RESUMEN
Background: The use of biomarkers, such as N-terminal pro-brain natriuretic peptide (NTpBNP), high-sensitivity C-reactive protein (hs-CRP) and high-sensitivity troponin (hs-TnI) is an alternative approach to detect the risk of heart failure (HF), but data on this approach are fragmentary in sub-Saharan Africa. The objective of this study is to determine the correlation between the risk of heart failure and the score of biomarkers in the population of asymptomatic diabetics in the city of GOMA. Methods: Asymptomatic diabetics in the city of Goma were cross-sectionally recruited at the Center of the Association of Diabetics in Congo (ADIC) in Goma, DRC during the period from February 5 to 19, 2023. The risk of insufficiency heart rate at 5 years was determined using pulse pressure. The biomarker score was calculated using NTproBNP, hs-CRP, hs-troponin and left ventricular hypertrophy (LVH). The association between the risk of heart failure and the biomarker score was evaluated using the logistic regression test at the threshold of p < 0.05. Results: Of a total of 408 diabetic patients examined, 29.9% had presented a risk of heart failure. The risk of heart failure was higher in patients with a high biomarker score (57.7%), in patients with type 1 diabetes (60%) and in patients with type 2 diabetes (57.1%). Independent risk of biomarker score on occurrence of heart failure. The risk of heart failure was multiplied by 2 if the biomarker score was intermediate (OR: 2.19, 95% CI: 1.11-4.34) and by 5 if the biomarker score was high (OR: 4.73, 95% CI: 1.84-6.20). Conclusion: The biomarker score is associated with the risk of heart failure in our study via the increase in the score elements as reported in European studies.
RESUMEN
BACKGROUND: In 2001, the World Health Organization (WHO) has recommended the use of artemisinin-based combination therapy (ACT) as the first-line treatment of uncomplicated malaria cases, as monotherapies had become ineffective in many parts of the world. As a result, the Democratic Republic of Congo (DRC) withdrew chloroquine (CQ) from its malaria treatment policy in 2002 and an artesunate (AS)-amodiaquine (AQ) combination became the ACT of choice in DRC in 2005. AQ-resistance (AQR) has been reported in several parts of the world and mutations in codons 72-76 of the Plasmodium falciparum chloroquine-resistance transporter (pfcrt) gene have been strongly correlated with resistance, especially mutations encoding the SVMNT haplotype. This haplotype was first identified in Southeast Asia and South America but was recently reported in two African countries neighbouring DRC. These facts raised two questions: the first about the evolution of CQ resistance (CQR) in DRC and the second about the presence of the SVMNT haplotype, which would compromise the use of AQ as a partner drug for ACT. METHODS: A total of 213 thick blood films were randomly collected in 2010 from a paediatric clinic in Kinshasa, DRC. Microscopy controls and real-time polymerase chain reaction (RT-PCR) were performed for Plasmodium species identification. Haplotypes of the pfcrt gene were determined by sequencing. RESULTS: The K76T mutation was detected in 145 out of 198 P. falciparum-positive samples (73.2%). In these 145 resistant strains, only the CVIET haplotype was detected. CONCLUSIONS: This study is the first to assess the molecular markers of resistance to CQ and AQ after the introduction of ACT in DRC. The results suggest first that CQR is decreasing, as wild-type pfcrt haplotypes were found in only 26.8% of the samples and secondly that the SVMNT haplotype is not yet present in Kinshasa, suggesting that AQ remains valid as a partner drug for ACT in this region.