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1.  Prehypertension and Hypertension among Schoolchildren in Brazzaville, Congo 
Background. To determine the prevalence and associated factors of prehypertension (pre-HT) and hypertension (HT) in schoolchildren at Brazzaville (Congo). Methods. This cross-sectional study was conducted from March to May 2011 in five representative urban schools in Brazzaville. American Pediatric Society's definition of pre-HT and HT was used. The measurement of blood pressure was obtained using auscultator method. Univariable and multivariable analyses were performed to establish associations between blood pressure levels and sociobiographical factors. Results. 603 children were included. The mean age was 11.8 ± 3.6 years (range 5–18 years). The prevalence of pre-HT was 20.7% (n = 125). Factors associated with pre-HT were secondary school (P = 0.02), private schools (P < 0.004), migrants (P = 0.03), the obese (P = 0.004), high socioeconomic level (P < 0.01), and overweight (P = 0.02). In logistic regression, the independent determinants of pre-HT were secondary school (P = 0.0001), migration (P = 0.04), obesity (P = 0.004), and overweight (P = 0.01). The prevalence of HT was 10.1% (n = 61) during the first screening and 3.3% (n = 20) in second screening. The independent determinants of HT were obesity (P = 0.0001) and overweight (P = 0.0001). Conclusion. Pre-HT and HT are emerging as a mass problem in Congolese schoolchildren with urban migration and overweight/obesity to be controlled and prevented.
PMCID: PMC4054926  PMID: 24963398
2.  Incidence and Predictors of Hand–Arm Musculoskeletal Complaints among Vibration-exposed African Cassava and Corn Millers 
Safety and Health at Work  2014;5(3):131-135.
Cassava and corn milling is a growing small-scale enterprise in Africa. We aimed to determine the incidence of hand–arm musculoskeletal complaints among vibration-exposed Congolese cassava and corn millers in the previous 12 months.
A cross-sectional study was conducted, prior to a follow-up study, from March to May 2013 among cassava/corn millers in Lubumbashi, Democratic Republic of Congo, in which 365 millers age-matched to 365 civil workers anonymously answered a questionnaire.
Overall incidence of hand–arm musculoskeletal complaints was 25.8% in millers (vs. 5.2% in civil workers; p < 0.001). The risk of experiencing musculoskeletal symptoms was seven times higher in millers [vs. civil workers; odds ratio (OR) = 7.10; 95% confidence interval (CI): 4.03–12.50; p < 0.0001]; 2.4 times higher in smoking millers (vs. smoking civil office workers; OR = 2.36; 95% CI: 1.42–3.88; p < 0.001); 3.6 times higher in millers with longer daily exposure (> 8 hours; vs. those working ≤ 8 hours; OR = 3.56; 95% CI: 1.93–3.61; p = 0.026); and 7.4 times higher in young millers (vs. older millers, OR = 7.39; 95% CI: 1.29–75.52; p < 0.001). Smoking, number of cigarettes, and daily exposure duration were positively correlated with musculoskeletal complaints.
This study revealed a relatively high incidence of musculoskeletal complaints among African cassava and corn millers. The use of anti-vibration protective equipment and the regulation of this hazardous occupation may reduce the burden of musculoskeletal disorders in millers.
PMCID: PMC4213888  PMID: 25379326
hand-arm vibration exposure; incidence; miller; musculoskeletal complaint
3.  Retinopathy in non diabetics, diabetic retinopathy and oxidative stress: a new phenotype in Central Africa? 
To evaluate the rates of retinopathy without diabetes and diabetic retinopathy (DR), associated with some markers of oxidative stress, antioxidants and cardiometabolic risk factors.
We determined the prevalence of DR in 150 type 2 diabetes mellitus (T2DM) patients, that of retinopathy in 50 non diabetics, the levels of body mass index (BMI), waist circumference (WC), blood pressure, lipids, 8-isoprostane, 8-hydroxydeoxyguanosine (8-OHdG), gamma-glutamyl transferase GT (GGT), oxidized low-density lipoprotein (OxLDL), thiobarbituric acid reacting substances (TBARS), reduced glutathione (GSH), superoxide dismutase (SOD), uric acid, creatinine, albumin, total antioxidant status (TAOS), zinc, selenium, magnesium, vitamin C, vitamin D, vitamin E, glucose, apolipoprotein B (ApoB).
