Acute acalculous cholecystitis following COVID-19 vaccination: a case report.

Acute acalculous cholecystitis is an acute inflammation of the gallbladder in the absence of stones, usually occurring in elderly and critically ill patients with underlying conditions. A 29-year-old man presented to the hospital complaining of abdominal pain in the right hypochondrium with permanent fever three days after Janssen COVID-19 vaccine inoculation. Abdominal ultrasound revealed a thickened gallbladder wall without evidence of gallstone consistent of an acute acalculous cholecystitis. Blood analyses revealed thrombocytopenia, eosinophilia and liver dysfunction. The Polymerase Chain Reaction (PCR) COVID-19 test was negative. As treatment, the patient benefited of pain management, antibiotic and fluid. In the evolution, there was a regression of clinical signs with persistence of liver dysfunction. The patient was discharged ten days after hospitalization. The Janssen COVID-19 vaccine is likely to induce acute acalculous cholecystitis as adverse event following vaccination.

Integration of Human African Trypanosomiasis Control Activities into Primary Healthcare Services: A Scoping Review.

Human African trypanosomiasis (HAT) also known as sleeping sickness is targeted for elimination as a public health problem by 2020 and elimination of infection by 2030. Although the number of reported cases is decreasing globally, integration of HAT control activities into primary healthcare services is endorsed to expand surveillance and control. However, this integration process faces several challenges in the field. This literature review analyzes what is known about integrated HAT control to guide the integration process in an era of HAT elimination. We carried out a scoping review by searching PubMed and Google Scholar data bases as well as gray literature documents resulting in 25 documents included for analysis. The main reasons in favor to integrate HAT control were related to coverage, cost, quality of service, or sustainability. There were three categories of factors influencing the integration process: 1) the clinical evolution of HAT, 2) the organization of health services, and 3) the diagnostic and therapeutic tools. There is a consensus that both active and passive approaches to HAT case detection and surveillance need to be combined, in a context-sensitive way. However, apart from some documentation about the constraints faced by local health services, there is little evidence on how this synergy is best achieved.

Passive Screening and Diagnosis of Sleeping Sickness with New Tools in Primary Health Services: An Operational Research.

INTRODUCTION: The integration of human African trypanosomiasis (HAT) activities into primary health services is gaining importance as a result of the decreasing incidence of HAT and the ongoing developments of new screening and diagnostic tools. In the Democratic Republic of Congo, this integration process faces multiple challenges. We initiated an operational research project to document drivers and bottlenecks of the process. METHODS: Three health districts piloted the integration of HAT screening and diagnosis into primary health services. We analysed the outcome indicators of this intervention and conducted in-depth interviews with health care providers, seropositives, community health workers and HD management team members. Our thematic interview guide focused on factors facilitating and impeding the integration of HAT screening. RESULTS: The study showed a HAT-RDT-positive rate of 2.2% in Yasa Bonga, 2.9% in Kongolo and 3% in Bibanga, while the proportion of reported seropositives that received confirmatory examinations was 76%, 45.6% and 68%, respectively. Qualitative analyses indicated that some seropositives were unable to access the confirmation facility. The main reasons that were given included distance, RDT rupture, lack of basic screening equipment and financial barriers (additional hospital fees not included in free treatment course), fear of lumbar puncture and the perception of HAT as a disease of supernatural origin. CONCLUSION: Passive screening using HAT RDTs in primary health services inevitably has some limitations. However, regarding the epidemiological context and some obstacles to integrated implementation, this cannot on its own be a relevant alternative to the elimination of HAT by 2020. FUNDING: We acknowledge the agency that provided financial support for this study, the Belgian Development Cooperation. The funder had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. Philippe Mulenga received financial support thanks to a doctoral grant from the Belgian Development Cooperation under the FA4 agreement. Funding for the study and Rapid Service Fees was provided by the Epidemiology and Tropical Diseases Unit of the Institute of Tropical Medicine, Antwerp.

Integration of Human African Trypanosomiasis Control Activities into Primary Health Services in the Democratic Republic of the Congo: A Qualitative Study of Stakeholder Perceptions.

