Changes in patient profiles in the cardiology department of the University Hospital Gabriel Touré (UH-GT) : results of two cross-sectional studies of 2010 and 2022.

BACKGROUND: Little is known about patient profile changes in medical facilities in our country, leading to this study to describe and compare patient profiles in 2010 and 2022. PATIENTS AND METHODS: This was a cross-sectional study with new outpatients aged 15 years and more seen in the cardiology department of the UH-GT. Measurements included height, weight and body mass index (BMI). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded. Quantitative data are presented as the mean with standard deviation, and categorical one as proportions. Statistical tests were the t test to compare means and chi-test for categorical variables. The level of significance was set to 0.05. RESULTS: The sample consisted of 515 new patients (199 in 2010 and 316 in 2022) with 59.1% female in 2010 and 60.1% in 2022 (p = 0.821). We noticed an increase in hypertension (59.1-71.8%, p = 0.003) and a decrease in tobacco smoking (from 13 to 05.4%, p = 0.002) and stroke (from 05.8 to 02.2%, p = 0.033). Height increased significantly from 1.59 m to 1.66 m, p = 0.002. SBP and DBP showed significant decreases in their means from 155.43 to 144.97 mmHg, p = < 0.001 for SBP and from 95.53 to 89.02 mmHg, p = < 0.001 for DBP. CONCLUSIONS: Cardiovascular risk factors showed different trends with decreasing tobacco smoking, similar to systolic and diastolic blood pressure, albeit with an increase in hypertension prevalence. Other CVrf values increased. Awareness campaigns must be reinforced and maintained to obtain their decrease.

[Epidemiological and clinical aspects of atrial fibrillation at the cardiology department of kati university hospital]. / Aspects epidemiologique et clinique de la fibrillation auriculaire au service de cardiologie du chu de kati.

Atrial fibrillation is the most frequent permanent rhythm disorder.Theaim of this work was to determine the epidemiological and clinical aspects of atrial fibrillation cases hospitalized in the cardiology department of the University Hospital of Kati. MATERIALS AND METHODS: We carried out a descriptive retrospective study, from January 2018 to December 2019.Patients of all ages and both sexes with clinical and EKG atrial fibrillation admitted to the department during the study period were included in the study.The variables studiedwere: socio-demographic characteristics, clinical signs, classification of atrial fibrillation, and comorbidities associated. RESULTS: A total of 52 patients were included in the studyof 203 cases hospitalized in the department, with a hospital prevalence of 25.61%, the female sex was predominant 69.23%. The main reason for consultation was heart failure syndrome (46.15%).Arterial hypertension (55.76%) was the mostassociatedcomorbidity. Permanent atrial fibrillation accounted for 63.46% of cases . CONCLUSION: Atrial fibrillation is the most frequent arrhythmia in our environment, preventive measures must be put in place for early detection and better management of comorbiditiesassociatedwith atrial fibrillation.

La fibrillation auriculaire est le trouble du rythme le plus fréquent. Le but de ce travail était de déterminer les aspects épidémiologiques et cliniques de la fibrillation atriale dans le service de cardiologie du CHU de Kati. MATÉRIELS ET MÉTHODES: Il s'agit d'une étude rétrospective descriptive menée de janvier 2018 à décembre 2019. Ont été inclus dans cette étude les patients de tout âge et des deux sexes ayant présenté une fibrillation atriale sur des critères cliniques et électrocardiographiques, admis dans le service pendant la période d'étude. Les variables étudiées étaient : les caractéristiques sociodémographiques, les signes cliniques et électriques, et les comorbidités associées. RÉSULTATS: Au total 52 patients ont été inclus dans l'étude sur 203 cas hospitalisés dans le service soit une prévalence hospitalière de 25,61%, le sexe féminin a été prédominant 69,23%. Le principal motif de consultation était le syndrome d'insuffisance cardiaque (46,15%). L'hypertension artérielle (55,76%) a été la comorbidité la plus associée. La fibrillation atriale permanente représentait 63,46% des cas. CONCLUSION: La fibrillation atriale est l'arythmie la plus fréquente dans notre milieu, des mesures préventives doivent être mise en place pour une détection précoce et une meilleure prise en charge des comorbidités associées.

