[Evaluation of the quality-of-life of patients with pacemakers : experience of Burkina Faso about 120 patients paired with the collaboration of doctors from AUVERGNE (France)]. / Évaluation de la qualité de vie des patients porteurs d'un stimulateur cardiaque (pacemaker) : expérience du Burkina Faso à propos de 120 patients appareillés avec la collaboration des médecins d'Auvergne (France).

INTRODUCTION: In Burkina Faso, cardiac stimulation was introduced in October 2000 has grown over time.In orderto evaluate the effectiveness of stimulation on life, we proposed to evaluate the quality of life of patients with a pacemaker. GENERAL OBJECTIVE: to study the effect of the pacemaker on the quality of life of patients PATIENTS AND METHODS: This was a cross-sectional study aimed at describingthe wearers of a pacemaker for at least six months at the Yalgado OUEDRAOGO University Hospital and the Schiphramedical center.The AQUAREL questionnaire has been adapted to our context to establish a quality-of-life score. RESULTS: The mean age of the study population was 68 years with a female predominance (53.3%). Complete atrioventricular block was the main indication of stimulation in 55%. The average duration of implantation was 41.6 months with extremes of 8 and 128 months. The primo implantation was found in 79.1 % of patients against 18.3 % for a first change of case and2.5 % for a second change of housing. Double chamber stimulation was performed in 65% of cases. DDD mode was the most used followed by VVIR. The average quality of life score was 90.12. Negative predictors of quality of life were age and female.A correlation between quality-of-life score and age, hypertension and dyslipidemia was found (p< 0.05). On the other hand, no correlation between the number of implantation, the duration of implantation and the mode of stimulation was found (p> 0.05). CONCLUSION: patients with a pacemaker have a good quality of life. However, quality-of-life is not correlated with the number of pacemakers, nor the duration and mode of stimulation.

Hypertensive crises in sub-Saharan Africa: Clinical profile and short-term outcome in the medical emergencies department of a national referral hospital in Burkina Faso.

BACKGROUND: Data on hypertensive crises (HC) are limited in sub-Saharan Africa (SSA). We aimed to characterize the pattern and short-term mortality of hypertensive emergencies (HE) and urgencies (HU). METHODS: This was a prospective cohort study. Consecutive patients with acute and severely elevated blood pressure (systolic>180mmHg and/or diastolic >120mmHg) with or without acute target-organs damage attending the emergency department (ED) of the Teaching Hospital of Yalgado Ouedraogo, Ouagadougou, Burkina Faso were included with a one-month follow-up. RESULTS: One hundred and sixty-six of 1254 patients presenting to the ED (January to march 2016) had HC (13.2%) and 113 of them (68.1%) had HE. The mean age was 50.9±15.9 years and males were 63.3% (n=105). Younger age (<45 years) accounted for 55% of the cases. History of known HTN was reported in 101 patients (60.8%). Among patients with HE, 62.8% had brain-related events, 30.1% had cardiac involvement and 31% had acute renal impairment. The overall survival rate was 89% within the first 72hours and 81% at fourteen days follow-up. At one-month follow-up, 36 patients died with a survival rate of 77.8%. Factors independently associated with death were history of known hypertension, acute brain-related damage and renal dysfunction and not being transferred to a specialized department. CONCLUSION: HC are not rare in SSA and are associated with higher morbidity and mortality in HE. Further studies are needed to determine factors that promote HC in African patients in order to better address the prevention and management strategies of such hypertensive entity.

[Evolution profiles of acute coronary syndromes and GRACE, TIMI and SRI risk scores in Burkina Faso. A monocentric study of 111 patients]. / Profils évolutifs des syndromes coronaires aigus et scores de risque GRACE, TIMI et SRI au Burkina Faso. À propos d'une série monocentrique de 111 patients.

