Epidemiological Surveillance of Blood Donors in Kinshasa, 2014 - 2018.

BACKGROUND: The systematic detection of HIV, hepatitis B (HBV) and C (HCV) viruses in any blood donor has been in effect at the University hospital of Kinshasa since 2005. However, no data on the monitoring of blood donors is available today. The purpose of this thesis was to draw up the sero-epidemiological assessment of the afore-mentioned virus during the period 2014 - 2018. METHODS: This is an observational study conducted in the University Hospital of Kinshasa donor population. RESULTS: A total of 9,128 blood donors were admitted to the Kinshasa University Clinics Blood Bank during the period from 01/01/2014 to 12/31/2018 for 11,054 blood donations. The highest attendance (50%) of blood donors was observed in 2014 and 2015. On the other hand, 2018 (11.9%; n = 1,085) was that of the lowest frequency of blood donors. The mean age of the blood donors was 34.72 ± 10.66 years. The minimum and maximum age corresponded to 16 years and 65 years, respectively. The median age was 34 years (interquartile range (IQR): 27 - 40 years). The majority of the study population (75%; n = 6,841) were at most 40 years old. There were significantly more male blood donors (77.3%; n = 7,060) than female blood donors (22.7%; n = 2,066). The difference between the two gender proportions was statistically significant (p < 0.0001) at risk α = 5%. The male/female gender ratio was 3:4. The seroprevalence of HIV, HBV, HCV and Treponema pallidum was estimated at 2.6% (n = 237), 4.7% (n = 429), 3.3% (n = 297) and 0.4% (n = 33), respectively. A total of 927 (10.16%) donors were infected with at least one agent transmissible by blood transfusion. CONCLUSIONS: The present surveillance proves that infectious transfusion safety in Kinshasa is still very low.

[Effects of Dacryodes edulis fruit oil on anxiety symptoms and cognitive performance in mice, after prolonged administration]. / Effets de l'huile des fruits de Dacryodes edulis sur les symptômes de l'anxiété et les performances cognitives chez la souris, après administration prolongée.

OBJECTIVE: To study the effects of prolonged administration of Dacryodes edulis (G. Don) H.J. Lam (HDE) fruit oil on the symptoms of anxiety and cognitive performance in mice. METHODS: Anxiolytic activity and effects of HDE (5 and 10 ml/kg) on cognitive performance were evaluated in male mice after oral administration for 45 days. Anxiolytic effects were investigated in open field test, elevated plus Maze and hole board test. The Morris Water Maze test was used to evaluate cognitive performance in mice. Efficacy of HDE (5 and 10 ml/kg) was compared with that of fluoxetine (2 mg/kg p.o). RESULTS: HDE decreases the total distance traveled, significantly increases the number of adjustments and the number of entries in the central area of open field. In the elevated cross labyrinth test, HDE increases the number of entries and the time spent in the open arms. HDE significantly increases the number of head insertion into the holes. In the Morris Water Maze test, HDE reduces latency before finding the platform and increases the time spent in the target quadrant. CONCLUSION: The results confirm anxiolytic effects and improved cognitive performance after prolonged oral administration of HDE in rodents.

Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa.

BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240.

Mortality in hyperglycemic crisis: a high association with infections and cerebrovascular disease.

AIM: Aim of the present study was to determine syndrome specific mortality rates and the precipitating factors associated with deaths following admission for hyperglycemic crisis to a high care unit. METHODS: Retrospective review of medical records for hyperglycemic crisis at Nelson Mandela Academic Hospital, Mthatha, Eastern Cape Province of South Africa from February 1 2010 to January 31 2011. All admissions were initially into the high care unit. RESULTS: The overall mortality rates (per admissions) was 13.9% (N.=15/108) with syndrome specific mortality rates (per admissions) of 11.9% (N.=8/67), 0% (N.=0/8) and 21.2% (N.=7/33) respectively for diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS) and hyperglycemia with dehydration (HD). The precipitating factors that were mainly associated with mortality were infections and cerebrovascular disease (CVD). The patients with CVD who died were all unconscious. There were no deaths where non-compliance with hypoglycaemic agents (14.8%, N.=16/108) was the precipitating factor. CONCLUSION: The overall mortality rates (per admissions) following high care unit admissions for hyperglycemic crisis was 13.9% with infections and CVD as the precipitating factors most associated with deaths.

