ABSTRACT
Blood and/or urine levels of 27 heavy metals were determined by ICPMS in 41 patients with dilated cardiomyopathy (DCM) and 29 presumably healthy subjects from the Katanga Copperbelt (KC), in the Democratic Republic of Congo (DRC). After adjusting for age, gender, education level, and renal function, DCM probability was almost maximal for blood concentrations above 0.75 and 150 µg/dL for arsenic and copper, respectively. Urinary concentrations above 1 for chromium, 20 for copper, 600 for zinc, 30 for selenium, 2 for cadmium, 0.2 for antimony, 0.5 for thallium, and 0.05 for uranium, all in µg/g of creatinine, were also associated with increased DCM probability. Concurrent and multiple exposures to heavy metals, well beyond permissible levels, are associated with increased probability for DCM. Study findings warrant screening for metal toxicity in case of DCM and prompt public health measures to reduce exposures in the KC, DRC.
Subject(s)
Arsenic , Cardiomyopathy, Dilated , Metals, Heavy , Cardiomyopathy, Dilated/chemically induced , Cardiomyopathy, Dilated/epidemiology , Case-Control Studies , Democratic Republic of the Congo/epidemiology , Environmental Exposure/analysis , Humans , ZambiaABSTRACT
BACKGROUND: Limited data are available regarding causes and outcomes of heart failure as well as organization of care in the developing world. METHODS AND RESULTS: We included consecutive patients diagnosed with heart failure from November 2014 to September 2016 in a university and private hospital of Lubumbashi, Democratic Republic Congo. Baseline data, including echocardiography, were analyzed to determine factors associated with mortality. Cost of hospitalization as well as challenges for care regarding follow-up were determined. A total of 231 patients (56 ± 17 years, 47% men, left ventricular ejection fraction 29 ± 15%, 20% atrial fibrillation) were diagnosed, more during heart failure hospitalizations (69%) than as outpatients (31%). Main risk factors for heart failure included hypertension (59%), chronic kidney disease (51%), alcohol abuse (38%), and obesity (32%). Dilated cardiomyopathy was the most prevalent etiology (48%), with ischemic cardiomyopathy being present in only 4%. In-hospital mortality rate was 19% and associated with an estimated glomerular filtration rate of <60 mL·min-1·1.73 m-2 (P < .01) and atrial fibrillation (Pâ¯=â¯.02). One hundred six patients (46%) were lost to follow-up, which was mainly related to lack of organization of care, poverty, and poor health literacy. Of the remaining 95 subjects, another 33 (35%) died within 1 year after presentation. The average cost of care for a 10-day hospitalization was higher in a private than in a university hospital (885 vs 409 USD). CONCLUSIONS: Patients admitted for heart failure in DRC have a high incidence of nonischemic cardiomyopathy and present late during their disease, with limited resources being available accounting for a high mortality rate and very high loss to follow-up.
Subject(s)
Cardiomyopathy, Dilated/complications , Delivery of Health Care/standards , Heart Failure/etiology , Hypertension/complications , Myocardial Ischemia/complications , Cardiomyopathy, Dilated/epidemiology , Cardiomyopathy, Dilated/physiopathology , Democratic Republic of the Congo/epidemiology , Developing Countries , Echocardiography , Female , Follow-Up Studies , Heart Failure/diagnosis , Heart Failure/epidemiology , Hospital Mortality/trends , Humans , Hypertension/epidemiology , Hypertension/physiopathology , Incidence , Male , Middle Aged , Myocardial Ischemia/diagnosis , Myocardial Ischemia/epidemiology , Prognosis , Retrospective Studies , Risk Factors , Stroke Volume , Survival Rate/trends , Time FactorsABSTRACT
Introduction: la maladie rénale chronique constitue un véritable problème mondial de santé publique du fait de l'augmentation de ses principaux facteurs de risque à savoir l'hypertension artérielle et le diabète sucré. Dans nos milieux à faible revenu et spécialement dans notre pays, peu d'études sont connues sur cette pathologie diagnostiquée à un stade très avancée et posant un problème de prise en charge.Méthodes: il s'agit d'une étude descriptive transversale ayant été menée durant la période allant de juillet 2014 à juillet 2015 au service de dialyse de CMDC. Ont été inclus tous les patients avec taux de filtration glomérulaire inférieur à 60ml/min/1,73 m2 ou créatinine élevée au-delà de trois mois durant notre période d'étude L'objectif de cette étude est de décrire les caractéristiques sociodémographiques, les facteurs de risque et les paramètres biologiques de patients reçus pour insuffisance rénale.Résultats: nous avons retenu 60 patients. L'âge moyen était de 51, 38+/-13, 47 ans avec la tranche d'âge la plus touchée comprise entre 50-59 ans. 51, 67% avaient un niveau d'instruction secondaire et 40% un niveau supérieur. Les facteurs de risque d'atteinte rénale étaient l' HTA 66, 64%, le diabète sucré 25%, l'usage des produits nephrotoxiques 35%, l'infection à VIH 11, 67%, l'obésité 10%, la drépanocytose 3, 3%. Le poids de naissance de naissance de nos patients ainsi que l'existence d'une maladie rénale familiale étaient des facteurs méconnus.85% de nos patients avaient un taux d'hémoglobine inférieur à 12g%.Conclusion: de cette observation, il ressort que l'âge de nos patients ne diffère pas de celui observé dans les autres milieux à revenu faible. Le niveau d'instruction de nos patients est plus élevé comparé aux autres études. Il serait mieux de développer des stratégies de dépistage précoce de la maladie rénale pour éviter d'aboutir à l'hémodialyse qui reste un traitement très onéreux