The prevalences of DR at 53y and Rtp at 62y were 44% (n=66) and 10% (n=5), respectively. The highest levels of 8-isoprostane, 8-OHdG, TBARS, SOD, and OxLDL were in DR. The lowest levels of vitamin D, vitamin C, TAOS, and vitamin E were in DR. In the case-control study discriminant analysis, the levels of vitamin C, vitamin D, ApoB, 8-OHdG, creatinine, Zn, vitamin E, and WC distinguished significantly non-diabetics without DR (controls), T2DM patients without DR and T2DM patients with DR.
Anticipation of DR onset is significantly associated with the exageration of oxidative stress biomarkers or decrease of antioxidants in African type 2 diabetics. Prevention of oxidative stress and abdominal obesity is needed. Supplementation in vitamin C, D, and E should be recommended as complement therapies of T2DM.
PMCID: PMC4003085  PMID: 24790873
anticipation; apolipoprotein B; diabetic retinopathy; oxidative stress; discriminant analysis; Africa
4.  Determinants of Symptomatic Vulvovaginal Candidiasis among Human Immunodeficiency Virus Type 1 Infected Women in Rural KwaZulu-Natal, South Africa 
Introduction. We sought to determine the association between HIV-induced immunosuppression, virologic correlates, and vulvovaginal candidiasis (VVC). Methods. This is a retrospective cohort study, where HIV infected and uninfected women were studied with VVC being the primary outcome. Ninety-seven HIV-infected and 101 HIV-uninfected women were enrolled between June and December 2011. Cases of VVC were confirmed. HIV RNA load was determined by RT-PCR and CD4 counts were obtained from medical records. Results. Fifty-two of 97 (53.6%) HIV-infected and 38/101 (37.6%) HIV-uninfected women were diagnosed with VVC (P = 0.032). The relative risk for VVC amongst HIV-infected patients was 1.53 (95% CI: 1.04–2 P = 0.024). Cases of VVC increased at CD4+ T cell count below 200 cells/mm3 (P < 0.0001) and plasma HIV RNA load above 10 000 copies/mL (P < 0.0001). VVC was associated with increased genital shedding of HIV (P = 0.002), and there was a linear correlation between plasma HIV load and genital HIV shedding (r = 0.540; R2 = 0.292; P < 0.0001). Women on HAART were 4-fold less likely (P = 0.029) to develop VVC. Conclusion. CD4 counts below 200 cells/mm3 and plasma HIV loads ≥10 000 copies/mL were significantly associated with VVC.
PMCID: PMC4000633  PMID: 24812479
5.  The Protective Effect of Phaseolus Vulgaris on Cataract in Type 2 Diabetes: A Profitable Hypothesis 
The pathophysiology of major ocular complications in type 2 diabetes mellitus (T2DM) among Bantu is not well understood. Several studies have been conducted to determine the basic reasons of visual deficiencies (VD) (blindness, visual impairment, and ocular eye diseases) in T2DM among Bantu from Central Africa. The quality of dietary intake was assessed in patients along with other ophthalmological assessments for diabetic retinopathy, cataract, glaucoma, and macular edema. Beans (Phaseolus vulgaris) and leafy vegetables are rich in antioxidants. The consumption of at least 3 ladles per meal, 3 times or more per week, has been identified as a potential protective factor against cataract. The anti-radical activity of beans is well known in the literature. Beans are considered to have a comparatively higher antioxidant activity than in many other vegetables. Our findings from previous epidemiologic studies establish that the antioxidant activity of P. vulgaris helps control blood glucose. We, therefore, hypothesize that the dietary supplements of bean can be a low-cost prevention approach to reduce cataract and much other visual comorbidity associated with T2DM. However, further epidemiological studies combined with molecular research need to be conducted to prove this hypothesis.
PMCID: PMC4017630  PMID: 24822230
Phaseolus vulgaris; Visual deficiencies; Antioxidant; Cataract; Diabetes Mellitus; Anti-radical Activity
6.  Assessing clustering of metabolic syndrome components available at primary care for Bantu Africans using factor analysis in the general population 
BMC Research Notes  2013;6:228.
To provide a step-by-step description of the application of factor analysis and interpretation of the results based on anthropometric parameters(body mass index or BMI and waist circumferenceor WC), blood pressure(BP), lipid-lipoprotein(triglycerides and HDL-C) and glucose among Bantu Africans with different numbers and cutoffs of components of metabolic syndrome(MS).
This study was a cross-sectional, comparative, and correlational survey conducted between January and April 2005, in Kinshasa Hinterland, DRC. The clustering of cardiovascular risk factors was defined in all, MS group according to IDF(WC, BP, triglycerides, HDL-C, glucose), absence and presence of cardiometabolic risk(CDM) group(BMI,WC, BP, fasting glucose, and post-load glucose).
