Arterial Hypertension and Pregnancy about 72 Cases

Background: Hypertension is the leading cause of cardiovascular disease worldwide. Hypertensive disorders in pregnancy also constitute a major global health threat. There are different types of hypertension that can occur during pregnancy;with different mechanisms and consequences for mother and fetus. Objectives: To determine the frequency of hypertension (hypertension) during pregnancy. Document the risk factors for pregnancy-related hypertension. Review the material and fetal complications which determine the prognosis. Methods and Patients: This was a retrospective cross-sectional study from January 1 to June 30, 2022 in the Obstetrics and Gynecology Department of the Brazzaville Hospital and University Center. We noted 72 cases of hypertension among 1188 births admitted during the reference period. Hypertension was defined as blood pressure 40/90mmHg. Results: Hypertension was observed in 6% of those giving birth. The average age of the patients was 28 ± 8 years (range 15 to 39 years). The age group of 15 to 34 years was the most affected, 56 cases (778%). The risk factors were young age (15 - 34 years), late transfer of women in labor, 49 cases (68%). Primiparity, 33 cases (45.8%), absence of prenatal consultation, 7 cases (9.7%), hypertension, 8 cases (11%), twinning, 4 cases (5%), fetal macrosomia, one case (1.3%). Maternal complications recorded were: 21 cases of eclampsia (29%), 6 cases of left ventricular failure (8.3%), 5 cases of anemia (6.9%), 2 cases of retroplacental hematoma (2.8%), 1 case of HELLP syndrome, as much renal failure. Fetal and neonatal complications were 23 cases of prematurity (32%), 10 cases of acute fetal distress (14%), 4 cases of hypotrophy (5.6%). Eleven cases of death (15.3%) were: 3 in utero. B in the neonatal period.

Papulosa Nigra Dermatosis Another Factor Associated with Cardio-Vascular Diseases?

Objectives: To determine the correlation between dermatosis papulosa nigra (DPN) and cardiovascular disease (CVD). Patients and Method: A retrospective study was conducted between April 2022 and March 2023 in cardiology at Loandjili General Hospital. Were included all adult patients older than 18 years of age presenting with DPN, and divided into two groups according to the presence of CVD. Hypertension (HT), endomyocardial fibrosis, dilated and restrictive cardiomyopathy, chronic pulmonary heart, ischemic heart disease, stroke, and valvular heart disease were retained as CVD. Pregnant women, Peutz Jeghers syndrome and all dermatosis with cardiovascular manifestations were excluded. Studied variables were clinico-demographic, hereditary and behavioral. Results: A total of 55 patients were selected. There were 40 patients with CVD, 15 patients without CVD, 43 women (78.1%) and 12 men (21.8%). Mean age was 52 ± 12.6 years (extremes: 22 - 85 years). There was a significant difference between age and sex (P 0.05). There were 34 hypertensive patients, 10 patients with diabetes mellitus, 7 strokes, 2 endomyocardial fibrosis and 2 ischemic heart diseases. Periorbital location was representative was frequently found in the group with CVD. Hereditary and behavioral factors were involved in the development of DPN and CVD. There was a significant correlation between DPN and onset in childhood (P 0.05), between hypertension and use of medication (P 0.05), and between onset in childhood (P 0.05) and use of mercury containing soap (P 0.05). Conclusion: DPN predominates in young women. The occurrence of CVD depends on DPN location. Hereditary and behavioral factors associated with development of DPN are CVD factor risks.

Epidemiological and Clinical Profile of Hypertensive Patients with Obstructive Sleep Apnea at CHU-B

Objectives: To detect obstructive sleep apnea syndrome (OSAS) in a population of hypertensive patients, using the Berlin questionnaire and to establish the epidemiological and clinical profile of patients. Patients and Method: This was a cross-sectional and analytical study, carried out from March to August 2019 at the CHU Brazzaville. Included are hypertensive patients followed as outpatients. The diagnosis of the OSAS was based on the answers to the Berlin questionnaire. Results: A total of 315 patients were included, including 210 women (64.9%). Prevalence of OSAS was 75.8% (n = 239). The average age of patients with sleep apnea was 58.5 ± 12.4 years with female predominance (64.9%). In the mixed analysis, the factors associated with (OSAS) were: occupation OR (2.56) 95% CI (1.15 - 5.69), obesity OR 7.50 (1.60 - 35.1) and abdominal obesity OR 2.36 CI 95% (1.36 - 4.08). Living standards were high in 59 cases (18.7 per cent). The medical history of previous hospitalization was present in 209 cases (66.3%), diabetes 95 (30.2%), and heart failure 57 cases (18.1%). Lifestyle patterns were: sedentary (n = 181;57.5%) alcohol consumption (n = 97;30.8%). On physical examination, overweight was noted in 96 cases (30.5%) and obesity in 91 cases (28.8%). The anomalies in the Berlin questionnaire were: snoring (n = 197;62.5%), waking fatigue (n = 127;40.3%), fatigue during the day (n = 97;30.8%). Conclusion: The prevalence of obstructive sleep apnea syndrome is high during arterial hypertension in our setting. Hence the need for sleep exploration through polysomnography, and prevention through the fight against the associated risk factors.

