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Background: The influence of race/ethnicity on the relationship between sedentary screen time and left ventricular mass has been recently suggested, but remains a subject of debate, and has never been explored in Africa. Purpose: To determine whether there is a racial/ethnic influence on the relationship between sedentary screen time and left ventricular mass in MAGhreb and Sub Saharan Africa Left-Ventricul ArGEometry Study (MAG-SALVAGES) participants. Methods: 100 blacks sub-Saharan African and 187 white Maghreb aged 18 - 55 years underwent an interview on their behavioral measures, physical activity and eating habits. Their left ventricular mass has also been measured by a resting transthoracic echography according to the American Society of Echography. Generalized linear models evaluated a test-for-trend across higher levels of sedentary screen time in progressive models with left ventricular measurements as dependent variables. The study population was stratified into quartiles of sedentary screen time (separately for whites and blacks) and examined the joint association of sedentary screen time and LVM within quartiles of physical activity. Results: Among White Maghreb, higher screen time was associated with smaller left ventricular mass (P < 0.001). This association persisted when adjusting for age, gender, heart rate, waist circumference, waist-to-hip ratio, systolic blood pressure QRS duration, TAPS and PAPS. Whereas, in blacks sub-Saharan African, the left ventricular mass was not associated with sedentary screen time. Conclusions: Sedentary screen time is associated with smaller left ventricular mass in White Maghreb, not in black sub-Saharan African. The lack of association in blacks supports a potential qualitative difference in the cardiovascular consequences of sedentary screen based behavior.

Background: Evidence that blacks have greater left ventricular mass (LVM) than whites has been demonstrated by large population-based American studies. However, to our knowledge, there is no study to date comparing LVM in Black Sub-Saharan Africans (BSSA) and the Maghreb white population. We compared LVM measured echocardiographically in asymptomatic BSSA and Maghreb. Methods and Results: A total of 100 asymptomatic BSSA and 189 Maghreb, (18 to 55 years old), underwent resting two-dimensional transthoracic echocardiography. LVM and geometry were assessed according to the 2015 American Society of Echocardiography and the European Association of Cardiovascular Imaging updated guidelines for cardiac chamber quantification. Crude or indexed LVM to body surface area or height2.7 was similar in BSSA and in Maghreb (132.7 ± 37.0 vs. 134.2 ± 35.7 g; 73.1 ± 17.8 vs. 72.9 ± 16.2 g/m2; 32.1 ± 9.8 vs. 33.6 ± 9.5 g/m2.7). However, the left ventricular posterior wall was thicker in BSSA. Patterns of left ventricular geometry (normal, concentric remodeling, or concentric or eccentric hypertrophy) were equally distributed among the two ethnic groups. Conclusions: Left ventricular posterior wall thickness but not LVM is greater in BSSA than in Maghreb.

There is a growing body of evidence showing a close correlation between left ventricular mass with cardiovascular morbidity and overall mortality. Therefore, identifying the determinants of left ventricular hypertrophy can be of great importance for cardiovascular prevention, for prognosis and therapeutic intervention. Objective: To assess the prevalence and identify the independent determinants of echocardiographic left ventricular hypertrophy in The MA-Ghreb and Sub-Saharan Africa Left-Ventricul ArGEometry Study (MAG-SALVAGES) participants. Methods: The MAG-SALVAGES is a community based study in which 100 asymptomatic Black Sub-Saharan African (BSSA) and 189 white skin Maghreb within the age of 18 to 55 years underwent a resting echocardiography. Multivariate logistic regression analysis was utilized to identify the independent determinants of LVH left ventricular hypertrophy. Results: Men represented the majority of the enrolled participants: 173 (59.9%). Echocardiographic left ventricular hypertrophy was seen in 10 (3.5%) participants. Age ≥40 years, female gender, overall obesity, abdominal obesity, hypertension status and less fruit consumption were significantly associated with echocardiography left ventricular hypertrophy. After adjusting for confounding factors, age ≥40 years, female gender, abdominal obesity and less fruit consumption were independently and significantly associated with echocardiographic left ventricular hypertrophy, as illustrated in the following equation: Y = 0.36 + 0.162 age >40 years + 2.69 female gender + 2.52 abdominal obesity + 1.31 less fruit consumption. Conclusion: Lifestyle changes for the prevention of abdominal obesity and encouraging fruit consumption may be beneficial in preventing left ventricular hypertrophy.

Background Insufficient iodine intake in pregnancy is associated with many adverse pregnancy outcomes. About 90% of African countries are at risk of iodine deficiency due to poor soils and dietary goitrogens. Pregnancy predisposes to insufficient iodine nutrition secondary to increased physiological demand and increased renal loss. Iodine deficiency is re-emerging in countries thought to be replete with pregnant women being the most affected. This review seeks to identify the degree of iodine nutrition in pregnancy on the entire African continent before and after the implementation of national iodization programmes. Methods A systematic search of published literature will be conducted for observational studies that directly determined the prevalence of insufficient iodine intake among pregnant women in Africa. Electronic databases and grey literature will be searched for baseline data before the implementation of population-based iodine supplementation and for follow-up data up to December 2018. Screening of identified articles and data extraction will be conducted independently by two investigators. Risk of bias and methodological quality of the included studies will be assessed using a risk of bias tool. Appropriate meta-analytic techniques will be used to pool prevalence estimates from studies with similar features, overall and by major characteristics including the region of the study, time period (before and after implementation of iodization programmes), sample size and age. Heterogeneity of the estimates across studies will be quantified and publication bias investigated. This protocol is reported according to Preferred Reporting Items for Systematic reviews and Meta-Analysis protocols (PRISMA-P) 2015 guidelines. Discussion This review will help ascertain the impact of national iodization programmes on the iodine nutrition status in pregnancy in Africa and advise policy on the necessity for monitoring and mitigating iodine deficiency in pregnancy in Africa. This review is part of a thesis that will be submitted to the Faculty of Health Sciences, University of Cape Town, for the award of a PhD in Medicine whose protocol has been granted ethics approval (UCT HREC 135/2018). In addition, the results will be published in a peer-reviewed journal. Systematic review registration PROSPERO CRD42018099434

Objective To identify environmental, pollutant metals, epidemiological, clinical, therapeutic, and able to predict case fatality among patients with anemia and hematological malignancy (HM). Methods This was a retrospective cohort study in black patient’s ≥ 20 years managed for recurrent fever, infections, anemia, and bacteremia between 2009 and 2015 at Kinshasa University Clinics, DRC. The outcomes such as incident HM and case fatality were assessed using univariate means, standard errors, relative risk (RR) and multivariate proportional Hazard ratio (HR) by Cox regression analysis, while Log-Rank test was performed for comparisons by Kaplan Meier curves (means, 95% CI, and median survival). Results Out of 105 incident HM patients (Male: Female ratio = 1), 57.1% (n= 60) experienced case fatality, There was no association between gender, residence, ethnicity, fever and mortality. There was a significant univariate association between age ≥ 55 years, serum chromium, serum cadmium, serum iodine, serum mercury, rainy season, hemolytic anemia, HM, bone pain, elevated Erythrocyte sedimentation, splenomegaly, abdominal pain, neutropenia, El Nino years, combined local dry season + global climate variability/El Nino, thrombocytopenia, multi-transfusions, bacteremia, lack of chemotherapy, and mortality. After adjusted for confounders using Cox regression models, only incident HM (HR = 16.8; 95% CI, P< 0.0001), Lack of chemotherapy (HR = 6.9, 95% CI, P< 0.002), and Bacteremia (HR= 4.2; 95% CI, P= 0.020) were the most significant and independent predictors of mortality. A separate analysis for HM patients, the mortality rates did not vary (P> 0.05) across HM sub-types: 71.4% (n= 10/14) in multiple myeloma, 84.3% (n= 15/18) in acute myeloid leukemia, 70% (n= 7/10) in myelodysplastic syndromes, 80% (n= 8/10) in chronic myeloid leukemia, 33.3% (n= 2/6) in acute myeloid leukemia, and 80% (n= 4/5) in acute lymphoid leukemia. Conclusion HM is a major cause of morbidity and mortality with epidemic rates explained by lack of chemotherapy, and recurrent bacteremia among Bantu patients facing aging, climate change, rainy seasons, and lack of palliative care.

