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Multiple Antihypertensive Therapy in Nephrology Practice

Open Journal of Nephrology 2017年第3期7卷 80-93页

作者： Yao Kouame Hubert Doro Arouna Guehi Monlet Cyr konan serge didier Gnionsahe Daze Appolinaire Department of Nephrology Treichville Teaching HospitalAbidjanCote d'Ivoire

Introduction: Hypertension (HT) can be the cause or consequence of chronic kidney disease. Its management often requires a multiple therapy due to its severity. Objective: To describe the profile of patients receiving a multiple anti-hypertensive therapy in nephrology practice. Materials and Methods: This was a prospective, descriptive study conducted in the department of Nephrology, Yopougon Teaching Hospital, from January 1 to October 31, 2016. We included all patients admitted to this department who had received at least three anti-hypertensive drugs. Results: Out of a total of 625 hypertensive patients admitted over the study period, we included 120 patients on multiple therapy, i.e. a 19% prevalence. HT was essential in 60% of cases, secondary to chronic glomerulonephritis (CGN) in 25%, to diabetes in 13.3% and to polycystic kidney disease (PKD) in 1.7%. The therapy consisted of the combination of 3 antihy-pertensive drugs in 36.7% of cases, 4 drugs in 49.2% and 5 drugs in 4.2%. The antihypertensive classes used were Calcium channel blockers (CCB) in 99.2% of cases, Diuretics (D) in 87.5%, Angiotensin Converting Enzyme Inhibitors (ACEI) in 70%, Centrally acting medication (C) in 66.7%, Angiotensin Receptor Blockers (ARB) in 25.8% and Beta-blockers (β-) in 6.7%. The main combinations were CCB + D + ACEI + C in 34.2% of cases, CCB + D + ACEI in 23.3%, and CCB + D + ARB + C in 12.5%. The combinations of antihypertensive drugs varied according to the cause of HT with a non-significant difference. Patient outcome was characterized by normal blood pressure in 64.2% of cases and normal renal function in 13.3%. The mortality rate was 17.5%. In multivariate analysis, stage 5 renal disease (p = 0.001), hypertensive retinopathy (p = 0.04) and hemoglobin level < 8 g/dl (p = 0.039) were associated with mortality. Conclusion: Multiple antihypertensive therapy, which is common in nephrology, is related to the severity of HT and not to its cause. We still use centrally acting

关键词： Hypertension Multiple Therapy Nephrology

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First Emergency Hemodialysis Session at the Nephrology Department of the Teaching Hospital of Yopougon: About 146 Cases

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Open Journal of Nephrology 2020年第4期10卷 338-347页

作者： konan serge didier Kissou Pegdebamba François Guei Monlet Cyr Diopoh Sery Patrick Aka Jean Astrid Yao Kouamé Hubert Nephrology-Internal Medicine Department D CHU Treichville Abidjan Ivory Coast Department of Nephrology CHU Yopougon Abidjan Ivory Coast

Context: Due to the late referral of the pads to the nephrologist and the lack of medical follow-up, many patients are admitted with complications from kidney disease requiring the urgent start of hemodialysis sessions. Purpose: Study the profile of emergency hemodialysis patients in order to ease their management. Methods: This was a retrospective, descriptive and analytical study carried out at the Nephrology Department of the Teaching Hospital of Yopougon from January 1st to December 31st, 2016. This study included all patients who had received a first session of hemodialysis in an emergency context. Results: We collected 146 patients with an average age of 39.80 ± 14.55 years and a sex ratio of 0.6 for men. Before admission, patients were known as hypertensives (63.9%), followed by CKD (23.9%) and HIV-infected (8.2%). The main clinical signs were hypertension (64.3%), edema (44.5%) and coma (30.1%). Anemia was observed in 97.2% of cases and it was less than 8 g/dl in 57.5%. Kidney failure was chronic in 75.3% and acute in 24.6%. Chronic nephropathies were glomerular (54.1%), vascular (20.5%). The main indications for hemodialysis were encephalopathy (33.5%), severe uremia (28%), acute pulmonary edema (19.8%), persistent anuria (11.6%) and hyperkalemia (5.4%). The vascular approach was a catheter in 97.2% (femoral site in 53.4% and jugular in 43.8% and arteriovenous fistula in 2.7%). Death was observed in 17.8%. In univariate analysis, age > 65 years (p = 0.04), coma (p = 0.004) and acute kidney failure (p = 0.02) were associated with the risk of death, and in multivariate analysis, only coma (p = 0.024, OR = 5.88) seemed to be associated with mortality risk for our patients. Conclusion: Hemodialysis in an emergency situation is a common practice in the Teaching Hospital of Yopougon and mainly concerns patients with CKD.