Peri-Annular and Septal Abscesses in Infectious Endocarditis. About 3 Cases Observed at the University Hospital of Brazzaville

Infectious endocarditis (IE) is a relatively rare but serious condition. We report 3 cases of infectious endocarditis complicated by peri-annular and/or septal abscess. The patients aged 24, 25 and 28 were all male. Global heart failure was observed in 2 cases. Atrioventricular block was noted in 2 cases (complete syncopation: 1 time;2nd degree Mobitz 2 1 time). Transthoracic echocardiography made it possible to diagnose abscess in all cases (aortic and septal peri-annulus: once, septal only: twice). The aortic insufficiency was grade 2 in all cases, mitral insufficiency grade 2 in 1. The front door was found once, with a dental location. Blood cultures were negative in all cases. A bi-probabilistic antibiotic therapy made it possible to control the infectious process in all the patients. Cardiac surgery, indicated in all cases, was performed in 1 case, consisting of flattening the abscesses and then placing a pacemaker in the patient with complete syncopal atrioventricular block. The outcome of all patients was favorable. Return to permanent sinus rhythm, associated with complete left bundle branch block, was noted at the 4th year of development in the pacemaker wearer. The other 2 patients are still awaiting medical evacuation.

Cardiac Tamponade: Epidemioclinical, Therapeutic and Evolutionary Aspects at the University Hospital of Brazzaville

Objectives: Contribute to improving the management of cardiac tamponade in Congo. Background: Cardiac tamponade is an acute or subacute compression of the heart chambers by pericardial effusion responsible for uncertain prognosis for patients. The objective of this study is to help improve the management of patients with cardiac tamponade. Patients and Methods: We conducted a retrospective and descriptive study at the University Hospital of Brazzaville, from January 2015 to December 31, 2019. Included were all patients hospitalized for cardiac tamponade. Epidemioclinical, therapeutic and evolutionary data were analyzed. Results: An overall of 14 patients were divided into 9 men (64.2%) and 5 women (35.7%), i.e. a sex ratio of 1.8. The mean age of patients was 34.2 ± 15.1 years old (18 years to 64). The most represented comorbidity was hypertension (n = 2;14.3%). The most frequent clinical sign was dyspnea (n = 14;100%). The ECG showed diffuse and concordant repolarization disturbances (n = 14;100%), sinus tachycardia (n = 13;92.8%), microvoltage (n = 12;85.7%). Cardiomegaly was constant (n = 14;100%). In terms of transthoracic ultrasound, we found: diastolic compression of the right ventricle (RV) (n = 12;85.7%), dilation of the inferior vena cava (IVC) (n = 12;85.7%). Treatment consisted of crystalloid vascular filling in all patients, pericardial puncture (n = 7;50%), surgical drainage (n = 12;85.7%), anti-tuberculosis drugs (n = 11;78, 6%), antimitotics could be administered in one case (n = 1;7.2%). Two cases of death were recorded, i.e. 14.3%. Conclusion: Cardiac tamponade, although it is a rare condition, remains a serious pathology and difficult to manage in our context.

Relationship between Obesity, Serum Uric Acid, Serum Potassium and Glomerular Filtration Rate with Electric Left Ventricular Hypertrophy in Blacks Central Africans with High Blood Pressure

