Aqueous Extract of Ceiba pentandra Stimulates the Production of Fetal Hemoglobin in Sickle Cell Patients

Subsequent studies have demonstrated the reversed activity of the aqueous extract of Ceiba pentandra on the deformity of sickled red blood cells in hypoxia conditions. The observation which related to an in vitro study had given rise to hopes as to the management of sickle cell disease (SCD) by the use of this plant species. In this paper, the authors aimed to investigate the effect of the aqueous extract of C. pentandra on the production of fetal hemoglobin in SCD patients. The work carried out hemoglobin electrophoresis, for a period of six months, on blood samples from SCD patients who voluntarily undergone routine treatment, based on the medicinal recipe prepared from the bark of the trunk and branches of C. pentandra, in a hospital center of herbal medicines located in Kinshasa. The medicinal recipe called BEAT-SS is a patented product of the hospital center named Centre de Phytothérapie Moderne NIECA. Blood samples from patients under treatment were taken to evaluate the behavior of different forms of hemoglobin (hemoglobin S, hemoglobin F and hemoglobin A2). Agarose gel electrophoresis with integrated reading was used for the separation of the different forms of hemoglobin, as well as their dosage on each sample of sickle blood. A reduction in the proportion of hemoglobin S and an increase in the proportion of fetal hemoglobin were found in all sickle cell patients during the treatment period. This observation could affirm that the management of sickle cell patients using the recipe prepared from the aqueous extract of C. pentandra could increase the level of fetal hemoglobin in these patients.

Total Hip Replacement: Short- and Medium-Term Morbidity and Mortality in the Department of Orthopedic Traumatology of Donka University Hospital, Guinea-Conakry

Introduction: Total hip prostheses are a reliable means of treating hip disorders. It is indicated when pain and reduced mobility of the hip become incompatible with the patient’s daily activities. In low-income countries, the risk factors for hip disease are numerous, but the means for its management, such as total hip prostheses, are not. The aim of this work was to determine the morbi-mortality of total hip prostheses in the short and medium term in our department and to review the literature. Patients and Method: This was a prospective and descriptive study over a period of 9 years. It involved 50 THPs performed on 45 patients. Patients who had received a THP and were followed up for at least two years were included. We excluded patients who were lost to follow-up. The Moore-type posterolateral minimally invasive approach was used. Complications were investigated from the immediate postoperative period and in the medium term. The final functional results were evaluated according to the Postel Merle d’Aubigné score. Results: We performed 50 THPs out of 750 procedures, i.e. , 6.6%. The indications were: primary coxarthrosis 60%, necrosis of the femoral head 26%, post-infectious balloon hip 4%, and pseudarthrosis of the femoral neck 10%. The average time to the consultation was 2.4 years with extremes of 1 and 5 years. According to the terrain, sickle cell disease represented 18%, tuberculosis 12%. Postoperative complications were lameness 12%, dislocation 6%, suppuration 6%, death 4%, peri-prosthetic fracture 8%, loosening 2%, peri-articular ossification 2%, and paralysis of the external popliteal nerve 2%. Conclusion: Whoever performs a THP is obliged to monitor the patient as long as he/she is alive. Complications are possible at any time and can negatively change the assigned goal and force the surgeon to be expensive and sometimes inconclusive secondary interventions.

Impact of Multifidus Muscle Morphometry on the Clinical Evolution of Chronic Low Back Pain