Effects of biomarkers of oxidative stress damage on prevalence and severity of visual disability among black Central Africans.

BACKGROUND: Because of the demographic transition, lifestyle changes, urbanization, and nutrition transition, Central Africans are at higher risk of ocular diseases associated with oxidative stress and visual disability. This study aimed to estimate the normal values of oxidant status defined by oxidized low-density lipoprotein (Ox-LDL), 8-Isoprostane and 8-hydroxy-deoxyguanosine (8-OHdG) and to determine their pathogenic role in the prevalence and the severity of visual disability among these black Africans. METHODS: This was a cross-sectional study, run in a case-control study randomly selected from Kinshasa province, DR Congo. The study included 150 type 2 diabetes mellitus (T2DM) patients (cases) matched for sex and age to 50 healthy non diabetic controls. Logistic regression models were used to identify independent determinants of visual disability. RESULTS: The presence rates were 8.5% for blindness, 20.5% for visual impairment and 29% for visual disability including blindness and visual impairment. After adjusted for taro leaves intake, red beans intake, T2DM, aging, waist circumference, and systolic blood pressure, we identified low education level (OR=3.3 95%CI 1.5-7.2; p=0.003), rural-urban migration (OR=2.6 95% CI 1.2-5.6; p=0.017), and high Ox-LDL (OR=2.3 95% CI 1.1-4.7; p=0.029) as the important independent determinants of visual disability. After adjusted for education, intake of red beans, intake of taro leaves, triglycerides, and T2DM, we identified no intake of safou fruit (OR=50.7 95% CI 15.2-168.5; p<0.0001), rural-urban migration (OR=3.9 95%CI 1.213; p=0.012), and high 8-OHdG (OR=14.7 95% CI 3.9-54.5; p<0.0001) as the significant independent determinants of visual disability. After adjusted for education level, no intake of red beans, no intake of Taro leaves, triglycerides, and T2DM, we identified no intake of Safou fruit (OR=43.1 95% CI 13.7-135.4; p<0.0001), age ≥ 60 years (OR=3.4 95% CI 1.3-9; p=0.024), and high 8-Isoprostane (OR=11 95% CI 3.4-36.1; p<0.0001) as the significant independent determinants of visual disability. CONCLUSIONS: Visual disability remains a public health problem in Central Africa. Antioxidant supplement, fruit intake, nutrition education, control of migration, and blocking of oxidative stress are crucial steps for delayed development of vision loss.

Determinants of altered sensorium at presentation with diabetic ketoacidosis.

AIM: The aim of this paper was to determine the prevalence of altered sensorium and their determinants in diabetic ketoacidosis (DKA). METHODS: Retrospective review of medical records for diabetic ketoacidosis admissions over a two year period. RESULTS: A total of 94 admissions for DKA in 89 patients were reviewed. Majority of admissions were female related. The mean age of the subjects was 39.1±18.5 years. The prevalence of altered sensorium defined as Glasgow coma scale (GCS) below 15 was 47.9%. In Model 1, systolic blood pressure (SBP) <90 mmHg (odds ratio [OR] 17.5 95% Confidence Interval (CI) 2.1-142.9; P=0.008 and calculated effective serum osmolality >320 mosmol/Kg (OR 3.6 95% CI 1.4-12.2; P=0.043 were independently associated with altered sensorium. In Model 2 where serum osmolality was substituted with uncorrected serum sodium, SBP <90 mmHg OR 19.6 95% CI 2.2-100; P=0.007, uncorrected serum sodium >150 mmol/L OR 18.5 95% CI 2.1-100; P=0.0009 and white cell count >25 x 106/L OR 3.6 95% CI 1.03-13.5; P=0.05 were independently associated with altered sensorium. CONCLUSION: Systolic blood pressure <90 mmHg, calculated effective serum osmolality >320 mosmol/Kg, uncorrected serum sodium >150 mmol/L and white bood count >25 x 106/L were independently associated with altered sensorium.

