[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.

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%)

[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.

[Gender and stroke in Brazzaville]. / Genre et accidents vasculaires cérébraux à Brazzaville.

BACKGROUND: The relationship between gender and cerebrovascular disease is controversial. The aim of our study was to evaluate the relationship between gender and vascular risk factors, biological variables and the severity of the neurological deficit in stroke. METHODS: This cross-sectional study, conducted from March to August 2011 in the department of neurology of the university hospital of Brazzaville which included all patients hospitalized for confirmed stroke. The study variables were: age, sex, vascular risk factors, NIHSS scores and Glasgow, blood pressure, and the biological exams and complications. Statistical analysis was performed on SPSS12. RESULTS: Eighty patients were included. The mean age was 62.7 ± 11.2 years, with 58.8% of men. Alcohol intake and smoking were more frequent in men than women respectively P=0.005 and P=0.032. Psychosocial stress was more often declared by women than men (P=0.042). However there was no significant difference in biological variables, the severity of stroke and the occurrence of complications CONCLUSION: Our study suggests that in the Congolese context, gender does not influence significantly most parameters during stroke, but men consume more alcohol and women are exposed to psychosocial stress.

[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.