Niveau de connaissance et conceptions d'une population urbaine au sud du Bénin sur les accidents vasculaires cérebraux / NA

Une meilleure connaissance sur les accidents vasculaires cérébraux (AVC) pourrait en améliorer la prévention. Objectif : Etudier le niveau de connaissance (NC) et la conception des sujets adultes de la ville de Cotonou, sur les AVC. Méthodologie : Il s'agit d'une étude transversale à visée descriptive et analytique, menée du 10 janvier au 27 avril 2018. L'échantillonnage était en grappes, ayant porté sur les sujets sans trouble psychiatrique connu, non professionnels de la santé et consentants à participer à l'étude dans cinq quartiers chacun de quatre arrondissements tirés au sort parmi les treize de la ville de Cotonou. Des propositions de réponses leur ont été faites concernant la définition, les manifestations, les facteurs de risque, la prévention, le traitement et le pronostic de l'AVC. De ces réponses aux questions, le NC des sujets a été catégorisé. Résultats : Il s'agissait de sujets scolarisés jusqu'au niveau universitaire (85,25%). Leur NC sur les AVC n'était pas bon (19,25%). Leurs sources d'informations sur les AVC étaient les médias (39,9%), parents et amis (34,3%). Leurs conceptions sur l'AVC étaient diverses : maladie dite spécifique aux riches (24,75%), aux adultes (20,75%) ; maladie due à la volonté de Dieu (17,75%), l'infidélité du (ou de la) conjoint(e) (8,75%), l'envoûtement (8,25%) ; maladie prévenue grâce à la foi en Dieu (30,5%), le respect des coutumes (10,5%) et traitée par les médicaments et tisanes (37%), les prières (33,75%). Les sujets avaient une attitude d'aide (80,8%), de compassion (67%) et de sympathie (63,5%) à l'endroit des victimes d'AVC. Le NC était associé à l'âge du sujet et sa capacité à identifier le cerveau comme organe affecté. Discussion-Conclusion : Des séances de communication pour un changement de comportement autour de l'AVC seront très utiles au Bénin.

Knowledge level and conceptions of an urban population in south of Benin about stroke Better knowledge about stroke could improve it prevention. Objective: To study the level of knowledge (LK) and the conception of adult subjects of Cotonou, on stroke. Methodology: This is a cross-sectional study with a descriptive and analytical aim, carried out from January 10 to April 27, 2018. The sampling was in clusters, focused on subjects without known psychiatric disorder, non-health professionals and who consented to participate to the study in five areas for each of four districts drawn at random from the thirteen districts of Cotonou. Proposals answers were made to them concerning definition, manifestations, risk factors, prevention, treatment and prognosis of stroke. From these answers to questions, the LK of subjects was categorized. Results: These were subjects educated up to university level (85.25%). Their LK on stroke was not good (19.25%). Their sources of information about stroke were medias (39.9%), parents and friends (34.3%). Their views on stroke were diverse: disease known as specific to rich persons (24.75%), to adults (20.75%); illness due to the will of God (17.75%), infidelity of spouse (8.75%), bewitchment (8.25%); disease prevented by the faith in God (30.5%), respect for customs (10.5%) and treated with medicines and herbal teas (37%), prayers (33.75%). Subjects had an attitude of help (80.8%), compassion (67%) and sympathy (63.5%) to victims of stroke. LK was associated with subject's age and ability to identify brain as the affected organ. Discussion-Conclusion: Communication sessions for behavior change concerning stroke will be very useful in Ben

[A retrospective assessment of 19 subjects compensated for the inhalation of aluminum powders (item 48, D.P.R. 482/75)]. / Valutazione retrospettiva su 19 soggetti indennizzati per inalazione di polveri di alluminio (voce 48, D.P.R. 482/75).

A study was made of 19 male subjects, mean age 54.7, S.D. 7.5 years, exposed to risk of aluminium dust inhalation for 16, S.D. 9.7 years, awarded compensation by the local provincial branch of INAIL (National Institute for Insurance against Occupational Accidents) in the period 1975-1988, as prescribed by item 48 of Presidential Decree 482/1975. The workers were divided into two groups on the basis of radiological signs of lung fibrosis (3 1/1 cases and 7 1/0 cases according to the ILO classification) or of COPD (Chronic Obstructive Pulmonary Disease) (9 cases). Careful examination of the work histories confirmed the previous observations of aluminium pneumoconiosis with moderate functional alterations in alumina production, potroom and casting workers.

Tubular Na+ handling in type I insulin-dependent diabetics during saline and ketone body infusion.