Out of 977 participants, 17.4%( n = 170), 11%( n = 107), and 7.7%(n = 75) had type 2 diabetes mellitus(T2DM), MS, and CDM, respectively. Gender did not influence on all variables. Except BMI, levels of the rest variables were significantly higher in presence of T2DM than non-diabetics. There was a negative correlation between glucose types and BP in absence of CDM. In factor analysis for all, BP(factor 1) and triglycerides-HDL(factor 2) explained 55.4% of the total variance. In factor analysis for MS group, triglycerides-HDL-C(factor 1), BP(factor 2), and abdominal obesity-dysglycemia(factor 3) explained 75.1% of the total variance. In absence of CDM, glucose (factor 1) and obesity(factor 2) explained 48.1% of the total variance. In presence of CDM, 3 factors (factor 1 = glucose, factor 2 = BP, and factor 3 = obesity) explained 73.4% of the total variance.
The MS pathogenesis may be more glucose-centered than abdominal obesity-centered in not considering lipid-lipoprotein , while BP and triglycerides-HDL-C could be the most strong predictors of MS in the general population. It should be specifically defined by ethnic cut-offs of waist circumference among Bantu Africans.
PMCID: PMC3685560  PMID: 23758878
Factor analysis; Metabolic syndrome; Black Africans; Type 2 diabetes
7.  Nadir CD4+, religion, antiretroviral therapy, incidence of type 2 diabetes mellitus, and increasing rates of obesity among black Africans with HIV disease 
The purpose of this study was to determine the cross-sectional association between some sociodemographic factors and antiretroviral therapy (ART), as well as the incidence and predictors of type 2 diabetes mellitus among Central Africans with human immunodeficiency virus (HIV) disease.
This study had a cross-sectional design and was a prospective analysis of 102 patients with HIV disease (49 on ART versus 53 not on ART) in Kinshasa, Democratic Republic of Congo, between 2004 and 2008. A Cox regression model was used to assess for any relationship between type 2 diabetes and exposure to combination ART without protease inhibitors, after adjusting for known risk factors for type 2 diabetes, nadir CD4 and CD8 levels, viral load, marital status, and religion.
Unexpectedly elevated rates of smoking, excess alcohol intake, and ART-related total, abdominal, and peripheral obesity were observed in our study group of HIV patients. At the end of follow-up, five patients were diagnosed with type 2 diabetes (incidence rate 4.9%, 9.8 per 1000 person-years). Univariate risk factors for type 2 diabetes were male gender (relative risk [RR] 1.1, 95% confidence interval [CI] 1.01–1.4; P = 0.019), traditional religion versus new charismatic religion (RR 1.1, 95% CI 1.01–1.3; P = 0.046), exposure to ART (RR 1.1, 95% CI 1.002–1.3; P = 0.034), and single status (RR 6.2, 95% CI 1.5–15; P = 0.047). In multivariate analysis, strong significant independent predictors of type 2 diabetes were belonging to a traditional religion (HR 2.1, 95% CI 1.1–4.2; P = 0.036) and a relative increase in nadir CD4 cell count (beta coefficient 0.003; P < 0.0001).
ART-related obesity and type 2 diabetes are becoming increasing problems in Central Africans with HIV disease. A relative increase in nadir CD4 count and traditional religion status appear to be the strongest independent predictors of type 2 diabetes.
PMCID: PMC3514076  PMID: 23226071
human immunodeficiency virus; diabetes mellitus; risk factors; Africans; religion
8.  Inflammatory status hepatic enzymes and serum creatinine in HIV-, HIV+ and HIV-TB co-infected adult Central Africans 
Background and aim
Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome is a major public health issue in Africa. The objective of this study was to determine which of isolated HIV-infection, isolated naive pulmonary tuberculosis (PTB), or naive HIV-PTB coinfection was more harmful to inflammatory, hepatic, and renal functions.
This cross-sectional study was undertaken among ten patients with isolated HIV infection, ten patients with isolated naive HIV infection, ten patients with isolated PTB and 32 patients with HIV-PTB coinfection, with the aim of determining which group had the highest levels of oxidative stress and hepatic and renal dysfunction markers. Serum aminotransferase (AST), alanine transferase (ALT), gamma-glutamyl transferase (GGT), and creatinine measurements were compared across the three groups of patients, who were managed from admission in the pulmonology division of the Brazzaville Teaching Hospital, Congo.
HIV patients had the highest levels of ALT, GGT, and creatinine before and after adjusting for age and sex. Adjusted levels of AST, ALT, GGT, and creatinine were higher in HIV-PTB coinfection patients than in sero-negative PTB patients.
