Variations de la lactatemie a l'effort et au cours de la recuperation chez des sportifs fumeurs

But : Evaluer l'influence du tabagisme et du niveau de dependance nicotinique sur la variation de la lactatemie pendant l'effort et apres la recuperation chez des sportifs. Materiel et methodes : 126 footballeurs (63 fumeurs et 63 non fumeurs) evoluant dans le championnat d'elite congolais ont ete soumis a un test d'effort rectangulaire et sous maximal; sur un cycloergometre. Des dosages repetes de lactates sanguins ont ete effectues et les variations de la lactatemie durant et apres l'effort ont ete comparees entre les deux groupes; en fonction de la dependance nicotinique. Resultats : nous avons observe une evolution de la lactatemie en deux phases dans les deux groupes ; une phase croissante et une decroissante. La lactatemie etait toutefois plus elevee lors de la phase croissante (p0;001); de meme que la vitesse d'elimination des lactates etait lus lente chez les fumeurs. Le taux des lactates etait directement proportionnel au degre de dependance nicotinique (p0;01). Conclusion : le tabac expose les footballeurs a une hyperlactatemie au cours de l'effort. Cette elevation est proportionnelle au degre de dependance nicotinique. Nos resultats renforcent l'interet des campagnes anti-tabac en milieu sportif dans le but d'ameliorer les performances des facteurs

[Orphans in Brazzaville orphanages]. / Situation des enfants orphelins dans les orphelinats de Brazzaville.

UNLABELLED: Children are orphaned everywhere, but their situation is particularly acute in developing countries. OBJECTIVES: To assess the epidemiologic situation of orphans in Brazzaville and to identify the social and medical determinants of their placement in institutions. MATERIAL AND METHODS: This exploratory cross-sectional study was conducted from March 3, 2003, through January 30, 2004 (11 months). Direct interviews based on a standardized questionnaire collected information from the orphans old enough to answer questions, their parental substitutes or guardians, and the orphanage directors. The evaluation of the conditions in the orphanages was based on observable, quantifiable indicators. ON THE WHOLE: We identified 12 orphanages and 162 children: 92 boys (56.8%) and 70 girls (43.2%). Their average age was 10.5 years +/- 3.5 (range: 3 months to 15 years). Overall, 38 (23.5%) had lost only their mother, 22 (13.6%) their father, and 102 (63%) both parents. The child was placed at the orphanage by the family in 97 cases (60%), the social services department in 50 cases (30.9%), and by the police or the Red Cross in 15 cases (9.3%). The reasons for placement were: lack of financial support (137 cases, 84.5%), other social reasons (8 cases, 4.9%), abandonment (3 cases, 2%) and unspecified causes (14 case, 8.6%). The principal causes of parents' deaths were: pregnancy and childbirth 73 cases (45%), war, 45 cases (28%), HIV infection, 26 cases (16%), malaria, 6 cases (4%), accidents, 8 cases (5%) and unknown, 4 cases (2.5%). CONCLUSION: Orphanages are one alternative for the survival of children without parents able to care for them. Attention to them, support of their activities, and improvement of the living conditions there are all important.

[Nighttime attendance at the Pediatric Emergency Room of the University Hospital Centre in Brazzaville, Congo]. / Consultations de nuit aux urgences pédiatriques du CHU de Brazzaville, Congo.

The University Hospital Center is the only hospital in Brazzaville, Congo with a pediatric emergency room. The purpose of this prospective study carried out from January 1 to December 31, 2006 was to evaluate nighttime emergency room attendance by comparing children (excluding newborns) admitted between 7 p.m. and 7 a.m. (group 1) to those admitted between 8 a.m. and 2 p.m. (group 2). A total of 5796 emergency room admissions were recorded including 2648 children (45.7%) between 7 p.m. and 7 a.m. and 2209 (38.1%) between 8 a.m. and 2 p.m. The delay for admission was comparable for the two groups. The death rate at the time of admission was significantly higher in group 1 than group 2: 84.6 % vs. 15.4 % (p<0.01). The main reasons for seeking emergency room care in group 1 were fever (84.6%), digestive problems (44.2%), cough (35.7%), and convulsions (13.9%). The rate of hospitalization was the same in the two groups: 56.7% in group 1 versus 52.8% in group 2. The most common reasons for hospitalization were acute gastroenteritis (24.7%), bronchopulmonary infection (18.9%), malaria (17.3%), severe septicemia (9.3%) and ORL infection (8.1%). Risk factors for hospitalization included age under 2 years, arrival before midnight, and malnutrition. The death rate within 24 hours after hospitalization was 23% in group 1 and 11.5% in group 2 (p<10-4). The death rate was higher in children admitted before midnight. Nighttime attendance as well as hospitalization and death rates remain high at the pediatric emergency room of the University Hospital Center in Brazzaville. The most frequent reason for attendance was fever. Improving outcomes will require providing better information to parents (reducing admission delay) and upgrading hospital resources in terms of patient assessment and medical intervention (health care personnel and facilities).

