Safety of Chloroquine or Hydroxychloroquine Plus Azithromycin for the Treatment of COVID-19 Patients in Burkina Faso: An Observational Prospective Cohort Study.

INTRODUCTION: Though chloroquine derivatives are used in the treatment of coronavirus disease 2019 (COVID-19) in many countries worldwide, doubts remain about the safety and efficacy of these drugs, especially in African communities where published data are scarce. METHODS: We conducted an observational prospective cohort study from April 24 to September 03, 2020, in Burkina Faso to assess (as primary outcome) the clinical, biological, and cardiac (electrocardiographic) safety of chloroquine or hydroxychloroquine plus azithromycin administered to COVID-19 patients. The main secondary outcomes were all-cause mortality and median time of viral clearance. RESULTS: A total of 153 patients were enrolled and followed for 21 days. Among patients who took at least one dose of chloroquine or hydroxychloroquine (90.1% [138/153]), few clinical adverse events were reported and were mainly rash/pruritus, diarrhea, chest pain, and palpitations. No statistically significant increase in hepatic, renal, and hematological parameters or electrolyte disorders were reported. However, there was a significant increase in the QTc value without exceeding 500ms, especially in those who received chloroquine phosphate. Three adverse events of special interest classified as serious (known from chloroquine derivatives) were recorded namely pruritus, paresthesia, and drowsiness. One case of death occurred. The average onset of SARS-CoV-2 PCR negativity was estimated at 7.0 (95% CI: 5.0-10.0) days. CONCLUSION: Hydroxychloroquine appeared to be well tolerated in treated COVID-19 patients in Burkina Faso. In the absence of a robust methodological approach that could generate a high level of scientific evidence, our results could at least contribute to guide health decisions that should be made based on different sources of scientific evidence including those from our study.

[High incidence of asymptomatic myocardial ischemia in a population of HIV-infected patients in Bobo-Dioulasso, Burkina Faso]. / Fréquence élevée de l´ischémie myocardique asymptomatique dans une population de patients infectés par le VIH à Bobo-Dioulasso, Burkina Faso.

INTRODUCTION: cardiovascular complications have become the 3th cause of death and the 4th reason for hospitalization in HIV-infected patients. The purpose of this study was to determine the frequency of asymptomatic myocardial ischemia in HIV-infected patients on antiretroviral therapy. METHODS: we conducted a descriptive cross-sectional study in November 2015. Asymptomatic HIV-1-infected patients on ARV treatment and followed up in the Day Hospital Unit of the Department of Infectious Diseases of the University Hospital Sanon Sourou of Bobo-Dioulasso were included in the study. Among enrolled patients data on cardiovascular risk factors were collected as well as two sitting blood pressure measurements after 10 minutes of rest were taken during consultations and resting 12-lead electrocardiogram (ECG) was performed. RESULTS: a total of 123 HIV-1-infected patients with a median age of 42 years (IQR: 36-50), among whom 79% were female subjects, were included in the study. Cardiovascular risk factors included: PAH (31.7%), obesity (33%), dyslipidemia (10.57%), active smoking (0.8%) and diabetes (0.8%). All patients with hypertension (5.7%) were insufficiently treated. The median duration of ARV treatment was 5.3 years (IQR: 3-7.7). Repolarization disorders were found in 26 cases (21.13%). They were divided into subepicardial ischaemia in 20 cases (16.26%), subendocardial damage in 2 cases (1.63%) and sequelae of necrosis in 4 cases (3.25%). Left ventricular hypertrophy (LVH) was found in 12 cases (9.76%) and, in particular, in hypertensive patients. Prolonged QTc interval was found in 7 patients (5.69%) regardless of the ARV drugs given. CONCLUSION: this study of HIV-1-infected patients highlights that asymptomatic myocardial ischemia is common. Screening programmes should be improved through more effective ischemia tests in order to better determine its severity in this sub-population with increased cardiovascular risk.

[Elite athletes' electrocardiogram in Bobo-Dioulasso, Burkina Faso]. / Electrocardiographie du sportif de haut niveau d'entrainement à Bobo-Dioulasso, Burkina Faso.

