Causes de réhospitalisation pour insuffisance cardiaque dans le service de cardiologie du CHU de Brazzaville (République du Congo) / The causes of rehospitalization for heart failure in the department of cardiology at the university hospital of Brazzaville (Republic of the Congo)

But: Identifier les causes de réhospitalisation pour insuffisance cardiaque (IC) Patients et méthode: cette étude transversale a été menée entre avril 2014 et mars 2015 dans le service de cardiologie du centre hospitalier universitaire de Brazzaville (République du Congo). Ont été inclus, les patients ayant des antécédents d'hospitalisation pour IC. Résultats: Quatre-vingt-onze patients, 54 femmes (59,3%) ont été inclus. Le sexe-ratio était de 0,7. La fréquence de réhospitalisation pour IC était de 19%. L'âge moyen était de 62 ± 16 ans (extrêmes: 24-89 ans). Le nombre moyen de réadmissions était de 2 ± 0,8 (extrêmes: 1 à 5), les réhospitalisation fréquentes (supérieur à 3) étaient de 33 (36,2%). Les patients présentaient un statut socioéconomique faible dans 59 cas (64,8%), et une hypertension artérielle dans 40 cas (43,9%). L'examen physique a retrouvé : une insuffisance cardiaque globale 77 cas (84,6%), une insuffisance cardiaque droite exclusive 5 cas (5,5%). Les causes de l'insuffisance cardiaque étaient: la cardiopathie hypertensive 40 cas (43,9%), la cardiomyopathie dilatée 28 cas (30,8%) et les valvulopathies 9 cas (10%). Les principales causes de réhospitalisation étaient: les écarts du régime hyposodé 64 cas (70,3%), la mauvaise observance du traitement 56 cas (61,5%), la grippe 15 cas (16,5%), la fibrillation atriale 12 cas (13,2%), débit de filtration glomérulaire réduite 12 cas (13,2%). La durée moyenne d'hospitalisation était de 11 ± 6,4 jours (extrêmes: 2-29). Le décès a été enregistré dans 5 cas (5,5%). Conclusion: L'absence de respect pour un régime pauvre en sodium et une mauvaise adhésion au médicament ont été les principales causes de réhospitalisation pour IC à Brazzaville. À cet égard, il est nécessaire de promouvoir l'éducation thérapeutique et d'améliorer l'accès au traitement.

Background: to identify the causes of readmission for heart failure (HF) Methods: this cross-sectional study was conducted in April 2014 to march 2015 in the department of cardiology, University Hospital of Brazzaville (Republic of the Congo). We had included, the patients who had a history of hospitalization for HF. Results: Ninety-one patients, 54 women (59.3%) were included. Sex-ratio was 0.7. The frequency of readmission for HF was 19%. The mean age was 62±16 years (range: 24-89). The average number of readmission was 2±0.8 (range: 1-5), the history of readmission ≥ 3, were 33 (36.2%). The patients were low socio-economic status in 59 cases (64.8%). In examination, patients were in congestive HF (n=77, 84.6%), right-sided HF (n=5). The causes of HF were: hypertensive heart disease (n=40, 43.9%), dilated cardiomyopathy (n=28, 30.8%), and valvular heart disease (n=9). The main causes of readmission were: excessive salt intake (n=64, 70.3%), poor drug-adherence (n=56, 61.5%), influenza (n=15, 16.5%), atrial fibrillation (n=12, 13.2%), reduced estimate glomerular filtration rate (n=12, 13.2%). The average length of hospitalization was 11±6.4 days (range: 2-29). The death was recorded in 5 cases (5.5%). Conclusion: No respect of low sodium diet and poor drug adherence, were the most causes of readmission for HF at Brazzaville. In regard of this facts, promoting therapeutic education is needed, and increasing access to treatment

[Echocardiographic profile of Congolese hypertensive patients]. / Profil échocardiographique des patients hypertendus Congolais.

