L’obesite abdominale dans la population generale a Bouake (Cote d’Ivoire) : Prevalence et correlation avec la pression arterielle

Objectifs: déterminer la prévalence de l'obésité abdominale dans la population générale à Bouaké et de déterminer une éventuelle association  entre elle et l’élévation des chiffres de pression artérielle.Materiel et Methodes: il s’agit d’une étude transversale descriptive et analytique qui a été menée au cours d’une séance de dépistage  systématique à Bouaké en 2017 chez des adultes. Elle a concerné 303 adultes âgés de 18 ans et plus. Des mesures de pression artérielle et du périmètre abdominal ont été prises avec remplissage d’un questionnaire standardisé. L’obésité abdominale (OA) est définie par un périmètre abdominal (PO) ≥ 102 cm chez l’homme et ≥ 88cm chez la femme. L’analyse statistique de nos données repose sur le test de Chi2 de Pearson etl’analyse de variance pour juger de la signification ou non des différences constatées (seuil de signification retenue, p<0,05). Enfin, en vue de vérifierl’existence d’une relation entre le PO et le niveau de pression artérielle, nous avons effectué une régression linéaire avec calcul du coefficient de  corrélation r.Resultants: L’âge moyen était de 45,86±15,84ans. On notait une prédominance féminine avec un sex-ratio de 0,77. La prévalence globale de l'OAétait de 34% (hommes : 3,65%, femmes : 30,56%). Chez les hommes avec une OA, la pression artérielle systolique moyenne était significativement plus importante que chez ceux indemnes d’obésité (150,92±25,05mmHg versus 131,65±23,26 mmHg ; p=0,010). On notait les mêmes observations avec la pression artérielle diastolique (100,58±17,81 mmHg versus 80,96±14,64 mmHg ; p=0,000). Chez les femmes avec une obésité abdominale, la pression artérielle systolique moyenne était significativement plus importante que chez celles indemnes d’obésité (139,75±24,96 vs 123.59±20,42 mmHg; p=0,000). On notait les mêmes observations avec la pression artérielle diastolique (87,17±14,59 vs 76,16±11,88 mmHg; p˂0,000). Sur la corrélation entre les modifications du périmètre abdominal et les pressions artérielles : celle systolique était positive et significative chez les hommes (r= 0,4474 ; p=0,0000) ; de même que celle diastolique (r=0,4496 ; p=0,0000). Cette même observation a été faite chez les femmes avec les pressions artérielles systolique (0,3522 ; p=0,0000) et diastolique (r= 0,3411 ; p=0,0000).Conclusion: l’obésité abdominale est très fréquente dans cette population noire africaine du centre de la Côte d’Ivoire. Elle est significativement associée à une élévation du niveau de pression artérielle dans les deux sexes. Mots-clés : Obésité abdominale - population générale - Bouaké - pression artérielle   English title: Abdominal obesity in the general population in Bouake (Ivory Coast): Prevalence and correlation with arterial pressure Objectives: to determine the prevalence of abdominal obesity in the general population in Bouake and to determine a possible association between it and the high blood pressure. Materials and Methods: this is a descriptive and analytical crosssectional study that was conducted during a systematic screening session inBouake in 2018 among adults. It involved 303 adults aged 18 and over. Blood pressure and abdominal perimeter measurements were taken with completion of a standardized questionnaire. Abdominal obesity (AO) is defined by an abdominal perimeter (AP) ≥ 102 cm in men and ≥ 88 cm in women. The statistical analysis of our data is based on the Pearson Chi square test and analysis of variance to determine the significance or not of the differences found (significance threshold, p <0.05). Finally, in order to verify the existence of a relation between the AP and the blood pressure level, we performed a linear regression with the calculation of the correlation coefficient r. Results: The mean age was 45.86 ± 15.84 years. There was a female predominance with a sex ratio of 0.77. The overall prevalence of AO was 34% (men: 3.65%, women: 30.56%). In men with AO, mean systolic blood pressure was significantly higher than in those without obesity (150.92 ± 25.05 mmHg versus 131.65 ± 23.26 mmHg, p = 0.010). The same observations were observed with diastolic blood pressure (100.58 ± 17.81mmHg versus 80.96 ± 14.64 mmHg, p = 0.000). In women with abdominal obesity, mean systolic blood pressure was significantly higher than in those without obesity (139.75 ± 24.96 mmHg versus. 123.59 ± 20.42 mmHg, p = 0.000). The same observations were made with diastolic blood pressure (87.17 ± 14.59mmHg versus 76.16 ± 11.88 mmHg, p˂0.000). On the correlation between changes in the abdominal perimeter and blood pressure: systolic pressure was positive and significant in men (r = 0.4474, p = 0.0000); as was diastolic (r = 0.4496, p = 0.0000). This same observation was made in women with systolic (0.3522, p = 0.0000) and diastolic (r = 0.3411, p = 0.0000) blood pressure. Conclusion: Abdominal obesity is very common in this African black population of central Côte d'Ivoire. It is significantly associated with increased blood pressure in both sexes. Keywords: Abdominal obesity - general population – Bouake - Ivory Coast - blood pressur

