Performance de l’oxymétrie nocturne dans le diagnostic du syndrome d’apnées du sommeil. Etude monocentrique menée au centre Hospitalier de Longjumeau/France: Performance of nocturnal oximetry in the diagnosis of sleep apnea syndrome. Single-center study from Longjumeau Hospital Center / France

Context and objective. Sleep apnea-hypopnea syndrome (SAHOS) is currently under diagnosed or ignored, due to a poor access to polysomnography, the ’gold-standard’’ diagnostic test. Yet, sleep disorder is linked to many complications mainly, cardiovascular disorders. The present study aimed to assess the relevance of overnight pulse oximetry in diagnosing SAHOS. Methods. A cross-sectional analysis was conducted between January 1st and September 30th, 2017. All patients suspected of SAHOS syndrome underwent an overnight pulse oximetry (OPO) and a respiratory polygraphy (PG). Data were analysed using Excel 2010 and SSPSS 21.0, to establish the sensitivity, specificity, the positive and negative predictive value and ROC curve was calculated to determine the performance of OPO compared to PG. Results. 201 patients were enrolled (median age of 64.6 +/- 11.8 years). Males (55%) and obese (medium BMI of 32 kg/m² were preponderant. The sensitivity and specificity of overnight pulse oximetry were 87 % and 85 %, respectively with ROC curve prominently rising at 0.75. Conclusion. The study showing a high sensitivity and specificity suggests that the overnight oximetry could stand as a more accessible alternative to polygraphy in the diagnosis of Sleep apnea-hypopnea syndrome where the latter is not available. Contexte & objectif. Le syndrome d’apnées du sommeil est une pathologie fréquemment sous diagnostiquée et souvent méconnue; particulièrement à cause d’une accessibilité insuffisante au gold-standard du diagnostic, la polysomnographie ou la polygraphie ventilatoire. Et pourtant, l’affection est responsable des complications surtout cardiovasculaires majeures. L’objectif de la présente étude était d’évaluer le niveau de performance de l’oxymétrie nocturne dans le diagnostic du syndrome d’apnées du sommeil. Méthodes. Enquête transversale menée entre le 1er janvier 2016 et le 30 septembre 2017. Tous les patients hospitalisés pour suspicion du syndrome d’apnées du sommeil ont bénéficié d’une oxymétrie nocturne et d’une polygraphie ventilatoire. Les logiciels Excel 2010 et SSPSS 21.0 ont permis d’analyser les données. Nous avons déterminé la sensibilité, la spécificité, la valeur prédictive positive et la valeur prédictive négative. La courbe ROC a été calculée. p < 0,05. Résultats. Au total 201 patients d’âge moyen de 64,6±11,8 ans, avec une prédominance masculine (55%) et en majorité obèses (IMC moyen de 32kg/m²) ont été inclus. La sensibilité et la spécificité de l’oxymétrie nocturne sont respectivement de 87 et de 85% avec une courbe ROC montrant une surface importante sous la courbe de 0,75. Conclusion. Avec sa sensibilité et spécificité élevées, l’oxymétrie nocturne peut constituer une alternative valable au diagnostic du syndrome d’apnées du sommeil. Son innocuité et sa bonne acceptabilité en font un outil facilement exportable et recommandable en cas de carence de moyens appropriés

Profil et facteurs prédictifs de mortalité du traumatisé grave dans la ville de Kinshasa: Profile and predictive factors of mortality of severe trauma patients in Kinshasa city

