Inflammatory biomarkers and prediction of insulin resistance in Congolese adults.

Several studies have shown that low levels of adiponectin (ADP) and high levels of alpha tumor necrosis factor (NFT) increase the risk or severity of many cardiometabolic diseases associated with insulin resistance. The main objective of this study was to evaluate the association between plasma adipokines and IR measured by HOMA-IR. The secondary objective was to determine the biomarker of the potential inflammation to predict IR in Congolese melanoderm subjects residing in Brazzaville. This cross-sectional study was conducted on 234 apparently healthy participants over the age of 18. Socio-demographic and clinical data were collected. Biological data, including the total ADP and NFT dosage, were measured using the ELISA method. Participants were categorized into two groups according to HOMA-IR ≥ 2.5. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for insulin resistance. An optimized model was obtained after the logistic regression. The analysis of the receptor's operating characteristics (OCR) was performed to determine the optimal threshold value and diagnostic characteristics, as well as the area under the curve (ASC). ADP averages were significantly low (11.49 ± 7.61 ng/mL; P < 0.001) while those of TNF were significantly higher (96.03 ± 44.09 pg/mL) in the HOMA-IR group ≥ 2.5. There was a positive and significant correlation (p < 0.05) between BMI, TT, CRPhs, TNF and HOMA-IR. And a negative and significant correlation was noted between ADP and HOMA-IR (r = - 0.39; P < 0.01). Similarly, a negative and significant correlation (p < 0.01) was noted between BMI, TT, TNF, CRPhs and ADP. The optimal threshold value of the total ADP for predicting IR was 17.52 ng/mL with a sensitivity of 89% [IC 95% (0.83-0.95)], 56% specificity [IC 95% (0.47-0.65)] and a CSA of 0.76 [IC 95% (0.69-0.81)]. After logistic regression, the CSA of the optimized model was 0.84 [IC 95% (0.79-0.89)]. ADP can be used as a highly plausible IR prediction biomarker.

Dog rabies control in West and Central Africa: A review.

Rabies is a neglected but preventable zoonotic disease that predominantly affects the most vulnerable populations living in remote rural areas of resource-limited countries. To date, every country on the African mainland is considered endemic for dog-mediated rabies with an estimated 21'500 human rabies deaths occurring each year. In 2018, the United Against Rabies collaboration launched the Global Strategic Plan to end human deaths from dog-mediated rabies by 2030. The epidemiology of rabies from most Western and Central African countries remains poorly defined, making it difficult to assess the overall rabies situation and progress towards the 2030 goal. In this review, we attempt to provide an overview of the current rabies situation in 22 West and Central African countries based on published scientific literature and information obtained from rabies focal points. To this end, information was collected on i) established surveillance, ii) diagnostic capacity, iii) post-exposure prophylaxis (PEP) availability and coverage, iv) dog population estimates, v) dog vaccination campaigns, vi) animal and human health communication (One Health), vii) molecular studies, viii) Knowledge, Attitude and Practices (KAP), ix) cost estimates and x) national control strategies. Although rabies is a notifiable disease in the majority of the studied countries, national surveillance systems do not adequately capture the disease. A general lack of rabies diagnostic capacity has an additional negative impact on rabies surveillance and attempts to estimate rabies burden. Recurrent shortages of human rabies vaccine are reported by all of the countries, with vaccine availability usually limited to major urban centers but no country has yet adopted the new WHO-recommended 1-week intradermal vaccination regimen. Most countries carry out subsidized mass dog vaccination campaigns on World Rabies Day. Such activities are indispensable to keep rabies in the public consciousness but are not of the scale and intensity that is required to eliminate rabies from the dog population. Countries will need to scale up the intensity of their campaigns, if they are to progress towards the 2030 goal. But more than half of the countries do not yet have reliable figures on their dog populations. Only two countries reached stage 2 on the Stepwise Approach towards Rabies Elimination ladder - indicating that their national governments have truly prioritized rabies elimination and are thus providing the necessary support and political buy-in required to achieve success. In summary, the sub-region of West and Central Africa seems to be divided into countries which have accepted the challenge to eliminate rabies with governments committed to pushing forward rabies elimination, while other countries have achieved some progress, but elimination efforts remain stuck due to lacking government commitment and financial constraints. The possibility to meet the 2030 goal without international solidarity is low, because more than two-thirds of the countries rank in the low human development group (HDI ≤ 152). Leading countries should act as role models, sharing their experiences and capacities so that no country is left behind. Unified and with international support it is possible to reach the common goal of zero human rabies deaths by 2030.

[Time series: pathologic determinants of cytobiochemical urinalysis and urinary infections at the University Clinics in Kinshasa]. / Séries temporelles: déterminants pathologiques des examens cytobiochimiques d'urines et infection urinaire entre 2011-2014 aux cliniques universitaires de Kinshasa.

