Stroke signs knowledge and factors associated with a delayed hospital arrival of patients with acute stroke in Kinshasa.

Background: Rapid recognition and early medical intervention are essential to reduce stroke-related mortality and long-term disability. This study aimed to evaluate awareness of stroke symptoms/signs and determine factors delaying the hospital arrival of patients with acute stroke in Kinshasa. Methods: Patients with stroke and/or accompanying family members were interviewed using a standard questionnaire, and their medical records were reviewed. Factors independently associated with a late arrival (≥4.5 h) to the hospital were identified using the logistic regression test in forward multivariate analysis. Results: Overall, 202 patients with an average age of 57.9 ± 13.1 years were included. Only 27 (13.4%) patients immediately associated the initial symptoms with a stroke episode. Delayed hospital arrival was observed in 180 (89.1%) patients. Unmarried status (adjusted odds ratio [aOR], 2.29; 95% confidence interval [CI], 1.17-4.88; p = 0.007), low education level (aOR, 2.29; 95% CI, (1.12-5.10; p = 0,014), absence of impaired consciousness (aOR, 3.12; 95% CI, 1.52-4.43; p = 0.005), absence of a history of hypertention (aOR, 1.85; 95% CI, 1.18-3.78; p = 0.041), absence of a history of diabetes (aOR, 1.93; 95% CI, 1.15-4.58; p = 0.013), heavy alcohol consumption (aOR, 1.83; 95% CI, 1.12-2.83; p = 0.045), absence of a severe to very severe stroke (aOR, 4.93; 95% CI, 0.82-1.01; p = 0.002), and presence of ischemic stroke (aOR, 2.93; 95% CI, 1.54-4.59; p = 0.001) were identified as independent determinants of delayed hospital arrival. Conclusions: This study depicted a low stroke awareness rate and a much longer prehospital delay than evidence-based guidelines recommend and identified eight factors that public health actions could target to promote the earliest management of stroke.

Factors associated with complications in ST-elevation myocardial infarction: a single-center experience.

BACKGROUND: ST-elevation myocardial infarction (STEMI) is a major public health problem. This study aimed to determine the prevalence and identify the determinants of STEMI-related complications in the Cardiology Intensive Care Unit of the Sud Francilien Hospital Center (SFHC). METHODS: We retrospectively analyzed the data of 315 patients with STEMI aged ≥ 18 years. Logistic regression was used to identify factors independently associated with the occurrence of complications. RESULTS: Overall, 315 patients aged 61.7 ± 13.4 years, of whom 261 were men, had STEMI during the study period. The hospital frequency of STEMI was 12.7%. Arrhythmias and acute heart failure were the main complications. Age ≥ 75 years (adjusted odds ratio [aOR], 5.18; 95% confidence interval [CI], 3.92-8.75), hypertension (aOR, 3.38; 95% CI, 1.68-5.82), and cigarette smoking (aOR, 3.52; 95% CI, 1.69-7.33) were independent determinants of acute heart failure. Meanwhile, diabetes mellitus (aOR, 1.74; 95% CI, 1.09-3.37), history of atrial fibrillation (aOR, 2.79; 95% CI, 1.66-4.76), history of stroke or transient ischemic attack (aOR, 1.99; 95% CI, 1.31-2.89), and low high-density lipoprotein-cholesterol (HDL-C) levels (aOR, 3.70; 95% CI, 1.08-6.64) were independent determinants of arrhythmias. CONCLUSION: STEMI is a frequent condition at SFHC and is often complicated by acute heart failure and arrhythmias. Patients aged ≥ 75 years, those with hypertension or diabetes mellitus, smokers, those with a history of atrial fibrillation or stroke, and those with low HDL-C levels require careful monitoring for the early diagnosis and management of these complications.

Insulin resistance-related differences in the relationship between left ventricular hypertrophy and cardiorespiratory fitness in hypertensive Black sub-Saharan Africans.

