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Pseudohyperkalemia is common in routine laboratory tests. The objective of the present study is to determine pseudohyperkalemia associated with blood sampling and to analyze other causes that may explain the occurrence of hyperkalemia. A prospective descriptive and analytical study was carried out over a period of 3 months, from November 2020 to January 2021, at the University Hospital Center Professor Zafisaona Gabriel Mahajanga. Samples intended for the determination of plasma potassium, of which the pre-analytical phase could be followed from the blood sampling to their analysis were included. One hundred and twenty nine samples were tracked. Hyperkalemia was observed in 51 cases, or 39.5%. The frequency of pseudohyperkalemia was 27.5% (n = 14). Pseudohyperkalemia predominated on samples from hospitalized patients, where the pediatric department was first (50%, n = 7), followed by the Emergency and Intensive Care Department (42.9%, n = 6). It was more frequent on samples taken by paramedical trainees (78.6%, n = 11). Pseudohyperkalemia associated with tourniquet placement for more than one minute was 42.9% (n = 6). The age of 0 to 15 years and over 60 years, the presence of edema, renal and / or cardiac signs, the use of hyperkalemic drugs, and hospitalization were significantly linked to the occurrence of hyperkalemia (p

Introduction: Sickle cell disease, also known as sickle cell anaemia, is an inherited haemoglobinopathy resulting in the production of the abnormal haemoglobin of sickle cell disease: haemoglobin S. Sickle cell patients are exposed to frequent deglobulation crises, often requiring several blood transfusions and hospitalisations at risk of transmission of infectious diseases such as hepatitis B (HBV). The objective of our study is to describe the immunisation against hepatitis B of vaccinated sickle cell patients and then to propose a course of action for non-immunised patients in the Haematology Department of the Joseph Ravoahangy Andrianavalona University Hospital (JRAHU). Material and Methods:The study was a prospective descriptive study investigating on the immunisation against hepatitis B of vaccinated sickle cell patient’s patients in the Haematology Department of the Joseph Ravoahangy Andrianavalona University Hospital (JRAHU) from June 2019 to March 2020. The study population concerned all sickle cell disease children under 15 years of age, girls or boys, of any ethnic origin, with or without clinical or biological signs of hepatitis, vaccinated against hepatitis B according to expanded program of immunization with at least 3 injections of hepatitis B vaccine, transfused or not. The included patients were be tested for HBsAg and anti-HBsAb. Results:During the study period, a total of 36 sickle cell patients were included. The average age was 8.2 years with an extreme of 2 and 13 years. Of the 36 sickle cell patients vaccinated, none had HBsAg and 28 patients (77.8%) were anti-HBsAb positive, protected against hepatitis B and 8 patients (22.2%) were serologically negative and at risk of contracting hepatitis B. Conclusion:Sickle cell disease patients are exposed risk of transmission of infectious diseases, if their antibody level between 1 and 10 mIU mL-1 is considered a poor response, those affected should receive a booster.

Introduction:Le bilan dhemostase est devenu une routine dans certains pays pour evaluer le risque hemorragique peri-operatoire. Lobjectif principal de cette etude etait devaluer les resultats des bilans dhemostase preoperatoires effectues au laboratoire dhematologie. Methodes et resultats:Une etude transversale retrospective descriptive et analytique a ete menee a lunite dhematologie du CHU Joseph Ravoahangy Andrianavalona pendant trois mois. Elle concernait des patients ayant realise des bilans dhemostase preoperatoires durant cette periode. Parmi 269 patients, 98 patients avaient des troubles de la coagulation preoperatoire. Le taux de prothrombine (TP) bas predominait dans 38,1% des cas, dont 68,9% etaient isoles et 31,1% etaient associes a lallongement de temps de cephaline active (TCA). La thrombocytose a ete retrouvee dans 37,3% des cas, la thrombocytopenie dans 15,3%. Lallongement du TCA a ete retrouve dans 9,3% des cas. Conclusion:Lesbilans dhemostase preoperatoire standards ne peuvent a eux seuls predire le risque de saignement. Leur prescription doit etre selective en fonction des antecedents et de la clinique. La recherche de letiologie des anomalies est importante pour ameliorer la prise en charge peri et post-operatoire. &nbsp