OBJECTIVES: The aims of this study was to assess evolution profile of acute coronary syndrome (ACS) based on risk level by GRACE, TIMI and SRI scores in the cardiology department, Yalgado Ouedraogo university hospital. PATIENTS AND METHODS: This was a prospective study of 111 consecutive patients admitted for ACS (mean age 57.61 years, 77.5% male) between January 1st and 2010 to May 31st 2015 in the department of cardiology. For each patient, risk scores were calculated and they were divided into risk group. Global survival at one month was described by Kaplan Meier method and prognostic factors were analyzed by multivariable Cox regression. RESULTS: The prevalence of ACS was 4.2%. Patients were admitted for ST-elevation ACS and non-ST-elevation ACS in 88.3% and 11.7%, respectively. Nineteen patients (17.1%) were admitted before the 12th hour. Hospital mortality was 8.1% and increased to 16.2% in one month. After risk stratification, one-month survival of patients with high risk, was shorter than patients at low-risk regardless of the score GRACE (log-rank=9.93, P=0.007), TIMI (log-rank=14.91, P=0.001) and SRI (log-rank=10.01, P=0.006). GRACE score (HR=1.01; P=0.002), TIMI (HR=1.33; P=0.01) and SRI (HR=1.02; P=0.01) were major prognostic factors for overall survival. CONCLUSION: ACS remains a serious disease with high morbidity and mortality in the days following the initial accident. These risk scores are applicable tools in Burkina Faso as evidenced statistic C (GRACE=0.75, TIMI=0.78 and SRI=0.74).

[Assessment of medical management of heart failure at National Hospital Blaise COMPAORE]. / Évaluation de la prise en charge médicale de l'insuffisance cardiaque à l'hôpital national Blaise COMPAORE.

AIM: The aim of this study was to assess the quality of medical management of heart failure at the National Hospital Blaise Compaoré according to the international guidelines. PATIENTS AND METHODS: A retrospective study was performed including consecutive patients admitted for heart failure documented sonographically from October 2012 to March 2015 in the Medicine and Medical Specialties Department of National Hospital Blaise Compaore with a minimum follow-up of six weeks. Data analysis was made by the SPSS 20.0 software. RESULTS: Eighty-four patients, mean age of 57.61±18.24 years, were included. It was an acute heart failure in 84.5% of patients with systolic left ventricular function impaired (77.4%). The rate of prescription of different drugs in heart failure any type was 88.1% for loop diuretics; 77.1% for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and 65.5% for betablockers. In patients with systolic dysfunction, 84.62% of patients were received the combination of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and 75.38% for betablockers. Exercise rehabilitation was undergoing in 10.7% of patients. The death rate was 16.7% and hospital readmission rate of 16.7%. CONCLUSION: The prescription rate of major heart failure drugs is satisfactory. Cardiac rehabilitation should be developed.

[Management and prognosis of pulmonary embolism associated with right heart thrombi: A prospective study at the University Hospital Yalgado Ouédraogo]. / Prise en charge et pronostic des embolies pulmonaires associées à des thrombi intracavitaires droits : à propos d'une série prospective au centre Hospitalier Universitaire Yalgado Ouédraogo.

OBJECTIVE: To describe the management and evolution of high risk of death pulmonary embolism associated with right heart thrombi. MATERIAL AND METHODS: We conducted a prospective cohort survey over a 54 month-period, from March 1st, 2012 to September 30th 2015. Were included all patients with pulmonary embolism and having high or intermediate-high risk of death. Patients were divided into two groups according to whether cardiac Doppler-echography found a thrombus in the right chambers or not (ICT+ vs. ICT-). The survival curves for the patients were obtained using the software STATA. RESULTS: The prevalence of pulmonary embolism associated with right heart thrombi was 4% in our study. Thrombi were mobile, straight localization in all cases. The ICT+group was characterized by a significantly higher proportion of congestive heart and chronic lung disease. The proportion of patients' thrombolysis was significantly higher in the ICT-group. In the ICT+group, thrombolysis significantly reduced mortality giving a 30-day survival of 80% against 20% among patients receiving only heparin. CONCLUSION: Pulmonary embolism associated with right heart thrombi including the atrium are not exceptional. These patients are at high risk of early death. Thrombolysis is significantly improving the mortality of pulmonary embolism associated with right-sided heart thrombi.

[Five years assessment of cardiac stimulation in two public hospitals in Burkina Faso: An experiment of collaboration with two hospitals in Auvergne]. / Bilan de cinq ans de stimulation cardiaque dans deux structures hospitalières publiques du Burkina Faso : expérience d'une collaboration avec deux centres hospitaliers d'Auvergne.