Intestinal parasites infections in hospitalized AIDS patients in Kinshasa, Democratic Republic of Congo.

To determine the prevalence and the species spectrum of intestinal parasites (IP) involved in hospitalized AIDS patients, a prospective observational and cross-sectional study was carried out in the four main hospitals in Kinshasa, Democratic Republic of the Congo. From November 2006 through September 2007, a single stool sample was collected from 175 hospitalized AIDS patients older than 15 years. Parasites were detected by light microscopy, including Ziehl-Neelsen, Fungi-Fluor, modified trichrome stains, and by immunofluorescence antibody tests and PCR for species diagnosis of microsporidia. At baseline, 19 patients (10.8%) were under antiretroviral therapy and 156 (89.2%) were eligible for ART. The main diagnosis for justifying hospitalization was intestinal infection associated with diarrhea in 87 out of 175 (49.7%). 47 out of 175 (26.9%) were found to harbor an IP, and 27 out of 175 (15.4%) were infected with at least one opportunistic IP (OIP). Prevalence rate for OIP were 9.7%, 5.1%, 1.7% and 0.6% for Cryptosporidium sp., Enterocytozoon bieneusi, Isospora belli and Encephalitozoon intestinalis respectively. Considering patients with diarrhea only, prevalence rate were 12.6%, 4.6%, 3.4% and 1.1% respectively. The other IP observed were Entamoeba histolytica/Entamoeba dispar in nine cases (5.1%), Ascoris lumbricoides in seven cases (4.0%), Giardia intestinalis in three cases (1.7%), hookworm in two cases (1.1%) and Trichiuris trichiura, Enterobius vermicularis, Schistosoma mansoni in one patient each (0.6%). No significant relationship was established between any individual IP and diarrhea. These results underline the importance of OIP in symptomatic AIDS patients regardless of diarrhea at the time of the hospitalisation, and showed that routine microscopic examination using stains designed for Cryptosporidium spp. or the microsporidia should be considered due to the absence of clinical markers.

[Is HIV/AIDS an independent risk factor of chronic rhinosinusitis among central African patients?]. / L'infection à VIH/SIDA exerce t-elle un rôle indépendant dans la génèse de rhinosinusite chronique en Afrique Centrale ?

OBJECTIVES: To investigate the independent effect of HIV/ AIDS in the genesis of acute or chronic rhinosinusitis. METHODS: This case-control study was performed among patients managed for chronic rhinosinusitis between January and April 2009 the ENT and Head and Neck Department General Hospital of Kinshasa, DRCongo. Cases were matched with controls according to gender and age. Logic regression analysis served to identify factors associated with presence of chronic rhinosinusitis. RESULTS: The study population with 108 patients included 81 cases ofrhinosinusitis, 27 controls, 78 females, 30 males, 52 with HIV/AIDS and 56 HIV seronegatives. The mean age was 34+/-19 years (range 1 year-74 years). Only HIV/AIDS was identified as a significant and independent determinant of presence of chronic rhinosinusitis (OR= 19,6 95% CI 4,3 -88,9; P< 0,0001). CONCLUSION: Early ENT evaluation and continuous follow-up of HIV-infected patients are suggested. Age upper 20 years and high education attainment were significantly associated with high risk of chronic rhinosinusitis among HIV-infected patients, respectively.

Classification and dramatic epidemic of diabetes mellitus in Kinshasa Hinterland: the prominent role of type 2 diabetes and lifestyle changes among Africans.