There is a significant association between HIV infection and increase in concentration of ALT, GGT, and creatinine.
PMCID: PMC3508561  PMID: 23204860
Africa; tuberculosis; HIV-tuberculosis coinfection; renal function
9.  Oxidative stress-elevated high gamma glutamyl transferase levels, and aging, intake of tropical food plants, migration and visual disability in Central Africans 
To investigate the independent pathogenic role of high serum gamma-glutamyl transferase (GGT) levels, sociodemographic data, dietary and environmental risk factors for visual disability (VD).
This was a case-control study, run in 200 black Congolese patients managed in Saint Joseph Hospital Ophthalmology Division from Kinshasa town. Logistic regression model was used to identify determinants of VD (n=58) among sex, age, cigarette smoking, alcohol abuse, rural-urban migration, education levels, aging ≥60 years, intake of red Beans, Safou fruit and Taro leaves, lipid profile, residence, socioeconomic status, and GGT.
After adjusting for confounding factors, we identified migration (OR=3.7 95% CI: 1.2-11.3; P=0.023), low education level (OR=3.1 95% CI 1.1-8.5; P=0.026), no intake of Safou fruit (OR=34.2 95% CI 11.5-102; P<0.0001), age ≥ 60 years (OR=2.5 95% CI 1.01-6.5; P=0.049), and serum GGT ≥10 U/L (OR=3.6 95% CI 1.3-9.6; P=0.012) as the significant and independent determinants of VD.
VD appears as a major public health problem in Central Africa to be prevented or delayed by control of migration, lifestyle changes, antioxidant supplements, appropriate diet, nutrition education, and blocking of oxidative stress.
PMCID: PMC3428548  PMID: 22937512
oxidative stress; serum gamma-glutamyl transferase; intake of tropical food plants; aging; vision loss
10.  Helicobacter pylori infection is identified as a cardiovascular risk factor in Central Africans 
Helicobacter pylori is now incriminated in the pathogenesis of atherosclerosis.
To examine the importance of H. pylori infection as a cardiovascular disease (CVD) risk factor.
Two hundred five patients (128 with H. pylori infection [HP-seropositive] and 77 without) had a baseline assessment for other potential CVD risk factors and were followed prospectively for 10 years (1999–2008). They were assessed on a monthly basis for the outcomes of carotid plaque, angina pectoris, myocardial infarction, and stroke. In the HP-seropositive group, male sex and quartile 4 for IgG anti-H. pylori antibodies (anti-HP Ab) were correlated with traditional CVD risk factors, stroke, myocardial infarction, and angina pectoris.
At the baseline assessment, the levels of carotid intima-media thickness, blood fibrinogen, total cholesterol, fasting plasma glucose, and uric acid were higher in H. pylori-infected patients than in the uninfected group. Serum HDL-cholesterol was significantly lower in the HP-seropositive group. Men had higher levels of IgG anti-HP Ab, waist circumference, blood pressure, uric acid, and total cholesterol than women. Within the HP-seropositive group, individuals in quartile 4 for IgG anti-HP Ab had higher rates of elevated fibrinogen, diabetes mellitus, low high-density lipoprotein cholesterol, arterial hypertension, and high total cholesterol than those in quartile 1. After adjusting for traditional CVD risk factors, H. pylori infection was the only independent predictor of incident carotid plaque (multivariate odds ratio [OR] = 2.3, 95% confidence interval [CI]: 1.2–7.2; P < 0.0001) and incident acute stroke (multivariate OR = 3.6, 95% CI: 1.4–8.2; P < 0.0001). Within the HP-seropositive group and after adjusting for traditional CVD risk factors, male sex was the only independent predictor of incident angina pectoris (multivariate OR = 3.5, 95% CI: 1.6–16; P < 0.0001), incident acute stroke (multivariate OR = 3.2, 95% CI: 1.4–28; P < 0.0001), and acute myocardial infarction (multivariate OR = 7.2, 95% CI: 3.1–18; P < 0.0001).
Our study provides evidence for an association among known CVD risk factors, carotid plaque, stroke, and H. pylori infection. Among infected individuals, there is a significant association among severity of HP-seropositivity, male sex, and CVD. The eradication of H. pylori infection may therefore reduce the emerging burden of CVD in Africa.
