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BACKGROUND: The systematic detection of HIV, hepatitis B (HBV) and C (HCV) viruses in any blood donor has been in effect at the University hospital of Kinshasa since 2005. However, no data on the monitoring of blood donors is available today. The purpose of this thesis was to draw up the sero-epidemiological assessment of the afore-mentioned virus during the period 2014 - 2018. METHODS: This is an observational study conducted in the University Hospital of Kinshasa donor population. RESULTS: A total of 9,128 blood donors were admitted to the Kinshasa University Clinics Blood Bank during the period from 01/01/2014 to 12/31/2018 for 11,054 blood donations. The highest attendance (50%) of blood donors was observed in 2014 and 2015. On the other hand, 2018 (11.9%; n = 1,085) was that of the lowest frequency of blood donors. The mean age of the blood donors was 34.72 ± 10.66 years. The minimum and maximum age corresponded to 16 years and 65 years, respectively. The median age was 34 years (interquartile range (IQR): 27 - 40 years). The majority of the study population (75%; n = 6,841) were at most 40 years old. There were significantly more male blood donors (77.3%; n = 7,060) than female blood donors (22.7%; n = 2,066). The difference between the two gender proportions was statistically significant (p < 0.0001) at risk α = 5%. The male/female gender ratio was 3:4. The seroprevalence of HIV, HBV, HCV and Treponema pallidum was estimated at 2.6% (n = 237), 4.7% (n = 429), 3.3% (n = 297) and 0.4% (n = 33), respectively. A total of 927 (10.16%) donors were infected with at least one agent transmissible by blood transfusion. CONCLUSIONS: The present surveillance proves that infectious transfusion safety in Kinshasa is still very low.
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Infecciones por VIH , Hepatitis B , Hepatitis C , Sífilis , Adulto , Donantes de Sangre , República Democrática del Congo , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Hepatitis B/diagnóstico , Hepatitis B/epidemiología , Hepatitis C/diagnóstico , Hepatitis C/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Estudios Seroepidemiológicos , Sífilis/diagnóstico , Sífilis/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To study the effects of prolonged administration of Dacryodes edulis (G. Don) H.J. Lam (HDE) fruit oil on the symptoms of anxiety and cognitive performance in mice. METHODS: Anxiolytic activity and effects of HDE (5 and 10 ml/kg) on cognitive performance were evaluated in male mice after oral administration for 45 days. Anxiolytic effects were investigated in open field test, elevated plus Maze and hole board test. The Morris Water Maze test was used to evaluate cognitive performance in mice. Efficacy of HDE (5 and 10 ml/kg) was compared with that of fluoxetine (2 mg/kg p.o). RESULTS: HDE decreases the total distance traveled, significantly increases the number of adjustments and the number of entries in the central area of open field. In the elevated cross labyrinth test, HDE increases the number of entries and the time spent in the open arms. HDE significantly increases the number of head insertion into the holes. In the Morris Water Maze test, HDE reduces latency before finding the platform and increases the time spent in the target quadrant. CONCLUSION: The results confirm anxiolytic effects and improved cognitive performance after prolonged oral administration of HDE in rodents.
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Ansiedad/tratamiento farmacológico , Burseraceae/química , Cognición/efectos de los fármacos , Aceites de Plantas/farmacología , Aceites de Plantas/uso terapéutico , Administración Oral , Animales , Ansiolíticos/farmacología , Ansiolíticos/uso terapéutico , Ansiedad/psicología , Nivel de Alerta/efectos de los fármacos , Miedo/efectos de los fármacos , Cuidados a Largo Plazo , Masculino , Ratones , FitoterapiaRESUMEN
STUDY OBJECTIVES: The screening of anti-Human Immunodeficiency Virus antibodies is mandatory in every blood donor admitted to the Blood Bank of Kinshasa University Clinics since 1984. However, no compiled data are available to date. The objective of this study was to establish the trend, prevalence, viral co-infections, and determinants of Human Immunodeficiency anti-Virus serology in blood donors admitted between 2003-2006 and 2008-2013. PATIENTS AND METHODS: A retrospective analysis was carried out at University Kinshasa Clinics, using blood donors' records during 2003-2006 and 2008-2013. The prevalence of the human immunodeficiency virus per year, age, sex and type of blood donors were estimated. Independent predictors of human immunodeficiency virus seropositivity were also identified. RESULTS: Out of 26,341 blood donors, 2.2% (n=576/26,341) were seropositive for Human Immunodeficiency Virus. Age<25 years (OR=1.7; 95% CI: 1.4-2; P<0.0001) and Hepatitis C virus seropositivity (OR=3; 95% CI; 1.8-4.9; P<0.001) emerged as independent predictors of Human Immunodeficiency Virus seropositivity. CONCLUSION: This study shows a strong association between the Human Immunodeficiency Virus and hepatitis C and younger age respectively. Further studies are needed to ensure safety of Blood donation in Democratic Republic of Congo.
