Impact of seasonal malaria chemoprevention in children aged 3 to 59 months in the Kangaba and Kolokani health districts between 2013 and 2015.

INTRODUCTION: Malaria is a public health problem in Mali. Seasonal chemo prevention (SCP) is of particular importance, hence its introduction by the WHO since 2012 in children aged 3 to 59 months from the start of the transmission season. This study aims to demonstrate the impact of SCP on malaria in the health districts of Kangaba and Kolokani. MATERIALS AND METHODS: Our retrospective study was carried out from 2013 to 2015 in the health districts of Kangaba and Kolokani using the databases of the NGO AMCP / ALIMA. Data from 2014 and 2015 were compared to data from 2013. RESULTS: The number of malaria cases in children under 5year in the area covered by the SCP shows a considerable decrease in Kangaba of 52% in 2014 and 49% in 2015, compared to the reference period being the year 2013. In Kolokani the decrease is 57% in 2014 and 40% in 2015 compared to the year 2013. Compared to deaths, a decrease of 50.5% was recorded in 2014 and 60.4% in 2015 compared to the year 2013, i.e. 51 and 61 fewer deaths compared to 2013, respectively, in health facilities. CONCLUSION: The SCP had made it possible to reduce significant mortality and malaria morbidity in the two health districts of Kangaba and Kolokani.

INTRODUCTION: le paludisme est un problème majeur de santé publique au Mali. La chimio prévention saisonnier a une importance particulière d'où son instauration par l'OMS depuis 2012 chez les enfants de 3 à 59 mois à partir du début de la saison de transmission. Cette étude vise à démontrer l'impact de la CPS sur le paludisme dans les districts sanitaires de Kangaba et de Kolokani. MATÉRIELS ET MÉTHODES: Notre étude rétrospective a été réalisée de 2013 à 2015 dans les districts sanitaires de Kangaba et de Kolokani en utilisant les bases de données de l'ONG AMCP/ALIMA. Les données de 2014 et 2015 ont été comparés à ceux de 2013. RÉSULTATS: Le nombre de cas de paludisme chez les enfants de moins de 5 ans dans la zone couverte par la CPS montre une baisse considérable à Kangaba de 52% en 2014 et 49% en 2015, par rapport à la période de référence étant l'année 2013. A Kolokani la baisse est de 57% en 2014 et 40% en 2015 par rapport à 2013. Par rapport aux décès, une baisse de 50,5% a été enregistrée en 2014 et 60,4% en 2015 par rapport à 2013, soit respectivement 51 et 61 décès en moins comparé à 2013, dans les structures de santé. CONCLUSION: La CPS avait permis une réduction de la mortalité importante et de la morbidité palustre dans les deux districts sanitaires de Kangaba et de Kolokani.

Clustering of target organ damage increases mortality after acute coronary syndromes in patients with arterial hypertension.

The impact of target organ damage (TOD) clustering in hypertensive patients with established cardiovascular disease has not been clearly defined. Multicentre, observational and prospective study of 1054 consecutive patients with acute coronary syndromes (ACSs). The objective was describing the impact of TOD on first-year mortality. Ankle-brachial index (ABI), left ventricular hypertrophy and renal dysfunction were assessed during hospital stay. Hypertensive patients accounted for 80% of the cohort and had slightly higher mean age, higher prevalence of risk factors, previous cardiovascular disease and TOD. During follow-up, mean time 387.9 (7.2) days and median 382 (364.0-430.0) days, mortality rate tended to be higher in hypertensive patients (6.1 versus 3.5%; P=0.16). Cox regression survival analysis identified pathological ABI as the only TOD independently associated with mortality. When assessed globally, the presence of at least one TOD predicted mortality only in patients with hypertension and differences in mortality rate appeared very early in the follow-up. A linear increase in mortality rate was observed with the clustering of TOD: 2.0%, if no TOD was present, 7.6% in one TOD, 11.1% in two TODs and 20.0%, if three TODs were present. An increased risk in the combined end point of ischaemic events was observed in hypertensive patients without TOD (odds ratio (OR): 3.18; 95% confidence interval (CI): 1.31-7.70; P=0.01) and was still higher in patients with hypertension and TOD (OR: 4.61; 95% CI: 1.90-11.80; P<0.01). TOD predicts mortality and ischaemic events of hypertensive patients after ACS.

