Hyperglycémie de stress: prévalence et impact sur la mortalité intra hospitalière au cours des accidents vasculaires cérébraux ischémiques à la phase aigue au Centre Hospitalier Universitaire Yalgado Ouédraogo, Burkina Faso / Stress hyperglycemia: Prevalence and impact on intra-hospital mortality during ischemic strokes in the acute phase at the Yalgado Ouédraogo University Hospital, Burkina Faso

Contexte et objectif. L'hyperglycémie de stress est fréquente et délétère à la phase aigüe de l'accident vasculaire cérébral ischémique. L'objectif de la présente étude était de déterminer la prévalence de l'hyperglycémie de stress à la phase aigüe de l'AVCI et d'analyser son impact sur la mortalité intra hospitalière Méthodes. Il s'est agi d'une série retrospective de cas qui s'est déroulée du 1er janvier 2021 au 31 Décembre 2022 dans les services des urgences médicales et de Neurologie du Centre hospitalier Yalgado Ouédraogo. Les patients non diabétiques de plus de 15 ans hospitalisés pour un AVCI confirmé par une imagerie cérébrale et ayant une hyperglycémie avec une hémoglobine glyquée normale ont été inclus. Résultats. La prévalence de l'hyperglycémie de stress était de 37,8 %. L'âge moyen était de 59,98 ± 15,9 ans avec des extrêmes de 20 et 98 ans. Le sex-ratio M/F était de 1,12/1. Les facteurs de risque vasculaire les plus fréquents étaient l'hypertension artérielle (54,1 %), la sédentarité (20,3 %) et l'antécédent personnel d'AVC (11 %). Le taux moyen de l'hyperglycémie était de 8,8 ± 2,2mmol/l avec des extrêmes de 7,0 à 15,3 mmol/l. La mortalité intra hospitalière était de 13,37 %. L'hyperglycémie à l'admission ≥ 7mmol/l (p= 0,0027) la température ≥ 38,5° à l'admission (p= 0,0107) et l'insuffisance cardiaque (p= 0,0045) ont émergé comme prédicteurs indépendants de la mortalité intra-hospitalière. Conclusion. L'hyperglycémie de stress est associée à un mauvais pronostic au cours de la phase aigüe des AVCI d'où la nécessité d'un monitorage de la glycémie et d'une prise en charge adaptée

Context and objective. Neonatal jaundice is a common symptom. The objective of the present study was to update the epidemiological profile and identify the factors associated with neonatal jaundice in sick newborns. Methods. A descriptive cross-sectional study was conducted from June 2022 to April 2023 at the Kinshasa University Hospital. The study included sick newborns who presented with mucocutaneous jaundice. Sociodemographic, perinatal, clinical and paraclinical variables were sought. Results. Out of 152 sick newborns, 102 (67.1 %) cases of jaundice were identified. Fullterm newborns (72.5 %), born vaginally (67.6 %) and whose mothers had presented with urogenital infections (98 %) and blood group O (53 %) rhesus positive (97.1 %) were the most represented. Jaundice appeared in the first week of life (85.3 %). Baseline total serum bilirubin was between 10 and 15 mmol/L (57.8 %). The infectious origin was noted in 85 % of cases (Klebsiella pneumoniae in 50 % of cases). Conventional phototherapy was used in 74.5 %. Vaginal delivery was the only associated factor (p=0.001). Conclusion. Neonatal jaundice is common in sick newborns. The infectious etiology must be systematically sought. Appropriate management helps reduce the occurrence of neurosensory after effects.

Post-stroke Complications and Mortality in Burkinabè Hospitals: Relationships with Deglutition Disorders and Nutritional Status.

