Reajustement des charges des appareils de traction cervicale au cours de l'arthrose cervicale a Kinshasa

Objectif : Reajuster les charges des appareils de traction cervicale par la mesure des ecarts entre les charges affichees et celles accrochees; en vue d'une correction eventuelle par rapport au poids du patient.Methodes : C'est une etude de cas portant sur 6 materiels de traction cervicale appartenant aux 4 centres de reeducation et aux Cliniques Universitaires de Kinshasa; de janvier 2005 a decembre 2010 dans la ville de Kinshasa. Le reajustement des charges de ces appareils de traction a permis de verifier a l'aide d'un dynamometre intercale entre la sangle de traction et l'autre bout de la corde; la concordance ou non des charges accrochees au bout libre de l'appareil et celles affichees au dynamometre lors de la traction. Nous avons calcule la variation de la charge de la tete sur la colonne cervicale en fonction du degre de la lordose et du niveau de la vertebre. Etant donne que la tete pese en moyenne 8;1% du poids corporel; la charge a accrocher devait etre superieure au poids de la tete pour exercer une reelle traction sur la colonne cervicale.Resultats : Le reajustement des charges des appareils de traction cervicale dans ces cinq services a montre des ecarts importants entre les charges accrochees et celles affichees au dynamometre; compris entre 1;5 et 10 kg. Il a ete aussi mis en evidence l'importance de la lordose cervicale et celle du niveau de la vertebre dans l'augmentation de la charge sur la colonne; les variations de charges obeissant a une progression arithmetique.Conclusion : Nos resultats peuvent donc permettre; dans un contexte des pays a faibles revenus; d'aider les praticiens a proceder au reajustement des appareils de traction avant la prise en charge

The phenotype and genotype of rheumatoid arthritis in the Democratic Republic of Congo.

INTRODUCTION: Little is known about rheumatoid arthritis in the black, particularly in Congolese, populations. Our objective was to describe the phenotype and genotype of rheumatoid arthritis (RA) in Congolese. METHODS: All consecutive rheumatoid arthritis (RA) patients attending Kinshasa University Hospital in a three-year time period were included. Demographics, clinical features and tobacco consumption were noted. Disease Activity Score (DAS)-28 based on the erythrocyte sedimentation rate (ESR), Health Assessment Questionnaire (HAQ), anti-citrullinated peptide antibodies (CCP) antibodies and rheumatoid factor (RF) were determined. Radiographs were scored according to Sharp-van der Heijde. On a subset of patients and controls HLA-DRB1 typing was performed. RESULTS: A total of 114 females and 14 males aged 51.2 ± 14.9 were included. Mean duration of symptoms was four years. Moderate tobacco consumption was reported in a minority of patients. DAS-28 at first visit was >5.1 and HAQ ≥0.5 in all patients. X-rays showed joint erosions and/or joint space narrowing, mostly of a moderate grade in 55.8% of patients. Anti-CCP and/or RF were present in 48.6% of patients with available data (n = 72) and in 3.0% of controls (n = 67). Radiographic changes and nodules were more frequent in RF or anti-CCP positive patients. One copy of the shared epitope was found in 13 patients (35.1%) and 3 controls (12.5%). Two copies were found in one patient (2.7%) and in one control (4.2%). CONCLUSION: Congolese patients with RA consult long after disease onset. Despite this delay, the majority presents without major damage and is RF, anti-CCP and SE negative. We put forward the hypothesis that besides different environmental factors there is probably also a particular genetic risk profile in Congolese patients, different from the HLA-DRB1 shared epitope.

Treatment of rheumatoid arthritis with methotrexate in Congolese patients.

