Evaluation du niveau de connaissance et des facteurs prédisposant aux hépatites B et C chez les patients suivis en consultations externes des trois hôpitaux de Kinshasa : étude transversale multicentrique: Assessment of level of knowledge and factors predisposing on hepatitis B and C in patients followed by external consultations of the three hospitals of Kinshasa: a multicenter cross-sectional study

Context and objective. Knowledge on prevention and risk factors for HBV and HCV in the community is essential in order to fight against efficiently the spread of HBV and HCV. The aim of this study was to assess the extent of the risk factors for hepatitis B and C virus infection in Congolese community settings through outpatients. Methods. A multicentric cross-sectional study was conducted from May to October 2016. It consisted directly in collecting information on hepatitis B and C from outpatients in 3 hospitals of Kinshasa: Clinique d’Or, CUK and CHEM. Data collection was done consecutively. Results. 133 patients were interviewed (male 66.9%, mean age 33.9 ± 7.8 years). Knowledge of hepatitis B or C was found in 58.6% patients. The predisposing factors of hepatitis B and C were on average 4 factors in the same person and 24.8% of the respondents had at least 4 predisposing factors. The high level of study was the major factor associated with best knowledge of hepatitis B and C (aOR: 15.81, 95% CI: 4.90-18.01, p <0.001). Conclusion. The frequency of predisposing factors for hepatitis B and C is high in our environment; sufficient information on the harmful effects of these viruses would reduce this frequency and increase knowledge about hepatitis B and C. Contexte et objectif. La connaissance par la population des moyens de prévention et des facteurs prédisposant est indispensable en vue de lutter efficacement contre la propagation des virus de l’hépatite B et C. L’objectif de cette étude était d’évaluer l’ampleur des facteurs prédisposant l’acquisition de l’infection par le virus de l’hépatite B et C en milieu communautaire congolais. Méthodes. Etude transversale multicentrique, ayant inclus des patients recrutés, par convenance en consultation externe des trois formations hospitalières de Kinshasa ; entre mai et octobre 2016. Elle avait consisté à recueillir directement par entretiens dirigés, des informations sur les connaissances des hépatites B et C. Résultats. Au total 133 sujets ont été interviewés (hommes 66,9%, âge moyen était de 33,9±7,8 ans). Près de 59% des patients avaient avoué avoir des connaissances sur les hépatites B et C. Les facteurs prédisposant aux hépatites B et C étaient en moyenne de 4 chez la même personne. Le niveau d’étude élevé a émergé comme seul facteur associé de manière indépendante, à la connaissance de l’hépatite B et C (ORa : 15,81 ; IC 95% : 4,90-18,01, p<0,001). Conclusion. La fréquence des facteurs prédisposant à l’hépatite B et C est élevée dans nos milieux, une information suffisante sur les méfaits de ces virus, permettrait de diminuer cette fréquence et d’augmenter la connaissance sur les hépatites B et C

Frequency and factors associated with proteinuria in COVID-19 patients: a cross-sectional study

Proteinuria is a marker of severity and poor outcome of patients in intensive care unit (ICU). The objective of this study was to determine the frequency of proteinuria and the risk factors associated with proteinuria in Congolese COVID-19 patients. The present cross sectional study of proteinuria status is a post hoc analysis of data from 80 COVID-19 patients admitted at Kinshasa Medical Center (KMC) from March 10th to July 10th, 2020. The population under study came from all adult inpatients (≥18 years old) with a laboratory diagnosis by polymerase chain reaction (PCR) of COVID-19 were selected and divided into two groups (positive proteinuria and negative proteinuria group). Logistic regression models helped to identify the factors associated with proteinuria. The P value significance level was 0.05. Among 80 patients who tested positive for SARS-CoV-2 RT-PCR, 55% had proteinuria. The mean age was 55.2 ± 12.8 years. Fourty-seven patients (58.8%) had history of hypertension and 26 patients (32.5%) diabetes. Multivariable analysis showed age ≥65 years (aOR 5,04; 95% CI: 1.51-16.78), diabetes (aOR 3,15 ;95% CI :1.14-8.72), ASAT >40 UI/L (aOR 7,08;95% CI:2.40-20.87), ferritin >300 (aOR 13,47 ;95% CI :1.56-26.25) as factors independently associated with proteinuria in COVID-19 patients. Proteinuria is common in Congolese COVID-19 patients and is associated with age, diabetes, ferritin and aspartate aminotransferase (ASAT)

