Perception de la tension au travail (job strain) en milieu hospitalier à Pointe-Noire, Congo-Brazzaville / Perception of job strain in the hospital environment at Pointe-Noire, Congo-Brazzaville

Objectif : Evaluer la situation de job strain et les manifestations psychosomatiques ressenties par les personnels soignants des hôpitaux de Pointe-Noire. Méthodologie : L'étude était une enquête transversale analytique. Un auto-questionnaire monté selon le modèle « demande-contrôle-soutien ¼ de KARASEK, avait été utilisé pour recueillir de manière anonyme des données sociodémographiques, des informations relatives à l'état de santé, à leur poste de travail et d'identifier des facteurs de risques psychosociaux. Résultats : Sur l'ensemble des cent cinquante (150) soignants retenus, 47,02% présentaient une faible latitude décisionnelle contre 52,98% avec une forte latitude. La forte demande psychologique était perçue par 50,33% des soignants contre 49,67% avec une faible demande. La situation de job strain était retrouvée chez 26,67% des soignants. Les services des urgences et de médecine étaient les plus exposés avec respectivement 25% et 20% du personnel en situation de job strain. Une faible ancienneté au travail prédisposait à une perception de job strain plus élevée. Les médecins spécialistes et les infirmiers représentaient les catégories professionnelles les plus tendus avec respectivement 42,86% et 30,23% des individus concernés. Un lien statistique était retrouvé entre d'une part le job strain et d'autre part les troubles musculosquelettiques et l'auto-estimation de l'impact du travail sur la santé. Conclusion : Les risques psychosociaux notamment le stress sont une préoccupation réelle dans les établissements de soins et cette enquête a permis de noter qu'ils pourraient avoir des conséquences sur la santé des soignants à Pointe-Noire.

Objective: To assess the job strain situation and the psychosomatic manifestations felt by the health care worker of the Pointe-Noire hospitals. Methodology: It was an analytical cross-sectional survey. A self-questionnaire set up according to the KARASEK "demand-control-support" model had been used to anonymously collect sociodemographic data, information on their health situation, at their workplace and identify psychosocial risk factors. Results: of one hundred and fifty (150) caregivers considered, 47.02% had low decision latitude versus 52.98% with high latitude. The high psychological demand was felt by 50.33% of the medics versus 49.67% with a low demand. The job strain situation was found among 26.67% of medics. Emergency and medical departments were the most exposed with 25% and 20% of staff in a job-strain situation respectively. Low job seniority predisposed to a higher feeling of job-strain. Specialist doctors and nurses represented the most strained professional categories with 42.86% and 30.23% of the individuals concerned respectively. A statistical relation was found between job strain on the one hand and musculoskeletal trouble and self-estimation of the impact of work on health on the other hand. Conclusion: Psychosocial risks, particularly stress, are a real concern in health institutions and this survey note that there could be impact on medics' health in Pointe-Noire.

[Pathological fracture revealing an osseous histoplasmosis. A case report on a 60-year patient]. / Fracture pathologique révélant une histoplasmose osseuse. A propos d'une observation chez une patiente de 60 ans.

The authors report a new case of African Histoplasmosis in a 60-year-old patient. It was an humeral localization revealing a pathological fracture which grew into an extension of osteolysis and a cutaneous fistulization likely to be a malignant bone tumor. The case has been diagnosed by surgical biopsy and histological analysis. Its antifungal treatment in progress resulted in the drainage of the out-flow that should permit the bone reconstruction by graft. The authors stress on the need to focus on this affection whenever, in a tropical area, one is faced with any chronic bone fistula that cannot positively be cured in spite of sound medical cares.

[The first Congolese case of cervical clear cell adenocarcinoma]. / Première observation congolaise d'un adénocarcinome à cellules claires du col de l'utérus.

The authors report the first Congolese case of uterine cervix clear cell adenocarcinoma in a menopausal multipara, whose mother had not been treated by diethystilboestrol (DES). The histological diagnosis was made on embedded-paraffin samples, stained by HE and PAS. Discharged from hospital on parents' request in order to be on infusion and brew-based traditional treatment, the patient died at home two months after diagnosis.

An atypical aortic atherosclerotic lesion in cynomolgus monkeys during hypercholesterolemia: a protection by smooth muscle cells against advanced lesions?

