Neurocognitive Profile of People Living with Human Immunodeficiency Virus Initiating Treatment in Kinshasa in the Dolutegravir Era, Democratic Republic of Congo

Context: Antiretroviral therapies improve the prognosis of NeuroAIDS contrasting with a high frequency of Minor Neurocognitive Disorders (MND) even in aviremic subjects. Objective: The objective of this study is to present the neurological and cognitive profile of People Living with HIV (PLHIV) initiating antiretroviral treatment in Kinshasa in the era of Dolutegravir (DTG). Methods: This is a multicenter, cross-sectional study with a descriptive aim carried out in 16 HIV Outpatient Treatment Centers (OTC) in Kinshasa from October 4, 2021 to February 15, 2022. The International HIV Dementia Scale (IHDS) correlated with the Activities of Daily Living (IADL) scale facilitated the categorization of NeuroCognitive Disorders (NCD) of PLHIV evaluated after carrying out a summary neurological examination. Results: Of the 96 patients recruited, 56.3% were women with a sex ratio of 0.68. The average age was 40.1 ± 12.1 years. The secondary education level was the majority at 64.6%. Malaria (44.8%) and tuberculosis (32.3%) were more common as opportunistic infections. They were alcoholics in (30.2%). Their history was heart disease (15.6%), high blood pressure (18.8%);drug abuse (10.4%). The IHDS score was light in 55.2% of cases. The correlation between IHDS/IADL watches asymptomatic neurocognitive impairments (ANI) in 77.1%, almost all of subjects are found with normal overall functioning (94.8%) and a disturbed neurological examination in 53.1% of cases with a predominance of motor impairments in 79.1%. Conclusion: In view of these results, early and systematic screening of NCD and associated factors remains necessary in our context. .

Profile of People Living with Human Immunodeficiency Virus Initiating Treatment in the Dolutegravir Era in Kinshasa, Democratic Republic of Congo

Background: For several decades, the introduction of AntiRetrovirals (ARVs) has improved the symptomatology of People Living with HIV (PLHIV), a spectacular reduction in morbidity and mortality, an improvement in life expectancy and quality of life of PLHIV. Objective: The objective of this study was to determine the profile of PLHIV initiating AntiRetroViral Treatment (ART) in the era of Dolutegravir in Kinshasa. Methods: Cross-section of a prospective cohort to determine the profile of PLHIV initiating ART in Kinshasa. The inclusions were from October 04, 2021 to February 15, 2022. Confirmation of the diagnosis was carried out by Nested PCR. The inclusion criteria were: being at least 18 years old, confirmed HIV positive, naïve to ART, consenting and having signed an informed consent. The parameters of interest followed for the present study were: age, sex, religion, level of study, marital status, occupation, height, weight, body mass index (BMI), the clinical profile, the opportunistic infections as well as the para-clinical assessment (biochemistry and molecular biology). Results: 67 (56.3%) women and 52 (43.7%) men were included, thus 119 patients, all confirmed positive for HIV by Nested PCR on the gag, pol and env regions. The average age of the patients included is 39.87 ± 12.36 years and the most represented age group is that of 36 to 45 years with 37 patients (31.9%). The average height was 1.66 ± 0.08 meters, with an average weight of 56.41 ± 13.30 kg, giving an average Body Mass Index (BMI) of 21.54 ± 5.17 kg/m2. The majority of patients were married (46.1%), of Protestant religion (70.7%), with secondary education (66.7%), and working in the informal sector (29.4%). 49 patients (41.5%) were in clinical stage 3 and 55 patients (47.0%) had a normal clinical status. Malaria (45.4%) and tuberculosis (29.4%) were the most common Opportunistic Infections. The mean values of the patients’ assessed biochemical parameters were within the ranges. The median VL value was 4.16 log10 RNA copies/ml. Subtype A (20.2%) is dominant. Mutations K65R (2 cases), T69P/N (5 cases), K70R (9 cases) and M184V (8 cases) were listed. Conclusion: In Kinshasa, PLHIV start ART late. The biochemical parameters evaluated are within normal ranges, with high VLs. Subtype A remains predominant and there are mutations conferring resistance to ART.

