ou medullaires en s’aidant de la cytometrie en flux. Entre 2009 a 2010, nous avons mene une etude dans le but de rapporter les cas de leucemie a tricholeucocytes diagnostiques au service d’hematologie biologique du CHU Joseph Ravohangy Andrianavalona et, grâce a une collaboration avec le service hematologie biologique du centre hospitalier Sud Reunion, nous avons pu comparer le profil immunophenotypique de nos patients avec la litterature. Durant deux annees, deux patients de sexe masculin âges de 58 et 68 ans ont ete diagnostiques comme leucemiques a tricholeucocytes. La symptomatologie clinique est dominee par une splenomegalie associee a une pancytopenie severe. L’hemogramme et le medullogramme retrouvent la presence de tricholeucocytes. Le profil immunophenotypique de nos patients est celui d’une leucemie a tricholeucocytes classique par la positivite de CD11c, CD103, CD25 et CD123. Mais le premier patient a presente une positivite du CD5 et CD23.

Purpose of the study Due to anemia and maternal, childhood and infancy diseases, blood transfusion is one of the most important medical cares given in sub-Saharan Africa, including Madagascar. World Health Organization encourages worldwide countries to maximize transfusion security. Until now, there was no data within a large population of blood donors. Therefore, the aim of this study was to assess the prevalence and time trends of hepatitis C virus (HCV) among all first-time blood donors coming into the National Centre of Transfusion Supply in Antananarivo. Material and methods This retrospective study was conducted at the National Centre of Transfusion Supply in Antananarivo from 2003 to May 2009. We looked up to all recorded results of systematic screening of blood donor candidates and we took data about all first-time blood donors, including age and gender. Forty-seven thousand five hundred and ten of 47,636 first-time blood donors were retained, the others were excluded due to lack of some data. Results The mean age of our donors was 33.3 years (35.8 for male, and 32.6 for female; P <

L’examen de routine des prelevements bacteriologiques presente generalement deux etapes : l’examen direct et la culture. L’objectif final de ces examens est d’identifier la plupart des bacteries responsables d’infection permettant ainsi au clinicien de justifier une antibiotherapie.

Les troubles de l'hémostase sont fréquemment observés en réanimation. L'objectif de cette étude est d'en déterminer l'incidence, les étiologies et la prise en charge pour en diminuer le risque de morbi- mortalité. Etude rétrospective sur une période de huit mois en réanimation chirurgicale du CHUA HUJRA. Les dossiers étudiés étaient ceux contenant tous les premiers bilans d'hémostase lors de l'admission du patient en réanimation, avec un âge supérieur à 15 ans. Etaient exclus les dossiers des post opérés (malade ayant subi une intervention chirurgicale). Les dossiers retenus pour l'étude étaient ceux qui ont présenté une ou plusieurs anomalies au niveau du bilan d'hémostase. Cent cinquante-cinq dossiers ont été colligés dont 20,64% ont présenté un trouble de l'hémostase. Les patients de sexe féminin (53,12%) étaient les plus concernés, avec une population âgée en moyenne de 49±19 ans. Trois patients (9,37%) ont présenté une notion de diathèse hémorragique à l'interrogatoire. Les différents troubles de l'hémostase étaient: une diminution du taux de prothrombine (100%), un taux de céphaline activé allongé (78,12%), un international normalized ratio élevé (43,75%) et des thrombopénies (40,62%). Chez 3,12% de ces cas, des accidents hémorragiques ont survenu. La plupart de ces troubles de l'hémostase étaient présents au décours d'hémorragies digestives (46,87%) dont la prise en charge était constituée par l'administration de vitamine K1 (68,75%) et de transfusion de plasma frais congelé (65,62%). D'autres pathologies ont été également incriminées. Une incidence de 15,62% de mortalité a été retrouvée. L'existence des troubles de l'hémostase en réanimation constitue un facteur pronostique imposant un dépistage et une prise en charge précoces et adéquats pour pouvoir en réduire le taux de mortalité.Key words: Coagulation, réanimation, transfusion, trouble de l´hémostase

