Remains of what appears to be a single, subadult
Hadropithecus stenognathus were recovered from a previously unexcavated site at Andrahomana Cave (southeastern Madagascar). Specimens found comprise ...isolated teeth and cranial fragments (including the frontal processes of the orbits), as well as a partial postcranial skeleton. They include the first associated fore- and hind-limb bones, confirming the hind-limb attributions made by Godfrey and co-workers in 1997, and refuting earlier attributions by Lamberton in 1937/1938. Of particular interest here are the previously unknown elements, including a sacrum, other vertebrae and ribs, some hand bones, and the distal epiphysis of a femur. We briefly discuss the functional implications of previously unknown elements.
Hadropithecus displayed a combination of characters reminiscent of lemurids, others more like those of the larger-bodied Old World monkeys, and still others more like those of African apes. Yet other characteristics appear unique. Lemurid-like postcranial characteristics may be primitive for the Archaeolemuridae.
Hadropithecus diverges from the Lemuridae in the direction of
Archaeolemur, but more extremely so. Thus, for example, it exhibits a stronger reduction in the size of the hamulus of the hamate, greater anteroposterior compression of the femoral shaft, and greater asymmetry of the femoral condyles. Nothing in its postcranial anatomy signals a close relationship to either the Indriidae or the Palaeopropithecidae.
Post-malaria neurological syndrome is a rare complication of malaria. Typically, it occurs in case of severe malaria. Here we report a case in a Malagasy patient presenting a non-severe Plasmodium ...falciparum malaria complicated by post-malaria neurological syndrome. The management of such a syndrome is radically different from non-severe malaria. No specific treatment is needed.
African histoplasmosis is a rare but not an exceptional condition and recently discovered in Madagascar. We report the fifth Malagasy case involving skin and nodes in an immunocompetent patient. ...Management of African histoplasmosis encountered many problems because of the availability of amphotericin B and cost of the biochemical tests in order to prevent major side effects in case of failure of oral antimycotic drug.
We report a rare case of a huge aspergilloma developed within a bronchiectasis due to pulling by a pulmonary fibrosis of systemic scleroderma. The patient is a 58-year-old woman presenting a ...deterioration of the general state associated with repeating hemoptysis, dyspnea, dysphagia, sclérodactylia, generalized cutaneous sclerosis and Raynaud's phenomenon. There was no antecedent pulmonary tuberculosis. The patient had a pulmonary arterial hypertension complicated by a chronic pulmonary heart at the stage of right cardiac decompensation. Aspergillosis serology was positive and the immunological assessment confirmed scleroderma. The computed tomography showed a huge oblong opacity in a small round bell shape ("signe du grelot", Monad's sign) in the left upper lobe developed within a bronchiectasis, and a bilateral pulmonary fibrosis. Although surgery remains the recommended treatment of an aspergilloma, the management of our patient was medical in front of contra-indication for surgery. The evolution was marked by repeating hemoptysis and stability of the pulmonary lesions 2 years later. The management of this entity remains difficult and complicated; the prognosis is in general unfavourable and depends at the same time on the evolution of scleroderma and the aspergilloma infection.
Few data are available about severe malaria in Madagascar. Our aims were to describe epidemiological, clinical and therapeutic aspects of severe malaria in patients in Antananarivo. We conducted a ...retrospective study from 1 March 2006 to 31 March 2008 at the infectious disease department. We recorded 61 cases of severe malaria among 1,803 in patients. Sex ratio was 2 and average age was 35.3 years old. Three pregnant women were recorded among women (15.8%). Self-medication was registered in 23%. Among 35 patients who received first medical care, no one had parasitological examination. The treatment was inadequate for all patients (n = 19). Conscience impairment (65.6%), jaundice (24.6%), seizure (18%) and prostration (14.8%) were the major severe signs. Diagnosis was made 6.54 days after the onset of the disease. Mortality rate was 11.5%. Self-medication, inappropriate primary care and delayed diagnosis represented risk factors for severe malaria in our cohort.
Résumé
Introduction
Les pathologies hépatiques dues à l’infection chronique par le virus de l’hépatite B (VHB) et de l’hépatite C sont devenues actuellement les premiers facteurs de comorbidité et de ...mortalité chez les patients infectés par le VIH (PVVIH). À Madagascar, aucune étude n’a été effectuée concernant ces co-infections. Ainsi, notre objectif était de déterminer la prévalence de la co-infection VIH/ VHB/VHC dans cinq centres hospitalo-universitaires malgaches, qui sont des centres de référence pour la prise en charge des PVVIH.
Méthodes
Il s’agissait d’une étude rétrospective, descriptive, transversale et multicentrique, durant la période du 2001 au 2011. La population d’étude comprenait des PVVIH appartenant aux files actives des cinq sites.
