Management of Hypertension in the Elderly Patient at Abidjan Cardiology Institute (Ivory Coast)

Background. Since the treatment of hypertension is beneficial for the elderly, we have undertaken this study that aims to evaluate the management of hypertension in elderly patient in Côte d'Ivoire. Methods. A retrospective study was conducted among 854 hypertensive elderly patients of Abidjan Cardiology Institute who were followed for a minimum of one year, between January 2000 and December 2009. Results. The patients mean age was 73.1 ± 5.3 years, and 59% were women. At the first presentation, it was mostly systolic-diastolic hypertension (51.8%) and isolated systolic hypertension (38.5%). Mean blood pressure was 169.4 ± 28.4 mmHg for systolic, 95.3 ± 15.7 mmHg for diastolic, and 74.1 ± 22.8 mmHg for pulse pressure. Pulse pressure was ≥60 mmHg in 80.4%. According to the European Guidelines stratification of the cardiovascular risk-excess attributable to high blood pressure, 82.1% of the sample had a very high added risk. The pharmacological therapy was prescribed in 93.5%. More than 66% of patients were receiving ≥2 antihypertensive drugs including fixed-dose combination drugs. The most common agents used were diuretics (63.5%) followed by angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in 61.3%. The most common agents used for monotherapy were calcium antagonists. When ≥2 drugs were used, diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were the most common. Blood pressure control was achieved in 42.6%. Conclusion. The control of elderly hypertension can be effective in Sub-Saharan Africa. He required at least two antihypertensive drugs to meet the recommended blood pressure target

Pneumococcal carriage in sub-Saharan Africa--a systematic review.

BACKGROUND: Pneumococcal epidemiology varies geographically and few data are available from the African continent. We assess pneumococcal carriage from studies conducted in sub-Saharan Africa (sSA) before and after the pneumococcal conjugate vaccine (PCV) era. METHODS: A search for pneumococcal carriage studies published before 2012 was conducted to describe carriage in sSA. The review also describes pneumococcal serotypes and assesses the impact of vaccination on carriage in this region. RESULTS: Fifty-seven studies were included in this review with the majority (40.3%) from South Africa. There was considerable variability in the prevalence of carriage between studies (I-squared statistic = 99%). Carriage was higher in children and decreased with increasing age, 63.2% (95% CI: 55.6-70.8) in children less than 5 years, 42.6% (95% CI: 29.9-55.4) in children 5-15 years and 28.0% (95% CI: 19.0-37.0) in adults older than 15 years. There was no difference in the prevalence of carriage between males and females in 9/11 studies. Serotypes 19F, 6B, 6A, 14 and 23F were the five most common isolates. A meta-analysis of four randomized trials of PCV vaccination in children aged 9-24 months showed that carriage of vaccine type (VT) serotypes decreased with PCV vaccination; however, overall carriage remained the same because of a concomitant increase in non-vaccine type (NVT) serotypes. CONCLUSION: Pneumococcal carriage is generally high in the African continent, particularly in young children. The five most common serotypes in sSA are among the top seven serotypes that cause invasive pneumococcal disease in children globally. These serotypes are covered by the two PCVs recommended for routine childhood immunization by the WHO. The distribution of serotypes found in the nasopharynx is altered by PCV vaccination

Characterization of hydrometeors in Sahelian convective systems with an X-band radar and comparison with in situ measurements. Part II : a simple brightband method to infer the density of icy hydrometeors

A simple scheme that is based on the shape and intensity of the radar bright band is used to infer the density of hydrometeors just above the freezing level in Sahelian mesoscale convective systems (MCS). Four MCS jointly observed by a ground-based X-band radar and by an instrumented aircraft as part of the Megha-Tropiques algorithm-validation campaign during August 2010 in Niamey, Niger, are analyzed. The instrumented aircraft (with a 94-GHz radar and various optical probes on board) provided mass-diameter laws for the particles sampled during the flights. The mass-diameter laws derived from the ground-radar vertical profile of reflectivity (VPR) for each flight are compared with those derived from the airborne measurements. The density laws derived by both methods are consistent and encourage further use of the simple VPR scheme to quantify hydrometeor density laws and their variability for various analyses (microphysical processes and icy-hydrometeor scattering and radiative properties)

