[Accidents in patients under anticoagulant therapy in the Department of Cardiology at the Yalgado Ouedraogo Teaching Hospital, Ouagadougou (Burkina Faso)]. / Les accidents du traitement anticoagulant dans le Service de Cardiologie du Centre Hospitalier Universitaire Yalgado Ouedraogo de Ouagadougou (Burkina Faso).

This study aimed to evaluate the profile of patients hospitalized for anticoagulant-induced hemorrhage. We conducted a retrospective, descriptive study within the Department of Cardiology at the Yalgado Ouedraogo Teaching Hospital, in Ouagadougou, over a period of 2 years from 1 January 2007 to 31 December 2008. All hospitalized patients with anticoagulant-induced hemorrhage were included in the study. The average age of patients was 49,31 ± 17,68 years, the sex-ratio was 2,17. Myocardial infarction was the first indication for anticoagulant treatment, with a rate of 21.05%. Anti vitamin K (AVK) was associated with hemorrhage in 63,16% (n=12) of patients versus 36,84% (n=7) of patients treated with low molecular weight heparins (LMWH); 10 patients had major hemorrhage while nine patients had minor hemorrhage. The average duration of Anti vitamin K (AVK) treatment was 16 ± 58 weeks. Hemorrhage in the digestive tract was the most frequent symptom (31,58%) and, in 89,47% of patients, treatment was associated with platelet aggregation. Treatment of hemorrhagic accident was based on definitive cessation of anticoagulant therapy in 73,68% of patients. Four patients (21.05%) died. The inaccessibility to antidotes such as protamine sulphate and PPSD (Prothrombin, Proconvertine, Stuart factor, and anti-haemophilia B factor) constitutes a real obstacle to adequate treatment for complications; a better education of patients receiving these drugs would be the most important preventive measure, because more than 50% of these accidents are preventable.

Maternal and fetal prognosis of subsequent pregnancy in black African women with peripartum cardiomyopathy.

BACKGROUND: The aim of this study was to describe maternal and fetal outcomes after pregnancy complicated by peripartum cardiomyopathy (PPCM). METHODS: We included women that had subsequent pregnancy (SSP) after PPCM and assessed maternal prognosis and pregnancy outcomes, in-hospital up to one week after discharge. Clinical and echocardiographic data were collected comparing alive and deceased women. Factors associated with pregnancy outcomes were assessed. RESULTS: Twenty-nine patients were included, with a mean age of 26.7 ± 4.6 years and a mean gravidity number of 2.3 ± 0.5 of. At the last medical control before subsequent pregnancy, there was no congestive heart failure, the mean left ventricular diastolic diameter (LVDD) was 53 ± 4 mm and the left ventricular ejection fraction (LVEF) was ≥50% in 13 cases (44.8%). Maternal outcomes were marked by 14 deaths (48.3%). Among the factors tested in univariate analysis, LVEF at admission had an excellent receiver-operating characteristic (ROC) curve to predict maternal mortality (AUC = 0.95; 95% CI 0.87-1, p < 0.001), with a cut off value of < 40% (sensitivity = 93% and specificity = 87%). Concerning fetal outcomes, baseline LVEF had the best area under the curve (AUC) to predict abortion or prematurity among all variables (AUC = 0.75; 95% CI 0.58-092, p = 0.003), with a cut-off value of < 50% (sensitivity = 79%, specificity = 67%). CONCLUSIONS: SSP outcomes are still severe in our practice. Maternal mortality remains high and is linked to ventricular systolic function at admission (due to pregnancy), while fetal outcomes are linked to baseline LVEF before pregnancy.

[Evaluation of patients' satisfaction in the department of cardiology at the University Hospital Yalgado Ouedraogo]. / Évaluation de la satisfaction des patients dans le service de cardiologie du CHU Yalgado Ouedraogo.

INTRODUCTION: Patients' satisfaction is an important component of health care quality evaluation. Patients and physicians are now care partners. This new relationship deserves to be evaluated. Our study aimed to evaluate the satisfaction of patients hospitalized in the Department of Cardiology at the University Hospital Yalgado Ouedraogo. METHODS: We conducted a cross-sectional descriptive study with a single data collection phase of all the patients hospitalized from 1 January to 30 June 2014. We administered SAPHORA questionnaire adapted to suit our context. The scores and the satisfaction rates were calculated according to the studied parameters. RESULTS: During the study period we collected data from 230 patients. The mean hospitalization time was approximately 10 days. 125 (53.2%) men were enrolled in the study, sex ratio was 1.1. 32% (n = 75) of patients were unschooled. Public servants accounted for 24.3% (n = 57) of our study population. The average age of our sample was 50.7 years. Patients over the age of 65 years accounted for 25.6% of the study population. 113 (48.1%) patients had been admitted as medical emergencies. 21 patients (8.9%) had a history of hospitalization in the Depatment of Cardiology. Dilated cardiomyopathy was the diagnosis made during hospitalization in 75 (32%) cases. The overall score of satisfaction of the patients treated in the Department of Cardiology was 78.3%. Satisfaction score on hospital admission was 68.1% and on patients' comfort was 65.8%. Satisfaction score on health care quality and on hospital discharge planning was 84.7% and 84.5% respectively. Patients' suggestions for improvement were based on comfort during hospital stay in 99 (42.1%) cases and on staff identification in 176 (74.9%) cases. CONCLUSION: The evaluation of the satisfaction is infrequent in our country. It is becoming increasingly frequent in western countries using common and validated tools. It is an important aspect that our hospitals should include in order to increase quality approach to accreditation.