Assessment of the factors and impact of obese sedentary employee membership in the composite structured exercise program

The objective is to determine the factors influencing and the impact of obese worker membership in the structured mixed exercise program. Analytical cross-sectional study of 157 obese workers, aged 18 to 59, randomly selected and subjected to a 3-day, one-day, moderate-intensity, structured exercise program of moderate-intensity to high including jogging, aerobic gymnastics, basketball, volleyball, swimming, abdominals, and walk of 10,000 not at the rate of three working days and two days of weekend recorded using a pedometer. This program has been combined with low-calorie nutrition education, rich in fiber and vitamins and have been associated with spontaneous physical exercise. The factors influencing the adherence of obese workers to the mixed structured exercise program were measured by the positive personal motivation associated with membership. Motivation to undertake the intervention program resulted from the home exercise program, attendance at appointments, better follow-up of prescribed protocols, and better self-reported adherence. Logistic regression was used to identify independent determinants of adherence to the intervention program. The value of p <0.05 defined the threshold of statistical significance. The overall adherence rate of obese workers to the exercise program was 84.1%. Cardiovascular risk factors were significantly higher in the more adherent compared to the less adherent (p = 0.001). Obesity, age under 50, and females were the major determinants of joining the structured mixed exercise program and multiplied by 5 if employees were obese and older. Less than 50 years (OR aj = 4.91 95% CI (1.36-6.14), p = 0.001 for the obese and OR aj = 4.87 95% CI (1.53-6.48), p = 0,000 for age under 50), and 2 for obese women (OR aj = 2.06 95% CI (1.23-4.79), p = 0.000). Obesity, female gender, and age under 50 influence and increase obese adherence to the mixed structured exercise program. The latter positively improve the associated cardiovascular, metabolic and behavioral risks in the context of occupational health

Factors associated with complications in ST-elevation myocardial infarction: a single-center experience

Abstract Background ST-elevation myocardial infarction (STEMI) is a major public health problem. This study aimed to determine the prevalence and identify the determinants of STEMI-related complications in the Cardiology Intensive Care Unit of the Sud Francilien Hospital Center (SFHC). Methods We retrospectively analyzed the data of 315 patients with STEMI aged ≥ 18 years. Logistic regression was used to identify factors independently associated with the occurrence of complications. Results Overall, 315 patients aged 61.7 ± 13.4 years, of whom 261 were men, had STEMI during the study period. The hospital frequency of STEMI was 12.7%. Arrhythmias and acute heart failure were the main complications. Age ≥ 75 years (adjusted odds ratio [aOR], 5.18; 95% confidence interval [CI], 3.92–8.75), hypertension (aOR, 3.38; 95% CI, 1.68–5.82), and cigarette smoking (aOR, 3.52; 95% CI, 1.69–7.33) were independent determinants of acute heart failure. Meanwhile, diabetes mellitus (aOR, 1.74; 95% CI, 1.09–3.37), history of atrial fibrillation (aOR, 2.79; 95% CI, 1.66–4.76), history of stroke or transient ischemic attack (aOR, 1.99; 95% CI, 1.31–2.89), and low high-density lipoprotein-cholesterol (HDL-C) levels (aOR, 3.70; 95% CI, 1.08–6.64) were independent determinants of arrhythmias. Conclusion STEMI is a frequent condition at SFHC and is often complicated by acute heart failure and arrhythmias. Patients aged ≥ 75 years, those with hypertension or diabetes mellitus, smokers, those with a history of atrial fibrillation or stroke, and those with low HDL-C levels require careful monitoring for the early diagnosis and management of these complications

Knowledge and practice of the physical activity prescription by generalists and specialist physicians of the city of Kinshasa: a cross-sectional study

