[Pericardial effusion with pretamponade leading to diagnosis of hypothyroidism: two cases in Congo]. / Epanchement péricardique en pré-tamponnade révélant une hypothyroïdie: deux observations au Congo.

The purpose of this report is to describe two cases of pericardial effusion with pre-tamponade leading to diagnosis of underlying hypothyroidism. Both patients were women with large longstanding pericardial effusion. The first patient was 47-years-old and the second was 46. Diagnosis of hypothyroidism, whose clinical features were equivocal in the first case case and frank in the second, was confirmed by hormone tests. Treatment consisted of pericardial drainage and hormone replacement therapy with increasing doses. Outcome was favorable in both cases with restoration of euthyroidism. Clinical status was satisfactory in both cases with a follow-up of five months in the first patient and three months in the second. Pericardial effusion with pretamponade is an exceptional complication of prolonged hypothyroidism that should be considered in patients presenting with large longstanding but well tolerated pericardial effusion with no evidence of infection or inflammation.

[Heart failure in elderly patients in Brazzaville, Congo: clinical and etiologic aspects and outcome]. / Insuffisance cardiaque du sujet âgé à Brazzaville: aspects cliniques, étiologiques et évolutifs.

The aim of the study is to report clinical, etiologic aspects and the outcome of heart failure in elderly hospital patients treated in Brazzaville, Congo. This retrospective study was carried out over a 20-month period from January 1, 2005 to August 31, 2006. In addition to age over 60 years, the main inclusion criteria was diagnosis of heart failure based on clinical, radiological, electrocardiographic, and echocardiographic evidence. A total of 223 patients, i.e., 50.0% of 446 patients over the age of 60 years evaluated, were included in the study. There were 125 women (56.1%) and 98 men (43.9%) (p = 0.0105). Mean age in the overall population was 70.4 +/- 6.2 years (range, 60 to 100 years). Heart failure was global in 148 cases (66.4%), left sided in 49 (22.0%), and right sided in 26 (11.6%). Left ventricular dysfunction was systolic in 93 cases (47.2%) and diastolic in 83 (42.1%) (p = 0.31). Underlying causes were hypertension in 77 cases (34.5%), coronary disease in 57 (25.6%), valvulopathy in 21 (9.4%), and myocardiopathy in 17 (7.6%). Chronic pulmonary heart disease was diagnosed in 25 cases (11.2%). Other cardiac diseases were found in 8 cases (3.6%). All patients underwent medical treatment. Thrombolytics were not used in cases involving myocardial infarction. The death rate was 20.2% (n = 45), i.e., 12 cases involving hypertensive cardiopathy, 8 involving coronary artery disease, 3 involving valvular cardiopathy, and 5 involving chronic pulmonary heart disease. The type of cardiopathy was undetermined in 17 cases. Heart failure is common in the elderly. Prevention depends on reducing cardiovascular risk factors especially arterial hypertension.

[Rheumatic heart disease in schoolchildren in Brazzaville]. / Les Cardiopathies rhumatismales en milieu scolaire à Brazzaville.

The purpose of this study is to screen for rheumatic heart disease as a basis for treatment of the disease and determination of its prevalence in schoolchildren in Brazzaville, Congo. Surveying was conducted in 4 schools located in suburban districts of Brazzaville from May to June 2005. A cohort of 2250 school children was enrolled by random sampling at 3 levels. Age ranged from 5 to 17 years. The variables recorded were age, sex, socioeconomic status, clinical features, and laboratory findings. Clinical selection was based on cardiac auscultation. Data analysis was performed using the Epi Data 3.1 and Stata 8.2 software packages (differences being considered as significant at p< 0.05). A total of 2232 children underwent testing including 1900 from public schools (boys, 47.5%; girls, 52.5%) and 332 from private schools (boys, 47.3%; girls, 52.7%) (p>0.05). The prevalence of rheumatic heart disease was 3,5 per thousand overall, 3.6 per thousand in children in the low socioeconomic status group, and 3 per thousand in the high socioeconomic status group (p<0.05). The ages of children presenting valvular cardiopathy ranged from 7 and 16-years-old and 75% lived in overcrowded dwellings. One or more previous episodes of strep throat were noted in all cases and had not been treated in 7 out of 8 cases. Valvular disease was significantly correlated with history of strep throat, overcrowded living conditions, and low socioeconomic status (p<0,01). Compliance with prophylactic treatment using benzathyn penicillin was 75% after one month of follow-up and 37.5% after three months.