OBJECTIVES: To assess echocardiographic aspect of Congolese hypertensive patients, and to identify predictive factors of left ventricular hypertrophy (LVH). PATIENTS AND METHODS: A transversal study was lead in Brazzaville from January 2011 to December 2013 (36 months). In total, 1125 hypertensive patients under treatment underwent transthoracic echocardiography. The test was carried out either as part of an initial assessment of the hypertension disease or during the development of evocative symptom or complication. Patients' sociodemographic data and echocardiographic parameters were collected and analyzed. RESULTS: There were 621 males (55.2%) and 504 females (44.8%), mean age 54.7±12 years. The main indication of the test were the hypertension initial evaluation in 792 cases (70.4%), dyspnea in 122 cases (10.8%), investigation of ischemic stroke in 101 cases (9%), cardiac failure and chest pain in respectively 58 and 52 cases. 5.3±4.7 years known duration of hypertension status was associated with overweight/obesity in 829 cases (73.7%), physical inactivity in 669 cases (59.5%), hypertension family history in 540 cases (48%), diabetes mellitus in 122 cases (10.8%), dyslipidemia in 82 cases (7.3%), smoking in 29 cases (2.6%). Echocardiographic test was abnormal in 590 cases (52.4%) and showed hypertrophic cardiomyopathy in 510 cases (45.2%), dilated and hypertrophic cardiomyopathy in 46 cases (4.1%), dilated cardiomyopathy with systolic dysfunction in 31 cases (2.8%), coronary artery disease in 4 cases (0.4%). LVH was concentric in 470 cases (84.6%), eccentric in 70 cases (12.6%), and in 16 cases (3%), it was a concentric left ventricular remodeling. The left ventricular's systolic ejection fraction average was 70.5±9.3%, relaxation disorders in 480 cases (42.6%). Age, male gender, income, known duration of hypertension and treatment were predictive factors of LVH. CONCLUSIONS: Echocardiographic profile of the Congolese hypertensive is quite various, left ventricular hypertrophy is the most predominant abnormality. Efficient management on the hypertension will lead to reduce its morbidity and mortality.

[Evaluation of venous thromboembolism risk and prophylaxis among hospitalized patients in Brazzaville]. / Évaluation du risque de maladie thromboembolique veineuse et de sa prévention chez des patients hospitalisés à Brazzaville.

OBJECTIVES: To identify patients at risk of venous thromboembolism and to evaluate the use of preventive measures. METHODS: A cross-sectional given-day observational and descriptive study was conducted among patients in the Brazzaville University Hospital. All hospitalized adult patients were included. Compliance with the recommendations of the American College of Chest Physicians (2004 version) on the risk of venous thromboembolism and use of prevention was evaluated. The study included 292 patients hospitalized from July 1 to 4, 2014 in eight medicine and four surgery and gynecology-obstetrics wards. RESULTS: The study population included 214 (73.3 %) patients at risk of venous thromboembolism hospitalized in medicine (n=83, 38.7 %), surgery (n=82, 38.3 %), and gynecology-obstetrics (n=49, 23 %) wards. There were 92 men (43 %) and 122 women (57 %), mean age 45.9±17.7years (range: 18-88). The risk of venous thromboembolism was low in 15 patients (7 %), moderate in 104 patients (48.6 %), and high in 95 patients (44.4 %). The main risk factors identified were: for surgical patients, long immobilization (42.6 %) and age>40years (33.1 %); for medical patients, long immobilization (24.7 %) and age>60years (18.5 %); for gynecology-obstetrics patients, age<60years (44 %), multiparity (15.4 %) and long immobilization (10.7 %). One hundred sixty-nine patients (79 %) had received one measure of prevention. There were 45 (54.2 %) medical patients, 81 (99 %) surgical patients and 43 (88 %) gynecology-obstetrics patients. Pharmacological prevention was used in 97 patients (57.4 %), mechanical prevention in 33 patients (19.5 %), and the two types of prevention in 39 patients (23.1 %). CONCLUSIONS: The risk of venous thromboembolism is common in hospitalized patients in Brazzaville, and the need for prevention is perceived but poorly understood. It is therefore essential to improve our knowledge of venous thromboembolism and its prevention.

Cost of management of nonvalvular atrial fibrillation in Brazzaville (Congo): preliminary findings.

The frequency of nonvalvular atrial fibrillation is increasing in sub-Saharan Africa, particularly as a consequence of population aging and the high prevalence of hypertension. The aim of this descriptive study was to determine the cost of management of this disease in the cardiology department at University Hospital of Brazzaville. The study included 50 patients aged 67.3 ± 12.8 years (range: 34 to 88 years). Among them, 21 (42%) were unemployed, and 49 (98%) had no health insurance. Their average monthly salary was 152.8 ± 149 € (range: 0 to 686 €). The mean total cost of care was 442.4 ± 109.8 € (range: 146.6 to 646.2 €). The average monthly salary was higher than the average cost of drugs (P <0.0001), or of additional tests (P <0.0001), or of hospital hospitality (P <0.0001). But the overall cost of care was substantially higher than the patients' mean salary (p <0.0001). This study illustrates the increasing healthcare costs related to the growing burden of cardiovascular disease in sub-Saharan Africa.

[Short-term prognosis of heart diseases managed at the pediatric intensive care unit of the Brazzaville University Hospital]. / Pronostic immédiat des cardiopathies prises en charge dans le service des soins intensifs pédiatriques du CHU de Brazzaville.