Evolutionary Profile of Opportunistic Infections in People Living with Human Immunodeficiency Virus during Six Months of Dolutegravir Based Antiretroviral Treatment in Kinshasa, Democratic Republic of Congo

Background: Opportunistic infections (OI), which are still a major problem in the care of People Living with HIV (PLHIV), occur in situations of immunosuppression. The AntiRetroViral Treatments (ART) used allow a spectacular reduction in the frequency of Opportunistic Infections. Objective: The objective of this study is to present the evolution of Opportunistic Infections in People Living with HIV under AntiRetroViral Treatment in Kinshasa in the era of Dolutegravir. Methods: The present study is a prospective cohort to present the evolutionary profile of OIs in PLHIV on ART for 6 months in Outpatient Treatment Centers (OTC) in Kinshasa. Sixteen OTCs had been included. The population of the present work was patients over 18 years of age at inclusion, infected with HIV-1 and initiating ART in the selected OTC. Results: On inclusion, 119 patients were included of which 56.3% were women. Malaria (45.4%), tuberculosis (29.4%) and cutaneous pruritus (23.5%) were the most common Opportunistic Infections (OIs). In the third month of ART, 37 patients came for the consultation of which 70.3% were women. Non-specific STIs (97.3%), skin pruritus (37.8%) and malaria (24.3%) were the dominant OIs among patients. At the sixth month of ART, 62 patients came for the medical consultation of which 61.3% were women. Skin pruritus (25.8%), dermatitis (22.6%) and rash (21%) were the most common OIs. Conclusion: The evolutionary profile is marked by the conservation of Opportunistic Infections such as dermatitis (pruritus and rashes) and malaria.

Biological Profile of People Living with Human Immunodeficiency Virus Starting Treatment in Kinshasa, Democratic Republic of the Congo

Context: The biochemical assessment is a real-time indicator of the state and evolution of an infection. Among other things, it makes it possible to determine the right moment when it becomes necessary to start or change a treatment. Objective: The objective of this study is to present the Biological profile of People Living with HIV starting AntiRetroViral treatment in Kinshasa in the era of Dolutegravir. Methods: The present study is a descriptive cross-sectional to determine the biological profile of People Living with HIV (PLHIV) starting AntiRetroViral Treatment (ART). The patient inclusion period was from October 4, 2021 to February 15, 2022. Sixteen centers were included. A sample of 5 ml of blood was taken in a tube with EDTA. Patients were randomly included consecutively in the centers during consultations. The population was made up of adults aged over 18, infected with HIV and starting ART. The parameters of interest retained for the present study were: sex, age, hemoglobin level, blood sugar, urea, creatinine, transaminases, total cholesterol, triglycerides, proteins total, as well as amylase. Results: 119 patients were included in this study in accordance with the inclusion criteria;67 (56.3%) are female, giving a sex ratio of 1.29 in favor of women. The average age of the patients is 39.87 ± 12.36 years. The most represented age group is that of 36 to 45 years with 37 patients (31.9%). The mean values of the biological parameters of the patients at the start of ART are as follows: 31.61 ± 20.71 IU/L for ALT/SGPT, 25.81 ± 19.96 IU/L for AST/SGOT, 79.35 ± 49.49 IU/L for Amylase, 108.13 ± 62.17 mg/dl for Total Cholesterol, 2.77 ± 1.27 mg/dl for Creatinine, 72.53 ±22.23 mg/dl for Glycaemia, 10.30 ± 2.33 g/dl for Hemoglobin, 7.91 ± 1.75 g/dl for Total Protein, 131.23 ± 68.80 mg/dl for Triglycerides, and 33.61 ± 26.27 mg/dl for Urea. Conclusion: Mean values of PLHIV are, for the most part, within the normal range. The average creatinine is higher than the normal average value while the average total cholesterol is below the limit values.

Compliance with First-Line AntiRetroViral Treatment (ART) for HIV Infection in the Era of Dolutegravir in Kinshasa, Democratic Republic of the Congo

Context: Two years after the transition to Dolutegravir (DTG), at the national level, data on compliance with the execution of this transition and the rational use of the new molecule are not available. Objective: The objective of this study was to determine compliance with first-line ART prescriptions among People Living with HIV starting AntiRetroViral treatment in Kinshasa during the Dolutegravir era. Methods: This study is a descriptive cross-sectional study to determine compliance with first-line ART prescriptions among people living with HIV during the Dolutegravir era in Kinshasa. Sixteen Outpatients Treatment Centers (OTCs) were included in the study for their expertise in the care of PLHIV, their technical collection platform and their accessibility. The parameters of interest were: age, sex, outpatient treatment centers, and medical prescription. Results: One hundred and nineteen (119) patients were included in this work in accordance with the inclusion criteria;67 (56.3%) are female, giving a sex ratio of 1.29 in favor of women. The average age of the patients included is 39.87 ± 12.36 years with extremities of 18 to 69 years. The most represented age group is that of 36 to 45 years with 37 patients (31.9%). One hundred and nineteen (119) patients were received from 16 centers in Kinshasa, according to 6 OTC for the district of Funa, 4 OTC for Tshangu and 3 OTC respectively for Lukunga and Mont-Amba. All the centers respect the new recommendations of the National Program;all patients (100%) are on the Tenofovir (TDF) + Lamivudine (3TC) + Dolutegravir (DTG) combination. Conclusion: Compliance with the prescription of DTG as a first-line ARV in the DRC is effective in the city province of Kinshasa.

