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Key Clinical Message: The use of negative pressure therapy in the management of gunshot wound have a favorable outcome, NPT is easy to build, accelerates wound budding, reduces patient's stay in hospital and its low cost. It showed reassuring results in the management of wound with soft tissue lost, comparatively to other dressing. Abstract: Wounds due to gunshot injuries are common in east of Republic Democratic of Congo and its management should be well known by surgeons and other health practitioners. Reconstruction is possible with simple surgeries using skin grafts and negative pressure therapy (NPT). In this study, we present our results of wounds treatment after gunshot injury with a simple non-surgical procedure using NPT. We present four patients with soft tissue losses caused by gunshot injury. These patients underwent an average of four to eight sessions of vacuum dressing, the length of hospital stay was decrease and soft tissue losses were reconstructed using at the end skin grafts.

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BACKGROUND: Tubal factor infertility (TFI) is common in sub-Saharan Africa and often secondary to pelvic inflammatory disease (PID). Anaerobes associated with bacterial vaginosis (BV) are also found in PIDs widely dominated by Chlamydia trachomatis (C. trachomatis), whose role in TFI is better demonstrated than that of BV. OBJECTIVES: To determine the prevalence of BV and C. trachomatis and to investigate the association between BV, C. trachomatis and TFI. METHODS: We included 137 patients treated for infertility between January 2020 and November 2021. Cases were defined as women with infertility aged 18-45 years presenting with TFI (n = 52), and controls as infertile women in the same age groups without TFI (n = 85). Data on social habits, life style and infertility parameters were collected, and we performed screening for BV and C. trachomatis. Multiple regression was used to measure associations. RESULTS: The prevalence of BV and C. trachomatis was 42.3% (58/137) and 23.4% (32/137), respectively. BV (61.5% vs 30.6%, p<0.001) and C. trachomatis (48.1 vs 8.2%, p<0.001) were more frequent in cases of TFI. BV and C. trachomatis increased the risk of TFI approximately 4-fold [aOR: 3.77 (1.61-8.83), p=0.002] and 14-fold [aOR: 13.77 (4.59-41.27), p<0.001], respectively. CONCLUSION: BV and C. trachomatis infection are strongly associated with TFI in Bukavu. Prevention and screening should be implemented to reduce the risk of TFI.

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BACKGROUND: Patients with HIV consult traditional healers (THs). These THs can both delay care for people living with HIV (PLHIV) and transmit HIV through poor infection control practices. The main objective of this study was to evaluate knowledge and practices of THs regarding HIV in Bukavu. METHODS: A cross-sectional study using quantitative approach was carried out among 71 THs in Bukavu City. The collected data included the following topics: personal and socio-demographic characteristics, HIV knowledge, and infection control practices. Descriptive statistics, independent-samples T-test or F-test, and multiple linear regression were used to analyze the data with a p-value < 0.05. RESULTS: The THs' mean age was 49.2 ± 11.2 years, and the majority were aged 40 to < 60 years. Males constituted 88.7% of THs with a male-to-female ratio of 7.9. In general, 47.9% of study participants had poor knowledge about HIV/AIDS infection, 45.1% of them had fair knowledge, and only 7.0% had good knowledge. Overall, 43.7% of THs had poor infection control practices, 52.1% of THs had fair practices, and only 4.2% of participants had good practices. Results of multiple linear regression analysis revealed that none of the personal and demographic variables studied were significant predictors of their knowledge about HIV/AIDS (p > 0.05). In terms of practices, two variables were significant predictors of infection control practices: living in Ibanda and receiving training in taking care of HIV/AIDS. CONCLUSION AND RECOMMENDATIONS: The study revealed that THs' knowledge about HIV infection was insufficient and that they had poor infection control practices. Formal standardized training on HIV infection should be organized for all THs so that they can always refer their patients to modern, reliable antiretroviral therapy (ART) clinics and reduce the risk of occupational exposure in their practices. Although PPE's assistance for THs is required in terms of protective measures, the province health authority must also oversee infection control procedures at THs' offices.

