Advances in General Practice of Medicine

Fast diffusion kurtosis imaging for venous stroke caused by cerebral venous thrombosis

Haijuan Kang — 2024-09-23

Background: Diffusion kurtosis imaging (DKI) has been found to be more precise than diffusion weighted imaging (DWI) for detecting irreversible infarction in acute ischemic stroke. This study aimed to evaluate whether fast DKI has distinctive advantages in detecting venous stroke caused by cerebral venous thrombosis (CVT).
Methods: All data from patients diagnosed with venous stroke due to CVT and qualified for mechanical recanalization treatment were collected. Fast DKI and DWI were obtained both before and after revascularization therapy, and lesions were measured. Lesion volumes on T₂ weighted imaging (T₂WI) were followed up at six months.
Results: A total of 11 patients were recruited. Compared to the contralateral brain, ADC values of the lesions in pre-operation increased significantly (1340.12±235.42 vs 919.75±128.98, P < 0.05), while MK decreased (0.59±0.11 vs 0.81±0.12, P < 0.05). And the same changing trend about ADC values (1258.94±185.08 vs 949.81±148.52, P < 0.05) and MK values (0.64±0.12 vs 0.83±0.12, P < 0.05) in post-operation. There was no significant difference in the volume of lesions between DKI and DWI during the same examination period (26.97 vs 29.28, P_pre > 0.05; 13.34 vs 13.14, P_post > 0.05). However, the lesion volume after revascularization was significantly reduced compared to the first DKI and DWI examinations (26.97 vs 13.34, P < 0.05), and the same as DWI (29.28 vs 13.14, P < 0.05). Volume of T2WI lesions after the 6th month diminished significantly compared with both DKI lesions and DWI lesions before treatment (7.25 vs 26.97, P < 0.05; 7.25 vs 31.19, P < 0.05). Fast DKI had a higher signal to noise ratio (SNR) than traditional DKI and DWI.
Conclusion: The MK of the venous stroke lesions decreased significantly in the subacute stage of CVT, suggesting reversible infarction. Fast DKI has more distinctive superiority in the evaluation of venous stroke. Fast DKI approach may hold great promise for patients in clinical setting because of a higher SNR than DWI. But the sample need to be further expanded because of only 11 patients recruited.

Prevalence and associated factors of hypertension in adults in Lubumbashi, Democratic Republic of the Congo: A hospital cross-sectional study

Placide Kambola Kakoma — 2024-08-07

Introduction: Hypertension is the leading cause of morbidity and mortality from cardiovascular disease worldwide. Knowledge of its prevalence and associated factors helps to prevent its complications. The objectives of this study were to determine the prevalence and associated factors of hypertension in hospitals in Lubumbashi, Democratic Republic of the Congo.
Methods: A cross-sectional analytic study was conducted among 520 adults from February 6 to November 30, 2023 in 2 health facilities in the city of Lubumbashi (Afia Polyclinic - Don Bosco and Jason Sendwe Provincial General Reference Hospital). Participants were selected by systematic random sampling. Hypertension was defined when the subject had a blood pressure (BP) ≥ 135/85 mmHg on diurnal Ambulatory Blood Pressure Monitoring (ABPM) or ≥ 180/110 mmHg on clinic oscillometric BP measurement (OBPM), or when he/she had self-reported hypertension and/or was taking antihypertensive medication even if diurnal ABPM was normal. Factors associated with hypertension were determined using a logistic regression model at the 5% significance level.
Results: The prevalence of hypertension was 32.8% (95% CI: 28.9%-37.0%). Factors significantly associated with hypertension included age ≥50 years (AOR = 4.0 [1.2-12.7]), dyslipidemia (AOR = 18.6 [3.2-107.4]), hypercalcemia (AOR = 171.6 [32.5-905.9]), hyperkalemia (AOR = 27.6 [7.1-107.8]), and hypernatremia (AOR = 948.1 [160.0-5619.3]).
Conclusion: This study reveals the high hospital prevalence of hypertension and the factors associated with it, emphasizing the necessity for targeted interventions for at-risk populations, especially the elderly and those with electrolyte imbalances.

