Shift métabolique du cardiomyocyte dans l’hypertrophie du ventricule gauche et potentielles cibles therapeutiques: Metabolic shift of cardiomyocyte in left ventricular hypertrophy and potential therapeutic targets

Left ventricular hypertrophy (LVH) is the strongest cardiovascular risk factor after age. It causes a decrease in cardiac efficiency. To improve this efficiency, the cardiomyocyte preferentially changes the use of energy substrate (metabolic Shift). Nowadays, the mechanisms underlying this metabolic shift remain poorly understood. This review focuses on the metabolic shift of the hypertrophied cardiomyocyte while evoking certain proteins that would be involved and / or play an important role as a therapeutic target. L’hypertrophie du ventricule gauche (HVG) est le plus grand puissant facteur de risque cardiovasculaire après l’âge. Elle entraine une diminution de l’efficience cardiaque. Pour améliorer cette efficience, le cardiomyocyte change préférentiellement l’utilisation de substrat énergétique (Shift métabolique). De nos jours, les mécanismes qui sous-tendent ce shift métabolique sont pour la plupart peu connus. Cette revue fait le point sur le shift métabolique du cardiomyocyte hypertrophié tout en évoquant certaines protéines qui y seraient impliquées ou joueraient un rôle important comme cibles thérapeutiques. &nbsp

Embolie pulmonaire survenue chez une patiente guérie d’une forme sévère de COVID-19 : A propos d’un cas clinique: Pulmonary embolism in a patient recovered from a severe form of COVID-19: a case report

Severe forms of Coronavirus Disease 2019 (COVID-19) are often associated with a high incidence of coagulopathies and thrombosis in the first ten days, which justifies the interest of preventing thromboembolic complications, in particular pulmonary embolism (PE), during hospitalization. Here we report the case of a patient cured of SARS-Cov-2 pneumonia complicated by an Acute Respiratory Distress Syndrome (ARDS) who presented with PE 13 days after release ICU. This rare observation poses the problem of close monitoring of recovered patients, the need for continuation and the duration of anticoagulation therapy after hospitalization. Les formes graves de la maladie à Coronavirus (COVID-19) sont souvent associées à une incidence élevée de coagulopathies et de thromboses, dans les dix premiers jours, qui justifie l’intérêt de prévenir les complications thrombo-emboliques notamment l’embolie pulmonaire (EP), en cours d’hospitalisation. Nous rapportons ici le cas d’une patiente guérie d’une pneumonie à SARS-CoV-2 compliquée d’un syndrome de détresse respiratoire aigu ayant présenté une embolie pulmonaire (EP) à 13 jours de sa sortie de Réanimation. Cette rare observation pose le problème de la nécessité de la surveillance étroite des patients guéris, de la poursuite et de la durée du traitement anticoagulant après la sortie d’hospitalisation et le retour à domicile

Lenteur de propagation de la COVID-19 en Afrique subsaharienne : réalité ou sommet de l’iceberg ? Cas de la République Démocratique du Congo

