Prévalence, connaissance et degré de contrôle de l'hypertension artérielle à Kisangani, RD Congo

Introduction: Déterminer la prévalence, la connaissance et le degré de contrôle de l'hypertension et analyser et comparer ces indicateurs en fonction des facteurs socio démographiques, héréditaires et environnement aux dans la population adulte de la ville de Kisangani, chef-lieu de la province Orientale en RD Congo. Méthodes: Nous avons mené une enquête transversale dans la population de Kisangani de juin 2010 à février 2011. L'étude a porté sur 1934 sujets âgés de ≥18 ans à l'exclusion des femmes enceintes. Les sujets ont été sélectionnés par échantillonnage aléatoire en grappes à quatre niveaux. Résultats: La prévalence de l'hypertension à Kisangani était de 28,3%. Parmi les sujets hypertendus, 72,2% se connaissaient hypertendus, 42,4% avaient leur hypertension contrôlée, 18,4% avaient l'hypertension au stade 2 et 6,5% avaient l'hypertension au stade 3. La prévalence de l'obésité était de 8%, celle de l'obésité abdominale de 13,5%. Les facteurs significativement associés à l'hypertension étaient l'âge, le sexe, le milieu de résidence, le niveau de scolarité, le niveau de revenu financier,la charge sociale,le statut dans le ménage,la prise des boissons alcoolisées, la sédentarité, l'hérédité d'hypertension, l'hérédité d'obésité, l'obésité et l'obésité abdominale. Conclusion: L'hypertension est très fréquente parmi les populations de Kisangani, aussi bien en milieu urbain qu'en milieu urbano-rural. Le niveau de contrôle de l'hypertension est plutôt satisfaisant; cependant la proportion d'hypertendus qui s'ignorent est préoccupante. Les systèmes des soins de santé de la ville de Kisangani devront s'atteler à améliorer les stratégies de dépistage de nouvelle «épidémie»

Resultats du Pastorex dans le diagnostic de méningite à Neisseria Meningitidis comparés à la culture

Introduction : La meningite est un probleme de sante publique dans les pays tropicaux. Elle atteint surtout les enfants et les jeunes adultes et sevit sous forme d'epidemies explosives tous les 10 a 12 ans. En Republique Democratique du Congo (RDC); on a recense au premier trimestre de 2010; 1852 cas dont 182 deces. Une epidemie a fait 17 morts a Kisangani en 2009.Cette etude avait pour objectifs d'identifier le germe en cause dans l'epidemie de 2009; de comparer les resultats biologiques de la meningite selon la coloration au gram; la culture et le test au latex de Pastorexrealises au niveau du liquide cephalorachidien (LCR).Materiel et Methode : Notre echantillon est fait de 33 echantillons de LCR sur lesquels la coloration de Gram; la culture et le test serologique au latex de Pastorex ont ete effectues. Ces echantillons ont ete preleves chez des malades atteints de meningite.Resultat : La coloration au gram a ete positive pour 94 des echantillons contre 6 des echantillons negatifs; 82 des echantillons ont montre des diplocoques gram negatifs. Le test de Pastorex a pour sa part identifie Neisseria meningitidis type C(NMC) dans 87;9 comme agent causal de cette epidemie de meningite. La culture sur gelose au sang du LCR etait concluante chez seulement 51;5 des echantillons. Conclusion : Dans la meningite a N. meningitidis; le test de Pastorexaun avantage diagnostic plus que la culture sur gelose au sang et permet egalement d'identifier le type de N.meningitidis

Hepatitis C infection markers among blood donors in Kisangani, Democratic Republic of Congo

