Epidemiological, Clinical, Therapeutic, and Evolutionary Aspects of Chronic End-Stage Renal Failure in the Nephrology Department of the University Hospital of Brazzaville in 2023

Objective: Chronic end-stage renal failure is a major public health problem in developing countries and is poorly documented. The objective of this study was to describe the epidemiological, diagnostic, therapeutic, and evolutionary aspects of patients admitted for end-stage renal failure to the Department of Nephrology at the University Hospital of Brazzaville. Patients and Methods: This was a descriptive cross-sectional study collecting prospective data that took place over 10 months. We included 128 patients who were exhaustively identified. Sociodemographic, clinical, therapeutic and developmental data were collected using a standardized and pretested pre-established survey form. The EPI info software enabled the analysis and processing of the data. Results: We reported a male predominance with a sex ratio of 2.5. The median age was 50 years. The first cause found was diabetes (55%) followed by hypertension (46%). The majority of patients had a dialysis emergency and half could not be dialyzed for financial reasons. Conclusion: Our results highlighted that certain epidemiological parameters of end-stage renal failure are constantly changing, such as frequency, while others remain static, including the main etiologies, gender, and age. However, mortality continues to increase and deserves more attention.

Management of Spontaneous Intracerebral Haemorrhage (sICH) at the University Hospital of Brazzaville (CONGO)

Spontaneous intracerebral haemorrhage (sICH) is characterised by bleeding within the brain parenchyma, without any accompanying vascular malformation, parenchymal abnormality or coagulation disorder. The study aimed to depict the management of sICH at the University Hospital of Brazzaville (UHB). It was an observational, descriptive, and cross-sectional analysis. Data collection was conducted retrospectively, covering the period from January 1, 2020 to August 31, 2022, spanning two years and eight months. The study examined socio-demographic, diagnostic, therapeutic, and evolutionary variables. We included 274 cases. We observed 160 men (58.4%) and 114 women (41.6%), resulting in a sex ratio of 1.4. The mean age was 55.3 ± 11.4 years, with ages ranging from 31 to 93 years. The detection of sICH was typically a result of experiencing motor deficits (59.5%) or disorders of consciousness (37.2%). The weightiness of one half of the body was the most common reason for seeking medical advice. Hematoma was capsulo-lenticular in 159 cases (58%) and capsulo-thalamic in 63 cases (23%). Hematomas were <30 ml in 162 cases (59.1%) and >30 ml in 112 cases (40.9%), and associated with hydrocephalus in 11.7% of cases. Conservative medical treatment was administered in 257 cases (94.2%) while surgical treatment was performed in 16 cases (5.8%). The surgical techniques used were external ventricular drainage (EVD) in 2 cases, ventriculo-peritoneal shunt in 5 cases, and hematoma evacuation in 10 cases. Death occurred before the 7th day of hospitalisation in 73 cases (57.8%) and after in 46 cases (42.2%). The median time to death was four days (Q1 = 2 days;Q3 = 7 days), with extremes of 0 and 216 days. .

Urological Emergencies at the University Hospital of Brazzaville: Epidemiological, Clinical, and Therapeutic Aspects

Introduction: Urological emergencies play a significant role in the medical and surgical activity of a urology department. The objective of this study was to determine the hospital prevalence of urological emergencies at the University Hospital of Brazzaville (CHUB), identify the different pathologies requiring urgent care, and list the various therapeutic methods. Patients and methods: A retrospective study of patients admitted to the medical and surgical emergencies department of CHUB over a 5-year period. Patient records admitted and treated for a urological emergency were included. The variables studied were the frequency of urological emergencies, patient age at admission, gender, nature of the emergency, and various therapeutic options. Results: Urological emergencies accounted for 4.3% of all medical and surgical emergencies. The mean age was 57 ± 28 years with a range of 3 to 93 years. The male-to-female ratio was 7.1. The most common conditions were urinary retention (54.67%), hematuria (17.20%), and renal colic (8.13%). Therapeutically, surgical urinary drainage was dominated by cystostomy. Conclusion: Urological emergencies are infrequent at the University Hospital of Brazzaville. Their management is often delayed.