关键词： Kidney Failure Hemodialysis Emergency

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Evolution of Proteinuria and Renal Function in Women with Pre-Eclampsia at the Gynecology Department of the Teaching Hospital of Cocody

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Open Journal of Nephrology 2023年第4期13卷 405-419页

作者： Ouattara Kolo Claude Meudje Youmbi Chimène Diopoh Sery Patrick konan serge didier Kouadio Marie Dominique Gnamon Ophélia Aka Marie Josiane Yao Kouamé Hubert Nephrology-Internal Medicine Department D CHU Treichville Université Felix Houphouet Boigny Abidjan C&ocircte d’Ivoire

Background: Pre-eclampsia has long been considered as a disease that disappears after the removal of the placenta. It has now been shown that its symptoms can persist for months after giving birth. Objectives: To study the evolution of proteinuria and renal function in women with pre-eclampsia. Patients and Methods: An analytical prospective study was carried out in the Hospitalization Unit of the Gynecology Department of the Teaching Hospital of Cocody (Abidjan) from May 3, 2021 to November 15, 2021. It focused on the follow-up of proteinuria and renal function in 50 women who had pre-eclampsia during their pregnancy, in the three months following their delivery. Results: The average age of the patients was 30.38 ± 6 years (range 18 and 40 years). Thirty-two percent were nulliparous and 62% had no risk factors for pre-eclampsia. The diagnosis of pre-eclampsia was made in 52% of cases before 37 weeks of amenorrhea. Sixty-two percent had Grade 3 arte-rial hypertension. The average proteinuria/creatininuria ratio was 3592.08 ± 7009.57 mg/g and 32% of women had glomerular grade proteinuria. The mean serum creatinine was 13.61 ± 12.62 mg/l. AKI (Acute Renal Failure) was present in 30% of women. All patients had received a central antihypertensive drug of which 88% were a calcium channel blocker. For the delivery mode, a Caesarean section was performed in 88% of cases. In the three months postpartum, 40% of women had persistent hypertension, 58% had persistent proteinuria and 6% had persistent impaired renal function. Prematurity (p = 0.0091), IUGR (intrauterine growth restriction) (p = 0.0012) and IUFD (intrauterine fetal death) (p = 0.0012) were associated with the persistence of proteinuria at M3 postpartum. Conclusion: Symptoms of pre-eclampsia do not automatically disappear after the delivery. Proteinuria and renal failure can persist beyond three months after the delivery and require treatment by a nephrologist.

关键词： Proteinuria Pre-Eclampsia Renal Function

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Outcomes of Hemodialysis Patients in Public Centres in Abidjan from September 2018 to October 2021: Data from the Renal Registry of Cote d’Ivoire

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Open Journal of Nephrology 2024年第3期14卷 413-426页

作者： Sery Patrick Diopoh Arthur Kanganga serge didier konan Kolo Claude Ouattara Marie-Dominique Kouadio Mohamed Alex Moudachirou Kouamé Hubert Yao Department of Medicine and Medical Specialties University Flix Houphout-Boigny Abidjan Cote dIvoire National Centre for Prevention and Treatment of Renal Failure Abidjan Cte dIvoire

Background: Hemodialysis is the most widely used renal replacement therapy in developing countries such as Cote d’Ivoire. Objective: To study the outcome of chronic hemodialysis patients in public centres in Abidjan using data from the Renal Registry of Cote d’Ivoire (2RCI). Method: This was a prospective analytical cohort study of End Stage Kidney Disease (ESKD) patients undergoing iterative hemodialysis in the network of public hemodialysis centres in Abidjan and who had been registered in the 2RCI register by September 2018. Results: Our study involved 363 cases out of 379 patients registered in the 2RCI registry database in 2018. The mean age of the patients was 47.3 ± 12.1 years, with a male predominance (sex ratio 1.97). In 70.24% of cases, they had no health insurance. The average duration of dialysis for our patients was 6.94 ± 4.1 years, with extremes of 2 and 28 years. This duration was less than 5 years in 44.3% of cases, between 6 and 10 years in 42.9% and more than 10 years in 12.6% of cases. The comorbidities found were hypertension in 95.6% of cases, diabetes in 7.8% and HIV in 4.6%. Anemia was found in 68% of cases and stroke in 8.6%. During the study period, 161 deaths were observed, representing a mortality rate of 44.35%. Acute lung oedema (29.8%), stroke (6.8%) and other cardiovascular diseases (19.3%) were the main causes of death. In multivariate analysis, factors such as age ≥ 65 years (HR = 3.66;CI 95% = 1.55 - 8.67;p = 0.003), “married/coupled” status (HR = 2.02;CI 95% = 1.24 - 3.31;p = 0.005) and normal weight at the start of dialysis (OR = 9.59, CI95% = 4.19 - 21.95;p = 0.001) were associated with the risk of death. Conclusion: Hemodialysis is performed in Abidjan on young patients. The mortality rate after three years of dialysis is very high. Hence the need to pursue the policy of decentralizing public centres and optimizing access to dialysis in terms of quality and quantity in order to improve patient survival.

