[Mortality rate in patients with heart failure at the Libreville University Hospital and associated factors]. / Létalité de l'insuffisance cardiaque au Centre Hospitalier Universitaire de Libreville (CHUL) et facteurs associés.

INTRODUCTION: Heart failure (HF) is a frequent cause of death in Africa. This study aims to determine the mortality rate of HF and to highlights its associated factors. METHODS: We conducted a retrospective cross-sectional study in the Department of Cardiology at the Libreville University Hospital. It focused on the analysis of the records of patients hospitalized for left or global HF. Data were collected from January 2014 to December 2016. RESULTS: Fatality rate accounted for 10.3%. The average age of dead patients (n=64) was 57,4 ± 17 years. Mean delay in treatment was 15± 18 days and decompensated heart failure was caused by a treatment gap in 51.4% of died patients. The association between high blood pressure and diabetes significantly increased the risk of death (OR= 2.2 (1,2-6,6)). The factors associated with mortality rate were essentially: arterial hypotension (OR=6.8 (3,2-14,1)), severe renal impairment (OR=3.5 (1,7-7,2)), cardio-thoracic index higher than 0.7 (OR= 54.4(15,3-193,1)), severe alteration in left ventricular ejection fraction (OR= 3.0(1,5-5,9)) and high NT-proBNP levels (OR=3.5(1,2-10,5)). Mortality increased significantly with the number of co-morbidities. Deaths were due to extracardiac complications in 28.4% of cases. CONCLUSION: Heart failure mortality is related to the severity and the precocity of the lesions. Delayed treatment and co-morbidities aggravate mortality. The identification of risk factors and a therapeutic education may reduce mortality in relatively young subjects.

[Mixed connective tissue disease: prevalence and clinical characteristics in African black, study of 7 cases in Gabon and review of the literature]. / La connectivite mixte: prévalence et caractéristiques cliniques chez le noir africain, étude de 7 cas au Gabon et revue de la littérature.

The literature reports that mixed connective tissue disease seems more frequent in the black population and among Asians. This study aims to determine the prevalence of mixed connective tissue disease (MCTD) among connective tissue disorders and all rheumatologic pathologies in a hospital population in Gabon as well as to describe the clinical features of this disease. We conducted a retrospective study by reviewing the medical records of patients treated for mixed connective tissue disease (Kasukawa criteria) and other entities of connective tissue disorders (ACR criteria) in the Division of Rheumatology at the University Hospital in Libreville between January 2010 and December 2015. For each case of MCTD the parameters studied were articular and extra-articular manifestations, anti-U1RNP antibodies levels, patient's evolution. Over a period of 6 years, data were collected by medical records of 7 patients out of 6050 patients and 67 cases of connective tissue disorders, reflecting a prevalence of 0.11% and 10.44% respectively. the 7 patients were women (100%), with an average age of 39.5 years. Articular manifestations included: polyarthritis, myalgias, chubby fingers and Raynaud's phenomenon in 87.5%, 87.5%, 28.6% and 14% respectively. The 7 patients had high anti-U1RNP antibodies levels, ranging between 5 and 35N (N≤ 7 IU). A case of death due to pulmonary arterial hypertension (PAH) was certified. This is the largest case series of MCTD reported in Black Africa. The disease seems to be rare among the black Africans; the reason could be genetic. The demographic and clinical aspects appear similar to those in Caucasians, Asians and Blacks except for a low frequency of Raynaud?s phenomenon among Blacks.