OBJECTIVE: To determine the main heart diseases of children admitted to our pediatric intensive care unit. PATIENTS AND METHODS: This cross-sectional study was conducted in 2011 (January to December) in the pediatric intensive care of the Brazzaville University Hospital. RESULTS: The study included 42 children, 27 of them girls (64.3%). Their mean age was 2.6 ± 3.4 years, and the mean age of their mothers 26.6 ± 5.1 years. The reasons for admission were dyspnea (n = 34, 81%), fever (n = 21, 50%), edema syndrome (n = 8, 19%), squatting (n = 5, 12%), impaired consciousness (n = 4), seizures (n = 3, 7.1%), shock (n = 2, 4.8%), and malaise (n = 1, 2%). Associated signs included coughing (n = 30, 71.4%), impaired general condition (n = 14, 33.3%), cyanosis (n = 9, 21.4%), and chest deformity (n = 15, 35.7%). Heart failure was found in 28 cases (66.7%), as was congenital heart disease. The main heart diseases were ventricular septal defects (n = 13), cardiomyopathy (n = 9), and the tetralogy of Fallot (n = 6). The most common factors of decompensation were anemia (n = 12, 28.6%) and bronchopneumonia (n = 11, 26.2%). The immediate mortality rate was 23.8%. CONCLUSION: The heart diseases in children admitted in critical situations usually required surgical care, not available in our country. Rapid treatment is possible by strengthening South-South cooperation with neighboring countries where cardiac surgery is available.

[Impact of severe hypertension in acute heart failure in Brazzaville (Congo)]. / Impact de l'hypertension artérielle sévère dans l'insuffisance cardiaque aiguë à Brazzaville (Congo).

This retrospective study to assess the role of hypertension in acute heart failure (HF) reviewed the case records of 86 patients, including 35 men (41%) and 51 women (59%), mean age 55.6 ± 18 years, who were hospitalized for an acute exacerbation of HF. The cardiovascular risk factors considered were hypertension (56%), diabetes (8%), and smoking (13%); 11 patients were alcoholics (13%). HF was global in 71 cases (83%). Among the underlying heart diseases, hypertensive cardiomyopathy was noted in 22 patients (26%) and valvular disease in 17 patients (20%); the precise cause was not elucidated in 40 (47%). A decompensation factor was identified in 53 cases (62%). Among the patients admitted on an emergency basis for acute HF, the relative risk (RR) of severe hypertension (n = 41, 48%) was 3.75 (95% CI: 2.31 to 6.08, p<0.0001), of heart rhythm disorder (n = 25 cases, 29%) 0.96 (95% CI 0.6 to 1.4, p = 0.5), and of poor adherence to standard treatment (n = 16, 18%) 2.2 (95% CI, 1.6 to 2.97, p<0.0001). Other decompensation factors were severely impaired renal function in 8 cases (9%) and stroke and anemia in 6 cases each (7%).

[Hypertensive emergencies at the University Hospital Center in Brazzaville, Congo]. / Les urgences hypertensives au Centre Hospitalier et Universitaire de Brazzaville (Congo).

The purpose of this retrospective study conducted in the emergency department of the University Hospital Center in Brazzaville, Congo was to determine the prevalence and clinical characteristics of hypertensive emergencies. With a total of 76 patients admitted during the study period, the prevalence of hypertensive emergency was 4%. The sex ratio was 1 and mean patient age was 57.3 years (range, 30 to 80 years). Risk factors included obesity in 62 cases (81.6%), history of hypertension in 65 (85.5%) and low socioeconomic level in 58 (76.3%). Mean delay for consultation was 50 hours (range, 1 to 240 hours). The disease underlying the hypertensive emergency was stroke with 38 cases (50%), heart failure in 20 (26.3%), hypertensive encephalopathy in 11 (14.4%), malignant hypertension in 9 (11.8%), and renal failure in 10 (13.1%). The mean length of emergency treatment was 14.7 hours (range, 5 to 48 hours). Eight deaths (10.5%) occurred during hospitalization in the emergency department.

[Non traumatic thoracic pain in adults: etiology and management at the CHU of Brazzaville (Congo)]. / Douleurs thoraciques non traumatiques de l'adulte: etiologies et prise en charge au CHU de Brazzaville (Congo).

This retrospective survey that is about the adult's non traumatic thoracic pains has been achieved during one period of three months in the service of the emergencies of the hospitable and academic center of Brazzaville. Her goal was to determine the prevalence of the thoracic pains, to specify their causes and the place of the cardiovascular diseases. We collected 88 cases left in 40 men (45.5%) and 48 women (54.5%). The sex-ratio was of 1.2. The middle age of the population of survey was of 38.8+/-17.3 years (extreme 18 and 74 years). The prevalence of the non traumatic thoracic pains was of 9.1%. Twenty-one patients (23.9%) were HIV, 9 patients (10.2%) were active smoke or weaned since less than three years. The associated signs were represented by the fever in 42 cases (47.7%), the dyspnoea in 37 cases (42%) and the cough in 33 cases (37.5%). The main diseases was represented by the respiratory diseases in 52 cases (59%), the oesophagus and gastric diseases in 16 cases (18.2%) and the cardiovascular disease in 10 cases (11.4%). The treatment analgesic has been used among 44 patients (50%) outside of the treatment of causes. The middle length of hospitalization in the service of the emergencies was of 25.7+/-8.3 hours, with the extremes of 12 and 48 hours. No deaths have been recorded.

