Relation entre pression pulsee; troubles visuels et severite de la retinopathie diabetique en Afrique sub-saharienne

Objectif: Determiner la relation entre la pression pulsee; les facteurs de risque traditionnels; les troubles visuels et la prevalence des differentes formes cliniques de la retinopathie diabetique. Materiel et methodes : Une etude transversale a ete menee entre le 1er decembre 2004 et le 16 juillet 2005 dans les centres de sante a Kinshasa. RDC. La population mere (n=3010 diabetiques) a servi a estimer la prevalence de la retinopathie diabetique tandis qu_fun echantillon representatif (n=301) a ete soumis a une approche analytique : age.20 ans; anthropometrique; composantes de la pression arterielle; glycemie a jeun; optometrie; fond d_foeil; severite de la retinopathie diabetique. Resultats : La baisse subjective etait associee a la retinopathie diabetique dans l_fechantillon (Or=2;7 IC951;1-5;4 ; p0;05) et en cas de diabete de type 2 (OR1;1-3;4 ;p0;05). La baisse subjective de l'acuite visuelle etait associee a la retinopathie diabetique dans l'echantillon (OR1;1-12;6 ;p0;05). Le risque de deficience visuelle etait plus que triple par la retinopathie diabetique chez les femmes (OR1;1-12;6 ;p0;05). Porter une grossesse apres le diagnostic de diabete multipliait par 3 le risque de retinopathie diabetique chez les femmes (OR1;1-13;2 ;p0;05). Apres regression logistique; le risque multivarie de retinopathie diabetique etait predit de facon independante par les antecedetnss familiaux de diabete sucre (OR1;2-8;8 ; p0;05); la duree du diabete . 4 annees (OR1;4-8;5 ;p0;01); la pression pulsee .60 mmHg (OR2- 12;8 ;p0;001). Conclusion : Un programme de prevention et de controle de la retinopathie diabetique et de ses facteurs de risque est souhaite pour l le benefice de l'urgence

Rates and Predictors of Stroke-Associated Case Fatality in Black Central African Patients : Cardiovascular Topics

Objective: To identify case fatality rates and predictors of stroke in a private clinic in Kinshasa; Democratic Republic of Congo. Methods: Two hundred and twelve black Africans were consecutively admitted to a clinic and prospectively assessed during the first 30 days by CT scan-proven stroke types and outcome. univariate and multivariate analyses were used to estimate the in-hospital mortality risk for the following baseline characteristics: age; gender; education; arterial hypertension; diabetes; stroke types; leukocyte count; and haematocrit; blood glucose; uric acid; fibrinogen and total cholesterol levels. Results: Haemorrhagic and ischaemic strokes were present in 52 and 48of the study population; respectively; and 44of all stroke type patients; 29of haemorrhagic stroke and 31of ischaemic stroke patients died. Compared to the survivors; deceased patients were significantly (p 0.001) older with higher leukocyte counts and haematocrit; haemoglobin and fibrinogen levels; but lower glycaemic levels. The variable significantly associated with all stroke type mortalities in the multivariate model was ischaemic stroke (HR Ci = 4.8-8.2 for tertile 3 and RR = 12.9; 95Ci = 7.8-18.4 for tertile 4; p 0.001) and higher glycaemia (RR Ci = 1.4-5.7 for tertile 3 and RR = 6.7; 95Ci = 5.2-9.2 for tertile 4; p 0.001). Conclusion: We have shown that all acute stroke types remain a deadly nosological entity; and ischaemic stroke; baseline haematocrit and fibrinogen levels; and dependency on others' care were significantly associated with all stroke mortalities. Moreover; hyperfibrinogaemia and hyperglycaemia were the significant predictors of case fatality in ischaemic stroke patients. in Africa; the top priority for resource allocation for stroke services should go to the primary prevention of stroke

Diets Rich in Vegetables and Physical Activity are Associated with a Decreased Risk of Pregnancy Induced Hypertension among Rural Women from Kimpese; DR Congo