OBJECTIVES: Cardiac stimulation becomes a reality in Burkina Faso. The aim of our study was to evaluate this activity over five years and to appreciate the impact of collaboration with French hospitals of Auvergne area in its development. MATERIALS AND METHODS: Prospective study including consecutively patients who underwent pacemaker implantation since June 2011. Data collected included indications, time to care, type of stimulation, complications, cost of treatment, and education and quality of life of the patient. RESULTS: Sixty-nine patients received definitive pacemaker from June 2011 to June 2016, of whom 45.5% were women. The mean age was 69 years (extremes 35 to 89s). Almost all patients (94%) were symptomatic (54% syncope and 30% dizziness and lipothymias). The main indication for definitive cardiac pacing was complete atrioventricular block of degenerative origin (83%). The mean time between indication and surgery was 8.2 days, and only 4% of patients received temporary stimulation. The lack of financial support was the main reason for the delay in taking charge. During the study period, the two health centers received support in the form of stimulation equipment, a technical platform, and regular training and practical training. This collaboration made it possible to overcome the lack of material, human and financial resources. We recorded as complications a case of case exteriorization, two cases of benign local hematoma and two cases of probe displacement. The quality of life of the patients improved markedly, none of patients undergoing surgery remained symptomatic. CONCLUSION: The organization of cardiac stimulation in Burkina Faso is a reality. Efforts must be made to sustain the activity and strengthen collaboration with hospitals in the north.

Complications aiguës de l'infarctus du myocarde (IDM) en milieu hospitalier universitaire au Burkina Faso : Profil et implications en santé publique

l'infarctus du myocarde (idM) constitue une urgence cardiologique absolue. Peu d'études ont été réalisées sur les complications précoces de cette affection au Burkina Faso. le but de ce travail était de décrire les aspects épidémiologiques, et évolutifs des complications aiguës de l'infarctus du myocarde dans le service de cardiologie du Chu Yo et d'entrevoir les implications en santé publique. il s'est agi d'une étude rétrospective sur une période de cinq (05) ans allant du 1er Janvier 2010 au 31 décembre 2014, portant sur les dossiers médicaux des patients hospitalisés dans le service pour syndrome coronarien aigu confirmé par l'eCg de surface et le dosage de la troponine sérique (SCa ST+ Troponine+). durant cette période, 2 469 patients ont été hospitalisés dans le service dont 102 pour infarctus du myocarde ST+, soit une prévalence hospitalière de 4,1 %. Quatre et vingt (80) patients étaient de sexe masculin contre 22 de sexe féminin, soit un sexe ratio homme/Femme de 3,6. l'âge moyen de nos patients était de 57 ans avec des extrêmes de 21 et 90 ans. l'hTa et l'obésité étaient les facteurs de risque modifiables les plus rencontrés avec respectivement 57,7 % (n= 58) et 29,7 % (n = 21). la grande majorité de nos patients (74,8 % (n = 76)) résidait en zone urbaine, et 84,3 % (n = 90) de nos patients avaient été hospitalisés dans le service après la 12e heure du début de la douleur. a l'électrocardiogramme de surface (eCg), les atteintes du territoire antérieur étaient le plus retrouvées, suivi de celles des territoires inférieur et antéro-septal avec respectivement 25,2 % ; 23,4 %. Soixante de nos patients (58,8 % des cas) avaient présenté des complications précoces, dominées par les complications hémodynamiques (37,2 %), rythmiques (25,5 %) et thromboemboliques (14,7 %). la thrombolyse à la streptokinase n'a pu être réalisée que chez 08 patients (7,8 %). nous avons enregistré 11,7 % (12) cas de décès. l'infarctus du myocarde est une urgence cardiovasculaire absolue avec la possibilité de survenue de complications surtout à la phase aiguë de la maladie. il s'agit complications en lien avec le retard de consultation des patients. Pour éviter les conséquences socio-économiques suite à l'idM, il importe de réduire les facteurs de risque cardiovasculaire modifiables et à réorganiser les services de santé pour y faire face avec une offre de soins et services de santé conséquente à tous les niveaux du système de santé

Affections cardio-vasculaires et l'infection à VIH en milieu hospitalier universitaire au Burkina Faso : profil épidémiologique, clinique et évolutif, et implications en santé publique