Objectives: The role of blood transfusion in the spread of hepatitis C virus (HCV) is of concern in the DRC. Screened since the end of 2004 in blood donors, few data are however available on HCV in Kisangani. A study is needed to determine the seroprevalence of HCV in blood donors. Patients and method: 1247 blood samples collected from all volunteer blood donors who donated blood from August 1, 2005 to April 30, 2006 at the Provincial Blood Transfusion Centre were tested for anti-HCV antibodies. At the same time as HCV serology, markers for HIV and HBV were tested. Results: A total of 51(4.1%) volunteer blood donors (Table I) were HCV antibody positive. Fifty-two (4.2%) of the subjects were HIV positive and 60 (4.8%) were HBV positive. The mean age of HCV-positive donors was 31.4 years (±13.1) (Table II). HCV-positive seropositivity is lower among donors aged 17 to 24 years compared with those aged 25 years and older (p < 0.05). Positive HCV seropositivity is not related to gender. Conclusion: The seroprevalence of hepatitis C virus is relatively high like that of HIV among volunteer blood donors in Kisangani. It justifies that every blood donor be tested for HCV in order to prevent its transmission in Kisangani

Multiple transfusions for sickle cell disease in the Democratic Republic of Congo: the importance of the hepatitis C virus.

BACKGROUND AND OBJECTIVES: Improvement of transfusion security in sub-Saharan countries requires the determination of priorities taking into account the specific context. PATIENTS AND METHODS: One hundred and forty patients with sickle cell disease (SCD) from one clinical centre for SCD in Kisangani, DRC were tested for HBsAg, anti-HIV antibodies, anti-HCV antibodies and for alloantibodies against red blood cells and human leucocyte antigens (HLA). RESULTS: Thirteen patients had not been transfused and were free of HBV, HIV or HCV infection. HBV, HIV and HCV infections were detected in 2/127 (1.6%), 1/127 (0.9%) and 10/127 (7.9%) transfused patients, respectively. All ten cases of HCV infection were associated with patients who had transfusions prior to the introduction of HCV testing in 2004 (P=0.043). Red blood cells and HLA alloantibodies were detected in 13/127 (10%) and 2/127 (1.6%), respectively. CONCLUSION: HCV testing should be a priority. The rhesus (Rh) phenotype, mainly the RhD antigen and the Kell antigen should be assessed in SCD patients. Further extended phenotyping and deleucocytation should not be considered as priorities.

Abnormalities of somatosensory evoked potentials in konzo--an upper motor neuron disorder.

OBJECTIVE: To determine whether the somatosensory pathways are involved or not in konzo. METHODS: In 1998, 21 konzo subjects (15 females and 6 males; mean age 21 years) underwent a SEP study with a two-channel-equipment (Medtronic Keypoint, Denmark) whereas in 2000, 15 subjects (7 females and 8 males; mean age 21 years) participated in a study with a 4-channel-equipment. RESULTS: Most subjects (19/21 in 1998 and 12/15 in 2000) showed normal median SEPs. The remainders had no median cortical responses. All 21 subjects in 1998 and 9 out of 15 in 2000 showed abnormalities of tibial SEPs mainly consisting of absence of cortical responses, prolonged cortical latencies, and central sensory delay to the lumbar spine. Most subjects showed normal absolute latencies both at peripheral and spinal levels. The SEP findings did not correlate with the severity, neither the duration of konzo, nor the experience or not of sensory symptoms at the onset of the disease. CONCLUSION: Our findings are not specific of konzo. However, they suggest involvement of intracranial somatosensory pathways and point to similarities with other motor neuron diseases.

Impairments, disabilities and handicap pattern in konzo--a non-progressive spastic para/tetraparesis of acute onset.

PURPOSE: To assess impairments, disabilities and handicap pattern in konzo. METHOD: The study included 17 konzo subjects, of which three were males and 14 females (mean age 21, median 18 years). A detailed neurological examination was performed on all subjects. Subsequently, an assessment of impairments, disabilities and handicap was done with a constructed rating scale partially based on the ICIDH-2 framework. RESULTS: The overall disablement picture in all subjects consisted of motor dysfunction in lower limbs leading to limitations in walking and movement activities, and restrictions in mobility. Hip mobility was severely impaired in most cases (15/17). Although konzo subjects showed normal muscle power in upper limbs (13/17), they had impaired fine motor function (10/17). CONCLUSION: Further studies are needed to assess the effectiveness of the WHO criteria for konzo in defining its forms. The applicability of the ICIDH-2 framework in this study demonstrates the possibility of its use as a common language among researchers in the field of motor disorders. However, a revision is suggested of its taxonomy, and a definition of operational criteria to clarify the content of different qualifiers provided to assess the level of functioning or disability.