Prevalence and prognostic influence of peripheral arterial disease in patients >or=40 years old admitted into hospital following an acute coronary event.

OBJECTIVE: A significant proportion of patients with ischemic heart disease have associated peripheral arterial disease (PAD), but many are asymptomatic and this condition remains underdiagnosed. We aimed to study the prevalence of PAD in patients with an acute coronary syndrome (ACS) and to evaluate its influence in hospital clinical outcomes. METHODS: The PAMISCA register is a prospective, multicenter study involving patients >or=40 years old with ACS admitted to selected Spanish hospitals. All patients had their ankle-brachial index (ABI) measured between days 3 and 7 after the ischemic event. RESULTS: 1410 ACS patients (71.4% male) were included. PAD determined by ABI was documented in 561 patients (39.8%). Factors independently related to PAD were age (OR: 1.04; 95% CI: 1.03-1.06; p<0.001), smoking (OR: 1.88; 95% CI: 1.41-2.49; p<0.0001), diabetes (OR: 1.30; 95% CI: 1.02-1.65; p<0.05), previous cardiac disease (OR: 1.54; 95% CI: 1.22-1.95; p<0.001) and previous cerebrovascular disease (OR: 1.90; 95% CI: 1.28-2.80; p<0.001). Following the ACS, an ABIor=40 years presenting with ACS is high and it is associated with increased cardiovascular risk.

[An experimental model to measure real intraocular pressure (IOP) during LASIK]. / Modelo experimental para medir la presión intraocular (PIO) durante LASIK.

PURPOSE: To design a model to measure real IOP during lasik in pig eyes. METHODS: A reusable blood pressure transducer was used. Each eye was placed on a stand with sufficient support for the surgical procedure. The globes were inflated with 5% glucosated solution through the optic nerve to attain an IOP of 10-20 mmHg. A 27-gauge catheter was then inserted from the pars plana to the anterior chamber cavity. Real IOP was transmitted via the catheter liquid column to an external sensor. A suction ring was applied and a flap was created. During the procedure, IOP was registered with the ML110 Bridge Amplifier connected to a baro transducer. RESULTS: Values of real IOP were measured in freshly enucleated pig eyes during the lasik procedure. The model was able to instantaneously register the changes in IOP induced by the application of a suction ring and the creation of a flap in the pig eyes with good reproducibility. At the end of the procedure the IOP values remained stable. CONCLUSIONS: We have developed an experimental model to observe the course of suctioning and changes in IOP simultaneously. This model seems to be accurate in obtaining IOP values from the anterior chamber cavity during LASIK.

[LASIK results of IntraLase femtosecond laser to correct myopia: efficacy, security and predictability]. / Resultados de LASIK realizado con láser de femtosegundo (IntraLase) para corrección de miopía: eficacia, predictibilidad y seguridad.

PURPOSE: To evaluate LASIK results obtained with the IntraLase femtosecond laser to correct myopia. METHODS: This was a prospective, single masked observer study. Flaps were created with the IntraLase femtosecond laser (FS). All laser procedures were performed by the same surgeon using the Technolas 217 excimer laser (Bausch & Lomb). We have analysed the uncorrected visual acuity (UCVA) at 1 day, 1 week, 1 month and 3 months after surgery and best spectacle-corrected visual acuity (BSCVA) after 3 months. RESULTS: 485 eyes with myopia were treated and their results evaluated. The mean preoperative sphere was of -3.9 D (SD 2.0) and a mean astigmatism of -0.9 D (SD 0.9) with BSCVA 1.1 (SD 0.1). The UCVA results were 0.94 (SD 0.1) at the first day postoperatively visit, 0.96 (SD 0.1) at first week, 1.00 (SD 0.1) at one month and 1.00 (SD 0.2) at 3 months. The refractive error at 3 months was -0.02 D (SD 0.3) and -0.1 D (SD 0.3) of myopia and astigmatism respectively. At 3 months 96.9% of eyes were within +/-1.00D and 93.6% of the eyes were within + 0.50 D. CONCLUSIONS: LASIK to correct myopia is a safe, effective and predictable procedure using IntraLase FS to create the flap.

[Evaluation of the efficacy of long term topical steroid treatment to prevent regression after hyperopic LASIK]. / Valoración de la eficacia de tratamiento corticoideo tópico prolongado para prevenir regresión en LASIK hipermetrópico.

