[Coronary artery aneurysms probably due to Kawasaki's disease]. / Anévrismes coronaires chez un adulte jeune évocateurs d'une probable maladie de Kawasaki.

We report the case of a young adult admitted to the Abidjan Heart Institute for coronary angiography to explore unstable angina. Coronary angiography showed multiple aneurysms which suggested sequelae of misdiagnosed Kawasaki disease.

[Self-medication among black African hypertensive patients: Factors and consequences]. / Recours à l'automédication chez l'hypertendu noir africain : ses facteurs et ses conséquences.

INTRODUCTION: Self-medication practice is under-evaluated among black African hypertensive patients. AIM: To assess the level of self-medication among black African hypertensive patients and to determine the factors favoring this practice and their consequences. METHODS: Prospective study during a 3-month period including 612 hypertensive patients followed in Abidjan cardiology institute. RESULTS: Mean age was 55.1. The patients had a self-medication use in 60.1% of cases. Medicinal plants and derived products were commonly involved. Self-medication use reasons were: influence of relatives (89.8%) and the fear of antihypertensive drugs adverses effects (54.9%). Multivariate analysis shows that factors of self-medication were age (56.6 years vs. 50.3 years, P<0.001), income less than 762 euros/month (88% vs. 75.4%; OR=2.73; 95% CI: 1.62-4.6; P<0,0001), obesity (70.4% vs. 35.6%; OR=1.24; 95% CI: 0.75-1.15; P=0.037), dyslipidemia (40.8% vs. 27.9%; OR=6.72; 95% CI: 0.57-2.13; P=0.043), antihypertensive association therapy (61.7% vs. 51.4%; OR=2.27; 95% CI: 0.25-0.97; P=0.037). Poor control of high blood pressure (HBP) was a consequence of self-medication (6.5% vs. 47.1%; OR=10.27; 95% CI: 4.65-56.4; P=0.034), repercussions of HBP on major organ (75% vs. 17.2%; OR=12.9; 95% CI: 8.5-19.6; P=0.0001). CONCLUSION: Self-medication is a common practice in African hypertensive patients. It has many consequences.

[Presumption of sleep apnea in a black African hypertensive population: Importance of the Epworth sleepiness scale in the diagnostic approach]. / Présomption d'apnées du sommeil dans une population d'hypertendus Noirs africains : intérêt de l'échelle de somnolence diurne d'Epworth dans l'approche diagnostique.

INTRODUCTION: Sleep apnea syndrome (SAS) is very little described in the hypertensive black African. PURPOSE: To screen sleep apnea syndrome using the rating scale of Epworth daytime sleepiness, and to investigate the determinant factors and to infer therapeutic consequences. METHOD: This is a retrospective and prospective study with descriptive and analytical purpose that focused on 200 hypertensive outpatients of the Cardiology Institute of Abidjan. The primary endpoint studied was the SAS. The diagnostic approach of SAS was performed using the rating scale of Epworth daytime sleepiness. RESULTS: The prevalence of sleep apnea was 45%. The average age of sleep apnea carriers was 56.1 years, with a male predominance (60%). The determinant factors of sleep apnea syndrome were male gender (60% versus 40%, P=0.021), obesity (77.8% versus 62.7%, P<0.0001), diabetes (26.7% versus 15.5%, P=0.5) and dyslipidemia (54.4% versus 27.3%, P=0.0009). Life in urban areas, occupation and smoking were not correlated with SAS in our series. The control of hypertension was better in non-apneic patients compared to apneic patients (63.6% versus 38.9%, P=0.04). The visceral impact of hypertension in apneic patients was highly significant (77.8% versus 41.7%, P=0.014). Therapeutically, it was noted the preferential prescription of combination therapy in apneic patients compared to non-apneic patients (82.3% versus 74.4%).

[Peripheral arterial disease of the lower limbs in African diabetic patients: ultrasonography and determining factors]. / Artériopathie des membres inférieurs du diabétique noir africain: aspects ultrasoniques et facteurs déterminants.

