Frequency and factors associated with arterial remodeling in persons living with human immunodeficiency virus in Parakou in 2019.

BACKGROUND: The side effects of antiretroviral drugs and the chronic inflammation induced by human immunodeficiency virus (HIV) infection contribute to the development of atherosclerotic arterial remodeling in people living with HIV (PLWH). OBJECTIVES: To determine the frequency and factors associated with arterial remodeling in PLWH treated at the university hospital of Parakou. METHODS: It was a cross-sectional, descriptive, and analytic study. Data were collected from March to August 2019 at the university hospital of Parakou in Benin. PLWH aged at least 18years and consenting were included. The diagnosis of arterial remodeling was retained in the presence of at least one of the following criteria: carotid intima-media thickness≥1mm, anteroposterior diameter of the abdominal aorta≥25mm, ankle brachial index<0.9, presence of atheromatous plaque. Data were recorded and analyzed with R 3.5.1 software, and the threshold of significance was 5%. RESULTS: A total of 114 patients have undergone arterial Doppler ultrasound. The majority were women (71.9%). The patients' mean age was 43.2±10.2years with extremes of 18 and 67years. The frequency of arterial remodeling was 24.6%. The most common atherosclerotic lesion found was atheromatous overload (IMT≥1mm). Age≥50y (p=0.003; ORa=4.9[1.5-15.6]), male sex (p=0.037; ORa=4.1[1.3-13.4]), and a family history of hypertension and/or diabetes (p=0.027; ORa=3.6[1.1-12.8]) were significantly associated with atherosclerosis in PLWH. CONCLUSION: Arterial remodeling was frequent among PLWH in Parakou in 2019. The associated factors were the classic cardiovascular risk factors that should be systematically taken into account in the follow-up of these patients.

[Loss of capture by myocardial ischemia: A case report]. / Perte de capture par ischémie myocardique : à propos d'un cas.

We report the case of a patient with pacemaker who presented chest pain during exercise followed by fainting. He has a history of arterial hypertension and diabetes. The initial examination was normal; the ventricular stimulation threshold was 1.125 volts (V) and cardiac enzymes were normal. Stress test has reproduced chest pain followed by loss of pacemaker capture and asystole. Coronary angiography showed a tight stenosis of the proximal anterior interventricular artery dilated by a drug-eluting stent. The control of stress test was normal. A stent thrombosis eight days later led to an acute coronary syndrome with recurrent syncope due to the loss of ventricular capture. The ventricular pacing threshold was then 2.25V. After revascularization and stabilization of the patient's clinical status, this threshold returned to 1.125V. This clinic case has confirmed that coronary artery disease could increase pacing threshold. It also highlights the usefulness of automatic capture algorithms in coronary patients. The stress test cannot only help to detect coronary artery disease but also allows the optimization of programming the pacemaker.

Detection of a Left Superior Vena Cava during a Pacemaker Implantation in Cotonou.

Persistent left superior vena cava (LSVC) is a rare congenital anomaly. Its prevalence in the general population is 0.1 to 0.5%. LSVC is 5 times rarer when accompanied by an absence of the right superior vena cava (RSVC). We present the case of a 54-year-old man who carries a persistent LSVC without RSVC. Clinically, this patient presented a regular bradycardia at 40 per minute associated with a heart failure syndrome. The electrocardiogram diagnosed a complete atrioventricular block and transthoracic echocardiography showed dilated left heart cavities and a left ventricular ejection fraction of 50%. During the procedure of pacemaker implantation, the probe followed an unusual LSVC-coronary sinus-right atrium path and it was not easy to pass through the tricuspid orifice. We propose a review of the literature on this subject, focusing on the clinical implications of this malformation in cardiac stimulation and in other areas of cardiology.

[Transformation of left bundle branch block into simulated bundle branch block after ablation of the right bundle in a patient with branch-to-branch reentry ventricular tachycardia]. / Transformation d'un bloc de branche gauche en bloc de branche déguisé après ablation de la branche droite chez un patient présentant des tachycardies ventriculaires par réentrée de branche à branche.

