Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The a...Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The aim of our study was to evaluate morbidity and mortality during and after anaesthesia in patients with versus without diabetes operated on at Monkole Hospital over the last ten years. Methods: Retrospective cohort study including all patients who underwent all-comers surgery excluding cardiac surgery between 2011 and 2021. Each diabetic patient was matched to 2 non-diabetic controls on age and sex. The evaluation criterion was the frequency of occurrence of at least one perioperative complication and/or death up to day 30. A multivariate analysis using a Cox model was used to determine the factors associated with the occurrence of this morbidity and mortality. The model was adjusted for comorbidities, preoperative hyperglycaemia, ASA score, type of anaesthesia and severity of surgery. Results: A total of 351 diabetic patients (mean age 53.3 ± 14.18 years) and 701 non-diabetic patients (mean age 53.52 ± 14.7 years) were included and analysed. Preoperatively, hyperglycaemia (blood glucose > 180 mg/dl) was observed in 24.3% of diabetic patients compared with 1.6% of non-diabetic patients. The incidence of overall perioperative complications was 25.6% in diabetic patients compared with 28.6% in non-diabetic patients (p = 0.27). The risk factors associated with this morbidity were general anaesthesia with oro-tracheal intubation vs loco-regional anaesthesia (OR = 3.06 [95%CI: 1.91 - 4.94];p Conclusion: This study shows that there is not significant increase in perioperative morbidity and mortality in diabetic patients compared with non-diabetic ones of similar severity. These results suggest that diabetes itself (excluding associated comorbidities) has only a minor impact on perioperative morbidity and mortality.展开更多
<strong>Background: </strong>Happy hypoxia is a new feature found in COVID-19 patients. It consists of the presence of severe hypoxemia but normal breathing rate. Failure to identify this hypoxia may have ...<strong>Background: </strong>Happy hypoxia is a new feature found in COVID-19 patients. It consists of the presence of severe hypoxemia but normal breathing rate. Failure to identify this hypoxia may have negative consequences on the survival of the patient. The objective of the present study was to measure the frequency of patients with happy hypoxia and to evaluate their survival at the Kinshasa University Hospital (KUH). <strong>Methods: </strong>This was a historical cohort of 141 hospitalized patients with COVID-19 at KUH from March 23 to June 15, 2020. Happy hypoxia was defined as oxygen saturation below 90% without dyspnea. Socio-demographic data, co-morbidities, follow up time of hospitalization and outcomes were studied. Survival was assessed using the Kaplan Meier curve. <strong>Results:</strong> Out of 141 hospitalized patients with COVID-19, 79 (56%) patients were at the severe or critical stage and 9 (6.4%) had a happy hypoxia on admission. Patients who had happy hypoxia on admission were generally older than 60 years of age (55.6%) (p = 0.023). Comparison of survival curves, based on the presence or absence of happy hypoxia, shows a statistically significant difference (p = 0.001). The presence of happy hypoxia reduces survival. <strong>Conclusion:</strong> The frequency of happy hypoxia among COVID-19 patients was low. Survival was reduced in patients with happy hypoxia. Prehospital pulse oximetry could serve as an early warning signal for the detection of happy hypoxemia in COVID-19 patients.展开更多
<strong>Background and aim</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"><strong>:</strong> Access to contr...<strong>Background and aim</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"><strong>:</strong> Access to contraceptive methods remains low in the world in general and in Sub-Saharan Africa (SSA). Data of these contraceptive methods in rural areas of the Democratic Republic of Congo (DRC) remain poorly known. The aim is to identify the socio-demographic characte</span><span style="font-family:Verdana;">ristics of clients associated with purchasing contraceptives methods via different </span><span style="font-family:Verdana;">distribution system in Kongo Central province.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Methods</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: Cross-sectional study including data from mini Lelo Family Planning contraceptive method distribution campaigns organized in 11 health zones of Kongo Central province, from January to March 2020 by community-based distributors (DBC), learner DBCs (DBCa), graduated DBCs (DBCg) and clinical providers (CP).</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: The median age of clients was 25 years old. A quarter of them were men and almost half of the clients were in a conjugal relationship and 46.5% were single. The majority (70.4%) had a high school education. The male condom was the most requested method during Lelo Family Planning, followed by implants. Natural methods remain the methods preferred by clients < 20 years and single;modern methods by those aged > 25 years. Among the hormonal methods, the implant was the most popular modern method, while the short and long-lasting injectable hormonal methods were more in demand by women < 25 years of age.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusion</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: Natural methods are still the most preferred among male clients despite the poor protection they provide. Modern methods have to be promoted for male’s partners to assure better couple protection especially in rural area where maternal mortality remain</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> high.</span></span></span>展开更多
