RESUMO
La chirurgie à coeur cardiaque est un mode de traitement des pathologies cardio-vasculaires et médicales. Elle n'est plus pratiquée en République Démocratique du Congo (RDC) depuis plusieurs décennies. Nous rapportons le cas clinique d'une fillette de 12 ans admise aux Cliniques Universitaires de Kinshasa pour atélectasie totale du poumon gauche, soignée auparavant comme une tuberculose pulmonaire, et dont le bilan a révélé un faux anévrysme géant de l'aorte descendante. Devant cette urgence, la seule thérapie possible, la chirurgie cardio-vasculaire, n'a pas été possible suite au manque d'équipements adéquats en RDC. Elle est décédée 4 jours après son diagnostic pendant qu'elle réalisait les formalités pour une évacuation sanitaire à l'étranger. La prise en charge d'urgence, notamment la chirurgie à coeur ouvert reste encore un challenge dans notre pays. Elle passe nécessairement par l'équipement de nos hôpitaux, surtout ceux de niveau tertiaire, et par l'amélioration du niveau socio-économique de nos populations
Assuntos
Procedimentos Cirúrgicos Cardiovasculares , Relatos de Casos , República Democrática do Congo , Atelectasia Pulmonar , Equipamentos CirúrgicosRESUMO
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.
Assuntos
Artrite Reumatoide/genética , Artrite Reumatoide/patologia , Cadeias HLA-DRB1/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/imunologia , Autoanticorpos/sangue , Autoantígenos/imunologia , República Democrática do Congo , Feminino , Genótipo , Humanos , Imunoensaio , Masculino , Pessoa de Meia-Idade , Fenótipo , Reação em Cadeia da Polimerase , Fator Reumatoide/sangue , Adulto JovemRESUMO
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.