Stroke frequently causes deglutition disorders, leading to a decline in nutritional status and complications, and increasing mortality. Sub-Saharan data are scarce. The objectives of this study were to assess complications and mortality among hospitalized patients in Burkina Faso during the first two weeks after stroke, and to investigate associated factors. Patients with stroke were followed prospectively in Ouagadougou and Bobo-Dioulasso hospitals. Deglutition disorders and nutritional parameters were assessed at baseline (D0) and on Days 8 (D8) and 14 (D14). Complications and mortality were recorded up to D14. Factors associated with complications and mortality were investigated using multivariate analysis. Of the 222 patients included, 81.5% developed at least one complication, and mortality was 17.1%. At D0, D8, and D14, the rate of deglutition disorders was 37.4%, 28.4%, and 15.8%, respectively, and that of undernourishment 25.2%, 29.4%, and 31.0%, respectively. In multivariate analysis, only the presence of deglutition disorders was a risk factor for developing at least one complication (OR = 5.47, 95% CI 1.81-16.51). Factors predicting death were the presence of deglutition disorders at D0 (OR = 7.19, 95% CI 3.10-16.66), and at least one seizure during follow-up (OR = 3.69, 95% CI 1.63-8.36). After stroke, the rates of complications, death, and undernourishment were high compared to Western countries. Prevention and management of deglutition disorders, and specific follow-up of patients with seizures could reduce post-stroke mortality.

[Anxiety and depression during chronic renal failure before end stage at the University hospital center Yalgado Ouedraogo of Ouagadougou (Burkina Faso)]. / Anxiété et dépression au cours de l'insuffisance rénale chronique avant le stade terminal au centre hospitalier universitaire Yalgado Ouédraogo de Ouagadougou (Burkina Faso).

AIM: We wanted to know the prevalence of depression and anxiety, as well as the associated factors in patients with chronic renal failure in Burkina Faso. PATIENTS AND METHODS: This was an analytical cross-sectional study conducted from February to May 2016. We included all adult patients with moderate or severe chronic renal failure. The diagnosis of anxiety and depression was made using the Hamilton scales. Identification of factors associated with both conditions required bi- and multivariate analyzes. RESULTS: The study involved 191 patients, with a mean age of 53.2±14.2 years and a sex ratio of 1.4. The prevalence of anxiety and depression was 42.4% and 66.5%, respectively. In 37.7% of cases, both anxiety and depression were noted. The mean age was 52.2±13.1 years for anxious patients and 53.5±13.3 years for the depressed. After multivariate analysis, female sex (odds ratio 2.2; adjusted P=0.014) was significantly associated with anxiety, and anxiety itself at depression (odds ratio 7.5; adjusted P<0.001). CONCLUSION: Anxiety and depression are very common during moderate or severe chronic renal failure in Burkina Faso. In view of their potentially serious consequences, there is a definite interest in their early detection by the nephrologist, especially in the female patient, and for early management.

[Hemorrhagic rupture of a giant arteriovenous malformation in a young man in Ouagadougou]. / Rupture hémorragique d'une malformation arterioveineuse géante hez un sujet jeune à Ouagadougou.

Vascular arteriovenous malformations (VAM) are aggressive vascular diseases associated with increased haemorrhagic risk in terms of morbidity and mortality. Vascular arteriovenous malformations are usually sporadic. The main symptom of VAM is hemorrhage, in 50% of cases. We here report the case of a 28 year old patient, hospitalized with right sided motor deficit of acute onset associated with consciousness disorder in the Department of Neurology at the Yalgado Ouédraogo University Hospital Center. The patient had a history of chronic headaches treated with self-medication and of right Bravais-Jacksonian seizures. Neurological examination, performed on admission, showed proportional right hemiplegia, Broca's aphasia, left eye pain associated with ptosis, left chemosis and febrile meningeal syndrome with a temperature at 40°C. On admission the NIHSS score was 21/42 and the ICH score was 2. Emergency cerebral CT scan showed cerebral hemorrhage in the basal ganglia and in the brainstem, intra-ventricular flood and basal cisterns. Blood count showed leukocytosis at 13 200/mm3 with granulocytic predominance (72.6%). Chest X-ray showed right alveolar pneumopathy. Tuberculin intradermal reaction (IDR) was positive to 17mm. Cerebral angioscanner, performed on day 24, showed arteriovenous malformation of the middle cerebral arteries and of the posterior vertebral arteries as well as thrombosis of the cavernous sinuses.

Therapeutic route of patients at the acute phase of their stroke in Burkina Faso.

