Epidemiological, Diagnostic and Therapeutic Aspects of Cardiogenic Shock in Children at the Albert Royer Children’s Hospital in Dakar

Introduction: The objective of this study was to evaluate the epidemiological, diagnostic and therapeutic aspects of cardiogenic shock in children at the Albert Royer Children’s Hospital in Dakar. Methods: This was a retrospective, descriptive and analytical study from January 2020 to February 2021, including all children aged 2 months to 16 years hospitalised for cardiogenic shock diagnosed on the basis of clinical and ultrasound criteria. Results: During the study, 38 patients were hospitalised for cardiogenic shock. The hospital prevalence was 4.2%. The mean age of onset of shock was 64 months, and there was a predominance of females with a sex ratio of 1.92. Consanguinity was found in 42% of the patients. Consanguinity was found in 42% of patients. Infection was identified as a trigger for cardiogenic shock in 18 (52.9%) of our patients. The most common type of heart disease was rheumatic heart disease in 12 (32%) of the patients. The mortality rate was 65.8%. Conclusion: Cardiogenic shock is a diagnostic and therapeutic emergency. Its prevalence and mortality are still high in developing countries.

Efficacy and safety of acarbose in the treatment of elderly patients with postprandial hypotension

Background Postprandial hypotension （PPH） occurs frequently in elderly people and may lead to syncope, falls, dizziness, weakness, angina pectoris, and stroke. Some studies suggest that the magnitude of the postprandial fall in blood pressure （BP） is influenced by the rate at which glucose enters the small intestine. We hypothesized that acarbose （α-glucosidase inhibitor）, a hypoglycemic agent that decreases the rate of glucose absorption in the small intestine, would attenuate PPH in the elderly, and would be safe in the treatment. Methods Forty-three elderly in-patients with PPH were recruited. All of them were in relatively stable conditions. They had semi-liquid standard meals without and with acarbose for the two following days： screening day and intervention day. Blood pressure and heart rate （HR） were recorded at baseline and every 15 minutes for 120 minutes using a non-invasive ambulatory blood pressure monitoring system during the study, and ejection fraction （EF） and fractional shortening （FS） were measured by two dimensional echocardiography. Results Compared with the screening day, the falls in systolic, diastolic and mean arterial blood pressure （SBP, DBP, MAP） （all P 〈0.05） were significantly attenuated after taking acarbose during breakfast, so were MAP （P 〈0.05） during lunch, DBP （P 〈0.05） and MAP （P 〈0.05） during supper. The change of HR was not statistically significant after taking acarbose in three meals. EF and FS were positively correlated with the relief rate. The effective power was 63%, and the incidence of adverse drug reaction （ADR） was 9%. Conclusion Acarbose is effective and safe in the treatment of elderly patients with PPH.

Baseline left ventricular ejection fraction associated with symptom improvements in both children and adolescents with postural tachycardia syndrome under metoprolol therapy

Background:Postural tachycardia syndrome(POTS)is a common childhood disease that seriously affects the patient’s physical and mental health.This study aimed to investigate whether pre-treatment baseline left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)values were associated with symptom improvement after metoprolol therapy for children and adolescents with POTS.Methods:This retrospective study evaluated 51 children and adolescents with POTS who received metoprolol therapy at the Peking University First Hospital between November 2010 and July 2019.All patients had completed a standing test or basic head-up tilt test and cardiac echocardiography before treatment.Treatment response was evaluated 3 months after starting metoprolol therapy.The pre-treatment baseline LVEF and LVFS values were evaluated for correlations with decreases in the symptom score after treatment(DSS).Multivariable analysis was performed using factors with a P value of<0.100 in the univariate analyses and the demographic characteristics.Results:A comparison of responders and non-responders revealed no significant differences in demographic,hemodynamic characteristics,and urine specific gravity(all P>0.050).However,responders had significantly higher baseline LVEF(71.09%±4.44%vs.67.17%±4.88%,t=2.789,P=0.008)and LVFS values(40.00[38.00,42.00]%vs.36.79%±4.11%,Z=2.542,P=0.010)than the non-responders.The baseline LVEF and LVFS were positively correlated with DSS(r=0.378,P=0.006;r=0.363,P=0.009),respectively.Logistic regression analysis revealed that LVEF was independently associated with the response to metoprolol therapy in children and adolescents with POTS(odds ratio:1.201,95%confidence interval:1.039–1.387,P=0.013).Conclusions:Pre-treatment baseline LVEF was associated with symptom improvement after metoprolol treatment for children and adolescents with POTS.