Monsieur l’Editeur. Après la Chine, l’Europe et les Etats Unis d’Amérique, l’Afrique Subsaharienne (ASS) connait, depuis mars 2020, l’épidémie à COVID-19. Avant l’arrivée de cette épidémie, l’Organisation Mondiale de la Santé (OMS) et les Experts en santé prédisaient tous une propagation fulgurante de la COVID-19 en ASS avec une mortalité sans précédent (1-3). Cette prédiction apocalyptique de l’impact de l’épidémie à COVID-19 en ASS était fondée sur la conjonction de plusieurs facteurs de vulnérabilité incluant, entre autres, la fragilité du système de santé et de l’économie, la promiscuité interindividuelle et la pauvreté extrême des populations vivant au jour le jour sans provisions, l’endémicité de certaines pathologies chroniques pouvant faire le lit de la COVID-19, telles que l’infection à VIH/SIDA, le paludisme, la drépanocytose, la malnutrition (4-8), l’accès limité à l’eau potable et aux médicaments essentiels, le déni de la maladie lié à un taux élevé d’analphabétisme et les échanges commerciaux intenses avec des pays asiatiques et européens, tels que la Chine, la France, la Belgique et l’Italie (1). Cependant, force est de constater qu’après 8 semaines d’épidémie, la propagation de l’infection à virus « SARS-CoV-2 » et la maladie COVID-19 subséquente ne semble pas corroborer les prévisions et les projections faites en référence à l’épidémie en cours dans les pays cités ci-dessus (2). La propagation de l’épidémie à COVID-19 dans les pays de l’ASS parait moins rapide et peu mortelle avec des différences notables entre les pays (9). En effet, selon le rapport de l’OMS du 2 mai 2020, le nombre de cas biologiquement confirmés et de décès était estimé, après 8 semaines d’épidémie, à 27,973 cas et 1,013, soit une létalité de 3,6 % (10) avec l’Afrique Sud portant le plus lourd fardeau de la COVID-19. Dear Editor, following China, European countries like France and Italy, and United States of America (USA), sub-Saharan African (SSA) countries are experiencing since March 2020 the epidemic of COVID-19. Before the occurrence of the epidemics, World Health Organization (WHO) Experts expected an exponential progression of COVID-19 with unprecedented number of deaths (1-3). Factors underlying this apocalyptic prediction included the weakness of health systems and economy, the high rate of illiteracy and poverty as well as the social promiscuity precluding the effective adoption of barriers measures against COVID-19 by communities most of which living with less than one USD, the coexistence of endemic diseases, such as malaria, tuberculosis, HIV/AIDS, malnutrition, sickle cell disease that can accelerate the development and progression of COVID-19 (4-8), and the intensive commercial exchanges between SSA countries and China as well as European countries like France and Italy (1). In face of this expected apocalyptic picture, WHO Experts urged SSA Governments to anticipate on the negative health, social and economic impact of COVID-19 by learning from the experience gained by China and other countries and thus prepare and organize the response against this epidemic (1-3). However, eight weeks (May 2020) after the start of the epidemics in SSA, the rate of progression of COVID-19 and subsequent mortality appear to not corroborate the expected apocalyptic prediction of WHO Experts in comparison with the picture seen in aforementioned countries (2). Indeed, the rate of progression of COVID-19 in SSA is low with fewer deaths compared to that of European and Asian countries as well as USA

Impact of Hypertension on the Survival of chronic hemodialysis patients in Kinshasa: A Historical Cohort Study: Impact de l’Hypertension sur la survie des patients hémodialysés chroniques à Kinshasa : Etude de cohorte historique

Context and objective. The relationship between hypertension and mortality among hemodialysis patients remains controversial. This study aimed to identify independent predictors of mortality and assess the impact of hypertension on the survival among Congolese chronic hemodialysis patients. Methods. This historical cohort study concerned Congolese chronic hemodialysis patients followed in two hemodialysis centers in Kinshasa between 2010 and 2013. The end point was survival (time-to-death). Patient and dialysis-related parameters were introduced in the Cox regression to identify independent predictors of mortality. We use Kaplan Meier method to describe survival. Survival curves based on the presence or not of Hypertension were assessed using the Log-Rank test. Results. 191 patients (mean age 52.3±12.3 years; men -68%; hypertensive 85 %), were included. Among them, 88 patients died (46 %) Independent predictors of all-cause mortality were: temporary catheter use [aHR 7.72; 95% CI 1.84-32.45;  p=0.024], low Socioeconomic Status (SES) [aHR 2.57; 95% CI 1.06-6.27; p=0.038], being non-hypertensive [aHR 2.38; 95% CI 1.35-3.04; p=0.003], presence of perdialytic complications [aHR 2.28; 95% CI 1.12-4.66; p=0.024] and non EPO use [aHR 2.23; 95% CI 1.32-3.74; p=0.038]. Compared to non-hypertensive, hypertensive patients had significantly better median survival (4 vs 16 months; Log rank p ≤0.001). Conclusion. Despite the very high mortality in the study population, Congolese chronic hemodialysis hypertensive patients had better survival compared to nonhypertensive patients. This paradox already reported in other studies can be explained by reverse epidemiology. Contexte et objectif. La relation entre l’hypertension et la mortalité chez les patients hémodialysés est très controversée. L’objectif de la présente étude était d’identifier les prédicteurs indépendants de la mortalité en hémodialyse chronique et d’évaluer l’impact de l’hypertension sur la survie des patients congolais hémodialysés. Méthodes. Cette étude de cohorte historique a concerné les patients hémodialysés chroniques congolais traités dans deux centres d’hémodialyse à Kinshasa entre 2010 et 2013. Les courbes de survie de Kaplan Meier basées sur la présence ou non d’hypertension ont été comparées à l’aide du test de Log-Rank. Résultats. 191 patients (âge moyen de 52,3 ± 12,3 ans; hommes 68%; hypertendus 85%) ont été inclus. Parmi eux, 88 étaient décédés (46%). Les prédicteurs indépendants de la mortalité toutes causes confondues étaient les suivants : utilisation de cathéters provisoires [aHR 7,72; IC à 95%: 1,84 à 32,45; p = 0,024], statut socioéconomique faible (SSE) [aHR 2,57; IC à 95% 1,06-6,27; p = 0,038], l’absence d’hypertension artérielle [aHR 2,38; IC 95% 1,35-3,04; p = 0,003], présence de complications per dialytiques [aHR 2,28; IC à 95% 1,12-4,66; p = 0,024] et la non utilisation de l’ EPO [aHR 2,23; IC 95% 1,32-3,74; p =0,08]. Comparés aux patients normotendus, les hypertendus avaient significativement une meilleure survie médiane (4 versus 16 mois ; Log Rank p ≤0,001). Conclusion. Malgré une mortalité très élevée dans la population d’étude, les patients hypertendus congolais en hémodialyse chronique avaient une meilleure survie par rapport aux patients normotendus. Ce paradoxe déjà signalé dans d’autres études peut s’expliquer par l’épidémiologie inverse. &nbsp

