[Evaluation of the prescription of troponin assay in the emergency department of Cheikh Zaid Hospital in Rabat]

Troponin is frequently requested in the emergency department thanks to its use in the diagnosis and management of acute coronary syndrome. However, its demand often goes beyond the scope of international recommendations. A cross sectional study was carried out on a cohort of patients consulting at Cheikh Zaid hospital from July 9, 2018 to August 17, 2018. The trial was performed according to the "ARCHITECT STAT High sensitive troponin-I" method. Out of the 71 patients studied for troponin, 19 returned positive [26% of them]. Among the positive patients, 8 had acute coronary syndromes [42%] and 4 other heart problems. The average age was 63, with minimal and maximal of 48 and 84 respectively. Males were over-represented over females with a ratio of 63%. 63% of the positive patients had several additional cardiovascular risk factors. 26% of them had a normal ECG. Troponin is overused considering the small percentage of patients with acute coronary syndromes

Complication de l'anticoagulation inefficace: la thrombose des protheses valvulaires cardiaques

Thrombosis of a mechanical valvular prosthesis is often a dramatic fatal complication. All thromboembolic risk factors lead to valvular thrombosis, the most common cause is insufficient anticoagulant treatment. The aim of this paper is to explain the importance of anticoagulation which remains the best preventive treatment. From 1995 to 2001, a total of 9 valvular thrombosis patients 6 females and 3 males-aged 26 to 50 years have been reported. 7 patients had mitral valve affection, one had aortic valve and the last one had tricusped affection. All of them received an insufficient anticoagulant regimen, 5 developed auricular fibrillation arrythmia. The delay between appearance of symptoms and management was 14 to 96h; 8 pateints had urgent operatins. 4 of them had a mechanical valvular replacement prothesis, one had bioprosthesis, 2 had thrombectomy, one had thrombolysis and one died during the operation. Mortality rate was 45% [4 patients], all of them were in a state of cardiogenic shock at their admission, 3 died at the immediate post operative period. Follow up of 5 patients for 3 years showed a good evolution. These data demonstrate that informing the patient and his family about the bad prognosis and the difficulty of treating these valvular thrombosis could be presented through a rigorous control of anticoagulant treatment

Treatment of sacred scabs in cardiac patient

The sacral scab constitutesa very serious decubitus complication in the enduringly bedridden patients; It is much more serious when it occurs on a deleterious vascular land in which the cutaneous vascularisation is precarious and hostile to skinning. The musculo - cutaneous rotation flap of gluteus maximus muscle constitutes a very good flap in the treatment of the sacral scab constituted on these lands because of its vascular reliability, its well codified dissection and of the very good quality of cover that it procures. The musculo - cutaneous flap of big buttock brings by its good musculo-cutaneous vascularisation dependent on the two gluteal arteries of these patients, a filling and a cover of the scab consecrated of very good plastic quality. From October 95 to June 2002, we counted among the twenty cases of scabsmedicated sacral, 2 cases of sacral scabs occurring respectively in diabetic and arterial deleterious vascular land in 2 aged patients aged 65 and 67 years, valids and operated in cardiovascular surgery for coronary pathology. They underwent a quadriple and a triple coronary bypass, followed by a prolonged stay in resuscitation. These two patients benefited of a paring first of soft-tissue and the room of detachment and a resection of the bony prominence; The cover has been achieved by a musculo - cutaneous rotation flap of the superior half of the maximusgluteus muscle with preservation of its innervation. No complication is to deplore regarding the viability of the flap, neither recidivism of scab after 6 years of evolution. The two patients don't present any problem of marching or stability of their hip