Consultations de nuit aux urgences pediatriques du CHU de Brazzaville; Congo

"Le centre hospitalier et universitaire (CHU) est le seul hopital de Brazzaville ayant une unite d'urgences pediatriques (UP). Nous avons evalue de facon prospective sa frequentation nocturne en comparant du 1"" janvier au 31 decembre 2006 les enfants (nouveau-nes exclus) admis la nuit (de 19 a 7 heures) (groupe 1) a ceux admis entre 8 et 14 heures (groupe 2). Au total; 5 796 passages ont ete enregistres aux UP; dont 2 648 (45;7) entre 19 et 7 heures et 2209 enfants (38;1) entre 8 h et 14 h.). Le delai d'admission etait comparable dans les 2 groupes. Le taux de deces a l'admission etait significativement superieur dans le groupe 1 a celui du groupe 2 (84;6vs 15;4; p0;01). Le motif de consultation dans le groupe 1 etait domine par la fievre; 81;4; les troubles digestifs; 44;2; la toux; 35;7; et les convulsions; 13;9. Les taux d'hospitalisation (56;7vs 52;8) etaient identiques dans les deux groupes. Les causes les plus frequentes en etaient les gastroenterites aigues; 24;7; les infections broncho-pulmonaires; 18;9; le paludisme; 17;3; les sepsis severes; 9;3et les infections ORL; 8;1. L'age inferieur a 2 ans; l'heure d'arrivee avant minuit et la malnutrition en constituaient les facteurs favorisants. Au cours des 24 premieres heures qui suivaient l'hospitalisation; 23des enfants du groupe 1 et 11;5de ceux du groupe 2 sont decedes (p10-4). Le deces etait plus frequent chez les enfants admis avant minuit. La sollicitation des UP la nuit au CHU de Brazzaville demeure importante avec des taux d'hospitalisation et de mortalite encore eleves. Les affections febriles en constituent les causes les plus frequentes. L'amelioration de leur pronostic doit passer par l'education des parents (reduction du delai de consultation) et le renforcement des capacites hospitalieres d'accueil et d'intervention (personnel medical; plateau technique)."

[Pulmonary tuberculosis in infants in Brazzaville, Congo. A review of 117 cases]. / Tuberculose pulmonaire du nourrisson à Brazzaville (congo). A propos de 117 cas.

Little information is available on pulmonary tuberculosis in infants in sub-Saharan Africa. This retrospective study was conducted in infants ranging in age from 1 to 23 months admitted to the Paediatric Departments of the University Hospital Centre in Brazzaville, Congo for pulmonary tuberculosis between January 1, 1999 and July 1, 2004. Tuberculosis was diagnosed on the basis of epidemiological, clinical, radiological, and follow-up data. All children over 12 months old underwent HIV testing. In case of positive test results, children between the ages of 12 and 18 months were retested after the age of 18 months. Of a total of 803 children admitted for tuberculosis during the study period, 117 (14.6%) were under the age of 24 months (53% males). Mean age was 17.5 months. The BCG test was mentioned in 75.2% of cases. Determination of the contagion in 50.4% of cases indicated that transmission was intrafamilial in 69.3% of cases. The mean delay for hospitalization was 2.6 months (range, 21 days to 16 months). Eighty-one patients (69.2%) presented severe malnutrition. Intrathoracic forms accounted for most cases with bronchopneumopathy (72.6%) and mediastinal adenopathy (40.2%). The incidence of bronchopneumonopathy and isolated forms was significantly higher in children over one year old than in children under one year old: 78.3% versus 21.7 % (p<0.01) and 62.8% versus 37.2% (p<0.001) respectively. A total of 35 children (43.8%) over the age of 12 months presented HIV infection. In comparison with HIV-negative children, HIV-positive children were more likely to present malnutrition and presented a statistically higher incidence of mediastinal adenopathy and multifocal forms. All associated extrathoracic lesions (21.4% of cases) occurred in HIV-positive children. Outcome was favourable in all HIV-negative children while 7 HIV-positive children (20%) died during treatment. Pulmonary tuberculosis in infants in Brazzaville is characterized by frequent association with HIV infection and prognosis is more severe in case of HIV co-infection.