Le Syndrome immunodéficitaire acquis (Sida) constitue l'une des épidémies les plus meurtrières de l'histoire de l'humanité. l'avènement des médicaments antirétroviraux(aRV) en modifiant l'histoire naturelle de la maladie, par l'amélioration de la survie des patients, les exposeraient à l'émergence des pathologies cardiovasculaires. Ce travail avait pour objectif de décrire les aspects épidémiologique, clinique, paraclinique et évolutif des affections cardio-vasculaires au cours de l'infection à Vih, et entrevoir les implications en santé publique. il s'est agi d'une étude rétrospective réalisée du 01 Janvier 2011 au 31 mars 2015, elle a inclus 91 patients Vih recrutés au Centre hospitalier universitaire Yalgado ouédraogo de ouagadougou, présentant des anomalies cliniques et/ou des facteurs de risque cardiovasculaires (FdRCV) évoquant une maladie cardiovasculaire. un bilan cardiologique était réalisé en vue d'une confirmation. l'âge moyen des patients ayant présenté une pathologie cardiovasculaire associant l'infection au Vih était de 45 ± 10 ans avec les extrêmes de 20 et de 83 ans. il y avait 53 femmes (58,24 %) pour un sexe ratio homme / femme de 0,7. les sujets du niveau socio- économique faible étaient les plus représentés avec une fréquence de 56 % des cas. le tableau clinique cardiovasculaire était dominé par l'insuffisance cardiaque globale (28,57 %). les signes majeurs étaient la dyspnée, la douleur précordiale, la toux, la tachycardie et la grosse jambe douloureuse. les manifestations cardiovasculaires étaient diverses, les maladies thromboemboliques (48,35 %) étaient les plus représentées. les atteintes myocardiques (17,59 %), les atteintes péricardiques (15,39 %) et les atteintes de l'endocarde (12,09 %) étaient notées en leurs proportions respectives. il est ressorti que 3,30 % des patients ont présenté un infarctus du myocarde chez des patients vivant avec le Vih (PVVih) sous traitement antirétroviral (aRV). la mortalité hospitalière était de 14,29 %. au vu de leur fréquence, de leur taux de décès et pour leur prise en charge précoce, les atteintes cardiovasculaires au cours de l'infection par le Vih seraient multiformes. une bonne connaissance de la question par le personnel médical et paramédical et une prise en charge précoce contribuerait à la réduction de létalité y afférente

Facteurs associés à l'équilibre du traitement antivitamine K au Centre Hospitalier Universitaire Yalgado Ouedraogo de Ouagadougou (Burkina Faso)

Objectif : Cette étude avait pour objectif d'étudier les facteurs associés à l'équilibre du traitement antivitamine K(AVK) chez les patients suivis au service de cardiologie du CHU-YO.Méthodologie : Il s'agit d'une étude rétrospective à visée analytique qui a recensé pendant une période de 3 mois les patients sous traitement AVK dans le service de cardiologie du CHU-YO. N'ont pas été inclus les patients dont les résultats des contrôles INR des 3 derniers mois ne figuraient pas dans le carnet de suivi. Le logiciel Epi info version 3.5 a servi à l'analyse statistique et le test de Khi2 à la comparaison au seuil de 0,05.Résultats : Nous avons colligé 193 patients. L'âge moyen était de 53 ans avec des extrêmes entre 14 et 95 ans. L'INR était stable dans 40% des cas et un accident hémorragique sous AVK a été observé dans 12%. Il y avait une prédominance non-significative de la proportion d'INR stable chez les patients qui avaient la possibilité de réaliser l'examen en leur lieu de résidence (40,7% vs 37,7%). La proportion d'INR stable était plus élevée chez les patients qui avaient un niveau d'instruction inférieur au secondaire (43% vs 35%) sans association statistique significative (p = 0,60). La proportion d'INR stable était plus élevée chez les patients sous traitement depuis au moins un an (45% vs 35%) sans association significative (p = 0,06). Les comorbidités ont été retrouvées dans 14% des cas sans association statistique avec la survenue d'un événement hémorragique. Le régime alimentaire pauvre en vitamine K a été institué chez 86% des patients, mais sans corrélation avec la stabilité de l'INR. Le bon niveau d'éducation thérapeutique était significativement associé au bon équilibre du traitement aux AVK (P = 0,0002). Conclusion : La qualité de l'éducation thérapeutique est l'élément clé du bon équilibre du traitement AVK au CHU-YO, d'où l'intérêt d'y mettre l'accent

[Severe pulmonary embolism and acute lower limb ischemia complicating peripartum cardiomyopathy successfully treated by streptokinase]. / Embolie pulmonaire grave et ischémie aiguë de membre inférieur compliquant une cardiomyopathie du péripartum traitées avec succès par thrombolyse à la streptokinase.

