AMHE Newsletter Haitian Medical Association Abroad

Association Medicale Haïtienne à l'Étranger

AMHE NEWSLETTER

Editor in Chief: Maxime J-M Coles, MD

Editorial Board: Rony Jean Mary, MD

Reynald Altema, MD

Technical Adviser: Jacques Arpin

spring 2020

april 27

Newsletter # 276

In this number - Words of the Editor, Maxime Coles,MD

- La chronique de Rony Jean-Mary,M.D.

- La chronique de Reynald Altéma,M.D.

- Chronicle of Slave rebellions in the Americas.

- You need to know the difference in symptoms:

- From The New York Times:

- Décès

- And more...

The Longevity of a Total Hip Replacement

Maxime Coles MD

2

In face of a patient presenting with a painful hip

joint enabling him to ambulate and forcing the

use of external supports or a wheelchair, one

can understand how daily living activities can

affect life. The hip become stiff and painful

rendering any task requesting mobility, difficult.

The individual contemplating such procedure

often report difficulties in wearing socks

because of inability to cross their legs.

Medications which have in the past relieved the

symptoms, ceased to benefit the patient. A hip

replacement become the best option to restore

functionality.

Anecdotally, the first total hip replacement was

performed in the mid-20th century. This is a

successful procedure which over the years has

allowed us to perfect the way of approaching the

joint to minimize the destruction of the anatomy

and to restore the function. Improvements in the

techniques and technology have greatly increase

the effectiveness of the hip joint. The Agency

for Health Research and Quality reports more

than 300,000 total hip reconstructions by total

hip replacement each year are performed in the

United States of America.

The hip joint is the largest joint of the human

body. It consists in a ball-and-socket articulation

where the ball represents the head of the femur

and the socket being a part of the pelvic bone

called acetabulum. An articulate cartilage

covered the joint surface allowing a smooth

motion. The joint is enveloped by a synovial

membrane responsible for the lubrication of the

joint eliminating any friction during motion. A

massive musculature supported by ligaments is

re-enforcing the capsule of the joint.

The most common cause of pain and disability

in a hip joint is degenerative arthritis. Many

arthritic process due to osteoarthritis, Traumatic

arthritis or rheumatoid arthritis can involve this

joint and interfere with the range of motion:

1- Osteoarthritis is the becoming of all joint

with time. It is aged-related and

represents the “tear and wear” of the

joint. Any patient older than 50 years of

age or older will manifest pain or

stiffness in relation to this type of

arthritis. Some may develop the

degeneration earlier than others because

of familial predispositions. The cushion

provided by the cartilage wears away

allowing the bones to rub against each

other causing stiffness and later pain and

inability to bear weight and ambulate.

2- Autoimmune diseases like Rheumatoid

arthritis in which the synovial membrane

become diseased, inflamed or thickened,

damaging the cartilage in allowing a loss

of joint surface. This kind of process

represents a group of disorders called

inflammatory arthritis.

3- Injuries to the hip joint following a

traumatic event like a fracture dislocation,

can damage the articular cartilage of the

hip joint and lead to stiffness, pain and

loss of motion. The blood supply to the

femoral head can become deficient after

the dislocation limiting the blood supply

to the femoral head and causing an

Avascular Necrosis. With time, the

avascular portion of the femoral head

collapse resulting in arthritis. Many

diseases like sickle cell and other

hemoglobinopaties, like Gaucher’s

disease can present with the same lack of

blood supply to the femoral head. We

have seen this complication in IV drug

abusers and infections around the hip joint

as well.

4- Many pathologies during infanthood or

adolescence can also present with such

problem. Kids with Developmental Hip

Dysplasia called in the past Congenital

hip dysplasia have shown a loss of

congruity at the hip joint leading to

degenerative process. Slipped capital

femoral epiphysis will also present with

stiffness and loss of range of motion but

with time, osteoarthritis and chondrolysis

may set in.

The Total Hip Replacement consists in the

removal of damaged cartilage and bone

including the femoral head with their

replacement by prosthetic components.

They are replaced by a metallic stem

inserted into the medullary canal of the

proximal femur. This stem can be

cemented in people with poor bone stock

or pressed fitted in younger individuals

with healthy bone. The orthopedic

surgeon will have also the choice to

3

replace the head with a metallic or

ceramic head over the tip of the

component. The damaged cartilage of

the acetabulum (socket) is also grounded

out and replaced with another metallic

component which can be stabilized with

cement, or screws alone. A spacer is then

inserted into the socket to fit the femoral

metallic head. This spacer can be of

plastic, ceramic or metallic forming a

smooth gliding surface.

When a surgical option is finally chosen

by a patient to become a recipient of a

Total Hip Replacement, it will require a

cooperative effort between the patient

and his family, the primary care

physician and the orthopedic surgeon.

Many factors will be analyzed during a

consultation once a patient is ready for

the replacement:

- Pain and disability rather than age

should be considered. We believe that 50

to 80 years of age-group have been

considered as typical ages for a hip

replacement but recipient should be

chosen on an individual basis. Total joint

arthroplasty has been performed

successfully on teenagers and elderly

who have demonstrated pain with every

day activities, unrelieved by anti-

inflammatory medication. Often,

stiffness and inability to ambulate after

failed attempts at rehabilitation and

ambulation with external support.

Radiologic images may show extensive

damage or deformity to the hip joint.

Occasionally an MRI or a CT scan study

may be needed to determine the quality

of the bone stock.

Other considerations for an evaluation prior

to such procedure, should include:

- The orthopedic consultant to decide

whether a hip replacement surgery is the

best method to relieve the pain and

improve the mobility. He will need to

explain the potential risks and

complications of such procedure in

opening a true dialogue with the patient.

The more the patient know, the better

he/she will be able to accept and manage

the expected changes. In discussing with

his/her patient, expectation for daily

living activities should be raised. - One has to understand that material used

in the components are subject to wear.

So patient’s weight needs to be discussed

with exercises programs to minimize

wear and loosening of the components.

This can be manifested by a painful joint

replacement. Avoidance of high impact

activities such as jogging, jumping,

hiking and even dancing is strongly

suggested. - A dental evaluation to minimize

bacteremia from any infection is

recommended. If needed, the dental

procedures should be carried prior to the

planned replacement. Even routine

cleaning procedure should be delayed to

decrease any risk. - Urinary problems like an inflamed

prostate, should be resolved prior to any

surgical treatment. Infections anywhere

in the body need to be treated. - Proper social planning with home

therapy will be arranged at discharge

from the hospital, after a short stay in

hospital first and maybe also a stay in an

extended care facility providing help

with cooking, bathing, laundry etc.