Virological and Molecular Profile of People Living with the Human Immunodeficiency Virus Starting Dolutegravir Based Antiretroviral Treatment in Kinshasa, Democratic Republic of Congo

Context: Despite the new recommendations “Test and Treat”, the virological and molecular parameters remain important information for Antiretroviral Treatment and adequate for monitoring of patients infected with HIV/AIDS. Objective: the Objective of this study is to present the virological and molecular profile of People Living with HIV starting Antiretroviral Therapy in Kinshasa in the era of the Dolutegravir. Methods: This was a transversal study to determine virological and molecular profile of People Living with HIV (PLHIV) starting an ARV Treatment. The patient’s inclusion period was from October 04, 2021 to February 15, 2022. A sample of 5 ml of blood was taken in a tube with EDTA anticoagulant for Molecular Biology analyzes (Viral Load and Sequencing) in all HIV patients, after reading and signing informed consent. The population was made up of adult patients over the age of 18, infected with HIV and starting ART. Results: 119 patients (56.3% of women) were included in this study, thus a sex-ratio of 1.29. The average age of patients included was 39.87 ± 12.36 years. The most represented age group is that of 36 to 45 with 37 patients (31.9%) followed by that from 26 to 35 years with 24 patients (20.7%). Out of 119 patients, 21 patients had an undetectable Viral Load (VL). The median value of VL was 4.16 log10 RNA copies/ml. 114 samples were successfully amplified. Subtype A was dominant with 23 cases (20.2%);followed by the subtype C and CRF02_AG each with 14.0%, and D (10.5 %). K65R (1.8%), T69P/N (4.4%), K70R (7.9%) and M184V (7.0%) mutations were listed as existing mutations for Nucleotide Transcriptase Inhibitors. Conclusion: 38 patients (31.93%) started the TARV with a positive virological prognosis. The subtype A remains dominant in Kinshasa with 23 cases (20.2%);followed by the subtype C and CRF02_AG each with 14.0%. For Inhibitors of Transcriptase Reverse Nucleotide;K65R, T69P/N, K70E/R and M184V mutations were found in patients’ naive of ARV Treatment.

Rationale of Longitudinal Cohort Study on Obstetrical Outcomes of Trichomonas vaginalis Infection in Kinshasa, DR Congo

Background: Trichomoniasis is the most common non-viral sexually transmitted infection (STI) in the world, and the occurrence of this infection during pregnancy is responsible for adverse obstetrical outcomes like premature labor, premature rupture of membranes (PROM) and low birth weight (birth weight < 2500 g). The association with a number of factors (maternal age, low level of education, low socio-economic status and multiple sexual partners, etc.) that can be found in our environment suggest its probably high prevalence amongst vaginal infections that are responsible for adverse obstetrical outcomes, but up-to-date estimates are lacking. Objective: To assess the obstetrical risk associated with Trichomonas vaginalis (T. vaginalis) infection in our environment. Methods: We designed a protocol for a prospective cohort study which will take place in four medical facilities in the city of Kinshasa, where all pregnant women with a pregnancy of at least 20 weeks and who will give written consent will be included. Vaginal swab specimens will be collected for T. vaginalis research by direct microscopy wet mount. Follow-up will consist of recording the process of the pregnancy and obstetrical outcomes. Conclusion: Results from this study will allow to enhance management and also bring updated estimates on T. vaginalis prevalence and its obstetrical outcomes for infected pregnant woman in our environment.

Rationale of a Cross-Sectional Descriptive Study on Associated Factors and Prognosis Maternal-Fetal Links to Early Onset Preeclampsia at the University Clinics of Kinshasa, DR Congo

Background: Preeclampsia (PE) is one of the forms of hypertensive diseases that occur during pregnancy. Early-onset preeclampsia (EOP), which occurred before 34 weeks, proved to be the deadliest. Indeed, it is characterized by a poor maternal and fetal prognosis. EOP has a disparate incidence in the world varying between 0.9% and 31%. Several risks factors are associated with the occurrence of EOP, which is responsible of several adverse obstetrical outcomes. Complications can affect up to 85% of pregnant women with EOP, especially when EOP appears very early, before 28 or even 25 weeks’ gestation. Objectives: To determine frequency of EOP at the University Clinics of Kinshasa, to describe sociodemographic and clinical characteristics of pregnant women with EOP and to identify its risks factors and its association adverse obstetrical outcomes. Methods: The study will be a cross-sectional analytical study in University Clinics of Kinshasa from January 2016 to December 2022. The minimal size will be 119. Our study population will consist of pregnant women who consult for antenatal best care and are neonates in our Clinic. Result will be presented as percentage proportion. Comparison and proportion means between groups will be made using Student’s test and Pearson’s chi-square test, respectively. Our test will be statistically significant for a p-value ≤ than less 0.05. Data will be collected and analysed anonymously and confidentiality. Conclusion: We believe that our study should enable us to identify profile of gestational carriers at risk of EOP in our environment, as well as prognosis associated with this entity, with a view to arousing particular interest in EOP.