PMCID: PMC3423148  PMID: 22923995
Helicobacter pylori; stroke; myocardial infarction; cardiovascular disease; carotid plaque; Africans
11.  Epidemiology, clinical, immune, and molecular profiles of microsporidiosis and cryptosporidiosis among HIV/AIDS patients 
The objective of this study was to determine the prevalence of intestinal parasites, with special emphasis on microsporidia and Cryptosporidium, as well as their association with human immunodeficiency virus (HIV) symptoms, risk factors, and other digestive parasites. We also wish to determine the molecular biology definitions of the species and genotypes of microsporidia and Cryptosporidium in HIV patients.
In this cross-sectional study, carried out in Kinshasa, Democratic Republic of the Congo, stool samples were collected from 242 HIV patients (87 men and 155 women) with referred symptoms and risk factors for opportunistic intestinal parasites. The analysis of feces specimen were performed using Ziehl–Neelsen stainings, real-time polymerase chain reaction (PCR), immunofluorescence indirect monoclonal antibody, nested PCR-restriction fragment length polymorphism, and PCR amplification and sequencing. Odds ratio (OR) and 95% confidence intervals were used to quantify the risk.
Of the 242 HIV patients, 7.8%, 0.4%, 5.4%, 0.4%, 2%, 10.6%, and 2.8% had Enterocytozoon bieneusi, Encephalitozoon intestinalis, Cryptosporidium spp., Isospora belli, pathogenic intestinal protozoa, nonpathogenic intestinal protozoa, and helminths, respectively. We found five genotypes of E. bieneusi: two older, NIA1 and D, and three new, KIN1, KIN2, and KIN3. Only 0.4% and 1.6% had Cryptosporidium parvum and Cryptosporidium hominis, respectively. Of the patients, 36.4%, 34.3%, 31%, and 39% had asthenia, diarrhea, a CD4 count of <100 cells/mm3, and no antiretroviral therapy (ART), respectively. The majority of those with opportunistic intestinal parasites and C. hominis, and all with C. parvum and new E. bieneusi genotypes, had diarrhea, low CD4+ counts of <100 cells/mm3, and no ART. There was a significant association between Entamoeba coli, Kaposi sarcoma, herpes zoster, chronic diarrhea, and asthenia, and the presence of 28 cases with opportunistic intestinal parasites. Rural areas, public toilets, and exposure to farm pigs were the univariate risk factors present in the 28 cases with opportunistic intestinal parasites. In logistic regression analysis, a CD4 count of <100 cells/mm3 (OR = 4.60; 95% CI 1.70–12.20; P = 0.002), no ART (OR = 5.00; 95% CI 1.90–13.20; P < 0.001), and exposure to surface water (OR = 2.90; 95% CI 1.01–8.40; P = 0.048) were identified as the significant and independent determinants for the presence of opportunistic intestinal parasites.
E. bieneusi and Cryptosporidium are becoming more prevalent in Kinshasa, Congo. Based on the findings, we recommend epidemiology surveillance and prevention by means of hygiene, the emphasis of sensitive PCR methods, and treating opportunistic intestinal parasites that may be acquired through fecal–oral transmission, surface water, normal immunity, rural area-based person–person and animal–human infection, and transmission of HIV. Therapy, including ART and treatment with fumagillin, is needed.
PMCID: PMC3422901  PMID: 22924007
diarrhea; Enterocytozoon bieneusi; Cryptosporidium hominis; Cryptosporidium parvum; risk factors; Africans
12.  Aging, female sex, migration, elevated HDL-C, and inflammation are associated with prevalence of metabolic syndrome among African bank employees 
The objective of this study was to compare four different criteria for diagnosing metabolic syndrome (MS) and to correlate sociodemographic data, liver enzymes, lipids, inflammation, and insulin resistance with MS definitions.
This cross-sectional study included a random number of 126 African bank employees from Brazzaville, Congo.
The prevalence of MS varied according to the different definitions used: 4.8% under World Health Organization (WHO) criteria, 8.7% under the National Cholesterol Education Program Adult Treatment Panel III (NECP-ATPIII) criteria, 14.3% under the International Diabetes Federation (IDF) for Europe, and 15.9% by the IDF for Central Africa. According to the IDF, specific cutoff points for the erythrocyte sedimentation rate, ≥13 mm at first hour and ≥30 mm at second hour, defined MS for Central Africa. The best agreement was observed between the IDF for Europe and the IDF for Central Africa (Kappa = 0.938; P < 0.0001) criteria. The worst agreements were between the WHO and IDF for Central Africa (Kappa = 0.419; P < 0.0001) criteria and between the WHO and IDF for Europe (Kappa = 0.462; P < 0.0001) criteria. The NECP-ATPIII criteria did not agree with either the IDF for Europe or the IDF for Central Africa criteria. There was a significant relationship between female sex, aging, elevated liver enzymes, elevated phospholipids, high homeostasis model assessment of insulin resistance, and MS defined by the IDF for Central Africa.
