[Portal cavernoma at child about two observations]. / Cavernome portal chez l'enfant a propos de deux observations.

We report two observations of portal cavernoma diagnosed successively in Bamako and Dakar. The first is a 6-year-old male admitted to the service for ascites and abdominal pain. At admission the clinical parameters (weight, height, temperature, cranial perimeter and temperature) were within the norms for age. The clinical examination noted a moderate skin-mucosal pallor, asthenia. The biological assessment returned to moderate normochrome anemia with impaired pancreatic function while renal and hepatic functions were maintained. The abdominal scan performed after two low-contribution abdominal ultrasounds, objected signs in favor of a portal cavernoma with perisplenic and gastric varicose veins. The second is an 8-year-old male child born from an unborn marriage and from a followed pregnancy with premature delivery. His pathological history includes a notion of prematurity that required a stay in neonatology with umbilical catheterization and repeated abdominal pain. He had an acute abdominal episode in March 2015 justifying a surgical hospitalization for suspicion of appendicitis. At admission the clinical parameters (weight, height, temperature, cranial perimeter and temperature) were within the norms for age. The abdominal ultrasound prescribed for this was suggestive of portal cavernoma, later confirmed by abdominal computed tomography.

Nous rapportons deux observations de cavernome portal diagnostiqué successivement à Bamako et à Dakar. Le premier est un enfant de 6 ans de sexe masculin admis dans le service pour ascite et douleurs abdominales. L'examen clinique notait une pâleur cutanéo-muqueuse modérée, une asthénie. Le bilan biologique retrouvait une anémie modérée normochrome normocytaire avec une fonction pancréatique perturbée tandis que les fonctions rénales et hépatiques étaient conservées. Le scanner abdominal réalisé après deux échographies abdominales peu contributives, objectivait des signes en faveur d'un cavernome portal avec varice péri-splénique et gastrique. Le second est un enfant de 8 ans de sexe masculin né d'un mariage non consanguin et issu d'une grossesse suivie avec accouchement prématuré. Il est le 3e enfant de sa fratrie et scolarisé. On retrouve dans ses antécédents pathologiques une notion de prématurité ayant nécessitée un séjour en néonatologie avec cathétérisme ombilical et des douleurs abdominales à répétition. L'enfant a commencé à se plaindre de douleurs abdominales récurrentes vers l'âge de 6 ans. Douleurs de siège péri ombilical sans réveil nocturne dans un contexte de constipation chronique d'allure fonctionnelle. Il a fait un épisode abdominal aigu justifiant une hospitalisation en chirurgie pour suspicion d'appendicite. A l'admission les paramètres cliniques (poids, taille, température, périmètre crânien et température) étaient dans les normes pour l'âge. L'échographie abdominale prescrite à cet effet était évocatrice de cavernome porte, confirmé par la suite par la tomodensitométrie abdominale.

Aspects épidémiologiques, cliniques, étiologiques et évolutifs des hépatites aiguës au Centre Hospitalier National d'Enfants Albert Royer-Dakar

Introduction : l'hépatite aiguë est fréquente et représente un problème de santé publique dans les pays en développement. Les étiologies sont dominées par l'hépatite A en Afrique subsaharienne et en Asie du Sud-Est. Cependant, très peu d'études locales ont porté sur cette pathologie. Objectif : Étudier les aspects épidémiologiques, cliniques et évolutifs des hépatites aiguës chez les enfants hospitalisés au CHNEAR. Matériel et Méthodes : il s'agissait d'une étude rétrospective réalisée au CHNEAR de Dakar du 1er janvier 2007 au 31 décembre 2017. Étaient inclus les enfants hospitalisés pour une hépatite aiguë. Les données socio démographiques, cliniques, paracliniques et évolutives ont été recueillies. L'analyse des données uni et bivariée était faite grâce au logiciel R studio version 3.5.0. Résultats : au total, 35 000 enfants étaient hospitalisés durant la période d'étude parmi lesquels 71 patients avaient une hépatite aiguë déterminant une prévalence hospitalière de 0,2%. L'âge moyen à l'admission était de 65 mois avec un sex-ratio de 1,5. L'ictère cutanéo-muqueux était le principal signe physique (81,7%). La cytolyse était constante avec une moyenne des ALAT de 549UI/L. Une insuffisance hépatocellulaire était notée chez 24% des patients. L'étiologie était dans la grande majorité des cas indéterminée (66,2%). L'hépatite A représentait 15,5% et la phytothérapie (18,3%). L'évolution était favorable dans l'ensemble sans aucun cas de rechute. La létalité était de 16,9%. Conclusion : l'étiologie des hépatites demeurent encore indéterminées dans une large proportion au CHNEAR de Dakar. Le pronostic reste réservé pour les formes graves avec insuffisance hépatocellulaire