Outcome of Patients with Lower Limbs Deep Vein Thrombosis at the University Hospital of Brazzaville (The Republic of the Congo)

The aim of this study was to describe the characteristics of patients with deep vein thrombosis (DVT) of the pelvic limbs at the time of diagnosis, and their course after hospitalization, in order to improve the management of DVT in our context. This was a descriptive longitudinal study, based on cases of deep vein thrombosis recorded between 1 January 2015 and 30 September 2018, in the cardiology and internal medicine department of the Brazzaville University Hospital Centre. During the study period, 4678 patients were hospitalized, including 52 with DVT. Thirty-three were reassessed. The frequency of DVT was 1.1% and the average hospitalization rate was 13.9 cases/year. The 33 patients were divided into 20 women and 13 men (sex ratio: 0.65). The mean age of the patients was 51.4 ± 17.8 years (extremes: 16 and 85 years). The main aetiological factors were cancer (19.1%), sickle cell disease (3%) and HIV immunosuppression (3%). The predominant risk factors were: prolonged immobilization (42.9%), pregnancy, long travel and obesity in the same number of cases (n = 3, i.e. 14.2%). The DVT involved the left pelvic limb in 75.8% of cases. Anticoagulants were administered in all patients, and compression stockings were worn in 97% of cases. The mean time to re-evaluation was 10.9 ± 9.4 months (extremes: three and 35 months). The mean measurements of the limb where the thrombosis had occurred at diagnosis and reassessment showed a significant difference. Venous Doppler showed compressible veins (60.6%), varicosities (36.3%), incompressible veins (30.3%) and thrombus (21.2%). Complications were: post-phlebitic disease (42.4%), death (21.2%), pulmonary embolism (18.2%), recurrence (18.2%). The DVT remains relatively rare, and its conventional therapeutic management is satisfactory. Systematic venous Doppler ultrasound reassessment should enable patients at risk of recurrence to be identified.

Socio-Demographic Profile of Patients Victims of Subaxial Cervical Spine Trauma at the University Hospital of Brazzaville (Congo)

Introduction: Traumatic spinal cord injuries (TSCI) are a public health problem. Subaxial cervical spine trauma (SCST) is the most common. They are a source of neurological consequences that can affect the functional prognosis, but above all vital. The objective of this study was to describe the profile of patients with lower cervical spine trauma. Method: We carried out a cross-sectional and retrospective study over seven years, from January 1, 2015, to December 31, 2021, in the multipurpose surgery department of the University Hospital Center of Brazzaville. We included all patients hospitalized for SCST, having performed at least one radiological examination. We excluded all patients whose records were incomplete. Results: We recorded 90 cases of SCST, and 60 cases met our selection criteria. The median age was 37 years, with the extremes of 6 and 83, the sex ratio of 3.6. The level of education was secondary in 45 cases (75%), and university in 13 cases (21.7%). Road traffic accidents accounted for 68.3% of cases, followed by falls in 16.7%. Motorcyclists were the most frequent victims (46.3%). Among the 60 patients in the series, three (5%) had health insurance. Conclusion: The SCST concerns subjects in their thirties, of the male sex. Road traffic accidents are the first cause, and mainly concern motorcyclists.

Accidental Ingestion of Petroleum in Children at the University Hospital of Brazzaville

