Prévalence de l’hypotension orthostatique et ses facteurs favorisants chez les hypertendus noirs africains traités

Introduction: Le but de cette étude était de déterminer la prévalence de l’hypotension orthostatique (HO) chez les hypertendus noirs africains traités, et rechercher ses facteurs favorisants. Méthodes: Il s’est agi d’une étude prospective transversale menée du 1er février 2007 au 31 janvier 2009 à la clinique cardiologique du CHU Campus de Lomé, incluant des patients régulièrement traités pour hypertension artérielle. La pression artérielle et la fréquence cardiaque étaient mesurées en décubitus dorsal puis immédiatement en orthostatisme (1ère et 3ème minutes). Résultats: Sur une population de 394 patients hypertendus traités, 81 cas d’HO (20,5 %) ont été observés dont 53 (65,4 %) étaient symptomatiques. Il s’agissait de 188 femmes (49,2%) et de 206 hommes (50,8%). L’âge moyen des hypertendus était de 53,4 ans ± 11,2 avec des extrêmes de 26 ans et de 81ans. Les patients ayant présenté une HO avaient un âge moyen significativement plus élevé : 60 ans contre 51 ans chez les autres (p= 0,01). L’HO était plus fréquente chez les patients traités par antihypertenseurs centraux, les patients ayant présenté un accident vasculaire cérébral, les diabétiques, les obèses. Conclusion: L’hypotension orthostatique est fréquente chez les hypertendus noirs africains traités. Il faut la rechercher systématiquement chez tous les hypertendus surtout mal contrôlés car elle peut être non seulement un facteur de mauvaise observance thérapeutique, mais aussi un facteur de risque cardiovasculaire indépendant

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

Electrocardiographic Left Ventricular Hypertrophy Among Gambian Diabetes Mellitus Patients

Background: The global prevalence of diabetes and its complications is increasing worldwide. Its role in coronary heart disease has been linked with the presence of left ventricular hypertrophy (LVH). The present study aims to determine the prevalence of electrocardiographic left ventricular hypertrophy (ECG-LVH) in adult diabetic subjects, its epidemiological and clinical correlates.Methods: A descriptive cross-sectional study involving 534 patients was conducted at the Edward Francis Small Teaching Hospital (formerly Royal Victoria Teaching Hospital), The Gambia. Four hundred and forty patients were included using a standard questionnaire. Anthropometry, laboratory investigations and electrocardiogram were carried out. We used the Lewis, Cornell, and Sokolow-Lyon Voltage criteria to define ECG-LVH. MinitabTM statistical software version 13.20 was used for analysis.Results: 146 (35.2%) patients had ECG-LVH using all 3 criteria and this prevalence was higher among women being 116 (79.5%). A generally high prevalence of overweight (155/37.4%) and obesity (119/28.6%) was observed among study participants, and both clinic-day systolic and diastolic blood pressure (BP) were significantly higher in those with ECG-LVH. Poor diabetes control was observed in both groups.Conclusion: There was a high prevalence of ECGLVH and it is especially so with combining multiple criteria, hence the need for screening. Clinic-day hypertension was associated with ECG-LVH hence the need for diagnosing and aggressive treatment of hypertension in patients with diabetes mellitus.Keywords: Diabetes mellitus, ECG-LVH, The Gambia, voltage criteri

Impact of dietary patterns, individual and workplace characteristics on blood pressure status among civil servants in Bida and Wushishi communities of Niger State, Nigeria

The global burden estimate of hypertension is alarming and results in several million deaths annually. A high incidence of sudden deaths from cardiovascular diseases in the civil workforce in Nigeria is often reported. However, the associations between Dietary Patterns (DPs), individual, and workplace characteristics of hypertension among this workforce have not been fully explored. This study aimed to identify DP in the Bida and Wushishi Communities of Niger State and establish its relationship with hypertension along with other individual and workplace characteristics. Factor analysis was used to establish DP, Chi-square test to identify their relationships with hypertension, and logistic regression to determine the predictor risk factors. The prevalence of hypertension was 43.7%; mean weight, height, and body fat were: 72.8±15 kg, 166±8.9 mm and 30.4%, respectively. Three DPs: “Efficient Diet,” “Local diet,” and “Energy Boost Diet” were identified. The factor loading scores for these factors were divided into quintiles Q1–Q5; none of them had a significant effect on hypertension status. Conversely, increase in age, the Ministry, Department, and Agency (MDA) of employment, frequency of eating in restaurants, and obesity were identified as significant risk factors. After adjusting for confounders (age, body mass index, MDA, and eating habits), a high score (Q5) in “efficient diet pattern” was significantly related to a lower likelihood of hypertension than a low score (Q1). The prevalence of hypertension among the participants was relatively very high. An increase in age and working in educational sector were risk factors associated with hypertension. Therefore, it is recommended that civil servants engage in frequent exercise and undergo regular medical checkups, especially as they get older. These findings highlight the need for large-scale assessment of the impact of variables considered in this study on hypertension, among the civil workforce across Niger state and Nigeria