INTRODUCTION: The advent of the neurovascular units and thrombolysis has improved support for stroke in developed countries. Our objective was to study the therapeutic route of stroke patients in Burkina Faso, a country with limited resources. METHODS: It was a prospective cohort study over a period of 4months, from February 02, 2014 to June 05, 2014, in medical emergencies and Neurology department of the teaching hospital Yalgado Ouedraogo. The study focused on patients diagnosed with stroke through brain imaging when they first entered hospital or during hospitalization. Variables of the study included socio-demographic data of the patients, route of the patients, nature of the stroke, treatment and clinical course. RESULTS: The time between the onset of clinical signs and the first contact with a peripheral public health unit extended from 30min to 24h with an average of 6h and 56min. The minimum time between the first contact with a peripheral public health unit and medical emergencies of the Teaching Hospital Yalgado Ouédraogo was 15min, and the maximum, two weeks. After their arrival in medical emergencies, patients spent on average 21h and 18min to achieve the cerebral CT scan. Concerning the treatment, the thrombolysis, which was not available yet, had never been prescribed, while 19% of patients were eligible according to the 4h30mn period criteria. CONCLUSION: Our study shows that the long delay in the access of neurological expertise is, in most cases, related to the therapeutic route of patients. Thus, the setting-up of a stroke sector would improve the management and the prognosis of cases in Burkina Faso.

Post-stroke epilepsy in Burkina Faso (West Africa).

Post-stroke epilepsy (PSE) is defined as "recurrent seizures following stroke with confirmed diagnosis of epilepsy". Our objective was to describe the epidemiological, clinical and therapeutic PSE aspects at the Yalgado Ouedraogo Teaching Hospital, the main reference centre for neurological conditions in Burkina Faso. We conducted a retrospective study from January 2006 to December 2014. The data on thirty-two (32) cases of PSE was collected from a total of 1616 patients hospitalized for stroke, representing a rate of 1.98%. The patients' ages ranged from 25 to 77years old with a mean age of 58±10.39. There were 21 men and 11 women, with a gender ratio of 1.9. The time of occurrence of PSE ranged between 10 and 3600days (10years). The brain CT scan helped distinguish the different subtypes of stroke. Sixty-four percent (64%) of the cases experienced ischemic stroke and 36% of the cases cerebral hemorrhage. With regard to medical treatment, 23 patients received monotherapy, and 4 patients dual therapy. Exactly 96.87% of seizures were stabilized during the hospitalization period. PSE is a symptomatic type of epilepsy occurring during stroke sequelae. It is important not to lose sight of this before the occurrence of any focal or generalized seizure after a stroke.

[Factors associated with depressive symptoms in chronic hemodialysis patients of centre hospitalier universitaire Yalgado Ouédraogo (Burkina Faso)]. / Facteurs associés à la symptomatologie dépressive chez les patients hémodialysés chroniques du centre hospitalier universitaire Yalgado Ouédraogo (Burkina Faso).

OBJECTIVE: To determine the factors associated with depressive symptoms in chronic hemodialysis patients at centre hospitalier universitaire Yalgado Ouédraogo de Ouagadougou (CHU-YO). PATIENTS AND METHODS: The study was cross sectional and descriptive, from June 2nd to July 30th, 2014. We included chronic hemodialysis patients of CHU-YO. The frequency of hemodialysis sessions was of every four to five days. The French version of Hamilton depression psychometric scale was used to assess depressive symptoms. The factors associated with depression were identified after descriptive and explanatory analysis. RESULTS: Depressive symptoms were identified in 140 of the 162 patients included in the study, or a prevalence of 86.4%. The average age of the 140 patients was 38.9±12.9years. In bivariate analysis, the risk of having depressive symptoms was 1.5 times for women, 1.7 times for patients with severe anemia, 1.5 times for hemodialysis catheter holders, 1.8 both in case of duration in hemodialysis less than six months. In multivariate analysis, gender and duration in hemodialysis were factors associated with the occurrence of depressive symptomatology. CONCLUSION: Our study confirms the high frequency of depressive symptoms in patients on hemodialysis. To improve the overall care of hemodialysis patients, we suggest routine screening for depressive symptoms and specific support.