INTRODUCTION: Diabetic peripheral arterial disease (PAD) of the lower limbs is underdiagnosed. METHODOLOGY: This was a prospective study conducted over a six-month period from November 2012 to April 2013. A total of 308 diabetic patients were included from three diabetes centers in Abidjan (Ivory Coast). AIM: To screen for PAD of the lower limbs in a diabetic population and to identify the determining factors. RESULTS: Among the 308 patients, the ankle-brachial index (ABI) was<0.9 in 68 (22.07%) patients considered to have PAD; the ABI was>1.3 in 56 (18.2%) patients who had suspected mediacalcosis. The average age of the PAD patients was 60.2 years. Female gender predominated (55.9%). The mean duration of diabetes was 9.6 years: 97.1% type 2 diabetes. The other cardiovascular risk factors in this population were hypertension (58.8%) and dyslipidemia (40.9%). Smoking was present in 29.4% of patients and obesity in 23.9%. PAD of the lower limbs was mild in 46 patients (67.6%), moderate in 16 (23.5%) and severe in 6 (8.8%). Duplex Doppler commonly showed lesions of the tibial arteries. Determining factors of diabetic PAD of the lower limbs were hypertension (58.8% vs 36.6%; OR=2.46; 95% CI: 1.13-5.36; P=0.034) and dyslipidemia (40.9% vs 8.3%; OR=7.6; 95% CI: 2.31-25.08; P=0.0009). For mediacalcosis, male gender (71.5% vs 39.7; OR=0.26 95% CI/0.10-0.64. P=0.004) was the only factor identified. CONCLUSION: Hypertension and dyslipidemia were predictive factors for diabetic PAD of the lower limbs in our African population.

[Pulse pressure monitoring in hypertensive black Africans]. / Intérêt du suivi de la pression pulsée chez l'hypertendu noir Africain

AIM: A pulse pressure above 60 mmHg in hypertensive subjects is an independent cardiovascular risk factor. There are few data on pulse pressure in sub-Saharan Africa. The aim of this study was to describe the pulse pressure in black Africans with arterial hypertension. METHODS: A 10-year study was carried out on 640 hypertensive sub-Saharan African subjects at the outpatient department of the Abidjan Heart Institute. The primary endpoint was to determine the prevalence of a high pulse pressure, the correlation between pulse pressure and cardiovascular risk factors, the impact of pulse pressure on target organs, and the variation in pulse pressure while on treatment during follow up. Evaluations were made at the start of the study, and in the first, third, sixth and twelfth months of follow up. The mean age was 56.2 years and 56% were female. RESULTS: The prevalence of a high pulse pressure in our patients was 60% at the start of the study. The factors contributing to a high pulse pressure were age over 50 years (75.3 vs 24.7%, p < 0001), gender (60 vs 40%, p = 0.02), and diabetes (76.7 vs 23.3%, p = 0.0006). Smoking, obesity and dyslipidaemia were not related to an elevation in pulse pressure. The control of pulse pressure was poor during monitoring. Only 17.8% of patients had their pulse pressure lowered below 60 mmHg between the first and fifth consultations. A high pulse pressure was a predictor of future myocardial complications but few target organs were significantly affected. Dual therapy with a diuretic was more effective in controlling the pulse pressure, with a reduction rate of 22% during follow up (19.2 mmHg), against a rate reduction of 11% (8.4 mmHg) in patients without a dual diuretic. CONCLUSION: The prevalence of pulse pressure above 60 mmHg was higher in hypertensive black Africans. Their control was poor, but dual therapy with a diuretic was more effective. Myocardial consequences were significant.

[Diagnostic approach and treatment of hypertension in healthcare workers in Abidjan's district (Ivory Coast)]. / Approche diagnostique et prise en charge de l'hypertension artérielle chez le personnel soignant du district d'Abidjan (Côte d'Ivoire).

BACKGROUND: Epidemiological data concerning hypertension among health care workers are scarce. PURPOSE: The aim of this study was to assess the diagnostic process and treatment of hypertension among a healthcare worker population in order to improve treatment. METHODS: This was a prospective study including 821 healthcare workers from Abidjan's publics hospitals. There were 208 medical doctors, 464 nurses and 149 assistant nurses. There were 59% women, 41% men. The mean age was 42.9 years. RESULTS: The prevalence of hypertension was 17.5%: 48.1% among teaching medical doctors, 13.6% in the group of other medical doctors, 14.9% in the nurses group and 18.8% in the assistant nurse group. After recruitment as a healthcare worker, 86.9% of the cases of hypertension were diagnosed. When hypertension was diagnosed, 74.3% had presented symptoms. The disease was diagnosed by a physician in 77.8% of cases and by a nurse in 22%. In many cases (67.8%), the follow-up was done by a cardiologist; 15.7% by general practitioners. However, 10.7% of the healthcare workers with hypertension had no medical follow-up. Single-drug treatment was most commonly used (49.7%); 36.4% were taking two drugs. Poor compliance with treatment was noted in 71.1% of he healthcare workers with hypertension (clearly poor compliance for 40.5% and problems with compliance for 30.6%). Among those with clearly poor compliance, 29% had stopped taking their medication and seven individuals had declined taking any medication. Poor compliance was most commonly observed among assistant nurses (52.9%) and nurses (42.6%). People taking a combination of two or three drugs complied better with their treatment.