Introduction: Petroleum ingestion is a health problem in Africa and can be responsible for significant mortality. Objectives: Improving the management of accidental petroleum ingestion in children, describe the socio-demographic characteristics, clinical, therapeutic and evolutionary profile of children hospitalized for accidental ingestion of petroleum and identify the factors associated with the occurrence of petroleum pneumopathy. Patients and Methods: We conducted a cross-sectional analytical study with retrospective collection from January 2016 to December 2015, i.e. in 24 months in the Pediatric Intensive Care and Infant Pediatrics departments at the University Hospital of Brazzaville. We included children who accidentally ingested petroleum. The variables studied were epidemiological, clinical, therapeutic, radiological and evolutionary. The statistical tests used were Pearson’s Chi2 and Odds ratio. The materiality threshold was set at 5%. Results: Out of 8013 children hospitalized, 78 (1%) had accidentally ingested petroleum, including 49 (62.8%) boys and 29 (37.3%) girls with an average age of 20 months. They were between 13 and 30 months old n = 44 (56.4%). The mothers were between 25 and 35 years old n = 49 (62.8%), no profession n = 31 (39.7%) and secondary education level n = 49 (62.8%). The mode of ingestion was self-ingestion (75.6%). The place of occurrence was the family home (92.3%). The motive of admission was breathlessness n = 59 (75.6%). An auscultation anomaly was noted n = 46 (59%), a pneumopathy n = 43 (55.1%). The treatment consisted of oxygen therapy n = 51 (65.4%), antibiotic therapy n = 70 (89.7%). The factors associated with the occurrence of a pneumopathy were: maneuvers performed and the existence of a cough. The lethality was 3.8%. Conclusion: The high frequency of accidental petroleum ingestions in children with an outcome often marked by pulmonary complications and the related case fatality rate requires primary preventive measures that rely on information, communication for behavior change with an emphasis on careful storage of toxic products and to refrain from harmful actions when faced with petroleum intoxication.

Epidemiology of Mortality in Polyvalent Intensive Care Unit at University Hospital of Brazzaville

Aim: To describe the epidemiological aspects of the patients who died in polyvalent intensive care unit at University Hospital of Brazzaville. Materials and Methods: This was a retrospective, cross-sectional study carried out in intensive care unit of University Hospital of Brazzaville, during period from January 2013 to December 2014. All patients who died at the unit regardless of age or sex were included. The parameters studied were age, sex, origin, reason for admission, causes of death, time of death, and length of hospitalization. Data were treated in Excel 2010 and Epi info 2007. Results: During the study period, 419 deaths out of 1121 admissions were recorded, representing a mortality rate of 37.4%. The average age was 46.2 ± 19.7 years with extremes ranging from 14 months to 90 years. The sex ratio was 0.9. Most of the deceased patients came from medical emergencies in 37.6% of the cases. Infectious (17.9%) and neurological (17.4%) pathologies were the most likely to cause death followed by cardiovascular pathologies (12.2%). Causes of death were dominated by severe sepsis and septic shock with 93.4% of infectious pathologies and stroke in 80.8% of neurological pathologies. In 42.3% of cases, the death occurred in the 8:00 p.m. to 6:00 a.m. time period. The average length of hospitalization for the deceased patients was 1.4 ± 0.5 days. All parameters studied significantly associated with mortality (p Conclusion: The mortality rate of patients admitted to the polyvalent intensive care unit at University Hospital of Brazzaville was high at 37.4%. Most of these patients were aged 40 years and older, male, with infectious and/or neurological pathologies. All deaths occurred within 48 hours of admission.

Child Acute Lower Respiratory Tract Infection in Pediatrics Intensive Care Unit at University Hospital of Brazzaville (Congo)

In order to contribute to reduction of morbidity and mortality due to low acute respiratory infections in pediatrics, the objective of this study was to determine the epidemiological profile and to identify the factors favoring and those associated with the risk of deceased. We reviewed the cases of children aged between 1 and 59 months hospitalized between January and December 2015 in the pediatric intensive care unit of the CHU of Brazzaville and retained those whose diagnosis of discharge was an ALRI. The study variables were: epidemiological, clinical, paraclinic, diagnostic, therapeutic and evolutionary. For 2012 hospitalized children, 400 (19.8%) were hospitalized for an ALRI. There were 235 boys (58.8%) and 165 girls (41.2%) of average age. Infants aged 1 to 11 months were the most affected n = 260 (65%). They were insufficiently immunized with haemophilus influenza B and pneumococcus n = 378 (94.5%);Fully immunized n = 20 (5%), the average delay for consultation after the first symptom was 5.03 ± 3.86 days;Denutrition was rated n = 180 (45%), positive retroviral serology n = 19 cases (4.8%). The main nosological varieties were: bronchiolitis n = 223 (55.7%), pneumonia n = 145 (36.2%). One death was rated n = 65 (16.3%). The mortality determinants were: prematurity, vaccination status and HIV/AIDS infection. The frequency and severity of ALRIs necessitates a strengthened program of integrated management of childhood illnesses, and public health actions targeting the factors that promote and contribute to the risk of death.

