Facteurs associés à l'infertilité féminine liée aux adhérences à Mbujimayi (RDC) / Factors associated with female infertility due to adherences in Mbujimayi (DRC)

Dans une société pro-nataliste, l'infertilité féminine est considérée comme un drame. Cette étude avait pour objectif d'identifier les facteurs associés à l'infertilité mécanique féminine liée aux adhérences pelviennes à Mbujimayi. MéthodologieIl s'agissait d'une étude cas-témoins, réalisée dans les Hôpitaux Généraux de Référence Dipumba et Saint Sauveur à Mbujimayi (RDC), durant une période allant du premier janvier 2006 au 31 décembre 2020. Nous avons colligé un total de 354 cas RésultatsLes facteurs associés à l'infertilité mécanique féminine étaient: l'âge inférieur à 20 ans qui multipliait par 4 le risque de développer des adhérences pelviennes (OR=4,01[1,19-13,49]); l'antécédent des infections sexuellement transmises (IST) (OR=1,77[1,06-2,96]) et l'antécédent de chirurgie abdomino-pelvienne (OR=1,76[1,07-2,88] qui multipliaient respectivement de presque par 2 le risque d'avoir les adhérences pelviennes. Ces associations étaient statistiquement significatives. ConclusionLes IST et la chirurgie abdomino-pelvienne exposent au développement des adhérences pelviennes et/ou aux altérations tubaires conduisant à l'infertilité féminine. Leur prévention doit se baser sur la prise en charge préventive des IST par la sensibilisation pour une sexualité responsable surtout chez les adolescentes, la rationalisation dans les indications et la bonne pratique de la chirurgie abdomino-pelvienne par les médecins.

Introduction: In a pro-natalist society, female infertility is considered a tragedy. This study aimed to identify the factors associated with female mechanical infertility related to pelvic adhesions in Mbujimayi. Methodology This was a case-control study, carried out in Dipumba and Saint Sauveur General Reference Hospitals in Mbujimayi (DRC), during a period from January 1, 2006 until December 31, 2020. We collected a total of 354 cases ResultsThe factors associated with female mechanical infertility were: age below 20 years, which multiplied by 4 the risk of developing pelvic adhesions (OR=4.01 [1.19-13.49]); history of sexually transmitted infections (STI) (OR=1.77[1.06-2.96]) and history of abdomino-pelvic surgery (OR=1.76[1.07-2.88] which respectively increased the risk of having pelvic adhesions by almost 2. These associations were statistically significant. Conclusion: Sexually transmitted infections (STI) and abdomino-pelvic surgery expose the patient to the development of pelvic adhesions and/or tubal alterations leading to female infertility. Their prevention must be based on the preventive management of STI by raising awareness for responsible sexuality, especially among adolescents, the rationalization of the indications and the good practice of abdomino-pelvic surgery by doctors

[Frequency and causes of female infertility in Mbujimayi, DRC]. / Frequence et causes de l'infertilite feminine a Mbujimayi, RDC.

The main objective of thisstudywas to determine the frequency of femaleinfertility in ourenvironment and subsequently, to describe the socio-demographiccharacterstics of patients and to identifytheir possible etiologies. METHODOLOGY: This was a retrospective and cross-sectional descriptive study carried out in the general reference hospitals of Dipumba and Saint Sauveur in Mbujimayi the DR Congo. The study covered a period of 15 years as from January 2006 to December 2020. Our sample was of 354 cases. RESULTS: The frequency of female infertility in our environment was of 9,6%. The median age of the patients was 32 years with a median duration of the marital union of 9 years. The history of abdomino-pelvicsurgery was found in 40,1% of cases, sexually transmitted diseases in 29,4% of cases and curettage in 20,6% of cases. The causes of infertility were more mechanical in 73% of cases followed by hormonal causes and/or mixed causes respectively in 10% and 9% of cases. In59,3% of cases, gynecological ultrasound was normal and hysterosalpingograhy showed tubal obstructions in 46,9% of cases followed by pelvicadhesions (13,0% of cases) and hydrosalpinx (7,1% of cases). CONCLUSION: Female infertility is a reproductive health concern in our community and its causes are many more mechanical.