Introduction:Reliability of biological assays results depends closely on the quality of the 3 biological stages: pre-analytical, analytical, and post-analytical.In each stage, a quality program including internal quality control (IQC) and external quality assurance (EQA) has to be assessed to ensure test result accuracy and precision. The coagulation laboratory plays an important role in the diagnosis and treatment of people with blood disorders, so though several lack of facilities in Malagasy labs, QC has to be implemented. Thus, this study aimed to analyze IQC and EQA in hemostasis tests in the Hematology laboratory of the CHU-HJRA in Antananarivo Madagascar in order to improve its analytical phases quality. Methods:This retrospective descriptive and analytical study was conducted from January 1st, to October 31st, 2021 in the Hematology laboratory of CHU-JRA within the routine coagulation tests (Prothrombin time PT and Activated partial prothrombin time aPTT). Regarding the EQA, percentage of deviation from the peer groups results were calculated. Then in order to analyze IQCs results, coefficient of variation and biases of IQCs results, corresponding respectively to precision and accuracy, were calculated and Levey-Jennings graphs were analyzed. Results:Regarding global results of EQA, 50% were within consensus compared to peer-group. And regarding IQC, for precision, one coefficient of variation for both PT and aPTT exceeded 5%, and for accuracy, no bias exceeds 10% deviation from the expected result. Levey-Jenningss plot showed more than 90% of the results to be within M±2 SD range. A violation 10x Westgard rules, corresponding to a systematic error was observed. Conclusion:Each out-of-control results has to be analyzed as part of strengthening quality program guaranteeing coagulation tests reliability.&nbsp

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.

The aim of the present study is to assess the performance of the biochemistry laboratory of Joseph Ravoahangy Andrianavalona by the dosage of the most prescribed 7 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 6 months from January 2020 to June 2020 involving 12 samples of External Evaluation of the Quality provided by the Quality Insurance Association of the clinical Biology Laboratories in France. Uremia, Serum creatinine, blood glucose, natremia, kaliemia, chlorure and were dosed on the 12 samples which carried out 84 dosages. During a period of 6 months the accuracy was 97.61%. The precision had been 100% if the Variation Coefficient Ratio (VCR) was below 1.50. This participation in the External Evaluation of the Quality program can then improve the quality of the laboratory. It is a step towards the accreditation process.

In whole, 56 patients were included. Amidst identified microorganisms were fungus (4,7%) and bacteria (95,3%) to which Gram negative bacilli represented 72,1% (n=44), Gram positive cocci 6,4% (n=10), Gram positive bacilli 8,2% (n=5) and Gram negative cocci 3,3% (n=2). Among these bacterias, Pseudomonas aeruginosa and Proteus sp were predominant, with respectively 41% (n=25), 23% (n=14). However, three cases of S. aureus reported, six with negative coagulase Staphylococcus, one with Escherichia coli, one with Klebsiella sp, one with Haemophilus sp, two cases with Neisseria sp and four cases with Corynebacterium sp. Two types of cultures were noticed, one of them monomorphic (91,1%, n=51) and the other polymorphic (8,9%, n=5) to which 3 associations of P. aeruginosa-Proteus sp, 1 association of P. aeruginosa- coagulase negative Staphylococcus and 1 association of P. aeruginosa- E. coli. No resistance to ciprofloxacin was observed with Pseudomonas, Neisseria sp, Haemophilus, and enterobacteria except for E. coli. No resistance to rifampicin was observed with S. aureus. However, the sensitivity of S. aureus to ciprofloxacin decreased (one bacterium out of three). The use of rifampicin or fluoroquinolones should be based on the type of ear infections