[Study of the Consumers' preference on the universal health coverage development strategy through health mutual in Ziguinchor Region, Southwest of Senegal]. / Étude de la préférence des usagers sur les stratégies de développement de la couverture sanitaire universelle à travers les mutuelles de santé dans la région de Ziguinchor au sud-ouest du Sénégal.

In Senegal, the informal and rural sector that accounts for over 80% of the population is covered only up to 7% by a health insurance system. That is why, for the implementation of development strategy of the universal health coverage (UHC) through mutual health insurance providers, the Government of Senegal has focused on this sector. The objective of this study was to assess the consumer's preference on the UHC development strategies through mutual health insurance providers. This was a qualitative and exploratory study based on a literature review, and indepth interview with the heads of households. It was also based on focus groups of people with and without health mutual membership, and the Expert Committee meetings. The results showed that the most critical attributes in the decision-making of consumers to join the health mutual in Ziguinchor were the membership units; the content of the benefit package, the payment modalities of the premium, the premium amount, the availability of transportation, the co-payment level, convention arrangement with health facilities, and health mutual governance. For a successful implementation of the UHC development strategy through health mutual organizations, policymakers should explore the possibility of introducing the modality of payment in kind, the revision of the co-payment amount, and the promotion of equity through the introduction of a differentiated premium contribution by income. They should also establish a crossborder strategy with The Gambia and Guinea-Bissau to improve health care access to people living in the borders. The promotion of innovative funding and risk equalization between health insurance schemes is also recommended. In areas where the microfinance institutions are well organized and structured their substitution to health mutuals should be an option the decision-makers have to explore.

[Kangaroo mother care for low birth weight infants at Albert-Royer National Children Hospital Center of Dakar]. / Les soins kangourou pour nouveau-nés de faible poids de naissance au centre hospitalier national d'enfants Albert-Royer de Dakar.

INTRODUCTION: Kangaroo care (KC) is an effective method to care for low birth weight (LBW) newborns, particularly in developing countries. The objective of this study was to estimate the efficacy of this method and its impact on morbidity and mortality of LBW infants admitted to the KC unit of Albert-Royer National Children's Hospital Center (ARNCHC) in Dakar, Senegal. MATERIAL AND METHODS: This was a retrospective, single-center study from July 2011 to July 2013. We collected sociodemographic, maternal, and obstetrical data, neonatal characteristics and information during KC (age and weight at inclusion, thermoregulation, feeding, growth, and overall progression). Data were entered and analyzed using SPSS version 9.0. RESULTS: We included 135 newborns, with a female predominance (sex ratio: 0.78). One-third of the mothers (35.5%) were primiparous and only 21.1% had a socioprofessional activity and the majority had a low educational level. The mean gestational age (GA) was 33.08±2.06 weeks of amenorrhea and the mean birth weight 1485±370 g. There were 20 term babies with intrauterine growth restriction (IUGR) (14.8%) and 115 (85.2%) preterm newborns, 83 (72.2%) of whom, showed IUGR. The mean duration of conventional care was 12.3 days (range: 4-27 days) and the main complications were respiratory distress (46.2%), infection (36.9%), and necrotizing enterocolitis (15.1%). At KC admission, the mean post-conceptional age was 34.2±2.46 weeks and the mean weight 1445±319 g (minimum, 700 g). The main complications in KC were infections (20.2%), hypoglycemia (18.5%), and gastro-esophageal reflux disease (16.4%). Only 56.3% of the babies were exclusively breastfed. The mean weight gain during the stay in the KC unit was 15.3±9.08 g/kg/day and the mean weight at discharge was 1761±308 g. Only three episodes of hypothermia were noted. The mean duration in the KC unit was 10.2 days (range: 3-24 days). Five babies died (3.7%): one during KC, one at home, and the three others after readmission to neonatology. CONCLUSION: Kangaroo care for LBW infants is highly effective in our context. This method should be spread to a large majority of health centers in the country.