IntroductionPre-eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. Although subclinical hypothyroidism (SCH) in pregnancy is one of the established risk factors for pre-eclampsia, the link between iodine deficiency, the main cause of hypothyroidism and pre-eclampsia remains uncertain. About two billion people live in areas with iodine insufficiency. The increased renal blood flow during pregnancy leading to increased renal iodine clearance together with the increased placental transfer of iodine to the fetus leads to further iodine deficiency in pregnancy. Iodine is one of the most potent exogenous antioxidants whose deficiency is associated with oxidant imbalance and endothelial dysfunction, one of the mechanisms associated with increased risk of pre-eclampsia.Methods and analysisA systematic search of published literature will be conducted for case–control studies that directly determined the iodine nutrition status of women with pre-eclampsia and appropriate normotensive controls. A similar search will be conducted for cohort studies in which the incidence of pre-eclampsia among pregnant women with adequate and inadequate iodine nutrition status was reported. Databases including MEDLINE, EMBASE, Google Scholar, SCOPUS and Africa Wide Information will be searched up to 31 December 2018. Screening of identified articles and data extraction will be conducted independently by two investigators. Risk of bias of the included studies will be assessed using a Newcastle-Ottawa Scale. Appropriate meta-analytic techniques will be used to pool prevalence and incidence rates, odds and relative risk of pre-eclampsia from studies with similar features, overall and by geographical regions. Heterogeneity of the estimates across studies will be assessed and quantified and publication bias investigated. This protocol is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocols (PRISMA-P) 2015 guidelines.Ethics and disseminationSince the proposed study will use published data, there is no requirement for ethical approval. This review seeks to identify the risk of pre-eclampsia associated with insufficient iodine nutrition in pregnancy. This will help to ascertain whether insufficient iodine intake may be an independent risk factor for pre-eclampsia. This will advise policy makers on the possibility of maximising iodine nutrition in pregnancy and reproductive age as one of the remedies for prevention of pre-eclampsia among populations at risk of inadequate iodine intake. This review is part of the thesis that will be submitted for the award of a PhD in Medicine to the Faculty of Health Sciences of the University of Cape Town. In addition the results will be published in a peer-reviewed journal.PROSPERO registration numberCRD42018099427.

Background and aim: COVID-19 is a public health problem but radiological data are still absent in developing countries. The aim of the study was to determine preliminary data from patients hospitalized for COVID-19 at the LOMO Medical Center during the first and second waves. Methods: Cross-sectional and descriptive study carried out in 83 patients with COVID-19 at the Lomo Medical Center in Limete during the period from March 19, 2020 to January 24, 2021. The clinical and radiological characteristics were studied. Results: The sample of our study is predominantly male (55%) over women (45%), resulting in a sex ratio of 1.2 (M/F). The results obtained from VS and D-dimer show high mean values in patients whose COVID-19 is confirmed positive but low in those from whom it is suspected/absent. The difference in means is statistically significant (p

Lumbar disc herniation (HDL) is a major public health problem in the world. Objectives: The study aimed to determine the clinical and radiological aspects of the lumbar disc herniation [LDH] operated in Kinshasa environments Hospital. Materials and methods: It was a well-documented 160 cases of LDH operated in Biamba Marie Mutombo hospital from January 2012 until December 2016 was evaluated. Results: The most interesting age group range from 31 to 50 years (68, 8%) with a mean age of 44, 7 ± 12, 3 years in that Females were the most affected with 55.6%. Sciatica L5 was found in 28.8% of cases compared to sciatica S1 (15.6%) and left lateralization in 48, 1%. As for imaging results, the posterolateral type was the most common with 53.8% of cases. The disc level: L4-L5 was the most affected in 61.1% of cases. The single LDH was the most common. The discrepancy between imaging and surgery results was 6.3% for medial herniated discs and 24.4% for posterolateral disc herniation. Conclusion: LDH is a pathological reality in hospitals of Kinshasa. The aspects found mainly corroborate literature observations. The discrepancy between imaging and surgery results was statistically insignificant.

Background: it is difficult to measure directly insulin sensitivity in routine practice. An easily measured anthropometric parameter associated with insulin resistance (IR) would be a very useful tool in detecting people at risk. Objective: To investigate the association between neck circumference (NC) and Insulin Resistance (IR) in Bantu population. Methods: Cross-sectional health screening conducted between February and May 2019, among Bantu population from Brazzaville in Republic of Congo. The analysis included 500 participants, aged ≥ 20 years. Anthropometric indices and blood pressure were measured by standard protocol. Fasting lipid profile, blood glucose and insulin were determined. Triglyceride Glucose index (TyG index) and triglyceride/high density lipoprotein ratio (TG/HDL) were calculated. IR was defined as HOMA-IR ≥ 2. TyG index was calculated by using the formula: Ln [TG (mg/dL) x FPG (mg/dL)/2]. To investigate if there was a statistically association between NC and IR parameters, a correlation was computed. To evaluate the influence of NC on IR parameters, the study population was divided in 3 groups by tertiles of NC in both men and women The diagnostic ability of NC, WC, TyG index and TG/HDL ratio to identify people with IR was determined with the receiver operating characteristic (ROC) curves. Results: NC was positively correlated with insulin, TG/HDL, TyG index and HOMA-IR. For all variables, this correlation was stronger in comparison with WC. In all participants, TG/HDL shows the largest AUC for IR detection (0.810, 95% CI: 0.765–0.855) followed by TyG index (0.799, 95% CI: 0.754–0.844), NC (0.624, 95% CI: 0.572–0.677), and WC (0.616, 95% CI: 0.560–0.672) in that order. Conclusion: NC is associated with IR. NC is better than WC to identify IR in Bantu population from Brazzaville in republic of Congo.

Background: The diagnosis of hypertension in children and adolescents is not always easy. The blood pressure-to-height ratios (BPHR) have been proposed as a screening tool for diagnosing hypertension. Objective: To evaluate the diagnostic value of BPHR for detecting hypertension in young adults. Methods: A cross-sectional study was conducted among 12621 healthy young adults aged of 18-25 years in Kinshasa, from July 2018 to February 2019. Systolic blood pressure-to-height ratio (SBPHR) was calculated as systolic blood pressure (SBP) in mmHg devised by height in centimeter. Diastolic blood pressure-to-height ratio (DBPHR) was calculated as diastolic blood pressure (DBP) in mmHg devised by height in centimeter. The receiver operating characteristics (ROC) curve analysis had allowed determining the cut-off points of SBPHR and DBPHR to detect hypertension. Results: The prevalence of hypertension, prehypertension, obesity and overweight were 10.5%, 9.2%, 3.0% and 22.4% respectively. The median values of SBPHR were 0.75 (0.69-0.79) mmHg/cm and 0.77 (0.67-0.80) mmHg/cm respectively in men and in women. The median values of DBPHR were 0.48 (0.44-0.53) mmHg/cm and 0.51 (0.49-0.56) mmHg/cm respectively in men and in women. Optimal cutoff points of SBPHR to identify hypertensionwere0.81mmHg/cm and 0.89 mmHg/cm respectively in men and in women. The threshold of DBPHR to detect hypertension was 0.54 mmHg/cm in both men and women. SBPHR and DBPHR had high sensitivity and specificity for identifying hypertension. Conclusion: SBPHR and DBPHR can be used to detect hypertension in Bantu young adults in Kinshasa.

Background and Aim: In limited resource settings, reliable epidemiological data generated from hypertension high risk geographical areas or people is a prerequisite for the planning of proven and effective interventions. The aim of the present survey was to assess the prevalence, awareness, control and factors associated with hypertension in adults living in the port City of Boma, located in the southwestern part of DRC. Methods: a cross-sectional survey using a modified WHO STEP wise questionnaire for data collection during face-to face interviews was conducted from March, 1 to April 15, 2018. We did multi-stage cluster sampling. Was an all-inclusive adult over the age of≥18 years having given informed consent. Information on demographic parameters, lifestyles, anthropometric measurements and blood pressure (BP) were obtained. Hypertension was defined as a mean of two BP≥140/90 mmHg or a self-reported history of antihypertensive drug use. Independent factors associated with hypertension were identified using logistic pressure analysis. P

This publication intends to provide a step-by-step description of the application of factor analysis performed at the two levels and interpretation of the results based on information seeking behaviour of medical professionals of five selected hospitals in O. R. Tambo District municipality in the Eastern Cape Province of South Africa. The data for analysis was collected on different variables using a closed-ended likert scale questionnaire. This study was a cross-sectional, comparative, and correlational survey conducted between January and April 2017, in the Mthatha Hospital Complex, O. R. Tambo District Municipality. The clustering of indicators for extraction of factors was well-defined owing to high loadings across all questions. The analysis was executed on a split data approach. The data were split by gender. The analysis was performed on the separate derived data sets. Descriptive analyses, correlations and component factor analyses were performed. The data consisted of 96.3% South African participants and 3.7% Non-South African. In addition, the sample was composed of 17.5% Males and 82.5% females; 13.8% medical doctors and 86.2% professional nurses. The percentage age distribution was