Masquerading bundle branch block associates left bundle branch block in the standard lead and right bundle branch block in the precordial leads. Mr R., 67 year old, was referred for investigation of syncope. He had a history of idiopathic dilated cardiomyopathy (normal coronary arteries; EF: 14%, CI: 2.2 l/min/m2 at later investigations). The ECG showed LBBB with left axis deviation, a PR interval at the upper limits of normal and ventricular premature beats. During observation, he had another syncopal episode and the ECG showed wide complex tachycardia (160 bpm) reduced by external cardioversion. Electrophysiological investigations showed inducible VT due to bundle branch reentry. The HV interval in sinus rhythm was 80 ms. Radiofrequency ablation of the right bundle led to first degree AVB with masquerading bundle branch block with an increased HV interval of 120 ms. The usual facility of ablation of the right bundle branch block is an argument in favour of the hypothesis whereby masquerading bundle branch block is a variety of RBBB with severe conduction defects of the two branches.

[Epidemiology of chronic obstructive arterial disease of the lower limbs and diabetic patients at the University Hospital of Cotonou (Benin)]. / Epidémiologie de l'artériopathie chronique oblitérante des membres inférieurs chez le diabétique au CHU de Cotonou (Bénin).

The aims of this study were to determine the prevalence of chronic obstructive arterial disease of the lower limbs and to identify the factors which contribute to its occurrence in a population of adult African francophone diabetics. This was a prospective study which included all consenting diabetics systematically over a 6 month period at the out patient clinic or during hospital admission. Patients with incomplete data were excluded. An ankle systolic pressure index of less than 0.9 was required for the diagnosis of obstructive arterial disease. Demographic parameters, the characteristics of the diabetes, the quality of blood sugar control, the presence of classical cardiovascular risk factors and the results of their treatment, the nature and distribution of the arterial lesions on ultrasonography were all studied. A univariate analysis and a multivariate analysis of their correspondences were undertaken to determine the correlation coefficients. The prevalence of arterial disease of the lower limbs in the 102 diabetics retained for the study (average age 53 years) was 33.3%. The arterial disease was distal in 47% of cases and diffuse in 26.5% of cases. The arterial wall was calcified in 19.6% of cases. In univariate analysis only age was correlated with arterial disease (p = 0.04), the duration of diabetes tended to be related (p = 0.07). In multi-factorial analysis of Correspondences with other factors, hypertension, hyperlipidaemia and multiple cardiovascular risk factors seemed to be correlated with arterial disease of the lower limbs. Therefore, arterial disease of the lower limbs is very common and an early complication of diabetic patients in Benin. Predisposing factors were age and, probably, duration of diabetes, hypertension, hyperlipidaemia and multiple cardiovascular risk factors.

[Blood levels of homocysteine in patients under 55 years of age with acute coronary insufficiency]. / Taux d'homocystéine sanguine chez les patients de moins de 55 ans, atteints d'insuffisance coronarienne aiguë.

OBJECTIVES: High blood levels of homocysteine have been recently described as a risk factor for thromboembolic events and early development of atherosclerosis. The aim of this work was to study homocysteine blood levels in patients under 55 years of age with acute coronary artery disease. PATIENTS AND METHODS: The study included 110 patients (98 men, 12 women) with poorly controlled angina pectoris (n = 35) or in the acute phase of myocardial infarction (n = 65). Homocysteine was assayed by liquid chromatography in all patients on the day of the acute episode and 24 hours later. Homocysteine levels were also determined in 40 controls under 55 years of age with no history of coronary artery disease. RESULTS: Blood level of homocysteine was 10.6 +/- 6.2 mumol/l in the patients and 7.7 +/- 2.5 mumol/l in the controls (p < 0.01). The difference was greater in the 30-40 year age rang with 14.4 +/- 2 mumol/l in patients versus 6.4 +/- 1.5 mumol/l in controls (p < 0.001). The assays were reproducible at 24 hours (difference less than 10%). The levels were significantly higher in patients with several diseased arteries than those with single-artery disease. The difference between patients and controls was especially remarkable for non-smokers and those with high cholesterol levels. CONCLUSION: Hyperhomocysteinemia would be a factor favoring early development of coronary atherosclerosis.

[Mucous diaphragm of the cervical esophagus. Apropos of 38 cases discovered during upper endoscopy at the General Hospital of Dakar. Relationship with the Kelly-Paterson or the Plummer-Vinson syndrome]. / Diaphragme muqueux de l'oesophage cervical a propos de 38 cas découverts au cours d'endoscopies hautes à l'Hôpital Principal de Dakar. Relation avec le syndrome de Kelly-Paterson ou de Plummer-Vinson.