PURPOSE: To evaluate the efficacy of long-term versus short-term steroid treatment in preventing regression after hyperopic LASIK. MATERIAL AND METHODS: This is a prospective single masked study. Hyperopic patients who were candidates for LASIK surgery were randomized to be treated with one week (topical dexametasone) in control group or one month (topical dexametasone the first week and topical fluormetalone the next three weeks) in study group. The three month postoperative manifest refraction was compared between the two groups. RESULTS: 105 eyes were included in each group. The mean preoperative spherical equivalent was 3.17 D SD 2.82 D (standard deviation) and 3.39 D SD 2.65 D in the study and control group, respectively (p=0.6). The final manifest refraction in the three-month postoperative visit was 0.62 D SD 0.68 D and 0.6 D SD 0.3 D in the study and control group respectively (p=0.6). CONCLUSIONS: Long-term topical steroid therapy does not appear to improve the refractive result in hyperopic LASIK.

Valoración de la eficacia de tratamiento corticoideo tópico prolongado para prevenir regresión en LASIK hipermetrópico / Evaluation of the efficacy of long term topical steroid treatment to prevent regression after hyperopic LASIK

Objetivo: Evaluar la eficacia del tratamiento corticoideo tópico prolongado en pacientes operados de LASIK hipermetrópico.Material y métodos: Se realiza un estudio prospectivo observador enmascarado. Pacientes candidatos a cirugía LASIK para la corrección de baja y moderada hipermetropía fueron asignados aleatoriamente a recibir tratamiento tópico corticoideo (dexametasona) una semana (grupo control) o un mes (dexametasona la primera semana y fluorometalona las tres siguientes), en el grupo estudio. Se comparó la refracción final manifiesta en ambos grupos.Resultados: Analizamos 105 ojos en cada grupo (estudio y control). El equivalente esférico medio preoperatorio era 3,17 D DE 2,82 D (desviación estándar) y 3,39 D DE 2,65 D en el grupo estudio y control respectivamente (p=0,6). La refracción final manifiesta a los 3 meses era 0,62 D DE 0,68 D y 0,6 D DE 0,3 D en el grupo estudio y control respectivamente (p=0,6).Conclusión: La regresión refractiva tras LASIK hipermetrópico, no parece ser modulable por el mayor o menor tratamiento corticoideo tópico

Purpose: To evaluate the efficacy of long-term versus short-term steroid treatment in preventing regression after hyperopic LASIK.Material and methods: This is a prospective single masked study. Hyperopic patients who were candidates for LASIK surgery were randomized to be treated with one week (topical dexametasone) in control group or one month (topical dexametasone the first week and topical fluormetalone the next three weeks) in study group.The three month postoperative manifest refraction was compared between the two groups.Results: 105 eyes were included in each group. The mean preoperative spherical equivalent was 3.17 D SD 2.82 D (standard deviation) and 3.39D SD 2.65D in the study and control group, respectively (p=0.6). The final manifest refraction in the three-month postoperative visit was 0.62D SD 0.68D and 0.6D SD 0.3D in the study and control group respectively (p=0.6).Conclusions: Long-term topical steroid therapy does not appear to improve the refractive result in hyperopic LASIK

Effects of thrombolysis in the evolution of right bundle-branch block complicating an acute anterior myocardial infarction.

INTRODUCTION: There is scant information about the effects of thrombolysis in the evolution of right bundle-branch block (RBBB) in the setting of acute anterior myocardial infarction. The aim of this study has been to analyse these effects and its impact on prognosis. METHODS: We studied 54 patients who presented a RBBB related to an acute anterior myocardial infarction. We defined two groups: those who received thrombolytic treatment and those who did not. We analysed the evolution of RBBB (transience, moment of onset, moment of disappearance) and its relationship with in-hospital mortality.Twenty-one patients (39%) received thrombolytic treatment (groupT) and 33 patients (61%) (group NT) did not. RESULTS: The incidence of late appearance (> 6 h) of RBBB was less frequent in group T compared with group NT (10% vs. 33%, p = 0.04). The incidence of transient block was similar in the two groups (57% vs. 45%, p ns). However, early disappearance of RBBB (in < 6 hours) was more common in group T than in group NT (33% vs. 9%, p = 0.04). Mortality was higher in patients with RBBB present at 24 h after admission) than in those with RBBB resolved in less than 24 hours (in group NT, 55% vs. 8%, p = 0.02 and in group T 50% vs. 0%, p = 0.02, respectively). CONCLUSIONS: Thrombolysis seems to influence the moment of onset and disappearance of RBBB by promoting its early disappearance and avoiding its late appearance. Disappearance of RBBB is associated with a better prognosis.

