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

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

Validation of Irma Cgea/crenk One Method of Evaluation of the Vitamin D at the Regional Center of Nuclear Study Laboratory of Kinshasa

The aim of the present study was to validate the method IRMA CGEA/CRENK for the evaluation of the vitamin D status by comparison to the commercial method DIASORIN. A blood sample was obtained from 30 volunteers with a good health state in general population (11 women and 19 men) to determine serum 25(OH) D, concentrations by all those methods. Using local laboratory cutoffs, vitamin D insufficiency and deficiency was defined as 25(OH) D values of 4-14 ng/ml and ˂ 4 ng/ml, respectively; vitamin D sufficiency as ≥15ng/ml [23]. Statistical analyses were performed using Excel 12.0 and SPSS 21 statistical software’s. Mean and standard deviation (SD), were used to evaluate the mean of vitamin D of the two methods. Student t TEST was used to compare mean of the two methods.  P value ≤ 0.05 defined the level of statistical significance. PEARSON correlation coefficient (r) was performed to evaluate the correlation between the two methods.  An r=0 means the missing of correlation: r<0 means a negative correlation; r=1 means a positive and perfect correlation; 0, 75<r<1 means a positive and strong correlation.  The concordance between IRMA CGEA/CRENK and the commercial method DIASORIN has been definite as the missing of statistic difference between the means of vitamin D with the two methods and a positive correlation between the levels of vitamin D of the two methods. The coefficient kappa was calculated for avoiding the rate of random in the concordance. The variations of the coefficient Kappa is ±1.  K= -1 means total discordance.  K=+1 means an absolute concordance. K near 0 means a mean concordance explain by random. K>0, 8 (80%) is the limit of the better concordance. No statistic difference was observed between the means of vitamin D of the method IRMA CGEA/CRENK and the commercial method DIASORIN (p=0,330).  The coefficient of correlation was: r = 0, 96. The equation of correlation was: y =1,429 + 1, 02 x (y= IRMA CGEA/CRENK, x= DIASORIN Commercial).  The coefficient kappa = 0, 85. 

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

Uterine Leiomyoma in Kinshasa, the Capital of the Democratic Republic of Congo

The aim of the present study was to determine the particularities of Uterine Leiomyomas among Congolese in Kinshasa the capital of the Democratic Republic of Congo (DRC) in the present conditions of medical practices. A sample of 644 patients with uterine leiomyoma were selected from 6440 cases of uterine leiomyoma among 30395 patients treated in gynecology units of three medical institutions of Kinshasa (University hospital of Kinshasa, Saint joseph hospital and Edith medical center) from January Ist ,2003 to December 31,2012. The study is a descriptive one. The following variables were taken account: medical history [age, age at menarche, parity, education, civil state, history of UL, symptoms and body mass index (BMI)]; lifestyle (smoking, alcohol intake); ultrasounds characteristics; hysteroslpingographies characteristics, treatment, and direct cost of treatment. Statistical analysis were performed using Excel 12.0 software. Demographic, clinical, ultrasound, hysterosalpingography and treatment data were evaluated using descriptive statistics: mean, standard deviation (SD), and percentage (%) as appropriate. The frequency of uterine leiomyoma was 21, 18%. That one concern mainly patients at 35 years old or more [49, 6% (35-44years), ?45years (20, 6%)], singles (70, 4%), null parous (59,4%), having a high level of study (university: 54, 6%), history of UL (56, 7%), and alcohol intake (75, 5%). Hemorrhage (33, 2%) and pelvic pain (31, 6%) are the most frequent expression of those tumors. The most of those patients have excess weight (43, 1%) or obesity (46, 5%). The majority of uterine leiomyoma was corporeal (82, 9%) intramuscular (42, 4%) and their number didn’t overtake five by patient (70, 8%) in majority of cases. Majoration of the uterine cavity (46, 5%) and Fallopian tubes obstructions (30, 6%) are the most frequent abnormalities in hysterosalpingography. Myomectomy is the main treatment (65, 2%). The mean of direct cost were 803$USA and 884$ USA for myomectomy and hysterectomy respectively

Manifestations cliniques de l’infection à Coronavirus SARS-Cov-2 (COVID-19): Clinical characteristics of coronavirus infection disease (COVID-19)