Human Immunodeficiency Virus Nephropathy in Central Africa: The Value of Renal Ultrasound

Introduction: HIV-Associated Nephropathy may shorten the life expectancy of affected patients. Its early detection is beneficial for the indication of treatment and hence prevention of progression to the end-stage of renal failure. The final diagnosis requires renal biopsy which may be difficult in some African area; clinical and ultrasound criteria may be helpful. The aim of this study was twofold: to characterize renal sonographic changes in HIV-positive patients with HIV associated Nephropathy and to investigate the correlation between renal sonographic changes and histological lesions in central Africa.Methods: A prospective and multi-center study conducted from January 2013 to July 2015 included, for renal ultrasound evaluation of the length, thickness and echogenicity, forty two of the 334 biologically confirmed HIV-positive patients who presented with significant proteinuria suggestive of HIV associated Nephropathy. And transcutaneous renal biopsy with histopathology has been performed in 16 patients of them. Statistical analyzes were used.Results: There were 100 men and 234 women; proteinuria was positive in 42 patients, (12.6%). The average length of the kidneys was 111 ± 8 mm (normal), with 10% of patients with pathological values (5% with kidneys of reduced size and 5%, increased size). The kidneys had an average thickness of 44 ± 5 mm (normal), with 21% of patients presenting an increase in renal thickness. Quantitative echogenicity was calculated at 1.492 ± 0.793 (normal), with 79% of patients with increased quantitative echogenicity. Of the 16 patients biopsied, all had tubulo-interstitial lesions, and 75% of them associated with glomerular lesions. In simple correlation analysis, tubular dilatation was positively and significantly related to quantitative echogenicity (r = 0.67, p < 0.01) and to renal parenchyma thickness (r = 0.67; 0.85, p ? 0.05). The relationship between the other parameters studied did not reach statistical significance. In multiple linear regression, glomerular hyalinosis, glomerular proliferation, tubular dilatation, tubular atrophy, interstitial fibrosis, and interstitial inflammation emerged as the main determinants of quantitative echogenicity; however, the relationship was statistically significant only for tubular dilatation (? = 0.305, p = 0.034).Conclusion: The present study showed the characteristic of renal change and the relation with histology found in central Africans patients

Longitudinal analysis of sociodemographic, clinical and therapeutic factors of HIV-infected individuals in Kinshasa at antiretroviral therapy initiation during 2006-2017.

