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

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Open Journal of Anesthesiology 2024年第3期14卷 93-107页

作者： Noelly Mukuna Wilfrid Mbombo Joseph Nsiala Aliocha Nkodila Alphonse Mosolo Freddy Mbuyi Jonathan Kukila Paul Kambala Rémy Kashala Chris Nsitwavibidila Patrick Kobo Dan Kankonde Gracias Likinda Jean Claude Mubenga Khazi Anga Lionel Diyamona Berthe Barhayiga Department of Anaesthesia and Intensive Care Kinshasa University Clinics University of Kinshasa Kinshasa DRC Department of Anaesthesia and Intensive Care Monkole Hospital Kinshasa DRC Protestant University of Congo Kinshasa DRC Laboratory Department Monkole Hospital Kinshasa DRC Department of Clinical Biology Kinshasa University Clinics University of Kinshasa Kinshasa DRC Surgical Department Monkole Hospital Kinshasa DRC Department of Internal Medicine Monkole Hospital Kinshasa DRC

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.

关键词： Anaesthesia Diabetes Morbidity Mortality Perioperative

Endoscopic Internal Urethrotomy in the Treatment of Male Urethral Stenosis in the Urology-Andrology Department of KARA Teaching hospital (Togo)

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Open Journal of Urology 2024年第1期14卷 20-26页

作者： Musapudi Éric Mbuya Komi Hola Sikpa Edoe Viyome Sewa Messan Semefa Agbedey Gnimdou Botcho Kodjo Tengue Tchilabalo Matchonna Kpatcha Urology and Andrology Department Kara Teaching Hospital Kara Togo Urology and Andrology Department Hubert Koutoukou Maga National Teaching Hospital Cotonou Benin Surgery Department University Clinics of Lubumbashi Lubumbashi DRC Aneho Prefectural hospital Center Aneho Togo Urology and Andrology Department Kpalime Prefectural Hospital Center Kpalime Togo Urology and Andrology Department Sokodé Regional Hospital Center Sokodé Togo Urology and Andrology Department Sylvanus Olympio Teaching Hospital Lomé Togo

Introduction: Endoscopic internal urethrotomy (EIU) is a method for stricture opening using transurethral incision by direct visualisation of the urethral channel, resulting in a widening of the urinary canal with the aim of improving the quality of bladder emptying. The aim of the study was to evaluate the indication and results of EIU in the treatment of stenosis of the male urethra in the Urology-Andrology Department of Kara Teaching hospital. Methodology: This was a cross-sectional descriptive study with retrospective data collection in the Urology-Andrology department of Kara Teaching hospital. It involved 21 records of patients with urethral stenosis treated by endoscopic internal urethrotomy (EIU) in the said department during the period from January 2021 to September 2023. The following variables were evaluated: age, circumstance of discovery, site, length, number, etiology of the urethral stenosis and evolution of the patients. Results: The mean age of the patients was 59.2 ± 11.7 years. Infectious etiology of stenosis was predominant with 10 patients (47.6%) followed by trauma with 5 cases (23.8%). The bulbar urethra was the most frequently observed site, with 11 cases (52.4%). The length was mostly less than 2 cm in 12 patients (57.1%). Stenosis was unique in 14 patients (66.7%). The mean postoperative follow-up time was 3.2 months. The result was immediately better in 11 patients (52.4%) and it was poor in 8 patients (38.1%) who required maintenance dilation sessions.

关键词： Internal Urethrotomy Urethral Stenosis Kara Togo

Hyperhomocysteinemia and Associated Biological Markers in a Congolese Population of Type 2 Diabetes Mellitus in Brazzaville

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Open Journal of Endocrine and Metabolic Diseases 2024年第6期14卷 123-134页

