L'insuffisance cardiaque du patient du troisième age à Bamako: Présentation clinique, thérapeutique et évolution / Heart failure of the elderly in Bamako: Clinical presentation, treatment and evolution

But.Décrire la présentation clinique, les modalités thérapeutiqueset l'évolution de l'insuffisance cardiaque du sujet âgé à Bamako. Méthodologie.Il s'agissait d'une étude rétrospective allant du 1ejanvier 2007 au 30 novembre 2009. Un total de 166 sujets âgés de 60 ans et plus atteints d'IC ont été recrutés parmi 1300 malades hospitalisés en cardiologie au CHU du Point G à Bamako. Résultats.La prévalence hospitalière était de 12,8%. Le sex-ratio était de 1,72 en faveur des hommes. La tranche d'âge la plus touchée était celle de 60-69 (48,2 %). Outre l'âge avancé et la ménopause (pour les femmes), les facteurs de risque cardiovasculaire (FRCV) ci-après ont été retrouvés: l'hypertension artérielle (49,4%), le tabagisme(34,3%), le diabète (9,0%), l'obésité (7,2%) et l'alcoolisme(5,4%). La dyspnée était sévère,aux stades III de la NYHAdans 11,8%des cas et IV dans 83 %des cas. Le groupe nosologique le plus important était l'insuffisance cardiaque globale (66,1%), suivi de l'insuffisance cardiaque gauche (27,1%) et l'insuffisance cardiaque droite (7,8%). La fraction d'éjection était conservée chez 59 % des patients. Les causes identifiéesétaient hypertensives (38,6%), primitives(15,7%), ischémiques(14,5%), rythmiques(9,6%) et le cœur pulmonaire chronique(7,8%). Le traitement était le plus souvent classique. Le taux delétalité hospitalière était de10, 2%. Conclusion.L'IC du sujet âgé atteintle plus souvent les hommes. L'HTA et le tabagismesont les FRCV les plusfréquents. L'IC est en règle globale ou gauche. Les principales étiologies sont l'hypertension artérielle, la cardiomyopathie primitive et la cardiopathie ischémique. Le taux de mortalité hospitalière est de 10.2%. Le suivi régulier, l'éducation et une meilleure observance thérapeutique pourraient améliorer laqualité de vie et réduire la mortalité.

Purpose. To describe the clinical presentation, therapeutic modalities and evolution of heart failure (HF) in elderly subjects in Bamako. Methodology. This was a retrospective study from January 1, 2007 to November 30, 2009. A total of 166 subjects aged 60 and over with heart failure were recruited from 1300 inpatients at the cardiology department of CHU du Point G in Bamako. Results. In-hospital prevalence was 12.8%. The sex ratio was 1.72 in favor of men. The age group most affected was 60-69 (48.2%). In addition to advanced age and menopause (for women), the following cardiovascular risk factors (CVRFs) were found: arterial hypertension (49.4%), smoking (34.3%), diabetes (9.0%), obesity (7.2%) and alcoholism (5.4%). Dyspnea was severe, NYHA stage III in 11.8% of cases and stage IV in 83%. The largest nosological group was congestive heart failure (66.1%), followed by left heart failure (27.1%) and right heart failure (7.8%). Ejection fraction was preserved in 59% of patients. The causes identified were hypertensive (38.6%), primary (15.7%), ischemic (14.5%), rhythmic (9.6%) and chronic pulmonary heart disease (7.8%). Treatment was usually conventional.The hospital case-fatality rate was 10.2%. Conclusion. HFin the elderly most often affects men. Hypertension and smoking are the most frequent CVRFs. HFis usually global or left-sided. The main etiologies are arterial hypertension, primary cardiomyopathy and ischemic heart disease. The in-hospital mortality rate is 10.2%. Regular follow-up, education and better compliance with treatment could improve quality of life and reduce mortality

[Sexual abuse: epidemiological, clinical aspects and management at gynaecological and obstetrical department of Dakar University Hospital]. / Profil épidémioclinique et prise en charge des victimes d'abus sexuels à la clinique gynécologique et obstétricale du CHU de Dakar.

OBJECTIVES: To carry out the epidemiological and clinical characteristics of supposed victims of sexual abuse and to evaluate case management. PATIENTS AND METHODS: A prospective study was conducted about cases of presumed sexual abuse received at the gynaecological and obstetrical clinic department of Aristide-le-Dantec hospital from January 2003 to May 2005. RESULTS: A total of 55 cases were reported and represented 0.4% of admissions in the clinic during the period of study. Twenty percent of them (20%) were referred on judicial requisition. The mean time between sexual abuse and consultation was 15 days. Victims were 14 years old in average, nulligeste in 96.5% of cases and living in the suburban area of Dakar. The presumed "violenter" was a man of 32 years, belonging to the environment of the victim in 70% of cases (spiritual guide, joint-tenant, friend of the family...). The type of sexual assault was an unprotected genito-genital intercourse in 67.3% of cases. On the clinical plan, 70.9% of patients suffered recent genital traumatism, 54.5% genital examination showed hymeneal lesions. The HIV test was positive in two cases. During the follow-up of the patients, three pregnancies occurred and for only 9.1%, a psychological assistance was proposed. CONCLUSION: Sexual abuses represent a current sociocultural issue. Prevention required large information campaign. Early management is necessary in order to prevent the sexual transmitted diseases and psychological side effects.

[Threatened preterm labour: assessment of its management at the Dakar University Teaching Hospital]. / Evaluation de la prise en charge des menaces d'accouchement prématuré au CHU de Dakar.

The objective is to specify epidemiological profile of pre term labour birth and evaluate the efficiency of the tocolysis protocol of Dakar University Teaching Hospital. It's a retrospective study which included 155 cases of spontaneous premature birth registered from January 1st 2000 to December 31 2002 in obstetrician clinic. The incidence is 15 per 1000 childbirth. The epidemiological profiles on a pauciparous woman (mean age: 25 years), of low economic and social level (90%), admitted with a bad antenatal follow-up and a pathology associated with pregnancy dominated by arterial hypertension (25%). The mean age of gestation is 30 weeks; severe forms are prevalent and tocolysis score of Baumgarten is equal or higher than 4 in 71.6%. The three principal etiologists are toxaemia, premature rupture of membranes and infections. An association Salbutamol-Phloroglucinol is carried out in 28 cases (18%) or with Phloroglucinol in 25 cases (16.1%). In summary, 138 patients (89%) were finally confined by low way after 5 hours a median time. Perinatal mortality was 347.2 per 1000; it's related to the large premature ones particularly having a weight of birth less than or equal to 1300 grams (78%). The threats of pre term labour are often diagnosed tardily. The access to the tocolysis in emergency is limited and it's effectiveness practises very weak. Use of calcic inhibitors and the systematisation of corticotherapy should improve the forecast of prematurity.