Oncocitoma de la carúncula. Caso clínico / Oncocytoma of the caruncle. Case report

Caso clínico: Presentamos el caso de un varón de 63 años que refiere la aparición de una lesión rojo anaranjada en la carúncula de su ojo derecho, con un crecimiento progresivo desde hacía seis meses. Se realiza su extirpación quirúrgica y un análisis histológico, llegando al diagnóstico de oncocitoma de carúncula. Discusión: El oncocitoma es un tumor poco frecuente, casi siempre benigno, de células que derivan de epitelios glandulares. Su histogenia y caracteristicas, así como su pronóstico se discuten brevemente (AU)

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D-Dimer is an early diagnostic marker of coronary ischemia in patients with chest pain.

BACKGROUND: Chest pain is a frequent symptom in the emergency department and often presents a diagnostic challenge. Because coronary thrombosis is a hallmark of acute ischemic syndromes, the substrates of the coagulation and fibrinolysis cascades may be markers of coronary ischemia. The objective of this study was to determine the diagnostic value of several hemostatic markers in patients presenting to the emergency department (ED) with chest pain syndromes. METHODS: Two hundred fifty-seven consecutive patients with acute chest pain were studied in this prospective study conducted in an urban ED. D-Dimer levels were measured at admission to the ED in all patients. We also measured thrombin-antithrombin complexes, prothrombin fragment 1+2, activated factor VII, and fibrinogen. We used regression analysis to estimate the likelihood of myocardial infarction and the diagnostic value of D-dimer. RESULTS: D-Dimer and fibrinogen levels were significantly higher in patients with acute ischemic events (myocardial infarction and unstable angina) than in nonischemic patients (P <.01 and P =.02, respectively). The other hemostatic markers were not significantly elevated in patients with ischemic events. D-Dimer level >500 microg/L had an independent diagnostic value for myocardial infarction and increased the diagnostic sensitivity of the electrocardiogram and history from 73% to 92%. CONCLUSION: D-Dimer, an expression of ongoing thrombus formation and lysis, is a marker of substantial incremental value for the early diagnosis of acute coronary syndromes presenting with chest pain. It adds independent information to the traditional assessment for myocardial infarction. D-Dimer can be incorporated into clinical decision models in the ED.

Elevated levels of plasmin-alpha2 antiplasmin complexes in unstable angina.

The evidence of elevated levels of several biochemical markers of prothrombotic state in patients with unstable angina suggests that thrombus formation and lysis play a pivotal role in acute coronary syndromes. The clinical syndrome of unstable angina encompasses a variety of clinical presentations of transient episodes of myocardial ischemia. This study was designed to assess plasmin generation in different settings of unstable angina. Evidence of plasmin generation in patients with unstable angina was measured by circulating plasmin-alpha2 antiplasmin complexes (PAP). A second objective was to identify whether PAP levels had a prognostic value to predict outcome. Eighty-five patients admitted to the coronary care unit for unstable angina were classified into three groups. Group A included 26 patients with postinfarction angina; group B comprised 26 patients with new onset angina; and group C included 33 patients with crescendo angina. Mean PAP levels were higher in the three groups compared to healthy controls. A significant correlation was found between levels of PAP and D-dimer, particularly in postinfarction angina (r = 0.6; p <0.0005). This trial adds new insights into the pathophysiology of unstable angina. It demonstrates that plasmin is generated in the different settings of unstable angina but particularly in postinfarction angina patients where a fibrin-rich thrombus is responsible of the symptoms. However, in this series PAP levels do not predict an uneventful outcome neither in the acute phase nor at long term (6 months).

[Myxoma of the left ventricle: a cause of syncope in an adolescent]. / Mixoma de ventrículo izquierdo como causa de síncope en adolescente.