High-performance sport results in electrocardiographic changes. Some are benign, other can cause sudden death. The purpose of this study is to describe the features of electrocardiogram at rest in elite athletes living in Bobo-Dioulasso. We conducted a cross-sectional descriptive study in the Department of Cardiology at the Souro Sanou University Hospital in Bobo-Dioulasso from August 2015 to February 2016. Elite athletes aged 17 to 35 years who had been training at least eight hours per week for more than six months, regardless of the type of sport, were enrolled. Two hundred elite athletes from four different sporting disciplines were included. The average age of athletes was 24 years (IIQ: 21-27). The median seniority in sport practice was 6 years (IIQ: 4-8) and the median duration of weekly training was 10 hours (IIQ: 10-10). Only 4% of the athletes had already undergone electrocardiogram. ECG showed abnormalities in 90.5% of cases and sinus bradycardia was the most common abnormality in 72.5% of cases. Left ventricular hypertrophy and left-atrial dilatation were reported in 44% and 34.5% respectively. Early repolarization syndrome was found in 47% of cases. In athletes, high-performance sport can result in electrical modifications. Practitioners need to know them in order to differentiate them from heart disease.

Spectrum of heart failure in sub-Saharan Africa: data from a tertiary hospital-based registry in the eastern center of Burkina Faso.

INTRODUCTION: Heart failure (HF) is a strong contributor to non-communicable diseases burden in sub-Saharan Africa (SSA). Few studies have addressed the pattern of HF in Burkina Faso. METHODS: We conducted a prospective cohort study in patients with acute HF in the Regional Hospital Center of Tenkodogo, eastern region of Burkina Faso. Patients were consecutively enrolled from 1st January 2015 to 31st December 2016 and followed up until June 2017. Primary outcome of interest was mortality. RESULTS: Overall 318 of 1805 cardiac cases presented with acute HF (17.62 %). Of the 298 patients included in the analysis process, 239 had de novo HF and 150 were male. The mean age was 58.56 ± 18.54 years. Eighty-eight patients presented with atrial fibrillation. The mean left ventricular ejection fraction (LVEF) was 38.20 ± 12.85 % with reduced ejection fraction (LVEF < 40%) accounting for 59.73% of the cases. Most of the study patients lived in rural areas. Hypertensive heart disease (50.34%) and idiopathic dilated cardiomyopathy (19.80%) were the leading causes of HF. Most patients received renin-angiotensin system blockers contrasting with a lower prescription rate of beta-blockers (99% versus 18.79% respectively). The incidence of all-cause mortality was 31 percent patients-years. CONCLUSION: Heart failure is frequent in SSA, affecting patients at younger age. Predominantly of non-ischemic cause, commonly hypertensive, the disease is associated with high mortality.

Epidemiology and long-term prognosis of atrial fibrillation in rural African patients.

BACKGROUND: Few studies have addressed the pattern of atrial fibrillation (AF) in rural Africa. The purpose of the study was to assess the epidemiology and long-term prognosis of AF in rural African patients in the Regional Hospital Center (RHC) of Tenkodogo, Burkina Faso. RESULTS: Overall, 107 of 1805 cardiac cases presented with AF (prevalence of 5.9%). Six patients were excluded. Mean age was 66.56 ± 14.92 years, and 53.47% were female. Hypertension was the most prevalent cardiovascular risk factor (59.41%). Congestive heart failure (HF) was reported in 85.15% of the study patients at presentation. Most of the study population presented with severe underlying heart disease (93.1%), and hypertensive heart disease was the most prevalent with 45.54% of the cases. The mean CHA2DS2VASc score in patients with non-valvular heart disease (n = 91) was 3.33 ± 1.25 (extremes 1-6) while the risk of bleeding was low (HAS-BLED score ≤ 1) in 82 patients (81.2%). Oral anticoagulation was prescribed in few cases (5.26%). During a follow-up period of 74.43 ± 23.94 weeks, acute HF and stroke occurred in respectively 43 and 6 patients. Forty-one patients (40.59%) died. The overall survival rate was 69% at 6-month and 59.4% at 1-year follow-up. Patients with idiopathic dilated cardiomyopathy were at higher risk of death than other patients (log-rank test = 11.88, p < 0.001) over time. CONCLUSION: AF is not rare in rural African patients and is associated with an increased long-term risk of HF, stroke, and mortality.

[Angioplasty of the unprotected left main trunk: short and medium term outcomes]. / L'angioplastie du tronc commun non protégé de l'artère coronaire gauche: devenir des patients à court et moyen termes.

