Causes of admission and mortality among patients admitted in 37 cardiology departments in 17 Sub-Saharan African countries: the FEBRUARY observatory (2016–2021) from African Research Network

Background

Cardiovascular disease (CVD) is a major cause of death worldwide. At least two-third of CVD death occurs in low- (LIC) and middle-income (MIC) countries. An estimated 1 million deaths were attributable to CVD in sub-Saharan Africa (SSA) alone. Scarce data are available about the admission for CVD and outcome in cardiology department in SSA.

Purpose

To describe admission for CVD and outcome of hospitalization in 17 in SSA countries.

Methods

We conducted a transversal and longitudinal study in CV department of 37 hospitals from 23 cities in 17 SSA countries (10 low income: Niger, Guinea, Benin, Mali, Democratic Republic of the Congo, Tchad, Burkina Faso, Togo, Burundi, Ethiopia and 7 middle income: Cote d'Ivoire, Senegal, Cameroon, Congo, Soudan, Mauritania, Gabon). The February study was designed by a multidisciplinary collaborative team of epidemiologists, pharmacists and cardiologists from Africa and France. This ongoing observatory included all inpatients in February from each year since 2016.Data including socio-demographic and clinical characteristics, causes of admission, clinical, biological, complementary examinations, treatments, length of stay and discharge diagnosis were collected by the investigating physicians. All analyses were performed through scripts developed in the R software (4.0.3 (2020-10-10))

Results

Overall, 4360 patients were included in the February study. Men represented 56.4%. Mean of age was 56.7±16.8 years. The main cause of admission was heart failure (41.5%) followed by acute coronary syndrome (11.9%) and stroke (11%). Cause of admission varied significantly across countries (p<0.01) and over the years (p<0.01). Proportions of admission for heart failure varied from 20% in Ethiopia to 62% in Guinea. Mean of length of stay was 9.95±22.4 days. All causes of admission confounded, in-hospital mortality rate was 11% (N=423). Mortality rate differed significantly according to causes of admission (p<0.01).Mortality rate among patients admitted for stroke, heart failure and acute coronary syndrome was respectively 18%, 12.3% and 9.5%. Overall, 31 (0.7%) were admitted for endocarditis and mortality rate among them was 20.8% (figure). Overall, mortality rate did not vary according to gender or over the years but was significantly different according to patient wealth index (p<0.05), countries (p<0.01) and level income countries (p<0.01). Mortality rate was significantly higher in LIC.

Conclusion

Heart failure, acute coronary syndrome and stroke represent the two-third of causes of admission. Overall, mortality rate in cardiology departments in SSA reached 11%.

Funding Acknowledgement

Type of funding sources: None.

Satellite Monitoring for Air Quality and Health

Data from satellite instruments provide estimates of gas and particle levels relevant to human health, even pollutants invisible to the human eye. However, the successful interpretation of satellite data requires an understanding of how satellites relate to other data sources, as well as factors affecting their application to health challenges. Drawing from the expertise and experience of the 2016-2020 NASA HAQAST (Health and Air Quality Applied Sciences Team), we present a review of satellite data for air quality and health applications. We include a discussion of satellite data for epidemiological studies and health impact assessments, as well as the use of satellite data to evaluate air quality trends, support air quality regulation, characterize smoke from wildfires, and quantify emission sources. The primary advantage of satellite data compared to in situ measurements, e.g., from air quality monitoring stations, is their spatial coverage. Satellite data can reveal where pollution levels are highest around the world, how levels have changed over daily to decadal periods, and where pollutants are transported from urban to global scales. To date, air quality and health applications have primarily utilized satellite observations and satellite-derived products relevant to near-surface particulate matter <2.5 μm in diameter (PM_2.5) and nitrogen dioxide (NO₂). Health and air quality communities have grown increasingly engaged in the use of satellite data, and this trend is expected to continue. From health researchers to air quality managers, and from global applications to community impacts, satellite data are transforming the way air pollution exposure is evaluated.

A multi-analysis approach for estimating regional health impacts from the 2017 Northern California wildfires

Smoke impacts from large wildfires are mounting, and the projection is for more such events in the future as the one experienced October 2017 in Northern California, and subsequently in 2018 and 2020. Further, the evidence is growing about the health impacts from these events which are also difficult to simulate. Therefore, we simulated air quality conditions using a suite of remotely-sensed data, surface observational data, chemical transport modeling with WRF-CMAQ, one data fusion, and three machine learning methods to arrive at datasets useful to air quality and health impact analyses. To demonstrate these analyses, we estimated the health impacts from smoke impacts during wildfires in October 8-20, 2017, in Northern California, when over 7 million people were exposed to Unhealthy to Very Unhealthy air quality conditions. We investigated using the 5-min available GOES-16 fire detection data to simulate timing of fire activity to allocate emissions hourly for the WRF-CMAQ system. Interestingly, this approach did not necessarily improve overall results, however it was key to simulating the initial 12-hr explosive fire activity and smoke impacts. To improve these results, we applied one data fusion and three machine learning algorithms. We also had a unique opportunity to evaluate results with temporary monitors deployed specifically for wildfires, and performance was markedly different. For example, at the permanent monitoring locations, the WRF-CMAQ simulations had a Pearson correlation of 0.65, and the data fusion approach improved this (Pearson correlation = 0.95), while at the temporary monitor locations across all cases, the best Pearson correlation was 0.5. Overall, WRF-CMAQ simulations were biased high and the geostatistical methods were biased low. Finally, we applied the optimized PM2.5 exposure estimate in an exposure-response function. Estimated mortality attributable to PM2.5 exposure during the smoke episode was 83 (95% CI: 0, 196) with 47% attributable to wildland fire smoke.Implications: Large wildfires in the United States and in particular California are becoming increasingly common. Associated with these large wildfires are air quality and health impact to millions of people from the smoke. We simulated air quality conditions using a suite of remotely-sensed data, surface observational data, chemical transport modeling, one data fusion, and three machine learning methods to arrive at datasets useful to air quality and health impact analyses from the October 2017 Northern California wildfires. Temporary monitors deployed for the wildfires provided an important model evaluation dataset. Total estimated regional mortality attributable to PM2.5 exposure during the smoke episode was 83 (95% confidence interval: 0, 196) with 47% of these deaths attributable to the wildland fire smoke. This illustrates the profound effect that even a 12-day exposure to wildland fire smoke can have on human health.

[Chronic Right Ventricular Failure Revealing a Large Compressive Hydatid Cyst at the Cardiology Department of the Aristide le Dantec Hospital (Dakar, Senegal)]

Hydatidosis, an anthropozoonosis caused by the development of the Echinococcus granulosus larva in human, is a parasitic infection that is endemic in many countries. Pericardial localization in the absence of other cardiac involvement is extremely rare. Its spontaneous evolution is serious because of the risk of rupture. We report the case of a 65-year-old patient, who received limb edema that had been going on for 4 months, and in whom the physical examination noted a 3/6 tricuspid regurgitation and a right heart failure syndrome. Transthoracic echocardiography revealed an intra-pericardial mass whose contents appeared fluid with hyperechogenic area. It measured 86x61 mm and significantly compressed the straight cavities. Thoracic computed tomography showed an appearance in favor of an aged intrapericardic hydatid cyst (GHARBI V) with mass effect on the right cavities. The hydatid serology was negative. The patient did not accept the surgical cure. She had been put on albendazole and diuretic treatment. Fatal outcome was reported after two-month follow-up.