Thrombopenie severe au cours du paludisme grave de l’enfant au chu de Yopougon (Cote d’iIoire): prevalence et facteurs associes

Introduction : Parmi les critères de gravité biologique de l’OMS du paludisme grave, seule l’anémie sévère a été retenue. L’objectif de cette étude était d’évaluer la prévalence de la thrombopénie sévère et d’en déterminer les facteurs associés au cours du paludisme grave. Matériel et méthode : Il s’est agi d’une étude transversale à partir de données recueillies entre le 1er octobre 2018 et le 31 mars 2019 (6 mois) au service de pédiatrie du CHU de Yopougon. Elle a concerné les enfants de 1 mois à 15 ans atteints de paludisme grave sans autres affections associées. Les données ont été recueillies sur une fiche d’enquête standardisée. Un modèle de régression logistique a été utilisé pour déterminer les facteurs associés à la thrombopénie sévère. Le seuil de significativité était de 5%. Résultats : L’âge moyen des 312 enfants était de 32 mois (+/- 24,72). Le sex-ratio était de 1,11.Le taux médian de plaquettes était de 94 000 cellules /mm3 (IIQ = 51 500 – 190 000). Une thrombopénie sévère a été retrouvée dans 23,08% des cas. La forme hémorragique a été retrouvée 2,24% des cas. Les facteurs associés à la thrombopénie sévère étaient le sexe (p = 0,01), l’anémie sévère (p = 0,03) et l’insuffisance pondérale (p= 0,01). Elle n’était pas associée à la mortalité (p = 0,23). Conclusion : La thrombopénie sévère est relativement fréquente au cours du paludisme grave. Son pronostic controversée explique qu’il ne soit pas jusqu’ici pris en compte comme facteur de gravité du paludisme. English title: Severe thrombocytopenia during severe malaria in children at Yopougon University Hospital (Ivory Coast): prevalence and associated factors Summary Introduction: Among the WHO biological criteria of severe malaria, only severe anemia was retained. The objective of this study was to assess the prevalence of severe thrombocytopenia and to determine the associated factors during severe malaria. Material and method: This was a cross-sectional study based on data collected between October 1, 2018 and March 31, 2019 (6 months) in pediatric department of university hospital of the Yopougon. It concerned children from 1 month to 15 years old with severe malaria without other disease. The data was collected on a standardized survey form. A logistic regression model was used to determine factors associated with severe thrombocytopenia. The significance level was 5%. Results: The mean age of the 312 children was 32 months (+/- 24.72). The sex ratio was 1.11. The median platelet count was 94,000 cells / mm3 (IQR = 51,500 - 190,000). Severe thrombocytopenia was found in 23.08% of cases. The hemorrhagic form was found in 2.24% of cases. Factors associated with severe thrombocytopenia were gender (p = 0.01), severe anemia (p = 0.03) and underweight (p = 0.01). It was not associated with mortality (p = 0.23). Conclusion: Severe thrombocytopenia is relatively common in severe malaria. Its controversial prognosis explains why it has not been taken into account as a serious factor in malaria. Keywords: Severe thrombocytopenia - Severe malaria - Chil

Contribution de l'investigation Paraclinique à la prise en charge des uropathies malformatives à l'Unité de Néphrologie Pédiatrique du Centre Hospitalier Universitaire de Yopougon, Côte d'Ivoire