peer reviewedBACKGROUND: The benefits of antiretroviral therapy (ART) underpin the recommendations for the early detection of HIV infection and ART initiation. Late initiation (LI) of antiretroviral therapy compromises the benefits of ART both individually and in the community. Indeed, it promotes the transmission of infection and higher HIV-related morbidity and mortality with complicated and costly clinical management. This study aims to analyze the evolutionary trends in the median CD4 count, the median time to initiation of ART, the proportion of patients with advanced HIV disease at the initiation of ART between 2006 and 2017 and their factors. METHODS AND FINDINGS: HIV-positive adults (≥ 16 years old) who initiated ART between January 1, 2006 and December 31, 2017 in 25 HIV care facilities in Kinshasa, the capital of DRC, were eligible. The data were processed anonymously. LI is defined as CD4≤350 cells/μl and/or WHO clinical stage III or IV and advanced HIV disease (AHD), as CD4≤200 cells/μl and/or stage WHO clinic IV. Factors associated with advanced HIV disease at ART initiation were analyzed, irrespective of year of enrollment in HIV care, using logistic regression models. A total of 7278 patients (55% admitted after 2013) with an average age of 40.9 years were included. The majority were composed of women (71%), highly educated women (68%) and married or widowed women (61%). The median CD4 was 213 cells/μl, 76.7% of patients had CD4≤350 cells/μl, 46.1% had CD4≤200 cells/μl, and 59% of patients were at WHO clinical stages 3 or 4. Men had a more advanced clinical stage (p <0.046) and immunosuppression (p<0.0007) than women. Overall, 70% of patients started ART late, and 25% had AHD. Between 2006 and 2017, the median CD4 count increased from 190 cells/μl to 331 cells/μl (p<0.0001), and the proportions of patients with LI and AHD decreased from 76% to 47% (p< 0.0001) and from 18.7% to 8.9% (p<0.0001), respectively. The median time to initiation of ART after screening for HIV infection decreased from 40 to zero months (p<0.0001), and the proportion of time to initiation of ART in the month increased from 39 to 93.3% (p<0.0001) in the same period. The probability of LI of ART was higher in married couples (OR: 1.7; 95% CI: 1.3-2.3) (p<0.0007) and lower in patients with higher education (OR: 0.74; 95% CI: 0.64-0.86) (p<0.0001). CONCLUSION: Despite increasingly rapid treatment, the proportions of LI and AHD remain high. New approaches to early detection, the first condition for early ART and a key to ending the HIV epidemic, such as home and work HIV testing, HIV self-testing and screening at the point of service, must be implemented

Tests diagnostiques de l’infection à Coronavirus (COVID-19) : des atouts et des limites: Diagnosis testing for Coronavirus infection disease (COVID 19): Assets and limits

The world is going through a serious health crisis due to the COVID 19 pandemic. Although little is known about COVID-19, we have observed an increased interhuman transmission of etiological agent SARS-Cov-2 and we assume that each new cases of COVID-19 get at least two or three news persons infected. Therefore, the test for detection of the infection should be much implemented as an efficient strategy to fight against the COVID 19 pandemic. The COVID-19 diagnostic tests are an essential tool for assessing the pandemic. This review paper will discuss the advantages and limitations of the diagnosis tests for COVID 19. There are 2 categories of tests: those that directly detect the virus or its component, and those that search for the antibodies generated by the virus infection. The&nbsp;real time Reverse transcriptase Polymerase chain reaction (test rt-RT-PCR)&nbsp;remains the gold standard for the diagnosis of COVID-19. Its sensitivity on the nasopharynx swab seems high, though false negative cases can occur, with an average of 30% of cases. Serological test detect specific antibodies against SARS-COV-2. They help identify individuals that have been infected by the virus, those healed and that have acquired immunity against the virus. They are diagnosis orientation tests of COVID-19. Until now, none of these tests are 100% reliable, but they are used by a qualified collaborating medical staff. They can help identify the majority of the infected and immunized individuals. Le monde entier fait face à une crise sanitaire sans précédent due à la pandémie de maladie à virus SARS-COV-2 alias COVID-19. Malgré les connaissances très incomplètes sur la COVID-19, on a constaté une contagiosité interhumaine élevée au début de la pandémie actuelle, et on estime que chaque nouveau cas de COVID-19 infecte en moyenne deux à trois personnes. En conséquence, la stratégie de lutte contre la pandémie à COVID-19 qui ébranle nos sociétés passe nécessairement par une intensification des tests de détection de l’infection. Ces tests diagnostiques de la COVID-19 sont un outil essentiel pour suivre la propagation de la pandémie. Ainsi, l’objectif de la présente revue de la littérature est d’aborder le diagnostic de l’infection à Coronavirus (COVID-19) en s’attardant sur les tests de diagnostic, leurs atouts et leurs limites. Il y a deux catégories de test : ceux qui recherchent la présence directe du virus ou de ses fragments, et ceux qui recherchent les anticorps résultant de l’infection par le virus du COVID-19. Le test real time –Reverse Transcriptase –Polymerase chain reaction (rt-RT-PCR) reste le gold standard pour le diagnostic de la COVID-19. Sa sensibilité sur les écouvillons nasopharyngés semble élevée, mais des faux négatifs peuvent se produire, avec une fréquence incertaine (environ 30% des cas). Les tests sérologiques détectent les anticorps spécifiques du SARS-CoV-2. Ils permettent l’identification des individus qui ont été infectés par le virus, se sont rétablis, et ont développé, en théorie, une réponse immunitaire efficace contre le virus. Ils constituent des tests d’orientation diagnostique de la COVID-19. A ce jour, aucun de ces tests n’est fiable à 100 %, mais, utilisés par un personnel médical qualifié et en combinaison, ils permettent l’identification de la majorité des individus infectés et immunisés

