Congenital Heart Disease Referred for Surgery: Analysis and Epidemiological Description in the Cardiology Department of CHU Ignace Deen

Introduction: Congenital heart disease includes all cardiac and vascular malformations. It accounts for approximately one third of all congenital malformations and is a public health problem, particularly in developing countries. The aim of this study was to analyze the epidemiological, clinical and paraclinical aspects of congenital heart disease. Methods: This was a retrospective descriptive and analytical study based on the records of 135 patients referred for surgery and followed up in the cardiology department of the Ignace Deen University Hospital, collected in November 2022. Results: Hospital prevalence was 5%. The mean age was 71 months, ranging from 1 month to 19 years. The age group over 24 months was the most represented (62%). The M/F sex ratio was 1.36. Urban origin was predominant (58%). The rate of children not attending school or dropping out was high (16%). Siblings with fewer than 4 children were the most common (88%). A heart murmur was the most frequent sign (78%), followed by cyanosis (36%) and heart failure (29%). The association between heart murmurs and CHD was proven with a p-value Conclusion: CHDs represent the main indication for paediatric cardiac surgery and follow-up (95%). We stress the importance of implementing a screening and management strategy for congenital heart disease.

Epidemiological, Clinical and Coronary Angiography Aspects of Acute Coronary Syndrome in the Cardiology Department of the Hospital Mother-Child “Le Luxembourg”Mali

Introduction: Cardiac catheterisation plays a fundamental role in the management of acute coronary syndrome. These explorations require heavy, complex and costly equipment and a large team of doctors, nurses and technicians with highly specialized training. Aims: To describe epidemiological, clinical and coronary angiography aspects of patients with acute coronary syndrome. Patients and Methods: Descriptive study from September 2019 to December 2023 in the Cardiology Department of the Hôpital Mère-Enfant of Bamako. Inclusion criteria were patients admitted for coronary angiography with the diagnosis of acute coronary syndrome. Results: During the study period, 1253 patients underwent coronary angiography, 596 of whom had acute coronary syndrome as an indication, representing a hospital frequency of 47%. Sex-ratio was 2.10. Mean age of patients was 58.5 ± 11.39 years. ST elevation acute coronary syndrome was the most common indication with 63.92% of cases. High blood pressure was the main cardiovascular risk factor with 58.7% of cases, and radial access approach was used in 98% of cases. Coronary angiography was pathological in 91.70% of cases (n = 548). Patients with lesions of anterior interventricular artery were 73.73% of cases. Tritruncal lesions accounted for 40.63% of cases. Conclusion: ST elevation acute coronary syndrome is the most frequent manifestation of acute coronary syndrome. Anterior interventricular artery is most often the culprit lesion for our patients.

Epidemiological, Clinical and Angiographic Profile of Chronic Coronary Syndromes in the Catheterization Room. Single-Centre Study Carried Out in the Cardiology Department of the Chu Aristide Le Dantec in Dakar (Senegal)

Background: Ischaemic heart disease is the cause of 7.4 million deaths per year. Their prevention is based on the management of cardiovascular risk factors, but also on the early detection and management of chronic coronary syndromes (CCS), for which few data are available in Africa. The main objective of our study was to determine the factors related to significative coronary artery disease in patients undergoing coronarography for suspected chronic coronary syndrome (CCS). Methodology: We conducted a retrospective descriptive and analytical study over 2 years (from January, 1st, 2018 to December 31st, 2019) in the Cardiology Department of the University Hospital Aristide Le DANTEC in Dakar. All patients admitted for coronary angiography for suspected chronic coronary syndrome were included. Results: One hundred and fifty-two patients were included with a mean age of 60.79 ± 9.73 years, the most represented age group was 60 - 69 years. Advanced age was the most frequent risk factor (77.63%) followed by sedentary lifestyle (56.58%) and hypertension (41.45%). Diabetes was present in 17.1% of cases. A history of angioplasty was found in 1.97% of patients. Typical pain was found in 71.05% of cases, atypical pain in 19.74% and exertional dyspnoea in 2.63%. The pre-test probability was intermediate in 67.1% of cases, low in 25% and high in 7.9%. Significative coronary lesion was found in 52.63% of the patients, while coronary angiography was normal in the remaining cases. Tritroncular status was observed in 37.50%, it was bitroncular in 26.25% and monotroncular in 36.25% of cases. Factors associated with significative coronary artery disease were age (p = 0.0001), diabetes (p = 0.006), previous angioplasty (p = 0.023), previous myocardial infarction (p = 0.018), typical angina (p = 0.001), intermediate pretest probability (p = 0.001). Low pretest probability was significantly correlated with the absence of a coronary lesion with a p = 0.001. Conclusion: Our study shows that screening for chronic coronary disease should be done especially in diabetics, elderly subjects and those with previous angioplasty taking into account symptoms and pretest probability to avoid unnecessary invasive procedures.