Context and objective. Little is known about the prognosis of severe trauma in sub-Saharan Africa. Thestudy analyses epidemioclinical features and treatment of severe trauma patients in 4 hospitals of Kinshasa. Mortality determinants were assessed. Methods. A retrospective cohort analysis of epidemuioclinical and theurapeutical data from 195 severe trauma patents admitted from January 1st 2009 to December 31st 2014. Data related to the accident (rescue type, delay to reference, the lesional assessement, and hemodynamic state upon arrival, radiological findings, medical or surgical care provided within the first 48 hours, and the outcome were recorded. Uni-or multivariable analyses were applied as appropriate. To assess death determinants. Results. A total of 195 patients (mean age: 38.8+/-14.6 years; sex ratio F/M = 3/1) were enrolled. Road accidents (90.8%) was the main cause, and not any patient benefited of pre-hospital medical assistance.The time to admission was of 19.2 +/-3.6 H. Head (82.6%) and/or thoracic trauma (67.1%) were the prevalent lesions. Many patients were comatous (86.2%) with uni or bilateral mydriasis, and almost half (42.1%) had respiratory distress. One out of 3 had hemmoragic shock. Only 27 patients were intubated, and a large proportion was hemodynamicly unstable (63.1%; group A). The rate of mortality in ICU was 73.3%. Poor prognosis was linked to five independent predictive facors among which: age >/= 65 years and the RTS score < 10 emerged. The risk of death was most increased in patients with thoracic trauma than others. Conclusion. Excess mortality in this study has identified risk factors which can help developing accurate tagerted strategies. Contexte et objectifs. Les données sur les pronostics des traumatisés graves (TG) en Afrique subsaharienne sont fragmentaires. L’étude analyse les données épidémio-cliniques et thérapeutiques des TG dans 4 hôpitaux de Kinshasa. Les s facteurs associés à la mortalité ont été recherchés. Méthodes. Une analyse de cohorte retrospective des données épidémiocliniques et du traitement des TG, admis entre le premier janvier 2009 et le 31 décembre 2014 a été entreprise. Les circonstances de l’accident données étudiées étaient: les caractéristiques démographiques, les circonstances de l’accident, le type de secours pré-hospitalier le délai de référence, le es données cliniques, le bilan radiologique et lésionnel, ainsi que le traitement médicochirurgical endéans les premières 48 heures ont été enregistré. Une analyse uni- et multivariée a été utilisée pour rechercher les facteurs associés au décès. Résultats. Au total, 195 patients (âge moyen : 38,8±14,6 ans ; sexe ratio F/H= 3/1) ont été inclus. Les accidents de voie publique (90,8%) ont été le principal motif d’admission et aucun patient n’a bénéficié d’une assistance médicale pré-hospitalière. Le délai de référence était en moyenne de 19,2 ± 3,6 h. les lésions céphaliques (82,6%) et thoraciques (67,1%) étaient les plus fréquentes. La majorité de patients étaient en coma (86,2%), et 57,9% avaient une mydriase uni ou bilatérale, tandis que 82 patients (42,1%) présentaient une détresse respiratoire et 35 (17,9%) étaient en choc hémorragique. Seulement 27 patients (13,8%) étaient intubés et la majorité avait un état hémodynamique instable. La mortalité en réanimation était de 73,3%. Cinq facteurs prédictifs indépendants associés à un mauvais pronostic ont été identifiés: parmi lesquels l’âge ≥ 65 ans, la saturation pulsée en oxygène < 90% le score RTS < 10. Le risque de décès était plus fréquent dans le groupe des traumatisés thoraciques que dans d’autres. Conclusion. La surmortalité dans cette enquête a permis d’identifier des facteurs pronostiques justifiant des stratégies ciblées de prise en charge

Aspects épidémio-clinique et évolutif de la Cirrhose du foie à Kinshasa : Etude Multicentrique: Multicentric study on epidemiological, clinical and progressive aspects of liver cirrhosis in Kinshasa