Asthma in Children at the Pediatric Intensive Care Unit of University Hospital of Brazzaville (Congo)

Objectives: To describe the epidemiological, clinical and therapeutic aspects of asthma in children at the Pediatric Intensive Care Unit of University Hospital of Brazzaville. Patients and methods: We reviewed the records of children hospitalized in the Pediatric Intensive Care Unit of University Hospital of Brazzaville from January 1 to December 31, 2015, and retained those from two months to 17 years hospitalized for asthma. The study variables were: age, sex, influence of seasons, history of atopy;the factors triggering the crisis, the type of follow-up, the degree of severity of asthma exacerbation, the type of treatment instituted and the course of the disease. In total, out of 2012 hospitalized children, 65 children met the inclusion criteria. Results: The hospital prevalence of asthma was 3.5%. Among 65 children of study, 42 (59.2%) were male and 29 (40.8%) female. The mean age was 3.9 ± 2.9 years (range from 2 months to 14 years). Children aged 30 months to 5 years were the most represented (40%). They were known as asthmatics, n = 18 (27.7%). Family atopy was found, n = 11 (16.9%). Acute Otorhinolaryngologic infections were in all cases the factors triggering the crisis. The peak frequency of hospitalizations for asthma occurred during the short rainy season. The crisis was moderate n = 46 (70%) and severe n = 19 (29%). Beta 2 mimetics were administered in all cases, by subcutaneous in 18 cases (27.7%) and inhaled in 47 cases (72.3%). The outcome was favorable in all cases with a mean hospital stay of 1.46 ± 0.92 days. Conclusion: Childhood asthma remains a public health challenge and severe asthma is the paradigm of uncontrolled and costly asthma. This first work suggests that a large-scale study be carried out for a better knowledge of it.

Placentas and Newborns of Patients Suffering from High Blood Pressure in University Hospital of Brazzaville

Objective: To analyze placentas and newborns of patients with high blood pressure (HBP). Materials and Methods: Case-control study conducted from 1 January to 31 October 2017 in University Hospital of Brazzaville (birth room, anatomy and pathology laboratory) and Faculty of Health Sciences of Brazzaville (laboratory of anatomy and organogenesis). It concerned 40 placentas freshly delivered and newborns of patients with HBP compared to 40 placentas and newborns of patients without HBP. The variables analyzed were related to mothers, placentas and the newborns. Results: The patients were similar in age (26.9 ± 1.2 years VS 26.5 ± 1.1 years, p = 0.17) and parity (1.26 ± 0.7 VS 1.61 ± 0.3, p = 0.26). The type of hypertension in the cases was dominated by pre-eclampsia (68%). A significant reduction in placental measurements was more observed in case of HBP: weight (431 ± 37 g VS 503 ± 26 g, p < 0.05), diameter (17.40 ± 1.2 cm VS 19.25 ± 1 cm, p < 0.05), and area (239.82 ± 15.7 cm2 VS 292.1 ± 22.2 cm2, p < 0.05). The macroscopic lesions were calcifications (75% VS 43.8%, p < 0.05) and the retro placental hematoma cup (18.8%) among the cases. Microscopic lesions were more observed in hypertensives: infarction (68.8% VS 18.8%, p = 0.004) and endarteritis (93.8% VS 12.5%, p < 0.05). The characteristics of newborns were significantly different between the two populations: prematurity (34.3% VS 9.3%, p < 0.05), mean weight (2577 ± 102 g VS 3060 ± 109 g, p < 0.05), the average APGAR score (6.7 ± 1.6 VS 7.8 ± 0.9, p 0.05). Conclusion: High blood pressure affects the placenta and the newborn. The placenta deserves to be systematically examined.

