[Cardiovascular risk evolution in patients treated for high blood pressure at the Armies Instruction's Hospital of Cotonou]. / Évolution du risque cardiovasculaire des patients traités pour HTA à l'hôpital d'instruction des armées de Cotonou.

UNLABELLED: This study was initiated to determine the progression of the cardiovascular risk (CR) in a 5-years period for those who went through high blood pressure treatment. It is a retrospective and descriptive study over a period of 9 years. Were included in that category, African patients treated in that period of time and who at least benefited from a 5-years medical care period. The total CR was calculated afterwards, for the needs for the study, using the tables of Framingham. All the data were collected after the first evaluation then brought up to date at the terms of 1, 3 and 5 years and with a last consultation for the patients whose medical care follow-up exceeded 5 years. For the 103 patients who had complete data, the average age was of 49.11±8 and the sex ratio of 2. Among them 14 (13.6%) died of cardiovascular complications. Among the 89 remaining patients, the CR at the beginning was very high in a proportion of 10.1%, high in 49.4%, moderated in 22.5% and weak in 18%. The general evolution is characterized by a stability of the proportion of the moderated CR (20 - 23%) and high CR (43 - 50%) but a very important increase in the proportion of the very high CR (10 to 21%) to the detriment of the weak CR (18 to 10%). The analysis of the individual evolution reveals an improvement of the CR among 19 patients (21.3%), its stability among 39 patients (43.8%) and a worsening among 31 patients (34.8%). These data are confirmed in a widened population of 321 patients of which the less complete data allow an estimate of the CR. CONCLUSION: The cardiovascular risk is difficult to evaluate. It is badly controlled in the long run.

[Protein C deficiency in black African with venous thromboembolism in Cotonou, Benin]. / Étude du déficit en protéine c dans la maladie thromboembolique veineuse au CNHU de Cotonou : étude réalisée chez 54 patients noirs africains vivant à Cotonou.

The aim of this study is to evaluate the frequency of protein C deficiency in venous thromboembolism in black African patients of Benin. It is a descriptive study. Inclusion criteria were: acceptance- having a venous thromboembolism. No exlusion criteria was retained. Protein C deficiency was diagnosed by quantitative technic with a Minividas materiel in the blood. Protein C dosage has been done before antivitamin k therapy and a second dosage has been done if the first one demonstrated a low level of protein C. Acuired aetiology have been research. For the 54 patients of this study mean age was 52.7±14.1 and sex-ratio 1.08. The frequency of protein C deficiency was 9.3% in all patients and 12.5% in those with clinical thrombophily (p=1). No acquired deficit has been found.

[Serum selenium and dilated cardiomyopathy in Cotonou, Benin]. / Sélénium plasmatique et cardiomyopathie dilatée à Cotonou (Bénin).

PURPOSE: Peripartum cardiac failure is common in savannah-Sahelian Africa. It is due to a form of dilated cardiomyopathy (DCM) known as peripartum cardiomyopathy (PPCM) that results from undetermined causes. Numerous risk factors have been identified and dietary selenium deficiency has been proposed as a possibility. The purpose of this study was to measure serum selenium levels in patients presenting cardiac insufficiency due to PPCM and DCM (nonpostpartum) in Cotonou, Benin and to compare patients with healthy postpartum women with comparable or identical obstetric features. METHODS: Measurements of selenium status were performed in 10 women (mean age, 27.1 years) with PPCM, 18 patients of both sexes (male/female, 11/7; mean age, 38.9 years) with DCM (non-peripartum), and 46 healthy recent post partum women (mean age, 29.8 years). The Wilcoxon nonparametric test was used for data analysis with a statistical significance level at a p-value <0.05. RESULTS: Mean serum selenium values were near similar in patients presenting PPCM and DCM (non peripartum): 94 +/- 12 microg/L versus 97 +/- 19 microg/L respectively. This difference was not significant. No value was less than 72 microg/L. Conversely significantly lower mean values were observed in the 46 healthy recent postpartum women: 76 +/- 13 microg/L (p = 0.0002). The lowest value was 57 microg/L. CONCLUSION: Serum selenium measurements in Cotonou showed that levels were higher in patients presenting PPCM or DCM (nonperipartum) than in healthy controls. Extremely low values were never observed. These results differed from those obtained in Bamako, Mali and in Niamey, Niger and argue against considering selenium deficiency as a risk factor for development of DCM (peripartum or not) in Cotonou.

