[Évaluation de la qualité de vie et description des facteurs associés, chez les patients en insuffisance cardiaque chronique vivant dans un pays d'Afrique de l'Ouest à faible revenu]. / Assessment of quality of life and description of associate factors in patients living with chronic heart failure in a low-income country of West Africa.

OBJECTIVE: To assess the quality of life (QOL) and describe associated factors in patients with chronic heart failure (HF) living in a low-income population in West Africa. METHODS: This is was a cross-sectional study conducted from January 2017 to June 2018, in the department of cardiology of the University Teaching Hospital (CHU-Campus) in Lomé (Togo). Enrolled patients had stable chronic HF and have been hospitalized in the past 6 months; QOL was assessed using the Minnesota Living with Heart Failure questionnaire (MLHFQ). RESULTS: 171 patients were included (women = 40.9%, 33% unschooled, 75% without health insurance; 46.8% in NYHA class II). The prevalence of depression was 62%. The mean total score of MLHFQ was 37.2 ± 22.3. In univariate analysis, there was a positive correlation between the total score and the following factors: age (r= 0.33, p ˂0.0001), NYHA classes (r= 0.67, p ˂0.0001), number of rehospitalizations (r= 0.61, p ˂0.0001), number of comorbidities (r= 0.43, p ˂0.0001), and the depression score (r= 0.67, p ˂0.0001). After adjustments, positive correlation persisted with NYHA classes (p ˂0.0001), number of rehospitalizations (p= 0.02), and depression (p ˂0.0001). CONCLUSION: The QOL of HF patients was moderately impaired and was comparable to values reported among high-income populations. Factors associated with poor quality of life were advanced NYHA classes, number of rehospitalizations, and depression.

Acne keloidalis nuchae and hypertension in black subjects: a case-control study.

OBJECTIVE: The aim of this case-control study was to look for an association between hypertension and acne keloidalis nuchae (AKN) in black subjects. RESULTS: We recruited 303 consenting subjects comprising 101 patients with AKN and 202 controls, case-matched by age (± 5 years). The mean patients age was 34.9 ± 10.7 years versus 35.6 ± 11.2 years for controls. The average duration of AKN progression in cases prior to consultation was 1831 days (5 years). The most frequently observed AKN lesions were papules (73/101; 72.3%), fibrous scars (42/101; 41.6%) and folliculitis/pustules (41/101; 40.6%). In terms of quality of life, the mean score of dermatology life quality index was 8.3 ± 5.2 (extremes: 0 to 22). In multivariate analysis, having a BMI of 25 kg/m2 or more (OR = 4.91; p < 0.001) and having systolic hypertension (OR = 1.22; p = 0.010) were associated with AKN.

Bilateral semilunar perihilar opacities in a patient with pulmonary hypertension.

Pulmonary arterial aneurysm is a rare entity with a high mortality if left untreated. Pulmonary arterial hypertension is an important cause of PAAs although other infective and auto-immune causes must be excluded when an aneurysm is identified.

Belhassen anterior fascicular ventricular tachycardia: a case in a black African.

Belhassen ventricular tachycardia can be characterized by a complete right branch block and a right axial deviation. This type, although rare, must be recognized to properly treat the patient, as verapamil treatment is effective.

[Pulmonary embolism at the University Hospital Campus of Lome (Togo): a retrospective study about 51 cases]. / L'embolie pulmonaire au centre hospitalier universitaire Campus de Lomé (Togo): étude rétrospective à propos de 51 cas.

INTRODUCTION: This study provides an analysis of the evolutionary, clinical and epidemiological aspects of pulmonary embolism at the University Hospital Campus of Lome. METHODS: We conducted a retrospective, analytic and descriptive study over a period of 39 months (November 1 , 2011- January 31, 2015). All the medical records of patients hospitalized for PE in the Department of Cardiology at the University Hospital Campus were analyzed. RESULTS: The prevalence of PE was 3.1%. Female/male sex ratio was 2.2. The average age was 52.7 ± 14.4 years. Risk factors for venous thromboembolic disease VTD were dominated by: obesity (54.9%), bedrest (25.5%) and long journey (17.6%). The main symptoms were: dyspnoea (98.0%), chest pain (78.4%) and cough (60.8%). Wells' score was high in 29.4% of cases. ECG showed: tachycardia (78.4%), right ventricular hypertrophy (RVH)(49.0%), S1Q3T3 aspect (47.1%) and right block (39.2%). Transthoracic Doppler echocardiogram showed right cavitary dilation and right intraventricular thrombus in 5.6% of cases. Thoracic angioscanner was normal in 9.8% of cases and showed embolus in 82.4% of cases. Treatment was based on Low Molecular Weight Heparin (LMWH) at therapeutic doses with antivitamin K (AVK) relay. Thrombolysis was performed in 8 patients. Evolution was favorable in 86.3% of cases. Case-fatality rate was 13.7%. CONCLUSION: The prevalence of PE is relatively low in our area but it is probably underestimated. PE is a therapeutic problem in Togo because of the high cost of complementary examinations and thrombolysis. Prevention is therefore the only effective weapon.

