[Impact of seasons, years El Nino/La Nina and rainfalls on stroke-related morbidity and mortality in Kinshasa]. / Impact des saisons, des années El Nino/La Nina et des précipitations sur la morbi-mortalité des accidents vasculaires cérébraux à Kinshasa.

INTRODUCTION: The significant impact of seasonality and climate change on stroke-related morbidity and mortality is well established, however, some findings on this issue are conflicting. The objective was to determine the impact of gender, age, season, year of admission, temperature, rainfall and El Nino phenomenon on ischemic and hemorrhagic strokes and fatal cases of stroke. METHODS: The study was carried out at the teaching hospital of Kinshasa, DRC, between January 1998 and December 2004. Rainy and dry seasons, elevated temperatures, indices of rainfalls El Nino years 1998, 2002 and 2004, but La Nina years 1999-2000 and neutral/normal years 2001 and 2003 were defined. RESULTS: Among 470 incident strokes, 34.5% of victims (n=162) died. Traditional seasons (small dry season, small rainy season, great dry season, great rainy season) and temperatures did not significantly (P>0.005) impact on stroke incidence. However, there was a positive association between the decrease in rainfall, El Nino, and incident ischemic strokes, but a significant positive association between the increase in rainfall, La Nina, and incident hemorrhagic strokes. Using logistic regression analysis, age ≥ 60 years (OR: 1.7, 95% CI: 1.2-2.5; P=0.018) and El Nino years (OR: 2, 95% CI: 1.2-3.3; P=0.009) were identified as the independent predictors of fatal strokes. CONCLUSION: Early warning systems should be developed to predict the impact of seasons and climate variability on stroke morbidity and mortality.

[Is HIV/AIDS an independent risk factor of chronic rhinosinusitis among central African patients?]. / L'infection à VIH/SIDA exerce t-elle un rôle indépendant dans la génèse de rhinosinusite chronique en Afrique Centrale ?

OBJECTIVES: To investigate the independent effect of HIV/ AIDS in the genesis of acute or chronic rhinosinusitis. METHODS: This case-control study was performed among patients managed for chronic rhinosinusitis between January and April 2009 the ENT and Head and Neck Department General Hospital of Kinshasa, DRCongo. Cases were matched with controls according to gender and age. Logic regression analysis served to identify factors associated with presence of chronic rhinosinusitis. RESULTS: The study population with 108 patients included 81 cases ofrhinosinusitis, 27 controls, 78 females, 30 males, 52 with HIV/AIDS and 56 HIV seronegatives. The mean age was 34+/-19 years (range 1 year-74 years). Only HIV/AIDS was identified as a significant and independent determinant of presence of chronic rhinosinusitis (OR= 19,6 95% CI 4,3 -88,9; P< 0,0001). CONCLUSION: Early ENT evaluation and continuous follow-up of HIV-infected patients are suggested. Age upper 20 years and high education attainment were significantly associated with high risk of chronic rhinosinusitis among HIV-infected patients, respectively.

Classification and dramatic epidemic of diabetes mellitus in Kinshasa Hinterland: the prominent role of type 2 diabetes and lifestyle changes among Africans.

BACKGROUND: Classification of diabetes mellitus is not easily stated in Central Africa using the current diabetes classification of World Health Organization/American Diabetes Association. The objective of the study is to determine the prevalence, classification and risk factors of diabetes mellitus in Kinshasa Hinterland. METHODS: A multilevel and stratified random sample cross-sectional study included 9770 black Africans (4580 men and 5190 women) aged 12 years and above in urban metropolitan (Kinshasa city) and rural (Kikwit) areas. Participants were examined and administered a structured questionnaire and a capillary whole blood glucose test was done. RESULTS: The mean age of participants was 46 +/- 15 years. Overall crude and age adjusted prevalences of diabetes were 25% (n = 2472) and 18%, respectively. Using WHO/ADA classification, Type diabetes (80%) was commoner than undetermined form (12%), Type 1B (3.5%), Type 1A (2.5%) and Other specific types (2%). According to plasma insulin and plasma C-peptide levels, participants with undetermined form were classified Type 2 diabetics. Thus, the rate of Type 2 diabetes among diabetics was estimated 92%. Urban location, age, abdominal obesity arterial hypertension, physical inactivity, inappropriate diet (lack of fruits-vegetables, refined sugar, animal fat and protein, starvation, social inequalities, cigarette smoking, alcohol intake were significantly and positively associated with diabetes in general and type 2 diabetes in particular. CONCLUSION: The high prevalence of diabetes is due to the unexpected high rates of type 2 diabetes, aging, urbanization, and sedentary lifestyle consequences. The majority of risk factors of diabetes are potentially modifiable by primary prevention.

[Relationship between pulse pressure, visual impairement and severity of diabetic retinopathy in sub-Saharan Africa]. / Relation entre pression pulsee, troubles visuels et severite de la retinopathie diabetique en Afrique sub-Saharienne.

OBJECTIVE: To determine the relationship between pulse pressure, traditional risk factors, vision impairment and different clinical forms of diabetic retinopathy. METHODS: A cross-sectional study was conducted between December 1st, 2004 and July 16th, 2005 within the care centers of Kinshasa, DRC. The origin population (n=3010 diabetics) served to estimate the diabetic retinopathy prevalence while a random sample of 301 diabetics participated to this analytic study: age>or=20 years, anthropometry, components of blood pressure, fasting glycaemia, optometry, fundoscopy, stages of diabetic retinopathy. RESULTS: The rate of diabetic retinopathy was 31.6% 95 CI: 26.3-36.9 in Kinshasa town. In the random sample, diabetic retinopathy was non proliferative in the majority (90%). Subjective decrease of acuity was associated with diabetic retinopathy in the sample (OR=2.7; 95% CI 1.1-5.4; p<0.05), among women (OR=2.7; 95% CI 1.3-5.7; p<0.05), and in patients with type 2-diabetes (OR=2; 95% CI 1.1-3.4; p<0.05). Objective decrease of acuity was associated with diabetic retinopathy in the study sample (OR=3.6; 95% CI 1.1-12.6; p<0.05). Visual impairment was significantly associated with diabetic retinopathy in women (OR=3.6; 95% CI 1.1-12.6; p<0.05) and proliferative diabetic retinopathy. Pregnancy after diabetes mellitus onset was a significant risk factor of diabetic retinopathy for women (OR=3.2; 95% CI 1.1-13.2; p<0.05). Using logistic regression analysis, family history of diabetic retinopathy (OR=3.2; 95% CI 1.2-8.8; p<0.05), diabetes duration >/=4 years (OR=3.4; 95% CI 1.4-8.5; p<0.01), and pulse pressure>or=60 mmHg (OR=5; 95% CI 2-12.8; p<0.001) were the independent and significant predictors of diabetic retinopathy. CONCLUSION: Urgent programme of prevention and control of diabetic retinopathy and its risk factors is needed.