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Donantes de Sangre , Infecciones por VIH/epidemiología , Hepatitis C/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Donantes de Sangre/estadística & datos numéricos , Comorbilidad , República Democrática del Congo/epidemiología , Femenino , Seropositividad para VIH/epidemiología , Seroprevalencia de VIH , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240.
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INTRODUCTION: The significant impact of seasonality and climate change on stroke-related morbidity and mortality is well established, however, some findings on this issue are conflicting. The objective was to determine the impact of gender, age, season, year of admission, temperature, rainfall and El Nino phenomenon on ischemic and hemorrhagic strokes and fatal cases of stroke. METHODS: The study was carried out at the teaching hospital of Kinshasa, DRC, between January 1998 and December 2004. Rainy and dry seasons, elevated temperatures, indices of rainfalls El Nino years 1998, 2002 and 2004, but La Nina years 1999-2000 and neutral/normal years 2001 and 2003 were defined. RESULTS: Among 470 incident strokes, 34.5% of victims (n=162) died. Traditional seasons (small dry season, small rainy season, great dry season, great rainy season) and temperatures did not significantly (P>0.005) impact on stroke incidence. However, there was a positive association between the decrease in rainfall, El Nino, and incident ischemic strokes, but a significant positive association between the increase in rainfall, La Nina, and incident hemorrhagic strokes. Using logistic regression analysis, age ≥ 60 years (OR: 1.7, 95% CI: 1.2-2.5; P=0.018) and El Nino years (OR: 2, 95% CI: 1.2-3.3; P=0.009) were identified as the independent predictors of fatal strokes. CONCLUSION: Early warning systems should be developed to predict the impact of seasons and climate variability on stroke morbidity and mortality.
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El Niño Oscilación del Sur , Lluvia , Estaciones del Año , Accidente Cerebrovascular/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Cambio Climático , República Democrática del Congo/epidemiología , Sequías , Femenino , Hospitales Universitarios/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Admisión del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Accidente Cerebrovascular/mortalidad , Temperatura , Adulto JovenRESUMEN
BACKGROUND: Symptomatic vulvovaginal candidiasis (VVC) is one of the most common problems leading women to seek advice in primary healthcare facilities. AIM: The aim of this study is to describe the associations between some hypothesized factors and the presence of symptomatic VVC. SUBJECTS AND METHODS: An analytical cross-sectional study was conducted. A total of 90 women diagnosed with symptomatic VVC and 108 women without symptomatic VVC were recruited when attending Umlazi D clinic, a primary health clinic in KwaZulu-Natal, South Africa between June 2011 and December 2011. Confirmed symptomatic VVC was determined by Gram stain and microbiological culture of vaginal swabs. For human immunodeficiency virus (HIV)-infected women, HIV ribonucleic acid load in plasma and genital fluid was determined by real-time-polymerase chain reaction (BioMerieux, Lyon, France). CD4 counts were obtained from patients' medical records. Data were analyzed using the statistical package for the social sciences (SPSS) version 21.0 (SPSS Inc.; Chicago, IL, USA). Multiple logistic regression models were used to exclude univariate confounders. All tests were two-sided and a P < 0.05 was considered to be significant. RESULTS: A total of 90% (81/90) of patients with symptomatic VVC complained of vulval itching, soreness and vaginal discharge when compared to 75.9% (82/108) of patients without symptomatic VVC (P < 0.01). Whilst pregnancy was independently associated with symptomatic VVC (P < 0.01), the latter was inversely related to Nugent's scores (P < 0.01). When compared with HIV negative women, the odds for symptomatic VVC increased among women with HIV-associated immunocompromise (CD4 counts < 200 cells/mm(3), P < 0.001), significantly shedding HIV in their genital tracts (P = 0.04), with plasma HIV load > 1000 copies/mL (P < 0.001). There was a significant negative association between the use of highly active anti-retroviral therapy and the presence of symptomatic VVC in HIV-infected women (P < 0.01). CONCLUSION: Although symptomatic VVC is not classified as acquired immunodeficiency syndrome-related condition, HIV-related immune compromised women and particularly those who are anti-retroviral therapy-naïve are likely to develop symptomatic VVC.