Setting a baseline for global urban virome surveillance in sewage

The rapid development of megacities, and their growing connectedness across the world is becoming a distinct driver for emerging disease outbreaks. Early detection of unusual disease emergence and spread should therefore include such cities as part of risk-based surveillance. A catch-all metagenomic sequencing approach of urban sewage could potentially provide an unbiased insight into the dynamics of viral pathogens circulating in a community irrespective of access to care, a potential which already has been proven for the surveillance of poliovirus. Here, we present a detailed characterization of sewage viromes from a snapshot of 81 high density urban areas across the globe, including in-depth assessment of potential biases, as a proof of concept for catch-all viral pathogen surveillance. We show the ability to detect a wide range of viruses and geographical and seasonal differences for specific viral groups. Our findings offer a cross-sectional baseline for further research in viral surveillance from urban sewage samples and place previous studies in a global perspective

Global monitoring of antimicrobial resistance based on metagenomics analyses of urban sewage

Antimicrobial resistance (AMR) is a serious threat to global public health, but obtaining representative data on AMR for healthy human populations is difficult. Here, we use meta-genomic analysis of untreated sewage to characterize the bacterial resistome from 79 sites in 60 countries. We find systematic differences in abundance and diversity of AMR genes between Europe/North-America/Oceania and Africa/Asia/South-America. Antimicrobial use data and bacterial taxonomy only explains a minor part of the AMR variation that we observe. We find no evidence for cross-selection between antimicrobial classes, or for effect of air travel between sites. However, AMR gene abundance strongly correlates with socio-economic, health and environmental factors, which we use to predict AMR gene abundances in all countries in the world. Our findings suggest that global AMR gene diversity and abundance vary by region, and that improving sanitation and health could potentially limit the global burden of AMR. We propose metagenomic analysis of sewage as an ethically acceptable and economically feasible approach for continuous global surveillance and prediction of AMR.Peer reviewe

Setting a baseline for global urban virome surveillance in sewage

The rapid development of megacities, and their growing connectedness across the world is becoming a distinct driver for emerging disease outbreaks. Early detection of unusual disease emergence and spread should therefore include such cities as part of risk-based surveillance. A catch-all metagenomic sequencing approach of urban sewage could potentially provide an unbiased insight into the dynamics of viral pathogens circulating in a community irrespective of access to care, a potential which already has been proven for the surveillance of poliovirus. Here, we present a detailed characterization of sewage viromes from a snapshot of 81 high density urban areas across the globe, including in-depth assessment of potential biases, as a proof of concept for catch-all viral pathogen surveillance. We show the ability to detect a wide range of viruses and geographical and seasonal differences for specific viral groups. Our findings offer a cross-sectional baseline for further research in viral surveillance from urban sewage samples and place previous studies in a global perspective

Les masses intracardiaques non infectieuses. Aspects diagnostique et thérapeutique à Lomé.

But : Souligner l’apport de l’échocardiographie transthoracique dans le diagnostic des thrombus intracardiaques et les myxomes, et le problème lié à leur prise en charge au Togo. Matériel et méthode : il s’agi d’une étude rétrospective sur une période de 6ans allant de janvier 2001 à décembre 2006 et effectuée à la clinique cardiologique du CHU-Campus. Etaient inclus dans notre étude les patients ayant bénéficiés d’une échocardiographie montrant la présence d’un thrombus ou myxome. Résultat : sur 2129 patients, 10 thrombus chez 8 patients et 2 myxomes chez 2 patients ont été diagnostiqués. Cinq thrombus étaient dans le ventricule gauche, 4 dans l’oreillette gauche, et 1 dans l’oreillette droite. Un myxome était dans l’oreillette gauche et l’autre dans le ventricule gauche. Le tableau d’insuffisance cardiaque était la circonstance de découverte dans 9 cas. Il y avait 1 cas de découverte fortuite pour un myxome. Les étiologies dans le cas de la thrombose étaient : 5 cas de cardiomyopathie dilatée, 1 cas de rétrécissement mitral, 1 cas de cardiomyopathie ischémique et 1 cas de coeur pulmonaire chronique. L’anticoagulation a été instituée dans tous les cas de thrombose. Le malade porteur du myxome du ventricule gauche a bénéficié de l’exérèse chirurgicale et l’autre patient est mort 1an après dans un tableau de défaillance cardiaque global par manque de traitement chirurgical. Conclusion : le diagnostic des thrombus intracardiaques et de myxome est basé sur l’échocardiographie. Cependant la prise en charge des cas chirurgicaux pose un problème dans notre pays où il n’existe pas encore de chirurgie cardiaque.Mots clés : Thrombus, myxome, échocardiographie transthoracique, anticogulation, chirurgie cardiaque.Object: to show the contribution of the transthoracic echocardiography in the diagnosis of the intracardiac thrombosis and myxoma, and the problem involved in their assumption of responsibility. Materiel and method: it was about a study retrospective on period of 6 years energy from January 2001 to December 2006 and carried out with the cardiologic clinic of the CHU-Campus. Were included in our study the patients having profited from an echocardiography showing the presence of an intracardiac mass. Result: on 2129 patients, 10 thrombi among 8 patients and 2 myxoma among 2 patients were diagnosed. Five thrombi were in the left ventricle, 4 in the left auricle, and 1 in the right auricle. One myxoma was in the left auricle and the other in the left ventricle. The cardiac table of insufficiency was the circumstance of discovered in 9 cases. There was 1 case of fortuitous discovery for a myxoma. The causes in the case of thrombosis were: 5 cases of dilated cardiomyopathy, 1 case of mitral stenosis, 1 case of ischemic cardiomyopathy and 1 case of chronic pulmonary heart. The anticoagulation was instituted in all the cases of thrombosis. One case of myxoma profited from the surgical treatment and the other patient died 1year afterwards in a table of cardiac deficiency total for lack of surgerycal treatment. Conclusion: The diagnosis of the intracardiac masses is based on the two-dimensional transthoracic echocardiography in our countries without of the transoesophageal echocardiography. However the assumption of responsibility of the surgical cases poses a serious problem in our countries in the process of development which do not lay out of cardiac surgery.Key words: Thrombosis, myxoma, transthoracic echocardiography, anticoagulation, cardiac surger