Proper equipment will be also delivered

at home like high toilet seat, pillow,

dressing etc.

It is important also for the one who become a

recipient of a Total Hip Replacement to know

about the possibility of failure of the component

of the prosthetic device through different

processes like dislocation, infection, fracture,

mechanical failure with wear of polyethylene,

breakage or loosening in the cement fixation etc.

Infections are seen in less than 2% of Total hip

replacements. Blood clots are common

complications especially in the pelvic veins and

can be life-threatening. Prophylaxis with

anticoagulation therapy and sequential

compressive devices or ankle pump will

facilitate the vascular flow. Early mobilization is

always enforced with precautions when sitting,

bending and even sleeping. One has always to

discuss those eventualities and the life

4

expectancy of such procedure. The conception

that all hip replacements provide a normal pain-

free function for the remaining of their life

needs to be discouraged fully. A recipient

should be also told about the possibility of a

leg-length discrepancy.

Studies in the United Kingdom in 2014 have

advertised Hip replacement were for people

with advanced degenerative arthritis and then a

revision was expected in the next 10 years.

Nowadays, it is difficult to hear about the

longevity of a revised hip replacement’s

surgery. The new hip replacement may activate

metal detectors at the airports security stand and

a special identification card confirming the

existence of an artificial hip, is generally

provided.

When a recipient asks how long a hip

replacement will last, the physician has no other

choice than to rely on historical data. Some

registries have shown hip replacement lasting

20 to 25 years or less but in fact they are limited

by the quality of data presented and the lack of

follow up as well, then reflecting a bias. We

may rely on annual reports looking at age and

sex distribution or implant design presented by

different National Joint registries in England,

Wales or Sweden etc., to give a plausible

answer. Data on a series of 23000 hip

replacements have suggested a decrease in the

revision rate.

Failure in arthroplasty can be measured in

many ways and patients who report failure in

one setting may also report success in another.

Revision surgery has an uncertain outcome

seeing patients and clinicians deciding on the

risks and benefits. We need to remember that

the goal for the revision surgery is as well to

relieve pain. Studies have shown that less than

20% of such patients in need of a revision

have not taken the choice. Women were found

to have better construct survivorship at all ages

than men. Data contributing to a 15-year

survival are also available from the Australian

and Finnish Registries.

To all who ask so often the pro’s and the cons

of a total hip replacement, we have to frankly

state that there is not enough information

available to predict how long a hip

replacement based on searches from the

Arthroplasty Registry data from the USA, UK,

Finland, Sweden, Denmark Australia etc.

These Registries contain almost ¾ of Hip

Replacement done in the last 20 years and

more than ½ were done because of

Degenerative Arthritis. In conclusion, a

proponent for a total hip replacement suffering

from degenerative arthritis should expect 15 to

20 years from a replacement with all

precautions required for the well-being of the

prosthetic components

Maxime Coles MD

References: 1- NJR. 14th Annual report 2017: London National Joint for England, Wales. Northern Ireland and Isle of Man

2016

2- Learmonth ID, Young C, Rorabeck, C: The operation of the century: Total Hip Replacement. Lancet 2007,

370: pp 1508-1519.

3- J Bone and Joint Surg. Am2018; 189:189-194.

4- NICE. Total Hip Replacement and Resurfacing arthroplasty for end stage arthritis of the hip: NICE

technology appraisal guidance 304 London National Institute and Care Excellence 2014.

5- Philliport R, Farizon F, Camillien JP, et Al: Survival of Cement less dual morbidity socket with a mean17

years follow-up: Rev Chir Orthop Reparatrice Appr Mot 2008, 84; pp e23-27.

6- Sorensen EH, Newman L, Freund EG, Long term results after Charnley hip replacement Egeskr Laeger,

1996, 158 pp 7228-7232 (In Danish)

7- Rozhydal Z, Janicek P, Havlicek V, Pazoureck L Long-term results of use of the CLS stems in primary total

hip replacement. Acta Chir Orhop Traumatology Cech 2998, 76:281-287 (In Czech)

8- National Joint Registry for England

5

Depuis l’apparition du COVID-19 voila déjà plus

de trois mois, des progrès sensibles ont été notés

en ce qui a trait à la compréhension de la maladie.

Mais il faudra admettre que la route déjà longue

et sinueuse, de là où nous sommes, vers les

sommets convoités , sera encore escarpée voire en

dent de scie, avant que le mal finisse par ouvrir

tous les secrets cachés dans son ventre.

On croyait d’abord à une pneumonie virale

accompagnée d’un processus inflammatoire

intense conduisant à une fibrose pulmonaire

dont la mort du patient était le corollaire

inexorable.

Mais on observa dans la suite que l’hypoxie était

la toile de fond de la maladie et que, en dépit de

la présence d’une ventilation adéquate qui devait

assurer la présence d’une quantité suffisante

d’oxygène au niveau des organes, ces derniers

n’étaient toujours pas bien alimentés en oxygène.

On imputait alors ce miss-match entre la

perfusion et la ventilation à une déficience des

Globules rouges devenus incapables d’assurer le

transport de l’oxygène vers les tissus. Et l’on

pensait à ce moment là, que c’était une

pathologie Globulaire . Par la suite ,on s’est

rendu compte que la maladie s’accompagnait de

douleur épigastrique intense, d’anxiété et de

détresse respiratoire, tous des signes cardinaux

qui faisaient croire à une origine cardiovasculaire

de la pathologie. en l’occurrence à de l’embolie

Pulmonaire. Les pathologistes de l’Amérique du

Nord, Canada et Etats unis y compris, ainsi que

ceux pratiquant Outre Atlantic, sont de plus en

plus convaincus de la présence d’une

coagulation intra vasculaire disséminée (DIC)

qui serait à la base de cette embolie pulmonaire.

Cette coagulation intra vasculaire disséminée

serait le résultat de processus inflammatoire aigu

au niveau de la paroi des veines déclenchant une

mobilisation des Pl atelets avec la formation, en

deuxième lieu, de caillots sanguins. . On a alors

compris que les respirateurs artificiels, les

ventilateurs en général, n’étaient pas aussi utiles

qu’on le croyait et l’on estimait même à un

certain moment que 80% des patient sous

ventilateurs artificiels avait fini par mourir.

Certains croyaient que la forte pression des

machines détruisait carrément les alvéolés au

niveau des poumons et compromettait le

processus respiratoire.

