Rationale of a comparative analytical study on matrix metalloproteinases associated with genital prolapse in Congolese women from the town of Kananga in the Democratic Republic of Congo: research protocol

Background: Genital prolapse is a pelvic static disorder associated with urinary, digestive and genital disorders which bother the patient. The fear of these discomforts has pushed many Western countries to adopt beneficial preventive measures for women at risk, notably the administration of estrogen-progestogens and the prevention of obstetric trauma. These two preventive factors play an inhibitory role on matrix metalloproteinases degrading the collagens which ensure ligament firmness. This link between matrix metalloproteinases and collagen is implicated by many researchers in the occurrence of genital prolapse. Objectives are to determine the epidemiological and clinical profile of genital prolapse, to identify the non-molecular factors associated with it, to determine the level of matrix metalloproteinases-1, -2 and -9 in non-prolapsed and prolapsed pelvic tissues, and to identify the types MMPs associated with genital prolapse in Congolese women from the town of Kananga in central Kasai in DR Congo. Methods: We designed a protocol for a comparative analytical study focusing on the epidemiology and the level of matrix metalloproteinases in non-prolapsed and prolapsed pelvic tissues in the Bon-Berger and Saint Georges hospitals in the city of Kananga. Women over 40 years of age and of any parity suffering from genital prolapse and other benign gynecological pathologies requiring hysterectomy will be included in the study according to non-probabilistic convenience sampling. Conclusions: This study will evaluate the level of matrix metalloproteinases-1, -2 and -9 in prolapsed tissues and identify the type of matrix metalloproteinases most associated with genital prolapse in our setting.

Normative Values of Bone Mineral Content and Bone Mineral Density Assessed by Double X-ray Absorptiometry in Congolese Urban Women

Introduction: The World Health Organization (WHO) have validated dual X-ray absorptiometry as the “gold standard” densitometric technique for assessing Bone Mineral Density (BMD) and Bone Mineral Content (BMC).The definitions of osteopenia and osteoporosis are based on its results Loss of bone mass with ageing or osteoprosis leads to decline of bone strength and fragility fractures. There are racial/ethnic differences in bone mass parameters for populations of different ethnic origins although living in the same environmental. WHO criteria for the diagnosis of osteoporosis and the associated risks of fractures are based on bone parameters assessed by dual x absorptiometry in postmenopausal Caucasian women. Studies have shown the necessity to establish reference data for bone mass measurements for each population according to habit and ethnicity.These data are lacking for Congolese populations. This study aims to establish spine and hip normative values in healthy Congolese women population and to compare them with those for Caucasian, Asian, and others ethnical groups. Materials and methods: 604 bantus women aged from 18 to 92 years were recruited after public media advertising and undergoes DXA of spine and hip. To be included in the study, women must fulfill the conditions of absence of factor affecting bone metabolism. Results: Bone mass parameters shows a growth up to the peak that is reached in the fourth decade followed by a slow decay that causes a loss of nearly 14.2% in BMD and BMC over a period of 20 years and, then a decrease more pronounced towards the sixtieth year (1.5% yearly), higher than among Caucasians Asians and Arabs. We found that the references curves for the lumbar spine and total hip are significantly differences from the Caucasian, Asean or Arab. Conclusion: Spine and hip normatives values of BMD and BMC of Congolese urban women was etablished and were different to those of compared populations

Factors associated with genital prolapse to Saint Joseph Hospital of Kinshasa

Introduction: the aim of this study was to identify factors associated with genital prolapse in the gynecology and obstetrics service of Saint Joseph hospital of Kinshasa. Methods: this was a retrospective case-control study conducted from 148 medical files of patients admitted in the gynecology and obstetrics service of Saint Joseph hospital from January 1, 2008 to December 31, 2017. It was based on the non-probabilistic sampling of suitability for cases selection. The T-student test, Chi-test and logistic regression were used in statistical analyses. Results: five factors independently associated with genital prolapse were identifying: obesity with BMI≥30Kg/m2 (OR: 3.770, 95% CI: 1.040-9.250; p=0.001), menopause (OR: 1.910, 95% CI: 1.090-10.930; p=0.001), fœtal macrosomia (OR: 4.290, 95% CI: 3.320-5.550; p=0.000), vaginal delivery (OR: 2.070, 95% CI: 1.010-5.210; p=0.006) and perineal tears (OR: 1.510, 95% CI: 1.250-1.910; p=0.000). Conclusion: these factors independently associated with genital prolapse can be used for screening of high-risk women in gynecological and obstetrical consultations in order to improve the treatment of genital prolapse in our milieu

Epidemiology and matrix metalloproteinases associated with pelvic organ prolapse: narrative review of the literature

Pelvic organ prolapse carries a risk of recurrence and leads to several disorders which bother the patient and alter her quality of life and her self-esteem. The objective of this review is to provide an overview of the published literature on the epidemiology and matrix metalloproteinases involved in the development of pelvic organ prolapse. We carried out online searches in electronic databases: Hinari, Google scholar, Pubmed and Embase; and manual searches of the references of each selected article to identify more studies not captured by the online search. Studies on adult women published in English and French over the past 25 years were collected. We excluded animal studies, those published multiple times, duplicates, letters, commentaries, editorial notes, congress report, clinical practice guidelines, case reports, studies of comorbidities (cervical cancer, fistulas, pregnancy), and those evaluating paraclinical examinations and treatment. A total of 153 articles were read and 84 studies were retained, including 33 on the prevalence of genital prolapse, 24 on its epidemiological and physiopathological risk factors, 7 on the recurrence of genital prolapse and its risk factors, 20 on the matrix metalloproteinases associated with pelvic organ prolapse and their regulatory factors. The identification of the epidemiology and matrix metalloproteinases associated with pelvic organ prolapse appears important for improving its treatment through appropriate advice and measures.

