[Presumption of sleep apnea in a black African hypertensive population: Importance of the Epworth sleepiness scale in the diagnostic approach]

INTRODUCTION

Sleep apnea syndrome (SAS) is very little described in the hypertensive black African.

PURPOSE

To screen sleep apnea syndrome using the rating scale of Epworth daytime sleepiness, and to investigate the determinant factors and to infer therapeutic consequences.

METHOD

This is a retrospective and prospective study with descriptive and analytical purpose that focused on 200 hypertensive outpatients of the Cardiology Institute of Abidjan. The primary endpoint studied was the SAS. The diagnostic approach of SAS was performed using the rating scale of Epworth daytime sleepiness.

RESULTS

The prevalence of sleep apnea was 45%. The average age of sleep apnea carriers was 56.1 years, with a male predominance (60%). The determinant factors of sleep apnea syndrome were male gender (60% versus 40%, P=0.021), obesity (77.8% versus 62.7%, P<0.0001), diabetes (26.7% versus 15.5%, P=0.5) and dyslipidemia (54.4% versus 27.3%, P=0.0009). Life in urban areas, occupation and smoking were not correlated with SAS in our series. The control of hypertension was better in non-apneic patients compared to apneic patients (63.6% versus 38.9%, P=0.04). The visceral impact of hypertension in apneic patients was highly significant (77.8% versus 41.7%, P=0.014). Therapeutically, it was noted the preferential prescription of combination therapy in apneic patients compared to non-apneic patients (82.3% versus 74.4%).

[Self-medication among black African hypertensive patients: Factors and consequences]

INTRODUCTION

Self-medication practice is under-evaluated among black African hypertensive patients.

AIM

To assess the level of self-medication among black African hypertensive patients and to determine the factors favoring this practice and their consequences.

METHODS

Prospective study during a 3-month period including 612 hypertensive patients followed in Abidjan cardiology institute.

RESULTS

Mean age was 55.1. The patients had a self-medication use in 60.1% of cases. Medicinal plants and derived products were commonly involved. Self-medication use reasons were: influence of relatives (89.8%) and the fear of antihypertensive drugs adverses effects (54.9%). Multivariate analysis shows that factors of self-medication were age (56.6 years vs. 50.3 years, P<0.001), income less than 762 euros/month (88% vs. 75.4%; OR=2.73; 95% CI: 1.62-4.6; P<0,0001), obesity (70.4% vs. 35.6%; OR=1.24; 95% CI: 0.75-1.15; P=0.037), dyslipidemia (40.8% vs. 27.9%; OR=6.72; 95% CI: 0.57-2.13; P=0.043), antihypertensive association therapy (61.7% vs. 51.4%; OR=2.27; 95% CI: 0.25-0.97; P=0.037). Poor control of high blood pressure (HBP) was a consequence of self-medication (6.5% vs. 47.1%; OR=10.27; 95% CI: 4.65-56.4; P=0.034), repercussions of HBP on major organ (75% vs. 17.2%; OR=12.9; 95% CI: 8.5-19.6; P=0.0001).

CONCLUSION

Self-medication is a common practice in African hypertensive patients. It has many consequences.

[Peripheral arterial disease of the lower limbs in African diabetic patients: ultrasonography and determining factors]

INTRODUCTION

Diabetic peripheral arterial disease (PAD) of the lower limbs is underdiagnosed.

METHODOLOGY

This was a prospective study conducted over a six-month period from November 2012 to April 2013. A total of 308 diabetic patients were included from three diabetes centers in Abidjan (Ivory Coast).

AIM

To screen for PAD of the lower limbs in a diabetic population and to identify the determining factors.

RESULTS

Among the 308 patients, the ankle-brachial index (ABI) was<0.9 in 68 (22.07%) patients considered to have PAD; the ABI was>1.3 in 56 (18.2%) patients who had suspected mediacalcosis. The average age of the PAD patients was 60.2 years. Female gender predominated (55.9%). The mean duration of diabetes was 9.6 years: 97.1% type 2 diabetes. The other cardiovascular risk factors in this population were hypertension (58.8%) and dyslipidemia (40.9%). Smoking was present in 29.4% of patients and obesity in 23.9%. PAD of the lower limbs was mild in 46 patients (67.6%), moderate in 16 (23.5%) and severe in 6 (8.8%). Duplex Doppler commonly showed lesions of the tibial arteries. Determining factors of diabetic PAD of the lower limbs were hypertension (58.8% vs 36.6%; OR=2.46; 95% CI: 1.13-5.36; P=0.034) and dyslipidemia (40.9% vs 8.3%; OR=7.6; 95% CI: 2.31-25.08; P=0.0009). For mediacalcosis, male gender (71.5% vs 39.7; OR=0.26 95% CI/0.10-0.64. P=0.004) was the only factor identified.

CONCLUSION

Hypertension and dyslipidemia were predictive factors for diabetic PAD of the lower limbs in our African population.

[Unusual association of endomyocardial fibrosis and aberrant migration of Dracunculus medinensis in the pericardium]

We report one case of endomyocardial fibrosis with a relapsing pericarditis, associated with an aberrant migration of Dracunculus medinensis in the pericardium, in a 22-year-old patient from an endemic zone of bilharziasis and dracunculosis in Côte d'Ivoire. The evolution has been marked by the appearance of thrombus in the right atrium. The patient died on the 49th day of hospitalization following an refractory cardiac insufficiency.

[Factors of compliance with the wearing of elastic compression stockings in a Sub-Saharan population]

INTRODUCTION

Elastic venous compression is the basic treatment of chronic venous insufficiency (CVI) and deep vein thrombosis (DVT). Very little data exist in sub-Saharan Africa concerning the wearing of compression stockings.

AIM

To determine the factors of compliance with wearing elastic compression stockings.

MATERIALS AND METHODS

This retrospective cross-sectional descriptive and analytical study involved 200 consecutive patients (93 cases of DVT, 94 cases of CVI, 13 cases of DVT and CVI). Data on compliance with wearing compression stockings and the factors influencing this compliance were collected.

RESULTS

The average age was 51±15 years old (range 17 and 91 years old). The sex ratio was 1. The majority of patients (78.5%) performed their occupation in a standing position, for more than 8hours per day for 80.5%. DVT were preferentially on the left side (52.9%) and proximal (44.4%). Concerning the CVI, the predominant symptoms were class C3 (52.3%), C4 and C5 (43.9%) of the CEAP classification. Bilateral involvement was dominant (53.3%) and the large saphenous vein was the most affected (66.9%) compared with 33.1% for the small saphenous vein exclusively. The most common type of stockings prescribed was the lower mid-thighs (57%), followed by the pantyhose (30%), in classes 3 (63%) and 2 (36.5%). The majority of patients (75%) agreed to wear their stockings after prescription with a good compliance rate of 58.5% at the beginning of the prescription. At the time of the study, this rate was 11%. The optimal duration of compliance with wearing compression stockings was 6 months (64%). Over 12 months this rate fell to 7.5%. The main causes were stocking-related compression discomfort (36.7%), patient neglect (21.5%), threading difficulties (16.9%), and an unfavorable working environment (8.7%). The determining factors of compliance with wearing of stockings were living in a couple (68.4% vs 54.2, P=0.04), CVI (53% vs 38.2%, P=0.04) and C3 (39% vs 80%), C4 (37.5% vs 17%), C5 (18% vs 3%) CVI (P=0.0005).

CONCLUSION

Compliance with wearing elastic compression stockings is mediocre. The main factors of non-compliance are discomfort, threading difficulties and patient neglect.