L’obésité en consultation cardiologique à Lomé: prévalence et facteurs de risque cardio-vasculaire associés - étude chez 1200 patients

Introduction: Les objectifs de ce travail étaient de déterminer la fréquence de l’obésité et celle des autres facteurs de risque cardio-vasculairechez ces patients obèses à Lomé (Togo). Méthodes: Il s’est agi d’une étude multicentrique transversale de prévalence. Elle s’est déroulée du 05septembre 2005 au 04 mars 2006 et a porté sur les malades vus en consultation externe dans 3 services de cardiologie de la commune de Lomé. Ont été inclus dans cette étude les malades ayant un surpoids selon les normes de l’OMS. Résultats: Parmi 1200 patients vus en consultations, 779 (64,92%) avaient une surcharge pondérale. L’âge moyen était de 49,53 ± 17,24 ans. L’obésité était plus fréquente chez les femmes (79,49%) que chez les hommes (20,51%). Un antécédent d’obésité familiale (61,8%) était le principal facteur favorisant. Les autres facteurs de risque cardio-vasculaire retrouvés étaient : sédentarité (82% vs50% chez les non obèses), hypertension artérielle (54,8% vs 39,2%), alcool (50,9% vs 43,9%), dyslipidémie (34,5% vs 20%), diabète (30,9% vs 10,7%) et tabac (14,1% vs 20,3%). La différence était statistiquement significative entre les deux groupes. Les principales complications cardiovasculaires observées chez les obèses étaient: l’ischémie myocardique (26,7%), l’hypertrophie ventriculaire gauche (46,4%), la dilatation cavitaire cardiaque (30,1%) et les accidents vasculaires cérébraux (7,1%).Conclusion: L’obésité est un problème de santé publique au Togo. Sa prévalence est très élevée et elle est le plus souvent associée aux autresfacteurs de risque cardio-vasculaire. Des mesures préventives doivent être mises en jeu pour lutter contre ce facteur de risque.Mots clés : Obésité, prévalence, facteurs de risque

Estimating the burden of selected non-communicable diseases in Africa: a systematic review of the evidence

