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

Expérience précoce de la réponse à la pandémie à Syndrome Respiratoire Aigu Sévère à Corona Virus SARS-COV 2 appelé aussi Corona Virus Disease 19 (COVID-19) aux Cliniques Universitaires de Kinshasa: Early experience of response to Severe Acute Respiratory Syndrome-Coranovirus-2 (SARS-COV-2) pandemic at Kinshasa university hospital

The Democratic Republic of Congo (DRC) declared the first case of Coronavirus infection disease (COVID-19) on March 10, 2020. Ever since then, assessment in terms of management and care outcomes for COVID-19 patients has not yet been formally established. Since, the number of patients has been increasing; however, there has been no formal guideline for COVID-19 patient management. This paper provides an overview of the experience of the overall management of COVID-19 at the Kinshasa University Hospital (KUH), between March and the end of April 2020. Clinical data of 49 patients from surronding municipalities, including 61% of males, are presented in this report. Patients were young (median age 34 years). At admission, 20.4% of patients were at advanced stage and 6.1% at severe stage, and almost all of them have been using self-medication prior to admission at the hospital. The lethality rate was 10.2%. In almost all the cases (8 cases out of 10), death occurred within the first 24 hours following the admission. The response to COVID-19 was set up after a few twists and turns. With the support of a few partners and the government, we are seeing an improvement in the management of COVID-19 at the KUH. Delayed referral, self-medication and stigma are among the factors that influenced the disease severity and contributed to the high mortaly we have observed. La République démocratique du Congo (RDC) a déclaré le premier cas de la maladie à Coronavirus (COVID-19) le 10 mars 2020. Depuis lors, l’évaluation de la prise en charge et de l’issue vitale des patients suivis n’ont pas encore été formellement rapportées. Le présent article donne un aperçu de l’expérience de la prise en charge globale de la COVID-19 aux Cliniques Universitaires de Kinshasa, entre mars et fin avril 2020. Quarante-neuf (âge médian 34 ans, sexe masculin 61%, habitant les communes environnantes) ont été inclus. Près d’un tiers des patients étaient admis aux stades critiques (20,4%) ou sévère (6,1%) recourant souvent à l’automédication. Le taux de létalité a été 10,2% des cas. Le décès était survenu endéans les 24 premières heures dans la quasi-totalité des cas (8 cas/10 patients). Les patients sont très jeunes. La riposte à la pandémie a été d’installation lente, renforcée progressivement par l’appui des partenaires traditionnels et du gouvernement central. L’impact de ces interventions a contribué à une amélioration de la prise en charge de la COVID-19 aux CUK. La référence tardive, mais aussi l’autoprise en charge à domicile, corollaires à la stigmatisation communautaire seraient une explication plausible au nombre élévé de décès enregistrés dans cette institution

Performance de l’oxymétrie nocturne dans le diagnostic du Syndrome d’apnées Hypopnées Obstructives du sommeil à Kinshasa

Contexte et objectif. La prise en charge d’un patient avec un syndrome d’apnées hypopnées obstructives du sommeil (SAHOS) nécessite l’enregistrement du sommeil qui reste très peu accessibilité en Afrique subsaharienne. La présente étude a évalué la performance de l’oxymétrie nocturne dans le diagnostic du SAHOS à Kinshasa. Méthodes. Dans une étude transversale et analytique, tous les patients à risque de SAHOS ont bénéficié d’une oxymétrie nocturne et d’une polygraphie ventilatoire entre juillet 2021 et mars 2022. La sensibilité (Se), la spécificité (Sp) et les valeurs prédictives positive (VPP) et négatives (VPN) de l’oxymétrie nocturne ont été déterminées. La courbe ROC a été rapportée, aire sous la courbe (ASC) calculée, p < 0,05. Résultats. 323 patients ont été inclus (âge moyen de 57,9 ± 13,1 ans avec un sex ratio H/F de 1,5). L’obésité centrale était présente chez 88 %. Le STOP-BANG moyen était de 4,8 ±0,9. Les comorbidités les plus rencontrées étaient l’HTA (58,5%), le diabète sucré (22,6%), la BPCO (9,3%) et l’AVC 2,2%. La Se et Sp étaient respectivement, de 94,4 et 88,9% et ASC à 0, 92. Conclusion. L’oxymétrie nocturne est un examen non invasif d’accès facile ayant une sensibilité et une spécificité élevée dans le diagnostic du SAHOS dans notre milieu. English title: Performance of nocturnal oximetry in the diagnosis of Obstructive Sleep Apnea Hypopnea Syndrome in Kinshasa Context and objective. Management of a patient with obstructive sleep apnea syndrome (OSAS) needs a sleep recording which is unavailable in sub-Saharan Africa. The present study aimed to evaluate the performance of nocturnal oximetry in the diagnosis of OSAHS in Kinshasa. Methods. In an analytical cross-sectional study, patients at risk of OSAHS underwent nocturnal oximetry and ventilatory polygraphy between July 2021 and March 2022. The sensitivity (Se), specificity (Sp) and positive (PPV) and negative (VPN) predictive values of nocturnal oximetry were determined. ROC curve was reported, area under the curve (AUC) calculated, p<0.05. Results. 323 patients were involved (average age of 57.9±13.1 years with a sex ratio M/F of 1.5). Abdominal Obesity was present in 88% of patients. The mean STOPBANG was 4.8 ±0.9. The most common comorbidities were hypertension (58.5%), diabetes mellitus (22.6%), Chronic Obstructive Pulmonary Disease (COPD) (9.3%) and stroke 2.2%. The Se and Sp were 94.4 and 88.9% respectively and AUC was 0.92. Conclusion. Nocturnal oximetry is a non-invasive examination of easy access with high sensitivity and specificity in the diagnosis of OSAHS in our environment. Keywords: Obstructive sleep apnea syndrome, nocturnal oximetry, ventilatory polygraphy, performance, Kinshas