关键词： Chronic Hemodialysis Death Renal Registry Cote d’Ivoire

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First Emergency Hemodialysis Session at the Nephrology Department of the Teaching Hospital of Yopougon: About 146 Cases

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Open Journal of Nephrology（肾脏病） 2020年第4期

作者： konan serge didier Kissou Pegdebamba François Guei Monlet Cyr Diopoh Sery Patrick Aka Jean Astrid Yao Kouamé Hubert

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Evolution of Proteinuria and Renal Function in Women with Pre-Eclampsia at the Gynecology Department of the Teaching Hospital of Cocody

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Open Journal of Nephrology（肾脏病） 2023年第4期

作者： Ouattara Kolo Claude Meudje Youmbi Chimène Diopoh Sery Patrick konan serge didier Kouadio Marie Dominique Gnamon Ophélia Aka Marie Josiane Yao Kouamé Hubert

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Implementing uterine balloon tamponade(UBT)device for immediate postpartum hemorrhage management:Leveraging resource allocation and highlighting noteworthy experiences

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Gynecology and Obstetrics Clinical Medicine 2023年第3期3卷 175-180页

作者： Mian Dehi Boston Guie Privat Apollinaire Horo Aka Edele Kouakou konan Virginie Aholoupke Bruno KonéSeydou Rochon Sarah Boni serge Burke Thomas F Felix Houphouet Boigny University Cote d’Ivoire Division of Global Health and Human Rights Department of Emergency MedicineCote d’Ivoire National Mother and Child Health Program Côte d'Ivoire Cote d’Ivoire Massachusetts General Hospital Division of Global Health and Human Rights BostonMAUSA Harvard T.H.Chan School of Public Health BostonMAUSA Harvard Medical School BostonMAUSA

Background The use of uterine balloon tamponade(UBT)devices for intrauterine packing and management of vaginal bleeding by uterine atony has shown promising results in improving the quality of care and reducing maternal *** This report aims to provide an overview of progress made in implementing UBT devices in northern Cote d'*** and methods A four-year retrospective study was conducted in the North-East(163,645),North-Center(351,909),and North-West(57,983).In 2017,UBT was adopted by members of the healthcare ***,5 national and 32 regional trainers have been *** training session was a theoretical and practical program with a low *** is a male condom tied to a urinary catheter,filled with *** outcomes included stopping bleeding,avoiding the need for surgery,and preventing maternal deaths(MD).In 2018,3,515 UBT devices were *** 2019,monitoring tools and transmission circuits of the data were *** 2020,the collection of data and local manufacturing was *** During the process,978 health workers,mainly midwife(52.0%)and nurses(32.2%)out of the 1,295 assigned were *** number of trained individuals decreased from 209 in 2019 to 160 in 2020.A total of 1,715 UBT devices were locally manufactured,adding to the existing gift of 5,080 devices,with total availability of 6,*** distribution of devices increased from 2017 to 2019 but decreased in *** rates increased from 87.3%in 2017(365/418)to 95.0%in 2019(556/585)and slightly decreased in 2020 to 98.0%(681/695).Adverse outcomes(144/2,193),included MD(35/2,193)and medical evacuation to the surgical center(109/2,193).Conclusion The implementation of UBT in northern Cote d'Ivoire successfully reduced maternal death rates caused by immediate post-partum hemorrhage(IPPH).However,to ensure sustainability,further improvements are needed,including increased monitoring,ongoing training,and device availability.

关键词： Implementation Uterine balloon tamponade Post-partum hemorrhage Health providers Health regions

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Comparison of Chronic Wound Inpatients and Outpatients’ Diets and Meals Nutrient Content in Taabo Wound Management Unit, Côte d’Ivoire

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Food and Nutrition Sciences 2023年第3期14卷 156-174页

作者： didier Y. Koffi Amoin Georgette konan Evans Ehouman Bassirou Bonfoh Unité de Formation et de Recherche en Biosciences Université Félix Houphouët-Boigny (UFHB) Abidjan Côte d’Ivoire Centre Suisse de Recherches Scientifiques en Côte d’Ivoire (CSRS) Abidjan Côte d’Ivoire Programme National de Lutte Contre l’Ulcère de Buruli (PNLUB) Abidjan Côte d’Ivoire Université Nangui Abrogoua (UNA) UFR Sciences de la Nature Abidjan Côte d’Ivoire