L'objectif de cette étude était de calculer la fréquence de l'infertilité féminine, décrire les caractéristiques sociodémographiques des patientes infertiles et, d'identifier les étiologies éventuelles. MÉTHODOLOGIE: Une étude descriptive rétrospective et transversaleétait réalisée dans les hôpitaux généraux de référenceDipumba et Saint Sauveur à Mbujimayien RD Congo et couvrait la période de 15 ans, soit de janvier 2006 à décembre 2020. La taille de notre échantillon est 354 cas. RÉSULTATS: La fréquence de l'infertilité féminine dans notre milieu était de 9,6%.L'âge médian des patientes était de 32 ans avec une médiane de la durée de l'union conjugale de 9 ans. L'antécédent de chirurgie abdomino-pelvienne était retrouvé dans 40,1% de cas, de maladies sexuellement transmissible dans 29,4% de cas et de curetage endo-utérin dans 20,6% de cas. Les causes d'infertilité étaient plus mécaniques dans 73% de cas suivies des causes hormonales et/ou des causes mixtes respectivement dans 10 et 9% de cas. Dans 59,3% de cas, l'échographie gynécologique était normale et à l'hystérosalpingographie, les obstructions tubaires ont représenté 46,9% de cas suivies des adhérences pelviennes (13,0% de cas) et l'hydrosalpinx (7,1% de cas). CONCLUSION: L'infertilité féminine est un problème de santé reproductive dans notre communauté et ses causes sont beaucoup plus mécaniques.

Studies on the pharmacokinetics and the metabolism of gitoxin in the guinea-pig: II. the enteral absorption and the enterohepatic recirculation.

Absorption of 3H-gitoxin and enterohepatic recirculation of the metabolites excreted in the bile were studied in the guinea-pig. Samples were assayed either by RIA or by selective counting of the radioactivity due to tritium. When administered as hydroalcoholic solutions into the stomach or into the duodenum, gitoxin is nearly completely absorbed (94.5%). But the availability of the drug in the systemic circulation is of only 35% (RIA) or 52% (CH2C12-soluble radioactivity). Only 3-5% of the metabolites excreted in the bile enter the enterohepatic cycle.

Studies on the pharmacokinetics and the metabolism of gitoxin in the guinea-pig: I. Disposition kinetics following an i.v. bolus of 3H-gitoxin.

Kinetics and metabolism of 3H-gitoxin were determined in the guinea-pig after the i.v. administration of 80 microgram gitoxin/kg. The time course of plasma concentration and urinary amounts remaining to be excreted were described according to the three-compartment linear body model. Apparent half-lives of 4.98 +/- 0.16 hr (plasma) and 24.0 +/- 0.5 hr (urine) were found according to the CH2Cl2-soluble radioactivity. The apparent volume of central compartment and the apparent volume of distribution were estimated with 0.44 +/- 0.05 l/kg and 14.33 +/- 1.131/kg respectively. During 96 hr, approximatively 5.3% of the radioactivity given were eliminated via the kidneys whereas almost 78.7% were recovered in faeces. In animals with bile-duct cannulated, approximatively 82.6% of the dose given were excreted in bile during 6 hr. The hepatic degradation of gitoxin was so fast that almost 70% of the radioactivity recovered in plasma, urine and bile samples after 2 hr could no longer be extracted by dichloromethane. In the lipophilic extracts diginatin and its derivatives were found as possible metabolites of gitoxin. At least four polar metabolites hardly hydrolysable by beta-glucuronidase and by arylsulfatase were detected by TLC in the aqueous extracts from the gastro-intestinal excretions.