Clinical, Therapeutic and Evolutionary Profiles of Hypertensive Emergencies in the Cardiology Department of the Ignace Deen National Hospital (Conakry)

Introduction: Hypertensive emergencies are a reality in the cardiology department of the Ignace Deen National Hospital. The aim of this study was to determine the clinical, therapeutic and evolutionary profile of hypertensive emergencies in the cardiology department of the Ignace Deen National Hospital. Methods: This was a longitudinal descriptive study of patients admitted to the cardiology department of the Ignace Deen National Hospital for hypertensive emergencies, over a period of six (6) months from 1 October 2020 to 31 March 2021. Results: Among the 638 patients admitted to the cardiology department during the study period, 102 cases of hypertensive emergencies were identified, representing a frequency of 15.99%. The mean age of the patients was 56.65 ± 13.33 years, with extremes of 23 and 90 years, and the sex ratio was 1.91 in favour of men. The associated cardiovascular risk factors were: age (76.47%), smoking (41.18%), sedentary lifestyle (31.37%), obesity (16.67%), dyslipidaemia (12.75%), diabetes (11.76%) and excessive alcohol consumption (11.76%). The various clinical pictures found were: acute pulmonary oedema 39 cases (38.23%), acute coronary syndrome 31 cases (30.39%), stroke 17 cases (16.67%), hypertensive encephalopathy 11 cases (10.78%), acute renal failure 3 cases (2.94%) and aortic dissection 1 case (0.98%). The drugs used on admission were calcium antagonists (Nicardipine 10mg) in 58 cases (56.86%), diuretics (Furosemide 20mg) in 44 cases (43.13%), nitrates (Risordan 20mg) in 39 cases (38.23%) and beta-blockers in 31 cases (30.39%). In terms of outcome, 88 (86.27%) patients had improved. However, 12 (11.76%) deaths were recorded. Conclusion: Hypertensive emergencies are a worrying condition with a high prevalence in the cardiology department of the Ignace Deen National Hospital.

Cardio-Renal Syndrome: Epidemiological, Clinical, Paraclinical, Etiological Aspects and Prognostic Factors in the Cardiology Department of the CHU Ignace Deen in Conakry