Devant cet imbroglio, cet embarras même auquel

nous expose la maladie, on reste perplexe

aujourd’hui, et l’on se demande tout carrément :

Quelle théorie accepter ? Qui a raison et qui a

tort ? S’agit-il d’une maladie pulmonaire, d’une

maladie globulaire ou d’une maladie

cardiovasculaire ? Il faut dire que la complexité

de la maladie n’aide pas vraiment à privilégier

aucune théorie aux dépens des autres.

D’ABORD PEUT-IL S’AGIR D’UNE

MALADIE PULMONAIRE ?.

Rony Jean-Mary, M.D.

DANS LE LABYRINTHE DU COVID -19 :

L’EVOLUTION DE LA MALADIE DE SON

APPARITION A MAINTENANT.

6

En révisant les images radiographiques des

patients atteints du Covid-19, on a observé un

aspect de verre dépoli au niveau des deux

poumons. Cela laisse croire à une origine

systémique et centrale de la maladie. Il est

expliqué que les macrophages du poumon aussi

appelés pneumocystose, qui sont censés protéger

les poumons contre l’accumulation de radicaux

toxiques, rôle qu’ils partagent d’ailleurs avec la

fine membrane qui recouvre la paroi des

poumons, sont depassés par une affluence de fer

libre et de radicaux toxiques ; Ce qui conduit

directement à de la fibrose pulmonaire. Les

poumons une fois fibrosés, perdent de leur

élasticité et collapsent automatiquement. Ceci

prouve que la pathologie est d’ordre

PULMONAIRE.

MAIS D’Où VIENNENT LES RADICAUX

LIBRES , EN PARTICULIER LE FER

DONT NOUS PARLONS ICI ?

Une explication en bref de la physiologie

respiratoire va nous permettre de mieux cerner la

pathologie du Covid -19.Le sang est la gazoline

du corps et le cœur en est le moteur. Il existe dans

le sang des cellules appelées Globules rouges qui

contiennent dans leur matrice une substance

appelée Hémoglobine. Cette substance complexe

est faite d’ions ferreux et ferrique( 2+ ,3+) au

nombre de 4 atomes par molécule,

d’hémoglobine, qui s’attachent sur le hème de

l’hémoglobine, et servent à transporter certains

gaz du corps dont le CO2, l’Azote (N)et

l’’Oxygène( O2).

Ces molécules de fer ont pour rôle de se dissocier

de l’hème au niveau des alvéoles pour attraper

l’oxygène et relâcher en échange le CO2 qu’ils

emmènent avec eux depuis les différents organes

du corps. L’oxygène de l’air une fois emmené à

travers les conduits respiratoires et échangé contre

le CO2 ,l’azote et les autres gaz, est aussitôt capté

par les atomes de fer pour être transporté vers les

organes. Il appert que le virus attaque l’hème de

L’hémoglobine, change sa configuration, et

empêche le fer d’y rester attaché : Ce qui rend le

globule rouge dysfonctionnel, donc incapable de

transporter l’oxygène. Il en résulte alors de

l’hypoxie au niveau du sang malgré la présence

d’un ventilateur mécanique forçant l’oxygène

dans les alvéoles. Dans des conditions normales

d’évolution, le jeu de bascule est maintenu entre

le captage et la relâche de l’oxygène au moment

de ses échanges avec les autres gaz..Mais comme

le fer ici n’assume pas tout à fait son rôle de

transporteur de l’oxygène, les radicaux libres et les

atomes de fer, s’accumulent dans les poumons

causant ce qu’on appelle le stress oxydatif. Et

Puisque l’hème de l’hémoglobine est affecté, on

peut dire qu’il s’agit bien là d’une maladie

GLOBULAIRE..

Mais en plus des deux composantes sus-citées, on a

aussi appris que le virus , en attaquant les

vaisseaux sanguins, déclenche un processus

d’inflammation et de coagulation qui, lorsqu’elles

sont intenses, et massives ,peuvent engendrer une

coagulation intra vasculaire disséminée, suivie d’

embolie pulmonaire généralisée. La coagulation

intra vasculaire disséminée se rencontre dans près

de 75% des cas. Et conduit inéluctablement à la

mort : D’où l’origine cardiovasculaire de la

maladie.

Comme on peut voir, le problème est pulmonaire,

par la réaction de fibrose qui s’est observée

bilatéralement. Il est globulaire, dû à l’incapacité

des globules rouges à transporter l’oxygène. Et il

est enfin cardiovasculaire responsable d’une

embolie pulmonaire massive, à partir d’une

réaction inflammatoire causée par l’infection.

L’EPIDEMIOLOGIE DU VIRUS ET LA

THEORIE DES SOUCHES

Si la pathologie du Covid -19 s’est révélée difficile

à appréhender, son épidémiologie, en l’occurrence

tout ce qui a à voir avec sa virulence , sa mutation,

son mode de transmission et sa distribution

géographique n’en sont pas moins complexes.

D’après certaines études, il y aurait une souche A

qui apparaissait à Wuhan, en Chine , au mois de

Septembre de l’année dernière. Elle n’avait causé

aucun dommage sérieux dans la population. Cette

souche A s’est mutée en une souche B vers le mois

de décembre, puis en une souche C qui était encore

beaucoup plus virulente que la souche B.

On avance que la souche A serait plus répandue

7

Sur la cotte ouest des Etats –Unis . Là , le contact

plus étroit avec la Chine où débarquent près de

1000 ressortissants chinois journalier ment, avait

pu conférer une certaine immunité à la

population..Par contre, quand la mutation de A à

B s’est opérée en Décembre, la cotte Est des

Etats -Unis n’était pas aussi bien préparée pour

affronter le virus, d’où le nombre élevé de morts

dans les villes et états de New York et de New

Jersey et de Massachussetts. Pour une raison non

encore élucidée, il y avait une deuxième mutation

de B en C dont la forme a couvert l’Italie et

l’Espagne en partie. D’où l’ampleur de la fatalité

dans ces deux derniers pays. Mais on a observé

que dans une petite ile du Portugal, située entre

L’Espagne et Portugal, le virus n’avait pas fait

trop de dégâts et l’on se réfère au pouvoir

protecteur du BCG, un vaccin contre la

tuberculose que les habitants du Portugal, du

Brésil et du Japon aurait reçu dans le passé. Il

s’agirait ici d’un cas d’immunité croisée. Ce qui

serait une bonne nouvelle pour les Haïti

considérant que beaucoup d’entre nous autres

Haïtiens avaient été vaccinés contre la

tuberculose dans le passé.

