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Background Stroke is one of the leading causes of morbidity and mortality worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability would occur in low- and middle-income countries. Between 2002 and 2020, estimation stroke mortality in Sub-Saharan Africa (SSA) was tripled. There is scarce data on management of stroke in SSA. Purpose To describe stroke care in cardiology departments in 17 SSA countries Methods We conducted a transversal and longitudinal study in CV department of 37 hospitals from 23 cities in 17 SSA countries (10 low income: Niger, Guinea, Benin, Mali, Democratic Republic of the Congo (DCR), Tchad, Burkina Faso, Togo, Burundi, Ethiopia and 7 middle income: Cote d'Ivoire, Senegal, Cameroon, Congo, Soudan, Mauritania, Gabon). The FEBRUARY study was designed by a multidisciplinary collaborative team of epidemiologists, pharmacists and cardiologists from Africa and France. This ongoing observatory included all inpatients in February from each year since 2016. Data including socio-demographic and clinical characteristics, causes of admission, clinical, biological, complementary examinations, treatments, length of stay and discharge diagnosis were collected by the investigating physicians. All analyses were performed through scripts developed in the R software (4.0.3 (2020-10-10)). Results Overall, 4360 patients were admitted to hospital over the 6 years of the study. Stroke was the third cause of hospitalization with 477 (11%) patients admitted. Proportions of patients admitted for stroke varied across countries from 0% in Ethiopia to 52% in DRC (p Conclusion Stroke was the third cause of admission with more than 1/10 patients and the second cause of mortality with almost 1/5 patients in cardiology departments in SSA. Funding Acknowledgement Type of funding sources: None.

Many parts of the developing world, especially Sub-Saharan Africa, completely lack access to cardiac pacing. The authors initiated a multinational program to implement cardiac pacing in 14 countries in Sub-Saharan Africa (1996 to 2018), aiming to eventually build self-sustainable capacity in each country. This was based on an "on-site training" approach of performing procedures locally and educating local health care teams to work within resource-limited settings, with prospective evaluation of the program. In 64 missions, a total of 542 permanent pacemakers were implanted. In 11 of these countries, the first pacemaker implant in the country was through the mission. More than one-half of those initially listed as suitable died before the mission(s) arrived. The proportion of implantations that were completely handled by local teams increased from 3% in 1996 to 98% in 2018. These findings demonstrate the feasibility and effectiveness of a proctorship-based approach to the development of local cardiac pacing capabilities in Sub-Saharan African nations.

Background High Blood Pressure is the worldwide leading global burden of disease risk factor. In Sub-Saharan Africa, the number of adults with raised blood pressure has alarmingly increased from 0.59 to 1.13 billion between 1975 and 2015. Blood pressure-lowering medicines are cornerstone of cardiovascular risk reduction. Data on management of anti-hypertensive drugs in sub-Saharan Africa are squarce. Purpose Our study aims to describe antihypertensive drugs strategies in Africa. Methods We conducted a cross-sectional survey in urban clinics during outpatient consultation specialized in hypertension cardiology departments of 29 medical centers from 17 cities across 12 African countries (Benin, Cameroon, Congo, Democratic Republic of Congo, Gabon, Guinea, Ivory Coast, Mauritania, Mozambic, Niger, Senegal, Togo). Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. Country income was retrieved from the World Bank database. All analyses were performed through scripts developed in the R software (3.4.1 (2017–06–30)). Results A total of 2198 hypertensive patients (58.4±11.8 years; 39.9% male) were included. Among whom 2123 (96.6%) had at least one antihypertensive drug. Overall, 30.8% (n=653) received monotherapy and calcium-channel blockers (49.6%) were the most common monotherapy prescribed follow by diuretics (18.7%). Two-drug strategies were prescribed for 927 patients (43.6%). Diuretics and Angiotensin-converting enzyme inhibitors was the combination most frequently prescribed (33.7%). Combination of three drugs or more was used in 25.6% (n=543) of patients. The proportion of drugs strategies differed significantly according to countries (p Antihypertensive strategies by country Conclusion Our study described antihypertensive drugs use across 12 sub-Saharan countries, and identified disparities specific to the income context. Inequity in access to drugs combination is a serious barrier to tackle the burden of hypertension in Africa.