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

Recommandations de la Société Congolaise de Néphrologie (SOCONEPH) pour la Prise en Charge des Patients en Dialyse dans le contexte de Pandémie à COVID-19 : Recommendations of the Congolese Society of Nephrology for the Management of Dialysis Patients in the Context of a COVID-19 Pandemic

Patients on haemodialysis are likely to be at increased risk of novel coronavirus disease (COVID-19). Preventive strategies must be implemented to minimize the risk of disease transmission in dialysis facilities, including education of staff and patients, screening for COVID-19 and separation of infected or symptomatic and non-infected patients. Les patients en hémodialyse présente un risqué élevé d’infection à SARS-Cov-2. Les stratégies préventives doivent donc être mises en place pour réduire le risque de transmission de la maladie en hémodialyse parmi lesquelles, l’éducation du staff médical ainsi que des patients, le screening de la maladie à COVID-19 ainsi que la séparation des patients infectés ou symptomatiques des non infectés. &nbsp

Prevalence of microalbuminuria and diagnostic value of dipstick proteinuria in outpatients from HIV clinics in Bukavu, the Democratic Republic of Congo.

BACKGROUND: Microalbuminuria is a marker of early kidney disease and high cardiovascular risk in various populations, including HIV positive patients. However, the diagnostic value of qualitative (dipstick) proteinuria and the burden of microalbuminuria in HIV positive patients living in sub-Saharan Africa are relatively unclear. METHODS: In a cross-sectional study, 235 HIV- positive outpatients were screened for proteinuria in 3 HIV-clinics in Bukavu. A spot urine sample from each subject was tested both by a dipstick and albumin-creatinine-ratio (ACR) assay. The performance of dipstick proteinuria exceeding 1+ was compared with that of microalbuminuria (≥ 30 mg/g creatinine). RESULTS: The prevalence of microalbuminuria and dipstick proteinuria ≥ (1+), ≥ (2+) and ≥ (3+) was 11%, 41%, 3.5% and 0.7%, respectively.Compared to microalbuminuria, the dipstick (proteinuria of 1+ or greater) had an overall sensitivity of 60% and a specificity of 61%. The positive predictive value was 15.4% and the negative predictive value 92.8%. CONCLUSION: Proteinuria is highly prevalent in HIV positive patients. The limited sensitivity and specificity of the dipstick to detect significant microalbuminuria make it unattractive as a screening tool in HIV positive patients

Factors associated with residual urine volume preservation in patients undergoing hemodialysis for end-stage kidney disease in Kinshasa

Abstract Background Decreased residual urine volume (RUV) is associated with higher mortality in hemodialysis (HD). However, few studies have examined RUV in patients on HD in Sub-Saharan Africa. The aim of this study was to identify predictors of RUV among incident hemodialysis patients in Kinshasa. Methods This historical cohort study enrolled 250 patients with ESRD undergoing hemodialysis between January 2007 and July 2013 in two hemodialysis centers in Kinshasa. RUV were collected over 24 h at the initiation of HD and 6 and 12 months later during the interdialytic period. We compared the baseline characteristics of the patients according to their initial RUV (≤ 500 ml/day vs >  500 ml/day) using Student’s t, Mann-Whitney U and Chi2 tests. Linear mixed-effects models were used to search for predictors of decreased RUV by adding potentially predictive baseline covariates of the evolution of RUV to the effect of time: age, sex, diabetes mellitus, hypertension, diastolic blood pressure, diuretics, angiotensin conversion enzyme inhibitors (ACEI), angiotensin receptor blockers, hypovolemia, chronic tubulointerstitial nephropathy, left ventricular hypertrophy and initial hemodialysis characteristic. A value of p < 0.05 was considered the threshold of statistical significance. Results The majority of hemodialysis patients were male (68.8%, sex ratio 2.2), with a mean age of 52.5 ± 12.3 years. The population’s RUV decreased with time, but with a slight deceleration. The mean RUV values were 680 ± 537 ml/day, 558 ± 442 ml/day and 499 ± 475 ml/day, respectively, at the initiation of HD and at 6 and 12 months later. The use of ACEI at the initiation of HD (beta coefficient 219.5, p < 0.001) and the presence of chronic tubulointerstitial nephropathy (beta coefficient 291.8, p = 0.007) were significantly associated with RUV preservation over time. In contrast, the presence of left ventricular hypertrophy at the initiation of HD was significantly associated with decreased RUV over time (beta coefficient − 133.9, p = 0.029). Conclusions Among incident hemodialysis patients, the use of ACEI, the presence of chronic tubulointerstitial nephropathy and reduced left ventricular hypertrophy are associated with greater RUV preservation in the first year of dialysis

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