Background There is currently no validated, effective, safe treatment for severe illness caused by SARS-CoV-2. CVO PLUS CURATIF (CVO+C) is a capsule formulation of two compounds of plant origin with anti-inflammatory and antiviral activities in vitro: artemisinin and 1,8-cineole. These compounds have been repurposed for possible use as an oral treatment against COVID-19. Methods We performed a phase 3 randomized clinical trials on patients over the age of 18 years with SARS-CoV-2 infection confirmed by RT-PCR and mild-to-moderate symptoms. Patients were randomly assigned to receive CVO+C (3 capsules per day) or placebo for 15 days. The primary outcome was the proportion of patients testing negative for SARS-CoV-2 by RT-PCR on day 28 and an absence of severe and serious adverse events. Recovery time, and biological parameters on days 7, 14, 21 and 28 of the trial were considered as secondary outcomes. The safety outcomes considered were adverse events on treatment. Results In total, 1,576 individuals underwent RT-PCR screening for SARS-CoV-2 infection during the study period. Positive test results were obtained for 591 subjects, 339 of whom met the inclusion criteria for this study. The final analysis included 339 subjects: 132 from the CVO+C arm and 144 from the placebo arm. Treatment efficacy differed significantly (p=0.011) between the CVO+C arm (87.1%, 95% CI: 81.3%-92.9%, with 70.45% of patients cured by day 14) and the placebo arm (75.0%, 95% CI: 67.8% - 82.1%), with an OR of 2.25. The median time to recovery was 14 days for the CVO+C group and 21 days for the placebo group. A total of 72 incidences of mild and moderate adverse events, 14 severe adverse events and no serious adverse events were observed in both groups. ConclusionCVO+C was effective for the treatment of mild-to-moderate COVID-19. None of the patients in the CVO+C arm displayed progression to the severe form of COVID-19. Liver kidney and metabolic functions were preserved in all patients.Trial registration: Registered at Pan African Clinical Trials Registry: (No. PACTR202103601407640, date of approval: 24/03/2021) and approved by the ethics committee of the Ministry of Public Health of Madagascar (approval No. 216 MINSANP/SG/AGMED/CERBM, 17/12/2020)

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.

International audience; Background: False positivity in blood screening may cause unnecessary deferral of healthy donors and exacerbate blood shortages. An international multicenter study was conducted to estimate the frequency of HCV and HIV false seropositivity in seven African countries (Burundi, Cameroon, Democratic Republic of Congo, Madagascar, Mali, Mauritania, and Niger).Study design and methods: Blood donations were tested for hepatitis C virus (HCV) and human immunodeficiency virus (HIV) with rapid detection tests (RDTs), third-generation enzyme immunoassays (EIAs), or fourth-generation EIAs. HCV (456/16,613 [2.74%]) and HIV (249/16,675 [1.49%]) reactive samples were then confirmed with antigen/antibody assays, immunoblots, and nucleic acid testing. Partial viral sequences were analyzed when possible.Results: The HCV reactivity rate with RDTs was significantly lower than with EIAs (0.55% vs. 3.52%; p < 0.0001). The HIV reactivity rate with RDTs was lower than with third-generation EIAs (1.02% vs. 2.38%; p < 0.0001) but similar to a fourth-generation assay (1.09%). Only 16.0% (57/357) and 21.5% (38/177) of HCV and HIV initial reactive samples, respectively, were repeatedly reactive. HCV and HIV infections were confirmed in 13.2% and 13.7%, respectively, of repeated reactive donations. The predominant HCV genotype 2 and 4 strains in West and Central Africa showed high genetic variability. HIV-1 subtype CRF02_AG was most prevalent.Conclusion: High rates (>80%) of unconfirmed anti-HCV and anti-HIV reactivity observed in several sub-Saharan countries highlights the need for better testing and confirmatory strategies for donors screening in Africa. Without confirmatory testing, HCV and HIV prevalence in African blood donors has probably been overestimated.

Introduction:onychomycosis is defined as a fungal infection of the nails. They represent the main cause of onychopathy. They constitute a public health problem because of their increased prevalence in the world ranging between 20 to 30%. However, they remain under documented in Madagascar. This study was conducted in order to determine the mycological profile of onychomycosis diagnosed in the Parasitology Mycology laboratory of CHU-JRA. Methods:a descriptive retrospective study was taken over a 13-year period from June 2005 to December 2018. The data presenting onychomycosis on the mycological outcome register were included in the study. Results showing the presence of fungi on direct examination and / or culture were considered positive. Results:during the study period, a prevalence of 17.75% (180/1014) was observed. The age of our patients ranged from 3 to 76 years. Women were the most affected in 68.34% (n = 123) with a sex ratio of 0.46. Onychomycosis was localized in 64.65% of the fingers (n = 128). Simultaneous involvement of the hands and feet was found in 10% of the cases (n = 18).Candida albicans (C. albicans)was the most isolated in 33.03% (n = 71) of cases, followed by other species of Candida (24.65%, n = 53) andTrichophyton spp(9.3%, n=17). Mixed infections associating dermatophytes, Yeasts and molds were found in 23.33% (n = 42) of the cases. Conclusion:this is the first investigation dealing with onychomycosis in Madagascar. These data may be useful for future research and in the development of preventive and educational strategies.