La détresse respiratoire du nouveau-né à terme au service de néonatologie du Centre hospitalier d'enfants Albert Royer de Dakar, Sénégal

Introduction : La Détresse Respiratoire (DR) est fréquente en néonatalogie, souvent liée à des difficultés d'adaptation ou à l'infection. Objectifs : Décrire les aspects épidémiologique, clinique, thérapeutique et pronostique de la détresse respiratoire du nouveau-né à terme au service de néonatologie Centre hospitalier National d'Enfants Albert Royer de Dakar (CHNEAR).Patients et méthode : Etude rétrospective, descriptive du 1er janvier au 31 décembre 2014, concernant les nouveau-nés à terme hospitalisés pour détresse respiratoire. Résultats : Nous avons colligé 214 cas de DR, soit une fréquence de 34,8% des nouveau-nés à terme. Le sex-ratio était de 1,06 et l'âge moyen de 8,5 jours. L'accouchement était fait par césarienne dans 39 cas (18,2%) et 132 nouveau-nés (61,5%) étaient eutrophiques. Une réanimation en salle de naissance avait été nécessaire pour 86 nouveau-nés (40,2%). La DR était précoce en salle de naissance dans 75 cas (35,0%) et 107 nouveau-nés (50%) étaient admis avant 48 heures de vie. Le transfert était fait par transport en commun dans 92 cas (42,8%). La DR était sévère chez 102 nouveau-nés (47,7%). La SpO2 moyenne était de 78% sous oxygène à l'admission. Les principales étiologies étaient l'infection néonatale (118 cas ; 55,1%), l'asphyxie périnatale (53 cas ; 24,8%), l'inhalation méconiale (30 cas ; 14,0%), les cardiopathies congénitales (29 cas ; 13,5%), la bronchiolite aiguë 20 cas ; (9,3%), l'atrésie des choanes (9 cas ; 4,2%). Une ventilation artificielle était réalisée pour 45 nouveau-nés (21,0%). La létalité était de 31,8% (68 décès). Cette létalité était significativement associée à l'existence d'une détresse respiratoire en salle de naissance (p = 0,007 ; OR 2,2), d'une hypertension artérielle pulmonaire (p <0,001 ; OR 5,1), d'un pneumothorax (p < 0,001 ; OR 3,3), d'une inhalation méconiale (p = 0,006 ; OR 4,0), et d'une cardiopathie congénitale (p = 0,004 ; OR 3,7). Conclusion : Les détresses respiratoires néonatales sont fréquentes et sont associées à une létalité élevée. La prise en charge en salle de naissance, pendant le transfert et en néonatologie doit être améliorée

[Prevalence and determinants of anemia in young children in French-speaking Africa. Role of iron deficiency]. / Prévalence et déterminants de l'anémie chez le jeune enfant en Afrique francophone--implication de la carence en fer.

