Efficacy and Safety of African Medicinal plants in the treatment of mild or moderate COVID-19: a randomized clinical trial using Doubase C ® (preprint)

Introduction At the start of the COVID-19 pandemic, an herbal medicine Doubase C = Uvaria brevistipita + Haroungana madasgascariensis (DBC) had received authorization for clinical trials in DR Congo. We aimed to determine its efficacy and safety compared to hydroxychloroquine-azithromycin (HCQ-AZI), the national standard treatment for COVID-19 at that time. Methods We conducted an open randomized clinical trial between May 2021 and January 2022. Only mild and moderate cases of COVID-19 (WHO classification) were included. Asymptomatic, severe and critical cases were excluded. Each patient's parameters (NEW score, Ordinale scale, viral load, EKG tracing) were evaluated sequentially and the proportion of changes was compared between the two arms on days 7 and 14. Results 376 patients randomized (mean age = 40 years, 14 % ≥ 60 years, 90.7% mild case, 9.3% moderate case). From day 7, 97.6 % of mild case had a marked improvement in their NEW score and Ordinal scale (p=ns). Among patients with moderate case, 5.8% progressed to the severe form of COVID-19 in the HCQ-AZI arm and no patient in the DBC arm (p=ns). The viral load was progressively negative (29.8 % negative viral load on day 7 and 86.7 % on day 14) (p=ns). 4.4 % of patients on HCQ-AZI experienced QTc interval prolongation and none in the DBC arm (p=0.021). We have not recorded any critical cases or deaths. Conclusions In both arms, most patients experienced clinical improvement but DBC offers better cardiac safety. The young age of the patients may have influenced the results.

Evolving profile of severe and critical COVID-19 according: Cases admitted to the University Hospital of Kinshasa (UHK) = the official name of the institution from March 24, 2020 to December 12, 2022 (preprint)

Background: Severe and critical forms of COVID-19 require early conventional oxygen therapy. Objective: The aim of this study was to analyze the evolution of Severe and critical COVID-19 patients treated at the University Hospital of Kinshasa according to News score. Methods: This was a historical cohort study carried out at the COVID-19 Treatment Center (of the University Hospital of Kinshasa (UHK) from March 24, 2020 to December 12, 2022. The target population was all patients (1159) admitted to the intensive care unit of the COVID-19 Treatment Center of the UHK. All tests were two-tailed with 95% CI and considered significant when P-value was < 0.05. Results: Of a total of 1159 patients, severe and critical forms accounted for 84.2% (n=976), with the age category of patients over 60 years the most represented at 52.2% (n=605), with a mean age of 58.1±17.3 years. Severe and critical patients with at least one comorbidity 74.2% (n=724) were admitted to CTCO CUK and 84.6% (n=981) of these patients required respiratory support with conventional oxygen therapy. Factors predictive of lethality were the use of CPAP and mechanical ventilation with HRa (95% CI) of 0.001 and 0.002 respectively, age> 60 years and late referral to UHK. Conclusion: Ultimately, this study showed that severe COVID-19 patients require early and effective management.

SARS-CoV2 mutations and impact on mortality: observational study in a sub- Saharan Africa hospital (preprint)

Background One year after the COVID-19 pandemic, the focus of attention has shifted to the emergence and spread of SARS-CoV-2 variants of concern (VOCs). The aim of the study was to assess the frequency of VOCs in patients followed for COVID-19 at Kinshasa university hospital (KUH) during the 3rd and 4th waves of the pandemic in Kinshasa. Hospital mortality was compared to that of the first two waves.Method The present study was conducted from June 2021 to January 2022 and included all patients in whom the diagnosis of SARS-CoV-2 infection was confirmed by the polymerase chain reaction (PCR). The laboratory team sequenced a subset of all SARS-CoV-2 positive samples with high viral loads define as Ct < 25 to ensure the chances to generate complete genome sequence. RNA extraction was performed using the Viral RNA Mini Kit (Qiagen). Depending on the platform, we used the iVar bioinformatics or artic environments to generate consensus genomes from the raw sequencing output in FASTQ format.Results During the study period, the original strain of the virus was no longer circulating. The Delta VOC was predominant from June (92%) until November 2021 (3rd wave). The Omicron VOC, which appeared in December 2021, became largely predominant one month later (96%) corresponding the 4th wave. In-hospital mortality associated with COVID-19 fell during the 2nd wave (7% vs 21% 1st wave), had risen during the 3rd (16%) wave before falling again during the 4th wave (7%) (p < 0.001).Conclusion The Delta (during the 3rd wave) and Omicron VOCs (during the 4th wave) were very predominant among patients followed for Covid-19 in our hospital. Contrary to data in the general population, hospital mortality associated with severe and critical forms of COVID-19 had increased during the 3rd wave of the pandemic in Kinshasa.