Peripartum cardiomyopathy is a cardiac disease at high thromboembolism potential. The authors report a case of peripartum cardiomyopathy admitted for congestive heart failure. Echocardiography found a dilated cardiomyopathy with severely impaired left ventricular systolic function and biventricular thrombi. During hospitalization his condition was complicated by severe bilateral pulmonary embolism and left lower limb arterial acute thrombosis. The treatment consisted of thrombolysis with streptokinase associated with dobutamine (in addition to the conventional treatment of heart failure and bromocriptine). The outcome was favorable, marked by pulmonary and lower limb arterial unblocking.

Isolated aortic valvular and pulmonary involvement during essential eosinophilia.

Endomyocardial fibrosis is the most classic and the most known complication of prolonged hypereosinophilic syndrome, whatever the cause. In Burkina Faso, this complication is most frequently encountered in idiopathic form of the syndrome. It commonly involves the apex of the ventricles with possible involvement of atrioventricular valves. The clinical picture is that of restrictive cardiomyopathy with poor prognosis. We report the case of a 22-year-old man with atypical cardiac involvement during idiopathic hypereosinophilic syndrome. Echocardiographic examination showed isolated aortic valve involvement. Left and right ventricular function was preserved. The apex of ventricles was free of lesion. Pulmonary CT-scan showed massive bilateral lung involvement. Treatment consisted of strict control of the eosinophilic process and pulmonary management. The patient suddenly died sudden pulmonary distress one month after first being seen.

[Evaluation of the knowledge of patients about the management of treatment with anti-vitamin K drugs in the Service of Cardiology of Ouagadougou]. / Évaluation du niveau de connaissance des patients sur la gestion du traitement par les antivitamines K dans le service de cardiologie de Ouagadougou.

INTRODUCTION: Vitamin K antagonists (VKA), the most widely prescribed oral anticoagulant therapy, represent a major public health problem by the adverse events related to their use. The aim of this study was to clarify the level of knowledge that patients have about the management of their oral anticoagulant treatment. PATIENTS AND METHODS: This was a descriptive cross-sectional study performed at Yalgado Ouedraogo university Hospital, over a period of three months starting from March 1st to May 31st 2012. A questionnaire was given to patients receiving VKA treatment for at least a month. RESULTS: Seventy patients were enrolled in the study of which 30 men. The median age was 49±16 years. Heart disease and venous thromboembolic disease justifying the introduction of VKA treatment were found respectively in 58.6 and 41.4% of the cases. The name of the VKA and the exact reason for the treatment were known respectively in 91.4 and 61.7% of the case. More than half of patients (68.6%) knew that the VKA makes blood more fluid. Forty-six patients (65.7%) cited INR as biological monitoring of treatment but only 28 patients (40%) were aware of INR target values. The majority of patients did not know the risks in case of overdose (72.8%) and underdosing (71.4%). Self-medication by non-steroidal anti-inflammatory drugs was reported by 18 patients (25.7%). Cabbage (74.3%) and lettuce (62.9%) were the main foods reported to be consumed moderately. CONCLUSION: The knowledge of patients on the management of VKA is fragmentary and remains insufficient to ensure the effectiveness of the treatment. The creation of a therapeutic education program is then necessary.

[Neurological complications of infective endocarditis in Burkina Faso. Clinical features, management and evolutionary profile]. / Les complications neurologiques des endocardites infectieuses au Burkina Faso. Caractéristiques cliniques, prise en charge et profil évolutif.

INTRODUCTION: Neurological complications are the most frequent extracardiac complications of infective endocarditis (IE). This study aimed to describe the epidemiological, clinical and paraclinical aspects, and outcome of neurological complications of infective endocarditis in three hospitals in the city of Ouagadougou in Burkina Faso. PATIENTS AND METHOD: From 1 January 2009 to 31 December 2012, we included all patients suffering from IE and selected those in whom a neurological complication was objectified. Neurological involvement was sought on clinical examination but especially CT brain (ischemic infarcts, hemorrhages, aneurysms and abscesses). Blood cultures were systematic. Echocardiography was done for vegetations and characteristics. RESULTS: Among 63 cases of IE, neurological complications were found in 14 patients (22.2%). The average age of patients with neurological complications was 37.4 ± 5.8 years. The sex ratio was 1.3 for women. Neurological damage consisted of nine cases of stroke (64.3%), three cases of hemorrhagic stroke (21.4%) and two cases of brain abscess (14.3%). Neurological complications had already occurred before hospitalization in 4 cases. Blood cultures were positive in 8 cases. Germs found were predominantly Staphylococcus aureus (5 cases) and Streptococcus a- viridans (2 cases). All cases of S. aureus were complicated by stroke. At echocardiography, vegetation was found in all cases. It was found on the mitral in 7 cases, the aorta in 3 cases, the mitral and aortic in 2 cases and the mitral and tricuspid in 2 cases also. The EI had occurred on a native valve in 11 cases, prosthesis in 4 cases (2 mitral and 2 aortic). The vegetations average diameter was 11.2 ± 2.1 mm (6.4 and 1 7.7 mm). Vegetations were mobile in 12 cases. The treatment consisted of antibiotics adapted to the antibiogram, neurological and cardiovascular monitoring. The evolution was marked by seven deaths (50%), including 5 deaths related to cerebral complication (71.4% of deaths). CONCLUSION: This study shows that neurological complications during infective endocarditis are frequent, dominated by stroke with a high mortality.

