Ulysse Minkobame’s research while affiliated with CHU de Lyon - Hôpital Femme-Mère-Enfant and other places
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Objective
To evaluate the use of the Foetal Medicine Foundation (FMF) algorithm in routine practice for early pre-eclampsia (PE) screening in Libreville.
Materials and Methods
We conducted a cohort study on pregnant women within their 11–13 + 6 weeks of gestation (WG). We had measured mean blood pressure (MBP), placental growth factor (PlGF), soluble Fms-like tyrosine kinase 1, Uterine Artery Pulsatility Index (UtA-PI) and resistance index (UtA-RI). Statistical analyses were considered significant for P < 0.05.
Results
There were 30 participants. At the first quarter (T1), 36.7% of them were at high risk of PE according to the FMF algorithm and were consequently prescribed aspirin (100 mg/d). By the end of the observation period, we have found a 13% incidence of PE. MBP was higher in the higher risk PE group than in the lower risk group as early as the T1 (90 ± 6 vs. 81 ± 6 mmHg; P = 0.0007, threshold is >86 mmHg/area under the curve (AUC) = 0.86; P = 0.0012). It was the same for PlGF (58 ± 24 vs. 88 ± 38 pg/ml; P = 0.03; threshold is <71.98 pg/ml/AUC = 0.73; P = 0.03). At the second quarter (20–27 WG), biochemical markers did not change between the two groups. UtA-RI, UtA-PI and notch were unconclusive individually, but they are still very important for FMF algorithm application.
Conclusion
Early detection of PE using the FMF algorithm is possible in routine practice in Gabon. MBP and PlGF levels at T1 seem to be very significant. However, the present study must continue to obtain the larger cohorts that would achieve more conclusive statistical analyses.
Introduction: B-lynch suture is effective in controlling delivery haemorrhage due to uterine atony that is resistant to medical and obstetric measures. However, there are still concerns about the potential complications resulting from poor uterotubal perfusion. Patients and Methods: This was a retrospective descriptive study of patients who underwent a B-Lynch technique at the Centre Hospitalier Universitaire Mère-Enfant Fondation Jeanne Ebori (CHUMEFJE) from January 1, 2019 to June 30, 2021. Results: The mean age was 28.9 ± 3.7 years. The B-Lynch technique stopped haemorrhage in 20 (83.3%) patients. Immediate or short-term post-operative complications were dominated by haemorrhagic shock in 5 (20.8%) patients. No deaths were recorded. Return of childbirth was observed in 18 (90%) patients. Eight (40%) patients became pregnant spontaneously. None presented major complications during pregnancy. Conclusion: The B-lynch technique is effective in cases of delivery haemorrhage caused by uterine atony that is resistant to medical and obstetric measures. It reduces maternal mortality while generally preserving subsequent fertility
Context: The first assisted reproduction center (PMA) to emerge in Gabon was a private health facility in 2001. Then in 2016 a second private clinic followed suit. Despite this, in vitro fertilization (IVF) remained inaccessible to the greatest number because of the expensive cost of this care offer. Evidenced by the fertility rate in Gabon, which remains one of the lowest in the world, 4% in 2017. In order to provide a solution to this problem, the current government authorities have thought of setting up a fertility service in vitro in a public hospital. Methodology: faced with the many difficulties observed, we proceeded as follows: Opinion of an expert in the equipment of an IVF center in November 2019; Architectural changes to the service; Staff training ; Order of missing equipment in October 2020; Establishment of collaboration and partnership; then organization of an IVF TEST session in November 2021 “free for patients”. Result: The service laboratory is now fully functional. Staff have acquired skills and continue to improve. Over one year we carried out 44 cycles, we obtained 16 clinical pregnancies. That is a percentage of 36%. We noted 1 miscarriage, 3 deliveries, and 12 ongoing pregnancies including a twin.