Introduction: Heart and kidney diseases are common among patients admitted to hospital and they coexist in a significant number of cases. The interactions between the cardiovascular system and the kidney have been known and described for many years and have led to the description of cardio-renal syndrome. The objective of this study was to determine the frequency;to describe the clinical, etiological and prognostic aspects of acute renal failure in patients hospitalized for chronic congestive heart failure. Method: This was a descriptive retrospective study from January 2, 2018 to December 31, 2022. Included in this study were all the complete records of patients hospitalized for chronic congestive heart failure with serum creatinine ≥120 μmol/I. We’re not included in this study, incomplete files, records of patients hospitalized for other pathologies, records of patients hospitalized for chronic congestive heart failure with normal renal function. Our study variables were qualitative and quantitative divided into clinical, paraclinical and prognostic data. Our data were analyzed using the EPI-info 7.2.2.6 software. Data entry and presentation were carried out using Word, Excel and PowerPoint from the 2016 Office Pack. Results: We collected 830 files of which 114 met our selection criteria, a frequency of 13.73%. The mean age of the patients was 47 ± 19 years. The F/M sex ratio was 1.23. The dominant etiologies were hypertension followed by diabetes with respectively 60.5% and 23.7%. Toxic factors including tobacco accounted for 7.9% of cases. Dyspnea accounted for 86.8%. Most of our patients were grade 3 or 36% based on systolic blood pressure on admission with an average of 164.16 ± 33.95 mmHg and an average diastolic blood pressure of 93.24 ± 20.40 mmHg. Biologically, the serum creatinine revealed a high frequency of 201 - 400 μmol/l (33% of cases) with an average value of 586.49 ± 631.44 μmol/l with the extremes 2.960 and 2448.68 μmol/I. Anemia was moderate in 34.2% of cases. Cardiac ultrasound was performed on 81 patients, the results of which showed dilated cardiomyopathy in 48.2% of cases. Renal ultrasound was performed only by 18 patients, renal suffering was found with 8.8%. Almost all (92.11%) of the patients had an acute renal failure of functional origin. More than half (65.80%) of our patients were at risk. Diuretics were the most prescribed antihypertensives with 87.71% followed by ACE inhibitors 78.94%. The average length of hospitalization was 13.81 ± 7.66 days with extremes of 24 hours and 41 days. Conclusion:The association of acute renal failure and chronic congestive heart failure is a frequent situation. The diagnostic approach must be guided by the context and the data of a meticulous examination supplemented by an appropriate paraclinical assessment. Kidney renal failure is mostly functional.

Therapeutic Education of Heart Failure: Prospective Study in the Cardiology Department of the Dalal Jamm National Hospital Center in Dakar

Context: Heart failure (HF) is a common pathology requiring many types of treatments, including therapeutic education, which has demonstrated a major benefit in terms of reducing re-hospitalization and mortality from HF or all other causes. Objective: The aim of this study was to evaluate the contribution of therapeutic education (TPE) in patients with heart failure. Methodology: This was a single-centre, interventional, non-randomized, before-and-after type study. It focused on hospitalized heart failure patients aged 18 and over. We evaluated the effect of TPE on therapeutic compliance, knowledge, practical attitudes, patient perceptions and quality of life. Results: Our study included 41 patients prior to therapeutic education: 17 men (41%) and 24 women (59%). The mean age was 54.7 ± 16.2 years. After the TPE sessions we evaluated 32 patients: The patients with good compliance increased from 75% to 90.63%, and patients with a low level of compliance (90.6%) decreased to 34.4%. An increase in the number of patients who had an attitude adapted to not exceeding the recommended amount of salt (6 before TPE and 22 after TPE), as well as in the number of patients who had an attitude adapted to physical activity (12 before TPE and 16 after TPE). There was also an increase in the number of patients who were confident about the outcome of their disease (12 before TPE and 16 after TPE), and a decrease in those who were hopeless (8 before TPE and 5 after TPE), an improvement in the quality of life score (45.03 before TPE and 15.78 after TPE). Conclusion: This study shows the beneficial effect of therapeutic education in patients hospitalized for heart failure in improving their level of knowledge, compliance with treatment, lifestyle habits and quality of life.

Mortality in Cardiology in Sub-Saharan Africa: Case of the Cardiology Department of the Teaching Hospital Sylvanus Olympio of Lome