[Super hypertension in cardiology department in Burkina Faso]. / La super hypertension artérielle en milieu cardiologique au Burkina Faso.

Super hypertension is defined as systolic BP ≥ 250mmHg and/or diastolic BP ≥ 150mmHg in presence or not of complications. The aim of our study was to describe the epidemiological and evolutive patterns of super hypertension in the cardiology department of the Yalgado Ouedraogo University Hospital. It was an observation cohort over a period of 26 months (July 2011 to August 2013). We recruited 34 patients, corresponding to a prevalence of 12.9% of all hypertensive patients. The median time of follow-up was 7.1 months. The mean age was 47 years old, with a sex-ratio of 1.3. Twenty-one (62%) of the patients were known hypertensive, out of who 24% were regularly rewiewed, 57% on treatment, but none was on regular medications. Dyspnoea was the reason for consulting in 38% of the cases. We noticed a fundoscopy stage III or IV in 55.9% of the cases. All patients had left ventricular hypertrophy on ECG, and 90% on echocardiography. Complication was noticed on admission in 91% of the cases. Chronic renal failure occured in 14.7% of the cases during follow-up, and overall mortality rate was 0.5 person years. Probability of survival over one month was 70% for all patients. The mean age of deceased was 35%. Presence of renal failure, unknown hypertension, and age<45 were factors linked to death (P<0.05). Super hypertension is a pathology of the youth, with high morbi-mortality. The prevention is done through early detection and efficient management of hypertension.

[Epidemiological characteristics and clinical features of black African subject's resistant hypertension]. / Caractéristiques épidémio-cliniques de l'hypertension artérielle résistante du sujet noir africain.

INTRODUCTION: Few studies in sub-Saharan Africa were interested in resistant hypertension. The objectives of this study were to determine the frequency of resistant hypertension in hypertensive black African population, and to describe its clinical and therapeutic features. PATIENTS AND METHODS: From May 1, 2010 to May 31, 2012, we included consecutively hypertensive followed in two hospitals in the city of Ouagadougou, under antihypertensive treatment at optimum dose and observant. Patients whose blood pressure was uncontrolled despite a triple antihypertensive therapy at the optimal dose including a diuretic associated with dietary measures have received ambulatory blood pressure monitoring. Following this examination, patients whose blood pressure was ≥135/85mmHg during the day and/or ≥120/70mmHg at night were considered resistant hypertension. We investigated the cardiovascular risk factors as well as target organ damages. We combined spironolactone 50mg in treatment when absence of contra-indication appreciated the evolution of blood pressure under this treatment. The measurement of plasma renin activity was not performed. Statistical analysis was performed using SPSS Version 17 for Windows. RESULTS: We included 692 patients with 14.6% of resistant hypertension. The average age of patients was 54.8±11.1years in the general population, 56.5±11.8years in the subgroup of non-resistant hypertension and 64.2±5.4years in the subgroup of resistant hypertension. The symptoms were represented by headache (11.9%), dizziness (9.9%) and chest pain (8.9%). Modifiable cardiovascular risk factors were dominated by dyslipidemia, diabetes and obesity/overweight. These risk factors were significantly more frequent in the subgroup of resistant hypertension. The global cardiovascular risk was high in 24.9% of cases in the general population, 22.5% in the subgroup of non-resistant hypertension and 38.6% in the subgroup of resistant hypertension. The target organ damages were significantly more frequent in the same subgroup of resistant hypertension. After addition of spironolactone, 21.8% of resistant hypertensive patients were controlled. CONCLUSION: This study shows that resistant hypertension is common in black Africans. It is mostly subjects of the sixth decade, with limited economic income and living in rural areas. In the absence of contra-indication, spironolactone contributed to decrease the morbidity of this pathology.