INTRODUCTION: This study aimed to determine short and medium term outcomes in patients with unprotected left main coronary disease treated by percutaneous intervention. METHODS: We conducted a retrospective study of all patients with unprotected left main coronary artery disease treated by percutaneous intervention between January 2004 and June 2009. Clinical and angiographic data were collected from their medical records and supplemented by a telephone interview with the patients or their doctors. RESULTS: Forty eight patients with an average age of 68.50 ± 14.06 years were included in the study. Acute coronary syndromes were the primary reason for admission (75%). Patients had distal left main lesions (77.1%) and pluritroncular lesions (64.6%). Bare-metal stents were implanted in 73% of patients. After a mean follow-up of 22 months, the rate of major cardiovascular events was 35.4% (20.8% of restenosis and 14.6% of revascularizations). Hospital mortality rate was 4.2%. Predictive factors of major cardiovascular events included an EuroSCORE ≥ 10 and a history of cardiovascular disease. CONCLUSION: Angioplasty of the left main trunk is an alternative approach to emergency situations or when surgery is not indicated. Patients' outcome is dependent on their overall risks factors before angioplasty.

[Accidents in patients under anticoagulant therapy in the Department of Cardiology at the Yalgado Ouedraogo Teaching Hospital, Ouagadougou (Burkina Faso)]. / Les accidents du traitement anticoagulant dans le Service de Cardiologie du Centre Hospitalier Universitaire Yalgado Ouedraogo de Ouagadougou (Burkina Faso).

This study aimed to evaluate the profile of patients hospitalized for anticoagulant-induced hemorrhage. We conducted a retrospective, descriptive study within the Department of Cardiology at the Yalgado Ouedraogo Teaching Hospital, in Ouagadougou, over a period of 2 years from 1 January 2007 to 31 December 2008. All hospitalized patients with anticoagulant-induced hemorrhage were included in the study. The average age of patients was 49,31 ± 17,68 years, the sex-ratio was 2,17. Myocardial infarction was the first indication for anticoagulant treatment, with a rate of 21.05%. Anti vitamin K (AVK) was associated with hemorrhage in 63,16% (n=12) of patients versus 36,84% (n=7) of patients treated with low molecular weight heparins (LMWH); 10 patients had major hemorrhage while nine patients had minor hemorrhage. The average duration of Anti vitamin K (AVK) treatment was 16 ± 58 weeks. Hemorrhage in the digestive tract was the most frequent symptom (31,58%) and, in 89,47% of patients, treatment was associated with platelet aggregation. Treatment of hemorrhagic accident was based on definitive cessation of anticoagulant therapy in 73,68% of patients. Four patients (21.05%) died. The inaccessibility to antidotes such as protamine sulphate and PPSD (Prothrombin, Proconvertine, Stuart factor, and anti-haemophilia B factor) constitutes a real obstacle to adequate treatment for complications; a better education of patients receiving these drugs would be the most important preventive measure, because more than 50% of these accidents are preventable.

[Prevalence and knowledge of arterial hypertension in the elderly: cross-sectional study conducted in Bobo-Dioulasso, Burkina Faso]. / Prévalence et connaissances de l'hypertension artérielle chez les personnes âgées: étude transversale menée à Bobo-Dioulasso, Burkina Faso.

This study aims to determine the prevalence of arterial hypertension (AH) in the elderly people as well as their knowledge of this disease. We conducted a cross-sectional, descriptive study in the town of Bobo-Dioulasso from October to November 2015 at the intervention sites of the Association of Medical Assistance to elderly people "KAFOLI". Patients aged 60 years and more, with or without hypertension, who wished to participate in the study were included. Subjects were considered to be hypertensive when they had systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥90 mmHg or when they were under antihypertensive treatment. Socio-demographic and clinical data as well as the risk factors associated with the disease were collected. Knowledges on arterial hypertension were based on general knowledges about arterial hypertension as sources of information about it. A total of 88 subjects were included in this study. The study involved 56 women and 32 men (sex ratio 0.57). The average age of patients was 71 years (IQR:66-76). The prevalence of arterial hypertension was 61,36% and it was associated with knowledges about AH and with alcohol consumption; 68.18 % of patients had knowledge of AH. The majority of them were followed up in first-level health care nursing centres (64,81%). This study highlighted a high prevalence of hypertension in elderly people living in Bobo-Dioulasso. The majority of these persons were aware of this disease. In the majority of cases follow-up was ensured by nursing staff.