[Value of a mass vaccination campaign: measles cases in the hospital milieu in Brazzaville (Congo)]. / Intérêt d'une campagne de vaccination de masse: cas de la rougeole en milieu hospitalier a Brazzaville (Congo).

In November 1986, Congo got up an immunization for measles of nine to 36 months old infants. The aim of this study was to compare the morbidness and the death rate of measles in a 20 months period before and after November 1986. The infants less than nine months old constituted 57.2% of the patients admitted after November 86 opposed to 19, 5% before November 86. The authors stand out for strategies that will let to immunize 97% of the infants.

[Acquired immunodeficiency syndrome in elderly persons in a tropical zone. Apropos of 175 cases in the Congo]. / Le syndrome d'immunodéficience acquise chez les personnes âgées en zone tropicale. A propos de 175 cas congolais.

The objective of this study has been to estimate the frequency of AIDS occurring in older age groups on the basis of hospital statistics and note the prognostic particularities in these groups. One hundred and seventy five (175) cases of AIDS reported to the University Hospital Center of Brazzaville occurring in persons aged 55 years and over were followed up retrospectively from 1 January 1990 to 31 December 1996. The results of this study indicate that AIDS is not rare in older age groups: 4.7% of all infected subjects registered during the period of study. The sex-ratio was 1.3/1 (99 males and 76 females). The overall mean age was 60.45. Contamination seems to be the most often of heterosexual origin. Many symptoms were found. The most frequent ones were weight loss (100% cases), fever (89.7%), diarrhoea (60.5%), neuro-psychiatric disorders (49.7%), and respiratory manifestations (50.2%). Lethal evolution was rapid, with 74% deaths at the end of the 1st year and 100% at the end of 2nd year, as a consequence of delayed diagnosis as well as the natural development of the disease. The results of this study point to the necessity of prevention strategies which include not only young, but older age groups as well.

[Kawasaki syndrome: apropos of 2 cases observed in Brazzaville]. / Le syndrome de Kawasaki: à propos de deux cas observés à Brazzaville.

The authors report for first time in Congo two cases of Kawasaki syndrome. One case from a five years boy carried out a typical form of an adeno-mucocutaneous syndrome; the other from a six month little girl was an incomplete form. In both cases, the immediate development has been excellent. The scarceness of this syndrome among the blacks and the diagnostic difficulties have been the background of the interest of this work.

[Etiology of oligoarthritis in equatorial Africa. A retrospective study of 80 cases in Brazzaville, Congo]. / Etiologies des oligoarthrites en Afrique équatoriale. Etude rétrospective de 80 cas au Congo-Brazzaville.

PURPOSE: The objective was to determine causes of oligoarthritis in patients hospitalized in a Central Africa teaching hospital. METHODS: We collected case reports of patients presenting with arthritis located in two or three joints. Analysis included the disease frequency, age, gender, and etiology. Etiology was defined according to common criteria used for the diagnosis of rheumatic diseases. RESULTS: Eighty patients (60 males and 20 females; age range: 7-80 years; mean age: 35.6 years) were included in the study. Altogether they represented 5.8% of in-patients and 14.3% of the patients suffering from arthritis. The following causes were observed: HIV-related arthritis, 21 cases (12 males and nine females; mean age: 32.2 years). Arthritis was asymmetrical, acute and non-erosive. Recovery was observed after administration of a non steroidal anti-inflammatory drug for 4-6-weeks. Gout: 17 patients (15 males and two females; mean age: 51.1 years). Gout was related with one or more of the following: alcoholism (16 cases), hypertension (nine cases), and obesity (three cases), and was chronic in 12 patients. Infection-related arthritis: 17 cases (five males and 12 females; mean age 25.3 years). Portal of entry was either cutaneous (five cases) or obstetrical (seven cases). Most of the time, the causative microorganism was Staphylococcus. Rheumatic fever: five patients (four males and one female; mean age 18 years). Juvenile chronic arthritis: three cases (one male and two females; mean age 12.6 years). Reactive arthritis: three cases (three males; mean age: 32). Etiology is still unknown for 14 cases. CONCLUSION: Oligoarthritis appears to be secondary to HIV or bacterial infection in young adults, while gout affects more often the elderly. This study confirms that spondylarthropathy is unusual in Sub-Saharan Africa. Furthermore, it emphasizes the existence of numerous cases in whom etiology of the diseases is unknown.

