Valeurs de référence de quelques paramètres hématologiques chez les femmes enceintes: étude transversale analytique multicentrique à Kinshasa, République Démocratique du Congo / Reference values of some hematological parameters in pregnant women in Kinshasa: A multicentric analytical cross- sectional study in Kinshasa, Democratic Republic of Congo

Pregnancy is a state characterized by physiological changes. These changes are interpreted by comparison between known reference values, which themselves depend on factors such as ethnicity, environment, diet, age, sex… However, the reference values being used in clinical practice in the Democratic Republic of Congo (DRC) are derived from general populations. Therefore, this study aimed to determine the reference values of hematological parameters among pregnant women in Kinshasa. Methods. This analytical cross-sectional study recruited pregnant women in Kinshasa, DRC from December 2022 to April 2023. The Complete blood count was carried out for all participants using Mindary BC-5150 hematology analyzer. The mean, median, and reference values were determined using SPSS version 23. Results. A Total of 451 healthy pregnant women were enrolled in the study. The participant age range was from 18 to 49 years old, 386 (85.6 %) were married and 152 (33.75) paucipare. The defined Reference values were: RBC : 2,79-4,78 x106/µl , Hb : 10,5-12,7 g/dl, HCT :24,3-38,9 %, MCV : 84,3-99,9 fl, MCH : 25,8-29,8 pg, MCHC : 30,0-36,1 g/dl, WBC : 2,83-10,56 x103/µl , Neutrophils :0,8-7,68 x103/µl , lymphocytes : 0,72-2,83 x103/µl , Monocytes :0,10-1,06 x103/µl , Eosinophils : 0,0-0,32 x103/µl , Basophils : 0,0-0,03 x103/µl , Platelet count :189-322 x103/µl, MPV : 7,9-12,6 fl. Conclusion. Changes were observed in hematological parameters between different trimesters of the pregnancy. Considerable differences were also observed when comparing reference values in the present study to those from studies conducted in other countries.

La grossesse est un état caractérisé par des changements physiologiques. Ces changements sont interprétés par comparaison à des valeurs de référence connues qui dépendent elles-mêmes de l'ethnie, de l'environnement, de l'alimentation, de l'âge, du sexe… Cependant, les valeurs de référence utilisées dans la pratique clinique proviennent de populations générales. La présente étude a visé à déterminer les valeurs de référence des paramètres hématologiques chez les femmes enceintes dans la ville de Kinshasa. Méthodes. Cette étude transversale et analytique a recruté des femmes enceintes à Kinshasa, de décembre 2022 à avril 2023. L'hémogramme a été réalisé chez toutes les participantes sur l'analyseur d'hématologie Mindray BC-5150. La moyenne, la médiane et les valeurs de référence ont été déterminées en utilisant le logiciel SPSS version 23. Résultats. Au total 451 femmes enceintes en bonne santé ont été incluses. La tranche d'âge de participantes était de 18 à 49 ans, 386 (85,6 %) étaient mariées et 152 (33,75 %) paucipares. Les valeurs de référence définies étaient : GR : 2,79-4,78×106/µl , Hb : 10,5-12,7 g/dl, HCT : 24,3-38,9 %, VGÇ : 84,3-99,9 fl, CCMH : 25,8-29,8 pg, TCMH : 30,0-36,1 g/dl, GB : 2,83-10,56 x103/µl , Neutrophiles :0,8-7,68 x103/µl , lymphocytes : 0,72-2,83 x103/µl , Monocytes : 0,10-1,06 x103/µl , Eosinophiles : 0,0-0,32 x103/µl , Basophiles : 0,0-0,03 x103/µl , Plaquettes : 189-322 x103/µl, VPM : 7,9-12,6 fl. Conclusion. Des changements ont été observés dans les paramètres hématologiques entre les différents trimestres. Des différences considérables ont également été observées entre nos valeurs de référence et celles des études menées dans d'autres pays.

Impact of adapted physical activity on blood pressure and hypertension control in the militaries of Kinshasa Garrison, Democratic Republic of Congo: A randomized controlled trial

Context and objective. Major handicap for operational conditioning of troops, hypertension requires innovative approaches for its prevention and management. The present study aimed to evaluate the impact of adapted physical activity (APA) on BP level of sedentary soldiers from Kinshasa garrison and the rate of hypertension control in those with high BP. Methods. Open, parallel randomized controlled trial carried out at Camp Lt-Colonel Kokolo (CVEC) from June 2016 to October 2017) in sedentary soldiers (57.6 %, hypertensives) allocated for 8 weeks to APA (n=119) or control (n=110). The randomization procedure used permuted blocks of four consecutive participants. The outcomes were baseline-adjusted betweengroup difference in BP level (all participants), in rate of BP control among hypertensives. Results. At the last available visit in 226 participants (119 vs 107), the baseline-adjusted BP difference between active and control group by intentionto-treat was 5.1 (95 % CI 1.2 -10.8)/3.0 (0.1-6.9) mmHg lower in the active group. The effect of APA was also significant across pre-specified categories of participants based on age, officers' rank, and hypertension status. Among 129 analyzed drug treated hypertensives (68 vs 61), the rate of BP control remained unchanged in the control group (43.8 to 44.3%) but increased (43.5% to 85.3 %) in the active group yielding a baseline-adjusted between group difference of 40.7 (32.2; 49.2) %. The probability to achieve hypertension control was greater (HR: 3.38 [95% CI: 1.48- 4.84] in the active group. PP analysis of 122 soldiers (80 vs 42) with data at all scheduled visits yielded confirmatory results for BP reduction and for hypertension control by APA. The changes in BP were positively correlated with concomitant reductions in heart rate. Conclusion. Exercise training induced a significant BP reduction in sedentary militaries and improved the control rate among those with drug treated hypertension