A Pilot Study about the First Cases of Coronary Angioplasty in Democratic Republic of Congo/Kinshasa: Patient Profile

Background: The objective of this pilot study was to describe clinical profile, electric, echocardiographic and angiographic caracteristics with procedural outcome of congolease patients undergoing coronarography in the first and only one cardiac catheterization center opened in Kinshasa. Methods: An analytical cross-sectional study was carried out over a period from October 2019 (date of establishment of the first coronary angiography unit in DR Congo) to March 2021. We proceeded to a serial sampling of the consecutive cases of all the patients who have an angiographic exploration of coronary arteries. Clinical, ECG and cardiac ultrasound data were collected in all patients. The indications for the coronary angiography examination were set by differents cardiologists on the basis of repolarization troubles in the electrocardiogram, cinetic troubles in echocardiography, positive stress test and chest pain in patients with cardiovascular risq factors. Results: The serie (47 patients) was predominantly male with a sex ratio M/W of 2.6. The average age was 59.8 ± 10.5 years. Arterial hypertension (HBP) was the main risk factor (89.4%);followed by diabetes mellitus (14.9%). Chest pain was the main functional sign with an atypical character in 44.7%. The ECG showed ST segment depression (17%) and T wave inversion (17%), the anterior region being the most affected. Hypokinesia was the most common echocardiographic abnormality (34%), followed by akinesia (10.6%). The anteroseptal and apical territories were affected in 12.8%. Dilated myocardiopathy (DMC) was significantly predominant in the male sex (29.4% vs 7.7%;p = 0.011). With radial puncture as the main approach, coronary angiography was pathological in 44% revealing mono-truncal lesions. The left coronary network was the most affected: the middle inter ventricular artery (12.8%), the proximal interventricular artery (10.6%) and the proximal circonflex artery (10.6%). In multivariate logistic regression analysis, age (for age > 50 years for men and >60 years for women), arterial hypertension and dilated cardiomyopathy emerged as independent determinants of pathological coronary angiography. Transluminal angioplasty was performed in 27.7% of patients. The bypass indication was retained in 4.3% of cases and medical treatment in 68%. Conclusion: Coronary angiography was used to diagnose lesions responsible for ischemic heart disease and to treat 27.7% of patients locally. The young age of patients and limited financial resources encourage the strengthening of preventive measures against cardio vascular risq factors.

Fatty Acid Composition of Hazelnut Kernel Oil from Coula edulis Collected in the Republic of Congo

Coula edulis is non-timber forest product (NTFP) used in Africa for its hazelnuts, which contain edible seeds with a demonstrated nutritional potential. However, there have been very few scientific studies of this species in the Republic of Congo. Thus, the aim of the current study was therefore to determine the fatty acid composition of the oil extracted from Coula edulis hazelnut seeds collected at random in the Republic of Congo. The oil was extracted using the Soxhlet method and its fatty acid composition was determined by gas chromatography. The extracted oil from Coula edulis hazelnut kernels is rich in monounsaturated fatty acids (95.28%), particularly oleic acid (94.5%), which classifies it as an oleic oil and gives it interesting nutritional and therapeutic properties. On the other hand, saturated fatty acids (4.15%) and polyunsaturated fatty acids (0.35%) are not well represented. Its low poly-unsaturated fatty acid content makes it more stable when stored at room temperature.

Epidemiological and Paraclinical Aspects of Helicobacter pylori Infection among Hepatitis B Virus Carriers in the Republic of Congo