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Two novel vaccines against malaria are proposed as a complementary control tool to prevent and reduce Plasmodium falciparum related disease and death in under-five children from moderate to high malaria transmission regions. The Democratic Republic of Congo (DRC) has committed to eradicate malaria by 2030, and significant efforts have been deployed to strengthen control and elimination measures. We aimed to understand factors influencing the malaria vaccine acceptability among the general population in eastern DRC. We conducted a survey among adult Congolese in Bukavu in March 2022. The questionnaire was adapted from the Behavioral and Social Drivers of vaccine uptake (BeSD) framework and was administered online and physically. Multivariate logistic regressions were built, and estimates were represented as adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95%CI). Out of 1612 adults (median age: 39 years, 46.15% female) surveyed, only 7.26% were aware of the malaria vaccine. However, 46.53% expressed willingness to vaccinate themselves, and 52.60% were open to vaccinating their under-five children. Adjusting for confounding factors, non-student/non-healthcare worker professions (aOR = 0.58, 95%CI [0.42-0.78]) and middle-income status (aOR = 1.87, 95%CI [1.25-2.80]) were significantly associated with self-vaccination acceptance. Age played a role in under-five child vaccination acceptability, with 25 to over 64 years showing increased acceptability compared to the 18-24 age group. Additionally, non-student/non-healthcare worker professions (aOR = 1.88, 95%CI [1.37-2.59]), medium education levels (aOR = 2.64, 95%CI [1.29-5.79]), and residing in semi-rural areas (aOR = 1.63, 95%CI [1.27-2.10]) were predictors of under-five child vaccination acceptance. The acceptability of the malaria vaccine for self and for under-five children was suboptimal for effective malaria control in this community in the DRC. Our study constitutes a call for the Expanded Program on Immunization to closely work with various stakeholders to strengthen risk communication for community engagement prior to and during the introduction of this novel and lifesaving tool, malaria vaccination.

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Key Clinical Message: Kernohan-Woltman phenomenon is a rare and paradoxical neurological situation in which a transtentorial lesion leads to compression of the contralateral cerebral peduncle responsible for compression of the descending corticospinal fibers with clinical consequence of a motor deficit ipsilateral to the primary lesion. This phenomenon should attract the attention of clinicians in order to avoid unfortunate incidents such as wrong-side craniotomy in neurosurgical practice. In this work, we report a similar situation. Abstract: The Kernohan-Woltman notch phenomenon is a rare and paradoxical neurological situation in which transtentorial damage is observed leading to compression of the contralateral cerebral peduncle responsible for compression of descending corticospinal fibers with the clinical consequence of a motor deficit ipsilateral to the primary lesion. This phenomenon has been found in several situations including tumors and cerebral hematomas after craniocerebral trauma. In this work, we have reported the case of a 52-year-old man with hemiparesis ipsilateral to a large chronic subdural hematoma.

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A well-conducted prenatal visit remains of paramount importance because it allows the preservation of mother and child health by reducing the rates of morbidity and mortality for them. However, the quality of prenatal visits remains a serious problem in our environment, and a new approach is urgently needed to improve the quality of prenatal visits in our environment.

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We report the case of a 14-year-old girl with pain and protrusion of the left eye and treated with diclofenac. Clinical and paraclinical examinations revealed a cerebral empyema and a left retro-orbital abscess complicating an acute ethmoiditis. Parenteral antibiotic remains essential in the management of acute ethmoiditis to prevent complications.

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PROBLEM: There are no studies on the association between high blood pressure and COVID-19 in South Kivu. OBJECTIVE: to determine the influence of arterial hypertension on the clinical characteristics and prognosis of COVID-19 patients hospitalized in the city of Bukavu. METHODOLOGY: Between June 2020 and June 2022, an open cohort of hypertensive and non-hypertensive COVID-19 patients admitted to two clinics in the city of Bukavu was formed. The primary endpoint was the occurrence of death. Thus, a prospective modeling of mortality by the Kaplan-Meier estimator was carried out. RESULTS: Among the 178 admissions for COVID-19, 68 (38.2%) patients were hypertensive. Compared to non-hypertensives, hypertensive patients were significantly older [61.0 (56.0-71.0) vs. 48.0 (32.7-64.0); p < 0,0001). During the observation period of 1059 patient-days, the incidence of death (3.2/100 patient-days) was non-significantly higher in hypertensive patients (4.3/100 patient-days) (p = 0.06). On the other hand, the independent predictors of death were Sepsis [adjusted HR = 3.7 (1.5-8.7)], CRP > 100 mg/L [adjusted HR = 3.0 (1.2-7, 0)] and SaO2 < 90 % [adjusted HR = 3.9 (1.3-11.8)]. CONCLUSION: This study shows that hypertension was very common in patients admitted for COVID-19 in the city of Bukavu but did not influence the vital prognosis of the latter, thus confirming the finds of most authors who have addressed the question.