Coronavirus Disease 2019 (COVID-19) is a contagious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the first reported case in sub Saharan Africa, countries have struggled to respond to the pandemic despite all the barrier measures and preventions strategies put in place; amongst them, Cameroon is characterized by a large amount of contamination and an increase in death rates. The purpose of this study was to assess the knowledge, attitudes and practices (KAPs) of the Cameroonian population on barrier and preventive measures against COVID-19; the first undertaken in the cities of Douala and Bangangte since the beginning of the COVID-19 pandemic. A cross-sectional study was carried out on 777 residents in the Littoral (Douala) and in the West (Bangante) regions of Cameroon from a structured, pre-tested and self-administered questionnaire (according to WHO guidelines). Data were collected and analyzed using SPSS version 18.0 software. For p=0.05, the difference was statistically significant. Out of 777 participants, 67.7% (n=526) were from Douala and 32.3% (n=251) from Bangangte. Seventy percent (70%) of our participants were aware of the main preventive measures against COVID-19 taken by the Cameroonian government. The most used preventive method was the practice of hand hygiene (88.9%); followed by social distancing (87.2%), respiratory hygiene (75.8%), and self-confinement (85.3%). The majority of our participants had a positive attitude towards hand hygiene (81.6%) and wearing a face mask (84.7%). About 52.9% wore a face mask occasionally, 66.67% always washed their hands, 53.1% always used a hand sanitizer to disinfect their hands and 65,4% regularly self-confined themselves homes. Improving behaviors / attitudes and practices remain a major challenge for our populations. It is important to integrate the community in decision-making and increase awareness among our populations. Further studies are required to assess the impact of strategies undertaken by the decision makers, to roll out the COVID-19 pandemic in Cameroon.

Background: To date, world widely, only a couple of papers have reported the association between pulmonary tuberculosis, Coronavirus disease 2019 (COVID-19) and pregnancy, and none of these reports was from sub-Saharan Africa where tuberculosis is endemic. Objective: the main objective of this study is to describe the co-infection Pulmonary Tuberculosis and Severe COVID-19 in pregnant young Woman at the University Hospital of Kinshasa. Method: The report case is of a pregnant woman aged 19 (Pare 2, Gesture 2, Abortion 0) with no known significant medical history, at 32 weeks of gestation based last menstrual period She has benefited from clinic examination, biological examinations (Ziehl’s on sputum), a chest CT scan and a morphological ultrasound. Result: On admission, COVID-19 was the only working diagnosis. However, the persistent coughing prompted clinicians to request a Ziehl-Neelsen staining of sputum that revealed the diagnosis of pulmonary TB. The reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 infection and HIV serology negative. A contrast-enhanced chest computed tomography (CT) showed airspace disease involving the right upper lobar, right medial basal segment and left upper lobe in the background of diffuse micro-nodular opacities favored to represent military pulmonary tuberculosis. There were associated cystic bronchiectasis in bilateral upper lobe and bilateral small amount of pleural effusion. Aforementioned findings were favored to represent a secondary or reactivation tuberculosis. The obstetrical ultrasound showed a single live intrauterine pregnancy in breech presentation, estimated at 34 weeks 3 days of gestation without usual features including detectable congenital malformation. Conclusion: The outcome of a pregnant woman with simultaneous COVID-19 and pulmonary tuberculosis is improved when the diagnosis is made early and management is promptly initiated. This attitude also improves the fetal prognosis. In the context of the COVID-19, the association of COVID-19 and pulmonary tuberculosis, especially in immunocompromised patients should be considered.

aims: To investigate the association between neck circumference (NC) and abdominal obesity indicators: waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), Lipid Accumulation Product (LAP), Visceral Adiposity Index (VAI) and Abdominal volume index (AVI), in Bantu population at Brazzaville. Methods: A total of 500 subjects (mean age: 47.2±13.6 years) were recruited in Brazzaville to perform anthropometric measurements, including WC and hip circumference (HC), NC, body mass index (BMI), Blood pressure, fasting glucose and insulin, and lipid profile (total cholesterol TC, high-density lipoprotein cholesterol HDL, low-density lipoprotein cholesterol LDL, and triglyceride TG levels) were determined. The LAP, VAI and AVI were calculated as: LAP=[WC (cm) – 65] x TG (mmol/l); VAI=[WC (cm) / 39.68+ 1.88 x BMI (kg/m2)] x [TG (mmol/l)/1.03) x [1.31/ HDL (cm)] for males and LAP=[WC (cm) – 58] x TG (mmol/l); VAI=[WC (cm) / 36.58+ 1.89 x BMI (kg/m2)] x [TG (mmol/l)/0.81) x [1.52/ HDL (cm)] for females. For both males and females: AVI=[2 cm x WC2 (cm)2 + 0.7 cm x (WC – HC)2]/1000. Results: NC was significantly (p

Traumatic brain injury is a global health problem, it is a major cause of devastating neurological sequelae and significant mortality. The underlying physiological events in traumatic brain injury are responsible for the poor clinical outcomes seen in patients. Inflammatory and oxidative stress changes in traumatic brain injury result in the release of inflammatory biomarkers, a reduction in the endogenous anti-oxidants and dysfunction of the blood brain barrier. An understanding of the natural history of oxidative stress and inflammatory changes in traumatic brain injury can help design appropriate management protocols to reduce mortality and morbidity in these patients. Aim of the study: The aim of this study was to identify potential biomarkers that are predictive of fatality in patients with moderate to severe traumatic brain injury. Methods: This was a prospective study of patients with moderate to severe traumatic brain injury managed at the Nelson Mandela Academic Hospital during the period March 2014 - March 2016. Following admission and management, the patient demographics (sex, age) and admission Glasgow Coma Score were recorded. Oxidative stress and inflammatory biomarkers in blood and cerebrospinal fluid where sampled on day 1 to 7. On day 14 only blood was sampled for the same biomarkers. The primary outcome was the Glasgow Outcome score assessed on day 90. Due to its simplicity the Glasgow Outcome scale was used to assess clinical outcomes at day 90. Because of difficulty in regular follow up due to the vastness of our region, difficult terrain and long travel distances a 3 month follow up period was used to avoid default. Results: Of the 64-patient’s, fatality was noted in 12.5% of them. There was a significant association between fatality and the; ages of the patients, anti-oxidant levels, proinflammatory biomarkers and admission Glasgow Coma Score. Conclusion: The admission Glasgow Coma Score, low anti-oxidant levels and elevated serum interleukin-1β levels were associated with fatal outcomes.

Objective: To investigate the association between neck circumference (NC) and traditional cardiometabolic risk factors (CMRF) among adult’s population at Kinshasa. Methods: A total of 400 participants were recruited. Spearman’s correlation coefficient was employed to test the correlations between NC and CMRF. The association of NC with CMRF (dependent variables) was assessed by logistic regression. The receiver operating characteristics (ROC) curve analysis had allowed determining the cut-off points of NC to detect the presence of CMRF. Results: The average of age and WC was 55.4±12.0 years and 79.8±12.0 cm, respectively. The median value of BMI was significantly higher in women (24.6 kg/m2) than in men (22.6 kg/m2); whereas the median value of NC was significantly higher in men (37.8 cm) than in women (33.3 cm) (p < 0.001). In both men and women, NC was positively correlated with TC, LDL, TG and WC. Additionally, FPG and HDL were positively correlated with NC significantly. Moreover, there was a significant positive correlation between NECK and FPG but a significant negative correlation between NECK and HDLc among women. TG in men, raised TC, LDL and WC were found to be significantly associated with neck circumference with ORs 1.25 (95% CI: 1.08, 1.44), 0.67 (95% CI: 0.53, 0.85), 1.13 (95% CI: 1.02, 1.26), 1.27 (95% CI: 1.12, 1.45) in men versus 1.18 (95% CI: 1.03, 1.36) in women, 1.19 (95% CI: 1.06, 1.34) in men versus 1.21 (95% CI: 1.06, 1.38) in women and 1.18 (95% CI: 1.06, 1.36) in men versus 1.43 (95% CI: 1.23, 1.66) in women, respectively. Cut-off points for NC to identify CMRF were between 37.5 and 38 cm in men, 32.5 and 33 cm in women. Conclusion: NC is associated with CMRF, and could be a useful and accurate tool to identify high risk participants.

