[Obstetrical vesico-vaginal fistula in Guinea: Data analysis of three sites of treatment at Engender Health ONG]. / Fistules vésico-vaginales obstétricales en Guinée : analyse des données de 3 sites de prise en charge de l'ONG Engender Health.

OBJECTIVE: To analyze the management of obstetric vesico-vaginal fistula in the three sites of Engender Health in Guinea. PATIENTS AND METHODS: It was a retrospective study of descriptive type having helped collect 450 cases of vesico-vaginal fistulas in three support sites engender health between January 2008 and December 2011. The variables studied were epidemiological, clinical and therapeutic reasons and treatment outcomes were evaluated after a decline of at least six months. RESULTS: The mean age of onset of the fistula was 25years, ranging from 12 to 55years and 58.8% (n=265) of patients were aged between 18 and 30years. The mean duration of fistula was 11years, ranging from 1 to 38years. Eighty-two percent (n=416) of patients were housewives and 66.4% (n=299) off school. The complex fistula with 66% (n=297) was the most frequent. The treatment consisted of a fistulorraphie after splitting vesico-vaginal in 93.3% (n=420) of cases. Therapeutic results considered after a mean of 8months have resulted in a cure in 79.3% (n=357) of cases, improvement in 4.2% (n=19) of cases and failure in 16 4% (n=74) of cases. CONCLUSION: Vesico-vaginal fistula is a major cause of maternal morbidity in Guinea. The establishment of a real health policy based on sound medical and social structures contributes to its eradication. LEVEL OF EVIDENCE: 5.

Ethnobotanical survey and antibacterial activity of some plants used in Guinean traditional medicine.

A total of 418 healers have been interviewed in Guinea, a coastal country of West Africa, ranging between 7 degrees 30 and 12 degrees 30 of northern latitude and 8 degrees and 15 degrees of western longitude. Plant species used by the local inhabitants to treat infectious diseases were identified using ethnobotanical, ethnographic and taxonomic methods. During these investigations, 218 plants were registered, of which the following were the most frequently used: Erythrina senegalensis, Bridelia ferruginea, Crossopteryx febrifuga, Ximenia americana, Annona senegalensis, Cochlospermum tinctorium, Cochlospermum planchonii, Lantana camara, Costus afer, Psidium guajava, Terminalia glaucescens, Uapaca somon and Swartzia madagascariensis. Most plants, and especially the leaves, were essentially used as a decoction. In order to assess antibacterial activity, 190 recipes were prepared and biologically tested, among which six showed activity (minimal inhibitory concentration<125 microg/ml) against Bacillus cereus, Mycobacterium fortuitum, Staphylococcus aureus, or Candida albicans, i.e., Entada africana, Chlorophora regia, Erythrina senegalensis, Harrisonia abyssinica, Uvaria tomentosa, and a mixture of six plants consisting of Swartzia madagascariensis, Isoberlinia doka, Annona senegalensis, Gardenia ternifolia, Terminalia glaucescens and Erythrina senegalensis.

Ethnomedical and ethnobotanical investigations on the response capacities of Guinean traditional health practioners in the management of outbreaks of infectious diseases: The case of the Ebola virus epidemic.

ETHNOPHARMACOLOGICAL RELEVANCE: The recent outbreak of Ebola virus infections has mostly remained confined to the West African countries Guinea-Conakry, Sierra-Leone and Liberia. Due to intense national and international mobilizations, a significant reduction in Ebola virus transmission has been recorded. While international efforts focus on new vaccines, medicines and diagnostics, no coherent national or international approach exists to integrate the potential of the traditional health practitioners (THPs) in the management of infectious diseases epidemics. Nevertheless, the first contact of most of the Ebola infected patients is with the THPs since the symptoms are similar to those of common traditionally treated diseases or symptoms such as malaria, hemorrhagic syndrome, typhoid or other gastrointestinal diseases, fever and vomiting. MATERIALS AND METHODS: In an ethnomedical survey conducted in the 4 main Guinean regions contacts were established with a total of 113 THPs. The socio-demographic characteristics, the professional status and the traditional perception of Ebola Virus Disease (EVD) were recorded. RESULTS: The traditional treatment of the main symptoms was based on 47 vegetal recipes which were focused on the treatment of diarrhea (22 recipes), fever (22 recipes), vomiting (2 recipes), external antiseptic (2 recipes), hemorrhagic syndrome (2 recipes), convulsion and dysentery (one recipe each). An ethnobotanical survey led to the collection of 54 plant species from which 44 identified belonging to 26 families. The most represented families were Euphorbiaceae, Caesalpiniaceae and Rubiaceae. Literature data on the twelve most cited plant species tends to corroborate their traditional use and to highlight their pharmacological potential. CONCLUSIONS: It is worth to document all available knowledge on the traditional management of EVD-like symptoms in order to evaluate systematically the anti-Ebola potential of Guinean plant species.