The IDF definition of the MS modified for Central Africa provides higher prevalence estimates of MS than the estimates based on the NECP-ATPIII and IDF for Europe criteria. Liver enzymes, phospholipids, and homeostasis model assessment of insulin resistance should be included in clinical practice to stratify cardiovascular disease risk among Africans.
PMCID: PMC3396108  PMID: 22807636
metabolic syndrome; insulin resistance; inflammation; liver enzymes; atherosclerosis; sub-Saharan Africa
13.  Regular, high, and moderate intake of vegetables rich in antioxidants may reduce cataract risk in Central African type 2 diabetics 
Antioxidant nutrients found in popularly consumed vegetables, including red beans, are thought to prevent diabetic complications. In this study, we assessed the frequency and contributing factors of intake of fruits and vegetables rich in antioxidants, and we determined their impact on the prevention of diabetes-related cataract extraction.
This was a cross-sectional study, run in Congo among 244 people with type 2 diabetes mellitus. An intake of ≥three servings of vegetables rich in antioxidants/day, intake of red beans, consumption of fruit, and cataract extraction were considered as dependent variables.
No patient reported a fruit intake. Intake of red beans was reported by 64 patients (26.2%), while 77 patients (31.6%) reported ≥three servings of vegetables rich in antioxidants. High socioeconomic status (OR = 2.3; 95% CI: 1.1–12.5; P = 0.030) and moderate alcohol intake (OR = 4; 95% CI: 1.1–17.4; P = 0.049) were the independent determinants of eating ≥three servings of vegetables rich in antioxidants. Red beans intake (OR = 0.282; 95% CI: 0.115–0.687; P < 0.01) and eating ≥three servings of vegetables rich in antioxidants (OR = 0.256; 95% CI: 0.097–0.671; P = 0.006) were identified as independent and protective factors against the presence of cataracts (9.8% n = 24), whereas type 2 diabetes mellitus duration ≥3 years was the independent risk factor for cataract extraction (OR = 6.3; 95% CI: 2.1–19.2; P < 0.001 in the model with red beans intake and OR = 7.1; 95% CI: 2.3–22.2; P < 0.001 in the model with ≥three servings of vegetables rich in antioxidants).
Red beans intake and adequate quantity of intake of vegetables rich in antioxidants were found to be associated with reduced risk of cataract in these Congolese with type 2 diabetes mellitus. Education on nutrition and health promotion programs are needed to encourage people to eat vegetables and fruit.
PMCID: PMC3396111  PMID: 22807635
red beans; cataract extraction; socioeconomic status; public health implications
14.  Biomarkers of Oxidative Stress and Personalized Treatment of Pulmonary Tuberculosis: Emerging Role of Gamma-Glutamyltransferase 
Background. The objectives were (i) to evaluate the impact of acute pulmonary tuberculosis (PTB) and anti-TB therapy on the relationship between AST, ALT, and GGT levels in absence of conditions related to hepatotoxicity; (ii) to evaluate the rate and the time of alterations of AST, ALT, and GGT. Design and Methods. A prospective followup of 40 adults (21 males; mean age of 34.7 ± 5.8 years) with active PTB on initial phase and continuation phase anti-TB. Results. Only 3% (n = 1) developed a transient and benign ADR at day 30 without interruption of anti-TB treatment. Within normal ranges, GGT decreased significantly from day 0 to day 60, while AST and ALT increased significantly and respectively. During day 0–day 60, there was a significant, negative, and independent association between GGT and AST. Conclusion. The initial two months led to significant improvement of oxidative stress. Values of oxidative markers in normal ranges might predict low rate of ADR.
PMCID: PMC3352232  PMID: 22611380
15.  Spontaneous intracerebral hemorrhage: Clinical and computed tomography findings in predicting in-hospital mortality in Central Africans 
Background and Purpose:
Intracerebral hemorrhage (ICH) constitutes now 52% of all strokes. Despite of its deadly pattern, locally there is no clinical grading scale for ICH-related mortality prediction. The first objective of this study was to develop a risk stratification scale (Kinshasa ICH score) by assessing the strength of independent predictors and their association with in-hospital 30-day mortality. The second objective of the study was to create a specific local and African model for ICH prognosis.