INTRODUCTION: cytobiochemical analysis of urine samples is the most requested complementary laboratory tool along with blood count. It has high predictive value in patients with urinary tract infections when it is properly done and scrupulously interpreted. The purpose of this study was to assess the rate, progression, determinants and cytobiochemical comorbidities of urinary tract infections. METHODS: we conducted a documentary, descriptive, analytical and comparative study of patients referred for cytobiochemical examinations of urine to the laboratories of the University Clinics in Kinshasa (UCK) between 2011 and 2014. RESULTS: a total of 8926 cytobiochemical tests were requested, with less than 2% of biochemical tests. The study involved more women than men (6426 women vs 2500 men), with a sex ratio of 3F: 1M. Cytobiochemical tests were more requested in the 30-39-year age group (17%; n=1517) mand during the rainy seasons 72% (n=3511), with a peak in May. Urinary tract infections accounted for 54,8% [adjusted estimates n=4892 including E. coli (n=1937), Klebsiella (n=993)] and were mainly diagnosed over the period 2012-2014. There was an independent and significant association between female sex (adjusted OR = 3.5; CI = 95%; 3.1-3.8; P<0.0001), admission during the rainy seasons (adjusted OR = 1.3; CI = 95%; 1.2-1.4; P<0.0001) and urinary tract infection. CONCLUSION: urinary tract infection was a major concern for female patients admitted during the rainy seasons and over the years 2012-2014 at the UCK. Urinary tract infections were rare over the Nina year 2011 after the hottest El Nino year, while the rate of urinary tract infections was the same over the years 2012-2014, which were relatively hot before the the hottest El Nino year 2015. This study highlights that there is an interaction between the hot and humid tropical climatic conditions of the city of Kinshasa and the global cold climate, in the context of climate variability, global warming, which may explain the outbreak of urinary infections in Kinshasa.

Association of Helicobacter pylori infection with the metabolic syndrome among HIV-infected black Africans receiving highly active antiretroviral therapy.

INTRODUCTION: The metabolic syndrome (MetS) is common in human immune deficiency virus (HIV)-infected individuals receiving highly active antiretroviral therapy (HAART). Immune deficiencies caused by HIV give rise to numerous opportunistic gastrointestinal pathogens such as Helicobacter pylori, the commonest cause of chronic gastritis. The study sought to determine the relationship between H pylori infection and the MetS among HIV-infected clinic attendees. METHODS: This cross-sectional study was carried out in a specialised heart clinic in Kinshasa, DR Congo. Between January 2004 and December 2008, 116 HIV-infected patients (61 with MetS and 55 without MetS) who underwent upper gastrointestinal endoscopy for dyspeptic symptoms were included in the study following an informed consent. Univariate associations were determined by odds ratios (OR), while multivariate logistic regression analysis was used to identify factors associated with the MetS. RESULTS: H pylori infection (OR = 13.5, 95% CI: 10.3-17.6; p < 0.0001) and peripheral obesity (median hip circumference ≥ 97 cm) (OR = 4.7, 95% CI: 1.2-18.8; p = 0.029) were identified as MetS-related factors in HIV-infected patients. Higher rates of the MetS were associated with increased incidence of HIV-related immunocompromise using World Health Organisation (WHO) staging criteria. There was a univariate significant difference in the prevalence of the MetS between antiretroviral therapy (ART)-naïve patients and patients treated by means of a first-line HAART regimen of stavudine (d4T), lamivudine (3TC) and nevirapine (NVP). However, this difference was not significant in multivariate logistic analysis. CONCLUSION: H pylori infection was significantly associated with the MetS in HIV-infected patients.

Inflammatory status hepatic enzymes and serum creatinine in HIV-, HIV+ and HIV-TB co-infected adult Central Africans.

BACKGROUND AND AIM: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome is a major public health issue in Africa. The objective of this study was to determine which of isolated HIV-infection, isolated naive pulmonary tuberculosis (PTB), or naive HIV-PTB coinfection was more harmful to inflammatory, hepatic, and renal functions. METHODS: This cross-sectional study was undertaken among ten patients with isolated HIV infection, ten patients with isolated naive HIV infection, ten patients with isolated PTB and 32 patients with HIV-PTB coinfection, with the aim of determining which group had the highest levels of oxidative stress and hepatic and renal dysfunction markers. Serum aminotransferase (AST), alanine transferase (ALT), gamma-glutamyl transferase (GGT), and creatinine measurements were compared across the three groups of patients, who were managed from admission in the pulmonology division of the Brazzaville Teaching Hospital, Congo. RESULTS: HIV patients had the highest levels of ALT, GGT, and creatinine before and after adjusting for age and sex. Adjusted levels of AST, ALT, GGT, and creatinine were higher in HIV-PTB coinfection patients than in sero-negative PTB patients. CONCLUSION: There is a significant association between HIV infection and increase in concentration of ALT, GGT, and creatinine.