Background Over the past few decades, the prevalence of hypertension has dramatically increased in Sub-Saharan Africa. Poor adherence has been identified as a major cause of failure to control hypertension. Scarce data are available in Africa. Purpose We assessed adherence to medication and identified socioeconomics, clinical and treatment factors associated with low adherence among hypertensive patients in 12 sub-Saharan African countries. Methods We conducted a cross-sectional survey in urban clinics of both low and middle income countries. Data were collected by physicians on demographics, treatment and clinical data among hypertensive patients attending the clinics. Adherence was assessed by questionnaires completed by the patients. Factors associated with low adherence were investigated using logistic regression with a random effect on countries. Results There were 2198 individuals from 12 countries enrolled in the study. Overall, 678 (30.8%), 738 (33.6%), 782 (35.6%) participants had respectively low, medium and high adherence to antihypertensive medication. Multivariate analysis showed that the use of traditional medicine (OR: 2.28, 95% CI [1.79–2.90]) and individual wealth index (low vs. high wealth: OR: 1.86, 95% CI [1.35–2.56] and middle vs. high wealth: OR: 1.42, 95% CI [1.11–1.81]) were significantly and independently associated with poor adherence to medication. In stratified analysis, these differences in adherence to medication according to individual wealth index were observed in low-income countries (p Conclusion This study revealed the high frequency of poor adherence in African patients and the associated factors. These findings should be useful for tailoring future programs to tackle hypertension in low income countries that are better adapted to patients, with a potential associated enhancement of their effectiveness. Figure 1. Percentage of patients according to their adherence level by patient wealth index stratified by country-level income.

Background. Sub-Saharan Africa experiences an epidemic surge in hypertension. Studies in African Americans led to the recommendation to initiate antihypertensive treatment in Blacks with a diuretic or a low-dose fixed combination including a diuretic. We mounted the Newer versus Older Antihypertensive Agents in African Hypertensive Patients (NOAAH) trial to compare in native African patients a fixed combination of newer drugs, not involving a diuretic, with a combination of older drugs including a diuretic. Methods. Patients aged 30-69 years with uncomplicated hypertension (140-179/90-109 mmHg) and two or fewer associated risk factors are eligible. After a 4-week run-in period off treatment, 180 patients will be randomized to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg or amlodipine/valsartan 5/160 mg. To attain and maintain blood pressure below 140/90 mmHg during 6 months of follow-up, the doses of bisoprolol and amlodipine in the combination tablets will be increased to 10 mg/day with the possible addition of α-methyldopa or hydralazine. NOAAH is powered to demonstrate a 5-mmHg between-group difference in sitting systolic pressure with a two-sided p-value of 0.01 and 90% power. NOAAH is investigator-led and complies with the Helsinki declaration. Results. Six centers in four sub-Saharan countries started patient recruitment on September 1, 2010. On December 1, 195 patients were screened, 171 were enrolled, and 51 were randomized and followed up. The trial will be completed in the third quarter of 2011. Conclusions. NOAAH (NCT01030458) is the first randomized multicenter trial of antihypertensive medications in hypertensive patients born and living in sub-Saharan Africa. ispartof: Blood Pressure vol:20 issue:5 pages:256-266 ispartof: location:England status: published

IntroductionLa proteine C reactive (CRP) est rarement augmentee au cours des poussees lupiques. Peut-on attribuer une valeur pronostique a l’augmentation de ce parametre biologique ?Materiel et methodesA travers une serie de lupus systemique repondant aux recommandations de l’American College of Rhumatology (ACR), nous avons voulu comparer, au cours des poussees lupiques, les patients avec CRP normale a ceux avec CRP significativement augmentee (≥ 30 mg/L), cela en l’absence de sepsis mise en evidence, et des augmentations pour lesquelles la normalisation de la CRP etait obtenue sous corticotherapie seule.ResultatsVingt-trois patients (12 femmes, 1 homme) de race noire ont ete retenus, repartis en deux groupes : groupe I avec une CRP superieure a 30 mg/L (n = 12), et groupe II avec CRP normale, servant de groupe temoin (n = 11). Dans le groupe I, la CRP moyenne etait de 279 mg/L correlee a une pleuresie (n = 1) et une pericardite (n = 5) isolees, ou associees (n = 1), sans facteurs de risque cardiovasculaire ni anomalies du bilan hepatique chez 9 patients sur 12. Les anticorps antinucleaires (AAN) etaient de specificite anti-ADN dans huit cas, anti-Sm (n = 2), anti-RNP (n = 1) et anti-SSA (n = 1). Dans le groupe II existait une pericardite dans sept sur neuf cas, sans facteur de risque cardiovasculaire ni perturbations du bilan hepatique chez 9 patients sur 11. Les anticorps etaient de specificite anti-ADN (n = 9), anti-Sm (n = 1) et non specifie dans un cas. Dans ces deux groupes, le bilan infectieux etait negatif, et predominait de facon egalitaire le lupus systemique (n = 8).DiscussionLe peu de donnees de la litterature africaine subsaharienne rend difficile l’interpretation de ces resultats dans le sens d’une specificite de ce profil dans ce type de population.ConclusionL’absence de profil specifique chez les patients avec CRP augmentee sans cause infectieuse nous fait discuter, dans la population noire particulierement exposee, la possibilite d’existence d’un sous-type de population exprimant plus facilement la CRP.