Big challenge in health impact of heavy metal: A case study

Ritu Tiwari — 2024-07-16

Herbal medicines are potential sources of therapeutic aids for human beings. WHO estimates that 80% of the world’s population depends on herbal products as their primary form of health care. Herbal plants are widely used nowadays because they have few side effects, are readily available, and are cost-effective. Herbal plants are easily contaminated by absorbing heavy metals from soil, air and water. The primary health concerns of heavy metals are Arsenic, Cadmium, Lead and Mercury. Heavy metal causes countless health-related issues, such as kidney and liver damage, skin cancer, etc. So, the estimation of heavy metals is fundamental. Modern techniques estimate heavy metals in herbal plants such as AAS, ICP-MS, ICP-AES and ICP-OES. This review article mainly contains general information about heavy metals, the health impact of heavy metals on the human body, case studies regarding heavy metal toxicity on human health and analytical techniques used to estimate heavy metals.

Predictors of in-hospital mortality among patients with status epilepticus in Lubumbashi, Democratic Republic of the Congo: A retrospective study

Marcellin Bugeme — 2024-04-04

Objective: Status Epilepticus (SE) is a condition characterized by an epileptic seizure that persists long enough or recurs at sufficiently short intervals to create a fixed and lasting epileptic condition. The objective of this study was to determine the prevalence and to identify predictors of in-hospital death among SE patients in Lubumbashi, Democratic Republic of the Congo (DRC).
Methods: We conducted a retrospective study from January 2020 to December 2022.
Results: Out of 3,006 patients admitted to the neurology department of the University Clinics of Lubumbashi, 97 presented with SE (i.e., a hospital prevalence of 3.23%). The mean age of the patients was 38.38±14.74 years, and men represented 77.3% of the cases. Epileptic patients represented 21.65% of the cases and 66.7% of them were on antiepileptic drugs (AEDs). Seizures were generalized in 72.16% of the patients. Seizures lasted 30 minutes or more in 50.52% of the cases. The most frequent etiologies were strokes, followed by central nervous system (CNS) infections. In-hospital mortality was 24.74% and the predictors of this mortality were CNS infections (adjusted OR = 22.34 [2.69-222.65]; p = 0.0006) and seizures lasting ≥ 30 minutes (adjusted OR = 10.98 [2.89-62.70]; p<0.0001).
Conclusion: SE is a major neurological emergency requiring early and multidisciplinary management to preserve the vital prognosis because, without treatment, SE causes important neurological complications and even death. The present study found a mortality of 24.74% which was associated with seizure duration of more than 30 minutes as well as with infectious etiologies.

Prediction of mortality in adult COVID-19 patients using chest CT severity scoring systems: A comparative analysis of different scores

Didier Ndyanabo Ndabahweje — 2024-02-22

Purpose: To compare the accuracy of mortality prediction of four CT severity scoring systems for COVID-19: CT severity score three levels, CT severity score, Total severity score, and Chest CT score.
Methods: This was a retrospective study of 278 patients hospitalized with COVID-19 confirmed by a positive polymerase chain reaction (PCR) and in whom a CT scan was performed to assess the severity of lung involvement. This assessment was performed using four different scoring systems, including the CT severity score three levels, the CT severity score, the Total severity score, and the Chest CT score.
Results: A total of 278 COVID-19 patients had chest CT scans, of whom 59 (21.22%) died and 219 (78.78%) survived. The ROC curves showed outstanding performance for the four chest CT severity scoring systems: 0.9580 for the CT severity score; 0.9532 for the CT severity score three levels; 0.9474 for the Total severity score; and 0.9327 for the Chest CT score. The comparison of these four ROC curves revealed no statistically significant difference between the four scoring systems (X² = 3.89; p = 0.2740).
Conclusion: The four chest CT severity scoring systems used predicted mortality in COVID-19 patients with excellent agreement and outstanding performance.