On en était déjà habitué à cette théorie des

souches lorsque le Docteur Luc Montagnier,

prix Nobel de Médecine, très connu pour ses

recherches sur le VIH, vint annoncer en début de

semaine que le virus étudié était le résultat d’une

recombinaison de deux virus différents dont un

coronavirus avec en plus un segment du VIH.

Pour le professeur Luc Montagnier, c’est un virus

créé à partir d’un laboratoire dont la finalité

pourrait avoir été de développer un vaccin contre

le HIV et qui se serait échappé accidentellement

des laboratoires Chinois. Le professeur

Montagnier affirme que des chercheurs Indiens

avaient fait la même découverte, mais qu’ils ont

du rentrer leurs trouvailles à cause de pressions

diverses dont ils étaient l’objet. Il a bien dit que

le virus a un peu perdu de sa virulence et qu’il ne

faut pas s’attendre à beaucoup de morts dans les

prochains jours. Le professeur a aussi ajouté que

contrairement aux chercheurs indiens, il n’a pas

cet âge ou l’on peut le forcer à cacher la vérité. Le

président Français Emmanuel Macaron lui-même

a avoué que des choses se sont passées à Wuhan

dont toute la vérité n’est pas bien connue. Il doit

avoir parlé au Professeur Montagnier pour être si

péremptoire dans ses déclarations. Mais à peine

Luc Montagnier a-t-il fini de parler que déjà des

voies s’élèvent contre lui au Canada et dans le

monde entier pour dire que le segment de HIV

qu’il prétend voir est comparable à un simple

mot d ‘un livre qui en apparaitrait dans plusieurs

autres livres en même temps et qu’il n’en n’est

rien. Le professeur qui a déjà gagné un prix

Nobel de médecine serait-t-il aussi naïf pour ne

pas pouvoir faire le distinguo entre ce qui est

ivraie et ce qui est du bon grain ? .

LES TESTS DE LABORATOIRE : Pour ceux

ou celles qui sont initiés à la science Médicale, il

ne fait pas de doute que certains tests vont

conduire sur une piste ou sur l’autre, dépendant

des résultats de laboratoire obtenus, et vont aider

à mieux comprendre la pathologie du Covid-19.

Par une RADIOGRAPHIE du thorax,par

exemple, on peut voir au niveau des poumons

cet aspect de verre dépoli qui s’explique par

l’accumulation de radicaux libres au niveau des

alvéoles. La GASOMETRIE va donner lieu à

une alcalose respiratoire due à l’expulsion

massive de CO2 et à de l’hypoxémie, qui sont

deux des caractéristiques de l’embolie

pulmonaire. Le taux d’érythropoïétine va être

élevé .Quand le rein n’est pas bien oxygéné , il

accélère la production d’érythropoïétine qui

stimule la moelle osseuse et entraine la

production de Globules rouges Une étude faite

à WUHAN en Chine sur les 14 tests les plus

usuellement recommandés, révèlent ce qui suit. :

a) PT OU PROTHROMBINE TIME est élevé.

b) le taux de fibrinogène est réduit.

c) la bilirubine totale est élevée

d) Di-dimères est élevé.

e) les enzymes du foie sont toutes élevées: dont

AST,ALT,LDH.

f) Le taux de créatinine est élevé.

g) le cellules blanches dont WBC et neutrophiles

sont élevées .

h) les lymphocytes sont réduits ainsi que…

i) le taux d’albumine est réduit

j)Le C-réactive protéine, marqueur de

l’inflammation est élevé dans 90% des

cas..(CRP)

K) le taux de procalcitonin peut être normal au

début mais s’il continue de monter au cours de la

8

maladie, cela peut être un mauvais pronostic..

L) Le troponin cardiaque est élevé Due à la

fréquence élevée de la coagulation intra

vasculaire disséminée, 75% des fois,il est

recommande de procéder à des tests de

coagulopathie en série pour détecter si un

problème de coagulation va avoir lieu ou non.

LE TRAIMENT :

la règle d’or consiste désormais à éviter d’utiliser

les ventilateurs et autres machines à pression

élevée qui non seulement sont inutiles mais

peuvent causer des dommages aux alvéoles. Bien

des protocoles ont été établis au cours des trois

dernières semaines qui sont aiguillés vers un

traitement symptomatique de la maladie. Le débat

qui revient sur le tapis est celui du milieu ambiant

dans lequel le virus va évoluer. Beaucoup de gens

meurent, dit-on, parce qu’ils n’avaient pas assez

de force pour combattre le virus. C’est l’éternelle

joute entre les adeptes de Louis Pasteur qui

privilégient la théorie microbienne face aux

adeptes d’Antoine Bechamp qui croient que la

maladie évoluera négativement seulement si elle

trouve un terrain propice à son évolution..On n’a

jamais autant parlé de vitamine C , de Zn , de

vitamine D, de Fish oïl et d’autres substances

naturelles dans l’histoire de la médecine

moderne : Toutes choses à même de renforcer (

booster) le système immunitaire de l’individu.

Mais on a aussi pensé à un traitement direct de la

condition avec des intrants pharmacologiques

appropriés.

1).-D’abord et avant tout, c’est le plaquenil qui a

fait couler beaucoup d’encre. L’autre nom du

plaquenil est l’hydroxy chloroquine, un

antipaludéen bien connu des milieux Haïtiens et

Africains où la malaria est endémique.. Le Dr.

Raoult Didier a parlé du succès monstre qu’il a

connu avec l’utilisation de la drogue.. Cependant

de plus en plus de gens rejettent le plaquenil à

cause des effets secondaires désastreux dont

l’utilisation est entachée.Beaucoup seraient morts

de toxicité cardiaque dit-on. On croit cependant

que l’effet du plaquenil serait du à ses propriétés

anti-inflammatoires qui préviennent le

déclenchement du processus inflammatoire et

par ricochet, de la dissémination intra

vasculaire aigue( DIC).On a note dans certaines

études avoir trouvé aucun malade souffrant de

Covid -19 parmi les personnes qui étaient déjà

sous plaquenil.il aurait donc un effet préventif et

protecteur contre le COVID-19. On ne sait pas

si les autres anti inflammatoires connus tels

l’acetaminophene, le cortisol , pourraient aussi

avoir un tel droit de cité.

2 ).-Apres le plaquenil, viennent directement les

antibiotiques avec en tête de liste le zithromax

que l’on associe généralement à un autre

antibiotique. Certains parlent en l’occurrence de

la tétracycline qui pourrait servir en lieu et

place de l’Azithromycin au cas où quelqu’un

serait allergique à ce dernier.