作者： V. R. Ikia Monde A. L. M. Boumba E. Mokondjimobe H. Poaty G. Loubano-Voumbi W. F. Ondongo A. G. Mayindou Kimbangu K. Onanga F. Elilie Mawa Ongoth E. Bouenizabila C. Andres H. G. Monabeka Biochemistry Laboratory Service University Hospital Center Brazzaville Congo Faculty of Health Sciences Marien NGOUABI University Brazzaville Congo Research Area of Pointe-Noire National Institute for Research in Health Sciences (IRSSA) Pointe-Noire Congo Microbiology and Molecular Biology Department Loandjili General Hospital Pointe-Noire Congo LOMO Research University Kinshasa DRC Department of Statistics Health Information and Epidemiology Surveillance Departmental Directorate of Health Care and Services Brazzaville Congo Department of Endocrinology University Hospital Center Brazzaville Congo Department of Biochemistry and Molecular Biology Bretonneau Regional University Hospital Tours France

The search for new biomarkers predictive of type 2 diabetes currently constitutes a research avenue in Bioclinical. Total homocysteine remains a preferred target due to its involvement in the occurrence of degenerative complications in type 2 diabetics. The aim of this work was to study hyperhomocysteinemia and other biochemical markers associated with T2D in the Congolese population. This was an analytical case-control study carried out between October 2022 and October 2023. The study population consisted of 150 subjects including 100 T2D patients and 50 control subjects. The main clinical data were collected on a pre-established form. Homocysteine determination was carried out by the sandwich ELISA method. The other biochemical markers were measured by colorimetric enzymatic methods. Hyperhomocysteinemia was present in 27.3% (41/150) of the entire study population. Type 2 diabetics had a frequency of hyperhomocysteinemia of 36% (36/100) and control 10% (5/50) (p = 0.001). The mean hyperhomocysteinemia concentration was 31.9 μmol/l with extremes ranging from 18 to 103 μmol/l. Means of biological markers between diabetics and controls showed a statistically significant difference (p = 0.01). The risk factors associated with this HHcy were: sex (OR = 3.5), age (OR = 9.4), sedentary lifestyle (OR = 3.4) and glycosylated hemoglobin (OR = 12) with a p-value <0.05 respectively. Our results suggest that hyperhomocysteinemia can be considered as a predictive biomarker in the bioclinic of Congolese type 2 diabetic patients.

关键词： Hyperhomocysteinemia Biological Markers T2DM Brazzaville

Evolution of Androgenic Deprivation in Treatment of Prostate Cancer in Kinshasa

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Open Journal of Urology 2021年第4期11卷 137-157页

作者： Dieudonné Molamba Moningo Junior Konga Liloku Alpha Tsita Mafuta Matthieu Nkumu Loposso Pablo Nkutima Diangienda Augustin Mongalembe Punga Maole Richard Koseka Demongawi Nkodila Aliocha Service of Urology University Hospital of Kinshasa Kinshasa DRC Department of Surgery Faculty of Medicine University of Kinshasa Kinshasa DRC Clinic of Pointe-à-Pitre Kinzanzi Quarter 11D Kinshasa DRC Public Health School Faculty of Medicine University of Kinshasa Kinshasa DRC

Context and Objective: Prostate cancer (PCa) is hormone-dependent cancer. In our area, most patients often arrive at the locally advanced stage or the metastatic stage. This justifies the choice of androgen deprivation as the mode of treatment. The objective of this study was to describe the socio-demographic characteristics of patients with PCa. Identifying the period during which the disease remains susceptible to androgen deprivation. Assessing the patient’s prognosis in terms of survival. Methods: This is a retrospective observational study of the course of patients managed for PCa. It involved 51 cases and was conducted at the Pointe à Pitre clinic (CPAP) in Matete Township during a period of 4 years (from March 2014 to June 2018). Results: The mean age of patients was 69.4 ± 9.7 years (40 - 92 years);39.2% of patients with PCa were aged between 70 - 79 years;45.1% had consulted for dysuria and 25.5% were hypertensive. All had performed the prostate biopsy, 47.1% were diagnosed at the metastatic stage, with PSA ≥ 100 ng/ml, Gleason scores 8 - 10, and clinical-stage TNM 3 - 4. About 51% were subjected to androcure, 23.5% had been surgically cased and 3.9% had undergone radical prostatectomy. 41.1% had resisted castration within a median of 1.4 years of response to treatment. The median survival was 30 months, with a mean survival of 26.6 months. Conclusion: Prostate cancer involved most of the patients in the age bracket of 70 to 79 years. The diagnosis was performed lately with a high resistance rate of castration and median survival of 30 months.