[Impact of anaemia on the prognosis of myocardial infarction in black Africans]. / Impact de l'anemie sur le pronostic de l'infarctus du myocarde chez le noir Africain.

OBJECTIVE: Anaemia is increasingly being described as a negative predictor of outcome after myocardial infarction. The objective of our study was to assess the prognosis post myocardial infarction in the short and medium term in black Africans with chronic anaemia. METHODS: We carried out a comparative case-control study on 272 patients (93 anaemic and 179 non-anaemic) hospitalised for myocardial infarction at the Cardiology Institute of Abidjan. One group included 93 patients who presented with anaemia concurrent with the myocardial infarction (haemoglobin level low: 13 g/dl for males and 12 g/dl for females, respectively). The other group comprised 172 patients who presented without anaemia during the acute phase of myocardial infarction. The haemoglobin rate was measured at admission, as were the biological markers of myocardial infarction. RESULTS: The mean age was 53.5 years for the anaemic patients and 52.6 years for the non-anaemic patients. We noticed a clear male predominance in both populations (81.7 vs 78.8%; p = 0.56). The mean haemoglobin level was lower in the anaemic patients compared to that in the non-anaemic patients (10.2 vs 15 g/dl). The anaemic patients were eight times more at risk for an unfavourable outcome (complications or death) compared to the non-anaemic patients (91.4 vs 57%; OR = 8.02; 95% CI: 3.5-19.07; chi(2) = 33.74; p < 0.0001). The anaemic patients were 3.7 times more at risk for right ventricular failure (NYHA class II and III) compared to the control population (69.9 vs 38.5%; OR = 3.7; 95% CI: 08-6.60; chi(2) = 24.06; p < 0.0001) and six times more at risk for cardiogenic shock (24.7 vs 5.3%; OR = 6.21; 95% CI: 2.56-15.43; chi(2) = 22.89; p < 0.0001). The mortality rate was significantly higher in the anaemic than the non-anaemic patients (35.5 vs 12.8%; OR = 3.73; 95% CI: 1.94-7.19; chi(2) = 19.18; p < 0.0001). CONCLUSION: Anaemia is an independent risk factor for a poor prognosis during the acute phase of myocardial infarction in black Africans.

[Unusual venous thrombosis revealing a human immunodeficiency virus infection and a protein S deficiency. Two cases and literature review]. / Thromboses veineuses inhabituelles révélatrices d'une infection par le virus de l'immunodéficience humaine et d'un déficit en protéine S. A propos de deux cas et revue de la littérature.

The authors report two cases of unusual venous thrombosis associated with protein S deficiency in patients with the acquired immunodeficiency syndrome. The first case was a superior mesenteric vein thrombosis caused by HIV-1 infection associated with protein S deficiency in a 53-year-old patient. The second case was a cerebral venous thrombosis in a 34-year-old patient with HIV-1 and HIV-2 infections associated with protein S deficiency. None of the two patients were receiving antiretroviral therapy at the time of diagnosis. The evolution of thrombosis was favorable in both patients with heparin therapy and antivitamin K (AVK).

[Black Africans' compliance to antihypertensive treatment]. / L'observance thérapeutique et ses facteurs chez l'hypertendu noir africain.

UNLABELLED: Hypertension is increasing in sub-Saharan Africa. It is difficult to follow a correct treatment in this environment. PURPOSE: Assessing the compliance of the drug therapy and identifying the characteristics of poor observant patients. METHODS: A study was carried out over one month at the outpatient department of the Abidjan Heart Institute among 200 sub-Saharan African hypertensives. Their compliance was estimated with the Compliance Evaluation Test of Girerd. RESULTS: The average age of the patients was 59 years and 59.5% of them were women. Most patients (60%) had a monthly pay lower than 100,000 CFA (Euros 152). Sixty two percent had no medical insurance. So 175 patients (87.5%) had difficulties to follow their treatment. Among them 55% had a very bad compliance and 32.5% had minor difficulties. Only 12.5% of them had a right compliance. A bad compliance was frequent between 30 and 70 years, in women (60.5%), in unemployed patients (93.7%), in married women (68.7%) and in executives (50%). Other factors of a poor compliance was a monthly income lower than 100,000 FCFA (64%), a number of daily tablets higher than three (77.3%), a number of daily administration >or= $ 3 (95.7%) and the high cost of drugs. A bad compliance is more frequent when herbal treatment is associated with medical drugs or used separately. CONCLUSION: The compliance of the antihypertensive treatment was poor. The causes are numerous, but they are very often related with the growing poverty in the black society.

