Kernohan-Woltman notch phenomenon in patient with subdural hematoma and ipsilateral hemiparesis in Bukavu.

Key Clinical Message: Kernohan-Woltman phenomenon is a rare and paradoxical neurological situation in which a transtentorial lesion leads to compression of the contralateral cerebral peduncle responsible for compression of the descending corticospinal fibers with clinical consequence of a motor deficit ipsilateral to the primary lesion. This phenomenon should attract the attention of clinicians in order to avoid unfortunate incidents such as wrong-side craniotomy in neurosurgical practice. In this work, we report a similar situation. Abstract: The Kernohan-Woltman notch phenomenon is a rare and paradoxical neurological situation in which transtentorial damage is observed leading to compression of the contralateral cerebral peduncle responsible for compression of descending corticospinal fibers with the clinical consequence of a motor deficit ipsilateral to the primary lesion. This phenomenon has been found in several situations including tumors and cerebral hematomas after craniocerebral trauma. In this work, we have reported the case of a 52-year-old man with hemiparesis ipsilateral to a large chronic subdural hematoma.

Atypical caudal regression syndrome with lumbar agenesis, hypoplastic sacrum without sacroiliac joints in the eastern Democratic Republic of Congo: a case report.

The agenesis of any segment of the lower spinal column referred to as "caudal regression syndrome" (CRS) is a rare congenital defect of the spine. This malformation is characterized by the absence of some or the entire lumbosacral vertebral segment. Etiological factors remain unknown. We report an atypical caudal regression syndrome with lumbar agenesis, disconnected from the remaining hypoplastic sacrum, in the Eastern part of the Democratic Republic of Congo (DRC).An 11-month-old female infant with no particular fetal or maternal history presented limb weakness with flexed knees and flanges in the popliteal fossae, sphincter atony, and a sensation of emptiness on palpation in the lumbosacral region. A 3D CT scan of the spine showed the absence of the lumbar spine and disconnection of the upper segment of the thoracic spine from the hypoplastic sacrum. We noted also the absence of the sacroiliac joints bilaterally and an unusual trigonal shape of the iliac bones. MRI and sonographic examination are required in the investigation of the disease. The management is multidisciplinary and depends upon the degree of the defect. Spine reconstruction has proven to be a valuable management technique but has many complications. We wanted to draw the medical world's attention to the existence of this extremely rare malformation in the east of the Democratic Republic of Congo, a mining area.

Predictors of acute stress disorder in victims of violence in Eastern Democratic Republic of the Congo.

Background: The Democratic Republic of the Congo underwent more than 25 years of war resulting in millions of deaths and in survivants struggling with trauma related disorders. The factors contributing to acute stress disorder following a traumatic event remain little understood. Emotion regulation might play a role in the development of acute stress disorder among victims of war-related violence. Objectives: We assessed the association between acute stress disorder expression and cognitive strategies of emotion regulation among injured victims of violence in the Eastern Democratic Republic of the Congo. Methods: This cross-sectional study included 120 patients (77% males, mean age 30 ± 11 years) with traumatic wounds admitted at the Bukavu General Hospital. We assessed acute stress disorder through the Stanford Acute Reaction Stress Questionnaire and emotion regulation strategies through the Cognitive emotional regulation questionnaire. Results: Using Pearson Chi2 and Student t-test we found that compared with patients without acute stress disorder (N = 56), patients with acute stress disorder (N = 64) were more likely to be victims of armed robbery (p = .02), of a bullet (p = .04), of having wounds with fracture (p = .03) or neurological damage (p = .05). In multivariate logistic regression, wounds with neurological damage [OR = 2.23 (1.03-6.05)] and maladaptive emotion regulation, namely self-blame [OR = 1.71 (1.01-3.21)] and rumination [OR = 1.97 (1.04-4.13)], were significant predictors of acute stress disorder. Conclusion: Acute stress disorder was prevalent in the aftermath of violence induced injuries and might be associated with emotion regulation strategies such as self-blame and rumination. HIGHLIGHTS Acute stress disorder is strongly associated with maladaptive emotion regulation strategies such as self-blame and rumination.Interventions targeting emotion regulation may reduce acute stress reactions in the aftermath of violence induced injuries.