BACKGROUND: Classification of diabetes mellitus is not easily stated in Central Africa using the current diabetes classification of World Health Organization/American Diabetes Association. The objective of the study is to determine the prevalence, classification and risk factors of diabetes mellitus in Kinshasa Hinterland. METHODS: A multilevel and stratified random sample cross-sectional study included 9770 black Africans (4580 men and 5190 women) aged 12 years and above in urban metropolitan (Kinshasa city) and rural (Kikwit) areas. Participants were examined and administered a structured questionnaire and a capillary whole blood glucose test was done. RESULTS: The mean age of participants was 46 +/- 15 years. Overall crude and age adjusted prevalences of diabetes were 25% (n = 2472) and 18%, respectively. Using WHO/ADA classification, Type diabetes (80%) was commoner than undetermined form (12%), Type 1B (3.5%), Type 1A (2.5%) and Other specific types (2%). According to plasma insulin and plasma C-peptide levels, participants with undetermined form were classified Type 2 diabetics. Thus, the rate of Type 2 diabetes among diabetics was estimated 92%. Urban location, age, abdominal obesity arterial hypertension, physical inactivity, inappropriate diet (lack of fruits-vegetables, refined sugar, animal fat and protein, starvation, social inequalities, cigarette smoking, alcohol intake were significantly and positively associated with diabetes in general and type 2 diabetes in particular. CONCLUSION: The high prevalence of diabetes is due to the unexpected high rates of type 2 diabetes, aging, urbanization, and sedentary lifestyle consequences. The majority of risk factors of diabetes are potentially modifiable by primary prevention.

Diets rich in vegetables and physical activity are associated with a decreased risk of pregnancy induced hypertension among rural women from Kimpese, DR Congo.

BACKGROUND: To assess whether the frequency pf pregnancy-induced hypertension is low, and vegetables intake and physical activity are protective against pregnancy-induced hypertension onset among rural women from Democratic republic of Congo. METHOD: This hospital-based and longitudinal study was carried out within the rural hospital of Kimpese, DR Congo were monitored from January 1st to March 31st 2003 on basis of demographic, diet, physical activity, anthropometry and blood pressure till the onset of types of pregnancy-induced hypertension and delivery. RESULTS: Out of 238 black pregnants, the incidence risk of arterial hypertension was 4.6% (n=11) whose 2.9% with Pre-Eclampsia and 1.7% with transient hypertension. Gestity, parity and birth weight of infants were significantly lower among hypertensive mothers, while positive family history and presence of oedemas were more elevated among hypertensive pregnants. The onset of Pre Eclampsia was higher within vendors and inactive women as well as among vegetarians (3.1%) than women with diet high in meat (9.7%). Pre Eclampsia occurred more (p<0.05) among pregnants with rare daily servings of vegetables (33.3%) than pregnants with 3 or more daily servings of vegetables (3.7%). Physical activity (RR=0.63 CI 95% 0.33 to 0.94) and = 3 daily servings of vegetables (RR=8.8 CI 95% 0.6 to 0.98) were significant (p<0.01) protective factors against Pre Eclampsia. Eclampsia was not observed. CONCLUSION: It is timely to promote diet rich in vegetables overweight reduction and physical activity among pregnants for the prevention of pregnancy-induced hypertension.

Diets rich in vegetables and physical activity are associated with a decreased risk of pregnancy induced hypertension among rural women from Kimpese, DR Congo.