Objective: Describe the epidemiological and paraclinical aspects of HP infection in hepatitis B virus carriers. Population and Method: This was a descriptive cross-sectional study running from January 1 to August 30, 2019, a period of 8 months. It took place in the Hospital Centers of the two major cities of Congo (Brazzaville and Pointe-Noire). The target population of our study consists of patients carrying HBV under antiviral treatment or not. Patients aged at least 18 years and consenting with a biological and morphological assessment were included. We did not include in our study patients taking or having taken antibiotics and/or PPIs less than 4 weeks ago. We excluded all patients who did not deposit fresh stools and those in whom stool extraction could not be done manually. The variables studied covered sociodemographic, clinical and paraclinical aspects. Data entry was done using Excel 8.0 software. Statistical analysis was carried out with SPSS 20.0 software. Results: During our study, we included 169 patients. The frequency of HPAG in the stools of HBV carriers in our study population was 63.9% (n = 109). Male patients represented 69% (n = 75) and female patients represented 31% (n = 34). The average age of the patients is 43.92 ± 13.51 years with extremes of 18 years and 80 years. Concerning profession, unemployed patients and those working in the private sector were the most represented in respectively 28.4% (n = 31) and 22.9% (n = 25) without statistical link. Households comprising between 4 - 10 people and the use of public latrines were the risk factors most represented in respectively 69% (n = 75) and 88% (n = 96) without statistical link. Clinically, hepatomegaly and signs of portal hypertension were most represented in 53% (n = 58) and 47% (n = 51). Biologically, HBV DNA was detectable in 60.5% of cases (n = 66).

A green cross-linking method for the preparation of renewable threedimensional graphene sponges for efficient adsorption of Congo red dye

Graphene-based materials possess significant potential for the treatment of dye wastewater due to their exceptional adsorption properties toward stubborn pollutants.However,their utilization is hindered by high preparation costs,low yields,environmental pollution during synthesis,and challenges in regenerating the adsorbent.This study proposes a novel approach to address these limitations by developing nitrogen-doped three-dimensional(3D)polyvinyl alcohol(PVA)crosslinked graphene sponges(N-PGA)using a cross-linking method with ammonium carbonate.This method offers a relatively mild,environmentally friendly approach.Ammonium carbonate serves as both a reducing and modifying agent,facilitating the formation of the intrinsic structure of N-PGA and acting as a nitrogen source.Meanwhile,PVA is utilized as the cross-linking agent.The results demonstrate that N-PGA exhibits a favorable internal 3D hierarchical porous structure and possesses robust mechanical properties.The measured specific surface area(BET)of N-PGA was as high as406.538 m^(2)·g^(-1),which was favorable for its efficient adsorption of Congo red(CR)dye molecules.At an initial concentration of 50 mg·L^(-1),N-PGA achieved an impressive removal rate of 89.6%and an adsorption capacity of 112 mg·g^(-1)for CR dye.Furthermore,it retained 79%of its initial adsorption capacity after 10 cycles,demonstrating excellent regeneration performance.In summary,the synthesized N-PGA displays remarkable efficacy in the adsorption of CR dye in wastewater,opening up new possibilities for utilizing 3D porous graphene nanomaterials as efficient adsorbents in wastewater treatment.

Epidemiological and Histopathological Profile of Prostate Cancer: A Retrospective Study in the Pathology Department of the University Clinics of Kinshasa

Background: Prostate cancer, the most common male cancer, represents a real public health problem in terms of its frequency and severity in different countries around the world. It disproportionately affects people of African descent wherever they live in the world [1]. To the best of our knowledge, its extent and particularities in the African environment are not well known. Objective: To determine the epidemiological and histopathological profile of prostate cancer in the CUK anatomopathology department. Methodology: This is a retrospective study conducted at the University Clinics of Kinshasa Anapathology Department from January 1, 2015 to December 31, 2022, a period of 8 years. Word processing and tables were entered using the Hp brand computer, with Microsoft Office WORD 2016 software. Data analysis was performed with SPSS version 22.0 software. Results were presented in tables and figures. Results: Prostate was diagnosed in 132 cases, i.e. 1.58% of all CUK laboratory analyses and 8% of cancers diagnosed. The age group most affected was 66-75 years, i.e. 59% of all subjects. Adenocarcinoma was the most frequent histological type, and biopsy dominated in 111 cases (84.1%). Conclusion: Prostate cancer is a real public health problem. Worldwide, and in the Democratic Republic of Congo, it is the most frequently diagnosed cancer in men, and the leading cause of cancer-related death in men. In the DRC, because of the delay in consulting our patients and the weakness of systematic screening, patients are seen at an advanced stage of the disease. Treatment is multidisciplinary, involving surgery, radiotherapy and chemotherapy (including targeted therapies). Patient awareness and screening campaigns will help to considerably reduce the delay in diagnosis and the morbidity and mortality associated with prostate cancer.

