Insuffisance Rénale Aigue Obstétricale : Expérience De La Maternité Issaka GAZOBY De Niamey (Niger)

Introduction Acute renal failure (ARF) is a serious obstetric complication of pregnancy, a real health problem in developing countries. It is more related to the pathologies of pregnancy affecting the mother rather than the fetus. The purpose of our study was to assess sociodemographic, clinical, therapeutic and evolutionary features in obstetric acute renal failure. Materials and Methods: A cross sectional study of 6 months (August 2015- January 2016) was conducted. The study involved pregnant women over 20- week amenorrhea including the immediate postpartum admitted for acute renal failure. Results: Thirty-two patients were involved. The mean age was 25.21 ± 5.14 years. Most of them were first-time mothers (53.1%). Surrounding hospital exits account for 71.9% of the admissions. 31.25% (N = 10) of the patients did not receive any antenatal care. The main clinical signs at admission were hypertension (86.6%), oliguria (40.5%) and edema syndrome (37.5%). Eclampsia and severe pre-eclampsia represented the causes of the ARF in 68.75% cases. Considering 8 patients (25%) who were supposed to undergo dialysis therapy, only one took the treatment. The average hospital stay was 15.20 ± 7.45 days. Renal function resolved in 68.75% of patients and 15.62% developed chronic renal sequelae. At the end of the study, we recorded 5 cases of maternal deaths and 10 cases of fetal death in utero. Conclusion: Obstetric ARF remains a serious complication of pregnancy for mother and child. It should be noted that hemodialysis was not accessible to all patients who were entitled to it due to lack of financial means. Therefore, regular monitoring of pregnancies should be prioritized, and, if possible, ensure that hemodialysis sessions are funded

Décentralisation De La Dialyse Au Sénégal : Expérience D’1 An Du Centre De Tambacounda A l’Est Du Pays

Hemodialysis has made numerous and significant progress in recent decades resulting in life expectancy increase (thirty or forty years). The aim of our study was to assess the treatment of acute and chronic hemodialysis in the reference center of Tambacounda. Patients and methods: This was a prospective study over a one-year period (April 2013 to March 2014) in the hemodialysis center of the regional hospital of Tambacounda, 450km away from Dakar. The study focused on epidemiological, clinical, paraclinical and scalable data. Results: Fifty-nine patients were involved in the study. The sex ratio was 0.85 (32F/ 27M). The mean age was 41.3 years [12-72 years old]. Nineteen patients were on dialysis treatment for acute renal failure (ARF) (32.2%) and 40 were chronic hemodialysis patients (67.79%). Fifty patients were under emergency dialysis (84.7%) including 17 in intensive care (28.8%). Most chronic hemodialysis patients had 3 sessions per week (98.3%). Only 9 patients were monitored in nephrology prior to dialysis (22%). Thirty-two patients had a femoral double-lumen catheter (54.23%), 6 patients used ordinary double- lumen jugular catheters (10.17%) and 3 received tunneled jugular catheters (5.09%). Eighteen patients had functional arteriovenous (AV) fistula (18.51%). The mean hemoglobin was 7 g/dl. Only 11 patients had erythropoietin-based therapy. In acute renal impairment there were 8 deaths (42.10%), whereas in chronic renal failure the fatality rate was 18.8% (n = 9). Conclusion: Our study has demonstrated the benefits of decentralizing dialysis treatment in the provinces. However there is a need to implement the accompanying measures, such as the availability of some essential medicines for all hemodialysis patients, and equipment of intensive care units

Compliance of hypertensive patients with antihypertensive drug therapy at the Renaissance Hospital of N’Djamena, Chad

Introduction: High blood pressure is a major cardiovascular risk factor. In hypertension, non-compliance is frequent. The objective of this work is to evaluate the therapeutic observances and to identify the predictive factors of poor compliances in Chadian hypertensive patients. Patients and Methods: It was a prospective cross-sectional study over a six-month period from January 15 to July 15, 2019. This was performed in the outpatient Cardiology and Nephrology units at the Renaissance Hospital of N’Djamena. We included all follow-up patients who had hypertension who consulted during the study period. However, dialysis patients and children were excluded from this study. The parameters studied were demographic characteristics, economic and therapeutic data and the rate of therapeutic compliance. Results: Eighty-seven patients were included. The average age was 50 years old. The sex ratio was 2.5. Sixty-seven percent (n = 58) of the patients were from urban areas. The predominant cardiovascular risk factors were smoking in 25% (n = 22) and diabetes in 23% (n = 20). Hypertension was uncontrolled in 76% (n = 66) patients. Adherence was poor in 66% (n = 57) of patients. The monthly cost of treatment was respectively 10,000 and 20,000 FCFA in 52% (n = 45) of cases. Combination therapy was observed in 70% of cases (n = 61) and 56% (n = 49) of patients had more than one drug intake. The adherence rate was 93% (n = 28) in the urban population (p < 0.001). All patients (n = 30) who were observing their treatment were educated (p < 0.001). The adherence rate was 20% (n = 6) in patients who had a monthly income less than 100,000 FCFA (p = 0.004). The adherence rate was 60% (n = 18) when the monthly cost was less than FCFA 10,000 (p = 0.003). The adherence rate was 77% (n = 23) in patients receiving monotherapy (p < 0.001). Conclusion: This study showed a low level of adherence in Chadian hypertensive patients. The complexity and cost of antihypertensive therapy, poor knowledge of hypertension, and ignorance of its severity have been the main factors of poor compliance