Incidence of QTc interval prolongation in patients treated for covid-19 with Doubase C or Hydroxychloroquine-azithromycin at University Hospital of Kinshasa (preprint)

Background: QTc prolongation has been described in COVID-19 patients treated with Hydroxychloroquine (HCQ) and Azithromycin (AZT) in western countries. In the Democratic Republic of the Congo (DRC), few studies have assessed the safety of these molecules, and neither have they for new molecules proposed for COVID-19 treatment, such as Doubase C. This study aimed to determine the incidence of QTc prolongation in COVID-19 patients treated with HCQ-AZT or Doubase C. Methods: This study was part of a randomized clinical trial. Data were collected from May 20, 2021, to January 15, 2022. Patients were randomized into two arms; one was treated with Doubase C and the other with HCQ-AZT at standard dosages. Only patients with mild to moderate COVID-19 were included. Results: A total of 261 patients were included. At inclusion, the two groups were comparable (52.5% men, 47.5% women, mean age 41±15 years. The incidence of prolonged QTc interval was 1.5% in the whole group (3.3% on the HCQ-AZT arm and 0% on the Doubase C arm). No ventricular arrhythmias or torsade de pointes, or cardiac arrest were observed. Conclusion: Unlike Doubase C, the HCQ-AZT strategy has a risk of QTc prolongation.

[Lesions on CT scan in patients hospitalized for coronavirus pneumonia during the first wave of the SARS-CoV-2 pandemic at the University Clinics in Kinshasa (DRC)]. / Lésions tomodensitométriques chez les patients hospitalisés pour pneumonie à COVID-19 lors de la première vague de la pandémie à SARS-CoV-2 aux Cliniques Universitaires de Kinshasa (RDC).

INTRODUCTION: the main purpose of this study is to describe chest computed tomography (CT) findings in 26 patients hospitalized with COVID-19 pneumonia during the first wave of the SARS-CoV-2 pandemic at the University Clinics in Kinshasa (UCK). METHODS: we conducted a descriptive study of chest CT findings in 26 patients hospitalized with coronavirus pneumonia at the UCK over a 9-month period, from March 17 to November 17, 2020. Hitachi - CT-scanner 16 slice was used in all our patients. After analyzing lesions, these were divided into lesions suggestive and non-suggestive of SARS-CoV-2 infection. RESULTS: the average age of patients was 53.02 years. Male sex was the most affected (76.9%). Respiratory distress was the most common clinical symptom (61.5%). Arterial hypertension and renal failure were the most common comorbidities (3O% and 6%). Bilateral ground-glass opacities, with a predominantly peripheral distribution, accounted for 69.2% of cases, followed by condensations (57.7%) and crazy paving (19.2%). Severe COVID-19 was most frequently found (34.61%). Distal and proximal pulmonary embolism was the most common complication (11.5%). Among the associated diseases, pleurisy and pulmonary PAH were most frequently found (30.8%). The majority of our patients had parenchymal lung lesions, corresponding to early-stage disease on CT (50%). CONCLUSION: at the UCK, during the first wave of SARS-CoV-2 pandemic, lesions on CT suggestive of COVID-19 were dominated by plaque-like ground-glass opacities, followed by nonsystematized parenchymatous condensations and crazy paving. The less observed atypical lesions consisted of unilateral, peribronchovascular pseudo-nodular condensations and infection in the remodeled lung. Severe COVID-19 was the most common CT finding. Proximal and distal pulmonary embolism was the most common complication. This study highlights that these findings are consistent with those reported in the literature.

Epidemiological, clinical Characteristics and mortality of patients Infected with SARS-CoV-2 Admitted of Kinshasa University Hospital, Democratic Republic of the Congo from March 24, 2020 to January 30, 2021: Two waves, two faces? (preprint)

BackgroundThe objective of our retrospective study was to establish a comparison between the first and the second waves of demographic and clinical characteristics as well as mortality and its determinants. MethodsA total of 411 COVID-19 patients were enrolled in Kinshasa University Hospital and categorized into two groups according to the pandemic pattern, demographics, and disease severity. The clinical characteristics were compared according to the two waves. To describe survival from the first day of hospitalization until death, we used Kaplan Meiers method. We used the Log Rank test to compare the survival curves between the two waves. The Cox regression was used to identify independent predictors of mortality. ResultsDuring the study period, 411 patients with confirmed COVID-19 were admitted to the hospital. The average age of patients in the 2nd wave was higher than in the first wave (52.4 {+/-}17.5 vs 58.1 {+/-}15.7, p=0.026). The mean saturation was lower in the first wave than in the second. The death rate of patients in the first wave was higher than in the second wave (p=0.009). Survival was reduced in the first wave compared to the second wave. In the first wave, age over 60 years, respiratory distress, law oxygen saturation ([≤]89%) and severe stage of COVID-19 emerged as factors associated with death, while in the second wave it was mainly respiratory distress, law oxygen saturation ([≤] 89%) and severe stage. The predictors of mortality present in both the first and second waves were respiratory distress and severe COVID-19 stage. ConclusionMortality decreased in the second wave. Age no longer emerged as a factor in mortality in the second wave. Health system strengthening and outreach to those at high risk of mortality should continue to maintain and improve gains.