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Brazzaville, Republic of the Congo

Kakou-Guikahue M.,Institute Of Cardiologie Dabidjan | N'Guetta R.,Institute Of Cardiologie Dabidjan | Anzouan-Kacou J.-B.,Institute Of Cardiologie Dabidjan | Kramoh E.,Institute Of Cardiologie Dabidjan | And 23 more authors.
Archives of Cardiovascular Diseases

Background. - Whereas the coronary artery disease death rate has declined in high-incomecountries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa,where their management remains a challenge.Aim. - To propose a consensus statement to optimize management of ACS in sub-Saharan Africaon the basis of realistic considerations.Methods. - The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing fea-tures of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, IvoryCoast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategiesand policies may be expected using readily available healthcare facilities.Results. - The outcome of patients with ACS is affected by clearly identified factors, including:delay to reaching first medical contact, achieving effective hospital transportation, increasedtime from symptom onset to reperfusion therapy, limited primary emergency facilities (espe-cially in rural areas) and emergency medical service (EMS) prehospital management, and hencelimited numbers of patients eligible for myocardial reperfusion (thrombolytic therapy and/orpercutaneous coronary intervention [PCI]). With only five catheterization laboratories in the10 participating countries, PCI rates are very low. However, in recent years, catheterizationlaboratories have been built in referral cardiology departments in large African towns (Abidjanand Dakar). Improvements in patient care and outcomes should target limited but selectedobjectives: increasing awareness and recognition of ACS symptoms; education of rural-basedhealthcare professionals; and developing and managing a network between first-line healthcarefacilities in rural areas or small cities, emergency rooms in larger towns, the EMS, hospital-basedcardiology departments and catheterization laboratories.Conclusion. - Faced with the increasing prevalence of ACS in sub-Saharan Africa, healthcarepolicies should be developed to overcome the multiple shortcomings blunting optimal manage-ment. European and/or North American management guidelines should be adapted to Africanspecificities. Our consensus statement aims to optimize patient management on the basis ofrealistic considerations, given the healthcare facilities, organizations and few cardiology teamsthat are available. © 2016 Elsevier Masson SAS. All rights reserved. Source

Poaty H.,French Institute of Health and Medical Research | Coullin P.,French Institute of Health and Medical Research | Coullin P.,University Paris - Sud | Leguern E.,French Institute of Health and Medical Research | And 14 more authors.
Bulletin du Cancer

The complete hydatidiform mole (CHM), a gestational trophoblastic disease, is usually caused by the development of an androgenic egg whose genome is exclusively paternal. Due to parental imprinting, only trophoblasts develop in the absence of a fetus. CHM are diploid and no abnormal karyotype is observed. It is 46,XX in most cases and less frequently 46,XY. The major complication of this disease is gestational choriocarcinoma, a metastasizing tumor and a true allografted malignancy. This complication is infrequent in developed countries, but is more common in the developing countries and is then worsened by delayed care. The malignancies are often accompanied by acquired, possibly etiological genomic abnormalities. We investigated the presence of recurrent cytogenetic abnormalities in CHM and post-molar choriocarcinoma using metaphasic CGH (mCGH) and high-resolution 244K aCGH techniques. The 10 CHM studied by mCGH showed no chromosomal gains or losses. For post-molar choriocarcinoma, 11 tumors, whose diagnosis was verified by histopathology, were investigated by aCGH. Their androgenic nature and the absence of tumor DNA contamination by maternal DNA were verified by the analysis of microsatellite markers. Three choriocarcinoma cell lines (BeWo, JAR and JEG) were also analyzed by aCGH. The results allowed us to observe some chromosomal rearrangements in primary tumors, and more in the cell lines. Chromosomal abnormalities were confirmed by FISH and functional effect by immunohistochemical analysis of gene expression. Forty minimum critical regions (MCR) were defined on chromosomes. Candidate genes implicated in choriocarcinoma oncogenesis were selected. The presence in the MCR of many miRNA clusters whose expression is modulated by parental imprinting has been observed, for example in 14q32 or in 19q13.4. This suggests that, in gestational choriocarcinoma, the consequences of gene abnormalities directly linked to acquired chromosomal abnormalities are superimposed upon those of imprinted genes altered at fertilization. ©John Libbey Eurotext. Source

Ikama M.S.,CHU de Brazzaville | Nkalla-Lambi M.,British Petroleum | Kimbally-Kaky G.,CHU de Brazzaville | Loumouamou M.L.,British Petroleum | Nkoua J.L.,CHU de Brazzaville
Medecine et Sante Tropicales

The goal of this retrospective study was to analyze the current profile of all 35 consecutive patients with infectious endocarditis seen at Brazzaville University Hospital's department of cardiology and internal medicine from January, 2001, through December, 2009. Infectious endocarditis was diagnosed most often when a heart murmur was associated with septicemia and typical vegetations on echocardiography. During this period, 24 women and 11 men were admitted for infectious endocarditis, accounting for 0.9% of admissions. Their median age was 30.6 ± 12.8 years (range: 15 to 66 years), and 69% were women. The preexisting lesions included rheumatic valvulopathy (9 cases), congenital heart disease (3 cases), and heart disease already treated surgically (3 cases). Among the valvular lesions, mitral regurgitation predominated (24 cases), isolated in 17 cases and associated with aortic regurgitation in 7. There were three cases of pure tricuspid regurgitation. A principal portal of infection was found in 24 patients (69%): oral (11 cases), urinary (7 cases), genital (5 cases), and cutaneous (1 case). A blood culture was performed for 14 patients (40%): seven were positive, four of them for streptococci. Vegetations were observed in 32 cases (91.4%) and mutilating valve lesions in 8 (22.8%). The complications included heart failure in 30 cases (86%) and an embolism in 8 (23%). One relapse was noted. Cardiac surgery was indicated for 13 patients (37%) but could not be performed. The hospital lethality rate was 29%. Infectious endocarditis is a rare disorder that can be life-threatening, especialy in the absence of cardiac surgery. Its prevention, although complex, constitutes the key to management in our setting. Source

Mbalawa C.G.,CHU de Brazzaville | Diouf D.,CHU de Brazzaville | Mbon J.B.N.,CHU de Brazzaville | Minga B.,CHU de Brazzaville | And 2 more authors.
Bulletin du Cancer

Justification. In many publications on cancer in Africa, the majority of patients were seen in advanced stages (III or IV) during the first consultation. So, it was important to look for factors that explain this situation. Methods. A survey by questionnaire was made in our Medical Oncology Department of University Teaching Hospital of Brazzaville from January to October 2010. The responsibility of advice to go to hospital was codified in Arrival in Advanced Stage (AAS) from the weakest (AAS 1) to the strongest (AAS 8) according to the knowledge in oncology. The impact of organ accessibility and the patient's instruction level were also evaluated. Results. One hundred and ninetysix patients seen in consultation, hospital day and hospitalization were asked and we had gathered the same information in patients' medical files. Our sample was essentially made by women (67,4%). The age of patients were from 21 to 83 years old with average of 53,8. The direct responsibility of the patient was weak (24,4%) by ignorance or fear of diagnosis. The hospital personal, the nurses and physicians who work in private were for a great part: 40,8%. The number of practitioners by category had limited the results because of the difficulty to join them. The medical doctor, specialist or not, were responsible at 25,5%. Conclusion. The medical vulgarization, large information, specialization training adapted were theway to choose in the resolution of the problem, which impact on therapeutic result was undeniable. © John Libbey Eurotext. Source

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