Anemia and iron deficiency are major public health issues worldwide and particularly in Africa. Reliable information about their prevalence and associated factors is required to allow for effective actions. In this study, we used data from recent (2006-2012) large population health surveys, carried out in 11 French-speaking African countries (Benin, Burkina Faso, Cameroon, Congo Brazzaville, Ivory Coast, Gabon, Guinea, Mali, Niger, Democratic Republic of Congo, and Senegal). Hemoglobin (Hb) was assessed and demographic and health-related parameters were obtained from nation-representative samples of children aged 6-59 months. Anemia (Hb<11g/dL) was found in 72.4% of the children (60.2-87.8%), with no gender difference but a slightly lower incidence in older children (62% at age 4-5 years versus 85% at age 9 months), especially for the more severe forms (2.1% versus 8.7%, respectively). Anemia was only slightly but significantly affected by location (75.5% in rural areas versus 67.3% in towns), income (79.8% in lower quintile of income versus 62.3% in higher quintile), or maternal education (74.1% in children from non-educated mothers versus 62.4% in children whose mothers had secondary education). Nearly 50% of women of child-bearing age had anemia. In the countries that report this information, less than 50% (17-65%) of children consumed iron-rich foods regularly and only 12% (7.4-20.5%) received iron supplementation. Infection and parasitism are known to affect some markers of iron status, because of the inflammatory reaction, thereby making the diagnosis of iron deficiency difficult. In the study countries, acute respiratory diseases and diarrhea affected 6.2 and 15.6% of children aged between 6 and 59 months, respectively; their distribution according to age and location is very different from the one of anemia, which is also the case for the distribution of malaria. It is thus likely that a large part of the anemia observed in young children is due to iron deficiency, although further research is needed to confirm this. This fully justifies the nationwide programs of iron fortification of flour, currently undergoing in most countries of French-speaking Africa. Their formal evaluation is still pending but the initial data suggest some efficacy, although far from optimal. It is thus likely that a more holistic approach, including iron fortification, actions against undernutrition and parasitism in children, and actions in favor of improving young women's iron and nutritional status, together with appropriate communication and education objectives, would be more effective.

[Relationship between the obstructive character of the tonsils and the sagittal cephalometric measurements]. / Relations entre le caractère obstructif des amygdales palatines et les mensurations céphalométriques du sens sagittal.

INTRODUCTION: The role of obstructive tonsils in the sagittal dimension of the skeleton-dental abnormalities is widely discussed in the literature but remains controversial. Data on the probable relationship between obstructive tonsils and the presence of these abnormalities were subjective. The objective of this study was to quantify the relationship between the obstructive character of the tonsils and the sagittal cephalometric measurements. MATERIALS AND METHODS: A cross-sectional study was performed in children aged between 6 to 12 years divided into 2 groups (A and B) according to the obstructive character of the tonsils. Cephalometric measurements were recorded on each child. Data were analyzed using SPSS 20.0 for Windows. At Student test was used to compare quantitative variables according to the obstructive character of the tonsils. Significance was set at p = 0.05. RESULTS: Subjects with obstructive tonsils (group B) are significantly more trend to have a convex facial profile and a skeletal class II with more mandibular retrusion and retroclined incisor compared with subjects without obstructive tonsils (group A). CONCLUSION: Early evaluation of children with obstructive tonsils can prevent sagittal dimension of the squeleto-dental abnormalities caused by upper airway obstruction. Thus late and more aggressive treatments which are not always as efficient as when they were performed during childhood will be avoided.

[Dehydration and malnutrition as two independent risk factors of death in a Senegalese pediatric hospital]. / Déshydratation et malnutrition : deux facteurs de risque de décès indépendants chez l'enfant sénégalais hospitalisé

UNLABELLED: Inpatient mortality is an indicator of the quality of care. We analyzed the mortality of under 5-year-old hospitalized children in the pediatric ward of Aristide Le Dantec Hospital for updating our data 10 years after our first study. METHODS: We analyzed the data of the children hospitalized between 1 January and 31 December 2012. For each child, we collected anthropometric measurements converted to a z-score related to World Health Organization growth data. Logistic regression-generating models built separately with different anthropometric parameters were used to assess the risk of mortality according to children's characteristics. RESULTS: Data from 393 children were included. The overall mortality rate was 10% (39/393). Using logistic regression, the risk factors associated with death were severe wasting (odds ratio [OR]=8.27; 95% confidence interval [95% CI]) [3.79-18], male gender (OR=2.98; 95% CI [1.25-7.1]), dehydration (OR=5.4; 95% CI [2.54-13.43]) in the model using the weight-for-height z-score; male gender (OR=2.5; 95% CI [1.11-5.63]), dehydration (OR=8.43; 95% CI [3.83-18.5]) in the model using the height-for-age z-score; male gender (OR=2.7; 95% CI [1.19-6.24]), dehydration (OR=7.5; 95% CI [3.39-16.76]), severe deficit in the weight-for-age z-score (OR=2.4; 95% CI [1.11-5.63]) in the model using the weight-for-age z-score; and male gender (OR=2.5; 95% CI [1.11-5.63]) and dehydration (OR=8.43; 94% CI [3.83-18.5]) in the last model with mid-upper arm circumference (MUAC). Dehydration and malnutrition were two independent risk factors of death. The protocols addressing dehydration and malnutrition management should be audited and performed systematically for each child's anthropometric measurements at admission.

