Devenir post-opératoire des ostéotomies tibiales hautes pour gonarthroses désaxées et avancées: Postoperative outcome of high tibial osteotomies for offaxis and advanced osteoarthritis

Context and objective. Despite being recognized as an alternative to total or unicompartimental prothesis in the treatment of offset and advanced femoro-tibial knee osteoarthritis, data about high tibial osteotomy (HTO) are paradoxically scarce in sub-Saharan Africa. This study aimed to describe the postoperative functional outcome of HTO. Methods. Thirty-one consecutive patients with advanced knee osteoarthritis (in valgus or varus), underwent HTO, using the Blaimont technique slightly modified by Clemens between 1998 and 2011, in three hospitals in Kinshasa. A retrospective assessment of the cases was done, based on the International Knee Society (IKS) score before and after the HTO. Results. After HTO, the IKS score was 78 points. The mechanical axis was 180° degrees (171 to 185°). After the surgery all the patients were able to squat, to sit with knees bent at 90°, and to move on a suitable distance compared to the preoperative perimeter. Neither rotational instability, nor mechanical discord were observed, but rather a case of misplacement of the spindle and two other cases of cutaneous necrosis. Conclusion. These results showing a functional improvement of the pain and the mobility in patients after HTO highlight the position of this technique as an effective alternative to of the TKA or UCP in the management of knee osteoarthritis. Contexte et objectif. Bien que l’ostéotomie tibiale haute de recentrage (OTH) dans le traitement des gonarthroses fémoro-tibiale désaxées et avancées soit reconnue comme alternative aux prothèses totales ou unicompartimentales, les données y relatives sont paradoxalement inexistantes en Afrique subsaharienne. L’objectif de la présente étude a été de décrire le devenir fonctionnel post opérative de l’OTH. Méthodes. Nous avons rétrospectivement examiné le devenir de trente et un patients consécutifs opérés par OTH pour gonarthroses avancées (en valgus ou en varus) entre 1998 et 2011, dans 3 formations hospitalières de Kinshasa, par une même équipe. Le recul était de 6,5 ans (maximum de 9 ans). Ils ont été tous opérés, selon la technique décrite par Blaimont et légèrement modifiée par Clemens. L’évaluation a été faite à l’aide du score international Knee society (IKS) avant et après OTH. Après l’intervention, 86,8% des patients étaient satisfaits ou très satisfaits. Résultats. Après OTH, le score IKS genou était de 78 points, le score IKS fonction était de 76 points. L’axe mécanique moyen était à 180 degré (de 171 à 185 degré). Les patients opérés étaient capables de s’accroupir, de s’asseoir les genoux fléchis à 90 de grés (100%), de se mettre en position à genoux et de se déplacer sur une distance confortable par rapport au périmètre de marche préopératoire (100%). Il n’y a eu aucun cas d’instabilité rotatoire ni de descellement mécanique mais plutôt un cas de mal positionnement de la broche et deux autres cas de nécrose cutanée. Conclusion. Ces résultats montrant une amélioration fonctionnelle de la douleur et de la mobilité des patients avec gonarthrose opérés, confirment que l’OTH est une alternative efficace des PTG ou des PUC dans la prise en charge des gonarthroses. &nbsp

Leçons apprises de la gestion des épidémies de la maladie à virus Ebola en République Démocratique du Congo de 2007 à 2017: Lessons learned from the management of Ebola outbreaks in the Democratic Republic of Congo from 2007 to 2017

Context and objective. DRC’s ecosystem provides conditions that are favorable to the occurrence of zoonotic diseases at the human-animal interface including Ebola virus disease (EVD). Because the level of lethality of EVD is high, the present study focuses on the epidemics that occurred in Mweka (2007 and 2008), Isiro (2012), Boende (2014) and Likati (2017) with a view to assess the response components during each outbreak and to identify those with relevant impact on the scale of the epidemic. Methods. An analytical retrospective study of secondary data collected during the management of the five aforementioned EVD epidemics in DRC was conducted.Charecteristics of each outbreak were described based on descriptive statistics, and univariate analyzes of each response component were conducted in relation to lethality. Results. A total of 422 cases were recorded with 282 deaths or 66.8% lethality. The vast majority of cases are in the 15 to 49 age group. The female sex is the most represented. Among all the elements of the answer, in a univariate model, the deployment of the mobile laboratory (p = 0.002), the functionality of the commissions (p =0.001), the deployment of a multidisciplinary team and the powerful surveillance system (p = 0.001) are significantly associated with lethality. Conclusion. Rapid deployment of the mobile laboratory in the field, deployment of multidisciplinary teams, efficient functionality of the commissions and a functional monitoring system significantly reduced the fatality rate. Contexte et objectifs. La RDC a un écosystème favorable à la survenue des maladies d’origine zoonotique à l’interface homme-animal dont la maladie à virus Ebola (MVE). Face à une létalité reconnue être élevée pour cette dernière, cette étude s’est focalisée sur les épidémies survenues à Mweka (2007 et 2008), à Isiro (2012), à Boende (2014) et à Likati (2017) afin de décrire les différents éléments de réponse mis en place lors de chacune de ces épidémies et identifier ceux qui ont une influence significative sur l’ampleur de l’épidémie. Méthodes. Une étude documentaire analytique sur les données secondaires recueillies lors de la gestion de ces cinq épidémies de la MVE survenues en RDC. Les statistiques descriptives ont été réalisées pour caractériser chaque épidémie. Les analyses univariées de chaque élément de réponse ont été menées en rapport avec la létalité. Résultats. Un total de 422 cas a été enregistré avec 282 décès soit 66,8 % de létalité. La grande majorité de cas se trouve dans la tranche d’âge de 15 à 49 ans. Le sexe féminin est le plus représenté. Parmi tous les éléments de la réponse, dans un modèle univarié, le déploiement du laboratoire mobile (p=0,002), la fonctionnalité des commissions (p=0,001), le déploiement d’une équipe multidisciplinaire et le système de surveillance performant (p=0,001) sont associés significativement à la létalité. Conclusion. Le déploiement rapide du laboratoire mobile sur le terrain, le déploiement des équipes multidisciplinaires, la bonne fonctionnalité des commissions et le système de surveillance fonctionnel ont permis de réduire significativement la létalité