[Epidemiology of Covid-19 and high blood pressure association at Mali'shospital]. / Epidemiologie de l'association Covid-19 et hypertension arterielle a l'hopital du Mali.

INTRODUCTION: High blood pressure is a major cardiovascular risk factor. Patients with cardiovascular risk factors are at risk of developing COVID-19. The objective of this study was to determine epidemiology of Covid-19 infected in patients with high blood pressure. PATIENTS AND METHOD: Descriptive cross-sectional study from April 2020 to June 2020 about patients hospitalized for Covid 19 by PCR diagnosis at the Hopital du Mali Bamako and having high blood pressure. Admission registry and patient charts were used to collect data. RESULTS: We collected 78 out of 484 in patients which mean hospital frequency of 16.11%. The mean age was 55.21 +/- 14.61 years. Sex ratio M / F was 1.36. Patients were followed for high blood pressure in 59% of cases. Medical history was ischemic heart disease in 2.6% and dilated cardiomyopathy in 2.6%. Main functional signs were cough in 41.02% and lost of taste in 11.53%. High blood pressure on admission was grade 2 in 37.2% and grade 3 in 3.8%. Treatments received were calcium channel blockers 41.02%, inhibitors of the reninangiotensinaldosterone system 16.66% and combinations 15.38%. Hospital mortality was 10.3%. There was no statistically significant difference in mortality between known hypertensive patients and de novo hypertensive patients. There was also no statistically significant difference in mortality by grade of hypertension. CONCLUSION: High blood pressure can be associated to Covid 19. Treatment is based on calcium channel blockers and reninangiotensinaldosterone system inhibitors. It has an impact on the prognosis of the disease with significant mortality.

INTRODUCTION: L'hypertension artérielle (HTA) est un facteur de risque cardiovasculaire majeur. Dans la littérature elle est fréquemment retrouvée chez les patients atteints de la COVID-19.L'objectif de cette étude est de décrire l'épidémiologie de cette association chez les patients hospitalisés pour Covid-19. PATIENTS ET MÉTHODE: L'Etude est transversale et descriptive ; elle a été réalisée sur la période du 1erAvril 2020 au 30 Juin 2020. Elle a concerné les patients hospitalisés pour Covid 19 avec un test PCR positif à l'hôpital du Mali de Bamako et ayant une HTA. Les registres d'admission et les dossiers des patients ont servi pour la collecte des données. RÉSULTATS: Nous avons colligé 78 sur 484 patients hospitalisés soit une fréquence de 16,11%. L'âge moyen était de 55,21 +/- 14,61 ans. Le sex ratio H/F était de 1,36.Les patients étaient suivis pour HTA dans 59% des cas. Les antécédents médicaux étaient la cardiopathie ischémique chez 2,6% et la cardiomyopathie dilatée chez 2,6%. Les principaux signes fonctionnels étaient la toux chez 41,02% et l'agueusie chez 11,53%. L'HTA à l'admission était de grade 2 dans 37,2% des cas et de grade 3 dans 3,8% des cas. Les traitements reçus étaient les inhibiteurs calciques 41,02%, les inhibiteurs du système rénine angiotensine aldostérone 16,66% et les associations 15,38%. La mortalité hospitalière était de 10,3%. Il n'y avait pas de différence statistiquement significative concernant la mortalité entre les patients connus hypertendus et les patients hypertendus de novo. Il n'y avait pas non plus de différence statistiquement significative concernant la mortalité selon le grade de l'HTA. CONCLUSION: l'HTA peut être associée au Covid 19. Le traitement est basé sur les inhibiteurs calciques et sur les inhibiteurs du système rénine angiotensine aldostérone. Elle a un impact sur le pronostic de la maladie avec une mortalité importante.

Analysing innovations among cattle smallholders to evaluate the adequacy of breeding programs.