Abstract Background The health benefits of regular physical activity (PA) are well documented. However, several people in both developed and developing countries do not meet PA recommendations. Health professionals are believed to be potential PA promoters. The purpose of this study is to gain insight into general and specialist practitioners’ knowledge, practices and PA prescription-related factors in private and public hospitals in Kinshasa. Methods A multicenter cross-sectional analytical study was conducted among general and specialist practitioners in the Democratic Republic of the Congo’s capital using a declarative and anonymous questionnaire. Results Overall, 40.2% of the participants were interested in their patient’s PA, 2.3% prescribed PA, and 0.9% did it correctly. Specialist physicians (SPs) prescribed PA more frequently than general practitioners (GP), and private hospital physicians prescribed PA more frequently than public hospital physicians. Five factors were independently associated with participants in prescribing PA: being in a private hospital increased the likelihood of prescribing PA by twofold (aOR, 1.83; 95% CI, 0.99–3.39; p = 0.055), being an SP increased the likelihood by sixfold (aOR, 6.22; 95% CI, 3.78–10.51; p = 0.000), being an internist increase the likelihood by sixfold (aOR, 5.81; 95% CI, 3.45–9.78; p = 0.000), being cardiologist by a factor of 12 (aOR, 12.91; 95% CI, 4.37–38.15; p = 0.000) and knowing the benefits of PA by a factor of 2 (aOR, 2.29; 95% CI, 1.29–4.08; p = 0.006). The most common reason given for a lack of interest in patients’ PA, followed by a lack of knowledge about current PA prescribing recommendations and a lack of time. Conclusions SPs and professionals in the private health sector were the most interested in their patients’ PA. A small portion of them actually prescribed it, and only a tiny proportion did it correctly. This bleak picture highlights a need to rethink the undergraduate medical curricula, especially about teachings on the importance and use of PA as a medicine in its own right in disease prevention and treatment

Stroke signs knowledge and factors associated with a delayed hospital arrival of patients with acute stroke in Kinshasa

Background: Rapid recognition and early medical intervention are essential to reduce stroke-related mortality and long-term disability. This study aimed to evaluate awareness of stroke symptoms/signs and determine factors delaying the hospital arrival of patients with acute stroke in Kinshasa. Methods: Patients with stroke and/or accompanying family members were interviewed using a standard questionnaire, and their medical records were reviewed. Factors independently associated with a late arrival (≥4.5 h) to the hospital were identified using the logistic regression test in forward multivariate analysis. Results: Overall, 202 patients with an average age of 57.9 ± 13.1 years were included. Only 27 (13.4%) patients immediately associated the initial symptoms with a stroke episode. Delayed hospital arrival was observed in 180 (89.1%) patients. Unmarried status (adjusted odds ratio [aOR], 2.29; 95% confidence interval [CI], 1.17–4.88; p = 0.007), low education level (aOR, 2.29; 95% CI, (1.12–5.10; p = 0,014), absence of impaired consciousness (aOR, 3.12; 95% CI, 1.52–4.43; p = 0.005), absence of a history of hypertention (aOR, 1.85; 95% CI, 1.18–3.78; p = 0.041), absence of a history of diabetes (aOR, 1.93; 95% CI, 1.15–4.58; p = 0.013), heavy alcohol consumption (aOR, 1.83; 95% CI, 1.12–2.83; p = 0.045), absence of a severe to very severe stroke (aOR, 4.93; 95% CI, 0.82–1.01; p = 0.002), and presence of ischemic stroke (aOR, 2.93; 95% CI, 1.54–4.59; p = 0.001) were identified as independent determinants of delayed hospital arrival. Conclusions: This study depicted a low stroke awareness rate and a much longer prehospital delay than evidence-based guidelines recommend and identified eight factors that public health actions could target to promote the earliest management of stroke

Circulating Proprotein Convertase Subtilisin/Kexin type 9 level independently predicts incident cardiovascular events and all-cause mortality in hemodialysis black Africans patients.

