Epidemiological, clinical and prognosis aspects of acute generalized peritonitis in South-Kivu Province: descriptive observational study of 278 cases.

Introduction: the aim was to determine epidemiological, clinical, therapeutic, and prognostic aspects of acute generalized peritonitis (AGP). Methods: we conducted an observational, cross-sectional and multicentre study over 2 years of 278 cases of acute generalized peritonitis operated in semi-urban and urban hospitals in South-Kivu Province, Democratic Republic of Congo. Results: the population of this study was young with a mean age was 28.9 ± 16.1 years with extremes of 1.3 years to 80 years with a sex ratio M: F of 0.8. Peritonitis aetiology was dominated by intestinal perforation 132 cases (47.4%), the admission time in 65, 5% was more than 72 hours. Acute abdominal pain was the most reason for consultation in 93.2% of cases, 11.9% of patients were in hypovolemic shock. In 40.6%, the treatment of patients consisted in intestinal resection with terminal anastomosis, or ileostomy in 32.7%. About the outcomes, 32.4% of the patients had a surgical reoperation and 15.8% of the digestive fistulas were reported. The average duration of the hospitalization was 23.4 ± 20.3 days. Morbidity rate was 14.7%. Conclusion: the AGP remains one of the abdominal emergencies observed in different semi-urban and urban hospitals of the province of South-Kivu, causing some problems of medical and surgical management, starting from the delay of admission, the severity of the symptoms related to the etiology of the intestinal perforation. In all cases, AGP requires a well-executed resuscitation procedure and surgical technique to improve the prognosis and reduce mortality, which seems to be high in this study.

Benefits of Early Enteral Feeding with a Locally Prepared Protein-Energy Ration after Surgery for Acute Generalised Peritonitis: A Randomised Trial in Two Hospitals in Bukavu, Eastern Democratic Republic of Congo.

Background: Acute generalised peritonitis (AGP) is a common and serious digestive surgery pathology. Undernutrition exacerbates patient condition and compromises their postoperative prognosis. Early enteral nutrition is recommended to reduce postoperative complications, but its availability and cost are problematic in low-income countries. The objective of this study was to evaluate the impact of providing early enteral feeding (EEF) to postoperative patients with intestinal perforation AGP using a locally prepared protein-energy food ration in two hospitals in Bukavu, a city of South Kivu, in the eastern part of the Democratic Republic of Congo. Methods: A prospective, randomised controlled trial with two groups of patients was conducted to investigate the effects of EEF with a local mixture versus enteral feeding after peristalsis had returned (control group) in patients who underwent laparotomy for AGP caused by ileal perforation. The local mixture consisted of soybean, maize, white rice, and pineapple. The trial included 66 patients with ileal perforation peritonitis. Results: The results comparing early enteral fed and nonfed patients showed significant differences in peristalsis recovery time (2.1 (0.6) days vs. 3.8 (1.2) days, p < 0.0001) and length of hospital stay (25.5 (14.9) days vs. 39.4 (25.3) days, p = 0.0046). Bivariate analyses indicated a significant early enteral feeding (EEF) reduced of 9.1% (vs. 36.4%, p = 0.0082) in parietal infections and 3.4% (28.1%, p = 0.009) in fistulas (p = 0.009) when EEF was included. In addition, EEF significantly reduced reintervention rates by 9.1% (p = 0.0003) and eliminated evisceration rates. EEF was also shown to reduce the incidence of malnutrition by 63.6% (p < 0.0001). Multivariate analysis showed that enteral nutrition significantly reduced the time to recovery of peristalsis (p = 0.0278) with an ORa of 0.3 and a 95% CI of 0.1-0.9. Moreover, EEF reduced malnutrition (p = 0.0039) with an ORa of 0.1 and a 95% CI of 0-0.4. Conclusion: EEF with locally sourced protein-energy rations can enhance a patient's nutritional status and facilitate postoperative recovery. This procedure is advantageous and involved early enteral nutrition using locally manufactured rations, especially for those operated on for acute generalised peritonitis in the Democratic Republic of Congo.

Colibri® insecticide induces male reproductive toxicity: alleviating effects of Lannea acida (Anacardiaceae) in rats.

