Profile of type B natriuretic peptides in diabetic patients in Brazzaville

Background and Objective: Cardiovascular disease is the leading cause of morbidity and mortality in diabetic patients. The objective of this study was to determine the frequency of diabetic patients with a serum BNP level greater than 100 pg / ml and to establish the relationship between BNP and other variables. Methods: This is a cross-sectional study carried out in 50 diabetic patients admitted to the metabolic diseases department of the University Hospital of Brazzaville between May and October 2018. Results: A single type 2 diabetic patient presented a BNP = 187.4 pg / ml, a frequency of 2%. BNP level was associated with age (p = 0.005) and creatinine (p = 0.003). The small number of samples and an untargeted population did not allow us to profile BNP in diabetic patients. Conclusion: the mean BNP is high in diabetics in Congo Brazzaville despite a small sample size which does not allow the results to be generalized.

Diabetes and COVID-19 in Congolese patients

Background

The global pandemic Coronavirus Disease 2019 (COVID-19) due to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is reported to be potentially severe in patients with morbid conditions. One common reported comorbidities is diabetes. We aimed in this study to precise the clinical characteristics and outcomes in a series of congolese diabetic patients affected by COVID-19 infection.

Patients and methods

We retrospectely studied from 256 COVID-19 patients, a cohort of 30 persons with previously known diabetes. The glycaemia controls have been obtained by plasma glucose assay. All patients have been tested positive to SARS-CoV-2 by RT-PCR method.

Results

The COVID-19 diabetic patients represented 11,7% of all COVID-19 patients with confidence interval of 95% [7,77–15,65]. Older individuals and male sex were predominent. Dyspnea and sauration of oxygen < 90 were significatives and added risk factors were noted in 63.3% of patients, particulary hyperglycaemia with hypertension or obesity. The mortality rate at the percentage of 36.7% was more prevalent in patients with added comorbidities (30%) versus without comorbidities (6.7%).

Conclusion

Congolese COVID-19 diabetic patients of male sex and older age exhibiting arterial hypertension and obesity are the most exposed to severe COVID-19 and increasead mortality rate.

[Diabetic ketoacidosis in children: epidemiological and prognostic aspects]

INTRODUCTION

In Congo, data on diabetic ketoacidosis (DKA) in children are old and rare. This study aims to describe the sociodemographic features of DKA and to identify risk factors for mortality.

PATIENTS AND METHODS

We conducted an analytical study on DKA in childred at the University Hospital in Brazzaville over the period from January 2013 to June 2016. We examined the socio-demographic, clinical, paraclinical and evolutionary variables. Chi-Square Test, Fisher's exact test and odds ratio were used in the univariate analysis process and logistic regression model in the multivariate analysis.

RESULTS

Out of 172 children hospitalized with diabetes 55 (31%) were hospitalized with ketoacidosis. They were girls (33; 60%) with an average age of 11.1± 4.9 years (ranging from 1 months to 17 years), 61.8% of parents came from low socioeconomic status. Ketoacidosis was the revealing symptom in 67.2 % of cases. The diagnosis made before hospitalization was wrong (50%). The triggering factor was often an infection (52.7%). Mortality rate was 12.7%. The risk factors for mortality in the univariate analysis were: age < 5 years (p=0,000006), average consultation time higher than 7 days (p= 0.001), severe dehydration (p = 0.0006), hemodynamic disorders (p= 0.0006), severe undernutrition (p= 0.02), Glasgow Coma Scale < 9 (p= 0.007) and diarrhea (p= 0.001).

CONCLUSION

The importance and the seriousness of ketoacidosis impose preventive measures based on awareness, information and education campaigns as well as on the management of risk factors for mortality.

Knowledge, Attitudes, and Practices of Parents Facing Child and Adolescent Obesity in Brazzaville, Congo

The study aimed to assess obesity-related knowledge, attitudes, and practices of parents when facing child and adolescent obesity in order to improve the quality of care. A case-control study was conducted from February 1 to July 1, 2013. The study compared parents of obese school children (group 1 or cases; n = 254) and those school children without obesity (group 2 or controls; n = 254). These children were drawn from public and private primary schools of Brazzaville (Congo). Obesity-related knowledge was satisfactory in 83.5% of the cases, attitudes were correct in 29% of the cases, and the practices good in 25.6% of the cases. The parents' obesity-related knowledge was satisfactory when the socioeconomic level of the family was high (P < .02), the mothers' educational level greater than primary (P < .001), and the fathers' educational level was greater than primary (P < 10-4). The same observation was obtained with obesity-related attitudes and practices of the parents when correct. This influence remained after the adaptation of fathers' educational level. In conclusion, the disease-related knowledge of parents can be considered satisfactory in the majority of the cases; however, obesity-related attitudes and practices remain incorrect in most of the cases.

[Arterial hypertension: epidemiological aspects and risk factors on pregnant and delivered woman]

OBJECTIVES

Determine frequency of hypertension in pregnancy and delivered women at the Teaching Hospital of Brazzaville and identify epidemiological aspects and risk factors.

PATIENTS AND METHODS

A prospective and transversal study was realized from november 2004 to january 2005 in the Teaching Hospital of Brazzaville. Forty two patients (8 pregnant women, 34 delivered) with hypertension, have been enregistered among 825 admissions in the departments of gynecology and obstetric. Arterial hypertension was defined by a blood pressure at 140/ 90 mm Hg or above.