The authors conducted a retrospective study over a period of 6 months in a hypertensive population in order to determine the correlation between serum uric acid on glomerular filtration rate (GFR) and estimated serum potassium with left ventricular hypertrophy (LVH) and obesity. This study enrolled 122 patients including 63 women (51.6%). The mean age was 55.9 ± 10.6 years (range 30 to 74 years). Obesity weight was found in 38 cases (31.1%) of which 20?were men (33.9%) and 18 women (28.6%). Abdominal obesity was found in 104 cases (85.2%). The average serum uric acid in patients with obesity weight was 63.3 ± 18.9 mg/L vs 62.4 ± 14.2 mg/L for no-obese patients (p?= 0.63). The average serum potassium in obese patients was 4.06 ± 0.42 mEq/L vs 4.02 ± 0.46 mEq/L for no-obese (p?= 0.65). The average GFR was 73.4 ± 21.4 ml/L in obese patients vs 66.6 ± 22.6 ml/min in no-obese (p?= 0.03). The LVH was found in 81 cases (66.4%). The LVH was found in 65 (62.5%) obese patients vs?16 (88%) non-obese patients (OR = 4.8, 95% 1.04?-?22?p?= 0.02). Only abdominal?obesity has been correlated with left ventricular hypertrophy after multivariate analysis. Emphasis must be focused on public health actions for effective and appropriate measures against obesity and hypertension, whose prevalence is increasing in our region.

Excessive Alcohol Intake and Cigarette Smoking among Black Schoolchildren in a Central African City (Brazzaville, Congo)

Objective: To determine the prevalence of excessive alcohol intake (EAI) and cigarette smoking (CS) in schoolchildren of Brazzaville. Methods: This cross sectional survey included a representative population of schoolchildren in Brazzaville (603 schoolchildren divided 325 girls and 278 boys). Results: The prevalence of EAI was 9% (n = 54). The mean age of EAI children was 16.2 ± 1.3 years (range: 13 - 18 years) vs 11.4 ± 3.4 years (range: 5 - 18 years) for no EAI children (p Conclusion: Low social level, siblings, addictions in parents were correlate addictions in schoolchildren. It is necessary to prevent the acute and futures complications of this addiction in our children.

Current Status of Acute Rheumatic Fever and Relationship with Acute Rheumatic Heart Disease at the University Teaching Hospital of Brazzaville (Congo)

Aim: To determine the epidemiological findings of acute rheumatic fever (ARF) and relationship with acute rheumatic heart disease (RHD). Patients and method: This cross sectional study was conducted from January 2012 to December 2016 (5 years) in the Department of Pediatrics. We had included patients aged from 5 to15 years old, admitted for ARF. Results: Twenty-nine black African children, 15 boys (51.7%) were included. The incidence was 5.8 cases/year. The mean age was 10.4 ± 2.7 years. The mean age of parents was 34.5 ± 6.9 years (range: 24-48) for mother and 41.2 ± 6.9 years (range: 28 - 56) for father. Parents were low-income 10 (34.5%), the delay of consultation was 17.7 ± 19.5 days. The medical history was: frequent pharyngitis 22 (76%), previous ARF 17 (58.6%), previous hospitalization 11 (38%). Signs were: polyarthralgia (n = 28, 96.6%), fever (n = 24, 82.8%), asthenia (n = 18, 62%), migratory polyarthritis (n = 12, 41.4%). Organic heart murmur has been reported in 13 cases (44.8%), and heart failure in 7 cases. The anomalies of blood analysis were inflammatory syndrome (100%), elevation of streptococcal enzymes (n = 27, 93%), and anemia (n = 16, 55.2%). In cardiac ultrasound, anomalies were: thickened valve (n = 13, 44.8%), mitral regurgitation (n = 13, 44.8%), dilatation of left ventricle (n = 9, 31%), aortic regurgitation (n = 5, 17.2%). The nosology of pathology was acute RHD (n = 15, 51.7%), ARF only (n = 14, 48.3%). Associated factors of acute RHD were: female sex (OR 1.52, 95%CI 0.35 - 6.6), low-income (OR 1.33, 95%CI 0.24 - 7.4), previous hospitalization (OR 2.7, 95%CI 0.58 - 13) and migratory polyarthritis (OR 1.12, 95%CI 0.25 - 4.9). Conclusion: The ARF remains prevalent in our countries. Its complications lead to sequelae that are difficult to treat, because of the lack of cardiac surgery centers in many sub-Saharan African countries including Congo. Prevention and effective treatment of angina should be applied by practitioners.

