Screening, Treatment and Control of High Blood Pressure on Five Sites in Mali

Introduction: High blood pressure is defined as blood pressure greater than or equal to 140 mm Hg for systolic and or 90 mm Hg for diastolic. It constitutes a major public health problem, the leading chronic disease in the world. The objective was to determine the prevalence, treatment rate and control of hypertension. Methods: This was a cross-sectional and descriptive study which took place over a period of 6 months in a hospital environment and in the general population. Results: Of the 1000 participants, 637 had hypertension, giving a prevalence of 63.70% with a female predominance. Thirty-three percent (33%) were unaware of their high blood pressure. The age group 60 and more was the most represented (44%). A proportion of 33 and 23.20 were overweight and obese participants, respectively. Male subjects were more overweight than female, unlike obesity which was more common among female subjects. Sixty-two percent (62%) of hypertensives were treated, of whom 44% were non-compliant. The excessively high cost and consumption of medications as needed were the main factors in therapeutic non-compliance. Twenty-two percent (22%) of all hypertensive patients and 35% of treated hypertensive patients were controlled. Women were more treated but less observant and less controlled than men. Therapeutic coverage and combination therapy rates were lower in rural areas. Hypertensives who had a high level of education were better treated and controlled than those who had no level. Conclusion: High blood pressure remains a real public health problem in Mali. It is more common in people aged 60 and over and in females. One in three hypertensives were unaware of their hypertension. The majority received antihypertensive treatments, but only a minority of them had their hypertension controlled.

COVID-19 and the Vascular Elderly Subject: Illustration of Therapeutic Management with Corticosteroids in an Elderly Diabetic Patient with COVID-19

Introduction: The severity of Sars-Cov-2 infection is associated with the development of acute respiratory distress syndrome (ARDS). The progression to ARDS appears to be driven by a major inflammatory mechanism potentially sensitive to corticosteroids. Observation: This article describes the case of an elderly patient was admitted to emergency departments for intense asthenia, accompanied by motor diarrhoea, dyspnoea with desaturation in ambient air, in a context of strong suspicion of infection linked to COVID-19. The article also reviews the existing literature on the diagnosis and treatment of this severe form of the disease. Conclusion: Corticosteroids, and in particular dexamethasone, have been shown to be effective in the management of patients with COVID-19, an oxygen-releasing disease.

ECG and Echocardiographic Findings of Female Hypertension (fHTN) in the Cardiology Department of the University Hospital Gabriel Touré (UH-GT)

Introduction: In our setting there is a lack of publications on female hypertension in general population motivating this study to look for electro- and echocardiographic findings of female hypertension. Methods: We performed a cross-sectional study during 6 months in the cardiology department of the UH-GT including 324 female patients aged 18 and more seen in the outpatient unit and by whom the diagnosis of hypertension was set. All patients consented to be study participants after receiving clearly information about the study and that care giving will not be affected by their eventual refusal. Data collection has been done with all needed confidentiality rules. A survey formular was used to collect data in order to record them in an Access database. Analysis was done using IBM SPSS software. Quantitative data are presented as mean with standard deviation and qualitative as proportion. Level of significance for statistic test was set at 5%. Results: During the study time 324 among 524 hypertensive patients visited our outpatient unit giving a prevalence of fHTN of 61.8%. The means for age, body mass index (BMI) in female hypertensive patients were respectively 52 ± 14.461 years and 27.35 ± 06.585 Kg/m2. Main ECG findings were left ventricular hypertrophy (LVH) and sinus tachycardia with respectively 93.6% and 46.4% followed by isolated ventricular extrasystole with 33.7%. Echocardiography findings included LVH, relative wall thickness (RWT) and reduced ejection fraction (EF) in respectively 41.05%, 37.35% and 21.91%. The left ventricular mass (LV) mass and geometry were abnormal in 44.4% and 37.3%. Remodeling as geometry modification (18.2%) and mitral flow Type 2 (90.4%) have been the most abnormal findings. Conclusion: Hypertension induced modifications mainly LVH in ECG and Echocardiography in female patients less than encountered among male hypertensive patients.