Contribution of the Tourniquet in the Prevention of Haemorrhages during Myomectomies at the University Hospital of Brazzaville

Objective: To check the effectiveness of tourniquet in the prevention of haemorrhage during myomectomies at the University Hospital of Brazzaville. Patients and methods: Analytical cross-sectional study, conducted at the University Hospital of Brazzaville from June 1, 2014 to June 30, 2016. Recruitment was performed by randomly matching each case of myomectomy performed using a tourniquet with two cases of myomectomy without tourniquet (50 cases vs 100 witnesses). We used as a tourniquet, the surgical glove knotted and tightened sufficiently at the level of the isthmus of the uterus to temporarily occlude the uterine arteries to ensure haemostasis lasting no more than one hour. Results: The mean age of the patients was similar in both groups (36, 1 ± 2.2 years vs 36.2 ± 1.9 years, P > 0.05). Menorrhagia was the most common indication of myomectomy in both groups (76% vs. 78% P > 0.05). The mean haemoglobin level of the patients before the myomectomies was 9.03 ± 1.10 g/dl vs 9, 75 ± 1.29 g/dl;P > 0.05. Intraoperative uterine features were similar in size (18 weeks gestation, 14 - 24) and number of myomas (5 vs 4, P > 0.05) in both groups. Polymyomectomy was more common in both groups (76% vs 73%, P > 0.05). Blood loss was reduced in the tourniquet group (90.5 ± 4.6 ml vs 200.4 ± 5.6 ml;P 0.05), as well as the use of blood transfusion (8% vs 50%, P 0.05). Use of the number of sutures was reduced in the group with tourniquet (3 ± 0.2 vs 6 ± 0.2 P 0.05). The duration of the procedure was shorter in the group with tourniquet (51.5 ± 4 min vs 83 ± 7 min, P 0.05). Postoperative mean haemoglobin of patients was no different between the two groups (9.4 ± 0.7 g/dl vs 9.2 ± 0.5, P > 0.05). The overall cost of management was reduced in the group with tourniquet (190,680 ± 1450 F CFA vs 256,800 ± 2350 FCFA;P 0.05). Conclusion: The use of tourniquet during myomectomies significantly reduces blood loss and the use of blood transfusion. We also obtain the notorious reduction in the use of sutures, the duration of interventions, and the overall cost of care. Thus, we encourage the systematic use of tourniquet during myomectomies by laparotomy.

Acute Renal Failure in Children at the University Hospital of Brazzaville

Introduction: Acute renal failure (ARF) is a medical emergency that does not spare children. Its interest lies in the search for etiologies and management made difficult by the poor quality of hospital technical platform in Africa. Objectives: To improve the management of ARF in children, determine its prevalence, and identify the causes and factors associated with mortality. Patients and Methods: We reviewed the records of children from one month to 17 years hospitalized between January 2016 and December 2018 in every pediatric department at the University Hospital of Brazzaville and included those whose discharge diagnosis included the item “ARF”. Study variables were age, sex, source, (para)clinical signs, stage and type of ARF, etiology and evolutionary profile. Results: Included were 18952 hospitalized children out of whose 253 had ARF 1.3%. There were 145 (57.3%) boys and 108 (42.7%) girls with an average age of 71.5 months. The mean time to consultation was 8.1 days. ARF was at failure stage in 147 cases (58.1%). It was functional in 210 cases (83.0%), out of which 95.1% resulted from severe dehydration. No extra-renal treatment was performed. Lethality was 34.4%. Hypovolemic shock (56.3%), severe sepsis (18.4%) and severe malaria (14.9%) were the main causes. Young age, provenance of the child, severe dehydration, deep coma, oligoanuria, stage of failure, hyperkalemia, absence of an extra-renal purification center were factors associated with mortality (p Conclusion: The high prevalence of ARF and its lethality requires public health actions including proper management of dehydration and malaria but also the creation of an extra-renal purification center.