Methods, availability, and applications of PM2.5 exposure estimates derived from ground measurements, satellite, and atmospheric models

Fine particulate matter (PM2.5) is a well-established risk factor for public health. To support both health risk assessment and epidemiological studies, data are needed on spatial and temporal patterns of PM2.5 exposures. This review article surveys publicly available exposure datasets for surface PM2.5 mass concentrations over the contiguous U.S., summarizes their applications and limitations, and provides suggestions on future research needs. The complex landscape of satellite instruments, model capabilities, monitor networks, and data synthesis methods offers opportunities for research development, but would benefit from guidance for new users. Guidance is provided to access publicly available PM2.5 datasets, to explain and compare different approaches for dataset generation, and to identify sources of uncertainties associated with various types of datasets. Three main sources used to create PM2.5 exposure data are ground-based measurements (especially regulatory monitoring), satellite retrievals (especially aerosol optical depth, AOD), and atmospheric chemistry models. We find inconsistencies among several publicly available PM2.5 estimates, highlighting uncertainties in the exposure datasets that are often overlooked in health effects analyses. Major differences among PM2.5 estimates emerge from the choice of data (ground-based, satellite, and/or model), the spatiotemporal resolutions, and the algorithms used to fuse data sources.Implications: Fine particulate matter (PM2.5) has large impacts on human morbidity and mortality. Even though the methods for generating the PM2.5 exposure estimates have been significantly improved in recent years, there is a lack of review articles that document PM2.5 exposure datasets that are publicly available and easily accessible by the health and air quality communities. In this article, we discuss the main methods that generate PM2.5 data, compare several publicly available datasets, and show the applications of various data fusion approaches. Guidance to access and critique these datasets are provided for stakeholders in public health sectors.

Acute circulatory failure in two cardiology departments in Dakar: 44 cases

INTRODUCTION

Acute circulatory failure is a life-threatening emergency whose prognosis depends on early management and aetiological diagnosis. The aim of our study was to assess the epidemiological, aetiological, therapeutic and prognostic aspects of acute circulatory failure in two cardiology departments in Dakar.

METHODS

This was a longitudinal, multicentre, descriptive study over a period of six months from October 2014 to March 2015. We included all patients with acute circulatory failure (systolic blood pressure < 90 mmHg, oligoanuria, tachycardia, tachypnoea, onset of altered consciousness) either on admission or during hospitalisation during the study period. A long-term survival survey (six months to one year) was conducted on all included patients.

RESULTS

Forty-four patients were enrolled. The average age was 54.9 years, ranging from 20 to 83 years. The gender ratio was 1.1. Acute circulatory failure occurred most often during hospitalisation (63%), with known cardiomyopathy in 47.7% of cases. Consciousness was impaired in 11 patients while oligoanuria was present in 27.3% of cases. Inflammatory syndrome was mostly found in 63.6% of cases and renal insufficiency and acute liver failure were reported in 45.5 and 29.5% of patients, respectively. Left ventricular dysfunction was the most common echocardiographic feature (70%). Acute circulatory failure was cardiogenic in most cases, with a predominance of advanced dilated cardiomyopathy (44.9%). Septic shock was found in 25% of patients, with pulmonary infection as the main location (20%). Nine per cent of patients had hypovolaemic shock. The most used inotropic drug was dobutamine in 79.5% of cases, followed by adrenaline (18.2%) and norepinephrine (4.5%). Intra-hospital mortality rate was high (52.3%) and one-year survival rate was 27.2%. Poor prognostic factors such as advanced age and renal impairment were associated with a higher overall mortality rate of 18 to 90%, with no statistical significance.

CONCLUSIONS

Acute circulatory failure is a diagnostic and therapeutic emergency with a high mortality rate.

Anal fistula plug vs rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis of studies with long-term follow-up

AIM

The aim was to compare the effectiveness of the anal fistula plug (AFP) with the rectal advancement flap (RAF) for complex cryptoglandular anal fistulas.

METHODS

We conducted a literature search to identify relevant available articles published without language restriction from Embase and PubMed databases and the Cochrane Library. Studies comparing outcomes with the AFP vs RAF for complex cryptoglandular anal fistulas were eligible for inclusion.

RESULTS

A total of 11 articles with 810 patients were included in this meta-analysis. Four RCTs and one observational clinical study provided long-term follow-up. The pooled analysis of all 11 studies indicated that there was no significant difference between the AFP and RAF in terms of healing rate, recurrence rate and incidence of fistula complications. However, the pooled results of studies with long-term follow-up revealed that the RAF group had a significantly higher healing rate (OR 0.32, 95% CI 0.13, 0.78, P = 0.01) and lower recurrence rate (OR 4.45, 95% CI 1.45, 13.65, P = 0.009) than the AFP group.

CONCLUSIONS

For the treatment of complex cryptoglandular anal fistulas, the RAF was superior to the AFP in terms of healing and recurrence rate after pooling of randomized controlled trials with long-term follow-up, even though a comparison based on the pooling of all studies showed no significant difference.

[Prevalence of cardiovascular risk factors in semi-rural area in Senegal]

OBJECTIVES

We aim to determine the prevalence of cardiovascular risk factors in the semi-rural population of the community of Gueoul in Senegal.

PATIENTS AND METHOD

This is a cross-sectional, observational and descriptive study. We conducted an exhaustive survey in 2012 according to the STEPS wise approach of the world health organization against Senegalese aged of 35 years and over who resided for at least 6 months in semi-rural area in the community of Gueoul. Pregnant women were excluded. Classical cardiovascular risk factors were collected and data analyzed using SPSS 18.0 software. The significance level was agreed for a value of P<0.05.

RESULTS

We examined 1411 subjects (1052 women) with a mean age of 48.5±12.68 years. The main cardiovascular risk factors were dyslipidemia (61,1%), physical inactivity (56.2%), abdominal obesity according to the International Diabetes Federation (53.9%), hypertension (46.4%), global obesity (13%), diabetes (7.2%) and smoking (2.5%). Hypertension was significantly associated with diabetes (P=0.001), abdominal obesity (P=0.001) and global obesity (P=0.0001). Sedentarity (P=0.001), global obesity (P=0.0001) and hypertension (P=0.001) were more frequent in women.

CONCLUSION

Cardiovascular risk factors are frequent and often associated in semi-rural area of Senegal, particularly in women. This condition should lead to develop prevention strategies of cardiovascular complications.

[Ambulatory Blood Pressure Measurement's Reults And Indications At Cadiology Department At Hôpital Aristide Le Dantec]

High blood pressure (HTA) is a public health problem. It affects more than one billion people around the world, more than a quarter of the world's population. In recent years the ABPM (Ambulatory Blood Pressure Measurement) has become a valuable and widely used tool for the diagnosis and management of hypertension. The aims of this study were to determine the indications of MAPA to the cardiology department of Aristide le Dantec Hospital; to determine the results and to evaluate the blood pressure profile of our patients.

METHODS

We carried out a retrospective study, over 37 months from December 2010 to December 2013 covering all the results of the ABPMs recorded during this period. Was included any patient over 18 years of age with an ABPM. All ABPMs with less than 50 good measures per 24 hours were not included.

