Prevalence of middle ear effusion among children with adenoid hypertrophy at a national referral hospital in Tanzania

Introduction: Middle ear effusion (MEE) is a common childhood disorder that causes hearing impairment due to the presence of fluid in the middle ear which reduces the middle ear's ability to conduct sound. Temporary or persistent hearing loss as a result of MEE causes speech, language and learning delays in children. There are few studies on MEE in Tanzania despite the huge burden of hearing loss among children with adenoid hypertrophy which is a known risk factor for MEE. Method: A cross-sectional study was conducted among 420 children aged nine years and below having adenoid hypertrophy with or without MEE. The diagnosis of adenoid hypertrophy was confirmed with a lateral view x-ray of the nasopharynx and tympanometry for cases with MEE. The primary objective of the study was to assess the prevalence of MEE among children with adenoid hypertrophy. Results: The prevalence of MEE among children with adenoid hypertrophy was 61.7%, with 218 (51.9%) males and 202 (48.1%) females. The most affected age group was 2-4 years with an incidence 193 (46%) and in this age group, males (53.9%) were more affected than females (46.1%). Generally, males, 134 (51.7%) were more affected by MEE than females, 125 (48.3%) of all 259 children with MEE. In terms of age group predominance by MEE, children aged 3-4 years, 107(41.3%) were more affected than all other age groups. Additionally, 4 (1.5%) children with MEE presented with hearing loss. Conclusion: There is a high prevalence of MEE among children with adenoid hypertrophy but no significant association with hearing loss.

Evaluation de la toxicité de «anteprost »: médicament traditionnel amelioré, utilisé contre l'hypertrophie benigne de la prostate

Objectif : Evaluer la toxicité du phytomédicament 'Antéprost' chez les animaux de laboratoire. Méthode : Après une extraction hydro-alcoolique, un criblage phytochimique a été réalisé. Ensuite une dose unique de 5000 mg/kg de poids corporel a été administrée aux cobayes dans l'étude de toxicité aiguë avec une surveillance des animaux pendant 15 jours. Au cours de l'étude de toxicité subchronique, trois différentes doses (153,6 mg/kg/jr, 307,2 mg/jr et 614.4 mg/kg) ont été administrées quotidiennement pendant 90 jours à des rats Wistar des deux sexes. Ils ont été surveillés pour tout signe de toxicité et les données relatives aux poids corporels, consommations alimentaires, para-mètres biologiques ainsi qu'à l'histologie des organes ont été relevées. Résultats : Plusieurs composés phytochimiques ont été mis en évidence dans notre extrait. Nous n'avons enregistré ni de mortalité ni de signes de toxicité aussi bien dans le comportement des co-bayes que dans leur consommation alimentaire au terme des quinze jours d'observation. L'étude de toxicité subchronique n'a révélé aucun signe de toxicité. Le poids corporel des animaux ainsi que la consommation alimentaire, les paramètres biochimiques, hématologiques et histologiques n'ont pas été significativement modifiés. Conclusion : Cette étude a permis de montrer que la DL50 d u médicament traditionnel amélioré''Antéprost'' est supérieure à 5g/kg chez le cobaye. Aucune toxicité n'a été observée au cours de l'étude de la toxicité subchronique de 90 jours. Toutes ces données suggèrent que le produit est rela-tivement non toxique aux doses étudiées

Particularités de prise en charge chirurgicale des goitres pluri-nodulaires bénins à l'Hôpital d'Instruction des Armées de Cotonou, Bénin