Background and Objective: Chronic obstructive pulmonary disease (COPD) is predicted to be the third leading cause of death worldwide by 2020. Its diagnosis remains a challenge in developing countries such as DRC, with the use of Gold standard, spirometry, limited. Chest imaging plays an important role in orientation. The absence of local radiological data from COPD had therefore motivated this study. The aim of this study is to establish a relationship between gender, environment and COPD. Materials and Methods: Retrospective and analytical study of clinical and thoracic imaging data (radiography and CT scan), collected from the records of 120 COPD subjects followed in three Kinshasa medical trainings between January 2014 and June 2017. Fisher's test compared the results obtained. The combination of imaging data and clinical phenotype through Pearson chi-square testing, logistic regression and odds-ratio (OR). The service threshold was set at 0.05. Results: the study population (average age of 64.52±6.82 years) was predominantly male (78.3% n=94). Results: the study population (average age of 64.52±6.82 years) was predominantly male (78.3% n=94). The proportions of sputum were more common in men than in women, the difference being statistically significant. Indeed, the male sex confers a triple risk (OR=3.1; IC 95% 1.2-8; P=0.015). Women were more exposed to domestic and/or occupational pollution (65.4% n=17; than men were (26.6% n=25). Indeed, the male sex conferred a risk of exposure to domestic pollution and/or occupational pollution multiplied by 14 times (OR=14.3; IC 95%; 2-100; P=0.001) and allergy conferred a risk of exposure to domestic pollution by 17 times (OR=17.1; IC95%: 2.1-137, p=0.007). Conclusion: This study showed the male sex and allergy is conferred a high risk of the domestic pollution or occupation pollution.

Background: This study determined the diagnostic performance of new biomarkers for a composite diagnosis of non-communicable diseases (NCDs) among Central Africans. Methods: This case-control study was conducted at LOMO Medical Centre, Kinshasa, DR Congo (DRC) between January – December, 2008. The cases comprised 226 participants with concurrent presence of at least 2 or more of NCDs. Anthropometric parameters and blood pressure were measured while blood samples were assayed for biomarkers. The receiver operating characteristics curve and the logistic regression model were applied. Results: Serum selenium (Se) had specificity and sensitivity of 72.4% and 91.1%, respectively with an area under the curve (AUC) of 0.802; Nitric oxide (NO) (specificity: 72.4%; sensitivity: 93.0%) (AUC = 0.800); Thyroid stimulating hormone (TSH) levels > 6 Mu/L (specificity: 75%; sensitivity: 65%) (AUC = 0.0.727); serum calcium levels of ≥ 110g/L (specificity: 76%; sensitivity: 75%) (AUC = 0.822); and daily salt intake of ≥10 g/day (specificity: 75%; sensitivity: 67%) (AUC = 0.653) in the diagnosis of all NCDs, which were all highly significant (

Background/aim: We calculated the homeostatic model assessment (HOMA) for estimating insulin sensitivity and beta-cell function in normal, healthy nondiabetics with infections (malaria, influenza, HIV, Helicobacter pylori, Chlamydia pneumoniae, and hepatitis C virus), type 2 diabetic black patients, and healthy controls from Kinshasa, DR Congo. Materials and methods: A case-control study was carried out between 2006 and 2007 for black Central African participants managed for HOMA.Results: In total, 219 patients and 110 healthy controls were matched for sex and age. The hyperbolic product for 85 infected patients occupied an intermediate position between the hyperbolic product for 110 controls and that of 134 type 2 diabetics. Inflammation/oxidative stress was present in all infected patients, as well as in the type 2 diabetics. Of the patients, 39.3% and 49.8% had insulin resistance and metabolic syndrome, respectively. Insulin resistance was more prevalent in nondiabetics with inflammation/oxidative stress (47.1%; P = 0.041) than in type 2 diabetics (34.3%). Type 2 diabetics had higher insulin sensitivity and lower beta-cell function but a similar HOMA-IR score. Conclusion: We recommend the assessment of insulin resistance in Central African patients with severe infections and type 2 diabetes.

Objectif Le present travail avait pour objectif d’estimer la seroconversion relative a l’hepatite B chez les donneurs de sang benevoles et reguliers aux Cliniques Universitaires de Kinshasa au cours de la periode allant du 15 mars 2012 au 31 decembre 2014. Methode Il s’agit d’une etude de cohorte retrospective, realisee chez les DS benevoles et reguliers qui ont fait au moins deux dons de sang aux Cliniques Universitaires de Kinshasa au cours de la periode d’etude. Resultats Au total, 1051 dons de sang ont ete enregistres provenant d’une cohorte de 352 DS benevoles et reguliers au cours de la periode allant du 15 mars 2012 au 31 decembre 2014. La moyenne d’âge etait de 32 ± 11,3 ans, l’âge median etait de 28 ans, la tranche d’âge la plus representee etait celle de 17 a 25 ans soit 38,5 % (405/1051) et la population estudiantine a represente 53,9 % (567/1051) de la population d’etude. Par contre, cette frequence diminuait avec l’augmentation de l’âge des donneurs de sang. La frequence de l’AgHBs etait de 0,9 % (9/1051) et l’annee 2014 a ete caracterisee par la frequence la plus elevee des cas de seroconversion soit 55,6 % (5 cas sur 9 cas positifs). Le taux d’incidence de la seroconversion du virus de l’hepatite B (AgHBs) etait estime a 0,00116 nouveau cas de seroconversion de l’AgHBs par personnes-mois soit 11,6 nouveaux cas de seroconversion de l’AgHBs par 10,000 personnes-mois. Conclusion La presente etude a montre que le taux d’incidence de la seroconversion de l’AgHBs etait faible chez les donneurs de sang benevoles et reguliers de la Banque de Sang des CUK.

Aim The objective of this study was to investigate the time related profile and efficiency of co-expression of the homeodomain proteins Pdx1, NeuroD, Ngn3, Pax6 and caspase3 with insulin, and to establish the time periods post PDL optimum for islets transplantation. Study design/methods In this experimental study, immunofluorescent staining procedure was performed on deparaffinized pancreatic duct ligated (PDL) tissues of 78 Sprague–Dawley rats. Quantification of protein coexpression was made using a computerized morphometry. The efficiency of co-expression was arbitrary defined by the value of mean ratio (score without unit) of insulin expression divided by each expression index of the other proteins, occurring within the time interval of 12–24 h post PDL. Statistical tool was used to analyze the efficiency of co-expression of proteins; analysis of variances (one way ANOVA) was used to compare the means of co-expression indexes across the time periods pre- and post PDL. P-values less than 0.05 were considered statistically significant; no post hoc test was done. Results The curve of insulin expression showed a crossover with that of the co-expression at different time periods pre- and post PDL. The optimal or higher efficiency of co-expression was observed for insulin and Ngn3 co-expression, while a good or medium efficiency was noted for the co-expression of insulin with Pdx1, insulin with NeuroD and insulin with Pax6. Low or weak efficiency was observed for the co-expression of insulin with caspase3. Conclusion We therefore propose an early islets transplantation using 12–24 h post PDL harvested pancreatic tissues.

Introduction : The metabolic syndrome (MetS) is common in human immune deficiency virus (HIV)-infected individuals receiving highly active antiretroviral therapy (HAART). Immune deficiencies caused by HIV give rise to numerous opportunistic gastrointestinal pathogens such as Helicobacter pylori, the commonest cause of chronic gastritis. The study sought to determine the relationship between H pylori infection and the MetS among HIV-infected clinic attendees. Methods : This cross-sectional study was carried out in a specialised heart clinic in Kinshasa, DR Congo. Between January 2004 and December 2008, 116 HIV-infected patients (61 with MetS and 55 without MetS) who underwent upper gastrointestinal endoscopy for dyspeptic symptoms were included in the study following an informed consent. Univariate associations were determined by odds ratios (OR), while multivariate logistic regression analysis was used to identify factors associated with the MetS. Results :H pylori infection (OR = 13.5, 95% CI: 10.3-17.6; p < 0.0001) and peripheral obesity (median hip circumference ≥ 97 cm) (OR = 4.7, 95% CI: 1.2-18.8; p = 0.029) were identified as MetS-related factors in HIV-infected patients. Higher rates of the MetS were associated with increased incidence of HIV-related immunocompromise using World Health Organisation (WHO) staging criteria. There was a univariate significant difference in the prevalence of the MetS between antiretroviral therapy (ART)-naive patients and patients treated by means of a first-line HAART regimen of stavudine (d4T), lamivudine (3TC) and nevirapine (NVP). However, this difference was not significant in multivariate logistic analysis. Conclusion :H pylori infection was significantly associated with the MetS in HIV-infected patients.