Ultrasound Assessment of Bone Mass in Central Africans Population

Background: Osteodensitometry, a procedure increasingly accepted by clinicians to access osteoporosis is not yet fully validated by WHO. It requires the establishment of normal values and references curves for each population, and in our community, this is not yet assessed.The purpose of this study was twofold: to describe the profile of the speed of sound of proximal phalangeal metaphysis and establish references curves in central Africans and to compare them with those of other populations specially Caucasians.Methods: This cross sectional study was carried out at Kinshasa, Democratic Republic of the Congo in Central Africa from January to December 2016.Four hundred twenty four subjects aged from 20 to 87 years old, were explored and the speed of sound in theirs proximal phalanges measured using ultrasound equipment. Age, gender, hormonal status and speed of sound were collected and analyzed.Results: The mean value of the Amplitude Dependent Speed of Sound (AD-SoS) showed a growth feature with age (from 2056 m/sec at second decade of life to 2145.27 m/sec at fourth decade followed by a progressive decrease which was present in both sexes but more marked in postmenopausal women (1927.06 m/sec). This mean value was higher than in Caucasian studies. In this study, age and hormonal status seems to be the bone quality most influencing anthropometric factors as seen in many series.The curve profile with age was also a polynomial curve as seen in others populations of the world.Conclusion: This study provides normal data for phalangeal ultrasound measurements and reference curve of central Africans which were compared to those of Western studies

Correlation between the Lactate Dehydrogenase Levels with Laboratory Variables in the Clinical Severity of Sickle Cell Anemia in Congolese Patients.

Sickle cell anemia is an inflammatory disease and is characterized by chronic hemolysis. We sought to evaluate the association of lactate dehydrogenase levels with specific clinical phenotypes and laboratory variables in patients with sickle cell anemia.The present cross-sectional study was conducted in Sickle Cell Centre of Yolo in Kinshasa, the Democratic Republic of Congo. Two hundred and eleven patients with Sickle Cell Anemia in steady state were recruited. Seventy-four participants with normal Hb (Hb-AA) were selected as a control group.The average rates of hemoglobin, hematocrit, and red blood cells tended to be significantly lower in subjects with Hb-SS (p<0.001). The average rates of white blood cells, platelets, reticulocytes and serum LDH were significantly higher in subjects with Hb-SS (p<0.001). The average rates of Hb, HbF, hematocrit and red blood cells of Hb-SS patients with asymptomatic clinical phenotype were significantly higher than those of the two other phenotypes. However, the average rates of white blood cells, platelets, reticulocytes, and LDH of Hb-SS patients with the severe clinical phenotype are higher than those of two other clinical phenotypes. Significant correlations were observed between Hb and white blood cell in severe clinical phenotype (r3 = -0.37 *) between Hb and red blood cells in the three phenotypes (r1 = 0.69 * r2 * = 0.69, r3 = 0.83 *), and finally between Hb and reticulocytes in the asymptomatic clinical phenotype and severe clinical phenotype (r1 = -0.50 * r3 = 0.45 *). A significant increase in LDH was observed in patients with leg ulcer, cholelithiasis and aseptic necrosis of the femoral head.The increase in serum LDH is accompanied by changes in hematological parameters. In our midst, serum LDH may be considered as an indicator of the severity of the disease

Age and hematological parameters according hemoglobin electrophoresis status in the study population.

<p>*Student test;</p><p>RBCs: Red Blood Cells; WBCs: White Blood Cells; MCV: Mean corpuscular volume; MCHC: Mean corpuscular hemoglobin concentration; LDH: Lactodehydrogenase</p><p>Age and hematological parameters according hemoglobin electrophoresis status in the study population.</p

Relationship between clinical phenotypes, LDH and sickle cell complications.

<p>Relationship between clinical phenotypes, LDH and sickle cell complications.</p

Clinical criteria and severity score based on phenotype.

<p>*ACP: Asymptomatic clinical phenotype;</p><p>**MCP: Moderate clinical phenotype;</p><p>***SCP: Severe clinical phenotype; BMI = Body Mass Index</p><p>Clinical criteria and severity score based on phenotype.</p

Correlation coefficients between LDH and haematological variables according clinical phenotype in the sickle cell study population.

<p>**: significant correlation at the 0.01 level;</p><p>*: significant correlation at the 0.05 level;</p><p>WBCs: White blood cells; LDH: Lactodehydrogenase</p><p>Correlation coefficients between LDH and haematological variables according clinical phenotype in the sickle cell study population.</p

Age and hematological parameters according clinical phenotypes of the study population.

<p>*Anova test;</p><p>ACP: Asymptomatic clinic phenotype; MCP: Moderate clinic phenotype; SCP: Severe clinic phenotype; HbF: Fetal hemoglobin; RBCs: Red Blood Cells; WBCs: White Blood Cells; MCV: Mean corpuscular volume; MCHC: Mean corpuscular hemoglobin concentration; LDH: Lactodehydrogenase</p><p>Age and hematological parameters according clinical phenotypes of the study population.</p