Acute Generalized Peritonitis in Intensive Care Unit at University Hospital of Brazzaville, Republic of Congo: Etiological, Therapeutic Aspects and Issues

Aim: To determine etiological, therapeutic aspects and issues of AGP in intensive care unit (ICU) at University Hospital of Brazzaville (UHB). Materials and Methods: It was a retrospective and descriptive study carried out from January to December 2016 in ICU at UHB. We collected completed medical records of patients admitted and operated for AGP regardless of age or sex. The parameters studied were age, sex, admission’s reasons, etiologies, management, post-operative complications, length of hospital and mortality. Data were treated in Excel 2010 and Epi info 2007. Results: Thirty-one complete medical records were identified (mean age: 40.6 ± 22.0 years). The sex ratio was 2.4. Shock was the most common reason for admission with 67.7% of the cases. The etiologies of AGP were dominated by gastroduodenal perforating ulcer (41.9%) followed by complicated appendicitis (19.4%). The management of all patients was medico-surgical. The bi antibiotic ceftriaxone-metronidazole was administered in 29 patients (93.6%). 18 patients (59.1%) received vasopressor therapy. The complications had occurred among 9 patients i.e. 29% of the cases;parietal suppurations represented 44.5% of the complications. The average length of hospitalization was 5.2 ± 4.6 days. The overall mortality was 41.9%. Conclusion: In our study, the most frequent etiologies were gastroduodenal perforating ulcer and complicated appendicitis. They affected young patients. The complications were dominated by parietal suppurations. The mortality rate was high.

Anesthetic Practice in Neurosurgery at University Hospital of Brazzaville (Congo)

Aim: To evaluate the anesthetic management of neurosurgical patients in University Hospital of Brazzaville. Materials and methods: We performed a transversal and descriptive study during the period from January to June 2015 into operating room of the University Hospital of Brazzaville. 60 cases of anesthesia have been analyzed. Results: The neurosurgery represented 2.88% of the activity of the operating room in University Hospital of Brazzaville. The average age was 44.7 ± 18.36 years old. The sex ratio was 1.07. The scheduled interventions have concerned 83.4% of cases. Surgical indications were concerned the spine degenerative disease and spinal trauma in 40% and 18.3% of cases respectively. The patients classified ASA I and II were most represented in 40% and 46.7% of cases respectively. General anesthesia was used in 98.4% of cases. The peroperative complications were represented by arterial hypotension (31.7%), hemorrhage (11.7%), bradycardia (5%), difficult intubation (3.3%) and one case of peroperative cardiac arrest. The blood transfusion rate was 18.7%. The stay in ICU concerned 8.3% of the cases. We recorded three cases (5%) of death in our series. Conclusion: The neuroanesthesia knows an evolution in our country because of increasing number of neurosurgeons;it’s necessary to train medical staff in her practice.

Impact of the Covid-19 Pandemic on Severe Childhood Malaria at the University Hospital of Brazzaville