BACKGROUND: Left ventricular hypertrophy (LVH) is associated with impaired cardiorespiratory fitness (CRF), a surrogate marker of poor outcome. Insulin resistance (IR) plays a central role in all stages of cardiovascular disease continuum. This study evaluates IR-related differences in the relationship between left ventricular mass (LVM) and CRF in asymptomatic newly diagnosed hypertensive Black sub-Saharan Africans. METHODS: In this cross-sectional observational study, 126 asymptomatic newly diagnosed hypertensive participants (50.5 ± 9.5 years) underwent comprehensive resting transthoracic echocardiographic examination and maximal incremental cardiopulmonary exercise test (CPET). CRF was estimated in maximal oxygen uptake (VO2max). CPET results were compared between participants with and without LVH. Multivariate analysis examined the influence of IR on the observed differences. RESULTS: Those with LVH had lower VO2max (15.7 ± 5.5 mL min-1 kg-1 vs. 18.4 ± 3.7 mL min-1 kg-1; P = 0.001) than those without LVH. In patients with IR, LVM (r = -0.261, P = 0.012), LVM indexed to body surface area (LVMIbsa; r = -0.229, P = 0.027), and LVM indexed to height to an allometric power of 2.7 (LVMIh2.7; r = -0.351, P = 0.001), and VO2max were negatively correlated. In hypertensive patients without IR, these same parameters and VO2max have no significant correlation. Body mass index (BMI), LVM, and LVMIbsa emerged as independent determinants of VO2max, explaining 46.9% of its variability (overall P = 0.001) in IR participants, a relationship not found in participants without IR. CONCLUSIONS: IR may participate in the deterioration of CRF associated with LVH. Measures to improve insulin sensitivity should be considered for improving CRF and therefore the prognosis of insulin-resistant hypertensive patients. Targeting IR in hypertensive patients with LVH could improve prognosis.

Association between insulin resistance and left ventricular hypertrophy in asymptomatic, Black, sub-Saharan African, hypertensive patients: a case-control study.

BACKGROUND: Conflicting information exists regarding the association between insulin resistance (IR) and left ventricular hypertrophy (LVH). We described the associations between obesity, fasting insulinemia, homeostasis model assessment of insulin resistance (HOMA-IR), and LVH in Black patients with essential hypertension. METHODS: A case-control study was conducted at the Centre Médical de Kinshasa (CMK), the Democratic Republic of the Congo, between January and December 2019. Cases and controls were hypertensive patients with and without LVH, respectively. The relationships between obesity indices, physical inactivity, glucose metabolism and lipid disorder parameters, and LVH were assessed using linear and logistic regression analyses in simple and univariate exploratory analyses, respectively. When differences were observed between LVH and independent variables, the effects of potential confounders were studied through the use of multiple linear regression and in conditional logistic regression in multivariate analyses. The coefficients of determination (R2), adjusted odds ratios (aORs), and their 95% confidence intervals (95% CIs) were calculated to determine associations between LVH and the independent variables. RESULTS: Eighty-eight LVH cases (52 men) were compared against 132 controls (81 men). Variation in left ventricular mass (LVM) could be predicted by the following variables: age (19%), duration of hypertension (31.3%), body mass index (BMI, 44.4%), waist circumference (WC, 42.5%), glycemia (20%), insulinemia (44.8%), and HOMA-IR (43.7%). Hypertension duration, BMI, insulinemia, and HOMA-IR explained 68.3% of LVM variability in the multiple linear regression analysis. In the logistic regression model, obesity increased the risk of LVH by threefold [aOR 2.8; 95% CI (1.06-7.4); p = 0.038], and IR increased the risk of LVH by eightfold [aOR 8.4; 95 (3.7-15.7); p < 0.001]. CONCLUSION: Obesity and IR appear to be the primary predictors of LVH in Black sub-Saharan African hypertensive patients. The comprehensive management of cardiovascular risk factors should be emphasized, with particular attention paid to obesity and IR. A prospective population-based study of Black sub-Saharan individuals that includes the use of serial imaging remains essential to better understand subclinical LV deterioration over time and to confirm the role played by IR in Black sub-Saharan individuals with hypertension.

