[Etiopathogenesis and type of congenital malformations observed in Kinshasa (Zaïre)]. / Etiopathogénie et type de malformations congénitales observées à Kinshasa, Zaïre.

The authors report on 115 malformed newborns, who are compared with 120 normal newborns from October 1985 up to September 1986 at the University Clinics of Kinshasa, Zaïre. There were 4,422 deliveries with 4,465 newborns, of whom 173 died during the perinatal period. The main results are: 1) the incidence of congenital defects is 2.5% births: a rate which is within the limits described by other authors: 2) polydactyly is the most frequent malformation; 3) two rare malformations were diagnosed: (1) a case of Arnold Chiari syndrome associated with polydactyly and (2) a case of temporal meningo-encephalocele; (4) factors for high risks of malformation are: advanced maternal age older than 35 years, consanguinity, a family history of birth defect and of stillbirths; 5) the diagnosis of even major congenital malformations is made macroscopically at birth in 95% because of lack of adequate instruments for antenatal diagnosis and the refusal of autopsy by the population (97%). For religious or mystical reasons, it is difficult to obtain a family's consent to perform autopsy in Kinshasa: people are convinced that life continues after death. So that a dead person needs the corporal integrity of his being.

Chronic renal failure in tropical Africa.

The high occurrence of end-stage renal disease among black Americans is a well established feature. Black Africans are also more affected by chronic renal diseases. This lethal condition may constitute a great challenge for nephrologists in the tropics where financial resources to fund dialysis treatment are very scarce. A realistic role for the tropical nephrologist is discussed.

Intracellular sodium and the response to nitrendipine or atenolol in African blacks.

The relationship between the hypotensive effect of nitrendipine (N), 20 mg/day (n = 17), or atenolol (A), 100 mg/day (n = 17), and the erythrocyte sodium [( Na]i) and potassium [( K]i) concentrations was investigated in hypertensive African blacks during a randomized double-blind study. After 6 weeks, both treatments significantly reduced supine and standing blood pressures; however, the magnitude of the decrease in supine systolic (-22.0 +/- 2.0 vs -12.1 +/- 3.4 mm Hg) and diastolic (-14.1 +/- 1.3 vs -7.6 +/- 2.1 mm Hg) pressures and in standing diastolic pressure (-16.0 +/- 1.7 vs -9.2 +/- 2.0 mm Hg) was more pronounced (p less than 0.05) in the N-treated than in the A-treated group. Pulse rate, plasma aldosterone, and plasma renin activity were lower (p less than 0.05) in the A-treated patients. Neither treatment had significant influence on [Na]i, [K]i, or ouabain-sensitive sodium efflux. The N-induced changes in supine systolic and diastolic pressure correlated (p less than 0.05) with age (r = -0.65 and r = -0.58, respectively) and pretreatment plasma renin activity (r = 0.71). Multiple regression analysis demonstrated a negative association between pretrial [Na]i and the change in systolic pressure during N treatment that was independent of age, pretreatment blood pressure, and change in pulse rate. Age and the change in supine pulse rate were also independently correlated with the change in diastolic pressure during N treatment. The results show a greater antihypertensive efficacy of N than A in the patients entered in this study and suggest that a higher intracellular sodium concentration could predict a better hypotensive response to N.

Calcium entry blockade or beta-blockade in long-term management of hypertension in blacks.

The long-term efficacy of nitrendipine and acebutolol was assessed during a 40-week double-blind randomized trial in 60 hypertensive blacks. Nitrendipine (mean dose 32 mg/day) and acebutolol (414 mg/day) were administered in monotherapy in increasing dosage and mefruside was added in patients not controlled by monotherapy. The recumbent and standing blood pressures were reduced (P less than 0.01 or less) during monotherapy with nitrendipine and acebutolol, but the magnitude of blood pressure reduction was greater (P less than 0.05 or less) during nitrendipine dosing. Pulse rate decreased (P less than 0.01) during acebutolol whereas nitrendipine induced a nonsignificant increase. Both treatments induced no changes in serum electrolytes, creatinine, urea, uric acid, lipids, plasma renin activity, and plasma and urinary aldosterone. The overall incidence of side effects was similar with both treatments but four patients discontinued nitrendipine because of headache. The addition of mefruside to nitrendipine or acebutolol produced a further fall of blood pressure in patients not controlled with monotherapy. Monotherapy with nitrendipine or acebutolol offers an effective, safe first-line antihypertensive treatment in blacks entered in this study; with the described dosages and therapeutic schedule, nitrendipine was somewhat more effective than acebutolol.

Effects of presensitization of antiheart serum on the rat embryonic heart.

