Knee Osteoarthritis and Risk Factors Associated

Objective: Report of risk factors associated to knee osteoarthritis to improve management and functional prognosis of patients. Methods and patients: Transversal and analytic survey conducted in Brazzaville University Teaching Hospital (Congo) on 13,041 patients between 2000 and 2012. The diagnosis of knee osteoarthritis was done before a mechanical knee pain and radiological signs according to Kellgren and Lawrence criterias. The functional disability has been appreciated by Lequesne functional pain rate. Results: 200 patients, 42 men (21%), 158 women (79%), sex ratio was 0.26. The average age was 57.4 years old, extremes were 25 - 82 years. The knee osteoarthritis predominated between 60 and 69 years for men (38%) and 50 - 59 years old for women (36%). Body mass index (BMI) average was 29.98 kg/m2. Co morbidities associated were arterial high blood pressure in 106 patients (53%) and diabetes mellitus (28.5%) and alcohol consumption (28%). Tobacco addiction was associated in 12%. 72.15% of women were post-menopausal, with an average length of menopause at 9.6 years. Obesity (45.5%) and overweight (35.5%) were associated with genu varum in 58.7% and genu valgum in 40.1%. Joint fluid was report in 30.5%. The functional disability evaluated by Lequesne functional pain rate was superior to 8 for more of 50% of patients. The knee osteoarthritis was mainly secondary in 81%. Conclusion: Age more than 57 years, female sex and menopause, obesity, genu varum or genu valgum, cardiovascular risk factors, were the main risk factors associated. Diagnosis was done too later and patients had an improvement functional disability.

Working in Psychiatry: Staff Perception of the Brazzaville Hospital and University Center

Background: In Congo-Brazzaville, there is a lake of mental healthcare provider and facilities specialized on psychiatric care: only two psychiatrists and one psychiatric department around the country. Poor appreciation of their role and work environment can negatively impact the esteem of psychiatric staff and lead to stigma and discrimination towards patients. Aims: The study aimed to assess the perception of the staff of the only psychiatric service in Congo. Material and methods: We conducted a cross-sectional descriptive, prospective survey;conducted among the psychiatric staff of the Brazzaville University Hospital in September 2019. An anonymous individual questionnaire was administered to collect: 1) socio-professional data, 2) perceptions (assignment, role, workload and working conditions), and 3) identify the main problems of the service. Averages and frequencies were calculated on Epi info 7.2.2.6. Results: Thirty out of 42 staff had responded (71.4%);16 were male and at their first psychiatric assignment (28/30), with an average age of 44.7 ± 7 and seniority of 8.4 ± 8.3 years. Among them: one psychiatrist, two psychologists, and 19 nurses. Their assignment in psychiatry was well perceived in 93.3% (27/30), as well as their role (the importance of psychiatric care and psychiatry). Working conditions were perceived as poor: precarious hygiene (93.3%), cohabitation with dangerous patients (82.1%), heavy workload due to lack of staff (100%). Of their professional future, 23.3% (7/30) were considering leaving. Conclusion: Almost all psychiatric staff had a good perception of their role and psychiatry, but not of the working conditions. Local measures to improve working conditions must be carried out to improve the attractiveness of psychiatry and the quality of care.

Neurolysis of the Median Nerve to the Carpal Canal by the Way Mini-Open: Review of 68 Files at Brazzaville University Hospital

Objective: To evaluate the results of neurolysis of the median nerve to the carpal tunnel in patients operated by the mini-open technique. Methods: The prospective study included 68 patients (16 men and 52 women) aged 43 to 80 years (mean age: 64 years). Patients were evaluated in pre- and post-operative by a questionnaire. The mini open technique with cutaneous approach to the heel of the hand following the 4th ray was performed in all patients under local, locoregional or general anesthesia. Results: The results were evaluated in 3 consultations, in the 1st, 3rd and 6th month. We obtained very good results in 54.4% of the cases (n = 37) and 30.9% (n = 21) of good results and 14.70% (n = 10) of poor results. No vascular, tendinous or neurological complications were noted. Two patients were reoperated for incomplete resection of the carpal ring ligament. The mini-open technique has achieved good results in all neurolysis despite the delay in surgical management. Conclusion: The results of the surgical treatment of the carpal tunnel syndrome depend on the precocity of the diagnosis and the surgical indication.