Context and objectives. Liver cirrhosis is relatively common and leads to multiple complications in developing countries where management is often late. However, data on this disease are paradoxically scarce in DR Congo. The present study was designed to describe epidemiological, clinical, therapeutic aspects as well as outcome of cirrhosis in the city of Kinshasa. Methods. In a retrospective study, 1,056 records of patients having liver cirrhosis and attending 8 hospitals over 11 years (2001-2011) in the city of Kinshasa were analyzed. The parameters of interest included sociodemographic, clinical and disease progression data. Results. Their mean age was 51 ± 16 years with a male predominance (68.8%). The etiologies of cirrhosis were dominated by alcoholism (49.6%) and viral hepatitis (22.4%). Among patients with viral hepatitis, 11.3 % were seropositive for HBsAg, 34.0% for anti-HCV and 54.7% for HBV-HCV. Almost half of the patients presented with abdominal pain (45%), physical asthenia (43%) and abdominal bloating (42%). The most common clinical signs found were ascites, hepatomegaly and lower limb edema. The outcome was marked by ascites in 64.7%, jaundice in 42.3%, malignant degeneration in 33% and digestive hemorrhage in 32%. Beside the symptomatic treatment, an etiological treatment was rarely tempted. No patient benefited from hepatic transplantation and 44.2% of patients died. Conclusion. Almost half of cirrhotic patients studied were alcoholic and the treatment still symptomatic. This study argues for a national policy for the management of liver cirrhosis and especially prevention through the fight against chronic alcoholism and vaccination campaigns against viral hepatitis B and C. Contexte et objectifs. La cirrhose est relativement fréquente et occasionne des multiples complications dans les pays en voie de développement où la prise en charge est souvent tardive. Cependant, les données y relatives sont fragmentaires en RD Congo. Les objectifs de la présente étude étaient de décrire les aspects épidémiologiques, cliniques, et évolutifs de la cirrhose hépatique dans la ville de Kinshasa. Méthodes. Il s’agissait d’une étude documentaire ayant colligé les dossiers médicaux de 1056 patients ayant présenté une cirrhose du foie dans 8 centres hospitaliers de la ville de Kinshasa entre 2001 et 2011. Les paramètres d’intérêt comprenaient les données sociodémographiques, cliniques, ainsi que l’évolution des patients sous l’attitude thérapeutique. Résultats. Leur âge moyen était de 51ans (ET=16) avec une prédominance masculine (68,8%). Les étiologies de la cirrhose étaient dominées par l’alcoolisme (49,6%) et l’hépatite virale (22,4%). Parmi les patients avec hépatite virale (22,4%), 11,3% de l’Ag HBs, 34% de l’Ac anti VHC et 54,7% de co-infection VHB-VHC étaient rencontrés. Près de la moitié des patients ont présenté à l’admission des douleurs abdominales (45%), de l’asthénie physique (43%) et un ballonnement abdominal (42%). L’ascite, l’hépatomégalie et les œdèmes des membres inférieurs étaient les signes physiques fréquemment rencontrés. L’évolution était marquée par une ascite chez 64,7%, un ictère chez 42,3%, une dégénérescence maligne chez 33% et une HD chez 32%. En dehors du traitement symptomatique, le traitement étiologique était rarement tenté. Aucun patient n’a bénéficié d’une transplantation hépatique et 44,2% des patients étaient  décédés. Conclusion. Près de la moitié des patients étudiés avait une cirrhose alcoolique dont la prise en charge reste très délicate expliquant la surmortalité. Cette étude plaide pour une politique nationale de prise en charge de la cirrhose du foie et surtout de prévention par la lutte contre l’alcoolisme chronique et les campagnes de vaccination contre l’hépatite virale B et C

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)

Congrès AFMED 2017 : Prévalence et facteurs de risque de l’hépatite B et C dans la communauté : Etude transversale des croyants de l’Eglise La Compassion et l’Eglise Providence Divine: Prevalence and Risk Factors of Hepatitis B and C in the Community: Cross-sectional Study of the Church’s Beliefs Compassion and Providence Divine Church

