Advances in General Practice of Medicine

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

Thu, 04 Apr 2024 11:00:35 +0800

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

Thu, 22 Feb 2024 17:02:42 +0800

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

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.

The research status and development trend of children health education

Dafang Wang — Sat, 12 Mar 2022 00:00:00 +0800

In pediatric clinical practice, it is found that common and frequently-occurring diseases in children have the characteristics of acute onset, rapid change, aggregation and being preventable and controllable. School health education is particularly important for the prevention and control of common and frequently-occurring diseases in preschool and school-age children. School health education refers to the combination of kindergarten, school and other places of staff advocated by the various learning experience, the development of students from now on to learn to deal with various expected health challenges with necessary cognitive skills and behavioral skills. The former State Education Commission and the Ministry of Health jointly promulgated the "Regulations on School Health Work" in 1980, making our country's school health work followed by regulations. In 1992, the "Basic Requirements for Health Education for Primary and Secondary School Students" was jointly promulgated, which clearly stipulated the objectives and basic contents of health education in primary and secondary schools in China. In 2007, the Central Committee of the Communist Party of China and the State Council in the `Opinions on Strengthening Youth Sports to Enhance the Physical Fitness of Adolescents (Central Document No.7)' required that 'local education administrative departments should include the implementation of health education in schools as one of the important indicators of school supervision and assessment', and 'schools at all levels should actively carry out adolescent health education activities such as disease prevention, scientific nutrition, health and safety, drug control and tobacco control, and ensure the necessary health education time'. Although the health problems of primary and middle school students have received continuous attention and investment from the state and society, the health literacy of primary and middle school students in China has not been significantly improved in recent years, and the overall downward trend of students' health level has not been fundamentally curbed, partly due to China's lagging school health education system. Through literature mining, this paper refines the research focus of foreign health education and the challenges faced by foreign health education. By combing the research progress of health behavior and academic performance, adolescent media cognitive ability and health education workers' health cognitive ability, it reflects the future research direction of health education in China.