[Retrospective study of 61 cases of multifocal tuberculosis in children in Brazzaville, Congo]. / Etude rétrospective de 61 cas de tuberculose multifocale chez l'enfant à Brazzaville, Congo.

The spread of HIV infection has changed several aspects of tuberculosis notably with regard to disseminated and multifocal forms that have become increasingly common. The purpose of this study was to evaluate epidemiologic, clinical, and prognostic factors associated with multifocal tuberculosis and to assess the impact of HIV infection. The files of children admitted for multifocal tuberculosis to the paediatric department of the Brazzaville University Hospital Centre in Congo were retrospectively reviewed. Patients that were not followed throughout treatment were not included. Multifocal tuberculosis was defined as the presence of at least two extrapulmonary sites. All patients over 18 months old were screened for HIV infection. From January 1995 to December 2005, a total of 61 children with a mean age of 7.2 years (range, 8 months to 15 years) were enrolled according to these inclusion criteria. Multifocal tuberculosis was bifocal (n=15), trifocal (n=44), and quadrifocal (n=2) for a total of 170 sites. To assess the impact of HIV infection, patients over the age of 18 months divided into two groups based on positive versus negative screening tests. The time delay for seeking care was comparable for the 38 HIV-positive children (all infected with HIV-1) and the 20 HIV-negative children. However HIV-positive children exhibited a higher rate of malnutrition, more tuberculosis sites (both quadrifocal patients), and increased mortality (10/38 versus 2/20). These differences were not statistically significant probably due to the small patient population. Multifocal tuberculosis is a major problem for paediatric departments in the Congo. Its unusually high incidence and special severity is linked mainly to HIV infection. Given the high incidence of co-infection, routine screening for HIV is recommended for paediatric patients with multifocal tuberculosis.

[Sexual behaviour among adolescents in Brazzaville, Congo]. / La sexualité de l'adolescent à Brazzaville, Congo.

AIM: Estimate sexual activity among Congolese adolescents in Brazzaville and appreciate the influence of sociocultural and economic factors on sexual behaviour. METHODS: Data were collected from 900 adolescents (389 males and 511 females) aged 10-19 years in the seven urban areas of Brazzaville. These subjects were randomly recruited by a two stage sampling. The data were gathered by an anonymous face-to-face questionnaire. Relative risk estimations were calculated for early or first sexual intercourse, multiple sexual partnerness and safe sex. RESULTS: A total of 474 respondents indicated that they were sexually active. Females were more sexually active, 270 compared with 204 males (p<0.05). The mean early age of coital debut was 14.6 years (S.D.=1.7 years). Early intercourse (before 14 years) was found in 73 males and 39 females (p<0.001). Multiple sexual partnerness was found in 81.3% of males, while the frequency of females was 51.1%. Risk factors for pregnancy and multiple sexual partnerness were unemployment mother, non school situation, early puberty and non sexual education. In contrast, regular religious activity was recognized as factor that had significant protection impact on sexual activity. The total use ratio of the condom was estimated at 42.2% in males. More females (41.7%) were using Ogino method of contraception. In addition, 102 females (36.8%) claimed to have already a pregnancy and the mean age was 16.1 years (S.D.=1.2 years). In 64.7% of these cases, teenagers chose the abortion as solution of an unwanted pregnancy. After the birth of a child, it was reported that 82.4% of adolescents gave up with school. CONCLUSION: Our results show the importance of problems associated to sexual activity among Congolese adolescents in Middle Africa. These data should be taken into account when planning the prevention of risk of sexual behaviours among adolescents.

