[Predictive factors of all-cause mortality in patients attending the medical emergency unit of Kinshasa University Hospital]. / Facteurs prédictifs de la mortalité des patients admis aux urgences médicales des cliniques universitaires de Kinshasa.

BACKGROUND: The management of medical emergencies is poorly organized in the Democratic Republic of Congo. In addition, the mortality of patients attending the medical emergency unit of Kinshasa University Hospital is relatively high, with death of patients occurring rather early. To date, factors associated with this mortality have been poorly elucidated. This study aimed to identify predictive factors of all-cause mortality in patients admitted to the medical emergency unit of the Kinshasa University Hospital. METHODS: Analytical prospective study of all patients admitted from 15th January to 15th February 2011 in the emergency unit of the internal medicine department of Kinshasa University Hospital (427 patients). Among these patients, 13 were dead at arrival and were excluded from this study. The 414 patients included were followed until discharge from the hospital. Demographic, clinical, biological, diagnostic, therapeutical and evolutive data were collected. Four multivariate logistic regression models were used to identify risk factors associated with mortality. RESULTS: Patients' median age was 40 years (interquartile range, 28-58 years), 54.5% were male, and 15.9% had a life-threatening pathological condition on admission. The overall mortality was 12.3%. According to multivariate analyses, transfer from other health care structures (OR: 3.5; 95% CI: 1.7-7.1), Glasgow Coma Scale score less than 14 on admission (OR: 11.1; 95% CI: 4.7-26.3), high creatinine level (OR: 4.2; 95% CI: 1.8-9.7), presence of cardiovascular (OR: 2.9; 95% CI: 1.5-5.7), renal (OR: 7.4; 95% CI: 3.2-17.3), hematologic and/or respiratory (OR: 6.1; 95% CI: 1.7-21.4) diseases, presence of sepsis and/or meningitis and encephalitis (OR: 5.2; 95% CI: 1.6-17.0) were significantly associated with a high risk of death. However, the Glasgow Coma Scale score less than 14 on admission and renal disease were the only predictive factors of mortality remaining after including demographic, clinical, diagnostic and therapeutical variables in the logistic regression model. CONCLUSION: Our study showed that transfer from another health care structure, low Glasgow Coma Scale score on admission, high creatinine level, cardiovascular, renal, hematologic and/or respiratory diseases, sepsis and/or meningitis and encephalitis were associated with an increased risk of death in Kinshasa University Hospital patients admitted in the medical emergency unit.

Focal and segmental glomerulosclerosis in nephrotic syndrome: a new profile of adult nephrotic syndrome in Zaire.

In order to assess renal pathology, 92 clinically well-documented cases of nephrotic syndrome (NS) in adults (median age: 29) were systematically biopsied upon admission to the University Hospital of Kinshasa, between 1986 and 1989. All biopsies were paraffin embedded and histologically assessed by the routine methods of light microscopic examination. Histologic lesions were classified according to standard criteria. Focal and segmental glomerulosclerosis (FSG) was found in 41% of patients. The remaining 59% included minimal epithelial disease or minimal change nephropathy (MCN) responsive to corticosteroid therapy (14%), proliferative glomerulonephritis (PGN) (11%), membranous glomerulopathy (MGP) (10%), amyloidosis (10%), membrano-proliferative glomerulonephritis (MPGN) (8%), and "end stage kidney" (ESK) (7%). These results strikingly indicate the high prevalence of FSG. In comparison with previous findings from the same milieu, there is a seven-fold increase of this entity (41% versus 6%). The findings herein reported define a new histologic profile of NS in Zaire, characterized by the predominance of FSG. While in the past the vast majority of NS (52%) were putatively related to the intercurrent parasitic diseases, among which malaria was the chief etiology, similar associations were less important. Instead, no definite causative agent emerged for this apparently idiopathic condition. Further epidemiological and morphological intercorrelation studies, as well as the studies aimed at the relationships with AIDS, are in progress, with the purpose of identifying putative etiologies and risk factors responsible for the increase of FSG in Zaire.

Duration and correlates of post-partum abstinence in four sites in Zaire.

Data on 2223 women with a child less than 25 months of age from four sites of two regions in Zaire were analyzed. The univariate correlates of current abstinence were determined on this population. A sub-sample of 778 women was then drawn for the development of multivariable model of predictors of the duration of abstinence. The median duration of abstinence in the two urban and two rural sites ranged from 4.5 to 8.8 months. The final multivariable model showed that low socio-economic status, rural residence, more living children, prolonged duration of breastfeeding and non-Zairian nationality were all important predictors of prolonged duration of abstinence. The relationship of duration of abstinence to that of amenorrhea is also important. While approx. 18% of the women included in this analysis continued to abstain for at least one month beyond the resumption of menses, the vast majority who did resume relations represent a target population for utilization of an alternate means of pregnancy prevention.

Maternal and sociodemographic correlates of child morbidity in Bas Zaire: the effects of maternal reporting.

Cross-sectional survey data, collected in Bas Zaire from the mothers of 1200 urban and 1670 rural children born in the last 5 years, are used to assess variations in diarrheal, malarial, helminthic, and other child morbidities by selected household, maternal and child factors. In a multivariate analysis, we focus on maternal age and birth order as determinants of recent illnesses to observe any parallels in their effects on child mortality. These relationships are found after adjusting for bias from differential maternal perceptions of illnesses.

Correlates and implications of breast-feeding practices in Bas Zaire.

PIP: A sample of 1871 women having a child under 3 years old in Bas Zaire was studied to determine the correlates of breastfeeding practices and to examine the interrelationships among breastfeeding, contraceptive practices and desire for pregnancy. The methods of analysis applied were life table analysis and its multivariate extensions. Most of the findings in this analysis are consistent with current literature on the correlates of the duration of breastfeeding. Maternal education, economic status, age, parity, urban residence, pregnancy, and sex of the index child were significantly related to the length of breastfeeding. Among non-pregnant women, current desire for pregnancy was also related to breastfeeding status when the length of time since birth of the last child was taken into consideration. Rural women were reportedly ready for another pregnancy sooner after the birth of their last child than were urban women. Breastfeeding appears to be the most important means of contraceptive protection in the study population. The effective traditional method of extended postpartum abstinence is not widely prevalent, particularly among the urban sample, and indeed seems to be on the decline. The data presented here also suggest that breastfeeding pratices are changing in this area of Africa where little economic development has occurred in the past 20 years. This research suggests that if current trends continue, fertility levels are likely to increase significantly. The findings also indicate that Bas Zairian mothers want to space their births and for this reason may be receptive to family planning programs that use appropriate strategies.^ieng

Factors influencing the use of traditional versus modern family planning methods in Bas Zaire.

Findings from a baseline survey conducted prior to the initiation of organized family planning efforts in one urban and one rural area of Bas Zaire reveal the widespread use of traditional methods and a surprisingly high level of knowledge of modern contraceptives. However, in the absence of a delivery system, use of the latter was extremely limited (4-5 percent of currently married women). The data reflect a deep-seated motivation for birth spacing, which is achieved primarily through withdrawal and abstinence. Of the variables tested as possible correlates, only economic status was related to use of both traditional and modern methods in the same direction. Use of a traditional method was largely determined by age of the youngest child and breastfeeding status. By contrast, use of a modern method was highest among women over 30 with higher levels of education and parity, who were not currently breastfeeding.

Physiologie du systeme urinaire

L'objet de cette petite brochure est de servir au praticien actuel et futur a mieux comprendre le rein