Anevrisme du ventricule gauche associe a une infection par le VIH chez un enfant de 13 ans

Contexte. Les anevrismes ventriculaires sont rares chez les enfants; et les theories concernant les facteurs etiologiques varient. Les objectifs. etaient de decrire l'experience d'un cas clinique et discuter les particularites de cette pathologie diagnostiquee chez un enfant infecte par le VIh. Patient et Methode. Il s'agit d'une etude prospective d'un anevrisme du ventricule gauche associe a une infection par le VIh1 chez un enfant de 13 ans a l'institut de cardiologie d'Abidjan. Resultats. Il s'agissait d'un enfant de 13 ans; de sexe masculin qui consultait pour une douleur thoracique associee a des palpitations puis une dyspnee d'effort. Le tableau clinique etait celui d'une douleur precordiale. L'electrocardiogramme a objective une hypertrophie ventriculaire gauche. L'echocardiographie Doppler objectivait un large anevrisme du ventricule gauche. L'indication d'une cure chirurgicale a ete retenue. Le bilan biologique preoperatoire a objective une serologie retrovirale positive pour le VIh 1. Ce patient n'a pas encore ete opere du fait de l'absence de couverture sociale. Il a ete traite avec de l'aspirine. Conclusion. Cette association; anevrisme du ventricule gauche et infection a VIh; est certes rare chez l'enfant mais avec la persistance de l'endemie VIh/SIDA dans notre milieu ; on pourrait en decouvrir d'avantage si les explorations en cardiologie sont vulgarisees

[Acute rheumatic carditis in Ivory Coast: changes in prevalence during the decade 2000-2009]. / Cardites rhumatismales en Côte d'Ivoire : évolution de la prévalence hospitalière durant la décennie 2000-2009.

BACKGROUND: Rheumatic fever and acute rheumatic carditis (ARC), though now rare in developed countries, are the main cause of acquired heart disease in children and young adults and remain endemic in developing countries. This study aims to establish the current prevalence of ARC in Ivory Coast. PATIENTS AND METHODS: A cross-sectional retrospective study was performed between January 2000 and December 2009 in the pediatric wards of the three university hospitals in Abidjan and in the Institute of Cardiology of Abidjan. It included all patients whose final diagnosis was ARC. RESULTS: There were 126 patients of which 57.1% were female. The mean age was 15 ± 6.7 years (range: 4 to 28 years). The average annual prevalence was 12.6 cases, with two peaks observed during the years 2004 (27 cases) and 2005 (20 cases). The hospital prevalence of ARC in the 10-year period was 1.1‰ which is less than in previous decades. The principal presentation leading to discovery of the ARC was heart failure (68.9%). This symptom was due to significant valvular regurgitation with dilatation of the cardiac chambers observed in 65.9%. Mitral regurgitation was the main lesion observed (87.3%). Apart from the cases of isolated pericarditis and three cases of mild mitral regurgitation, all other patients were suffering from valvular lesions as a result of previous rheumatic fever. CONCLUSION: A decrease in the hospital prevalence of ARC was observed. However the cases that were seen were diagnosed late and had a tendency to be severe.

[Prevalence of obesity in school children in Ivory Coast]. / Prévalence de l'obésité en milieu scolaire en Côte d'Ivoire.

BACKGROUND: According to the World Health Organization, an increased prevalence of hypertension in children is observed since several years due to an epidemic of childhood obesity. What is the extent of this epidemic in our African context? METHOD: We conducted a prospective descriptive study of pupils encountered in primary and secondary schools of the district of Abidjan from May 3 to June 1st 2010. A sample of 2038 pupils aged 6 to 18 years was randomly selected. Overweight in pupils was assessed by body mass index (BMI). RESULTS: There were 1182 girls (58%) and 856 boys (42%) whose average age was 12.7±3.6 years. The average weight was 42.6kg±16 (range 14.6 to 106.2kg), the average size was 1.48m±0.19 (range 1 to 1.95m). BMI was 17.2kg/m(2)±3.7 (range 14.6-35.7). The prevalence of obesity was of 5%. In addition, 4% of the students were overweight, 39% extremely thin, 25% thin and 27% normal. Obesity was more common in girls (6.8%) than boys (1.8%). The prevalence of obesity in hypertensives was 16%. BMI influenced the systolic and diastolic blood pressure in both sexes (P<0.001 in both cases). CONCLUSION: Childhood obesity exists in a country like the Ivory Coast where wealthness is far from generalized. A well-organized management of childhood obesity is necessary to avoid complications such as hypertension.

[Infective endocarditis complicating patent ductus arteriosus: emergency surgical treatment of two cases]. / Endocardite infectieuse compliquant une persistance du canal artériel et opérée en urgence : à propos de deux observations.

Infective endocarditis is a rare complication of patent ductus arteriosus nowadays. About two patients, aged 7 and 5 years old, we diagnosed and treated a patent ductus arteriosus complicated with an infective vegetative endocarditis with a risk of pulmonary embolism. We report in this observation this clinical and surgical experience.

Management of hypertension in the elderly patient at abidjan cardiology institute (ivory coast).

Background. Since the treatment of hypertension is beneficial for the elderly, we have undertaken this study that aims to evaluate the management of hypertension in elderly patient in Côte d'Ivoire. Methods. A retrospective study was conducted among 854 hypertensive elderly patients of Abidjan Cardiology Institute who were followed for a minimum of one year, between January 2000 and December 2009. Results. The patients mean age was 73.1 ± 5.3 years, and 59% were women. At the first presentation, it was mostly systolic-diastolic hypertension (51.8%) and isolated systolic hypertension (38.5%). Mean blood pressure was 169.4 ± 28.4 mmHg for systolic, 95.3 ± 15.7 mmHg for diastolic, and 74.1 ± 22.8 mmHg for pulse pressure. Pulse pressure was ≥60 mmHg in 80.4%. According to the European Guidelines stratification of the cardiovascular risk-excess attributable to high blood pressure, 82.1% of the sample had a very high added risk. The pharmacological therapy was prescribed in 93.5%. More than 66% of patients were receiving ≥2 antihypertensive drugs including fixed-dose combination drugs. The most common agents used were diuretics (63.5%) followed by angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in 61.3%. The most common agents used for monotherapy were calcium antagonists. When ≥2 drugs were used, diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were the most common. Blood pressure control was achieved in 42.6%. Conclusion. The control of elderly hypertension can be effective in Sub-Saharan Africa. He required at least two antihypertensive drugs to meet the recommended blood pressure target.

[Tuberculous pleural effusion and HIV infection at the pulmonary disease clinic in Abidjan, Ivory Coast]. / Pleurésies tuberculeuses et infection à VIH en milieu pneumologique à Abidjan, Côte d'Ivoire.

Clinical, radiographic, biological, histological and pathological data from thirty HIV-infected patients with tuberculous pleural effusion were prospectively collected at the pulmonary disease clinic at the University teaching hospital of Treichville in Abidjan from April to December 1999. Patients mean age was 35 years, ranging from 16 to 79. The white cell count in the serous effusion pleural fluid was high with predominant lymphocytes. Microscopy examination of the aspirate did not show AFB. The Tuberculin Skin Test remained negative for 16 patients (53%). Multiple pleural biopsies showed typical tuberculous follicles in 19 patients (63%) and a non-typical inflammatory reactions in eleven patients (37%).