Peripartum Cardiomyopathy: Epidemiological, Clinical, Para-Clinical and Therapeutic Aspects at the Tombouctou Hospital

Introduction: Peripartum cardiomyopathy (PPCM) is a heart failure whose etiology is still unknown. The aim of work was to study peripartum cardiomyopathy in its epidemiological, clinical, paraclinical and therapeutic aspects at the Tombouctou hospital. Methods: This is a descriptive cross-sectional study carried out in the Medicine Department of the Timbuktu hospital from January 1 to December 31, 2019. It concerned patients who presented heart failure between the 8th month of pregnancy and the first 5 months postpartum. Results: During the study,23 patients were collected. Average age of the patients was 23.50 ± 3.50 years with extremes of 16 and 34 years. Incidence of Peripartum cardiomyopathy (PPCM) was 1/345 pregnancies. Average parity was 3.20 with extremes of 1 and 8. Symptoms appeared at postpartum with 87% of cases. A significant delay in diagnosis was observed. Global heart failure was the mode of decompensation with 70%. Electrocardiographic signs were mainly sinus tachycardia (87%) and left ventricular hypertrophy (83%). Cardiac ultrasound showed in all cases dilated cardiomyopathy and it was associated with thrombus in left ventricle cavity for three cases. Left ventricular ejection fraction was severely impaired in 70% of cases. Pulmonary hypertension was significant in 52%. Most commonly drugs we used in our series at acute stage were duretics: furosemide 100% and spironolactone 70% (100% and 70%) and ACE inhibitors (90%). Beta-blockers (bisoprolol and carvedilol) were used in 15 patients. Bromocriptine (prolactin inhibitor) was used for 2 patients. Conclusion: Peripartum cardiomyopathy is a serious cardiac complication of pregnancy of unknown cause, common in the African population.

循证医学分析:全科医学 研究诚信与"没有存在感"的法律

循证医学可以说是现代最重要的创新之一,但出版偏倚和研究透明度不足是影响循证实践基础的严重问题。令人担心的是,这些重要问题在很长一段时间内基本未解决或解决不力。目前监管工作已被证明不足以消除这些问题。幸运的是,在过去的5年里,我们看到了一些有望解决这些问题的进展,将来可以把这些问题作为"污点故事"来回顾。不过时间才是仲裁者,以检验这项补救措施的最终效果。本文按照时间顺序对这些问题进行分析,记录了为解决这些问题所经历的失败、可行和正在进行的措施,以期真正解决这些问题。