[Overview of the knowledge and attitudes of physicians in Brazzaville on obstructive sleep apnea syndrome]. / État des lieux des connaissances et attitudes des médecins de Brazzaville sur le syndrome d'apnée obstructive du sommeil.

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is the leading sleep-related breathing disorder. Its complications and its repercussions on the quality of life of patients make the OSAS a real public health problem. The objective of this study is to both asses physicians knowledge of OSAS and describe their attitudes towards suspect subjects in Brazzaville. MATERIAL AND METHOD: This was a cross-sectional study of 230 doctors practicing in various hospitals in the city of Brazzaville. The data collection was done by a self-questionnaire developed after a bibliographic analysis on the OSAS. The questionnaire was completed without recourse to a source of information. RESULTS: Our sample consisted of 141 (70.50%) general practitioners and 59 (29.50%) specialist physicians. The average of the knowledge score was 9.34 points±3.03 points. The general level of physician knowledge about SAS was good in 2% of cases, average in 44% of cases and low in 54% of cases. The level of knowledge was related to the number of times the OSAS diagnosis was mentioned by the physician in his practice (P<0.001), to the doctor's grade (P=0.003); to his university of origin and to the quantity of sources of information. When faced with suspects OSAS subjects, the doctor, the doctor directed the patient in 62% of the cases in ENT and in 49% in the pulmonology. CONCLUSION: The knowledge of the doctors on the OSAS are weak; this results in poor management of this pathology in the Congo.

Profil des affections respiratoires du sujet âgé au service de pneumologie du CHU de Brazzaville

Les défaillances du système immunitaire induites par l'âge avancé favorisent le développement d'affections diverses en association avec les comorbidités et les mauvaises conditions socioéconomiques.L'objectif de cette étude était de décrire les caractéristiques cliniques et évolutifs du sujet âgé hospitalisé en milieu pneumologique Congolais. Matériels et Méthodes:Nous avons réalisé une étude rétrospective, comparative entre groupes de patients : 4008 patients âgés de moins de 65ans et 570 hospitalisés pour une pathologie respiratoire du service de pneumologie du centre hospitalier universitaire (CHU) de Brazzaville. Résultats:Sur les 4578 dossiers enregistrés, la proportion de patients âgés de plus 64ans a été 12,45% (570 cas/4578). L'analyse multi variée a permis de retenir les résultats suivants : les sujets âgés étaient plus de sexe masculin (OR=1,22[1,01-1,48], p=0,03), avec comme co morbité une HTA (OR=1,95[1,37-2,79], p<0,001). Le statut VIH de ces patients était inconnu (OR=0,16[0,11-0,25], p<0,001). La tuberculose était moins retrouvée avec OR=0,50[0,38-0,66], p<0,001 par contre La BPCO, Le Cancer broncho-pulmonaire et pleural étaient prépondérant respectivement avec des OR=5,95[3,49-10,14], p<0,001 ; OR=3,42[2,08-5,66] et OR=4,15[2,20-7,81]. Le taux de mortalité était de 23,68% chez les sujets âgés versus 19,14% chez les jeunes (p<0,001).Conclusion : Le sujet âgé hospitalisé au service de pneumologie présentait des pathologies liées au tabac, et des pathologies tumorales. L'infection tuberculeuse était moins retrouvée

[Spirometric and radiographic profile of patients with pulmonary tuberculosis treated and cured at the Department of Pulmonology of Brazzaville University Hospital]. / Profil spirométrique et radiographique des patients anciens tuberculeux pulmonaires traités et guéris au service de pneumologie du CHU de Brazzaville.

INTRODUCTION: Tuberculosis is a real public health problem in Congo. Pulmonary localization can lead to sequelae of respiratory functional repercussions. OBJECTIVE: Describe the spirometric and radiographic profile of patients treated with pulmonary tuberculosis treated and cured. PATIENTS AND METHODS: This was a cross-sectional study that included 150 patients with previous pulmonary tuberculosis with positive microscopy treated and cured in the Pulmonary Department of Brazzaville University Hospital. In which we performed a functional exploration (Spirometry) and a chest X-ray. The study took place from 1st January 2016 to 31st August 2016. RESULTS: The spirometry performed in all patients was pathological in 68.67% (103 cases/150) of the cases. Among them 74.76% (77 cases/103) had a restrictive profile (FEV1/FVC >70% and CVF <80%), 9.71% (10 cases/103) an obstructive syndrome (FEV1/FVC ≤70% and CVF >80%) and 15.53% (16 cases/103) a mixed syndrome (FVC <80% and FEV1/FVC <70%). Of the 150 chest radiographs performed, 120 or 80% were pathological; the degree of parenchymal stage III destruction represented 28.33%. There was a significant correlation between the degree of parenchymal destruction and the delay in treatment on the one hand and between the degree of parenchymal destruction and the different pulmonary volumes and volumes on the other hand. CONCLUSION: The prevention of these respiratory functional disorders is based on the prophylaxis of tuberculosis on early diagnosis of the disease.

