[Practice of home blood pressure monitoring in a population of hypertensive patients in subsaharan Africa]. / Pratique de l'automesure tensionnelle dans une population d'hypertendus en Afrique subsharienne.

AIM: To investigate home blood pressure monitoring (HBPM) practice among treated hypertensive patients in a subsaharan Africa setting. PATIENTS AND METHODS: Cross-sectional observational study over a five-month period from April 30 to September 30, 2019. The survey was carried out among treated hypertensive patients aged at least 18-years-old, received in outpatient consultations department at the Abidjan Heart Institute during the study period. We assessed the rate of patients performing HBPM, and compared characteristics and rate of blood pressure control between patients according to the realization of HBPM. RESULTS: Three hundred hypertensive patients (mean age 59.2±12.0 years, sex ratio 1.4) were included. Of these, 68.3% reported to have information about HBPM. In 42.3% of cases, patients had an electronic blood pressure device at home, the majority of which were devices with arm cuffs (65.3%). The study showed that 40.3% of the patients had received education on hBPSM, most commonly provided by practitioners (71.9%). Among our population study, 36.3% performed HBPM, of whom only 13.8% according to the 3-day standardised protocol. In multivariate analysis, HBPM appeared to be an independent factor associated with better blood pressure control. CONCLUSION: HBPM is rarely used by patients with hypertension in our practice. Most of the patients do not receive education about HBPM and adequate training in order to perform it routinely.

[Prescribing habits of physical activity by cardiac physicians in Côte d'Ivoire]. / Habitudes de prescription de l'activité physique par des médecins cardiologues en Côte d'Ivoire.

Regular physical activity (PA) has multiple health benefits that contribute to the prevention and management of many non-communicable diseases such as cardiovascular disease. However, a large proportion of the world's population is not active enough to benefit its health. Despite the potential of physicians to increase the level of PA practice in both primary and secondary prevention, there appears to be little intervention in this direction during medical consultations. What is the situation in Côte d'Ivoire? We conducted a prospective study that focused on the description and analysis of the practice of PA awareness and prescribing of Côte d'Ivoire cardiologist physicians and to examine the extent to which their socio-cultural characteristicsdemographics, their personal PA practices, barriers and needs influenced their PA prescribing in primary or secondary prevention settings. The results showed a high rate of overweight and obesity (64 %) and a low level of PA (40 %). We noted a high rate of locating (90 %) and advising AP (92 %). High blood pressure (98 %) and obesity (94 %) were the major conditions for which physicians prescribed PA. They were mainly about walking (94 %) and through oral counselling (80 %). Among the brakes identified were mainly the lack of knowledge about PA prescribing, lack of consultation time and lack of motivation of patients in 48 %, 44 % and 34 % of cases respectively. In terms of the needs expressed to promote the prescription of PA, it was mainly the personal conviction of the physician of the interest of prescribing an PA (80 %), of the organization of training on the prescription of PA (78 %) and completion of patient handouts (56 %).

[Coronary artery aneurysms probably due to Kawasaki's disease]. / Anévrismes coronaires chez un adulte jeune évocateurs d'une probable maladie de Kawasaki.

We report the case of a young adult admitted to the Abidjan Heart Institute for coronary angiography to explore unstable angina. Coronary angiography showed multiple aneurysms which suggested sequelae of misdiagnosed Kawasaki disease.

[Self-medication among black African hypertensive patients: Factors and consequences]. / Recours à l'automédication chez l'hypertendu noir africain : ses facteurs et ses conséquences.

