[Interests and limitations of percutaneous coronary intervention strategy in nonagenarian patients: A single center experience]. / Intérêts et limites de l'angioplastie coronaire chez les patients nonagénaires : expérience monocentrique.

AIM: To expose our center results in the angioplasty in nonagenarians and to evaluate its effectiveness but also the MACEs and the mortality in the short and long term. METHODS: A retrospective study of 98 patients admitted to the Antibes hospital center from November 2013 to September 2018. RESULTS: The median age was 91.8 [90.8-93.4]. 52.6% was male. 9.7% of the patients had a polyvascular site. 50.6% of patients had moderate renal failure. The radial approach was used in 88.4% of cases. 21.6% of patients had tri-truncal lesions, while 46.4% were monotruncular, LAD artery was the culprit artery in 67% of cases. One stent per lesion was used in the majority of cases. Our successful rate was 90%. After angioplasty, 96% of the patients underwent double antiaggregation platelet therapy, 74.4% under clopidogrel. The presence of arrhythmias before angioplasty, the femoral approach, the coronary dissection and cardiogenic shock after angioplasty were predictors of short- and long-term mortality. Diabetes, history of myocardial infarction, impaired left ventricular ejection fraction, calcified coronary lesions, occurrence of arrhythmias or signs of heart failure on post-procedure were predictors of MACE occurrence. CONCLUSIONS: This study demonstrates that angioplasty in selected population of nonagenarians is perfectly feasible with a good risk/benefit ratio and specifies the different predictors of MACE, both short- and long-term mortality.

[Geoclimatology and severity of snake bite envenomations in Benin]. / Géoclimatologie et sévérité des envenimations par morsure de serpent au Bénin.

Envenomations following snakebite are common in Benin where they constitute, particularly in certain areas, a significant problem for the local populations and health workers. The present epidemiological study describes the snakebite envenomations which occurred in 18 medical centres of the country (6 departmental hospitals and 12 provincial hospitals). The studied variables were: prevalence, length of hospitalisation, major complications, quality of therapeutic management and development of the disease according to area. The study covered a period from April 2000 to March 2001. 486 cases of snakebite necessitating hospitalisation were notified including 413 (85%) in the two northern departments: Atacora and Borgou. Males were largely predominant (90%) and patients under 40 years were the most numerous (82%). The dry season seemed a period of higher risk (75% of the cases). The delay between the bite and admission to hospital, studied for 120 patients in the area of Atacora (North-West Benin), was relatively long: the average was 4 days, with extremes ranging from 10 hours to 21 days. This delay explained the severity of the complications diagnosed. They can be listed according to decreasing frequency: shock, coagulopathy, acute renal failure, respiratory distress. Less than 20% of the patients could benefit from antivenom. Management in emergency care units was impossible in most cases, none of the medical centres (except in Porto-Novo, the capital) having an intensive care unit with artificial ventilation available. Average mortality was 22%. Poisonous snakebites remain serious in Benin, mainly in the northern part of the Country. Access to health care and the quality of the management must be improved. This will require significant efforts from health workers, medical authorities as well as the local population. It is urgent to plan a national therapeutic consensus to reduce the high mortality due to snakebites.