[Peripheral arterial disease in black African diabetics: epidemioclinical, ultrasonographic profile and determining factors]

BACKGROUND

Diabetes can lead to micro and macro-angiopathies. The peripheral arterial disease (PAD) is a serious and an incapacitating disease. It is still under-estimated and under-treated throughout the world, particularly in sub-Saharan Africa. Doppler ultrasound, and in particular ankle brachial index (ABI), can be used to detect it. The aim was to determine the prevalence of PAD to study the clinical and ultrasonographic aspects and to identify the determining factors.

PATIENTS AND METHODS

This was a descriptive and analytical study over a period of 5 years, including a total of 782 diabetic patients hospitalised in the diabetology department of the CHU la Reference Nationale.

RESULTS

Among the 782 patients, 166 (21.2%) had an ABI < 0.9 reflected the PAD and 72 (9.2%) had an ABI > 1.3, suggestive of mediacalcosis. PAD of the lower limb was mild in 102 patients (61.4%), moderate in (26.3%) and severe in (12.3%). The mean age of the arteritic patients was 56.4 ± 10.2 years. Male gender predominated (59.6%) with a sex ratio of 1.6. All patients had type 2 diabetes (100%). The mean duration of diabetes was 13 ± 5.9 years. The majority of our patients with arterial disease had diabetes for at least 10 years (54.2%). The other cardiovascular in this population were obesity (45.2%), followed by hypertension and dyslipidaemia (32.5%). Diabetes was unbalanced (HbA ≥7%) in the majority of cases (75.3%). Clinically, the majority of patients had a trophic disorder (68%). Asymptomatic patients accounted for 24.6% of cases and those with intermittent claudication for 7.4%. Duplex doppler of the lower limbs showed that all patients with PAD had atheromatous lesions. The distal location was predominantly in the tibial arteries (54.8%). The determinants of PAD in this diabetic population were hypertension (p = 0.01) and obesity (p = 0.01).

CONCLUSION

In our series, PAD was often discovered at an advanced stage, with a non-negligible prevalence. The determining factors found were hypertension and obesity. Screening and control of major cardiovascular risk factors is a priority in the management of this disease.

[Prevalence of dyslipidemia in the biochemistry laboratory of the Reference National Teaching Hospital of N'Djamena, Chad.]

INTRODUCTION

les dyslipidémies constituent un facteur de risque majeur dans la survenue des maladies cardio-vasculaires. La recherche de ce facteur et sa prise en charge adéquate contribuerait à prévenir ces maladies qui sont la plus grande cause de décès dans le monde. L'objectif de cette étude était d'évaluer la prévalence des dyslipidémies au laboratoire de biochimie du Centre Hospitalier Universitaire de Référence Nationale de N'Djamena. MATéRIEL ET MéTHODES: il s'agissait d'une étude transversale d'une durée de cinq ans (2015-2020) portant sur tous les patients ayant au moins un paramètre lipidique dans le registre du laboratoire. Les méthodes enzymatiques sur un automate de biochimie de type Cobas Integra 400 (Roche Diagnostics) ont été utilisées pour le dosage de cholestérol total, LDL-c, HDL-c et de triglycérides.

RESULTS

Au total 2038 patients avec une prédominance masculine (sex-ratio :1,33), ont été enregistrés, l'âge moyen de nos patients était de 56,45±8,8 ans. La prévalence des dyslipidémies était de 44,2%. Les différents types des dyslipidémies étaient repartis comme suit : l'hypercholestérolémie (40,52%) ; l'hyper LDLémie (33,02%) ; l'hypoHDLémie (14,72%) ; l%hypertriglyc%rid%mie (11,72%) et l'hyperlipidémie mixte (40,5%). On notait une évolution croissante de la prévalence de dyslipidemie au cours des cinq années de periode d'étude.

CONCLUSIONS

la forte prévalence des dyslipidémies dans notre étude témoigne d'une situation préoccupante au Tchad, d'où l'intérêt d'étudier la prévalence des dyslipidémies et des autres facteurs de risque cardiovasculaire à l'échelle nationale et l'utilité d'organiser des campagnes d'éducations et d'informations sur les maladies cardiovasculaires et les facteurs de risque cardiovasculaire afin de r'duire cette pr'valence.

[Management of heart failure at the CHU the National Reference of Ndjamena/Chad]

INTRODUCTION

Heart failure (HF) is a syndrome of diverse etiologies, and a real public health problem in both developed and developing countries. The aim of this study was to determine the clinical, etiological, therapeutic and evolutionary aspects of heart failure.

MATERIALS AND METHODS

This was a descriptive and analytical study carried out in the cardiology department of the national referral university hospital in N'Djamena (Chad).

RESULTS

Heart failure accounted for 30.84% of cardiovascular pathologies hospitalized in the cardiology department during the study period. The mean age of our patients was 52 ± 34 years, with extremes ranging from 18 to 87 years. Females predominated, accounting for 50.7% of cases, with a M/F sex-ratio of 0.97. Hypertensive heart disease (33.7%), valvular heart disease (16.6%) and ischemic heart disease (15.1%) were the most frequent etiologies. The drugs most frequently used were loop diuretics (97%), ACE inhibitors (96%) and beta-blockers (93.5%). The in-hospital mortality rate was 9% in our series.