Background: Cardiovascular disease is the leading cause of death worldwide. The specificities of cardiology mortality in Togo are not well known. The objective of this study was to determine the profile of deaths in the cardiology department of the Sylvanus Olympio Teaching Hospital (CHU SO) in Lome. Materials and Methods: This was a cross-sectional study conducted over a period of 06 years, from January 1, 2015 to December 31, 2021, in the cardiology department of the Sylvanus Olympio Teaching Hospital in Lome. In this study, we included all medical records of patients who died in hospital in the cardiology department during the study period. Results: During the study period, 2762 patients were hospitalized in the cardiology unit at CHU SO. We recorded 112 deaths meeting our criteria, for an intrahospital mortality rate of 4.19%. The average age of patients was 53.79 ± 18.27 years. Hypertension was present in 47.3%. Sickness insurance coverage was not available for 94.64% of those who died. The major cardiovascular diseases observed were myocardium in 43.75% whose dilated cardiomyopathy accounted for 71.42%;and rhythmic lesions in 34.82%. Biological infectious syndrome (56.25%), renal failure (48.21%), anemia (47.27%), lung infection (32.14%), hyponatremia (33.04%) were the main comorbidities observed. Among the circumstances of death, sudden death was found in 32.14%, cardiogenic shock in 20.54% and septic shock in 13.39%. Conclusion: The profile of deaths in the cardiology department of the CHU SO reveals that myocardial injuries are more present with circumstances of death dominated by sudden death.

Pulse rate estimation based on facial videos:an evaluation and optimization of the classical methods using both self-constructed and public datasets

Pulse rate is one of the important characteristics of traditional Chinese medicine pulse diagnosis,and it is of great significance for determining the nature of cold and heat in diseases.The prediction of pulse rate based on facial video is an exciting research field for getting palpation information by observation diagnosis.However,most studies focus on optimizing the algorithm based on a small sample of participants without systematically investigating multiple influencing factors.A total of 209 participants and 2,435 facial videos,based on our self-constructed Multi-Scene Sign Dataset and the public datasets,were used to perform a multi-level and multi-factor comprehensive comparison.The effects of different datasets,blood volume pulse signal extraction algorithms,region of interests,time windows,color spaces,pulse rate calculation methods,and video recording scenes were analyzed.Furthermore,we proposed a blood volume pulse signal quality optimization strategy based on the inverse Fourier transform and an improvement strategy for pulse rate estimation based on signal-to-noise ratio threshold sliding.We found that the effects of video estimation of pulse rate in the Multi-Scene Sign Dataset and Pulse Rate Detection Dataset were better than in other datasets.Compared with Fast independent component analysis and Single Channel algorithms,chrominance-based method and plane-orthogonal-to-skin algorithms have a more vital anti-interference ability and higher robustness.The performances of the five-organs fusion area and the full-face area were better than that of single sub-regions,and the fewer motion artifacts and better lighting can improve the precision of pulse rate estimation.

护理干预促进慢性呼吸困难患者自我管理的研究进展:整合性综述

目的旨在通过系统综述,确定针对复杂慢性病患者增强自我管理的干预措施,以改善慢性呼吸困难,为护理人员促进该类人群的自我管理提供依据。方法2023年12月,系统检索Medline、Scopus、Web of Science、CINAHL、Cochrane图书馆和乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证实践数据库。对纳入研究进行数据提取和综合,研究人员采用Rayyan文献管理软件筛选标题及摘要,并依据JBI研究质量评估工具进行方法学质量评估。结果共纳入18项研究。这些研究探讨了针对慢性呼吸困难的各种干预措施,包括药物干预(氧气疗法和吸入疗法)和非药物方法(教育计划、呼吸练习、液体摄入管理、身体感知技术、同伴支持、情商培训和网络应用程序的使用)。这些干预措施减轻了患者情绪困扰,可以使患者在自我管理方面变得独立自主。结论促进复杂慢性病患者对慢性呼吸困难的自我管理需要采取综合方法,但目前研究中没有充分考虑到针对患者行为改变的干预措施,需要进一步开展相关研究完善干预措施。

Understanding the molecular crossroads in acute liver failure:A pathway to new therapies