3).-.La troisième classe de médicaments se

retrouve parmi les anticoagulants dont

l’héparine en première loge. L’héparine est

utilisée pour son effet anticoagulant et pour ses

propriétés antivirales. L’héparine semble

s’attacher aux récepteurs du virus empêchant à

celui-ci d’attaquer les globules rouges sanguins.

En cas de résistance à l’héparine , il faudra

considérer le TPA. Mais il faudra tenir compte

des exigences dont s’accompagne la prescription

d’un tel médicament. On parle enfin de

l’Aspirin qui doit être considérée dans les cas

de pathologie cardiovasculaire.

On a fait bien des progrès depuis que la maladie

a commencé à ravager la planète voila de cela

quelques mois..Mais on est encore loin de cette

maitrise et de cette certitude absolue qui

permettraient à tout le monde de dormir

tranquillement sans craindre d’être affecté soi-

même par la maladie et d’en tomber victime. De

nouvelles données viennent chaque jour

bouleverser certaines notions que l’on

considérait bien ancrées. On parle même de la

possibilité qu’à l’hiver, nous soyons encore la

proie d’une nouvelle flambée de l’infection qui

pourrait se révéler aussi meurtrière que la

presente. Les consignes doivent être maintenues

et la prudence est encore de mise. Prions que les

gens cessent de mourir et que le monde soit un

jour vainqueur de ce mal qui nous terrasse tous.

Rony Jean-Mary, M.D.

Coral Springs, FL

le 24 avril 2020.

Ronjeanmary@yahoo.com.

9

Reynald Altéma, MD

MODULATION OF IMMUNE SYSTEM

TO PROTECT AGAINST COVID-19

It has become a dangerously new normal on a daily basis that we exchange news about the fallen: a

colleague, coworker, acquaintances, a luminary and so on. The stats are very telling however: in urban

areas, neighborhood with high concentration of Blacks are disproportionately affected and idem for

mortality rate, more males than females regardless of ethnic group, more complications among those with

preexisting cardiovascular conditions. Although old age is a risk factor, there have been enough casualties

among the not so young to make this tiny RNA particle protected by a fatty but spikes-protected carapace to

cause havoc to all comers.

No one has publicly stated the obvious but the policy in place is an undeniable departure of the binary

approach of high tech versus low tech but rather a dual intervention emphasizing prevention on one hand

and reliance on the big guns as needed. In fact, the dearth of protective devices in a society accustomed to

disposable supplies in huge quantity has led to a recalibration of assumptions, practices and has even led to

the mushrooming of a cottage industry of home-made face masks, reuse of once-before-quickly-discarded

N95 masks. Along the way, we are discovering that the rush to intubate may not be so wise1. Simpler

methods like keeping a patient in the prone or lateral decubitus position may make all the difference, even

among intubated patients. Basic but time-tested methods like hand washing is being promulgated with the

zeal of a convert with a new discovery.

Analysis of the stats leads one to ask several questions: why the gender discrepancy? Why the racial

difference? Last but not least, what else can one add to the list of preventive behavior such as social

distancing, confinement, frequent hand washing and wearing a mask when going outside?

There are fortunately some good ideas to explain the above questions. In a book published at the beginning

of this month, The better half: on the genetic superiority of women, the author, Dr. Moalem2 makes the case

of the better genetic predisposition of genetic females (XX) to deal with diseases by possessing 1000 genes

per X chromosome and the genetic male (XY) having only 70 genes on the Y chromosome. This, he claims,

explains genetic females’ tendency to outlive genetic males, to better handle pathologic stresses and have a

better outcome to serious illnesses, including infections. This is an interesting concept and reading of this

book is highly recommended to help us become better clinicians and find out about gender-specific disease

profiles. Just in passing the price that genetic females pay for a stronger immune system is a

disproportionate rate of autoimmune maladies.

The gender disparity is not cast in stone in the mortality rate of Covid-19. In some other countries, the

difference is far less striking and like so many instances of genetic predisposition and disease manifestation,

the concept of nature versus nurture tells us that epigenetic factors, aka behavior or lifestyle, can make a

difference. Hence cigarette smoking, alcohol use, lack of exercise, unhealthy diet, obesity are all additional

10

factors that can accelerate, worsen disease manifestation and predispose to complications. Timing of seeking

medical care is always a determining factor and genetic males tend to lag behind genetic females and this

adds another layer to the data.

It follows from the above that minority populations in this country that have always suffered

disproportionately from cardiovascular complications will be at higher risk of complications when afflicted

by Covid-19.

Along the line of a dual approach to counter this pandemic, is there anything one can do in addition to, not

instead of, the basic measures being touted daily or in addition to classic therapeutic interventions? The

answer is yes with the understanding that there is no panacea. The best and most one can do is to take

measures to minimize risk; we can’t eliminate risk at 100%.

The pathogenesis of the disease tells us that the virus is sneaky. It penetrates our cells and imposes its will

so it uses our replication process for its own’s, while devising all clever ways to evade our immune system.

So long as it remains undetected, it replicates as it deems fit in an exponential fashion. By the time it reaches

a sizable number and our immune system reacts, it goes into overdrive and this is what creates the major

problems with dead cells accumulating in the airways and interfering with normal gas exchange; this opens

a domino effect and other major organs begin to fail. By the time this happens, we are in serious danger

zone and the best that can be done is damage control. Being in the danger zone as we well know is

associated with high morbidity and mortality. Obviously and fortunately only about 5 to 10% at the most of

infected persons reach the danger zone. The vast majority either have no symptoms or mild illness. It would

seem then that to the extent the immune system is able to prevent significant replication of the virus, then

the likelihood of disease is low. We need to always remember that unfortunately not being symptomatic is a

double-edged sword as it allows propagation of the virus from the vector to others. This is the reason why

wearing a mask and practicing the basic measures becomes so important. The low hanging fruit seems to

point toward having a solid immune system. So, what are some means of improving one’s immune system?

• First and foremost is good gut health. The microbiome of the gut determines our overall health

status3. The use of high fiber is a sine qua non. Prebiotics (leeks, onions, honey, to name a few),

probiotics (yogurt, kefir, cottage cheese, etc..) are a good starting point. Antioxidants are also very

good. Obviously, some are already high in fiber such as fruits like berries, beans, vegetables; dark

chocolate (pleasure and health such a combination!), nuts and so on. A simple amino acid, L-

glutamine is preferentially used by the enterocytes, colonocytes and even lymphocytes as

respiratory fuel. [After a bout of diarrhea, it’s a good idea to take prebiotics, probiotics to replenish

the balance of the gut microflora and also take L-glutamine for a period of up to 3 weeks]4,5.