Urinary incontinence in a female adolescent due to an ectopic ureter opening into the vestibulum: A case report.

Ectopic ureter opening into the vestibulum (EUV) is a rare congenital cause of urinary incontinence in female adolescents. Diagnosis be challenging. We report an EUV in a 16- year-old female. This is the first case of EUV reported in DR Congo. The evaluation and diagnosis are discussed.

Evaluation du développement psychomoteur de l'enfant congolais par l'échelle de Bayley pour le développement des enfants. Deuxième édition

Introduction: les pays à ressources limitées présentent un haut risque de retard dans les 4 domaines du développement et le taux d'un handicap dans un de ces domaines est très élevé. L'objectif de cette étude est de déterminer l'âge de développement psychomoteur de l'enfant congolais en utilisant l'échelle de Bayley 2ème édition (BSID II).Méthodes: étude descriptive, observationnelle réalisé auprès les nourrissons en bonne santé apparente de Kinshasa (Centre de Santé BOMOI, CH de Kingasani II) et de la cité d'Idiofa dans la province du Kwilu durant la période allant de Janvier 2010 à janvier 2012. Les variables d'intérêts étaient les caractéristiques sociodémographiques (âge, sexe, milieu d'habitation), l'Index de développement psychomoteur (PDI) et Index de développement mental (MDI) et l'échelle comportementale (BRS) évalués à l'aide de l'échelle de Bayley 2nde édition (BSID-II). Résultats: sur 366 nourrissons retenus, 51,9% étaient du sexe féminin (sex ratio 1H/1F). L'âge chronologique et développemental médian était de 16,8 et 17 mois respectivement. Les valeurs moyennes de PDI et MDI étaient de 104,0±17,4 et 100,5±15,0 respectivement. Le retard mental et moteur sévère noté chez ces nourrissons était respectivement de 4,9% et 4,1%. Dans toutes les composantes du développement psychomoteur, les nourrissons du milieu rural avaient significativement une médiane d´âge élevée (p<0,05).Conclusion: les enfants en milieu urbain sont en avance en ce qui concerne la motricité, le cognitif et ont aussi un comportement meilleur par rapport à ceux du milieu rural

Assessing the prevalence of hepatitis B virus infection among health care workers in a referral hospital in Kisantu, Congo DR: a pilot study.

We aimed to determine hepatitis B virus (HBV) prevalence and risk factors for health care workers (HCWs) to contract HBV infection in a referral hospital in the Democratic Republic of Congo. From October 2015 to August 2016, we recruited 97 HCWs (55 males and 42 females, aged 41.2 ± 10 yr) from Kisantu St. Luke's Hospital, a Congolese referral hospital located in the province of Kongo Central. Serum samples were assayed for HBV markers using ELISA. A questionnaire was used to record the HCWs' demographics, medical histories, and risk factors. The overall prevalence of exposure to HBV infection [HBsAg+, and/or hepatitis B core antibody (anti-HBc)+] was 56.7% (55/97). HBsAg positivity was found in 18.6% (18/97) of the HCWs whereas 29.9% (29/97) were anti-HBc positive. Approximately 8.2% (8/97) of the HCWs tested positive for both HBsAg and anti-HBc. Being a physician [odds ratio (OR)=2.8 (95% CI: 1.34-12.23)], a laboratory technician [OR=3.35 (95% CI: 1.35-5.21)], and having multiple sex partners [OR=3.05 (95% CI: 1.13-9.09)] were found to be factors associated with HBV infection. Exposure to HBV is common among HCWs at Kisantu St. Luke's Hospital. Isolated HBsAg was also prevalent among them. There is a high risk that HBV could be spread to others. Therefore, there is an urgent need for HBV screening, treatment, and vaccination policies.