This study focuses on the fortuitous discovery of an atypical atherosclerotic lesion in four of 49 male adult cynomolgus monkeys (macacus fascicularis) which were maintained for a long time at a high level of hypercholesterolemia, and in seven of 19 female cynomolgus monkeys examined from the second to the 24th week of hypercholesterolemic diet: this lesion was in formation or already mature during this period of diet. This atypical lesion was formed by a collagen and elastic network surrounding synthetic smooth muscle cells without fibrofatty or fibrous plaques. Lipids were occasionally seen in the inner intima. The lesion appeared early (from the third week of diet). Once established, its morphology did not change. It became more extensive, but was not complicated by lipid overload in spite of prolonged, permanent hypercholesterolemia. This response to hypercholesterolemia is interesting because the activity of the smooth muscle cells differs from that observed in the classic lesion: they intervene earlier, their replication is very marked and rapid, their elastin secretion is greater and remains constant over time, and their phagocytic properties are reduced. This experimental study examines the installation and the maintenance of this lesion and raises the problem of its origin.

[Entomophthoramycosis: a case report of a Congolese child with rapid regression using ketoconazole]. / Basidiobolomycose: une observation chez un enfant congolais avec régression rapide sous kétoconazole.

We report the second Congolese case of subcutaneous entomophthoramycasis, a rare tropical disease expressed as cellulitis. Despite characteristic clinical features, the diagnosis for this twelve-year old child was confirmed four years after the beginning of the disease. Dramatic clinical improvement was observed within the first month of treatment with ketoconazole.

Les cancers gastriques au CHU de Brazzaville : a propos de 31 cas operes

Les auteurs rapportent 31 cas de cancers gastriques operes dans le service de Chirurgie Digestive du CHU de Brazzaville du 1er juillet 1986 au 30 juin 1992 soit 6 ans. On compte 21 hommes et 10 femmes. L'age des patients est compris entre 21 et 71 ans avec une moyenne de 49 ans. La symptomatologie; pylomorphe; est dominee par les signes tardifs (alteration de l'etat general et signes de stenose antro-pylorique). Le traitement chirurgical; palliatif dans plus de la moitie des cas est realise pour le confort des malades; compte tenu des stades tres evolues de ces patients. L'evolution est decevante avec une survie moyenne allant de 3 a 18 mois

Aspects anatomopathologiques observes au cours des nephrectomies au CHU de Brazzaville (Congo)

De janvier 1990 a decembre 1993 soit en 4 ans; trente (30) pieces de nephrectomie ont ete enregistrees et examinees dans le Service d'Anatomie et de Cytologie Pathologiques; du CHU de Brazzaville. Les pathologies renales qui ont conduit a la nephrectomie frappent egalement l'homme et la femme (50 per cent de cas). Les aspects anatomo-pathologiques sont polymorphes; dominees par l'inflammation (53;4 per cent). Selon l'age; les lesions histologiques observees entre 0 et 20 ans sont dominees par le nephroblastome (9 cas) suivies des pyelonephrites (4 cas) et exceptionnellement le carcinome renal a cellules claires (1 cas). Apres 20 ans les lesions inflammatoires a type de pyelonephrites par obstruction calculeuse sont predominantes (12 cas); secondairement viennent les carcinomes renaux a cellules claires (2 cas). Les tumeurs benignes (cystadenome; lipomyofibrome) sont rares

[Pneumocystis carinii pneumonia in patients with AIDS in the Congo]. / Pneumocystoses observées au Congo chez les malades atteints de SIDA.

Forty-five bronchoalveolar lavages (BAL) were performed in Brazzaville in AIDS patients who did not expectorate acid- and alcohol-resistant bacilli (AARB). All patients presented with respiratory symptoms (cough, dyspnoea or chest pain), and all but 6 of them had abnormal radiography of the chest. Four cases of pneumocystosis were diagnosed (9%); 3 of these patients had interstitial pneumonia and dyspnoea. No AARB was found at microscopic examination of BAL which showed Pneumocyctis carinii; no culture on Löwehstein's medium could be made. The authors consider that the low prevalence of pneumocystosis in Africa, compared with industrial countries, is due to a smaller dissemination of the parasite in Africa rather than to immunodepression which is known to be more pronounced in AIDS patients from industrial countries.

[Anatomopathologic diagnosis of parasitosis in Congo]. / Le diagnostic anatomopathologique des parasitoses au Congo.