[Endomyocardial fibrosis: report of 22 Congolese cases]. / La fibrose endomyocardique: à propos de 22 cas congolais.

A study has been made of 22 cases of endomyocardial fibrosis (EMF) observed over a 12-year period. The epidemiological characteristics have been described, and the importance of the echocardiographic findings in the diagnosis of the disease has been emphasized. EMF constitutes 0.3% of the total admissions in the department, 0.9% of the cases of cardiac failure, and 3% of the cases involving subjects under 40 years old. The patient population consisted of 13 men and 9 women with an average age of 35.6 +/- 16.4 years (age range: 8.5-77 years). The diagnosis of EMF was based on clinical, radiological, electrocardiographic, and echocardiographic findings (22 cases), and surgical examination (1 case). In 8 cases, parasitosis (filariasis: the patients came from a known endemic area) with hypereosinophilia was observed. Three of these patients had associated high blood pressure. In 13 subjects, a severe right adiastolic syndrome was noted. Two patients presented with tachycardia, 2 others had signs of overall cardiac failure, and 5 subjects suffered from palpitations connected with arrhythmia. Thoracic X-ray showed cardiomegaly in all cases, lung involvement in 15 cases, normal lungs in 5 cases, and bilateral hilar stasis in 2 cases. Electrocardiography mainly showed endomyocardial fibrosis (15 cases), supraventricular arrhythmia, notably auricular fibrillation (13 cases), and conductive disorders (12 cases), which were frequently associated. Echocardiography showed the presence of EMF in 21 cases (95.5%). Doppler (n = 9 cases) detected tricuspid failure in 9 subjects, and mitral failure in 1 subjects. EMF was exclusively located on the right side in 19 cases, bilateral in 2 cases, and on the left in 1 case, which required surgery. Four patients died (i.e., 1 case of sudden death, 1 case of pulmonary embolism, 1 case of neurological coma, and 1 case of cardiac arrhythmia). The authors, like many others, note the clinical polymorphism of EMF, the predisposition to the disease caused by the presence of helminthiasis, which should be eradicated, the diagnostic value of echocardiography-Doppler, and the efficiency of surgery in the treatment of this condition.

[Aortic dissection among blacks. Report of 6 Congolese cases]. / La dissection aortique chez les Noirs. A propos de six cas congolais.

INTRODUCTION: The authors report on six cases of aortic dissection (AD). The work intended to bring out AD characteristics and attempt to define a profile of African patients who manifested this disease. The diagnosis of AD was determined on the basis of: clinical and radiological criteria (six cases); echocardiographic data (five cases); aortographic and surgical informations (two cases). PATIENTS AND METHODS: There were three males and three females with an average age of 40.2 years, with a variation of +/- 10.6 years (from 17 to 49). The frequency of AD was estimated at 1.8/10,000 admissions considering all causes and 5.4/10,000 for cardiovascular disease. Strain was the only triggering factor--noted in two cases (Observations 2 and 3). All patients suffered from severe arterial hypertension (AHT) of which there was one case of renovascular AHT based on the Takayasu arteritis. All symptoms and physical findings were the same described in literature. Operations were successful on two patients. The four unoperated patients died (tamponade: two cases, undetermined cause: two cases). CONCLUSION: The authors conclude as to the similarity of the AD charts described in the literature. However they stress the almost exclusive role of AHT in African studies series as well as that, in rare cases, of Takayasu's disease. They recommend preventing AD through the sustained and effective treatment of AHT.

