[Diabetic nephropathy: an epidemiological study based on proteinuria in a population of black African diabetics in Cotonou, Benin]. / Néphropathie diabétique: une étude épidémiologique fondée sur la protéinurie dans une population de diabétiques noirs africains à Cotonou, Benin.

We evaluated proteinuria to determine the frequency of diabetic nephropathy and to study epidemiological aspects of this disease. We measured 24-hour urinary protein excretion in 152 diabetic patients. We recorded the age and sex of each patient, the duration of diabetes and blood glucose concentration. Proteinuria was diagnosed in 28% of the diabetic patients. The frequency of proteinuria was higher in men (33%) than in women (19%). The highest frequency (37.5%) was observed in subjects aged 70 years or over. In these patients, the higher frequency of proteinuria was associated with a longer duration of diabetes. However, proteinuria was detected in 28% of patients with diabetes diagnosed less than one year previously, suggesting a long period of undiagnosed diabetes in these subjects. Finally, proteinuria was more frequent in patients treated with insulin (42%) than in those treated orally (25%). Thus, diabetic nephropathy is a frequent complication in black diabetic patients in Cotonou. As hemodialysis and kidney transplantation are very expensive and access to these treatments is limited in developing countries, preventive measures based on optimizing patient management and the early diagnosis of diabetes and its complications are required.

[Hypothyroidism: clinical and etiological aspects in Cotonou (Republic of Benin)]. / Les hypothyroïdies: aspects cliniques et étiologiques à Cotonou (Bénign).

To evaluate the frequency of clinical manifestations and to study the etiological aspects of hypothyroidism in hypothyroid patients in Cotonou, we carried out a retrospective analysis of the medical reports on hypothyroid patients followed in our clinical practice. A total of 33 patients was thus studied, comprising 8 men (24%) and 25 women (76%) with mean age of 45,8 years for men and 40,4 years for women. The more frequent clinical manifestations observed were: face edema (45%), weight gain (45%), paresthesia (42%), fatigue (39%), lethargy (30%) and bradycardia (24%). Constipation (12%), sensation of cold (9%), depilation (6%) and dry skin (6%) were less frequently observed. Myalgia, hoarseness and menstrual irregularities were present in 15% of the cases respectively. Regarding the etiology, 82% of the cases were primary hypothyroidism and only 18% were of central origin. Thyroidectomy was the leading cause in our hypothyroid patients, representing 70% of all cases and 85% of primary hypothyroidism. Radioiodine treatment and autoimmune thyroiditis were equally found in 6% of the cases. Central hypothyroidism was related to a pituitary adenoma in four cases (12%) and to Sheehan syndrome in two cases (6%). As it can be expected, hypercholesterolemia was present in 82% of the patients but creatine phosphokinase elevation was more frequent (94% of the patients). Compared to the data reported in the literature, the frequency of the symptoms and signs of hypothyroidism seems to be underevaluated in our study and the frequency of autoimmune thyroiditis as a cause of hypothyroidism is low.

[Types of hypertension in pregnant women of Benin admitted to the National University Hospital of Cotonou]. / Les différents types d'hypertension artérielle chez les femmes enceintes béninoises admises au CNHU de Cotonou.

We carried out a retrospective and prospective study between January 1995 and August 1996, of pregnant women with high blood pressure. The aim of this work was to determine the prevalence of each type of hypertension according to the classification of the American College of Obstetricians and Gynecologists (ACOG) and to evaluate the prognosis for the mother and child. The prevalence of hypertension in pregnancy was found to be 7.65%. A family history of hypertension, obesity and a personal history of hypertension in pregnancy were all risk factors. Severe hypertension (diastolic blood pressure (DBP) > 110 mm Hg) affected 59.4% of the women. Chronic hypertension occurred in 41.51% of cases, preeclampsia in 26.41% of cases, associated preeclampsia in 18.87% of cases and isolated hypertension in 13.21% of cases. Eclampsia (70.6%) was the principal maternal complication in this study population. Fifty-four of the women gave birth to normal babies, 21 to hypotrophic babies, 15 gave birth prematurely and 3 had miscarriages. Six of the seven deaths involved women with DBP above 110 mm Hg.

[Families of antihypertensive drugs and blood pressure exercise profiles in black Africans at the National University Hospital of Cotonou]. / Familles d'antihypertenseurs et profil tensionnel d'effort chez des Noirs africains au CNHU de Cotonou.

