Predictors of stroke - associated mortality in Africans.

BACKGROUND: The objective of the study was to examine the association of the stroke-related mortality with gender, age, ethnicity, social class, blood pressure, fibrinogen, selected clinical data and meteorologic parameters in hospitalized Africans. METHODS: A series of 1032 consecutively hospitalized incident cases of acute stroke between 1987 and 1991 was studied. Univariate and multivariate analyses were used to estimate the risk (odds ratio=OR) of stroke mortality for meteorologic parameters on the month before the accident onset and selected sociodemophysiological variables on the day of admission. RESULTS: The variables significantly associated with stroke mortality in multivariate analysis were male sex (OR= 2.3 [1.3 - 4.1]), low social class (OR= 2.0 [1.2 - 4.0]), migrant tribes (OR= 1.7 [1.5 - 1.8]), ischemic stroke (OR= 1.4 [1.2 - 1.6]), heart rate >=100 bpm (OR= 1.1 [1.0 - 1.2]), age > or =60 years (OR= 1.03 [1.01 - 1.06]), systolic blood pressure> 160 mmHg (OR= 1. 02 [1.01 - 1.03]), and fibrinogen > or =400 mg/dl (OR= 1.01 [1.002 - 1. 02]). However, diastolic blood pressure > 90 mmHg and global radiation< 340 Cal/cm(2)/day were significantly (p< 0.05) and inversely associated with stroke mortality. CONCLUSION: Our results indicate that male sex, older age, low social class, migration, ischemic stroke and higher baseline levels of heart rate, systolic blood pressure and fibrinogen are significant predictors of stroke mortality, but lower global radiation and higher diastolic blood pressure are inversely linked.

Hematocrit and stroke in black Africans under tropical climate and meteorological influence.

OBJECTIVES: To assess the relationship between hematocrit and risk of fatal and non-fatal stroke in conjunction with meteorological variations. DESIGN: Prospective study of a series of Africans living in Kinshasa, Congo, followed up for 5 years. SUBJECTS: A total of 1,032 unselected patients consecutively admitted to hospitals for acute stroke. Main outcome measures. Fatal and non-fatal ischemic or hemorrhagic strokes. The association of hematocrit with stroke morbidity and mortality and meteorological variables were evaluated by simple or multiple linear regression and logistic regression. RESULTS: Patients were aged 53.7 +/- 12.1 years. Hematocrit was mostly correlated with mean ambient air temperature (r = 0.124; p < 0.001) and atmospheric pressure at 6 a.m GMT (r = 0.157; p < 0.001). Patients with hematocrit > 40% presented the highest levels of systolic blood pressure, fibrinogen, body temperature, resting heart rate, duration of coma and incidence of all stroke types and ischemic stroke (p < 0.001). Hematocrit > 40% was associated with stroke mortality (Odds ratio, 6.2, 4.5-8.6; p < 0.001). The risk of stroke mortality was multiplied by 21, 18.3 and 4.2 in conditions of a mean ambient air temperature > 28 degrees C, atmospheric pressure 975-977 mm Hg and body temperature > 37 degrees C respectively. CONCLUSIONS: Our study suggests that higher hematocrit is associated with an increased risk of stroke morbidity and mortality, particularly ischemic stroke at noon. This risk is probably mediated by increased susceptibility of African older hypertensive subjects to meteorological variations.

[A clinical study of cardiac manifestations related to acquired immunodeficiency syndrome (AIDS) in Kinsaha]. / Etude clinique des manifestations cardiaques au cours du syndrome d'immunodéficience acquise (sida) à Kinshasa.

A prospective study was performed from march 31 st 1991 to september 30th 1992 on cardiac involvement in course of AIDS. Clinical, electric, sonographic and radiologic aspects were analysed within 83 patients of the study. In this cohort, 45.8% of patients had shown a cardiac involvement through all strates and respectively: a pericarditis with effusion in 24 patients (27.7%), a dilated cardiomyopathy in 14 patients (16.9%) and infective endocarditis in 1 patient (1.2%). Dispncea between classes II and IV of NYHA was the main complaint. Tachycardia, silent cardiac sounds and congestive heart failure were the prominent features of the clinical examination of the cohort. Because of the likely high prevalence of cardiac manifestations in course of AIDS, clinicians and researchers have to pay attention to this situation.

Le profil biologique de la fievre typhoide a Kinshasa

Les auteurs etudient quelques aspects biologiques de la fievre typhoide a Kinshasa chez 208 patients. Anemie (40;6 pour cent); leucopenie (22;8 pour cent); hyperleucocytose (21;3 pour cent); uremie elevee (60 pour cent); creatinemie augmentee (6 pour cent); transaminases perturbees (56;9 pour cent) pour les SGOT; 52;5 pour cent pour les SGPT: telles sont les caracteristiques essentielles des examens hematobiochimiques. Les coprocultures sont positives dans 38;1 pour cent des cas et les homocultures le sont dans 77;9 des cas. Salmonella typhi (S. typhi) est rarement isole dans les urines (2 pour cent); Salmonella paratyphi B (S.para typhi B) n'a ete isole qu'une fois

Etiologie de la fievre au cours du SIDA : a propos de 64 cas

La presente etude recherche les causes frequentes de la fievre associee a l'infection a VIH dans une zone tropicale. Prospective; elle porte sur 64 patients dont 23 hommes et 41 femmes hospitalises pour une fievre isolee ou associee a d'autres symptomes. Le bilan clinique et paraclinique retient: le paludisme (40 pour cent); la tuberculose pulmonaire (37;5 pour cent); la cryptococcose neuro-meningee et la toxoplasmose cerebrale (12;5 pour cent chacune); la fievre typhoide (7;8 pour cent); le sarcomede kaposi (6;2 pour cent); l'infection urinaire a Escherichia coli (4;7 pour cent); la trypanosomiase humaine africaine et les salmonelloses mineures (1;6 pour cent chacune). La courbe de la fievre au cours de l'infection a VIH n'a aucune allure pathognomonique