In the part ten years, 9,650 anatomopathologic examinations have been carried out in the National Laboratory of Histopathology for Public Health in Brazzaville: 250 cases of parasitic infestation were diagnosed. In order of frequency were noted; 144 cases of bilharzia due to Schistosoma haematobium with 75 genito-urinary localisations and 51 appendicular cases, 31 cases of onchocercosis with a majority of subcutaneous nodules (17), 17 cases of digestive helminthiasis all locate in the ileo-caecal-appendix and discovered during systematic appendicular exploration, 13 cases of colitic or recto-sigmoidal amebiasis. These results point out 68 cases of appendicular parasitism. This should be in favour of more systematic anatomopathological examination of the ileo-caecal appendix both in tropical and in temperate regions.

[Experimental atherogenesis: early wall changes in the cynomolgus monkey]. / Athérogénèse expérimentale: modifications pariétales précoces chez le singe cynomolgus.

The early parietal changes in atherogenesis are characterized by: Increase of endothelial permeability with proteoglycans and L.D.L. storage. Lysis of internal elastic lamellae. Penetration into sub-endothelial space of monocytes macrophages and transformation into foam cells. Parietal fibrosis and proliferating smooth muscle cells play a role in the extension of lipid deposit.

Fibroblasts in dermal tissue repair. Electron microscopic and immunohistochemical study.

The cellular dynamics of dermal regeneration were studied in nonsutured cutaneous wounds of female pigs and monkeys with electron microscopy and immunohistochemistry to demonstrate the origin and the development of fibroblasts forming granulation tissue. The results indicate that fibroblasts do not originate from histiocytes but from resting fibroblasts in the wound margins. These resting fibroblasts first become undifferentiated mesenchymal cells termed "X" cells. The "X" cells then multiply, migrate, and invade the wound defect in approximately 3 days, transforming into highly active fibroblasts. The active fibroblasts are endowed with the capacity of further transformation to fibroclasts and myofibroblasts. The latter two cell populations then effectively cause remodeling of newly formed tissue and contraction of wound margins.

[Repair of the connective tissue in a non-sutured skin wound]. / La réparation conjonctive d'une plaie cutanée non suturée.

During the healing of a second intention wound, granulation tissue is built up during the inflammatory and detersive phase which commences in the wound edges as soon as the loss of substance is created. Granulation tissue becomes scar tissue via connective and vascular proliferation and epidermization takes place concurrently. The origin of the fibroblasts composing the granulation tissue is debated: monocytes or fibroblasts from the wound edges? Ultrastructural and immunohistochemical data from studies of experimental wounds in the pig and the monkey make it possible to determine their origin and follow their progress. These cells originate from the fibroblasts of the wound edges and become undifferentiated cells which multiply and migrate to reach the loss of substance. There they become activated fibroblasts and contribute to repairing the loss of substance by secreting fibronectin and type I and type III collagen. As differentiated fibroblasts and myofibroblasts, they remodel and contract scar tissue.

Coronary atheroma in the cynomolgus monkey: predictive value of serum and cutaneous lipoprotein measurement.

Hyperlipaemia was induced by a high fat diet in 11 cynomolgus monkeys. Morphological study of coronary arteries was carried out in 5 coronary samples from these 11 monkeys. The degree of arterial involvement was compared with the serum and cutaneous lipoprotein levels. These experimental data confirm that cutaneous apoprotein B measurement is the best marker for evaluation of coronary atheroma.

[The fibroblast]. / Le fibroblaste.

The fibroblast, major cell of connective tissue, secretes the various elements of interstitium: collagens, proelastin, glycoproteins and proteoglycans. It maintains the turnover of these structures and intervenes, also, in the cholesterol LDL metabolism. These various properties explains its different morphological aspects. In young patients, it is an active secretory cell. Its voluminous cytoplasm contains a well developed endoplasmic reticulum and others organelles. It is always in close connection with collagen fibers. The cytoskeleton consists of a fine network visible throughout the cytoplasm and near of secretory areas. In adult patients, the fibroblast keeps the same characteristics, but the endoplasmic reticulum is poorer than in young subjects. In old patients (physiologic or pathologic ageing) it becomes a quiescent cell. It is a flattened cell; its cytoplasm contains a poorly developed endoplasmic reticulum and numerous dense bodies. Its cytoskeleton is characterized by voluminous fascicles or bundles of microfilaments into large cytoplasmic areas. This modified fibroblast has not direct contact with collagen. In all cases, various stimuli can: activate the fibroblast. Then this cell becomes a large cell with very abundant reticulum endoplasmic, ribosomes, polysomes, and numerous secretory vesicles. It is an active secreting cell; becomes fibroblast and; change into myofibroblast by presence of myofilaments in its cytoplasm.