Clinical, Biological, Immunological and Therapeutic Profile of Patients Co-Infected with HIV-HBV and/or HCV in Kinshasa, in the Democratic Republic of the Congo: Multicenter Cross-Sectional Study

Background and Objective: HIV infection is often associated with HBV and HCV infection, together leading to high morbidity and mortality in developing countries. The objective of this study is to describe the clinical, biological, immunological and therapeutic profile of patients co-infected with HIV-HBV and/or HCV. Methods: A cross-sectional and descriptive study including 180 people living with HIV (PLWHIV) in the city of Kinshasa province was conducted. Socio-demographic, clinical, biological and serological characteristics were analyzed. Results: The frequency of HIV-HBV/HCV co-infection was 23.9%. The distribution of age and sex of patients did not differ significantly according to co-infection status. The notion of pedicure and manicure was significantly more observed in patients free from viral hepatitis (51.1% versus 32.6%, p = 0.034). The median duration of knowledge of the HIV status which was longer in the co-infected (4 years versus 2 years, p = 0.022). A lower median level of GPT was observed in co-infected compared to other patients (14 IU/L versus 20 IU/L, p = 0.041). Serum albumin (3.1 g/L versus 3.3 g/L, p = 0.034) and prothrombin (58.3% versus 65.6%, p = 0.045) were lower in HIV co-infected-VHB and/or VHC. The median INR was higher in co-infected than in other patients (1.6 versus 1.4;p = 0.009). Patients without therapy Antiretroviral (TARV) medication were more numerous in co-infected (20.9% versus 8.0%, p = 0.025). Conclusions: The profile of PLWHIV was dominated by the presence of pedicures and manicures with high transaminases and without anti-viral treatment.

Genetic diversity and occult hepatitis B infection in Africa: A comprehensive review

BACKGROUND Occult hepatitis B infection(OBI)is a globally prevalent infection,with its frequency being influenced by the prevalence of hepatitis B virus(HBV)infection in a particular geographic region,including Africa.OBI can be transmitted th-rough blood transfusions and organ transplants and has been linked to the development of hepatocellular carcinoma(HCC).The associated HBV genotype influences the infection.AIM To highlight the genetic diversity and prevalence of OBI in Africa.METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a comprehensive search on PubMed,Google Scholar,Science Direct,and African Journals Online for published studies on the prevalence and genetic diversity of OBI in Africa.RESULTS The synthesis included 83 articles,revealing that the prevalence of OBI varied between countries and population groups,with the highest prevalence being 90.9%in patients with hepatitis C virus infection and 38%in blood donors,indicating an increased risk of HBV transmission through blood transfusions.Cases of OBI reactivation have been reported following chemotherapy.Genotype D is the predominant,followed by genotypes A and E.CONCLUSION This review highlights the prevalence of OBI in Africa,which varies across countries and population groups.The study also demonstrates that genotype D is the most prevalent.

Morbidity and Mortality during Anaesthesia in Patients with versus without Diabetes: Single-Centre Cohort Study

Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The aim of our study was to evaluate morbidity and mortality during and after anaesthesia in patients with versus without diabetes operated on at Monkole Hospital over the last ten years. Methods: Retrospective cohort study including all patients who underwent all-comers surgery excluding cardiac surgery between 2011 and 2021. Each diabetic patient was matched to 2 non-diabetic controls on age and sex. The evaluation criterion was the frequency of occurrence of at least one perioperative complication and/or death up to day 30. A multivariate analysis using a Cox model was used to determine the factors associated with the occurrence of this morbidity and mortality. The model was adjusted for comorbidities, preoperative hyperglycaemia, ASA score, type of anaesthesia and severity of surgery. Results: A total of 351 diabetic patients (mean age 53.3 ± 14.18 years) and 701 non-diabetic patients (mean age 53.52 ± 14.7 years) were included and analysed. Preoperatively, hyperglycaemia (blood glucose > 180 mg/dl) was observed in 24.3% of diabetic patients compared with 1.6% of non-diabetic patients. The incidence of overall perioperative complications was 25.6% in diabetic patients compared with 28.6% in non-diabetic patients (p = 0.27). The risk factors associated with this morbidity were general anaesthesia with oro-tracheal intubation vs loco-regional anaesthesia (OR = 3.06 [95%CI: 1.91 - 4.94];p Conclusion: This study shows that there is not significant increase in perioperative morbidity and mortality in diabetic patients compared with non-diabetic ones of similar severity. These results suggest that diabetes itself (excluding associated comorbidities) has only a minor impact on perioperative morbidity and mortality.

