ABSTRACT
PURPOSE: To assess the safety and efficacy of partial splenic embolization (PSE) to reduce the need of transfusions and improve hematologic parameters in patients with hypersplenism and sickle cell disease (SCD). MATERIAL AND METHODS: This prospective study includes 35 homozygous hemoglobin S patients with SCD and hypersplenism who underwent PSE from 2015 until 2021 in Kinshasa. Patients were evaluated, before and after PSE (1, 3 and 6 months), using clinical, laboratory and ultrasonographic methods. PSE was performed with the administration of gelatin sponge particles embolizing 60-70% of the splenic parenchyma. RESULTS: The mean age was 10 (± 4) years and (21/35, 60%) were male. After PSE Leucocytes decreased at 3 months (16 692.94 vs 13 582.86, p = 0.02) and at six months Erythrocytes increased 2 004 000 vs. 2 804 142 (p < 0.001), Platelets increased (168 147 vs. 308 445, p < 0.001) and Hemoglobin increased (5.05 g/dL vs. 6.31 g/dL, p < 0.001) There was a significant dicrease in the need of transfusions from 6 (2-20) before PSE to 0.06 (0-1) after PSE (p < 0.001). The most frequent complication was splenic rupture (4/35, 11.4%), seen only and in all patients with hypoechogenic nodules at baseline. CONCLUSION: PSE is a safe procedure in patients with SCD and hypersplenism, that do not have hypoechogenic nodules in the spleen. PSE improves the hematological parameters and reduces the frequency of blood transfusions.
Subject(s)
Anemia, Sickle Cell , Embolization, Therapeutic , Hypersplenism , Humans , Hypersplenism/therapy , Hypersplenism/etiology , Male , Anemia, Sickle Cell/complications , Anemia, Sickle Cell/therapy , Embolization, Therapeutic/methods , Female , Child , Prospective Studies , Adolescent , Treatment Outcome , Spleen/diagnostic imaging , Child, Preschool , Blood Transfusion/methodsABSTRACT
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
Subject(s)
Humans , Male , Female , Blood Pressure , Exercise , Hypertension , Military Personnel , Disease PreventionABSTRACT
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is impacting the mental health of the population, but data on its impact in developing countries are lacking. The purpose of this study is to assess the psychological aspects of the COVID-19 pandemic in the population of Kinshasa. METHODS: This cross-sectional and analytical study included 456 randomly selected respondents in the Ngafani district of the municipality of Selembao during the period from August 1 to October 30, 2020. Socio-demographic data, and data concerning COVID-19 and its impact on mental health, were studied. Anxiety and depression were studied using the Hospital Anxiety and Depression Scale (HADS). RESULTS: The two genders were represented in equal proportions; the patients had a mean age of 40.4±17.2 years with a high frequency of patients aged over 50 years. All had agreed to observe social distancing, but only 36.8% had accepted isolation. Using the HADS, 47.4% had a doubtful anxiety state and 23.7% had a definite anxiety state; 36.8% had a doubtful depressive state and 25% had a definite depressive state. Old age (≥50 years), female gender, lack of occupation, and isolation were independent determinants associated with anxiety and depression. CONCLUSION: The frequency of anxiety and depression during the COVID-19 pandemic was high. Older age, female gender, lack of a profession, and isolation were associated with anxiety and depression.