RESULTS

A total of 204 MAPA results were included of a total of 307. The mean age was 49.6 ± 11.5 years with extremes of 25 years and 78 years. The sex ratio was 1.5 in favour of women. Indications were dominated by labile HTA (34.8%); masked HTA (27.9%) and suspicious of the white coat effect (12.3%). The analysis of the results showed that MAPA was normal in 49.5%. The white coat effect was found in 32% (65 patients) of ABPM. In patients with abnormal ABPM, permanent systolic-diastolic hypertension predominated (57%). HTA masked was noted in 25.7% of our patients and HTA white coat was found in 3.8% of cases. In the hypertensive patients treated, MAPA revealed a poor blood pressure balance in 42.1%. Among the HTA prognostic factors we noted32.4% of patients were "Non Dippers", a pulse pressure greater than or equal to 60 mmHg in 59%.

CONCLUSION

The use of this exploration is an important aid to practitioners in the diagnostic, therapeutic and prognosis phase of the management of hypertension. It should become more important as it provides better information on the blood pressure profile for the patients.

[Left ventricular hypertrophy in black African subjects with artery hypertension: Results of a cross-sectional survey conducted in semi-rural area in Senegal]

OBJECTIVES

To assess the prevalence of left ventricular hypertrophy according to electrocardiographic and echocardiographic criteria among hypertensive patients living in semi-rural Senegalese area.

PATIENTS AND METHODS

According to the World Health Organization STEPSwise approach, we conducted, in November 2012, a cross-sectional and exhaustive study in the population aged at least 35 years old and living for at least six months in the semi-rural area of Guéoul. We researched electrocardiographic and echocardiographic left ventricular hypertrophy in hypertensive subjects. Data were analyzed with SPSS 18.0 software version. The significance level was agreed for a value of P<0.05.

RESULTS

We examined 1411 subjects aged on average of 48.5±12.7 years. In total, 654 subjects were hypertensive and screening of left ventricular hypertrophy (LVH) was effective in 515 of them. According to Sokolow-Lyon index, 86 subjects (16.7%) presented electrocardiographic LVH, more frequently in men (P=0.002). According to Cornell index and Cornell product, LVH was founded respectively in 66 (12.8%) and 52 subjects (10.1%), more frequently in female (P=0.0001; P=0.004). It was more common in grade 3 of hypertension however criteria. In echocardiography, prevalence of LVH was 2.2% (13 cases) according to the left ventricular mass, 9.3% (48 cases) according to the left ventricular mass indexed to body surface area and 8.2% (42 cases) according to the left ventricular mass indexed to height^2.7. LVH was significantly correlated with the electrocardiographic LVH according to Sokolow-Lyon index (P<0.0001) and the grade 3 of hypertension (P=0.003).

CONCLUSION

Although rare in hypertensive Senegalese living in semi-rural area, left ventricular hypertrophy is correlated with severity of grade of hypertension. Screening by electrocardiogram will allow better follow-up of these hypertensive subjects.

[Comparative Study Of Coronary Artery Disease In Diabetics And Non-Diabetics In The Department Of Cardiology Of Aristide Le Dantec University Hospital]

The aim of this study was to compare the features of coronary artery disease between diabetic and non-diabetic patients.

PATIENTS AND METHODS

A case-control study was carried out from 1 May 2013 to 31 July 2015 in the department of cardiology of Aristide le Dantec university hospital. Forty-five diabetic patients and forty-five non-diabetic patients who underwent coronary angiography and / or angioplasty were included.

RESULTS

There was a male predominance with a sex ratio of 1.6 in both groups. The mean age was 62.26 years for diabetics and 59.06 years for non-diabetics (p = 0.6). In diabetics, symptomatology was dominated by silent ischemia (48.9%) versus typical angina pain (68.9%) in non-diabetics. Myocardial infarction was the most common indication of coronary angiography in both groups. Coronary angiography revealed one-vessel disease (46.6% versus 41.7% p = 0.822), double vessel disease (26.7% versus 41.7% p = 0.091) and triple vessel disease (26.7% versus 16.6% p = 0.561). Angioplasty was indicated in 37.8% of diabetics versus 63.9% of non-diabetics. Nine diabetic patients and three non-diabetic patients had an indication of coronary artery bypass grafting.

CONCLUSION

Our study confirms the greater frequency of silent ischemia and multiple-vessel disease in diabetics as well as a more frequent indication of coronary artery bypass grafting in these patients.

Clinical effect of treating secondary asthma attacks of children Mycoplasma pneumoniae with combined therapy of montelukast and azithromycin

OBJECTIVE

To discuss the clinical effects of treating secondary asthma attacks of children Mycoplasma pneumoniae with combined therapy of montelukast and azithromycin.

PATIENTS AND METHODS

96 children patients diagnosed with secondary asthma attacks of Mycoplasma pneumonia were enrolled in this study. They were randomly divided into two groups: the control group (n=49) and the observation group (n=47). Patients in the control group received combined therapy using azithromycin and bronchodilators or glucocorticoid, and patients in the observation group received a combined therapy of montelukast, azithromycin and bronchodilators or glucocorticoid. The lung function indexes, T lymphocyte subpopulation, cytokines levels, positive rate of lgG and lgM, asthma control rate and recurrence rate were compared between groups before and after treatment.

RESULTS

The levels of V-T, t-PTEF/t-E, MTIF/MTEF and TEF25/PTEF in both groups increased after treatment, but we observed a more significant improvement in the observation group. The CD4+ and CD4+/CD8+ levels in both groups also increased after the intervention, while the level of CD8+ decreased. The IL-10, IL-17 and TGF-β levels decreased more intensely in the observation group.

DISCUSSION

The positive rate of lgG and lgM in both groups decreased significantly after the intervention. In the observation group, the asthma control rate was higher while the recurrence rate was lower. Although montelukast had little effect on improving the immune function, it was certainly beneficial for controlling the symptoms of asthma and improving the prognosis.

CONCLUSIONS

Using combined therapy of montelukast and azithromycin for treating the secondary asthma attacks of children mycoplasma pneumonia can relieve immunological and inflammatory reactions and improve the lung function.

[Cardiovascular manifestations in systemic lupus erythematosus in Dakar: Descriptive study about 50 cases]

Systemic lupus erythematosus is a non-specific inflammatory disorder of an organ of unknown cause and autoimmune origin. Visceral injuries, including those cardiovascular, determine the prognosis of this disease primarily affecting women. The objectives of this study were to determine the frequency and describe the cardiovascular manifestations in systemic lupus erythematosus in a lupus population of the Dakar region. This is a multicenter prospective study descriptive and analytical conducted in the region of Dakar (Senegal) from 14 February 2011 to 2 July 2012. Patients were either hospitalized or monitored as outpatients. Included were all patients with lupus and meeting at least four criteria of the American College of Rheumatology of lupus disease classification 1997. All patients underwent physical examination, an electrocardiogram and an echocardiogram looking for cardiovascular damage. The collected data were entered into the Epi Info version 3.5.1 and processed with SPSS 16.0 software. Quantitative variables are described in the median and the qualitative workforce, percentage and frequency. We have included 50 patients. The average age of the population was 36.18 years. A female predominance is noted with a sex ratio man/woman of 0.09. Cardiovascular functional symptoms were dominated by dyspnea stage II to IV NYHA (26%) and palpitations (22%). The physical signs we have found were mainly tachycardia (40%), spontaneous turgor of the jugular veins (29%), a muffling of the heart sounds (29%) and a infandibulopulmonairy shock (18%). The frequency of cardiovascular events was 46%. Electrical cardiac events were dominated by sinus tachycardia (40%) of repolarization disorders (16.3%) type of ischemia, injury, ischemia injury, necrosis and hypertrophy with 18% atrial and left ventricular hypertrophy each. Furthermore, one case of BAV first degree at 280 ms was recorded. We found 19 cases of pericarditis including 2 tamponade, 3 cases of dilated cardiomyopathy hyperkinesias with impaired ejection fraction less than 35% and 8 patients with mild PAH important. In systemic lupus erythematosus, cardiovascular events are worrying and may remain asymptomatic for awhile. Their research must be systematic in order to treat early.