On the basis of the documentary analysis and interview, we noted that the total funds in the four interventions whose identified axes made it possible to know how the resources mobilized for the AIDS response were dis...On the basis of the documentary analysis and interview, we noted that the total funds in the four interventions whose identified axes made it possible to know how the resources mobilized for the AIDS response were distributed during the period of 2008 to 2017. These funds are distributed as follows: Treatment: 1,016,982,472 USD;Prevention: 302,542,391 USD;Governance: 459,246,584 USD;Mitigation of the impact: 115,757,443 USD. It should be noted that the analysis of resource allocations by component during the period 2008 to 2017 reveals significant disparities. Indeed, it was noted that the treatment component has received significant funding compared to the other components. It is followed by governance, prevention and impact mitigation which happens to be the component that received less funding compared to the other four (4) components.展开更多
Background and Aim: In hemodialysis patients, 24-hours interdialytic ABPM better detects TOD than dialysis unit blood pressure. Therefore, the present study was aimed to assess the diagnostic performance of 24-hours A...Background and Aim: In hemodialysis patients, 24-hours interdialytic ABPM better detects TOD than dialysis unit blood pressure. Therefore, the present study was aimed to assess the diagnostic performance of 24-hours ABPM vs. dialysis unit BPs for the diagnosis of ECG-LVH in steady state chronic hemodialysis black patients. Methods: From March 31 to September 30, 2018, interdialytic ABPM was performed after a mid-week hemodialysis session for 24 hours using a Spacelab 90207 ABPM monitor in the non-access arm in 45 stable chronic hemodialysis black patients (age ≥ 20 years, hemodialysis for at least 3 months and informed consent) attending 3 hemodialysis centers in Kinshasa. Ambulatory BP was recorded every 20 minutes during the day (6 AM to 10 PM) and every 30 minutes during the night (10 PM to 6 AM). ECG-LVH was defined using Cornell product criteria. ROC curve method was used to assess the performance of dialysis unit BPs vs. interdialytic 24-hours ABPM in diagnosing ECG-LVH. P 0.05 defined the level of statistical significance. Results: Whatever the method of BP measurement, all the SBP values were related to ECG-LVH with similar AUC and overlapping 95% CI;however, they were not significantly different from each other. 24-hours interdialytic ambulatory SBP (AUC 0.748;95% CI 0.58 - 0.94) had the highest area under the curve. Conclusion: The present study showed that although all the two BP measurement methods equally detected ECG-LVH, 24-hours ABPM tended to have the highest diagnostic performance.展开更多
<strong>Background and Aim:</strong> Cancer is a public health problem in developing countries. It is aggravated by diagnostic confirmation difficulties. The aim of this study was to determine the epidemio...<strong>Background and Aim:</strong> Cancer is a public health problem in developing countries. It is aggravated by diagnostic confirmation difficulties. The aim of this study was to determine the epidemiological profile of cancers in Congolese rural areas. <strong>Methods</strong>: A historical cohort study was conducted with 914 histopathological protocols at the IME/Kimpese hospital from January 2008 to December 2013. <strong>Results</strong>: The mean age of patients was 55.2 ± 14.5 years, and 61.9% were women with a sex ratio of 2W/M. Ductal carcinoma (23.6%), squamous cell carcinoma (23.5%) and adenocarcinoma (23.1%) were the most common cancers. The most affected organs were breast (26.3%) and prostate (14.3%). 41.5% of cancers had an undifferentiated character and more than half (51.1%) a differentiated character. The majority of this cancer infiltrated other organs (57.9%). Among cancers where grade was found, 16% and 10.8% were respectively grades 1 and 4, and the presence of metastases was observed in 10.9% of cancers. Conclusion: Cancer is more frequent in elderly women with a predominance of squamous and ductal carcinoma. The presence of a national cancer registry is necessary in the country for a good follow-up of cancer cases.展开更多