Multidetector CT in Quantitative Morphometric Assessment of Post-Menopausal Vertebral Fractures in Black Women of Central Africa

Background: Osteoporosis and major Non-Communicable Diseases (NCDs) are identified by WHO as leading cause of death worldwide. Its economic burden is heavy worldwide and in particularly in low income countries. DXA availability is poorly in our country. Spine CT scanner with sagittal reformation images are known for the ease quotation of vertebral fractures by quantitative morphometric system described by Genant et al. (1996). This study aims to determine the rate and the features of vertebral fractures in postmenopausal black women living in Kinshasa/DRC using CT scanner sagittal reconstructions.Patients and methods: 430 consecutives post-menopausal women referred for Thoraco-lumbar CT scanner from June 2011 to June 2016 were enrolled in this study and theirs CT images used to quote vertebrae.Results: 12.89% of a total of 4730 vertebrae were fractured whose more than half (7.82%) of grade 1. The fracture rate is lower than in Caucasian and ASEAN and increase with ageing and duration of menopausis (24.51% in 70 years of age and over).Conclusion: Vertebral fracture global frequency was 12.89%. Vertebral fractures are present in our population and adverse consequences will arises in terms of morbidity and mortality. Lack of infrastucture, health policy and powerty will contributes to boost for a bader pronostics.The method is reproductible and can be used as routine clinical tools in conditions of poor availability of DXA

Ultrasound Assessment of Bone Mass in Central Africans Population

Background: Osteodensitometry, a procedure increasingly accepted by clinicians to access osteoporosis is not yet fully validated by WHO. It requires the establishment of normal values and references curves for each population, and in our community, this is not yet assessed.The purpose of this study was twofold: to describe the profile of the speed of sound of proximal phalangeal metaphysis and establish references curves in central Africans and to compare them with those of other populations specially Caucasians.Methods: This cross sectional study was carried out at Kinshasa, Democratic Republic of the Congo in Central Africa from January to December 2016.Four hundred twenty four subjects aged from 20 to 87 years old, were explored and the speed of sound in theirs proximal phalanges measured using ultrasound equipment. Age, gender, hormonal status and speed of sound were collected and analyzed.Results: The mean value of the Amplitude Dependent Speed of Sound (AD-SoS) showed a growth feature with age (from 2056 m/sec at second decade of life to 2145.27 m/sec at fourth decade followed by a progressive decrease which was present in both sexes but more marked in postmenopausal women (1927.06 m/sec). This mean value was higher than in Caucasian studies. In this study, age and hormonal status seems to be the bone quality most influencing anthropometric factors as seen in many series.The curve profile with age was also a polynomial curve as seen in others populations of the world.Conclusion: This study provides normal data for phalangeal ultrasound measurements and reference curve of central Africans which were compared to those of Western studies

Efficacy of antiviral drug AV2 in the treatment of human papillomavirus-associated precancerous lesions of the uterine cervix: A randomized placebo-controlled clinical trial in Kinshasa, DR Congo. (KINVAV study)

Background: Cervical Cancer (CC) is a major public health problem in DR Congo; the high incidence of CC is due to the inexistence of effective screening programs based on cytology and/or HPV detection followed by appropriate treatments. This situation highlights the need to implement efficacious and inexpensive treatment methods. This study aims at evaluating the efficacy of a topical antiviral drug named AV2® as a treatment for HPV-associated lesions of the cervix. Methods: Women will undergo cytology sampling, HPV testing and Visual inspection of the cervix after application of 5% acetic acid (VIA). VIA-positive women will be randomized to one of two groups to receive treatment by either AV2®or placebo. They will undergo control examinations after two months and after six months. In case of persistent lesions on VIA, treatment by cryotherapy will be done. The primary outcomes will be the change of lesions, the clearance of HPV DNA, and the correlation of the two 2 months after treatment with AV2®. Conclusion: This study is the first large-scale study in Africa to evaluate systematically the efficacy and safety of a topical antiviral drug for the treatment of HPV associated lesions of the cervix. Its findings will direct the planning of suitable algorithms for CC screening and treatment. Clinical trial registration: ClinicalTrials.gov – Unique identifier: NCT02346227, registered on November 8, 2014

Association between nausea and vomiting of pregnancy and postpartum depression: the Japan Environment and Children’s Study

Objective Postpartum depression (PPD) is a global emotional distress that affects women and their offspring regardless of their culture. The association between nausea and vomiting of pregnancy (NVP) and PPD has been widely described only for the severe form of NVP. We aimed to assess the relationship between PPD and NVP with regards to its severity. Methods Data from the Japan Environment and Children’s Study (JECS), a birth cohort study, were analyzed. PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Multiple logistic regression models were performed to assess the association between NVP and PPD. Results Out of the 80,396 women included in the study 14% had PPD. Among them 4,640 (42.1%) had mild NVP; 3,295 (29.9%) had moderate NVP whereas 1,481 (13.4%) had severe NVP. All forms of NVP were associated with PPD and the association gradually increased with the severity of NVP symptoms with odd ratio (OR): 1.26; 95% confidence interval (CI): 1.18–1.35 for mild, OR: 1.28; 95% CI: 1.19–1.38 for moderate and OR: 1.54; 95% CI: 1.42–1.68 for severe NVP. Conclusion Japanese women with NVP were more susceptible to develop PPD and the more severe the NVP symptoms were, the greater the risk of PPD. Thus, close monitoring of NVP-affected women is recommended