Management of sickle cell disease during pregnancy: experience in a third-level hospital and future recommendations.

OBJECTIVE: To describe the outcomes of sickle-cell disease in pregnancy according to the different treatments adopted before and during pregnancy and to propose a systematic approach to treat sickle-cell disease (SCD) during pregnancy. METHODS: A retrospective descriptive study compared pregnancy outcomes among women with SCD who stopped hydroxyurea (HU) once pregnant (Group 1), were never treated before and during pregnancy (Group 2) or were treated by HU before conception who received prophylactic transfusion during pregnancy (Group 3). For each group we recorded the population's characteristics and the transfusion-related, obstetrical, perinatal and SCD complications. RESULTS: We found 11 patients for group 1 (9/11 with at least 3 painful crises during the 12 months before conception), 4 for group 2 (3/4 with no sickle-cell complications during the year before pregnancy) and 2 for group 3 (one with previous multiorgan failure (MOF), one with previous stroke). No transfusion-related complication occurred. Group 1 and 2 developed SCD complications and a high number of acute transfusions and hospital admissions. Group 3 showed none of these complications, but one patient developed preeclampsia and preterm birth. Several obstetrical and perinatal complications occurred in group 1. CONCLUSION: Not treating sickle-cell during pregnancy increases maternal and perinatal morbidity, even in mildly affected women. All sickle-cell pregnancies should be treated, according to the treatment adopted before but also to patient's SCD-history. We propose chronic transfusion to women with previous stroke or MOF or already under transfusion program, and HU for severely and mildly affected patients, respectively from the second and third trimesters. Additional prospective studies are needed to validate the results of the proposed protocol.

Traitement par la technique de Latarjet des instabilités antérieures de l'épaule au centre hospitalier de l'Ordre Malte de Dakar

Introduction : Le but de cette étude était d'évaluer les résultats cliniques et radiologiques des patients ayant une instabilité antérieure traitée par la technique de Latarjet. Patients et méthodes : Dans cette étude rétrospective 14 patients (15 épaules) ont été opérés entre janvier 2013 et décembre 2016 pour une luxation récidivante de l'épaule selon la technique de Latarjet à foyer ouvert. La fonction de l'épaule a été appréciée selon les cotations de Rowe, Duplay , et WOSI (the Western Ontario ShoulderInstability). Les résultats radiographiques ont concerné la consolidation du greffon et la position de la butée. Résultats : Le recul moyen était de 34 mois (7- 64). Douze patients étaient très satisfaits de la stabilité et de la fonction de leur épaules. il n'y avait pas de récidive. Selon la cotation de Walch et Duplay les résultats étaient bons (n=13) et moyen (n=1). Selon Rowe ils étaient bons (n=13) et mauvais ( n=1). Selon la cotation WOSI ils étaient excellents ( n=8), bons ( n=4), et moyens (n=2). Toutes les butées ont consolidées. Elles étaient sous l'équateur. Elles étaient affleurantes (n=14), médiale (n=1). Conclusion : Ce travail suggère que la technique de Latarjet réalisée à foyer ouvert offre aux patients une stabilisation de l'épaule, des mobilités quasi-normales, et la possibilité de reprendre dans de bonnes conditions des activités professionnelles et sportives

Robust and Biocompatible Hybrid Matrix with Controllable Permeability for Microalgae Encapsulation.

Hybrid beads with entrapped microalgae Chlamydomonas reinhardtii were synthesized for the sustainable production of high value metabolites via photosynthesis. Encapsulating the microalgae requires an exquisite control of material properties, which has been achieved by modifying the composition (alginate, polycation, and silica). A coating of PDADMAC precluded cell leakage as indicated by the OD750 value of the culture medium, and the homogeneous distribution of silica prevented bead shrinkage from the strong electronic force of PDADMAC, resulting in a robust and biocompatible matrix for the cells. Besides fabricating suitable porous beads for the diffusion of expected metabolites, the permeability can be controlled to a certain degree by applying different molecular weights of PDADMAC. The hybrid alginate+silica/CaCl2+PDADMAC beads possessed sufficient mechanical rigidity to sheer force under constant stirring and good chemical stability to chelating agents such as sodium citrate. Moreover, the encapsulated cells exhibited excellent long-term viability and cellular functionality, which retained about 81.5% of the original value after a 120 day encapsulation as observed by microscopy and oximetry measurement. This study is not only significant for understanding the critical role of polycations and silica involved in the synthesis of hybrid beads but also important for real-scale bioengineering applications.

[Early form of Wilkie's syndrome: a rare complication of scoliosis surgery, about a case and review of the literature]. / Forme précoce du syndrome de Wilkie: complication rare de la chirurgie pour scoliose à propos d'un cas et revue de la littérature.

Superior mesenteric artery syndrome is a rare complication occurring after surgical treatment for scoliosis. Surgical correction of the scoliotic spine produces vertical traction on the mesenteric artery and the narrowing of the aortomesenteric angle, hence the compression of the third part of the duodenum causing the syndrome. We here report the case of a young girl with an early form of superior mesenteric artery syndrome secondary to surgical correction of idiopathic scoliosis. The patient underwent posterior spinal fusion for idiopathic scoliosis. On the third postoperative day she experienced uncontrollable vomiting associated with no evacuation of faeces and no passing of flatus. Urgent abdominal CT scan was performed which allowed the diagnosis of superior mesenteric artery syndrome. Treatment consisted in the rest of the digestive tract associated with early parenteral nutrition and correction of fluid and electrolyte imbalances. Lacking evidence of clinical improvement, surgical indication was posed. The evolution was favourable with an uneventful postoperative recovery and the resumption of adequate food intake on the fourth postoperative day. The patient was discharged on the seventh postoperative day. Contributing factors are young age, long-limbed morphotype with BMI below 18. CT scan shows an important gastric dilatation associated with complete halt of the third part of the duodenum. The treatment is multidisciplinary, medical (first-line treatment) and surgical (if medical treatment do not help). A better knowledge of the predictors of medical treatment failure would reduce the length of hospital stay.