IntroductionCe travail a pour objectifs d’étudier les aspects épidémiologiques et cliniques, les différentes modalités de prise en charge, et l’évolution des syndromes coronaires aigus à Dakar.MéthodesIl s'agit d'une étude prospective concernant une cohorte de patients hospitalisés au niveau des services de cardiologie de l'hôpital Principal de Dakar et de l'hôpital Aristide Le Dantec pour un syndrome coronaire aigu entre le 01 Septembre 2005 et le 31 Août 2006.RésultatsDurant la période d’étude, 59 patients avaient présenté à l'admission un syndrome coronaire aigu, soit une prévalence hospitalière de 4,05%. L’âge moyen était de 57,1 ± 3,5 ans. L'indice moyen des facteurs de risque était de 3,56 ± 1,7. Quatre vingt onze pour cent (91%) des patients avaient au moins deux facteurs de risque cardio-vasculaires. Les délais moyens d'arrivée et de prise en charge étaient respectivement de 53,2 ± 21,3 heures et 3,4 ± 1 heures. L'analyse des tracés électrocardiographiques associée au dosage des troponines, avait permis de retenir les diagnostics d'infarctus du myocarde avec sus-décalage persistant du segment ST chez 89,8% patients, d'infarctus du myocarde sans sus-décalage du segment ST chez 5,1% patients, et d'angor instable dans 5,1% des cas. La mortalité hospitalière était de 15,25% et la mortalité à un mois de 18,64%.ConclusionAu Sénégal, les syndromes coronaires aigus sont caractérisés par un âge de survenue relativement jeune chez des patients polyfactoriels et une lourde mortalité. C'est dire tout l'intérêt d'une prévention primaire efficace par la lutte contre les facteurs de risque cardio-vasculaires.

BackgroundSince the discovery of the ABO blood group system by Karl Landsteiner in 1901, several reports have suggested an important involvement of the ABO blood group system in the susceptibility to thrombosis. Assessing that non-O blood groups in particular A blood group confer a higher risk of venous and arterial thrombosis than group O.Epidemiologic data are typically not available for all racial and ethnics groups.The purpose of this pilot study was to identify a link between ABO blood group and ischemic disease (ID) in Africans, and to analyze whether A blood group individuals were at higher risk of ischemic disease or not.MethodsA total of 299 medical records of patients over a three-year period admitted to the cardiology and internal medicine department of military hospital of Ouakam in Senegal were reviewed. We studied data on age, gender, past history of hypertension, diabetes, smoking, sedentarism, obesity, hyperlipidemia, use of estrogen-progestin contraceptives and blood group distribution.In each blood group type, we evaluated the prevalence of ischemic and non-ischemic cardiovascular disease. The medical records were then stratified into two categories to evaluate incidence of ischemic disease: Group 1: Patients carrying blood-group A and Group 2: Patients carrying blood group non-A (O, AB and B).ResultsOf the 299 patients whose medical records were reviewed, 92 (30.8%) were carrying blood group A, 175 (58.5%) had blood group O, 13 (4.3%) had blood group B, and 19 (6.4%) had blood group AB.The diagnosis of ischemic disease (ID) was higher in patients with blood group A (61.2%) than in other blood groups, and the diagnosis of non-ischemic disease (NID) was higher in patients with blood group O (73.6%) compared to other groups. In patients with blood group B or AB compared to non-B or non-AB, respectively there was no statistically significant difference in ID incidence.Main risk factor for ID was smoking (56.5%), hypertension (18.4%) and diabetes (14.3%).In our study, there was no statistical difference between blood group A and non-A in myocardial infarction (MI) incidence (p = 0.09, 95% CI = 0.99–2.83) but a statistically significant difference between blood group A and non-A in stroke and coronary artery disease (CAD) incidence (p < 0.0001, 95% CI = 1.80–3.37 and p < 0.0001 95% CI = 1.82–3.41 respectively) was found.The incidence of ID in men was significantly higher in blood group A (95% CI = 2.26–4.57, p < 0.0001) compared with non-A group, while there was no statistically significant difference in women (p = 0.35). However, an overall effect was detected to be statistically significant regardless of gender (p < 0.0001).ConclusionOur study suggests an association between blood group A and ID in sub-Sahara Africans.In African countries, where most of health facilities are understaffed, more rigorous studies with a larger population are needed to give a high level of evidence to confirm this association in order to establish the need to be more aggressive in risk factor control in these individuals.