BACKGROUND Cancer diagnosis is increasing around the world and in the Democratic Republic of the Congo(DRC).The proportion of thyroid cancer has increased over the past three decades.There are very few studies on canc...BACKGROUND Cancer diagnosis is increasing around the world and in the Democratic Republic of the Congo(DRC).The proportion of thyroid cancer has increased over the past three decades.There are very few studies on cancer epidemiology,and in particular on thyroid cancer in the DRC.AIM To establish the most recent proportion of thyroid cancer in the DRC compared to other cancers.METHODS This is a retrospective and descriptive study of 6106 consecutive cancer cases listed in the pathological registers of 4 Laboratories in the city of Kinshasa.This study included all cancer cases recorded in the registers between 2005 and 2019.RESULTS From a sample of 6106 patients,including all cancer types,68.3%cases were female and 31.7%were male.Breast and cervical cancer were the most common types of cancer in women and,prostate and skin cancer were the most common types in men.Thyroid cancer was sixth in proportion in women and eleventh in men compared to all cancers.Papillary carcinoma was the most common of thyroid cancers.Rare cancers such as anaplastic and medullary thyroid carcinomas had a proportion of 7%and 2%,respectively.CONCLUSION Newer diagnostic tools led to a surge in cancer diagnoses in the DRC.Thyroid cancer has more than doubled its proportion over the last several decades in the country.展开更多
Background and Objective: 24-h ambulatory blood pressure monitoring (ABPM) aids to precisely identify patients with true resistant hypertension (tRH). The present study was aimed to assess the frequency and correlates...Background and Objective: 24-h ambulatory blood pressure monitoring (ABPM) aids to precisely identify patients with true resistant hypertension (tRH). The present study was aimed to assess the frequency and correlates of tRH among patients with clinically suspected RH. Methods: Medical records of treated hypertensive patients referred in four healthcare centers for BP control evaluation by 24-h ABPM were reviewed to assess the prevalence of tRH. Inclusion criteria were age ≥ 18 years, clinical diagnosis of RH. Data on demographic, clinical, laboratory, 2D-echocardiography and 24-h ABPM parameters were retrieved from patient’s medical records. True RH (tRH) was defined as office blood pressure (BP) ≥ 140/90 mmHg and 24-h ambulatory BP ≥ 130/80 mmHg. Simple and multiple linear regression analyses were used to assess factors associated with systolic BP (SBP) as a proxy of RH among patients with tRH. P 0.05 defined the level of statistical significance. Results: Of 636 patients referred for BP control evaluation by 24-h ABPM, 75 (11.7%) had suspected RH by office BP measurements. After 24-h ABPM, pseudo or apparent RH (aRH) and tRH were observed in 15 (2.3%) and 60 (9.4%) patients, respectively. BMI (p = 0.007) and blood glucose (p = 0.024) were positively associated with SBP whereas a negative association was observed with eGFR (p = 0.022) among tRH hypertensive patients in multiple regression analysis. Conclusion: True RH was a common finding among patients with clinical RH and associated with obesity and silent target organ, especially kidney dysfunction. The present study highlights the diagnostic and prognostic importance of 24-h ABPM among patients with clinical RH.展开更多
文摘Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The aim of our study was to evaluate morbidity and mortality during and after anaesthesia in patients with versus without diabetes operated on at Monkole Hospital over the last ten years. Methods: Retrospective cohort study including all patients who underwent all-comers surgery excluding cardiac surgery between 2011 and 2021. Each diabetic patient was matched to 2 non-diabetic controls on age and sex. The evaluation criterion was the frequency of occurrence of at least one perioperative complication and/or death up to day 30. A multivariate analysis using a Cox model was used to determine the factors associated with the occurrence of this morbidity and mortality. The model was adjusted for comorbidities, preoperative hyperglycaemia, ASA score, type of anaesthesia and severity of surgery. Results: A total of 351 diabetic patients (mean age 53.3 ± 14.18 years) and 701 non-diabetic patients (mean age 53.52 ± 14.7 years) were included and analysed. Preoperatively, hyperglycaemia (blood glucose > 180 mg/dl) was observed in 24.3% of diabetic patients compared with 1.6% of non-diabetic patients. The incidence of overall perioperative complications was 25.6% in diabetic patients compared with 28.6% in non-diabetic patients (p = 0.27). The risk factors associated with this morbidity were general anaesthesia with oro-tracheal intubation vs loco-regional anaesthesia (OR = 3.06 [95%CI: 1.91 - 4.94];p Conclusion: This study shows that there is not significant increase in perioperative morbidity and mortality in diabetic patients compared with non-diabetic ones of similar severity. These results suggest that diabetes itself (excluding associated comorbidities) has only a minor impact on perioperative morbidity and mortality.
