Cardiomyopathie du péripartum: aspects cliniques, thérapeutiques et évolutifs à propos de 24 cas / Clinical features, management and outcome of peri-partum cardiomyopathy: a study of 24 patients

Introduction. La fréquence, la présentation et le devenir de cardiomyopathie du peripartum (CMPP) varient considérablement dans le monde. Au Niger, les données sont inexistantes d'où le but de notre étude qui était de préciser les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs de la cardiomyopathie du peripartum (CMPP). Méthodologie. Il s'agit d'une étude rétrospective concernant les patientes hospitalisées pour CMPPau pôle de Cardiologie de l'Hôpital National de Niamey du 01/01/2019 au 31/12/2019. Les facteurs de risque et les aspects épidémiologiques, cliniques, paracliniques, diagnostiques, thérapeutiques et évolutifs ont été étudiés. Résultats. La prévalence hospitalière de la CMPP était de 3,83%. L'âge moyen était de 27,4 ans (extrêmes de 16 et 45 ans). La multiparité a été rapportée chez 79 % des patientes contre 21% qui étaient primipares. La dyspnée était le signe le signe fonctionnel rapporté chez toutes les patientes. Les anomalies échocardiographiques les plus fréquentes étaient l'HVG (75%) et L'HAG (45,83%). L'hypocinésie était diffuse dans 100% des cas. L'altération de la fraction d'éjection du ventricule du ventricule gauche (FEVG) était moyenne dans 50%. Toutes les patientes ont ont eu comme traitement des bétabloquants, des diurétiques et des IEC. L'évolution a été favorable dans 87,5 % des cas. Les principaux facteurs pronostiques péjoratifs étaient la multiparité (79%) une fraction d'éjection du ventricule inférieure à (FEVG)

Introduction. The frequency, presentation and outcome of peripartum cardiomyopathy (PCM) vary considerably throughout the world. In Niger, data are non-existent, hence the aim of our study, which was to clarify the epidemiological, diagnostic, therapeutic and evolutionary aspects of peripartum cardiomyopathy (PPCM). Methodology. This is a retrospective study concerning patients hospitalized for CMPPat the Cardiology pole of the National Hospital of Niamey from 01/01/2019 to 31/12/2019. Risk factors and epidemiological, clinical, paraclinical, diagnostic, therapeutic and evolutionary aspects were studied. Results. The hospital prevalence of CMPP was 3.83%. The mean age was 27.4 years (extremes 16 and 45 years). Multiparity was reported in 79% of patients versus 21% who were primiparous. Dyspnea was the functional sign reported in all patients. The most frequent echocardiographic abnormalities were LVH (75%) and GAH (45.83%). Hypokinesia was diffuse in 100% of cases. Impaired left ventricular ejection fraction (LVEF) was moderate in 50%. All patients were treated with beta-blockers, diuretics and ACE inhibitors. Progression was favorable in 87.5% of cases. The main pejorative prognostic factors were multiparity (79%) lower ventricular ejection fraction (LVEF)

Clinical classification of diabetes in tropical west Africa.

The objective of this work was to classify and describe the different types of diabetic patients detected in West Africa. In four health centres (three in Ivory Coast, one in Niger) 310 new cases were detected and followed up over 1 year. Classification was based on age at diagnosis, BMI, ketonuria, basal and stimulated C-peptide levels at inclusion, and response to antidiabetic therapy. In this population, males were predominant (sex ratio = 2.40), and random blood glucose levels very high at screening (mean +/- SE, 18.6 +/- 0.4 mmol/l). Only one case of fibrocalculous pancreatic diabetes and one possible case of diabetes mellitus related to malnutrition were detected. IDDM was diagnosed in 11.3% of the patients, half of them above 35 years. Leanness was observed in 59% of the patients with NIDDM. A dramatic decrease of fasting blood glucose was observed in all groups after 2 months of treatment, especially in NIDDM. As IDDM and non-obese NIDDM presented great similarities before treatment, even for C-peptide levels, a point score system is proposed to classify these two groups at baseline. In conclusion, it is confirmed that the form of diabetes previously defined as related to malnutrition is a very rare entity in black African populations. In contrast, African diabetes is characterised by the high proportion of NIDDM patients with low BMI, and reduced beta-cell function, rarely associated to ketonuria. This form of diabetes seems to be adequately controlled with oral hypoglycaemic drugs and/or diet in the year following diagnosis.

Hypertension arterielle (HTA) et grossesse au Niger : etudes cas/temoins a propos de 70 cas

Du 1er aout 1990 au 25 octobre 1990; 40 cas de l'H.T.A. au cours de la grossesse ont ete enregistres lors des consultations prenatales au centre de Sante Maternelle et Infantile de Poudriere (sur 784 C.P.N.) Parallelement; 70 femmes enceintes normotendues ont ete choisies comme temoin; dans la meme population obstetricale; et appariees sur l'age gestationnel; et la gestation. Sur la base des criteres cliniques et biologiques; notre echantillon se repartit comme suit: - 39 cas d'H.T.A. gravidique soit 55;7 pour cent - 19 cas de toxemie gravidique soit 27;1 pour cent - 4 cas d'H.T.A. ou maladie renale soit 5;7 pour cent - 7 cas d'H.T.A. non classee soit 10 pour cent - 1 cas d'H.T.A. pre-existante soit 1;5 pour cent. Quel que soit le type d'H.T.A.; nous avons note qu'il se pose trois types de problemes : Pronostic maternel; pronostic foetal; therapeutique