Association inflammatory myopathies and tumors are not fortuitous but association with hepatocellular carcinoma is rarely reported in literature. We described a case of association polymyositis hepatocellular carcinoma in 37-year-old black African patient, with fatal issue.

Although acral ischemia can involve several underlying mechanisms, suspicion of lupus warrants testing for antiphospholipid antibodies in patients with blue toe syndrome.

CRP rarely increases during systemic lupus exacerbations.This retrospective study of patients with systemic lupus diagnosed according to ACR criteria examined all patients with no intercurrent infectious disease and responding to corticosteroid treatment and compared the patients with normal and with significantly elevated (or = 30 mg/l) CRP.23 black patients (22 women, 1 man) were selected and classified in two groups: group I with CRP30 mg/l (n = 12) and the controls, group II, with normal CRP (n =11). In group I, mean CRP was 279 mg/l. Four patients had isolated pericarditis, and one pericarditis associated with pleurisy. Nine patients had no cardiovascular risk factors or abnormal liver function enzymes. Antinuclear antibodies were specific for anti-DNA (n= 8), anti-Sm (n = 2), anti-RNP (n = 1), and anti-SSA (n = 1). In group II, seven patients had pericarditis, and nine had no cardiovascular risk factors or liver function results. Antinuclear antibodies were specific for anti-DNA (n = 9), anti-Sm (n = 1) and unknown (n = 1).The paucity of data about black Africans in the literature makes it difficult to interpret these results in terms of their specificity for this population or as a typical profile of elevated CRP without infectious disease.In absence of a specific profile for patients with elevated CRP without intercurrent infectious disease, we consider the possibility of a subgroup of the black population that may be particularly vulnerable and express CRP more easily.

Tuberculosis can be reactivated under specific treatment, as immune reconstitution inflammatory syndrome (IRIS), in HIV patients under antiretroviral treatment. We report two observations of tuberculosis exacerbation with extension to other territories (lymph node and pericarditis) occurring 3 weeks and 4 months after administration of tuberculosis treatment, with a favourable development, in absence of rehabilitation or addition of complementary therapy These observations show the necessity of increased surveillance on the short, medium and long term in patients with both treatment for tuberculosis and antiretroviral treatment.

We describe a case report of a young Gabonese lady who presented an acute pulmonary oedema and we suspected a paripartum cardiomyopathy. Subsequent investigations showed isolated left ventricular noncompaction. A few months later, the same disease was disclosed at her 9 year-old son who presented a cardiac insufficiency. Therefore, we suspect a family form of left ventricular noncompaction. And it is the first description in subsaharan Africa. The hereditary character of this new form of cardiomyopathy linked to a genetic mutation on the X chromosome is well known. This disease is associated with heart failure, high incidence of systemic thromboembolism complications or ventricular arrhythmia. The echocardiography and the cardiac magnetic resonance imaging has been reported to be tools for diagnosis. In Africa, access to these techniques remains a privilege. So the discovery of illness is often late and the family screening are special. In our area, the therapeutic management is the medical treatment of heart failure. Implatable cardioverter defibrillator or heart transplantation are not available. So long-term prognosis of our patients with congestive heart failure stays poor. With best equipment in our hospitals and good training of African cardiologists, we should improve the management of our patients.

Association inflammatory myopathies and tumors are not fortuitous but association with hepatocellular carcinoma is rarely reported in literature. We described a case of association polymyositis hepatocellular carcinoma in 37-year-old black African patient, with fatal issue.

To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa, we compared in a randomised clinical trial (NCT01030458) single-pill combinations of old and new antihypertensive drugs in patients (30-69 years) with uncomplicated hypertension (140-179/90-109 mm Hg). After 4 weeks off treatment, 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (n=89; R) or amlodipine/valsartan 5/160 mg (n=94; E) and followed up for 6 months. To control blood pressure (