The extreme emergency in biochemistry matches with the detection and/or monitoring of an acute or chronic pathological condition, at the root of a vital failure or a systemic imbalance deleterious for the organism. This study aims at determining the prescription profile of biochemical tests prescribed on call at the Paraclinical Training and Biochemistry Research Unit of the Joseph Ravoahangy Andrianavalona. The specific objectives are to determine the proportion of tests prescribed by the departments qualified as "urgent" and to determine the frequency of request for each biochemical parameter prescribed during on-call duty. This is a descriptive retrospective study over a period of 5 Months, from November 2016 to March 2017. All the biochemical testing prescribed during the study period and carried out in the laboratory of Joseph Ravoahangy Andrianavalona University Hospital Center were used. Out of the 595 biochemical testing prescribed during on-call period, 588 (98.82%) were included in the study. Two hundred and seventy-four (46.60%) of these testing were prescribed by departments classified as "non-urgent" and 314 (53.40%) by departments classified as "urgent". We found that non-urgent parameters were prescribed such as lipid status and HbA1c at less than 2%. Creatinine was prescribed at 99.60%, followed by blood ionogram at 65.99% and urea at 40.48%. Biochemical parameters prescribed during on-call periode are limited and that biologists must develop a list of feasible biochemical parameters on call periode for better management of patiens as soon as possible.

Background In the context of the Covid-19 pandemic and following the increasing number of suspicious Covid-19 cases in Madagascar, Malagasy laboratories are overflowed mainly due to lack of human resource and available material restriction. The development and validation of rapid and easy-to-perform diagnostic methods are worth of interest and high priority. The aim of this prospective study was to evaluate the performances of a rapid immunochromatographic test for the detection of SARS-CoV-2 antigen, in comparison to Reverse transcription polymerase chain reaction (RT-PCR). Methods The fluorescence immunochromatographic SARS-CoV-2 antigen test StandardTM Q COVID-19 Ag Test (SD Biosensor Republic Korea) was evaluated in samples derived from patients who were examined for disease categories. Diagnostic accuracy was determined in comparison to SARS-CoV-2 RT-PCR considered as gold standard. Results A total of 200 samples were included; 94 were RT-PCR positive. Median patients’ age was 38.36 years, 63.5 % were male. Overall sensitivity and specificity of the Standard TM Q COVID-19 Ag (SD Biosensor® Republic Korea) were 62.66 % and 100 %, the sensitivity was significantly higher (100 %) in samples with high viral loads (Ct

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.

The main reason of this study is to determine from which serum hemolysis index the interference was positive for the kaliemia dosage on automaton BS 300 (Mindray®). The secondary aim was to establish a reliable reporting for the clinicians in front of hemolysed samples for the kaliemia dosage. The hemolysis additions method was run to create an increasing hemoglobin range of concentration varying from 0 to 12 g/dl. To determine an influence of the hemolysis on the measure, the variation limit of 10% was chosen. Statistic analysis was done by XLSTAT, therefore the student paired t-test allowed us to compare parameters rates dosed before and after hemolysis. The threshold for statistical significance was 0.05. According to this study, kaliemia positive interference became significant from hemolysis index [+++]: H4 = 1.5 g/dl.

Alloimmunization to platelet antigens exposes to a serious immunological incident. We report a probable case of a post-transfusion purpura from homozygous sickle cell child alloimmunized against platelet antigen. We detail the challenges of alloantibody identification and transfusion management. These challenges are due to the lack of laboratory techniques for typing HLA and HPA system and the use of leukocyte-depleted (filtered) blood products.

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.