BACKGROUND: To assess whether the frequency pf pregnancy-induced hypertension is low, and vegetables intake and physical activity are protective against pregnancy-induced hypertension onset among rural women from Democratic republic of Congo. METHOD: This hospital-based and longitudinal study was carried out within the rural hospital of Kimpese, DR Congo were monitored from January 1st to March 31st 2003 on basis of demographic, diet, physical activity, anthropometry and blood pressure till the onset of types of pregnancy-induced hypertension and delivery. RESULTS: Out of 238 black pregnants, the incidence risk of arterial hypertension was 4.6% (n=11) whose 2.9% with Pre-Eclampsia and 1.7% with transient hypertension. Gestity, parity and birth weight of infants were significantly lower among hypertensive mothers, while positive family history and presence of oedemas were more elevated among hypertensive pregnants. The onset of Pre Eclampsia was higher within vendors and inactive women as well as among vegetarians (3.1%) than women with diet high in meat (9.7%). Pre Eclampsia occurred more (p<0.05) among pregnants with rare daily servings of vegetables (33.3%) than pregnants with 3 or more daily servings of vegetables (3.7%). Physical activity (RR=0.63 CI 95% 0.33 to 0.94) and > or = 3 daily servings of vegetables (RR=8.8 CI 95% 0.6 to 0.98) were significant (p<0.01) protective factors against PreEclampsia. Eclampsia was not observed. CONCLUSION: It is timely to promote diet rich in vegetables overweight reduction and physical activity among pregnants for the prevention of pregnancy-induced hypertension.

[Risk factors of stroke among Congolese black hypertensive diabetics]. / Facteurs de risque d'accident vasculaire cérébral chez les diabétiques hypertendus noirs congolais de type 2.

BACKGROUND: The relationship between diabetes mellitus and risk of stroke is well established. This risk is more elevated for hypertensive diabetics men. OBJECTIVE: To determine the incidence and the risk factors of stroke among hypertensive diabetics. METHODS: This prospective study has considered baseline demographic, behavioural and biological parameters collected in 2002 among black Congolese hypertensive diabetics from Kinshasa till the onset of stroke or not in 2006. RESULTS: Out of 492 followed-up patients (279 women, 213 men, 57+/-10 years), 41.9% were old of age > or = 60 years, and 16.5% experienced acute stroke. In univariate analysis, a significant association between age > or = 60 years, cigarette smoking, excessive alcohol intake, diabetes duration > or = 2 years, pulse pressure > or = 60 mmHg, acute bacterian pneumonia, left ventricule hypertrophy, hypertensive retinopathy, diabetic retinopathy, diabetic foot, diabetic neuropathy, congestive heart failure, chronic renal failure, lack of diabetic treatment compliance and the occurrence of acute stroke. However, multivariate analysis identified only acute bacterian pneumonia, diabetic retinopathy, diabetic neuropathy, chronic renal failure and pulse pressure > or = 60 mmHg as the independent risk factors of stroke onset among these black congolese hypertensive diabetics with the following and respective values of relative risk (hazard ratio): 6,2 (IC 95%: 3.2 to 11.9; P<0.0001), 2,2 (IC 95%: 1.2 to 4.1; P<0.01), 3.6 (IC 95%: 1.9 to 6.8; P<0.0001), 6.4 (IC 95%: 2.9 to 14.1; P<0.01) and 4.1 (IC 95%: 1.6 to 10.3; P<0.0001). CONCLUSION: The rate of stroke onset is high among these hypertensive diabetics. This is the consequence of independent and respective action of infection, diabetic retinopathy, diabetic neuropathy, chronic renal failure and arterial stiffness.

[Association between the viruses of the acquired immunodeficiency syndrome and the hepatitis C virus among young blood donors in Kinshasa: Retrospective analysis of 10 years]. / Association entre les virus du syndrome d'immunodéficience acquise et le virus de l'hépatite C chez les jeunes donneurs de sang à Kinshasa : analyse rétrospective de 10 années.