After sensitization by rabbit anti-rat-heart serum (AHS), Wistar rats were injected with 9 ml/kg of AHS on day 9 of gestation. The incidence of malformations was 31.5% and that of cardiovascular malformations was 21.8%. The main malformations were microphthalmia, ventricular septal defect, pulmonary stenosis, and general edema. No antinuclear antibody was detected in the maternal sera by the fluorescent antibody technique. No complete heart block was found in the fetuses by electrocardiography. The fluorescent antibody technique demonstrated localization of rat IgG and rat C3 on the maternal myocardium, but a light-microscopic study revealed no myocarditis or endocarditis in either the maternal or the fetal heart. The types of malformation were similar to those observed after a single administration of antikidney serum, which presumably involves yolk sac dysfunction. These results show that both the existence of the immune complexes of antibodies against AHS and the administration of AHS on day 9 are necessary to cause yolk sac dysfunction or other teratogenic changes.

Epidemiological study of blood pressure and hypertension in a sample of urban Bantu of Zaïre.

Blood pressure and anthropometric characteristics were studied in a 10% random sample (n = 675) of Bantu, aged greater than or equal to 10 years and living in an urban quarter of Kinshasa, Zaïre. The prevalence and awareness of hypertension as well as the therapeutic situation in adult participants aged greater than or equal to 20 years were also evaluated. Systolic and diastolic blood pressure tended to be higher in males than in females. In adults greater than or equal to 20 years, systolic and diastolic pressure were positively and independently correlated with both age and body weight. In youths (10-19 years old), systolic pressure was associated with age and body weight, while in girls diastolic pressure was related to age only. Using WHO criteria, the overall prevalence of definite hypertension in adults was 9.9% (13.6% in males and 6.8% in females). The prevalence of borderline hypertension was 7% (8.4% in males and 5.6% in females). Of the participants studied with definite and borderline hypertension (n = 49), 69% were not aware of their blood pressure elevation; 31% were aware, but only 13% were treated and 3% were controlled. It is concluded that hypertension is not uncommon in these urban Bantu and that programmes for screening and educating the population should be developed and implemented.

[Physiologic variability of erythrocyte concentrations and transport of sodium and potassium]. / Variabilité physiologique des concentrations et des transports érythrocytaires du sodium et du potassium.

Sodium concentrations in erythrocytes are lower in women during the luteal phase of the menstrual cycle than in women studied during the follicular phase and in men. Sodium cotransport activity is lower in women during the follicular phase than in men. Women taking oral contraceptives show no monthly variations in erythrocyte sodium concentrations. Subjects with a family history of essential hypertension have higher sodium concentrations in erythrocytes than those with a different family background, partly because of reduction in sodium cotransport activity. Negroes have marked erythrocyte sodium accumulation due to lower activity of the sodium-potassium pump and cotransport system; they also have reduced sodium-lithium counter-transport. There is no difference between negroes with or without haemoglobin S. There are no changes in erythrocyte potassium concentrations in relation to sex, menstrual phase, race, familial essential hypertension, presence of haemoglobin S or use of oral contraceptives. These physiological variations indicate the factors which must be standardized to study sodium concentrations in cells and sodium transmembrane flux.

Relative potency of a beta-blocking and a calcium entry blocking agent as antihypertensive drugs in black patients.

The short-term efficacy of nitrendipine (N) as a first stage antihypertensive drug in black patients has been assessed and compared with acebutolol (A) in a double-blind study. Forty patients were randomized and after a 4 week run-in period on placebo, the active treatment was administered for 6 weeks starting with 20 mg N or 200 mg A once daily. The dose was increased up to 60 mg N or 600 mg A as needed. Nitrendipine appeared to be more efficient than acebutolol in reducing blood pressure and the N-induced fall in blood pressure was achieved after 2 weeks. After 2 and 6 weeks on N, the recumbent blood pressure was decreased by 13% and 12% for the systolic and by 14% and 11% for the diastolic pressure. The concurrent decreases in the A group averaged 4% and 5% for the systolic and 5% and 10% for the diastolic pressure after 2 and 6 weeks. Pulse rate and plasma renin activity in the N group were slightly increased and body weight was decreased at the end of the active treatment period.

[Intestinal amoebiasis in Zaire children (author's transl)]. / Amibiase intestinale de l'enfant en milieu Zairois.

A study of 385 cases of acute intestinal amoebiasis observed from 1960 to 1978 in the clinic of pediatrics of Kinshasa university. The epidemiologic, diagnostic aspects and the evolution are considered. The disease is responsible for 1,6 p. 100 of the admissions in the clinic of pediatrics for the considered period, with most cases (75 p. 100) in children under six years. Diagnosis, easily suspected if a dysenteric syndrome is obvious, is then confirmed by the detection of hematophagous amoebas in the stools. In children affected by malnutrition, incidence of complications and a lethal rate are both high.