Contribution of the Tourniquet in the Prevention of Haemorrhages during Myomectomies at the University Hospital of Brazzaville

Objective: To check the effectiveness of tourniquet in the prevention of haemorrhage during myomectomies at the University Hospital of Brazzaville. Patients and methods: Analytical cross-sectional study, conducted at the University Hospital of Brazzaville from June 1, 2014 to June 30, 2016. Recruitment was performed by randomly matching each case of myomectomy performed using a tourniquet with two cases of myomectomy without tourniquet (50 cases vs 100 witnesses). We used as a tourniquet, the surgical glove knotted and tightened sufficiently at the level of the isthmus of the uterus to temporarily occlude the uterine arteries to ensure haemostasis lasting no more than one hour. Results: The mean age of the patients was similar in both groups (36, 1 ± 2.2 years vs 36.2 ± 1.9 years, P > 0.05). Menorrhagia was the most common indication of myomectomy in both groups (76% vs. 78% P > 0.05). The mean haemoglobin level of the patients before the myomectomies was 9.03 ± 1.10 g/dl vs 9, 75 ± 1.29 g/dl;P > 0.05. Intraoperative uterine features were similar in size (18 weeks gestation, 14 - 24) and number of myomas (5 vs 4, P > 0.05) in both groups. Polymyomectomy was more common in both groups (76% vs 73%, P > 0.05). Blood loss was reduced in the tourniquet group (90.5 ± 4.6 ml vs 200.4 ± 5.6 ml;P 0.05), as well as the use of blood transfusion (8% vs 50%, P 0.05). Use of the number of sutures was reduced in the group with tourniquet (3 ± 0.2 vs 6 ± 0.2 P 0.05). The duration of the procedure was shorter in the group with tourniquet (51.5 ± 4 min vs 83 ± 7 min, P 0.05). Postoperative mean haemoglobin of patients was no different between the two groups (9.4 ± 0.7 g/dl vs 9.2 ± 0.5, P > 0.05). The overall cost of management was reduced in the group with tourniquet (190,680 ± 1450 F CFA vs 256,800 ± 2350 FCFA;P 0.05). Conclusion: The use of tourniquet during myomectomies significantly reduces blood loss and the use of blood transfusion. We also obtain the notorious reduction in the use of sutures, the duration of interventions, and the overall cost of care. Thus, we encourage the systematic use of tourniquet during myomectomies by laparotomy.

Phytochemical Characterization of Three Plants and Their Antisickling Activity in the Management of Sickle Cell Disease

Natural plant products have been used by the population of the south-eastern part of Côte d’Ivoire in the management of sickle cell anemia. This study was aimed at investigating the antisickling activity of the hydro-ethanolic extract of a combination of the leaves of J. secunda, J. gossypiifolia and P. nigrescens. These three plants species were used in the Ivorian traditional herbal medicine. Preliminary phytochemistry was carried out using standard methods. As for the sickling reversal test, the Hb SS blood sickling was induced with 2% sodium metabisulfite. After 120 minutes of incubation, the plant extract was added. Every 30 minutes for a period of 120 minutes, a drop of the prepared solution was observed at (40×) magnification and the percentage of reversion calculated. The phytochemical analysis revealed the presence of Alkaloids, Flavonoids, Polyphenols, Catechic Tannins, Sterols and Polyterpenes. The results of the reversal test showed that the percentage of sickling reversal effect of the combination of the plants (75.00 ± 4.33b,c) was highly superior than the negative control (10.17 ± 0.55d) but was significantly (p < 0.05) the same as the percentage of the individual plant (J. secunda: 83.50 ± 2.33a;J. gossypiifolia: 78.00 ± 3.67b,c and P. nigrescens: 77.83 ± 2.89b,c) and the positive control (80.66 ± 2.22a,b). From the results, the extracts J. secunda, J. gossypiifolia and P. nigrescens have shown to be therapeutically beneficial to the population. Their use is also justified in the management of sickle cell disease in the south-eastern part of Côte d’Ivoire.

Cryptococcal Antigenaemia among Treatment-Naïve Adult HIV-Infected Nigerian Patients

Background: There is a high burden of HIV-related cryptococcal meningitis in Sub-Saharan Africa and it is a leading cause of morbidity and early mortality among severely immunocompromised patients. Objectives of the Study: This study was carried out to determine the prevalence of cryptococcal antigen (CrAg) and the relationship of positivity to CD4+ve T cell counts and WHO clinical stage among severely immunocompromised treatment naive adult HIV-infected Nigerian patients. Methods: This was a hospital based cross sectional and prospective study carried out among newly diagnosed and confirmed HIV infected patients. Bio data of consenting consecutive subjects was collected by the attending physician using structured questionnaire. Rapid point of care lateral flow assay kits (IMMY, USA) was used to screen plasma samples from subjects strictly following manufacturer’s instructions. Data were analysed with statistical package for social sciences (spss 15.0) software. Results were presented in simple tables with frequencies and percentages while statistical significance was taken to be p value ≤ 0.05. Results: Of 432 subjects, there were 184 (42.6%) males and 248 (57.4%) females in the study. The median CD4 count of the subjects was 74 (range 6 - 1264) cells/ul. Seven (1.6%) of the subjects were positive for cryptococcal antigen (CrAg) and all were females (100%). Six (85.7%) of CrAg positives had CD4+ T cell count less than 100 cells, while 1 (14.3%) had count above 200cells/ul. The WHO clinical stage of studied patients was;stage I 163 (37.7%), stage II 132 (30.6%) stage III 95 (22.0%) and stage IV 42 (9.7%). Among the CrAg positive subjects, 3 (42.9%) were in WHO clinical stage l while 4 (57.1%) were in stage II disease. Conclusion: The observed overall prevalence of CrAg positivity among studied patients was low but occurred most frequently among the severely immunocompromised subjects. Advancement in WHO clinical stage was not a predicting risk factor for cryptococcal antigenaemia in studied adult HIV infected patients.