[Prevalence of atherosclerotic carotid plaques in semi-rural Gueoul, Senegal: Survey of 1411 subjects]

AIMS

The purpose of this study was to investigate the prevalence of atherosclerotic carotid plaques and association with cardiovascular risk factors and vascular diseases in a semi-rural area of Gueoul in Senegal.

PATIENTS AND METHOD

This was a cross-sectional, descriptive study over a period of one month in 2012 in Senegalese people who were older than 35 years, and resided in semi-rural Gueoul for at least six months. Carotid plaques were measured with a portable Doppler Diadop 50(®) and defined by an intima-media thickness greater than 1.5mm. P-values less than 0.05 were considered statistically significant.

RESULTS

The survey involved 1411 individuals with a sex ratio of 2.93 and an average age of 48.5 years. Prevalence of risk factors was high: dyslipidemia (61.1 %), physical inactivity (56.2 %), abdominal obesity (53.9 %), hypertension (46.4 %), obesity (12 %), diabetes (7.2 %) and smoking (2.5 %). Prevalence of atherosclerotic carotid plaques was 6.8 %, including 42.7 % with bilateral plaques. Prevalence increased with age (P=0.001), hypertension (P=0.0001), diabetes (P=0.004) and metabolic syndrome (P=0.008). There were no significant associations with the other risk factors. The presence of carotid plaques was associated with medical history of stroke (P=0.01), myocardial infarction (P=0.02) and peripheral artery obstructive disease (P=0.5).

CONCLUSION

Prevalence of atherosclerotic carotid plaques seems weak but it is associated with many cardiovascular risk factors. It requires measures for early diagnosis and prevention of cardiovascular diseases in Senegal.

[Study of echocardiographic parameters of rheumatoid arthritis black African without clinically evident cardiovascular manifestations: A cross-sectional study of 73 cases in Senegal]

INTRODUCTION

Research of cardiac involvement in patients with rheumatoid arthritis can prevent complications and place in a logical secondary prevention. The objective of this study was to investigate the echocardiographic parameters in a population of Senegalese patients with rheumatoid arthritis without clinically evident cardiovascular manifestations.

PATIENTS AND METHOD

We conducted a descriptive cross-sectional study, which included prospectively from outpatients in the internal medicine department of university hospital center Aristide Le Dantec in Dakar, Senegal, with a diagnosis of rheumatoid arthritis without clinically evident cardiovascular disease. It focused on a sample of 73 patients of both sexes aged at least 18 years. Following clinical examination, we conducted laboratory tests (CRP, fibrinogen, ESR, rheumatoid factors: Latex and Waaler-Rose, anti-CCP, antinuclear factors and anti-ENA antibodies), ECG, echocardiography standard. Data were analyzed using a descriptive study of the different variables with the calculation of proportions for categorical variables, and the positional parameters and dispersion for quantitative variables.

RESULTS

A total of 73 patients with rheumatoid arthritis without obvious cardiac events and meeting the criteria of definition of the ACR 1987 were included in the study. The mean age was 44.17±14.43 years with extremes of 18 and 75 years. The mean duration of RA was 5.93±4.78 years. The concept of family inflammatory arthritis was reported in 35.60% of cases and almost one in six patients had at least a factor of cardiovascular risk (16.96%). The abnormalities found in Doppler echocardiography were dominated by diastolic LV dysfunction (42.46%), increased left ventricular mass in 35.61%. Valvular leaks of variable grades were highlighted regarding all orifices but were rarely significant.

CONCLUSION

The realization of echocardiography in patients with rheumatoid arthritis without clinically evident cardiovascular manifestations helps to highlight cardiovascular abnormalities related to the natural course of the disease.

Hydrophobically-associating cationic polymers as micro-bubble surface modifiers in dissolved air flotation for cyanobacteria cell separation

Dissolved air flotation (DAF), an effective treatment method for clarifying algae/cyanobacteria-laden water, is highly dependent on coagulation-flocculation. Treatment of algae can be problematic due to unpredictable coagulant demand during blooms. To eliminate the need for coagulation-flocculation, the use of commercial polymers or surfactants to alter bubble charge in DAF has shown potential, termed the PosiDAF process. When using surfactants, poor removal was obtained but good bubble adherence was observed. Conversely, when using polymers, effective cell removal was obtained, attributed to polymer bridging, but polymers did not adhere well to the bubble surface, resulting in a cationic clarified effluent that was indicative of high polymer concentrations. In order to combine the attributes of both polymers (bridging ability) and surfactants (hydrophobicity), in this study, a commercially-available cationic polymer, poly(dimethylaminoethyl methacrylate) (polyDMAEMA), was functionalised with hydrophobic pendant groups of various carbon chain lengths to improve adherence of polymer to a bubble surface. Its performance in PosiDAF was contrasted against commercially-available poly(diallyl dimethyl ammonium chloride) (polyDADMAC). All synthesised polymers used for bubble surface modification were found to produce positively charged bubbles. When applying these cationic micro-bubbles in PosiDAF, in the absence of coagulation-flocculation, cell removals in excess of 90% were obtained, reaching a maximum of 99% cell removal and thus demonstrating process viability. Of the synthesised polymers, the polymer containing the largest hydrophobic functionality resulted in highly anionic treated effluent, suggesting stronger adherence of polymers to bubble surfaces and reduced residual polymer concentrations.

[Prevalence survey of cardiovascular risk factors in the general population in St. Louis (Senegal)]

BACKGROUND

Cardiovascular diseases are becoming with their risk factors a real health problem in Africa. The objectives of this study were to assess the prevalence of risk factors for cardiovascular diseases in the general population in Saint-Louis, Senegal.

METHODOLOGY

This is a cross-sectional, descriptive and analytical made in May 2010, in the Senegalese aged 15, residing in the city of Saint-Louis, Senegal. A systematic random sampling and stratified cluster has been achieved. Cardiovascular risk factors for research were: hypertension, diabetes, dyslipidemia, smoking, obesity, physical inactivity and metabolic syndrome.