Human African trypanosomiasis is close to elimination in several countries in sub-Saharan Africa. The diagnosis and treatment is currently rapidly being integrated into first-line health services. We aimed to document the perspective of stakeholders on this integration process. We conducted 12 focus groups with communities in three health zones of the Democratic Republic of the Congo and held 32 interviews with health-care providers, managers, policy makers, and public health experts. The topic guide focused on enabling and blocking factors related to the integrated diagnosis and treatment approach. The data were analyzed with NVivo (QSR International, Melbourne, Australia) using a thematic analysis process. The results showed that the community mostly welcomed integrated care for diagnosis and treatment of sleeping sickness, as they value the proximity of first-line health services, but feared possible financial barriers. Health-care professionals thought integration contributed to the elimination goal but identified several implementation challenges, such as the lack of skills, equipment, motivation and financial resources in these basic health services. Patients often use multiple therapeutic itineraries that do not necessarily lead them to health centers where screening is available. Financial barriers are important, as health care is not free in first-line health centers, in contrast to the population screening campaigns. Communities and providers signal several challenges regarding the integration process. To succeed, the required training of health professionals, as well as staff deployment and remuneration policy and the financial barriers in the primary care system need to be addressed, to ensure coverage for those most in need.

[Chronic kidney disease: associated factors, etiologies, clinical and biological parameters at Lubumbashi city in Democratic Republic of Congo]. / Maladie rénale chronique: facteurs associés, étiologies, caractéristiques clinique et biologique à Lubumbashi en République Démocratique du Congo.

INTRODUCTION: Chronic kidney disease is fast becoming a worldwide public health problem due to the increase of hypertension and diabetes mellitus, its main risk factors. In countries like DRC where majority of population are in the low income bracket, very few studies about this disease, usually diagnosed at a very advanced stage have been conducted. As a result of such, cases are not always properly taken care of and managed. METHODS: We opted for a descriptive cross-sectional study and it was conducted during the period from July 2014 to July 2015 at CMDC dialysis service. Were included all patients with glomerular filtration rate lower than 60ml / min / 1,73 m2 or high level of creatinine longer than three months during the study period Goal. This study aims at describing the sociodemographic characteristics, risk factors and biological parameters of patients admitted for kidney failure. RESULTS: We selected 60 patients. The average age was 51, 38 + / _ 13, 47 with the most affected included age group between 50-59 years. 51, 67% had completed secondary education and 40% higher. Risk factors of renal damage were the HTA 66, 64%, 25% diabetes mellitus, use of nephrotoxic products 35%, HIV infection 11, 67%, 10% obesity, sickle cell disease 3, 3%. The birth weight birth of our patients as well as existing renal disease in family were unknown factors. 85% of our patients had hemoglobin levels below 12 g%. CONCLUSION: From this observation, it appears that the age of our patients did not differ from that observed in other low-income communities. The level of education of our patients is higher compared to other studies. It would be better to develop strategies for early detection of kidney disease to avoid ending hemodialysis remains a very expensive treatment.

Maladie rénale chronique: facteurs associés, étiologies, caractéristiques clinique et biologique à Lubumbashi en République Démocratique du Congo

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

[Inaccurate information about the size of the penis in the Democratic Republic of the Congo: about 21 information sources]. / Information non précise sur la taille du pénis en République Démocratique du Congo: à propos de 21 sources.

INTRODUCTION: Penis size is a huge topic of anxiety for a lot of men. Some of them are unhappy with their penis size as shown in the study conducted by Tiggemann in 2008. There are relatively few studies on erect penis size. This may reflect cultural taboos of researchers or doctors interacting with men who are in a state of sexual arousal. On the other hand, it is important for people who announce details on penis size to give the average penis size first and then sizes suggested by the researchers. METHODS: We performed a cross-sectional survey in the two major urban centres of the Democratic Republic of Congo namely Kinshasa and Lubumbashi over a period of two years from May 2014 to May 2016. A total of 21 information sources constituted our sample, 8 in Kinshasa and 13 in Lubumbashi. We found it sufficient because in our culture discussing about sexual matter is rare. The parameters studied were: the nature of the source, the accuracy of the measurement method, the presence of bibliographical reference, the announced penis size. RESULTS: The majority of information sources used were radio or television broadcastings (23,8%); this can be explained by the fact that there are an increasing number of radio and television stations in our country and especially in large cities. With regard to accuracy of information about penis measurement method when sharing the message about penis size, our study showed that the majority of information sources did not indicate it when they announced penis size to the public (85,7%). Several sources did not report bibliographical references (57,1%). Announced data analysis on penis size showed that the average penis size was: 14 cm (28,6%), 15 cm (23,8%) and 15-20 cm (19%). CONCLUSION: All these results are intended to offer a warning to all players responsible for diffusing information on sexual health (penis size): scientific rigor consists in seeking information from reliable sources.