Selenium plasmatique et cardiomyopathie dilatée à Cotonou (Bénin)

RÉSUMÉ â€¢ Objectifs. L'insuffisance cardiaque péripartum, fréquente en Afrique soudano-sahélienne, est liée à une cardiomyopathie dilatée (CMD) de cause inconnue appelée cardiomyopathie du péripartum (CMPP). Parmi les facteurs de risque identifiés, la carence alimentaire en sélénium est discutée. Le but de ce travail est d'évaluer le taux de sélénium plasmatique de patientes en insuffisance cardiaque par CMD, péripartum ou non, à Cotonou (République du Bénin)et de le comparer à celui de parturientes en bonne santé à statut obstétrical proche ou identique. Méthodologie. Afin de préciser le statut en sélénium à Cotonou les auteurs ont dosé le sélénium plasmatique chez 10 béninoises(âge moyen = 27,1 ans) atteintes de CMPP, chez 18 patients/es atteints/es de CMD (11 femmes,7 hommes, âge moyen = 38,9 ans) et chez 46 béninoises « témoins » en bonne santé ayant accouché récemment (âge moyen = 29,8 ans). Le test de Wilcoxon (non paramétrique) a été utilisé pour la comparaison statistique avec un seuil < 0,05. Résultat. Les valeurs de sélénémie sont très proches (94 ± 12 µg/L et 97 ± 19 µg/L), avec des différences non significatives, dans les 2 groupes de patients/es porteuses de CMPP ou de CMD.Aucune valeur n'est inférieure à 72 µg/L. Les valeurs sont par contre significativement plus basses(76 ± 13 µg/L, P = 0,0002) chez les 46 témoins, accouchées récentes en bonne santé, la valeur la plus basse étant à 57 µg/L. Conclusion. Les sélénémies des malades, porteuses de CMPP ou de CMD, sont plus élevées que celles des patientes du groupe témoins en bonne santé à Cotonou. Il n'existe aucune valeur très basse (< 40 µg/L), qu'il s'agisse des malades ou des témoins. Ces résultats, différents de ceux observés dans des études antérieures à Bamako (République du Mali) et surtout à Niamey (République du Niger), vont à l'encontre de l'hypothèse d'un déficit en sélénium à l'origine des CMD, péripartum ou non, à Cotonou

Etude du déficit en proteine C dans la maladie thromboembolique veineuse au CNHU de Cotonou: étude realisée chez 54 patients noirs vivant à Cotonou

L'objectif de cette etude est de depister le deficit en proteine C dans une population de patients noirs africains atteints de maladie thromboembolique veineuse. C'est une etude descriptive transversale qui a inclus systematiquement tous les patients hospitalises pour MTEV aigue ou suivis dans les suites de MTEV qui ont accepte d'y participer. Un dosage quantitatif de la proteine C a ete realise sur un equipement de type Minividas. Le prelevement sanguin a ete effectue en dehors de tout traitement antivitamine K. Un deuxieme prelevement est effectue pour confirmation au cas ou le premier dosage affirme un deficit. En cas de deficit la recherche d'une etiologie acquise est systema- tique. Pour les 54 patients retenus la sex-ratio etait de 1;08 et l'age moyen est de 52;7+/- 14;1 ans. Un deficit en proteine C a ete diagnostique chez 9;3des patients et 12;5des patients presentant des criteres de thrombophilie ( p=1). Aucune etiologie acquise n'a ete mise en evidence

[Atypical venous thrombosis and protein S deficiency: report of a case]. / Thromboses veineuses atypiques multiples révélatrices d'un déficit en protéine S: a propos d'un cas.

A 29 year old man is admitted for hypovemic shock and abdominal pain. This critical condition was due to a diffuse mesenteric venous thrombosis and intestinal infarction. Five meters of small bowel are resected. Few days later a superficial brachial venous thromboembolism grows to superior cava venous and bilateral pulmonary embolism. A plasmatic protein S level was 17%. This deficiency is considered to be the support of these atypical extended and repetitive venous thromboembolism. With an optimal nutrition and long oral anticoagulation this patient is alive 17 months after his admission.

[Geoclimatology and severity of snake bite envenomations in Benin]. / Géoclimatologie et sévérité des envenimations par morsure de serpent au Bénin.

Envenomations following snakebite are common in Benin where they constitute, particularly in certain areas, a significant problem for the local populations and health workers. The present epidemiological study describes the snakebite envenomations which occurred in 18 medical centres of the country (6 departmental hospitals and 12 provincial hospitals). The studied variables were: prevalence, length of hospitalisation, major complications, quality of therapeutic management and development of the disease according to area. The study covered a period from April 2000 to March 2001. 486 cases of snakebite necessitating hospitalisation were notified including 413 (85%) in the two northern departments: Atacora and Borgou. Males were largely predominant (90%) and patients under 40 years were the most numerous (82%). The dry season seemed a period of higher risk (75% of the cases). The delay between the bite and admission to hospital, studied for 120 patients in the area of Atacora (North-West Benin), was relatively long: the average was 4 days, with extremes ranging from 10 hours to 21 days. This delay explained the severity of the complications diagnosed. They can be listed according to decreasing frequency: shock, coagulopathy, acute renal failure, respiratory distress. Less than 20% of the patients could benefit from antivenom. Management in emergency care units was impossible in most cases, none of the medical centres (except in Porto-Novo, the capital) having an intensive care unit with artificial ventilation available. Average mortality was 22%. Poisonous snakebites remain serious in Benin, mainly in the northern part of the Country. Access to health care and the quality of the management must be improved. This will require significant efforts from health workers, medical authorities as well as the local population. It is urgent to plan a national therapeutic consensus to reduce the high mortality due to snakebites.