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.

OBJECTIVETraumatic brain injury (TBI) is a significant cause of morbidity and mortality worldwide. Clinical outcomes in TBI are determined by the severity of injury, which is dependent on the primary and secondary brain injury processes. Whereas primary brain injury lesions are related to the site of impact, secondary brain injury results from physiological changes caused by oxidative stress and inflammatory responses that occur after the primary insult. The aim of this study was to identify important clinical and biomarker profiles that were predictive of recovery after moderate to severe TBI. A good functional outcome was defined as a Glasgow Outcome Scale (GOS) score of ≥ 4.METHODSThis was a prospective study of patients with moderate to severe TBI managed at the Nelson Mandela Academic Hospital during the period between March 2014 and March 2016. Following admission and initial management, the patient demographic data (sex, age) and admission Glasgow Coma Scale score were recorded. Oxidative stress and inflammatory biomarkers in blood and CSF were sampled on days 1–7. On day 14, only blood was sampled for the same biomarkers. The primary outcome was the GOS score—due to its simplicity, the GOS was used to assess clinical outcomes at day 90. Because of difficulty in performing regular follow-up due to the vastness of the region, difficult terrain, and long travel distances, a 3-month follow-up period was used to avoid default.RESULTSSixty-four patients with Glasgow Coma Scale scores of ≤ 12 were seen and managed. Among the 56 patients who survived, 42 showed significant recovery (GOS score ≥ 4) at 3 months. Important predictors of recovery included antioxidant activity in the CSF (superoxide dismutase and total antioxidant capacity).CONCLUSIONSRecovery after TBI was dependent on the resolution of oxidative stress imbalance.

Background The global burden of hematologic malignancy (HM) is rapidly rising with aging, exposure to polluted environments, and global and local climate variability all being well-established conditions of oxidative stress. However, there is currently no information on the extent and predictors of HM at Kinshasa University Clinics (KUC), DR Congo (DRC). This study evaluated the impact of bio-clinical factors, exposure to polluted environments, and interactions between global climate changes (EL Nino and La Nina) and local climate (dry and rainy seasons) on the incidence of HM. Methods This hospital-based prospective cohort study was conducted at Kinshasa University Clinics in DR Congo. A total of 105 black African adult patients with anaemia between 2009 and 2016 were included. HM was confirmed by morphological typing according to the French-American-British (FAB) Classification System. Gender, age, exposure to traffic pollution and garages/stations, global climate variability (El Nino and La Nina), and local climate (dry and rainy seasons) were potential independent variables to predict incident HM using Cox regression analysis and Kaplan Meier curves. Results Out of the total 105 patients, 63 experienced incident HM, with an incidence rate of 60%. After adjusting for gender, HIV/AIDS, and other bio-clinical factors, the most significant independent predictors of HM were age ≥ 55 years (HR = 2.4; 95% CI 1.4–4.3; P = 0.003), exposure to pollution and garages or stations (HR = 4.9; 95% CI 2–12.1; P

Vulvo-vaginal candidiasis (VVC) is a common condition in human immunodeficiency virus (HIV)-infected women. Toll-like receptor (TLR) 2 and TLR4 are key pattern-recognition receptors of the innate immune system in sensing Candida albicans. The aim of this study was to assess the expression of TLR2 and TLR4 signaling pathways in HIV-infected and uninfected women with VVC. Cervico-vaginal fluids (CVF) were obtained from 7 HIV infected and 11 HIV uninfected clinic attendees in KwaZulu-Natal between June, 2011 and December, 2011. VVC was diagnosed clinically and confirmed by Gram stain and culture of genital samples. Monocytes were isolated from a healthy adult volunteer, pre-incubated with anti-TLR2, anti-TLR4 and a combination of anti-TLR2/anti-TLR4 monoclonal antibodies. Monocytes were then stimulated by CVF. Levels of cytokines were measured by Luminex® multiplex immunoassays. Compared with baseline concentrations, stimulation with CVF of HIV+VVC+ women post-TLR2 blockage increased IL-6, IL-10 and IL-13 production by 165.5, 162.5 and 106.7%, respectively. Using paired T-tests, there was a significant difference in the increase of the concentrations of IL-6 (P = 0.04), IL-10 (P = 0.003), and IL-13 (P = 0.031) when comparing stimulation by CVF of HIV+VVC+ versus stimulation by CVF of HIV-VVC+ patients. There was a linear correlation between genital HIV RNA loads and mean level production of IL-6 (r = 0.722; R2 = 0.679; P = 0.067) as well as IL-8 (r = 0.910; R2 = 0.833; P = 0.004). Findings suggest potential roles of TLR2 in the pathogenesis of VVC among HIV-infected women. Key words: Symptomatic VVC, HIV, TLR2 and TLR4.

Background: Hypertensive patients with insulin resistance (IR) are at greater risk of cardiovascular disease and may represent a particular subset of hypertension (HTN) requiring special medical attention. Quantitative measurements of the IR are not suitable for routine clinical practice. Met-abolic syndrome (MetS) or simply abdominal obesity (AO) is surrogate of IR. The performance of the recently proposed Sub-Saharan Africa cut-off point of abdominal obesity for identifying IR in hypertensive patients has never been evaluated. Aims: The main objective was to compare the performance of the newly proposed Sub-Saharan Africa specific threshold of abdominal obesity (AO-SSA) to that of IDF (AO-IDF) in identifying IR in Congolese Black Hypertensive Patients. Methods: A cross-sectional study was conducted at the Heart of Africa Cardiovascular Center, Lomo Medical Clinic, Kinshasa Limete, DR Congo, between January 2007 and January 2010. Homeostatic model assessment (HOMA) index was calculated to determine IR. Multivariate logistic regression analysis was used to assess the independent determinants of IR. The intrinsic (sensitivity and specificity) and extrinsic (positive predictive value and negative predictive value) characteristics of the AO-SSA, AO-IDF, AO-ATP III, MetS-SSA, MetS-IDF, and MetS-ATP III were calculated. The kappa statistic was determined for agreement between the ATPIII, IDF and SSA defined AO and MetS with HOMA-IR. Results: Men represented the majority of the enrolled patients: 105 (64.4%) and the mean age of all participants were 57 ± 11 years. Insulin resistance was found in 79.1% of the study population with 88.7, 79.3, 84.6, 71.4, 75.5, 91.1, 60.3 and 44.8 respectively among patient with MetS-ATP, MetS-IDF, MetS-SSA, AO-ATP III, AO-IDF, AO-SSA, diabetics and non-obese non-diabetic hypertensive patients. In multivariate analysis, the risk of IR was associated independently and significantly (p < 0.05) with cigarette smoking, low-HDL-C, hyperuricemia, and diastolic HTN, as shown in the following equation: Y = ﹣1.404 + 1.054 Cigarette Smoking + 0.872 low HDL-C + 0.983 hyperuricemia + 0.852 diastolic hypertension. The AO-SSA, with 87.7% sensitivity and 67.6% specificity, was the only surrogate who showed an acceptable agreement with the HOMA-IR index. Abdominal obesity defined according to other thresholds and the metabolic syndrome whatever the used diagnostic criteria have a slight agreement with the HOMA-IR index. Conclusion: IR was found to be prevalent in our study population. Cigarette smoking, low-HDL-C, hyperuricemia, and isolated diastolic HTN magnify IR. The AO-SSA is an easy and cost efficient method to diagnose IR in Congolese Black Hypertensive Patients. Further study in wider group is indicated to validate our findings.

