Albert Schweitzer Hospital

About: Albert Schweitzer Hospital is a healthcare organization based out in Lambaréné, Gabon. It is known for research contribution in the topics: Population & Plasmodium falciparum. The organization has 1029 authors who have published 1568 publications receiving 43581 citations.

Nitric oxide generation in children with malaria and the NOS2G-954C promoter polymorphism.

Abstract: Previous epidemiological studies have demonstrated a protective association between the NOS2G-954C (NOS2Lambarene) polymorphism in inducible nitric oxide synthase and severe malaria. The polymorphi...

High-Dose Spinal Cord Stimulation for Treatment of Chronic Low Back Pain and Leg Pain in Patients With FBSS, 12-Month Results: A Prospective Pilot Study

Abstract: OBJECTIVES: To investigate the long-term effect of high-dose spinal cord stimulation (HD-SCS) in patients with chronic refractory low back and leg pain due to failed back surgery syndrome (FBSS). STUDY DESIGN: Prospective case series; pilot study. MATERIALS AND METHODS: Patients with chronic low back and leg pain (CBLP) due to failed back surgery syndrome (FBSS) were screened for SCS according to the Dutch Neuromodulation Society guidelines. Patients with a pain score of >50 (on a visual analogue scale from 0 to 100) for both low back and leg pain, were selected for participation in this study. During intraoperative screening one or two electrodes were implanted to ensure adequate paresthesia coverage of the back and leg pain area. During the 14 days trial period patients received two programs: a conventional or low-dose (LD) program with 30 Hz; 390 musec and a high-dose (HD) program with 420 Hz, 400 musec. They all started with LD-SCS and changed to HD-SCS after three days. If patients reported more than 50% pain relief with either program a rechargeable neurostimulator was implanted for permanent SCS. The scores for low back pain and leg pain were recorded separately. Other therapy related outcomes that were collected are pain medication use, Quebec back pain disability scale (QBPDS), patient satisfaction, employment status, stimulation settings, and adverse events. We present the 6- and 12-months results. Results are presented as mean +/- SD. RESULTS: Thirteen patients, nine females and four males (mean age: 49.7 +/- 8.1 years), were included between July 2015 and March 2016. Eleven patients responded to SCS during the trial period and were implanted with a neurostimulator. Most patients preferred HD-SCS over LD-SCS and the overall use of HD-SCS increased over time. At 6 to 12 months follow-up, two patients discontinued the study. In one patient low back pain returned despite optimal stimulation settings. The second patient was neither satisfied with LD nor HD and had the system explanted. VAS Leg pain at baseline was 71.2 +/- 33.8 and reduced to 25.7 +/- 24.0 at 6 months and 23.4 +/- 32.0 at 12 months. VAS Back pain at baseline was 66.7 +/- 33.2 and reduced to 36.8 +/- 41.6 at 6 months and 26.1 +/- 33.2 at 12 months. Pain medication was significantly reduced and QBPDS improved from 59.2 +/- 12.2 at baseline to 44.1 +/- 13.7 at 12 months. Five patients returned to work and overall patient satisfaction at the end of the study was high. CONCLUSION: This pilot study shows promising results of offering HD-SCS in addition to LD-SCS for treatment of chronic back and leg pain in patients with failed back surgery syndrome.

Severe malaria in children leads to a significant impairment of transitory otoacoustic emissions--a prospective multicenter cohort study.

Abstract: Severe malaria may influence inner ear function, although this possibility has not been examined prospectively. In a retrospective analysis, hearing impairment was found in 9 of 23 patients with cerebral malaria. An objective method to quickly evaluate the function of the inner ear are the otoacoustic emissions. Negative transient otoacoustic emissions are associated with a threshold shift of 20 dB and above. This prospective multicenter study analyses otoacoustic emissions in patients with severe malaria up to the age of 10 years. In three study sites (Ghana, Gabon, Kenya) 144 patients with severe malaria and 108 control children were included. All malaria patients were treated with parental artesunate. In the control group, 92.6 % (n = 108, 95 % confidence interval 86.19–6.2 %) passed otoacoustic emission screening. In malaria patients, 58.5 % (n = 94, malaria vs controls p < 0.001, 95 % confidence interval 48.4–67.9 %) passed otoacoustic emission screening at the baseline measurement. The value increased to 65.2 % (n = 66, p < 0.001, 95 % confidence interval 53.1–75.5 %) at follow up 14–28 days after diagnosis of malaria. The study population was divided into severe non-cerebral malaria and severe malaria with neurological symptoms (cerebral malaria). Whereas otoacoustic emissions in severe malaria improved to a passing percentage of 72.9 % (n = 48, 95 % confidence interval 59–83.4 %) at follow-up, the patients with cerebral malaria showed a drop in the passing percentage to 33 % (n = 18) 3–7 days after diagnosis. This shows a significant impairment in the cerebral malaria group (p = 0.012 at days 3–7, 95 % confidence interval 16.3–56.3 %; p = 0.031 at day 14–28, 95 % confidence interval 24.5–66.3 %). The presented data show that 40 % of children have involvement of the inner ear early in severe malaria. In children, audiological screening after severe malaria infection is not currently recommended, but is worth investigating in larger studies.