Médecine tropicale : revue du Corps de santé colonial
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Practice Guideline Guideline
[Practical guidelines for the management of Ebola infected patients in the field].
Ebola hemorrhagic fever appears after an incubation of 3 days to 3 weeks. The first symptoms are fever accompanied by general and hemorrhagic signs leading to death in 50 to 90% of cases. During epidemics definition of cases permits prompt diagnosis. ⋯ Persons having been in close contact with patient should be kept under medical surveillance for 21 days. Recovering patients should use condoms for three months. Bodies of deceased patients should be handled by trained teams and buried quickly.
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Malaria requiring intensive care is characterized by failure of one or more organ systems and/or development of several metabolic disorders secondary to the presence of Plasmodium faliciparum in the blood. Severe imported malaria in non-immunized adults causes multiple organ failure with variable degrees of altered mental status. Acute pulmonary edema is frequent, jaundice associated with mild disturbance of liver function is consistent, arterial hypertension due to hypovolemia is usual, and acute renal insufficiency is uncommon. ⋯ Supportive symptomatic treatment, e.g. mechanically assisted ventilation and kidney dialysis, is required. In endemic zones over 90% of deaths involve children without access to intensive care facilities. Mortality rates associated with management of severe imported malaria in intensive care range from 10 to 30%.
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At the beginning of the 1960s a campaign was carried out to eradicate endemic trepanematosis in the South Pacific. During the year 2000, twenty cases of yaws were diagnosed on Santo Island in Vanuatu. Recrudescence of this disease was confirmed by a seroprevalence testing showing 20.9% positive VDRL in 273 serum tests. ⋯ Cooperation of the population and involvement of mobile units and primary health-care providers were key factors in the success of this campaign. Further action will include training of health care workers and improvement of sanitary conditions in villages. Seroprevalence testing to assess the effectiveness of this campaign is to be carried out in 2003.
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A postal survey carried out by TDR (UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases) on sixty three (63) African medical journals in July 2002 found that the majority of medical and health journals were under-funded, did not publish regularly, lacked high quality articles and standard peer review practice and were mostly invisible to the rest of the international medical community. In French speaking Africa less than ten medical journals publish regularly and only five are indexed in Medline. Ten (10) countries out of twenty three (23) have no medical journal at all. ⋯ Academic traditions play an important role on the decision of French speaking African researchers to publish outside their country. The impact of African health research on local researchers, health professionals and policy makers in French speaking Africa, all of whom have little access to major international health journals and a poor command of the English language, is questionable. In 2002, TDR facilitated the launching of the Forum of African Medical Editors (FAME) to promote the creation of sustainable, high quality public health and medical journals in Africa in order to encourage African health researchers to publish also for their colleagues in their country.
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The prognosis of emergency cesarean section is poor for both the mother and child in developing countries. The respective impact of obstetrical and surgical factors has rarely been analyzed. This prospective study was carried out in 370 women (mean age, 30.5 years) who underwent emergency cesarean section at Principal Hospital in Dakar, Senegal, between January 1 and December 31, 1997. ⋯ Child mortality was significantly higher in the absolute emergency group (RR = 5.4; IC95% = 3.2-8.9, p < 10(-6)). Mother and child mortality rates were correlated with the severity of obstetrical manifestations and delay of care. Findings also showed that a well-organized care system lowers the operative risk of emergency cesarean section even in developing countries.