Many breeding programs have been implemented in developing countries, many of which have been unsuccessful. To better understand the failure of these breeding programs, it is proposed to analyze their adequacy with innovations that are actually adopted by smallholders. The proposed methodology takes account of these innovations, the reasons for their adoption and the objectives of livestock keeping. The N'Dama cattle-breeding program in Senegal was used as a case study. Surveys were carried out among 54 farmers: 27 breeders who participated in this program, 17 of whom recently resigned, and 27 breeders who have never participated. Feeding was the most frequently cited area of innovation, followed by infrastructure. Genetics, animal health and reproduction held the third rank. Milk production appeared as an important objective of breeders, although the context remains one of strong multifunctionality. Principal component analysis highlighted three categories of breeders according to the innovations they adopted: institutional, modernizing, and integrating innovators. The groups of institutional and modernizing innovators dominate, gathering each 41% of the farmers. In the first category, breeders have organized themselves in an association and use N'Dama sires, livestock aiming at an insurance objective. In the second category, artificial insemination with exotic breeds and other technical innovations (cowshed, vaccination, urea treatment of straw) are used to improve production of milk and meat. The third group is termed 'integrating innovators,' since their innovations aim at integrating livestock and crop production. Gathering 18% of the sampled breeders, this group presents intermediate features between the two previous groups, using animals as draught power and for manure production. These results indicate that a process of intensification is at play and that the genetic improvement through the selection of N'Dama cattle for production criteria does not meet the breeders' demand. However, the N'Dama's adaptive traits justify its use as part of the breeding strategy of farmers, either in pure-breeding or in crossbreeding. The study thus tends to show the interactive link between genetic improvement and other innovations. It suggests that the success of a breeding program depends on its adequate positioning within the set of innovations adopted by breeders and proposes a method to inform breeding programs accordingly.

[Interest of multidetector CT virtual hysterosalpingography in the diagnosis of utero-peritoneal fistulas about 4 cases]. / Intérêt de l'hystéroscanner dans le diagnostic de la fistule utéro-péritonéale à propos de 4 cas.

We report four cases of uterine fistula found with the multidetector CT virtual hysterosalpingography. Patients were received for suspicious of a utero-peritoneal fistula at hysterosalpingography. They were young people at childbearing age (average age of 33 years), multigravidae, two of whom were nulliparous, one primiparous and one multiparous. We noted a history of voluntary interruption of pregnancy by curettage and a cesarean section. For the opacification, we used the classic hysterography standard equipment by means of 1/5 diluted iodine with saline solution as contrast. The multidetector CT virtual hysterosalpingography revealed small uterine perforations including three which were located in uterine posterior face at cervico-isthmic area and corporeal area, bringing about a utero-peritoneal fistula. The multidetector CT virtual hysterosalpingography is a simple and powerful technique for the diagnosis of utero-peritoneal fistula. It is convenient and then deserves an important place in the evaluation of uterine fistula.

[Epidemiology and prognosis of cervix cancer. Experience of the University Gynecology and Obstetric Clinic Ignace Deen of Conakry in 10 years: 1982-1991]. / Epidémiologie et pronostic du cancer du col de l'utérus. Expérience de la Clinique Universitaire de Gynécologie et d'Obstétrique Ignace Deen de Conakry, en dix ans: 1982-1991.

The cancer of the cervix is a tumor that can be detected at an early stage. Unfortunately, it is still detected lately in our service. Thus, it is the underlying cause of death by gynecological affection. After a preliminary work in 1982 about 35 case histories, the authors undertake a 10 years retrospective study where they showed that: the cancer of the cervix is the primary gynecological cancer (78.7%), it obtains between 25 and 65 years, the most often associated factors are early sex, (28%), poor living conditions (22%), cercivitise (17%), metrorrhagias (24%) and leucorrhoea are the most frequent signs. buding lesions are the dominant macroscopic form (68%) epidermoid carcinoma is the most important histological type, 98.7% cancer cases are detected at advanced stages (T3 and T4), the prognosis is dramatic: most patients die at home. This is a great public health issue the solution of which implies the collective action of decision-markers, health personnel and the communities themselves in order to promote early detection.

[Indications and anomalies of extended electrocardiogram recording (24 hours) at the Gabriel Toure university hospital in Bamako]. / Les indications et anomalies de l'enregistrement de longue duree (24 heures) de l'electrocardiogramme au CHU Gabriel Toure de Bamako.