Tuberculose pulmonaire du nourrisson a Brazzaville (Congo). A propos de 117 cas

La tuberculose pulmonaire du nourrisson est peu documentee en Afrique subsaharienne. Nous avons realise une etude retrospective chez les enfants ages de 1 a 23 mois; admis pour tuberculose pulmonaire dans les services de Pediatrie du CHU de Brazzaville entre le 1e janvier 1999 et le 1e juillet 2004. La tuberculose etait diagnostiquee sur des arguments epidemiologiques; cliniques; radiologiques et evolutifs. Tous les enfants ages de plus de 12 mois avaient beneficie d'une serologie VIH. En cas de positivite; les enfants entre 12 et 18 mois etaient testes a nouveau apres l'age de 18 mois. Parmi 803 enfants admis pour tuberculose; 117 (14;6) etaient ages de moins de 24 mois (53de garcons) ; leur age moyen etait de 17;5 mois. La notion de BCG etait relevee dans 75;2des cas. Le contage tuberculeux; note dans 50;4des cas; etait le plus souvent intrafamilial (69;3des cas). Le delai moyen de recours a l'hopital etait de 2;6 mois (extremes : 21 jours - 16mois). Une malnutrition severe etait presente chez 81 patients (69;2). Les formes intra-thoraciques etaient dominees par les broncho-pneumonies (72;6) et les adenopathies mediastinales (40;2). Au dessus de un an; la bronchopneumonie etait significativement plus frequente (78;3versus 21;7; p 0;01) et les formes isolees etaient significativement plus frequentes (62;8versus 37;2; p 0;001) que chez les enfants de moins de un an. Une infection a VIH-1 existait chez 35 enfants (43;8) de plus de 12 mois. Par rapport aux enfants seronegatifs; les enfants infectes par le VIH etaient plus souvent malnutris; et ils avaient une frequence statistiquement plus elevee d'adenopathies mediastinales et de formes multifocales. Tous les enfants seronegatifs ont gueri; tandis que 7 enfants infectes par le VIH (20) sont decedes en cours du traitement. La tuberculose pulmonaire du nourrisson a Brazzaville se caracterise par son association frequente au VIH et par la severite du pronostic en cas de co-infection par le VIH

Tabagisme chez l'adolescent a Brazzaville (Congo)

Objectifs : Evaluer la prevalence du tabagisme chez l'adolescent et en identifier les facteurs determinants. Methode : Il s'agit d'une enquete transversale realisee d'octobre 2005 a Aout 2006 dans les sept arrondissements de Brazzaville (Congo). L'echantillonnage s'est effectue selon la methode de sondage en grappes a partir des sept arrondissements de Brazzaville. Resultats : 4135 adolescents de cette etude; 444 d'entre eux soit 10;3fumaient. La consommation de tabac apparaissait significativement elevee chez les garcons que chez les filles (p0;01); chez les 15-19 ans que chez les 10-14 ans (p0;001); chez les non scolarises (p0;05); en l'absence de pratique religieuse (p0;01); et chez les adolescents issus de familles nulli et monoparentales. En revanche; il n'existait pas de difference significative entre les adolescents fumeurs ayant une activite sportive (42;6) et les autres (57;4). Enfin; parmi ces adolescents; 65fumaient moins de 5 cigarettes par jour et 3plus de 20 cigarettes. Conclusion : Malgre une prevalence inferieure a celle observee dans les pays temperes; le tabagisme a Brazzaville merite une attention particuliere; en raison du risque potentiel d'aggravation

[Risk factors for low birth weight in Brazzaville, Congo]. / Facteurs de risque de petit poids de naissance à Brazzaville, Congo.

OBJECTIVE: To determine prevalence of low birth weight (LBW) in Brazzaville (Congo) and to identify associated risk factors. MATERIAL AND METHOD: A case-control study was performed over a 2-month period. A total of 488 infants with LBW were compiled consecutively from May to June 2005. These subjects were compared to 488 infants with normal birth weight (2500-4000 g). RESULTS: LBW concerned 12.4% of births. The frequency of LBW was higher among teenagers and mothers aged at least 30 years, and among mothers of low socio-economic status. The other principal risk factors of LBW were: primiparity and high parity; previous abortion; body mass index of mother inferior to 18; existent of hypertensive arterial pression, ancient or gravidic. A best control of pregnancy (number of antenatal visits>3 or at least one ultrasound) was linked with a low frequency of LBW. CONCLUSION: Prevalence of LBW in Brazzaville was higher than in developing countries. An appropriate implementation of the National Program of Health during pregnancy and improvement of living conditions could contribute to minimize this phenomenon.

[Early neonatal presentation to the pediatric emergency department, Brazzaville (Congo)]. / Consultations et réadmissions avant l'âge d'un mois aux urgences pédiatriques, Brazzaville (Congo).