Methotrexate (MTX) is the anchor drug in the treatment of rheumatoid arthritis (RA) but data concerning the effectiveness of treatment with this compound are lacking in the Congolese population. In the present study, the evolution of RA in Congolese patients on MTX treatment is reported from before disease-modifying antirheumatic drug (DMARD) initiation till 20 months later. All consecutive DMARD-naïve RA patients (ACR 1987 criteria) attending the rheumatology unit of the University Hospital of Kinshasa from January 2008 to September 2010 were included. All were treated with MTX (started at 7.5 mg/week) and bridging steroids (started at 30mg/day). Treatment adaptations of MTX and concomitant drugs are reported as well as evolution of disease activity (DAS28-ESR), functionality (Health Assessment Questionnaire), radiological damage, and safety over 20 months. Of 98 patients recruited, more than one third were lost at follow-up. A follow-up visit at 20 months was available for 51 patients. These 48 women and 3 men had a mean age of 51.2 ± 13 years and a mean delay from symptom onset till their first visit of 3.2 years. At 20 months, the average MTX dose was 9.7 mg weekly. A second DMARD was added in three patients. The average dose of prednisone at 20 months was 7.5 mg daily. A significant improvement of DAS28 and functional disability was observed and 35.3 % of patients entered remission (DAS28 <2.6). A progression of X-ray damage was observed in one third of patients. Two patients had to stop MTX because of severe side effects and two patients developed diabetes. Methotrexate and bridging steroids therapy is effective also in sub-Saharan Africa but the average weekly MTX dose remains low. Implementation of a regular follow-up is a major issue.

Etude comparee du diagramme de Kinshasa a celui de magnin dans le pronostic de l'accouchement

Objectif : Faire une evaluation comparative entre le diagramme previsionnel des dystocies utilise de Kinshasa et celui de MAGNIN. Materiel et methodes : Cette etude transversale etait realisee dans les Services de Radiologie et d'Obstetrique des Cliniques Universitaires de Kinshasa de 2006 a 2011. Elle a concerne 196 gestantes; toutes selectionnees sur base de la radiopelvimetrie et de la cephalometrie du diametre biparietal realisee a terme. Les criteres de non inclusion portaient sur les cesariennes anterieures; les vices majeurs du bassin; les presentations autres que cephaliques; lespresentations incompatibles avec l'accouchement par voie basse et les obstacles praevia. Ces cas etaient simultanement soumis aux 2 diagrammes concernes dans cette etude. La conformite de leurs previsions respectives avec les modes d'accouchement observes etait verifiee a la fin. Resultat : La sensibilite; la specificite; la valeur predictive positive et la valeur predictive negative du diagramme de Kinshasa etaient respectivement de 93;6; 98;8; 99 et 92;4. La comparaison des resultats du diagramme de Kinshasa a ceux du MAGNIN avait donne une concordance de 95;9 contre 60;2 et un taux d'echecs de 4;1 contre 11;2. En particulier; le diagramme de MAGNIN etait indecis dans 28;6 des cas. Conclusion : Le diagramme teste dans cette etude semble se reveler plus performant que celui de MAGNIN

Clinical and epidemiological features of rheumatic diseases in patients attending the university hospital in Kinshasa.

The aim of the present retrospective and hospital-based study was to describe epidemiological and clinical features of rheumatic diseases in patients attending the University Hospital of Kinshasa (UHK). Rheumatic complaint was a reason for consultation in 12.1% of outpatients attending the Department of Internal Medicine of the UHK. Osteoarthritis was the most common rheumatic disease (59.2%), followed by soft tissue rheumatism (16.1%), gout (9.3%), and spondylarthropathies (7.5%). The cumulative frequency of autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, dermatomyositis, and mixed connective tissues disease) and the frequency of osteoporosis were 5.2 and 2.7%, respectively. Lumbar spine was the part of the skeleton mostly affected by osteoarthritis. Pathological fractures in osteoporosis, subcutaneous nodules, rheumatoid factor, and erosive bone lesions in rheumatoid arthritis were rarely found. Compared to the previous studies performed in the same hospital, our results disclose a threefold increase of rheumatic outpatients. The paucity of erosive arthritis and extra-articular manifestations suggest the less severity of rheumatoid arthritis in our patients. Likewise, the absence of femoral and wrist osteoporotic fractures and the scarcity of advanced vertebral crush fractures suggest the mildness of osteoporosis.

