Epidemiological, clinical, therapeutic and evolutionary specificities of the association between venous thromboembolic event and cancer in sub-Saharan Africa: Case of Togo.

BACKGROUND: Our study aimed to describe the clinical, paraclinical, therapeutic and outcomes of patients with venous thromboembolic event (VTE) associated with cancer in the context of limited resources. MATERIALS AND METHODS: This was a descriptive cross-sectional study over a period of six years from March 1, 2016 to March 31, 2022, in the cardiology department and the oncology unit of the Sylvanus Olympio Teaching Hospital of Lome. Our study examined medical records of patients who were at least 18 years old and had venous thromboembolic disease and cancer that was histologically confirmed. This study did not include records that were incomplete or records from patients with coronavirus disease. RESULTS: Our study included 87 patients with average age of 56.36±15.26 years. The discovery of VTE occurred incidentally in 28.74%. Venous thrombosis was isolated in 68.96% and proximal in 95%. Pulmonary embolism was bilateral in 77.77%. Gynaecological and urological cancers were found in 33.33% and 32.19% respectively. Adenocarcinoma was the histological type of cancer found in 47.13%. Cancers were at a very advanced stage in 74.71%. Treatment with antivitamin K was prescribed in 12.65%. In our study, there were 58 patients who passed away with a mortality rate of 66.66%. The cause of death was a complication of VTE in 22.42% and related to the course of cancer in 63.79% of cases. CONCLUSION: VTE during cancer is particular with a fatal evolution due to the severity of VTE and the very advanced stage of cancer.

[The chronic constrictive pericarditis, a real calcified gangue realizing a mid-ventricular bottleneck: A case report]. / La péricardite chronique constrictive, une véritable gangue calcifiée réalisant un goulot d'étranglement médio-ventriculaire : à propos d'un cas.

A 30-year-old woman consulted for a predominantly right-sided global heart failure chart that had been evolving for about 3 months. Its antecedents include a concept of poorly treated pleuropulmonary tuberculosis at the age of 8 years. Lateral chest X-ray, transthoracic echocardiography and thoracic CT showed ventricular ring calcification with mid-ventricular compression with apical ballooning. The diagnosis of chronic mid-ventricular constrictive pericarditis of tuberculosis etiology was retained. The patient was put on diuretic treatment and the immediate evolution is favorable with a regression of the signs of congestion. Surgical decortication has been indicated.

[Effusive pericarditis: clinical and etiological aspects in Lomé]. / Les péricardites liquidiennes : aspects cliniques et étiologiques à Lomé.

OBJECTIVE: to describe the course and the etiologic, prognostic, and therapeutic aspects of effusive pericarditis (EP) in Togo. MATERIAL ANDMETHODS: Prospective and longitudinal study conducted at the cardiology department of Sylvanus Olympio Teaching Hospital of Lome from February 1, 2011, to January 31, 2014, of patients hospitalized for EP, confirmed by Doppler echocardiography. RESULTS: The study included 38 patients. The hospital incidence rate of EP was 2.0%. The mean age was 42.5 ± 14.9 years (range: 16 to 73 years) with a sex ratio of 0.7. Exertional dyspnea, poor general condition, chest pain, and fever were the main symptoms. Pericardial effusion was abundant in 24 patients (63%). The Koch bacillus was identified on direct examination in five patients (13%) and only from sputum. HIV serology was positive in 18 patients (47%). Pericardial fluid was collected from 24 patients (63%). Pathology examinations of pericardial tissue found nonspecific inflammation in 5 patients and pericardial tuberculosis in 7. The causes of EP were: tuberculous (55%), idiopathic (16%), bacterial (8%), HIV-related (5%), uremic (5%), neoplastic (5%), lupus (3%), and rheumatic (3%). CONCLUSION: EFP is a frequent, serious, even deadly disease in Africa because of the HIV-AIDS pandemic. Treatment depends on the cause, most often tuberculosis.

[Prevalence survey of cardiovascular risk factors in the general population in St. Louis (Senegal)]. / Enquête de prévalence des facteurs de risque cardiovasculaire en population générale à Saint-Louis (Sénégal).

BACKGROUND: Cardiovascular diseases are becoming with their risk factors a real health problem in Africa. The objectives of this study were to assess the prevalence of risk factors for cardiovascular diseases in the general population in Saint-Louis, Senegal. METHODOLOGY: This is a cross-sectional, descriptive and analytical made in May 2010, in the Senegalese aged 15, residing in the city of Saint-Louis, Senegal. A systematic random sampling and stratified cluster has been achieved. Cardiovascular risk factors for research were: hypertension, diabetes, dyslipidemia, smoking, obesity, physical inactivity and metabolic syndrome. RESULTS: The survey involved 1424 individuals with 983 women (69%). The average age was 43.4±17.8years. The prevalence of risk factors was: hypertension (46%), diabetes (10.4%), total cholesterol (36.3%), hyperLDLcholesterol (20.6%), obesity (body mass index≥30kg/m(2)) (23%), abdominal obesity (48.7% according to International Diabetes Federation and 33.2% according to National Cholesterol Education Program) physical inactivity (64.7%), smoking (5.8%) and metabolic syndrome (15.7%). There was predominance in women of risk factors except for smoking and diabetes. The overall cardiovascular risk was high in 24.9% according to the Framingham model, 28.8% (European Society of Hypertension) and 6.1% (SCORE). CONCLUSION: This survey found a high prevalence of cardiovascular risk factors in a general population in Senegal, predominant in women. This should lead to better develop a strategy to prevent cardiovascular diseases.