Healthy eating, exercise are good habits to develop and maintain

11

• Vitamin D. More of a hormone than a vitamin, the level of vitamin D does matter for the

immune system. Studies have shown an increased risk of URI (Upper Respiratory Infection),

including the flu, with low level of vitamin D. The prevalence of low level of vitamin D is

significantly high among darker-skinned individuals. Although the controversy about the value

of Vitamin D in good health has somewhat abated, unfortunately not many of afflicted patients

and physicians among our midst heed to the evidence. A simple search on the website of

Harvard Chan School of Public Health6 can be useful to delve into this matter. The use of

vitamin D as adjuvant during an episode of Covid-19 especially among groups known to have a

high prevalence of deficiency or anybody deficient for that matter is basically part of standard

practice7. The dose used during an infection can be increased over maintenance dose to

increase blood level. One can safely use 5000-10,000 IU/day for a few weeks and then obtain a

blood level.

• Vitamin C. No other vitamin has been the scorn of scientists more than vitamin C. It all started

when Linus Pauling of double Nobel Prize fame in the early seventies fawned over it and

promoted a daily megadose8. Intentional or not it took the allure of promotion of a panacea.

This issue was elegantly litigated elsewhere and there is no need to rehash it9. Nonetheless,

history will retain that he did take it daily and lived to the golden age of 93 but died of prostate

cancer. It’s universally agreed that no panacea exists and vitamin C is no exception, but

painstakingly completed studies over the years have proven that it has a great role to play in

inflammatory illnesses (pancreatitis, wound healing), and especially in infectious

diseases6,9,10,11. I gave several references in the previous issue of the AMHE Bulletin about the

therapeutic role it plays in patients with URI, and in Covid-19. The basic science behind the

role of vitamin C resides in the fact that it acts as a modulator of white cells, especially

neutrophils, lymphocytes, phagocytes12. In summary, during an infection, the serum level of

vitamin C drops as the above cells quickly accumulate vitamin C as protection against

oxidative damage while at the same time releasing reactive oxygen species to kill the

pathogens and cells containing them, like snuffing them out in the bud. The dose needed in an

acute infection is not standardized in the literature. Suffice it to say that one can take up to 9

grams/day orally so long as it doesn’t cause diarrhea. To enhance the absorption of vitamin C

from the gut, a clever delivery is used. There’s now the liposomal form that results in higher

serum level through enhanced bioavailability. Liposomal vitamin C comes in concentration of

1gm-3 gm; because of a rush on it, lately its availability has been spotty at times. Based on

available scientific evidence, it behooves one to take vitamin C during an acute episode of

Covid-19 or for that matter in any URI including bacterial pneumonia. The IV form for

hospitalized patients can be used but the liposomal form is next best. The dose of the IV is also

not yet standardized. It ranges from 1.5gm TID to as much as 50 gm/per day (this much higher

dose is primarily used in China). A caution: for patients known to have G6PD deficiency or

renal insufficiency, one should use the lower dose; diarrhea is a limiting factor (when caused

by vitamin C).

• Zinc. It’s normally found in legumes, nuts, whole grains. It does help the immune system

prevent replication of coronavirus in vitro13. It had gained its fame initially against the common

cold. It’s now one more an option in the face of Covid-19. It should be noted that zinc

deficiency is associated with dysgeusia and hypo or anosmia. Interestingly these two

complaints are being found in Covid-19 patients. It’s not, to my knowledge, known if such

patients are deficient in zinc but it would be curious to check their level and find this out. A

typical dose is 220mg daily or BID during the period of treatment. One caveat: don’t take the

nasal formulation as it can temporarily or permanently impair sense of taste.3,6

12

• Selenium. It’s readily found in nuts, grains, seafood. It plays an important role in the immune

response and optimal function of both B and T cells. As such it’s used as adjunctive therapy in

HIV cases because of its known antiretroviral activity. It also helps to regenerate vitamin C

from its oxidized form and in helping in antioxidant protection. Caution: some people can’t

tolerate exogenous selenium pills because of insomnia. Dose ranges from 25 to 100

micrograms, as tolerated14,15,16.

We are learning as we go along with this pandemic. Trying to stay healthy is a daily commitment.

Even when we do everything that we are supposed to do, there’s still no guarantee of the outcome.

However, enhancing the immune system is another layer of security that we can count on as we are

trying to stay safe.

References:

1. https://www.nytimes.com/2020/04/20/opinion/coronavirus-testing-

pneumonia.html?referringSource=articleShare

2. Moalem, Sharon, MD, PhD, The better half. On the genetic superiority of women. Farrar, Strauss,

Giroux. NY, 2020.

3. http://webmd.com

4. Kim MH, Kim H. The Roles of Glutamine in the Intestine and Its Implication in Intestinal

Diseases. Int J Mol Sci. 2017;18(5):1051. Published 2017 May 12.

5. Perna S, Alalwan TA, Alaali Z, et al. The Role of Glutamine in the Complex Interaction between

Gut Microbiota and Health: A Narrative Review. Int J Mol Sci. 2019;20(20):5232. Published 2019

Oct 22. doi:10.3390/ijms20205232

6. http://www.hsph.harvard.edu

7. Ginde, AA,. Association between serum 25-hydroxyvitamin D level and upper respiratory tract

infection in the Third National Health and Nutrition Examination Survey. Archives of Internal

Medicine. 2009 Feb 23;169(4):384-90.

8. Pauling L. The significance of the evidence about ascorbic acid and the common cold.

ProcNatAcadSci, Vol 68, 11, 2678-2681, November1997.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=4941984

9. Hemilä, H. Vitamin c and the common cold. Br J Nutr. 1992 Jan;67(1):3-16.

10. Scott, P. et al. Vitamin C status in patients with acute pancreatitis. BJS, Vol 80, 6, June 1993.

11. Hemilä, H. Vitamin C and Infections. Nutrients. 2017;9(4):339. Published 2017 Mar 29.

12. Wilson JX. Mechanism of action of vitamin C in sepsis: ascorbate modulates redox signaling in

endothelium. Biofactors. 2009;35(1):5–13. doi:10.1002/biof.7

13. te Velthuis AJW, et al. (2010) Zn2+ Inhibits Coronavirus and Arterivirus RNA Polymerase

Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture. PLoS

Pathog 6(11): e1001176. doi:10.1371/journal.ppat.1001176

14. http://www.lpi.oregonstate.edu

15. Huang Z, Rose AH, Hoffmann PR. The role of selenium in inflammation and immunity: from

molecular mechanisms to therapeutic opportunities. Antioxid Redox Signal. 2012;16(7):705-743.