[Assessment of the state and future of basic neonatal resuscitation equipment, in first-line health facilities in Senegal after 3years]. / Évaluation de l'état et du devenir du matériel de base destiné à la prise en charge du nouveau-né à la naissance dans les structures sanitaires périphériques au Sénégal, après un recul de trois ans.

BACKGROUND: Neonatal mortality is a major public health problem. The main causes are infections, prematurity and asphyxia at birth. In view of reducing this high mortality, primary healthcare facilities were equipped with basic equipment for the care of newborns and their key workers were trained in essential newborn care. Three years after this implementation, the present study assesses the state and conditions of use of this basic equipment intended for taking care of newborns at birth. METHOD: This assessment was conducted from 16 March to 3 April 2009. It was based on observations and interviews on a sample of healthcare facilities. RESULTS: Healthcare facilities were generally equipped with ventilator bags and masks (87%) (60/69). In more than half of the healthcare centers (20/38), they were not used often because the workers were renewed and not educated in their use. They were practically all in good condition. Eighty-five percent (59/69) of healthcare facilities had at least one aspirator, generally adapted to newborns (negative pressure, 100 mmHg). The maintenance of the material was globally satisfactory because the aspirator bottles were most often clean. As for the aspirator tubes, they were always available but a few cases of supply rupture were observed in some healthcare centers. The warming table was available in only 52% (36/69) of healthcare facilities. Fifteen tables did not comply with initial specifications. CONCLUSION: This assessment highlights that the basic equipment intended for newborn care was generally available, functional and maintained well after 3 years. This strategy could be scaled up in order to contribute to reducing the newborn mortality.

[Morel-Lavallée lesion in orthopaedic surgery (Nineteen cases)]. / Épanchement de Morel-Lavallée en chirurgie orthopédique (À propos de 19 cas).

AIMS: The object of this work is the study of especially ancient clinical forms of the effusion of Morel-Lavallée, to discuss the place of deep fascial fenestration by Ronceray and to propose criteria of therapeutic indication. PATIENTS AND METHOD: Our study concerns a continuous retrospective series over 20 years from 1989 till 2009. Eleven men and eight women, 36.7 year-old on average were treated for an effusion of Morel-Lavallée. The dominant etiology was represented by the accidents of the public highway. The collection was discovered after 41.4 days on average (extremes of 1-180 days). The volume of the collection was on average of 1237cm(3) (extremes 60cm(3)-12L). RESULTS: The conservative treatment concerned all patients who had a recent collection lower than three weeks and three others who had an ancient collection. The surgical treatment was established after all 10 times among which four in first intention and six times after failure of the previous treatment. The cure was obtained in 91% of the patients who had a recent collection by the only conservative method and among four patients by the method of Ronceray. To the three others, it was obtained after iterative unbridlings and talcage treatment. CONCLUSION: The authors insist on certain rare forms met in Africa in particular the "virtual form", the ancient forms and the too plentiful forms (12L). They plead for use deep fascial fenestrations by Ronceray for these last ones.