Complications du diabète sucré: expérience des Cliniques Universitaires de Kisangani

Une etude a la fois prospective et retrospective a ete menee aux Cliniques Universitaires de Kisangani pour degager les complications evolutives associees au diabete sucre de l'adulte. Quatre-vingt-deux pour cent des malades ont des complications evolutives. Elles sont dominees par les infections(39;6 pour cent); l'HTA (24;2 pour cent) et les neuropathies (22 pour cent). Le coma acido-cetosique (13;3 pour cent) est la plus frequente des complications metaboliques. Presque toutes les complications sont retrouvees au debut de la maladie quelque soit le type de diabete sucre

Anti-A60 immunoglobulin G in the serodiagnosis of tuberculosis in HIV-seropositive and seronegative patients.

OBJECTIVE: A60 is a high molecular weight mycobacterial antigen complex. The detection of immunoglobulin (Ig) G antibodies to A60 has been advocated as a reasonably sensitive and specific test for active tuberculosis (TB). We aimed to compare the sensitivity of this test among HIV-seropositive and HIV-seronegative patients with pulmonary TB. METHODS: The presence and concentration of anti-A60 IgG antibodies was assessed by enzyme-linked immunosorbent assay in 208 HIV-seropositive and 91 HIV-seronegative Zaïrian patients with smear-positive pulmonary TB. The relationship between anti-A60 IgG levels and HIV serostatus, CD4+ lymphocyte counts, presence of clinical AIDS, and tuberculin skin test results was verified. RESULTS: Only 36.5% of the HIV-seropositive, compared with 69.2% of the HIV-seronegative patients had a positive anti-A60 IgG test (P < 0.00001). Among HIV-seropositive patients, anti-A60 IgG levels did not differ according to CD4+ lymphocyte counts, presence of clinical AIDS, or tuberculin skin test results. CONCLUSIONS: Among patients with pulmonary TB, the sensitivity of testing for anti-A60 IgG was much lower among HIV-seropositive than among HIV-seronegative patients, even from the early stages of HIV-related immunodeficiency. This limits the utility of anti-A60 IgG-antibody testing in the diagnosis of TB among HIV-infected patients.

Hypotrophie foetale : influence des facteurs foeto-funiculo-placentaires aux Cliniques Universitaires de Kisangani

Les auteurs etudient le role joue par les facteurs funiculaires et placentaires dans la survenue de l'hypothropie foetale a la maternite des Cliniques Universitaires de Kisangani. Ils constatent que la gemellite; le placenta praevia et les infractus placentaires sont des facteurs determinants et que le placenta de l'enfant hypotrophique pese generalement moins de 500 grammes

Place des maladies maternelles gravidiques et des antecedents gyneco-obstetricaux dans la survenue du retard de croissance intra-uterin (RCIU) aux Cliniques Universitaires de Kisangani (CUKIS)

Les auteurs etudient le role des maladies gravidiques et des antecedents gyneco-obstetricaux dans la survenue de l'hypotrophie foetale et arrivent a la conclusion que le paludisme; les syndromes vasculorenaux; les parasitoses intestinales; les infections genitales; les anemies; les cardiopathies; la primiparite et la secondiparite constituent des facteurs explicatifs du retard de croissance intra-uterin (RCIU) au Zaire

[Results of tuberculosis treatment in a health district in Zaire]. / Résultats du traitement de la tuberculose dans une zone de santé au Zäire.