RESULTS

The survey involved 1424 individuals with 983 women (69%). The average age was 43.4±17.8years. The prevalence of risk factors was: hypertension (46%), diabetes (10.4%), total cholesterol (36.3%), hyperLDLcholesterol (20.6%), obesity (body mass index≥30kg/m(2)) (23%), abdominal obesity (48.7% according to International Diabetes Federation and 33.2% according to National Cholesterol Education Program) physical inactivity (64.7%), smoking (5.8%) and metabolic syndrome (15.7%). There was predominance in women of risk factors except for smoking and diabetes. The overall cardiovascular risk was high in 24.9% according to the Framingham model, 28.8% (European Society of Hypertension) and 6.1% (SCORE).

CONCLUSION

This survey found a high prevalence of cardiovascular risk factors in a general population in Senegal, predominant in women. This should lead to better develop a strategy to prevent cardiovascular diseases.

[Prevalence and factors related to therapeutic adherence among black African outpatients with stable coronary artery disease in a cardiology department of Dakar in Senegal]

INTRODUCTION

The management of coronary artery disease has made important progress. Adherence to therapeutic measures is a great challenge for improving the long-term prognosis. In this work, we evaluate factors related to therapeutic adherence in black African patients with stable coronary artery disease.

METHODOLOGY

We conducted a survey over three months (February-May 2008) in three cardiology departments in Dakar. We studied the regularity of drug intake, the adherence to the dietary advices and the appointments for consultation as well as the factors related to adherence. Good adherence was defined by a compliance rate greater or equal to 80% and a compliance rate less than 40% defined poor adherence.

RESULTS

We included 105 patients (61 men) with a mean age of 60.67±11.29 years. Good compliance was noted in 56.2% of cases for drug treatment, 42% for dietary advices and 65% for appointments for consultation. A history of acute coronary events (P=0.04), a good knowledge of the disease (P=0.03) and a healthcare (P=0.02) were the factors related to a good adherence to drug treatment, whereas ischemic cardiomyopathy was a factor for poor adherence (P=0.002). Knowledge of coronary disease was the only factor correlated with good adherence to lifestyle (P=0.014).

CONCLUSION

Therapeutic adherence remains unsatisfactory in Black African patients with stable coronary artery disease, hence the importance of patient education to reach a good adherence for therapeutic, because better adherence improves long-term prognosis of coronary artery disease.

[A familial form of ventricular non compaction in a mother and two of his sons in St. Louis, Senegal]

We report a familial form of ventricular non compaction in a mother and two of her sons. It was a young man of 25 years who presented with NYHA stage III dyspnea and a cough with bloody sputum. The clinical examination found left ventricular failure. The echocardiogram done showed left ventricular dilatation with large trabeculae separated by deep intertrabecular recesses in both ventricles suggestive of a non-biventricular compaction. It was possible to note from the family screening by echocardiography of the mother and half-brother a left ventricular non compaction while they were asymptomatic. Thus we concluded a familial form of ventricular non-compaction. This is the first familial case described in Senegal.

Vascular complications of infective endocarditis

The complications of infective endocarditis (IE) are frequent and severe. Our objectives were to analyze the clinical, paraclinical, and prognostic features of IE vascular complications observed in two cardiology units, in Dakar.

PATIENTS AND METHODS

We retrospectively studied 90 patients presenting with of IE, hospitalized between January 2005 and February 2011. The diagnostic criteria for IE were modified Duke University criteria. We selected in our study population, patients with vascular complications.

RESULTS

Seventeen patients (18.8%) presented with one or more vascular complications of IE: eight male and nine female patients, with a mean age of 28 years. Infective endocarditis occurred on an abnormal valve in 15 cases. We identified 22 vascular lesions: ten neurological complications, seven arterial complications in the limbs, two myocardial infarctions, two cases of pulmonary embolism, and one splenic infarction. The vascular complication revealed an IE in seven cases. The vascular complication occurred during antibiotic treatment, in 15 cases including seven cases before the 14th day, nine of the 17 patients died. Death was related to vascular complications in six cases, in one case it was related to septic shock.

CONCLUSION

Vascular complications of IE are frequent, the most common are neurological. Their prevention requires early and adequate management of IE.

[Epidemiological, clinical and ultrasonographic aspects of right-sided infective endocarditis in Senegal: 6 cases]

Right-sided infective endocarditis accounts for 5 to 10% of endocarditic involvement and usually affects the tricuspid valve. The purpose of this report is to describe epidemiological, clinical and echocardiographical aspects of 6 cases of right-sided infective endocarditis observed in the Cardiology Department of Aristide Le Dantec Hospital in Dakar, Senegal from December 2007 to February 2010. Diagnosis was based on Duke's modified criteria. There were 3 men and 3 women with a mean age of 28.2 years (range: 20 and 43). Five of the 6 patients presented tricuspid endocarditis including one case associated with pulmonary endocarditis. In another case, pulmonary endocarditis was associated with aortic endocarditis. Infective endocarditis was acute in three cases and primary in four. One case of infective endocarditis was observed in a tetralogy of Fallot. Fever was present in 4 cases with an mean temperature of 38.4 degrees C (range, 37.2 to 40 degrees C) and heart failure was present in 5 cases. In 2 patients, blood cultures were positive for Staphylococcus aureus. All patients had leucocytosis with a neutrophilic predominance. Doppler echocardiography depicted vegetations in all cases. Contributing factors included congenital heart disease in 1 case, insertion of a venous catheter in 2 and dental infection in 2. No patient was addicted to intravenous drugs or infected by HIV. Outcomes included one in-hospital death with signs of refractory heart failure. Right-sided endocarditis is often primary and is dominated by the tricuspid involvement. It affects both sexes. Contributing factors include venous catheterization during the postpartum period and dental infection. Prevention requires strict asepsis during venous catheter insertion, treatment of dental infections and improved management of congenital heart disease.

[Flaccid paraplegia revealing an adenoma of Conn: a case report]

We report the case of Conn's adenoma in a 36-year-old woman, revealed by low extremities weakness. The patient had hypertension at 170/90 mmHg. Her initial potassium level was low i.e., 1.5 mmol/L. The diagnosis, confirmed by hormonal investigation, showed an elevation of plasma aldosterone and lower plasma renin activity. Abdominal MRI revealed a lesion in left adrenal gland, measuring 1.8 cm in diameter and taking contrast in periphery, compatible with an adrenal adenoma. The patient underwent a left laparoscopic adrenalectomy and microscopic examination confirmed the diagnosis. The postoperative course was uneventful with normalization of serum potassium level and blood pressure.

[Pulmonary embolism mimicking acute anterior myocardial infarction: diagnostic trap]

Pulmonary embolism remains the major malingerer of acute chest disease. The clinical and electrocardiographic manifestations may deviate to a diagnosis of myocardial infarction. We report a case of bilateral pulmonary embolism in a patient of 50 years. The electrocardiogram showed ST elevation in anteroseptal and lateral leads. The diagnosis of acute myocardial infarction was selected and a fibrinolysis achieved. Getting out under beta-blocker therapy, antiplatelet, statin and angiotensin-converting enzyme inhibitors after 10 days hospitalization, the patient was readmitted one month later for a massive pulmonary embolism. Coronary angiography performed after the second hospitalization was normal.

[Role of thrombolysis in massive pulmonary embolism]

AIMS

Massive pulmonary embolism is a life threatening pathology with a high mortality over 20%. Thrombolysis is one of therapy ways that leads to a lower rate of death. The aim of the study is to show interest, limits and complications of thrombolytic therapy in massive pulmonary embolism.