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BACKGROUND: Obstetric haemorrhage is the leading direct cause of maternal mortality in South Africa. OBJECTIVE: To determine the incidence, indications, associations and maternal outcomes of emergency peripartum hysterectomies. METHODS: A descriptive and retrospective analysis of patients who had peripartum hysterectomy between 1(st) February 2007 and 31(st) January 2009 in Nelson Mandela Academic Hospital at Mthatha city. RESULTS: The incidence of 0.95% of peripartum hysterectomies (n=63 or 9.5/1000 births) increased with the increasing maternal age from 0.121% at age of less than 20 years to 0.5% at age more or equal to 30 years. Similarly the incidence increased with parity from 0.332% for Primiparity to 0.468% at parity of four or more. The indications for the operation were uterine atony 19/63 (30.2%), secondary haemorrhage/puerperal sepsis 17/63 (27%) and ruptured uterus 16/63 (23.4%). The main intra operative complication was haemorrhage 13/63 (20.6%). Repeat laparotomy was done in 10/63 (15%) of patients due to haemorrhage. Admission to intensive care unit was 25/63 (39.7%). The case specific mortality rate was of 19 % (n=12). The main causes of death were hypovolaemic shock and septicemia. CONCLUSION: The incidence of peripartum hysterectomies was high and was associated with ruptured uterus and puerperal sepsis which are preventable.
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Histerectomía/estadística & datos numéricos , Periodo Periparto , Centros Médicos Académicos , Adulto , Cuidados Críticos , Femenino , Humanos , Histerectomía/efectos adversos , Complicaciones Intraoperatorias/epidemiología , Edad Materna , Auditoría Médica , Hemorragia Posoperatoria/epidemiología , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Sudáfrica/epidemiología , Adulto JovenRESUMEN
AIM: Aim of the present study was to determine syndrome specific mortality rates and the precipitating factors associated with deaths following admission for hyperglycemic crisis to a high care unit. METHODS: Retrospective review of medical records for hyperglycemic crisis at Nelson Mandela Academic Hospital, Mthatha, Eastern Cape Province of South Africa from February 1 2010 to January 31 2011. All admissions were initially into the high care unit. RESULTS: The overall mortality rates (per admissions) was 13.9% (N.=15/108) with syndrome specific mortality rates (per admissions) of 11.9% (N.=8/67), 0% (N.=0/8) and 21.2% (N.=7/33) respectively for diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS) and hyperglycemia with dehydration (HD). The precipitating factors that were mainly associated with mortality were infections and cerebrovascular disease (CVD). The patients with CVD who died were all unconscious. There were no deaths where non-compliance with hypoglycaemic agents (14.8%, N.=16/108) was the precipitating factor. CONCLUSION: The overall mortality rates (per admissions) following high care unit admissions for hyperglycemic crisis was 13.9% with infections and CVD as the precipitating factors most associated with deaths.