Oxidative stress-elevated high gamma glutamyl transferase levels, and aging, intake of tropical food plants, migration and visual disability in Central Africans.

AIM: To investigate the independent pathogenic role of high serum gamma-glutamyl transferase (GGT) levels, sociodemographic data, dietary and environmental risk factors for visual disability (VD). METHODS: This was a case-control study, run in 200 black Congolese patients managed in Saint Joseph Hospital Ophthalmology Division from Kinshasa town. Logistic regression model was used to identify determinants of VD (n=58) among sex, age, cigarette smoking, alcohol abuse, rural-urban migration, education levels, aging ≥60 years, intake of red Beans, Safou fruit and Taro leaves, lipid profile, residence, socioeconomic status, and GGT. RESULTS: After adjusting for confounding factors, we identified migration (OR=3.7 95% CI: 1.2-11.3; P=0.023), low education level (OR=3.1 95% CI 1.1-8.5; P=0.026), no intake of Safou fruit (OR=34.2 95% CI 11.5-102; P<0.0001), age ≥ 60 years (OR=2.5 95% CI 1.01-6.5; P=0.049), and serum GGT ≥10 U/L (OR=3.6 95% CI 1.3-9.6; P=0.012) as the significant and independent determinants of VD. CONCLUSION: VD appears as a major public health problem in Central Africa to be prevented or delayed by control of migration, lifestyle changes, antioxidant supplements, appropriate diet, nutrition education, and blocking of oxidative stress.

Helicobacter pylori infection is identified as a cardiovascular risk factor in Central Africans.

BACKGROUND: Helicobacter pylori is now incriminated in the pathogenesis of atherosclerosis. OBJECTIVE: To examine the importance of H. pylori infection as a cardiovascular disease (CVD) risk factor. METHODS: Two hundred five patients (128 with H. pylori infection [HP-seropositive] and 77 without) had a baseline assessment for other potential CVD risk factors and were followed prospectively for 10 years (1999-2008). They were assessed on a monthly basis for the outcomes of carotid plaque, angina pectoris, myocardial infarction, and stroke. In the HP-seropositive group, male sex and quartile 4 for IgG anti-H. pylori antibodies (anti-HP Ab) were correlated with traditional CVD risk factors, stroke, myocardial infarction, and angina pectoris. RESULTS: At the baseline assessment, the levels of carotid intima-media thickness, blood fibrinogen, total cholesterol, fasting plasma glucose, and uric acid were higher in H. pylori-infected patients than in the uninfected group. Serum HDL-cholesterol was significantly lower in the HP-seropositive group. Men had higher levels of IgG anti-HP Ab, waist circumference, blood pressure, uric acid, and total cholesterol than women. Within the HP-seropositive group, individuals in quartile 4 for IgG anti-HP Ab had higher rates of elevated fibrinogen, diabetes mellitus, low high-density lipoprotein cholesterol, arterial hypertension, and high total cholesterol than those in quartile 1. After adjusting for traditional CVD risk factors, H. pylori infection was the only independent predictor of incident carotid plaque (multivariate odds ratio [OR] = 2.3, 95% confidence interval [CI]: 1.2-7.2; P < 0.0001) and incident acute stroke (multivariate OR = 3.6, 95% CI: 1.4-8.2; P < 0.0001). Within the HP-seropositive group and after adjusting for traditional CVD risk factors, male sex was the only independent predictor of incident angina pectoris (multivariate OR = 3.5, 95% CI: 1.6-16; P < 0.0001), incident acute stroke (multivariate OR = 3.2, 95% CI: 1.4-28; P < 0.0001), and acute myocardial infarction (multivariate OR = 7.2, 95% CI: 3.1-18; P < 0.0001). CONCLUSION: Our study provides evidence for an association among known CVD risk factors, carotid plaque, stroke, and H. pylori infection. Among infected individuals, there is a significant association among severity of HP-seropositivity, male sex, and CVD. The eradication of H. pylori infection may therefore reduce the emerging burden of CVD in Africa.

Aging, female sex, migration, elevated HDL-C, and inflammation are associated with prevalence of metabolic syndrome among African bank employees.