Predictors of mortality in COVID-19 patients at Kinshasa University Hospital, Democratic Republic of the Congo (from March to June 2020)

Introduction: since the 1st case of coronavirus disease 2019 (COVID-19) in Kinshasa on March 10th 2020, mortality risk factors have not yet been reported. The objectives of the present study were to assess survival and to identify predictors of mortality in COVID-19 patients at Kinshasa University Hospital.Methods: a retrospective cohort study was conducted, 141 COVID-19 patients admitted at the Kinshasa University Hospital from March 23 to June 15, 2020 were included in the study. Kaplan Meier's method was used to described survival. Predictors of mortality were identified by COX regression models.Results: of the 141 patients admitted with COVID-19, 67.4 % were men (sex ratio 2H:1F); their average age was 49.6±16.5 years. The mortality rate in hospitalized patients with COVID-19 was 29% during the study period with 70% deceased within 24 hours of admission. Survival was decreased with the presence of hypertension, diabetes mellitus, low blood oxygen saturation (BOS), severe or critical stage disease. In multivariate analysis, age between 40 and 59 years [adjusted Hazard Ratio (aHR): 4.07; 95% CI: 1.16 - 8.30], age at least 60 years (aHR: 6.65; 95% CI: 1.48-8.88), severe or critical COVID-19 (aHR: 14.05; 95% CI: 6.3-15.67) and presence of dyspnea (aHR: 5.67; 95% CI: 1.46-21.98) were independently and significantly associated with the risk of death.Conclusion: older age, severe or critical COVID-19 and dyspnea on admission were potential predictors of mortality in patients with COVID-19. These predictors may help clinicians identify patients with a poor prognosis

Admission hyperglycemia and associated risk factors among patients with acute stroke in intensive care units in Kinshasa, the Democratic Republic of the Congo

Context and objective. Despite being established as a correlate of unfavorable outcome in acute stroke, little is known about the burden and associated risk factors of admission hyperglycemia in acute stroke in sub-Saharan Africa. The present study aimed to assess its frequency and associated risk factors in Congolese patients admitted in Intensive Care Units (ICUs) in the acute phase of stroke. Methods. A multicenter (6 ICUs) prospective cohort study including consecutive patients with acute stroke was undertaken from July 15th, 2017 to March 15th, 2018.The Glasgow Coma Scale helped to determine the severety of the disease at admission. Stress hyperglycemia was considered for a random blood glucose levels at admission ˃140 mg/dL in patients without type 2 diabetes mellitus (T2DM). Independent factors associated with admission hyperglycemia were assessed using logistic regression analysis. Results. Out of 194 patients (mean age 58.7±13.1 years; 64% males, 74.7% light to moderate stroke severity; 59% hemorrhagic stroke) enrolled, admission hyperglycemia was found in 106 (54.6%) of patients (mean age 60.1 ± 14.3 years; 67% men, 67% hypertension) with 77 (72.6%) and 29 (27.4 %) of them having stress and chronic hyperglycemia, respectively. Independent predictors of admission hyperglycemia were age [aOR 1.98; 95%CI 1.17-3.36), GCS < 8 (aOR 3.83; 95% CI 1.99-7.35) and diabetes (aOR 9.02; 95%CI 3.38-14.05). Conclusion. More than half of critically ill patients exhibit admission hyperglycemia with age, severity of stroke and known diabetes as its main associated risk factors

Performance de l'oxymétrie nocturne dans le diagnostic du syndrome d'apnées du sommeil. Etude monocentrique menée au centre Hospitalier de Longjumeau/France

Contexte & objectif. Le syndrome d'apnées du sommeil est une pathologie fréquemment sous diagnostiquée et souvent méconnue; particulièrement à cause d'une accessibilité insuffisante au gold-standard du diagnostic, la polysomnographie ou la polygraphie ventilatoire. Et pourtant, l'affection est responsable des complications surtout cardiovasculaires majeures. L'objectif de la présente étude était d'évaluer le niveau de performance de l'oxymétrie nocturne dans le diagnostic du syndrome d'apnées du sommeil. Méthodes. Enquête transversale menée entre le 1er janvier 2016 et le 30 septembre 2017. Tous les patients hospitalisés pour suspicion du syndrome d'apnées du sommeil ont bénéficié d'une oxymétrie nocturne et d'une polygraphie ventilatoire. Les logiciels Excel 2010 et SSPSS 21.0 ont permis d'analyser les données. Nous avons déterminé la sensibilité, la spécificité, la valeur prédictive positive et la valeur prédictive négative. La courbe ROC a été calculée. p < 0,05. Résultats. Au total 201 patients d'âge moyen de 64,6±11,8 ans, avec une prédominance masculine (55%) et en majorité obèses (IMC moyen de 32kg/m²) ont été inclus. La sensibilité et la spécificité de l'oxymétrie nocturne sont respectivement de 87 et de 85% avec une courbe ROC montrant une surface importante sous la courbe de 0,75. Conclusion. Avec sa sensibilité et spécificité élevées, l'oxymétrie nocturne peut constituer une alternative valable au diagnostic du syndrome d'apnées du sommeil. Son innocuité et sa bonne acceptabilité en font un outil facilement exportable et recommandable en cas de carence de moyens appropriés