The pandemic caused by the new coronavirus  (SARS-CoV-2) in Wuhan, China in December 2019 is a very contagious disease. The World Health Organization (WHO) has declared the ongoing epidemic to be a global public health emergency. Currently, research on this new coronavirus is in progress and several publications are available. The clinical manifestations linked to infection with the new Coronavirus-SARS-COV-2 virus seem to be polymorphic and multi-systemic, going beyond the typical respiratory nosological pattern described (fever, asthenia and respiratory symptoms cough and difficulty in breathing). These manifestations can be cardiovascular, dermatological, ORL, hepatic, renal, ophthalmological and neurological. This review describes the clinical manifestations as well as the pathogenesis known to date of the coronavirus disease 2019 (COVID-19); the diagnosis and treatment are not included in this mini review. La pandémie causée par le nouveau virus du coronavirus (SARS-CoV-2) à Wuhan, en Chine, en décembre 2019 est une maladie très contagieuse. L’Organisation mondiale de la Santé (OMS) a déclaré que l’épidémie en cours était une urgence mondiale de santé publique. Actuellement, les recherches sur ce nouveau coronavirus sont en cours et plusieurs publications sont disponibles. Les manifestations cliniques liées à l’infection au nouveau Corona-virus SARS-COV-2 semblent être très polymorphes et multi systémiques, dépassant largement le cadre nosologique typiquement respiratoire. Ces manifestations peuvent être cardio-vasculaires, dermatologiques, ORL, hépatiques, rénales, ophtalmologiques et même neurologiques. Cette revue décrit les manifestations cliniques ainsi que de la pathogénie connues à ce jour du coronavirus 2019 (COVID-19) ; le diagnostic et le traitement ne seront volontairement pas abordés

A possible case of spontaneous Loa loa encephalopathy associated with a glomerulopathy

It is well known that renal and neurological complications may occur after antifilarial treatment of patients infected with Loa loa. Conversely, spontaneous cases of visceral complications of loiasis have been rarely reported. A 31-year-old Congolese male patient who had not received any antifilarial drug developed oedema of the lower limbs, and then transient swellings of upper limbs. Two months after, he developed troubles of consciousness within several hours. At hospital, the patient was comatose with mild signs of localization. Laboratory tests and an abdominal echography revealed a chronic renal failure due to a glomerulopathy. Three weeks after admission, Loa microfilariae were found in the cerebrospinal fluid, and a calibrated blood smear revealed a Loa microfilaraemia of 74,200 microfilariae per ml. The level of consciousness of the patient improved spontaneously, without any specific treatment, but several days after becoming completely lucid, the patient died suddenly, from an undetermined cause. Unfortunately, no biopsy or autopsy could be performed. The role of Loa loa in the development of the renal and neurological troubles of this patient is questionable. But the fact that such troubles, which are known complications of Loa infection, were found concomitantly in a person harbouring a very high microfilarial load suggests that they might have been caused by the filarial parasite. In areas endemic for loiasis, examinations for a Loa infection should be systematically performed in patients presenting an encephalopathy or a glomerulopathy

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

Vitamin D Deficiency and Risk of Uterine Leiomyoma among Congolese Women. A Hospital-Based Case-Control Study

The aim of the present study was to assess the relationship, between Vitamin D deficiency and uterine leiomyoma in Congolese women.From April 1 to October 31, 2014, 216 patients with ultrasound diagnosis of uterine leiomyoma (cases) and 216 women without this condition (controls) recruited in six medical facilities in Kinshasa were enrolled in the present study. A single blood sample was obtained from all participants to assess serum17β-estradiol and progesterone concentration using RIA and 25(OH) D by IRMA. Vitamin D deficiency was defined as 25(OH) D levels <4 ng/mL and <12 ng/mL using local and IOM cut-off levels, respectively. Chi square, Student t and Mann Whitney tests were used for group comparison. Logistic regression analysis was used to identify factors associated with Vitamin D deficiency. Vitamin D deficiency was observed in 17.1% and 47.7% of patients with ULM using local and IOM criteria defining different steps of vitamin D respectively. Compared to controls, the difference was statistically significant only when using local criteria (17.7% vs 10.2%; p = 0.028).ULM main risk factors were age ≥35 years (aOR=2,974; 95%CI 1,702-5,139; p = 0,001); null parity (aOR=3,951;95%CI 2,311-6,754;  p= 0,001). Familial history of ULM (aOR=2,619; 95% CI 1,376-4,986; p =0,003) personal history of ULM a(OR3,776; 95% CI 1,885-7,565;  p=0,001); absence of menopause(OR5,502; 95% CI 2,615-11,517; p= 0,001); high serum progesterone levels (aOR 2,320 95% CI1,136-4,711; p= 0,021),   alcohol consumption  (aOR0,295; 95 % CI 0,150-0,580; p= 0,001) and Vitamin D deficiency(aOR2,153; 95% CI 1,035-4,517; p=  0,040).  Vitamin D deficiency was a common finding in patients with ULM and emerged as one of the main risk factors. However, this relationship need to be confirmed with a representative sample of women with ULM

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