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

[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.

Determinants of long-lasting insecticidal net use in Burkina Faso after a mass distribution in the Diébougou health district.

BACKGROUND: In 2009, a mass distribution of long-lasting insecticidal nets (LLINs) was conducted in an experimental site of the Diébougou health district. Carried out 1year after the distribution, this study aimed to determine the presence of LLINs in households, to determine the LLIN use rate, and thirdly, to identify key factors associated with LLIN use in households. METHODS: We conducted a cross-sectional descriptive and analytical study, which covered the entire Diébougou health district. The study population consisted of households in the district. The statistical unit was the household head, or if absent his designated representative. For the selection of households to be studied, we considered the health centers and their geographic accessibility. We thus defined three zones: an area within 5 km of health centers, the area between 5 and 10 km away, and the area beyond 10 km. In each area, we randomly selected 20 households, totaling 60 households in the area of each health center, giving a sample of 840 households to be surveyed. We selected 60 households per health center in accordance with the time and financial resources allocated to data collection. The data were analyzed using the Epi Info 3.5.1 software package. The Chi square test was used to investigate the association between the dependent and independent variables with statistical significance set at P<0.05. When an association was demonstrated, the relative risk (RR) was calculated with the 95% confidence interval. RESULTS: A total of 822 households (97.8%) were surveyed, households inhabited by 6379 people including 1175 (11.4%) children under 5 years of age and 158 (2.5%) pregnant women. The overall use of LLINs was 76.5%. This rate was 81.7% in children under 5 years and 57.6% among pregnant women. Factors influencing the use of LLINs were the implementation of a communication plan by health actors (RR=2.42 [2.03-2.83]), the social position of the household head (RR=1.62 [1.43-1.83]), the marital status of the household head (RR=1.41 [1.33-1.49]), the number of persons per room (RR=1.39 [1.08-1.78]), the religion of household head (RR=1.21 [1.15-1.27]), the level of education of the household head (RR=1.15 [1.06-1.24]), and the number of IECs (information, education, communication) sessions followed by the household (RR=1.14 [1.08-1.20]). CONCLUSION: The results of this study provide guidance on measures to ensure the success of the mass distribution of LLINs to the entire country.

[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.

[Polyneuropathies in patients treated with HAART in Bobo-Dioulasso hospital, Burkina Faso]. / Les polyneuropathies chez les patients traités par les ARV au CHU de Bobo-Dioulasso, Burkina Faso.

Peripheral neuropathies (PN) represent the most common neurological manifestation in patients with HIV infection. Introduction of highly active antiretroviral therapy (HAART) had a significant impact on the epidemiology of HIV-associated neuropathies even in poor-resources countries. HIV-infected patients were followed up over a 2-years period from January 2002 to December 2003. PN was clinically diagnosed based on abnormalities of ankle reflexes or vibratory perception and if patients described pain, paresthesia or numbness. Electromyography was not performed in this study Among the 133 HIV-infected patients treated with HAART 31 patients (23 females and 8 males) with 38.8 of mean age were followed up for PN. 95.5% among them were HIV1-infected. According to the availability of the antiretroviral therapy, 9 patients were treated with protocol A including lamivudine + stavudine + nevirapine, 12 patients with protocol B including combination of stavudine + lamivudine + efavirenz, and 10 patients with protocol C with other combinations of antiretroviral therapies. Average CD4 cell count was 229.3/microl and 60% of the sample had < 200 CD4 cell counts at the time of diagnosis. PN occurred within 5.6 months from the institution of the HAART and 80% less than 3 months after the beginning of the treatment. Burning feet syndrome was found in 16.1% of the sample. 45.2% of polyneuropathies occurred in late stage of HIV infection (< 200 CD4/microl). The presence of PN was related to decreased CD4 cells counts and neurotoxic antiretroviral therapy Introduction of HAART has modified the course and the prognosis of HIV infection even in poor resources setting. The incidence of toxic neuropathies is increasing with longer patients' life expectancy and represents a major factor in treatment limitation and the neurological side effects of HAART should be well identified by physicians.

Injection practices in Burkina Faso in 2000.

BACKGROUND: Unsafe delivery and overuse of injections can result in the spread of hepatitis B virus, hepatitis C virus, and HIV. The aim of the present survey was to estimate the frequency of safe injection practices in Burkina Faso. METHOD: Using the new standardized World Health Organization tool to assess injection practices, we selected 80 primary health facilities with a two-stage cluster sampling method, collected information using structured observations and provider interviews, and analyzed the data using Epi-Info software. RESULTS: We observed 116 injections in 52 facilities. In 50 facilities [96%; 95% confidence interval (CI) 85-99%] injections were given with a new, single-use syringe and needle. In 29 facilities (56%; 95% CI 36-74%), staff recapped needles using two hands. All 80 facilities visited had a stock in the community to provide new, single-use syringes and needles. In 61% (95% CI 54-79%) of facilities, staff reported needlestick injuries in the last 12 months. Used needles were discarded in open containers in 66 facilities (83%; 95% CI 55-96%) and observed in the surroundings of 46 facilities (57%; 95% CI 32-80%). CONCLUSIONS: In 2000, most of the health facilities in Burkina Faso were using sterile injection equipment. However, practices were still observed that could expose patients, health care workers, and communities to risks, and that required specific interventions.