Background: To assess whether the frequency pf pregnancy-induced hypertension is low; and vegetables intake and physical activity are protective against pregnancy-induced hypertension onset among rural women from Democratic republic of Congo. Method: This hospital-based and longitudinal study was carried out within the rural hospital of Kimpese; DR Congo were monitored from January 1st to March 31st 2003 on basis of demographic; diet; physical activity; anthropometry; and blood pressure till the onset of types of pregnancy-induced hypertension and delivery. Results: Out of 238 black pregnants; the incidence risk of arterial hypertension was 4.6(n=11) whose 2.9with Pre-Eclampsia and 1.7with transient hypertension. Gestity; parity and birth weight of infants were significantly lower among hypertensive mothers; while positive family history and presence of oedemas were more elevated among hypertensive pregnants. The onset of Pre Eclampsia was higher within vendors and inactive women as well as among vegetarians (3.1) than women with diet high in meat (9.7). Pre Eclampsia occurred more (p0.05) among pregnants with rare daily servings of vegetables (33.3) than pregnants with 3 or more (3.7). Physical activity (RR=0.63 CI950.33 to 0.98) were significant (p0.01) protective factors against pre eclampsia. Eclampsia was not observed. Conclusion: It is timely to promote diet rich in vegetables overweight reduction and physical activity among pregnants for the prevention of pregnancy-induced hypertension

Diets Rich in Vegetables and Physical Activity are Associated with a Decreased Risk of Pregnancy Induced Hypertension among Rural Women from Kimpese; DR Congo

Background:To assess whether the frequency pf pregnancy-induced hypertension is low; and vegetables intake and physical activity are protective against pregnancy-induced hypertension onset among rural women from Democratic republic of Congo. Method: This hospital-based and longitudinal study was carried out within the rural hospital of Kimpese; DR Congo were monitored from January 1st to March 31st 2003 on basis of demographic; diet; physical activity; anthropometry; and blood pressure till the onset of types of pregnancy-induced hypertension and delivery. Results: Out of 238 black pregnants; the incidence risk of arterial hypertension was 4.6(n=11) whose 2.9with Pre-Eclampsia and 1.7with transient hypertension.Gestity; parity and birth weight of infants were significantly lower among hypertensive mothers; while positive family history and presence of oedemas were more elevated among hypertensive pregnantsThe onset of Pre Eclampsia was higher within vendors and inactive women as well as among vegetarians (3.1) than women with diet high in meat (9.7).Pre Eclampsia occurred more (p

Diets Rich in Vegetables and Physical Activity are Associated with a Decreased Risk of Pregnancy Induced Hypertension among Rural Women from Kimpese; DR Congo

Background:To assess whether the frequency pf pregnancy-induced hypertension is low; and vegetables intake and physical activity are protective against pregnancy-induced hypertension onset among rural women from Democratic republic of Congo. Method: This hospital-based and longitudinal study was carried out within the rural hospital of Kimpese; DR Congo were monitored from January 1st to March 31st 2003 on basis of demographic; diet; physical activity; anthropometry; and blood pressure till the onset of types of pregnancy-induced hypertension and delivery. Results: Out of 238 black pregnants; the incidence risk of arterial hypertension was 4.6(n=11) whose 2.9with Pre-Eclampsia and 1.7with transient hypertension.Gestity; parity and birth weight of infants were significantly lower among hypertensive mothers; while positive family history and presence of oedemas were more elevated among hypertensive pregnantsThe onset of Pre Eclampsia was higher within vendors and inactive women as well as among vegetarians (3.1) than women with diet high in meat (9.7).Pre Eclampsia occurred more (p

Prevalence and risk factors of arterial hypertension among urban Africans in workplace: the role of body mass index

Background: Studies on the prevalence of hypertension among Africans in workplace did not deal with risk factors of hypertension. Thus there is a need to screen urban central Africans at workplace for environmental risk factors of hypertension. Method: A cross-sectional survey was conducted at the Kinshasa National Company of Electricity. A representative sample of 333 employees was screened. Tobacco; alcohol use and level of physical activity measures were obtained. Weight; height; BMI; waist; hip; conicity; blood pressure; pulse pressure and pulse rate were measured. Data were analysed using univariate and multivariate statistics. Results: The prevalence of hypertension was 21.3. Hypertension was associated with aging; higher professional position; eastern origin; migration; alcohol use; wider pulse pressure 60mmHg; wider waist 90cm; wider hip 97cm; obesity; and left ventricle hypertrophy. Independent predictors of hypertension were age; wider waist; wider hip; alcohol intake; and left ventricle hypertrophy. In another logistic regression model; only waist90 cm (OR=2.5 CI95 1.3-4.9; p0.01) and age