文摘<strong>Background: </strong>Happy hypoxia is a new feature found in COVID-19 patients. It consists of the presence of severe hypoxemia but normal breathing rate. Failure to identify this hypoxia may have negative consequences on the survival of the patient. The objective of the present study was to measure the frequency of patients with happy hypoxia and to evaluate their survival at the Kinshasa University Hospital (KUH). <strong>Methods: </strong>This was a historical cohort of 141 hospitalized patients with COVID-19 at KUH from March 23 to June 15, 2020. Happy hypoxia was defined as oxygen saturation below 90% without dyspnea. Socio-demographic data, co-morbidities, follow up time of hospitalization and outcomes were studied. Survival was assessed using the Kaplan Meier curve. <strong>Results:</strong> Out of 141 hospitalized patients with COVID-19, 79 (56%) patients were at the severe or critical stage and 9 (6.4%) had a happy hypoxia on admission. Patients who had happy hypoxia on admission were generally older than 60 years of age (55.6%) (p = 0.023). Comparison of survival curves, based on the presence or absence of happy hypoxia, shows a statistically significant difference (p = 0.001). The presence of happy hypoxia reduces survival. <strong>Conclusion:</strong> The frequency of happy hypoxia among COVID-19 patients was low. Survival was reduced in patients with happy hypoxia. Prehospital pulse oximetry could serve as an early warning signal for the detection of happy hypoxemia in COVID-19 patients.
文摘<strong>Background and aim</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"><strong>:</strong> Access to contraceptive methods remains low in the world in general and in Sub-Saharan Africa (SSA). Data of these contraceptive methods in rural areas of the Democratic Republic of Congo (DRC) remain poorly known. The aim is to identify the socio-demographic characte</span><span style="font-family:Verdana;">ristics of clients associated with purchasing contraceptives methods via different </span><span style="font-family:Verdana;">distribution system in Kongo Central province.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Methods</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: Cross-sectional study including data from mini Lelo Family Planning contraceptive method distribution campaigns organized in 11 health zones of Kongo Central province, from January to March 2020 by community-based distributors (DBC), learner DBCs (DBCa), graduated DBCs (DBCg) and clinical providers (CP).</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: The median age of clients was 25 years old. A quarter of them were men and almost half of the clients were in a conjugal relationship and 46.5% were single. The majority (70.4%) had a high school education. The male condom was the most requested method during Lelo Family Planning, followed by implants. Natural methods remain the methods preferred by clients < 20 years and single;modern methods by those aged > 25 years. Among the hormonal methods, the implant was the most popular modern method, while the short and long-lasting injectable hormonal methods were more in demand by women < 25 years of age.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusion</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: Natural methods are still the most preferred among male clients despite the poor protection they provide. Modern methods have to be promoted for male’s partners to assure better couple protection especially in rural area where maternal mortality remain</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> high.</span></span></span>
文摘On the basis of the documentary analysis and interview, we noted that the total funds in the four interventions whose identified axes made it possible to know how the resources mobilized for the AIDS response were distributed during the period of 2008 to 2017. These funds are distributed as follows: Treatment: 1,016,982,472 USD;Prevention: 302,542,391 USD;Governance: 459,246,584 USD;Mitigation of the impact: 115,757,443 USD. It should be noted that the analysis of resource allocations by component during the period 2008 to 2017 reveals significant disparities. Indeed, it was noted that the treatment component has received significant funding compared to the other components. It is followed by governance, prevention and impact mitigation which happens to be the component that received less funding compared to the other four (4) components.
文摘Background and Aim: In hemodialysis patients, 24-hours interdialytic ABPM better detects TOD than dialysis unit blood pressure. Therefore, the present study was aimed to assess the diagnostic performance of 24-hours ABPM vs. dialysis unit BPs for the diagnosis of ECG-LVH in steady state chronic hemodialysis black patients. Methods: From March 31 to September 30, 2018, interdialytic ABPM was performed after a mid-week hemodialysis session for 24 hours using a Spacelab 90207 ABPM monitor in the non-access arm in 45 stable chronic hemodialysis black patients (age ≥ 20 years, hemodialysis for at least 3 months and informed consent) attending 3 hemodialysis centers in Kinshasa. Ambulatory BP was recorded every 20 minutes during the day (6 AM to 10 PM) and every 30 minutes during the night (10 PM to 6 AM). ECG-LVH was defined using Cornell product criteria. ROC curve method was used to assess the performance of dialysis unit BPs vs. interdialytic 24-hours ABPM in diagnosing ECG-LVH. P 0.05 defined the level of statistical significance. Results: Whatever the method of BP measurement, all the SBP values were related to ECG-LVH with similar AUC and overlapping 95% CI;however, they were not significantly different from each other. 24-hours interdialytic ambulatory SBP (AUC 0.748;95% CI 0.58 - 0.94) had the highest area under the curve. Conclusion: The present study showed that although all the two BP measurement methods equally detected ECG-LVH, 24-hours ABPM tended to have the highest diagnostic performance.