RESULTS

Arterial hypertension constituted 5.1% of the total admissions. Average of the patients was 27 +/- 8 years (age range: 14 and 40 years). Two patients (4.8%) haven't been sent to school, 29 (69%) had the secondary level, twenty (47.8%) were housewives. Seventeen patients (40.5%) had realized 2 prenatal consultations at the most. Patients were divided in 4 groups: Chronic hypertension (n = 4), pre eclampsia surimposed on chronic hypertension (n = 4), pregnancy hypertension only (n = 15), preeclampsia (n = 19). Prim gravidity (38.1%) and family history of hypertension (40.4%) were the most frequent risk factors. Obesity, gemality, previous pre eclampsia represented respectively 14.3%, 9.5% and 4.8%.

[Treatment of hyperthyroidisms in Brazzaville Teaching Hospital, Congo]

Between January 1994 and December 2003, a total of 118 patients (MIF = 1/13) with thyrotoxicosis was studied at the endocrine and metabolic diseases unit of the Centre Hospitalier Universitaire de Brazzaville, in Congo. 72 patients (61%) had Graves' hyperthyroidism, 23 (19.6%) had toxic multinodular goitre while the rest had toxic adenoma (7.6%), and thyroiditis (4.2%). The mean age was 26.6 +/- 7.9 years for Graves' cases and 49.4 +/- 9.3 years for toxic multinodular goitre cases. The clinical presentation was similar to other reported series. Thirty-seven patients (31.3%) did not return after the first admission. All patients responded to carbimazole therapy and no major side-effect was recognized. Ten patients (8.5%/) underwent subtotal thyroidectomy, among them one developed hypothyroidism a year later. The result of this study shows that thyrotoxicosis is not a rare condition in Congo.

[Thyroid disorders in the Brazzaville Teaching Hospital]

The authors report their experience with thyroid disorders. Between January 1994 and December 2003, a total of 567 patients (sex ratio: 1/20, men to women) with thyroid disease were examined in the endocrine and metabolic department of the Brazzaville Teaching Hospital. Their mean age was 43 years. 333 (58.7%) had a simple goiter, 118 (20.8%) hyperthyroidism, most often related to Graves' disease (60.8%). Other disorders included multinodular goiters (19.2%), toxic adenoma (7.1%) and thyroiditis (13.8%). Hypothyroidism was identified in 7.4% of cases, mainly following thyroid surgery. Thyroid cancer was rare (4 cases).

[Ketoacidosis in children and teenagers in Congo]

Diabetes mellitus is frequent in African children and adolescents. Its treatment faces some problems and complications. Ketoacidosis is among the main complications and its prognosis is bad. This retrospective study reports 93 cases of young patients observed over 10 years. It aims at presenting the characteristics of ketoacidosis in Brazzaville. The results of this study have reported ketoacidosis in 79.3% of the cases. Stopping the treatment (48.1%) and infections (28.6%) were the main factors. In 18.3% of the cases, the disease started by ketoacidosis. Despite the high mortality rate (18.2%), a favourable evolution was observed in 83.3% of the cases. It is the first cause of death in children suffering Diabetes mellitus in the Department for diabetes mellitus and endocrine diseases at Brazzaville University Hospital. Health education of both parents and children, a qualified personnel should help reduce the frequency of this complication.

[Epidemiological and clinical aspects of the diabetic foot at the Central University Hospital of Brazzaville]

This study was carried out in the Metabolic Disease Department of the University Hospital of Brazzaville, between January 1995 and December 1999. Our purpose was to define epidemiological and clinical aspects of trophic disorders of the lower limbs, as observed among 247 diabetic patients. Diabetic foot was observed in 86.2% of adult patients with diabetes type 2, and in 13.8% of patients with diabetes type 1. The average duration of diabetes was 8 years. In 2.8% of cases, diabetes was discovered as a result of trophic disorders. Among observed lesions, infectious foot prevailed (63.9%) and mal perforant was exceptional (1.2%). The mortality rate before surgical intervention was high (22.6%).

[Ketoacidosis coma auguring diabetes in black adults]

A particular form revealing diabetes mellitus in the black race is described: adult's inaugural ketoacidosis requiring a temporary insulin treatment, followed by a variable remission stage. We present in this work the clinical and evolutive characters of this coma inaugurating diabetes mellitus from twenty seven (27) patients of the metabolic diseases departement (CHU-Brazzaville). Among adult patients presenting a ketoacidosis coma, the prevalence rate of inaugural form is forty two percent (42%). The evolution is marked by a remission stage varying between six months and seven years.

[Hypothyroidism among adults in Congo: report of 23 cases]

Four hundred and ninety six congolese patents with thyroid pathology were studied in CHU of Brazzaville, Congo, between July 1984 and June 1999. Twenty three patients (4.64%) had hypothyroidism. There were 22 females and 1 male. The mean age was 43.8+/-12.4 years. The clinical presentation was similar to other reported series. The most frequent etiology was the surgery of thyroid. This surgery was realized in 52.2% of cases for Graves disease. The idiopathic hypothroidism was discovered in 5 cases (21.7%). All patients respondedto L-thyroxine therapy and no major side effect was recognized.