A Prospective Analysis of Potential and Observed Drug-Drug Interactions, Adverse Events and its Associated Risk Factors in Hospitalized Cardiology Patients in Benin.

BACKGROUND & AIMS: The objective is to ascertain the pattern of potential drug-drug interactions (pDDIs) and record any observed DDIs and adverse events (AEs) in hospitalized Beninese cardiology patients from Sub-Saharan Africa and analyze all risk factors associated with DDIs and AEs. METHODS: It was a prospective study in which data including AEs were assessed from medical files and interview of patients and their relatives. Patients who were treated with more than two drugs and who remained in the hospital for at least 48 hours were included. A computerized database system Pharma IAM- VIDAL version 2011 was used to identify the pattern for potential DDIs. RESULTS: 156 patients were included in this study. The prevalence of potential DDIs was estimated at 93 % (145/156). Forty (5.1%) among 804 potential DDIs identified were observed clinically. The observed DDIs were attributable to low blood pressure (27.5%), hyponatremia (22.5%), hemorrhage (20.0%), hyperkalemia (17.5%) and nephrotoxicity (7.5%). The combination of spironolactone and furosemide resulted in hyponatremia while the combination of enoxaparin and potassium resulted in hyperkalemia. ACE inhibitor (or ARAII) in combination with furosemide resulted in the nephrotoxicity cases observed. Enoxaparin, Acetyl salicylic acid, Acenocoumarol and Clopidogrel were decreasingly involved in the pairs of drugs responsible for observed hemorrhages. 29 patients out of 156 (18.6%) had at least one AE. AEs were mainly (34.2%) of metabolic type. Severe AEs, which represented 18.4% was mostly from nephrotoxicity and metabolic disorders. More than 14 active substances multiplied the risk factor for AEs occurrence by 42, while more than 14 days hospitalization increased this risk by 42. CONCLUSION: This study highlights the need to optimize treatments by strictly regulating blood pressure, serum sodium and potassium levels, coagulation parameters and looking for clinical signs of hemorrhage. Physician should be aware of certain drug associations that may carry a risk of severe adverse events.

[Left ventricular hypertrophy in chronic hemodialysis patients at CNHU-HKM of Cotonou]. / Hypertrophie ventriculaire gauche chez les hémodialysés chroniques du CNHU-HKM de Cotonou.

INTRODUCTION: Left ventricular hypertrophy (LVH) is a predictor of mortality in hemodialysis. It takes a very high proportion among cardiovascular complications. OBJECTIVE: It was to determine the frequency of LVH and identify its associated factors among chronic hemodialysis patients of CNHU-HKM. METHODS: This is a cross-sectional, descriptive and analytical, which took place 1st February to 31st October 2014. The sample consisted of patients aged over 15 years, chronic hemodialysis for at least 3 months. LVH is defined by a Left Ventricular Mass Index (LVMI)>115 g/m2 for men and >95 g/m2 in women. Doppler ultrasound was performed during 15 to 20 hours after the last hemodialysis session. Factors associated as sociodemographic characteristics, history, biological data, dialysis parameters were sought by logistic regression univariate analysis. The significance level was less than 0.05. RéSULTS: The sample size was 141 patients, 39% of women with a sex-ratio of 1.6. The average age was 50.1±12.3 years. The frequency of hypertension was 67.4%; diabetes: 14.9%; smoking: 9.2%; the rise of the pre-dialysis blood pression: 46.8%. The frequency of LVH was 54.6% and the associated factors were: the elevation of the predialysis blood pression (P=0.04), obesity (P=0.01), central catheter (P=0.03), anemia (P=0.02) and cardiomegaly (P<0.001). CONCLUSION: LVH is frequent in hemodialysis of CNHU-HKM. It is necessary to optimize the hemodialysis sessions and to achieve better management of associated factors.

Profil lipidique des patients traités par statines en service de cardiologie, CNHU, Bénin. Les objectifs cibles de LDL-C sont-ils atteints ?

Introduction : Les maladies cardiovasculaires sont une cause majeure d'incapacité et de décès prématurés à l'échelle mondiale et les dyslipidémies représentent un facteur de risque majeur d'athérosclérose. Le but est d'évaluer l'atteinte des objectifs de LDL-C chez les patients traités par statines dans le service de cardiologie du CNHU-HKM de Cotonou.Méthode : Il s'agit d'une étude rétrospective, portant sur la période du 1er juin 2013 au 31 décembre 2014, nous avons inclus de façon exhaustive les patients de plus 18 ans, hospitalisés et traités par statines. Les données cliniques, biologiques, thérapeutiques et évolutives ont été révisées et une stratification de risque basée les tables SCORE (Systematic Coronary Risk Evaluation) a été faite à postériori.Les taux de LDL-C des patients ont été comparés aux cibles de LDL-C retenues par les recommandations de l'European Society of Cardiology (ESC) 2011. La valeur de p<0,05 est retenu comme seuil de significative.Résultats : Sur 551 patients hospitalisés, 130 patients étaient traités par statines. L'âge moyen est de 60,01 ±12,78 ans, le sex ratio H/F est de 1,65. Chez 53,8% des patients on retrouvait une dyslipidémie avec 40% d'hypercholestérolémie. Les autres facteurs de risque athéromateux étaient dominés par l'HTA (72,3%). Le niveau de RCV était élevé chez 93,8% des patients à l'instauration des statines. La prescription des statines était principalement faite en prévention secondaire. L'objectif de LDL-C cible n'était pas atteint chez 61% des patients. La valeur seuil du LDL-C initiale ≥ 1,6 g/l était prédictive de non atteinte de l'objectif LDL-C. Conclusion : Les objectifs cibles de LDL-C sont atteints chez moins de 4 patients sur 10 dans notre série. Notre étude suggère la nécessité de mettre en place des stratégies appropriées pour l'atteinte des objectifs de LDL-C au cours du traitement par statines

Prevention of venous thromboembolism among inpatients at Cotonou teaching hospital, Benin.

AIM: The aim of this retrospective study was to evaluate the use and appropriateness of preventive measures for venous thrombosis among adult inpatients in a Benin teaching hospital. PATIENTS AND METHODS: All patients were systematically enrolled. The risk of venous thrombosis was estimated according to international guidelines. Thromboembolic events were diagnosed using the Wells score and, when possible, by paraclinical investigations. The following variables were studied: the risk of venous thrombosis, the use and appropriateness of preventive measures, and the frequency of thromboembolic events. The data were analyzed with Epiinfo 6.04.fr and SPSS software, and significance was assumed at p=0.05. RESULTS: The study population consisted of 487 patients recruited in four surgical wards, four general wards and one obstetric-gynecology ward. Mean age was 38.7+/-11.3 years and the sex ratio 0.51. The risk of thrombosis was considered low in 15% of patients, moderate in 60.8%, high in 21.1% and very high in 3.1%. Prophylactic measures were prescribed to 33.9% of the patients overall, 53.6% in the obstetric gynecology ward, 28.5% in the surgical wards and 12.9% in the general wards. The frequency of preventive measures rose with the level of risk (p<0.0001). Preventive measures consisted of passive mobilization, aspirin, enoxaparin and acenocoumarol. The prescriptions were appropriate in only 6% of cases. Among 198 patients who were monitored for two months after hospital discharge, 8% had a venous thromboembolic event. Such events were more frequent in the absence of prophylaxis (12% vs 3.3%, p=0.02). CONCLUSION: The risk of venous thromboembolic is recognized but poorly managed in this Bénin teaching hospital.