[Idiopathic subvalvular aneurysm of the left ventricle. Anatomical, clinical and developmental characteristics. Apropos of 13 cases]. / Anévrismes sous-annulaires idiopathiques du ventricule gauche. Caractères anatomiques, cliniques et évolutifs. A propos de 13 cas.

The authors report 13 cases of idiopathic subvalvular left ventricular aneurysm (ISVLVA), observed over a 7-year period in a total of 29,617 patients (0.04%). They describe the clinical features, results of complementary investigations and clinical course of this disease. The diagnosis was based on angiographic and anatomical findings in 4 cases and on echocardiographic findings in 10 cases. This series consisted of 10 females and 3 males with a mean age of 37.3 +/- 2.1 years (range: 9 to 72 years). Clinical signs consisted of palpitations in 2 cases, angina pectoris in 4 cases, heart failure in 9 cases, and systolic murmur of mitral incompetence in 13 cases. Chest x-rays showed vaulting of the left ventricle in 8 cases (61.5%). ECG showed sinus rhythm in 11 cases, atrial fibrillation in 2 cases, ventricular tachycardia in 1 case and junctional tachycardia in 1 case. The erythrocyte sedimentation rate was raised in 10 cases (76.9%). Complementary examinations revealed ISVLVA, which was often very large, calcified (7 cases), thrombosed (6 cases), situated on the posterolateral surface of the left ventricle, in a mitral subvalvular position (13 cases) and responsible for mitral incompetence (13 cases). The coronary arteries were normal in the 5 cases in which they were studied. No aetiology was found. Complications included death (1 case), heart failure (9 cases) and arrhythmias (3 cases). No systemic embolism was observed. Medical treatment (digoxin, furosemide, antiarrhythmics) was considered to be fairly effective, but insufficient to prevent episodes of heart failure and arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tricuspid infectious endocarditis in Brazzaville. Apropos of 12 cases]. / Endocardites infectieuses tricuspidiennes à Brazzaville. A propos de douze cas.

The authors report their experience of the clinical and echocardiographic aspects and course of tricuspid infectious endocarditis, based upon 12 cases collected between September 1985 and December 1992. The diagnosis was confirmed on the basis of the association of signs of septicemia (12 cases), at least two positive blood cultures for the same organism (9 cases) and well-defined vegetations seen by trans-thoracic echocardiography (12 cases). All patients were young women: mean age = 21.8 +/- 4.7. None were heroin addicts but one was positive for human immune deficiency virus. Tricuspid infectious endocarditis was most often acute (9 cases), primary (10 cases, post-abortum (11 cases), due to Staphylococcus aureus (5 cases), and complicated by cardiac failure (12 cases) and lung abscess (4 cases). Four patients died of septicemia (2 cases), of cardiac failure and lung abscess (2 cases). One had severe tricuspid incompetence requiring surgery. It has not yet been possible to operate on this patient because of the lack of cardiac surgery facilities in Congo. The prevention of tricuspid infectious endocarditis depends above all on the fight against clandestine abortions and against the development of intravenous drug abuse.

[Recovery from exercise in trained smokers]. / Récupération post-exercice chez le sportif fumeur.