Antecedentes: La República Democrática del Congo atravesó más de 25 años de guerra, resultando en millones de muertos y en los sobrevivientes experimentando trastornos relacionados con trauma. Los factores que contribuyen a desarrollar un trastorno de estrés agudo después de un evento traumático permanecen poco comprendidos. La regulación emocional podría jugar un rol en el desarrollo del trastorno de estrés agudo entre las víctimas de violencia relacionada con la guerra.Objetivos: Evaluamos la asociación entre la expresión del trastorno de estrés agudo y estrategias cognitivas de regulación emocional entre las víctimas de violencia lesionadas en el este de la República Democrática del Congo.Métodos: Este estudio transversal incluyó a 120 pacientes (77% varones, edad media 30 ± 11 años) con heridas traumáticas ingresados al Hospital General de Bukavu. Evaluamos el trastorno de estrés agudo a través del Cuestionario de Reacción Aguda al Estrés de Stanford y estrategias de regulación emocional a través del Cuestionario de Regulación Emocional Cognitiva.Resultados: Usando el Chi2 de Pearson y la prueba de t de Student encontramos que en comparación con pacientes sin trastorno de estrés agudo (N=56), los pacientes con trastorno de estrés agudo (N=64) fueron más probablemente víctimas de robo a mano armada (p=.02), de bala (p=.04), de tener heridas con fractura (p=.03) o daño neurológico [OR= 2.23 (1.03-6.05)] y regulación emocional desadaptativa, esto es, culpa [OR= 1.71 (1.01-3.21)] y rumiación [OR= 1.97 (1.04-4.13)], fueron predictores significativos de trastorno de estrés agudo.Conclusión: El trastorno de estrés agudo fue prevalente después de lesiones provocadas por violencia y podría asociarse con estrategias de regulación emocional como la culpa y la rumiación.

Multiple Bladder Diverticula Presenting in an 82-Year-Old Congolese Male.

Bladder diverticulum is a congenital malformation characterized by the outpouching of the bladder following an obstruction of urine flux. We present a case of 82-year-old Congolese male patient presented at our facility with a poor urinary stream and lower abdominal pain. A distended abdomen was found on physical examination while the external genitalia were normal. All blood laboratory values were found to be within normal ranges. The patient's urine analysis revealed an uncountable number of white blood cells. Ultrasonography revealed multiple diverticula in the right posterolateral and posterior wall. An ultrasound of the abdomen revealed numerous bladder diverticula in the bladder's left posterolateral and posterior aspects, mild right-sided hydronephrosis, and severe left hydronephrosis with a thinned-out cortex. Both ureters were normal. A computed tomographic (CT) scan of the abdomen confirmed the diagnosis. The patient underwent an open laparotomy which allowed complete ablation of the diverticula followed by bladder wall repair. A one-week course of antibiotics was prescribed, and the patient was discharged fully recovered with no immediate complications. Although bladder diverticula are a congenital malformation, the presence of multiple diverticula suggests that the condition is acquired. In elderly patients, open laparotomy combined with intravenous antibiotics yields positive results.

Hand grenade blast injuries in the Eastern Democratic Republic of Congo: a case series of 38 patients.

INTRODUCTION: The armed conflict in the Kivu province of the Democratic Republic of Congo has caused close to 12,000 deaths. One of the most lethal weapons in armed conflicts is the high explosive hand grenade. The study aimed to describe the epidemiology, presentation, and outcomes of hand grenade blast injuries (HGBI) in the Kivu province. METHODS: In this case series, the authors present 2017 to 2020 HGBI admissions at a Congolese trauma center. Measures of central tendency and spread were computed for continuous data. Complication and mortality rates were equally computed. Admission-to-discharge data were disaggregated by the body part injured and by complication status and visualized using time-to-event curves. RESULTS: Thirty-eight HGBI patients aged 31.4 (range 17-56) years were included in the study. Twenty-six (68.4%) were male and the patients were admitted 1.8 days post-injury on average. The patients were hemodynamically stable at admission; 84.2% received the antitetanic vaccine, 21.1% received broad-spectrum antibiotics, and all were debrided (100.0%). The complication rate was 13.2%, and the most common complication was anemia (7.9%). In addition, the mortality rate was 2.6%. The median admission-to-discharge time was 17.0 (range 4-71) days, and it was prolonged in patients with lower extremity injuries (23.0 days). CONCLUSION: HGBIs cause avertable death and disability in the Kivu regions. These data suggest that the burden of HGBIs can be reduced with appropriate preventive and health systems strengthening interventions.

Firearm injuries among children due to the Kivu conflict from 2017 to 2020: A hospital-based retrospective descriptive cohort study.

INTRODUCTION: Firearm-related injuries are deadly but avoidable. The case of Kivu, a region in the Eastern Democratic Republic of Congo (DRC), is alarming. Decades of unresolved regional conflicts birthed armed groups that have massacred inhabitants and injured several children. This regional instability has also created barriers to seeking and obtaining timely care, decreasing the survival rate. This region's lack of data on paediatric fatal and nonfatal firearm injuries (F&NFFIs) needs studying. Thus, we aim to determine the prevalence and evaluate the outcomes of paediatric F&NFFIs in Kivu. METHODS: We included all F&NFFI paediatric patients (≤18 years), admitted at our institution between 2017 and 2020. We extracted data from patient records. Next, we assessed the relationship between determinants of paediatric outcomes using the Chi-square test and the student's t-test. Confounders were identified using cox regression. RESULTS: This study included 101 paediatric patients, mostly male (63.4%), with an average age of 15.9 years residing 164.4 km on average from the hospital. On average, they were admitted 2.9 days post-injury, with the most affected anatomical regions being lower limbs (53.5%) and upper limbs (18.8%). The mean length of stay was 52.9 days, and the mortality rate was 4.0%. Also, injury complications increased the mean length of stay and mortality rate. In addition, mortality was correlated with circulatory failure and anaemia. DISCUSSION: Paediatric F&NFFIs in Eastern DRC is a preventable tragedy. Mortality is increased by injury complications and correlates with some biological factors. Prevention strategies should be developed to protect children and appropriate measures should be established to improve rates of prehospital care and early hospital presentation to lower mortality and improve paediatric outcomes.