AIM: To specify indications and main anomalies of the 24 hours electrocardiogram in Bamako. METHODOLOGY: The study was retrospective and conducted from 1st January 2008 to 31st July 2013, on patients whose file comprised a readable recording holter. The Holter recordings were analyzed by the software synetec (syneview 2) of ELA medical. Patients data were analyzed by SPSS 18 and redaction made using Word 2010. RESULTS: 90.2% of the recordings were retained. Mean Age of the sample was of 44,02 ± 16,95 years, the sex-ratio H: F 1,18 with 79.3% of patients coming from the services of cardiology. The indications were: palpitations (32.6%), suspicions of disorder of the rate/rhythm (27.2%), loss of consciousness, cerebral vascular accidents ischemic each one 15.2% and seeks of cause of faintness in (9.8%). An anomaly was found for the indications of disorder of the cardiac rhythm, palpitations, the cerebral vascular accidents ischemic, fainting and the losses of consciousness in resp. 80%, 66.6%, 28.5%, 22.2% and 14.2%. CONCLUSION: The 24 hours electrocardiographic recording is an examination of a great value in looking for cardiac rhythm disorders field of the disorders of the cardiac rhythm. Its provision will have to be effective in the university structures and the evolution towards the forms at longer duration quickly undertaken in Mali.

BUT: Préciser les indications et les principales anomalies du Holter électrocardiographique à Bamako. MÉTHODOLOGIE: L'étude était retrospective allant du 1er janvier 2008 au 31 juillet 2013 et portait sur des patients dont le dossier comportait un enregistrement holter bien lisible. Les enregistrements Holter étaient analysés par le logiciel synetec (syneview 2) de la société ELA médical. Les données des patients ont été analysées par SPSS 18 et saisies sur Word 2010. RÉSULTATS: 90,2% des examens holter effectués ont été retenus. L'âge moyen de l'échantillon était de 44,02 ± 16,95 ans, le sex-ratio H:F 1,18 avec 79,3% de patients provenant des services de cardiologie.Les indications étaient: palpitations ( 32,6%), suspicions de trouble du rythme (27,2 %), perte de connaissance, accidents vasculaires cérébraux ischémiques chacun 15,2% et recherche de cause de malaise dans (9,8%). Une anomalie était retrouvée pour les indications de trouble du rythme cardiaque, les palpitations, les accidents vasculaires cérébraux ischémiques, les malaises et les pertes de connaissance dans resp. 80%, 66,6, 28,5%, 22,2% et 14,2%. CONCLUSION: L'enregistrement Holter électrocardiographique de 24 heures est un examen d'une grande valeur dans le domaine des troubles du rythme cardiaque. Sa mise à disposition devra être effective dans les structures universitaires et l'évolution vers les formes à durée plus longue rapidement entreprise au Mali.

[Knowledge and practices of hypertension in nursing staff of the Hospital Gabriel Touré and Point G]. / Pratiques et connaissances sur l'hypertension arterielle du personnel soignant des CHU Gabriel Toure et Point G.

OBJECTIVE: This work aimed to study the quality of diagnosis and management of high blood pressure (HBP) by the practitioners of the Gabriel TOURÉ and point G teaching hospitals of Bamako. MATERIALS AND METHODS: It was a descriptive and analytical, cross-sectional study during the study period from 1st March 2009 to 28 February 2010. It included all physicians and paramedics of the teaching hospital of the Point G and Gabriel TOURÉ in Bamako. RESULTS: A total of 283 practitioners (physicians and the paramedics) from both teaching hospitals have accepted our questionnaire, including 133 doctors and 185 paramedics. CHU Gabriel TOURÉ accounted for 55.1%, the majority came from the department of cardiology with 18.4%. Doctors accounted for the largest square with 47.0%. The majority of our practitioners (59%) say it takes at least one session during three medical consultations to diagnose the HBP. Only 29,60% define the HBP from 140/90 mm Hg. With a blood pressure goal of 58, 30% and 57.20% of practitioners claimed to retain 140/90 mm Hg, respectively for the diabetic and the renal-insufficient patients. A considerable number of our practitioners (27.9%) still used in pregnant women the triplet diuretic/IEC/diet without salt. The information of patients on some important aspects of the pathology prior to any therapeutic strategy had been conducted in 63.6. CONCLUSION: The high blood pressure must be a major concern for medical and paramedical staff today.