AIM: Assess the influence of tobacco on recovery after exercise in sportsmen. METHODS: Sixty-three smokers aged 18-33 years, practising soccer, participated in this study. These subjects belonged to second division congolese league clubs. Heart rate (HR) was studied during recovery of moderate exercise (Ruffer's test), but also recovery index and arterial pressure. Kinetics of the HR was studied for 7 min for recovery. A control group consisted of 50 non smokers, practising soccer at similar level. RESULTS: Smokers showed heart rate values significantly higher (P < 0.001). Non smokers presented a low recovery index. The recovery has generally two components: the first is slow in smokers, while the second is a fast one. However, recovery rate for the smokers was more rapid during the alactic phase. There exists also differences with regards to smoking tobacco dependence: when compared to great smokers, lower smokers exhibited a faster first phase and a slower second phase. These differences were significant. DISCUSSION AND CONCLUSION: The smokers and non smokers differences are discussed with reference to the effects of nicotinemia and carbon monoxide on sympathetic-parasympathetic balance. Cardiovascular changes during exercise have a twofold control: decrease a vagal tone and increase of sympathetic activity. The comparison of smokers and non smokers concerning recovery led to suppose that there exists a difference in regards of the catecholaminergic sensitivity. The problem of thermoregulation must not be neglected during recovery. As smokers are considered, cutaneous thermolysis is perhaps important when these subjects perform exercise in ambient hot air. Here against, it is known that thermolysis mechanisms are not similar in smokers and non smokers. In conclusion, this study showed that smoking tobacco induce a lower physical condition in sportmen. Recovery rate after exercise may function as a predictor of fitness in smokers.

[Infectious endocarditis of gyneco-obstetric origin. Apropos of 15 cases]. / Endocardite infectieuse à porte d'entrée gynéco-obstétricale. A propos de 15 cas.

With the object of analyzing current characteristics of post-partum and post-abortum infective endocarditis (IE), authors carried out a retrospective study of 15 cases between september 1985 and may 1992. Mean age was 22.2 +/- 4.0 years. Origin of sepsis was delivery (1 case), abortion (14 cases). There was no underlying cardiac lesion in 9 cases, rheumatic heart disease in 6 cases. Infecting organisms were Staphylococcus aureus (n = 6), streptococcus D (n = 3), Clostridium perfringens (n = 2). There were 10 acute and 5 subacute IE, 7 right-sided, 7 left-sided, and 1 right and left-sided IE. Vegetations were determined by transthoracic echocardiography in 12 cases (80%). The main complications were heart failure (15 cases), and pulmonary or arterial embolism (7 cases). Lethality was 53.3% and was not different in tricuspid acute IE and left-sided IE. Treatment was the more difficult as cardiac surgery is expensive or even inaccessible. Accordingly, prevention is primordial. It consist of antibiotic prophylaxis and fight against illicit abortion.

[Infectious endocarditis. Experience of a service in Brazzaville. 47 cases]. / Endocardite infectieuse. Expérience d'un Service Brazzavillois. A propos de 47 cas.

The aim of this study was to report the authors' experience of infective endocarditis (IE) from 47 cases collected between 1976 to 1991. Infective endocarditis (IE) was documented with surgical (n = 9), microbiological (n = 26), and echocardiographic (n = 30) criteria. There were 11 male, 36 female: mean age, 26.2 +/- 10.3 years (extremes: 17 and 47). The authors noted a great importance of gynecological portal entry (13 cases), acute infective endocarditis (23 cases i.e. 48.9%), heart failure (39 cases i.e. 82.9%), and pulmonary (4 cases i.e. 8.5%) and systemic (8 cases i.e. 17.0% embolism. Surgical treatment was impossible in Brazzaville. Trans-thoracic echocardiography was performed in 38 cases and revealed vegetations in 30 cases i.e. 78.9%. Twenty patients died (42.5%) because heart failure. There was no significant difference in letality between infective endocarditis treated surgically or no, between native valve or prosthetic valve infective endocarditis, between culture negative or culture positive infective endocarditis (IE). This study corroborate that infective endocarditis is a heavy illness, characterized by high frequency of heart failure. The authors insist upon the prevention of infective endocarditis.

[Ambulatory Electrocardiogram In Stroke Patients At The University Hospital Of Brazzaville: 81 Cases]. / Electocardiogramme Longue Duree chez les Patients Victimes D'Accident Vasculaire Cerebral a Brazzaville: 81 cas.