关键词： Deprivation Prostate Cancer (PCa) Pointe à Pitre Clinic (CPAP)

Epidemiological, Clinical, Paraclinical and Therapeutic Profile of Prostate Tumors at Panzi hospital, Democratic Republic of the Congo

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Open Journal of Urology 2023年第7期13卷 259-269页

作者： Kitumaini Munyahali John Buhendwa Jean-Paul Cikwanine Muka Alain Bafunyembaka Batende David Nanga Baruba Ruffin Baraka Munyali Desire Alumeti Ndanda Levi Luhiriri Mangaza Emilie Amisi Ona Longome Albert Ahuka Department of Surgery Panzi Hospital Faculty of Medicine Université Evangelique en Afrique Bukavu DRC Department of Anesthesia and Resuscitation Panzi Hospital Faculty of Medicine Université Evangelique en Afrique Bukavu DRC

Tumor pathologies of the prostate gland are represented by benign prostate tumor and prostate cancer and are generally seen after 50 years. The objective of this work was to study the epidemiological, clinical, paraclinical and therapeutic aspects of prostate tumors at the General Reference hospital of Panzi (drc). Patients and Methods: Retrospective cross-sectional study on 70 patients followed in hospital or on an outpatient basis for prostate tumor in the urology department of the General Reference hospital of Panzi from January 1, 2013 to December 31, 2017. The epidemiological, clinical and paraclinical parameters (pathology with Gleason score, prostate volume on ultrasound, urinary impact on ultrasound, urea level, creatinine level and PSA level) and therapeutics were studied. Results: Prostate tumors represent 3.84% of surgical pathologies. The average age of the patients was 68.2 years with the extremes of 47 and 90 years old. The patients were transferred in 78.6% of the cases. Acute urine retention was the most common reason for consultation with 42.8%. The PSA rate > 4 ηg in 92.9% of the cases. Benign prostatic hyperplasia was found in 62.8% of patients against 35.7% of prostate adenocarcinoma and 41.7% of prostate cancers were moderately differentiated. The prostate volume was 41 - 60 g in 35.7% of the cases. No urinary impact in 71.4% of patients. Surgical treatment was in 85.7% and RTUP was the most used at 40%. A hospital stay between 15 and 21 days in 30% of cases. The cure rate was 81.4% and 14.3% developed urethral stenosis. Conclusion: Prostate tumors are common in people over the age of 50 who see for acute retention of urine. Benign enlarged prostate is the most common. Treatment is codified and in the event of a complicated prostatic tumor, surgery remains the choice for the comfort of the patients and the popularization of an early detection of these pathologies is necessary for the prevention of complications.

关键词： Prostate Hyperplasia Adenocarcinoma PSA Panzi

Hysterosalpingographic Findings among Patients Undergoing Infertility Work-Up in Kisangani, Democratic Republic of the Congo

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Open Journal of Obstetrics and Gynecology 2019年第2期9卷 267-277页

作者： Jean-Didier Bosenge Nguma Antoine Modia O’yandjo Jeanot Juakali Sialikyolo Gaston Litalema Liogo Antoine Molua Aundu Roger Amisi Kitoko Gédeon Katenga Bosunga Department of Gynecology-Obstetrics Faculty of Medicine and Pharmacy University of Kisangani Kisangani DRC Department of Medical Imaging Radiology Unit Kisangani University Hospital Kisangani DRC Department of Medical Imaging Unit of Imaging of Women University of Kinshasa Kinshasa DRC Department of Surgery Faculty of Medicine and Pharmacy University of Kisangani Kisangani DRC