OBJECTIF: Ce travail visait à étudier la qualité du diagnostic et de la prise en charge de l'hypertension artérielle par les praticiens du CHU Gabriel TOURE et de point G de Bamako. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude transversale descriptive et analytique, pendant la période d'étude du 1er mars 2009 au 28 Février 2010. Elle a concerné l'ensemble des médecins et des paramédicaux des centres hospitalo ­ universitaires du Point G et Gabriel TOURE de Bamako. RÉSULTATS: Au total 283 praticiens (médecins et des paramédicaux) des deux centres hospitalo - universitaires ont accepté notre questionnaire, dont 133 médecins et 185 paramédicaux. Le CHU Gabriel TOURE représentait 55,1%, la majorité provenait du service de cardiologie avec 18,4%. Les médecins ont constitué la plus grande proportion avec 47,0%. La majorité de nos praticiens (59%) affirmaient qu'il faut au moins une séance de prise tensionnelle pendant trois consultations médicales pour diagnostiquer l'HTA. Seulement 29,60% définissent l'HTA à partir de 140/90 mm Hg. Comme objectif tensionnel 58, 30% et 57,20% des praticiens affirmaient retenir 140/90 mm Hg respectivement chez le diabétique et l'insuffisant rénal. Un nombre considérable de nos praticiens (27,9 %) utilisait encore chez la femme enceinte le triplet Diurétique/IEC/Régime sans sel. L'information des patients sur certains aspects importants de la pathologie avant toute stratégie thérapeutique avait été effectuée dans 63,6. CONCLUSION: L'hypertension artérielle doit être une préoccupation majeure pour tout personnel médical et paramédical de nos jours.

[Chronic kidney failure at subclinical stage in hypertensive patients in the cardiology department of the Gabriel TOURE university hospital]. / L'insuffisance renale chronique au stade infraclinique chez l'hypertendu dans le service de cardiologie du CHU Gabriel TOURE.

OBJECTIVE: This work aimed to describe the epidemiological, clinical, biological and ultrasound aspects of the subclinical renal failure in hypertensive patients in the department of cardiology of the Gabriel TOURÉ University Hospital of Bamako. PATIENTS AND METHODS: The study was cross-sectional and prospective from 1 January 2007 to 31 December 2007 in the cardiology department of the Gabriel Touré University Hospital. These were all patients who achieved at least the basic test for renal impairment such as serum creatinine, 24h proteinuria, renal ultrasound. RESULTS: Total of 114 patients with kidney failure without evocative clinical symptoms have been included, among them 60 men and 54 women, average age of 57 years. In the hypertensive population, the beginner to moderate chronic renal failure had a frequency of 12.9% (114/880), the sex ratio was 1.11 in favor of men. Patients aged less than 60 years were more numerous with a frequency of 61.5%. Dyspnea (38.6%), and headache (36.8%) were the main manifestations of the high blood pressure (HBP). Renal disease characterized by microalbuminuria was predominant compared to the macro-albuminuria: 25.5% versus 7%. Renal ultrasound was abnormal in 14.1% with a predominance of stage 0 (86%), stages 1 and 2 were each 7%, we have not found any stage 3. CONCLUSION: Chronic renal failure is a frequent complication of the hypertension. Some biological tests are necessary for the diagnosis. Renal ultrasound remains a useful test for its assessment. The optimal treatment of high blood pressure is essential, as it not only reduces the overall cardiovascular risk of patients, but also slows or even stabilizes the worsening of renal function.