[Acute nontraumatic limb ischemia]. / Ischemies aigues on traumatiques des membres.

Twenty four patients (18 males, 6 females, Mean age 50 years) with acute non traumatic limb ischemia were operated on in our institution. The ischemia has been observed after 24 hours in 15 patients (62,5 % versus 7 patients (37,5 %) within 24 hours. The arterial femoral was often (54,1 %) the site of occlusion. Embolism (29,2 %) and thrombosis (54,2 % were the cause of acute limb ischemia. All patients were treated by embolectomy or thrombectomy. The overall mortality was 29,2 % with a limb salvage rate of 45,8 % and secondary amputation rate of 29,2 %. According to our experience, the diagnosis of acute non traumatic limb ischemia is not instituted early and the rate of hospital mortality and morbidity remain high.

Ischemies aigue on traumatiques des membres

Twenty four patients (18 males; 6 females; Mean age 50 years) with acute non traumatic limb ischemia were operated on in our institution. The ischemia has been observed after 24 hours in 15 patients (62;5versus 7 patients (37;5) within 24 hours. The arterial femoral was often (54;1) the site of occlusion. Embolism (29;2) and thrombosis (54;2were the cause of acute limb ischemia. All patients were treated by embolectomy or thrombectomy. The overall mortality was 29;2with a limb salvage rate of 45;8and secondary amputation rate of 29;2. According to our experience; the diagnosis of acute non traumatic limb ischemia is not instituted early and the rate of hospital mortality and morbidity remain high

The hypolipidemic effects of Afzelia Africana in type II diabetic patients in Nigeria

Background: The projected rise in the world prevalence of diabetes mellitus poses new challenges in poor countries. Soluble fibre incorporation into the diet of diabetic patients has been shown to reduce the glyceamia and lipaemia of diabetes mellitus. Design and method: The hypolipidemic effect of soluble fibre supplementation using the seed of locally available legume tree plant - Afzelia africana was studied in 13 Nigerian patients with type 2 diabetes mellitus. The subjects were randomly selected from the out patient diabetes mellitus clinic of Nnamdi Azikiwe University Teaching Hospital; Nnewi. They were fed with unsupplemented and supplemented standardized diet for the first 2 days and subsequent 4 days respectively. The fibre supplementation was prepared and incorporated into the meal portions according to previously described technique and acceptability study. Outcome measures: The fasting serum levels of TC; TG; HDL-C; LDL-C and HDL/TC ratio were estimated before and after the unsupplemented and fibre supplemented meals. The data obtained were analyzed using paired t-test. The correlation between the total energy requirement and the reduction in TC; pre and post fibre supplemented meals were determined using the linear coefficients. Result: The results showed a significant reduction (P0.05) in mean fasting TG; LDL-C and improvement in HDL/TC ratio following a 4 day supplemented meal. The relation between the difference in TC before and after the supplemented meal and total energy requirement was not significant (P 0.05). Conclusion: The exploitation and incorporation of this source of soluble fibre in diabetic diets reduced the lipaemia of diabetes mellitus

[Early post-operative arrhythmias in endomyocardial fibrosis or chronic parietal endocarditis in 84 cases studied at the Cardiology Institute of Abidjan]. / Arythmies post-opératoires precoces dans la fibrose endomyocardique ou endocardite pariétale chronique à propos de 84 cas etudiés à l'Institut de Cardiologie d'Abidjan (ICA).

The authors have studied rhythmic events happened during early post-operative period in 84 operated patients for endomyocardial fibrosis, synonym nowadays to chronic parietal endocarditis, in the Institute of Cardiology of Abidjan (Côte d'lvoire), from January 1977 to July 1991. The mean age has been 15.6 +/- 43 years old. Endocardectomy was left in 25 cases, right in 32 and at last bilateral in the 19 others. The surgical way has been a left and/or right atriotomy. Mitral and/ ortricuspide valvular surgery has been always realised. The absolute prevalence of patients having presented one or several arrhythmias, atrial tachycardia and premature ventricular beats. The favouring factors have been the period of exclusion of the aortic root from circulation and number of endomyocardectomy. Atrial fibrillation has been related to auricular volume. Most of nodal arrhythmias have appeared with surgery. Endomyocardial fibrosis surgery has been greatful in rhythmic plan in 16% of patients. Early post-operative arrhythmias have been responsible forone case of the death of the operated patients and they have been present in seven other cases of the death.

