[Characteristics of acute coronary syndromes in Sub-Saharan African women]. / Particularités des syndromes coronariens aigus chez la femme en Afrique subsaharienne.

INTRODUCTION: Acute coronary syndromes have been rarely studied in the female population in Sub-Saharan Africa. This Sub-Saharan serie has shown an increase in the prevalence of acute coronary syndromes among the female population, compared to previous studies. Through this retrospective study, we evaluated the epidemiological, clinical, paraclinical, therapeutic and evolutionary features of acute coronary syndromes on women at the Principal Hospital of Dakar. METHODOLOGY: This was a retrospective study of patients hospitalized for acute coronary syndrome over a period of 5 years from January 1st, 2010 to December 31st, 2014, at the Cardiology Department of the Principal Hospital of Dakar. RESULTS: The prevalence of diabetes and obesity was statistically higher for women than for men. Atypical symptomatology was much more apparent (P=0.0000), admission times at the emergency department for acute coronary syndromes were relatively longer (=0.005). Therapeutically, medical care was almost identical regardless of gender. CONCLUSION: In Senegal, acute coronary syndrome in women is characterized by the atypical symptomatology with delayed diagnosis and management. The fight against this reputedly masculine pathology requires a good awareness campaign.

[Resistance to acenocoumarol revealing a missense mutation of the vitamin K epoxyde reductase VKORC1: a case report]. / Résistance à l'acénocoumarol révélant une mutation faux sens Val66Met de la vitamine K époxyde réductase VKORC1 : à propos d'une observation.

A significant proportion of the interindividual variability of the response to vitamin K antagonist (VKA) treatment has been associated with genetic factors. Genetic variations affecting the vitamin K epoxide reductase complex subunit 1 (VKORC1) are associated with hypersensitivity or rarely with resistance to VKA. We report the case of a black women patient who presents a resistance to acenocoumarol. Despite the use of high doses of acenocoumarol (114 mg/week) for the treatment of recurrent pulmonary embolism, the International Normalized Ratio was below the therapeutic target. This resistance to acenocoumarol was confirmed by the identification of a missense mutation Val66Met of the vitamin K epoxide reductase.

[Vascular complications at the femoral access: impact of the percutaneous closure device Perclose]. / Complications vasculaires de l'abord artériel fémoral: impact du système de fermeture percutanée Perclose.

INTRODUCTION: Vascular complications at the femoral access site is an important factor of morbidity. The aims of this study were to evaluate the efficacy and safety of the percutaneous closure device (Perclose) during interventional cardiology procedures. PATIENTS AND METHODS: All patients with percutaneous closure of the femoral access site by the Perclose system in 2010 were included. We evaluated the indications of the procedures, the success rate of implantation and the bleeding complications according to antithrombotic therapy used. RESULTS: Three hundred and seventy five patients underwent a percutaneous closure by the Perclose system. Acute coronary syndromes with or without elevation of ST segment were the main indications of procedures (74.9%). The success rate of percutaneous closure of the femoral access site was 97.3%. The rate of minor, moderate, and severe bleeding of the entire cohort according to the GUSTO classification was respectively 4.2%, 0.5% and 1%. Bleeding complications were similar in both groups of patients (2.1% vs 7% P=0.122). In case of unsuccessful deployment of femoral closure devices, the risk of bleeding complications range from 4.3% to 60% (P=0.0000036). CONCLUSION: The use of the Perclose system is associated with a low rate of severe bleeding at the femoral access site. However, the failures of percutaneous closure increase the risk of bleeding complications.

[Very late bare-metal stent thrombosis 10 years after the implantation: a case report]. / Thrombose très tardive d'un stent nu dix ans après son implantation : à propos d'une observation.

Very late thrombosis occurring after bare-metal stent (BMS) implantation is a rare complication. It differs from very late thrombosis of drug-eluting stents in terms of both frequency and pathophysiological mechanism. We report a case of very late stent thrombosis of a bare-metal stent 10 years after his implantation for treatment of a myocardial infarction. The patient had a new acute coronary syndrome without persistent ST-segment elevation related to bare-metal stent thrombosis. He was treated by thrombo-aspiration and implantation of a new bare-metal stent.

[Use of drug-eluting stents: impact of French recommendations on the rate of clinical restenosis at 2 years]. / Utilisation des stents actifs : impact des recommandations françaises sur le taux de resténose clinique à deux ans.