It has been reported that patients with type I insulin dependent diabetes mellitus (IDDM) are characterized by reduced Na+ excretion during water immersion and saline infusion and abnormal glomerulo-tubular balance. Aims of the present study were therefore to investigate firstly the fractional tubular Na+ reabsorption during saline infusion to clarify the altered tubular site and secondly the glomerulo-tubular balance during acute increase of glomerular filtration rate induced by sodium acetoacetate infusion in IDDM. During saline and euglycaemic glucose clamp, after an overnight fast, glomerular filtration rate, renal plasma flow, filtration fraction and plasma sodium were 99 +/- 15 ml min-1 1.73 m-2, 452 +/- 109 ml min-1 1.73 m-2, 0.23 +/- 0.04 and 142 +/- 8 mmol l-1 (Mean +/- SD) in 10 type I insulin dependent diabetic patients and 96 +/- 18, 452 +/- 87, 0.21 +/- 0.02, 143 +/- 2 in five matched normal subjects, respectively. The lithium and sodium clearances were significantly lower in diabetic patients than in normal subjects (23 +/- 5 ml min-1 1.73 m-2 vs 28 +/- 6, p less than 0.05 and 1.1 +/- 0.4 vs 1.6 +/- 0.3, p less than 0.01 respectively). The fractional lithium reabsorption was greater (0.77 +/- 0.04 vs 0.72 +/- 0.03, p less than 0.05) and the distal fractional sodium reabsorption smaller (0.22 +/- 0.04 vs 0.27 +/- 0.03, p less than 0.01) in the diabetic patients compared to the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

[Volume of the extracellular liquid and renal function during short-term administration of angiotensin converting enzyme inhibitors in essential hypertension]. / Volume dei liquidi extracellulari e funzione renale in corso di somministrazione a breve termine di ACE-inibitori nell'iperteso essenziale.

Short term angiotensin converting enzyme inhibition may induce a transient salt and water retention in patients with hypertension or heart failure. To verify the glomerular and tubular effects of short term converting enzyme inhibition, thirteen patients with mild to moderate essential hypertension (WHO I-II) were treated orally either with perindopril (4 mg o.d.) or captopril (25 mg b.i.d.) for one week. Both drugs reduced supine mean blood pressure significantly (p less than 0.01) (perindopril from 126 +/- 11 to 108 +/- 7 mmHg, mean +/- SD, and captopril from 132 +/- 12 to 121 +/- 16). Plasma volume (radio-iodinated albumin space) was unchanged while mean extracellular fluid volume (inulin space) increased although not significantly (from 5.05 +/- 1.32 l/sqm to 5.71 +/- 2.21 with perindopril and from 4.96 +/- 2.6 to 5.6 +/- 1.7 with captopril). Sodium clearance decreased (from 1.4 +/- 0.6 to 1.1 +/- 0.5 ml/min 1.73 sqm with perindopril, p less than 0.05, and from 0.97 +/- 0.44 to 0.88 +/- 0.51 with captopril, n.s.). In 9 patients (6 on captopril and 3 on perindopril) extra-cellular fluid volume increased simultaneously with reduction in glomerular filtration rate and in proximal tubule sodium re-absorption as well as an increase in distal tubule sodium reabsorption. In these patients the changes in proximal and distal tubule sodium reabsorption were significantly (p = 0.05) different from those of the patients with no extra-cellular fluid expansion.(ABSTRACT TRUNCATED AT 250 WORDS)

Na/H and Li/Na exchange in red blood cells of normotensive and hypertensive patients with insulin dependent diabetes mellitus (IDDM).

It has been shown that red blood cell Li/Na exchange, also called countertransport (Li/Na CTT) is increased in patients with insulin dependent diabetes mellitus (IDDM) with clinical or subclinical nephropathy and elevated blood pressure. Because recent experimental evidence confirms that red cell Li/Na CTT is a mode of functioning of the Na/H exchange (Na/H CTT), we have measured both transport modes in 23 IDDM (16 hypertensive and seven normotensive) and in eight normotensive controls with normal glucose tolerance. Na/H and Li/Na CTT were significantly increased in hypertensive compared to normotensive diabetics and controls. Na/H CTT was 78 +/- 28 mmol/L cell/h in hypertensive IDDM, 50 +/- 21 in normotensive IDDM, and 55 +/- 24 in the controls. Li/Na CTT was 0.37 +/- 0.13 mmol/L cell/h, 0.27 +/- 0.10, and 0.25 +/- 0.11, respectively. Na/H and Li/Na CTT were significantly correlated (r = .38, P less than .05). The proximal tubule sodium reabsorption, measured as the fractional Li+ reabsorption, was significantly correlated to red cell Na/H CTT (r = .38, n = 29, P less than .05), but not to the Li/Na CTT (r = .21, n = 29). In conclusion this work confirms that Na/H and Li/Na CTT are function modes of the same transporter and that an increased activity of Na/H CTT might play a role in the blood pressure increase in IDDM.

Renal hemodynamic changes induced by hypertension and its treatment.