[Cost of emergency cardiovascular care at the University Hospital Center in Brazzaville, Congo]. / Coût financier de la prise en charge des urgences cardiovasculaires au Centre Hospitalier et Universitaire de Brazzaville (Congo).

The purpose of this cross-sectional retrospective study was to evaluate the cost of managing cardiovascular emergencies in the Emergency Department of the Brazzaville University Hospital in the Republic of the Congo. This study included 197 patients admitted for stroke in 90 cases, heart failure in 65 and hypertensive emergency in 42 from July to December 2006. The mean duration of hospitalization was 45.2 +/- 18.3 hours (range, 6 to 72 hours). Cost calculation took into account consultation fees, blood tests, imaging, medication, therapeutic procedures and the first day of hospitalization. The overall cost of stroke care ranged from 147.000 to 177.000 CFA francs (220.50 to 265.50 euros), i.e., a mean per-patient cost of 158.120 +/- 6.900 CFA francs (237.18 +/- 10.35 euros). The overall cost of heart failure care ranged from 69.000 to 99.600 CFA francs (104.4 to 149.4 euros), i.e., a mean per-patient cost of 81.900 +/- 10.474 CFA francs (122.85 +/-15.71 euros). The overall cost of hypertension emergency care ranged from 74.600 to 18.4600 CFA francs (111.90 to 276.90 euros), i.e., a mean per-patient cost of 159.600 +/-44.107 CFA francs (239.40 +/- 66.20 Euros). Most people living in Brazzaville cannot afford emergency care for stroke, cardiac failure or hypertensive emergency. These findings underline the urgent need to implement a health insurance system and to encourage the use of generic drugs.

[Heart failure in elderly patients in Brazzaville, Congo: clinical and etiologic aspects and outcome]. / Insuffisance cardiaque du sujet âgé à Brazzaville: aspects cliniques, étiologiques et évolutifs.

The aim of the study is to report clinical, etiologic aspects and the outcome of heart failure in elderly hospital patients treated in Brazzaville, Congo. This retrospective study was carried out over a 20-month period from January 1, 2005 to August 31, 2006. In addition to age over 60 years, the main inclusion criteria was diagnosis of heart failure based on clinical, radiological, electrocardiographic, and echocardiographic evidence. A total of 223 patients, i.e., 50.0% of 446 patients over the age of 60 years evaluated, were included in the study. There were 125 women (56.1%) and 98 men (43.9%) (p = 0.0105). Mean age in the overall population was 70.4 +/- 6.2 years (range, 60 to 100 years). Heart failure was global in 148 cases (66.4%), left sided in 49 (22.0%), and right sided in 26 (11.6%). Left ventricular dysfunction was systolic in 93 cases (47.2%) and diastolic in 83 (42.1%) (p = 0.31). Underlying causes were hypertension in 77 cases (34.5%), coronary disease in 57 (25.6%), valvulopathy in 21 (9.4%), and myocardiopathy in 17 (7.6%). Chronic pulmonary heart disease was diagnosed in 25 cases (11.2%). Other cardiac diseases were found in 8 cases (3.6%). All patients underwent medical treatment. Thrombolytics were not used in cases involving myocardial infarction. The death rate was 20.2% (n = 45), i.e., 12 cases involving hypertensive cardiopathy, 8 involving coronary artery disease, 3 involving valvular cardiopathy, and 5 involving chronic pulmonary heart disease. The type of cardiopathy was undetermined in 17 cases. Heart failure is common in the elderly. Prevention depends on reducing cardiovascular risk factors especially arterial hypertension.

Bilharzioses au Senegal oriental : prevalence chez les enfants de la region de Bandafassi

Une enquete epidemiologique a etemenee au Senegal Oriental - arrondissements de Bandafassi - dans le but d'etablir la prevalence des bilharzioses intestinale et urinaire chez les enfants d'age scolaire de 6 a 14 ans. Les selles et les urines de 505 enfants de 10 villages ont ete examinees; et parallelement les points d'eaux susceptibles de constituer des biotopes pour lesmollusques hotes intermediaires - Biomphalaria sp. et Bulinus sp. - ont ete recenses et explores. L'existence de foyers perennes de bilharziose intestinale dans la region de Bandafassi au coeur de la brousse est etablie. La distribution sporadique de praziquantel se montre efficace mais totalement insuffisante pour eradiquer des foyers de Schistosoma mansoni perennes dans les sites explores