[Conduction disorders in chronic parietal endocarditis or endomyocardial fibrosis. 170 cases at the Cardiology Institute of Abidjan]. / Troubles de conduction dans l'endocardite pariétale chronique ou fibrose endomyocardique. A propos de 170 cas colligés à l'Institut de Cardiologie d'Abidjan.

The authors have conducted research on conduction disturbances in the endomyocardial fibrosis, synonymous with chronic parietal endocarditis, about 170 cases at the Institute of Cardiology in Abidjan, from January 1977 to June 1991. The anatomical and/or angiographic examination have permitted to describe 64 cases of right fibrosis, 24 cases of left fibrosis and 82 cases of bilateral fibrosis. Conduction anomalies have been observed among 42.9% of the patients. Among 92 anomalies recorded, the most frequent has been the first degree heart block (43.5%) and the incomplete right bundle branch block (30.4%). The old age of the patients and the right localization were the factors associated with conduction disturbances in endomyocardial fibrosis (difference not significant). Yet, fibrosis surgery, especially the decortication of the fibrous endocardium of the right ventricle, have generated one or many conduction anomalies among most of our operated patients. The right branch of the fasciculus of the His has been the most injured by the fragmented techniques of METRAS who had, therefore, the merit to have minimized the incidence of the complete post-operative heart blocks still high in European and Brazilian series. In term of prognosis, no conduction disturbance has directly caused a patient's death, even if those anomalies cannot be totally ruled out in the 16 cases of sudden death.

[Left auricular myxoma and myocardial infarction]. / Myxome auriculaire gauche et infarctus du myocarde.

The authors report the case of a 40 year old man with a postero-inferior myocardial infarction. Echocardiography showed a large left atrial myxoma. Coronary angiography performed 20 days after the onset of infarction was completely normal. The tumour was successfully removed surgically. The authors review the literature of this rare association (20 reported cases) which were commonly observed since the widespread use of echocardiography and coronary angiography. These investigations have improved the understanding of the physiopathology of this association. One of the possible hypotheses of diastolic mitral obstruction by the tumour was the probable mechanism of infarction in this case due to prolonged impaired coronary filling due to low cardiac output.

[Spontaneous coronary artery dissection: apropos of a case with associated spasm and regression of the dissection]. / La dissection coronaire spontanée: à propos d'un cas avec spasme associé et régression de la dissection.

The authors report the case of a 34 year old woman with postpartum myocardial infarction due to spontaneous coronary dissection of the distal circumflex artery. A spontaneously regressive spasm of the right coronary artery was also observed. The outcome with heparin, glyceryl trinitrate and calcium antagonist therapy was favourable. Over one year later, coronary angiography showed total resolution of the dissection and a large aneurysm of the inferior and septal walls of the left ventricle. This case is an example of post-partum spontaneous coronary dissection, in a particular vascular context. There are, however, other causes of spontaneous coronary artery dissection (atherosclerosis, eosinophilic syndrome...). Spasm may aggravate the consequences of coronary artery dissection and cause worse myocardial damage. The medical treatment, especially with regards to thrombolytic therapy, requires further codification.

Les arythmies dans l'endocardite parietale chronique : a propos de 160 cas

Dans cet article; il s'agit d'une etude dont le travail avait pour but d'evaluer la nature et la prevalence des arythmies au cours de l'endocardite parietale chronique (EPC) ou fibrose endomyocardique (FEM) et de determiner le role de certains facteurs tels que l'age; la taille des cavites; le niveau des pressions telediastoliques dans la survenue de ces arythmies. Cette etude retrospective portait sur 160 patients hospitalises a l'Institut de Cardiologie d'Abidjan du 1er janvier 1977 au 31 decembre 1989. Le diagnostic de EPC a ete porte soit par l'angiocardiographie soit par l'autopsie. Les explorations cardiologiques habituelles ont ete realisees et l'electrocardiogramme a ete systematiquement analyse pendant l'hospitalisation et a chaque consulltation.On y trouve des troubles du rythme les plus frequemment rencontrees. D'autres arythmies sont plus frequentes chez les enfants que chez les adultes. Les donnees quelque peu contradictoires conduisent a evoquer l'intervention d'autres facteurs dans le determinisme des arythmies; notamment supraventriculaires; rencontrees au cours de l'EPC