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Trastornos Cerebrovasculares/complicaciones , Trastornos Cerebrovasculares/mortalidad , Hiperglucemia/complicaciones , Hiperglucemia/mortalidad , Infecciones/complicaciones , Infecciones/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Glucemia/metabolismo , Niño , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sudáfrica/epidemiología , Adulto JovenRESUMEN
AIMS: To classify and characterize the clinical features of various diabetes classes among young black South Africans. METHODS: Cross sectional study of 60 black patients with diabetes, all less than 30 years of age and attending Nelson Mandela Academic Hospital, Mthatha, South Africa. Diabetes was classified as Types 1A, 1B and 2 based on the anti-glutamic acid decarboxylase status and serum C-peptide response to intravenous injection of glucagon. RESULTS: Mean age was 19.6±4.8 years (n=60) with similar gender distribution. The mean duration of diabetes was 24.2±45.1 months. Type 1A was the class of diabetes in 55% (n=33/60) of patients. Type 1B and 2 accounted for 30% (n=18/60) and 15% (n=9/60) of patients respectively. Patients classified as Type 2 had higher waist circumference and higher prevalence of acanthosis nigricans than Types 1A and 1B groups. History of diabetes in a first degree relative and hypertension were found in similar proportions of patients with Types 1A, 1B and 2 diabetes. Five Type 1A diabetes patients had body mass index of 26.2-41kg/m(2) and this included two newly diagnosed patients with body mass index of 26.7kg/m(2) and 33.2kg/m(2). CONCLUSION: The majority of our young black South Africans with diabetes are of the Type 1A class. Acanthosis nigricans was not found in any patient with Type 1 A diabetes. A minority of Type 1 A diabetes patients were obese at initial diagnosis.
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Diabetes Mellitus Tipo 1/sangre , Insulina/metabolismo , Acantosis Nigricans/epidemiología , Adolescente , Adulto , Población Negra , Estudios Transversales , Diabetes Mellitus Tipo 1/inmunología , Diabetes Mellitus Tipo 1/fisiopatología , Femenino , Glutamato Descarboxilasa/inmunología , Humanos , Secreción de Insulina , Masculino , Obesidad/complicaciones , SudáfricaRESUMEN
OBJECTIVE: To determine the magnitude, socio-demographic and epidemiological characteristics of injury at a Provincial referral hospital. METHODS: This review was conducted on all trauma patients admitted at the Mthatha Hospital Complex and Nelson Mandela Academic Hospital from the 1(st) January 1997 to the 31(st) December 2000. RESULTS: The incident rate of injuries was 3.2% (n=2460/75,833 total admissions). Injured patients were mostly black (80%) and males (ratio: 5 men: 1 woman). Only 8.1% of injured patients were transported to hospital by ambulances. The leading causes of injuries were inter-personal violence accounting for 60% of cases, and motor vehicle accidents accounting for 19%; of them 38% were due to poor visibility, over speeding, and fatigue. The overall mortality was 33% (n=821) independently predicted by poverty (OR=8.2 95%CI 6-11.1; P<0.0001) and age>40 years(OR=7.8 95%CI 7.7-12.1;P<0.0001). CONCLUSION: The burden of injury is a mass issue that warrants regional attention with quality of care and training.
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Accidentes de Tránsito/mortalidad , Factores Socioeconómicos , Violencia/estadística & datos numéricos , Heridas y Lesiones/mortalidad , Adolescente , Adulto , Distribución por Edad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Estudios Retrospectivos , Distribución por Sexo , Sudáfrica/epidemiología , Heridas y Lesiones/clasificación , Heridas y Lesiones/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Diabetic Retinopathy (DR) remains a common and one of the major causes of blindness in the developed and western societies. The same situation is shown in emerging economic areas (5,6). In sub-Saharan Africa (SSA) however, the issues of visual disability due to diabetes mellitus (DM) are overshadowed by the presence of the prevalent and common nutritional deficiency diseases and eye infections OBJECTIVE: This clinic-based study was conducted to determine whether diabetic retinopathy is independently related to visual disability in black patients with diabetes mellitus (DM) from Kinshasa, Congo. METHODS: A total of 299 urban patients with DM and low income including 108 cases of visual disability and matched for time admission and DM type to 191 controls, were assessed. Demographic, clinical, and ophthalmic data were assessed using univariate and multivariate analyses. RESULTS: Age ≥60 years, female sex, presence of diabetic retinopathy (DR), proliferative DR, shorter DM duration, glaucoma, macular oedema, diabetic nephropathy were the univariate risk factors of visual disability. Using logistic regression model, visual disability was significantly associated with female sex and diabetic retinopathy. CONCLUSION: The risk of visual disability is 4 times higher in patients with diabetic retinopathy and 2 times higher in females with DM. Therefore, to prevent further increase of visual disability, the Congolese Ministry of Health should prioritize the eye care in patients with DM.
