Search

INTRDUCTION: l'hypertension artérielle est un problème majeur de santé publique en Afrique subsaharienne par sa fréquence élevée et le risque cardiovasculaire qu'elle entraine. L'objectif de cette étude était d'évaluer la prévalence des facteurs de risques cliniques et biologiques de l'hypertension artérielle à Bamako (Mali). METHODES: il s'agit d'une étude cas-témoin, stratifiée en fonction du sexe, portant sur 72 participants dont 36 hypertendus et 36 contrôles. Vingt-deux paramètres biochimiques plasmatiques ont été mesurés et analysés par des tests univariés et multivariés. RESULTATS: une hyperhomocystéinémie a été retrouvée chez 55,6% des femmes (p = 0,03) et 100% des hommes (p = 0,007) hypertendus. Le N-terminal pro b-type natriuretic peptide (NT-Pro-BNP) était également augmenté chez 16,7% des femmes (VIP 1 dans le modèle multi-varié) et des hommes hypertendus (p = 0,00006). Un bon modèle multivarié prédictif (OPLS-DA) a uniquement été obtenu chez les femmes hypertendues, avec un Q2cum = 0,73, attestant ainsi d'un important dimorphisme sexuel associé à l'hypertension artérielle. Ce modèle impliquait huit paramètres dont la concentration plasmatique était modifiée (homocystéine, NT-Pro-BNP, potassium, urée, glycémie, sodium, chlore et protéines totales). CONCLUSION: nous avons noté une association significative entre l'hyperhomocystéinémie et l'hypertension artérielle. Par conséquent, le dosage de l'homocystéine associé à une bonne prise en charge diminuerait le risque cardiovasculaire tout en améliorant la qualité de vie des patients hypertendus.

This survey concerns 16 patients admitted to Bangui teaching national hospital center, coming from Ngakobo health center 450 km from the South East of Bangui, between September 2001 and May 2002. All of them have undergone a basic ophthalmological examination 16 patients have been hospitalised in the service of ophthalmology among them, 11 didn't go to the consultation. All the 16 patients were males, 18 to 46 years old. Five of them had bilateral corneal lesions and eleven patients presented unilateral lesions. Two patients had a corneal perforation at admission. The initial visual acuity of the concerned eye was estimated between LP(-) and 3/10th. The visual acuity valued after exit was LP(-) to 6/10. Four patients out of sixteen (two eyes with bilateral lesions and two with unilateral lesion) (six eyes) received as initial treatment, water rinse on the spot of the accident, then a local treatment by antibiotics administrated in the dispensary of the Ngakobo Province. Eight patients (two bilateral and six unilateral lesions) received a traditional treatment while five of them received it before their transfer to Bangui and 3 patients just before their arrival in Bangui. Four patients (five eyes) had no treatment at all. The nature of this traditional treatment, often of mineral and vegetal origin has not been specified. The main after-effects are corneal opacities, varying according to size, localization and gravity. At the beginning, 9 cases out 16 are generally diffused and superficial keratitis. After some days of treatment, 8 cases developed into corneal opacity freeing thus the visual axis. 3 cases of keratitis developed into a purulent melting then to a corneal perforation. Elapidae's spits on the eye are frequent in sugar cane cultivation areas. They can provoke some severe erosive corneal lesions, in absence of adequate and early management. The administration of traditional treatment most often complicates the clinical issue. Nursing staff, medical personnel and family should pay attention to the ocular toxicity of these septic matters and to the first cares provided to the patient before his early transfer to hospital.