Background and Aim: Cardiovascular risk (CVR) factors, namely hypertension (HT), diabetes mellitus and obesity, are a public health problem in sub-Saharan Africa because of health transition. The additional effect of the social gradient within the railway companies in Congo-Brazzaville on high CVR is not yet established. The aim of this study was to determine the extent of hypertension, diabetes mellitus, overweight, and obesity and to identify the contributing factors of fatness and hypertension. Methods: This was a cross-sectional study conducted in April 2013. A simple random sample of 255 out of all 2550 workers from the railway companies of Congo was examined for epidemiological, clinical and biological variables. Results: Out of the study sample, 231 (90.6%), 79 (31%), and 52 (20.4%) were men, rural dwellers, and senior executives, respectively. The mean age was 45 ± 13 years (range 19 to 63 years). The rates of overweight, hypertension, obesity, and diabetes mellitus were 40.3% (n = 103), 29.4% (n = 75), 7.5% (n = 19), and 3.5% (n = 9), respectively. In univariate analysis, female sex (OR 2.7, 95% CI 1.13 - 6.45, p = 0.01), senior executive (OR 2.4; 95% CI: 1.3 - 4.5; p = 0.003) and physical inactivity (OR 2.5; 95% CI: 1.5 - 4.2; p 21; p CI: 1.2 - 8.3) were also significantly associated with obesity. In logistic regression, overweight (OR = 4.8, 95% CI 2.8 - 11, p

Objectives: To assess the associations of high density lipoprotein cholesterol (HDL-C) and Framingham cardiovascular (CVD) with diabetic retinopathy (DR). Methods: A cross-sectional study of random sample of 200 T2DM Central Africans. Sociobiographical, laboratory and eye examination main outcome measures were investigated using Tertiles of HDL-C (stratification = lowest 10% were the significant independent determinants for DR. In the highest HDL-C group, smoking status and 10-year Framingham risk ≥ 10% were the significantly independent determinants for DR. In 10-year Framingham risk ≥ 10% group, smoking status, insulin resistance and increasing levels of HDL-C were the significantly independent determinants for DR. Conclusion: DR and VD remain a public health problem in T2DM Central Africans. Some Central Africans with DR and VD appear to have higher HDL-C than T2DM Central Africans without DR and VD. HDL-C in T2DM patients with DR, may be tightly controlled by genetic factors (black Bantu ethnicity) than the other lipoproteins as reported among Indians, African-Americans, and Japanese individuals. The most preventable environmental risk factors for DR were smoking status, global cardiovascular disease risk, insulin resistance and oxidative stress.

Background.To determine the prevalence and associated factors of prehypertension (pre-HT) and hypertension (HT) in schoolchildren at Brazzaville (Congo).Methods.This cross-sectional study was conducted from March to May 2011 in five representative urban schools in Brazzaville. American Pediatric Society’s definition of pre-HT and HT was used. The measurement of blood pressure was obtained using auscultator method. Univariable and multivariable analyses were performed to establish associations between blood pressure levels and sociobiographical factors.Results.603 children were included. The mean age was11.8±3.6years (range 5–18 years). The prevalence of pre-HT was 20.7% (n=125). Factors associated with pre-HT were secondary school (P=0.02), private schools (P<0.004), migrants (P=0.03), the obese (P=0.004), high socioeconomic level (P<0.01), and overweight (P=0.02). In logistic regression, the independent determinants of pre-HT were secondary school (P=0.0001), migration (P=0.04), obesity (P=0.004), and overweight (P=0.01). The prevalence of HT was 10.1% (n=61) during the first screening and 3.3% (n=20) in second screening. The independent determinants of HT were obesity (P=0.0001) and overweight (P=0.0001).Conclusion.Pre-HT and HT are emerging as a mass problem in Congolese schoolchildren with urban migration and overweight/obesity to be controlled and prevented.

Resume Contexte Il n’y a pas d’information importante (securite, selection et fidelisation des donneurs de sang, politiques du recrutement) relative aux donneurs de sang non remuneres (nouveau donneur benevole, donneur benevole regulier ou donneur familial) aux Cliniques Universite de Kinshasa (CUK), RDC. Ainsi, l’objectif de cette etude etait de determiner l’ampleur et les determinants de l’ajournement des donneurs de sang. Methodes Une etude documentaire a ete menee a la Banque de Sang des CUK entre 2010 et 2013 selon les criteres d’ajournement temporaires ou definitifs. Resultats Parmi les donneurs de sang potentiels ( n = 1220), d’âge moyen de 32,7 ± 11,1 ans, 86,3 % ( n = 1049) hommes contre 14 % ( n = 174) femmes avec un sex ratio de 6 hommes :1 femme,65,9 % ( n = 798), 27,7 % ( n = 338) et 6,9 % ( n = 89) etaient respectivement des types volontaire et regulier, nouveaux donneurs volontaires et familial. Seuls 6,5 %( n = 79) ont ete ajournes pour hypertension arterielle (2,2 % n = 27), corticotherapie (2,0 % n = 25), et anemie (0,7 % n = 8). Apres ajustement pour des facteurs de confusion, la regression logistique a identifie l’âge ≥ 50 ans, le sexe feminin, nouveau donneur benevole, donneurs de sang familial comme les determinants independants et significatifs de l’ajournement au don de sang. Conclusion La transfusion sanguine doit etre focalisee chez les donneurs de sang âges, feminins, les nouveaux donneurs de sang volontaires et les donneurs de sang familiaux a la Banque de Sang des CUK.

Background: Some published studies on the patient’s activity before the stroke occurrence indicate that thereis an increased risk of the onset of acute stroke during these activities. In our community, these data are not yet assessed. The purpose of this pilot study was to examine whether intracerebral hemorrhage may be linked to patient’s physical activity before the onset and to carry out any relationship with location of the hemorrhage. Methods: The patient’s activity before the onset of stroke and location of hemorrhage in 58 patients (40 men and 18 women, aged 39 to 81years) admitted with spontaneous intracerebral hemorrhage seen by CT in Kinshasa, Democratic Republic of the Congo, from 2012 to 2015, were recorded and analyzed using logistic regression models. Results: In 31% of the case, the onset developed after emotional factors, in 24% in the lavatory, in 15% during housework and in 12% during sexual activity (X-squared = 8.319, p-value = 0.081). There was no significant difference between those activities and the site of intracerebral hemorrhage (p?0.05). Conclusion: Most patients in this series seemed to be stricken by the hemorrhagic stroke during some physical activity. It is less certain that location of intracerebral hemorrhage was linked with these activities.

The objective of this study was to identify important biomarker differences between absence of HM and expected morphopathologic types of HM. A retrospective analysis study of adult patients aged ≥ 20 years was managed by cytologic aspects such as normal myelogram vs. HM types between 2009 and 2015. Out of 105 patients, 63 (60%) experienced incident HM while 42, 14, 18, 10, 10, 6, and 5 patients had normal myelogram, multiple myeloma (MM), acute myeloid leukaemia (AML), myelodysplastic syndromes (MDS), chronic myeloid leukaemia (CML), acute myeloid leukaemia (CLL) and acute lymphoid leukaemia (ALL), respectively. In Discriminant Analysis (DA), only levels of transfusion, Hb, and WCC discriminated significantly (Wilks lambda =0.159; P < 0.0001) the study groups through Function 1 [Eigen value (EV) = 2.591; cumulative variance (CV) = 78, 7% and Canonical correlation (CC) = 0.849], Function 2 (EV = 0.619; CV = 97.5%; CC = 0.618), and Function 3 (EV = 0.081; CV = 100%; CC = 0.274). The highest Mahalanobis distance (Min D Squared = 0.162) was observed between CML and MDS. For early diagnosis, precise medicine, and good practice in hematologic oncology, DA separated CML, MDS, MM, AML, CLL, and ALL from normal myelogram in Congolese patients.

Hypertension is not only an important risk factor, but also an important cause of spontaneous intracerebral hemorrhage. Its high prevalence in Africa reflects a high incidence of cerebral hemorrhage ranging from 30% to 60% against 10% to 20% in industrialized countries. The aim of our study was to determine the role of hypertension before the onset of intracerebral hemorrhage and its variations during the first three months. This was a longitudinal study conducted at the University Hospital of Brazzaville from 1st January to 31st August 2012 with all patients admitted for intracerebral hemorrhage. Patients with subarachnoid or pure intraventricular hemorrhage were excluded. The study variables were: history of hypertension, knowledge of its history, treatment, blood pressure on admission and during the first 3 months and the relationship between blood pressure and evolution. Statistical analysis was performed using the software SPSSS 16.1. The significance level was set at p < 0.05. During the study 261 patients were hospitalized for stroke, of which 82 (31.42%) were for intracerebral hemorrhage. The mean age was 55 ± 11 years and sex ratio of 2 men:1 woman. Hypertension was found in 80.5% of cases, of which 65.2% had known hypertension, but 82.6% had discontinued treatment. The mean systolic blood pressure was 194 ± 41 mm Hg and diastolic 104 ± 20 mm Hg. The location was deep in 85.71%. The normalization of blood pressure was obtained from the second week. After adjusting for confounders using logistic analysis, only uncontrolled hypertension was associated significantly and independently associated with a higher mortality rate (p = 0.042).

