Firearm injuries among children due to the Kivu conflict from 2017 to 2020: A hospital-based retrospective descriptive cohort study

Introduction: Firearm-related injuries are deadly but avoidable. The case of Kivu, a region in the Eastern Democratic Republic of Congo (DRC), is alarming. Decades of unresolved regional conflicts birthed armed groups that have massacred inhabitants and injured several children. This regional instability has also created barriers to seeking and obtaining timely care, decreasing the survival rate. This region\u27s lack of data on paediatric fatal and nonfatal firearm injuries (F&NFFIs) needs studying. Thus, we aim to determine the prevalence and evaluate the outcomes of paediatric F&NFFIs in Kivu. Methods: We included all F&NFFI paediatric patients (≤18 years), admitted at our institution between 2017 and 2020. We extracted data from patient records. Next, we assessed the relationship between determinants of paediatric outcomes using the Chi-square test and the student\u27s t-test. Confounders were identified using cox regression. Results: This study included 101 paediatric patients, mostly male (63.4%), with an average age of 15.9 years residing 164.4 km on average from the hospital. On average, they were admitted 2.9 days post-injury, with the most affected anatomical regions being lower limbs (53.5%) and upper limbs (18.8%). The mean length of stay was 52.9 days, and the mortality rate was 4.0%. Also, injury complications increased the mean length of stay and mortality rate. In addition, mortality was correlated with circulatory failure and anaemia. Discussion: Paediatric F&NFFIs in Eastern DRC is a preventable tragedy. Mortality is increased by injury complications and correlates with some biological factors. Prevention strategies should be developed to protect children and appropriate measures should be established to improve rates of prehospital care and early hospital presentation to lower mortality and improve paediatric outcomes

Association hypertrophie bénigne de la prostate et diabète sucré de type 2 au Sud-Kivu

Context Benign prostate hyperplasia (BPH) is a highly prevalent condition. In addition to age and androgens, type 2 diabetes mellitus (T2DM) which is expanding worldwide and in Sub-Saharan Africa is frequently cited as a risk factor. Further, T2DM is increasingly noted among BPH patients of South-Kivu region, in the Eastern part of the Democratic Republic of Congo (DRC). This association may adversely affect the clinical expression, the treatment as well as the evolution of BPH. Objectives - To check the presence of an association between BPH and T2DM in South-Kivu region; - To determine possible underlying mechanisms that could support this association. Methodology This study is based on hospital observations of a higher prevalence of diabetes among patients operated for BPH compared to that of the general population. These findings are subsequently verified on a large scale in the South-Kivu Province. Among the associative mechanisms between BPH and T2DM described in the literature, we highlight those which are frequently observed in our study. Finally, the potential influence of ethnicity on prostatic volume is reported. Results Prostatic volume and prostate symptoms are statistically higher in diabetics than in non-diabetics. Hyperinsulinemia, poor glycemic control and lower testosterone levels are the associative mechanisms observed in this study. Obesity markers are scant among diabetic subjects. Ethnicity also seems to modulate prostate volume. Conclusion T2DM is an important determinant of BPH in South-Kivu region. Thus, it is appropriate to integrate urological assessment in the follow-up of diabetic men over 40 years old. In addition, glycemic imbalance should be investigated in patients with enlarged prostate.Contexte  L’hypertrophie bénigne de la prostate (HBP) est une affection à forte prévalence. Outre l’âge et les androgènes, le diabète sucré de type 2 (DST2), qui est en forte expansion dans le monde et surtout en Afrique Subsaharienne, est fréquemment cité parmi les facteurs de risque.En outre, le DST2 est de plus en plus observé chez les patients souffrant d’HBP au Sud-Kivu dans l’Est de la République Démocratique du Congo (RDC). Cette association peut influencer de façon néfaste l’expression clinique, la prise en charge et l’évolution de l’HBP. Objectifs  - Vérifier l’association HBP et DST2 au Sud-Kivu ; - Identifier les mécanismes possibles qui pourraient sous-tendre cette association. Méthodologie L’étude est issue des constats faits en milieu hospitalier d’une fréquence élevée de sujets diabétiques parmi les patients opérés d’HBP par rapport à la prévalence dans la population générale. Ces constats sont par la suite vérifiés à large échelle dans la population du Sud-Kivu. Parmi les mécanismes associatifs décrits dans la littérature entre l’HBP et le DTS2, une démarche est menée pour identifier ceux qui se manifestent souvent dans notre étude. Enfin, une observation portant sur l’éventuelle influence de l’appartenance ethnique sur le volume prostatique est mise en évidence. Résultats  Le volume prostatique ainsi que les symptômes prostatiques sont statistiquement plus importants chez les diabétiques que chez les sujets non-diabétiques. L’hyperinsulinémie, le mauvais contrôle glycémique ainsi que le taux bas de la testostérone sont les variables associatives observées dans ce travail. Les marqueurs d’obésité sont rares parmi les diabétiques. L’appartenance ethnique exercerait également une certaine influence sur le volume prostatique. Conclusion  Le diabète sucré de type 2 est un important déterminant d’HBP au Sud-Kivu. Ceci étant, il sied d’intégrer un bilan urologique dans le suivi des diabétiques chez les sujets masculins âgés de 40 ans révolus. En outre, la recherche des perturbations glycémiques chez des patients présentant une glande prostatique volumineuse est recommandée.(MED - Sciences médicales) -- UCL, 201