Superiorite du polymorphisme du systeme HLA par la biologie moleculaire sur le polymorphisme par la serologie aux Cliniques Universitaires de Kinshasa

Le present travail a consiste en l'etude sur systeme HLA de classe II dans la population congolaise. Quatre vingt douze echantillons provenant des sujets sains on ainsi ete types par des methodes de Biologie moleculaire; en utilisant la technique de PCR-SSO et en comparant les resultats a ceux obtenus; par la methode serologique; dans la meme population. Trente et un; 16; 16 et 14 alleles ont ete respectivement reveles aux loci DR; DP et DQ alors que la methode serologique n'avait detecte que 11 et 3 alleles aux loci DR et DQ respectivement et aucun allele au locus DP. Parmi les alleles observes; les plus frequents sont DRBI*1501 pour le locus DRB1; DQB1*0602 pour le locus DQB1 et DPB1*01011 pour le locus DPB1. Ces resultats montrent que le polymorphisme HLA etudie par la Biologie moleculaire est de loin plus etendu que lorsqu'on l'etudie par les methodes serologiques ou celles d'Immunologie cellulaire

Low frequency of HLA-B27 and scarcity of ankylosing spondylitis in a Zairean Bantu population.

Ankylosing spondylitis (AS) is an inflammatory rheumatic disease which is thought to be rarely seen in African Blacks. Its genetic predisposition has been stressed in Caucasians where the HLA-B27 antigen is firmly linked to the disease. In the present study, HLA-B27 antigen was determined in 146 individuals of Bantu root. Only one of these subjects was found to possess HLA-B27 antigen. This study correlates the low frequency of HLA-B27 with the observed scarcity of AS in patients attending a clinic in Kinshasa for osteoarticular diseases.

HLA-DR gene frequencies in a Zaïrean population with particular reference to rheumatic diseases.

Epidemiological studies have shown that rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus are uncommon in black Africans, and in this population the prevalence and the clinical features of these rheumatic diseases are variable. Environmental and genetic factors have been pointed out to explain this variability. In the present study, HLA-DR genes have been determined in a Zaïrean population in order to compare our results with those found elsewhere in other black populations of the same Bantu origin. Our results show that the frequency of HLA-DR1 is higher than in Nigerians, Zimbabweans and Xhosas, the decrease in Xhosas being statistically significant (p < 0.006). The HLA-DR3 frequency is higher in Zaïreans than in Nigerians but not significantly, while it is lower than in Xhosas (p < 0.003) and in Zimbabweans (not significant). The HLA-DR4 frequency is higher in Zaïreans than in Nigerians but it is lower than in Xhosas and Zimbabweans; the differences are not statistically significant. The HLA-DR8 frequency is lower in Zaïreans than in Nigerians while it is higher than in Xhosas (p < 0.002) and in Zimbabweans (not significant). These data suggest that genetic factors partly explain the clinical and epidemiological variability of rheumatic diseases in black Africans.

Role of alfacalcidiol on bone quality and immunomodulation in autoimmune disease and organ transplantation.

In autoimmune diseases, as well as in organ transplantation, corticosteroids are often an obligatory part of the treatment regimen. The deleterious effect of corticosteroids on bone metabolism is well known, although still controversial [1-3]. It is easier to maintain bone mass than to restore it. Although the treatment of choice for prevention of bone loss is hormone replacement therapy, it cannot always be applied, and for many reasons compliance is low over the world. Alternative strategies to prevent bone loss are now tried out in many centers. Calcitonin and bisphosphonates are well-known antiresorbing drugs, but costs and long-term efficiency for calcitonin and fear for bone toxicity for the bisphosphonates limits their use for prevention. An attractive strategy to prevent osteoporosis is the treatment with alfacalcidiol because it is a natural product with important effects on bone metabolism in physiological and pharmacological dosages. Calcium absorption from the gut and mineralization of the bone matrix are optimalized by alfacalcidiol. The purpose of this paper is to report on our experience with alfacalcidiol concerning bone mass and quality in corticosteroid-induced osteoporosis in experimental animals and on long-term bone quality in autoimmune diseases and organ transplantation. We have studied the effects of alfacalcidiol on bone mass and quality in ovariectomized animals with and without corticosteroids. In these fundamental studies we have found that alfacalcidiol had a profound protective and curative effect not only on bone mass but also on bone quality as tested by mechanical testing, namely, impact torsional loading test of whole bones. The combination of alfacalcidiol with estrogens was less effective than alfacalcidiol, but more effective than estrogens alone [4-6] (Fig. 1).