[New-onset seizures in patients with immunodeficiency virus infection in Bobo-Dioulasso Hospital (Burkina Faso)]. / Crises d'épilepsie d'apparition récente et infection par le VIH au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

Seizures are common in advanced stages of immunodeficiency virus (HIV) infection. HIV-infected outpatients and inpatients in the national hospital in Bobo-Dioulasso among whom seizures occurred had been recruited over four years. There were mainly male (30/13) with an average age of 35 years with extremes ranging from 22 to 60 years. New-onset generalised seizures occurred in all cases of cryptococcal meningitis or partial motor secondary generalised in 64% among patients with suspected cerebral toxoplasmosis due to the efficiency of the treatment of the antitoxoplasmic proof. Identified causes such as suspected cerebral toxoplasmosis (65%), suspected tuberculous meningitis (7%) as CSF culture is not available, cryptococcal meningitis (16%) were found in this study. In four cases among 43 patients, no identified causes could be determined. CD4 lymphocytes count which was available in 24 patients was under 200/41 in 74% of the cases. This study indicates clearly that seizures in young adults are strongly associated with focal brain lesions and cerebral toxoplasmosis is becoming an important cause of seizure in tropical area. This should imply a screening of toxoplasmosis with new-onset seizure in young people.

[Neurologic manifestations associated with HIV infections at the Bobo-Dioulasso Hospital Center (Burkina Faso)]. / Manifestations neurologiques associées à l'infection par le VIH au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

Neurological manifestations of HIV infection are frequent and diverse. Diagnosis is often difficult due to geographical factors. 686 of the 3409 patients admitted to the Internal Medicine ward of Bobo-Dioulasso in 1995-1996 were HIV seropositive. This represents a prevalence of 20.1%. The sociodemographic and clinical characteristics of 101 patients with neurological problems during the study period are reported in this paper. This case series represents 14% of the HIV-positive admissions. The mean age was 35.7 years and 43% of the cases were aged 30 to 40 years. Sex-ratio was 1.6 male for 1 female. Focal deficits were observed in 36 of cases. Peripheral neuropathy (37%), meningitis or meningoencephalitis (20%), fitting (8%) and myelitis (8%) were the other clinical presentations. The etiology of the focal deficits was not ascertained because of the lack of tomodensitometry, specific serology and necropsy. Any neurological manifestation in a HIV seropositive patient should prompt investigations in order to diagnose those infections which can be treated, especially Toxoplasma gondii abscess and Cryptococcus neoformans meningitis.

[Risk and severity factors in cerebrovascular accidents in west african Blacks of Burkina Faso]. / Etude des facteurs de risque et de gravité des accidents vasculaires cérébraux chez des noirs ouest-africains au Burkina Faso.

This report presents the findings of a retrospective review of 193 cases of cerebrovascular attacks (CVA) diagnosed on the basis of clinical data over a 3-year period at the Bobo Dioulasso Hospital in Burkina Faso. CVA accounted for 15.1% of admissions for cardiovascular disorders. Mean patient age was 58.4 +/- 14 years and the male to female ratio was 2:1. From a socioeconomic standpoint 72% of patients had low incomes and 22% were laborers. Risk factors were poorly controlled hypertension (83.9%), obesity (44.2%), hyperlipidemia (20.6%), thromboembolism (16.6%), smoking (12.4%), hypercholesterolemia (8.1%) and diabetes (7.3%). Further study is needed to confirm risk related to red blood cell abnormalities. The event was transient ischemic attack in 22 cases (11.7%) and stroke in 171 cases (88.3%). Hospital mortality was high (31.6%) with a significantly higher death rate in elderly (p < 0.05) and female (p < 0.001) patients. Recurrent CVA within a mean delay of 9 to 12 months following the initial event was observed in 11.4% of survivors and was fatal in 80%. The authors emphasize the need for improvement in the management of arterial hypertension by district physicians and for prevention of thromboembolic complications in high-risk patients.

[AIDS-related cryptococcal meningitis at the Bobo-Dioulasso Hospital Center: five case reports]. / La cryptococcose neuro-méningée au cours du SIDA au Centre Hospitalier de Bobo- Dioulasso: à propos de cinq cas.

The authors report five cases of Cryptococcus neoformans meningitis in HIV-positive patients hospitalized in the Souro Sanou National Hospital Center of Bobo-Dioulasso (Burkina Faso). There were 3 men and 2 women with a mean age of 36 years (range: 29 to 47 years). Presenting symptoms were persistent headache and/or mental confusion and neurosensory defects. Cerebrospinal fluid was clear with less than 20 lymphocytes/mm3. Albumin concentration greater than 0.50 g/l was observed in only one case. India ink smear and culture demonstrated strains of Cryptococcus neoformans sensitive to amphotericin B in all five cases, flucytosin in 3 cases, and ketoconazole in two cases. Four patients died within 15 to 32 days after admission (mean 22.5 days). Delayed diagnosis and inconsistent availability of systemic antifungal drugs are major limiting factors in the management of Cryptococcus neoformans meningitis in Burkina Faso.