Bone marrow edema caused by altered pedal biomechanics.

OBJECTIVE: To review the magnetic resonance imaging (MRI) appearance of bone marrow edema (BME) and to discuss the applications of this imaging modality in the diagnosis of associated disorders. A case of BME in the foot is also provided to acquaint the reader with how MRI may assist in establishing a differential diagnosis in patients with normal radiographs and clinical findings that suggest osseous injury. CLINICAL FEATURES: A 42-yr-old woman suffered from persistent pain along the dorsum of her foot that worsened with jogging. There was foot pronation and palpable pain and swelling at the third tarsometatarsal joint. An MRI was performed, but it was initially misinterpreted. A second review of the MRI examination established the presence of stress-induced BME adjacent to the articular margins of the third tarsometatarsal joint. INTERVENTION AND OUTCOME: Medical treatment consisted of a cortisone injection into the left third tarsometatarsal joint, which provided transient relief. Chiropractic treatment included flexible custom orthotics prescribed to specifically address her foot pronation. This was the only chiropractic treatment employed. CONCLUSION: In the presented case, the sensitivity of MRI to stress-induced BME identified the cause of this patient's symptoms and, more importantly, directed management. Because of its ability to demonstrate anatomic and physiologic information, MRI is the ideal imaging modality for assessing suspected injury to the osseous tissues. In patients who relay historical information that suggests chronic or acute osseous injury but demonstrate no radiographic changes to support the clinical suspicion of bony abnormality, an MRI may be indicated to exclude occult injury.

Double patella syndrome with a form of multiple epiphyseal dysplasia.

OBJECTIVE: To present an interesting and unusual case of double patella syndrome in a patient with multiple epiphyseal dysplasia. The pertinent clinical and radiographic findings and a brief review of the literature are discussed. CLINICAL FEATURES: An 11-yr-old male patient suffered from occasional right hip pain and limited range of motion, as well as a nontender soft tissue mass in the right knee. Radiographic examination of the hips and knees demonstrated double-layered patellae and bilateral coxa magna deformity. INTERVENTION AND OUTCOME: Although surgery was initially recommended, conservative chiropractic management was employed and resulted in complete resolution of the patient's presenting hip symptoms. CONCLUSION: This case is the first reported of double patella seen on MRI and demonstrates the value of this technology in the noninvasive preoperative assessment of double patella syndrome. The patient's clinical and radiographic features led to the correct diagnosis.

Cervical spondylolysis: three levels of simultaneous involvement.

OBJECTIVE: To discuss an interesting case depicting multiple levels of cervical spondylolysis. Differential diagnosis and a brief review of the literature are discussed. CLINICAL FEATURES: A 24-yr-old man suffered from constant neck discomfort of approximately 4 months' duration. After physical examination, X-rays were performed and revealed multiple congenital anomalies. The patient's symptoms are considered independent of the radiographic findings. INTERVENTION AND OUTCOME: This patient was successfully treated with conservative chiropractic management and experienced complete resolution of his presenting symptoms. CONCLUSION: This case nicely demonstrates the congenital nature of cervical spondylolysis. It is unusual in that no prior case report has described three levels of involvement. The spondylolysis and other changes of the neural arch should not be confused with fracture.

Differences in the potencies of inhaled steroids are not reflected in the doses prescribed in primary care in New Zealand.

OBJECTIVE: To determine whether the average doses of inhaled beclomethasone, fluticasone and budesonide prescribed in primary care reflect the relative potencies of these medicines. METHODS: Retrospective analysis of 95,540 prescriptions for inhaled steroids written by 293 general practitioners in Auckland, New Zealand, between November 1995 and June 1998. In addition, 177 general practitioners were presented with two case histories describing patients with uncontrolled asthma who were not on treatment with inhaled steroids. They were asked which medicine they would prescribe and in what dose. RESULTS: The average daily doses prescribed were 600 microg for fluticasone, 747 microg for beclomethasone and 1184 microg for budesonide. The average dose of fluticasone was 80% of that for beclomethasone. In May 1997, when 4.5% of the prescriptions for inhaled steroids were for fluticasone, the average doses of fluticasone and beclomethasone were 632 microg and 760 microg, respectively. By May 1998, when 23% of prescriptions were for fluticasone, the average doses of fluticasone and beclomethasone were little changed at 610 microg and 726 microg, respectively. In response to the two case histories, the average doses of fluticasone chosen were 71% and 77% of the doses of beclomethasone. CONCLUSIONS: The average prescribed dose of fluticasone was 80% of that for beclomethasone, even though fluticasone is at least twice as potent as beclomethasone. Similar findings were observed when the general practitioners responded to the case histories. The high doses of fluticasone prescribed may be due to a failure to appreciate that fluticasone is twice as potent as beclomethasone and to the availability of high strength preparations of fluticasone, i.e. 250 microg per actuation.