BACKGROUND: The objective of this study was to compare four different criteria for diagnosing metabolic syndrome (MS) and to correlate sociodemographic data, liver enzymes, lipids, inflammation, and insulin resistance with MS definitions. METHODS: This cross-sectional study included a random number of 126 African bank employees from Brazzaville, Congo. RESULTS: THE PREVALENCE OF MS VARIED ACCORDING TO THE DIFFERENT DEFINITIONS USED: 4.8% under World Health Organization (WHO) criteria, 8.7% under the National Cholesterol Education Program Adult Treatment Panel III (NECP-ATPIII) criteria, 14.3% under the International Diabetes Federation (IDF) for Europe, and 15.9% by the IDF for Central Africa. According to the IDF, specific cutoff points for the erythrocyte sedimentation rate, ≥13 mm at first hour and ≥30 mm at second hour, defined MS for Central Africa. The best agreement was observed between the IDF for Europe and the IDF for Central Africa (Kappa = 0.938; P < 0.0001) criteria. The worst agreements were between the WHO and IDF for Central Africa (Kappa = 0.419; P < 0.0001) criteria and between the WHO and IDF for Europe (Kappa = 0.462; P < 0.0001) criteria. The NECP-ATPIII criteria did not agree with either the IDF for Europe or the IDF for Central Africa criteria. There was a significant relationship between female sex, aging, elevated liver enzymes, elevated phospholipids, high homeostasis model assessment of insulin resistance, and MS defined by the IDF for Central Africa. CONCLUSION: The IDF definition of the MS modified for Central Africa provides higher prevalence estimates of MS than the estimates based on the NECP-ATPIII and IDF for Europe criteria. Liver enzymes, phospholipids, and homeostasis model assessment of insulin resistance should be included in clinical practice to stratify cardiovascular disease risk among Africans.

Biomarkers of oxidative stress and personalized treatment of pulmonary tuberculosis: emerging role of gamma-glutamyltransferase.

Background. The objectives were (i) to evaluate the impact of acute pulmonary tuberculosis (PTB) and anti-TB therapy on the relationship between AST, ALT, and GGT levels in absence of conditions related to hepatotoxicity; (ii) to evaluate the rate and the time of alterations of AST, ALT, and GGT. Design and Methods. A prospective followup of 40 adults (21 males; mean age of 34.7 ± 5.8 years) with active PTB on initial phase and continuation phase anti-TB. Results. Only 3% (n = 1) developed a transient and benign ADR at day 30 without interruption of anti-TB treatment. Within normal ranges, GGT decreased significantly from day 0 to day 60, while AST and ALT increased significantly and respectively. During day 0-day 60, there was a significant, negative, and independent association between GGT and AST. Conclusion. The initial two months led to significant improvement of oxidative stress. Values of oxidative markers in normal ranges might predict low rate of ADR.

[Lipid, lipoproteins and atherogenesis profiles in sickle cell disease among Central African patients]. / Évaluation du profil lipoprotéique et du risque athérogène chez les drépanocytaires homozygotes et hétérozygotes de Brazzaville.

Lipid and lipopproteins disorders are well established in sera from sickle cell disease (SCD) patients out of Central Africa. The present case-control study was conducted to compare serum levels of total cholesterol (TC), HDL-C, triglycerides (TG), LDL-C and TC/HDL-C ratio (atherogenic index) from SCD homozygotes (SS) in steady state, SCD heterozygotes (AS) and controls (AA) in Brazzaville, Congo. Significant reductions of TC and LDL-C vs. increase in TG were reported in SS. However, significant decrease in HDL-C and increase in atherogenic index were observed in AS. We recommend prevention of oxidative stress, dyslipidemia and atherosclerosis in SCD using hygiene-diet measures. Only longitudinal studies in large populations will provide pathophysiological basis of lipid and lipoproteins disorders in SCD.

Relationship between Younger Age, Autoimmunity, Cardiometabolic Risk, Oxidative Stress, HAART, and Ischemic Stroke in Africans with HIV/AIDS.

Background and Purpose. It now appears clear that both HIV/AIDS and antiretroviral therapy (HAART) use are associated with higher risk of cardiovascular disease such as stroke. In this study, we evaluated the prevalence, the risk factors, and the cardiometabolic comorbidities of stroke in HIV/AIDS Central African patients. Methods. This hospital-based cross-sectional study collected clinical, laboratory, and imaging data of black Central African heterosexual, intravenous drug nonuser, and HIV/AIDS patients. Results. There were 54 men and 62 women, with a female to male ratio of 1.2 : 1. All were defined by hypercoagulability and oxidative stress. Hemorrhagic stroke was reported in 1 patient, ischemic stroke in 17 patients, and all stroke subtypes in 18 patients (15%). Younger age <45 years (P = .003), autoimmunity (P < .0001), and metabolic syndrome defined by IDF criteria (P < .0001) were associated with ischemic stroke. Conclusions. Clustering of several cardiometabolic factors, autoimmunity, oxidative stress, and lifestyle changes may explain accelerated atherosclerosis and high risk of stroke in these young black Africans with HIV/AIDS. Prevention and intervention programs are needed.