[Infective endocarditis in sub-Saharan african children, cross-sectional study about 19 cases in Ouagadougou at Burkina Faso]. / Les endocardites infectieuses chez l'enfant africain subsaharien, étude transversale à propos de 19 cas à Ouagadougou au Burkina Faso.

INTRODUCTION: Infective endocarditis is a transplant of a microorganism on a most often injured endocardium. It is rare in children. This work aimed to determine the frequency of endocarditis of the child, to describe clinical presentation, data from echocardiography, microbiological profile and clinical course. PATIENTS AND METHODS: From May 1 2010 to April 30 2011, we consecutively included children received for infective endocarditis in two medical centers in the city of Ouagadougou: Saint-Camille medical center and teaching hospital Yalgado-Ouedraogo. We investigated the functional and general signs and treatment already received. The physical examination looking for an infectious syndrome, pneumonia, heart failure and entrance doors. Blood cultures, blood count, creatinine, blood chemistry, HIV status, electrocardiogram, chest radiography and cardiac Doppler ultrasound were systematic. The diagnosis of the disease was based on Duke criteria. RESULTS: Nineteen endocarditis in children were reported, that is 1.7% of admissions. The average age was 4.7 ± 2.6 years (extremes: 1 and 14). The sex ratio was 1.7 for girls. The clinical presentation was a common infectious syndrome. Impaired general condition and congestive heart failure were present on admission in six cases, respectively. The front door was dental in nine cases (47.4%), skin in four cases (21%) and ENT in three cases (15.8%). A peripheral vein was implicated in one case. In the two other cases, no front door had been found. HIV serology was positive in four cases. As for the blood cultures, they were positive in 13 cases. The germs found were Streptococcus in 10 cases and staphylococcus in three cases. Echocardiography had revealed vegetations in 18 cases. These vegetations were localized on the mitral in nine cases. Multiple locations were found in four cases. Underlying heart disease was dominated by rheumatic valve disease (68.4%), healthy heart forms were found in two cases. Treatment consisted of antibiotics, antipyretic treatment and that of heart failure as appropriate. The evolution was marked by five deaths (26.3%) in an array of septic shock. Death was more important in congenital heart disease. CONCLUSION: Infective endocarditis of the child is common in our practice. The clinical syndrome is common infectious. Streptococcus and Staphylococcus are the two germs found. The main door is dental. Hence, dental care should be promoted for better prevention of infective endocarditis in our context.

[Factors associated with poor blood pressure control in hypertensive black Africans: cross-sectional study of 456 hypertensive patients from Burkina Faso]. / Facteurs associés à un mauvais contrôle de la pression artérielle chez les hypertendus noirs africains : étude transversale de 456 hypertendus burkinabé

INTRODUCTION: Hypertension in black is more frequent with early onset and clinically more severe. The blood pressure control and the decrease of global cardiovascular risk are two main goals of the treatment of hypertension. The objectives of this study were to determine the proportion of uncontrolled hypertension in hypertensive patients followed as outpatients and to investigate the factors associated with poor control. PATIENTS AND METHODS: This is a descriptive cross-sectional study including 456 hypertensive patients known and followed as outpatients. Blood pressure measurement was performed between 8 am and 12 noon both arms in the supine position, after a compliance averaging 8 minutes of rest. We searched for conventional cardiovascular risk factors (age superior or equal to 45 years for men and superior or equal to 55 for women, physical inactivity, overweight/obesity, smoking, diabetes and dyslipidemia) and calculated the global cardiovascular risk according to the Framingham model. Was regarded as uncontrolled high blood pressure SBP superior or equal to 140 mmHg and/or DBP superior or equal to 90 mmHg. Univariate analysis and multivariate logistic regression (using SPSS program version 17) were conducted to look for factors associated with poor blood pressure control. RESULTS: We recruited 456 hypertensive patients including 259 women (56.8%). Modifiable cardiovascular risk factors also hypertension were dominated by dyslipidemia (29.8%) and diabetes (24.6%). The global cardiovascular risk calculated using the Framingham model was low in 21.3%, moderate in 34.0%, high in 24.8% and very high in 19.9% of cases. The proportion of uncontrolled hypertension was 54.2% (n=247 including 126 women and 121 men). This poor blood pressure control was associated (multivariate analysis) at age superior or equal to 60 years, low socioeconomic status, high to very high cardiovascular risk, antihypertensive monotherapy, treatment duration superior or equal to 10 years, an associated treatment and non-compliance therapy. CONCLUSION: More than half of hypertensive patients in our study were not adequately controlled on antihypertensive therapy. Factors of poor control were age superior or equal to 60 years, low socioeconomic status, high to very high cardiovascular risk, antihypertensive monotherapy, treatment duration superior or equal to 10 years, an associated treatment and non-compliance therapy.