Cardiovascular (CV) disease is the leading cause of mortality in patients with end-stage kidney disease (ESKD). The aim of the present study was to determine whether Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) could be an independent predictor of CV events and all-cause mortality in black African haemodialysis patients. We carried out a prospective cohort study of all consecutive hemodialysis (HD) patients between August 2016 and July 2020, admitted in six hemodialysis centers of Kinshasa, Democratic Republic of Congo. Independent determinants of plasma PCSK-9 measured by ELISA were sought using multiple linear regression analysis. Kaplan-Meier's method described the incidence of CV events while competitive and proportional risk models looked for independent risk factors for death at the .05 significance level. Out of 207 HD patients, 91 (43.9%) died; 116 (56.1%) have survived. PCSK9 level was significantly higher in deceased patients compared to survivors: 28.0 (24.0-31.0) ng/l vs 9.6 (8.6-11.6) ng/ml (p <  0.001). Patients with plasma PCSK9 levels in tertile 3 had a higher incidence of CV events and mortality compared to patients with plasma PCSK9 levels in tertile 2 or tertile 1 (p <  0.001). Tertile 3 negatively influence survival rates (26.6%) compared to tertile 2 (54.7%) and tertile 1 (85.3%). Patients in tertile 3 and tertile 2 had a 4-fold higher risk of death than patients in tertile 1. After adjustment for all parameters, competitive risk analysis showed that mortality was 2 times higher in patients with stroke. Similarly, serum albumin < 3.5 g/dL or PCSK9 in tertile 3 were respectively associated with 2 or 6 times higher rates of deaths. Elevated plasma PCSK9 level is an independent major predictor of incident CV events and all-cause mortality in black African HD patients

Proprotein Convertase Subtilisin/Kexin 9 level is independently associated with 10-year cardiovascular risk in blood donors in Kinshasa: A cross-sectional study based on Framingham predictive equation

Context and objective: Proprotein Convertase Subtilisin Kexin type 9 (PCSK9) plays an important role in lipid homeostasis. The present study aimed&nbsp; to determine whether PCSK9 is a potential cardiovascular risk (CVR) factor among apparently healthy people. Methods:&nbsp; A cross-sectional&nbsp; study was conducted between August 2016 and July 2020 in the City of Kinshasa, Democratic Republic of the Congo. Volunteer and regular blood&nbsp; donors from the Catholic medical network (Bureau Diocésain des OEuvres Médicales [BDOM]/Kinshasa) were enrolled in this study. Serum PCSK9&nbsp; and lipid levels were measured by ELISA and enzymatic colorimetric method, respectively. Framingham’s predictive equation was used for predicting&nbsp; cardiac events. Pearson's correlation coefficients (r) were calculated to assess the association between the different lipid fractions and&nbsp; PCSK-9. The search for the determinants of 10 year-risk of a high cardiovascular event was carried out using the cultivariate binary logistic&nbsp; regression model. Results: Of 296 subjects included in the present study, 264 (89.1 %) had low and 32 (10.8 %) high CVR. Age ≥ 50 years (aOR 5), low HDL-c (aOR 5),&nbsp; high LDL-c (aOR 6), hypertriglyceridemia (aOR 4), and belonging to the 3rd tertile of PCSK9 ((aOR 4.4) emerged as independent determinants of high&nbsp; CVR. Conclusion: High plasma levels of PCSK9 are associated with high CVR in apparently healthy people. Prospective studies in the general population&nbsp; to confirm this Framingham cardiovascular prediction are needed.&nbsp; &nbsp; French title: Le taux de Proprotein Convertase Subtilisin/Kexin 9 est indépendamment associé au risque cardiovasculaire à 10 ans chez les donneurs de sang à Kinshasa : Etude transversale basée sur Contexte et objectif: La Proprotéine Convertase Subtilisine Kexin type 9 (PCSK9) est importante dans l'homéostasie des lipides. Cette étude visait à&nbsp; établir le rôle potentiel de PCSK9 comme facteur de risque cardiovasculaire (RCV). Méthodes. L’enquête transversale couvrant la période d’août 2016 à juillet 2020 a été conduite dans la ville de Kinshasa (RD Congo), sur des donneurs de sang volontaires et réguliers au sein du réseau médical catholique (BDOM). La technique Elisa a permis l’analyse de PCSK9 sérique et le taux des lipides était dosé par la méthode enzymatique colorimétrique. L'équation de prédiction des événements CV a recourru à la méthode Framingham. La corrélation entre le taux des lipides sériques et le PCSK-9 a été faite à l’aide de corrélation linéraire de Pearson. La régression logistique binaire multivariée a déterminé le niveau du risque futur&nbsp; des événements CV. Résultats: 264/296 sujets (89,1 %) avaient un RCV faible, 32 (10,8 %) un RCV élevé. Les principaux déterminants du RCV étaient :&nbsp; âge ≥ 50 ans (ORa 5), taux bas de HDL-c (ORa 4), taux élevé de LDL-c (ORa 6) et/ou de triglycéride (ORa 4) et l'appartenance au 3ème tertile de PCSK9 (ORa 4). Conclusion: Le taux plasmatique élevé de PCSK9 constitue un facteur de risque un RCV élevé dans cette population en bonne santé apparente. L’extension de l’étude dans la &nbsp; pulation générale est nécessaire pour la validation de ces résultats. &nbsp; &nbsp; &nbsp