STUDY OBJECTIVES: The screening of anti-Human Immunodeficiency Virus antibodies is mandatory in every blood donor admitted to the Blood Bank of Kinshasa University Clinics since 1984. However, no compiled data are available to date. The objective of this study was to establish the trend, prevalence, viral co-infections, and determinants of Human Immunodeficiency anti-Virus serology in blood donors admitted between 2003-2006 and 2008-2013. PATIENTS AND METHODS: A retrospective analysis was carried out at University Kinshasa Clinics, using blood donors' records during 2003-2006 and 2008-2013. The prevalence of the human immunodeficiency virus per year, age, sex and type of blood donors were estimated. Independent predictors of human immunodeficiency virus seropositivity were also identified. RESULTS: Out of 26,341 blood donors, 2.2% (n=576/26,341) were seropositive for Human Immunodeficiency Virus. Age<25 years (OR=1.7; 95% CI: 1.4-2; P<0.0001) and Hepatitis C virus seropositivity (OR=3; 95% CI; 1.8-4.9; P<0.001) emerged as independent predictors of Human Immunodeficiency Virus seropositivity. CONCLUSION: This study shows a strong association between the Human Immunodeficiency Virus and hepatitis C and younger age respectively. Further studies are needed to ensure safety of Blood donation in Democratic Republic of Congo.

Relationship between waist circumference and cholesterol in Central Africans with congestive heart failure.

BACKGROUND: There are controversies as to what the traditional risk factors for coronary heart disease should be in sub-Saharan Africa. OBJECTIVE: To assess the relationship between cholesterol and cardiovascular disease risk factors including Helicobacter pylori infection in black Africans with congestive heart failure. METHOD: A cross-sectional and observational study of 48 men and 52 women. RESULTS: Congestive heart failure was associated with abdomal obesity, hypertension, chronic renal failure, moderate levels of low HDL-C, excessive alcohol intake and hyperuricaemia, but low levels of cholesterol and triglycerides. TC was related by Univariate analysis with red cells, glucose, weight, waist circumference with HDL-C, CRP, fibrinogen and IgG antibodies against H pylori. Multivariate analysis revealed that waist circumference (B=0.688) and HDL-C (B=0.826) were the significant determinants of TC. There was a respective U-shaped relationship between CVD (P>0.05), chronic renal failure (P<0.05) H. pylori-induced chronic gastritis (P<0.05) and the HDL-categories. Ischemic stroke and myocardial infarction were significantly (p<0.05) associated with low HDL-C, respectively. Clinical insulin resistance (P<0.01) was predominantly more commonin the intermediate HDL-C category than in low and high HDL-categories. There was an inverse relation between lower TC: HDL-C ratio, high HDL-C and abdominal obesity/ insulin resistance in men. H. pylori gastritis was positively related to higher TC: HDL-C ratio in both men and women. CONCLUSION: Preventive measures, more studies on the interplay between HDL-C level and its function and a specific ethnic dfinition of metabolic syndrome in the African are needed.

Prevalence and risk factors of arterial hypertension among urban Africans in workplace: the obsolete role of body mass index.

BACKGROUND: Studies on the prevalence of hypertension among Africans in workplace did not deal with risk factors of hypertension. Thus there is a need to screen urban central Africans at workplace for environmental risk factors of hypertension. METHOD: A cross-sectional survey was conducted at the Kinshasa National Company of Electricity. A representative sample of 333 employees was screened. Tobacco, alcohol use and level of physical activity measures were obtained. Weight, height, BMI, waist, hip, conicity, blood pressure, pulse pressure and pulse rate were measured. Data were analysed using univariate and multivariate statistics. RESULTS: The prevalence of hypertension was 21.3%. Hypertension was associated with aging, higher professional position, eastern origin, migration, alcohol use, wider pulse pressure >60 mmHg, wider waist >90 cm, wider hip >97 cm, obesity, and left ventricle hypertrophy Independent predictors of hypertension were age, wider waist, wider hip, alcohol intake, and left ventricle hypertrophy. In another logistic regression model, only waist >90 cm (OR = 2.5 C1 95% 1.3-4.9; p < 0.01) and age =55 years were identified as significant predictors of hypertension. CONCLUSION: There is a need to stop this high prevalence of hypertension significantly predicted by higher waist and age. BMI is inefficient to predict hypertension.