Background. Hepatitis B and C are a real public health problem due to the increased prevalence of these two viruses around the world. The present study aimed to evaluate the prevalence of hepatitis B and C, the exposure factors of these hepatitis in ecclesiastical environment and to sensitize these populations on the factors of hepatitis B and C.Methods. We conducted a descriptive cross-sectional study of members of the two churches during the period of worship from 6 August to 30 September 2017. The interview allowed the collection of sociodemographic characteristics and risk factors, to determine the Ag HBs and the anti HCV Ac and analyzed on SPSS 21.Results. During this period, 159 subjects were studied (52% women sex ratio 1H: 1F of average age of 31.2 ±12.2 years with extremes of 16 and 68 years. Among these, 40.3% were students, 46.5% of the respondents had a notion of hepatitis B and C. the prevalence of hepatitis B was 1.9% ie 3 cases and that of hepatitis C is 0%. The most common hepatitis B and C exposure factors were hospitalization or surgery (64.2%), non condom use (66%), transfusion 22%, piercing (19.5%), drug use (5%) ; 6% of respondents had no exposure factor, 50.3% had no more than 3 exposure factors. Factors associated with non-condom use were single (ORa: 16.5 95% CI: 2.1-26.9), young age (<25 years) (ORa: 4, 95% CI: 2, 4-6.8), the status of the student (ORa: 3.6, 95% CI: 2.1-6.3). Conclusion. Almost 2 percent of study population exhibit hepatitis B. The most frequent exposure factor for hepatitis B and C among young students, the most common being non-condom use, the determinants of which were bachelor's status, young age, and student status. Contexte et objectif. Les hépatites B et C constituent un réel problème de santé publique suite à l‟augmentation de la prévalence de ces deux virus dans le monde. L‟objectif de la présente étude était d‟évaluer la prévalence des Hépatites B et C, les facteurs d‟exposition de ces hépatites en milieu Ecclésiastique et de sensibiliser ces populations sur les facteurs des hépatites B et C.Méthodes. Etude transversale descriptive réalisé auprès des membres des deux Eglises au cours de culte, durant la période du 6 aout au 30 septembre 2017. L‟interview a permis de collecter les caractéristiques socio-démographiques et les facteurs de risque, un prélèvement de sang a permis de déterminer les Ag HBs et les Ac anti VHC et analysées sur SPSS 21.Résultats. Pendant la période d‟étude, 159 sujets étaient enrôlés (52% de femmes sex ratio 1H : 1F, âge moyen de 31,2±12,2 ans avec extrêmes de 16 et 68 ans). Parmi eux, 40,3% étaient des étudiants. 46,5% des répondants avez une notion de l‟hépatite B et C. La prévalence de l‟hépatite B était de 1,9% soit 3 cas et celle de l‟hépatite C était de 0%. Les facteurs d‟exposition aux hépatites B et C les plus retrouvés étaient l‟hospitalisation ou les interventions chirurgicales (64,2%), la non utilisation de préservatif (66%), la transfusion 22%, le piercing (19,5%), l‟usage de drogue (5%). 6% des répondants n‟avaient aucun facteur d‟exposition, 50,3% avaient au plus 3 facteurs d‟exposition. Les facteurs associés à la non utilisation de préservatif de manière indépendante étaient le statut de célibataire (ORa : 16,5 IC 95% : 2,1-26,9), le jeune âge (<25 ans) (ORa : 4, IC 95% : 2,4-6,8), le statut de l‟étudiant (ORa : 3,6, IC 95% : 2,1-6,3).Conclusion. Près de deux pourcent de sujets enquêtés présentent une hépatite virale B. Le facteur d‟exposition aux hépatites B et C cités par les jeunes étudiants est le non usage du préservatif ayant comme déterminants le statut du célibataire, le jeune âge et le statut de l‟étudiant

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 acceptability of HIV self-testing (HIVST) among university students in a Peri-Urban area of the Democratic Republic of Congo (DRC)

Introduction: this paper examines the acceptability of HIV self-testing (HIVST) by students in a university in the DRC and identifies factors associated with uptake of HIVST. Methods: a cross-sectional study was conducted with a sample of 290 students from Kikwit University. Data were summarized using proportions and predictions of acceptability of HIVST by logistic regression. Results: the average age of students was 22.5 years, with the majority of the students being male (57%). Just over half the students sampled, reported being sexually active (51.8%). One hundred and sixty four (75%) reported that they had one sexual partner and fifty-six (25%) two or more sexual partners in the past year. Sixty-six percent had used condoms during their last sexual encounter. The acceptability of HIVST was high (81.4%) and 66.1% of students stated that they would confirm the self-test at a local health facility. The knowledge about the importance of the self-test (OR 5.02; 95% CI:1.33-18.88; p=0.017), the perception that counseling pre and post-test were important (OR 2.91; 95% CI:1.63-5.19; p < 0.0001) and the willingness to realize the test with a partner (OR 2.46; 95% CI:1.43-4.23; p=0.034) were factors associated with HIVST. Conclusion: the acceptability of HIVST was high and therefore its implementation is feasible in our country. However, prior to implementation, additional factors such as cost; access of HIVST; false reassurance of the test; missed early infections in the window period, limited counseling and linkage to care options, need to be considered

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