文摘<strong>Background and Aim:</strong> Cancer is a public health problem in developing countries. It is aggravated by diagnostic confirmation difficulties. The aim of this study was to determine the epidemiological profile of cancers in Congolese rural areas. <strong>Methods</strong>: A historical cohort study was conducted with 914 histopathological protocols at the IME/Kimpese hospital from January 2008 to December 2013. <strong>Results</strong>: The mean age of patients was 55.2 ± 14.5 years, and 61.9% were women with a sex ratio of 2W/M. Ductal carcinoma (23.6%), squamous cell carcinoma (23.5%) and adenocarcinoma (23.1%) were the most common cancers. The most affected organs were breast (26.3%) and prostate (14.3%). 41.5% of cancers had an undifferentiated character and more than half (51.1%) a differentiated character. The majority of this cancer infiltrated other organs (57.9%). Among cancers where grade was found, 16% and 10.8% were respectively grades 1 and 4, and the presence of metastases was observed in 10.9% of cancers. Conclusion: Cancer is more frequent in elderly women with a predominance of squamous and ductal carcinoma. The presence of a national cancer registry is necessary in the country for a good follow-up of cancer cases.
文摘BACKGROUND Cancer diagnosis is increasing around the world and in the Democratic Republic of the Congo(DRC).The proportion of thyroid cancer has increased over the past three decades.There are very few studies on cancer epidemiology,and in particular on thyroid cancer in the DRC.AIM To establish the most recent proportion of thyroid cancer in the DRC compared to other cancers.METHODS This is a retrospective and descriptive study of 6106 consecutive cancer cases listed in the pathological registers of 4 Laboratories in the city of Kinshasa.This study included all cancer cases recorded in the registers between 2005 and 2019.RESULTS From a sample of 6106 patients,including all cancer types,68.3%cases were female and 31.7%were male.Breast and cervical cancer were the most common types of cancer in women and,prostate and skin cancer were the most common types in men.Thyroid cancer was sixth in proportion in women and eleventh in men compared to all cancers.Papillary carcinoma was the most common of thyroid cancers.Rare cancers such as anaplastic and medullary thyroid carcinomas had a proportion of 7%and 2%,respectively.CONCLUSION Newer diagnostic tools led to a surge in cancer diagnoses in the DRC.Thyroid cancer has more than doubled its proportion over the last several decades in the country.
文摘Background and Objective: 24-h ambulatory blood pressure monitoring (ABPM) aids to precisely identify patients with true resistant hypertension (tRH). The present study was aimed to assess the frequency and correlates of tRH among patients with clinically suspected RH. Methods: Medical records of treated hypertensive patients referred in four healthcare centers for BP control evaluation by 24-h ABPM were reviewed to assess the prevalence of tRH. Inclusion criteria were age ≥ 18 years, clinical diagnosis of RH. Data on demographic, clinical, laboratory, 2D-echocardiography and 24-h ABPM parameters were retrieved from patient’s medical records. True RH (tRH) was defined as office blood pressure (BP) ≥ 140/90 mmHg and 24-h ambulatory BP ≥ 130/80 mmHg. Simple and multiple linear regression analyses were used to assess factors associated with systolic BP (SBP) as a proxy of RH among patients with tRH. P 0.05 defined the level of statistical significance. Results: Of 636 patients referred for BP control evaluation by 24-h ABPM, 75 (11.7%) had suspected RH by office BP measurements. After 24-h ABPM, pseudo or apparent RH (aRH) and tRH were observed in 15 (2.3%) and 60 (9.4%) patients, respectively. BMI (p = 0.007) and blood glucose (p = 0.024) were positively associated with SBP whereas a negative association was observed with eGFR (p = 0.022) among tRH hypertensive patients in multiple regression analysis. Conclusion: True RH was a common finding among patients with clinical RH and associated with obesity and silent target organ, especially kidney dysfunction. The present study highlights the diagnostic and prognostic importance of 24-h ABPM among patients with clinical RH.