Introduction : Le goitre "bénin" est une hypertrophie diffuse de la thyroïde normo-fonctionnelle, non-inflammatoire et non-cancéreuse. Le but de la présente étude était d'analyser les particularités de prise en charge des goitres pluri-nodulaires relevant d'une indication chirurgicale. Matériel et méthode : Cette étude de cohorte rétrospective a été réalisée du 1er janvier 2013 au 1er janvier 2018 à l'Hôpital d'Instruction des Armées - Centre Hospitalier Universitaire de Cotonou, Bénin. Ont été inclus les patients opérés pour goitre pluri nodulaire bénin. Ont été exclus les patients atteints de pathologies thyroïdiennes non nodulaires ou de cancer thyroïdien. Les données étudiées ont été : l'âge, le sexe, la profession, le lieu de résidence, le motif de consultation, les signes cliniques, les signes échographiques, la prise en charge chirurgicale, les complications per et post-opératoires et l'histologie définitive de la pièce d'exérèse. Ces données ont été colligées à l'aide du logiciel Excel 2016. Résultats : Pendant la période d'étude 2,46% des consultations ORL ont bénéficié d'une prise en charge chirurgicale pour goitre pluri-nodulaire bénin (19 cas/an) : 71 femmes (72,45%) et 27 hommes (27,55%), moyenne d'âge de 36 ans (17 à 44 ans). D'un point de vue socio-économique : 50 patients exerçaient une profession libérale et 35 patients étaient sans emploi fixe. Les motifs de consultation étaient une masse cervicale (67 patients), des signes d'hyperthyroïdie (20 patients) ou des signes de compression de l'axe viscéral du cou (11 patients). La durée moyenne avant consultation ORL était de 7,62 ans (1 à 18 ans). L'examen clinique avait objectivé une glande thyroïde "ferme" (70 patients ; 71,4%) pluri-nodulaire (76 patients ; 77,55%) sans adénopathie cervicale palpable (100%). Deux tiers des patients avaient un goitre de grade 3 de l'OMS. Les gestes chirurgicaux étaient une thyroïdectomie subtotale (52 ; 53,1%), une thyroïdectomie totale (30 patients ; 30,6%) et une lobectomie unilatérale avec isthmectomie (16 patients ; 16,3%). L'examen anatomo-pathologique a été réalisé pour toutes les pièces de thyroïdectomie objectivant un goitre macro-folliculaire chez 51 patients (52,04%). Aucun cas de décès n'a été enregistré. Les suites opératoires ont été marquées par un taux de paralysie récurrentielle de 2,78 % en termes de nerf à risque ainsi qu'une reprise chirurgicale pour drainage d'hématome compressif (2,04%). Conclusion : Le traitement de choix du goitre pluri-nodulaire bénin est théoriquement la thyroïdectomie totale. Cependant, le recours à une l'opothérapie et la nécessité d'un long suivi post-opératoire limite ses indications chez les patients de niveau socio-économique défavorable. Les techniques chirurgicales de thyroïdectomies partielles ou subtotales gardent tout leur intérêt dans ces indications

Electrocardiographic Left Ventricular Hypertrophy among Gambian Diabetes Mellitus Patients

Background: The global prevalence of diabetes and its complications is increasing worldwide. Its role in coronary heart disease has been linked with the presence of left ventricular hypertrophy (LVH). The present study aims to determine the prevalence of electrocardiographic left ventricular hypertrophy (ECG-LVH) in adult diabetic subjects; its epidemiological and clinical correlates.Methods: A descriptive cross-sectional study involving 534 patients was conducted at the Edward Francis Small Teaching Hospital (formerly Royal Victoria Teaching Hospital); The Gambia. Four hundred and forty patients were included using a standard questionnaire. Anthropometry; laboratory investigations and electrocardiogram were carried out. We used the Lewis; Cornell; and Sokolow-Lyon Voltage criteria to define ECG-LVH. MinitabTM statistical software version 13.20 was used for analysis.Results: 146 (35.2) patients had ECG-LVH using all 3 criteria and this prevalence was higher among women being 116 (79.5). A generally high prevalence of overweight (155/37.4) and obesity (119/28.6) was observed among study participants; and both clinic-day systolic and diastolic blood pressure (BP) were significantly higher in those with ECG-LVH. Poor diabetes control was observed in both groups.Conclusion: There was a high prevalence of ECGLVH and it is especially so with combining multiple criteria; hence the need for screening. Clinic-day hypertension was associated with ECG-LVH hence the need for diagnosing and aggressive treatment of hypertension in patients with diabetes mellitus

Echocardiographic Assessment of Left Atrial Size in Patients with End-Stage Renal Disease : Cardiovascular Topic

Background: Cardiac disease is the most common cause of death in patients with end-stage renal disease. It is assumed that the high rate of cardiovascular mortality is related to accelerated atherosclerosis. Patients with chronic renal insufficiency have an increased prevalence of coronary artery disease; silent myocardial ischaemia; complex ventricular arrhythmias; atrial fibrillation; left ventricular hypertrophy; annular mitral and aortic valve calcification; and enlargement of the left atrium; than patients with normal renal function. It is also well known that haemodialysis is associated with cardiovascular structural changes and rapid fluctuations in electrolyte levels. In this study; we sought to estimate left atrial size by means of echocardiography and to determine any correlations between different echocardiographic measurements in patients with end-stage renal disease. Methods: We analysed data from 123 patients who were on regular haemodialysis; by means of traditional transthoracic echocardiographic examination. The usual statistical parameters; correlations and the Student's t-test were performed; with levels of significance of p 0.01 and p 0.05. Results: The most presented age group was 60 to 69 years old; with a predomination of females (56.1). We found dilated left atrium in 26.02of the study patients and a high statistical correlation between different methods of measurement and calculated volumes of the left atrium. Conclusion: Evaluation of left atrial size should be determined by several different measurements; and left atrial enlargement should be seen as a risk factor for advancing disease