Background The burden of non-communicable diseases (NCDs) is rapidly increasing globally, and particularly in Africa, where the health focus, until recently, has been on infectious diseases. The response to this growing burden of NCDs in Africa has been affected owing to a poor understanding of the burden of NCDs, and the relative lack of data and low level of research on NCDs in the continent. Recent estimates on the burden of NCDs in Africa have been mostly derived from modelling based on data from other countries imputed into African countries, and not usually based on data originating from Africa itself. In instances where few data were available, estimates have been characterized by extrapolation and over-modelling of the scarce data. It is therefore believed that underestimation of NCDs burden in many parts of Africa cannot be unexpected. With a gradual increase in average life expectancy across Africa, the region now experiencing the fastest rate of urbanization globally, and an increase adoption of unhealthy lifestyles, the burden of NCDs is expected to rise. This thesis will, therefore, be focussing on understanding the prevalence, and/or where there are available data, the incidence, of four major NCDs in Africa, which have contributed highly to the burden of NCDs, not only in Africa, but also globally. Methods I conducted a systematic search of the literature on three main databases (Medline, EMBASE and Global Health) for epidemiological studies on NCDs conducted in Africa. I retained and extracted data from original population-based (cohort or cross sectional), and/or health service records (hospital or registry-based studies) on prevalence and/or incidence rates of four major NCDs in Africa. These include: cardiovascular diseases (hypertension and stroke), diabetes, major cancer types (cervical, breast, prostate, ovary, oesophagus, bladder, Kaposi, liver, stomach, colorectal, lung and non-Hodgkin lymphoma), and chronic respiratory diseases (chronic obstructive pulmonary disease (COPD) and asthma). From extracted crude prevalence and incidence rates, a random effect meta-analysis was conducted and reported for each NCD. An epidemiological model was applied on all extracted data points. The fitted curve explaining the largest proportion of variance (best fit) from the model was further applied. The equation generated from the fitted curve was used to determine the prevalence and cases of the specific NCD in Africa at midpoints of the United Nations (UN) population 5-year age-group population estimates for Africa. Results From the literature search, studies on hypertension had the highest publication output at 7680, 92 of which were selected, spreading across 31 African countries. Cancer had 9762 publications and 39 were selected across 20 countries; diabetes had 3701 publications and 48 were selected across 28 countries; stroke had 1227 publications and 19 were selected across 10 countries; asthma had 790 publications and 45 were selected across 24 countries; and COPD had the lowest output with 243 publications and 13 were selected across 8 countries. From studies reporting prevalence rates, hypertension, with a total sample size of 197734, accounted for 130.2 million cases and a prevalence of 25.9% (23.5, 34.0) in Africa in 2010. This is followed by asthma, with a sample size of 187904, accounting for 58.2 million cases and a prevalence of 6.6% (2.4, 7.9); COPD, with a sample size of 24747, accounting for 26.3 million cases and a prevalence of 13.4% (9.4, 22.1); diabetes, with a sample size of 102517, accounting for 24.5 million cases and a prevalence of 4.0% (2.7, 6.4); and stroke, with a sample size of about 6.3 million, accounting for 1.94 million cases and a prevalence of 317.3 per 100000 population (314.0, 748.2). From studies reporting incidence rates, stroke accounted for 496 thousand new cases in Africa in 2010, with a prevalence of 81.3 per 100000 person years (13.2, 94.9). For the 12 cancer types reviewed, a total of 775 thousand new cases were estimated in Africa in 2010 from registry-based data covering a total population of about 33 million. Among women, cervical cancer and breast cancer had 129 thousand and 81 thousand new cases, with incidence rates of 28.2 (22.1, 34.3) and 17.7 (13.0, 22.4) per 100000 person years, respectively. Among men, prostate cancer and Kaposi sarcoma closely follows with 75 thousand and 74 thousand new cases, with incidence rates of 14.5 (10.9, 18.0) and 14.3 (11.9, 16.7) per 100000 person years, respectively. Conclusion This study suggests the prevalence rates of the four major NCDs reviewed (cardiovascular diseases (hypertension and stroke), diabetes, major cancer types, and chronic respiratory diseases (COPD and asthma) in Africa are high relative to global estimates. Due to the lack of data on many NCDs across the continent, there are still doubts on the true prevalence of these diseases relative to the current African population. There is need for improvement in health information system and overall data management, especially at country level in Africa. Governments of African nations, international organizations, experts and other stakeholders need to invest more on NCDs research, particularly mortality, risk factors, and health determinants to have evidenced-based facts on the drivers of this epidemic in the continent, and prompt better, effective and overall public health response to NCDs in Africa

La fibrillation auriculaire chez le noir Africain: Aspects epidemiologiques, etiologiques et facteurs pronostiques

In this retrospective work realized during two years (1st january 2002 to 31 december 2003), relative to 300 cases hospitalized at the Cardiology Institute of Abidjan, the authors have studied theepidemiologic, etiologic and prognosis factors of black african atrial fibrillation in hospital cercle. The atrial fibrillation was the most frequent atrial arythmia in the practice with a prevalence of 13.06%.The average age of patients was 46.45 } 17.58 years, with male predominance (57.3%). Atrial fibrillation was associated to a cardiac disease in 93.6% of cases, where as none etiology was founded in4.7% of cases. Rheumatic valvulopathies (especially mitral valvulopathies), where the most frequent etiology (39%), followed by cardiomyopathies (33%). External electrical cardioversion had the best rate of atrial fibrillation reduction (81.8%), in comparison with anti-arythmic drugs (45.1%). However, atrial fibrillation arise the problem of it management on account of the frequent recurrence and complications. The frequency of stroke and death was respectively 13.3% and 4%. The factors of bad prognosis where : age over 70 years, dilatation of left atrium over 45 mm, dilatation of left ventricule over 60 mm, failling of left ventricule systolic fonction (% R . 20%), duration of atrial fibrillation over 6 months, rheumatic valvulopathies, dilated and hypokinetic cardiomyopathies. Dans ce travail retrospectif realise sur une periode de deux ans (du 1er janvier 2002 au 31 decembre 2003) et qui a porte sur 300 cas hospitalises a lfInstitut de Cardiologie dfAbidjan, nous avons etudie les caracteristiques epidemiologiques, etiologiques et les facteurs pronostiques de la fibrillation auriculaire chez le noir africain en milieu hospitalier. Au cours de cette etude, la fibrillation auriculaire etait le trouble de rythme auriculaire le plus frequent dans la pratique quotidienne avec un taux de prevalence de 13,06 %. Lfage moyen des malades etait de 46,45 } 17,58 ans, avec une predominance masculine (57,3%). La fibrillation auriculaire etait associee a une Cardiopathie dans 93,6% des cas, alors qufaucune etiologie nfetait retrouvee dans 4,7% des cas. Les valvulopathies rhumatismales (surtout mitrales) representaient la premiere etiologie (39%) devant les cardiomyopathies (33%). Dfune facon generale, la fibrillation auriculaire etait reduite chez 66% des patients ; le meilleur taux de reduction etait obtenu avec la cardioversion electrique externe (81,8%), comparativement aux medicaments anti-arythmiques (45,1%). Cependant, la fibrillation auriculaire posait un probleme deprise en charge en raison des recidives frequentes et des complications thromboemboliques. Les frequences des complications  thromboemboliques et de deces etaient respectivement de 13,3% et4%. Les facteurs de mauvais pronostic de la fibrillation auriculaire etaient : lfage superieur a 70 ans, la dilatation de lforeillette gauche au-dela de 45 mm, la dilatation du ventricule gauche au-dela de 60 mm, lfeffondrement de la fonction systolique du ventricule gauche (%R . 20%), une duree de la fibrillation auriculaire d