Recommandations de la Société Congolaise de Néphrologie (SOCONEPH) pour la Prise en Charge des Patients en Dialyse dans le contexte de Pandémie à COVID-19 : Recommendations of the Congolese Society of Nephrology for the Management of Dialysis Patients in the Context of a COVID-19 Pandemic

Patients on haemodialysis are likely to be at increased risk of novel coronavirus disease (COVID-19). Preventive strategies must be implemented to minimize the risk of disease transmission in dialysis facilities, including education of staff and patients, screening for COVID-19 and separation of infected or symptomatic and non-infected patients. Les patients en hémodialyse présente un risqué élevé d’infection à SARS-Cov-2. Les stratégies préventives doivent donc être mises en place pour réduire le risque de transmission de la maladie en hémodialyse parmi lesquelles, l’éducation du staff médical ainsi que des patients, le screening de la maladie à COVID-19 ainsi que la séparation des patients infectés ou symptomatiques des non infectés. &nbsp

Hypertension and Associated Cardiometabolic Risk Factors among Civilian Aircrew: Hypertension et facteurs de risque cardiométabolique chez le personnel navigant civil

Context and objective. Cardiometabolic risk factors profile of flight and cabin crew has never been previously assessed in low-resource settings such as sub-Saharan African countries. The present study aimed to evaluate the prevalence of hypertension, its determinants, and associated cardiometabolic risk factors among flight and cabin crew. Methods. A total of 379 aircrew members, 112 women (29.6%) and 88 Caucasians (23.2%) of whom 237 flight crew (62.5%) including 175 pilots (46.2%) and 142cabin crew (35.5%) underwent a medical examination for either initial or renewal medical certificate Class I or II as per the ICAO and the CAA/DRC recommendations including blood chemistry, ECG, and echocardiogram. Results. Much more prevalent (p&lt;0.001) among flight than cabin crew (32.4% vs 13.1%), hypertension in these civilian aircrew was in most cases undiagnosed, untreated, and therefore uncontrolled. The prevalence of overweight/obesity (72.4% vs 53.6%; p=0.001), subclinical atherosclerosis (13.5% vs 4.1%; p=0.006), dyslipidemia (61.4% vs 47.1%; p =0.009), left ventricular hypertrophy (14.4% vs 3.0%; p&lt;0.001), and high cardiovascular risk estimate (21.7% vs 12.9%; p=0.045) predominated among flight crew. The odds of hypertension increased with aircrew category (aOR for flight vs cabin crew: 4.96; 95% CI: 2.16-11.38; p&lt;0.001), abdominal adiposity (Present vs absent (2.51 1.19 – 5.30; p=0.015), overweight/obesity (aOR: 2.88; 95%CI: 1.22-6.77; p =0.016), subclinical atherosclerosis (aOR: 5.10; 95%CI: 1.99-13.10; p = 0.001), fast heart rate (aOR: 2.62; 95%CI: 1.01-6.79; p =0.049), and LVH (aOR: 4.90; 95%CI: 1.29-18.62; p =0.02). Conclusion. Fight crew is associated with higher prevalence of hypertension and associated cardiometabolic risk factors highlighting the need for a comprehensive prevention and care program for this particular category of Civilian Aircrew. Contexte et objectif. Les facteurs de risque cardiométaboliques n’ont pas encore été étudiés entre Personnel Navigant Technique (PNT) et Commercial (PNC). L’étude a évalué la prévalence de l’hypertension (HTA), ses déterminants et les facteurs de risque cardiométaboliques associés chez les PNTs et PNCs. Méthodes. L’analyse médicale pour le renouvellement de certificat de classe 1 ou 2 selon l’OACI a concerné 379 personnes navigants ; 112 femmes (29,6%) et 88 caucasiens (23,2%). De 237 PNTs, 175 étaient des pilotes (46,2%) et 142 PNCs (35,5%). Résultats. Plus répandue (32,4% vs 13,1%; p &lt;0,001) parmi les PNTs que les PNCs, l’HTA chezle personnel navigant était dans la plupart des cas non diagnostiquée, non traitée et non contrôlée. La prévalence du surpoids/obésité (72,4% vs 53,6%; p =0,001), de l’athérosclérose infraclinique (13,5% vs 4,1%; p = 0,006), de la dyslipidémie (61,4% vs 47,1%; p = 0,009), de l’HVG (14,4% vs 3,0%; p &lt;0,001), et du risque cardiovasculaire élevé (21,7% vs 12,9%; p = 0,045) était plus majorée parmi les PNTs. Le risque de présenter l’HTA augmentait avec la catégorie PNT (aOR: 4,96; IC 95%: 2,16-11,38; p &lt;0,001), l’adiposité abdominale (aOR: 2,51; IC 95%: 1,19-5,30; p = 0,015), le surpoids / obésité (aOR: 2,88; IC 95%: 1,22-6,77; p = 0,016), l’athérosclérose infraclinique (aOR: 5,10; IC 95%: 1,99-13,10; p =0,001), la tachycardie (aOR: 2,62; IC 95%: 1,01) -6,79; p = 0,049) et l’HVG (aOR: 4,90; IC à 95%: 1,29-18,62; p = 0,02). Conclusion. La profession PNT est associée à une prévalence plus élevée de l‘HTA et à des facteurs de risque cardiométaboliques associés, ce qui souligne la nécessité d’un programme complet de prévention et de soins pour cette catégorie particulière du personnel navigant civil

Mixed structured physical exercise program for obese workers: combating sedentary and metabolic risk factors related to metabolism workplace syndrome

To develop a program of high volume physical exercises, of moderate to high intensity, adapted to the working context of Kinshasa. In a trial study of structured, spontaneous and mixed physical exercise programs associated with nutrition education, lasting 3 months, from November 7 to January 7, 2014. 30 obese sedentary workers 44 ± 844 ± 8.6 on average, year-olds were randomly selected from 157 obese individuals out of a general population of 400 employees in the personal list of the selected company. These workers were divided into three groups of physical exercises, of which the first group consisted of 10 workers in a three-day, moderate to high intensity structured exercise program, including: jogging, aerobics, basketball, volleyball, swimming, abdominals and walking of 10,000 steps a day. The second group was also composed of 10 workers undergoing a spontaneous exercise program of the same duration, intensity and frequency including: walk, up and down the stairs and finally the third group composed and then the third group of 10 workers submitted to a mixed exercise program (the mixture of the two programs). Quantitative variables were expressed as mean ± standard deviation. The ANOVA test was used to compare the variables of two groups. A value of p-value ≤ 0.05 was considered a threshold of statistical significance. Decreased weight, waist circumference and body mass index were observed intra group before and after exercise programs. After the intervention, the group subjected to the mixed exercises improved more significantly (p = 0.0001) the morphological parameters of the obese than the group subjected to the structured and spontaneous exercises with diet. A moderate to high intensity, high volume mixed exercise program significantly improves the morphology of obese sedentary workers compared to the structured and spontaneous exercise program. It can be considered as an effective non-pharmacological strategy to combat the nutritional and epidemiological transition in the workplace, where obesity is the main cornerstone