PATIENTS AND METHODS

This descriptive study presents 8 cases of pulmonary embolism admitted to the Cardiology Division of Grand-Yoff from March 2003 to March 2006. All cases confirmed by Tomodensitometry (TDM) with massive pulmonary embolism were included in this study.

RESULTS

We used thrombolytic only in 8 cases of massive pulmonary embolism about 32. In-hospital prevalence was 25%. The average age was 49.8 ± 19.1 (from 15 to 72) and sex-ratio 0.33. Seven patients had a moderate clinical probability Well's score and one of them 1 had a high clinical probability. The clinical signs were: cardio-vascular collapse (7 cases), syncope (1) and cardio-vascular arrest. The electrocardiogram showed a sub-epicardial ischemia (4 cases), a right bundle branch block and a Mac Ginn White's sign. Two patients had a right-basal opacification at the chest X ray. The echocardiography found 5 cases of right ventricular dilatation, 1 case of paradoxal septum, 1 case of multiple thrombi in the right ventricule. The TDM confirmed diagnosis with 3 cases of bilateral pulmonary embolism, 1 case of pulmonary aneurysm. The treatment used thrombolytic : 1,500,000 IU of streptokinase, sympathomimetic drugs, anticoagulation with heparins and vitamin K antagonists.

[Evolution and thromboembolic complications of the idiopathic peripartal cardiomyopathy at Dakar University Hospital: forward-looking study about 33 cases]

The aims of this work are to study the nursery futures during idiopathic myocardiopathy of peripartum (IMPP), to measure the prevalence of thromboses and spontaneous contrast during the IMPP and to determine their evolution.

METHODOLOGY

It is about a longitudinal exploratory study carried out with the Aristide-Le-Dantec teaching hospital of Dakar, beginning January 2001 to November 2004, having included 33 patients.

RESULTS

The average age of the patients was 26 years; the average pregnancy was of 3.39 gestures. The signs of cardiac insufficiency were constant and four patients (12%) had presented an ischemic cerebral vascular accident. We had raised an auricular case of fibrillation and tachycardia atrial multifocal. The transthoracic echography (ETT) noted an aspect of hypokinetic myocardiopathy dilated with deterioration of the systolic function of the left ventricle, a thrombus in ten patients (30.3%) and a spontaneous contrast in two cases (6%). The transoesophageal echocardiography (ETO) was superposable with the ETT with regard to dimensions of the cardiac cavities and the presence of thrombus but its sensitivity was higher (100% against 66%) with regard to the detection of contrasts spontaneous. All the patients had the treatment of a congestive heart failure associated to an anticoagulant treatment. The evolution was marked by an improvement of the heart failure. The thrombus and spontaneous contrast had disappeared in all the patients. The absence of anaemia and the presence of spontaneous contrast (p=0.003) were correlated with the presence of thrombosis (p=0.05).

CONCLUSION

The idiopathic myocardiopathy of the peripartum is a relatively frequent affection in zone Soudano-Sahelian. Occurrence of thromboses is frequent at the time of this affection. Our study confirms the superiority of the echocardiography transoesophageal in the detection of intracardiac spontaneous contrast. The evolution can be favourable subject to a rigorous care and a regular surveillance.

[Huge right atrial myxoma revealed by right heart failure]

Right atrial myxoma is a heart benignant tumor characterized by an important clinical polymorphism. We report a case of a 30-year-old female with a diagnosis of a big right atrial myxoma. The diagnosis has been done by transthoracic echocardiography which showed an important tumorous mass in the right atrium. It was moving, inhomogeneous and takes over the whole of right atrium cavity. The surgical excision of the tumor has been done under extracorporal circulation. The patient died after a second intervention for tricuspid failure.

Use of zero-valent iron nanoparticles in inactivating microbes

Nanoscale zero-valent iron (NZVI) particles were investigated in inactivating gram-positive Bacillus subtilis var. niger and gram-negative Pseudomonas fluorescens bacteria, and the fungus Aspergillus versicolor. NZVI particles were synthesized using NaBH(4) and Fe(NO(3))(3).9H(2)O, and the microbial suspensions were subjected to the treatments of NZVI particle suspensions with concentrations of 0.1, 1 and 10mg/ml for 5min. Field emission scanning electron microscope (FE-SEM) was used to characterize the synthesized NZVI particles, suspensions and the surface morphologies of the treated agents. FE-SEM images showed that the NZVI particles were spherical with a fairly uniform size of about 20-30nm, and the iron precipitates FeO(OH) appeared in needle-shape aggregates. When treated directly with NZVI particles under aerobic condition, the surfaces of microbes were quickly coated with needle-shape yellow-brown iron oxides. In this study, complete inactivation was achieved both for B. subtilis var. niger and P. fluorescens when treated with 10mg/ml NZVI particles with vigorous shaking under aerobic condition. When NZVI particle concentration decreased to 1, 0.1mg/ml, there was still a complete inactivation for P. fluorescens, while for B. subtilis var. niger the inactivation decreased to 95%, 80%, respectively. However, no inactivation was observed for the fungus A. versicolor when treated the same manner. Physical coating, disruption of membrane and generation of reactive oxygen species have played major roles in the inactivation observed.

[Pulmonary embolism: autopsy study of 73 cases in Senegal]

INTRODUCTION

The Pulmonary emblism is a vascular disease which is characterized by the more or less complete obstruction of one or several pulmonary arteritis and/or their branches by an embol. Very polymorphic affection, mortal in the massiv form, it has in the average forms of the atypical or misleading aspects which make its clinical diagnosis difficult. The diagnostic strategy of the pulmonary embolism remains incompletely solved. The objectives of this work are: --to evaluate the prevalence with the autopsy of the pulmonary embolism and its distribution according to the age, --to appreciate the correlation enters the ante and the post-mortems diagnoses.

PATIENTS AND METHODS

It is about a retrospective study, over 10 years period, having inclued the files of all the patients died in the various services of medicine or surgery of the university hospital of Aristide Le Dantec but also those transferred from outside of the hospital and at which the pulmonary diagnosis post-mortem of embolism was retained.

RESULTS

Sixty thirteen (73) cases of pulmonary embolism had been found during autopsies during the period of study (10 ans), that is to say a prevalence of 1.9%. The average was 35 years. The most representative age bracket was that ranging beetwin 21 and 30 years is 36% of the studied population. On the 73 indexed patients, 30 (41%) were transferred from outside of the hospital and 43 (59%) came from the servicies of medecine and surgery with a prevalance of the service of cardiology (26%). The correlation beetween ante-mortems diagnosis and the anatomical result was 11% for the whole of the patients incleded in the study. However, it was 42% for the sub-grup of patients comming from the service of cardiology.

CONCLUSION

The prevalence with the autopsy of pulmonary embolism is weak. The clinical diagnosis of this affection is difficult even in a specilised service with a high rate of negatif forgeries. This pathology is very under- evaluated even in these services.