Introduction: Malaria management has been a source of concern for health systems since the advent of the Covid-19 pandemic. Objective: To assess the impact of the Covid-19 pandemic on severe childhood malaria in Brazzaville. Material and Method: A quasi-experimental intervention/non-intervention study was carried out between March and October 2020 in the pediatric departments of the Brazzaville University Hospital. Children aged three months to 15 years hospitalized were the target population. Two groups were formed: the “intervention” group, that of children hospitalized between March and October 2020 and the “control” group that of those hospitalized between January and August 2015. The study variables were epidemiological, clinical, biological and therapeutic. Chi-square and T-Student tests were used. The impact of the intervention was assessed by the absolute risk difference. Results: Of 1392 children hospitalized, 199 (14.6%) had severe malaria with an average age of 6.94 years. These were children under 5 years old n = 95 (47.7%) of low socioeconomic level n = 145 (72.9%) seen on average after 4.6 +/? 2.4 days. Repeated convulsions (56.8%) and anemia (20.1%) were the main reasons for hospitalization. These were isolated forms (n = 146;73.4%) of which n = 84 (42.2%) neurological and n = 62 (31.2%) anemic. The lethality was 13.1%. Delayed consultation, fever, repeated convulsions, pallor, respiratory distress, sickle cell anemia, thrombocytopenia and hypoglycemia are associated with death. The risk difference for signs of severity between the two periods was 16.6 for repeated convulsions;14.3 for severe anemia. The relative risk between the two studies was 1.8. Conclusion: The increase in morbidity and mortality in severe malaria since the beginning of the Covid-19 pandemic encourages the maintenance of the balance between the management of the Covid-19 pandemic and that of other worrying health problems.

Morbidity and Mortality in Adolescents at the University Hospital of Brazzaville

Introduction: Adolescent morbidity and mortality is a health concern. Objective: To determine morbidity, identify the causes of morbi-mortality and the factors associated with adolescent mortality in Brazzaville. Patients and Methods: A retrospective, descriptive and analytical study was carried out at the Brazzaville Hospital and University Center between January 2015 and December 2016. Adolescents hospitalized in clinical services whose records were workable were included. The Epidemiological, clinical and evolutionary variables were analyzed. The statistical test used was the khi-two, the significance level set at 0.05. Results: In total, Out of 67,488 hospitalized patients, 2062 were adolescents: 3% including 891 (43.2%) boys and 1171 (56.8%) girls mean age 14.8 ± 2.92 years, seen in average 9.38 days after the onset of symptoms. Childbirth 415 (20.1%), malaria 309 cases (14.9%), major sickle cell crisis 223 (10.8%) and traumatic injuries 166 cases (8.05%) are the main causes of morbidity. One death was recorded in n = 193 (9.4%), of which n = 104 (5.0%) in the first 48. Tumors, malaria and status epilepticus are the leading causes of death. The female sex, the age between 15 and 19 years, the young age of the father, the higher level of education of the adolescent and the low socio-economic level of the parents are associated with the death. Conclusion: Adolescent morbidity is worrying and mortality is significant. It is important that policies on this issue be developed with an emphasis on the main causes of morbi-mortality, including malaria control and sex education.

Socio-Demographic Profile of Adults Admitted in Emergency for Brain Trauma Injuries at the University Hospital of Brazzaville (Congo)

The aim of this study was to evaluate socio-demographic profile of adults admitted in emergency for Traumatic Brain Injury (TBI) at the University Hospital of Brazzaville in the Republic of Congo. We performed a prospective study within a period of six months, into the surgical unit of the emergency department of the University Hospital of Brazzaville. A total of 2617 patients were recorded, among which 268 cases were TBI (10.25%) where 142 cases were sampled in our series. The average age was 36.7 ± 16.6 years. The sex ratio was 6.1. The TBI was mainly due to road accident in 121 cases (85.2%) described as follows: motorcycle accident about 48 cases (39.7%) and the pedestrian’s injuries about 42 (34.8%). In the majority of the cases, cautions were not taken by the drivers;during the case of the motorcycle accident, about 97.9% of the riders did not wear a helmet. The TBI remains a growing public health concern in the low-income countries, like in Africa. Measurements on the road traffic regulation are to be strengthened to reduce the growth of this silent epidemic.