Materials and Methods:
Age, sex, hypertension, type 2 diabetes mellitus (T2DM), smoking, alcohol intake, and neuroimaging data from CT scan (ICH volume, Midline shift) of patients admitted with primary ICH and follow-upped in 33 hospitals of Kinshasa, DR Congo, from 2005 to 2008, were analyzed using logistic regression models.
A total of 185 adults and known hypertensive patients (140 men and 45 women) were examined. 30-day mortality rate was 35% (n=65). ICH volume>25 mL (OR=8 95% CI: 3.1-20.2; P<0.0001), presence of coma (OR=6.8 95% CI 2.6-17.4; P<0.0001) and left hemispheric site of ICH (OR 2.6 95% CI: 1.1-6; P=0.027) were identified as significant and independent predictors of 30-day mortality. Midline shift > 7 mm, a consequence of ICH volume, was also a significant predictor of mortality. The Kinshasa ICH score was the sum of individual points assigned as follows: Presence of coma coded 2 (2 × 2 = 4), absence of coma coded 1 (1 × 2 = 2), ICH volume>25 mL coded 2 (2 × 2=4), ICH volume of ≤25 mL coded 1(1 × 2=2), left hemispheric site of ICH coded 2 (2 × 1=2), and right hemispheric site of hemorrhage coded 1(1 × 1 = 1). All patients with Kinshasa ICH score ≤7 survived and the patients with a score >7 died. In considering sex influence (Model 3), points were allowed as follows: Presence of coma (2 × 3 = 6), absence of coma (1 × 3 = 3), men (2 × 2 = 4), women (1 × 2 = 2), midline shift ≤7 mm (1 × 3 = 3), and midline shift >7 mm (2 × 3 = 6). Patients who died had the Kinshasa ICH score ≥16.
In this study, the Kinshasa ICH score seems to be an accurate method for distinguishing those ICH patients who need continuous and special management. It needs to be validated among large African hypertensive populations with a high rate of 30-day in–hospital mortality.
PMCID: PMC3409977  PMID: 22865958
Clinical and neuroimaging data; intracerebral hemorrhage; predictors of mortality; sub-Saharan Africa
16.  Human immunodeficiency virus and AIDS and other important predictors of maternal mortality in Mulago Hospital Complex Kampala Uganda 
BMC Public Health  2011;11:565.
Women with severe maternal morbidity are at high risk of dying. Quality and prompt management and sometimes luck have been suggested to reduce on the risk of dying. The objective of the study was to identify the direct and indirect causes of severe maternal morbidity, predictors of progression from severe maternal morbidity to maternal mortality in Mulago hospital, Kampala, Uganda.
This was a longitudinal follow up study at the Mulago hospital's Department of Obstetrics and Gynaecology. Participants were 499 with severe maternal morbidity admitted in Mulago hospital between 15th November 2001 and 30th November 2002 were identified, recruited and followed up until discharge or death. Potential prognostic factors were HIV status and CD4 cell counts, socio demographic characteristics, medical and gynaecological history, past and present obstetric history and intra- partum and postnatal care.
Severe pre eclampsia/eclampsia, obstructed labour and ruptured uterus, severe post partum haemorrhage, severe abruptio and placenta praevia, puerperal sepsis, post abortal sepsis and severe anaemia were the causes for the hospitalization of 499 mothers. The mortality incidence rate was 8% (n = 39), maternal mortality ratio of 7815/100,000 live births and the ratio of severe maternal morbidity to mortality was 12.8:1.
The independent predictors of maternal mortality were HIV/AIDS (OR 5.1 95% CI 2-12.8), non attendance of antenatal care (OR 4.0, 95% CI 1.3-9.2), non use of oxytocics (OR 4.0, 95% CI 1.7-9.7), lack of essential drugs (OR 3.6, 95% CI 1.1-11.3) and non availability of blood for transfusion (OR 53.7, 95% CI (15.7-183.9) and delivery of amale baby (OR 4.0, 95% CI 1.6-10.1).
The predictors of progression from severe maternal morbidity to mortalitywere: residing far from hospital, low socio economic status, non attendance of antenatal care, poor intrapartum care, and HIV/AIDS.
There is need to improve on the referral system, economic empowerment of women and to offer comprehensive emergency obstetric care so as to reduce the maternal morbidity and mortality in our community.
PMCID: PMC3155916  PMID: 21756355
17.  Relationship between Younger Age, Autoimmunity, Cardiometabolic Risk, Oxidative Stress, HAART, and Ischemic Stroke in Africans with HIV/AIDS 
ISRN Cardiology  2011;2011:897908.