In this editorial we comment on the article published in a recent issue of the World Journal of Gastroenterology.Acute liver failure(ALF)is a critical condition characterized by rapid hepatocellular injury and organ dysfunction,and it often necessitates liver transplant to ensure patient survival.Recent research has eluci-dated the involvement of distinct cell death pathways,namely ferroptosis and pyroptosis,in the pathogenesis of ALF.Ferroptosis is driven by iron-dependent lipid peroxidation,whereas pyroptosis is an inflammatory form of cell death;both pathways contribute to hepatocyte death and exacerbate tissue damage.This comprehensive review explores the interplay between ferroptosis and pyroptosis in ALF,highlighting the role of key regulators such as silent information regulator sirtuin 1.Insights from clinical and preclinical studies provide valuable perspectives on the dysregulation of cell death pathways in ALF and the therapeutic potential of targeting these pathways.Collaboration across multiple disciplines is essential for translating the experimental insights into effective treatments for this life-threatening condition.

Percutaneous Coronary Intervention in Acute Coronary Syndromes at the Mother-Child University Hospital Luxembourg in Bamako

Introduction: Acute coronary syndromes (ACS) are a diagnostic and therapeutic emergency. Objective: Studying the feasibility, difficulties and results of coronary angioplasty in acute coronary syndromes at the Luxembourg Mother-Child University Hospital in Bamako. Patients and Methods: Cross-sectional, descriptive study with prospective recruitment over 18 months from September 2020 to February 2022. All patients aged at least 18 years old admitted for SCA and having undergone PCI during the study period were included. Result: We collected 249 patients for SCA, of whom 160 underwent angioplasty, either an angioplasty/SCA ratio of 0.64. The average age of the patients was 59.54 ± 11.62 with extremes of 32 and 92 years. The age group of 45 to 65 years was the most representative. The predominance was male, sex ratio of 2.4. The main cardiovascular risk factors were high blood pressure (58.23%) and diabetes (45.78%). Persistent ST-segment elevation on the electrocardiogram was present in 71.48%. The treatment time was more than 12 hours after the first medical contact in 95.5%. The approach was radial in 96.5% of cases. Coronarography was pathological in 91.16% of our patients. The lesions were tri-truncular in 34.13% with the anterior inter ventricular as culprit artery in 72% of cases. The majority of patients (64%) had undergone angioplasty with implantation of an active stent. Angioplasty was performed successfully in 98% and per procedural mortality was 1.87%. Only 6.45% of ACS with ST elevation benefited from primary angioplasty. Conclusion: Percutaneous coronary intervention is performed routinely in our center with satisfactory results. Difficulties exist, related to the diagnostic delay of ACS and the high cost of angioplasty.

Associated Factors to Poor Blood Pressure Control in Hypertensives Followed Up at the Campus University Hospital of Lome (Togo)

Introduction: Hypertension is a real public health issue and its control is very difficult. We aim to determine the frequency of uncontrolled hypertension in hypertensive patients followed up as an outpatient at the campus university hospital of Lome (Togo) and to search for the associated factors. Methodology: The study was cross-sectional, descriptive and analytical, carried out from February (2022) to August 2022 in 260 hypertensive patients aged 22 years old, followed up (on an) as an outpatient for at least 3 months at the Lome University Hospital campus. A univariate then multivariate analysis were conducted in order to highlight the most common factors significantly linked to uncontrolled. Results: The mean age of hypertensives was 56.4 ± 12.7 years, the sex ratio (M/F) was 0.59. Prevalence of uncontrolled blood pressure was 42%. Associated Factors to poor blood pressure control in our study were age > 60 years (OR = 1.6 CI [1.17 - 2.50]), low socio-economic level (OR = 2.2 CI [1.96 - 4.33]), high cardiovascular risk level (OR = 3.1 CI [2.18 - 4.52]), non-adherence to regular blood pressure monitoring (OR = 3.3 CI [2.21 - 5.55]), low compliance to treatment (OR = 4.1 CI [2.33 - 6.76]) and a chronic renal failure (OR = 2.1 CI [1.21 - 3.10]). Conclusion: Nearly half of the hypertensives in our study had poorly controlled blood pressure by antihypertensive treatment medication. The factors of this poor control were age > 60 years, low socio-economic level, high or very high level of cardiovascular risk, low compliance to treatment, and renal failure.