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Complicaciones de la Diabetes , Diabetes Mellitus/fisiopatología , Retinopatía Diabética/complicaciones , Trastornos de la Visión/etiología , Adulto , África del Sur del Sahara/epidemiología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Población Negra , Estudios de Casos y Controles , República Democrática del Congo/epidemiología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/epidemiología , Femenino , Hospitales de Enseñanza , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Factores Socioeconómicos , Encuestas y Cuestionarios , Población Urbana/estadística & datos numéricos , Trastornos de la Visión/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Because of the demographic transition, lifestyle changes, urbanization, and nutrition transition, Central Africans are at higher risk of ocular diseases associated with oxidative stress and visual disability. This study aimed to estimate the normal values of oxidant status defined by oxidized low-density lipoprotein (Ox-LDL), 8-Isoprostane and 8-hydroxy-deoxyguanosine (8-OHdG) and to determine their pathogenic role in the prevalence and the severity of visual disability among these black Africans. METHODS: This was a cross-sectional study, run in a case-control study randomly selected from Kinshasa province, DR Congo. The study included 150 type 2 diabetes mellitus (T2DM) patients (cases) matched for sex and age to 50 healthy non diabetic controls. Logistic regression models were used to identify independent determinants of visual disability. RESULTS: The presence rates were 8.5% for blindness, 20.5% for visual impairment and 29% for visual disability including blindness and visual impairment. After adjusted for taro leaves intake, red beans intake, T2DM, aging, waist circumference, and systolic blood pressure, we identified low education level (OR=3.3 95%CI 1.5-7.2; p=0.003), rural-urban migration (OR=2.6 95% CI 1.2-5.6; p=0.017), and high Ox-LDL (OR=2.3 95% CI 1.1-4.7; p=0.029) as the important independent determinants of visual disability. After adjusted for education, intake of red beans, intake of taro leaves, triglycerides, and T2DM, we identified no intake of safou fruit (OR=50.7 95% CI 15.2-168.5; p<0.0001), rural-urban migration (OR=3.9 95%CI 1.213; p=0.012), and high 8-OHdG (OR=14.7 95% CI 3.9-54.5; p<0.0001) as the significant independent determinants of visual disability. After adjusted for education level, no intake of red beans, no intake of Taro leaves, triglycerides, and T2DM, we identified no intake of Safou fruit (OR=43.1 95% CI 13.7-135.4; p<0.0001), age ≥ 60 years (OR=3.4 95% CI 1.3-9; p=0.024), and high 8-Isoprostane (OR=11 95% CI 3.4-36.1; p<0.0001) as the significant independent determinants of visual disability. CONCLUSIONS: Visual disability remains a public health problem in Central Africa. Antioxidant supplement, fruit intake, nutrition education, control of migration, and blocking of oxidative stress are crucial steps for delayed development of vision loss.