OBJECTIVES: To identify and analyze factors influencing the readmission of newborns to the paediatric emergency unit of university hospital of Brazzaville after their stay in maternity. MATERIAL AND METHODS: A prospective survey was conducted in newborns discharged from maternity for household, excluding infants delivered by caesarean section. RESULTS: A total of 458 (6.3%) newborns were recruited among 7233 children admitted in the paediatric emergency unit. The visits took place between 8 am-1 pm (51.7%), 14 pm-19 pm (31.7%) and 20 pm-7 am (16.4%). Visit motives were cough, fever, digestive signs, and malformations. Main causes of hospitalization were severe sepsis (21.8%), bronchopulmonary infections (23.0%), isolated fever (12.6%), malformations (5.3%). Low bith weight newborns and newborns with shorter length of stay at maternity (less than 24 h) were most often hospitalized than infants with normal weight (P < 0.01). CONCLUSION: Increased length of hospitalization in maternity, systematic medical examination of newborn in maternity, better information of mothers on breastfeeding, and improved health care should contribute to decrease the rehospitalization rate during the first month of life.

[Radiological specifities of pulmonary tuberculosis in Congolese children: effect of HIV infection]. / Aspects radiographiques de la tuberculose pulmonaire chez l'enfant Congolais: influence de l'infection a VIH.

The purpose of this retrospective study was to identify special features of radiological lesions associated with pulmonary tuberculosis in HIV-infected children. A retrospective review was carried out on the files of children between the ages of 18 months and 15 years admitted to the University Hospital Centre in Brazzaville, Congo for pulmonary tuberculosis between January 1995 and December 2004. A total of 486 patients were analyzed including 174 (35.8%) HIV-infected patients (group 1) and 312 (64.2%) non-HIV-infected patients (group 2). Radiological findings in the two groups were compared. Parenchymal lesions were observed in a total of 474 patients including 172 (99.0%) in group 1 and 302 (96.8%) in group 2 (p> 0.05). The incidence of bilateral lesions (overall, 260 patients, i.e., 54.9%) was higher (p< 0.01) in HIV-infected patients than in non-HIV-infected patients: 66.1% (n=115) versus 46.5% (n=145) respectively. Most unilateral lesions (overall, 214 patients) involved the right lung but the difference between the two groups was not significant. The distribution of parenchymal lesions in function of radiological aspect was similar (p> 0.05) in two groups. The prevalence of mediastinal adenopathy (46.1% overall, i.e. 244 patients) was higher in HIV-infected children than in non-HIV-infected children: 75.9% (n=132) versus 46.4% (n=92) respectively. Pleural involvement (overall, 67 patients) was always associated with parenchymal lesions, and was found with similar frequency in the two groups. Our findings indicate that the presence of diffuse parenchymal lesions in both lungs is a characteristic radiological finding of pulmonary tuberculosis in HIV-infected children. Another specific feature of HIV/tuberculosis co-infection was high frequency of miliary and mediastinal adenopathy.

[Retrospective study of visceral surgical emergencies in children at the University Hospital Center of Brazzaville (Congo)]. / Etude rétrospective des urgences chirurgicales viscérales de l'enfant au CHU de Brazzaville (Congo).

The purpose of this study was to estimate the Incidence of visceral surgical emergencies In children and to determine the main causes and their prognoses. A retrospective study was carried out among children ranging from 1 month to 15 years who underwent emergency visceral surgery in the pediatric surgery unit of the University Hospital Center in Brazzaville, Congo. A total of 185 of the 206 children (14.1%) admitted for emergency visceral surgery were included In the study. The study population was predominantly male (67%). Most patients (71.3%) were over 5 years of age. The main indications for visceral surgery were acute appendicitis (30.3%), peritonitis (28.1%), strangulated hernia (22.2%), abdominal contusion (7.6%), intussusception (6.4%), other causes of intestinal obstruction (2.7%), and abdominal wounds (2.7%). Peritonitis was due to ruptured appendix in 76.9% of cases. Strangulated hernias were inguinal in 70.7% of cases and wnbilical in 29.3%. Intussusception was idiopathic in all cases and usually observed in infants under 6 months of age (58.3%). Postoperative recovery was uneventful in 79.5% of cases and complicated in 16.2%. EIght deaths (4.3%) were recorded. For the patient that died, the delay between initial symptoms and admission was longer than 3 days in 87.5% of cases and the interval for surgical treatment was longer than 6 hours in all cases. Early diagnosis and prompt surgical treatment are favorable prognostic factors for the outcome of emergency visceral surgery.