[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.

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

[Ambulatory Electrocardiogram In Stroke Patients At The University Hospital Of Brazzaville: 81 Cases]. / Electocardiogramme Longue Duree chez les Patients Victimes D'Accident Vasculaire Cerebral a Brazzaville: 81 cas.

OBJECTIVE: To assess the value of Holter ECG in the assessment of patients experiencing ischemic stroke. PATIENTS AND METHODS: This was a prospective descriptive study conducted in the Department of Neurology of the University Hospital Center in Brazzaville between June 2011 and June 2012. RESULTS: There were 53 men (63.9%) and 30 women (36.1%), mean age 60.6 ± 12.7 years (range = 20 to 85 years). The average body mass index was of 26.9 ± 4.6 (range = 15.6 and 35.3). Patients were obese in 19 cases (22.8%), overweight in 16 cases (19.2%). Hypertension was found in 44 patients (53%), diabetes mellitus in 14 patients (16.8%), dyslipidemia, smoking, respectively, six (7.2%) and one case. The Holter ECG performed in 81 patients showed: sinus rhythm in 78 cases (96.3%), an average frequency of 79.1 ± 17.6 beats per minute (range = 50 to 163 years), atrial fibrillation in seven cases (8.6%), one case of atrial flutter, supraventricular tachycardia bursts in 14 cases (17.2%), supraventricular extrasystoles in 78 cases (96.3%), 65 cases (80.2%) with doublets and 27 cases (33.3%) with triplets. In 35 cases, there were more than 70 supraventricular extrasystoles per 24 hours. Ventricular extrasystoles were present in 59 cases (72.8%), including 24 cases of doublets (29.6%), 14 cases (17.2%) of bigeminy and three cases of nonsustained ventricular tachycardia. Breaks were significant in both cases. The study of HRV showed a 100.4 ± 45.8 to SDNN ms (range = 20 to 206 ms), 44 patients (54.3%) had impaired heart rate variability in 44 (54.3%). CONCLUSION: The ischemic stroke is a serious life-threatening and functional. Administering a Holter ECG is essential to find a cardioembolic cause, allowing for the most appropriate treatment.

OBJECTIF: Evaluer l'intérêt de l'Holter ECG dans le bilan des patients victimes d'accident vasculaire cérébral ischémique. MÉTHODES ET PATIENTS: c'est une étude prospective et descriptive dans le service de neurologie du centre hospitalier et universitaire de Brazzaville entre juin 2011 et juin 2012. RÉSULTATS: Il s'agissait de 53 hommes (63,9%) et de 30 femmes (36.1%), âgés en moyenne de 60,6±12,7 ans (extrêmes =20 et 85 ans). L'index de masse corporel moyen de 26,9±4,6 (extrêmes =15,6 et 35,3). Les patients étaient obèses dans 19 cas soit 22,8%, en surpoids dans 16 cas soit 19,2%. L'hypertension artérielle était retrouvée chez 44 patients (53%), le diabète sucré chez 14 patients soit (16,8%), la dyslipidémie tabagisme dans respectivement six (7,2%) et un cas. L'Holter ECG réalisé chez 81 patients avait montré: un rythme sinusal dans 78 cas (96,3%), une fréquence moyenne à 79,1±17,6 battements par minute (extrêmes =50 et 163 ans), une fibrillation auriculaire dans sept cas (8,6%), un cas de flutter auriculaire, des salves de tachycardie supraventriculaire dans 14 cas (17,2%), des extrasystoles supraventriculaires dans 78 cas (96,3%) dont 65 cas (80,2%) avec des doublets et 27 cas (33,3%) avec des triplets. Dans 35 cas, il existait plus de 70 extrasystoles supraventriculaires par 24 heures. Les extrasystoles ventriculaires étaient présentes dans 59 cas (72 ,8%) dont 24 cas de doublets (29,6%), 14 cas (17,2%) de bigéminisme et trois cas de tachycardie ventriculaire non soutenue. Les pauses significatives ont été observées dans deux cas. L'étude de la variabilité sinusale avait montré une SDNN à 100,4±45,8 ms (extrêmes =20 et 206 ms), 44 patients (54,3%) avaient une altération de la variabilité sinusale dans 44 cas soit 54,3%. CONCLUSION: L'accident vasculaire cérébral ischémique est une pathologie grave engageant le pronostic vital et fonctionnel. La réalisation d'un Holter ECG est indispensable à la recherche d'une cause cardioembolique permettant l'adaptation thérapeutique.

[Cardiovascular risk factors and echocardiography in patients victims of ischemic stroke in brazzaville: 83 cases]. / Facteurs de risque cardiovasculaire et echographie doppler cardiaque chez les patients victimes d'accident vasculaire cerebral ischemique a brazzaville: 83 cas.