Purpose: The multifidus muscle is an important extensor muscle of the lumbar spine. It plays a major role in the stability and realization of axial rotation movements of the thoraco-lumbar spine. Its atrophy by fatty degeneration would be at the origin of the occurrence of chronic low back pain which constitutes a public health problem in Senegal. Taking into account its anatomy is essential for the etiopathogenic analysis and the treatment of low back pain. The purpose of our work was to investigate the impact of multifidus muscle morphometry on the anatomy-clinical evolution of low back pain. Material and method: this was a prospective study over a period of 30 months from November 2019 to May 2022. It involved 100 patients seen in the neurology department of Fann Hospital for chronic low back pain and who had already had a scanner falling within the criteria for low back pain. We used 3D Slicer, SPSS 20, Excel 2016 software to model and analyze the morphometric data of the multifidus muscle after physiotherapy and control lumbar scans. Results: The sex ratio was 2.23. The average age of the patients was 45 ± 7 years. On the initial CT scan, according to the Hadar classification, we noted a predominance of grade 2 with 56% in L5/S1, followed by grade 1 with 32% and grade 3 with 14%. In L4/L5, the majority of patients, 67%, had grade 1. A conflicting circumferential disc bulge with the roots predominating in L5/S1 was present in 94% of men (p-value = 0.02). Before physiotherapy, the average volume of the multifidus was 193 mm3 ± 39, after physiotherapy it was 203 mm3 ± 42 with a progression rate of 5.2%. Clinically, severe type pain had regressed from 86% before physiotherapy to 0% after physiotherapy (p-value = 0.03). Conclusion: Taking into account the morphometry of the multifidus is an essential element in the management of chronic low back pain.

Aseptic Pseudoarthrosis of the Humeral Diaphysis. Epidemiological Features—Therapeutic Assessment

Objective: The aim of this work was to assess the epidemiological factors of the pseudoarthroses of diaphyseal humeral fractures in order to prevent them and also to assess the results of their treatment by screwed plate associated with an auto-graft. Material and method: This was a retrospective series of 36 aseptic pseudoarthroses of the humeral diaphysis treated by screwed plate, associated or not with a bone autograft between January 1997 and December 2016 at the Treichville University Hospital. The criteria of inclusion refer to the existence of an aseptic pseudoarthrosis of the humeral diaphysis treated by screwed plate. The approach was antero-external. Two thirds of pseudoarthroses were between the middle 1/3. 23 atrophic pseudoarthroses (65%) and 13 hypertrophic pseudoarthroses. Functional results were assessed using the Steward and Hundley criteria. Results: Mortality was zero, and postoperative complications were dominated by 4 hematomas and 2 transient iatrogenic paresthesias of the radial nerve. The sequelae were minor and the consolidation was acquired in 97.25% of patients. Conclusion: The treatment of aseptic pseudoarthroses of the humerus by screwed plate associated with an auto-graft is a reliable technique, inexpensive with a satisfactory functional outcome.

Pelvic Reconstruction after Chronic Pubic Symphysis Diastasis and Bladder Herniation

The research proposes a surgical technique for patients with chronic pubic symphysis diastasis and bladder herniation by means of a pelvic reconstruction technique. Three patients were treated initially in other hospitals and referred to us. All presented with pubic symphysis diastasis greater than 7 cm and bladder herniation. Two patients were initially treated with external fixation, and in one patient, the symphysis diastasis had been completely neglected. All cases presented good evolution with the proposed technique, which is described in details in the paper.

Clinical,Laboratory and Echografic Evaluation of Patients with Deep Vein Thrombosis Following Total Knee Arthroplasty

Introduction: Total knee arthroplasty, being a major surgery, carries a risk of post-operative deep vein thrombosis (DVT). The main objective of the present study was to elucidate the association of clinical, laboratory, and echographic findings with the occurrence of DVT. Patients and Methods: The present study was prospective and non-randomized, with restricted exclusion criteria. Forty patients were submitted to total knee arthroplasty due to osteoarthritis. Patients were clinically evaluated by laboratory tests, assessment of pain and calf circumference, and the presence of Homans’ sign. Echo Doppler was performed in each patient on postoperative day 7. The echographic evaluation divided the patients into two groups: positive (G1) and negative for thrombosis (G2). All patients received prophylactic heparin during the 7-day hospital admission. Results: Eleven patients complained of pain (analgesic medication was used during the entire admission). Leg circumference variation from the pre-operative period to post-operative day 7 was: G1, 1.70 ± 1.12 cm and G2, 0.68 ± 1.25 cm (p = 0.03). Homans’ sign was considered positive in 10 patients. Echographic evaluation was positive in 11 patients (27.5%). No cases of pulmonary embolism, infection, or death were observed. Conclusions: The incidence of DVT was 27.5%, with an increase in leg circumference being the main predictive factor (p = 0.03).