16. Mattmiller SA, Carlson BA, Sordillo LM. Regulation of inflammation by selenium and

selenoproteins: impact on eicosanoid biosynthesis. J Nutr Sci. 2013;2:e28

13

A revolt of 23 African slaves in New York city, in the province of New York was formatted

during the year 1712. They killed 9 whites before they were stopped in their efforts. In 70 blacks

arrested and jailed, 21 were convicted.

Chronicle of Slave rebellions in the Americas.

Maxime Coles MD

All societies practicing slavery will have to deal with slave revolts because there is that desire for Freedom in

any human being. One can express it in their songs or their story-telling nights. It becomes part of their culture

and an art in knowing how to implant it on others with the same background.

History is full of examples of such revolts. When a Roman slave named Spartacus (73-71 BC) rose against

abuses committed by the Roman Empire or a Scandinavian Slave Tunni, in the 9th century, revolted against

the Swedish Monarchy, you can also understand well how the slaves of Santo Domingo, Bookman, Dessalines

and others may have felt in the 18th century (1791) against the French Imperialism of Napoleon Bonaparte.

The French revolution indeed bought to us the words of Liberty and Equality for all.

Muhammed led the east African slaves in the Zani Rebellion in Iraq to revolt against the Abbasid Caliphate.

Nanny of the Maroons revolted against the British in Jamaica. In continental United States, Denmark Vesey

rebelled in South Carolina.

Ancient Sparta had serfs called helots who rebelled against the Spartans as reported by Herodotus. English

peasants revolted in 1381 to obtain reform in the feudalism system in England and increase the right of the

serfs and Richard II agreed to their requests. In Russia, the slaves were called Kholops and slavery remained an

institution until 1723 when Peter the Great converted the slaves into serfs. They became outlaws called

“Cossacks” living in the southern steppes. Numerous rebellions and Cossacks uprisings with Ivan Bolotnikov

(1606), Stenka Razin (1667), Kondraty Butavin (1707) are some of the many hundred outbreaks across Russia.

Numerous African slave revolts took place in America during the 17th, 18th and 19th centuries. More than 250

uprising have been documented. Slaves like Gabriel Prosser (Richmond, VA 1800), Denmark Vesey

(Charleston SC 1822) Nat Turner (South Hampton County VA 1831) merit their named to be mentioned and

this is the story of the most striking revolts that I want to bring to light.

I have taken solemnly that task to bring to light the most distinctive slave revolutions in the Americas and

chose to review some of the most epic African slave revolts which have marked forever the new world in this

“Chronicle of African Slave revolts in the Americas”. I am sure you will find time to appreciate what our

ancestors have done to make Haiti a free Nation for the Haitians.

This month, we will talk about the 1712 New-York revolt in the British province of New York.

1712 New York slave revolt

British province of New York

The NY Slave Revolt in 1712 Maxime Coles MD

14

New York city was known to have the largest slave population in the New England There were

no large plantations while slaves worked as “house slaves” like servants, artisans, dock workers

etc. New York city differed from any southern cities. More they worked also among free blacks.

Slaves were able to communicate and planned conspiracy easily.

When the English took over the colony New Amsterdam in 1664 from the Dutch, they imposed

different rules and restricted the free slaves from marrying or possessing any land. A slave

market was built in the area of what we call now “Wall Street” to facilitate the sale of slaves

imported by the Royal African Company. B the beginning of 1700’s around 20% of the

population were enslaved black people. Measures require blacks to carry a pass to travel more

than a mile from home. Gatherings of more than 3 people, were prohibited.

On the night of April 6. 1712 a group of 20 black slaves set up fire to a building (Maiden Lane)

near Broadway. They were armed with guns, hatchets and swords to attack the whites. Colonial

forces arrested seventy blacks. Among the one arrested six committed suicide and 21 were

convicted and sentenced to death including one woman and a child. 20 blacks were burned to

death and one was execute on a breaking wheel (“Supplice de la Roue”). I can add that the

Supplice of the Wheel was popular with the French colonialist in the Caribbean and one has to

remember after the French revolution in 1789 the way Vincent Oge perished on the place of Cap-

Haiti.

More restrictive laws were passed in the colony affecting Blacks and Indians slaves. As we

already described earlier, they were not permitted to stay in group of more than three (3), nor

they will be able to carry firearms or gambling. Rape, Conspiracy or propriety damage were

punished by the death penalty. Free blacks were still allowed to own land. Anthony Portuguese,

owned land which represent the present-day Washington Square Park and his daughters and

grand-children still remained present owners.

To free a slave, a tax of 200 pounds was needed and it was debated in 1715 before the Lords of

Trade in London by the Governor Hunter, that a slave might inherit part of a master wealth and

share his lifetime fortune.

References:

1- Diehl, Lorraine B (October 5, 1992) “Skeletons in the Closet”. New York Magazine: New York Media LLC pp 78-86.

2- New York Slave Revolt 1712. In O’Callaghan, E.B. (ed.) Documents relative to the Colonial History of the State of New York procured in Holland, England and France. Albany, New York: Weeds, Parson (2016-06-14)

3- “New York’s Revolt of 1712”. Africans in America (January 5, 2008). 4- “The Freedmen of New Amsterdam”. In McClure Zeller, Nancy Anne (ed). A Beautiful and Fruitful

Place: New Netherland Institute (April 4, 2018). selected. 5- Geismer, Joan H. (April 2004). The Reconstruction of Washington Square Arch and Adjacent Site

Work”. New York City Department of Park and Recreation, P 10 (April4, 2018). 6- Johnson, Mat (2007), The Great Negro Plot, New York: Bloomsbury. 7- Horton, James & Horton, Lois (2005), Slavery and the Making of America, New York: Oxford

University Press,

15

Ma solitude

Maxime Coles MD

Du coin de l’oeil, j’ observe attentivement

Ce regard divin, et ce sourire angelique.

Qui fleurissent mon coeur d’allegresse

Dans une solitude maladive.

Comment pourais-je chanter tes louanges

Sur ce quai, abandonne dans la cohue?

Que deviendra mon etre qui pavanne,

Assoiffe de ton nectar?

Que dirais-je ce soir-la, muse de mes reves

Dans cette multitude de regards

Alors que le parfum que tu emanes

M’ennivre encore d’un Bonheur soutenu.

