Clinical Management and Long-Term Follow-Up of Patients with Peripartum Cardiomyopathy: A Prospective Registry Study

Introduction: Peripartum cardiomyopathy (PPCM) is a rare pathology in Western countries but is common in Africa. Its progression is highly variable, left ventricular function improves in almost one-third to one-half of patients. In sub-Saharan Africa, there are few prospective cohort studies. We aimed to describe the long-term evolutionary aspects of this pathology in a sub-Saharan African country, so we developed a PPCM registry;here, we present the first results after 2 years of follow-up. Methodology: This work was performed at the cardiology clinic of the Aristide Le Dantec Teaching Hospital of Dakar from January 01, 2017, to January 01, 2021, for a total duration of 4 years. This was an observational, longitudinal prospective study including patients admitted for peripartum cardiomyopathy. Results: During our study, 5372 patients were admitted to the cardiology clinic. Considering the inclusion criteria, 79 patients were consecutively recruited. The mean age was 30.5 ± 6.7 years, ranging from 18 to 42 years. Half of the patients came from rural areas (56.3%), and 78.2% of patients had a low socioeconomic status. Multiparity and twin pregnancies were noted in 72.8% and 20% of the patients, respectively. A total of 91% of patients had advanced NYHA stage 4 heart failure, and 3 patients had cardiogenic shock. Left ventricular dilatation was found in 52 patients, and severe left ventricular systolic dysfunction was found in 50 patients (90.9%). During hospitalization, 19 patients (34.5%) had complications. The evolution in the hospital was favourable in 45 patients (81.8%). The global mortality rate was 7.3% at 2 years. In multivariate analysis, fewer patients with a dilated left ventricle, a severe alteration of the LVEF and an advanced age progressed towards remission. Conclusion: The long-term evolution of PPCM is very variable. Despite a good rate of remission, progression to end-stage heart failure and death is not negligible in cases of advanced maternal age and severe left ventricular impairment.

Age norms for grating acuity and contrast sensitivity measured by Lea tests in the first three years of life

AIM： To determine age norms in the first three years of life for grating visual acuity and contrast sensitivity obtained with Lea grating test and Hiding Heidi low contrast face test. METHODS： Lea grating test was used to estimate binocular grating acuity and Hiding Heidi low contrast face test was used to estimate contrast sensitivity in 600 healthy infants and children. Age ranged from 3 to 36 mo subdivided into 12 groups subjected for full ophthalmologic and pediatric examinations.RESULTS： The grating acuity developed along the first three years of life. It ranged from 1.88±0.32 c/d at 3mo to 30.95±0.77 c/d at 36 mo. The most rapid development was during the first 12 mo and the slowest development was from 30 to 36 mo. The contrast sensitivity showed rapid development in the first two years of life. Its mean value ranged from 4.23±1.17 at 3mo to 78.26±8.21 at 24 mo. It was constant at the highest score（80） thereafter.CONCLUSION： Age norms for grating acuity along with contrast sensitivity offer a more comprehensive measure of spatial vision and should be incorporated in clinical practice for better visual assessment in preverbal and nonverbal children.

Sensorineural hearing dysfunction after discharge from critical care in adults:A retrospective observational study

Background Patients undergoing intensive care are exposed to risk factors for hearing impairment.This study assessed the worse changes in pure tone average(PTA)thresholds after intensive care and identified the factors associated with worse hearing function.Methods We conducted a single-centre retrospective study,and included adult patients admitted to the intensive care unit(ICU)of Kurashiki Central Hospital between January 2014 and September 2019,who had regular pure tone audiometry performed before and after ICU admission.Correlations between changes in PTA threshold and patient characteristics,were evaluated.The included ears were classified as those with worse hearing(>10 dB increase in the PTA threshold)and those without worse hearing,and the baseline characteristics were compared.Results During the study period,125 ears of 71 patients(male:female ratio,35:36;mean age,72.5±12.3 years)met the eligibility criteria.Age,sex,and the use of furosemide were not correlated with changes in PTA threshold.Univariate analysis showed that ears with worse hearing were associated with a lower serum platelet count than ears without worse hearing(153±85×10^(9)/L vs.206±85×10^(9)/L,respectively;P=0.010),and the rate of planned ICU admission(elective surgery)was higher in the worse hearing group(57.1% vs.28.8%,respectively;p=0.011).Conclusions Age,sex,and the use of furosemide did not have adversely affect hearing function.Low serum platelet count and planned admission appear to be risk factors for worse hearing.

Risk of cardiovascular disease among parents of children diagnosed with cancer:a population-based study from Denmark and Sweden

Dear Editor,Receiving a cancer diagnosis is a traumatic life event that impacts not only the patients but also their families[1].Parents of patients with a cancer diagnosed in early life might experience a life crisis with various negative emotions,including the difficult decision-making in cancer treatment,concerns related to the side effects of the treatment and comorbidities,the worry for progression and relapse of the cancer and the risk of loss of the child due to death,as well as the physical demand of caregiving[2,3].