OBJECTIVE: To assess the value of Holter ECG in the assessment of patients experiencing ischemic stroke. PATIENTS AND METHODS: This was a prospective descriptive study conducted in the Department of Neurology of the University Hospital Center in Brazzaville between June 2011 and June 2012. RESULTS: There were 53 men (63.9%) and 30 women (36.1%), mean age 60.6 ± 12.7 years (range = 20 to 85 years). The average body mass index was of 26.9 ± 4.6 (range = 15.6 and 35.3). Patients were obese in 19 cases (22.8%), overweight in 16 cases (19.2%). Hypertension was found in 44 patients (53%), diabetes mellitus in 14 patients (16.8%), dyslipidemia, smoking, respectively, six (7.2%) and one case. The Holter ECG performed in 81 patients showed: sinus rhythm in 78 cases (96.3%), an average frequency of 79.1 ± 17.6 beats per minute (range = 50 to 163 years), atrial fibrillation in seven cases (8.6%), one case of atrial flutter, supraventricular tachycardia bursts in 14 cases (17.2%), supraventricular extrasystoles in 78 cases (96.3%), 65 cases (80.2%) with doublets and 27 cases (33.3%) with triplets. In 35 cases, there were more than 70 supraventricular extrasystoles per 24 hours. Ventricular extrasystoles were present in 59 cases (72.8%), including 24 cases of doublets (29.6%), 14 cases (17.2%) of bigeminy and three cases of nonsustained ventricular tachycardia. Breaks were significant in both cases. The study of HRV showed a 100.4 ± 45.8 to SDNN ms (range = 20 to 206 ms), 44 patients (54.3%) had impaired heart rate variability in 44 (54.3%). CONCLUSION: The ischemic stroke is a serious life-threatening and functional. Administering a Holter ECG is essential to find a cardioembolic cause, allowing for the most appropriate treatment.

OBJECTIF: Evaluer l'intérêt de l'Holter ECG dans le bilan des patients victimes d'accident vasculaire cérébral ischémique. MÉTHODES ET PATIENTS: c'est une étude prospective et descriptive dans le service de neurologie du centre hospitalier et universitaire de Brazzaville entre juin 2011 et juin 2012. RÉSULTATS: Il s'agissait de 53 hommes (63,9%) et de 30 femmes (36.1%), âgés en moyenne de 60,6±12,7 ans (extrêmes =20 et 85 ans). L'index de masse corporel moyen de 26,9±4,6 (extrêmes =15,6 et 35,3). Les patients étaient obèses dans 19 cas soit 22,8%, en surpoids dans 16 cas soit 19,2%. L'hypertension artérielle était retrouvée chez 44 patients (53%), le diabète sucré chez 14 patients soit (16,8%), la dyslipidémie tabagisme dans respectivement six (7,2%) et un cas. L'Holter ECG réalisé chez 81 patients avait montré: un rythme sinusal dans 78 cas (96,3%), une fréquence moyenne à 79,1±17,6 battements par minute (extrêmes =50 et 163 ans), une fibrillation auriculaire dans sept cas (8,6%), un cas de flutter auriculaire, des salves de tachycardie supraventriculaire dans 14 cas (17,2%), des extrasystoles supraventriculaires dans 78 cas (96,3%) dont 65 cas (80,2%) avec des doublets et 27 cas (33,3%) avec des triplets. Dans 35 cas, il existait plus de 70 extrasystoles supraventriculaires par 24 heures. Les extrasystoles ventriculaires étaient présentes dans 59 cas (72 ,8%) dont 24 cas de doublets (29,6%), 14 cas (17,2%) de bigéminisme et trois cas de tachycardie ventriculaire non soutenue. Les pauses significatives ont été observées dans deux cas. L'étude de la variabilité sinusale avait montré une SDNN à 100,4±45,8 ms (extrêmes =20 et 206 ms), 44 patients (54,3%) avaient une altération de la variabilité sinusale dans 44 cas soit 54,3%. CONCLUSION: L'accident vasculaire cérébral ischémique est une pathologie grave engageant le pronostic vital et fonctionnel. La réalisation d'un Holter ECG est indispensable à la recherche d'une cause cardioembolique permettant l'adaptation thérapeutique.