GOAL: Investigate the cardiovascular risk factors and evaluate the usefulness of echocardiography in the assessment ischemic stroke. MATERIALS AND METHODS: Prospective and descriptive study in the neurology department of the teaching hospital of Brazzaville between June 2011 and June 2012, 83 patients enrolled and 55 echocardiograms performed. RESULTS: The risk factors found were: obesity (19, 22.8%), overweight (16, 19.2%), high blood pressure (44, 53%), diabetes (14, 16.8%), dyslipidemia (6, 7.2%), and smoking (2). Left ventricular ejection fraction (LVEF) was 68.5 ± 10.3%. There was a hypokinetic and dilated cardiomyopathy in four cases (7.2%), left ventricular hypertrophy in eight cases (14.5%), left atrial enlargement in 13 cases (23.6%). We have identified a tight mitral stenosis. The diastolic profile was a relaxation-type disorder in 46 patients (83.6%). Echocardiography identified 12 (14.4%) lesions potentially embolic: dilated cardiomyopathy (n = 4), ischemic heart disease (n = 6), tight mitral stenosis (n = 1), acute pulmonary heart post-embolic (n = 1). CONCLUSION: Echocardiography is an essential examination for the investigation of a cardioembolic cause in the assessment of a stroke, enabling therapeutic adaptation..

BUT: Rechercher les facteurs de risque cardiovasculaire et évaluer l'intérêt de l'échocardiographie dans le bilan un accident vasculaire cérébral ischémique. MATÉRIEL ET MÉTHODES: Etude prospective et descriptive dans le service de neurologie du centre hospitalier et universitaire de Brazzaville entre juin 2011 et juin 2012, 83 patients inclus et 55 échocardiographies réalisées. RÉSULTATS: On avait retrouvé comme facteurs de risque: obésité (19; 22,8%), surpoids (16; 19,2%), l'hypertension artérielle (44; 53%), le diabète (14; 16,8%), la dyslipidémie (6; 7,2%) et tabagisme (2). La fraction d'éjection ventriculaire gauche moyenne (FeVG) était de 68,5±10,3%. Il y avait une cardiomyopathie dilatée hypokinétique dans quatre cas (7,2%), une hypertrophie ventriculaire gauche dans huit cas (14,5%), une hypertrophie auriculaire gauche dans 13 cas (23,6%). Nous avons identifié un rétrécissement mitral serré. Le profil diastolique était type trouble de la relaxation chez 46 patients (83,6%). L'échocardiographie a identifiées 12 (14,4%) lésions potentiellement emboligènes: myocardiopathie dilatée (n=4), cardiopathie ischémique (n=6), rétrécissement mitral serré (n=1), cœur pulmonaire aigu post-embolique (n=1). CONCLUSION: L'échocardiographie est un examen indispensable à la recherche d'une cause cardioembolique dans le bilan d'un accident vasculaire cérébral permettant l'adaptation thérapeutique.

[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.

[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%).

[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.

[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.

[Rheumatic heart disease in schoolchildren in Brazzaville]. / Les Cardiopathies rhumatismales en milieu scolaire à Brazzaville.

The purpose of this study is to screen for rheumatic heart disease as a basis for treatment of the disease and determination of its prevalence in schoolchildren in Brazzaville, Congo. Surveying was conducted in 4 schools located in suburban districts of Brazzaville from May to June 2005. A cohort of 2250 school children was enrolled by random sampling at 3 levels. Age ranged from 5 to 17 years. The variables recorded were age, sex, socioeconomic status, clinical features, and laboratory findings. Clinical selection was based on cardiac auscultation. Data analysis was performed using the Epi Data 3.1 and Stata 8.2 software packages (differences being considered as significant at p< 0.05). A total of 2232 children underwent testing including 1900 from public schools (boys, 47.5%; girls, 52.5%) and 332 from private schools (boys, 47.3%; girls, 52.7%) (p>0.05). The prevalence of rheumatic heart disease was 3,5 per thousand overall, 3.6 per thousand in children in the low socioeconomic status group, and 3 per thousand in the high socioeconomic status group (p<0.05). The ages of children presenting valvular cardiopathy ranged from 7 and 16-years-old and 75% lived in overcrowded dwellings. One or more previous episodes of strep throat were noted in all cases and had not been treated in 7 out of 8 cases. Valvular disease was significantly correlated with history of strep throat, overcrowded living conditions, and low socioeconomic status (p<0,01). Compliance with prophylactic treatment using benzathyn penicillin was 75% after one month of follow-up and 37.5% after three months.