Prevalence and associated factors of uncontrolled hypertension in hypertensive patients in the city of Goma, DRC

Herman Ngadjole Chelo — 2023-03-02

Background: The objectives of this study were to determine the proportion of uncontrolled hypertension in hypertensive patients followed up on an outpatient basis and to investigate the factors associated with this poor control.
Methods: This was a cross-sectional analytical study of 167 hypertensive patients followed in eight health facilities in Goma city. Uncontrolled hypertension was defined as systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg.
Results: The proportion of uncontrolled hypertension was 95.2%. In bivariate analysis, no factor was associated with uncontrolled hypertension.
Conclusion: Almost all hypertensive patients in our study were poorly controlled by antihypertensive treatment. These results highlight the need for a cohort study to determine the factors associated with this excessively high prevalence of uncontrolled hypertension in hypertensive patients on antihypertensive drugs, in order to allow targeted actions to try to control hypertension by antihypertensive drugs.

Gilles de la Tourette syndrome in Central Africa: A case report

Marcellin Bugeme — 2022-12-28

Gilles de la Tourette syndrome (GTS), also known as Tourette disorder or Tourette syndrome, is a neurodevelopmental disorder that is characterized by the presence of multiple motor and one or more vocal/phonic tics. These tics are generally more common during childhood and reach a maximum severity between 10 and 12 years. Ticks tend to decrease during late adolescence and adulthood in a majority of patients. We report an observation of GTS diagnosed in a 12-year-old child who was taken care of by clonazepam with a good improvement in its symptomatology. This condition has been reported only very rarely in black sub-Saharan Africans and this is probably the first case of GTS reported in Central Africa.

Three first cases of Meige syndrome in Central Africa

Marcellin Bugeme — 2022-12-23

Meige syndrome (MS) is a rare type of focal dystonia characterized by unintentional bilateral activity in facial and mandibular muscles in combination with blepharospasm (spasm in the orbicular muscle). Often unknown cause, MS can be primary (idiopathic) or secondary (to medications or brain degenerative pathologies). Its treatment is based in most cases on botulinum toxin injections, not available in our environment. Nevertheless, clonazepam treatment has allowed us to improve the symptoms of our patients. We report MS in three patients, all with no particular history of consulting for involuntary facial movements. The diagnosis of MS was essentially based on the clinical picture. After treatment with clonazepam, the clinical course in all three patients was marked by the almost complete disappearance of these abnormal movements. In all cases, clinical progress was favorable with an average decline of 12 months; no recidivism was noted.

Etiology of breast development and asymmetry

Elisabeth N. Adkins — 2022-07-14

Etiology of breast development and asymmetry is a fascinating research topic physiologically as well as pathophysiology from a certain condition. The shape, contour, and size of the breast are unique to each female. These factors are influenced by genetics, weight, exercise, menstruation cycles, pregnancy, menopause status, and age. An attempt was made to research the breast development at fetal development and transitioning into adulthood and menopause. Additionally, we compare breast development in males to the developments in females. Although breast asymmetry is experienced by all women, it ranges from grossly undetectable to the need for surgical intervention. It is thought that breast asymmetry has intrinsic and extrinsic factors that determine the type and the extent of asymmetry observed. Hormones at play and their effect on breast asymmetry throughout breast development has been charted. Breast asymmetry is most often secondary to benign breast disorders and unassociated with a risk for malignancy. As the perception of one’s body image is an integral part of self-confidence, breast asymmetry has the potential to affect every woman’s quality of life, regardless of the degree of asymmetry. Throughout this effort, our aim was to analyze and understand breast development in males and females, breast changes from the prepubertal to post-menopausal period, benign pathological changes, summarizing the etiologies of breast asymmetry, and their effects on quality of life.

Availability and quality of family planning services in Idjwi Island, DRC

Maurice Nyamalyongo Masoda — 2022-07-13

Objective: The objective of this study was to assess the availability and quality of FP services in health facilities (HFs) on Idjwi Island in the eastern Democratic Republic of the Congo (DRC).
Methods: From March 1 to 31, 2022, a descriptive cross-sectional study was conducted in several HFs on Idjwi Island. Identified 31 HFs have been comprehensively included. Data were collected through interviews, literature reviews, and observations, guided by a questionnaire.
Results: Of the 31 HFs included, 29 (93.6%) of them provided FP services on an availability basis, of which 27.6% (8/29) met the criteria for high-quality services. The most widely available methods were male condoms, combined oral contraceptive pills, and progestin-only injectable contraceptives.
Conclusion: The availability of FP services in HFs on Idjwi Island remains high but their quality is low. To improve access to and use of FP, efforts should focus on improving quality in this rural part of the country.