Fatal and nonfatal firearm injuries in the eastern Democratic Republic of Congo: a hospital-based retrospective descriptive cohort study assessing correlates of adult mortality.

INTRODUCTION: The Eastern Democratic Republic of Congo (DRC) has been the battleground for multiple armed conflicts, resulting in many fatal and nonfatal firearm injuries (F&NFFIs). Chronic insecurity has stressed the health system's resources and created barriers to seeking, reaching, and receiving timely care further increasing the F&NFFI burden. Our institution is the largest trauma center in the region and receives the bulk of F&NFFI cases. We aimed to identify correlates of mortality in Congolese F&NFFI patients. METHODS: We included all F&NFFI patients admitted to our institution between 2017 and 2020. We extracted data from patient charts and admission logs. We identified mortality correlates using the two-sample t-test, Chi-square test, and multivariable regression analysis. A P-value of less than 0.05 was considered statistically significant. RESULTS: This study included 814 adult patients, mostly male (86%) with an average age of 34.5 years and living 154.4 km away from the hospital on average. The most affected anatomical sites were the lower limbs (48.2%) and upper limbs (23.2%). The median length of stay was 34.0 days, and the in-hospital mortality rate was 3.6%. In addition, mortality was negatively correlated with diastolic blood pressure (P = 0.01), SaO2 (P < 0.001), and hemoglobin concentration (P = 0.002). CONCLUSION: F&NFFIs cause an enormous burden in the region, and mortality is correlated with some clinical and biological variables. Thus, the study findings will inform F&NFFI referral, triage, and management in low-resource and mass casualty settings.

Factors associated with hospital outcomes of patients with penetrating craniocerebral injuries in armed conflict areas of the Democratic Republic of the Congo: a retrospective series.

INTRODUCTION: Penetrating craniocerebral injuries (PCCI) are types of open head injuries caused by sharp objects or missiles, resulting in communication between the cranial cavity and the external environment. This condition is deemed to be more prevalent in armed conflict regions where both civilians and military are frequently assaulted on the head, but paradoxically their hospital outcomes are under-reported. We aimed to identify factors associated with poor hospital outcomes of patients with PCCI. METHODS: This was a retrospective series of patients admitted at the Regional Hospital of Bukavu, DRC, from 2010 to 2020. We retrieved medical records of patients with PCCI operated in the surgical departments. A multivariate logistic regression model was performed to find associations between patients' admission clinico-radiological parameters and hospital outcomes. Poor outcome was defined as a Glasgow Outcomes Score below 4. RESULTS: The prevalence of PCCI was 9.1% (91/858 cases) among admitted TBI patients. More than one-third (36.2%) of patients were admitted with GCS < 13, and 40.6% of them were unstable hemodynamic. Hemiplegia was found in 23.1% on admission. Eight patients had an intracerebral hemorrhage. Among the 69 operated patients, complications, mainly infectious, occurred in half (50.7%) of patients. Poor hospital outcomes were observed in 30.4% and associated with an admission GCS < 13, hemodynamic instability, intracerebral hemorrhage, and hemiplegia (p < 0.05). CONCLUSION: The hospital poor outcomes are observed when patients present with hemodynamic instability, an admission GCS < 13, intracerebral hemorrhage, and hemiplegia. There is a need for optimizing the initial care of patients with PCCI in armed conflict regions.

Alobar holoprosencephaly in mining-related areas of the Eastern region of the Democratic Republic of the Congo: A case series.

BACKGROUND: Recent case reports described three cases of holoprosencephaly (HPE) in the area with high mining-related pollution of the southern region of the Democratic Republic of the Congo (DRC). We reported two male neonates with clinically diagnosed HPE in the localities of Fizi and Kitutu, two mineral areas in the Eastern region of the same country (DRC), where artisanal surface mining is predominant with high exposure to radiation and heavy metals from mining. CASES' PRESENTATIONS: Two newborns from adult and multigravida mothers without pregnancy complication. The birth weights were 3,200 g and 2,500 g, respectively, and the malformations noticed were essentially the single median eye, the absent nose, polydactyly for one case, and proboscis for the other case. They both died a few minutes later after birth. CONCLUSION: The etiologic factors of HPE remain unknown but seem to be multifactorial from both genetic and environmental factors. We hypothesize under reserve for these two cases that mining and radiation expositions were likely potential environmental associated factors to the occurrence of these malformations.