[Electrocardiography coupled with transthoracic echocardiography at rest in the diagnosis of cardiac impairments in type 2 diabetics: lessons learned from a cross-sectional case series in Burkina Faso]. / Electrocardiographie couplé à l'échocardiographie transthoracique de repos dans le diagnostic des atteintes cardiaques chez le diabétique de type 2: les enseignements d'une série transversale au Burkina Faso.

Diabetes is a powerful independent cardiovascular risk factor. The aim of this study is to describe the electrocardiographic and echocardiographic abnormalities observed in patients with type 2 diabetes treated in the Department of Medicine at the University Hospital in Bobo-Dioulasso. We conducted a descriptive cross-sectional study of all patients with type 2 diabetes who gave consent from April to September 2014. We gathered clinical data from all the patients. They, moreover, underwent electrocardiography and doppler echocardiography. A total of 155 diabetics were investigated. The average age of patients was 55 years (IQR: 47-64) with a female predominance (sex ratio 0.5). Electrocardiographic abnormalities included repolarization abnormalities (31%) and atrial rhythm disorders (16,12%). Echocardiographic examination showed left ventricular hypertrophy (LVH) in 20,64% of cases. Left atrium was dilated in 14.19% of cases, LV was dilated in 1.3% of cases. Abnormal left ventricular ejection fraction was detected in 3.87% of cases. Nosological entities included hypertensive heart disease in 27 cases (54%), ischemic heart disease in 19 cases (38%), dilated cardiomyopathy in 2 cases (4%) and diabetic cardiomyopathy in 2 cases (4%). Heart failure was detected in 22 cases (44%) independently from cardiac impairment. Electrocardiographic and echocardiographic abnormalities are frequent in type 2 diabetes population at the University Hospital in Bobo-Dioulasso. Improved cooperation between cardiologists and diabetologists as well as the establishment of adequate technical screening equipment would be prerequisite for better cardiac risk stratification in this population.

Septal alcoholization in hypertrophic cardiomyopathy: about 11 cases.

Outcomes of septal alcoholization in hypertrophic obstructive cardiomyopathy are not enough studied in all centers. The purpose of this study was to determine the outcomes of septal alcoholization in hypertrophic obstructive cardiomyopathy in our hospital. A retrospective and prospective descriptive study focused on all patients aged at least 18 years treated by alcohol septal ablation between July 2005 and June 2010 in the cardiology unit of Clermont-Ferrand teaching Hospital. The inclusion criteria were, hypertrophic obstructive cardiomyopathy with left ventricular outflow tract obstruction ≥ 50 mmHg, symptomatic despite optimal medical therapy. The clinical, paraclinical data and the results of alcohol ablation were collected from medical records of patients and a telephone conversation with the patients or their physicians. These data were analyzed by EPI info 6.04. Eleven patients with average age of 56.27 ± 15, 83 were included of which 81.8% of men. The main indications of alcohol septal were dyspnea stage NYHA II-IV (45.5%), lipothymia (18.2%) and invalidating angina (18.2%). Main electrocardiographic abnormalities were left ventricular hypertrophy and disorders of repolarization with 72.7% each. Minor conductive disorders were found in 45.5% of the cases. The left ventricular outflow tract obstruction was 98.18 ± 25.93 mmHg before alcohol septal ablation and 18.91 ± 31.97 mmHg after a follow-up of 25.64 ± 21.97 months. The success rate was 81.8%. Conductive disorders (45.5%) required the establishment of a definitive pacemaker in 36.4% of the patients. A cardiac defibrillator was implanted at 27.3%. Septal alcoholization was succesful.

Right ventricular outflow tract tachycardia worsened during pregnancy.

We report the case of a 35 years old woman without underlying heart disease who was diagnosed with a right ventricular outflow tract tachycardia worsened during pregnancy. The diagnosis of ventricular tachycardia was made early in her pregnancy course but the patient had symptoms three months earlier. Her disease course was marked by rhythmic storms during the second trimester of pregnancy that led to three hospitalizations accounting for about two weeks in total. The combination of nadolol 80 mg and flecainide tablets 150 mg improved her rhythmic storms. Radiofrequency allowed a radical cure of this ventricular tachycardia. The patient is now asymptomatic 27 months after radiofrequency treatment.