Epidemiological, Clinical and Etiological Profile of Rhythmic Emergencies at the University Hospital of Brazzaville, Republic of Congo

Objectives: To describe the epidemiological, clinical and etiological aspects of rhythmic emergencies at the University Hospital of Brazzaville. Patients and Methods: This was a retrospective descriptive study conducted in the cardiology and internal medicine department of the University Hospital of Brazzaville from January 1, 2014 to June 30, 2016. Were included, all patients admitted for a severe rhythm disorder diagnosed on the surface electrocardiogram. Rhythmic emergency was defined as a severe rhythm disorder of abrupt onset and required rapid management. Data entry and analysis were performed with Epi Info software version 3.5.1. Results: During the study period, 2269 patients were hospitalized, including 138 for a rhythmic emergency. The frequency of rhythmic emergencies was 6.1%. The patients were divided into 76 women and 62 men (sex ratio = 0.81). The mean age of the patients was 63.1 ± 16.9 years (extremes: 17 and 91 years). The socio-economic level was low for 103 patients (74.6%), medium for 26 (17.7%), and high for nine (6.6%). The average time to consultation was 13.7 ± 12.3 days. On admission, the signs were: heart failure (103 cases;74.6%) including 22 acute cases;dyspnea (94 cases;68%);palpitations (38 cases;27.5%);functional impotence (13 cases;9.4%);collapse (nine cases;6.5%);chest pain (two cases;1.4%). The type of rhythmic emergency was: rapid atrial fibrillation (103 cases;74.6%), ventricular tachycardia (14 cases;10.1%), junctional tachycardia (10 cases;7.2%), rapid atrial flutter (10 cases;7.2%), tachysystole (one case;0.7%). The context of occurrence was: hypokalemia (8 cases;5.8%), drunkenness (two cases;1.4%), acute gastroenteritis (one case;0.7%). Cardiovascular risk factors were: hypertension (62 cases;45.2%), smoking (17 cases;12.1%), dyslipidemia (12 cases;8.7%), diabetes (11 cases;8%), obesity (10 cases;7.2%). Underlying heart disease was: dilated cardiomyopathy (40 cases;29%), hypertensive cardiomyopathy (26 cases;18.8%), valvulopathy (24 cases;17.4%). Ischemic heart disease, chronic pulmonary heart disease, and cardiothyreosis were noted equally (n = 5;3.6%). No heart disease was noted in 24 patients (17.4%). Conclusion: Rhythmic emergencies are frequent in Brazzaville. They are dominated by atrial fibrillation and often occur on heart disease.

Bronchogenic Cyst in a 23-Month-Old Infant at the University Hospital of Brazzaville

The bronchogenic cyst, a congenital pulmonary malformation of often late revelation is rare. Its clinical manifestation, depending on the size of the cyst and its location, is dominated by respiratory symptoms. We report a case of a bronchogenic cyst in a 23-month-old infant treated with salbutamol combined with corticosteroid therapy for a third episode of breathing difficulty and wheezing. A chest X-ray and CT scan guided the diagnosis. Histological confirmation was made on an operative specimen after removal of the cyst. The immediate and mid-term outcome was good.

Peri-Annular and Septal Abscesses in Infectious Endocarditis. About 3 Cases Observed at the University Hospital of Brazzaville

Infectious endocarditis (IE) is a relatively rare but serious condition. We report 3 cases of infectious endocarditis complicated by peri-annular and/or septal abscess. The patients aged 24, 25 and 28 were all male. Global heart failure was observed in 2 cases. Atrioventricular block was noted in 2 cases (complete syncopation: 1 time;2nd degree Mobitz 2 1 time). Transthoracic echocardiography made it possible to diagnose abscess in all cases (aortic and septal peri-annulus: once, septal only: twice). The aortic insufficiency was grade 2 in all cases, mitral insufficiency grade 2 in 1. The front door was found once, with a dental location. Blood cultures were negative in all cases. A bi-probabilistic antibiotic therapy made it possible to control the infectious process in all the patients. Cardiac surgery, indicated in all cases, was performed in 1 case, consisting of flattening the abscesses and then placing a pacemaker in the patient with complete syncopal atrioventricular block. The outcome of all patients was favorable. Return to permanent sinus rhythm, associated with complete left bundle branch block, was noted at the 4th year of development in the pacemaker wearer. The other 2 patients are still awaiting medical evacuation.