[Study of fetal heart rate abnormalities observed on cardiotocography in Lubumbashi: about a cases followed at the Lubumbashi University Clinic and the General Hospital of the Cinquantenaire]. / Etude des anomalies du rythme cardiaque fœtal observées à l'examen cardiotocographique à Lubumbashi: cas suivis aux Cliniques Universitaires de Lubumbashi et à l'Hôpital Général du Cinquantenaire Karavia.

Cardiotocography (CTG) has recently come into use in Lubumbashi but no thorough study has yet been conducted to identify its impact on perinatal morbi-mortality. This study aims to determine the frequency of fetal heart rate abnormalities (FHR)in order to identify the associated factors and to propose a suitable management. We conducted a cross-sectional, descriptive study of 411 women in labour over a period of 19 months (March 2015-December 2016). In patients with pathologic FHR abnormalities, sensitivity and positive predictive value of cardiotocography in the screening test for acute fetal distress were 82.95% and 45.35% respectively. FHR abnormalities were found in two women in labour out of five. Decelerations were the most frequent FHR abnormalities observed (50.8%) with a remarkable predominance of late decelerations (22.1% of all abnormalities). The factors associated with pathological FHR abnormalities were prolonged labor (OR = 14.64, CI = 3.91-54.81), chorioamnionitis (OR = 14.56, CI = 3.83-55.34), chronic maternal anemia (OR = 4.99, CI = 1.48-16.85), primiparity (OR = 2.69, CI = 1.49-4.85), prematurity (OR = 2.90, CI = 1.51-5.54) and prolonged pregnancy (OR = 3.22, CI = 1.38-7.52). Intrauterine growth retardation and arterial hypertension were mainly associated with flat lines and late decelerations (OR = 7.79, CI = 2.50-24.30 and OR=2.74, CI = 1.31-5.72). CTG is a screening tool for the identification of acute fetal distress but with high false-positive rate (55%); it should be associated with other second-line screening tests for acute fetal distress in order to reduce this rate. Factors associated with pathologic FHR abnormalities often cause acute fetal distress thus requiring a rigorous analysis of CTG traces.

Wolf-Hirschhorn Syndrome: Clinical and Genetic Data from a First Case Diagnosed in Central Africa.

Wolf-Hirschhorn syndrome (WHS) is a multiple congenital anomaly-intellectual disability syndrome caused by a deletion involving chromosome 4p16.3. We report clinical and genetic findings of the first WHS patient diagnosed in central Africa. This boy who presented with cleft palate, microcephaly, severe growth delay, and intellectual disability was 12 years old. Typical craniofacial features were present, though the characteristic "Greek helmet" appearance of the nose was less evident, probably reflecting a variable expression related to the genetic background. The clinical diagnosis of WHS was confirmed by array CGH, which revealed a terminal 4p16.3 deletion of 3.47 Mb, typically associated with a milder phenotype, contributing to the long survival of this child in a developing country.

[Study of the prevalence of nosocomial infections and associated factors in the two university hospitals of Lubumbashi, Democratic Republic of Congo]. / Etude de la prévalence des infections nosocomiales et des facteurs associes dans les deux hopitaux universitaires de Lubumbashi, République Démocratique du Congo: cas des Cliniques Universitaires de Lubumbashi et l'Hôpital Janson Sendwe.

INTRODUCTION: To estimate the prevalence "on any given day" of nosocomial infections and to determine their associated factors. Then, to estimate the prevalence of microorganisms responsible for nosocomial infections in Lubumbashi, Democratic Republic of Congo. METHODS: A descriptive cross-sectional study was conducted in two hospitals in Lubumbashi in five inpatient units (Surgery, Gynecology and Obstetrics, Internal Medicine, Pediatrics and Recovery). The sample consisted of 171 hospitalized patients who were questioned using a standardized questionnaire. Patient's medical record allowed us to know the type of antibiotic administered to the patient 48 hours after admission. Our study was conducted in February 2010 as part of the first local prevalence survey on nosocomial infections. RESULTS: Our study collected data on 59 patients with nosocomial infection. The overall prevalence was 34.5% (17.0% with acquired nosocomial infection and 17.5% with imported infection). According to the World Health Organization, nosocomial infection is a hospital-acquired infection which was not present or incubating at the time of patient admission. The following risk factors have been associated with acquired nosocomial infections: duration of hospitalization (long stay hospital patients, hospital length of stay of more than seven days has a higher risk than shorter length of stay, hospital length of stay of less than or equal to seven days (prevalence ratio: RP =3.6 [IC A 95%.1.4-8.9])). Among nosocomial infections, surgical site infections were the most common (27.1%), followed by lung infections (22.0%) and urinary tract infections (17.0%). Microbiological examination highlighted five germs responsible for nosocomial infection in infected patients: Escherichia coli (11.9%), Staphylococcus aureus (6.8%), Pseudomonas aeruginosa (5.1%), Shigella spp (5.1%) and Salmonella typhimurium (1.7%). Microbiological examination was performed in 31.0% (n = 59). Cefotaxime, third-generation cephalosporin was the most prescribed antibiotic (37.9%), followed by amoxicillin (19.6%) and ampicillin (16.3%) for monotherapy. Dual and triple therapy was also prescribed. Parenteral route was the most used for anti-infective administration. There was a significant difference in the prevalence of nosocomial infections between the two university hospitals; the prevalence of acquired nosocomial infection was 22.2% in University Clinics of Lubumbashi and 13.1% in Sendwe hospital. CONCLUSION: In our study, the overall prevalence of nosocomial infections was 34.5%. Surgical site infections were the most common (27,1%). Escherichia coli was the most common germ (11.9%).