[Prevalence and factors related to therapeutic adherence among black African outpatients with stable coronary artery disease in a cardiology department of Dakar in Senegal]. / Prévalence et facteurs liés à l'observance thérapeutique chez des patients noirs africains coronariens stables, suivis en ambulatoire en service de cardiologie de Dakar au Sénégal.

INTRODUCTION: The management of coronary artery disease has made important progress. Adherence to therapeutic measures is a great challenge for improving the long-term prognosis. In this work, we evaluate factors related to therapeutic adherence in black African patients with stable coronary artery disease. METHODOLOGY: We conducted a survey over three months (February-May 2008) in three cardiology departments in Dakar. We studied the regularity of drug intake, the adherence to the dietary advices and the appointments for consultation as well as the factors related to adherence. Good adherence was defined by a compliance rate greater or equal to 80% and a compliance rate less than 40% defined poor adherence. RESULTS: We included 105 patients (61 men) with a mean age of 60.67±11.29 years. Good compliance was noted in 56.2% of cases for drug treatment, 42% for dietary advices and 65% for appointments for consultation. A history of acute coronary events (P=0.04), a good knowledge of the disease (P=0.03) and a healthcare (P=0.02) were the factors related to a good adherence to drug treatment, whereas ischemic cardiomyopathy was a factor for poor adherence (P=0.002). Knowledge of coronary disease was the only factor correlated with good adherence to lifestyle (P=0.014). CONCLUSION: Therapeutic adherence remains unsatisfactory in Black African patients with stable coronary artery disease, hence the importance of patient education to reach a good adherence for therapeutic, because better adherence improves long-term prognosis of coronary artery disease.

[Prevalence and determinants of hypertension in Lomé (Togo): results of a screening in May 2011]. / Prévalence de l'hypertension artérielle et description de ses facteurs de risque à Lomé (Togo) : résultats d'un dépistage réalisé dans la population générale en mai 2011.

BACKGROUND: The prevalence of hypertension in the Sub-Saharan Africa region is increasing as a manifestation of the epidemiological transition, and this fact will oblige these countries to mobilize significant resources. World Bank estimates cheaper to prevent cardiovascular disease than to treat people once these diseases are established suggesting the need to know the prevalence of hypertension in order to allow prevention programs in our population. However, data in Togolese populations are rare. The purpose of the present study was to determine the prevalence of high blood pressure and its risk factors in Lomé. METHODS: We performed a cross-sectional survey among 2002 unselected respondents of the municipality of Lomé in May 2011. A questionnaire has been filled about family history of hypertension, habits and practices that affect hypertension on behalf of each respondent and anthropometric data and blood pressure has been measured. RESULTS: The prevalence of high blood pressure was 36.7% (34.6% of male vs. 38.4% of female, OR=0.85; 95%CI=0.7-1.02; P=0.08); 42.4% of the hypertensive respondents have been diagnosed at the screening. Blood pressure was positively correlated to the age (SBP: r=+0.46; P=0.001; DBP: r=+0.36; P<0.001), the body mass index (SBP: r=+0.7; P<0.001; DBP: r=+0.89; P<0.001) and waist circumference (SBP: r=+0.28; P<0.001; DBP: r=+0.3; P<0.001). There was a significant relationship between arterial hypertension and obesity (OR=1.65; 95%CI=1.47-1.84; P=0.003), salt consumption (OR=1.4; 95%CI=1.13-1.72; P<0.001) and oral contraception (OR=2.1; 95%CI=1.29-3.43; P=0.002). CONCLUSION: There was a high prevalence and low awareness of arterial hypertension in the municipality of Lomé with a female prevalence. This affection was correlated to age, salt consumption and obesity. This study raises the need for accentuating the prevention in our poor populations which are unable to face adverse outcomes which can occur.

[Screening for asymptomatic peripheral arterial occlusive disease of the lower limbs by measuring the ankle-brachial index in the general population (Senegal)]. / Dépistage de l'artériopathie oblitérante asymptomatique des membres inférieurs par la mesure de l'index de pression systolique dans la population générale de Saint-Louis (Sénégal).

