Médecine tropicale : revue du Corps de santé colonial
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Sensitivity, specificity, and predictive value are the standard parameters used to evaluate the efficacy of diagnostic tests. However all three parameters assume the existence of a gold standard test. ⋯ The solution involves assessment of agreement between two raters. This article based on an example drawn from an African setting describes the value and computation of the most widely used tool for assessing agreement and reproducibility of measures, i.e., the kappa coefficient.
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The purpose of this retrospective study was to determine the profile of medical emergencies and their management in a university hospital center in a tropical area. Between July 1 and December 31, 2001, all patients examined in a medical and surgical emergency room were included. Obstetrical emergencies, pediatric emergencies, emergencies admitted directly to the cardiology, ORL emergencies and urologic emergencies were not included. ⋯ Gastrointestinal events accounted for 20.23% of cases, cardiovascular events for 9.12%, respiratory events of 8.56%, metabolic events for 1.78%, trauma for 48.20% and infectious disease for 12.09%. Surgical mortality was 2.41%. Most problems facing the intensivist treating medical emergencies in a tropical setting involved resuscitation.
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Over a 10-year period, a series 96 patients were treated for laryngotracheal and bronchial foreign bodies in the ENT department of the Ouagadougou University Hospital Center (Burkina Faso). The purpose of this study was to analyze the epidemioclinical features and therapeutic pitfalls encountered in that series and to propose measures to improve management. The age of patients ranged from 10 months to 14 years. ⋯ Tracheostomy was performed in 10.4% of cases mainly in patients with foreign bodies located in larynx. One patient died during extraction. In addition to providing more information and education on prevention of laryngotracheal and bronchial foreign bodies, better management requires better training of medical personnel and improvement of technical facilities.
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Organization of emergency care services prior to hospital admission has progressed at a satisfactory pace in developed countries. A performance model in this field is the French emergency service called service d'aide médicale d'urgence (SAMU). ⋯ As a result, it may be asked if emergency care services is really a luxury. The authors base their conclusion on analysis of the conditions and outcome of emergency patient care in three African countries in which it is essentially a requirement.
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Epidemiological data from the French National Reference Center for Imported Diseases showed that the estimated number of cases of imported malaria in France increased from 5,940 in 1998 to 7,127 in 1999 and 8,056 in 2000. This three-year progression ended in 2001 when the number of estimated cases fell back to 7,223. It was due mainly to the concomitant increase in the number of people traveling to endemic zones especially in Africa. ⋯ Less than 10% of the 45% of patients claiming use of prophylaxis complied properly. Analysis of the drugs used for curative treatment in 2000 showed an increase in the use of quinine and mefloquine and decrease in the use of halofantrine. The main objectives remain reduction of mortality and improvement of prevention.