The impact of malaria parasites on the placenta and perinatal outcome at Korle Bu teaching hospital, Accra, Ghana: a case control study

Objective: Malaria remains a complex and overwhelming health problem affecting vulnerable groups such as pregnant women and their infants in Ghana. Malaria during pregnancy does not only pose a threat to the mother but can cause serious structural damages to the placenta and subsequently affect the pregnancy outcome. The aim of the study was to investigate the impact of Plasmodium parasites on the placenta and perinatal outcome of women delivering at Korle Bu Teaching Hospital. A better understanding of the impact of malaria parasites on the placenta morphology and prenatal outcome is crucial for better management of pregnant women and their babies. Methods: The study involved testing blood collected from postpartum placentas and examining the placental tissue for Plasmodium parasites, after which they were classified as study group (Plasmodium positive) or control (Plasmodium negative). The patients in the study group with similar gestational and maternal age were matched with patients from the control group. The morphological characteristics of the placenta and the perinatal outcome of the two patient groups were compared using an unpaired t-test. Results: Sixteen (16, 13.6%) out of 118 women tested positive for Plasmodium parasites on the maternal side of the placenta by both rapid diagnostic test and microscopy and /or tested positive for malarial parasite during pregnancy, whiles the rest (102, 86.4%) had no history of malaria in the index pregnancy and tested negative. The mean placenta weight was significantly reduced in the study group (difference: -102.0g; 95% Confidence Interval [CI]: 424.4g, 486.6g) who delivered during early term (p=0.02). Patients in the study group, who delivered during late term, had a significantly reduced mean placenta diameter (difference: -2.5cm; 95% CI: 20.0cm, 21.4cm) (p=0.003) and delivered infants with lower mean birth weight (difference: - 0.693kg; 95 CI: 3.268kg, 3.475kg) (p<0.001). Conclusion: Malaria during pregnancy does not only pose a threat to the mother but to the fetus and our results add evidence that malaria parasites cause alterations to certain morphological characteristics of the placenta which subsequently affect the birth weight as the pregnancy progresses to late term

Hamstrings anterior cruciate ligament reconstruction with and without platelet rich fibrin matrix.

PURPOSE: Anterior cruciate ligament (ACL) rupture is the most common complete ligamentous injury in the knee. Many studies explored ACL graft integration and maturation, but only a few assessed the application of platelet rich fibrin matrix (PRFM) as augmentation for ACL reconstruction. The main aim of this study was to test the PRFM augmentation in terms of graft-bone integration and knee stability. The secondary aim was to investigate patient-reported functional status. METHODS: Prospective evaluation has been done in two consecutive series of patients who underwent ACL reconstruction with semitendinosus and gracilis (STG) grafts: 14 patients were operated with PRFM augmentation and 14 patients without PRFM augmentation. Objective clinical evaluation (Rolimeter) and MRI evaluation were performed at 1 year from surgery. Subjective evaluation (IKDC) was performed pre-operatively and at 6 months, 1 and 2 years from surgery. RESULTS: A statistically significant difference was not detected between the two groups in terms of MRI and objective clinical evaluation, although PRFM-augmented patients showed a statistically significant higher clinical improvement. CONCLUSIONS: The procedure described for PRFM augmentation in ACL STG reconstruction does not improve radiologic graft integration and knee stability after 1 year and should not be used by clinicians to this purpose. However, it may result in a short-term improvement of patient-reported knee function, and future research should focus on further developing PRP treatment to optimize ACL clinical outcome. LEVEL OF EVIDENCE: III.

Leishmaniasis and autoimmune diseases in pediatric age.

Leishmaniasis is a group of diseases caused by the protozoa Leishmania, endemic in the Mediterranean countries. Clinical manifestations can be divided into three different forms: cutaneous leishmaniasis, mucosal leishmaniasis and the visceral leishmaniasis, the most severe form which is potentially lethal if untreated. Immunology and pathogenesis are complex: many different aspects of immune response, resistance and susceptibility to Leishmania have been studied but many others remain to be clarified. The gold standard in diagnosis of visceral Leishmaniasis is the presence of amastigotes in bone marrow or tissue sections. Patients can be initially misdiagnosed as having an autoimmune disease because it may mimic diseases like systemic lupus erythematosus, autoimmune hepatitis, dermatomyositis or others disorders. As in pediatric age the risk of life-threatening complications is very high, leishmaniasis, must be kept in mind to the clinician, in order to avoid wrong diagnosis and an inappropriate immunosuppressive therapy.

Bone graft from greater trochanter in posterior wall fractures with impacted fragments.

BACKGROUND: Posterior wall fracture is the most common acetabular fracture. Comminuted fractures with an impacted segment represent a subtype of this injury. The subchondral bone of the articular zone is compressed and causes a bone defect. The impacted fragment should be isolated, mobilized, and then reduced. A bone graft should be used to fill the gap. The other fragments are fixed following the reduction of the impacted segment. MATERIALS AND METHODS: Ten patients with comminuted fractures and impacted segments with bone defects were enrolled in our study, from January 2010 to July 2012. Autogenous bone grafts from the greater trochanter were used to fill the gap in all patients. The reduction was achieved through the insertion of the graft above the impacted fracture, and plate fixation was performed subsequently. Merle d'Aubigne and Postel scoring, modified by Matta, was applied to evaluate the patients during follow-up. The mean follow-up was 12 months. RESULTS: The clinical results included one "excellent", four "very good", four "good" and one "poor". Pain in the zone of graft harvesting was not detected in any patient. Femoral head necrosis was observed in one case. No other severe complications were detected. CONCLUSIONS: Using an autogenous bone graft to fill the bone defect supplies excellent mechanical stability without any severe complications at the donor site. This surgical technique seems to be effective and safe in treating a comminuted fracture of the posterior wall in association with an impacted segment. LEVEL OF EVIDENCE: Level IV.

