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Determinants of the Sensorineural Hearing Loss in Patients with Multidrug-Resistant Tuberculosis in Kinshasa (Democratic Republic of the Congo): A Prospective Cohort Study

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International Journal of Otolaryngology and Head & Neck Surgery 2023年第6期12卷 411-425页

作者： Mireille Avilaw Mpwate Eddy Mampuya Mbambu Gabriel Mabuaka Lema Christian Nzanza Matanda Dominique Mayuku Mupepe Michel Kayomo Kaswa Murielle Luengiladio Aloni Nicole Muzutie Anshambi Fabrice Mankangu Matuta Luc Losenga Lukasu Serge Katya Mpwate pierre zalagile akilimali Innocent Murhula Kashongwe Zacharie Munogolo Kashongwe Jean Marie Ntumba Kayembe Richard Nzanza Matanda Department of Otorhinolaryngology University Hospital of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of The Congo Division of Cardiology Department of Internal Medicine University Hospital of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of The Congo National Tuberculosis Control Program in Democratic Republic of The Congo Kinshasa Democratic Republic of The Congo Provincial Coordination for The Fight against Tuberculosis Kinshasa Democratic Republic of The Congo Multidrug-Resistant Tuberculosis Unit “Centre d’Excellence Damien” Damien Foundation Kinshasa Democratic Republic of The Congo Department of Anatomy-Pathology University Hospital of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of The Congo Kinshasa School of Public Health Faculty of Medicine University of Kinshasa Kinshasa Democratic Republic of The Congo Pneumology Unit Department of Internal Medicine University Hospital of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of The Congo

Background: The onset of the hearing loss is a major challenge during the treatment of multidrug-resistant tuberculosis (MDR-TB). Aminoglycoside-based regimens, to a lesser extent based on bedaquiline, induce ototoxic sensorineural hearing loss. Research on risk factors is essential to enable high-risk individuals to benefit from preventive measures in settings with limited resources. Objective: This study aimed to assess the determinants of the hearing loss in patients with MDR-TB. Methods: This prospective multicenter cohort study included 337 patients with MDR-TB. It was performed in Kinshasa (Democratic Republic of the Congo) between January 2020 and January 2021. Sociodemographic, clinical, biological, therapeutic, and audiometric data were exported and analyzed using Stata 17 and MedCalc. The fixed-effect linear regression panel model was used to assess the degree of the hearing loss over time according to the following covariates: therapeutic regimen (aminoglycosides, bedaquiline, or alternate), stage of chronic kidney disease (CKD), age at inclusion, body mass index, serum albumin level, HIV status, alcohol intake, hypertension, and hemoglobin level. The Hausman test was used to select between fixed- and random-effect estimators. The threshold for statistical significance was set at p Result: A total of 236 patients (70%) received an aminoglycoside-based regimen, 61 (18%) received a bedaquiline-based regimen, and 40 (12%) received aminoglycosides relayed by bedaquiline. The frequency of the hearing loss increased from 62% to 96.3% within six months for all therapeutic regimens. The Hearing loss worsened, with moderate (72.4%) and profound (16%) deafness being predominant. An Exposure to the treatment for more than one month (β coeff: 27.695, Se: 0.793, p β coeff: 6.102, Se: 1.779, p β coeff: 5.610, Se: 1.682, p = 0.001), and an eGFR β coeff: 6.730, Se: 2.70, p = 0.013) were the independent risk factors associated with the hearing loss in patients with MDR-TB

关键词： Multidrug-Resistant Tuberculosis Determinants Hearing Loss DRC

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Sensorineural Hearing Loss in Multidrug-Resistant Tuberculosis Patients in Kinshasa (Democratic Republic of Congo): Prospective Cohort Study of Therapeutic Regimen with Aminoglycoside versus Bedaquiline

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Journal of Tuberculosis Research 2023年第3期11卷 109-119页

作者： Mireille A. Mpwate Eddy M. Mbambu Christian N. Matanda Gabriel M. Lema Michel K. Kaswa Murielle L. Aloni Nicole M. Anshambi Fabrice M. Matuta Luc L. Lukasu Dominique M. Mupepe Serge K. Mpwate pierre Z. akilimali Zacharie M. Kashongwe Richard N. Matanda Department of Otorhinolaryngology University Clinics of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of Congo National Tuberculosis Control Program in the Democratic Republic of Congo Kinshasa Democratic Republic of Congo Provincial Coordination for the Fight against Tuberculosis Kinshasa Democratic Republic of Congo Multidrug-Resistant Tuberculosis Unit “Centre d’Excellence Damien” Damien Foundation Kinshasa Democratic Republic of Congo Division of Cardiology Department of Internal Medicine University Clinics of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of Congo Department of Anatomy-Pathology University Clinics of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of Congo Kinshasa School of Public Health Faculty of Medicine University of Kinshasa Kinshasa Democratic Republic of Congo Pneumology Unit Department of Internal Medicine University Clinics of Kinshasa Kinshasa 11 University of Kinshasa Kinshasa Democratic Republic of Congo