Hypertensive Emergencies in the Department of Cardiology at the Teaching University Hospital of Brazzaville (Republic of the Congo): Preliminary Study

Background: Hypertensive emergencies are still a common mode of finding hypertension.?Objective: to determine the epidemiological, clinical and paraclinical characteristics of the hypertensive emergency, and to evaluate the factors associated with poor blood pressure control. Patients and method: cross-sectional and analytical study, conducted from July 2010 to June 2014 (4 years), in the cardiology department of the Brazzaville University Hospital. Included, patients admitted were those systolic blood pressure (BP)?≥ 180 mm Hg, and diastolic BP ≥ 110 mm Hg, with target organ involvement. A minimum biological assessment, an ECG, a chest X-ray, a brain CT-scan and a cardiac ultrasound were required.?Results: Fifty patients were included, including 31 women (62%). The mean age was 53.8?±?13.7 years old, age;?68%), low income?population (n = 23;?46%). Hypertension was often known (n = 49;98%), and poor compliance?(n = 33;67.4%). Associated risk factors were: obesity (n = 13),?and?diabetes (n = 7). The average consultation time was 4.1?±?3.7 days. The reasons for hospitalization were: dyspnea (n = 24;?48%), neuro-sensory signs (n = 24;?48%),?and?functional limb impotence (n = 15;?30%). The major laboratory abnormalities were hyperuricemia (n = 16;?32%) and hyperglycemia (n = 16). Left ventricular hypertrophy was noted at the ECG (n = 29;?58%). Cardiac ultrasound showed a LVEF ?40% (n = 8). The main hypertensive emergencies were: heart failure (n = 23;?46%), stroke (n = 23;?46%), severe renal failure (n = 10;20%), and malignant hypertension (n = 23;46%). The average hospital stay was 11.4?±?5.5 days, and 1 death was recorded. BP was uncontrolled in 38 cases (76%). Factors associated with uncontrolled blood pressure were: female sex (OR 3;?95% CI 0.8 - 11.5) and low-income patient (OR 1.26;?95% CI 0.34 - 4.68).?Conclusion: organs affected during hypertensive emergencies are most often the heart, the brain and the kidney in our context. Early management of hypertension will?reduce these complications.

Hypertension, diabetes mellitus, overweight and obesity in employees under health transition at the railways company in Congo-Brazzaville

Background and Aim: Cardiovascular risk (CVR) factors, namely hypertension (HT), diabetes mellitus and obesity, are a public health problem in sub-Saharan Africa because of health transition. The additional effect of the social gradient within the railway companies in Congo-Brazzaville on high CVR is not yet established. The aim of this study was to determine the extent of hypertension, diabetes mellitus, overweight, and obesity and to identify the contributing factors of fatness and hypertension. Methods: This was a cross-sectional study conducted in April 2013. A simple random sample of 255 out of all 2550 workers from the railway companies of Congo was examined for epidemiological, clinical and biological variables. Results: Out of the study sample, 231 (90.6%), 79 (31%), and 52 (20.4%) were men, rural dwellers, and senior executives, respectively. The mean age was 45 ± 13 years (range 19 to 63 years). The rates of overweight, hypertension, obesity, and diabetes mellitus were 40.3% (n = 103), 29.4% (n = 75), 7.5% (n = 19), and 3.5% (n = 9), respectively. In univariate analysis, female sex (OR 2.7, 95% CI 1.13 - 6.45, p = 0.01), senior executive (OR 2.4;95% CI: 1.3 - 4.5;p = 0.003) and physical inactivity (OR 2.5;95% CI: 1.5 - 4.2;p < 0.001) were significantly associated with overweight. Female sex (OR 7.5, 95% CI: 2.6 - 21;p < 0.001) and senior executive (OR 3.17;95% CI: 1.2 - 8.3) were also significantly associated with obesity. In logistic regression, overweight (OR = 4.8, 95% CI 2.8 - 11, p < 0.0001), and obesity (OR = 6.8, 95%CI 2.1 - 22, p = 0.01) were identified as the most important and independent determinants of hypertension. Conclusions: Fatness is emerging and it is the most contributing factor of hypertension among workers at the Congolese railway companies. There is also a significant interaction between non-modifiable factors (genetic: females and family history) and modifiable factors (inactivity, fatness) for higher risk of hypertension. Health promotion should be emphasized by physical activity programs.

What Strategy for a Severe Stroke in Africa: Palliative Care or Unreasonable Obstinacy?