Prevalence and Risk Factors of Arternal Hypertension among Urban Africans Workplace: The Obsolete Role of Body Mass Index

Background: Studies on the prevalence of hypertension among Africans in workplace did not deal with risk factors of hypertension. Thus there is a need to screen urban central Africans at workplace for environmental risk factors of hypertension. Method: A cross-sectional survey was conducted at the Kinshasa National Company of Electricity. A representative sample of 333 employees was screened. Tobacco; alcohol use and level of physical activity measures were obtained. Weight; height; BMI; waist; hip; conicity; blood pressure; pulse pressure and pulse rate were measured. Data were analysed using univariate and multivariate statistics. Results: The prevalence of hypertension was 21.3. Hypertension was associated with aging; higher professional position; eastern origin; migration; alcohol use; wider pulse pressure 60mmHg; wider waist 90cm; wider hip 97cm; obesity; and left ventricle hypertrophy. Independent predictors of hypertension were age; wider waist; wider hip; alcohol intake; and left ventricle hypertrophy. In another logistic regression model; only waist90 cm (OR=2.5 CI95

Prevalence and Risk Factors of Arternal Hypertension among Urban Africans Workplace: The Obsolete Role of Body Mass Index

Background: Studies on the prevalence of hypertension among Africans in workplace did not deal with risk factors of hypertension. Thus there is a need to screen urban central Africans at workplace for environmental risk factors of hypertension. Method: A cross-sectional survey was conducted at the Kinshasa National Company of Electricity. A representative sample of 333 employees was screened. Tobacco; alcohol use and level of physical activity measures were obtained. Weight; height; BMI; waist; hip; conicity; blood pressure; pulse pressure and pulse rate were measured. Data were analysed using univariate and multivariate statistics. Results: The prevalence of hypertension was 21.3. Hypertension was associated with aging; higher professional position; eastern origin; migration; alcohol use; wider pulse pressure 60mmHg; wider waist 90cm; wider hip 97cm; obesity; and left ventricle hypertrophy. Independent predictors of hypertension were age; wider waist; wider hip; alcohol intake; and left ventricle hypertrophy. In another logistic regression model; only waist90 cm (OR=2.5 CI951.3-4.9; p

Environnement; sante et hygiene. [editorial]

L'environnement englobe l'ensemble des influences qui s'exercent sur l'homme et sur son bien-etre. La maladie devient une inadaptation au milieu exterieur; cet etat etant conditionne par le milieu interieur de l'homme; ces interactions du milieu interieur (la nature; le terrain) avec le milieu exterieur constituent la peristase

Apport de l'echographie dans l'exploration de la douleur pelvienne: revue de 4050 cas

La place de l'echographie abdomino-pelvienne dans l'evaluation diagnostique de la douleur pelvienne a ete etudiee de facon retrospective chez 4050 femmes zairoises adressees au Centre d'Echographie MEDICIS de Kinshasa. Apres une bonne repletion vesicale; chaque patiente a subi une echographie pelvienne par voie transabdominale ou sus-pubienne avec incidences sagittales; transversale et frontale grace a une echographie de marque Aloka type SS-620 equipe d'une sonde convexe de 3;5MHZ. 40;7 pour cent des patientes examinees en echographie gynecologique y sont adressees pour douleur pelvienne. L'age de plus de la moitie de ces femmes est compris entre 20 et 30 ans. La frequence des cas de douleur pelvienne double avec le nombre d'accouchements et d'avortements egal ou superieur a 2. [abstract terminated]

L'actualite sur le traitement de l'hypertension arterielle

L'hypertension arterielle est devenue pour le monde entier un reel probleme de sante publique et constitue un facteur de risque cardiovasculaire majeur. Elle accelere l'installation de l'attaque herosclerose coronaire et cerebrovasculaire. Les mecanismes de la potentialisation de l'atherogenese dans l'hypertension arterielle se revelent fort complexes. L'approche therapeutique qui constitue la substance de ce texte est donc empirique. Actuellement on pense que les beta-bloquants et les inhibiteurs de l'enzyme de conversion seront prescrits avant 50 ans; les diuretiques et les inhibiteurs calciques apres 50 ans