Introduction: Hysterosalpingography is an important tool in the investigation of the causes of female infertility. In developing countries such as the Democratic Republic of Congo, the HSG is the basic tool for performing first-line anatomical (pelvic) assessment. The aim of this study is to determine the prevalence of the different lesions observed in hysterosalpingography carried out during the assessment of infertile women monitored in Kisangani. The study set also out to look for differences in these lesions according to the type of infertility. Methods: This cross-sectional study was conducted in Kisangani from June 2016 to December 2018. The 130 cases of hysterosalpingography performed for female infertility assessment during the study period were included, of which 33.07% for primary infertility and 66.93% for secondary infertility. Results: The mean age of the patients was 33.52 ± 6.01 years;the history of pelvic inflammatory disease was noted with a predominance for secondary infertility (11% vs. 4.65%). Using hysterosalpingography, 7 (5.38%) patients had a normal result;94 (72.31%) had tubal obstruction;25 (19.23%) had hydrosalpinx;11 (8.46%) had uterine fibroids;pelvic adhesions were suspected in 12.64% of cases. There was no obvious association between all these lesions and the type of infertility. Conclusion: We found that tubal obstructions were the most prevalent lesions in this study, regardless of the type of infertility. These lesions would reflect the high prevalence of septic abortions and sexually transmitted infections in developing countries such as the Democratic Republic of the Congo.

关键词： Hysterosalpingography Female Infertility Tubal Obstruction Hydrosalpinx Pelvic Adhesion Uterine Fibroids

Pelvic Organs Prolapse in Low-Resources Countries: Epidemiology, Risk Factors, Quality of Life. Narrative Review

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Open Journal of Urology 2023年第7期13卷 238-250页

作者： Eloge Ilunga-Mbaya Dénis Mukwege Prosper Lukusa Tshilobo Kenny Raha Maroyi Rahma Rashid Tozin Dieudonné Sengeyi Mushengezi Urogynecology Unity University Clinics of Kinshasa University of Kinshasa Kinshasa DRC Department of Gynecology and Obstetrics PANZI Hospital Evangelical University of Africa Bukavu DRC Department of Paediatrics Center for Human Genetics Research of University Clinic of Kinshasa and KU Leuven University of Kinshasa Kinshasa DRC Department of Gynecology and Obstetrics Urogynecology Unity PANZI Hospital Evangelical University of Africa Bukavu DRC Department of Gynecology and Obstetrics University Clinics of Kinshasa University of Kinshasa Kinshasa DRC

Objective: Pelvic organ prolapse is an emerging public health problem affecting adult women of all ages with a negative impact on social, physical well-being, and psychological. Its presents several challenges in countries with low resources. This literature review aims to examine POP in its epidemiological aspects, risk factors, and staging by taking up the challenges associated with low-resource settings and identifying some avenues for future research. Methods: We searched the PubMed, Google Scholar, and Scopus databases. The other studies were identified by checking the secondary references in the original citation. We have collected studies on adult women published in English for the last 30 years. In total, 71 articles were read. We excluded studies from all newspaper articles, Studies presenting co-morbidities (fistulas, cervical cancer, pregnancy), those evaluating treatment, letters, comments, case reports, practice guidelines, news, historical articles, legal cases, published erratum, and congresses. Results: 16 studies examining the epidemiology have been identified with 11 in countries defined by the World Bank as limited or intermediate resources. 18 on risk factors whose 10 in countries with limited or intermediate resources, 10 on staging and 27 on physiopathology. Conclusion: POP affects the young more in low-resource settings. Its prevalence remains underestimated for several reasons. Several risk factors found are the same as those of women in countries with a high standard of living. However, there are some specific risk factors for these resource-limited settings.

关键词： Epidemiology Low Resources-Countries Pelvic Organs Prolapse Risk Factors

Profile of Endoscopic Lesions and Prevalence of <i>H. pylori</i>Infection at the Digestive Endoscopy Unit of Panzi General Reference hospital in Bukavu

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Open Journal of Gastroenterology 2021年第11期11卷 230-243页

作者： Nteranya Musole Adonis Bwemere Mungwete Josue Motcheyo Chepig Hyacinthe Tchass Chasinga Cimanya Cubaka Fortunat Abedi Zalufa Marlène Bihehe Masemo Dieudonné Kasereka Kikwaya Jerry Malamba Lez Didier Vangossum Marc Panzi General Reference hospital Service of Internal Medicine Bukavu Congo (DRC) Faculty of Medecine Evangelic University of Africa Bukavu Congo (DRC) Panzi General Reference hospital Service of Pathologies Bukavu Congo (DRC) Medical Center of the Community Service of Radiology Lubumbashi Congo (DRC) University Clinic of Lubumbashi Service of Internal Medicine Lubumbashi Congo (DRC) UHC Saint Pierre Service of Gastroenterology Bruxelles Belgium Free University of Brussels Brussels Belgium