Ureteral switch for bilateral ureteropelvic junction obstruction in a case of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is characterized by congenital aplasia of the uterus and the upper part of the vagina. Secondary sexual characteristics and karyotype are normal. This syndrome affects at least 1 out of 4500 women.MRKH may be isolated (type I) but it is more frequently associated with other malformations (MRKH type II).We present a typical case of MRKH type II associated with bilateral pelvic kidneys ectopia, ureteropelvic junction (UPJ) obstruction and high inserting ureters. The ureteral switch was performed at the time of pyeloplasty to prevent postoperative obstruction secondary to the angulation. © 2013 Pan African Urological Surgeons' Associatio

Kernohan–Woltman notch phenomenon in patient with subdural hematoma and ipsilateral hemiparesis in Bukavu

Key Clinical Message Kernohan–Woltman phenomenon is a rare and paradoxical neurological situation in which a transtentorial lesion leads to compression of the contralateral cerebral peduncle responsible for compression of the descending corticospinal fibers with clinical consequence of a motor deficit ipsilateral to the primary lesion. This phenomenon should attract the attention of clinicians in order to avoid unfortunate incidents such as wrong‐side craniotomy in neurosurgical practice. In this work, we report a similar situation. Abstract The Kernohan–Woltman notch phenomenon is a rare and paradoxical neurological situation in which transtentorial damage is observed leading to compression of the contralateral cerebral peduncle responsible for compression of descending corticospinal fibers with the clinical consequence of a motor deficit ipsilateral to the primary lesion. This phenomenon has been found in several situations including tumors and cerebral hematomas after craniocerebral trauma. In this work, we have reported the case of a 52‐year‐old man with hemiparesis ipsilateral to a large chronic subdural hematoma

Predictors of acute stress disorder in victims of violence in Eastern Democratic Republic of the Congo

Background: The Democratic Republic of the Congo underwent more than 25 years of war resulting in millions of deaths and in survivants struggling with trauma related disorders. The factors contributing to acute stress disorder following a traumatic event remain little understood. Emotion regulation might play a role in the development of acute stress disorder among victims of war-related violence. Objectives: We assessed the association between acute stress disorder expression and cognitive strategies of emotion regulation among injured victims of violence in the Eastern Democratic Republic of the Congo. Methods: This cross-sectional study included 120 patients (77% males, mean age 30 ± 11 years) with traumatic wounds admitted at the Bukavu General Hospital. We assessed acute stress disorder through the Stanford Acute Reaction Stress Questionnaire and emotion regulation strategies through the Cognitive emotional regulation questionnaire. Results: Using Pearson Chi2 and Student t-test we found that compared with patients without acute stress disorder (N = 56), patients with acute stress disorder (N = 64) were more likely to be victims of armed robbery (p = .02), of a bullet (p = .04), of having wounds with fracture (p = .03) or neurological damage (p = .05). In multivariate logistic regression, wounds with neurological damage [OR = 2.23 (1.03-6.05)] and maladaptive emotion regulation, namely self-blame [OR = 1.71 (1.01-3.21)] and rumination [OR = 1.97 (1.04-4.13)], were significant predictors of acute stress disorder. Conclusion: Acute stress disorder was prevalent in the aftermath of violence induced injuries and might be associated with emotion regulation strategies such as self-blame and rumination. HIGHLIGHTS Acute stress disorder is strongly associated with maladaptive emotion regulation strategies such as self-blame and rumination. Interventions targeting emotion regulation may reduce acute stress reactions in the aftermath of violence induced injuries

Alobar holoprosencephaly in mining‐related areas of the Eastern region of the Democratic Republic of the Congo : a case series

Background Recent case reports described three cases of holoprosencephaly (HPE) in the area with high mining-related pollution of the southern region of the Democratic Republic of the Congo (DRC). We reported two male neonates with clinically diagnosed HPE in the localities of Fizi and Kitutu, two mineral areas in the Eastern region of the same country (DRC), where artisanal surface mining is predominant with high exposure to radiation and heavy metals from mining. Cases' presentations Two newborns from adult and multigravida mothers without pregnancy complication. The birth weights were 3,200 g and 2,500 g, respectively, and the malformations noticed were essentially the single median eye, the absent nose, polydactyly for one case, and proboscis for the other case. They both died a few minutes later after birth. Conclusion The etiologic factors of HPE remain unknown but seem to be multifactorial from both genetic and environmental factors. We hypothesize under reserve for these two cases that mining and radiation expositions were likely potential environmental associated factors to the occurrence of these malformations