Les accidents vasculaires cerebraux a Kinshasa: etude tomodensitometrique

Au bout de 4 ans (juillet 88-juillet 92) de pratique d'une technique nouvellement acquise; la tomodensitometrie par ordinateur (TDM) dans notre milieu; les auteurs analysent 121 cas d'accident vasculaire cerebral (AVC) chez les Noirs Africains de Kinshasa. L'AVC est une pathologie du sujet jeune et plus frequemment chez celui du sexe masculin (2/1). L'hemorragique est moins frequent que l'ischemique (2/3). L'AVC survient dans le territoire de l'artere cerebrale moyenne (77;5 pour cent) et plus volontiers a gauche. L'hypertension arterielle reste l'antecedent morbide le plus rencontre suivi de la drepanocytose

L'impact du pouvoir medical sur l'ethique et la philosophie

L'image idealisee et divinisee du medecin disparaitra. Il n'en restera rien. Quel est celui ou celle qui n'a pas un medecin en qui il a confiance; qui ne va pas vers lui lorsqu'il est souffrant; ou lorsqu'il a un probleme? Nous y repondons. Le pouvoir du medecin est immense et le savoir en est sa limite superieure. La medecine est une profession qui exige un certain nombre de qualites morales avec une vision humaniste dans le respect de la vie et de la nature humaine

Place de la chirurgie dans le traitement du cancer du sein au Zaire

Les particularites clinicopathologiques du carcinome mammaire dans notre milieu sont connues. Les difficultes liees a l'insuffisance des infrastructures confinent le traitement de cette affection a la chirurgie seule. Dans une etude retrospective portant sur 45 patientes; les auteurs analysent les resultats de leur traitement. L'age moyen etait de 46 ans avec des extremes de 27 ans et 70 ans. Le stade avance du carcinome (Stade III et IV) chez 88des patientes; a justifie une mastectomie radicale. La survie a 5 ans est respectivement de 80au stade II; 19au stade III et 0au stade IV; alors qu'a 10 ans la survie pour les memes stades est de 40pour le stade II et 0pour les autres stades. Ces taux de survie qu'il faudrait comparer avec une etude ulterieure sur l'evolution naturelle au cancer du sein dans notre milieu; pose le probleme de la portee curative effective du traitement chirurgical seul face a des stades aussi avances

La transplantation cardiaque : mise a jour

Les auteurs rapportent 1 cas de transplantation cardiaque. Apres une anamnese et un traitement clinique complet; une mise au point a ete realisee. Celle-ci comprend un catheterisme cardiaque complet avec mesure des resistances pulmonaires; une fraction d'ejection isotopique; un groupe sanguin et la clearance de la creatine de 24 heures. L'evolution du patient est assombrie par la persistance des affections avec une survie de 1 an

Hygiene publique en derive au Zaire : plaidoyer pour la relance de la sante publique! [editorial]

L'heritage colonial en matiere de l'hygiene est en derive au Zaire. La deterioration des conditions du milieu surtout dans les grandes villes du Zaire se manifeste sous plusieurs facettes; dont celles d'insalubrite generalisee dans divers secteurs. Les consequences de cette insalubrite sur la sante publique sont faciles a identifier. En effet; les excreta et les eaux usees domestiques contiennent une gamme tres variee des micro-organismes saprophytes et pathogenes impliques dans l'eclosion des maladies diarrheiques

Etude de la valeur nutritive de la menispermacee triclisia gilletii de Wild; plante legumineuse du Mayombe

Les jeunes feuilles de Triclisia gilleti sont comestibles sous forme d'ingredients d'assaisonnement dans le Mayombe. C'est ainsi que les auteurs mettent en evidence la teneur en eau; lipides; cendres; elements mineraux majeurs; fibres; proteines et en glucides assimilables de ce type de Menispermacee. Ce legume possede une richesse en eau (63;64 pour cent); en protides (11;68 pour cent); en fibres (46 pour cent) et en glucides assimilables (38;89 pour cent). Sa composition biochimique prouve sa superiorite a certains legumes largement consommes au Zaire. Et la haute teneur en fibres de cette plante la recommande comme traitement dietetique de l'obesite et du diabete sucre

Physiologie du systeme urinaire

L'objet de cette petite brochure est de servir au praticien actuel et futur a mieux comprendre le rein