Background and Purpose. It now appears clear that both HIV/AIDS and antiretroviral therapy (HAART) use are associated with higher risk of cardiovascular disease such as stroke. In this study, we evaluated the prevalence, the risk factors, and the cardiometabolic comorbidities of stroke in HIV/AIDS Central African patients. Methods. This hospital-based cross-sectional study collected clinical, laboratory, and imaging data of black Central African heterosexual, intravenous drug nonuser, and HIV/AIDS patients. Results. There were 54 men and 62 women, with a female to male ratio of 1.2 : 1. All were defined by hypercoagulability and oxidative stress. Hemorrhagic stroke was reported in 1 patient, ischemic stroke in 17 patients, and all stroke subtypes in 18 patients (15%). Younger age <45 years (P = .003), autoimmunity (P < .0001), and metabolic syndrome defined by IDF criteria (P < .0001) were associated with ischemic stroke. Conclusions. Clustering of several cardiometabolic factors, autoimmunity, oxidative stress, and lifestyle changes may explain accelerated atherosclerosis and high risk of stroke in these young black Africans with HIV/AIDS. Prevention and intervention programs are needed.
PMCID: PMC3262512  PMID: 22347662
18.  Advanced age, altered level of consciousness and a new diagnosis of diabetes are independently associated with hypernatreamia in hyperglycaemic crisis 
There is limited literature on hypernatreamia in the setting of hyperglycaemic crisis. This is despite the fact that the presence of hypernatreamia may impact on the classification of hyperglycaemic crisis and its management particularly with regards to the nature of fluid therapy. We determined the prevalence of hypernatreamia and its associated factors at presentation for hyperglycaemic crisis.
This was a retrospective review of data for hyperglycaemic crisis admissions in Nelson Mandela Academic Hospital, Mthatha, South Africa. The prevalence of hypernatreamia (uncorrected Serum Sodium at presentation >145 mmol/L) was determined. Hyperosmolality was defined by calculated effective osmolality >320 mosmols/Kg. Multivariate logistic regression was undertaken using variables that were statistically significant in univariate analysis to ascertain those that were independently associated (Odds Ratio (OR) with 95% Confidence Interval (CI)) with hypernatreamia.
The prevalence of hypernatreamia in our admissions for hyperglycaemic crisis was 11.7% (n = 32/273 including 171 females and 102 males). All admissions with hypernatreamia met the criteria for hyperosmolality. Age ≥ 60 years (OR = 3.9 95% CI 1.3-12.3; P = 0.018), Altered level of consciousness (OR = 8.8 95% CI 2.3-32.8; P < 0.001) and a new diagnosis of diabetes (OR = 3.7 95%CI 1.2-11.5; P = 0.025) were independently associated with hypernatreamia.
The prevalence rate of hypernatreamia in hyperglycaemic admissions was high with all hypernatreamic admissions meeting the criteria for hyperosmolality. Advanced age, altered conscious level and a new diagnosis of diabetes were independently associated with hypernatreamia.
PMCID: PMC3103444  PMID: 21501465
Hypernatreamia; Hyperglyceamic crisis; prevalence; determinants; South Africa
19.  Caractéristiques sociodémographiques et sémiologiques de la sphère ORL des patients avec infection par le VIH/SIDA à Kinshasa, RD Congo 
L’absence de données congolaises relatives à l’épidémiologie, aux plaintes et signes cliniques de la sphère ORL dans l’infection par le VIH en consultation d’otorhinolaryngologie justifie l’initiation de la présente étude. L’objectif de notre étude était de décrire les aspects sociodémographiques et sémiologiques de la sphère ORL chez les patients avec infection à VIH/SIDA dans le service d’ORL de l’hôpital Général de Kinshasa, République Démocratique du Congo.
Etude transversale réalisée entre Janvier et Avril 2009 dans le service d’ORL de l’Hôpital Général de Kinshasa, RDC.
Au total, 52 patients infectés par le VIH/SIDA et d’âge moyen de 40,6±13 ans ont été enquêtés. Le sexe féminin, la tranche d’âge de 30 -40 ans, les mariés et les veufs, les nantis et les plus scolarisés étaient les caractéristiques observées chez les patients infectés par le VIH/SIDA. Les céphalées et la rhinorrhée sous toutes ses formes, l’hypertrophie de la parotide, les adénopathies cervicales constituaient les aspects sémiologiques les plus rencontrés.
La connaissance des aspects sociodémographiques et sémiologiques est indispensable dans le diagnostic précoce de l’infection par le VIH/SIDA.
PMCID: PMC3172645  PMID: 21918702
Afrique sub-Saharienne; céphalées; rhinorrhée; VIH/SIDA

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