Intoxicatrion accidentelle par ingestion de fer chez l'enfant : a propos de deux cas a Dakar

Introduction : L'intoxication au fer est un motif exceptionnel d'hospitalisation en pediatrie au centre hospitalier universitaire de Dakar.Observations : Nous rapportons les observations de deux enfants de 3 ans et 20 mois admis au service d'urgence pediatrique de l'hopital Aristide Le Dantec pour une intoxication de moderee a severe apres l'absorption d'une quantite importante de sulfate de fer. Les manifestations cliniques etaient dominees par les troubles digestifs et les troubles neurologiques a type de convulsions tonico-cloniques et de coma stade I. Le dosage sanguin du fer montrait des taux au dessus des limites normales. L'evolution clinique etait satisfaisante apres le lavage gastrique et les mesures de reanimation. Conclusion : Un diagnostic precoce et une prise en charge diligente des cas d'intoxication au fer permet d'en reduire la morbidite et la mortalite. Nous insistons egalement sur l'information des familles pour une meilleure securisation des comprimes de fer prescrits aux adultes

[Pédiatric haemophilus influenzae b meningitis in Dakar]. / Méningite pédiatrique à haemophilus influenzae b à Dakar.

OBJECTIVE: This study had for aim to determine the etiology of Haemophilus b pediatric meningitis. DESIGN: A retrospective study of 216 biologically confirmed cases was carried out during 6 years (January 1995- December 2000) on children 0 to 15 years of age, hospitalized at the Albert Royer Children Hospital Center. RESULTS: Haemophilus influenzae b is the first cause of pediatric meningitis (19.7%) followed by Nesseria meningitidis (14.5%), and Streptococcus pneumoniae (13.6%). The Haemophilus influenzae b meningitis cases are distributed all year round with a peak between January and March, that is to say, during the dry and cool season. They affect children at an average age of 11.7 months, with a sex ratio of 1.1 for boys. Almost all of the patients live in the low-socio-economic areas of the Dakar suburbs (92.8%). More than 90% of the H. influenzae b isolates are sensitive to ceftriaxone (96%) chloramphenicol (93%), and to ampicillin (91%). Clinical evolution is marked by death (17.8%) and recovery with psychological, sensory, and motor sequels (19.9%). CONCLUSION: This report should help to include the combined vaccine Antihaemophilus influenzae b in the Senegalese Broad Vaccination Program. The final aim is the reduction of morbidity and mortality of infections due to Haemophilus influenzae b.

[Low level educated community health workers training: a strategy to improve children access to acute respiratory treatment in Senegal]. / La formation des agents de santé communautaire instruits: une stratégie pour améliorer l'accès des enfants au traitement des infections respiratoires aiguës au Sénégal.

BACKGROUND: Acute respiratory infections (ARI) are the leading cause of death in childhood. Most of children's deaths happen at home without health level first cares. However in Senegal only health workers are allowed to prescribe antibiotics. A competency-based training was developed to improve and assess the management of acute respiratory infections in young children aged 2 to 59 months by low level educated community health workers (CHWs) in 4 districts of Senegal. The first findings showed the CHWs capable of acquiring the skills needed to effectively manage ARI cases in accordance with the World Health Organization's ARI case management strategy. The aim of this study was to assess the quality of their management after a 1 year follow-up. METHODS: We provided to CHWs 3 days course in ARI management. After the 3-day course, a 4-month follow-up was performed. We organized a 1-day refresher course every month and in every district. In order to assess the quality of management of CHWs we analyzed the management process and compared the CHWs classification to the classification of the first level health facilities. RESULTS: Twenty-three percent (3727/15,965) of IRA cases of district were managed by CHWs. Ninety percent (2738/3042) among them were well classified, well managed and well followed-up. But 28% of severe pneumonia cases were misclassified as pneumonia. About treatment, 22.5% of 'cough or cold' got wrong treatment with cotrimoxazole and 10.3% of severe pneumonia got cotrimoxazole without referral. Less than half of severe pneumonia benefited of the first follow-up and only 18% of the second. CONCLUSIONS: The results highlight that a CHWs low-level educated in French, trained and followed-up could apply the WHO algorithm of IRA management. They could help to give proximal care related to children ARI, to the community. But it seems useful of emphasizing the recognition of danger signs and the follow-up of severe cases.

[Supervision of body composition and cardiovascular parameters in long sprint running athletes (400 m)]. / L'entrainement au sprint long (400 metres plat): suivi de la composition corporelle, des constantes cardiovasculaires et de l'electrocardiogramme des athletes.