Résultats
Cent soixante patients étaient inclus. Le sex-ratio était de 0,92. L’âge moyen des PVVIH était de 33,42 ± 10 ans, avec des extrêmes de huit mois et de 60 ans. La prévalence globale des co-infections était de 7,5 %, dont 6,25 % pour le VIH/VHB et 1,25 % pour le VIH/VHC. On ne notait pas une co-infection VIH/VHB/VHC. La prévalence de la co-infection était similaire dans les deux genres. La majorité des co-infectés était célibataire,
n
= 8 (66,7 %). Deux sur trois des travailleurs de sexe avaient une co-infection.
Conclusion
La prévalence de la co-infection dans ces cinq centres de références était basse. Elle était probablement sous-estimée à cause de deux problèmes majeurs: le manque de moyen pour le dépistage, le nombre élevé de perdus de vue des PVVIH. Ainsi, un grand défi doit être relevé à tous les acteurs de santé à Madagascar pour remédier à ces fléaux.
The authors describe clinical and epidemiologic characteristics of severe presentations of Rift valley fever (RVF) during the 2008 epidemic in Madagascar.
The diagnosis was confirmed by RVF virus ...polymerase chain reaction (PCR), or detection of specifics antibodies by Elisa.
Sixteen cases of severe RVF were recorded. The sex-ratio was 7/1 and median age was 32 years (20/59 years). The risk factors of infection were: contact with infected animals or their meat (n=8), and travelling to a risk area (n=2). Hemorrhagic, neurological, and ocular manifestations were observed respectively in 87.5%, 43.8% and 6.3% of cases. All patients who died (n=4) presented with a hemorrhagic form of the disease.
The hemorrhagic form was the most frequent presentation of RVF and was responsible for a high level of mortality. Epidemiologic surveillance must be implemented.
The objective of our study was to describe the discrimination profile of healthcare personnel towards people living with HIV/AIDS (PLWHA) in medical settings in Madagascar.
A prospective, ...multicentric, descriptive, and analytic study was made with a questionnaire filled in anonymously, between February and August 2009, in 17 Madagascar hospitals (public and private).
Thirty-six percent of PLWHA reported that they had been confronted with discrimination in the medical field. The age (30-40 years) and the level of education had an impact on discrimination in our study (p<0.05). Paramedics were the most responsible for discrimination (n=8/13) (61.5 %). Discrimination in the medical field was listed as: refusal of the patient to be managed in the hospital (n=5/27) (18.5 %) because of the fear of discrimination (n=4/5) (80 %) and sharing serological status with healthcare providers. Discrimination by the medical staff was listed as the unjustified use of some tools (stethoscope, tensiometer, thermometer) and by the refusal to manage PLWHA (p>0.05). Fifty-three percent of healthcare providers answered the question on HIV transmission mode correctly. Fifteen percent replied that HIV was transmitted by saliva, and 20 % by physical contact.
As elsewhere, discrimination of PLWHA in the medical field is present in Madagascar. Fighting discrimination should be included in the strategy against propagation of HIV infection.
Helicobacter pylori is a worldwide infection. However very few data are actually available on H. pylori seroprevalence in the Malagasy population. We carried out a transversal study in a sample of ...persons who met the following criteria: older than 15 years old, presence in the medicine internal unit 2 (University Hospital Center of Antananarivo) during the period of the study whatever the reason. H. pylori infection was identified serologically by using ELISA (G.A.P IgG H. pylori ELISA, Bio-Rad, France). Several factors were evaluated including serological status, demographic information, the reason of the presence in the unit, factors influencing H. pylori infection: socio-economic status, siblings, promiscuity consumption of alcohol, use of tobacco, water source and history of gastroscopy. The presence of clinical symptoms, such as dyspepsia and abdominal pain, was determined. Forty-five men and 45 women were included (mean age: 41.8 +/- 3.4 years). The seroprevalence of H. pylori infection was 82%. H. pylori infection was higher in men than in women (p < 0.02). Promiscuity constituted the principal factor influencing H. pylori infection. The seroprevalence of the H. pylori infection appears to be comparable to the rate encountered in developing countries. Considering this high rate of the H. pylori infection, eradication of H. pylori should be commonly recommended when facing gastrointestinal pathologies potentially induced by H. pylori.
Résumé
Le syndrome neurologique postpaludisme (SNPP) est une complication rare du paludisme. Il survient habituellement après un paludisme grave. Nous rapportons un cas de SNPP compliquant un ...paludisme simple à
Plasmodium falciparum
chez un patient malgache. La prise en charge du SNPP est complètement différente d’un accès palustre. Aucun traitement spécifique n’est nécessaire.