INTRODUCTION: Self-medication practice is under-evaluated among black African hypertensive patients. AIM: To assess the level of self-medication among black African hypertensive patients and to determine the factors favoring this practice and their consequences. METHODS: Prospective study during a 3-month period including 612 hypertensive patients followed in Abidjan cardiology institute. RESULTS: Mean age was 55.1. The patients had a self-medication use in 60.1% of cases. Medicinal plants and derived products were commonly involved. Self-medication use reasons were: influence of relatives (89.8%) and the fear of antihypertensive drugs adverses effects (54.9%). Multivariate analysis shows that factors of self-medication were age (56.6 years vs. 50.3 years, P<0.001), income less than 762 euros/month (88% vs. 75.4%; OR=2.73; 95% CI: 1.62-4.6; P<0,0001), obesity (70.4% vs. 35.6%; OR=1.24; 95% CI: 0.75-1.15; P=0.037), dyslipidemia (40.8% vs. 27.9%; OR=6.72; 95% CI: 0.57-2.13; P=0.043), antihypertensive association therapy (61.7% vs. 51.4%; OR=2.27; 95% CI: 0.25-0.97; P=0.037). Poor control of high blood pressure (HBP) was a consequence of self-medication (6.5% vs. 47.1%; OR=10.27; 95% CI: 4.65-56.4; P=0.034), repercussions of HBP on major organ (75% vs. 17.2%; OR=12.9; 95% CI: 8.5-19.6; P=0.0001). CONCLUSION: Self-medication is a common practice in African hypertensive patients. It has many consequences.

[Presumption of sleep apnea in a black African hypertensive population: Importance of the Epworth sleepiness scale in the diagnostic approach]. / Présomption d'apnées du sommeil dans une population d'hypertendus Noirs africains : intérêt de l'échelle de somnolence diurne d'Epworth dans l'approche diagnostique.

INTRODUCTION: Sleep apnea syndrome (SAS) is very little described in the hypertensive black African. PURPOSE: To screen sleep apnea syndrome using the rating scale of Epworth daytime sleepiness, and to investigate the determinant factors and to infer therapeutic consequences. METHOD: This is a retrospective and prospective study with descriptive and analytical purpose that focused on 200 hypertensive outpatients of the Cardiology Institute of Abidjan. The primary endpoint studied was the SAS. The diagnostic approach of SAS was performed using the rating scale of Epworth daytime sleepiness. RESULTS: The prevalence of sleep apnea was 45%. The average age of sleep apnea carriers was 56.1 years, with a male predominance (60%). The determinant factors of sleep apnea syndrome were male gender (60% versus 40%, P=0.021), obesity (77.8% versus 62.7%, P<0.0001), diabetes (26.7% versus 15.5%, P=0.5) and dyslipidemia (54.4% versus 27.3%, P=0.0009). Life in urban areas, occupation and smoking were not correlated with SAS in our series. The control of hypertension was better in non-apneic patients compared to apneic patients (63.6% versus 38.9%, P=0.04). The visceral impact of hypertension in apneic patients was highly significant (77.8% versus 41.7%, P=0.014). Therapeutically, it was noted the preferential prescription of combination therapy in apneic patients compared to non-apneic patients (82.3% versus 74.4%).

[Assessment of treatment adherence among black Africans with heart failure]. / Évaluation de la compliance chez l'insuffisant cardiaque noir africain.

STUDY AIM: to analyze patient-related factors that may influence adherence in patients with heart failure in an African cardiology department. METHODOLOGY: This prospective observational study took place in the in-patient department of the Abidjan cardiology institute and enrolled consecutive patients hospitalized for decompensated heart failure from January to November 2014. The inclusion criteria were chronic heart failure in patients older than 18 years, developing for at least 6 months and treated by medication. The revised heart failure compliance questionnaire was used. RESULTS: The study included 121 patients. Overall adherence was poor in 88.4% of patients. Multiple linear regression analyses showed that use of traditional medicine was associated with poor adherence for the following 3 components: keeping follow-up appointments, medication intake, and sodium limitations. Overall adherence increased with the number of hospitalizations (OR = 1.69, 95% CI 1.13-2.53; p = 0.01). This increase persisted after adjustment for age, sex, educational level, marital status, medical insurance coverage and the use of alternative medicines (traditional and Chinese) (OR = 1.70; CI 1.12-2.28; p = 0.01). CONCLUSION: Adherence among black Africans with heart failure remains poor, influenced too much by traditional medicine. Therapeutic education is essential to improve patients' knowledge about their disease and its treatment.

[Peripheral arterial disease of the lower limbs in African diabetic patients: ultrasonography and determining factors]. / Artériopathie des membres inférieurs du diabétique noir africain: aspects ultrasoniques et facteurs déterminants.