Pattern of Left Ventricular Geometry in Hypertension: a Study of a Hypertensive Population in Nigeria

Background: Hypertension is a leading cause of cardioxasular morbidity and mortality in Nigeria. The main aim of this study was to deterine the prevalence of left ventricular hypertrophy and left ventricular geometric patterns among hypertensives in Kano; Nigeria. Methods: The study was cross-sectional in design; and carried out in 3 echocardiography laboratories within the City of Kano; Nigeria. Patients with hypertension without other cardiac disorders were serially recruited and studied after obtaining informed consent. Results: A total of 186 patients were studied over 7 months; 89 males (47.9) and 97 females (52.1). The prevalence of left ventricular hypertrophy was 61.8. Thirty five patients (18.8) had normal left ventricular geometry and these were predominantly females and had the lowest mean age and shortest duration of hypertension. Sixty eight patients (36.6) had eccentric hypertrophy; 47 (25.3) had concentric hypertrophy and 36 (19.4) had concentric remodelling. Independent predictors of the various geometric patterns were identified. Conclusion: A high prevalence of left ventricular hypertrophy was observed with eccentric hypertrophy being the most common geometric pattern. Gender influenced the pattern of left ventricular geometry

Blood Pressure Control and Left Ventricular Hypertrophy in Hypertensive Nigerians

Background : Hypertension is a disease characterized by end-organ complications; leading to high morbidity and mortality in many cases. People with untreated or uncontrolled hypertension often run the risk of developing complications directly associated with the disease. Left ventricular hypertrophy (LVH) has been shown to be a significant risk factor for adverse outcomes both in patients with hypertension and in the general population. We investigated the prevalence and pattern of LVH in a treated hypertensive population at the University College Hospital; Ibadan; Nigeria; using non-hypertensive subjects as control. Design and Setting : A prospective observational study performed at the University College Hospital; Ibadan; Nigeria. Methods : Patients had 6 visits; when at least one blood pressure measurement was recorded for each hypertensive subject and average calculated for systolic blood pressure (SBP) and diastolic blood pressure (DBP) separately. The values obtained were used for stratification of the subjects into controlled and uncontrolled hypertension. Subjects also had echocardiograms to determine their left ventricular mass. Results : LVH was found in 14 (18.2) of the normotensive group; 40 (20.8) of the uncontrolled hypertensive group and 14 (24.1) of the controlled hypertensive group when left ventricular mass (LVM) was indexed to body surface area (BSA). When LVM was indexed to height; left ventricular hypertrophy was found in none of the subjects of the normotensive group; while it was found present in 43 (22.4) and 14 (24.1) subjects of the uncontrolled and controlled hypertensive groups; respectively. Significant difference in the prevalence of LVH was detected only when LVM was indexed to height alone. Conclusion : Clinic blood pressure is an ineffective way of assessing BP control. Thus in apparently controlled hypertensive subjects; based on office blood pressure; cardiac structural changes do remain despite antihypertensive therapy. This population is still at risk of cardiovascular events

Prevalence and Covariates of Electrocardiographic Left Ventricular Hypertrophy in Diabetic Patients in Tanzania : Cardiovascular Topics

Background : Left ventricular hypertrophy (LVH) has been demonstrated to be a powerful predictor of cardiovascular (CV) morbidity and mortality in diabetic as well as hypertensive patients. However; less is known about the prevalence of electrocardiographic LVH (ECG-LVH) and its relation to other CV risk factors in diabetic patients in sub-Saharan Africa. Therefore; the aim was to assess the prevalence of ECG-LVH in diabetic patients in Dar es Salaam; Tanzania; and its relation to other cardiovascular risk factors. Methods: Two hundred and thirty-seven consecutive patients attending the Muhimbili diabetic clinic were studied. ECGlvH was diagnosed by Sokolow-Lyon voltage and Cornell voltage-duration product criteria. Q waves; ST-segment deviation; T-wave abnormalities and intraventricular conduction defects were classified by the Minnesota codes. Blood pressure (BP); serum creatinine; cholesterol and triglyceride levels; and HbA1c and urinary albumin and creatinine concentrations were determined. Results: The prevalence of LVH in patients was 16by either ECG criteria; 12.2by Sokolow-Lyon and 5.1by Cornell product criteria. Patients with LVH had significantly higher systolic and mean BP and pulse pressure; and a higher prevalence of ST-segment abnormalities; T-wave inversion and albuminuria than those without LVH (all p 0.05). in multivariate logistic regression analysis; systolic BP was the only independent predictor of ECG-LVH. The prevalence of ECG-LVH increased by 15per 10 mmHg higher systolic BP [OR 1.151 (95CI 1.00921.314); p 0.05]. Clustering of cardiovascular risk factors differed significantly between type 1 and type 2 diabetes patients. On average; type 1 patients had 0.8 and type 2 had 2.2 additional CV risk factors. Conclusion: ECG-LVH was present in 16of diabetic patients in Tanzania. Systolic BP was the most important predictor of ECG-LVH. Clustering of CV risks was significantly higher in type 2 than in type 1 diabetics; demonstrating the need for systematic multiple risk-factor assessment in these patients