La candeur de ta chaire spirituelle

Encourage mes instincts

Alors que mon ame arbore ses secrets

Sur le chemin de ma Destinee.

La nuit reflete ma solitude

Et comme berce par une pleine lune,

Mes pensees s’envolent eparlillees

Vers ce firmament etoile.

Dans ce confinement, je pense

A nos amis disparus sur le front,

Comme des voyageurs du temps

Qui surement nous preparent le chemin.

Je dedie ce poeme a tous nos compagnons qui ont sacrifie leur vie dans cette pandemie.

Puissent ce Dieu de Misericorde les recevoir dans son royaume, a bras ouverts.

Maxime Coles MD (4-21-2020)

16

COVID-19 continue a devaster Notre communaute medicale.et recemment Louis

Edouard Fontaine MD, un de nos jeunes et fougeux de la promotion 1996, EST

passe de vie a trepas, combattant cette pandemie, a Brooklyn NY. Sinceres

condoleances a ses parents et allies affectes par ce deuil. Paix a son ame et que la

Terre lui soit legere.

Maxime Coles MD. 4-19-2020.

COVID-19 a coûté la vie à un autre médecin parmi nous à l'AMHE. Bredy

Pierre-Louis MD nous a quitté pour rejoindre son Créateur, combattant la

pandémie en première ligne. Sincères condoléances à sa femme Maggie, ses

enfants, sa famille et ses amis. Que tu reposes en paix, Bredy.

Maxime Coles MD

Marie Camel Pierre-Louis MD n"est plus de ce monde. Elle nous a quitte le 3 Avril 2020,

combattant cette pandemie a NY. Elle a dedie sa vie a prendre soin des plus faibles et des

opprimes. Je l'ai bien connu sur les bancs de la faculte alors que nous oeuvrons a la faculte

de Medecine. Nous sommes de la promotion 1976 (Price Mars) et comme plusieurs d'entre

nous. elle s'est rendue aux USA pour parfaire ses etudes. Elle a travaille d'arache-pied en

maladies infectueuses et s'est specialisee dans le SIDA. Elle laissera un vide parmi nous,

difficile a combler. Bon voyage Marie Carmelle et que la terre te soit legere, La AMHE

presente ses sinceres concoleances a la famille et aux amis affectes par ce deuil.

Maxime Coles MD

ICS US Section Past President, Prof. Kazem Fathie MD of Las Vegas, was a friend of mine

and we worked closely for the last 33 years to make the International College of Surgeons

and the American Academy of Orthopedical and Neurological Surgeryrespected

organizations in the USA. He was awarded a Presidential Recognition Award during the 2010

Annual Convention in Denver, acknowledging the tremendous contributions he has made to

both academies. He was chairman, at the AANOS and become President of the US ICS

Section in 2001.

He was a scientist, a poet, and a friend we found time to appreciate over the years. We will

miss him dearly. Rest in Peace Kazem.

Maxime Coles MD.

CLOVID-19 claimed another life in the AMHE Medical community on

Sunday 19 April 2020. Jean Marie Claude Desrosiers graduated in 1982 and

came to the state to specialize in Geriatric Medicine. He practiced for years

in the New York area and become a Geriatric specialist The AMHE is

sending it sincere condolences to his family and friends affected by this

loss.

Maxime Coles MD

***

***

***

***

17

Leslie Augustin (TI-Jo) n'est plus de ce monde. Il a ete rejoindre son createur. Leslie

EST Le jeune frere de Ducarmel Augustin MD and a note from Henriot St Gerard MD

nous raconte un peu de son passage sur Terre. Sinceres condoleance de la AMHE a

Ducarmeta la famille Augustin et aux amis affectes par cette perte. Maxime Coles MD

Henriot St Gerard MD dixit:

A Tous:

Je veux par la présente vous annoncer Le décès de Leslie Augustinjeune frère de Notre confrère

Ducarmel.

Leslie vivait en Haïti et EST décédé Des suites d’une rupture d’anévrysme cérébral. La situation qui

prévaut à cause de la pandémie du coronavirus rend les circonstances plus difficiles. Nous vous

encourageons à entourer Le confrère de tout Le support possible.

Nous présentons nos condoléances à toute la famille et nous les assurons de nos pensées et prières pour

les accompagner au cours de cette épreuve.

Les coordonnées de Ducarmel:Augustin MD peuvent etre retrouvee at AMHE.org

Sincèrement

Henriot St Gerard MD

***

18

Le Newsletter est publié toutes les 3 semaines.

Prochaine parution: 18 mai 2020

1) Common Cold:

-Sneezing

-Stuffy nose

-Sore throat

-Coughing

-Mild body aches

2) Seasonal Allergies

-Stuffy and runny nose

-Sneezing

-Itchy eyes, mouth, and skin

-Wheezing

Maxime Coles MD Dixit:

You need to know the difference in symptoms:

3) Influenza:

-Fever or/and Chills

-Cough

-Muscle and body aches

-Headaches

-Fatigue

-Sore Throat

-Runny and Stuffy nose

4) COVID-19 Infection

-Dry Cough

-Fever

- Shortness of Breath

- Fatigue

-Nasal Congestion

- Aches and Pains

From The New York Times:

Covid-19 Trickles Into Haiti: ‘This Monster Is Coming Our Way’

The virus has been slow to hit the country. But as laid-off Haitians return from hard-

hit areas, doctors are preparing furiously for an outbreak they fear will strain the

nation’s threadbare health care system.

https://www.nytimes.com/2020/04/22/world/americas/coronavirus-haiti.html?smid=em-share

19

Published on the AMHE Facebook page last two weeks Articles parus sur la page Facebook de l'AMHE durant la dernière semaine

Coronavirus en Haïti: les experts craignent plus de 20000 morts - Because farmers can't sell to restaurants and

markets, the vegetables are left to waste. MC - Thank you, Daniel.Laroche, MD/ MC - DES CONSEILS

APPROPRIÉS, COMPLETS ET PRÉCIS. - Les noirs ne sont pas bien traites en Chine et ils souffrent de la

pandemie. MC - Monument National qui a ete temoin des noces du Roi Henry Christophe, datant de 1810, -

Surveillance COVID-19, Haiti, 2020 - Karl Latortue MD, president du chapitre AMHE-NY avec Ricot Dupuis

de Radio Soleil (New York). Maxime Coles MD - Can you name the capital of any African Country? MC - Un

rappel historique et une revue des bienfaits de la Chloroquine (Quinine) - Pouvez-vous deviner qui vient dîner

le dimanche de Pâques. Maxime Coles MD - Le pays de mes ancetres!. And more…