Incidence, Clinical Presentation and Angiographic Findings among Patients with Coronary Artery Ectasia in Gaza

Background: Coronary artery ectasia (CAE) is a rare form of aneurysmal coronary heart disease. This condition increases risk of ischemia that leaded to stable angina pectoris and also acute coronary syndrome. Objective: To evaluate the incidence of CAE and to analyze clinical and angiographic characteristics among patients with symptomatic coronary artery disease. Methods: Retrospective trial of diagnostic coronary angiography which was performed at Alshifa hospital in Gaza, included all patients with coronary heart disease and underwent diagnostic coronary angiography from March 2014 to March 2023. We evaluate the incidence, clinical presentation and angiographic findings of patients with symptomatic coronary ectasia. Results: Of the 12,534 angiograms analyzed, CAE was found in 539 patients, an incidence of 4.3%. The mean age was 59.2 ± 11.7 years, and male gender predominate 81.8%. A 285 (52.9%) of patients found to have single ectatic vessel at their angiographic results. In two vessels 120 patients (22.3%), in three vessels 95 patients (17.6%) and in three vessel plus left main in 39 patients (7.2%). 70.9% angiograms showed pure ectasia without associated significant stenotic lesions in the same vessel. The right coronary artery (RCA) was the commonest affected vessel by ectasia. The most common presentation of patients is non ST segment elevation acute coronary syndrome. Conclusion: The incidence of coronary ectasia was 4.3%. Non ST segment elevation acute coronary syndrome was the most common clinical presenting. Only 30% of patients have additionally significant coronary artery stenosis. The majority of patients had single vessel involvement and right coronary artery was the most common involved vessel. Despite a dapper understanding of CAE in last years, there are still come critical issues about optimal treatment. Large multicenter randomized control trials are recommended to guide the clinician in the management of this complex sitting of patients.

Acute Coronary Syndrome of Young Subjects at the Luxembourg Mother-Child University Hospital in Bamako

Introduction: Acute coronary syndrome is often the first event of coronary disease of young subjects. Objective: To study sociodemographic, clinical, paraclinical, therapeutic and evolutionary aspects of acute coronary syndrome of young subjects. Patients and Methods: Descriptive cross-sectional study with prospective recruitment from October 01, 2020 to March 31, 2022. Were included all patients admitted for acute coronary syndrome whose age was less or equal to 45 years and who had undergone coronary angiography at the Mother-Child University Hospital on Luxembourg from Bamako. Results: During the study period, we collected 60 patient files out of 198. These 60 patient files met our inclusion criteria. Hospital frequency was 30.30%. Average age of patients was 40.43 ± 3.9 years. Sex ratio M/F was 5.3. Main cardiovascular risk factor was smoking tobacco (23.42%), followed by dyslipidemia (13.92%). Functional signs were dominated by angina 62% followed by dyspnea 25.3%. Persistent ST-segment elevation on electrocardiogram was present in 76.4%. Left ventricular systolic dysfunction was present in 26.5%. Time to first medical contact was more than 12 hours in 62.7% of cases. Radial approach was adopted in 94% of cases. Coronary angiography was pathological in 85% (n = 51) of cases. Lesions were single-vessel disease in 47.1% and culprit artery was anterior interventricular in 51% of cases. Dual anti-platelet aggregation was aspirin and ticagrelor in 91.8% of cases. Angioplasty was performed in all patients who had significant abnormalities at coronary angiography. In-hospital mortality was 3.9%. Conclusion: Acute coronary syndromes exist in young Africans with a male predominance. Main cardiovascular risk factor is smoking tobacco. Coronary lesions are single vessel disease in the majority of case. Most of patients meet medical team after 12 hours. Time to first medical contact is a main challenge in our country.