Introduction: Palliative care, firstly used for chronic diseases, is currently indicated for some acute pathology such as Stroke. Its implementation improves the quality of care for end-of-life patients. The aim of our study is to report a series of patients who died in the intensive care stroke unit of Brazzaville. Method: It was a descriptive study of a series of 13 cases of severe stroke, admitted to the intensive care unit of the university hospital of Brazzaville, between January 2015 and December 2017. Sociodemographic, clinical, paraclinical and prognostic variables were studied. Result: The mean age of the patients was 46 ± 11.5 years with a male predominance in 69.2% (n = 9). They were all hypertensive. The motor deficit and consciousness disorder association was the reason for admission in 84.6% (n = 11) and an epileptic seizure of 15.4% (n = 2). The mean NIHSS at admission was 21 ± 5, that of Glasgow 6 ± 3. Stroke was hemorrhagic in 84.6% (n = 11) and malignant infarction in 15.4% (n = 2). All of these patients received invasive resuscitation with assisted ventilation and all died within 8 days of admission. Conclusion: The issue of limitation of care deserves to be debated, and is proposed on a case-by-case basis, in the face of a serious stroke. Therapeutic relentlessness is not only expensive, but also raises the problem of suffering of the individual at the end of life.

Marfan Syndrome Complicated by Aortic Arch Aneurysm and Aortic Dissection: A Case Report from Congo

Context and Aim: Marfan syndrome is a transmissible genetic disease of the connective tissue that is rarely encountered in Congo and in sub-Saharan African countries. Its cardiovascular complications can be life frightening. The management of that disease is still limited in our country because of a lack of technical capacity in cardiovascular surgery. The aim of this clinical report is to show the interest of echocardiography and especially angioscanner as the main technique in the diagnosis of the severity of this disease, elaborate a literature review, but also to highlight the difficulties encountered in the management of that affection in our countries. Observation: The authors report the medical observation of a 48-year-old adult with a history of cataract of the left eye and a subluxation of the lens for which he underwent surgery in 2016, without any etiology being found. He is a smoker at a rate of 6 packs yearly. He consulted for progressively worsening dyspnea and constrictive mediosternal pain. The clinical examination revealed a moderate alteration of the general state, apyrexia, a blood pressure of 140/90 mmHg, a SPO2 of 97% in ambient air, a respiratory frequency of 32 cycles/min, signs of left ventricular insufficiency, a diastolic murmur of aortic insufficiency of intensity 4/6th, a long-limbed morphotype with a wingspan superior to the height and a kyphoscoliosis. Chest X-ray showed cardiomegaly with a cardiothoracic ratio of 58%, a highly dilated and uncoiled aorta, convexity of the left inferior arch, and venocapillary hypertension and a quiet alveolar-interstitial pulmonary oedema. The ECG was in sinus rhythm and showed a poor R-wave progression in anteroseptal leads. Echocardiography showed significant aortic root dilatation up to 72.6 mm and aortic regurgitation grade IV. Angioscanner showed a dissected aortic aneurysm and areas of emphysema located in the lungs. The medical treatment was palliative with beta blocker and angiotensin II receptor antagonists, diuretics and analgesics. The patient is awaiting surgery. Conclusion: Marfan syndrome is a genetic disease of the connective tissue that can manifest itself by cardiovascular, pulmonary, orthopedic, ophthalmological and cutaneous signs. Echocardiography and especially angioscanner are the tools of choice for the diagnosis and follow-up of this condition. Surgery is reserved for serious complications of this condition.

Acute Renal Failure in Children at the University Hospital of Brazzaville

Introduction: Acute renal failure (ARF) is a medical emergency that does not spare children. Its interest lies in the search for etiologies and management made difficult by the poor quality of hospital technical platform in Africa. Objectives: To improve the management of ARF in children, determine its prevalence, and identify the causes and factors associated with mortality. Patients and Methods: We reviewed the records of children from one month to 17 years hospitalized between January 2016 and December 2018 in every pediatric department at the University Hospital of Brazzaville and included those whose discharge diagnosis included the item “ARF”. Study variables were age, sex, source, (para)clinical signs, stage and type of ARF, etiology and evolutionary profile. Results: Included were 18952 hospitalized children out of whose 253 had ARF 1.3%. There were 145 (57.3%) boys and 108 (42.7%) girls with an average age of 71.5 months. The mean time to consultation was 8.1 days. ARF was at failure stage in 147 cases (58.1%). It was functional in 210 cases (83.0%), out of which 95.1% resulted from severe dehydration. No extra-renal treatment was performed. Lethality was 34.4%. Hypovolemic shock (56.3%), severe sepsis (18.4%) and severe malaria (14.9%) were the main causes. Young age, provenance of the child, severe dehydration, deep coma, oligoanuria, stage of failure, hyperkalemia, absence of an extra-renal purification center were factors associated with mortality (p Conclusion: The high prevalence of ARF and its lethality requires public health actions including proper management of dehydration and malaria but also the creation of an extra-renal purification center.