Essential hypertension is associated with increased intrarenal resistance that may go undetected unless the fractional distribution of cardiac output to the kidney is measured. Several hypotensive drugs induce a transient reduction of renal blood flow and glomerular filtration rate due to the reduction in renal perfusion. This may represent an untoward effect especially in subjects already presenting a clinically relevant reduction of renal function. Loop diuretics, cardioselective and intrinsic sympathomimetic activity (ISA) beta-blockers, calcium entry-blockers, and angiotensin-converting enzyme (ACE) inhibitors either do not significantly reduce or even increase renal perfusion. This is one more reason for considering these agents as first choice drugs for the treatment of hypertension.

Kidney hemodynamics after ketone body and amino acid infusion in normal and IDDM subjects.

Little information is available on the hemodynamic response (renal reserve) of the diabetic kidney during an acute amino acid infusion, which has been shown to increase glomerular filtration rate (GFR) in normal humans. We recently found that the infusion of ketone bodies is able to raise GFR in both normal subjects and insulin-dependent diabetes mellitus (IDDM) patients. The aim of this study was to evaluate the renal reserve in 15 IDDM patients with a duration of diabetes of greater than 9 yr [8 with albumin excretion rate less than 15 micrograms/min (group 1) and 7 with albumin excretion rate greater than 100 micrograms/min (group 2)] and in 8 normal subjects during amino acid infusion (33 mumol.kg-1.min-1, Travasol 10% wt/vol solution containing 0.154 mM sodium chloride concentration; Travenol, Savage, MD) and during acetoacetic sodium salt (25 mumol.kg-1.min-1) infusion. Blood glucose was clamped at euglycemic levels. The infusion of sodium acetoacetate resulted in a 10- to 15-fold increase in circulating concentrations of ketone bodies, which were similar in magnitude in normal subjects and diabetic patients. The GFR peak increase above baseline after sodium acetoacetate infusion was 28% in normal subjects and 27% in group 1 and 19% in group 2 diabetic patients. The infusion of amino acid solution produced a three- to fivefold increase in plasma concentrations of amino acids in both normal subjects and diabetic patients. The GFR peak increase above baseline after amino acid infusion was significantly lower in diabetic patients (IDDM group 1: 5%, P less than .01; IDDM group 2: 6%, P less than .01) than in normal subjects (38%).(ABSTRACT TRUNCATED AT 250 WORDS)

Red blood cell sodium and potassium fluxes in psoriatic patients.

Psoriasis might be a widespread membrane disorder. Therefore, the red blood cell sodium, potassium and lithium outward fluxes (through Na-K-ATPase, Na-K-Cl co-transport, Li-Na countertransport and passive permeability), as well as the Na and K content, were studied in 31 psoriatic patients and 23 normal controls. A significant increase in intracellular potassium content, in the maximal velocity of the Na-K ATPase and of Na-K-Cl co-transport as well as in the outward passive permeability for Na were found in the psoriatic patients compared with controls. On the contrary, no differences were observed in sodium content, Li-Na countertransport and passive potassium permeability between the two groups. These results are compatible with a selective increase in inward, as well as outward, membrane permeability to sodium, which is compensated for by increased activity of the Na-K pump, and of the outward Na-K-Cl cotransport with a secondarily increased erythrocyte potassium content. They indicate that the red blood cell might be a useful model for the study of membrane transport in psoriatics.

Time course of changes in blood pressure, aldosterone and body fluids during enalapril treatment: a double-blind randomized study vs hydrochlorothiazide plus propranolol in essential hypertension.

Aldosterone suppression is said to play a major role in the long term hypotensive efficacy of angiotensin converting enzyme inhibitors. However, in previous reports from other laboratories, plasma volume has been found mostly increased and sodium balance sometimes positive. The effects of the angiotensin converting enzyme inhibitor enalapril (10-40 mg/day, p.o., for 6 weeks) on blood pressure, body fluid volumes, renal function and plasma aldosterone were compared to those of hydrochlorothiazide (50 mg/day, p.o.) alone for 2 weeks and in association with propranolol (80-160 mg/day, p.o.) for 4 more weeks during a randomized double-blind parallel study in 14 essential hypertensives. Hydrochlorothiazide alone and in combination with propranolol induced slight and not significant change in either blood pressure and body fluids. The maximum hypotensive response to enalapril was achieved only after 2 weeks of continuous treatment possibly because after 1 week the hypotensive efficacy was lessened by a significant (P less than 0.05) fluid retention secondary to a transient and not significant fall in renal perfusion. At this time aldosterone was not significantly changed compared to pretreatment values. After 6 weeks on enalapril, blood pressure was significantly reduced, plasma aldosterone further but not significantly decreased and extracellular fluid volume was normal. These findings indicate that aldosterone suppression contributes to the blood pressure lowering effect of enalapril by offsetting the salt and water retention observed on starting treatment and due to direct vasodilation.