The results of the treatment of tuberculosis have been evaluated among 407 patients distributed into 268 cases of pulmonary tuberculosis with positive smears (TP+), 70 pulmonary forms with negative smears (TP-) and 69 cases of extrapulmonary tuberculosis (TEP). A group 1 of 361 patients including new cases and late relapses and consisting of 236 TP+, 59 TP- and 66 TEP has been put through the treatment pattern: 2S6H7T7 + 10H7T7 or 2S6H7 + 10S2H2. Group 2, of 21 patients consisting of failures, early relapses and previously but irregularly treated cases, was given a pattern: 2R7E7H7Z7 + 10R2H2. In group 3, 25 new cases were given a short treatment: 2R7E7H7Z7 + 4R7H7. In group 1 we have recorded 68.42% cured patients, 8.59% failures and 14.40% neglects of treatment. The remaining 8.59% include deceased, transfers and patients put through extended treatment. The rate of cure was better among TEP patients (95.46%) than among TP- patients (79.66%) and TP+ patients (58.05%); failures were proved to be more frequent among TP+ patients (11.88%) than among TP- patients (3.39%) and TEP patients (1.51%). In group 2 and 3 successes have amounted to 95.24% and 84% respectively. Considering rates of cure, irregular treatments, neglects and failures with standard patterns (group 1), it appears to be desirable that rifampicin-including short patterns are added to antitubercular therapeutic strategies of developing countries.

Prospective study on the relationship between intensive bactericidal therapy and leprosy reactions.

A systematic study was performed on the reactions occurring during several short-course therapy regimens for the treatment of paucibacillary and multibacillary patients. Most type 1 upgrading reactions in paucibacillary (PB) leprosy were mild to moderate and of short duration, while the time of onset was extremely variable. Their incidence was higher in the regimen rifampin (RMP) 900 mg once weekly for ten weeks than when a single dose of RMP 40 mg/kg body weight was given or 1500 mg in one dose followed by one year of dapsone (DDS) 100 mg daily. In multibacillary (MB) leprosy, three regimens were compared: MB-WHO regimen; regimen C, consisting of daily RMP 600 mg, ethionamide (ETH) 500 mg, and DDS or clofazimine (CLO) 100 mg for six months, followed by six months of daily DDS or CLO; and regimen D, identical to regimen C but comprising daily DDS or CLO plus ETH 500 mg during the second semester. Type 1 upgrading reactions occurred more frequently in MB patients and were more severe than in PB patients. They occurred more frequently and were more severe in regimens C and D than in the MB-WHO regimen. CLO 100 mg daily prevented type 1 reactions in MB patients and rendered them less severe. ENL was also more frequent in regimens C and D and was not prevented by CLO in the dosage used. Although there is some correlation between type 1 reactions and the total amount of RMP administered, other aspects of RMP administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Traditional structures clash with new imperatives.

PIP: Many factors need to be considered when planning and instituting a program designed to reduce or maintain birthrates. A question that arises in the case of a country such as Zaire is what would be the effects of a doubling of population size by the year 2000. The population of Zaire has more than doubled since independence in 1960, increasing from about 13 million to about 30 million, of which 44% are under the age of 15. If, as projected, total population gain doubles in the next 25 years, a minority of the population will have to produce the food and goods necessary to sustain the young, unproductive majority. Even at this time frequent food shortages and the lack of basic amenities such as sanitation and adequate housing are facts of daily life. Further population increases will only add to the burden. The government of Zaire, while it must respect traditional cultural values, has a responsibility to alleviate the problems and has taken several steps toward encouraging family planning and increasing the status of women in social and professional spheres. The National Family Planning Bureau provides birth control services and information free of charge to hospitals, clinics, and public health dispensaries throughout the country. Emphasis is on choice rather than limitation. The government has also created a Bureau of Women's Rights with the objective of promoting women's rights throughout Zaire. Additionally, the creation of coeducational schools has encouraged changes in attitudes toward family planning. Boys and girls can now compete on equal terms. There has been some involvement of women in government and business and an increase in job opportunities, particularly in areas once dominated by men. Yet, there is widespread resistance to family planning from many parts of the population. Program implementation has been difficult because of the family structure. Many couples have no freedom with regard to family planning. The clan, which has ultimate responsibility for the support of the children, actually makes the decision. This system of shared responsibility means that the doctor or health care specialist seeking to promote family planning must understand local custom. The traditional method of family planning is sexual abstinence from the time of the child's birth until the child begins to walk. This resulted in an average of 2 years between births and contributed to the practice of polygamy, but the availability of contraceptives has changed the situation markedly. It is often the husband, who wants to maintain control over his family, who is reluctant to accept government family planning policies. Another factor which has inhibited the acceptance of family planning is the mortality rate among young children.^ieng