Clinical diagnosis of cardiac tumours is often difficult. We present the case of a 17 year-old boy in whom a left ventricular tumour was discovered during on diagnostic work-up for a syncope. The tumour was removed and histology confirmed the diagnosis of myxoma.

[Transmyocardial revascularization with laser]. / Revascularización transmiocárdica con láser.

Patients with severe angina pectoris, refractory to medical treatment, in which conventional revascularization (PTCA or bypass surgery) is not possible because they present advanced coronary artery disease with a poor distal bed, account for an important clinical problem due to an increasing incidence, combined with poor quality of life, an elevated risk of severe complications, repeated hospital admissions and high mortality rate. Laser transmyocardial revascularization provides a new therapeutic alternative for these patients. Although up to now there are only a few published series, with a small number of patients, the results obtained in the two ongoing multicentric studies in Europe and the United States (including more than 500 patients at present) are quite promising. It is a simple surgical procedure, but its associated mortality is not to be dismissed (in the beginning 12% and currently 5%), because patients are in an advanced evolutionary stage. In Spain this procedure has been available since April 1996 and the results have been encouraging. In our small series we have noted a significant symptomatic improvement and better quality of life.

Colchicine treatment for recurrent pericarditis. A decade of experience.

BACKGROUND: The most troublesome complication of acute pericarditis is recurrent episodes of pericardial inflammation, occurring in 15% to 32% of cases. The cause of the recurrence is usually unknown, although in some cases it may be traced to viral infection or may be a consequence of coronary artery bypass grafting. The optimal method for prevention has not been fully established; accepted modalities include nonsteroidal anti-inflammatory drugs, corticosteroids, immunosuppressive agents, and pericardiectomy. METHODS AND RESULTS: Based on the proven efficacy of colchicine therapy for familial Mediterranean fever (recurrent polyserositis), several small studies have used colchicine successfully to prevent recurrence of acute pericarditis after failure of conventional treatment. Recently, we reported the results from the largest multicenter international study on 51 patients who were treated with colchicine to prevent further relapses and who were followed up for < or = 10 years. CONCLUSIONS: In light of new trial data that have accumulated in the past decade, we review the evidence for the efficacy and safety of colchicine for the prevention of recurrent episodes of pericarditis. Clinical and personal experience shows that colchicine may be an extremely promising adjunct to conventional treatment and may ultimately serve as the initial mode of treatment, especially in idiopathic cases.

Colchicine for large pericardial effusion.

On the basis of our reported experience with colchicine for recurrent pericarditis, we administered colchicine to two patients with large pericardial effusions complicating idiopathic pericarditis. The first was a 26-year-old male who showed clinical deterioration following emergency pericardiocentesis and aspirin (3 g/day) for 10 days; the second was a 2-year-old girl who was unsuccessfully treated with aspirin (100 mg/kg/day) for 2 weeks, followed by corticosteroids for 7 months. Administration of colchicine (1 mg/day) instead of aspirin in the first case, and with a rapid tapering-off of the corticosteroids in the second case, led to complete regression of the pericardial effusion on echocardiography within 1 week and 1 month, respectively. Colchicine was discontinued after 1 month in the first patient and was continued for 6 months in the child. Neither has had a recurrence at 24 and 6 months of follow-up, respectively. No side effects of colchicine were observed. We conclude that colchicine may be effective in the treatment of large pericardial effusion when therapy with nonsteroidal anti-inflammatory drugs and/or corticosteroids fails.

Cardiac arrhythmias and left ventricular hypertrophy in systemic hypertension and their influences on prognosis.

Left ventricular hypertrophy (LVH) is the adaptative mechanism of the heart to systolic overload of the left ventricle. Nevertheless, LVH plays a role in some complications, such as cardiac arrhythmias. Patients with LVH are more likely to develop ventricular arrhythmias than the hypertensive population without LVH. Further, the relation between left ventricular mass and ventricular arrhythmias is graded and continuous. The arrhythmias described in hypertensive patients with LVH are usually isolated premature ventricular contractions. The presence of electrocardiographic criteria of LVH represents a risk of higher incidence of sudden death, especially in men. The risk is even greater in the presence of ventricular arrhythmias. The presence of late potentials has been recently characterized as more related to ventricular arrhythmias than LVH. Antihypertensive drugs that can reduce LVH also have a beneficial effect on cardiovascular morbility and mortality.