Cardiopathies ischémiques et troubles psychoaffectifs chez le noir africain : à propos de 50 cas colliges au CHU Campus de Lomé

Objectifs : Analyser les résultats à cours et moyen termes, identifier les problèmes de prise en charge de l’hypertendu et proposer des mesures de prévention. Méthode : Il s’est agi d’une étude prospective longitudinale effectuée dans l’unité de cardiologie de l’hôpital secondaire de Bè du 1er octobre au 30 septembre 2006. Ont été inclus dans cette étude les malades hypertendus selon les nouvelles normes (JNCVII). Le traitement des données a été informatisé. Résultat : Notre étude nous avait permis de recenser 147 patients hypertendus sur 164 enregistrés soit une prévalence de 89,63%. La prévalence en fonction du sexe donnait une prédominance féminine avec un sex-ratio de 0,27. Les céphalées (65,39%), les palpitations (55,78%), les douleurs thoraciques (53,06%) ont été les principaux motifs de consultation. L’alcoolisme (34%), la prise de café (29,9%) et l’obésité (29,3% étaient les facteurs de risques prédominants ; 36,7% des patients étaient de père hypertendu et 31,3% de mère hypertendue. 73,5% de nos patients étaient au stade 2 de la classification JNCVII, 72,8% avaient une pression pulsée supérieure à 60 mmHg. Les patients obèses représentaient de 36,7% et 38,1% avaient un surpoids. Tous les patients étaient mis sous régime demi-salé et 74,82% sous régime amaigrissant. Les médicaments essentiellement utilisés ont été les diurétiques (83,67%), les inhibiteurs de l’enzyme de conversion (75,51%), les bêta bloquants (55,10%), les inhibiteurs calciques (37,41%), les antihypertenseurs centraux (9,52%). Le taux de participation était de 93,88% à trois mois et de 63,27% à six mois. Les principales complications ont été : cardiaques (49,5%), oculaires (12,9%), neurologiques (9,7%) et rénales (6,5%). L’évolution était favorable chez 39,9% des patients. Nous avions noté 2,15% de décès. Conclusion : L’HTA est un réel problème de santé publique au Togo. Le respect des mesures hygiénodiététiques et la prise régulière des médicaments antihypertenseurs pourraient réduire ce taux de létalité qui demeure élevé. Mais la prévention demeure l’arme la plus efficace. Mots clés : Hypertension artérielle, prise en charge, Togo.Objective: To analyse the results at short and long terms. To identify the problems of the take over of the hypertensive patients and to propose preventive measures. Methods: Il is about a retrospective study done in the cariological unit at (Hospital Secondaire Be). From 1st October 2006 to 30th September 2006; have been included in this study the hypertensive patients according to the new gages (JNCVII). The treatment of the out come is delta processed. Results: Our study have permitted us to gather 147 hypertensive patients on 164 registered or a prevalence of 89.63%. The prevalence in function of sex gave female predominance with a sex ratio of 0.27. The headache (65.39%), palpitation (55.78%) chest pains (53.06%) have been the principal reasons of consultation. The alcoholism (34%) the use of coffee (29.9%) and obesity (29.3%) were the predominance risk of factories, 36.7% of the patients were of a hypertensive fathers and 31,3% of hypertensive mothers. 73.5% of our patients were in 2 stage as classified by the JNCVII, 72.8% were having pulse pressure wore than 60 mmgh. The patients with obesity were representing 36.7% and 38.1% were having over weight. All the patients were on low salted diet and 74.82% on the essential medicines used have been the diuretics (83.67%), the inhibitors of conversion enzyme (75.51%), the beta - bloquants (55.10%), the central antihypertensive 9.52%. The level of participation were of 93.88% at 3 months and of 63.27% at six months. The principal complications have been cardiac (49.5%), sight (12.9%) neurological (9.7%) and renal (6.5%). The evolution was favourable with 39.9% of the patients. We have noted 2.15% of death. Conclussion: the arterial hypertensive is a real public health problem in Togo. The prevention is still the more efficient means. The obedience of the hygieno dietetic measures and the regular use of the antihypertensive drugs may reduce this level of letality which is still higt.Key words: Hypertensive, take over, Togo