Background: The cardiovascular risk factors including type 2 diabetes mellitus (T2DM) are a public health problem in sub-Saharan Africa. The aim of this study is to determine the prevalence and factors associated with stroke in T2DM patients admitted to the emergency Unit in Brazzaville. Patients and Methods: This is the preliminary findings of a cross-sectional study including patients with T2DM, admitted in Emergency Unit of University Hospital of Brazzaville from January to April 2011. One hundred and seven patients were included. Sex ratio was 1.5. Results: The mean age was 60.3 ± 10.2 years (range 40 - 80 years). Stroke story was noted in 5 cases (4.6%). The main pathologies were metabolic complications (n = 51; 47.6%) and cardiovascular diseases (n = 36; 33.6%), dominated by stroke (17 cases). Epidemiological factors associated with stroke were high standard living (OR = 3, 95% CI: 1.02 - 8.9, p = 0.03), polypharmacy (OR = 3.7, 95% CI: 1.27 - 10.8, p = 0.01), previous hospitalization (OR = 3.1, 95% CI: 1.07 - 8.9, p = 0.03), and the absence of antiplatelet therapy (OR = 4.2, 95% CI 1.2 to 15, p = 0.03). Clinical associated factors were coma (OR = 3.3, 95% CI 1.14 to 9.6, p = 0.02) and the presence of severe hypertension (OR = 4, 95% CI: 1.2 - 12, p = 0.02). Finally, prognostic factors were the transfer in intensive care unit (OR = 9.8, 95% CI: 2.7 - 34, p < 0.001). Conclusion: The first cardiovascular complication in patients with T2DM admitted in emergency at University Hospital of Brazzaville is stroke. Primary prevention in high-risk patients is still inadequate.

Background: Antenatal care (ANC) services are the gateway for integrated management of several conditions that adversely affect the mother and foetus. More stillbirths than neonatal deaths in South Africa are a reflection of poor quality ANC services. Aim: The primary aim of this study was to explore the reasons for late booking, and also to determine pregnant women’s knowledge, perceptions and attitude towards antenatal care services they receive in Mthatha area in Eastern Cape, South Africa. Setting: This was a qualitative study, conducted at Mbekweni Health Centre in the King Sabata Dalindyebo (KSD) subdistrict municipality of the Eastern Cape Province. Methods: This qualitative study consisted of selected pregnant women who presented after 19 weeks of gestation at Mbekweni Health Centre. Data were collected through two different methods, namely, semi-structured interviews and focus group discussions were used until saturation of the themes were reached. The interviews were transcribed verbatim and thematic analyses were undertaken. Results: Twenty women participated in the study. They were diverse in terms of age 18–41 years, gravidity 1–6 and time of ANC booking 20–28 weeks. The interviews identified a variety of personal, service and organisational reasons for late ANC booking. The themes identified for late ANC bookings were: health care system related issues, socio-economic factors, women’s perceptions and knowledge, and failure of family planning services. Conclusions: Women’s beliefs, knowledge and perceptions regarding antenatal services outweigh the perceived benefit of early ANC visit. The majority of women had lack of knowledge of contraception, early signs of pregnancy, purpose, timing and benefits of ANC visit.

Summary Background Despite widespread recognition that the burden of diabetes is rapidly growing in many countries in sub-Saharan Africa, nationally representative estimates of unmet need for diabetes diagnosis and care are in short supply for the region. We use national population-based survey data to quantify diabetes prevalence and met and unmet need for diabetes diagnosis and care in 12 countries in sub-Saharan Africa. We further estimate demographic and economic gradients of met need for diabetes diagnosis and care. Methods We did a pooled analysis of individual-level data from nationally representative population-based surveys that met the following inclusion criteria: the data were collected during 2005–15; the data were made available at the individual level; a biomarker for diabetes was available in the dataset; and the dataset included information on use of core health services for diabetes diagnosis and care. We first quantified the population in need of diabetes diagnosis and care by estimating the prevalence of diabetes across the surveys; we also quantified the prevalence of overweight and obesity, as a major risk factor for diabetes and an indicator of need for diabetes screening. Second, we determined the level of met need for diabetes diagnosis, preventive counselling, and treatment in both the diabetic and the overweight and obese population. Finally, we did survey fixed-effects regressions to establish the demographic and economic gradients of met need for diabetes diagnosis, counselling, and treatment. Findings We pooled data from 12 nationally representative population-based surveys in sub-Saharan Africa, representing 38 311 individuals with a biomarker measurement for diabetes. Across the surveys, the median prevalence of diabetes was 5% (range 2–14) and the median prevalence of overweight or obesity was 27% (range 16–68). We estimated seven measures of met need for diabetes-related care across the 12 surveys: (1) percentage of the overweight or obese population who received a blood glucose measurement (median 22% [IQR 11–37]); and percentage of the diabetic population who reported that they (2) had ever received a blood glucose measurement (median 36% [IQR 27–63]); (3) had ever been told that they had diabetes (median 27% [IQR 22–51]); (4) had ever been counselled to lose weight (median 15% [IQR 13–23]); (5) had ever been counselled to exercise (median 15% [IQR 11–30]); (6) were using oral diabetes drugs (median 25% [IQR 18–42]); and (7) were using insulin (median 11% [IQR 6–13]). Compared with those aged 15–39 years, the adjusted odds of met need for diabetes diagnosis (measures 1–3) were 2·22 to 3·53 (40–54 years) and 3·82 to 5·01 (≥55 years) times higher. The adjusted odds of met need for diabetes diagnosis also increased consistently with educational attainment and were between 3·07 and 4·56 higher for the group with 8 years or more of education than for the group with less than 1 year of education. Finally, need for diabetes care was significantly more likely to be met (measures 4–7) in the oldest age and highest educational groups. Interpretation Diabetes has already reached high levels of prevalence in several countries in sub-Saharan Africa. Large proportions of need for diabetes diagnosis and care in the region remain unmet, but the patterns of unmet need vary widely across the countries in our sample. Novel health policies and programmes are urgently needed to increase awareness of diabetes and to expand coverage of preventive counselling, diagnosis, and linkage to diabetes care. Because the probability of met need for diabetes diagnosis and care consistently increases with age and educational attainment, policy makers should pay particular attention to improved access to diabetes services for young adults and people with low educational attainment. Funding None.

Background Paucity of data on the prevalence, treatment and control of hypertension in individuals living with type 2 diabetes mellitus (T2DM) in the rural communities of South Africa may undermine efforts to reduce the morbidity and mortality associated with cardiovascular diseases. This study examines the socio-demographic and clinical determinants of uncontrolled hypertension among individuals living with T2DM in the rural communities of Mthatha, South Africa. Methods This cross-sectional study involved a serially selected sample of 265 individuals living with T2DM and hypertension at Mthatha General Hospital, Mthatha. Uncontrolled hypertension was defined as systolic blood pressure greater than or equal to 140mmHg and diastolic blood pressure greater than or equal to 90mmHg in accordance with the Eight Joint National Committee Report (JNC 8) (2014). We performed univariate and multivariate logistic regression analyses to identify the significant determinants of uncontrolled hypertension. Results Of the total participants (n = 265), the prevalence of uncontrolled hypertension was 75.5% (n = 200). In univariate analysis of all participants, male gender (p = 0.029), age≥65 years (p = 0.016), unemployed status (p

Prior to the advent of HAART (Highly Active retroviral therapy), studies of insulin resistance in HIV infection showed normal insulin sensitivity. The metabolic disturbances due to HAART are now reported in our setting. To investigate potential associations between cardiometabolic indices, innate and adaptive immunity, adipokines, and markers of insulin resistance (IR) in HIV/AIDS patients on first-line antiretroviral therapy (ART) were studied. This cross-sectional study selected HIV/AIDS patients treated with ART at public clinics of Mthatha Municipality, South Africa. Age, waist-to-hip ratio, blood pressure, total cholesterol (TC), HDL-C, LDL-C, triglycerides, C-peptide, uric acid, C-reactive protein (CRP), glucose, and albuminuria were the cardiometabolic indices. Innate immunity (lymphocytes), adaptive immunity (CD4 cell count), adipokines (adiponectin, leptin), and insulin resistance markers—fasting serum Insulin and homeostasis model assessment—IR score were also explored. Out of 258 selected patients, aged 38.1 ± 9.3 years, 79.5 % were females. There was a univariate correlation between HOMA-IR score and triglyceride (r = 0.331; P