In a context where SARS-CoV-2 population-wide testing is implemented, clinical features and antibody response in those infected have never been documented in Africa. Yet, the information provided by analyzing data from population-wide testing is critical to understand the infection dynamics and devise control strategies. We described clinical features and assessed antibody response in people screened for SARS-CoV-2 infection. We analyzed data from a cohort of 3464 people that we molecularly screened for SARS-CoV-2 infection in our routine activity. We recorded people SARS-CoV-2 diagnosis, age, gender, blood types, white blood cells (WBC), symptoms, chronic disease status and time to SARS-CoV-2 RT-PCR conversion from positive to negative. We calculated the age-based distribution of SARS-CoV-2 infection, analyzed the proportion and the spectrum of COVID-19 severity. Furthermore, in a nested sub-study, we screened 83 COVID-19 patients and 319 contact-cases for anti-SARS-CoV-2 antibodies. Males and females accounted for respectively 51% and 49% of people screened. The studied population median and mean age were both 39 years. 592 out of 3464 people (17.2%) were diagnosed with SARS-CoV-2 infection with males and females representing, respectively, 53% and 47%. The median and mean ages of SARS-CoV-2 infected subjects were 37 and 38 years respectively. The lowest rate of infection (8%) was observed in the elderly (aged > 60). The rate of SARS-Cov-2 infection in both young (18–35 years old) and middle-aged adults (36–60 years old) was around 20%. The analysis of SARS-CoV-2 infection age distribution showed that middle-aged adults accounted for 54.7% of SARS-CoV-2 positive persons, followed respectively by young adults (33.7%), children (7.7%) and elderly (3.8%). 68% (N = 402) of SARS-CoV-2 infected persons were asymptomatic, 26.3% (N = 156) had influenza-like symptoms, 2.7% (N = 16) had influenza-like symptoms associated with anosmia and ageusia, 2% (N = 11) had dyspnea and 1% (N = 7) had respiratory failure, which resulted in death. Data also showed that 12% of SARS-CoV-2 infected subjects, had chronic diseases. Hypertension, diabetes, and asthma were the top concurrent chronic diseases representing respectively 58%, 25% and 12% of recorded chronic diseases. Half of SARS-CoV-2 RT-PCR positive patients were cured within 14 days following the initiation of the anti-COVID-19 treatment protocol. 78.3% of COVID-19 patients and 55% of SARS-CoV-2 RT-PCR confirmed negative contact-cases were positive for anti-SARS-CoV-2 antibodies. Patients with severe-to-critical illness have higher leukocytes, higher neutrophils and lower lymphocyte counts contrarily to asymptomatic patients and patients with mild-to-moderate illness. Neutrophilic leukopenia was more prevalent in asymptomatic patients and patients with mild-to-moderate disease for 4 weeks after diagnosis (27.1–42.1%). In Patients with severe-to-critical illness, neutrophilic leukocytosis or neutrophilia (35.6–50%) and lymphocytopenia (20–40%) were more frequent. More than 60% of participants were blood type O. It is also important to note that infection rate was slightly higher among A and B blood types compared with type O. In this African setting, young and middle-aged adults are most likely driving community transmission of COVID-19. The rate of critical disease is relatively low. The high rate of anti-SARS-CoV-2 antibodies observed in SARS-CoV-2 RT-PCR negative contact cases suggests that subclinical infection may have been overlooked in our setting.
COVID‐19 pandemic is ongoing with devastating consequences. Here we investigated SARS‐COV‐2 infected pregnant African women and described their clinical and laboratory features. Inflammatory factors including complement C3c, Procalcitonin (PCT) and C‐reactive protein (CRP) were elevated in SARS‐CoV‐2 infected pregnant women. Also, SARS‐CoV‐2 infected pregnant women are characterized by a stressed hepatobiliary function. The case concomitantly infected with SARS‐COV‐2 and Plasmodium falciparum had pancytopenia a condition characterized by the fall in the number of erythrocytes, leukocytes and thrombocytes.
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... This might be explained by the fact that Iraqi men often marry later, around their thirties, due to the country's economic circumstances. Additionally, in the age range of 21 to 40 years, Opheelia and Mohammed [11,12] discovered that 52.0% and 54.0% of all infertile males, respectively, match the current study. Our results, however, disagree with those of [13], who found that 40% of infertile men were between the ages of 26 and 30. ...
... Our understanding of the immune process in the study area remains poor because few studies are available. Two studies have investigated the understanding of clinical features and humoral immunity in response to SARS-CoV-2 infection [26,27], while another examined biochemical and haematological markers in COVID-19 cases [28]. Moreover, few data are available on genome sequencing of SARS CoV-2 [29], the epidemiology of the first cases [30] and the emergence of variants of concern [31,32]. ...
... However, a recent study has shown that co-infection may be associated with higher in-hospital mortality compared to SARS-CoV-2 mono-infection [5]. Current knowledge on malaria and COVID-19 co-infection in pregnant women remains limited [6,7], especially in Latin America, where Plasmodium vivax infection is highly prevalent. ...
... Two reviewers (TS and LB) independently reviewed the 33 full articles and excluded 23 articles as per the PICO criteria of the review question. Of these, one article was found as a conference abstract on a population of unknown gestational age, and a full text was not accessed since there was no reply from the author (44). A study by Dabash et al. (45) was excluded because the same study was published in an earlier volume of the same journal and contained the same co-authors who were included by us in the review (38). ...
... In addition, the tourniquet was released at 60-min intervals. Earlier studies have shown this interval to be safe (21,22). Taylor et al. applied tourniquets to the infundibulo-pelvic ligaments and the uterine isthmus; their study demonstrated that it was safe to leave an absorbable pericervical tourniquet permanently in place after completion of the myomectomy (8). ...
... It has been emphasized that the replacement of uterine curettage by MVA reduces the mortality rate from 1.23-0.07% [24]. A systematic review that analyzed complications related to MVA showed that less than 5% of women experienced hemorrhage without blood transfusion, less than 0.1% presented with uterine perforation or bleeding requiring blood transfusion, less than 0.5% were hospitalized, and only 3% had repeated aspirations, with no maternal deaths reported [25]. ...
... Family planning methods must be included in secondary school curricula as well as STI control. Moreover, knowledge and acceptability of contraception remain low in our regions[2,7,11]. This body of weightlessness can be reduced by the amendment of the abortion law which remains restrictive in our countries and all the key points noted by experts from West and Central Africa[12]. ...
... [7] This lack of knowledge about the dosage of misoprostol may affect the effectiveness of the treatment. In fact, it is essentially the pharmacokinetics of misoprostol, the route of administration and the dose that determine the rate of efficacy [9]. ...
... This increases the unmet need for family planning among PAC clients and is seen as a missed opportunity. Women are more likely to accept a family planning method post-abortion if offered appropriate counselling and method provision at the same setting [9]. ...