INTRODUCTION: Diabetic peripheral arterial disease (PAD) of the lower limbs is underdiagnosed. METHODOLOGY: This was a prospective study conducted over a six-month period from November 2012 to April 2013. A total of 308 diabetic patients were included from three diabetes centers in Abidjan (Ivory Coast). AIM: To screen for PAD of the lower limbs in a diabetic population and to identify the determining factors. RESULTS: Among the 308 patients, the ankle-brachial index (ABI) was<0.9 in 68 (22.07%) patients considered to have PAD; the ABI was>1.3 in 56 (18.2%) patients who had suspected mediacalcosis. The average age of the PAD patients was 60.2 years. Female gender predominated (55.9%). The mean duration of diabetes was 9.6 years: 97.1% type 2 diabetes. The other cardiovascular risk factors in this population were hypertension (58.8%) and dyslipidemia (40.9%). Smoking was present in 29.4% of patients and obesity in 23.9%. PAD of the lower limbs was mild in 46 patients (67.6%), moderate in 16 (23.5%) and severe in 6 (8.8%). Duplex Doppler commonly showed lesions of the tibial arteries. Determining factors of diabetic PAD of the lower limbs were hypertension (58.8% vs 36.6%; OR=2.46; 95% CI: 1.13-5.36; P=0.034) and dyslipidemia (40.9% vs 8.3%; OR=7.6; 95% CI: 2.31-25.08; P=0.0009). For mediacalcosis, male gender (71.5% vs 39.7; OR=0.26 95% CI/0.10-0.64. P=0.004) was the only factor identified. CONCLUSION: Hypertension and dyslipidemia were predictive factors for diabetic PAD of the lower limbs in our African population.

[Acute rheumatic carditis in Ivory Coast: changes in prevalence during the decade 2000-2009]. / Cardites rhumatismales en Côte d'Ivoire : évolution de la prévalence hospitalière durant la décennie 2000-2009.

BACKGROUND: Rheumatic fever and acute rheumatic carditis (ARC), though now rare in developed countries, are the main cause of acquired heart disease in children and young adults and remain endemic in developing countries. This study aims to establish the current prevalence of ARC in Ivory Coast. PATIENTS AND METHODS: A cross-sectional retrospective study was performed between January 2000 and December 2009 in the pediatric wards of the three university hospitals in Abidjan and in the Institute of Cardiology of Abidjan. It included all patients whose final diagnosis was ARC. RESULTS: There were 126 patients of which 57.1% were female. The mean age was 15 ± 6.7 years (range: 4 to 28 years). The average annual prevalence was 12.6 cases, with two peaks observed during the years 2004 (27 cases) and 2005 (20 cases). The hospital prevalence of ARC in the 10-year period was 1.1‰ which is less than in previous decades. The principal presentation leading to discovery of the ARC was heart failure (68.9%). This symptom was due to significant valvular regurgitation with dilatation of the cardiac chambers observed in 65.9%. Mitral regurgitation was the main lesion observed (87.3%). Apart from the cases of isolated pericarditis and three cases of mild mitral regurgitation, all other patients were suffering from valvular lesions as a result of previous rheumatic fever. CONCLUSION: A decrease in the hospital prevalence of ARC was observed. However the cases that were seen were diagnosed late and had a tendency to be severe.

[Prevalence of obesity in school children in Ivory Coast]. / Prévalence de l'obésité en milieu scolaire en Côte d'Ivoire.