Hemopathies malignes a Niamey : a propos de 90 observations sur 6 ans

Les auteurs presentent le bilan d'une retrospective sur les hemopathies malignes diagnostiquees dans les hopitaux nationaux de Niamey et de Lamorde sur une periode de six ans. Sur les 9 myelogrammes pathologiques observes; la leucemie lymphoide chronique represente 33;33 pour cent des cas contre 22;21 pour cent pour les leucemies aigues; 18;88 pour cent pour la leucemie myeloide chronique et 15;55 pour cent pour les lymphomes. Tous les sexes sont concernes avec une legere predominance masculine sauf pour la leucemie lymphoide chronique et la leucemie aigue myeloide. S'agissant de la leucemie lymphoide chronique; elle touche plus particulierement le sujet age de plus de 40 ans alors que la leucemie aigue lymphoide est l'apanage des sujets ages de moins de 20 ans et la leucemie myeloide chronique plus frequente chez l'adulte jeune

Etude de la tension arterielle chez l'adolescent en milieu scolaire dans la communaute urbaine de Niamey : a propos de 550 sujets

La tension arterielle (TA) de l'enfant et de l'adolescent qui a fait l'objet de cette etude constitue un probleme preoccupant de l'heure. Ce travail a ete effectue au cours de l'annee scolaire 1988-1989 a Niamey. Il a porte sur 550 eleves les deux sexes confondus. Il a ete note que la TA est significativement correlee avec chacun des 4 parametres (age; poids; taille et surface corporelle) et une forte correlation existe entre l'age et les autres parametres

Hospitalizations in Niger (West Africa) for complications from arterial hypertension.

Fifty-four patients hospitalized in Niger for complications from hypertension between September 1988 and October 1989 were studied. The following complications were observed: left ventricular hypertrophy (56%), coronary vascular defect (35%), left heart deficiency (26%), cardiac failure (32%), retinopathy (56%), renal insufficiency (35%), and stroke (24%). The most frequent risk factor was Type A personality (76%), followed by stress (48%), excess weight (37%), tobacco use (35%), hyperuricemia (35%), hypercholesteremia (17%), and diabetes (15%). Complications from hypertension may well become a major problem for African countries as they develop.

[Postpartum myocardiopathy. Clinical and echographic evaluations of the response to treatment. 30 cases observed in the Sudan-sahelian area]. / La myocardiopathie post-partum. Evaluations clinique et échographique de la réponse au traitement. Trente cas observés en région soudano-sahélienne.

Thirty cases of postpartum cardiomyopathy observed in a savannah-sahelian region of Africa (Niamey, Republic of Niger) are reported. The dilated cardiomyopathy was diagnosed by comparing clinical signs with electrocardiographic, radioscopic and echocardiographic findings. A simplified therapeutic regimen was used in all cases: rest during 2 months, sodium restriction, diuretic and digoxin therapy (1 tablet of each drug every other day). Patients were followed up for a mean period of 13 months. The course of the disease was evaluated at regular intervals by echocardiography which provided accurate information on left ventricular function. At the time of diagnosis all patients had congestive heart failure. Complete remission was defined as the absence of all signs and a normal social life. Twelve patients answered this definition with a mean follow-up of 13 months. Nine patients (mean follow-up 24 months) were in incomplete remission; a large left ventricular aneurysm had developed in 2 of them. In 6 other patients the follow-up was too short (1 to 8 months) for a prognosis to be formulated. In postpartum cardiomyopathy 3 factors are indicative of a poor prognosis: 1) absence of free interval between delivery and first signs of heart failure; 2) history of cardiomyopathy after previous deliveries; 3) poor response to treatment with persistent cardiomegaly. On the other hand, the severity of the initial cardiomegaly and impairment of ventricular contractility, and the presence of permanent hypertension or pericardial effusion have no significant influence on the response to treatment. Irreversible contraception is justified in great multiparous women. In primiparous and oligoparous women a temporary contraception is necessary, a new pregnancy being conceivable only after complete remission and under close supervision.

Iron deficiency, pregnancy and breast-feeding in the Republic of Niger.

Body iron stores in 173 African women were evaluated by serum ferritin radioimmunoassay. The population studied was selected only by its accessibility in Guesheme, Dosso county, and other villages in Niamey and Dosso counties, Republic of niger. Iron fumarate (Fumafer) was systematically administered orally (400 mg/d) for one month. 95 women were revisited at the end of treatment. 22% of revisited women were iron deficient before treatment (serum ferritin less than 12 ng/ml); after one month of treatment only 8% had serum ferritin below the threshold value of 12 ng/ml, in spite of the low doses of iron fumarate administration; and the response to treatment was more significant in multiparous women. These results emphasize the very high prevalence of iron deficiency in the population studied, and demonstrate the need for systematic iron treatment of the multiparous women living in rural areas. The efficacy of low doses of iron fumarate is clear.