Venous Thromboembolic Disease in a Regional Hospital in Mali

Introduction: Venous thromboembolism (VTE) is a nosological group which mainly includes deep vein thrombosis (DVT) and pulmonary embolism (PE), it is frequently associated with high morbidity and mortality. We initiated this study with the aim of studying VTE in a cardiological hospital environment in a regional hospital in Mali. Methodology: This was a descriptive study with prospective recruitment over 1 year from June 20, 2019 to June 20, 2020, covering patients hospitalized and followed in consultation in the cardiology department of the Ségou regional hospital in Mali. Results: We collected 31 cases of VTE out of 366 patients, representing a frequency of 8.47%. The sex ratio was 0.88. VTE risk factors were dominated by immobilization (29.03%), pregnancy and postpartum (16.12%), heart failure (16.12%). The reason for consultation was dyspnea (93.54%) followed by chest pain (83.87%). On admission the clinical manifestations were tachycardia (74.19%), tachypnea (90.32%), muffled heart sounds (70.96%), global heart failure syndrome (51.6%). According to VTE probability scores;51.61% of patients had an intermediate clinical probability according to the simplified Wells score for PE and 54.84% had an intermediate clinical probability for the simplified Geneva score for DVT. D-Dimers were only performed in 12 patients (38.70%) and were elevated in all. A chest CT angiogram showed PE in 90% of patients (n = 28/31). Venous Doppler ultrasound of the lower limbs showed venous thrombosis in 3 patients. Conclusion: Venous thromboembolism, although underdiagnosed, is common in our health structures. Prevention, particularly heparinoprophylaxis and early recovery in a hospital environment, remains the effective means of combating this condition.

Evolutionary and Prognostic Aspects of Thrombolysed Patients for Acute Coronary Syndrome ST+ at CHU Ernesto Guevara De La Serna. Las Tunas (Cuba)

Introduction: Acute myocardial infarction (IDM) occupies the first place in terms of mortality, among ischemic pathologies. Thrombolysis in the case of medical treatment for acute myocardial infarction (AMI) is undoubtedly the most revolutionary performed to date in this context, with a significant reduction in the mortality rate. The aim of our study was to describe the epidemiological aspects, the criteria for myocardial reperfusion post thrombolysis, the complications during thrombolysis and the complications of acute myocardial infarction in the cardiology department of the CHU Ernesto Guevara De La Serna of Las Tunas (Cuba). Methods: A retrospective cross-sectional descriptive study was carried out from June 2009 to December 2011. The patients hospitalized during this period in the USIC (coronary intensive care unit) for SCA ST(+) were included in the study. The variables studied were: Age, sex, myocardial reperfusion criteria, complications during thrombolysis and complications of myocardial infarction. Results: A total of 207 patients were included. The male sex represented 72.5% of the cases, giving a sex ratio of 2.63. The age group > 60 years was predominant with 54.2% of the cases. Thrombolysed patients represented 65.2% of the cases. Myocardial reperfusion criteria were observed in the majority of thrombolysed patients: relief of precordial pain (77%), regression of the ST segment to 50% of its previous level (81.5% of patients). Bleeding was observed in 1.5% of thrombolysed cases. Complications were encountered in 57% of non thrombolysed patients with a lethality of 5.6%. Conclusion: The male sex was the most affected. Thrombolysis was effective in the majority of patients. The post thrombolysis bleeding rate was low. More than half of the cases of SCA ST(+) not thrombolysed presented complications.

Design, Synthesis and <i>in Vitro</i>Antibacterial Activity of 2-thiomethyl-benzimidazole Derivatives

A series of novel substituted benzimidazole (7a - n) derivatives were synthesized and characterized by 1H, 13C Nuclear Magnetic Resonance (NMR) spectra and High Resolution Mass Spectrometry (HRMS). The substitution was done in position -1 and -2 by appropriate groups. These compounds are obtained by N-alkylation reaction with thiomethyl-1H-benzimidazole intermediates (5a - g). Design of intermediates (5a - g) was made by condensation reaction between 2-methylbenzimidazole thiourunium salt (3) and functionalized halides (4) in the presence of sodium hydroxide (NaOH). Among the twenty-one compounds synthesized, ten were evaluated for their antimicrobial activity on three bacterial strains namely: Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923 and Pseudomonas aeruginosa ATCC 27853. Only E. coli ATTC 25922 was susceptible to the synthesized derivatives 5g, 7f and 7h with a significant antibacterial activity (CMI is between 250 and 500 μg/mL).