Contexte: Cette étude vise à évaluer l'apport des examens paracliniques dansla prise en charge des uropathies malformatives de l'enfant en milieu hospitalier. Patients et méthode: Nous avons mené une étude rétrospective et descriptive du 1erDécembre 2008 au 31 Décembre 2020à l'unité de néphrologie pédiatrique du Centre Hospitalier Universitaire de Yopougon. Elle concernait 152 patients âgés de 0 à 15 ans, porteurs d'une uropathie malformativede diagnostic radiologique. Résultats: Sur 152 patients, 36 (23,7%) étaient porteurs d'une uropathie malformative de diagnostic anténatal confirmée en période postnatale immédiate chez 30 (83,3%) patients. Les valves de l'urètre postérieur représentaient la malformation la plus fréquente (n=58 ; 38,2%). Dix-huit (11,8%) patientsavaient une insuffisance rénale chronique à l'admission. Une infection urinaire était documentée chez 15 (9,9%) enfants. Les germes majoritairement identifiés à l'examen cytobactériologique des urines étaient Klebsiella pneumoniae (n=5 ; 33,3%) et Pseudomonas aeruginosa (n=4 ; 26,7%). A l'antibiogramme réalisé chez 14 patients porteurs d'infection urinaire sur 15, une multirésistance était objectivé echez 5 (35,7%) patients. Une urétrocystographie rétrograde a été réalisée chez 42 (27,63%) patients. Un reflux vésico-urétral était visualisé chez 18 (42,9%)patients. Après la réalisation d'un uroscanner, 11,2%(n=17) des diagnostics initiaux ont été reconsidérés et 5,3% (n=8) des patients présentaient d'autres uropathies malformatives associées. Cinquante-six(36,8%) patients ont étés traités chirurgicalement. Conclusion: L'exploration paraclinique des uropathies malformatives est essentielle à leur prise charge d'où la nécessité d'un équipement adéquat des structures de santé.   Background: This study aims to evaluate the contribution of paraclinical examinations in the management of malformative uropathies in children in a hospital setting. Patients and method: We conducted a retrospective and descriptive study from December 1st, 2008 to December 31st, 2020 at the pediatric nephrology unit of the Yopougon University Hospital Center.  It involved 152 patients aged 0 to 15 years who had a malformative uropathy of radiological diagnosis. Results: Out of 152 patients, 36 (23.7%) had a malformative uropathy found on antenatal diagnosis and confirmed in the immediate postnatal period in 30(83.3%) patients. Posterior urethral valves were the most frequent malformation (n=58/152 ; 38.2%). Eighteen (11.8%) patients had chronicrenal failure at admission. A urinary tract infection was documented in 15 (9.9%) children. The organism mostly identified on cytobacteriological examination of urine were Klebsiella pneumoniae (n=5 ; 33.3%) and Pseudomonas aeruginosa (n=4 ; 26.7%). Multi drug-resistant organisms were found in 5 (35.7%) patients out of 14 who had an antibiotics. Forty-two (27.6%) had a retrogradeuretrocystography and a vesico-urethral reflux was visualized in 18(42.9%) of them. After performing a CT scan, 11.2% (17/152) of the initial diagnoses were reconsidered and 5.3% (n=8) of patients had other associated malformative uropathies. Fifty-six (36.8%) patients had surgical treatment. Conclusion: Laboratory investigations are essential in the management of malformative uropathies. Health care facilities should therefore be provided with adequate equipment for the management. &nbsp

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

Characterization of hydrometeors in Sahelian convective systems with an X-band radar and comparison with in situ measurements. Part I : Sensitivity of polarimetric radar particle identification retrieval and case study evaluation

The particle identification scheme developed by Dolan and Rutledge for X-band polarimetric radar is tested for the first time in Africa and compared with in situ measurements. The data were acquired during the Megha-Tropiques mission algorithm-validation campaign that occurred in Niger in 2010. The radar classification is compared with the in situ observations gathered by an instrumented aircraft for the 13 August 2010 squall-line case. An original approach has been developed for the radar-in situ comparison: it consists of simulating synthetic radar variables from the microphysical-probe information and comparing the two datasets in a common "radar space." The consistency between the two types of observation is good considering the differences in sampling illustrated in the paper. The time evolution of the hydrometeor types and their relative proportion in the convective and stratiform regions are analyzed. The farther away from the convection one looks, the more aggregation dominates, riming diminishes, and hydrometeors are less dense. Particle identification based on the polarimetric radar will be applied to a 5-yr African dataset in the future