[Cardiovascular risk factors and echocardiography in patients victims of ischemic stroke in brazzaville: 83 cases]. / Facteurs de risque cardiovasculaire et echographie doppler cardiaque chez les patients victimes d'accident vasculaire cerebral ischemique a brazzaville: 83 cas.

GOAL: Investigate the cardiovascular risk factors and evaluate the usefulness of echocardiography in the assessment ischemic stroke. MATERIALS AND METHODS: Prospective and descriptive study in the neurology department of the teaching hospital of Brazzaville between June 2011 and June 2012, 83 patients enrolled and 55 echocardiograms performed. RESULTS: The risk factors found were: obesity (19, 22.8%), overweight (16, 19.2%), high blood pressure (44, 53%), diabetes (14, 16.8%), dyslipidemia (6, 7.2%), and smoking (2). Left ventricular ejection fraction (LVEF) was 68.5 ± 10.3%. There was a hypokinetic and dilated cardiomyopathy in four cases (7.2%), left ventricular hypertrophy in eight cases (14.5%), left atrial enlargement in 13 cases (23.6%). We have identified a tight mitral stenosis. The diastolic profile was a relaxation-type disorder in 46 patients (83.6%). Echocardiography identified 12 (14.4%) lesions potentially embolic: dilated cardiomyopathy (n = 4), ischemic heart disease (n = 6), tight mitral stenosis (n = 1), acute pulmonary heart post-embolic (n = 1). CONCLUSION: Echocardiography is an essential examination for the investigation of a cardioembolic cause in the assessment of a stroke, enabling therapeutic adaptation..

BUT: Rechercher les facteurs de risque cardiovasculaire et évaluer l'intérêt de l'échocardiographie dans le bilan un accident vasculaire cérébral ischémique. MATÉRIEL ET MÉTHODES: Etude prospective et descriptive dans le service de neurologie du centre hospitalier et universitaire de Brazzaville entre juin 2011 et juin 2012, 83 patients inclus et 55 échocardiographies réalisées. RÉSULTATS: On avait retrouvé comme facteurs de risque: obésité (19; 22,8%), surpoids (16; 19,2%), l'hypertension artérielle (44; 53%), le diabète (14; 16,8%), la dyslipidémie (6; 7,2%) et tabagisme (2). La fraction d'éjection ventriculaire gauche moyenne (FeVG) était de 68,5±10,3%. Il y avait une cardiomyopathie dilatée hypokinétique dans quatre cas (7,2%), une hypertrophie ventriculaire gauche dans huit cas (14,5%), une hypertrophie auriculaire gauche dans 13 cas (23,6%). Nous avons identifié un rétrécissement mitral serré. Le profil diastolique était type trouble de la relaxation chez 46 patients (83,6%). L'échocardiographie a identifiées 12 (14,4%) lésions potentiellement emboligènes: myocardiopathie dilatée (n=4), cardiopathie ischémique (n=6), rétrécissement mitral serré (n=1), cœur pulmonaire aigu post-embolique (n=1). CONCLUSION: L'échocardiographie est un examen indispensable à la recherche d'une cause cardioembolique dans le bilan d'un accident vasculaire cérébral permettant l'adaptation thérapeutique.

[Profile of infective endocarditis at Brazzaville University Hospital]. / Profil de l'endocardite infectieuse au centre hospitalier universitaire de Brazzaville.

