[Self-medication among patients admitted to the emergency department of Kinshasa University Hospital]

A cross-sectional descriptive study was conducted at Kinshasa University Hospital (KUH) to determine the prevalence of self-medication among patients admitted to KUH and to identify commonly used drugs. 391 patients aged 14 to 92 years admitted to the KUH emergency department between 15 January and 15 February 2011 were included in the study. 233 patients out of a total of 391 (59.6%) used self-medication between the onset of symptoms and the visit to KUH. The number of drugs used ranged from 1 to 7. Of the 233 patients who practiced self-medication, 224 (96.1%) used pharmaceutical drugs alone, 4 (1.7%) used traditional African remedies alone, 1 (0.4%) used Chinese medicine alone, and 4 (1.7%) combined pharmaceutical drugs with traditional African remedies. Analgesics and antipyretics (44.3%), non-steroidal anti-inflammatory drugs (NSAIDs) (26.3%), antimalarials (20.6%) and antibacterials (12.3%) were the most commonly used pharmaceutical drugs. Paracetamol was the most commonly used analgesic and antipyretic (89.1%). Among NSAIDs, diclofenac (65%) was the most widely used. Artemisinin-based combination drugs (40.4%) were the most commonly used antimalarials, with lumefantrine being the most common. The most widely reported antibacterials were betalactam antibiotics (ampicillin and amoxicillin) (42.9%). The results show that self-medication, based mainly on commonly prescribed pharmaceutical drugs, appears to be a common therapeutic option before seeking hospital care and may be a major threat to individual and community health.

[Dilation of the aortic root in ventricular septal defects. Risk factor of aortic insufficiency]

The diameter of the aortic root was measured in 151 patients with small ventricular septal defect (Qp/Qs less than 2 and pulmonary vascular resistance less than 1.5 U.m-2) and correlated with the presence of absence of aortic regurgitation. In 26 cases the aortic juxtavalvular region (bulbus) was dilated above 2 SD compared to a control group. All patients with aortic regurgitation of with cusp prolapse belonged to this group of 26 cases. Aortic root dilatation seems to have a specificity of 89 p. 100, a sensitivity of 75 p. 100 and a negative predictive value of 98 p. 100 in relation to the occurrence of aortic insufficiency. The finding of an aortic root dilatation associated with a ventricular septal defect should incite to a closer supervision of non-operated patients should be used as an argument when discussing the surgical closure of the ventricular septal defect.

[Interventional catheterization in infantile congenital aortic valve diseases]

The authors present their experience of percutaneous aortic valvuloplasty in 10 neonates and 12 children with critical aortic stenosis. In the neonate group the left ventricular aortic gradient dropped from 49 +/- 20 mmHg to 15 +/- 16 mmHg. This improvement persisted in 57 p. cent of the cases after 2 years. In the older group (mean age 6 years) the gradient was reduced from 73 +/- 22 mmHg to 30 +/- 17 mmHg with maintained results in 78 p. cent after 2 years. Aortic incompetence occurred in the majority of cases but did not seem to be more important than after surgical commissurotomy. In critical stenosis, balloon aortic valvuloplasty seems to be a valuable alternative to surgery as a palliative measure before prosthetic valve replacement.

High incidence of hypoglycaemia in African patients treated with intravenous quinine for severe malaria

Changes in plasma glucose and insulin concentrations were monitored over 24 hours in 28 African patients receiving quinine intravenously in an average dose of 8.5 mg base/kg over one hour eight hourly for severe malaria. The patients (nine children and 19 adults) were moderately undernourished; none was pregnant or had renal insufficiency. Plasma insulin concentrations rose during the infusion and then declined. Plasma glucose concentrations were decreased at two, three, and four hours after the start of the infusion. Insulin: glucose ratios were raised between half an hour and two hours after the start of the infusion. The three infusions of quinine increased plasma insulin concentrations in a similar way. In nine patients, including four children, plasma glucose concentrations fell below 2.8 mmol/l on one or two occasions. At the time of the hypoglycaemia plasma insulin concentrations were inappropriately high as shown by a consistent and often considerable increase in the insulin:glucose ratio. Hypoglycaemia that may pass unnoticed in comatose patients is thus a common complication of treating severe malaria with quinine, in particular in children. Its high incidence calls for attentive monitoring and preventive measures.