Prognostic Factors for Acute Heart Failure (AHF) in the Cardiology Intensive Care Unit (ICU) of the University Hospital Point G (UH Pt G)

Background and Aim: The absence of data in our context motivates this study aiming to determine the frequency of AHF at the ICU, assess the in-hospital evolution of the disease and to find out poor prognosis.Material and Methods: It was an observational and descriptive study covering the time from January 1, 2014 to March 30, 2017 involving all inpatient records in ICU. From January 2014 to December 2017, collected data included those on socio-demographic, history of diseases and physical examination, and some labor dataincluding Pro BNP, serum creatinine, blood ionogram,?cardiac enzymes and blood count. Also data electrocardiography, echocardiography and in-hospital evolution were collected. Statistical Analysis:Statistical analysis was performed using SPSS (IBM Inc) version 18. Results: AHF occured in 47.36% with a mean age of 58.74 ± 18.407 and extremes of 17 and 90 years, women representing 53.1% (sex ratio Male:Female = 0.88). Hypertension and diabetes were the predominant cardiovascular risk factors with respectively 67.4% and 18.4%. At admission?44%, 37.7% and 17.9% of patients were respectively hypertensive,?normotensive and hypotensive. The clinical expression was mainly global heart failure with 42.6% followed by left heart failure and right heart failure with respectively 37% and 20.4%. The coronary syndromes (all forms) was the first cause of ICA with 34% of cases followed by pulmonary embolism and hypertension with respectively 25.3% and 24.1%. Mean hospital stay was 5.61 ± 3.527 days (1 to 25 days). Complications were recorded in 18.5% of patients with cardiogenic shock in half of all cases. In multi-variate analysis, only hypotension at admission was shown to be the independent factor of poor prognosis with p = 0.016 and OR = 4.453 (1.322 - 14.996). Conclusion: As a common manifestation heart failure can be rapidly fatal in presence of collapsus or hypotension at admission. These factors should be accurately managed to reduce mortality, which remains high in our context.

Assessment of Common Dental Indices and Need for Periodontal Treatment in the Cardiology Outpatients Unit at the University Hospital Gabriel Touré(UH-GT) in Bamako

Introduction: Little is known through the literature about dental status of patients seen in cardiology department, motivating this study which aims to assess most dental indices of outpatients and the need for periodontal treatment. Methodology: It was a cross-sectional study from November 2016 to April 2017 in the cardiology outpatient unit of the University Hospital Gabriel Touré (UH-GT) in Bamako. Included were all patients with minimum 24 teeth and willing to be involved in the study. History, cardiovascular parameters and dental examination by a resident in Odontostomatology were performed for each patient. Data were analyzed using SPSS 18, quantitative as means and standard deviation (SD) and categorical as proportions. Khi-2 Test, analysis of variance were applied with a significance level set at 0.05. All patients give their verbal consent after being informed about the procedures in the study. Results: Our sample involved 100 patients (66% female, mean age of 54.12 ± 16.150 and patients ≥ 60 years most represented with 50% for male and 37.9 for female patients. Tooth brush use was practiced by 100% and 98.5% respectively for male and female patients and twice daily brushing by 97.1% of male and 97% of female patients. Brushing duration was less than 3 minutes for 35.3% and 31.8% of respectively male and female patients. Plaque index and calculus index were in the male group with respectively 0.79 and 1.06 for male and 0.63 and 0.79 for female (p = 0.047 and 0.020). Mean Decayed Missed and Filled Teeth (DFMT) index showed a significantly increase from 0.22 in the age group under 30 to 0.68 for that other 60 years. Only 2.9% and 9.1% of respectively male and female patients had community paradontal index for treatment needs (CPITN) classe 0. The need for treatment was TN1 meaning instruction to an oral cavity hygiene, similar for both sex (55.9 and 57.6 respectively for male and female patients) and highest in the age-group 30 - 44 increased to 70%. The need for professional intervention in oral cavity was higher for men and higher for patients aged 45 - 59 and ≥60 years. Conclusion: Drawing attention of practitioners on the additional risk of bad periodontal conditions and education on a broad basis already in the school must be part of a preventive program in order to have a code 0 as goal.

Prognostic Factors Associated with Aortic Dissection at the Cardiac Intensive Care Unit of the Point “G” Hospital University Center, Bamako, Mali

Objective: The purpose of this study was to describe the prognostic factors associated with aortic dissection with the cardiology intensive care unit of the Point “G” Hospital University Center. Methodology: This was a descriptive transversal study from January 2010 to February 2017 that included all inpatients during this period. Results: Of 6912 patients admitted, 23 patients were admitted for an aortic dissection, a frequency of 0.33%. Of these, (6) six were under age 50 (26.1%) and the majority age group was 50 - 69 years old. Cardiovascular risk factors were high blood pressure, smoking, and diabetes with 73.9%, 60% and 13% of cases, respectively. At the clinic, chest pain and dyspnea were the main symptoms with respectively 65.2% and 52.2% and with 56.5% asphygmy was associated with pain. Para-clinically, renal failure and anemia were the major laboratory abnormalities found with respectively 43.75% and 31.25% of cases. Doppler echocardiography revealed lesions associated with aortic dissection. In the thoracic angioscan, the aortic dissection was type A (43.5%) and 56.5% type B. The co-morbidities, the associated lesions and the hemodynamic state of the patient indicate the degree of urgency. The treatment was medical. The evolution was full of complications with 52.2% of deaths including 7 (seven) type A patients. Intra-hospital death was 26.1%. Other complications were heart failure (47.8%), the renal failure (43.75%) and an aortic aneurysm (34.8%). Conclusion: Aortic dissection is a life-threatening medical and surgical emergency.