Epidemiological profiles of human immunodeficiency virus and hepatitis C virus infections in Malian women:Risk factors and relevance of disparities

AIM:To document the epidemiologic patterns and risk factors of human immunodeficiency virus(HIV)and hepatitis C virus(HCV)infections in Mali in order to develop prevention means for both diseases.METHODS:Two prospective studies were conducted in Bamako in 2009 among 1000 pregnant women(i.e.,young women)who consulted six reference health centers,and in 2010,among 231 older women who attended general practice in two hospitals.Antibody tests and molecular analysis(performed only for HCV)were used to quantify the frequencies of both infections.The data were collected from patients recruited through a questionnaire.Transmission risk factors of both diseases were identified by univariate and multivariate analysis.RESULTS:HCV seroprevalence was 0.2% for young and 6.5% for older women.HIV prevalence was similar in both populations(4.1% vs 6.1%).In older women,the analysis of risk factors highlighted an association between HCV infection and episodes of hospitalization(P < 0.01).The study did not show an association between HIV infection and the variables such as hospitalization,transfusion,tattoo,dental care,and endoscopy.A significant decrease of HIV seroprevalence was detected in young women who used condoms for contraception more than for other purposes(P < 0.01).By contrast,HIV seroprevalence was significantly increased in young women using condoms mainly to prevent sexual infections rather than for contraception(P < 0.01).No HCV/HIV coinfection was detected in our study.CONCLUSION:Risk factors and epidemiologic data of HIV and HCV as well as the absence of co-infection strongly suggest epidemiological disparities between these diseases.

Serum-free culture of H pylori intensifies cytotoxicity

AIM： To perform a long culture passage of H pylori without serum, taking into account its cytotoxicity and the presence of the probable new cytotoxic factor. METHODS： One sample of H pylon 60190 （ATCC 49503） was grown on Brain Heart Infusion （BHI） agar containing 0.5% 2,6-di-O-methyl-β-cyclodextrin without any serum, being passaged 70-100 times every 3-4 d for approximately 2 h, while another sample of H pylori contained 70 mL/L fetal calf serum without 2,6-di-O- methyl-β-cyclodextrin. Their supernatant and extract after 16 h in culture were evaluated for changes in cell morphology and for cell viability using HeLa cells. Furthermore, the characteristics of the probable cytotoxic factor in the extract were examined on partial purification studies and its oytotoxicity was evaluated in various human cells. RESULTS： The supernatant and the extract of the bacterium grown on serum-free medium had strong cytotoxicity compared with those grown on serumcontaining medium. They irreversibly damaged HeLa cells without vacuolation that was altogether different from that of the bacterium when grown with serum. Their cytotoxicity was easily measured by cell viability assay. The probable cytotoxic factor partially purified and detected by chromatography had characteristics difference from that of vacuolating toxin and a broad cytotoxicity toward various cell lines. CONCLUSION： Serum-free long culture method of H pylorl makes its supernatant and its extract cytotoxic enough to be easily measured by cell viability assay. The probable cytotoxic factor has a unique characteristic and might be a new cytotoxin.

Biological properties of differently-aged human keratinocytes:population doubling time growth curve and cell cycle analysis

Objective To explore the biological properties of keratinocytes from differently-aged healthy human beings. Methods Keratinocytes from fetus,teenager and middle-aged groups were separated and cultured. The population doubling time (PDT) and cell growth curve in different cells were compared,and the cell cycles were analyzed by flow cytometry. Results ① In primary culture of keratinocytes,the adherence time in middle-aged group was longer than that in fetus and teenager groups. However,all cell morphology showed no obvious differences. In subculture of keratinocytes,with donator’s age increasing,time of cell adherence prolonged,passage number decreased and differences in cell morphology were obvious. ② The average PDT of keratinocytes was shorter in fetus group than in teenager and middle-aged groups. But difference in cell growth curve between different passages was not observed. ③ Keratinocytes showed G2/M period in fetus group but G0/G1 period in teenager and middle-aged groups mainly. Conclusion As age increases,the biological properties of keratinocytes change obviously.

Abdominal and pelvic adhesions: Possible role of leiomyomas and skin scar anomaly in profiling high risk patients