BACKGROUND: According to the World Health Organization, an increased prevalence of hypertension in children is observed since several years due to an epidemic of childhood obesity. What is the extent of this epidemic in our African context? METHOD: We conducted a prospective descriptive study of pupils encountered in primary and secondary schools of the district of Abidjan from May 3 to June 1st 2010. A sample of 2038 pupils aged 6 to 18 years was randomly selected. Overweight in pupils was assessed by body mass index (BMI). RESULTS: There were 1182 girls (58%) and 856 boys (42%) whose average age was 12.7±3.6 years. The average weight was 42.6kg±16 (range 14.6 to 106.2kg), the average size was 1.48m±0.19 (range 1 to 1.95m). BMI was 17.2kg/m(2)±3.7 (range 14.6-35.7). The prevalence of obesity was of 5%. In addition, 4% of the students were overweight, 39% extremely thin, 25% thin and 27% normal. Obesity was more common in girls (6.8%) than boys (1.8%). The prevalence of obesity in hypertensives was 16%. BMI influenced the systolic and diastolic blood pressure in both sexes (P<0.001 in both cases). CONCLUSION: Childhood obesity exists in a country like the Ivory Coast where wealthness is far from generalized. A well-organized management of childhood obesity is necessary to avoid complications such as hypertension.

Solution equilibria and structural characterisation of the palladium(II) and mixed metal complexes of peptides containing methionyl residues.

Palladium(II) complexes of the peptides GlyMet, GlyMetGly and GlyGlyMet containing methionyl residues were studied by potentiometric and 1H NMR spectroscopic methods. The coordination of terminal amino and deprotonated amide nitrogen and thioether sulfur donor atoms was suggested in the mono complexes of GlyMet and GlyMetGly. The fourth coordination site of these complexes can be occupied by solvent molecule, chloride or hydroxide ions or by another ligand molecule in the bis or mixed ligand complexes. The second ligand coordinates monodentately via the thioether function in acidic media and the amino group under neutral or basic conditions. The stoichiometry of the major species formed in the palladium(II)-GlyGlyMet system is [PdH(-2) L]- and this is coordinated by the amino, two-amide and the thioether donor functions. Thioether bridged mixed metal complexes formed in the reaction of [Pd(dien)]2+ and [Cu(GlyMetH(-1))] or [Ni(GlyMetGlyH(-2))]- also have been detected by spectroscopic techniques.

[Bacteriologic aspects of Haemophilus influenzae meningitis in children at the Central University Hospital of Treichville]. / Aspects bactériologiques des méningites dues à Haemophilus influenzae chez l'enfant au CHU de Treichville.

The object of our study was to contribute to the knowledge of the epidemiology and bacteriology of Haemophilus influenzae so as to ensure better treatment of patients consulting the Treichville Teaching Hospital. In the bacteriology laboratory of that hospital, between January 1996 and December 1999, we diagnosed by culture and/or soluble antigen, 203 cases of Haemophilus influenzae in children. We observed that biovar IV was dominant (49.7) amongst the 163 (80.3%) positive cultures. Serovar b was the most frequent capsular type found 189/203 (93%). Of the 203 specimens, the frequency of other capsular forms was e 9/203 (4.5%), f 3/203 (1.5%), c 2/203 (1%). Resistance to ampicillin is currently estimated at 39.9%, whereas resistance to chloramphenicol is estimated at 5.5%.

[Malignant melanoma in the Ivory Coast. Epidemiologic and histo-prognostic aspects. Report of 195 cases]. / Mélanomes malins en Côte-d'Ivoire aspects épidémiologiques et histopronostiques. A propos de 195 cas.

Malignant melanomas (MM) are rare tumors of very bad prognosis. Few studies have precised the anatomopathological aspects and prognosis of these tumors in Africa and especially in Côte d'Ivoire. This has prompted us to review 195 cases of MM diagnosed in our laboratories in order to precise their epidemiological and anatomical features. Biopsies and/or surgical specimens fixed in 10% buffered formalin have been studied using the paraffin embedding methods and staining with hematoxylin and eosin, Masson's trichrome and Fontana. 117 men (60%) and 78 women (40%) with a medium age of 57 years were studied. Cutaneous MM were predominant (174 cases, 93%) with 57.8% located on the foot. Non classified (38.2%) and nodular (33.6%) forms were more frequent with only 19% of acral lentiginous melanomas. The prognosis of our cases was poor with 71% of levels IV or V according to Clark and Mihm, Breslow's thickness superior to 3 mm in 93% of cases and ulceration in 91.3%. Our study emphasizes the poor prognosis of MM in Côte d'Ivoire. These tumors are frequent in the elderly and located predominantly on the foot.