[Predictive factors of lost to follow-up status during tuberculosis treatment in Brazzaville]. / Facteurs prédictifs associés au statut de perdu de vue au cours du traitement antituberculeux à Brazzaville.

INTRODUCTION: The abandonment of TB treatment has consequences both individual by increasing the risk of drug resistance and collective seeding entourage. The aim of this study is to determine the risk factors to be lost sight of during TB treatment. PATIENTS AND METHODS: He acted in a prospective cohort study of patients with microbiologically confirmed tuberculosis, beginning TB treatment and followed for six months. The comparative study between 75 patients lost (PL) and 108 no-patients lost (NPL). RESULTS: The presence of a large distance between the home center [OR=3.73 (1.21-11.05), P=0.022], to alcohol poisoning [OR=3.80 (3.80-11.3), P=0.031], the number of compressed high (depending on the patient) [OR=7.64 (1.96-29.8), P=0.007], stigma [OR=7.85 (1.87-33), P=0.004] were related to PL status. For against the implementation of the directly observed treatment by the community [OR=0.2 (0.03-0.92), P=0.04], be [OR=0.18 (0.05-0.63), P=0.07] were linked to reduced risk of being lost. CONCLUSION: Reducing the rate of PL requires patient compliance with good attitudes in post-education and ease of access to TB centers.

Profil respiratoire et performance motrice chez les patients congolais atteints de broncho-pneumopathie chronique obstructive lors du test de marche de six minutes

Objectifs : Identifier et analyser chez les broncho-pneumopathes chroniques obstructifs (BPCO) en état stable, les facteurs déterminants de la distance parcourue au test de marche de six minutes (TDM) et de la dyspnée en fin de test. Patients et méthodes : Les patients BPCO ont été évalués par épreuves fonctionnelles, questionnaire de Saint-Georges (QRSG) et TDM avec mesures de capacité respiratoire (CI) et d'oxymétrie. Résultats : Quatre-vingt-deux patients (volume expiré par seconde [VEMS] moyen 56 ± 19%) ont été étudiés. La distance moyenne au TDM était de 477 ± 89% (72 ± 14% valeurs prédites [VP]). La distance au TDM (cm) était corrélée avec le VEMS, le rapport CI/CPT, la CPT, le CI avant le test et le rapport capacité de diffusion du monoxyde de carbone ramenée au volume aléatoire (DLCO/VA). En pourcentage VP, la distance au TDM était corrélée à la capacité résiduelle fonctionnelle (CRF), à la CI avant le test et au score activité du QRSG. La dyspnée fine de TDM était corrélée avec la CRF, la dyspnée pré-TDM et avec les scores activités et totale du QRSG.Conclusion : Les facteurs déterminants de la dyspnée au cours du TDM sont complexes ; ils dépendent de facteurs fonctionnels et non-fonctionnels. Le TDM est un test d'exploration à valeur intégrative dans la BPCO

[Primary mandibular tuberculosis]. / Tuberculose mandibulaire primitive.

CASE REPORT: A 42 year-old patient presented a chronic submandibular tumefaction. Antibiotics were not effective. Diffuse osteolysis was noted on the panoramic. The diagnosis was provided by biopsy. The patient was cured after 9 months of antituberculosis tritherapy. DISCUSSION: Mandibular tuberculosis osteitis is extremely rare. Clinical and radiological presentation is not specific. Diagnosis can be suggested by the chronic course and the epidemiologic context.

[The effects of smoking and the degree of nicotine dependence on aerobic capacity in sportsmen]. / Effets du tabagisme et du niveau de dépendance nicotinique sur la capacité aérobie chez le sportif.

AIM: To assess the effects of smoking and the degree of nicotine dependence on aerobic capacity in smokers undergoing endurance training. METHODS: 126 smokers aged between 18 and 31 years playing in the football teams of the Congolese first (n = 64) and second divisions (n = 64) co-operated voluntarily in the study. Aerobic capacity was determined by Cooper's running test. Absolute VO2max and that related to body weight were subsequently calculated. The degree of nicotine dependence of each subject was assessed by the Fagerstrom questionnaire. A control group consisted of 125 non-smokers playing at the same level. RESULTS: The values of VO2max achieved by the smokers were significantly less (p < 0.05) than those achieved by the non-smokers. The first division players had a higher aerobic capacity than the second division players. Moreover the analysis of variance showed an influence of nicotine dependence on aerobic capacity. The subjects who were heavily dependent on nicotine had lower VO2max values than those less dependent. Moreover for the same level of dependence there were differences between the first and second division players. CONCLUSION: The inhalation of tobacco smoke leads to an alteration in aerobic capacity. This is directly influenced bythe degree of nicotine dependence whatever the level of training of the subject.

[Course of pulmonary tuberculosis in diabetics]. / Evolution de la tuberculose pulmonaire chez les diabétiques.