OBJECTIVES: The purpose of this study was to investigate the prevalence of peripheral arterial disease (PAOD) and cardiovascular risk factors associated with the ankle-brachial index (ABI) in Senegalese patients aged 40 years and over. METHODOLOGY: We prospectively studied a random sample of Senegalese aged 40 years and older, residing in the city of St.-Louis, Senegal. The ABI was measured with a portable doppler (DIADOP 50) using 4 and 8Hz dual frequency probes. The standards were: normal ABI 0.9 to 1.3; peripheral artery obstructive disease (PAOD) ABI less than 0.9; incompressible artery ABI greater than 1.3. Cardiovascular risk factors were also studied. RESULTS: Seven hundred and seventy-one subjects (mean age 57 ± 11.2 years, 559 women) were examined. Cardiovascular risk factors were: sedentary lifestyle (76.4%), hypertension (68%), obesity (32.1%), elevated LDL-cholesterolemia (27.8%), diabetes (18.3%) and tobacco smoking (6.9%). Ninety-three subjects (12.1%) had PAOD and 37 subjects (4.8%) had an incompressible artery. PAOD was significantly more common in sedentary subjects (P=0.008), in the elderly (P=0.0006) and in patients with a history of coronary artery disease (P=0.04). Smoking was not strongly associated with PAOD. CONCLUSION: PAOD is common in Senegalese and is associated with high prevalence of cardiovascular risk factors.

[Flaccid paraplegia revealing an adenoma of Conn: a case report]. / Paraplégie flasque révélant un adénome de Conn : à propos d'un cas.

We report the case of Conn's adenoma in a 36-year-old woman, revealed by low extremities weakness. The patient had hypertension at 170/90 mmHg. Her initial potassium level was low i.e., 1.5 mmol/L. The diagnosis, confirmed by hormonal investigation, showed an elevation of plasma aldosterone and lower plasma renin activity. Abdominal MRI revealed a lesion in left adrenal gland, measuring 1.8 cm in diameter and taking contrast in periphery, compatible with an adrenal adenoma. The patient underwent a left laparoscopic adrenalectomy and microscopic examination confirmed the diagnosis. The postoperative course was uneventful with normalization of serum potassium level and blood pressure.

[Ischemic cardiomyopathy in Lome: epidemiologic aspects and risk factors (study of 461 cases)]. / Les cardiopathies ischemiques (CI) à Lomé: aspects épidémiologiques et facteurs de risque (etude de 461 cas).

UNLABELLED: According to the WHO, cardiovascular disease such as arterial hypertension and ischemic heart disease will be the main non-communicable diseases in developing countries in the next decades. In Togo, there is no statistic on this disease on this day. Our objectives were to study the epidemiological aspects and to describe the risk factors of this affection in our surroundings. It is about a multicentric transverse study from June 1st, 2004 to May 31, 2007, in 3 sanitary formations of the city of Lomé. RESULTS: The frequency of ischemic heart disease was 11, 46%. There was a feminine predominance with a sex-ratio of 0.71. The average age of the patients was about 55.3 +/- 13.4 years with extremes of 18 and 95 years. The cardiovascular risk factors were: dyslipidaemia (76.9%), hypertension (75.3%), left ventricular hypertrophy (72.8%), abdominal obesity (71.1%), hyperuricemia (50.5%), hyperglycemia (41.9%) of which overt diabetes (29%) and smoking (3%). There was a feminine predominance at the hypertensive and the obese. The women accumulated more modifiable risk factors than the men. The middle risk indication was of 2.34 +/- 0.9 at the men and 2.55 +/- 0.8 at the women. The different clinical forms were: stable angina (71.2%), unstable angina (1.7%) and myocardial infarction (5.2%); silent ischemia represented 21.9%. The antero-septal territory was the more reached in case of myocardial infarction and the antero-lateral territory in case of ischemia. CONCLUSION: A sanitary politic centered on the eviction of the risk factors should help to reduce the prevalence of this affection for a long time in our surroundings.

[Epidemiology and diagnostic circumstances of arterial hypertension in the hospital environment in Kpalime (second largest city in Togo)]. / Epidemiologie et circonstances de decouverte de l'hypertension arterielle (HTA) en Milieu Hospitalier a Kpalime (Ville Secondaire du Togo).

UNLABELLED: Arterial hypertension is a real health problem worldwide. The goal of this survey is to evaluate its prevalence and risk in hospital environment. It was a prospective and multi-centred survey which took place in the cardiology department in Kpalimé hospital from the 4th August 2005 to the 4 th July 2006 then a period of almost ten months. Our survey allowed us count 584 people suffering from hypertension out of 2641 patients which makes a prevalence of 22%. Distribution according to the global sample gave a predominance of 56.3 % for women against 43.7% for men. The age of our patients varied between 20 years and 95 years with an average of 53.4 years +/- 15.02. According to the age the group which was more touched was the one between 46 and 69 years. Distribution according to social and professional segments was dominated by the housewives (27.9%), the civil servants (17.8 %) and the trade men (14.0%). Symptomatology is dominated by a dyspnea during an physical effort (28.8%), signs having no relation with AHT (20.2%) and headache (19.5%). Factors for most frequent risk were: obesity (56.8%), consumption of alcohol (22.1%) and dyslipidemia (13.4%). The rate of morbidity is about 59.5% and the mortality is about 11%. CONCLUSION: AHT in Togo is a real problem of public health. It occurs in the poorest social segments, causing a problem of medical care. The prevention remains the most efficient mean to avoid sickness and should be necessarily based on a real change of attitude by the authorities and the medical staff as the sensibilization of the population.