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Población Negra , Ceguera/sangre , Diabetes Mellitus Tipo 2/sangre , 8-Hidroxi-2'-Desoxicoguanosina , Adulto , Anciano , Biomarcadores/sangre , Ceguera/complicaciones , Ceguera/epidemiología , Estudios de Casos y Controles , Estudios Transversales , República Democrática del Congo/epidemiología , Desoxiguanosina/análogos & derivados , Desoxiguanosina/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Dinoprost/análogos & derivados , Dinoprost/sangre , Escolaridad , Femenino , Humanos , Lipoproteínas LDL/sangre , Masculino , Persona de Mediana Edad , Estrés Oxidativo , Dinámica Poblacional , Prevalencia , Índice de Severidad de la Enfermedad , Triglicéridos/sangre , Personas con Daño Visual , Circunferencia de la CinturaRESUMEN
BACKGROUND: South Africa (SA) is experiencing a rapid epidemiologic transition as a consequence of political, economic and social changes. In this study we described, based on hospital data, the mortality patterns of Non communicable Diseases (NCD), Communicable Diseases (CD), the NCD/CD ratios, and the trends of deaths. METHODS: We conducted a cross-sectional survey of all deaths occurring in several public hospitals in the Eastern Cape Province of SA between 2002 and 2006. Causes of deaths were coded according to the ICD 10 Edition. RESULTS: A total of 107380 admissions responded to the inclusion criteria between 2002 and 2006. The crude death rate was 4.3% (n=4566) with a mean age of 46±21 years and a sex ratio of 3.1 men (n=3453): 1 woman (n=1113). Out of all deaths, there were 62.9% NCD (n=2872) vs. 37.1% CD (n=1694) with NCD/CD ratio of 1.7. The ratio NCD/CD deaths in men was 1.3 (n=1951/1502) vs. NCD/CD deaths in women of 1.9 (n=735/378). The peak of deaths was observed in winter season. The majority of NCD deaths were at age of 30-64 years, whereas the highest rate of CD deaths was at age< 30 years. The trend of deaths including the majority of NCD, increased from 2002 to 2006. There was a tendency of increase in tuberculosis deaths, but a tendency of decrease in HIV/AIDS deaths was from 2002 to 2006. CONCLUSION: Non-communicable diseases are the leading causes of deaths in rural Eastern Cape province of SA facing Post-epidemiologic transition stages. We recommend overarching priority actions for the response to the Non-communicable Diseases: policy change, prevention, treatment, international cooperation, research, monitoring, accountability, and re-orientation of health systems.
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BACKGROUND: Hypertension is a common cardiovascular disease, affecting adults worldwide and it accounts for up to 30% of all deaths. The need for better control of arterial hypertension justifies observational studies designed to better understand the real-life management of hypertensive patients. The ASTRAL study was primarily designed to evaluate the percentage of hypertensive patients achieving blood pressure goals after eight weeks of treatment with a fixeddose combination of ramipril/hydrochlorothiazide (HCTZ). METHODS: The study was a multi-centre, non-comparative, Open-label, observational study conducted in 36 centres in five sub-Saharan African countries, namely Cameroon, Congo Brazzaville, Democratic Republic of Congo (DRC), Madagascar and Nigeria. Four hundred and forty-nine men and women 18 years of age or older with hypertension not controlled by an ACE inhibitor, a diuretic or any other monotherapy or anti-hypertensive combination not containing a diuretic in a fixed dose were considered eligible for inclusion in this eight-week study. The study consisted of three visits, visit one (V1) at baseline, visit two (V2) after four weeks and visit three (V3) after eight weeks. RESULTS: The mean age of the patients was 54.7 ± 11.7 years (20-90 years) and most were categorised by the WHO criteria as either overweight or obese (71.6%). After four and eight weeks of treatment with the study drug, systolic and diastolic blood pressures significantly changed from baseline: -24.7/-14.2 mmHg (p < 0.001) and -31.7/-17.9 mmHg (p < 0.001), respectively. There were 60.2% of the non-diabetics on prior monotherapy who, at eight weeks, fulfilled the primary blood pressure goal for SBP and DBP, versus 26.5% of the diabetic patients, also on monotherapy. Few adverse events were reported, with facial oedema and dry cough recurring twice in two patients. CONCLUSION: Fixed-dose combination of ramipril/HCTZ is therefore effective, tolerable and has a good safety profile for blood pressure control in black Africans.
