[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.

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.

Prise en charge de l'insuffisance cardiaque au Centre Hospitalier Universitaire de Brazzaville : aspects socio-économiques

Introduction : Le but de l'étude était d'évaluer le coût de la prise en charge de l'insuffisance cardiaque et l'impact du niveau socio-économique sur l'attitude des patients.Patients et méthodes : Il s'agit d'une étude prospective et analytique réalisée dans le service de cardiologie et de médecine interne du Centre Hospitalier et Universitaire de Brazzaville, du 1er janvier au 31 décembre 2014. Ont été inclus, les patients hospitalisés pour une insuffisance cardiaque. Le coût financier était exprimé en franc de la coopération financière pour l'Afrique (FCFA). Résultats : La série comportait 279 patients répartis en 117 hommes (41,9%) et 162 femmes (58,1%), âgés en moyenne de 57,7 &plus 16,6 ans. Le revenu mensuel était inférieur à 90.000 FCFA dans 65,9% des cas, entre 90.000 et 180.000 FCFA dans 23,3% des cas et supérieur à 180.000 FCFA dans 10,8% des cas. Les patients sans aucun niveau d'instruction représentaient 27,6%. Ceux ayant les niveaux du primaire, du secondaire et du supérieur respectivement 24%, 36,6% et 11,8%. Le délai moyen de consultation était de 22 ± 23,3 jours. Il s'agissait d'un premier épisode d'insuffisance cardiaque chez 170 patients (60,9%), d'une récidive chez les 109 autres (39,1%). Pour ce dernier groupe de patients, l'observance médicamenteuse était bonne (18,3%), présentait des problèmes minimes (21,1%), n'était pas effective (60,6%). L'insuffisance cardiaque était droite chez 16 patients (5,7%), gauche chez 70 patients (25,1%) et globale chez 193 patients (69,2%). Le bilan paraclinique était réalisé chez 276 patients (98,9%) dans un délai moyen de 3,8 ± 4,2 jours. La durée moyenne d'hospitalisation était de 15,7 ± 8,5 jours, et le coût global moyen de 181.821,8 ± 79.026,3 FCFA. La prise en charge médicamenteuse ainsi que des frais d'hospitalisation relevaient du patient dans 108 cas (38,7%), d'un proche parent dans 171 cas (61,3%)

Profil épidémiologique et clinique de l'hypertrophie ventriculaire gauche d'origine hypertensive chez 33 patients suivis à l'hôpital général de Loandjili (Pointe-Noire - Congo Brazzaville)

L'hypertrophie Ventriculaire Gauche (HVG) est l'une des complications de l'hypertension Artérielle (HTA), et elle peut être responsable d'autres complications secondaires.Objectif : Déterminer le profil épidémiologique et clinique des complications secondaires à l'HVG.Patients et méthodes : Il s'est agi d'une étude descriptive et transversale réalisée dans le service de cardiologie de l'hôpital général de Loandjili du 1er mai 2008 au 30 avril 2015, soit 84 mois. Ont été inclus tous les patients suivis pour une HTA avec HVG, pour une sténose aortique serrée (RAC) et pour une cardiomyopathie hypertrophique (CMH), présentant une ou plusieurs complications ultérieures.Résultats : Trente-trois (33) patients étaient retenus sur 1500 hypertendus, soit une fréquence relative de 2,2%. Le sex-ratio était de 1,53, correspondant à 20 hommes (61%) pour 13 femmes (39%). L'âge moyen était de 56,18 ± 11,53 ans, avec des extrêmes allant de 32-83 ans. La symptomatologie était caractérisée par quinze (15) cas d&rsqu o;IVG (45,4%), quatorze (14) cas d'IC globale (42,4%), deux (2) cas (6%) de douleurs thoraciques, et deux (2) cas (6%) de perte de connaissance. Quarante-trois (43) complications secondaires étaient observées : 7 cas (14%) d'accident vasculaire cérébral (AVC), 13 cas (30,2%) de cardiopathies hypertensives (CHTA), 13 cas (30,2%) de cardiomyopathie dilatée (CMD), 5 cas (11,6%) d'insuffisance coronarienne, 2 cas (4,7%) d'arythmie complète par fibrillation atriale (ACFA), 2 cas (4,7%) (CMH), 1 cas (2,3%) RAC et 1 cas (2,3%) d'ischémie des membres. Le délai d'apparition moyen des complications secondaires était de 3,42 ± 2,7 ans, avec des extrêmes 1 an à 10 ans. Ce délai n'était pas statistiquement lié au sexe (p > 0,05), ni aux complications secondaires (p > 0,05), ni non plus à l'âge (p > 0,05). Conclusion: L'HVG est précoce, et représente une source insidieuse de complications secondaires neurologiques, cardiaques et vasculaires. Ces complications secondaires à l'HVG ont des délais d'apparition variables, indépendamment de l'âge et du sexe

[Arterial hypertension and control in Brazzaville (Congo): role of ambulatory blood pressure monitoring (ABPM)]. / Hypertension artérielle et niveau de contrôle à Brazzaville (Congo) : place du Holter tensionnel.