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Introduction: sickle cell disease is the most common inherited hemoglobin disease globally and remains a significant concern worldwide and in Africa. This study aimed to determine the clinical profile of children with sickle cell disease followed up in two hospitals in Bukavu. Methods: we conducted a cross-sectional multicenter retrospective study. Medical folders of children with sickle cell disease followed up at the Cliniques Universitaires de Bukavu and Clinique Ami des Enfants, collected from January 2018 to December 2019, have been used. Results: in 55 sickle cell children, 31 cases (54.4%) were male against 24 (43.6%) females. The average age was 101.09 months (between 12 and 222 months). Diagnosis has been established before two years, with an average age of 14.27 months. The main circumstance of the discovery of the disease is anemia. Electrophoresis was the primary test of diagnosis in 81.8% of cases. Transfusion was done an average of 5.98 times (0 and 10 times) during different treatment period. Anaemia and infectious phenomena were encountered respectively in 96.4% and 96.4%. However, acute chest syndrome was only found in 9.1%. Conclusion: sickle cell disease has been diagnosed precociously before two years and anemia was the main circumstance of discovery. A better knowledge of caregivers about the various clinical aspects and an early screening could improve the quality of life of these children.

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BACKGROUND: Vitiligo is a skin disorder characterized by selective loss of melanocytes resulting in circumscribed, depigmented macules and patches. Although it does not cause physical pain that warrants a patient to complain, its effects can be psychological, leading to stigmatization and suicidal ideation. PATIENTS AND METHODS: We conducted a cross-sectional study with a descriptive aim over a period of one year and 8 months (February 1, 2019, to September 30, 2020). The patients attending the dermatology-venereology services of the University Clinics of Bukavu (CUB) and the Saint-Luc Clinic of Bukavu (CSLB) were recruited into the study. It focused on patients received in consultation for vitiligo. The diagnosis of vitiligo was made based on clinical examination and when in doubt, a skin biopsy was carried out to confirm histological diagnosis. The data were entered and analysed using Epi info3.5.1. RESULTS: The prevalence of vitiligo in this study was 2.0%. The mean age was 24.5 years and range from 6 months to 73 years. The age group most affected was 0 to 9 years with 41.9%. The female sex represented 61.3% and the M/F sex ratio was 1.5. Stress (12.9) and repeated trauma (6.5) were the most reported triggers. Family history was present in 29.0% of cases. Atopy (29.0%) and thyroiditis (9.7%) were the most common associated pathologies. Preferred lesion locations were the face (48.4%), external genitalia (41.9%) and extremities (22.6%). The predominant clinical form was non-segmental vitiligo (80.6%). Among the paraclinical examinations carried out, the inflammatory assessment was the most disturbed (9.7%). CONCLUSION: Vitiligo is a dermatosis that can affect anyone; regardless of gender, age or race.

CONTEXTE: Le vitiligo est une affection cutanée caractérisée par une perte sélective de mélanocytes entraînant l'apparition des macules et des plaques dépigmentées. Bien qu'il ne cause pas la douleur physique qui justifie qu'un patient se plaigne, ses effets peut être psychologique, conduisant à la stigmatisation et aux idées suicidaires. PATIENTS ET MÉTHODES: Nous avons mené une étude transversale à visée descriptive sur une durée d'un an et 8mois (du 1er février 2019 au 30 septembre 2020). Les patients fréquentant les services de dermatologie-vénéréologie des Cliniques Universitaires de Bukavu (CUB) et de la Clinique Saint-Luc de Bukavu (CSLB) ont été recrutés dans l'étude. Elle s'est concentrée sur les patients reçus en consultation pour vitiligo. Le diagnostic de vitiligo a été fait sur la base d'un examen clinique et lorsqu'il y avait un doute, une biopsie cutanée était réalisée pour confirmer histologiquement le diagnostic. Les données ont été saisies et analysées à l'aide d'Epi info3.5.1. RÉSULTATS: La prévalence de vitiligo dans cette étude était 2,0 %. L'âge moyen était de 24,5 ans avec des extrêmes allant de 6 mois à 73 ans. La tranche d'âge la plus touchée était de 0 à 9 ans avec 41,9 %. Le sexe féminin représentait 61,3% et. CONCLUSION: Le vitiligo est une dermatose qui peut toucher n'importe qui ; sans distinction de sexe, d'âge ou de race. MOTS CLÉS: Vitiligo, Bukavu, République Démocratique du Congo.