Evaluation of the Quality of Life of Patients Suffering from Chronic Rhinosinusitis in a Hospital Setting in Kinshasa

Background and objective: Chronic rhinosinusitis (CRS), a common disease worldwide, has a major impact on patients’ quality of life (QoL). In recent years, the measurement of health-related QoL has made it possible to assess the patient’s state of health, the severity of the CRS and the treatment. The aim of this study was to assess the QoL of patients with CRS in a hospital setting in Kinshasa. Methods: This was a cross-sectional analytical study conducted from June 2020 to May 2021 in the ENT service of the Kinshasa University Hospital and the Monkole Hospital Center. The study involved 113 patients aged at least 18 years, whose QOL was compared with that of a control group consisting of 100 non-patients. QOL was assessed using the Sino-Nasal Outcome Test (SNOT-22) Questionnaire. Results: The mean age of the patients was 41.0 years (18 - 74 years) and that of the controls was 39.1 years (19 - 77 years). More than half of the participants were university graduates. The median SNOT-22 score was 44 (14 - 78) in patients and 7 (1 - 40) in controls. Compared with subjects without CRS, patients with CRS had significantly higher scores in all four domains of the SNOT-22. Around 9 out of 10 patients had a severely impaired QoL compared with 2 out of 10 controls. Considering mildly impaired QoL, we found that in the otological and sleep domains, scores were not significantly different between patients and controls. In the case of severely impaired QoL, however, only the otological domain showed a non-significant difference in scores between the two groups. Conclusion: CRS is a real public health problem in our environment and significantly alters the QoL of patients suffering from it, with repercussions on their professional productivity;hence the need for better management.

Coordination of Regulation Devices for Damping Power Oscillations in a Dynamic Disturbance Context: A Fuzzy Logic-Based Approach Applied to the Electrical Grid of the Republic of Congo

This article presents a fuzzy logic-based approach to coordinate the control devices of the power system, such as Power System Stabilizers (PSS) and Static Synchronous Compensators (STATCOM), to damp power oscillations caused by dynamic disturbances. At first, we used the Lyapunov method to study the dynamic stability of the power grid in the Republic of Congo. This method allowed us to analyze the eigenvalues of the state variable matrix and highlight the eigenvalues in the complex plane. Secondly, we proposed a fuzzy logic-based controller to account for uncertainties existing near the thresholds. The inputs to this controller are the generator speed and generator rotor angle. We demonstrated the effectiveness and feasibility of this fuzzy control by applying it to the power grid of the Republic of Congo, with three power stabilizers and two STATCOMs. .

Toxoplasmosis among pregnant women:High seroprevalence and risk factors in Kinshasa,Democratic Republic of Congo

Objective:To determine the seroprevalence of toxoplasmosis in pregnant women,as well as the proportion of acutely infected and risk factors in the Democratic Republic of Congo.Methods:Thirty maternities in Kinshasa were randomly selected and women attending antenatal consultation were invited to participate.They were interviewed with a structured questionnaire about known risk factors(age,meat consumption,contact with soil,and presence of cat)and a venous blood sample was taken.Sera were analysed for total immunoglobulins(Ig)by VIDAS Toxo Competition using Enzyme Linked Fluorescent Assay.IgM was determined by VIDIA Toxo IgM and IgG avidity by VIDAS Toxo IgG avidity.Results:A total of 781 women were included.Median age was 28 years old(IQR:8.S).And 627women(80.3%;95%CI:77.5-83.1)were found to be positive to total Ig and 17 out of 387(4.4%;95%CI:2.3-6.4)were positive to IgM.IgC avidity was low for 2(11.8%)women,intermediate for 2(11.8%)and high for 13 women(76.4%).There was no statistically significant association between Toxoplasma gondii infection and any risk factors assessed.Conclusion:In Kinshasa,toxoplasmosis endemicity is highly prevalent.One woman out of twenty five had a recent toxoplasmosis infection and 20%were not protected against primoinfection,indicating a need for measures to prevent and control toxoplasmosis during pregnancy.

Profile of retinal diseases in adult patients attending two major eye clinics in Kinshasa,the Democratic Republic of Congo

AIM:To determine the frequency and types of retinal diseases and the extend of the related visual loss in adult patients attending two public eye clinics of Kinshasa,Democratic Republic of Congo.METHODS:Review of medical records of patients with retinal diseases seen in the major eye clinics in Kinshasa,the University Hospital of Kinshasa(UHK)and Saint Joseph Hospital(SJH),from January 2012 to December 2014.Demographics and diagnoses were retrieved and analyzed.Outcome measures were frequency and prevalence of retinal diseases,blindness and low vision.RESULTS:A total of 40965 patients aged 40 y or older were examined during this period in both clinics.Of these,1208 had retinal disease,giving a 3-year and an annual prevalence of 3%and 1%,respectively.Mean age was 61.7±10.7 y,and 55.8%of the patients were males.Arterial hypertension(68.1%)and diabetes(43.3%)were the most common systemic comorbidities.Hypertensive retinopathy(41.8%),diabetic retinopathy(37.9%),age-related macular degeneration(AMD;14.6%),and chorioretinitis and retinal vein occlusion(7.3%each)were the most common retinal diseases,with 3-year prevalence rates of 1.3%,1.0%,0.43%,and 0.21%respectively.Bilateral low vision and blindness were present in 26.8%and 8.4%of the patients at presentation.Major causes of low vision and blindness were diabetic retinopathy(14.8%),AMD(4.9%),retinal detachment(2.8%),and retinal vein occlusion(2.5%).The prevalence was significantly higher among males than females,and at the UHK than SJH.CONCLUSION:Retinal diseases are common among Congolese adult patients attending eye clinics in Kinshasa.They cause a significant proportion of low vision and blindness.