Introduction: Thanks to the opening of the digestive endoscopy unit in the Reference General hospital of Panzi in Bukavu in the Democratic Republic of the Congo, which inspired our work on the profile of endoscopic le... 详细信息

Introduction: Thanks to the opening of the digestive endoscopy unit in the Reference General Hospital of Panzi in Bukavu in the Democratic Republic of the Congo, which inspired our work on the profile of endoscopic lesions observed in a series of 1000 patients correlated with clinical and demographic criteria with the contribution of pathology examinations of the 292 biopsies performed. The aim of our work is to evaluate the prevalence of significant endoscopic lesions as well as that of H. pylori infection. Material and Methods: This is a retrospective, descriptive and analytical study, ranging from the 16th of December 2014 to the 16th of June 2016. It covered 1000 patients who benefited from a high digestive endoscopy and 292 of them had a biopsy with pathological examination. The data obtained were recorded and analyzed using the Epi-info software and chi-square test. Results: fifty-five percent of these patients were women. 66% of the patients were under 50 years of age. Their major symptom was epigastric pain (89.2%), the most observed endoscopic lesion was erythematous gastritis (82%) therefore we have noticed 21.

关键词： High Digestive Endoscopy Lesion H. pylori

A Case-Control Study of Obstetric Fistula Risk Factors in the Democratic Republic of the Congo

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Open Journal of Obstetrics and Gynecology 2016年第12期6卷 740-753页

作者： Leon Mubikayi Eric J. Chow David O. Matson Emmanuel Nzau Barthelemy Tandu Christian Medical Institute of the Kasai Tshikaji Democratic Republic of the Congo (DRC) School of Medicine Kasayi University Kananga Democratic Republic of the Congo (DRC) Biamba Marie Mutombo hospital Kinshasa Democratic Republic of the Congo (DRC) Graduate Program in Public Health Eastern Medical School Norfolk USA Department of Pediatrics Eastern Virginia Medical School Norfolk USA School of Medicine University of Kinshasa Kinshasa Democratic Republic of the Congo (DRC)

Background: Pregnant women in the Democratic Republic of Congo (drc) are at increased risk for developing obstetric fistulas (OFs) as a result of obstructed labor, in conditions similar to many other African countries. No case-control study of biological and social risk factors for OF has been reported from the drc. This study aimed to identify factors that would aid in prevention and early identification of women who are at risk of developing OF. Methods: Participants were enrolled in a case-control study at four obstetric clinics in the central drc. Cases of OF were evaluated as they presented, then a control participant was enrolled among women presenting subsequently to the same clinic, seeking to match parity at the time of the fistula and tribe of the case. A questionnaire was administered to elicit physical, obstetric, demographic, socioeconomic, religion, geographic, and delivery attributes of the participants. Case-control comparisons sought to identify independent risk factors for OF in the total case-control pairs and in subgroups of the participants. Logistic regression was utilized to identify independent risk factors for OF in the total case-control study group and in selected subgroups of the participants, and linear regression was utilized to estimate the variation explained between case and control outcomes from the variables independently significant in the logistic regression models. Results: A total of 177 case-control pairs were enrolled. Among all pairs, shorter height of the case (odds ratio = 1.06, 95% Confidence Limits 1.02 - 1.12);more kilometers travelled to the delivery site (1.02, 1.01 - 1.02);her village, not town, residence (OR = 5.52, 2.72 - 11.2), and her lower professional status (2.95, 1.53 - 5.72) were statistically independent factors associated with OF development. When applied in linear regression comparison of the pairs, these variables yielded an r2 = 0.48, imputing 48% of the difference in delivery outcome between

关键词： Obstetric Fistula Case-Control Risk Factors Democratic Republic of the Congo