[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.

[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.

[Diagnostic approach and treatment of hypertension in healthcare workers in Abidjan's district (Ivory Coast)]. / Approche diagnostique et prise en charge de l'hypertension artérielle chez le personnel soignant du district d'Abidjan (Côte d'Ivoire).

BACKGROUND: Epidemiological data concerning hypertension among health care workers are scarce. PURPOSE: The aim of this study was to assess the diagnostic process and treatment of hypertension among a healthcare worker population in order to improve treatment. METHODS: This was a prospective study including 821 healthcare workers from Abidjan's publics hospitals. There were 208 medical doctors, 464 nurses and 149 assistant nurses. There were 59% women, 41% men. The mean age was 42.9 years. RESULTS: The prevalence of hypertension was 17.5%: 48.1% among teaching medical doctors, 13.6% in the group of other medical doctors, 14.9% in the nurses group and 18.8% in the assistant nurse group. After recruitment as a healthcare worker, 86.9% of the cases of hypertension were diagnosed. When hypertension was diagnosed, 74.3% had presented symptoms. The disease was diagnosed by a physician in 77.8% of cases and by a nurse in 22%. In many cases (67.8%), the follow-up was done by a cardiologist; 15.7% by general practitioners. However, 10.7% of the healthcare workers with hypertension had no medical follow-up. Single-drug treatment was most commonly used (49.7%); 36.4% were taking two drugs. Poor compliance with treatment was noted in 71.1% of he healthcare workers with hypertension (clearly poor compliance for 40.5% and problems with compliance for 30.6%). Among those with clearly poor compliance, 29% had stopped taking their medication and seven individuals had declined taking any medication. Poor compliance was most commonly observed among assistant nurses (52.9%) and nurses (42.6%). People taking a combination of two or three drugs complied better with their treatment.

Arterial thrombosis in patients with human immunodeficiency virus: two-case reports and review of the literature.

Thrombosis during HIV infection was commonly vein thrombosis. Arterial thrombosis is also more and more described. We report two cases detected in the Abidjan Cardiology Institute. Case Reports. Case 1: an HIV infected female presented with sudden loss of consciousness and right hemiplegia. She had been taking HAART regimen for five years. Neck vessels ultrasonography revealed thrombosis on left ICA. Anticoagulant treatment leads to reduction of symptoms and left ICA partial recanalization. Case 2: male HIV infected taking HAART therapy was admitted for an acute pain of left lower limb; examination showed a decrease of heat, sensitivity, and mobility of this limb with popliteal and tibial pulses abolished. Arterial ultrasonography and CT angiography showed occlusion on the lower third of superficial femoral artery and homolateral popliteal artery suggesting a thrombosis of this artery. He underwent a femorotibial bypass surgery and anticoagulant treatment. The outcome was good with reappearance of local heat of the limb and tibial pulses. Probable etiology is early carotid atherosclerosis associated with protein S deficiency in the first case and antiphospholipid syndrome in the second case. Conclusion. Arterial thrombosis might occur in HIV infection. Several etiological factors could be involved in the pathogeny of these arterial thromboses.