Hypertension in Clinical Practice: Control Rate in Short Term and Associated Factors in the Cardiology Department of the University Hospital Gabriel Touré(UH-GT) in Bamako (Mali)

Introduction: Hypertension (HTN) is for many decades a worldwide major risk factor for cardiovascular disease.However, hypertension control rates are globally low in the world. Studies on observance have been published in Mali but there is to our knowledge no published data about HTN control rate. We therefore conducted this study to assess the control rate in short term after 3 months management and to look for factors associated with HTN control. Materials and Methods: This study designed as prospective was conducted in the cardiology department of the University Hospital Gabriel Touré (UH-GT) from March 24 to September 24, 2017. All outpatients aged 18 years and more who came for visit and with hypertension as diagnose were involved. All patients have consented to participate in the study. Sociodemographic and data on physical examination including measures for BP, height, weight, waist circumference (WC) and direct costs as reported by the patients were recorded. Patients were asked about medication discontinuation and if yes why and then they were informed about the need to take regularly medication. The concept of chronic disease was explained to them. A formulary served to collect data that were inserted into a Microsoft Access database and analyzed using SPSS version 18. After describing of sociodemographics and continuous variables, crosstabs and finally a logistic regression was performed to look for blood pressure control predictors. Results: There was no statistical difference in sociodemographics between older and newly diagnosed patients. At 3 months globally 40.90% (31.1 for old Patients and 09.8% for newPatients) of the sample were controlled (Figure 1). For old patients, hypertension control rate at inclusion was 12.78% and reached 49.44% at 3 months (Figure 2). After logistic regression only HTN duration was significant predictor with Odd-ratio of 0.365 [0.213 - 0.624] 95% CI and p-value patients as reference). During the study period therapeutic regimen remained unchanged in 73.1% (44.4 for old Patients and 28.7 for newPatients. Calcium channel blocker (CCB), diuretics (DIU) and ACE-inhibitors (ACE-I) were the most prescribed drugs without statistical difference between patients with and without blood pressure under control. Conclusion: Short term hypertension control rate is low and patient follow-up must incorporate information at each visit as well as information through others channels for preventing hypertension. The duration of hypertension was found to be predictor for hypertension control.

Endocrine and Cytogenetic Profile of Variations in Genital Development: Series of 9 Cases at the Mali Hospital

We carried out a retrospective and descriptive study in the Medicine and Endocrinology service of the Mali Hospital from January 2015 to December 2018. Nine cases of anomalies in sexual differentiation were referred for pubertal delay, growth retardation, gynecomastia, micropenis or infertility. Outcomes: The average age was 14 years;5 patients were declared female at birth;2 were married without children;7 patients came from the region of Kayes;8 patients consulted for pubertal delay;1 patient presented with association of a blind vagina and 2 bilateral inguinal gonads. 3 of 4 patients declared male at birth had a micropenis;2 patients had gynecomastia with a history of hypospadias. Ultrasound and biological data showed a clinical-hormonal picture of hypergonadotropic hypogonadism in 6 patients, 1 case of hypogonadotropic hypogonadism with hypercorticism and 2 cases with normal gonadotropic axis;two cases of azoospermia. Karyotypic analysis showed: 3 cases of SK, 2 cases of Klinefelter Syndrome, 2 cases of Androgen Insensitivity Syndrome and 2 cases of male 46 XX syndrome including one with sry negative. Conclusion: The precise diagnosis of anomalies in sexual differentiation remains complicated in Mali, due to the inadequacy of the technical platform. Diagnosis must be made at an early stage to allow normal growth, puberty and satisfactory fertility. Taking charge of the medical treatment possibly associated with plastic surgery could give good results.