[Impact of seasons, years El Nino/La Nina and rainfalls on stroke-related morbidity and mortality in Kinshasa]. / Impact des saisons, des années El Nino/La Nina et des précipitations sur la morbi-mortalité des accidents vasculaires cérébraux à Kinshasa.

INTRODUCTION: The significant impact of seasonality and climate change on stroke-related morbidity and mortality is well established, however, some findings on this issue are conflicting. The objective was to determine the impact of gender, age, season, year of admission, temperature, rainfall and El Nino phenomenon on ischemic and hemorrhagic strokes and fatal cases of stroke. METHODS: The study was carried out at the teaching hospital of Kinshasa, DRC, between January 1998 and December 2004. Rainy and dry seasons, elevated temperatures, indices of rainfalls El Nino years 1998, 2002 and 2004, but La Nina years 1999-2000 and neutral/normal years 2001 and 2003 were defined. RESULTS: Among 470 incident strokes, 34.5% of victims (n=162) died. Traditional seasons (small dry season, small rainy season, great dry season, great rainy season) and temperatures did not significantly (P>0.005) impact on stroke incidence. However, there was a positive association between the decrease in rainfall, El Nino, and incident ischemic strokes, but a significant positive association between the increase in rainfall, La Nina, and incident hemorrhagic strokes. Using logistic regression analysis, age ≥ 60 years (OR: 1.7, 95% CI: 1.2-2.5; P=0.018) and El Nino years (OR: 2, 95% CI: 1.2-3.3; P=0.009) were identified as the independent predictors of fatal strokes. CONCLUSION: Early warning systems should be developed to predict the impact of seasons and climate variability on stroke morbidity and mortality.

Non-syndromic deafness associated with a mutation and a polymorphism in the mitochondrial 12S ribosomal RNA gene in a large Zairean pedigree.

Hereditary non-syndromic deafness has been associated with a point mutation in the mitochondrial 12S rRNA gene. We present data from deaf individuals in 12 nuclear families originating from a small village in Zaire. The patients have a sudden-onset and profound, bilateral sensorineural deafness with a highly variable age of onset. Inheritance is compatible with a mitochondrial DNA defect. Sequencing of the mitochondrial 12S rRNA gene revealed the presence of a homoplasmic 1555 A to G mutation in the patients and their normal siblings. The mutation is invariably associated with a T to C transition at 1420 in the same gene. Additional (mitochondrial or autosomal) genetic defect(s) or an environmental factor must be implicated in the expression of the defect. In Epstein-Barr-virus-transformed lymphocytes harbouring the normal or mutant mitochondrial DNA, no differential effect of aminoglycosides on protein translation was observed.

J-shaped relationship between mortality and admission blood pressure in black patients with acute stroke.

AIM: The charts of 388 patients admitted for a recent stroke at the University of Kinshasa Hospital, Department of Medicine, were analysed to assess the case fatality rate and its determinants. RESULTS: During the hospitalization period (average 31 days), 169 deaths (44%) were recorded. Mortality was higher (P<0.05) in women (54%) than in men (42%), in haemorrhagic (61%) than in ischaemic (26%) strokes, and in patients with depressed consciousness, motor deficits, tachycardia or atrial fibrillation on admission. Mortality increased with advancing age, the depth of coma, the severity of motor deficit and the plasma glucose level on admission. Plasma glucose, urea and the leucocyte count were higher in patients who died than in survivors. Patients with and without a history of hypertension, diabetes or stroke recurrence had similar mortality rates. The latter tended to be higher in smokers and alcohol consumers. Using logistic regression analysis, depressed consciousness (P<0.001), tachycardia (P<0.001), plasma urea on admission (P<0.05) and a history of alcohol consumption (P<0.05) emerged as significant predictors of mortality. Admission systolic/diastolic blood pressure was similar in those who died (177 +/- 41/104 +/- 26 mmHg) and in survivors (171 +/- 41/101 +/- 23 mmHg). However, in the whole study population and in subgroups of patients who were comatose or conscious on admission, mortality showed a J-shaped relationship to admission systolic blood pressure with low rates in the range 160-199 mmHg before and after adjustment for age and sex, higher rates being observed for higher or lower blood pressure ranges. CONCLUSIONS: Depressed consciousness, ECG abnormalities, delayed admission and elevated plasma urea predict a high case fatality rate whereas systolic blood pressure within the range 160-199 mmHg appears to be optimal for survival in the patient group studied.