Persistance du canal arteriel : Aspects epidemiologiques, circonstances de depistage et prise en charge

Patent Ductus Arteriosus (PDA) Incidence is not exactly determined in Togo. Comprehensive data are currently unavailable on diagnosis and therapy in fact of inadequate structures. Some children with PDAhave been operated on in foreign countries thanks to the NGO “Terre des Hommes” (TDH). This study was undertaken to determine the incidence, diagnosis conditions and therapy analyses on PDA in Togo.Methods: Retrospective study has been done. We investigated medical reported of 53 children under the age of 15 years with PDA admitted at TDH during the period of January 1er 1990 to December, 31,2002. Data on clinical, Para clinical and postoperative follow up. Statistical analysis through chi-square was carried out threshold 5%.Results: The incidence of PDA was 25% of all congenital neart diseases (CHDS) admitted to TDH. There were more females than males (36 versus 17). Man age were 4.5 ± 4,5 ( 3 months to 15 years ). Infection of the upper respiratory treat (31.40%) and dyspnea (28.92%) were the most symptoms. Continuous heart murmur (98.11%)), poor growth (47.17%) and widely and fixedly split second heart sound (45.30%) were founded on physical examination. Cardiomegaly (94.33%) and pulmonary hyper vascularisation (73.60%) are been performed on thoracic radiography. Sinusal cardiac rate was founded in 93.33%. Velocity in pulmonary artery was increased in 69.44%. Left-to right shunt tensions have been founded in 56.77%. Overall latest morality was 3.84% by congestive heart failure.Conclusion: PDA is an CHDS frequently founded in our country but it’s treatment is unavailable here. Only creation of a cardiovascular surgery canter could reduce the morbidity and mortality of this pathology in our countries because; diagnosis and transfer of children are done with lateness. Introduction : L’incidence de la persistance du canal artériel (PCA) est encore mal connue au Togo. Cette affection pose des problèmes diagnostic et de prise en charge par manque de structures adéquates.Certains enfants porteurs de PCA ont été opérés à l’étrange grâce aux oeuvres de bienfaisance de « Terre des Hommes » (TDH). Cette étude a pour objectifs de déterminer l’incidence de cette pathologie, étudierses aspects cliniques et analyser sa prise en charge au Togo.Matériel et méthode : Il s’est agi d’une étude rétrospective de 53 dossiers d’enfants de moins de15 ans porteurs d’une PCA enregistrés à TDH au cours de la période du 1er Janvier 1990 au 31 décembre 2002.Nous avons étudié les paramètres cliniques, para cliniques, thérapeutiques et évolutifs. Le traitement des données a été informatisé. Nous avions utilisé le test de Khi2 au seuil 5% pour les comparaisons. Résultats : La PCA a représenté 25% des cardiopathies congénitales (CC) enregistrés à TDH. La sexratio a été de 0,47. L’âge moyen a été de 4,5 ans (3 mois -15 ans). Les infections broncho-pulmonaires (31,40%), la dyspnée (28,92%) ont été les circonstances de découverte les plus fréquentes. Le souffle systolo diastolique (98,11%), le retard staturo-pondéral (47,17%) et les anomalies de B2 (45,30%) ont été les signes physiques dominants de l’examen physique. La cardiomégalie (94,33%) et l’hyper vascularisation pulmonaire (73,60%) ont été les principaux signes radiologiques. Le rythme cardiaque a été régulier dans (93,33%) des cas. La vélocité  ans l’artère pulmonaire a été augmentée dans 69,44%des cas. Le shunt a été gauche droit dans 65,96% des cas et la PCA a été associée aux CIV dans 56,77% des cas. Deux décès (3,84%) ont été enregistrés par complication hémodynamique. Conclusion : La PCA est une pathologie fréquente dont la prise en harge n’est pas encore possible au Togo, seule la création d’un centre de chirurgie cardiovasculaire réduirait la mortalité de cette affection encore élevée dans nos pays car le diagnostic et le transfert des patients se font avec un grand retard