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INTRODUCTION: SARS-CoV-2 serology tests could play a crucial role in estimating the prevalence of COVID-19. The purpose of this study was to estimate the prevalence of COVID-19 among travellers and workers in Bukavu, a city in eastern Democratic Republic of the Congo. METHODS: between May and August 2020, the Cellex qSARS-CoV-2 IgG/IgM Rapid Test (Cellex, Inc., USA), lateral flow immunoassay was used to rapidly detect and differentiate antibodies against SARS-CoV-2 among travellers and workers seeking medical certification. RESULTS: among the 684 residents of the city of Bukavu screened for COVID-19 (4.2% Hispanic, 2.8% other African, 0.9% Asian), the seroprevalence anti-SARS-CoV-2 antibodies was 40.8% (IgG+/IgM+: 34.6%; IgG+/IgM-: 0.5%; IgG-/IgM+: 5.4%). Cumulative seroprevalence of anti-SARS-CoV-2 IgG antibodies increased from 24.5% to 35.2% from May to August 2020. Independent predictors of SARS-CoV-2 antibodies were age > 60 years [adjusted OR = 2.07(1.26-3.38)] and non-membership of the medical staff [adjusted OR = 2.28 (1.22-4.26)]. Thirteen point nine percent of patients seropositive for SARS-CoV-2 antibodies were symptomatic and hospitalized. CONCLUSION: this study shows a very high seroprevalence of SARS-CoV-2 antibodies among travellers and workers in Bukavu, a city in eastern Democratic Republic of the Congo, which may positively affect community immunity in the study population. Thus, the management of COVID-19 should be contextualized according to local realities.

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INTRODUCTION: This study highlights the determinants of the use of health services by adherents to the three mutual health insurances in the town of Bukavu in the Democratic Republic of the Congo. METHODS: We conducted a descriptive cross-sectional study, based on a perception survey among users of healthcare services affiliated to the mutual health insurances in the Bukavu health zones. The encoding and statistical analysis were carried out using the Epi INFO version 2010 software. RESULTS: The main determinants of the use of healthcare services by adherents to the mutual health insurances are: the member's place of residence, the level of education of the head of household, the previous experience of care in the healthcare structure partner of the mutual health insurances, the reputation of the structure partner of the mutual health insurances and the ability of households to pay the user fee. CONCLUSION: This study highlights that, beyond the financial barrier, the implementation of a mutual health organisation should promote a better regulation of the user fee and a good quality of care to meet the care needs of members. The factors emerging from the study as a major determinant of the use of health services by adherents to a mutual health insurance are often not taken into account in the implementation of mutual health insurance in contexts similar to those of Bukavu.

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INTRODUCTION: In Bukavu, transfused blood is selected using rapid diagnostic tests (RDTs). These tests are easily performed without specialized equipments. This study aims to evaluate the virological quality of transfused blood assessed using rapid diagnostic tests. METHODS: A blood sample was drawn from a blood bag and collected in a 4ml dry tube in 5 Health Care Facilities over a month. Counter analysis was performed on each sample using rapid tests and ELISA. Intrinsic and extrinsic values were calculated. Cohen's kappa coefficient was used to evaluate the reliability of RDT compared with ELISA. RESULTS: Three hundred and twelve samples were collected; 5 samples were positive for one or the other virologic marker while 307 samples were negative in all the tests. However Elisa showed, out of the 307 samples which were RDT test negative, 15 other positive samples including 3 samples positive for HIV, 3 for HCV and 9 for HBV. In addition, ELISA validated some RDT-positive samples and contradicted other results. Sensitivity and positive predictive value from rapid diagnostic tests were very low. The reliability of these tests was satisfactory, medium or low. CONCLUSION: Blood assessed using RDTs poses a non negligible risk of viral infections. This study highlights the need for more reliable and efficient tests in our Health Care Facilities.