BACKGROUND: Imidacloprid, a neonicotinoid insecticide, has been associated to severe reproductive toxicity in mammals. Although some preventive measures have been reported, curative strategies are yet to be explored. The present study was designed to investigate the alleviating effects of Lannea acida on the reproductive toxicity of colibri®, a commercial formulation of imidacloprid, in adult male rats. MATERIALS AND METHODS: Seventy rats were orally administered with colibri® (22.5 mg/kg, 10 mL/kg) for 14 days and treated for other 14 or 28 days with either aqueous or methanol extracts of L. acida (170 or 340 mg/kg). Control animals were similarly treated with clomiphene citrate or vitamin E. Sexual organ weights, spermatozoa characteristics, sexual hormones, stress markers and testis histology were evaluated at the end of each treatment period. RESULTS: Colibri® exposition induced reproductive toxicity marked by a decrease in sex organ weights, spermatozoa count, motility and viability. Colibri® also decreased testosterone, luteinizing hormone, follicle stimulating hormone concentrations and increased testicular oxidative stress. Spermatozoa morphology and testis histology were also severely altered. Similar to clomiphene citrate and vitamin E, treatment with L. acida extracts significantly (p ≤ 0.05-0.001) reversed the above-mentioned damages, especially after 28 days of treatment with aqueous (340 mg/kg) and methanol (170 mg/kg) extracts. CONCLUSION: Present results indicate that L. acida exerts curative effects against colibri®-induced male reproductive toxicity. These results justify the use of this plant as fertility enhancer and suggest that it could be an alternative in the management of pesticide-derived male infertility.

CONTEXTE ET JUSTIFICATIF: Les effets toxiques de l'imidaclopride; insecticide de la famille des néonicotinoïdes, sur la fertilité sont largement documentés. Cependant, les mesures curatives restent encore à explorer. L'objectif de ce travail était d'évaluer les effets curatifs de Lannea acida sur la toxicité reproductive du colibri®, une formulation commerciale de l'imidaclopride, chez le rat mâle. MATÉRIEL ET MÉTHODES: Soixante-dix rats ayant reçu par gavage le colibri® (22,5 mg/kg, 10 mL/kg) pendant 14 jours ont été répartis en groupes et traités pendant 14 ou 28 jours à l'extrait aqueux ou méthanolique de L. acida (170 ou 340 mg/kg). Les groupes témoins recevaient le citrate de clomifène ou la vitamine E. Au terme de chaque période de traitement, quelques paramètres de fertilité ainsi que les marqueurs du stress et l'histologie testiculaire étaient évalués. RÉSULTATS: Une diminution significative de la masse des organes sexuels, de la densité, la motilité, la viabilité spermatiques et des hormones sexuelles (testostérone, LH et FSH) a été notée chez les animaux exposés au colibri®. Ce toxique a également généré le stress oxydatif et les dommages testiculaires. Tout comme le citrate de clomifène et la vitamine E, les extraits de plante ont significativement (p ≤ 0,05-0,001) réparé ces altérations, notamment aux doses de 340 et 170 mg/kg des extraits aqueux et méthanolique respectivement. CONCLUSION: Ces résultats renseignent que L. acida est. doué de propriétés curatives contre la toxicité reproductive du colibri®. Ceci suggère que cette plante serait une alternative prometteuse dans le traitement de l'infertilité masculine.

[Volvulus of the small bowel due to ascaris lumbricoides package: about a case]. / Volvulus du grêle sur paquet d'ascaris: à propos d'un cas.

We report an exceptional case of a 7 year-old patient with necrotic small bowel volvulus due to adult ascaris lumbricoides. At the admission, the child had intestinal obstruction evolving since two days with alteration of general state. Abdominal radiography without preparation showed small bowel air-fluid levels and tiger-stripe appearance evoking the diagnosis of acute intestinal obstruction associated with abdominal mass. After resuscitation, the surgical treatment consisted of laparotomy which showed necrotic volvulus of the terminal ileum containing adult ascaris lumbricoides. The patient underwent small bowel resection, approximately one meter of affected section was removed and then an ileostomy was performed. The evolution was favorable. The patient underwent ileorectal anastomosis four weeks later. After a 2 year follow-up period the child had no symptoms.