Electrocardiographic Left Ventricular Hypertrophy with Strain Pattern : Prevalence; Mechanisms and Prognostic Implications : Review Article

Background: Electrocardiographic left ventricular hypertrophy with strain pattern has been documented as a marker for left ventricular hypertrophy. Its presence on the ECG of hypertensive patients is associated with a poor prognosis. This review was undertaken to report the prevalence; mechanism and prognostic implications of this ECG abnormality. Materials and methods: We conducted a comprehensive search of electronic databases to identify studies relating to the title of this review. The search criteria were related to the title. Two of the reviewers independently screened the searches. Results: Results were described qualitatively. The data were not pooled because there were no randomised studies on the topic. The prevalence of ECG strain pattern ranged from 2.1 to 36. The highest prevalence was reported before the era of good antihypertensive therapy. The sensitivity as a measure of left ventricular hypertrophy ranged from 3.8 to 50; while the specificity was in the range of 89.8 to 100. Strain pattern was associated with adverse cardiovascular risk factors as well as increased all-cause and CV morbidity and mortality. ST-segment depression and T-wave inversion on the ECG was recognised as the strongest marker of morbidity and mortality when ECG-LVH criteria were utilised for risk stratification in hypertensive subjects. Conclusion: Electrocardiographic strain pattern identifies cardiac patients at higher risk of cardiovascular-related as well as all-cause morbidity and mortality

Electrocardiographic Abnormalities in Patients with Heart Failure : Cardiovascular Topics

Background : The morbidity and mortality from heart failure (HF) differ between patients with reduced ( 50) and with preserved ( 50) left ventricular ejection fraction (LVEF) on account of many factors; including abnormalities detected in the electrocardiogram (ECG). The aim of this study was to determine and compare the ECG abnormalities between HF patients with reduced and with preserved LVEF. Methods : The study was cross-sectional in design and carried out in Aminu Kano teaching hospital and Murtala Mohammed specialist hospital; Kano; Nigeria; from April 2005 to June 2006. We studied the resting electrocardiograms of all HF patients aged 15 years and older who were referred to the two centres for echocardiography. Results: A total of 113 patients were studied and 98.2of them had abnormal ECGs. Forty-two patients (37.2) had preserved LVEF while the remaining 71 (62.8) had reduced LVEF. Left ventricular hypertrophy ( LVH) was the commonest ECG abnormality; found among 55 patients (77.5) with reduced LVEF; and 21 patients (50) with preserved LVEF (p = 0.0026). The commonest arrhythmia was atrial fibrillation; found among 10 patients (14.1) with reduced LVEF and eight patients (19.1) with preserved LVEF (p = 0.486). Prolonged corrected QT interval was found among 30 (71.4) and 56 patients (78.9) with preserved and reduced LVEF; respectively (p = 0.370). Conclusion: Most of the patients with heart failure studied in Kano; Nigeria had abnormal electrocardiograms; and the most common abnormality was LVH

Comparison of Araoye's criteria with standard electrocardiographic criteria for diagnosis of left ventricular hypertrophy in Nigerian hypertensives