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

Les cardiopathies rhumatismales en milieu scolaire a Brazzaville

L'objectif de l'etude est de determiner la prevalence des cardiopathies rhumatismales en milieu scolaire a Brazzaville; Congo; et traiter les cas ainsi depistes. Une enquete de prevalence a ete realisee dans 4 ecoles des quartiers suburbains de Brazzaville. L'etude s'est deroulee aux mois de mai et juin de l'annee 2005. Le sondage etait aleatoire a trois niveaux aupres d'un echantillon de 2250 ecoliers. L'age etait compris entre 5 et 17 ans. Les variables etudiees etaient : l'age; le sexe; le statut socio-economique; les aspects cliniques et para cliniques. La selection clinique etait basee sur l'auscultation cardiaque. Les logiciels Epi Data 3.1 et Stata 8.2; ont permis la saisie et l'analyse des donnees (difference significative pour p0;05). Le nombre d'enquetes etait de 2232. Il y avait 1900 enfants issus des ecoles publiques (47;5de garcons; 52;5de filles); 332 issus de l'ecole privee (47;3de garcons; 52;7de filles) p0; 05. La prevalence clinique des cardiopathies rhumatismales etait de 3;5(3;6chez les ecoliers de classe sociale basse et 3chez ceux de haut statut socio-economique; p0;05). L'age des enfants presentant des cardiopathies valvulaires etait compris entre 7 et 16 ans; 75d'entre eux vivaient dans des habitations surpeuplees. Un ou plusieurs antecedents d'angines etaient retrouves dans tous les cas; non traitees dans 7 cas sur 8. Il y avait une relation entre les antecedents d'angines; la promiscuite; et le statut socio-economique (p0;01). La compliance au traitement prophylactique par la benzathine penicilline etait de 75au 1er mois du suivi; et seulement de 37;5au 3e

[Arterial hypertension: epidemiological aspects and risk factors on pregnant and delivered woman]. / Hypertension artérielle: aspects epidémiologiques et facteurs de risque chez la gestante et l'accouchée.

OBJECTIVES: Determine frequency of hypertension in pregnancy and delivered women at the Teaching Hospital of Brazzaville and identify epidemiological aspects and risk factors. PATIENTS AND METHODS: A prospective and transversal study was realized from november 2004 to january 2005 in the Teaching Hospital of Brazzaville. Forty two patients (8 pregnant women, 34 delivered) with hypertension, have been enregistered among 825 admissions in the departments of gynecology and obstetric. Arterial hypertension was defined by a blood pressure at 140/ 90 mm Hg or above. RESULTS: Arterial hypertension constituted 5.1% of the total admissions. Average of the patients was 27 +/- 8 years (age range: 14 and 40 years). Two patients (4.8%) haven't been sent to school, 29 (69%) had the secondary level, twenty (47.8%) were housewives. Seventeen patients (40.5%) had realized 2 prenatal consultations at the most. Patients were divided in 4 groups: Chronic hypertension (n = 4), pre eclampsia surimposed on chronic hypertension (n = 4), pregnancy hypertension only (n = 15), preeclampsia (n = 19). Prim gravidity (38.1%) and family history of hypertension (40.4%) were the most frequent risk factors. Obesity, gemality, previous pre eclampsia represented respectively 14.3%, 9.5% and 4.8%.

[Acute rheumatic fever among children in the Republic of Congo: report of 56 cases]. / Le rhumatisme articulaire aigu chez l'enfant en République du Congo à propos de 56 cas.

Authors report the results of a retrospective study (January 1993-December 1996) concerning 56 patients. The aim of this study was to describe epidemiology, diagnosis, evolution and treatment of rheumatic fever during childhood in the Teaching Hospital of Brazzaville. The frequency of the disease was 1.17%. There were 36 girls and 20 boys (p = 0.02). The mean age was 10 years and 8 months. Past of sore throat and recurrences of acute rheumatic fever have been notified respectively in 27 (48.2%) and 11 cases (19.6%). Arthritis were observed in 3 patients (5.4%), and 7 others (12.5%) didn't have any carditis. Fourty nine patients (87.5%) presented carditis, among which mitral regurgitation was the commonest cardiac lesion. Heart failure was observed in 25 patients (44.6%). The inflammatory process was treated by corticoid drugs and penicillin. Surgery realized in 22 patients consisted in valvuloplasty (5), bioprosthesis replacing (12). Beyond mitral valve replacing, 3 children profited of: tricuspid commissurotmy (1), surgery of congenital heart disease (2). Two patients profited of aortic prothesis. Six patients(10.7%) died because of: cardiac failure(3), infectious endocarditis (2), probable thrombosis of mechanic aortic valve (1). Primary and secondary prevention of this severe affection are primordial in Congo.

[Subvalvular left ventricular aneurysm. Report of 2 cases]. / Anévrisme sous annulaire du ventricule gauche. A propos de deux cas.

The authors report both Senegalese's cases of subvalvular left ventricular aneurysm (SVLVA). The aim of the study was to describe the clinical and paraclinical aspects of this disease. Mitral regurgitation an heart failure were constant. Beyond cardiomegaly observed in both patients, one of them presented vaulting of the left ventricle. In the two cases, electrocardisgram showed sinus rhythm, and biology an inflammatory syndrome. One patient had also tuberculosis. Transthoracic echocardiography showed an aneurysm situated in a mitral subvalvular position, thrombosed in one case. Medical treatment with furosemid and digoxin has been administrated. One patient received also drugs against tuberculosis. Surgery of aneurysm had not been possible. During the evolution, we have observed persistence of heart failure in one patient. The other one died, probably after a cerebral embolism. Autopsy confirmed the echocardiographic aspects and integrity of myocardium and coronary arteries.