Baseline Iron Status and Indices of Oxidative Stress in a Cohort of Pregnant Women in Kinshasa, DR Congo

Objective: To determine baseline iron and oxidative status in a cohort of pregnant women before iron supplementation in our setting. Background: Screening of iron deficiency before supplementation during pregnancy has been scarce. Therefore, following routine iron supplementation confounding results might be found in outcomes of groups of patients considered. Taking in account that body/serum iron status is reportedly linked to maternal oxidative status, we aimed to associate assessment of baseline iron and oxidative status of women in need of oral supplementation during pregnancy. Methods: This is a cross-sectional study concerning 74 women attending antenatal care at the University Clinics of Kinshasa from September 2017 throughout June 2018, with a singleton pregnancy not exceeding 19 weeks, regardless of age and parity. Variables of the study included sociodemographic and anthropometric ones along with parameters of iron status (hemoglobin, hematocrit, ferritin, serum iron, transferrin and iron saturation capacity). Oxidative status was assessed using superoxide dismutase (SOD) and uric acid as antioxidants, while oxidant agents were oxidized LDL and blood glucose (beside serum iron and ferritin). According to local standards anemia was defined as hemoglobin 10 g/L and pathologic serum ferritin as 15 ng/ml. For statistical calculations we used t-test, chi-square test and Pearson’s correlation test, the significance being stated at p ≤ 0.05. Results: At recruitment (15.9 ± 1.7 9 week gestational age) mean hemoglobin value of the overall study group was 10.3 ± 1.5 g/dl. Anemia was diagnosed to 39 women that represented 52.2% of the study group, most of anemic women belonging to low socioeconomic sub-group (69.2% vs 29%;P < 0.001). The majority was para 2, with average weight of 70.2 ± 14.5 Kg (P not significant between sub-groups) and BMI of 26 ± 5.2 Kg/m2 (P < 0.01). The proportion of obeses was 18.9%. The proportion of intestinal parasitosis was significantly higher among anemic women (61.5% vs 34.3%;P < 0.02) that had lower alimentary iron intake (22.8 ± 4.9 gr/day vs 31.4 ± 9.5 gr;P < 0.001). Of markers of iron status serum ferritin and iron were lower in anemic women (7.5 ± 3.9 ng/ml vs 35.7 ± 17.1 ng/ml;P < 0.001 and 52.7 ± 38.9 μg/dl vs 96.2 ± 41.8 μg/dl, respectively. Both sub-groups were similar in serum transferrin. As of markers of oxidative stress anemic women had significantly higher superoxide dismutases (SOD) (1056.4 ± 762.1 UI/L vs 682.6 ± 543.9 UI/L (P < 0.02) and oxidizedd anti LDL Ac (439.6 ± 209.5 UI/L vs 192.8 ± 136.3 UI/L (P < 0.001). Serum iron, ferritin, SOD and oxidized LDL were more likely to assess iron and oxidative status in our setting. Conclusion: The rate of anemic mothers found in our study (52.2%) has been quite constant in our setting for years, meaning endemicity. Serum iron and ferritin were significantly lower in anemic women, which is supportive of routine iron supplementation during pregnancy. Significantly higher level of SOD and oxidized LDL in anemic women suggests that maternal anemia may count into oxidative stress likely to be found in these women.

Maternal and perinatal outcomes of induction of labor at term in the university clinics of Kinshasa, DR Congo