OBJECTIF: Ce travail visait à décrire les aspects épidémiologiques, cliniques, biologiques et échographiques de l'insuffisance rénale infraclinique chez l'hypertendu dans le service de cardiologie du CHU Gabriel TOURE de Bamako. PATIENTS ET MÉTHODES: L'étude était transversale et prospective allant du 1er Janvier 2007 au 31 Décembre 2007 dans le service de cardiologie du CHU Gabriel TOURE. Il s'agissait de l'ensemble des patients ayant au moins réalisé le bilan minimum d'atteinte rénale à savoir la créatininémie, la protéinurie de 24h, l'échographie rénale. RÉSULTATS: Au total 114 sujets présentant une insuffisance rénale sans manifestations cliniques évocatrices ont étés inclus, dont 60 hommes et 54 femmes, en moyenne âgés de 57 ans. Dans la population d'hypertendus, l'IRC débutante à modérée avait une fréquence de 12,9% (114/880), le sex ratio était de 1,11 en faveur des hommes. Les patients âgés de moins de 60 ans étaient plus nombreux avec une fréquence de 61,5%. La dyspnée (38,6%) et les céphalées (36,8%) étaient les principales manifestations de l'HTA. L'atteinte rénale marquée par la micro- albuminurie était prédominante par rapport à la macro- albuminurie: 25,5% contre 7%. L'échographie rénale était anormale dans 14,1% avec une prédominance du stade 0 (86%), les stades 1 et 2 représentaient chacun 7%, nous n'avons pas trouvé de stade 3. CONCLUSION: L'insuffisance rénale chronique reste une complication fréquente de l' HTA. Certains examens biologiques sont nécessaires pour le diagnostic. L'échographie rénale reste un examen utile pour son évaluation. Le traitement optimal de l'hypertension artérielle est essentiel car cela permet non seulement de diminuer le risque cardiovasculaire global des patients, mais aussi de ralentir la péjoration de la fonction rénale, ou même de la stabiliser.

[Arterial hypertension and pregnancy in Bamako: epidemiologic and clinical aspects]. / HTA et grossesse a Bamako: épidemiologie et clinique.

AIM: To study epidemiological aspects of the high blood pressure in pregnancy in Bamako. MATERIAL AND METHODS: The study was prospective from january to december 2006 about 250 pregnant with arterial hypertension and without any other cardiovascular disorder. The study was performed in CHU Gabriel Touré and CSRef I and V in Bamako using SPSS v. 11 for collecting and analyzing data. RESULTS: Arterial hypertension prevalence was 6,5%, with 38% between 20-29 years. 36,8% of them were primigravida 32,4% and 32,4% had 1-3 gestations. 85,6% were married, 74% housewives. 57,6% of the pregnant were not send to school and 28% had primary school instruction 16,4% took contraceptives and 6% were obese. 57,2% didn't have the required minimal number of 3 prenatal consultations and 76,8% were seen in the third trimenon. High blood pressure stage 1 was seen in 40% and stage 2 in 42,4%. Pre-eclampsia and chronic Hypertension made resp. 50,4% and 22%. CONCLUSION: High blood pressure in pregnancy is characterized by an later occur, by housewives with predominance of stage 1 and 3. Prenatal care is characterized by difficulties in realizing investigations and consultations in quantitative insuffisant prenatal consultations.

Gene expression of leptin and uncoupling proteins: molecular end-points of fetal development.

Uncoupling proteins (UCPs) are considered to be major determinants of energy expenditure in mammals. During development in rodents, the expression of the UCP genes occurs sequentially. UCP2 mRNA is expressed long before birth. UCP1 mRNA expression in brown adipose tissue (BAT) starts in the late fetal period, and the expression of UCP3 mRNA begins immediately after birth in BAT and skeletal muscle. The postnatal induction of UCP1 gene expression is due mainly to cold stimuli, whereas the switch-on of UCP3 mRNA expression after birth requires the stimulus of food intake, specifically of lipids in the mother's milk. However, UCP3 mRNA expression after birth is also highly sensitive to leptin, and administration of a single injection of leptin to neonatal mice that were not allowed to suckle partly mimicked the natural induction of UCP3 gene expression in BAT and skeletal muscle. The speed of the effects of leptin on UCP3 mRNA expression suggests a direct action on skeletal muscle and BAT. The injection of leptin produced minor effects on UCP1 mRNA expression, and no effects were observed on UCP2 mRNA. In summary, leptin appears to contribute to the regulation of UCP3 gene expression in the perinatal period. Whatever the mechanism of action of leptin in BAT and skeletal muscle, it is already functional at birth.