Multifocal humeral fractures.

INTRODUCTION: Multifocal humeral fractures are extremely rare. These may affect the neck and the shaft, the shaft alone, or the diaphysis and the distal humerus. There is no classification of these fractures in the literature. MATERIALS AND METHODS: From 2004 to 2010, 717 patients with humeral fracture were treated surgically at our department. Thirty-five patients presented with an associated fracture of the proximal and diaphyseal humerus: synthesis was performed with plate and screws in 34 patients, and the remaining patient had an open fracture that was treated with an external fixator. RESULTS: Mean follow-up was 3 years and 3 months. A classification is proposed in which type A fractures are those affecting the proximal and the humeral shaft, type B the diaphysis alone, and type C the diaphysis in association with the distal humerus. Type A fractures are then divided into three subgroups: A-I, undisplaced fracture of the proximal humerus and displaced shaft fracture; A-II: displaced fracture of the proximal and humeral shaft; and A-III: multifragmentary fracture affecting the proximal humerus and extending to the diaphysis. DISCUSSION: Multifocal humeral fractures are very rare and little described in the literature, both for classification and treatment. The AO classification describes bifocal fracture of the humeral diaphysis, type B and C. The classification suggested in this article mainly concerns fractures involving the proximal and humeral shaft. CONCLUSIONS: A simple classification of multifocal fractures is suggested to help the surgeon choose the most suitable type of synthesis for surgical treatment.

Platelet rich fibrin matrix effects on skeletal muscle lesions: an experimental study.

Even though muscle injuries are very common, few scientific data on their effective treatment exist. Growth Factors (GFs) may have a role in accelerating muscle repair processes and a currently available strategy for their delivery into the lesion site is the use of autologous platelet-rich plasma (PRP). The present study is focused on the use of Platelet Rich Fibrin Matrix (PRFM), as a source of GFs. Bilateral muscular lesions were created on the longissimus dorsi muscle of Wistar rats. One side of the lesion was filled with a PRFM while the contralateral was left untreated (controls). Animals were sacrificed at 5, 10, 40 and 60 days from surgery. Histological, immunohistochemical and histomorphometric analyses were performed to evaluate muscle regeneration, neovascularization, fibrosis and inflammation. The presence of metaplasia zones, calcifications and heterotopic ossification were also assessed. PRFM treated muscles exhibited an improved muscular regeneration, an increase in neovascularization, and a slight reduction of fibrosis compared with controls. No differences were detected for inflammation. Metaplasia, ossification and heterotopic calcification were not detected. This preliminary morphological experimental study shows that PRFM use can improve muscle regeneration and long-term vascularization. Since autologous blood products are safe, PRFM may be a useful and handy product in clinical treatment of muscle injuries.

Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study.

There is no agreement on the ideal type of surgical management for Achilles tendon rupture. The present randomized prospective study was performed to compare outcome data of open and percutaneous repair in the treatment of Achilles tendon rupture. Forty consecutive patients with acute rupture of Achilles tendon were recruited. Patients were randomized to receive open (group A) or percutaneous repair with Tenolig (group B). All patients followed the same rehabilitation protocol except for slight differences in the duration of immobilization. Follow-up included objective evaluation (at 4 and 12 months), subjective evaluation using the SF-12 questionnaire (at 24 months), and bilateral ultrasound scanning and isokinetic testing (at 12 months). The differences in the parameters evaluated clinically were not significant except for ankle circumference, which was significantly greater in group B. There were two minor complications in the open repair group and one case of failed repair in the percutaneous group. SF-12 questionnaire, ultrasound and isokinetic test data did not show significant differences between the groups. The present study demonstrates that the open and the percutaneous technique are both safe and effective in repairing the ruptured Achilles tendon and that both afford the same degree of restoration of clinical, ultrasound and isokinetic patterns. Medium-term results were substantially comparable. Percutaneous repair is performed on a day-surgery basis, it reduces cutaneous complications and operation times, and enables faster recovery, enhancing overall patient compliance. To us, these characteristics make it preferable to open repair in managing subcutaneous ruptures of Achilles tendon in non-professional sports practicing adults.

Fracture callus in osteopetrosis.

The histologic features of bone callus after a traumatic fracture in a patient with osteopetrosis are presented. The fracture callus develops in stages that are apparently normal. The tissue is initially rich in bone-forming cells and vessels. One year later, however, unlike mature osteopetrotic bone, the tissue shows no Haversian organization.

Intravascular papillary endothelial hyperplasia in the hand of a fencer.

A case of intravascular papillary endothelial hyperplasia in the hypothenar eminence of a 23-year-old female fencer is described. Differential diagnosis with other similar benign and malignant lesions was made using histopathology and immunohistochemistry. The possible post-traumatic proliferative histogenesis is discussed. The non-malignant nature of the mass was confirmed after a three year follow-up.