Acute coronary syndrome in young Sub-Saharan Africans: a prospective study of 21 cases.

BACKGROUND: Coronary heart disease remains the leading cause of death in developed countries. In Africa, the disease continues to rise with varying rates of progression in different countries. At present, there is little available work on its juvenile forms. The objective of this work was to study the epidemiological, clinical and evolutionary aspects of acute coronary syndrome in young Sub-Saharan Africans. METHODS: This was a prospective multicenter study done at the different departments of cardiology in Dakar. We included all patients of age 40 years and below, and who were admitted for acute coronary syndrome between January 1st, 2005 and July 31st, 2007. We collected and analyzed the epidemiological, clinical, paraclinical and evolutionary data of the patients. RESULTS: Hospital prevalence of acute coronary syndrome in young people was 0.45% (21/4627) which represented 6.8% of all cases of acute coronary syndrome admitted during the same period. There was a strong male predominance with a sex-ratio (M:F) of 6. The mean age of patients was 34 ± 1.9 years (range of 24 and 40 years). The main risk factor was smoking, found in 52.4% of cases and the most common presenting symptom was chest pain found in 95.2% of patients. The average time delay before medical care was 14.5 hours. Diagnosis of ST-elevation myocardial infarction in 85.7% of patients and non-ST-elevation myocardial infarction in 14.3% was made by the combination electrocardiographic features and troponin assay. Echocardiography found a decreased left ventricular systolic function in 37.5% of the patients and intraventricular thrombus in 20% of them. Thrombolysis using streptokinase was done in 44.4% of the patients with ST-elevation myocardial infarction. Hospital mortality was 14.3%. CONCLUSION: Acute coronary syndrome is present in young Sub-Saharan Africans. The main risk factor found was smoking.

Prevalence and determinants of hypertension and associated cardiovascular risk factors: data from a population-based, cross-sectional survey in Saint Louis, Senegal.

BACKGROUND: The incidence of cardiovascular disease is growing worldwide and this is of major public health concern. In sub-Saharan Africa, there is a lack of epidemiological data on the prevalence and distribution of risk factors of cardiovascular disease. This study aimed at assessing the prevalence of hypertension and other cardiovascular risk factors among an urban Senegalese population. METHODS: Using an adaptation of the WHO STEPwise approach to chronic disease risk-factor surveillance, we conducted a population-based, cross-sectional survey from 3 to 30 May 2010 on 1 424 participants aged over 15 years. Socio-demographic and behavioural risk factors were collected in step 1. Physical anthropometryc measurements and blood pressure were documented in step 2. Blood tests (cholesterol, fasting blood glucose, and creatinine levels) were carried out in step 3. RESULTS: The prevalence of hypertension was 46% (95% CI: 43.4-48%), with a higher prevalence in females (47.9%) than males (41.7%) (p = 0.015), and 50% of these hypertensive were previously undiagnosed. Mean age was 53.6 years (SD: 15.8). In known cases of hypertension, the average length of its evolution was 6 years 9 months (range 1 month to 60 years). Hypertension was significantly associated with age (p = 0.001), socio-professional category (p = 0.003), dyslipidaemia (p < 0.001), obesity (p < 0.001), physical inactivity (p < 0.001), diabetes (p < 0.001) and stroke (p < 0.001). CONCLUSION: We found a high prevalence of hypertension and other cardiovascular risk factors in this population. There is need of a specific programme for the management and prevention of cardiovascular disease in this population.

Mortality associated with cardiovascular diseases in three hospitals of Lomé-city.

The aims of present study were; to determine the mortality rate related to cardiovascular diseases and the causes of those deaths in local hospitals. We conducted a cross sectional study carried out from January 2005 to June 2006, in three hospitals of Lomé. All deaths registered in the departments of cardiology and neurology from cardiovascular diseases were taken into account. The number of patients who died from cardiovascular diseases was 200 on 2386 admitted patients (11.86%). The average age was 54.4 ± 15.6 years (range: 18-102). Cerebrovascular stroke was the most represented disease (56.9%), followed by heart failure (35.7%), and cardiac arrhythmias (15.9%). Hospital mortality due to cardiovascular afflictions was high in Lome-city due to the deficient organization of the cardiovascular resuscitation units. Better organization, more equipment for cardiovascular care units and better public health efforts surrounding control of cardiovascular risk factors could go a long way towards the reduction of this high mortality rate of cardiovascular diseases in our hospitals.