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INTRODUCTION: Prolonged waiting times for medical consultations become a factor in patient dissatisfaction. This study aimed to measure the waiting times for medical consultation and to identify the causes and the consequences from the perspective of improvement of the organisation of medical services. METHODS: We conducted a cross-sectional descriptive study at the General Provincial Reference hospital in Bukavu and at the Biopharm Hospital Center. Data were collected using a literature review, the monitoring of the waiting times and individual interviews of patients and care providers. Quantitative data analysis was accomplished using Epi Info 7.2.0.1.software. Qualitative data were analyzed searching for themes. RESULTS: More than 70% of patients in 3 major Departments at the General Provincial Reference Hospital in Bukavu waited more than 30 minutes before being seen. More than 40% of patients in the 4 major Departments at the Biopharm Hospital Center waited between 0 and 15 minutes. In the Department of Gynecology and Obstetrics at the General Provincial Reference hospital in Bukavu 56% of patients had shorter waiting times (0-15 minutes). The two main causes of prolonged wait times included administrative burden of medical services and physicians delay. Serious implications included a reduction in attendance, in medicinal recipes as well as patients' fatigue. The availability of qualified health staff, the computerization of hospital services and continuous staff training are priorities to reduce waiting times. CONCLUSION: Waiting times vary from one hospital to another and from one department to another within the same hospital, depending on several factors. This study describes possible measures for improvement of waiting times for medical consultations.

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INTRODUCTION: Typhoid fever is a major public health problem in developing countries because of the obsolescence of health infrastructure and of an almost non-existent water distribution network. In the Democratic Republic of the Congo, in general, and in Bukavu, in particular, blood culture is inaccessible to the majority of patients. This study aimed to assess the sensitivity of Salmonella spp to antibiotics commonly used for the tratment of typhoid fever in Bukavu. METHODS: We conducted a cross-sectional study over a period of 6 months. Any subject suspected of having typhoid fever was included in the study. Blood culture was systematically performed in any selected patient. The identification of bacterial strain and antibiotic susceptibility tests were performed using conventional methods. The following antibiotics were tested: amikacin, Aamoxicillin, augmentin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, ciprofloxacin, cotrimoxazole, doxycycline, gentamicin, negram, norfloxacin. RESULTS: Our study included 460 sick subjects; blood cultures were positive in 144 (31.30%) patients. Salmonella spp was the most isolated germ (41.66%). In Bukavu, isolated Salmonella spp strains were sensitive to ciprofloxacin (91.7%), ceftazidime (81.7%), ceftriaxone (80%), norfloxacin (80%), amikacin (76.6%) and cefuroxime (73.3%). They remained resistant to other antibiotic molecules. CONCLUSION: These results show a decreased sensitivity to most of the antibiotics. Antibiotic susceptibility test is necessary in patients with typhoid fever for improved patient management.

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INTRODUCTION: In sub-Saharan Africa, diagnostic methods for tuberculosis are inadequate and are essentially based on microscopy. They constitute a real obstacle to the control of tuberculosis. This study aimed to evaluate the performance of GeneXpert MTB/RIF test compared to classical Ziehl-Neelsen staining at the the general referral provincial hospital of Bukavu, in the east of the Democratic Republic of the Congo after 10 months of use. METHODS: The results of Ziehl-Neelsen staining and GeneXpert MTB/RIF molecular biology test performed in 452 patients with suspected tuberculosis were collected. This study compares the validity of these different diagnostic tests in the detection of tuberculosis. RESULTS: In the entire group, the frequency of the pulmonary tuberculosis was 16.3%. The positivity rate was significantly higher in GeneXpert MTB/RIF test than in Ziehl-Neelsen staining in the entire group (15.9% vs 9.3%, p = 0.03) and in HIV seropositive patients (52.0% vs 24.0%; p = 0.007). However, the sensitivity of GeneXpert MTB/RIF test compared to that in Ziehl-Neelsen staining wasn't maximum (95.2%). Finally, GeneXpert MTB/RIF test detected rifampicin resistance in 20.8%. CONCLUSION: This study confirms the superiority of GeneXpert MTB/RIF test compared to Ziehl-Neelsen staining in the detection of tuberculosis and in the prediction of multi-resistance. Its systematic use coupled with Ziehl-Neelsen staining would better control tuberculosis in sub-Saharan Africa.

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