This retrospective study on the impact of diabetes on the course of pulmonary tuberculosis was conducted in 32 diabetic patients with tuberculosis treated at the Brazzaville University Hospital between January 1994 and December 1998. This group was compared with a control group of 100 non-diabetic patients with tuberculosis. HIV-positive patients were excluded from the study. Diabetes appeared to have an induction and aggravating effect on tuberculosis. Tuberculosis is more frequent in diabetics than in non-diabetics. Radiological signs of tuberculosis are more pronounced in diabetics. Treatment failure and death are also more frequent. Tuberculosis aggravates diabetes and increases the frequency of complications compared with diabetics without tuberculosis.

Pneumocystis carinii is rare in AIDS in Central Africa.

PIP: Pneumocystis carinii occurs in 60-65% of cases of acquired immunodeficiency syndrome (AIDS) in Europe and North America. Its prevalence in Africa is unknown, however, due to a lack of suitable investigative techniques. Initial studies suggest that this parasitic complication may be lower in Africa. An investigation of AIDS case in Harare, Zimbabwe, revealed pneumocystosis in only 22%. Reported here are the results of a study of 45 Congolese patients with AIDS conducted at the Brazzavile University Hospital. The patients were 24-54 years of age (mean age, 37 years); 20 were female. All patients presented with pulmonary manifestations, but not with open pulmonary tuberculosis. Analysis of bronchoalveolar lavage fluid obtained by bronchofibroscopy revealed the presence of P carinii in only 5 cases (11%). 2 of these patients were women aged 25 and 49 years old and 3 were men aged 31, 35, and 51 years old. 4 presented with interstitial pneumopathy; the 5th had a localized lesion of the right lung.^ieng

[Respiratory diseases at hospitals in Brazzaville, Congo]. / Affections respiratoires en milieu hospitalier à Brazzaville, Congo.

The authors has recorded all respiratory diseases encountered in the chest department of the University Hospital of Brazzaville, from January 1 to December 31, 1988. The case-records of 912 patients were involved in this study. Respiratory disease were found to be more frequent in men than in women. Tuberculosis ranked first (52.08%), followed by acute lung infections (32.65%) and asthma (5.15%). Malignant tumours were rare (1.53%). The incidence of HIV infection was high (10.51%), and this disease was often associated with tuberculosis (10.30%). Subjects in the 20-29 years age group were those most affected. The overall mortality rate was 13.48%. Mortality increased with age, exceeding 30% in patients over 60. Mortality rates were 15% in acute lung infections and 10% in tuberculosis.

[Opportunistic parasitic diseases and mycoses in AIDS. Their frequencies in Brazzaville (Congo)]. / Parasitoses et mycoses opportunistes au cours du SIDA. Leurs fréquences à Brazzaville (Congo).

To determine the frequency of opportunistic parasitic and mycotic diseases in adult AIDS patients in the Congo, a study was conducted at l'Hôpital Universitaire de Brazzaville in 1986 and 1987. Diagnosis of AIDS was made using the WHO clinical definition for Africa (Bangui, 1985) and HIV seropositivity Pasteur Elisa test. Oral pharyngeal candidiasis occurred in 36% of cases. Intestinal parasitic profile found in 118 patients, 2/3 of whom were associated with chronic diarrhoea showed clearly relative frequency of isosporiasis (Isospora belli): 9.3% and rarity of crystosporidiosis: 4.2%. 12 meningitic cryptococcosis cases out of 139 patients was confirmed (8.6%); for cerebral toxoplasmosis, it was by comparing the serum toxoplasmosis antibody and cerebrospinal fluid rates on 75 patients that an estimation of 20% was reached. Pneumocytis carinii pneumonia seems to be rare, lower than 10%. No case of disseminated histoplasmosis and malignant strongyloidiasis was observed.

PIP: Studies conducted with locally available means at the University Hospital in Brazzaville have provided data on opportunistic parasitic and mycotic disease in AIDS patients in the Congo. The diagnosis of AIDS was based on the World Health Organization clinical definition for Africa and on positive ELISA tests. Patients were prospectively studied in 1986-87. 12 cases of meningitic cryptococcosis were found in 139 patients studied, for a rate of almost 9% of AIDS cases. Prior to the AIDS epidemic only 2 cases were published in the Congo. 35.6% of 146 cases studied showed oral pharyngeal candidiasis on clinical examination. The frequency of esophageal and bronchopulmonary candidiasis could not be estimated with the means available. 118 AIDS patients had intestinal parasites, of whom 2/3 had chronic diarrhea. 9.3% were caused by Isospora belli and 4.2% by Cryptosporidiosis. Other intestinal flora were apparently affected by routinely administered antiparasite treatments. An estimate of 20% for cerebral toxoplasmosis was obtained by comparing serum toxoplasmosis antibody and cerebrospinal fluid rates for 75 patients. The rate of pneumocystis carinii pneumonia appears on indirect evidence to be under 10%. No cases of disseminated histoplasmosis or malignant strongyloidiasis were observed. The biggest differences between the patterns of opportunistic infection in industrialized countries and especially the US and in the Congo appear to be the lesser frequency in the Congo of pneumocystosis and the greater frequency of Isosporosis and cerebral toxoplasmosis.