Les cardiopathies acquises de l’enfant au centre Hospitalo-Universitaire de Bouake: etude preliminaire

Objectifs: décrire les principaux aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs des cardiopathies acquises chez l’enfant au CHU de Bouaké pour améliorer leur prise en charge.Matériels et méthode: Il s’agissait d’une étude rétrospective et descriptive réalisée au CHU de Bouaké de juillet 2016 à Décembre 2016. Elle a concerné tous les enfants âgés de 0 à 15ans diagnostiqués d’une cardiopathie acquise à l’examen clinique et à l’échocardiographie. Les variables d’études portaient sur les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs.Résultats: Quarante cas de cardiopathies acquises ont été identifiées sur la période de l’étude soit une prévalence hospitalière de 1,81‰. Cette prévalence était de 29% lorsqu’on rapporte le nombre de cas au nombre total de cardiopathies sur la période de l’étude. Toutes les tuniques cardiaques étaient concernées dans des proportions variables et selon l’étiologie : valvulopathies (49% des cas) ; cardiomyopathies (25,5%) et péricardites (24,5%). Il s’agissait surtout d’une insuffisance mitrale rhumatismale (15/40) et d’une péricardite aigue (12/40). Les cardiomyopathies et l’HTA secondaire était rencontré respectivement dans 3 cas /40 et 5 /40. Le taux de mortalité était de 14,7%.Conclusion: Le rhumatisme articulaire aigue reste toujours la grande pourvoyeuse de cardiopathies en Afrique sub aharienne. A noter l’émergence de cardiomyopathie chez l’enfant compliquant souvent une HTA secondaire.Mots clés: Enfant, IM, RAA, cardiomyopathie, HTA, PéricarditeEnglish Title: Acquired cardiopathies of the child in the Teaching Hospital of Bouake (Center OH Ivoiry-Coast): preliminary studyEnglish AbstractObjective: To describe the main epidemiological, diagnostic, therapeutic and progressive aspects of heart diseases acquired in children at the University Hospital Center of Bouake to improve their care.Materials and method: This was a retrospective and descriptive study carried out at the University Hospital Center of Bouake from July 2016 to December 2016. It concerned  all children aged 0 to 15 years diagnosed with acquired heart diseases, on clinical examination and echocardiography. The study variables covered epidemiological, diagnostic, therapeutic and evolutionary aspects.Results: Forty cases of acquired heart diseases were identified during the study period. The hospital prevalence was of 1.81‰. This prevalence was 29% when reporting the number of cases to the total number of heart conditions over the study period. All cardiac tunics were involved in varying proportions and according to etiology: valvulopathy (49% of cases); cardiomyopathy (25.5%) and pericarditis (24.5%). These were mainly rheumatic mitral insufficiency (15/40) and acute pericarditis (12/40). Cardiomyopathy and secondary hypertension were found in 3 cases / 40 and 5/40, respectively. The mortality rate was 14.7%Conclusion: Acute rheumatic fever is still the major provider of heart diseases in sub- Saharan Africa. Note the emergence of cardiomyopathy in children often complicating secondary hypertension.Keywords: Child, mitral insufficiency, acute articular rheumatism, cardiomyopathy, Arterial hypertension, Pericarditi