[Active rheumatic heart disease: findings from an 17-case series in the University Hospital Center of Dakar, Senegal]

This report is based on retrospective review of the charts of 18 patients with pre-existing active rheumatic heart disease compiled over a period of two years (January 2000 to December 2001). The purpose of this study was to determine the incidence of acute degenerative joint disease, to describe the clinical features and natural course of the disease, and to highlight the main points in the fight against degenerative joint disease and rheumatic heart disease. The prevalence of active rheumatic disease was 3.7%. Mean patient age was 15.5 years (range: 8 to 25 years). Female sex was predominant with 13 girls and 4 boys (sex ratio: 3.25). The most common clinical symptoms were migratory polyarthritis involving large joints in 14 cases (82.3%) and left heart insufficiency in 13 (76.4%). Additional clinical findings included oscillating fever in 8 cases (47.05%), tooth decay in 11 (73.3%), and poor buccodental hygiene in 14 (93.3%). Blood tests to evaluate inflammation demonstrated high values in all patients with mean ASLO titer of 950 UI/l, mean serum fibrin level of 7.8 g/l, and mean C-reactive protein level of 28.5 mg/l. The erythrocyte sedimentation rate was high in 15 cases (88.2%). In addition to showing heart valve disease, electrocardiography demonstrated first-degree atrioventricular block in 1 case. Chest x-ray revealed cardiomegaly in 15 cases (88.2%). Doppler ultrasonography of the heart showed isolated rheumatoid disease in 11 cases (64.7%). All patients responded favourably to treatment with corticosteroids and penicillin. The incidence of recurrence of active disease was high (70.5%) thus supporting use of high loading doses. Rheumatic heart disease is a public health problem in Africa and requires appropriate preventive measures.

Acupuncture for nocturnal enuresis in children: a systematic review and exploration of rationale

OBJECTIVES

This review identified reports of acupuncture for childhood nocturnal enuresis, with the aim of ascertaining whether acupuncture is efficacious and or better than standard therapy for treating enuresis.

MATERIALS AND METHODS

Studies of children of either gender <18 years of age who received acupuncture treatment for nocturnal enuresis, were considered. The primary outcome measure was change in the mean number of wet episodes following treatment. Electronic searching was supplemented by hand searching of western medicine and traditional Chinese medicine (TCM) journals along with English language alternative medicine journals. Trials were assessed for quality and sources of bias. Meta-analysis was performed and the overall weighted odds ratio (OR) and associated 95% confidence interval (CI) were computed using the fixed effect model; the Forest plot was used to demonstrate results.

RESULTS

Two hundred six abstracts were identified, of which 11 studies were eligible for data extraction. All the trials were of low methodological quality. There was some evidence that acupuncture is useful for nocturnal enuresis when used in conjunction with other treatment that may also include a different form of acupuncture (OR 3.98, CI: 2.2-7.2). When one form of acupuncture is compared with another there was marked heterogeneity, implying that some forms of acupuncture are effective.

CONCLUSION

This review provides tentative evidence for the efficacy of acupuncture for the treatment of childhood nocturnal enuresis. Due to the low methodological quality of studies, evidence to identify, which parameters of acupuncture work best, is lacking. More rigorous trials are clearly warranted.

URODYNAMIC FINDINGS IN ADULTS WITH PRIMARY NOCTURNAL ENURESIS

PURPOSE

We evaluate bladder function in adults with primary nocturnal enuresis (PNE) since childhood.

MATERIALS AND METHODS

We recruited all patients older than 16 years who presented to our PNE clinic with persistent enuretic symptoms. All patients were assessed by a detailed voiding diary, uroflowmetry and ultrasonography of the urinary tract. Urodynamic studies were performed for those with moderate or severe PNE (more than 3 wet nights a week).

RESULTS

The study included 18 males and 29 females with a mean age of 20 years (range 16 to 43). Of these patients 37 (79%) had moderate or severe symptoms and 17 (38%) also had daytime urinary symptoms. Urodynamic studies were conducted in 30 patients, including 12 males and 16 females (93%) with detrusor overactivity. In addition, 73% of patients had urodynamic evidence of functional bladder outflow obstruction, including dysfunctional voiding and detrusor sphincter or detrusor pelvic discoordination. Two male patients (6.7%) had an obstructive pattern on urodynamics and subsequent cystoscopic examination confirmed the presence of congenital obstructive urethral lesions. Sixteen patients (53%) had significantly reduced bladder capacity of less than 300 ml.

CONCLUSIONS

Unlike in early childhood, the majority (79%) of enuretic adults had significant symptoms, and more than a third also had daytime urinary symptoms. We believe that PNE in adults is not only a psychologically disturbing condition, but also a urological disorder with significant underlying bladder dysfunction that warrants special attention to management.

[Electrocardiographic recording of long duration (Holter) of 24 hours during idiopathic cardiomyopathy of the peripartum]

The idiopathic myocardiopathy of the peripartum (IMPP) is a frequent disease in the Soudano-Sahelian zone of Africa whose evolution is loaded with many complications hemodynamic, thrombo-embolic and rhythmic. The prevalence and the meaning of the rhythm disorders are unknown. The aims of this prospective study are to measure and to describe the prevalence of the anomalies observed in Holter ECG of 24 hours. It's about a description cross-sectional study realized at the Cardiology Department (CHU Dakar) and 19 patients with IMPP were included, from October 2000 to July 2002. A recording ECG of 24 hours (Holter) was realized on all the patients. The average age was 29.4+/-6.9 years with a low socio-economic level (100%). The diagnosis of IMPP done before childbirth in 4 cases (21%) and the post partum on 15 patients (78.9%). The dyspnea was constant, the chest pain in 12 cases (63.1%) and palpitations in 8 cases (42%). The average rate of hemoglobin was of 10.85+/-2.05 g/dL. The standard electrocardiogram recorded a sinusal tachycardia (68.4%), a cavitary hypertrophy (78.8%), and disorders of the repolarization (47.3%). The cardiac echo-Doppler noted a cavitary dilatation (84.2%), a constant alteration of the left ventricular systolic function with a fraction of average ejection of 29.7+/-10.3%. The anatomy of the valves was normal. The recording Holter ECG of 24 hours recorded a sinusal tachycardia in 17 cases (89.4%), ventricular extrasystoles on 7 patients (36.8%), 4 cases of ventricular tachycardia non-sustained and double ventricular extrasystole on 1 patient, auricular extrasystoles in 4 cases (21%) and 1 case of auriculo-ventricular block of the first degree. The study of heart rate variability founded a mean value of 106 ms.

[Spiral CT in aortic dissection]

Patients with suspected dissection of the thoracic aorta require immediate diagnostic evaluation so that urgent therapeutic interventions can begin. Two women with suspected aortic dissection and one man with abdominal aortic aneurysm underwent color-flow Doppler echocardiography and CT angiography with multiplanar reconstructions. Spiral CT showed ascending aortic dissection (type A Stanford) in two cases and descending aortic dissection (type B Stanford) in one case. It also access the visualization of the intimal flap, the extent of dissection, the size of the aorta, and the presence of pericardial fluid. CT angiography is an accurate diagnostic procedure for patients with suspected aortic dissection and possesses several advantages over other modalities such as transthoracic echocardiography, transesophageal echocardiography and aortography.