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Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Antihipertensivos/administración & dosificación , Hidroclorotiazida/administración & dosificación , Hipertensión/epidemiología , Ramipril/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Angiopatías Diabéticas/tratamiento farmacológico , Angiopatías Diabéticas/epidemiología , Combinación de Medicamentos , Femenino , Insuficiencia Cardíaca/epidemiología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
AIM: The aim of this paper was to determine the prevalence of altered sensorium and their determinants in diabetic ketoacidosis (DKA). METHODS: Retrospective review of medical records for diabetic ketoacidosis admissions over a two year period. RESULTS: A total of 94 admissions for DKA in 89 patients were reviewed. Majority of admissions were female related. The mean age of the subjects was 39.1±18.5 years. The prevalence of altered sensorium defined as Glasgow coma scale (GCS) below 15 was 47.9%. In Model 1, systolic blood pressure (SBP) <90 mmHg (odds ratio [OR] 17.5 95% Confidence Interval (CI) 2.1-142.9; P=0.008 and calculated effective serum osmolality >320 mosmol/Kg (OR 3.6 95% CI 1.4-12.2; P=0.043 were independently associated with altered sensorium. In Model 2 where serum osmolality was substituted with uncorrected serum sodium, SBP <90 mmHg OR 19.6 95% CI 2.2-100; P=0.007, uncorrected serum sodium >150 mmol/L OR 18.5 95% CI 2.1-100; P=0.0009 and white cell count >25 x 106/L OR 3.6 95% CI 1.03-13.5; P=0.05 were independently associated with altered sensorium. CONCLUSION: Systolic blood pressure <90 mmHg, calculated effective serum osmolality >320 mosmol/Kg, uncorrected serum sodium >150 mmol/L and white bood count >25 x 106/L were independently associated with altered sensorium.
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Trastornos de la Conciencia/etiología , Cetoacidosis Diabética/psicología , Adulto , Bicarbonatos/sangre , Enfermedades Transmisibles/complicaciones , Trastornos de la Conciencia/sangre , Trastornos de la Conciencia/epidemiología , Cetoacidosis Diabética/sangre , Cetoacidosis Diabética/etiología , Cetoacidosis Diabética/terapia , Urgencias Médicas , Femenino , Escala de Coma de Glasgow , Humanos , Hipernatremia/etiología , Hipotensión/etiología , Hipotensión/psicología , Leucocitosis/etiología , Masculino , Persona de Mediana Edad , Concentración Osmolar , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/complicaciones , Adulto JovenRESUMEN
AIM: Metabolic syndrome defined by International cut-off values are limited to detect people at high cardiometabolic risk in Central Africans in comparison with metabolic syndrome defined by ethnic-specific definition. We examined the relationship between metabolic syndromes, diabetes control, abdominal obesity, HDL-cholesterol groups and atherosclerotic complications. MATERIALS AND METHODS: A representative sample of type-2 diabetic central Africans from Kinshasa were studied. Outcome measures included control of diabetes, atherosclerosis, abdominal obesity, insulin resistance, total cholesterol, triglycerides, HDL-cholesterol, metabolic syndromes and atherosclerosis. RESULTS: Of 1266 type-2 diabetic patients (48.8%), (61.8%), (27.1%) and (81%) had uncontrolled diabetes, atherosclerotics, metabolic syndrome (IDF/Europe), and metabolic syndrome (IDF/local) respectively. There was a significant U-shaped relationship between atherosclerotics complications, insulin resistance, delta postprandial glycaemia and HDL-cholesterol stratification. There was also a significant U-shaped relationship between cardiometabolic risk (P<0.01) and atherosclerotic complications. CONCLUSION: Type-2 diabetic Central Africans exhibit very high rates of uncontrolled diabetes, atherosclerotic complications and metabolic syndrome. Both, abdominal obesity, insulin resistance, low and very high HDL-cholesterol levels are cardiometabolic risk factors.