Screening of Myocardial Cardiotoxicity Induced by Anticancer Chemotherapy and the Importance of Global Longitudinal Strain

Introduction: The improvement of survival in patients with cancer and the expansion of therapeutic options have led to the emergence of a new profile of cardiotoxicity, specifically associated with antimitotic agents. Our study aimed to assess the incidence of chemotherapy-induced myocardial toxicity in patients with cancer. Patients and Methods: We conducted a looking-forward longitudinal cohort study including all patients admitted to the Cardiology departments of Aristide le Dantec Hospital and Dalal Jamm National Hospital Centre for apre-chemotherapy check-up. The included patients did not undergo any pre-existing cardiopathy. Results: Over a period of two years ranging from January 2019 to December 2021, a total of 37 patients were included in the study. Notably, there was a female predominance (92%) with an average age of 49.7 years ± 13.69. Breast cancer accounted for 70% of the neoplasms. Laboratory findings revealed moderate anemia in 19 patients (51%). At inclusion, the left ventricle (LV) was of normal size (LV diastole at 44.46 ± 4.97 mm). The systolic function of the left ventricle was normal in all patients, with an average ejection fraction (EF) of 63.1% ± 5.80 and a mean global longitudinal strain (GLS) of −20.4% ± 2.58. The most commonly used agents were anthracyclines. During follow-up, 3 patients (8.1%) developed clinical symptoms of left heart failure, and LV dysfunction on echocardiography was observed in 5 (13.5%) patients, with a significant decrease in EF Conclusion: The incidence of cardiac toxicity is not negligible, hence the importance of early screening. Strain imaging is an essential tool that should be performed as part of the assessment before chemotherapy and re-evaluated during treatment.

Unveiling significant risk factors for intensive care unit-acquired weakness:Advancing preventive care

In this editorial,we discuss an article titled,“Significant risk factors for intensive care unit-acquired weakness:A processing strategy based on repeated machine learning,”published in a recent issue of the World Journal of Clinical Cases.Intensive care unit-acquired weakness(ICU-AW)is a debilitating condition that affects critically ill patients,with significant implications for patient outcomes and their quality of life.This study explored the use of artificial intelligence and machine learning techniques to predict ICU-AW occurrence and identify key risk factors.Data from a cohort of 1063 adult intensive care unit(ICU)patients were analyzed,with a particular emphasis on variables such as duration of ICU stay,duration of mechanical ventilation,doses of sedatives and vasopressors,and underlying comorbidities.A multilayer perceptron neural network model was developed,which exhibited a remarkable impressive prediction accuracy of 86.2%on the training set and 85.5%on the test set.The study highlights the importance of early prediction and intervention in mitigating ICU-AW risk and improving patient outcomes.

Contribution of Stress Testing to the Management of Ischemic Heart Disease in Mali

Introduction: Exercise stress testing (on a treadmill or ergometer bicycle) is an important test in cardiology for diagnosing myocardial ischemia. This test in Mali is still in its beginning compared to other countries in the sub-region. The lack of data in Mali prompted this study, which aimed to evaluate the indications of this activity and its diagnostic contribution to cardiology in Mali. Materials and Methods: This was a retrospective, descriptive study. The study was conducted at the “TOUCAM” medical clinic in Kati based on the analysis of stress test reports between January 2016 and August 2022. Result: During the study period, we documented 73 patients who underwent exercise testing on a bicycle ergometer for suspected coronary heart disease. The mean age of our patients was 47.5 ± 13.8 years (14 and 79 years). Males accounted for the majority (78.1%). The sex ratio is 3.5. More than half of our patients were overweight or obese (77.1%). Hypertension and diabetes affected 52.1% and 25.8% of patients, respectively. 20.8% of patients had coronary artery disease. renin-angiotensin-aldosterone system blockers (56.8%) and beta-blockers (51.3%). The main indications were chest pain (63.0%) and ischemia detection (15.1%). A modified STEEP protocol was used. The majority of our patients (71.2%) achieved at least 85% of their maximum theoretical heart rate. The main reason for the termination of the study was fatigue (57.3%). The average duration was 11.3 ± 4.2 minutes. 24.7% thought the stress tests were positive and 17.8% thought they were controversial. Conclusion: This study demonstrates the importance of stress testing in the diagnosis and treatment of ischemic heart disease, especially in settings where we have very limited access to coronary angiography.