Indications and results of pleuropulmonary decortications in the university hospital of Kinshasa.

In a retrospective and prospective study the authors assess factors influencing postoperative results in patients operated on for pachypleuritis with late referral to the hospital. There were 78 cases in the retrospective (1970-1984) and 28 cases in the prospective (1985-1992) parts of the study. The total number of treated cases is 106 (75 males and 31 females). There were 32 children (> 15 years of age) and 74 adults (< or = 15 years). General condition was good in 45 patients (11 children and 34 adults) and poor in 61 patients (21 children and 40 adults). Ninety percent of the patients were operated on at least one month after the appearance of their symptoms. Eighty-one patients (75.4%) had an empyema secondary to bronchopulmonary infection (34 tuberculous). Other etiologies were: thoracic trauma: 23 cases (19 open and 4 internal); miscellaneous: 2 cases. The commonest isolated organisms were S. aureus, (21.4%), Klebsiella (21.4%) Pseudomonas (13%), Proteus mirabilis, P. vulgaris, P. aeruginosa (11.9%), E. coli (8.4%) and Pyocyaneus (5.9%). In all cases, a total decortication was performed. Good result was achieved in 55/106 (51.8%). There were 39/106 (36.9%) poor results and 12 operative deaths (11.3%). No correlation could be found between results and age, sex or etiology. A significant correlation appeared between duration of symptoms and postoperative results. The longer the delay; the worse the results.

Hydroxyprolinuria in normal Zairean children.

Hydroxyprolinuria has been measured in 378 normal Zairean children aged between 3 and 13 years using the Kivirikko's method; 192 of them were boys and 186 were girls. Results show an age-related increase of urinary excretion of hydroxyproline in both sexes, girls having higher absolute values than boys. However, this difference is pronounced when values are corrected according to body size. Our values are slightly higher than those found in the literature.

Bone mass in Zaireans: radiogrammetric determination.

Bone mass was measured in 230 subjects with ages ranging from 15 to 54 years (110 males and 120 females), using the radiogrammetric method on the second metacarpal bone. Results of the study show that bone mass increases with age up to 34 years and then decreases, both in males and females, although males have significantly higher values than females. The decrease is however more marked in females than in males.

Bone tissue composition: biochemical anatomy of bone.

Bone is chemically built up as a mineralized matrix which comprises collagen and a small amount of noncollagenous proteins. This paper points out some useful methods to evaluate the bone composition. Demineralizing extraction of bone powder with EDTA allows the determination of matrix size and degree of extractability. These parameters vary with bone type, anatomical site of the bone, disease, species, and drug treatment. The study of bone particles in situ can be done by separation of bone powder according to their density. A shift of the bone particles to higher density fractions reflects an increased amount of older, more mineralized osteons in the bone with its consequences on the mechanical competence of the bone. Quantity and quality of bone matrix mineralization are related to bone cell activity which can be studied indirectly by further exploration of the composition of the bone matrix. Many noncollagenous proteins are buried in the extracellular bone matrix from where they can be released when bone is resorbed. These proteins can then act on bone cells in an autocrine or paracrine manner. Altered concentrations of noncollagenous proteins in bone matrix are described in three pathological conditions associated with changes in other bone properties: osteoarthritis, osteopenia, and osteogenesis imperfecta. The functional significance and origin of these changes will have to be subjected to further study.

Ankylosing spondylitis in two Zaïrian brothers.

Ankylosing spondylitis has never been described in Zaïre and is considered to be rare in black African populations. We report two cases observed in the University Hospital of Kinshasa. The two patients are brothers. The diagnosis is based on anaemnestic, clinical and radiological findings. We therefore demonstrate the existence of this disease in Zaïre and presume that other similar cases may be diagnosed.

Drug trials in developing countries: the need for ethics.

Drug trials in developing countries may contribute to a better understanding of the properties of antirheumatic drugs. Before this can be done, however, there is a need for ethical committees to oversee the trials and for effective regulation of drug availability.