Background and aims: Adhesions can cause important morbidity including abdominal and pelvic pain, intestinal obstructions, and infertility. When adhesions are formed, there is no efficient method, nowadays, to resolve them, thus the reduction of their prevalence relies on the prevention. Profiling high risk patients for abdominal and pelvic adhesions (APA) is an important step to this prevention. The risk factors of adhesions in our institution, the association between APA, leiomyomas and skin scar anomaly (SSA) were investigated. Methods: A cross-sectional study was conducted from March 1st to June 30th 2013 including patients who underwent laparotomy or laparoscopy. Patients’ characteristics, presence of a SSA and leiomyomas, as related to adhesions, were analyzed. Student’s t, Pearson’s Khi-square, Fisher’s Exact, Mann-Whitney tests and logistic regression were used. P values < 0.05 were considered statistically significant. Results: The frequency of adhesions was 41.74%. Patients had a mean age of 32.69 ± 8.94 years. Those with a previous abdominal surgery (PAS), SSA and leiomyomas had respectively 12 times [OR: 11.98, CI95 (4.63 - 30.97)], 3 times [OR: 2.79, CI95 (1.16 - 6.71) and 2.5 times [(OR: 2.49, CI95 (1.07 - 5.78)] more adhesions. In logistic regression, a PAS and leiomyomas remained associated significantly to adhesions with p = 0.000 and p = 0.037 respectively. Conclusion: In peritoneal adhesions, leiomyomas and SSA are other factors that may allow a cautious selection of high risk patients who must benefit from particular attention during surgery. Further well designed studies are necessary to investigate the accurate clinical relation among those three conditions.

Eating Habits among Lithiasic Patients in Kinshasa, the Democratic Republic of Congo

Introduction: Worldwide, the incidence of kidney stones has been progressively increasing. Various factors can influence the risk of stone formation, including lifestyle and eating habits. The dietary investigation is a standard of care in patients with urolithiasis. The objectives of this study were to determine the dietary habits of lithiasis patients in the city of Kinshasa and to investigate the association between dietary habits and the composition of the stones. Material and Methods: From January 2017 to September 2019, 85 patients attending 8 hospitals participated in the nutrition survey. Various foods commonly consumed in the Democratic Republic of Congo were categorized based on their composition: foods rich in animal proteins, foods rich in calcium, foods high in sugar, foods high in oxalate, and various vegetables and fruits. We also investigated daily water intake. The composition of the collected stones was analyzed by infrared spectrophotometry. Results: The mean (SD) age of patients was 47.1 (14.0) years, 63.5% of patients were males, 75.3% of the patients had stones located in the upper urinary tract, and 7.1% were undernourished. Most of patients consumed vegetables (77.6%), animal proteins (62.4%), and foods rich in oxalate (58.8%). The daily water intake was less than 1500 mL in more than half of the patients (68.2%). Major anhydrous uric acid stones were associated with a high body mass index (p = 0.025). Male patients with a high oxalate diet had more calcium oxalate stones (64.3%) compared to other types of stones (p = 0.041). Conclusion: High consumptions of vegetables and low water intake were linked to the formation of calcium oxalate monohydrate stones. More data are needed to confirm these findings.

Effectiveness of Ionic Correction along with Conventional Physiotherapy in Patients Recovering from Stroke: A Case Study

Background and Aims: Brain damage caused by stroke is associated with sensorimotor and/or cognitive impairment, depending on area of brain affected and the severity of attack. The aims of this study were to show the importance of physiotherapy associated with electrolyte and mineral balance through diet correction in patients recovering from stroke. Methods: This is a follow-up study of two patients with stroke followed at Kinshasa International Hospital Center during period from May 16 to July 1, 2020. The first had received physiotherapy with foods for correction of the existing ionic and mineral deficiency and the second had only received pharmacological management with conservative physiotherapy without making a change in diet. Clinical and electrolyte monitoring was performed at regular intervals in both patients. The variables of interest evaluated in both patients were FIM, MOTOR/SENSORY and Ionic balance. Results: The parameters of FIM, motors and sensory functions were improved during follow-up, however they remained disturbed in the control. Na+, Cl﹣, K+, Ca2+, and ionic Ca+ improved from intake to discharge. The biological parameters deteriorated during follow-up in the control. At Day 1, only K+ which was higher in the control than the case. At discharge, a significant drop in K+ control was noted (4.1 vs 3.4);of Na+ (142 vs 125) and of Cl﹣ (109 vs 85). Conclusion: The results show that ionic balance by diet correction associated with physiotherapy is more effective than conventional physiotherapy associated with pharmacological management.

Diagnostic Performance of SD Bioline, Accurate, Fortress and Encode Compared to the Mindray CLIA 1200i Test in Volunteer Blood Donors at Kinshasa University Hospital