Assessment of ventricular diastolic function in AIDS patients from Congo: a Doppler echocardiographic study.

OBJECTIVE: To investigate the prevalence of left ventricular dysfunction in African patients infected with the human immunodeficiency virus (HIV). The hypothesis was that HIV infected patients with left ventricular dysfunction are asymptomatic. METHODS: M mode, cross sectional, and Doppler echocardiography were performed in 49 consecutive patients (30 HIV positive (HIV+) carriers and 19 AIDS patients). None of the patients or 58 controls had a medical history of cardiovascular abnormalities. RESULTS: Cardiac abnormalities were not suspected on physical, electrocardiographic, and radiological examination. Forty-two of the HIV infected patients had left ventricular diastolic dysfunction; this was more pronounced in AIDS patients than in HIV+ carriers. Systolic function was normal in both stages of HIV infection. Left ventricular isovolumic relaxation time (mean SD)) increased from 87.2 (12.4) ms in the carrier state to 103.9 (19.3) ms in AIDS (p < 0.05, Bonferoni correction), peak early filling velocity declined from 0.54 (0.1) to 0.44 (0.1) m/s (p < 0.05), and late velocity increased from 0.64 (0.1) to 0.69 (0.2) m/s. A restrictive filling pattern was explained by concentric hypertrophy in 23 HIV infected patients, and by systemic amyloidosis with left ventricular dilatation in 12 of 49 HIV infected patients. CONCLUSIONS: Echocardiography is a useful technique for detecting left ventricular diastolic dysfunction in HIV infected patients with clinically unsuspected cardiac lesions. Systolic function was normal despite the presence of such cardiac abnormalities.

The role of early hemodynamic impairment and disease duration on diabetic cardiomyopathy and hypertension in central Africans with atherosclerosis.

Diabetes mellitus (DM) is strongly associated with cardiomyopathy and hypertension. This study focuses on early hemodynamic impairment and DM exposure time amplified by atherosclerosis before the onset of associated cardiomyopathy and hypertension in central Africans. Prospectively, demographic, hemodynamic, lipid, anthropometric, and urinary data of 48 atheromatous diabetics, 39 uncomplicated diabetics, and 27 normal subjects before incidence of cardiomyopathy, hypertension, stroke, and peripheral vascular disease (PVD) were analysed. Age, waist-hip ratio (WHR), DM duration, blood pressures (BPs), pulse pressure (PP), mean arterial pressure (MAP), lipidic profile, and microalbuminuria were more elevated in atheromatous diabetics than in uncomplicated diabetes and normal subjects. PP, MAP, BP of atheromatous diabetics were significantly (P<.01) correlated with age, DM duration, and microalbuminuria, but stroke volume was negatively (P<.001) correlated with diastolic blood pressure (DBP) and microalbuminuria. The evolution of atheromatous diabetes was characterized by the onset of the highest rates of hypertension (86.2%), cardiomyopathy and congestive failure (69%), stroke (46%), and PVD (42%). Atheromatous diabetes of central Africans is associated with early and age-induced significant changes of PP, BP, the highest rates of hypertension, cardiomyopathy, stroke, and PVD. Impaired left ventricular function, as stroke volume decreases with increasing DBP, C-peptide, and microalbuminuria, precedes cardiomyopathy and congestive failure in African diabetics.