Un cas de thrombolyse a la phase aigüe d’un infarctus cerebral avec le tenecteplase au Congo

Nous rapportons un cas de thrombolyse utilisant le tenecteplase, d’évolution favorable chez un patient de 49 ans, hypertendu, tabagique, admis pour une hémiplégie et une hémihypoesthésie gauches associées à une dysarthrie et une désorientation temporospatiale. Le score NIHSS initial était à 18. Le scanner cérébral réalisé à 2h05 du début était normal avec un score ASPECT à 10. Il a bénéficié d’une thrombolyse avec le tenecteplase 0,1mg/kg à 3h10. L’évolution a été marquée par une régression du déficit neurologique avec un score NIHSS à 1 à 24 heures. Le scanner de contrôle a noté une dédifférenciation cortico-sous-corticale avec légère hypodensité dans le territoire postérieur de l’artère cérébrale moyenne droite. Le traitement par thrombolytique est possible en Afrique subsaharienne, en dépit de l’accès difficile aux médicaments.We report a case of thrombolysis using tenecteplase, with a good outcome in a patient of 49 years old, with history of hypertension and smoking, who was admitted with left hemiplegia and hypoesthesia associated with dysarthria and disorientation. The initial NIHSS score was 18. CT scan performed at the 2:05 start was normal with an ASPECT score to 10. He received thrombolysis with tenecteplase 0.1 mg / kg at 3:10. The 24h outcome was marked by a regression of the neurological deficit with an NIHSS score at 1. The CT scan noted a mild hypodensity in the posterior territory of the right middle cerebral artery. Thrombolysis in acute stroke is possible in Sub-Saharan Africa, despite a limit access to drugs

Blood pressure tracking in urban black South African children: birth to twenty cohort

Background Hypertension is an emerging public health problem in South Africa. Recent evidence from longitudinal studies has shown that hypertension in adulthood can be traced back to childhood. There is scarcity of longitudinal data on paediatric blood pressure (BP) particularly in African populations. The objective of this study is to assess the prevalence of hypertension and evaluate BP tracking between childhood and late adolescence among South African black Children. Methods This study utilized data from the Birth to Twenty cohort, which is comprised of children born in Soweto, Johannesburg in 1990 (N = 3273, 78.5 % black). Data on BP and anthropometry were collected at six follow-up periods between ages 5 and 18 years. Blood pressure status was classified using the Fourth report on National High Blood pressure program in children and adolescents. Pearson correlation coefficients and relative risk ratios (RR) were used to describe tracking of BP between childhood and late adolescence. Results The overall point prevalence ranged from 9.2 to 16.4 % for prehypertension and 8.4 to 24.4 % for hypertension. Tracking coefficients ranged from 0.20 to 0.57 for SBP and 0.17- 0.51 for DBP in both sexes over the 14 years of measurement. The proportion of children who maintained an elevated BP status between childhood, adolescence and age 18 years ranged from 36.1 % at age 5 years to 56.3 % at age 13 years. Risk of having elevated BP at 18 years ranged from; RR: 1.60 (95 % CI: 1.29–2.00) at 5 years to RR: 2.71 (95 % CI: 2.32–3.17) at 14 years of age. Conclusions This study reports high prevalence of elevated BP which tracks from early childhood into late adolescence. These findings emphasize the importance of early identification of children at risk of developing elevated BP and related risk factors plus timely intervention to prevent hypertension in adulthood

Rates of untreated, treated, and controlled hypertension and relationships between blood pressure with other cardiovascular risk factors in Brazzaville (Republic of the Congo): May Measurement Month 2017-Sub-Saharan Africa.

Hypertension (HT) is a growing burden worldwide, leading to over 10 million deaths each year. In Brazzaville, the prevalence of HT was 32.5% in 2004. The mortality for stroke in 2008 and heart failure in 2013 were, respectively, 24% and 20.2%. May Measurement Month (MMM) is a global initiative initiated by the International Society of Hypertension aimed at raising awareness of HT and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure (BP) measurement, the definition of HT and statistical analysis followed the standard MMM protocol. The screening was carried out in Brazzaville, and the screening sites were distributed in different districts of the city in public places and health facilities. A total of 3842 individuals were screened during MMM17. After multiple imputations, 1576 (41.0%) had HT. About 956 (29.7%) individuals not receiving anti-hypertensive medication, were hypertensive. Four hundred and nine (66.0%) individuals receiving anti-hypertensive medication, had uncontrolled BP. Systolic and diastolic BPs after adjustment for age and sex differed significantly in association with use of anti-hypertensive medication (P < 0.0001), previous stroke (P = 0.001 for systolic), and waist circumference (P < 0.0001). MMM17 was the largest BP screening campaign undertaken in Congo. Almost one-third of screenees had untreated HT, and two-thirds of treated hypertensives were not well controlled. These results suggest that opportunistic screening can identify significant numbers with raised BP

May measurement month 2018: an analysis of blood pressure screening results from Republic of the Congo.

To determine the proportion with hypertension among opportunistic screenees in the Republic of the Congo. This cross-sectional study was conducted in Republic of the Congo in May 2018. This screening was done in urban and rural areas that included Brazzaville, Pointe-Noire, District of Ngoyo, and District of Nkayi. The study protocol was provided by the International Society of Hypertension, and local ethical clearance was obtained. The data were processed by the May Measurement Month global project team. In total, 6169 people were screened, 2418 of which were female (39.2%). Most of the people screened were from 18 to 29 years old (n = 4184, 67.8%). The proportion of hypertension found was 22.2% (n = 1371). Among the hypertensive patients, 40.2% were aware of their hypertension, but only 493 (36.0%) were on antihypertensive treatment, and only 16.0% were controlled. The frequency of diabetes was 2.2% (n = 135), 2.3% (n = 139) had a previous stroke, and overweight and obesity were present in 15.4% (n = 952) and 7.3% (n = 449), respectively. Hypertension is frequent in the Republic of the Congo, and levels of awareness, treatment and control are low. Actions are needed to increase access of all to a correct diagnosis and treatment of hypertension to achieve universal health coverage