Les cardiopathies congenitales (cc) au Togo aspects epidemiologiques cliniques, diagnostiques et therapeutiques A propos de 141 cas colliges a terre des hommes “(TDH)”

The congenital cardiopathies re frequent pathologies but their incidence is still badly known in developing countries. Contrary to the industrialised countries, this pathology still pose big problems ofdiagnosis and treatment in our countries. In Togo, some children porters of CC have benefited the kindness of. “Terre des Hommes”. Our study has been done towards the evaluation of their take-over.Objective: To study the epidemiology, their clinic, diagnosis and therapeutic aspects.Materials and methods: It is about the retrospective study of 141 files of the children suffering from CC from January 1990 through December 2002 at TDH Lome. The treatment of the results has been done by computer.Results: The CC have represented 14.13% of the pathologies taken over by the TDH. The sex ratio is of 1.13. The averages age of the parents is of 1.8+/ -5 years. The dyspnoea, the repeated cough and fortuity + ours souffle have constituted to the principal revelation sings. The systolic souffle (82.48%), the tachycardia (48.90%) and the polypnea (42.33%) have been the physical dominating sing. Acardiomegalie have been observed in 89.31% of cases. The cardiac hypertrophy had been found in 87% of patients. Come on top of the CC, the CIV (27.11%) followed by PCA (20.18%). The petrology of theFollot (16.96%) and the CIA (06.25%) 112 patients have been transferred to foreign countries of which 74.10% Suisse 107 CC have been operated. The evolution has been favourable in 89.18%. In Togo, the discovery of the CC has been done lately posing therefore a problem of therapeutic choice. The placing of a cardiovascular Surgical Unit will reduce mortality of the congenital cardiopathics

Incidence, circonstances de decouverte, et prise en charge des communications interventriculaires (civ) au Togo.