Asunto(s)
Población Negra/etnología , Diabetes Mellitus Tipo 2/etnología , Síndrome Metabólico/etnología , HDL-Colesterol/sangre , Estudios Transversales , República Democrática del Congo/etnología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Femenino , Humanos , Resistencia a la Insulina/fisiología , Masculino , Síndrome Metabólico/sangre , Síndrome Metabólico/diagnóstico , Persona de Mediana EdadRESUMEN
OBJECTIVE: To assess associations between nose-throat (NT) diseases and passive smoking prevalence among school children. METHODS: A cross-sectional survey was carried out on a randomized multistage sample of 381 school children (50.9% males, aged 9.8 ± 3.5 years) from Kinshasa town. Parents and children were asked to fill in a questionnaire detailing their smoking habits. The NT symptoms and diseases were assessed by the survey NT specialist. RESULTS: The prevalence of passive smoking was 38.6% (n = 147). Residence in peripheral areas, catholic school system, elementary level, exposure of family to passive smoking, history of NT surgery, medicines and menthol inhaling, headache, nasal pain, dysphagia, odynophagia, dysosmia, dysphonia, pharyngeal irritation, dry throat, snooze, and chronic pharyngitis were more reported by passive smokers. After adjusting for confounding factors, passive smoking (OR = 16.7 95%CI 3.3-83.3), catholic system(OR = 2 95%CI 1.2-3.2), and elementary degree(OR = 1.4 95%, CI 1.1-2.1) were identified as independent determinants of chronic pharyngitis. CONCLUSION: Parents should not smoke in the same room used by their children.
Asunto(s)
Enfermedades Nasales/etiología , Enfermedades Faríngeas/etiología , Contaminación por Humo de Tabaco/efectos adversos , Niño , Estudios Transversales , República Democrática del Congo/epidemiología , Femenino , Humanos , Modelos Logísticos , Masculino , Enfermedades Nasales/epidemiología , Oportunidad Relativa , Enfermedades Faríngeas/epidemiología , Faringitis/epidemiología , Faringitis/etiología , Prevalencia , Factores de Riesgo , Contaminación por Humo de Tabaco/estadística & datos numéricosRESUMEN
The first objective of this study was to determine the baseline prevalence of metabolic syndrome and its individual components using the NCEP-R/ATPIII criteria, IDF criteria for Europe, and IDF criteria for Africa: waist circumference of at least 94 cm for men and women. The second objective was to investigate the incidence and the determinants of type 2 diabetes in a prospective cohort of 807 non-diabetic Central Africans aged >or= 40 years from December 2004 to September 2008. During 3,156 person-years of median follow up, there were 93 type 2 diabetes cases (11.5%), corresponding to an incidence of 29 (95% CI 15-43) per 1,000 person-years. The independent predictors of incident type 2 diabetes were age >or= 45 years, physical inactivity, non-diabetic hyperglycaemia and metabolic syndrome regardless of criteria used. In conclusion, urgent prevention strategies are needed to curb the type 2 diabetes epidemic in Africa.
Asunto(s)
Envejecimiento , Población Negra/estadística & datos numéricos , Diabetes Mellitus Tipo 2/etnología , Síndrome Metabólico/etnología , Actividad Motora , Adulto , África Central/epidemiología , Distribución por Edad , Estudios Transversales , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Estilo de Vida , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Factores de RiesgoRESUMEN
OBJECTIVES: To investigate the independent effect of HIV/ AIDS in the genesis of acute or chronic rhinosinusitis. METHODS: This case-control study was performed among patients managed for chronic rhinosinusitis between January and April 2009 the ENT and Head and Neck Department General Hospital of Kinshasa, DRCongo. Cases were matched with controls according to gender and age. Logic regression analysis served to identify factors associated with presence of chronic rhinosinusitis. RESULTS: The study population with 108 patients included 81 cases ofrhinosinusitis, 27 controls, 78 females, 30 males, 52 with HIV/AIDS and 56 HIV seronegatives. The mean age was 34+/-19 years (range 1 year-74 years). Only HIV/AIDS was identified as a significant and independent determinant of presence of chronic rhinosinusitis (OR= 19,6 95% CI 4,3 -88,9; P< 0,0001). CONCLUSION: Early ENT evaluation and continuous follow-up of HIV-infected patients are suggested. Age upper 20 years and high education attainment were significantly associated with high risk of chronic rhinosinusitis among HIV-infected patients, respectively.