[The athlete's heart: an echocardiographic case-control study on Senegalese athletes]

The aim of this work is to study the echocardiographic parameters of male trained athletes. It is about a case-control study comparing 3 groups: basketball players, cyclists and not sports healthy subjects. All the subjects benefited from an echocardiography (time motion, two-dimensional and pulse Doppler). The mean age is of 23.5 years for the cyclists group, 24 years for the basketball players and of 26.2 years for the control group. Compared with the control group, the left ventricular telediastolic dimensions, left ventricular mass index and the pulmonary flow velocity are higher in athletes group. The basketball players have a higher left ventricular diameter and parameter of systolic function than cyclists group. The septal diameter is higher in the cyclists group. This study finds some differencies in Senegalese athletes in the characteristics of the standard athletic heart syndrome.

[Left atrial myxoma. Report of 2 cases operated in Senegal]

Cardiac tumours are rare and are dominated by left atrial myxoma. The authors report 2 cases of left atrial myxoma operated in the Cardiology department of Dakar (Senegal). Clinical signs were heart failure, cardiac sounds mimicking mitral valve disease and alteration of general state. The electrocardiogram showed sinus rhythm in 1 case and atrial flutter in the second case. The chest-x-ray show cardiac enlargement. Diagnosis was suggested by echocardiography and confirmed by anatomy. Evolution was favourable in one case and the other patient died.

[Role of transesophageal echocardiography in the diagnosis of aortic dissection. Report of 5 cases]

Aortic dissection is medical and surgical emergency. About 5 cases, the authors emphasized the role of transesophageal echocardiography in the diagnosis of aortic dissection. For all patients we realized a clinical examination, electrocardiogram, chest X ray, thoracic and transesophageal echocardiography and laboratory studies. Echocardiography were performed by an apparatus Hewlett Packard sonos 1000 with colour doppler and multiplanar transesophageal. Transesophageal echocardiography made the diagnosis by showing dilatation of aorta, intimal flap, false channel; this exam also allow to classify the aortic dissection.

[Subvalvular left ventricular aneurysm. Report of 2 cases]

The authors report both Senegalese's cases of subvalvular left ventricular aneurysm (SVLVA). The aim of the study was to describe the clinical and paraclinical aspects of this disease. Mitral regurgitation an heart failure were constant. Beyond cardiomegaly observed in both patients, one of them presented vaulting of the left ventricle. In the two cases, electrocardisgram showed sinus rhythm, and biology an inflammatory syndrome. One patient had also tuberculosis. Transthoracic echocardiography showed an aneurysm situated in a mitral subvalvular position, thrombosed in one case. Medical treatment with furosemid and digoxin has been administrated. One patient received also drugs against tuberculosis. Surgery of aneurysm had not been possible. During the evolution, we have observed persistence of heart failure in one patient. The other one died, probably after a cerebral embolism. Autopsy confirmed the echocardiographic aspects and integrity of myocardium and coronary arteries.

[Post myocardial infarction septal rupture. Report of 2 cases]

The authors report 2 cases of post myocardial infarction septal-rupture. There were one woman and one man aged respectively of 52 and 69 years. Risk factors were diabetes associated in one case with hypertension, and in the other case with tobacco addict. Both patients presented a ventricular septal defect murmur, and cardiac failure. Myocardial infarction (MI) was inaugural, semi-recent, and concemed interventricular septum or circumference of myocardium. Cardiac enzymes were high. Echocardiography showed a left ventricular apical aneurysm, and septal rupture. An abnormal blood flow pattern from left to right ventricle was visualized at Döppler. Medical treatment of Ml and cardiac failure were administrated. Surgery had not been possible. Both patients died respectively after 36 days and 4 days by cardiogenic shock.

[Infective endocarditis at the University Hospital of Dakar. Clinical, outcome, and therapeutic features]

Mainly because of rheumatic fever,infective endocarditis (IE) is frequent in our countries and is associated with many diagnostic and therapeutic problems. We perform a retrospective study on 86 cases of IE hospitalized from December 1986 to November 1996. The prevalence of IE is 4.3% and there is a female predominance (the sex ratio is 0.56). The mean age is 26.45+/-13.22 years. 74.4% of the patients have of low socioeconomic status. The mean duration of inhospital stay is 54 days and the average diagnosis retardation is 35 days. The source of infection is found in 19 cases (15 sources are dental). The main clinical signs are: fever (63.9%), anaemia (67.4%) and weight loss (38.3%). The underlying heart disease is mainly due to rheumatic valve regurgitation (95.3%). The blood culture find microbialagent in 12.7%. Echocardiography reveals vegetations in 69.7% of patients. The main complications are : heart failure (47.6%) and stroke (33.7%). The mortality rate is high (30.7%). The treatment is only medical, none of the patients has surgical repair. This study shows that IE is frequent and is associated with many complications and a high mortality rate. These observations amphasize the importance of prevention of rheumatic fever.

[Cardiac tamponade. Clinical, paraclinical, outcome, and therapeutic features. Report of 15 cases]

The authors perform a prospective study of 15 cases of cardiac tamponade in the Department of Cardiology of the University Hospital of Dakar (Senegal) from January to July 1999. The prevalence of cardiac tamponade is 4 %. The mean age is 33 years. There is no sex predominance. The clinical findings are: class III or IV NYHA dyspnea (86.6 %), pulsus paradoxus (66.6 %), and decrease intensity of the heart sounds (100 %). The electrocardiogram revealed sinus rhythm in 86.6 %, a low voltage of the QRS in all cases, and abnormalities of repolarization, mainly inverted T waves (73.3%). The echocardiography shows circumferential pericardial effusion (66.6 %), a "swinging heart" (53.3 %) and compression of right heart chambers (66.6 %). The main etiology was tuberculosis. The evolution is good after pericardiocentesis, surgical drainage and medical therapy. Cardiac tamponade is cardio-vascular emergency almost always due to tuberculosis with a good outcome if a prompt pericardiocentesis is performed.

[Cardiac thyrotoxicosis and left ventricular thrombosis, a case report]

Authors report about a left ventricular thrombus as a complication of thyrotoxic heart disease, on a 45 years old woman. Clinical state featured signs of thyrotoxicosis, global cardiac failure and hypertension. The electrocardiogram showed a left axis deviation, the chest X-ray a cardiac enlargement (cardio-thoracic index = 0.55) on behalf of left movement of heart walls and severe left ventricule dysfunction (Ejection fraction about 18%). This exam also found a big thrombus at he left ventricule apex. The treatment disappearance of the thrombosis and improvement of cardiac failure signs and echographic parameters. Authors discuss circumstances leading to thrombosis in thyrotoxic heart disease, and the usefulness of anticoagulant drug therapy.

[First case of primary IgA glomerulonephritis (Berger's disease) in Senegal]

Berger's disease or IgA glomerulonephritis is the most common glomerular nephropathy in Europe and represent a rare event in blacks. Here, we describe the case of a 43 years old black Senegalese whose disease was discovered while investigating a persistent proteinuria with high blood pressure and chronic renal failure, but without hematuria. We point out the uncommon feature of this clinical presentation and the importance of bad prognostic factors presented by this patient. We obtained a good outcome by means of converting enzyme inhibitors and corticosteroid therapies: regression of renal failure and normalization of blood pressure. The generalization of renal biopsy practice would lead to a better knowledge of the incidence of this disease among Senegalese people. Indeed, renal biopsy is the main tool to diagnose glomerulonephritis and subsequently adapt the therapy aimed at preventing the possible evolution to end stage renal disease.