INTRODUCTION: The follow-up of performances and the prevention about possible incidents at the athletes make necessary the medical supervision in physical training. The aims of this study are to estimate the effect of a precompetition training program in athletes' body composition, and cardiovascular modifications (in clinical examination and electrocardiogram) MATERIALS AND METHODS: Ten athletes (3 men and 7 women; mean age of 23.6 +/- 3.16 years) of Dakar international Athletics' Center are subjected to a training on a period of 2 months in aerobic dominant followed by a period of 3 months in anaerobic dominant. At the beginning and the end of training program, an electrocardiogram is recorded after blood pressure (BP) measure in lying and standing posture and heart rate (HR) take. The weight, height and cutaneous folds are measured to calculate the body fat percentage, fat body mass, fat-free mass and body mass index. Every athlete has performed the Ruffier test Comparisons are realized by the paired t-test, statistically significant for a p value < 0,05 RESULTS: Significant declines after training interest HR (79.2 +/- 14.7 vs 63.2 +/- 10.25 beat min(-1); p< 0.001), systolic BP in standing posture (11.8 +/- 0.44 vs 10.6 +/- 0.96 mmHg; p= 0.02), and Ruffier index (4.4 +/- 3.28 vs 2.23 +/- 1.62; p= 0.048) whereas the fat-free mass increased (53.14 +/- 8.41 vs 54.16 +/- 9.67 kg; p= 0.046). At the electrocardiogram, the number of athletes having sinusal bradycardia is crossed from 1 to 4; there is no modification as for the two cases of uncomplete right bundle-branch block and the pre-existent left ventricular hypertrophy. Negative T waves in V1 and V2 leads are present in one athlete before training and in two others after. CONCLUSION: The impact of the specific training on body is real, interesting more the cardiovascular system.

[Cardiovascular emergencies in Subsaharan Africa]. / Urgences cardiovasculaires en Afrique subsaharienne.

BACKGROUND: The increasing prevalence of cardiovascular diseases in subsaharan Africa and their related mortality and morbidity have been established. A large number of them present as emergencies. The purpose of this first multicentric study was to assess the causes, management and outcome of cardiovascular emergencies in savannah and forest environments. METHODS: A total of 665 patients were included from seven participating centers in seven countries: 417 were classified as belonging to the savannah zone (Dakar, Nouakchott, Ouagadougou, N'djamena) whereas 248 patients were from the forest zone (Abidjan, Libreville, Yaounde). Patients were examinated by one or several cardiologists. Statistical analysis was performed by the Medical Statistic Unit of the Hopital Nord, Marseille (France). RESULTS: There were more men (53.4%) than women (46.6%). 77.7% of the patients lived in urban areas. Most of them had low or very low incomes. Patients reached the hospitals in ambulances only in 6.2% of cases. The remaining others were transported by routine urban vehicle or bicycle or ambulation. The mean delay between the onset of symptoms and the arrival to the emergency unit was 6.8 days. Three immediate situations were preponderant: severe hypertension (32.2%), heart failures NYHA IV (27.5%), stroke (20.3%). Underlying conditions were: mainly chronic hypertension (52.3%), cardiomyopathies (20.6%), valvular heart diseases (11.1%). Coronary heart diseases were rare (6.1%). The observed mortality was 21.2% without any differences in age groups. The most common emergencies resulting in death included: stroke (31.9%), vascular collapses (18.4%), pulmonary embolism (9.2%). The patients from the savannah zone were younger, more often classified in the low or average socioeconomic level. Hypertension was more frequent in forest zones. Valvular heart diseases were more frequent in savannah. Cardiomyopathies were comparable in both zones. Coronary heart disease was slightly more common in the savannah area. DISCUSSION: Compared with patients from western countries, the African patients are younger because some diseases affect young people like rheumatic heart disease or postpartum and infectious cardiomyopathies. The difficulties to reach health care facilities made the outcome more severe. Hypertension and valvular heart disease deserve priority in preventive strategy. Cardiomyopathies have to be studied to precise their causes. Finally, the management of cardiovascular emergencies needs a special care in the hospitals owing to their increasing frequency and their severity.