Admission hyperglycemia and associated risk factors among patients with acute stroke in intensive care units in Kinshasa, the Democratic Republic of the Congo: Hyperglycémie à l’admission et facteurs associés chez les patients avec Accident Vasculaire Cérébral en phase aiguë dans les soins intensifs à Kinshasa, en République Démocratique du Congo

Context and objective.&nbsp;Despite being established as a correlate of unfavorable outcome in acute stroke, little is known about the burden and associated risk factors of admission hyperglycemia in acute stroke in sub-Saharan Africa. The present study aimed to assess its frequency and associated risk factors in Congolese patients admitted in Intensive Care Units (ICUs) in the acute phase of stroke.&nbsp;Methods.&nbsp;A multicenter (6 ICUs) prospective cohort study including consecutive &nbsp;patients with acute stroke was undertaken from &nbsp;July 15th, 2017 to March 15th, 2018.The &nbsp;Glasgow Coma Scale helped to determine the severety of the disease at admission. Stress hyperglycemia was considered for a random blood glucose levels at admission ˃140 mg/dL in patients without type 2 diabetes mellitus (T2DM). Independent factors associated with admission hyperglycemia were assessed using logistic regression analysis.&nbsp;Results.&nbsp;Out of 194 patients (mean age 58.7±13.1 years; 64% males, 74.7% light to moderate stroke severity; 59% hemorrhagic stroke) enrolled, admission hyperglycemia was found in 106 (54.6%) of patients (mean age 60.1 ± 14.3 years; 67% men, 67% hypertension) with 77 (72.6%) and 29 (27.4 %) of them having stress and chronic hyperglycemia, respectively. Independent predictors of admission hyperglycemia were age [aOR 1.98; 95%CI 1.17-3.36), GCS &lt; 8 (aOR 3.83; 95% CI 1.99-7.35) and diabetes (aOR 9.02; 95%CI 3.38-14.05).&nbsp;&nbsp;Conclusion.&nbsp;More than half of critically ill patients exhibit admission hyperglycemia with age, severity of stroke and known diabetes as its main associated risk factors. Contexte et objectif. L’hyperglycémie à l’admission en phase aiguë d’AVC est établie comme délétère sur l’issue. Les données sont néanmoins éparsesen Afique subsaharienne quant à&nbsp; son ampleur et aux facteurs associés. Cette étude a évalué &nbsp;la fréquence et les facteurs associés, chez les patients congolais admis en phase aiguë d’AVC dans 6 USI de Kinshasa.&nbsp;Méthodes. L’étude multicentrique de cohorte prospective a inclus &nbsp;des patients consécutifs&nbsp; admis en phase aiguë d’AVC, entre les 15 juillet 2017 et 15 mars 2018. Le score de Glascow a permis d’apprécier la gravité du tableau à l’admission. Les facteurs de risque indépendant associés à l’hyperglycémie ont été recherchés, à l’aide d’une analyse de régression logistique multivariée.&nbsp;Résultats. De 194 patients&nbsp; inclus (H&nbsp;; 64%), 74,7% &nbsp;avaient une forme&nbsp; légère &nbsp;à modérée &nbsp;et 59% avaient un AVC hémorragique. Un patient sur 2 avait une hyperglycémie à l’admission. Les prédicteurs indépendants de l’hyperglycémie à l’admission étaient l’âge [a OR 1,98&nbsp;; IC 95%, 1,17-3,36), un GCS &lt; 8 (ORa 3,83&nbsp;; IC 95%&nbsp;: 1,99-7,35) et le diabète (ORa 9,02&nbsp;; IC 95%&nbsp;: 3,38-14,05)].&nbsp;Conclusion. Plus de la moitié des patients avec AVC en phase aiguë présentent une hyperglycémie à l’admission avec comme principaux facteurs de risque associés, l’âge, la gravité de l’AVC et le diabète connu

