Advances in General Practice of Medicine

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

Thu, 02 Mar 2023 13:26:09 +0800

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

Wed, 28 Dec 2022 14:33:18 +0800

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

Fri, 23 Dec 2022 11:55:14 +0800

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

Thu, 14 Jul 2022 15:47:20 +0800

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

Wed, 13 Jul 2022 10:55:36 +0800

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.

Gender-specific anterior cruciate ligament – gait forces

Bharadwaj Cheruvu, Amy Neidhard-Doll, Tarun Goswami — Wed, 18 May 2022 15:13:40 +0800

The purpose of this study was to investigate gender-based differences in gait biomechanics and to evaluate those effects on forces generated on the ACL during walking. Estimation of gender-specific ACL forces in the frontal plane can provide a better understanding of the biomechanical patterns underlying higher female injury risk. The present study used a sample from the Fels Longitudinal Study to test the hypothesis that there are significant gender-differences in frontal plane ACL loading during walking. A cross-sectional sample of 178 participants, including 79 males and 99 females was used to evaluate differences in gait kinetics. Females walked at higher cadence with narrower steps (P < 0.05). No difference was observed in the peak flexion force and knee rotation moment between males and females (P = 0.51 and 0.07), respectively. Peak abduction moment was significantly lower among females than in males (P = 0.05). A regression equation was developed which considers a person’s weight and height in addition to forces which could give better estimate of the forces acting on the ligament. The peak force acting on the ACL during walking reaches as high as 0.44 of BW, regardless of gender.

Antimicrobial resistance of Salmonella enterica Typhi in the Western and Southern Regions of the Democratic Republic of the Congo: Phenotypic profile and molecular characterization of isolates associated with epidemics of Typhoid Fever

Thu, 28 Apr 2022 14:31:45 +0800

Background: This study has its foundation following the emergence of the phenomenon of antimicrobial resistance of Salmonella enterica enterica Typhi associated with severe complications, such as intestinal perforations with a significant lethality.
Objectives: Of this antimicrobial resistance, to determine the phenotypic profile, to detect the chromosomal molecular markers (CMMs) such as the class 1 integrons (intl-1) and ESBLs (bla_TEM-1, bla_OXA-1and bla_CTX-M-1) and to measure the association between the phenotypic profile and CMMs of typhoid isolates in concerned areas.
Methods: Salmonella Typhi strains of typhoid epidemic areas were confirmed by serotyping tests. The antimicrobial susceptibility testing was conducted by disc diffusion method using the following commercial antimicrobials: Chloramphenicol-C, Ampicillin-AMP, Sulfamethoxazole-RL and Trimethoprim-W (former first-line antimicrobials), Ciprofloxacin-CIP or Cefotaxime-CTX, Ceftriaxone-CRO, Ceftazidime-CAZ (first-line antimicrobials), Tetracycline-TE, Amoxicillin-Potassium clavulanate-AMC, Nalidixic acid-NA, Cefoxitine-FOX, Gentamicin-CN (varied antimicrobials) and FEP-Cefepime (4GC). The phenotypic antimicrobial resistance profile was determined by Kirby-Bauer diffusion method on Mueller-Hinton agar. To perform the molecular characterization, the Salmonella Typhi isolates DNA has been extracted by Sigma Aldrich kit and the CMMs detection was performed by DNA Engine for PCR test. The association between phenotypic profile and CMMs has been measured by Pearson’s chi-square test.
Results: Out of 320 Salmonella Typhi isolates, 50 were identified conform. The phenotypic profile of antimicrobial resistance was 59.5% in all the Western and Southern regions and 61% in the provinces of Kinshasa City and Bas-Congo to the former antimicrobials of first intention and the mean of CMMs rates were 22.5% and 27.4%, respectively. Those isolates showed a significant resistance profile to AMP, C and RL in those last two provinces.
Conclusion: The rate of phenotypic multidrug-resistance of Salmonella Typhi isolates was more than 50% with the predominance of CMMs in Kinshasa and Bas-Congo. This study suggests to give up the use of AMP, C and RL in those two provinces. This may also indicate that the antimicrobial resistance surveillance system would be one strategy to manage food borne pathogens.

Impact of Coronavirus disease 2019 on macroeconomics and overall development in the Democratic Republic of Congo

Wed, 30 Dec 2020 14:01:05 +0800

Cryptococcus neoformans meningitis in an immunocompetent adult: A case report

Georges Yumba Numbi, Berthe Kamalo Mwad, Olivier Mukuku, Claude Mulumba Mwamba — Wed, 18 Nov 2020 16:51:26 +0800

Neuromeningeal cryptococcosis (NMC) is relatively rare in immunocompetent subjects. We report a Congolese case of NMC diagnosed in an apparently immunocompetent subject. A 35-year-old woman was admitted for acute meningoencephalitis. The cerebrospinal fluid (CSF) examination revealed cytological and biochemical abnormalities and the presence of Cryptococcus neoformans on direct examination with India ink and in culture. The serum dosage of cryptococcal antigens was titrated at 1:32. HIV and syphilis antibodies were negative and the blood CD4 lymphocyte count was 610/mm³. The patient had no other immunosuppressive factors, in particular no hematologic abnormalities, no solid tumor, or malnutrition. She was unsuccessfully treated with fluconazole intraveinously, and died after 10 days of treatment. This observation reminds us that NMC can occur in subjects without apparent immunosuppressive factor with a misleading clinical presentation. It is a rare infection with a severe prognosis even in immunocompetent patients.

Acute renal failure as severe malaria complication in Lubumbashi: Management and follow-up in an under-equipped setting

Mon, 02 Nov 2020 08:42:49 +0800

Purpose Acute renal failure (ARF) or acute kidney injury (AKI) is one of the major criteria for the severity of malaria according to WHO. The objective was to determine the frequency as well as to evaluate the management and follow-up of ARF during malaria in children in Lubumbashi. Material and methods This is a descriptive cross-sectional study over 48 months (January 1st, 2016 to December 30th, 2019) carried out at the pediatric service of the University Clinics of Lubumbashi. All children with an ARF with a positive thick blood smear were included in the study. Data were analyzed with SPSS 19 software. Results During this period, 910 patients (49.1%) were admitted for malaria. Among them, 14 patients, i.e. an intra-hospital prevalence of 0.78%, of which 6 boys (42.9%) and 8 girls (57.1%) had ARF. The mean age is 7.9±3.5 years. The serum creatinine level was between 0.54 and 15.2 mg/dL with a mean of 5.7 mg/dL. Kidney dialysis was only effective in 3 patients (21.4%) and diuretics were given 100% in all children. The mean length of stay was 13.4±8.7 days (range: 1 day and 18 days). Mortality was 21.4%. Conclusion The present study shows that ARF in childhood malaria in Lubumbashi is infrequent but of high mortality in our environment with limited resources where care is lacking and monitoring difficult.