The study population consisted of ninety patients between the ages of 22 and 64 years. All had mild or moderate hypertension at rest and were subjected to exercise tests using a cycloergometer. The sex ratio for the patients was 0.875. Blood pressure and heart rate were recorded at three time points, at three minute intervals. The initial load was thirty watts for men and 25 watts for the women. A graph of changes in blood pressure with exercise was produced for each type of antihypertensive drug or combination of drugs. At least nine patients were treated with each type of drug or combination, and blood pressure and heart rate were recorded during exercise to produce the exercise blood pressure profile. Healthy adults generate curves that lie between Y'1 = 0.5X + 108.43 and Y"1 = 0.34X + 83.95 [2]. Any patient generating a curve lying between these two limits was regarded as having a normal exercise blood pressure profile. This study identified two groups of hypertension treatments with respect to exercise blood pressure profile. Abnormal exercise blood pressure profiles were obtained with treatments involving inhibition of calcium receptor activity, diuretics and central antihypertensive drugs. Normal exercise blood pressure profiles were obtained with treatments involving the inhibition of adrenoreceptor activity, alone or in conjunction with a diuretic, and with combined central antihypertensive drug and diuretic treatment.

[Renal complications associated with human acquired immunodeficiency virus infection in a population of hospital patients at the Hospital and University National Center in Cotonou]. / Complications rénales associées à l'infection par le virus de l'immunodéficience acquise humaine dans une population hospitalisée au CNHU de Cotonou.

We studied 92 HIV-positive patients retrospectively between January 1994 and December 1996 and prospectively from January to July 1997. We determined serum creatinine and 24-hour proteinuria. The median age of the patients was 22 (+/- 4) years and most patients were aged between 25 and 45 years. The sex ratio was 2.17 and most patients were infected with HIV-1 (67.39%). Renal failure occurred in 27.16% of cases, due to changes in blood pressure and infectious diseases. Three patients had a nephrotic syndrome caused by HIV. Thirty-eight cases of lung infection, ten of urinary infection, twelve infections of the digestive system and fifteen cases of skin infection were recorded. The median duration of stay in hospital was 23 (+/- 8) days and the median cost of hospitalization was 147,450 F CFA (+/- 31,057). The treatment given was purely symptomatic and three patients died during the study. One patient suffered chronic renal failure and is now undergoing hemodialysis. Preventive treatment would be of great value.

Prevalence des anticorps anti-VHC chez les malades drepanocytaires polytransfuses a Cotonou (Benin)

Dans une etude prospective; trente malades drepanocytaires polytransfuses ont ete soumis au depistage des marqueurs seriques du Virus de l'Hepatite C (VHC) par la methode ELISA suivie de la confirmation par le test Immunoblot 2eme generation. Ce groupe a ete compare a 30 autres malades porteurs de la meme tare mais n'ayant jamais ete soumis a une hemotherapie. La prevalence des anti-VHC etait respectivement de 20 pour cent et 0 pour cent dans les 2 groupes. La difference observee etait significative. Au Benin; la transfusion sanguine constitue donc pour le receveur; un risque non negligeable d'exposition au VHC

Valeurs de reference de 11 proteines seriques dans une population apparemment en bonne sante

"Les auteurs rapportent les valeurs normales de 11 proteines seriques dans une population de sujets adultes. Les proteines etudiees comprennent: les proteines de la reaction immunitaire (IgG; IgM; IgA); celles de la reaction inflammatoire et celles du statut nutritionnel. Le dosage a ete realise sur un immunonephelemetre ""ICS"" de la firme Beckman avec des immunerums dont la plupart a ete prepare a Cotonou. L'examen des resultats montre que par rapport au sujet de race blanche; le profil proteique du Beninois se caracterise par une hypergammaglobulinemie de type IgG et IgM et une hypogammaglobulinemie de type IgA; une augmentation du taux de certaines proteines de la reaction inflammatoire comme les orosomucoides; 1 antitrypsine; et de ceux des composants C3 et C4 du complement"

Prévalence des anticorps du virus de l'hépatite C chez des donneurs de sang et des malades transfusés à Cotonou au Benin

Dans une etude prospective; les auteurs ont determine la prevalence des anticorps anti-VHC chez les donneurs de sang; les malades drepanocytaires polytransfuses et non transfuses. La prevalence de portage d'anticorps dans chacun des groupes etait respectivement de 1;4 pour cent; 16 pour cent et 0 pour cent. Le nombre de produits potentiellement contaminants etant de 140 par an; le risque de contamination par le sang est donc eleve. Il est donc important de tout mettre en oeuvre pour la recherche des anticorps anti-VHC chez les donneurs de sang