[Left ventricular hypertrophy in hypertensive African blacks: echocardiographic study of 452 patients]. / L'hypertrophie ventriculaire gauche du Noir Africain hypertendu: étude échocardiographique chez 452 sujets.

OBJECTIVE: The aim of this study was to define in a population of hypertensive Black African, the frequency of left ventricular hypertrophy (LVH), the different kind of LVH, and the factors of LVH occurring. METHODS: Clinical and echographic (according to Penn convention) data was collected in 452 consecutive hypertensive patients (193 women and 259 men). LVH was defined as an indexed left ventricular mass (ILVM) > 134 g/m2 in man and 110 g/m2 in woman. RESULTS: The mean systolic blood pressure was 187 mmHg, and the mean diastolic, 111 mmHg. The mean ILVM was 135.25 g/m2. LVH was present in 53.3% of the patients. Concentric LVH represented 48.5%, eccentric LVH 41.1%, and asymmetric hypertrophy of the septum, 10.4%. LVH increased with patient's age (p = 0.008), hypertension severity (p = 0.0001), and the ancientness of the hypertension (p = 0.0001). CONCLUSION: LVH is frequent in hypertensive black African, and concentric LVH is the most frequent kind of LVH. Factors of LVH occurring are patient's age, severity and the ancientness of the hypertension.

[Characteristics of renal disease in hypertensive morbidities in adults in Burkina Faso]. / Caractéristiques de l'atteinte rénale dans la morbidité hypertensive de l'adulte au Burkina Faso.

In the aim to determine the importance of renal disease in hypertensives (BP > 160/95 mmHg), we conducted a retrospective study in Burkina Faso, a black african country. 342 adults hypertensive (200 men, 142 women, mean age: 50.6 +/- 13.8 years) hospitalized in the departments of Cardiology or Internal medicine from January 1995 to December 1997 were included. Patients were at their first hospital stay in 273 cases (79.8%). When technical conditions were available, assessments were systematically done. Blood pressure was 183.6 +/- 36.4/113.3 +/- 23.1 mmHg. Total morbidity concerned 316 patients (92.4%). Cardiovascular complications (CVC) have been diagnosed in 236 patients (69%) with a mean age of 51.6 +/- 14 y, neurologic complications (NC) in 85 patients (24.9%, mean age: 55.7 +/- 12) and renal disease (RD) in 123 patients (36%; mean age: 44.7 +/- 14.5 y). Mean age of single RD (n: 27, mean age: 39.5 +/- 12.8 y) was significantly lower than no complicated hypertensives (n: 42, mean age: 48.2 +/- 11.6 y) or single CVC (n: 104, mean age: 55 +/- 12.5) or single NC (n: 34, mean age: 55.1 +/- 11.1) or associated comorbidities (n: 135, mean age: 49.1 +/- 14.5). Patients under 40 years of age have had higher 24 hours proteinuria than other patients (1.05 +/- 1.17 g (n: 51) vs 0.45 +/- 0.68 (n: 170), p < 0.01). Chronic renal failure occurred in youngest patients (n: 72, age: 39.7 +/- 13.4 vs 53.7 +/- 12.3; p < 0.01) with a most high prevalence in rural (31.6%) than urban patients (15.8%; p < 0.01). End stage renal failure concerned 49 patients (mean age: 35.9 +/- 12.7). 27 patients died during hospital stay by renal failure in 17 cases (mean age: 37 +/- 11). CVC in 5 cases (mean age: 68.6 +/- 8) and NC in 5 cases (mean age: 60.2 +/- 9.2). Among survivals, 72 patients (28.9%) were of a bad short-term prognosis and 38 had end stage renal failure. In conclusion, our data suggest that renal disease will be common cause of hypertension and also a selective factor for long term survival of hypertensives in a country where renal replacement therapy is not available.