Context: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health problem in developing countries such as the Democratic Republic of Congo (DRC), which continues to face the emergence of MDR-TB cases. Because of the ototoxic effects of AGs, the World Health Organization (WHO) has recommended the introduction of the bedaquiline regimen. However, very few data are available regarding the susceptibility of bedaquiline to induce hearing loss, hence the present study set out to compare the AG-based regimen and the bedaquiline-based regimen in the occurrence of hearing loss in MDR-TB patients. Methods: This is a prospective multicenter cohort study that included 335 MDR-TB patients, performed in Kinshasa (DRC) during the period from January 2020 to January 2021. Sociodemographic, clinical, biological and audiometric data were analyzed using Stata 17. Repeated-measures analysis of variance was used to compare changes in the degree of hearing loss over time between the two groups of patients on AG and bedaquiline regimens. The double-difference method was estimated using regression with fixed-effects. A p value < 0.05 was considered the threshold for statistical significance. Results: The degree of hearing loss was similar between the two groups at the first month [AGs (28 dB) vs BDQ (30 dB);p = 0.298]. At six months, the mean degree of hearing loss was significantly greater in the aminoglycoside regimen group [AGs (60.5 dB) vs BDQ (44 dB);p < 0.001]. The double difference was significant, with a greater increase in hearing loss in the AGs group (diff-in-diff 18.3;p < 0.001). After adjustment for age and serum albumin, the group receiving the AG-based regimen had a 2-point greater worsening than those with bedaquiline at the sixth month (diff-in-diff 19.8;p Conclusion: Hearing loss is frequent with both treatment regimens, but more marked with the Aminoglycoside-based regimen. Thus, bedaquiline should also benefit for audiometric monitoring in future MDR-TB p

关键词： Multidrug-Resistant Tuberculosis Aminoglycosides Bedaquiline Hearing Loss

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Prognostic Signification of Admission Hyperglycemia among Acute Stroke Patients in Intensive Care Units in Kinshasa,the Democratic Republic of the Congo

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World Journal of Cardiovascular Diseases 2019年第9期9卷 665-680页

作者： Josée K.Tshituta Francois B.Lepira Francois P.Kajingulu Jean Robert R.Makulo Ernest K.Sumaili pierre Z.akilimali Aliocha N.Nkodila Freddy M.Mbuyi Angele I.Masewu Stephane Mutombo Eric B.Amisi Jean pierre M.Ilunga Wilfrid B.Mbombo Patrick M.Mukuna Adolphe M.Kilembe Department of Anesthesiology and Reanimation University of Kinshasa HospitalKinshasaThe Democratic Republic of the Congo Division of Nephrology Department of Internal MedicineUniversity of Kinshasa HospitalKinshasaThe Democratic Republic of the Congo Department of Epidemiology&Biostatistics Kinshasa School of Public HealthUniversity of Kinshasa School of MedicineKinshasaThe Democratic Republic of the Congo Centre medical cite des Aveugles KinshasaThe Democratic Republic of the Congo

BACKGROUND AND AIM: Although admission hyperglycemia has been reported to be associated with unfavorable outcomes in acute stroke, little is known about this association in sub-Saharan Africa. Therefore, the aim of the present study was to assess the prognostic significance of admission hyperglycemia in the acute phase of stroke in Congolese patients. METHODS: In a multicenter prospective cohort study, consecutive patients with acute stroke were examined in 5 Emergency Rooms or Intensive Care Units of Kinshasa between July 15th, 2017 and March 15th, 2018. The severity of stroke was assessed at admission using the Glasgow Coma Scale. Stress hyperglycemia was defined as random blood glucose levels at admission > 140 mg/dL in patients without known type 2 diabetes mellitus (T2DM). The endpoint was 10-day all-cause in-hospital mortality. Survival (time-to-death) curves were built using the Kaplan Meier methods. Cox proportional analysis was used to identify predictors of 10-day all-cause in-hospital mortality. The predictive performance of blood glucose level to predict 10-day all-cause in-hospital mortality was assessed using ROC curve analysis. RESULTS: Out of 194 patients (mean age 58.7 ± 13.1 years;64% males, 74.7% light to moderate stroke severity;63.4% ischemic stroke) enrolled, 106 (54.6%) had admission hyperglycemia with 77 (72.6%) having stress hyperglycemia. Ninety four deaths (48.5%);mortality rate of 6 deaths per 100 person-days (95%CI 2.7 - 9.3) occurred during a median follow up time 6 (5 - 7) days equivalent to 1542 person-days. Independent predictors of 10-day all-cause in-hospital mortality were admission hyperglycemia regardless of diabetes status (aHR 3.77;95%CI 1.92 - 7.42;p < 0.001), GCS - 5.23;p = 0.001) and non-use of mechanical ventilation (aHR 1.97;95%CI 1.05 - 3.70;p = 0.034). Blood glucose concentrations (AUC 0.743;95%CI 0.672 - 0.814) had a better predictive performance for 10-day all-cause in-hospital mortality with an optimal value of 154 m

关键词： Admission Hyperglycemia Stroke Prognostic Significance Black Africans

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