Percepção materna da desidratação em crianças com diarréia: estudo de concordância com diagnóstico médico Maternal perception of dehydration in children with diarrhoea: a study of agreement with medical diagnosis

Realizou-se estudo em um hospital infantil do Rio de Janeiro, em crianças hospitalizadas por diarréia, no período de janeiro/87 a fevereiro/88, com o objetivo de destacar a percepção materna dos sinais e sintomas da desidratação em crianças menores de três anos de idade, confrontando-a com o diagnóstico médico. Os sinais e sintomas mais identificados pelas mães foram o número de evacuações, número de vômitos, estado da sede e dos olhos. As mães tiveram dificuldade em perceber a quantidade de urina, o estado de umidade da boca e língua e turgor da pele. Identificaram estes sinais quase sempre como normais ou no máximo, moderadamente alterados. As mães que tenderam a subestimar a gravidade da desidratação apontada pelo médico tem nível de escolaridade baixo, filhos desnutridos e maior dificuldade de acesso ao hospital. Já as que tenderam a superestimar a gravidade, têm melhor nível de instrução, filhos melhor nutridos, maior facilidade de acesso ao hospital, bem como passaram por um menor número de serviços de saúde antes de chegar ao hospital estudado. As mães que concordaram com o diagnóstico médico classificaram-se em uma situação intermediária, embora se aproximando mais das que subestimaram a gravidade. Aquelas mães que já haviam vivenciado um episódio de desidratação anterior no seu filho não apresentaram maior concordância com o diagnóstico do médico, mostrando que o repasse de informação no serviço de saúde foi nulo ou inadequado.<br>The mother's perception of signs and symptoms of dehydration in children under three years of age was studied and compared with the medical classification. The study was carried out in a children's hospital in the city of Rio de Janeiro, among children hospitalized with diarrhoea between January, 1987 and February, 1988. The number of excretions and of vomitings, thirst and condition of eyes constituted the signs and symptoms most frequently reported by mothers. However, they had difficulty in judging the amount of urine, humidity of mouth and tongue and turgidity of the skin. These signs were almost always regarded as normal or, at most, as indicating only slight alteration. Those mothers who tended to underestimate the severity of the dehydration indicated by the physician were of a lower educational level and had more severely undernourished children and greater difficulty of access to the hospital. On the other hand, those who tended to overestimate it belonged to a higher educational level, had better-nourished children, greater ease of access to the hospital and were attended to by a smaller number of health care services before reaching the hospital surveyed. Those who agreed with the medical diagnosis were in ,an intermediate situation, although they tended to be closer to those who underestimated the gravity of the dehydration. Those mothers whose children had already gone through a dehydration episode did not present a more intense agreement with the physician's diagnosis, thus evidencing that the information afforded at the health care service was either non-existent or inadequate

The improvement of care for paediatric and congenital cardiac disease across the World: a challenge for the World Society for Pediatric and Congenital Heart Surgery

The diagnosis and treatment for paediatric and congenital cardiac disease has undergone remarkable progress over the last 60 years. Unfortunately, this progress has been largely limited to the developed world. Yet every year approximately 90% of the more than 1,000,000 children who are born with congenital cardiac disease across the world receive either suboptimal care or are totally denied care.While in the developed world the focus has changed from an effort to decrease post-operative mortality to now improving quality of life and decreasing morbidity, which is the focus of this Supplement, the rest of the world still needs to develop basic access to congenital cardiac care. The World Society for Pediatric and Congenital Heart Surgery [http://www.wspchs.org/] was established in 2006. The Vision of the World Society is that every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care. The Mission of the World Society is to promote the highest quality comprehensive care to all patients with pediatric and/or congenital heart disease, from the fetus to the adult, regardless of the patient's economic means, with emphasis on excellence in education, research and community service.We present in this article an overview of the epidemiology of congenital cardiac disease, the current and future challenges to improve care in the developed and developing world, the impact of the globalization of cardiac surgery, and the role that the World Society should play. The World Society for Pediatric and Congenital Heart Surgery is in a unique position to influence and truly improve the global care of children and adults with congenital cardiac disease throughout the world [http://www.wspchs.org/]