Le coeur pulmonaire chronique. A propos de 35 cas colliges à la clinique cardiologique du CHU Campus de Lomé

Le coeur pulmonaire chronique (CPC) est l’une des causes d’insuffisance cardiaque droite. Il faut cependant le considérer comme une affection pneumologique car ses causes sont de ce ressort avec, au premier rang, les insuffisances respiratoires chroniques obstructives. Nos objectifs étaient d’étudier les aspects épidémiologiques, cliniques et paracliniques des CPC à la clinique cardiologique du CHU Campus de Lomé. Patients et méthode: Il s’agit d’une étude rétrospective menée sur 4 ans, du 1er juin 2004 au 31 mai 2008 et portant sur 35 cas de coeur pulmonaire chronique. Résultats : La prévalence du coeur pulmonaire chronique était de 0,61%. Il y avait une prédominance féminine avec un sex-ratio de 0,75. L’âge moyen était de 58,6± 17,03 ans avec des extrêmes de 22 et 90 ans. Les signes d’appels cliniques étaient dominés par la dyspnée (88,6%), la toux (34,3%), les oedèmes des membres inférieurs (45,7%), la condensation pulmonaire (40%), la tachycardie (34,3%) et la turgescence des veines jugulaires (25,7%). Les signes échocardiographiques étaient essentiellement dominés par la dilatation du ventricule droit et l’hypertension artérielle pulmonaire (100%), la dilatation de l’oreillette droite (88,6%), le septum paradoxal (17,1%) et la dilatation de l’artère pulmonaire (11,4%). Les principales étiologies et facteurs de risque associés étaient : l’obésité (34,3%), l’asthme (28,6%), la bronchite chronique (20,0%), le tabac (8,6%) et la tuberculose (14,3%). Conclusion : Le CPC est relativement peu fréquent dans notre milieu. La lutte contre l’obésité et le tabagisme, un suivi régulier des BPCO et un traitement précoce et correct de la tuberculose devraient permettre de minimiser cette affection. Mots clés : Coeur pulmonaire chronique, épidémiologie, diagnostic.The chronic cor pulmonale is one cause of right cardiac failure. It should however be regarded as a pneumologic affection because its causes are of this spring with, with the first rank, the obstructive chronic respiratory insufficiencies. Our objectives were to study the epidemiologic, clinical and paraclinic aspects of the chronic cor pulmonale to the cardiologic private clinic of the Campus university hospital of Lome. Patients and method: It is about a retrospective study undertaken over 4 years, of June 1, 2004 to May 31, 2008 and bearing on 35 cases of chronic cor pulmonale. Results: The prevalence of the chronic cor pulmonale was of 0.61%. There was a female prevalence with a sex-ratio of 0.75. The Middle Age was of 58.6±17.03% years with extremes of 22 and 90 years. The clinical signs of calls were dominated by dyspnoea (88.5%), cough (34.3%), the oedemas of the lower extremities (45.71%), pulmonary condensation (40%), tachycardia (34.29%), turgescence of the jugular veins (25.71%). The echocardiography signs were primarily dominated by the dilation of the right ventricle and pulmonary arterial hypertension (100%), the dilation of the right auricle (88.5%), paradoxical septum (17.1%), the dilation of the pulmonary artery (11.4%). The principal etiologists and associated risk factors were: obesity (34.3%), asthma (28.6%), chronic bronchitis (20.0%), tobacco (8.6%), tuberculosis (14.3%). Conclusion: The chronic cor pulmonale is relatively not very frequent in our medium. The fight against obesity and the nicotinism, a regular follow-up of the BPCO and an early and correct treatment of tuberculosis should make it possible to minimize this affection.Key words: Chronic cor pulmonale, epidemiology, diagnosis