The epidemiological aspect of the CIV is badly known our countries. More over their takeover often gives a problem in one part with the reason of povety of the population in other part almost inexistence of a specialised centre in this area. Objective: describe the incidence of the CIV in childwood in Togo ; analyse the circumstances of their discovery and evaluate their takeover. Methodology: We have proceded retrospective study covering a period of 13 years. (I January 1990 to 31 December 2002) on 196 files of children who have benefitted the Service of Medico-Surgical care and the Sanitary transfer of nongourvement organisation (Terre des Hommes). The out come have been treated by computer. Resultats and discussion: During this period the incidence of the CIV have increased progressively (7.7% in 1990 39.13% in 2002). These represented 25% of the Congenital Cardiopathys taken over by (Terre des Hommes). The sex ratio is 1.58 in favour of boys. The average age is of 3.8 +/- 2 years. The effort dyspnea (75.5%). The brancho pulmonary infection (55.10%) and retardement of growth (36.73%) were the principal cause of consultation. The Systolique souffle, the sound of the B2 in the pulmonary chamber the tachycardia, the polypnea, the deformation of the thorax, the enlargement of the base of the heart have been the dominating physical Sings with respectively 93.88%, 75%, 63.26%, 51.02%, 40.81%. The Rx of the heart (tele coeur) have noted a cardiomegaly in 39 patients which is 79.59%. The “Echo-Doppler” have confirmed the CIV in all the cases. The form of CIV has been precised in 39 patients (small form in 9 cases, middle form in cases, large CIV in 19 cases). In conclusion: The CIV are the frequent CC in Togo. Their incidence increase progressively with the comming of the Cardiac Echo-Doppler. The discovery is done lately at the complication stage. In front of every cardiac souffle, “Echo-Doppler should be to enable early diagnosis of the CIV. This will permits their early surgical take over which is only in abroad.  Les aspects Epidémiologiques des CIV sont mal connus dans nos pays. De plus leur prise en charge pose souvent des problèmes en raison d’une part de la pauvreté des populations et d’autre part de la quasi Inexistence des Centres Spécialisés dans ce domaine. Objectifs : - Déterminer l’incidence des CIV chez les enfants au Togo ; Analyser les circonstances de leur découverte ; et en évaluer la prise en charge thérapeutique. Méthodologie : Nous avons effectué une étude rétrospective couvrant une période de 13 ans (1 janvier 1990 au 31 décembre 2002) et portant sur 196 dossiers d’enfants ayant bénéficié du service des soins médico-chirurgicaux et des transferts sanitaires de l’ONG « Terre des Hommes ». TDH est la seule organisation qui s’occupe des transferts d’enfants malades au Togo. Les données ont été traité avec l’outil informatique (logiciel EPI info V. 06. 4) le test du Khi2 au seuil de 5% a été utilisé pour les comparaisons. Résultats et discussion : Durant cette période, l’incidence des CIV a augmenté progressivement (7,7% en 1990 à 39,13% en 2002). Ces CIV ont représenté 25% des cardiopathies congénitales prise en charge par Terre des Hommes. La sexe ratio est 1.58 en faveur des garçons. L’âge moyen était de 3.8 +/- 2ans. La dyspnée à l’effort (75,51%), les infections broncho-pulmonaires (55,10%) et le retard de croissance (36,73%) étaient les principaux motifs de consultation. Le souffle systolique l’éclat de B2 au foyer pulmonaire, la tachycardie, la polypnée, la déformation thoracique et le choc de pointe étalé ont été les signes physiques dominant avec respectivement 93.88%, 75%, 63,26%, 51,02%, 40,81%. Le télécoeur avait noté une cardiomégalie chez 39 patients soit 79,59%. Au cathétérisme cardiaque l’Echo-Doppler avait confirmé le diagnostic de C.I.V dans tous les cas. La raille de la C.I.V avait été précisée chez 39 patients seulement (petite taille dans 9 cas, moyenne taille dans 11 cas, C.I.V large dans 19 cas). En conclusion : Les CIV sont les CC les plus fréquentes au Togo. Leur incidence augmente progressivement avec l’avènement de l’Echo-Doppler cardiaque. Le dépistage se fait tardivement au stade des complications. Devant tout souffle cardiaque une Echo-Doppler doit être demandé afin de faire un diagnostic précoce des CIV. Ceci permettra leur meilleure prise en charge chirurgicale qui ne se fait qu’à l’étranger

Pediatric cardiomyopathies: causes, epidemiology, clinical course, preventive strategies and therapies

Pediatric cardiomyopathies, which are rare but serious disorders of the muscles of the heart, affect at least one in every 100,000 children in the USA. Approximately 40% of children with symptomatic cardiomyopathy undergo heart transplantation or die from cardiac complications within 2 years. However, a significant number of children suffering from cardiomyopathy are surviving into adulthood, making it an important chronic illness for both pediatric and adult clinicians to understand. The natural history, risk factors, prevalence and incidence of this pediatric condition were not fully understood before the 1990s. Questions regarding optimal diagnostic, prognostic and treatment methods remain. Children require long-term follow-up into adulthood in order to identify the factors associated with best clinical practice including diagnostic approaches, as well as optimal treatment approaches. In this article, we comprehensively review current research on various presentations of this disease, along with current knowledge about their causes, treatments and clinical outcomes