Background and Purpose: Intracerebral hemorrhage (ICH) constitutes now 52% of all strokes. Despite of its deadly pattern, locally there is no clinical grading scale for ICH-related mortality prediction. The first objective of this study was to develop a risk stratification scale (Kinshasa ICH score) by assessing the strength of independent predictors and their association with in-hospital 30-day mortality. The second objective of the study was to create a specific local and African model for ICH prognosis. Materials and Methods: Age, sex, hypertension, type 2 diabetes mellitus (T2DM), smoking, alcohol intake, and neuroimaging data from CT scan (ICH volume, Midline shift) of patients admitted with primary ICH and follow-upped in 33 hospitals of Kinshasa, DR Congo, from 2005 to 2008, were analyzed using logistic regression models. Results: A total of 185 adults and known hypertensive patients (140 men and 45 women) were examined. 30-day mortality rate was 35% (n=65). ICH volume>25 mL (OR=8 95% CI: 3.1-20.2; P 7 mm, a consequence of ICH volume, was also a significant predictor of mortality. The Kinshasa ICH score was the sum of individual points assigned as follows: Presence of coma coded 2 (2 × 2 = 4), absence of coma coded 1 (1 × 2 = 2), ICH volume>25 mL coded 2 (2 × 2=4), ICH volume of ≤25 mL coded 1(1 × 2=2), left hemispheric site of ICH coded 2 (2 × 1=2), and right hemispheric site of hemorrhage coded 1(1 × 1 = 1). All patients with Kinshasa ICH score ≤7 survived and the patients with a score >7 died. In considering sex influence (Model 3), points were allowed as follows: Presence of coma (2 × 3 = 6), absence of coma (1 × 3 = 3), men (2 × 2 = 4), women (1 × 2 = 2), midline shift ≤7 mm (1 × 3 = 3), and midline shift >7 mm (2 × 3 = 6). Patients who died had the Kinshasa ICH score ≥16. Conclusion: In this study, the Kinshasa ICH score seems to be an accurate method for distinguishing those ICH patients who need continuous and special management. It needs to be validated among large African hypertensive populations with a high rate of 30-day in–hospital mortality.

Lipid and lipopproteins disorders are well established in sera from sickle cell disease (SCD) patients out of Central Africa. The present case-control study was conducted to compare serum levels of total cholesterol (TC), HDL-C, triglycerides (TG), LDL-C and TC/HDL-C ratio (atherogenic index) from SCD homozygotes (SS) in steady state, SCD heterozygotes (AS) and controls (AA) in Brazzaville, Congo. Significant reductions of TC and LDL-C vs. increase in TG were reported in SS. However, significant decrease in HDL-C and increase in atherogenic index were observed in AS. We recommend prevention of oxidative stress, dyslipidemia and atherosclerosis in SCD using hygiene-diet measures. Only longitudinal studies in large populations will provide pathophysiological basis of lipid and lipoproteins disorders in SCD.

This study aims to develop a risk score model, based on available clinical data to assess absolute risk of dying among admissions for hyperglycemic crisis in Eastern Cape, one of South Africa’s most disadvantaged provinces. Data from 268 admissions for hyperglycemic crisis at Nelson Mandela Academic Hospital, Mthatha, for the 2 year periods of 2008 and 2009 were used to develop multivariate logistic regression and cox proportional hazards models for the time to onset of death and the area under curve (AUC) of the receiver-operating-characteristic curve (ROC). The risk score models included the following independent variables that were associated with mortality: systolic blood pressure (SBP) 10 × 106/L OR = 16.7 (95%CI 2.1–143; p = 0.0008) and HR = 5.7 (95%CI 1.8–7; p = 0.021) and Platelet count 10 × 106/L (AUC = 0.642, 95% CI 0.557–0.727; p

The aim of this study was to estimate the incidence of acute malnutrition and to identify predictors of case fatality among burn patients in the poorest South African province, Eastern Cape. This longitudinal follow-up study was conducted among consecutive burn patients admitted to Nelson Mandela Academic Hospital, Mthatha, South Africa, between 2006 and 2008. Patients were monitored and treated daily from admission to discharge. Outcomes were acute protein malnutrition and mortality. Patients’ demography, total body surface area (TBSA) of the burn, cause of the burn, weight, height, location of the burn, hemoglobin, serum albumin, wound infection, and antibiotics after culture and sensitivity results were the potential predictors of in-hospital mortality. A Cox’s proportional hazards model for the time to death was then used to identify independent predictors of mortality after adjusting for confounding factors. Kaplan–Meier survival curves were generated for each arm of exposure status. In all, 67 patients (35 males, 59 children) were studied. The mean (range) age was 8 ± 12 years (1 month to 59 years). The cumulative incidence of acute malnutrition was 62.0% (n = 42): 46.3% (n = 31) at admission and 15.7% (n = 11) after 7 days of hospitalization. Incidence of mortality was 16.4% (n = 11 with in-hospital acute malnutrition). The only significant and independent predictors of mortality were total body surface area (TBSA) burn >40% [hazard ratio (HR) 10.5, 95% confidence interval (CI) 1.7–63; P

We aimed to describe the physical activity and to investigate the association between classical hypertension, obesity, diabetes, and new inflammation, IDF-defined metabolic syndrome, insulin resistance CV risk factors.This was a cross-sectional study based on interviews and physical and biochemistry measurements among Central African patients.Waist circumference (WC), blood pressure, weight and height to calculate body mass index (BMI), fasting glucose, CRP, ERS, uric acid, cholesterol (C), LDL-C, HDL-C, triglycerides, elements of homeostatic model assessment (HOMA) including insulin, HOMA index, QUICKI, insulin sensitivity (%S), beta-cell function (%β) and insulin resistance (IR).Of the 60 patients included, 30 (50%) were physically inactive versus 30 (50%) active. In pooled analyses, in men and in women, there was significant and positive correlation between WC and seating/laying down position (WC=92.41+1.49 seating time in hours, R(2)=0.11; P0.0001). The mean value of CRP and ERS were higher and those of all indices of HOMA were lower in inactive patients. The discriminant function for physical activity was Z (score=barycentre)=-7.36+1.013 HOMA index where -1.4 was the barycentre for active and +1.4 for inactive. HOMA index2.42 was the optimal cut-off value to detect physically inactive patients: sensitivity=93.3%, specificity=100%, area under ROC=0.991±0.01 95%=0.975-1.0; P0.0001.The association between low-grade inflammation markers, insulin resistance and physical inactivity favours the hypothesis that a low-grade inflammatory status and enhanced insulin, sensitivity may constitute a part of the CV benefits from physical activity.

Aims Atherosclerosis is now accepted as a chronic vascular inflammatory disorder that is present in a variety of conditions such as obesity, physical inactivity, hypertension, type 2 diabetes, metabolic syndrome/insulin resistance and renal impairment. In this paper, we determine the cardiometabolic causes and consequences of elevated erythrocyte sedimentation rate (ESR) among healthy bank employees from Brazzaville, Central Africa. We also aimed at determining the optimal cut-points for ESR associated with higher cardiometabolic risk using ROC analysis. Materials and methods This cross-sectional survey used data from participants examined from 1 to 30 December, 2008. A simple random of 126 bank employees, 42 ± 9 years old, completed an interviewer administered questionnaire and had anthropometric, QTc, cardiac index and blood pressure measurements performed by trained nurses using standardized procedures. Fasting glucose, lipids, ESR and creatinine were measured using a venous blood sample. Cardiometabolic risk was defined by obesity, physical inactivity, low energy expenditure, long QTc, dyslipidaemia, hypertension, metabolic syndrome, type 2 diabetes, coronary heart disease (CHD) and decline of estimated glomerular filtration rate (EGFR). Results The population was defined by epidemic rates of physical inactivity, hypertension, obesity, excessive alcohol intake and CHD. This higher cardiometabolic risk and the ESR values were more frequent in females than males. There was a significant (P Conclusions Aging, female sex, physical inactivity, low energy expenditure, reduced body total water and obesities are considered as the causes of elevated ESR. Dyslipidaemia, hypertension, type 2 diabetes, renal function decline and coronary heart disease are the consequences of elevated ESR. Weight loss, exercise, appropriate diet, and pharmacological means are needed to control the emergence of Western diseases among these African employees.