At the occasion of 15,000 high endoscopies performed during the past 5 years at the general Hospital of Dakar (Senegal) 38 mucous diaphragms of cervical esophagus were discovered. 36 patients are Black Senegalese; 29 females and 9 males with a mean age of 37. Dysphagia was present 29 times and anemia 22 times. Endoscopies diagnosis is easy, putting into light a mucous diaphragm at the level or immediately below Killian mouth. 18 of these cases have been classified as Kelly-Paterson syndrome. Performed in 30 patients, the treatment consists in breaking down the mucous diaphragm with an endoscope. It is difficult to keep on endoscopic monitoring, although it is essential because the risk of cancerisation.

[Mucoid webs of the cervical esophagus. Apropos of 38 cases discovered during upper endoscopy at the Hôpital Principal of Dakar. Relationship to Plummer-Vinson syndrome]. / Diaphragmes muqueux de l'oesophage cervical. A propos de 38 cas découverts au cours d'endoscopies hautes à l'Hôpital Principal de Dakar. Relation avec le syndrome de Plummer-Vinson.

Thirty-eight cervical esophageal mucous diaphragms were discovered in the course of 15,000 high endoscopies carried out over the past 5 years at Dakar General Hospital. Thirty-six of the sufferers were Black Senegalese. The 29 women and 9 men had an average age of 37 years. Dysphagia was diagnosed 29 times, and anemia 22 times. Endoscopic diagnosis readily shows the mucous diaphragm at the level of, or immediately below, KILLIAN's mouth. PLUMMER-VINSON's syndrome affected 16 of these patients. Treatment consists in collapsing the mucous diaphragm by putting the endoscope through it: this happened to 30 of the patients. Endoscopic surveillance is indispensable because of the risk of cancer, but is difficult to perform.

Valeur pronostique péri-opératoire des anomalies de la repolarisation ventriculaire découvertes sur l'ECG pré-opératoire au Centre Hospitalier et Universitaire de Cotonou

But : Le but de cette étude était de déterminer la valeur pronostique des anomalies de la repolarisation ventriculaire découvertes sur l'ECG réalisé avant la chirurgie non cardiaque. Méthode : Cette étude prospective effectuée sur une période de 10 mois a inclus des patients âgés de 18 ans au moins ayant réalisé un ECG préopératoire interprété par un cardiologue. Ces patients ont été suivis pendant l'intervention et jusqu'à H48 après. Les évènements cardiovasculaires anormaux étaient enregistrés pendant l'intervention et les deux premiers jours post-opératoires.Résultats : Quatre-vingt-dix-sept (97) patients ont été inclus. Les anomalies de la repolarisation ont été retrouvées chez 58,8% des patients. L'aspect d'ischémie sous-épicardique et la repolarisation précoce étaient les anomalies de la repolarisation les plus fréquentes avec des fréquences respectives de 42,3% et 14,4%. L'hypotension artérielle était l'évènement cardiovasculaire le plus retrouvé en per-opératoire devant la tachycardie sinusale, la poussée hypertensive, le choc cardiogénique et l'accélération de la fibrillation atriale. L'hypotension artérielle était le seul évènement cardiovasculaire péjoratif en per-opératoire, associé aux anomalies de la repolarisation avec un test statistiquement significatif (55,4% versus 32,5% ; p = 0,02). La période post-opératoire a été marquée par la survenue de deux (2) décès dans le groupe des patients ayant présenté une anomalie de repolarisation.Conclusion : L'ECG des patients subissant une chirurgie non-cardiaque contient des informations pronostiques importantes. Les résultats de notre étude montrent que l'ischémie sous-épicardique doit être considérée comme un facteur de risque indépendant d'hypotension per opératoire

Etude du déficit en proteine C dans la maladie thromboembolique veineuse au CNHU de Cotonou: étude realisée chez 54 patients noirs vivant à Cotonou

L'objectif de cette etude est de depister le deficit en proteine C dans une population de patients noirs africains atteints de maladie thromboembolique veineuse. C'est une etude descriptive transversale qui a inclus systematiquement tous les patients hospitalises pour MTEV aigue ou suivis dans les suites de MTEV qui ont accepte d'y participer. Un dosage quantitatif de la proteine C a ete realise sur un equipement de type Minividas. Le prelevement sanguin a ete effectue en dehors de tout traitement antivitamine K. Un deuxieme prelevement est effectue pour confirmation au cas ou le premier dosage affirme un deficit. En cas de deficit la recherche d'une etiologie acquise est systema- tique. Pour les 54 patients retenus la sex-ratio etait de 1;08 et l'age moyen est de 52;7+/- 14;1 ans. Un deficit en proteine C a ete diagnostique chez 9;3des patients et 12;5des patients presentant des criteres de thrombophilie ( p=1). Aucune etiologie acquise n'a ete mise en evidence