The goal of this retrospective study was to analyze the current profile of all 35 consecutive patients with infectious endocarditis seen at Brazzaville University Hospital's department of cardiology and internal medicine from January, 2001, through December, 2009. Infectious endocarditis was diagnosed most often when a heart murmur was associated with septicemia and typical vegetations on echocardiography. During this period, 24 women and 11 men were admitted for infectious endocarditis, accounting for 0.9% of admissions. Their median age was 30.6 ± 12.8 years (range: 15 to 66 years), and 69% were women. The preexisting lesions included rheumatic valvulopathy (9 cases), congenital heart disease (3 cases), and heart disease already treated surgically (3 cases). Among the valvular lesions, mitral regurgitation predominated (24 cases), isolated in 17 cases and associated with aortic regurgitation in 7. There were three cases of pure tricuspid regurgitation. A principal portal of infection was found in 24 patients (69%): oral (11 cases), urinary (7 cases), genital (5 cases), and cutaneous (1 case). A blood culture was performed for 14 patients (40%): seven were positive, four of them for streptococci. Vegetations were observed in 32 cases (91.4%) and mutilating valve lesions in 8 (22.8%). The complications included heart failure in 30 cases (86%) and an embolism in 8 (23%). One relapse was noted. Cardiac surgery was indicated for 13 patients (37%) but could not be performed. The hospital lethality rate was 29%. Infectious endocarditis is a rare disorder that can be life-threatening, especialy in the absence of cardiac surgery. Its prevention, although complex, constitutes the key to management in our setting.

Achieving blood preSsure goals sTudy in uncontrolled hypeRtensive pAtients treated with a fixed-dose combination of ramipriL/hydrochlorothiazide: the ASTRAL study.

BACKGROUND: Hypertension is a common cardiovascular disease, affecting adults worldwide and it accounts for up to 30% of all deaths. The need for better control of arterial hypertension justifies observational studies designed to better understand the real-life management of hypertensive patients. The ASTRAL study was primarily designed to evaluate the percentage of hypertensive patients achieving blood pressure goals after eight weeks of treatment with a fixeddose combination of ramipril/hydrochlorothiazide (HCTZ). METHODS: The study was a multi-centre, non-comparative, Open-label, observational study conducted in 36 centres in five sub-Saharan African countries, namely Cameroon, Congo Brazzaville, Democratic Republic of Congo (DRC), Madagascar and Nigeria. Four hundred and forty-nine men and women 18 years of age or older with hypertension not controlled by an ACE inhibitor, a diuretic or any other monotherapy or anti-hypertensive combination not containing a diuretic in a fixed dose were considered eligible for inclusion in this eight-week study. The study consisted of three visits, visit one (V1) at baseline, visit two (V2) after four weeks and visit three (V3) after eight weeks. RESULTS: The mean age of the patients was 54.7 ± 11.7 years (20-90 years) and most were categorised by the WHO criteria as either overweight or obese (71.6%). After four and eight weeks of treatment with the study drug, systolic and diastolic blood pressures significantly changed from baseline: -24.7/-14.2 mmHg (p < 0.001) and -31.7/-17.9 mmHg (p < 0.001), respectively. There were 60.2% of the non-diabetics on prior monotherapy who, at eight weeks, fulfilled the primary blood pressure goal for SBP and DBP, versus 26.5% of the diabetic patients, also on monotherapy. Few adverse events were reported, with facial oedema and dry cough recurring twice in two patients. CONCLUSION: Fixed-dose combination of ramipril/HCTZ is therefore effective, tolerable and has a good safety profile for blood pressure control in black Africans.

[Loa loa filariasis: cause of severe eosinophilia]. / La filariose a Loa loa: cause d'hyperéosinophilie majeure.

Two cases of very high hypereosinophilia (28,160 and 11,232/mm3) observed in congolese patients are presented. Although microfilaraemia was not detectable, loiasis was diagnosed, given the clinical manifestations, epidemiological data, history of sub-conjunctival migration of the adult worm (in one case), spectacular recovery (clinical and biological) after treatment with diethylcarbamazine. This "allergic form" of filariasis is often considered unusual in indigenous subjects.

[Needle-biopsy of liver in the Brazzaville General Hospital. Results of 42 cases (author's transl)]. / La ponction-biopsie du foie a l'Hôpital Général de Brazzaville. Résultats à propos de quarante-deux cas.

42 needle-biopsies were realized in the two Medicine Departments of the General Hospital, Brazzaville. The authors strike the balance of those biopsies. They show the advantage off the needle-biopsy and histologic study of primary carcinoma of liver.