Background: Left ventricular hypertrophy (LVH) is a major risk factor for cardiovascular morbidity and mortality. Various electrocardiographic (ECG) criteria for LHV give poorer performance in black subjects when compared with white subjects. Araoye proposed a code system for improved ECG diagnosis of LVH in blacks. The Araoye's criteria are yet to be validated in black subjects.Study design: Electrocardiograms and echocardiograms were obtained from 100 hypertensive subjects and 60 controls. ECG LVH was determined by the Araoye's code criteria; Sokolow-Lyon; Cornell voltage; and Romhilt-Estes point score. Echocardiographic LVH was defined by LV mass indexed for height at 97.5 percentile of the controls (126g.m-1 and 130g.m-1 in females and males respectively). Results: The prevalence of echocardiographic LVH indexed for height was 34and 1.67in the hypertensive and controls respectively while the prevalence of electrocardiographic LVH among the hypertensives were 18by Romhilt Estes score; 48by Sokolow-Lyon's criteria; 22by Cornell's criteria and 51by Araoye's criteria. The sensitivity and specificity respectively of the various electrocardiographic criteria were 65.7and 76.8for Sokolow-Lyon; 25.7and 88.8for Cornell's criteria 25.7and 92.8for Romhilt-Estes score and 71.4and 74.4for Araoye's criteria. Araoye's criteria did not differ significantly from Sokolow-Lyon criteria in identifying LVH but differed significantly from Cornell and Romhilt-Estes criteria. The number of positive codes in Araoye's criteria was significantly associated with the blood pressures; LV dimensions; and LV mass. Conclusion: The Araoye's code system for electrocardiographic diagnosis of LVH offer no comparative advantage over Sokolow-Lyon's criteria. However; the number of positive codes in Araoye's criteria identifies those individuals with more severe LVH

Effets du clenbutérol sur l'expression de l'IGF-1 et des IGFPBs par les cellules musculaires C2C12

Nous avons etudie les effets du clenbuterol; un agoniste du recepteur ?2-adrenergique entrainant l'hypertrophie musculaire; sur l'expression de l'IGF-1 et des IGFBPs par les myotubes de cellules C2C12 en culture. A la concentration de 10-4 M; le clenbuterol a entraine une augmentation du niveau de l'ARN messager de l'IGF-1; IGFBP-4 et de l'IGFBP-5. L'effet sur l'IGFBP-5 est apparu apres 24h alors que les effets sur l'IGF-1 et l'IGFBP-4; plus tardifs; ont ete observes au bout de 48 heures d'incubation. Ces resultats montrent que le clenbuterol agit directement sur les cellules musculaires pour augmenter de l'expression de l'IGF-1 et des IGFBPs; mediateurs possibles de l'hypertrophie musculaire

Le syndrome de Klippel-Trenaunay : premiere description au Mali; a propos de 7 cas observes dans le service de chirurgie de l'Hopital du Point G; Bamako

Les auteurs rapportent pour la premiere fois au Mali une serie de 7 cas de syndrome de Klippel-Trenaunay. Les anomalies les plus frequemment rencontrees sont les varices et l'allongement et/ou l'hypertrophie du membre; la rarete des troubles dermatologiques pourrait etre liee a la discretion de certaines lesions cutanees chez le sujet noir. Ils passent en revue les differentes complications et insistent sur les nombreuses formes frustres qui justifient la recherche systematique du syndrome chez certains individus; surtout ceux porteurs de troubles dactyliques

La stenose hypertrophique du pylore aux Cliniques Universitaires de Kinshasa

Dix-sept enfants atteints de stenose hypertrophique du pylore ont ete soignes aux Cliniques Universitaires de 1960 a 1985. Sur le plan epidemiologique; les auteurs ont retenu les elements suivants: l'incidence annuelle est faible; la maladie se recrute davantage dans les couches socio-economiques defavorisees; la predominance masculine est indeniable; l'age du debut de la maladie est de deux semaines et le quatrieme enfant a ete plus touche par la maladie contrairement aux notions classiques. En ce qui concerne les aspects cliniques; le tableau est domine par le trepied vomissement; deshydratation et la presence d'ondes peristaltiques a travers l'abdomen. Le diagnostic est anamnestique et clinique dans 90 pour cent de cas. Un transit gastro-duodenal est indispensable dans les cas difficiles. L'amelioration des resultats therapeutiques passe par une prise en charge precoce; et par l'application stricte de principe de chirurgie pediatrique

A study of the effect of nifedipine in reversing left ventricular hypertrophy in hypertensive patients

Using WHO hypertensive criteria; 184 patients with hypertension were chosen (102 male; 82 female); aged 58-78 years old. Other heart diseases were ruled out by physical examination; electrocardiographic examination; chest-ray and echocardiography. All the cases had one or more criteria of left ventricular hypertrophy (LVH): Interventricular septal thickness at diastole; left ventricular posterior wall thickness at end diastole and left ventricular mass index. The findings in this study imply that it is good practise to include nifedipine in the treatment regimen of patients whose hypertension is complicated with LVH and (or) ischaemic heart disease