Use of Vitamins K antagonists in non-valvular atrial fibrillation thromboembolic risk prevention in Burkina Faso.

INTRODUCTION: Atrial fibrillation is the commonest cardiac rythm disorder. Thromboembolic accidents are common complications that should be prevented by anticoagulant treatment. The aim of our study is to assess the use of vitamins K antagonists in the prevention of thromboembolic risk in atrial fibrillation. METHODS: It was a descriptive retrospective study of patients folders, performed in the cardiology department from January 1st 2010 to December 31st 2011. The study included all patients with non valvular atrial fibrillation. Thromboembolic risk was assessed through the CHA2DS2VASc score, and hemorrhagic risk through the HAS-BLED score. RESULTS: Atrial fibrillation accounted for 10.6% of all hospitalizations (103/970). Five patients had contra indication to anticoagulants. Non valvular AF was noticed in 68 cases (66%). The non valvular AF was chronic in 40 cases (59%) and paroxystic in eight cases (12%). The median age of the population was 64.5+13.8 years old. Median CHA2DS2VASc score was 3.9 + 1.6. Two patients had a score < 1. Sex, place of residence, age > 65, and cardiac failure did not interfere with prescription of vitamins K antagonists. Ischemic stroke and intra cavity thrombus were the indications for vitamins K antagonists' prescriptions. The median HAS-BLED score was 3.5 + 1.5. The rate of vitamins K antagonists use was 35.3%. One case of death due to hemorrhagic stroke was noticed. CONCLUSION: Guidelines on thromboembolic risk prevention are poorly used in the cardiology department. But the use of scoring systems allows the assessment of vitamins K antagonists treatment benefit/risk in atrial fibrillation, and minimizes the hemorrhagic risk.

Assessing causes of death in the Cardiology Department of Yalgado Ouédraogo University Hospital.

INTRODUCTION: Analysis of the underlying causes of death can develop action plans for prevention of death that could be avoided. The aim of our study was to analyse the causes of cardiovascular deaths in the cardiology department of Yalgado Ouedraogo University Hospital. METHODS: The study was a descriptive retrospective study over a 24 month period among patients who died in the department. RESULTS: Prevalence of death in the cardiology department was of 13.2%. Sex ratio was of 1.2 and 72.7% of patients were residing in Ouagadougou. Mean age of patients was 56.1 years and 59.4% of patients were under 65 years old. Hypertension was the major cardiovascular risk factor (46.1%) and 27.4% of patients had a medical history of dilated cardiomyopathy. Cardiogenic shock was the immediate cause of death in 55.5% of cases and the initial cause of death was hypertension and its complications in 46.1% of cases. Death was not notified in 18% of cases and no death had been medically certified. CONCLUSION: Death statistics are the most reliable data for public health interventions. However, it is necessary to establish an effective method of data gathering according to the WHO standards in order to facilitate international comparison.

Epidemiological and clinical features, ultrasound findings and prognosis of right-sided infective endocarditis in a teaching hospital in Ouagadougou.

INTRODUCTION: Right-sided infective endocarditis is rare. It accounts about 5 to 10% of all infective endocarditis cases and is prevalent in patients with congenital heart disease, intravascular devices and drug addiction. Our study aimed to describe the epidemiological, clinical and echocardiographic characteristics of right-sided endocarditis and evaluate the prognosis after treatment. METHODS: From January 2010 to December 2011 we recruited all patients admitted to Yalgado Ouedraogo Teaching Hospital for infective endocarditis, and selected those who had a right-sided location. The Duke criteria were used for diagnosis. We analysed entry points and underlying heart disease. The causative organisms were tracked using blood sample cultures. Ultrasound characteristics were described, and treatment and prognosis were evaluated. Patients' follow up was conducted from recruitment to 30 June 2012. RESULTS: In the two-year period, 14 cases of right-sided infective endocarditis were recorded, including seven cases in children. They accounted for 29.1% of all infective endocarditis cases. The mean age was 25.5 ± 12.5 years (range 9-80 years). The venous route was implicated in 12 cases (85.7%). Blood cultures were positive in 11 patients. The bacteria isolated were Streptococcus pneumonia in six cases, Staphylococcus aureus in three and Hemophilus influenza in two cases. HIV status was positive in three patients. Underlying heart diseases were dominated by congenital heart disease in six cases and peripartal cardiomyopathy in four others. Vegetations were located in the right heart in only 11 cases. With antibiotic treatment, a lowering of temperature was shown within an average of 10 days of follow up. Two fatalities were reported. CONCLUSION: This study showed that right-sided endocarditis is common in our clinical practice. This infection was prevalent in patients with congenital heart disease or peripartal cardiomyopathy in our context, and the venous route seemed to be the main entry point.