Summary We present a case of poly-agglutinability syndrome associated with non-Hodgkin lymphoma observed in a 45-year-old woman hospitalized for asthenia, pallor, and cervical lymphadenopathy and no fever in previous history. Poly-agglutination syndrome was fortuitously discovered during erythrocyte grouping. Tn poly-agglutination is strongly suspected in pancytopenia, inconclusive bone marrow results and the absence of infection in the patient. This hypothesis could not be confirmed because we did not have lectin Dolichos biflorus, Ulex europaeus, Salvia horminum, Salvia sclarea and Arachis hypogoea nor treatment with papain nor with polybrene. In our case, the delay between the onset of this poly-agglutinability syndrome and malignant lymphoma has not been established. This possible association, found in this patient, justifies the need for careful clinical observation of patients with syndrome of poly-agglutinability in blood grouping.

Studies on the possible influence of periodontal disease on preterm birth (PB) and/or low birth weight (LBW) remain inconclusive especially due to the difficulty of assessing the numerous pregnancy risk factors. The aim of this study is to compare periodontal parameters in non-smoking pregnant women in Madagascar.A cohort study with 204 pregnant women (mean age: 25.6 years) was conducted in public prenatal care health clinics in Madagascar. Socioeconomic and obstetric information was obtained. Periodontal parameters, such as periodontal probing depth and clinical attachment loss (AL), were recorded during the second semester of pregnancy.The mean gestational age was 37.8 weeks. At delivery, 42 newborns (20.6%) were PBs (37 weeks) and 22 newborns (10.8%) were of LBW (2,500 g). Nine (4.4%) newborns were PBs and of LBW (PLBW), and 149 newborns (73%) were of normal birth. The mean plaque index and papillary bleeding index were significantly higher (P0.05 and P0.001, respectively) in the PB group than in the normal birth group. Periodontitis (at least three sites from different teeth with clinical ALor=4 mm) was significantly associated with PB (P0.001), LBW (P0.001), and PLBW (P0.01). The rates of periodontitis were considerably higher in PB (78.6%), LBW (77.3%), and PLBW (77.8%) groups than in the full-term (8.6%), normal weight (16.5%), and normal birth (2.7%) groups.The strong association among periodontitis, PB, and LBW in this study highlights the need to consider the periodontal status of pregnant women in Madagascar.

International audience; BACKGROUND: In Madagascar, the last study on sickle cell disease (SCD) was done in the early 1980s. The country is known as endemic for malaria and respiratory infections. The main objective of this study was to estimate the prevalence of SCD; the secondary objective was to evaluate its association with malaria and respiratory infections. METHODS: This is a cross-sectional study which was carried out in a rural village in the south east coast of Madagascar between May 2011 and November 2013. Participants were children aged between 2-59 months presenting with fever measured by axillary temperature >=37.5~°C at inclusion. Genotyping of haemoglobin S was done by PCR and malaria was diagnosed by Rapid Diagnostic Test. Research for viral and atypical bacterial respiratory pathogens was performed on nasopharyngeal swabs. Uni-and multivariate polytomous logistic regression was done to assess associations between microbiological results and SCD status, with HbAA phenotype as reference. RESULTS: A total of 807 children were analysed. Prevalence of SCD among febrile children was 2.4% (95% CI, 1.5-3.7%) and that of SCT was 23.8% (95% CI, 20.9-26.9%). There was no difference in the prevalence of malaria infection according to haemoglobin status (p = 0.3). Rhinovirus (22.5%), adenovirus (14.1%), and bocavirus (11.6%) were the most common respiratory pathogens detected. After univariate analysis, patients with SCD were more frequently infected by parechovirus (p = 0.01), while patients with SCT were more prone to RSV A or B infection (p = 0.01). After multivariate analysis, HbAS phenotype was associated with higher risk of RSV A and B infection compared to HbAA (adjusted OR = 1.9; 95% CI: 1.2-3.1, p = 0.009), while HbSS phenotype was associated with higher risk of parechovirus infection (adjusted OR = 6.0; 95% CI: 1.1-31.3, p = 0.03) compared to HbAA, independently of age, gender, period per quarter, and the other viruses. CONCLUSION: The prevalence of SCD among under-five children presenting with fever was high in the study population. No association was found between SCT and malaria but few viruses, especially parechovirus, seem to play an important role in the occurrence of pneumoniae among SCD patients.