AIMS: The drug-eluting stents (DES) reduce restenosis rate compared to bare metal stents. The clinical efficacy is greater in some subgroups of patients at high risk of restenosis. The aim of this study is to evaluate the use of drug-eluting stent based on the recommendations of the French Society of Cardiology and its impact on the restenosis rate at 2 years. METHODS: We included all patients who had coronary angioplasty with stenting in 2008. We evaluated the percentage of drug-eluting stent, the proportion of patients for which the French recommendations have been followed, and the rate of clinical restenosis at 2 years. RESULTS: Four hundred and seventy-nine angioplasties were performed in 2008. The percentage of drug-eluting stents was 21.8%. Acute coronary syndrome with or without elevation of the ST segment were the main indications of angioplasty (67.9%). For the 115 drug-eluting stents implanted in 2008, French recommendations were followed in 93% of cases (107 stents). For 89 patients who received DES, these recommendations were followed in 91% of cases (81 patients). The clinical restenosis rate at 2 years evaluated in 89% of patients was 5.6%. The rate of in-stent restenosis in bare metal and drug-eluting stents were 5.9 and 3.7%. CONCLUSION: The use of DES in our center is characterized by a small rate and a good compliance of the recommendations of the French Society of Cardiology. This strategy is associated with a low rate of restenosis at 2 years of follow-up.

Asthme aigu grave au service de reanimation de l'hopital principal de Dakar

Introduction: L'asthme aigu grave constitue une urgence medicale pouvant mettre en jeu le pronostic vital. L'objectif de ce travail est d'evaluer les aspects epidemiologiques; cliniques; paracliniques et therapeutiques de l'asthme aigu grave en reanimation .Patients et methode: Il s'agissait d'une etude retrospective ayant collige tous les patients de plus de 15 ans admis dans le service de reanimation de l'hopital Principal de Dakar entre octobre 2000 et octobre 2002 pour une crise d'asthme avec presence de criteres de gravite. Nous avions analyse les elements epidemiologiques; les aspects cliniques et paracliniques ainsi que les differentes modalites de prise en charge medicamenteuse et la ventilation artificielle.Resultats: Trente trois patients avaient ete inclus dans cette etude. L'age moyen etait de 44 ans avec un sex-ratio de 1;65. A l'admission 26des patients ventiles presentaient un silence auscultatoire; un etat de choc ou un coma avec score de Glasgow inferieur a 12. Au niveau de la gazometrie; on notait la presence d'une acidose de type respiratoire; metabolique ou mixte chez respectivement 48; 9et 12des patients. La ventilation assistee etait indiquee chez 45des patients. L'evolution etait le plus souvent favorable avec un taux de mortalite de 6.Conclusion: Le pronostic des patients admis dans un service de reanimation pour asthme aigu grave est favorable

[Pulmonary embolism: autopsy study of 73 cases in Senegal]. / L'embolie pulmonaire: étude nécropsique à propos de 73 cas.

INTRODUCTION: The Pulmonary emblism is a vascular disease which is characterized by the more or less complete obstruction of one or several pulmonary arteritis and/or their branches by an embol. Very polymorphic affection, mortal in the massiv form, it has in the average forms of the atypical or misleading aspects which make its clinical diagnosis difficult. The diagnostic strategy of the pulmonary embolism remains incompletely solved. The objectives of this work are: --to evaluate the prevalence with the autopsy of the pulmonary embolism and its distribution according to the age, --to appreciate the correlation enters the ante and the post-mortems diagnoses. PATIENTS AND METHODS: It is about a retrospective study, over 10 years period, having inclued the files of all the patients died in the various services of medicine or surgery of the university hospital of Aristide Le Dantec but also those transferred from outside of the hospital and at which the pulmonary diagnosis post-mortem of embolism was retained. RESULTS: Sixty thirteen (73) cases of pulmonary embolism had been found during autopsies during the period of study (10 ans), that is to say a prevalence of 1.9%. The average was 35 years. The most representative age bracket was that ranging beetwin 21 and 30 years is 36% of the studied population. On the 73 indexed patients, 30 (41%) were transferred from outside of the hospital and 43 (59%) came from the servicies of medecine and surgery with a prevalance of the service of cardiology (26%). The correlation beetween ante-mortems diagnosis and the anatomical result was 11% for the whole of the patients incleded in the study. However, it was 42% for the sub-grup of patients comming from the service of cardiology. CONCLUSION: The prevalence with the autopsy of pulmonary embolism is weak. The clinical diagnosis of this affection is difficult even in a specilised service with a high rate of negatif forgeries. This pathology is very under- evaluated even in these services.