Objective: This paper aims at assessing outcomes following induction of labor and characteristics likely to predict vaginal delivery. Study design: This is a descriptive retrospective cohort study including all women with singleton pregnancies who delivered at term in the university clinics of Kinshasa, DR Congo, from January 01, 2006 until December 31, 2010. Induction was initiated regardless of cervical status. Methods of induction included: oxytocin perfusion, vaginal Misoprostol, intracervical insertion of the Foley catheter and amniotomy. Results of induction were compared in terms of failure of labor, cesarean section, fetal distress, and neonatal distress. Logistic regression was used to seek for independent contributing factors for adverse outcomes. Results: During the period of the study 115 patients at term (3.2%) were concerned with induction of labor. Means for maternal age, gestational age and weight at confinement were 30.5 ± 5.7 years, 37.95 ± 1.54 weeks and 69.3 ± 15.1 kg, respectively. The mean parity and gravidity were 2.4 ± 1.9 and 2.9 ± 1.9, respectively. The mean Bishop score was 6.2 ± 1.5 at the first induction, with 66 women (57.3%) having less than 7. Indications for induction were: preeclampsia (52 = 54.1%), premature rupture of membranes (34 = 29.5%), post term (17 = 14.6%), gestational diabetes (5 = 4.3%), stillbirth (5 = 4.3%), polyhydramnios (3 = 2.6%) and cardiopathy (1 = 0.8%). Methods of induction at the first attempt included: oxytocin (86 = 74.7%), vaginal misoprostol (20 = 17.3%), transcervical Foley catheter balloon (14 = 12.1%), and amniotomy (1 = 0.8%). Failure to induce uterine contraction at the first attempt was noted in 9/115 (7.8%) women. Vaginal delivery occurred in 78 (66.9%) women, and cesarean section in 34 (29.6%). The majority of cesarean sections were performed at the primary induction, most of them (29/34 = 85.3%) in women with bad Bishop score. Failure of induction was more likely to occur in association with high maternal weight (OR 6.8;CI 1.2 - 39.7), and somewhat birth weight (OR 2.1 but CI containing 1). Risk for cesarean section was increased in association with induction of labor in cases of high maternal weight (OR 10.3, CI 16.0 - 67.0), and somewhat of high birth weight (OR 2.3, but CI containing 1). Fetal distress was associated only with maternal weight (OR 15.7, CI 1.3 - 187.8), and neonatal distress only with Bishop score (OR 10.9, CI 1.1 - 108.0). Conclusion Induction of labor in our setting in order to get vaginal delivery is affected of a high risk of adverse outcomes such as failure of induction, cesarean delivery, fetal and neonatal distress. This risk is significantly influenced by maternal weight, birth weight and Bishop score. Lack of worse outcomes between the first and the subsequent attempts to induce labor can be regarded as a reason to try induction even in the presence of unfavorable cervix.

Routine Iron Supplementation during Pregnancy: Its Reflection on Iron and Oxidative Status in a Cohort of Pregnant Women in Kinshasa, DR Congo

Background:?Due to maternal and fetal physiologic demand, the rate along with amplitude of anemia is expected to rise over pregnancy. The iron and oxidative status also are expected to vary accordingly. It is thus assumed that iron supplementation will somewhat modify the profile observed in markers of iron and oxidative status of our series. Objectives: We aimed to measure variations of indices of iron and oxidative status of iron supplemented women over pregnancy. Methods: This is a prospective observational cohort of 74 pregnant women with singleton pregnancy whose baseline iron and oxidative status have been recently assessed at University Clinics of Kinshasa, DR Congo. Women with anemia (Hb < 10 g%) took iron for curative purposes (320 mg/day of ferric ammonium citrate) while the others received preventive iron supplementation (160 mg/day). Iron was associated with 15 mg folate/day. Nutritional iron intake was measured through a 24-hour recall using a questionnaire of common foods, including stuffs and habits likely to impede iron absorption. Biological parameters of iron and oxidative status included hemoglobin, hematocrit, ferritin, serum iron, transferrin, superoxide dismutase or SOD, uric acid, oxidized LDL and blood glucose. For statistical calculations we used t-test, chi-square test, ANOVAR and regression, the significance being stated at p Results: Trimester wise evolution of hematologic status in anemic women shows a rise in values of hemoglobin (+average 1 gr/dl) and hematocrit (+3%) throughout pregnancy, with significant change only between recruitment and 28 - 32 weeks. In non anemic women a significant decrease was observed, although levels remained normal. For ferritin (7.5 - 53 ng/mL from recruitment to term) and transferrin (107 - 157 g/L), significant rise was found in anemic women from recruitment to 28 - 32 weeks, while in non anemic notable change occurred only for transferrin (133 - 204 g/L). Serum iron significantly increased (53 - 83 μg/dL) from recruitment to 28 - 32 weeks in anemic women only. So, following supplementation, values of blood parameters tended to be similar for both goups at term. Non anemic women did not benefit from supplementation. SOD decreased and LDL values increased alongside supplementation. This represents a growing oxidant threat for both anemic and non anemic women. This could be related to iron overload and/or unabsorbed iron. Conclusion: Iron supplementation improved iron status in anemic women, not in non anemic. Differences that were significant between groups at recruitment disappeared by 28 - 32 weeks. Non anemic women did not benefit from supplementation. SOD decreased and LDL values increased alongside supplementation. This represents a growing oxidant threat for both anemic and non anemic women. This could be related to iron overload and/or unabsorbed iron. Doses of iron should be decreased (at least halved) and duration of treatment restricted to not more than 12 weeks.