Chronic and potential non-healing wounds are a great challenge for patients, physicians, and wound care professionals and the health system. A balanced nutrition intake is essential for health as well as a speedy recovery of such wounds. The study objective was to compare chronic wound inpatients supplemented with food nutrient content with outpatients with their usual intake in a cross-sectional study. Patients’ food samples were taken for chemical analyses. The protein, beta-carotene, sodium, magnesium, manganese, and potassium content prove statistically significant differences. Outpatients’ diets are more diversified than inpatients’ diets, and supplementation diet richest in beta-carotene and in protein. Outpatients have better dietary diversity than those who were hospitalized. The result provides insights of supplementary food as critical issues pertaining to chronic wounds management. However, analyzing bioavailability of nutrient on patients’ blood may provide more knowledge in the appropriate integrated wound management.

关键词： Chronic Wound Biochemistry Nutrient Content Wound Management Cô te d’Ivoire

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Spontaneous Disappearance of a Ruptured Intracranial Aneurysm

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Open Journal of Modern Neurosurgery 2019年第2期9卷 164-171页

作者： André Tokpa Louis Derou konan serge Yao Dominique Oka N’dri Department of Neurosurgery Teaching Hospital of Bouaké Bouaké C&#244 te d’Ivoire Department of Neurosurgery Teaching Hospital of Yopougon Abidjan C&#244 te d’Ivoire

The spontaneous disappearance of a ruptured intracranial aneurysm is unusual and its mechanism remains incompletely understood. However, several hypotheses are put forward and are mostly found in Virchow’s triad. We report the case of a man who suffered subarachnoid hemorrhage by rupture of a blister aneurysm of the P1 segment of the left posterior cerebral artery. A control arteriography performed one week after the rupture showed a disappearance of the aneurysm and a significant vasospasm of the carrier artery. Angiograms performed at 3 weeks and 3 months confirmed this disappearance of the aneurysm and a return to normal artery size. Clinically the patient was doing well. Therefore his aneurysm was spontaneously declared cured. Several studies are needed to clarify the natural history of spontaneously thrombosed aneurysms and elucidate their occurrence mechanism in order to improve the management of intracranial aneurysmal pathology.

关键词： Intracranial Aneurysm Subarachnoid Hemorrhage Cerebral Angiography Spontaneous Thrombosis

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COVID-19 Infection and Acute Kidney Injury: About 43 Cases Report Collected at the Nephrology Department of the Farah Polyclinic in Abidjan

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Open Journal of Nephrology 2022年第4期12卷 410-425页

作者： Badomta Dolaama serge didier konan Sery Patrick Diopoh Mohamed Alex Moudachirou Komlan Georges Tona Eyram Yoan Makafui Amekoudi Mawufemo Claude Tsevi Kouamé Hubert Yao Farah Polyclinic Abidjan Cote d’Ivoire Nephrology and Hemodialysis Department Teaching Hospital of Sylvanus Olympio Lome Togo Nephrology Department Teaching Hospital of Treichville Treichville Cote d’Ivoire Nephrology Department Teaching Hospital of Kara Lome Togo

Background: Acute kidney injury (AKI) is one of the increasingly described complications of coronavirus infection. Objectives: To identify factors associated with death in patients with acute kidney injury (AKI) during Coronavirus disease (COVID-19) in Abidjan, C?te d’Ivoire. Material and Method: This was a monocentric retrospective analytical study of all patients over 18 years of age with AKI during COVID-19 at the Farah Polyclinic in Abidjan, C?te d’Ivoire. AKI was defined and ranked according to Kidney Disease Improving Global Outcomes (KDIGO) 2012. The data were collected from the medical record and processed using RStudio. Results: Forty-three cases were collected. The average age was 58.5 12 years. The sex ratio (M/F) was 4.4. The main comorbidities were high blood pressure (60.4%) and diabetes (37.2%). AKI was at KDIGO stage 3 in 58%, KDIGO 2 in 21% and KDIGO 1 in 21%. The diagnosis of acute tubular necrosis was retained in 44.2% of patients followed by acute functional kidney injury in 32.6%. Hemodialysis was initiated in 48.8% of cases. The main indication of dialysis was anuria (46.6%). In total, 55.8% of patients died. Factors associated with death were KDIGO stage (p = 0.049), and invasive ventilation (p Conclusion: Mortality is high in patients with AKI during COVID-19 infection.

关键词： Coronavirus Acute Kidney Injury Abidjan 2020

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