[Student nurses' and nurse midwives' behavior concerning sexuality and prevention of sexually transmitted diseases in Cotonou (Benin)]. / Comportement des étudiants infirmiers et sages-femmes vis-à-vis de la sexualité et de la prévention des maladies sexuellement transmissibles à Cotonou (Bénin).

Sexually-transmitted diseases (STDs) remain a public health problem in Benin. However, few studies have focused on the future educators, the student nurses. We studied a cross-section of the population of student nurses at the Institut National Médico-Social at Cotonou in December, 1995. The aim of the study was to describe nurses' sexual behavior and their views on STD transmission and prevention. Information was obtained from 141 students by means of an anonymous questionnaire. We found that first sexual relationships often occurred at a young age (12 years old). Sexual relations generally began between 0.25 and 60 months after meeting the partner for the first time. Men were more likely to have multiple partners than women (P < 0.05). The students' views on STD transmission and the use of condoms indicated that they lacked information. About half the students said that they use condoms during sexual intercourse. We identified four groups of students, based on condom-use. This may make more effective student education possible in the future. We suggest improved education of student nurses, greater emphasis in the school curriculum on sexually-transmitted diseases and the creation of a counseling service at the Institute.

[Dysfunction of aortocoronary bypass. Prognosis]. / Dysfonction des pontages aorto-coronaires. Etude pronostique.

From 1978 to 1988, 108 patients with at least one occluded or stenosed aorto-coronary bypass graft (over 75% stenosis) underwent coronary angiography on average 31 months after the initial coronary bypass surgery. The occluded or stenosed coronary graft was either a saphenous vein (n = 126 including 9 sequentials) or internal mammary artery (n = 5). The bypassed artery was the left anterior descending (n = 66), right coronary (n = 40), left marginal (n = 25) or diagonal (n = 9). The number of occluded or stenosed grafts by patient was 1.2. The left ventricular ejection fraction was 55% (range 25 to 77%). During a mean follow-up period of 60 months after coronary angiography, there were 14 cardiac deaths and 15 non-lethal myocardial infarctions. Treatment comprised 12 angioplasties, 26 new bypass grafts and 3 cardiac transplantations. The 8 year actuarial survival was 84%. The survival without infarction at 8 years was 69%. Survival was significantly decreased to 72% when the occluded or stenosed graft was located on the left anterior descending artery. The survival without infarction at 8 years was 52% in the patients with dysfunction of left anterior descending artery grafts and 89% when the diseased graft was located on another artery (right coronary, left marginal, diagonal). Therefore, the data of this retrospective study show that coronary graft dysfunction on the right coronary, left marginal or diagonal arteries do not greatly influence life expectancy in the medium term after coronary bypass surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Doppler echocardiographic evaluation of aortic valve prosthesis. Analysis of the reproducibility of pressure gradients and surface measurements]. / Evaluation des prothèses valvulaires aortiques par échocardiographie Doppler. Analyse de la reproductibilité des measures de gradients et de surfaces.

Doppler echocardiography has become the method of choice for the evaluation of cardiac valve prostheses. In order to determine the reproducibility of the measurements of pressure gradient and valve surface area, 55 patients with aortic valve prostheses without clinical dysfunction and having at most a trivial regurgitation on color Doppler examination underwent a double evaluation during an average interval of 9 +/- 5 months. The maximum and mean pressure gradients were recorded and the valve surface area calculated using the continuity equation in all cases. The subaortic diameter was taken to be constant and equal to the external diameter of the prosthesis. No significant differences were found between the two evaluations of mean pressure gradient and valve surface area. The intra-patient variability was +/- 8 mmHg for the maximum pressure gradient, +/- 6 mmHg for the mean pressure gradient, +/- 0.33 cm2 for valve surface area calculated using the maximum velocities and +/- 0.44 cm2 when the velocity-time integrals were used. When expressed as a percentage, the mean coefficient of variation was 21 +/- 17% for the maximum pressure gradient, 21 +/- 18% for the mean pressure gradients, 21 +/- 15% for the valve surface area calculated using the maximum velocities and 22 +/- 14% when the ratio of velocity-time integrals was used.(ABSTRACT TRUNCATED AT 250 WORDS)