IntroductionBehçet’s disease (BD) is a rare vasculitis in sub-Saharan Africa. Vascular thrombosis, especially venous, is common in this condition and also constitutes a basic diagnostic criterion. Its affection of the superior vena cava is rather rare with only a few cases described in the literature.Case reportA 42-year-old male patient was seen at consultation presenting with a pulsatile, warm and slightly painful right latero-cervical swelling extending to the supraclavicular fossa with the presence of collateral venous circulation for three weeks prior to presentation associated with a mild headache. There were oral and genital ulcerations and erythematous skin lesions associated with a history of inflammatory recurrent arthralgia. Chest computed tomo-angiography showed cruoric internal jugular vein thrombosis extending to the superior vena cava with significant venous collateral circulation. The patient was treated with prednisolone (1 mg/kg/day) and colchicine (2 mg/day), as well as anticoagulation with heparin and vitamin K antagonist (Acenocoumarol) with regular INR monitoring. Clinical evolution was favorable during hospitalization, with residual discrete right supraclavicular swelling. There was no bleeding associated with anticoagulants use.ConclusionThe case stresses the importance of maintaining a high degree of suspicion for Behçet’s disease in all cases of venous thrombosis.

Infective Endocarditis (IE) is an endocardial infection usually caused by bacteria that affects not only the native heart valves but also, with increasing frequency intravascular implanted devices and congenital heart diseases. Despite medical advances, IE remains a life-threatening disease with substantial morbidity and mortality. In Africa, its diagnosis and treatment are still a major challenge in clinical practice. The objective of this work was to study the epidemiological, clinical features, diagnostic techniques currently used in medical practice and the range of micro-organisms that are responsible. This was a retrospective study done at Principal Hospital of Dakar. We include all patients who were admitted with clinical manifestations of definite or possible IE according to the extended DUKE criteria between January 1st, 2005 and December 31st, 2014. We collected and analyzed epidemiological, clinical, paraclinical and outcomes data of 42 patients. Hospital prevalence of IE was 0.078% (42/53711). The mean age was 27.5+/- 18 years with a sex ratio (M/F) of 0.55. IE were more common in patients with damaged or abnormal heart valves (78.6%) and in thoses with underlying structural defects (14.3%). The most common presenting symptoms were fever (90%) and cardiac murmurs (81%). Extracardiac clinical manifestations were very rare. The usual laboratory parameters of inflammation were elevated in 90% of patients. Blood cultures were negative in 50% of cases and positive in 21.4%. The main organism found was Staphylococcus aureus. Echocardiography found vegetations in 95.2% of cases, chamber enlargement in 73.8% and mitral regurgiation in 83.3%. Broad-spectrum penicillins including ampicillin and gentamycine were used for all patients. Major complications were heart failure (47.6%). Strokes and cerebral abcess (23.8%) and Vascular emboli 14.3%. Hospital mortality was 31%. IE remains a life-threatening disease with hight mortality despites improved techniques of diagnosis and modern antibiotics.

L'insuffisance cardiaque à fraction d’éjection préservée est une affection de plus en plus fréquente dont le diagnostic est difficile car elle prédomine chez les sujets âgés présentant d'autres pathologies. Le but de ce travait était d’évaluer les aspects épidémiologiques, cliniques, paracliniques et thérapeutiques de cette affection en milieu hospitalier. Il s'agit d'une étude prospective, descriptive réalisé au niveau du service de cardiologie de l'hôpital principal de Dakar sur une période de 01 an (01 février 2008 - 31 janvier 2009). Le diagnostic d'insuffisance cardiaque avait été retenu chez 111 patients. Au sein de ce groupe de patient, l’échodoppler cardiaque mettait en évidence une dysfonction diastolique isolée du ventricule gauche dans 32 cas (28,8%). L’âge moyen des patients était de 65,7 ± 9,1 ans. On notait une prédominance féminine avec sex ratio à 1,28 (18 femmes / 14 hommes). Une hypertension artérielle était retrouvée chez tous les patients. L’électrocardiogramme inscrivait une hypertrophie ventriculaire gauche et une fibrillation auriculaire chez respectivement 21 (65%) 4 patients (13%). L’échodoppler cardiaque trans-thoracique mettait en évidence une hypertrophie ventriculaire gauche et une dilatation de l'oreillette gauche chez respectivement 18 (56%) et 24 patients (75%). Le flux mitral était pseudonormal, restrictif, ou de type trouble de la relaxation chez respectivement 13 (41%), 10 (31%) et 9 (28%) patients. L'insuffisance cardiaque à fraction d’éjection préservée est caractérisée dans nos régions par la précocité de sa survenue et la présence chez tous les patients d'un long passé d'hypertension artérielle non équilibrée.