Impact of Atrial Septal Defect Closure on Mortality in Older Patients

Background:Atrial septal defect(ASD)is a common form of adult congenital heart disease that can lead to long-term adverse outcomes if left untreated.Early closure of ASD has been associated with excellent outcomes and lower complication rates.However,there is limited evidence regarding the prognosis of ASD closure in older adults.This study aims to evaluate the mortality rates in older ASD patients with and without closure.Methods:A retrospective cohort study was conducted on patients aged 40 years or older with ASD between 2001 and 2017.Patients were followed up to assess all-cause mortality.Univariable and multivariable analyses were performed to identify the predictors of mortality.A p-value of<0.05 was considered statistically significant.Results:The cohort consisted of 450 patients(mean age 56.6±10.4 years,77.3%female),with 66%aged between 40 and 60 years,and 34%over 60 years.Within the cohort,299 underwent ASD closure(201 with transcatheter and 98 with surgical closure).During the median follow-up duration of 7.9 years,51 patients died.The unadjusted cumulative 10-year rate of mortality was 3%in patients with ASD closure,and 28%in patients without ASD closure(log-rank p<0.001).Multivariable analysis revealed that age(hazard ratio[HR]1.04,95%confidence interval[CI]1.006–1.06,p=0.01),NYHA class(HR 2.75,95%CI 1.63–4.62,p<0.001),blood urea nitrogen(BUN)(HR 1.07,95%CI 1.03–1.12,p<0.001),right ventricular systolic pressure(RVSP)(HR 1.07,95%CI 1.003–1.04,p=0.01),and lack of ASD closure(HR 15.12,95%CI 5.63–40.59,p<0.001)were independently associated with mortality.Conclusion:ASD closure demonstrated favorable outcomes in older patients.Age,NYHA class,BUN,RVSP,and lack of ASD closure were identified as independent factors linked to mortality in this population.

Totally Occluded Coarctation of the Aorta in a Young Adult

We report the case of a 20-year-old female patient presenting with a totally occluded coarctation of the aorta. The patient was admitted for the evaluation of resistant grade III high blood pressure. The physical examination revealed a blood pressure gradient between the upper and lower limbs, absent femoral pulses, a diffuse continuous murmur over the chest, and hyperpulsatility of the carotid arteries and sternal notch. A transthoracic echocardiography outlined a narrowing in the caliber of the isthmic aorta without acceleration of flow or gradient. Thoracic CT angiography revealed a complete aortic coarctation with interruption of continuity between segment 3 and the descending aorta.

Functional Capacity of Patients with Venous Thromboembolic Disease Six to Twelve Months after Treatment

Background: Venous thromboembolism (VTE) is among the leading causes of hospital-related disability-adjusted life years lost. We aimed to determine the prevalence and determinants of functional capacity impairment six to twelve months after an acute VTE event. Methods: This was a cross-sectional study conducted between January and April 2021 in two referral hospitals of Yaoundé, including consenting adult patients admitted to these hospitals six to twelve months ago for VTE. We excluded dead patients and those with any comorbidity or symptoms limiting physical activity. The functional outcome was assessed with the six-minute walk test. Functional capacity impairment was defined as walking distance lower than the expected value. Results: We included 27 cases in this study with a mean age of 53.2 ± 14.4 years. The prevalence of functional capacity impairment was 29.6% (95% CI: 14.8 - 48.1). Factors associated with poor functional outcome were obesity (OR: 59.5;95% CI: 4.6 - 767.2;p - 207.4;p = 0.017), massive PE (OR: 30;95% CI: 2.5 - 354;p = 0.004), and poor adherence to treatment (OR: 30.3;95% CI: 2.5 - 333.3;p = 0.004). Conclusion: Functional capacity impairment is common in the medium-term after VTE and factors associated with this poor outcome are obesity, the severity of the VTE, and poor adherence to treatment.