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.
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…