Epidemiological, clinical Characteristics and mortality of patients Infected with SARS-CoV-2 Admitted to Kinshasa University Hospital (KUH), the Democratic Republic of the Congo from March 24th, 2020, to January 30th, 2021: Two waves, two faces?

Context and objective: Like all epidemics, the COVID-19 pandemic occurs in several highly diverse waves. The objective of the present study was to&nbsp; compare the demographic and clinical characteristics and mortality of patients between the first and second waves of COVID-19. Methods: This was a historical follow-up study conducted at the Kinshasa University Hospital (KUH) between March 2020 and January 2021. We used&nbsp; the χ² test to compare proportions. Survival was described by the Kaplan Meier method. Cox regression was used to identify independent&nbsp; predictors of mortality. Results: A total of 411 COVID-19 patients were enrolled. Compared to wave 1 patients, wave 2 patients were significantly&nbsp; older (52.4 ±17.5 vs. 58.1 ±15.7; p=0.026). The death rate of patients in the first wave was higher than in the second wave (p=0.009). Survival was&nbsp; more reduced in the first wave compared with the second wave. Predictors of mortality present in both the first and second waves were respiratory&nbsp; distress and severe COVID-19 stage. Conclusion: The first wave was more lethal than the second wave with respiratory distress and severe COVID-19&nbsp; stage as independent predictors in both waves. Strengthening the health system and raising awareness of preventive measures including&nbsp; vaccination should continue to sustain gains.&nbsp; &nbsp; French title: Caractéristiques épidémiologiques, cliniques et mortalité des patients infectés par le SRAS-CoV-2 admis aux Cliniques Universitaires&nbsp; de Kinshasa, République démocratique du Congo du 24 mars 2020 au 30 janvier 2021 : Deux vagues, deux visages ? Contexte et objectif: Comme toutes les épidemies, la pandémie à COVID-19 sévit en plusieurs vagues très diversifiées. L’étude a comparé les&nbsp; caractéristiques démographiques et cliniques ainsi que la mortalité des patients entre la 1ère et la 2ème vague de COVID-19. Méthodes: Il s’agissait&nbsp; d’une étude de suivi historique réalisée aux Cliniques Universitaires de Kinshasa entre mars 2020 et janvier 2021. Le test de χ² a permis la&nbsp; comparaison des proportions, et la la survie a été étudiée par la méthode de Kaplan Meier. L’identification dess prédicteurs indépendants de la&nbsp; mortalité a été déterminée par la régression de Cox. Résultats: Des 411 patients enrôlés, ceux de la 2ème vague étaient beaucoup plus âgés ((58,1 ±15,7 vs 52,4 ±17,5 ; p=0,026). La 1ère vague a été&nbsp; plus meurtrière que la seconde (p=0,009). La survie était plus réduite dans la première vague par rapport à la seconde. Les facteurs prédictifs de&nbsp; mortalité présents à la fois dans la première et la deuxième vague étaient la détresse respiratoire et le stade COVID-19 sévère. Conclusion: La 1ère&nbsp; vague était plus meutrière que la 2ème avec comme prédicteurs indépendants la détresse respiratoire et le stade COVID-19 sévère dans les deux&nbsp; vagues. Le renforcement du système de santé et la sensibilisation sur les mésures préventives dont la vaccination devraient continuer à maintenir&nbsp; les gains