Background and Purpose: The hepatitis C prevalence rate is among the highest the world. Thus, in the context of transfusion safety, WHO has made it compulsory to screen blood bags by rapid diagnostic orientation tests (TROD) validated in regions that do not have the capacity to use more sophisticated technologies. The purpose of this study is to assess the performance of the TRODs commonly used in Kinshasa. Methods: This was a cross-sectional and analytical study carried out from August 26, 2019 to January 20, 2020 in 200 voluntary blood donors at the University Clinics of Kinshasa (CUK). The detection of anti-HCV antibodies was carried out by Mindray (gold standard) and the SD Bioline, Encode, Fortress and Accurate tests. The diagnostic performance of TRODs was evaluated compared to the Mindray test. Results: Of a total of 200 donors, 112 (56.0%) were male versus 88 (44.0%) female with a sex ratio of 1M: 1F. HCV seroprevalences by Mindray, and other tests were 29.5%, 28.0%, 27.0%, 27.0% and 31.5%, respectively;the Se, Sp, VPP, VPN, SD Bioline, Accurate, Fortress and Encode were 74.6%, 92.9%, 81.5%, 89.7%, respectively;74.6%, 92.9%, 81.5%, 89.7%;74.6%, 91.4%, 78.6%, 89.6%;69.5%, 70.0%, 65.1%, 84.4%. Conclusion: The diagnostic performance of TRODs evaluated in this study does not meet European Union standards (Se = 100%;Sp > 99.5%). The Ministry of Health should promote large-scale validation of TRODs based on World Health Organization guidelines.

Turning up the NAD^(+)-mitophagy axis to treat Alzheimer's disease

The increase in the prevalence of individuals with Alzheimer's disease(AD)combined with the lack of a cure calls for the development of novel therapies against AD(Canter et al.,2016).The key disease-defining pathological features of AD are the accumulation of extracellular amyloid-beta(Aβ)plaques(accompanied by increasing intracellular Aβ_(1-42))and higher intracellular neu rofi brilla ry tangles,comprised mostly of hyperphosphorylated tau protein/pTau(Goedert,2015;Hardy,2017).It is evident that the elderly are more predisposed to develop AD,and thus aging is considered to be the primary risk factor for AD.By extra polation,strategies that delay aging may also slow down(if not stop)AD.

Pit-and trench-forming osteoclasts:a distinction that matters

Osteoclasts（OCs）seeded on bone slices either drill round pits or dig long trenches.Whereas pits correspond to intermittent resorption,trenches correspond to continuous and faster resorption and require a distinct assembly of the resorption apparatus.It is unknown whether the distinction between pits and trenches has any biological relevance.Using OCs prepared from different blood donors,we found that female OCs achieved increased resorption mainly through pit formation,whereas male OCs did so through trench formation.Trench formation went along with high collagenolytic activity and high cathepsin K（CatK）expression,thereby allowing deeper demineralization.A specific CatK inhibitor abrogated the generation of trenches,while still allowing the generation of pits.OCs obtained from bone marrow were more prone to generate trenches than those obtained from blood.Scanning electron microscopy of bone surfaces eroded in vivo showed trenches and pits of similar size as those made by OCs in culture.We conclude that the distinction between trench-and pit-forming OCs is relevant to the differences among OCs from different skeletal sites,different individuals,including gender,and results from differences in colIagenolytic power.This indicates a biological relevance and highlights the importance of discriminating between pits and trenches when assessing resorption.

Histologically proven hepatic steatosis associates with lower testosterone levels in men with obesity

Men with obesity often present with low testosterone(T)and sex hormone-binding globulin(SHBG)levels.Several mechanisms for this have been proposed,but as SHBG is secreted by hepatocytes and sex steroids undergo hepatic metabolization,this study investigates whether severity and histological components of nonalcoholic fatty liver disease(NAFLD)are associated with sex steroid levels in obese men.This cross-sectional study included 80 obese men(age:46±11 years;body mass index:42.2±5.5 kg m^-2).Serum levels of total T and estradiol(E.)were measured using liquid chromatography coupled with tandem mass spectroscopy(LC/MS-MS)and SHBG and gonadotropins by immunoassay.Liver biopsies were evaluated using Steatosis.Activity,and Fibrosis scoring.Participants with steatohepatitis had similar median(1st quartile-3rd quartile)total T levels(7.6[5.0-11.0]nmol l^-1 vs 8.2[7.2-10.9]nmol l^-1;P=0.147),lower calculated free T(cFT)levels(148.9[122.9-188.8]pmol 1-1 s 199.5[157.3-237.6] pmol l^-1;P=0.006),and higher free E.T ratios(10.0[6.4-13.9]×10^-3 vs 7.1[5.7-10.7]×10^-3;P=0.026)compared to men with only nonalcoholic fatty liver.Among the histological components of NAFLD.only steatosis was independently associated with total T(r=-0.331.P=0.003)and cFT levels(r=-0.255.P=0.025).Obese men with.steatohepatitis have even lower cFT levels compared to those without,an association mainly driven by grade of steatosis.Whether this reflects a subgroup of men with a more severe obesity-related phenotype or results from direct relations between hepatic steatosis and sex steroid metabolism needs further investigation.