OBJECTIVES: To evaluate the rate control in the hypertensive patients and to identify the predictive factors of non-control. METHODS: It was about a cross-sectional study with prospective collection of data over a period of 36 months. It has been held in Brazzaville, and included a consecutive series of 620 hypertensive patients known and treated for at least 6 weeks, having profited from an ambulatory blood pressure monitoring (ABPM) with therapeutic aiming. We used the TONOPORT V and the software Cardiosoft 6.51 of GE Health Care, respectively for the recording and the data analysis. The threshold fixed on the average of 24-hour was BP<130/80 mmHg, and the patients divided into two groups according to whether they were or not controlled. RESULTS: They were 352 men (56.8%) and 268 women (43.2%), old on average of 53.8 ± 9.7 years (ranges: 29 and 89 years). The standard of living of the patients was average in 330 cases (53.2%), weak in 132 cases (21.3%), and high in 71 cases (11.5%). The other associated risk factors were sedentariness in 275 cases (44.4%), overweight/obesity in 134 cases (21.6%), dyslipidemia in 121 cases (19.5%), diabetes mellitus in 90 cases (14.5%), and tobacco addiction in 25 cases (4%). The hypertension, old of 5.8 ± 5.7 years on average, was controlled among 215 patients (34.7%). The 24- hour BP average was 139 ± 14 mmHg for the SBP and 88.2 ± 10.2 mmHg for the DBP. The awake and asleep BP averages were respectively 141 ± 14 mmHg and 133 ± 16.2 mmHg for the SBP, 90.5 ± 10.5 and 81.2 ± 11.1 mmHg for the DBP. The antihypertensive protocol used was a monotherapy in 130 cases (21%), bitherapy in 287 cases (46.3%), tritherapy in 154 cases (24.8%), quadritherapy or more in 27 cases (4.3%). Prevalence of non-dipping was 43%. Age and male gender were the significant predictors of poor control. CONCLUSION: The rate control of hypertension in our study population remains low. Its improvement passes by the education of the hypertensive patients and the improvement of their living conditions.

[Profile of infective endocarditis at Brazzaville University Hospital]. / Profil de l'endocardite infectieuse au centre hospitalier universitaire de Brazzaville.

The goal of this retrospective study was to analyze the current profile of all 35 consecutive patients with infectious endocarditis seen at Brazzaville University Hospital's department of cardiology and internal medicine from January, 2001, through December, 2009. Infectious endocarditis was diagnosed most often when a heart murmur was associated with septicemia and typical vegetations on echocardiography. During this period, 24 women and 11 men were admitted for infectious endocarditis, accounting for 0.9% of admissions. Their median age was 30.6 ± 12.8 years (range: 15 to 66 years), and 69% were women. The preexisting lesions included rheumatic valvulopathy (9 cases), congenital heart disease (3 cases), and heart disease already treated surgically (3 cases). Among the valvular lesions, mitral regurgitation predominated (24 cases), isolated in 17 cases and associated with aortic regurgitation in 7. There were three cases of pure tricuspid regurgitation. A principal portal of infection was found in 24 patients (69%): oral (11 cases), urinary (7 cases), genital (5 cases), and cutaneous (1 case). A blood culture was performed for 14 patients (40%): seven were positive, four of them for streptococci. Vegetations were observed in 32 cases (91.4%) and mutilating valve lesions in 8 (22.8%). The complications included heart failure in 30 cases (86%) and an embolism in 8 (23%). One relapse was noted. Cardiac surgery was indicated for 13 patients (37%) but could not be performed. The hospital lethality rate was 29%. Infectious endocarditis is a rare disorder that can be life-threatening, especialy in the absence of cardiac surgery. Its prevention, although complex, constitutes the key to management in our setting.

[Pericardial effusion with pretamponade leading to diagnosis of hypothyroidism: two cases in Congo]. / Epanchement péricardique en pré-tamponnade révélant une hypothyroïdie: deux observations au Congo.

The purpose of this report is to describe two cases of pericardial effusion with pre-tamponade leading to diagnosis of underlying hypothyroidism. Both patients were women with large longstanding pericardial effusion. The first patient was 47-years-old and the second was 46. Diagnosis of hypothyroidism, whose clinical features were equivocal in the first case case and frank in the second, was confirmed by hormone tests. Treatment consisted of pericardial drainage and hormone replacement therapy with increasing doses. Outcome was favorable in both cases with restoration of euthyroidism. Clinical status was satisfactory in both cases with a follow-up of five months in the first patient and three months in the second. Pericardial effusion with pretamponade is an exceptional complication of prolonged hypothyroidism that should be considered in patients presenting with large longstanding but well tolerated pericardial effusion with no evidence of infection or inflammation.

[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